Fibromyalgia and Physiotherapy

physiotherapy session

What is it?

Fibromyalgia is the diagnosis given for the condition of widespread pain and joint stiffness, without a definitive cause, such as tissue damage or inflammation. This condition is now believed to be caused by a disorder of the way the brain processes pain which causes a hyper-sensitive response to pain, or registering a painful response to something that doesn’t usually cause pain.

What are the symptoms?

Symptoms vary from person to person and can be different from day-to-day also. The key symptom is widespread pain and this is characterised in most patients. This pain can either be heightened, or it may be from a minimal source, such as your jumper touching your skin. Some patient will also feel stiff and achy, and may have fatigue or tiredness from normally easy, everyday activities. Sleep may also be affected and some patients may have what is termed as the “Fibro-Fog”, a feeling of altered brain processing where you may struggle to learn or remember new things.

What are the causes?

The exact cause is still currently unknown however researchers are working hard to understand this condition better. One theory is that your brain has developed a change in the way it processes painful signals in the body. Another theory, closely linked to the previous, is that there are changes in chemicals in the brain of people with fibromyalgia which affect things like mood, appetite, behaviour and even how you respond to stressful situations. These chemicals include dopamine, serotonin and noradrenaline. Another thought cause is due to a previous psychological stress in that person’s life. This might include something that had threatened their life, an infection or even previous abuse.

What are the treatments for Fibromyalgia?

The APS (American Pain Society), the AWMF (Association of the Scientific Medical Societies in Germany ) and EULAR(European League Against Rheumatism) guidelines recommended with different strength the following treatments:

  1. Pharmacological treatment
  2. Non-Pharmacological treatment

1)Pharmacological treatment:

  • Amitriptyline: is a tricyclic antidepressant known to inhibit both serotonin and noradrenalin reuptake
  • Anticonvulsants: Pregabalin (PGB) and Gabapentin (GBP)
  • Serotonin–Noradrenalin Reuptake Inhibitors (SNRI): Duloxetine for depression and reduction of the pain
  • Selective Serotonin Reuptake Inhibitors: in treating the pain, fatigue, depression and sleep problems
  • Opioids: such as tramadol for treating the pain
  • Cyclobenzaprine is a centrally acting muscle relaxant
  • Cannabinoids: have been shown to have analgesic properties as well as sleep promoting affects
  • Analgesic Treatments (Non-Steroidal Anti-Inflammatory (NSIADs) and Acetaminophen)

All three guidelines recommend against the use of NSAIDs (as a single intervention) or corticosteroids.

2) Non-Pharmacological treatment:

  • Acupuncture
  • Aerobic exercise/Strength training
  • Hypnotherapy
  • Cognitive-behavioral therapy (CBT)
  • Multicomponent therapy
  • Trigger point injections

At 5 STAR CLINIC we use a multicomponent treatment including the use of Acupuncture, Hypnosis and Aerobic exercise/Strength training.

What the research says?

Acupuncture:

the analgesic effects of acupuncture are known to activate peripheral and central pain control systems by releasing various endogenous opioids or nonopioid compounds, such as beta-endorphins, enkephalins, dynorphins, serotonin, norepinephrine, gamma-aminobutyric acid, or ATP.

Excitingly, clinical studies of acupuncture therapy for FM showed promising results that acupuncture is effective in relieving symptoms of FM.

Hypnotherapy:

The hypnosis intervention was demonstrated to be significantly more effective than a no-treatment condition in reducing pain in chronic-pain patients. Moreover, the efficacy of hypnosis in reducing pain was consistently confirmed for a wide variety of different chronic-pain conditions hypnotherapy group showed a significantly better outcome with respect to their:

  • pain experience,
  • fatigue on awakening,
  • sleep pattern
  • global assessment

at 12 and 24 weeks

Research studying treatment satisfaction with hypnosis has found high rates of satisfaction among participant.

Aerobic exercise/Strength training:

Aerobic and muscle strengthening exercises are the between the most effective way of reducing pain and improving global well-being in people with fibromyalgia and that stretching and aerobic exercises increase health-related quality of life.

In addition, combined exercise produces the biggest beneficial effect on symptoms of anxiety and depression.

Strength training has showed reduction in pain, fatigue, number of tender points, with increased functional capacity and quality of life.

So how can physiotherapy help?

A physiotherapist will be able to provide you with a graduated exercise programme, gently increasing the amount of work you do which has been shown to increase functional ability and reduce pain and tenderness. They may also be able to do hydrotherapy which will be relaxing for your muscles and provide a nice stimulation to the nerves in your skin. Some physiotherapists will also perform massage, acupuncture and other hands-on techniques which may also reduce symptoms.

References:

Clauw, J. D. (2009). Fibromyalgia: An overview. The American Journal of Medicine. 122(12), pp. S3-13
Clauw,J. D. (2014). Fibromyalgia: Clinical Review. Clinical Crossroads, 311(15), pp. 1547-55
Deare, J. C., Zheng, Z., Xue, C. C. L., Liu, J. P., Shang, J., Scott, S. W. & Littlejohn, G. (2013). Acupuncture for treating Fibromyalgia. Cochrane database for systematic reviews.
NHS. (2019). Fibromyalgia. URL: https://www.nhs.uk/conditions/fibromyalgia/symptoms/ [Last Accessed: 02/12/2019]
Theadom, A., Cropley, M., Smith, H. E., Feigin, V. L. & McPheron, K. (2015). Mind and Body Therapy for Fibromyalgia. Cochrane database of systematic reviews.
Images: www.freedigitialphotos.net
Kia S. and Choy E.(2017). Update on Treatment Guideline in Fibromyalgia Syndrome with Focus on Pharmacology
doi: 10.3390/biomedicines5020020
Bellato E. et al(2012) Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment
doi: 10.1155/2012/426130
Zhang X et al(2019)Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials
doi: 10.2147/JPR.S186227
Haanen HC(1991),Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia.
Dillworth T. and Jensen MP(2010),The Role of Suggestions in Hypnosis for Chronic Pain: A Review of the Literature
Elkins G., Jensen MP, and Patterson DR(2007),Hypnotherapy for the Management of Chronic Pain
doi: 10.1080/00207140701338621