For the past few years I have worked with some wonderful and frustrated people experiencing the phenomenon known as fibromyalgia. We work together in sessions to help ease symptoms, each customized to the person’s tolerance level. Some want the deepest pressure while others need the lightest touch. Massage can help, but first, what is it?
What Is Fibromyalgia?
Fibromyalgia Syndrome (FMS) is one of the most controversial conditions in American health, affecting up to 4% of the adult population. There is ample information published, much of it not reviewed, untested, or unsubstantiated.
Is it an autoimmune disorder? If it is, it shares nothing in common with any other autoimmune system disease.
It does, however, often appear as a secondary response to an underlying autoimmune condition, especially Sjogren’s syndrome and inflammatory bowel disease.
Is it a form of arthritis? There is no documentation on joint inflammation as a part of fibromyalgia, although it often shows up in discussions of arthritis, and many people with arthritis also report having fibromyaglia.
Is it just superficial trigger points? The histology says no, although trigger points and tender points can occur at the same locations.
Is it all in these clients’ heads?… Maybe. But not in the sense of being “psychosomatic” or made up by malingerers hoping to get disability benefits.
According to the most recent and consistently accurate research, fibromyalgia is neither a musculoskeletal nor an autoimmune disorder. It is a central nervous system condition involving a phenomenon called central sensitization. This puts it in the same category as other serious chronic pain syndromes like postherpetic neuralgia (the intractable pain that sometimes follows an outbreak of shingles) and complex regional pain syndrome (a chronic pain problem that begins as an injury but becomes self-sustaining within the nervous system). The difference is that no outside force appears to trigger the beginning of the chronic pain signals.
Fibromyalgia patients and their health care teams need know the true origins of this condition in order to manage it successfully, regardless of treatment strategy they are contemplating. Some researchers are now testing which bodywork modalities have the best outcomes for FMS patients, ranging from myofascial release to lymphatic drainage and beyond.
Treatment for FMS begins with a good diagnosis, which is a challenge. This condition is typically diagnosed by ruling out other diseases with similar signs and symptoms, including Lyme disease, multiple sclerosis, rheumatoid arthritis, lupus, hypothyroidism, candidiasis, and several others. Several of these diagnostic differentials are also made by ruling out similar-looking conditions, and it is quite possible for a person to have more than one of these conditions at a time. Further, a long history of confusion between FMS tender points and myofascial pain syndrome (MPS) trigger points continues to cloud the issue.
For most people FMS is a lifelong condition. Treatment focuses on finding ways to manage the disorder so that the patient may lead as normal a life as possible. This includes patient education, careful exercise, and often cognitive behavioral therapy.
Drug therapies for FMS include mild antidepressants to reduce levels of depression and manage pain, to improve sleep quality. Painkillers are generally avoided, because they interfere with sleep and are habit-forming. An anti-seizure drug has been successful with pain management without some of the side effects that this class of drugs often involves.
- Analgesics, including NSAIDs (have varying effectiveness)
- Antidepressants to aid with sleep, pain and mood
- Anti-seizure drugs to help with pain
- Anti-parkinsons drugs
Fibromyalgia & Massage Therapy
Risks: People with fibromyalgia live with chronic, invisible, widespread and unpredictable pain. It is important that their pain not be exacerbated by massage that is insensitive or too aggressive.
Benefits: Massage has much to offer fibromyalgia patients in terms of pain relief, sleep quality, improved mood, and reduced anxiety. Massage as part of an emphasis on good self-care is often part of a successful treatment strategy.
Options: Research suggests that while many kinds of massage improve fibromyalgia symptoms, lighter and gentler work is more effective than deeper, more intrusive types of bodywork, especially for clients new to massage.
If you or someone you know needs relief of FMS symptoms I would be happy to talk more about how the therapy of massage can help.
See you on the table!
Ruth Werner, A Massage Therapist’s Guide to Pathology