According to statistics reported by National Fibromyalgia Association (1), the current number of diagnosed fibromyalgia patients has exceeded 10 million in United States alone. The report also suggested that the current global prevalence of fibromyalgia is about 3 – 6% (with some parts of the world more richly populated with fibromyalgia patients).
Fibromyalgia is a chronic, debilitating disease characterized by an increased sensation, sensitivity to pain and discomfort that may involve different parts of the body. Most cases are associated with symptoms such as mood swings, musculo-skeletal pain and memory disturbances. Women are more likely to develop this disorder, statistically. This disorder can be triggered by a physical trauma, excessive psychological stress or infections.
Generally, medical drugs are usually prescribed to suppress the pain involved. However, in recent years, physical therapy such as Yoga, Tai Chi, aerobics or exercises are widely adopted by patients in the management of chronic pain. As such, the question is “does these physical therapies really works to relieve fibromyalgia pain“?
Symptoms Of Fibromyalgia
Chronic pain syndromes affect 10 – 55% of the world’s population. It is safe to assume that a vast majority of cases are due to fibromyalgia as per a latest report published in Current Pain and Headaches Report (3). The most frequently reported symptoms of fibromyalgia are as follows:
- Lethargy: Patients of fibromyalgia complain about prolonged sleeping hours, they tend to be tired all the time and are lethargic even after long hours of sleep. Patients also report shortness of breath during sleep (also known as sleep apnea) and ‘restless leg syndrome’.
- Impaired cognition: Cognition refers to the intellectual and intelligence of an individual, and is measured as a capacity of a person to align their attention, focus or concentration to accomplish a desired task. Patients of fibromyalgia develop impaired cognition; making mental working and intellectual tasks fairly challenging.
- Pain: Fibromyalgia pain is often the most common complaint of such patients, it can be severe or mild, localized or widespread (in majority of the cases). It usually occurs over a significant time period that may range from months or weeks.
- Other complaints: Abdominal pain, headaches, mood swings and depression are also frequently reported by patients who are suffering from fibromyalgia.
What May Cause Fibromyalgia?
Despite a number of clinical and research studies, very little is known about the possible causes of fibromyalgia. Yet researchers believe that following causative agents are very frequently linked to fibromyalgia.
- Infections: Microbial infections have shown to trigger fibromyalgia in some patients.
- Hereditary: It is suspected that some chromosomal mutations can increase the risk of developing fibromyalgia. This disease may also run in families via inheritance of some genetic mutations.
- Physical and psychological trauma: Studies have shown that ‘post-traumatic stress disorder’ after severe life changing events or accidents can also trigger fibromyalgia.
What May Increase Your Risk Of Developing Fibromyalgia?
The onset of fibromyalgia is mostly abrupt but may be gradual in some cases. Here are some associated risk factors that are very strongly linked to this condition.
- Family history: Genetic inheritance has been proved as one of the most significant risk factor by many research studies. Therefore, if you have a family history of fibromyalgia, the risk is significant that other members of the family may also develop this disease during their lifetime.
- Females: Research has shown that women are more prone towards this disease than men. According to data reported by Clinical and Experimental Rheumatology (4), out of a study sample of 1,727,765 the percentage of female patients who were diagnosed with fibromyalgia was 87.6% (or 1,513,995) as opposed to only 12.3% males (213,034).
- Rheumatic disease: Individuals with rheumatic arthritis or lupus are predisposed to this disease as well.
Complications Of Fibromyalgia
Mood swings and disturbances in sleep are likely to disrupt everyday routine jobs. Lack of cognitive coordination can disrupt the efficiency of tasks that requires mental alertness. This results in an overall increase in depression and mood swings, causing further complications.
Treatment And Drugs For Fibromyalgia
- Antidepressants: SSRI and SNRI agents such as Duloxetine and Milnacipran help with the lethargy and pain experienced during fibromyalgia. Fluoxetine and amitriptyline may also be prescribed to assist sleep.
- Anti-seizures’: Gabapentin and Pregabalin are the drugs commonly used to counter pain and seizures, thus overall reducing the symptoms of fibromyalgia.
- Pain-killers: Naproxen, acetaminophen, ibuprofen and tramadol are the drugs that are easily available ‘over the counter’ and can relieve fibromyalgia pain provide for a short period of time. These drugs help curb the sensations of pain, but do not treat fibromyalgia.
