Issue link: https://www.massageandbodyworkdigital.com/i/72098
FIBROMYALGIA'S MYSTERIES FIBROMYALGIA IN REVIEW Affecting anywhere from 3–6 million Americans, fibromyalgia syndrome (FMS) is categorized as either primary or secondary. A primary diagnosis means the cause is unclear—the existing evidence suggests it may be a neuroendocrine dysfunction.1 Secondary FMS, the form most MTs will see, is caused by traumatic physical or psychological insult; therefore, it is important to understand these insults as a factor in cause and care. The condition's duration is measured in years, and lifetime involvement is common. It occurs in children and adults of all ages and socioeconomics levels, with a strong prevalence in females aged 35–55.2 FMS occurs more frequently in families who share a history of depression, alcoholism, childhood physical and sexual abuse, drug abuse, or eating disorders. There may also be a genetic predisposition for FMS.3 The syndrome often mimics similar diseases, and several diseases that occur simultaneously with FMS can contribute to a confusing clinical picture. Associated conditions of FMS include anxiety, bowel difficulties, chronic fatigue syndrome, depression, headaches, insomnia, menstrual difficulties, myofascial pain syndrome, noncardiac- related chest pain, peripheral neurogenic pain, temporomandibular joint (TMJ) dysfunction, and some forms of arthritis. THE SYMPTOMATIC PICTURE The severity of FMS fluctuates, and complications often occur that affect the person's quality of life. Symptoms of the chronic condition can be exacerbated by depression, extreme weather changes, insufficient sleep, long periods of immobility, overexertion, stress, and the presence of simultaneous infectious illnesses. The pain is pervasive, and the condition can endure for decades. However, it is not progressive, does not deteriorate the joints or organs, and is not fatal. After years of labeling FMS as a psychological aberration or a nonexistent condition, clinicians have now narrowed the pathophysiology to a probable central nervous system and/ or endocrine disorder. Those with FMS have hypersensitive pain (which signals activity in the brain) and a dysfunction in the muscle's pain receptors. The brain of a fibromyalgia patient reacts differently than those of nonsufferers while reporting pain, and FMS clients can show sensitivity to light touch as well as measurable abnormalities in nonpainful stimulus tests. According to criteria established by the American College of Rheumatology,4 the clinical diagnosis depends on confirmation of at least 11 of 18 tender points on the body (see Tender Point Map 37), but laboratory tests, MRIs, and muscle biopsies to determine the presence of FMS are usually nondiagnostic. Overall signs and symptoms include: • Allodynia (a normally nonpainful stimulus perceived as painful). • Pain lasting at least three months. • Pain and/or tenderness palpable in at least 11 of 18 points. • Generalized muscular aching. • Lack of restorative sleep, unrelated to the number of hours slept. • Pain and depression exacerbated by insomnia. • Pain exacerbated by exertion. • Moderate to profound fatigue. • Generalized stiffness, worse at the beginning and end of the day and after periods of immobility. • Distal paresthesia (numbness, tingling, burning, and stinging in the hands and feet). • Cold intolerance. Through massage therapy, allodynia can be addressed with careful desensitization techniques, including decreasing the perception of pain with general Swedish massage. Insomnia and its attendant anxiety and irritability can be addressed by placing the client in a deep parasympathetic state. Generalized stiffness can be relieved with respectful and thorough range of motion (ROM). ROM exercises, combined with gentle joint stretches, are essential. Breathing restrictions, which typically accompany chronic pain and stress, can also be addressed during the massage therapy and homework sessions. MASSAGE THERAPY ASSESSMENT The initial assessment of an FMS client is based on excellent history taking, not on the therapist's manual evaluation—the verbal assessment could last at least half of the initial hour-long session. The client will have had many medical misdiagnoses, and her frustration may need to be vented to a compassionate massage therapist. Trust must be built, and knowledge gained, before the client is palpated. During this process, there are some important things to consider, including an understanding of tender points, the ability to set reasonable therapeutic goals, and proper preparation. TRIGGER POINT VS. TENDER POINT When approaching your work with the fibromyalgia client, there is a clear clinical difference between a trigger point and a tender point, and the effective treatment of the FMS client depends on the therapist's understanding of significantly different approaches for each. The therapist should keep the following in mind: FMS tender points are bilateral, and are typically found in the areas indicated in the Tender Point Map. FMS tender points are 36 massage & bodywork september/october 2011