What is fibromyalgia pain syndrome?
Fibromyalgia pain syndrome affects the muscles, fascia (lining of muscles), tendons (bands at the ends of muscles that connect muscles to bones), and connective tissues in the body. This condition can be painful and debilitating and is characterized by widespread muscle stiffness, pain, muscle pain, joint pain, tender areas called trigger points, depression, extreme fatigue, and difficulty sleeping. Fibromyalgia is not a life-threatening disease in itself, but it significantly decreases the quality of life for those who suffer from it. Pain interferes with the ability to perform daily activities, emotional disorders, such as depression and anxiety, can affect personal relationships.
Fibromyalgia is a chronic condition characterized by widespread muscle and joint pain that is often accompanied by fatigue and a variety of other symptoms. It is not a sign of a serious underlying condition and does not increase the risk of other diseases; however, it can seriously affect quality of life as pain often interferes with the patient’s ability to perform daily activities. Persistent and widespread pain can also cause sleep disturbances, while the frustration of controlling pain can affect mood, emotional state, and relationships with other people, which in turn can lead to depression. There are medications that can help alleviate or cover up symptoms, but they are not without side effects, some of which can also exacerbate existing problems. Antidepressants help a person cope with symptoms and sleep better, but again they have side effects. Alternative therapies such as acupuncture, biofeedback, meditation, and herbal remedies can also help. Massage therapy is another alternative treatment that has proven to be the most valuable modality in assisting the healing of the muscles and connective tissues involved in this potentially debilitating condition.
Myofascial tissue
All the muscles of the body are wrapped in a thin, strong and resistant fabric similar to cellophane wrap. Normally this cover is elastic and flexible, but injury, sedentary lifestyle, and physiological factors can cause this cover to contract, harden and tighten. Myofascia runs from the muscle belly to the tendons, where the muscles join the bones. When myofascia becomes restricted and tense, it restricts muscle movement and decreases circulation, oxygen supply, nutrients, and electrolyte availability (important for muscle contraction and relaxation) to the muscles. This can become very painful, causing restriction in movement and creating a host of problems and imbalances in muscle function. All of these symptoms will cause a person to limit and decrease physical activity, which only makes the problem worse.
Trigger points
Restrictions caused by myofascial dysfunction promote trigger point formation. The presence of trigger points in the muscles causes the pain to spread to other areas of the affected muscle and to other nearby muscles. These TPs (trigger points) lack vital nutrients, oxygen, and blood supply and can feel colder than surrounding tissues. The presence of a TP will generally further affect the function of the muscles creating a cascade effect. Simply explained, without proper intervention the problem worsens and the pain and dysfunction further aggravate, causing more pain and dysfunction. The dysfunction leads to further injury as other muscles and joints try to compensate and take on extra work due to a lack of muscle strength and movement in the affected area. Joints become irritated, muscle fatigue occurs by compensating the muscles increasing the risk of injury and possibly causing falls leading to fractures and other injuries.
Muscle function is decreased
Studies conducted on fibromyalgia reveal the presence of myofascial abnormalities, trigger points, as well as decreased muscle function due to physiological and nervous system abnormalities. Researchers have found that with fibromyalgia the muscles appear to have an inability to “rest” and are always activated even during sleep. This does not allow the muscles to relax and can cause small tears and injury to the microscopic cells of the muscle due to constant activity. Muscles that cannot rest and exchange waste properly lead to an increase in the accumulation of lactic acid and other substances. This is similar to what happens after intense exercise. In fact, people with fibromyalgia require a longer recovery time after exercise due to this fact. Some literature suggests that the trigger points should ideally be released prior to muscle activity, such as stretching and workouts, or the problems may worsen and affect other muscles and tissues.
Evaluate, Treat, Repeat!
A trained massage therapist, after performing a comprehensive exam that includes muscle function and range of motion, can develop a personalized care plan to help with fibromyalgia pain syndrome. Initially, the first visit should consist of a thorough consultation to treat the client in a safe and holistic manner. A complete medical history, as well as a medication evaluation, should be performed to look for side effects of current medications that may affect treatment options. A consultation with the client’s physician may be necessary if there are medical conditions that may be inconsistent with massage therapy. Current activity level should also be assessed to understand the client’s current and past activity level, as well as any repetitive movements that may be increasing pain. Pain should be assessed on a scale of 1 to 10 and should be compared to the previous level of function. An analysis of posture and gait will also allow the masseur to identify problem areas. Finally, a practical assessment of myofascia, sensitive areas, skin temperature, and trigger point examination should be performed. The duration of the sessions and the choice of modality should be approached according to the pain level and the massage tolerance of the individual client. If the pain level is 6 or more, initial manual lymphatic drainage should be performed to decrease swelling to lessen the discomfort of treatment. Assure the client that in order to perform the treatment efficiently they must follow certain steps. It is important to reassess the client’s condition at each visit and to be flexible in the overall treatment plan. The client must fully understand that if excessive pain is experienced after the session, it is important that they communicate this to the therapist so that the treatment can be modified accordingly. Communication between the client and the therapist will improve the treatment outcome and help build trust in the therapist’s relationship with the client.
What can massage do?
The goal of massage for fibromyalgia pain syndrome is to decrease pain and, in turn, increase function and a sense of well-being. If there is excessive swelling and pain, manual lymphatic drainage will increase circulation to the lymphatic system and optimize its function, thus allowing the therapist to perform the treatment comfortably and pain-free for the client. The next myofascial release will allow the therapist to access the muscle layers that will then be massaged and evaluated, starting with the superficial layers and continuing with the deeper ones as the patient’s pain level decreases and allows it. Meanwhile, the therapist will also locate the PDs and treat those areas accordingly. Stretches will be suggested for the client to perform at home only after the TPs are addressed and corrected. Magnesium sulfate (Epson salt) baths will be recommended between treatments to help relax muscles. Due to diligent treatment and the overall effects of massage (an increase in serotonin and endorphin levels), eventually the client will report that they sleep better, experience less pain, function more efficiently, and feel better overall. The client and the therapist will decide on a maintenance plan that will be perpetually adjusted according to the client’s symptoms.
Winning the fight!
Too often, people with fibromyalgia pain syndrome give up the fight, but there is help, and if action is taken, living with fibromyalgia doesn’t have to be debilitating. Previous function and enjoyment of life can be restored and there is light at the end of the tunnel with proper treatment. I also want to mention here, that there are other symptoms that accompany fibromyalgia that were not discussed in this article, many of which are caused by the constant state of pain and grief due to decreased function, as well as by psychological problems. Pain can be a debilitating factor, affecting thought processes as well as emotional well-being, and creating tension in personal relationships. Financial problems related to job performance issues can also exacerbate the crisis. This suffering is not necessary and I advise anyone experiencing chronic pain of any kind to seek help so that life can be pleasant again. Even if your loved ones are diagnosed with fibromyalgia with chronic pain, remind them that there is help and hope. Find a massage therapist near you who will be patient and help you on your journey to combat chronic pain and start living life again!