Lifestyle Of Fibromyalgia Patients
- Proper sleep: In fibromyalgia, the patient feel stressed and fatigued most of the time. Therefore getting proper sleep is essential for such patients. The patient should make sure they set a proper time table and sleeping habits in order to minimize flaring of symptoms.
- Dealing with stress: Over working and taking unnecessary stress can result in disrupted mood and increased depression. Therefore, in order to avoid flaring, it is recommended to avoid excessive work. Other strategies like practicing stress releasing activities such as Yoga are also helpful in some cases.
- Healthy lifestyle: Eating fresh fruits and being positive about life along with stress relieving activities can help such patients to manage disabling symptoms.
- Exercising: Regular exercise optimize the health and wellness of body and brain. Walking, swimming, yoga and other sources of physical activities are not only good for the body but also helps in releasing stress and elevating the mood.
Can Physical Therapy Relieve Fibromyalgia Pain?
According to a latest research published in the peer reviewed journal Arthritis Care and Research (2), author suggested that physical therapy exercises and patient education are can help to relieve fibromyalgia pain in inducing immediate pain relief in patients.
The 6-week program in which 41 fibromyalgia patients were enrolled resulted in improving various clinical and subjective parameters. Almost all patients reported remarkable improvement in the pain symptoms, fatigue, subjective mood assessments, gain in the distance walked and other ailments.
Physical Therapy Interventions For Fibromyalgia Management
There are number of holistic and alternative strategies that are used by physical therapists to enhance musculo-skeletal flexibility and strength. Report in Scandinavian Journal of Rheumatology (8) suggested that the quality of results and overall outcome of therapy can be improved by employing a multi-modal approach.
Besides, it also suggested that maintaining physical fitness and target oriented exercises improve physical endurance and fatigue symptoms. Other helpful remedies listed in the report with proven efficacy include trigger point injection, massage, TENS, hydrotherapy, acupuncture and whole body cryotherapy.
A detailed account of these interventions are discussed under:
- Stretching Exercises
Specialized stretching exercises not only improves endurance and physical strength but also decreases stiffness and spasm due to pain. Periodic stretching increases range of motion and reduces the pain symptoms.
Here are a few tips:
- For small group of muscles, it is ideally recommended to perform 5 – 10 reps (for larger group of muscles even 5 or less are okay).
- Maintain the muscular contraction for at least 30 to 60 seconds.
- If stretching exercises are performed under the supervision of a registered chiropractor or physical therapist, the practitioner may also use laser therapy and other associated therapies in conjunction with stretching exercises.
Matsutani (6) and associates conducted a detailed study in order to assess the effect of muscle stretching exercises with or without laser treatment in fibromyalgia patients in order to assess the effect on pain reduction and perception. Twenty patients were enrolled with the positive history of fibromyalgia (with half of the patients receiving only stretching exercises while remaining receiving both stretching and laser therapy).
After the study period, Matsutani and other investigators concluded that stretching exercises with and without laser therapy are equally helpful in reducing the tender spots, pain sensitivity, threshold for pain and other fibromyalgia symptoms.
- Aerobic Exercises
Aerobic exercises are low impact exercises that provides conditioning to the connective tissue matrix without causing any pain or discomfort. According to a research published in Journal of Rheumatology (7), investigator Valéria Valim and associates compared the efficacy of aerobic exercises and stretching exercises in fibromyalgia patients. 66-female patients were randomly assigned to either stretching exercise group or aerobic exercise group.
After 20 week study period, investigators identified that although stretching exercises are helpful in reducing the pain and flexibility, but does not improve emotional and mental health. However, aerobic exercises are helpful in increasing oxygen saturation of tissues that may reduce in depression, emotional health and vitality.
The study concluded that aerobic exercises are superior to stretching exercises in the promotion of mental health, emotional health, vitality, social aspects and functional capacity besides reducing pain sensitivity in fibromyalgia patients.
- Massage Therapy
Massaging helps in releasing stress, elevates mood and gently exercise the muscles to help ease the pain. It also elevates mood and manages depression or anxiety symptoms. There are various types and varieties of massage therapy but the most helpful intervention in fibromyalgia patients is ‘myofascial release’ technique.
Report published in Evidence-Based Complementary and Alternative Medicine (9) delivered the results of a study in which investigators compared the efficacy of massage therapy over placebo treatment. It was identified that over a 6-month study period, the positive effects of myofascial release were evident within weeks in terms of reduction in pain intensity and sensitivity, improvement in the quality of life and management of depression symptoms.
