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fibromyalgia and the role of
therapeutic massage
This painful mystery illness has led many a sufferer through
a fruitless maze of medical tests and visits. Yet this
frustrating and sometimes
controversial syndrome is at last revealing some of its secrets…..
A fibromyalgia sufferer typically looks well, but feels
terrible. The entire body generally aches and specific tender
points are intensely painful. The
patient complains to you of fatigue, poor sleep, tight,
twitchy muscles, mental
“fogginess” and endless medical
investigations that come back negative. You’ve probably seen such patients
before. The difficulties of
fibromyalgia are compounded by medical organisations
not fully recognising a
“fibromyalgia disease” or agreeing
on the status of fibromyalgia as a condition. Fortunately for patients,
research
has revealed some guidelines for
treatment such as massage, exercise, sleep and understanding.
Fibromyalgia Syndrome (known also as FM or FMS) literally
means “muscle fibre pain” and is a common condition,
affecting about 3.4% of women and
0.5% of men1 although some researchers claim an incidence of up to 12.9%2,
yet underlining the controversy of
the condition, certain rheumatologists would claim a rate of 0%, arguing that
fibromyalgia does not exist!
However, the term fibromyalgia syndrome (which was first used in a 1987
research
paper3) remains a very useful way of describing a specific
syndrome which has been increasingly studied in recent
years, and is beginning to yield some answers.
What is Fibromyalgia?
Fibromyalgia is a type of muscular rheumatism. The defining
features as described by the 1990
of Rheumatology classification
criteria include pain (from light pressure) in at least 11 of 18 specified
tender
points (as per illustration). The
tender points coincide with prominent tendon attachment points. Pain in
fibromyalgia is in all four
quadrants of the body. Joint inflammation is generally not observable in
fibromyalgia
and blood tests for inflammatory
changes are usually negative.
A pair of tender points is located in the following
location:
1. at the base of the skull beside the spinal column
2. at the base and rear of the neck
3. on top of the shoulder toward the back
4. on the breast bone
5. on the outer edge of the forearm about
2cm (approx. 1
inch) below the elbow
6. over the shoulder blade
7. at the top of the hip
8. above and to the outer side of
the
buttocks just above the kneecap
Along with generalised muscular
pain and (at times) exquisitely painful tender points, other key symptoms
included poor sleep, fatigue,
mental “fogginess” and lowered mood. These symptoms overlap with a number of
other conditions4 such as chronic
fatigue syndrome (where less pain is generally reported) and lowered thyroid
function.
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NP
Nutri-Pharm (Aust)
Pty Ltd
Nutri-Pharm
fibromyalgia and the role of
therapeutic massage
The fact that fibromyalgia symptoms are fairly generalised (apart from the tender points) and differ
slightly from
patient to patient has
unfortunately led to many mis-diagnosed patients, and
many labelled as hypochondriacs. A
Swedish study involving doctors experienced with chronic
fatigue and fibromyalgia syndromes showed a
discrepancy between a doctor’s
“ideal” role of diagnosis and support, and the reality of a more sceptical approach
to patients with these conditions5.
Research is providing a new insight into fibromyalgia and
highlights the roles of therapeutic massage, exercise
and most definitely a supportive and compassionate approach.
The prime clue about fibromyalgia concerns the lack of deep,
restorative sleep in sufferers. The deepest phase of
sleep is known as delta phase and
coincides with the release of growth hormone. As well as promoting growth in
children this hormone provides a
crucial tissue repair function, particularly with muscle and associated
connective
tissue, which both undergo
considerable daily wear and tear.
The sleep patterns of many fibromyalgics
have been recorded and it is known that many patients do not achieve
delta phase sleep. A Canadian study
produced fibromyalgia symptoms in healthy students by depriving them of
deep sleep for three consecutive
nights6.
It therefore appears that most fibromyalgics
cannot repair their muscles and connective tissues properly due to
inadequate sleep quality. This
underlines the key role of specialised massage
therapy in fibromyalgia. In a recent
study of the muscle and collagen
tissue of fibromyalgia patients7, amino acids for collagen were significantly
lower
than normal, indicating a lowered tissue repair ability.
Another study showed that the muscles of fibromyalgia
patients were less able to utilise oxygen8 than
control
subjects.
So fibromyalgic
muscle can be viewed as tight, achy, delicate, and probably microscopically damaged.
