FIBROMYALGIA

Definition

Fibromyalgia is defined as a chronic musculoskeletal condition of unknown etiology and is characterized by widespread pain and an increased pain sensation. The dysregulated function of what we call the HPA axis, and the mechanism of central sensitization (now known as nociplastic pain) increases the patient’s sensitivity to pain. Fibromyalgia, though become more commonplace in doctor’s offices, is only suspected to affect 2-4% of the population with a higher in women 50-80 years old.

LITERATURE - DIAGNOSIS AND TREATMENT OF fibromyalgia

Symptomology of fibromyalgia falls under three criteria: aspects of physical (musculoskeletal), pain regulation (neuroendocrine), psychological wellness and mood disorders. Poor sleep is reported in up to 80% of patients, with sleep and musculoskeletal problems being the most sought after care for these patients.

Because there is an absence of absolute, definitive diagnostic criteria with universal applicability, providers often settle upon this diagnosis following negative testing for other differentials. ~ Belatto et al.

Patients with fibromyalgia also tend to have functional and emotional imbalances such as persistent fatigue, sleep disturbances, a burning or prickling sensation (paresthesia), cognitive disorders, and mood disturbances. There are a wide variety of pharmacological medications on the market to help treat the widespread pain, help with sleep and cognition. NSAIDS, Tramadol, and antidepressants are on the list of widely used medications for this application. Studies have shown however, that those with anxiety or depression are less likely to adhere to these medications long term due to their side effects.

Research has shown that despite the sensitivity to touch, massage has shown to be an effective long-term-gain approach. One study showed that working with the connective tissue provided patients with pain at first but long term reward later. The connective tissue of fibromyalgia patients is densely filled with inflammation so gently approaching this tissue can be effective. Moreover, the approach to massage for these patients should start with very gentle painless manipulation with a gradual increase in intensity over 1-2 weeks. This massage approach has shown to improve restful sleep, decrease anxiety/depression, and reduces the intensity of perception of pain. It should be noted that Swedish massage was not effective and should not be used on these patients.

As with any approach using acupuncture, studies have shown that acupuncture can be useful to treat the symptoms of fibromyalgia. Patients often find acupuncture to be effective for their pain, their sleep disturbances and has improved their quality of life.

Survey Results

Our Canada-wide survey is very much in line with the literature on non-pharmacological approaches to treating fibromyalgia. Patients are finding massage - though we did not qualify which type of massage - to be helpful with their pain and other symptoms. We do also see a slight elevation in the use of acupuncture which is really promising to us.

FEMADE APPROACH TO TREATING fibromyalgia

Our Massage therapy approaches fibromyalgia from both a physical symptom and a mental health perspective. With these patients it is crucial that we work with the patient to obtain the right intensity of the massage to both activate that signaling to the brain that we are working on the connective tissue in a safe way with exacerbating the pain signals. But we also ensure that the approach is promoting relaxation and relieves stress and anxiety.

While it is difficult from a TCM perspective to articulate the differentiation of our acupuncture approach as compared to inexperienced acupuncturists in the area of fibromyalgia, we use very specific workflows to reduce the symptoms of fibromyalgia and increase quality of life. With this, we work very closely to the patient to understand which symptoms are most burdensome and treat those in the primary rounds of acupuncture. Peeling back the layers of the onion, continued acupuncture then allows us to explore and treat secondary symptoms as we begin to clear out the primary ones.

Our Naturopathic approach requires a thorough intake of the patient’s history. The key is to look at lifestyle cues that tell us what areas we need to focus on. For instance we know that in patients with fibromyalgia there is a lot of central nervous system pain and a lot of people do not achieve restorative sleep. As such this tells us there may be hormonal imbalances, stress imbalances, sex or sleep imbalances. Indeed it is a lot of detective work. For someone with neuropathies and pain syndromes it is multifactorial.

Lastly, understanding that fibromyalgia is largely accompanied by mood disorders, and has an impact on mental health due to it being so largely misunderstood, we offer psychotherapy to address some of the root causes of stress, and stress management. We also offer peer support for a more casual mental health support outlet as well as virtual group support sessions to help build a community.

Resources

Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3503476/

Efficacy of acupuncture in the treatment of fibromyalgia. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567806/

Effects of Manual Therapy on Fatigue, Pain, and Psychological Aspects in Women with Fibromyalgia. https://pubmed.ncbi.nlm.nih.gov/32604939/

Psychological impact of fibromyalgia: current perspectives. https://pubmed.ncbi.nlm.nih.gov/30858740/