Issue link: https://www.massageandbodyworkdigital.com/i/1481961
FIBROMYALGIA HISTORY AND DEFINITION Fibromyalgia, which translates to "fiber-muscle pain," is a situation that has been acknowledged for generations. References to body-wide pain can be found in historical documents predating the Middle Ages. But it is a surprisingly poorly understood condition that continues to be explored, so our comprehension of it is in constant evolution. It wasn't until 1816 that Western physicians began putting together the collection of signs and symptoms, including pain, stiffness, fatigue, and sleep disorders, into a predictable syndrome that might have been what we now call fibromyalgia. In those days, it was sometimes called muscular rheumatism, fibrositis syndrome, myofascitis, or a myriad of other names that implied inf lammation. But it wasn't until a team of researchers found no signs of inf lammation in biopsied "tender points" that the more accurate term was applied. (That was using 1976 tools; since, some subtler indicators of inf lammation have been detected with fibromyalgia, but not necessarily at the site of tender points.) Historically, fibromyalgia has been conf lated with a similar, but not synonymous, condition called myofascial pain syndrome (MFPS). Indeed, it is possible that what early observers documented was MFPS instead of, or in addition to, fibromyalgia. Differences between fibro- associated "tender points" and MFPS-associated "trigger points" have been noted, but this remains a touchy and controversial topic—especially since trigger points themselves have become a subject of much contention. One widely accepted definition is this: Fibromyalgia is a neurosensory disorder characterized by abnormalities in pain processing by the central nervous system (CNS). So, while it is named for its main symptom of widespread pain, it is a nervous system problem having to do with pain processing in the CNS. This understanding is also under challenge, as certain changes in the peripheral nervous system seem to be a problem for many people who meet the diagnostic criteria for fibro. Regardless of whether fibro is a problem in the CNS, the peripheral nervous system, or the musculoskeletal system, its impact on people who have it is all- encompassing. For this reason it's often discussed as a good fit for a biopsychosocial approach to coping and treatment—it has biological factors in terms of tissue and chemical changes; it has psychological factors in terms of effects on mood, self-efficacy, and the way pain is given meaning; and it has social factors because it inf luences relationships, socioeconomic status, the support one might need from others, and the tendency to self-isolate, which is associated with increased levels of pain. This is an important model because we see that fibro and similar conditions often don't respond well to treatment strategies that do not address all three domains of the biopsychosocial approach. FIBROMYALGIA PATHOPHYSIOLOGY This is the part of the discussion where I would usually dive into what physiologic changes occur with the disease under discussion so we can identify the origin of its major signs and symptoms and make some informed judgments about the appropriateness of massage therapy. However, this article is focused more on the human experience of fibro and the skills it takes to be a helpful care provider. L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 39 BIOPSYCHOSOCIAL MODEL BIOLOGICAL physical health, genetics, medications SOCIAL peers, family, support systems, relationships PSYCHOLOGICAL coping, self- efficacy, mood, mental health FIBRO