Fibromyalgia affects the soft tissue of the body, causing muscle pain and fatigue. If you suffer from fibromyalgia, find out how chiropractic may help manage your symptoms.
Chiropractic Treatment for Fibromyalgia
This study was undertaken to determine whether 30 treatments combining ischemic compression and spinal manipulation could effectively reduce levels of pain intensity, sleep disturbance, and fatigue associated with fibromyalgia. In addition, the researchers wanted to identify which baseline characteristics may be predictors of outcome, and to study the dose-response relation.
Fifteen women, all members of a regional fibromyalgia association completed the trial. All subjects had experienced fibromyalgia for longer than three months. Subjects received thirty treatments including spinal manipulation and ischemic compression. Levels of improvement in pain intensity, fatigue, and sleep quality were evaluated after fifteen treatments, after the completion of the full thirty treatments, and at one month after the study. Pain intensity had to improve by at least 50% by the end of treatment for a patient to be classified as a responder; nine patients qualified as responders.
60% of the patients reported an average improvement of 77.1% in pain intensity. Quality of sleep improved by 63.5%, and fatigue level by 74.8%. The researchers theorize that sleep quality and fatigue improved because those symptoms were aggravated, at least in part, by pain. Lowered pain levels were maintained during the month-long follow-up period. This suggests that the effects of chiropractic treatment continued to help patients, even though the actual treatments had ended. Previous studies of drug treatments for fibromyalgia have shown that medications cease to be effective once drug intake stops.
The authors found that it may be possible to predict which patients are more likely to respond well to chiropractic care. Those more likely to respond poorly to treatment were older, had greater intensity of symptoms, more tender points and a more chronic illness. Those patients that showed a less than 35% improvement in pain intensity after fifteen treatments did not show satisfactory improvement after thirty treatments.
This study is of limited usefulness for several reasons. The sample size is small, self-selected, a single treating physician was used, and no control group or appropriate blinding procedures were used. However, this study does suggest that chiropractic care may play a role in the management of fibromyalgia. The authors conclude:
“Most subjects with fibromyalgia appear to have responded favorably to a course of 30 chiropractic treatments including spinal manipulation and ischaemic compression therapy. Fifteen treatments seem to be an adequate cutoff point to determine if a significant improvement in pain has occurred and if further care is warranted. Chiropractic care appears to provide benefits for at least 1 month after stopping therapy. A placebo-controlled randomized clinical trial is recommended in the near future to test these hypotheses.”
Hains G, Hains F. Combined ischemic compression and spinal manipulation in the treatment of fibromyalgia: a preliminary estimate of dose and efficacy. Journal of Manipulative and Physiological Therapeutics 2000;23(4):225-230.
The researchers found that FM patients had the most dysfunction in the stress response system, but that LBP patients had some of the same characteristics.
“From a clinical point of view, it is our impression that in individual cases FM, over the years, often ensues from LBP or other localized pain disorders…In view of the notion that patients with FM and LBP both experience chronic pain, that FM can develop after LBP, and that both disorders display rather similar neuroendocrine abnormalities (albeit to a different degree), one might conclude that the pain in FM is the primary factor underlying its pathogenesis.”
What is clear from this study is that both FM and LBP patients exhibit disruption of the neuroendocrine system, especially in the system that controls how the body responds to stress. Similar dysregulation has been found in patients with PTSD, depression, and chronic fatigue syndrome.
Griep EN, Boersma JW, Lentjes EG, et al. Function of the hypothalamic-pituitary-adrenal axis in patients with fibromyalgia and low back pain. The Journal of Rheumatology 1998;25:1374-1381.
Patients with chronic pain syndromes frequently exhibit symptoms including nightmares, intrusive and recurrent recollections, and symptoms of increased arousal associated with posttraumatic stress disorder, (PTSD). This study’s purpose was to determine the prevalence of PTSD-like symptoms in a population of FMS patients seeking treatment from a pain center. The researchers also set out to evaluate the relationship between the symptoms of FMS, PTSD-like symptoms and disability. Considering the impact of PTSD symptoms the authors hypothesized that FMS patients with higher levels of PTSD-like symptoms would report greater disability, pain, affective distress, and greater difficulties in adapting to chronic pain when compared to FMS sufferers that did not report similar levels of PTSD-like symptoms.
