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Fibromyalgia, a syndrome with widespread chronic pain as its hallmark, is an enigmatic ailment with no known cause, no simple diagnostic test and no cure. While not a “cure”, massage therapy is an effective means for helping people manage their fibromyalgia. Most clients with fibromyalgia syndrome (FMS) say that they ache all over. They describe their pain in a variety of ways, such as burning, stabbing, gnawing, aching, stiffness or soreness. The American College of Rheumatology (ACR) estimates there are between three and six million people in the U.S. with fibromyalgia syndrome.
While the cause of FMS remains elusive, many believe that certain events may trigger this syndrome’s onset. Some of the trigger suspects include viral or bacterial infections, automobile accidents, rheumatoid arthritis and tragic events (physical and psychological). Many experts believe that an abnormally functioning central nervous system is at the root of FMS. Hormone and neurochemical imbalances are common findings during the medical evaluation of someone with fibromyalgia. The complexity of FMS may call for an entire medical team in the person’s care, including a rheumatologist, an endocrinologist and a neurologist.
Physicians often have difficulty diagnosing FMS because its symptoms have a high degree of variability and they overlap with a long list of other conditions. In 1990, the ACR listed two primary criteria for the classification of fibromyalgia. The first is a history of widespread pain involving all four quadrants of the body (right side, left side, above waist, below waist) for a minimum of 3 months. The second criterion which points to FMS is the presence of pain in at least 11 of 18 tender points when touched or pressed. It is suggested that a massage therapist confirm that his/her client received a diagnosis of fibromyalgia from a physician, to insure that something else isn’t the cause of the client’s maladies.
Clients with FMS not only report pain associated with specific “tender points” used for diagnosis, but also describe pain that is associated with myofascial trigger points. Pain originating from either source can fluctuate and is further aggravated by various physical, environmental and emotional factors. Fatigue, stiffness, poor sleep, and a host of other related symptoms often send fibromyalgia sufferers to seek relief from this disabling pain from a massage therapist. An ABC News/USA Today/Stanford University Medical Center April 2005 poll on chronic pain reported that more than half of Americans live with chronic or recurrent pain. According to this poll, 28 percent of Americans had tried massage therapy for relief of their chronic pain. Many fibromyalgia sufferers report massage as bringing them more relief than any other treatment prescribed by their physicians.
Massage is an excellent way to decrease pain, relax muscles, improve circulation, passively stretch muscles and create an overall feeling of well-being. In 1994, research at the Touch Research Insititute, Miami School of Medicine demonstrated that fibromyalgia responds well to massage. Rheumatologists evaluating the participants in this study found that only those receiving massage reported decreases in pain, fatigue, stiffness and improvements in their quality of sleep.
With such a high degree of variability of FMS symptoms and a client’s preferences, communication during the massage process is essential. Encourage feedback from your client, and adjust your administration to maximize his/her comfort. Starting out slowly with some moist heat application or initially warming the muscles with light strokes can allow for the client to relax into your care and guide you toward his/her needs. When the practitioner begins slowly, it is easier to assess the client’s needs, sensitivity and tolerance levels.
Many forms of massage can ease fibromyalgia pain. While gentle techniques may be favored by some FMS clients, others may benefit greatly from deep work, such as penetrating ischemic work on trigger points. For some with FMS pain, low-force or non-force techniques help them the most — without overstimulating their already overburdened nervous system. Strenuous massage that uses deep tissue and/or neuromuscular techniques may possibly trigger flare-ups of muscular pain and make some FMS sufferers feel worse, which can exacerbate other symptoms associated with fibromyalgia like sleep problems, depression, lack of concentration and fatigue.
Following treatment, FMS clients should be instructed to take it easy for awhile. Soreness may be present the day after treatment, especially if trigger points were treated. After the massage, drinking plenty of water and soaking in a warm (not hot) Epsom salts bath, with a few drops of a muscle relaxing essential oil (such as lavender, bay laurel or white birch), can provide relief from soreness and promote restful sleep. If deep work was included in the session, it is especially important for your client to consume extra water, and having water on hand for the client at the close of the treatment, or sending your client home with a bottle of water can be a nurturing physical enforcement of your instructions to him or her. You might mention to your client that the enzyme bromelain, harvested from the pineapple stem, has been shown to reduce muscle and tissue inflammation. [Note: Use caution when combining bromelain with anticoagulants (blood thinners), such as enoxaparin or warfarin. This enzyme is a natural blood thinner and may increase the medication’s effect.]
Elusive and debilitating, chronic pain associated with FMS affects all aspects of one’s life. Individuals with FMS and experts in the field agree that those who are most successful in controlling their symptoms utilize a comprehensive approach to their healing that integrates multiple modalities. Long term massage therapy has been shown to offer the most benefits for FMS and can enable you to successfully help your clients manage their pain and get control of their fibromyalgia.
Editor’s Note: See the related article, “Fibromyalgia Part 2: Nine Massage Techniques”.
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