What Is Fibromyalgia Pain Syndrome?
By Leah Lyn Fitzgerald, Licensed Massage Therapist
Fibromyalgia pain syndrome affects the muscles, fascia (covering of the muscles), tendons (bands at the ends of muscles that connect muscles to bones) and connective tissues of the body. This condition can be painful and debilitating and is characterized by generalized muscle stiffness, soreness, muscle pain, joint pain, tender areas called trigger points, depression, extreme fatigue and sleeping difficulties. Fibromyalgia is not a life threatening illness in itself but does significantly decrease the quality of life of its sufferers. Pain interferes with the ability to perform everyday activities, emotional disturbances, like depression and anxiety can take its toll on personal relationships.
Fibromyalgia is a chronic condition which is characterized by widespread muscle and joint pain that is typically 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 illnesses, however, it can seriously affect the quality of life as the pain often interferes with the patient's abilities to perform everyday activities. Widespread and persisting pain can also cause sleep disturbances, while the frustration of managing the pain can affect the sufferer's mood, emotional state and relationship with other people which in turn can lead to depression. There are medications that can assist to relieve or cover up symptoms but these are not without side effects, some of which may also potentiate the problems already present. Antidepressants assist the person to cope with the symptoms as well as sleep better, but again have side effects. Alternative therapies such as acupuncture, biofeedback, meditation, herbal medicine may help as well. Massage therapy is another alternative treatment that has been shown to be the most valuable modality to assist healing of muscles and connective tissues involved in this potentially debilitating condition.
All muscles of the body are enveloped by a thin, tough, and resilient tissue similar to cellophane wrap. Normally this covering is elastic and pliable but injuries, sedentary lifestyle, and physiological factors can cause this covering to constrict, stiffen and tighten up. The myofascia extends from the muscle belly all the way to the tendons where muscles attach to bones. When myofascia becomes restricted and tight it restricts muscle movement and decreases circulation, oxygen supply, nutrients, and electrolytes (important for muscle contraction and relaxation) availability to muscles. This can become very painful, causing restriction in movement and creating an abundance of muscle function problems and imbalances. All these symptoms will cause a person to limit and decrease physical activity which only makes the problem worse.
Restrictions caused by dysfunction in myofascia promote the formation of trigger points. The presence of trigger points in muscles refer pain to other areas of the muscle involved and other muscles nearby. These TPs (trigger points) are lacking in vital nutrients, oxygen and blood supply and may feel cooler that surrounding tissues. The presence of a TP will generally affect the muscle(s) function even more creating a cascade like effect. Simple explained, without proper intervention the problem worsens and pain and dysfunction becomes even worse, causing more pain and dysfunction. Dysfunction leads to more injuries as other muscles and joints try to compensate and take on extra work due to the lack of strength and muscle movement in the affected area. Joints become irritated, muscle fatigue occurs in compensating muscles increasing risk of injuries and possibly causing falls leading to fractures and other injuries.
Muscle Function is Diminished
Studies done on fibromyalgia reveal the presence of myofascial abnormalities, trigger point, as well as diminished muscle function due to nervous system and physiological abnormalities. Researchers have found that with fibromyalgia muscles seem to have an inability to "rest" and are always firing even during sleep. This doesn't allow muscles to relax and may cause small tears and injuries in the microscopic cells of the muscle due to constant activity. The muscles unable to rest and exchange wastes adequately cause an increase in the buildup of lactic acid and other substances. This is similar to what happens after intense exercise. In fact, persons with fibromyalgia require an increased recovery time after exercise due to this fact. Some literature suggest that trigger points should ideally be released before muscle activity such as stretching and workouts or the problems may become worse and affect other muscles and tissues.
Assess, Treat, Repeat!
A trained massage therapist, after performing a thorough exam including muscle function and range of motion, can develop a customized plan of care to assist in fibromyalgia pain syndrome. Initially the first visit should consist of a thorough consultation in order to treat the client safely and holistically. A thorough medical history as well as medication assessment should be performed to scan for side effects of current medications which may affect treatment choices. A consultation may be needed with the client's physician if medical conditions are present that may be contradictions to massage therapy. Present activity level should also be assessed in order to gain knowledge of clients current and past activity level as well as any repetitive movements that may be increasing the pain. Pain should be evaluated on a 1 to 10 scale and should be compared to previous level of function. A posture and gait analysis will also allow the massage therapist to pinpoint problem areas. Finally, a hands on assessment of myofascia, tender areas, skin temperature, and scan for trigger points should be performed. Length of sessions and modality choice should be approached according to individual client's pain level and tolerance to massage. If pain level is 6 or higher manual lymphatic drainage should be performed initial to decrease swelling in order to lessen the discomfort of treatment. Assure the client that in order to perform the treatment efficiently certain steps have to take. It is important to reassess the client's condition with each visit and be flexible in the overall treatment plan. The client needs to fully understand that if excess pain is being experienced after the session it is important to relate this the therapist so that treatment may be modified accordingly. Communication between the client and therapist will improve treatment outcome and assist to develop trust in the client therapist relationship.
What Can Massage Do?
The goal of massage for fibromyalgia pain syndrome is to decrease pain and in turn increase function and sense of well-being. If swelling and excess pain is present manual lymphatic drainage will increase circulation to the lymphatic system and optimize its function, thus allowing the therapist to perform treatment in a comfortable manner and not cause pain to the client. Next myofascial release will allow the therapist to access muscle layers which will then be massaged and assessed, starting with superficial layers and continuing with deeper layers as the patient's pain level diminishes and allows. All the while the therapist will also be locating TPs and treating those areas accordingly. Stretches will be suggested for the client to perform at home only after TPs are addressed and corrected. Magnesium Sulfate (Epson salt) soaks will be recommended between treatments to assist in relaxation of muscles. Due to diligent treatment and the general effects of massage, (an increase in serotonin and endorphins levels), eventually the client will report better sleep, experience less pain, function more efficiently, and feel better overall. The client and therapist will decide on a maintenance plan which will be perpetually adjusted according to client's symptoms.
Winning the Fight!
Too often persons with fibromyalgia pain syndrome my give up the fight, but help is out there and if action is taken, living with fibromyalgia does not have to be debilitating. Prior 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 go along with fibromyalgia that were not discussed in this article, many of which are caused by the constant pain state and grief due to the decrease in function as well as psychological issues. Pain can be a debilitating factor, will effect thought processes as well as emotional well-being and create a strain on personal relationships. Economic problems relating to job performance issues may also add to the crisis. This suffering is not necessary and I advise anyone experiencing chronic pain of any type to seek assistance so that life can be enjoyable again. Even if your loved ones are diagnosed with fibromyalgia are chronic pain, remind them that there is help out there and there is hope. Find a massage therapist near you that will be patient and assist you with your journey to fight chronic pain and start living life again!