- Transcutaneous Electrical Nerve Stimulation (TENS)
TENS is one of the specialized interventions of physical therapy that manages fibromyalgia symptoms with the help of electric current by altering central excitability (a term that suggests lower than optimal threshold of brain for excitement). In addition, it also activate central inhibition pathways to control the excitability of brain. The overall effect is, reduction in pain and sensitivity of tissues. According to a research published in Pain (10), TENS therapy is effective in the management of acute pain and discomfort in the flaring of fibromyalgia symptoms.
Fibromyalgia is a chronic relapsing remitting condition that can significantly alter the quality of life. Physical therapy procedures and treatments have strong and safe track record and are accepted widely as a holistic and drug free therapy in order to enhance mobility, stiffness and soreness of muscles as well as pain reduction in the setting of fibromyalgia.
Hydrotherapy (also known as aqua therapy) is an effective remedy that is recommended by physiotherapists for the chronic management of fibromyalgia pain. Use of warm water, rhythmic vibration (or rippling effect) and buoyancy of water makes it easier to perform physical activity or exercises. Likewise, it also reduces stiffness and improves the psychological aspects of mental and physical wellness in patients.
Other effective alternative remedies in the long term management as well as to relieve fibromyalgia pain are:
Fine needles are inserted on specific pressure points of the body to stimulate the neurotransmitter release that may aid in enhancing the blood flow, reduce pain and slowly helps in relieving symptoms of fibromyalgia.
- Tai chi
Slow and deep breathing combination is used in a variety of exercises to help relief stress and freshen the mind.
According to several researches, physical therapy and alternative care can efficiently support and manage chronic health problems including headaches, back and neck pains as well as scoliosis, spinal stenosis and fibromyalgia.
In simple words, it can be concluded that physical therapy is several times better than pharmacological interventions due to holistic methods and mainly due to the fact that physical therapy targets more than one system and symptom (thereby reducing the overall dependence on medications).
1. Lawrence, R. C., Felson, D. T., Helmick, C. G., Arnold, L. M., Choi, H., Deyo, R. A., … & Wolfe, F. (2008). Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II. Arthritis & Rheumatism, 58(1), 26-35.
2. Gowans, S. E., DeHueck, A., Voss, S., & Richardson, M. (1999). A randomized, controlled trial of exercise and education for individuals with fibromyalgia. Arthritis Care & Research, 12(2), 120-128.
3. Queiroz, L. P. (2013). Worldwide epidemiology of fibromyalgia. Current pain and headache reports, 17(8), 1-6.
4. Haviland, M. G., Banta, J. E., & Przekop, P. (2010). Fibromyalgia: prevalence, course, and co-morbidities in hospitalized patients in the United States, 1999-2007. Clinical and experimental rheumatology, 29(6 Suppl 69), S79-87.
5. Gowans, S. E., DeHueck, A., Voss, S., Silaj, A., Abbey, S. E., & Reynolds, W. J. (2001). Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia. Arthritis Care & Research, 45(6), 519-529.
6. Matsutani, L. A., Marques, A. P., Ferreira, E. A., Assumpção, A., Lage, L. V., Casarotto, R. A., & Pereira, C. A. (2007). Effectiveness of muscle stretching exercises with and without laser therapy at tender points for patients with fibromyalgia. Clin Exp Rheumatol, 25(3), 410-15.
7. Valim, V., Oliveira, L., Suda, A., Silva, L., de Assis, M., Neto, T. B., … & Natour, J. (2003). Aerobic fitness effects in fibromyalgia. The Journal of rheumatology, 30(5), 1060-1069.
8. Stucki, M. O. G. (2000). Physical therapy in the treatment of fibromyalgia. Scandinavian journal of rheumatology, 29(113), 78-85.
9. Castro-Sánchez, A. M., Matarán-Peñarrocha, G. A., Granero-Molina, J., Aguilera-Manrique, G., Quesada-Rubio, J. M., & Moreno-Lorenzo, C. (2010). Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia. Evidence-Based Complementary and Alternative Medicine, 2011.
10. Dailey, D. L., Rakel, B. A., Vance, C. G., Liebano, R. E., Amrit, A. S., Bush, H. M., … & Sluka, K. A. (2013). Transcutaneous electrical nerve stimulation reduces pain, fatigue and hyperalgesia while restoring central inhibition in primary fibromyalgia. PAIN®, 154(11), 2554-2562.