Subjects were ninety-three consecutive patients referred to a university based pain treatment center FMS program. The average age of the patients was 46 years, and the patients were predominately female (98%). This group’s demographics were comparable to the demographics of FMS patients seeking treatment from rheumatologists and pain medicine specialists. Patients were subject to a comprehensive FMS evaluation, and completed self-report questionnaires measuring disability, PTSD-like symptoms, and psychosocial responses to their pain condition. The researchers assigned the subjects to one of two groups, labeled either PTSD+ or PTSD- based on the level of self-reported PTSD-like symptoms.
Fifty-six percent of the patients reported levels of PTSD-like symptoms that were clinically significant and comprised the PTSD+ group. They reported levels of disability, life interference, emotional distress, and pain that were significantly greater than the levels reported by the PTSD- group. Over eighty-five percent of PTSD+ patients exhibited significant disability, compared to fifty percent of the PTSD- group. The PTSD- also fared better than the PTSD+ group when the researchers looked at coping ability.
The authors comment on the possible underlying mechanism that links FMS and PTSD.
“Although the psychological sequelae of PTSD are relatively well delineated, the long-term effects of such symptoms on physical disorders are still relatively unexplored. One could argue that those who retain elevated levels of PTSD-like symptoms beyond a reasonably expected adjustment period may have been predisposed to poor coping or impaired psychological response. In those cases, both FMS and PTSD symptoms may be a consequence of inadequate psychological resources. In effect, the predisposition to poor coping may be the underlying factor for both FMS and PTSD. Alternatively, symptoms of PTSD may make adjustment to or recovery from chronic pain more difficult. The complicating nature and burden of coping with PTSD symptoms may increase the likelihood of a pain condition becoming chronic. Although the cross-sectional nature of the current study does not permit us to draw any definitive conclusions on the causal relation between PTSD and FMS symptoms, the positive relation between these problems suggests that extra attention should be provided to FMS patients with PTSD-like symptoms.”
The authors note that although PTSD+ group exhibited many of the symptoms of PTSD, there was no thorough clinical interview. Therefore, it cannot be assumed that those in the PTSD+ group would merit a diagnosis of PTSD. However, the authors assert that their results “suggest that understanding symptoms characteristic of PTSD may be particularly important in understanding FMS and that assessment of PTSD-like symptomology among FMS patients may have important clinical implications.” They authors suggest future study to investigate the underlying mechanisms of the FMS and PTSD relationship.
Sherman J, Turk D, Okifuji A. Prevelance and Impact of Posttraumatic Stress Disorder-Like Symptoms on Patients With Fibromyalgia Syndrome. The Clinical Journal of Pain. 2000;16:127-134.
Fibromyalgia patients are at risk of vitamin D deficiency according to a new study from Ireland. In the study, 36% of fibromyalgia patients had deficient levels of vitamin D and 62% had insufficient levels. That meant only 15% of patients were getting adequate levels of the vitamin.
The patients were mostly middle-aged women. Researchers pointed out that the women’s vitamin D levels may have been affected by the fact they lived in seldom-sunny Ireland. When it is sunny, patients may still choose to stay indoors because of their disability and pain.
Low vitamin D levels can increase the risk of cognitive impairment in older adults, severe asthma in children, cancer, and more. Vitamin D helps the body maintain normal blood levels of calcium and phosphorus. It also allows the body to absorb calcium to strengthen the bones.
Previous research has investigated the relationship between vitamin D deficiency and musculoskeletal pain with conflicting results. In some studies, fibromyalgia patients had low levels of the vitamin but in others their levels were no different than control participants. In one study vitamin D supplementation appeared to have no specific clinical benefits for fibromyalgia patients.
Still, there does appear to be link between vitamin D deficiency and muscle pain. While more research is needed to understand this link, vitamin D supplements could benefit the overall health of fibromyalgia patients.
Consult with your chiropractor or health practitioner to learn which vitamins are right for you.
Jan A, et al. “Serum 25-hydroxy vitamin D levels in patients with fibromyalgia” BSR2012; Abstract 231.
Walsh, Nancy. Medpage Today. Vitamin D May be Help in Fibromyalgia. May 3, 2012. Accessed May 10, 2012. http://www.medpagetoday.com/MeetingCoverage/BSR/32497.
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