Pathology 2: Fibromyalgia
Due Date: 27/07/09
Fibromyalgia is a syndrome, with chronic pain disorder that affects the client physically, mentally and socially. The syndrome is characterised by chronic widespread pain, multiple tender points, abnormal pain processing, sleep disturbances, fatigue and often psychological distress (National Fibromyalgia Association 2009).
Tender point pain occurs in local sites, usually in the neck and shoulders. The pain then spreads out from these areas. The actual pain starts at the muscles. The joints are not affected. There are no lumps or nodes associated with these points of pain, and no signs of inflammation (swelling). People diagnosed with fibromyalgia feel pain in at least 11 to 18 specific tender points.
Widespread pain described as stiffness, burning, and aching. The pain also “radiates,” or spread, to nearby areas. Most patients report feeling some pain all the time. Many describe it as “exhausting.” The pain can vary depending on the time of day, weather changes, physical activity, and the presence of stressful situations. The pain is often more intense after disturbed sleep” (About.com: Health Topics A- Z).
Clients who suffer from this syndrome severely can be enormously debilitating and interfere with basic daily activities.
Females are more likely to be diagnosed with the syndrome than males.
“Fibromyositis (Fibro = Fiber; itis = inflammation) Also known as fibromyalgia, a group of conditions involving chronic inflammation of a muscle, its connective tissue coverings and tendons, and capsules of nearby joints. Symptoms are nonspecific and involve varying degrees of tenderness associated with specific trigger points, as well as fatigue and frequent awakening from sleep” (Marieb, Hoehn, 2007, p. 320).
“People with – experience pain from stimuli not normally perceived as painful, which is partially because of lowered pain thresholds and partially the result of central sensation involving an unbalanced autonomic nervous system response to physical, chemical and psychological stressors” (Salvo, 2008, p.139-40).
A notable imbalance in this syndrome is related to higher levels in the substance of P (neuroreceptor and neuromodulator associated with transmission of pain impulses to the central nervous system).
Fibromyalgia condition usually develops after phychologic trauma, local or general infections, medications, and excessive use of aspartame, as well as to physical trauma such as whiplash.
McCance and Huether talk about this in their book Pathophysiology – The Biologic Basis For Disease In Adults & Children 4th ed. They state that: "The etiology of Fibromyalgia has been debated for more than a century and that this syndrome cannot be caused by one single factor. There are different factors involved, for example: Flu like viral illness, chronic fatigue syndrome, HIV, Lyme disease, physical trauma, emotional trauma, also medications, especially steroid withdrawal. Fibromyalgia may overlap with myofascial pain syndromes; also rheumatic disease may coexist if not manifest with Fibromyalgia" (McCance & Huether, 2002. p.1399).
There are some clients that show signs of a genetic predisposition, with other family members also affected.
“A total of 2595 incident cases of fibromyalgia were identified between 1997 and 2002. Age-adjusted incidence rates were 6.88 cases per 1000 person-years for males and 11.8 cases per 1000 person-years for females. Females were 1.64 times (95% confidence interval=1.59 – 1.69) more likely than males to have fibromyalgia. Patients with fibromyalgia were 2.14 to 7.05 times more likely to have one or more of the following comorbid conditions: depression, anxiety, headache, irritable bowel syndrome, chronic fatigue syndrome, systemic lupus erythematosus, and rheumatoid arthritis” (National Fibromyalgia Association 2009).
“The disorder has an increased frequency among women 20 to 50 years old. The prevalence of the disease has been estimated between 0.7% and 13% for women, and between 0.2% and 3.9% for men” (Fibromyalgia Support, 2009).
Signs & Symptoms:
· Chronic, widespread pain
· Heightened pain in response to pressure
· Tingling of the skin
· Prolonged muscle spasms
· Weakness in the limbs
· Nerve pain
· Functional bowel disturbances
· Chronic sleep disturbances
· Impaired concentration
· Problems with short and long term memory
· Impaired speed of performance
· Inability to multi-task
· Cognitive (relating to thought processes) overload
· Diminished attention span
· Myofascial pain syndrome
· Localised pain (shoulders, neck, low back, hips, etc..)
· Urinary problems (burning while passing urine)
· According to the American College of Rheumatology, diagnosis is made if there is diffuse muscular pain along with 11 to 18 tender points described. (Dr. Premkumar, 2000, p.137)
“Other underlying ailments, such as chronic fatigue syndrome, irritable bowel syndrome, and rheumatoid arthritis, can also be present. New patients should be checked for these underlying conditions as well as fibromyalgia” (Fibromyalgia Support, 2009).