This helps
explain why measures which may help
other patients, such as intense rehabilitation exercises, repetitive motion
exercises, high impact training and
vigorous massage are generally bad news for fibromyalgia patients. Their
muscles simply cannot repair
themselves quickly enough to cope with these more intense modalities.
Massage in fibromyalgia is then best done in a gentler
fashion, addressing the delicate nature of the muscle
tissue, and with more relaxed, less painful muscles as a suitable end point.
A Swedish study9 which examined connective tissue massage,
involved a series of fifteen massages conducted
over a ten week study period. 23
fibromyalgia patients were in the study group and 25 fibromyalgia patients were
in a control reference group. After
the ten week period, the massage group had pain reduction of 37%, used less
analgesics, had improved mood and
reported improved quality of life when compared to the reference group.
Many massage therapists have a favourite
massage blend with rosemary oil, lavender or similar ingredients, and
give favourable
anecdotal reports as to their success in fibromyalgia. Myopax
has been developed as an extension
to this line of therapeutic
response.
Massage therapy in fibromyalgia is crucial in terms of two
other aspects of the condition: sleep and exercise.
Many patients report muscle cramps and twitches as
interfering with a restful sleep. It would appear that
afternoon or early evening massage
sessions might convey the best chance of improving sleep quality.
There are many studies which confirm the benefit of exercise
in the treatment of fibromyalgia. An analysis of 16
exercise therapy studies10
concluded that “supervised aerobic exercise training has beneficial effects on
physical
capacity and fibromyalgia
symptoms”.
The difficulty with an exercise program for fibromyalgia, of
course, is overcoming the muscle tightness and pain to
engage in the activity. Again
massage becomes relevant as a pre-exercise therapy. Another advantage of
exercise is the body’s release
during physical activity of the chemical messenger serotonin. It is thought
that
serotonin production is low in
fibromyalgia sufferers, and exercise, particularly in the afternoon may be able
to
improve sleep quality later that
evening, thanks to increased serotonin release. Serotonin is involved in many
of
the body’s normal functions
including pain processing, mood, digestion and sleep. Many of these functions are
affected in fibromyalgia, suggesting a serotonin related cause.
Current evidence would support a massage routine to assist
with the two key parts of a fibromyalgia sufferer’s
day. The first is to relieve
morning stiffness. The second aspect is in setting up a sound sleep. This would
involve afternoon exercise of some
form, and using massage either pre-exercise or before bed to give delicate
fibromyalgic
muscles their best chance of repair. Myopax may be
used in such a massage routine to maximise the
benefits for the patient.
Long term exercise programs are achievable for fibromyalgia
patients. One such program at the University of
benefits. Exercise programs lasted
50 to 70 minutes, 5 days per week.
Fibromyalgia is a complex syndrome, but understanding the
nature of its achy, fragile muscles gives massage
therapy a pivotal role in its
management.
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1 University of
2 Epidemiology of Fibromyalgia, Neumann L, Buskila D, Curr Pain Headache Rep
2003 Oct; 7 (5): 362-8
3 Fibromyalgia Syndrome: An Emerging
but Controversial Condition JAMA 1987; 257: 2782-7
4 Overlapping Conditions among Patients
with Chronic Fatigue Syndrome, Fibromyalgia and Temporomandibular
Disorder. Aaron LA et al Arch
Intern Med 2000 Jan 24; 160 (2): 221-7
5 Ideal versus Reality: Physicians Perspectives on Patients
with Chronic Fatigue Syndrome (CFS) and Fibromyalgia. Asbring
P, Narvanen AL Soc Sci
Med 2003 Aug; 57 (4): 711-20
6 1975
7 Collagen and Muscle Pathology in
Fibromyalgia Patients. Gronemann et al Rheumatology (
8 Muscle Metabolism in Fibromyalgia
studied by P-31 Magnetic Resonance Spectroscopy during Aerobic and Anaerobic
Exercise. Lund E et al, Scand
J Rheumatol.
2003; 32 (3): 138-145
9 Connective Tissue Massage in the
Treatment of Fibromyalgia. Brattberg G Eur J Pain. 1999 Jun; 3 (3): 235-244
10 Exercise for Treating Fibromyalgia Syndrome, Busch A et al Cochrane Database Syst
Rev. 2002; (3): CD003786
11 A Successful, Long term Exercise Program for Women with
Fibromyalgia Syndrome and Chronic Fatigue Syndrome and Immune Dysfunction
Syndrome. Karper
WB,
Prepared By:
Technical Director All Rights Reserved.
Email: info@nutripharm.net NPMAR3001/0104
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