“Symptoms in Children. In general, children with fibromyalgia most often have sleep disorders and widespread pain” (About.com: Health Topics A –Z).
Fritz states: “Fibromyalgia is a condition characterized by aching and pain in the muscles, tendons, and joints all over the body but especially along the spine. Measurable changes in body chemistry and function occur in some people who have fibromyalgia, and these changes may be responsible for certain symptoms. However, fibromyalgia is not associated with muscle, nerve, or joint injury; inadequate muscle repair; or any serious bodily damage or disease. Also, people who have fibromyalgia are not at greater risk for any other musculoskeletal disease” (Fritz, 2004. p.610).
Indications and contraindications for massage therapy:
· Stress – reduction
· Regular physical activity such as walking, biking, swimming, or water aerobics (clients who are physically fit will experience less symptoms).
· Medication maybe used to reduce pain, improve sleep and combat depression (watch as a massage therapist as pain scale may change with client on pain killers).
· Application of moist heat and massage are proven beneficial in the management of pain and discomfort for this syndrome.
· Massage should be tailored to each client, depending on how they are feeling at the time, as symptoms vary from day to day, also client maybe on pain killers.
· The pain of Fibromyalgia usually seems worse when a person is trying to relax and is less noticeable during busy activities or exercise (Fritz, 2004).
· Clients may request deep – pressure massage, this commonly provokes strong reactions for several days after treatment.
· Massage for stress reduction, removal of toxins, tenderpoint relief, break up adhesions (http://www.thebodyworker.com/, 1999-2009).
· Very slow increase in depth of massage strokes, from session to session, and carefully deactivation of trigger-points, are recommended.
· Address any other medical condition. (Salvo, 2008, p.141)
Yes: Detailed history from client every time as symptoms vary.
Yes: enquire about medications and be informed about the side effects of these medications.
Yes: full body relaxation massage of short duration.
Yes: gentle cross fiber friction over entire muscles, stretching and strokes such as effeurage are beneficial.
Yes: Hot packs on painful areas.
No: Massage may not be beneficial to all clients.
Do not use anything that will add to inflammation such as heat; Often over sensitive to touch. Refer to Naturopath and Acupuncturist for treatment if it is not working. Diet and Lifestyle changes are necessary (www.thebodyworker.com, 1999-2009).
“Massage has been shown to increase relaxation of muscles, decrease fatigue, decrease pain, produce sleep, decrease edema and increase mobility. It has been shown to increase communication, decrease depression and anxiety and produce a general increase in sense of well being. All these effects directly address the symptoms of fibromyalgia” (Dr. Premkumar, 2000, P.138).
Clients with Fibromyalgia are going to vary with pain, symptoms and tolerances. Therefore the therapist needs to adapt to each individual client with this syndrome to help improve their lifestyle.
About.com: Health Topics A – Z. Retrieved July, 22nd, 2009, from http://adam.about.com/reports/fibromyalgia.htm
Buraun, M., & Simonson, S. (2007). Introducation to Massage Therapy 2nd ed. Lippincott: Williams & Wilkins.
Don L. Goldenberg, M., Carol Burckhardt, P., & Leslie Crofford, M. (2004). Management of Fibromyalgia Syndrome . Jama , 292:2388-2395.
Dr. Premkumar, K. (1959). Pathology A to Z: A handbook for massage therapists (2nd Ed.). Canada: VanPub Books.
Fibromyalgia Support. (2009). Causes, Symptoms and Signs of Fibromyalgia. Retrieved July, 22nd, 2009, from http://www.fibromyalgia-support.org/fibromyalgia-causes-symptoms-signs/fibromyalgia-causes-symptoms-signs.html
Frtiz, S. (2004). Mosby’s Fundamentals of Therapeutic massage (3rd Ed.). Missouri: Mosby
Huether, S., & McCance, K. (2002). Pathophysiology: The Biologic Basis For Disease In Adults & Children (4th ed.).St. Louis, Missouri: Mosby, Inc.
National Fibromyalgia Association. (2009). Retrieved July, 20th, 2009, from http://www.fmaware.org/site/pageserver?pagename=fibromyalgia
Pathology for Massage Therapists. (1999-2009). Retrieved August, 6th, 2009, from http://www.thebodyworker.com/pathology-F.htm
Salvo, S, G. (2008). Mosby’s Pathology for Massage Therapists (2nd Ed.). Elsevier Health Science.
Wikipedia. Fibromyalgia. Retrieved July, 22nd, 2009, from http://en.wikipedia.org/wiki/fibromyalgia