Here is some of the information I recently shared in my July newsletter. Each newsletter has a specific focus. This month is focused on fibromyalgia and Chronic Pain information. If you would be interested in receiving my newsletters, please head over to my contact page and sign up.
Tidbits, Updates and Resources:
1.Five myths about pain that many manual therapists are sick of Hearing by Nick Ng (can be found in Massage & Fitness Magazine).
2. 3 steps to be an even more effective pain relief therapist by Irene Diamond--a 45 minutes video of a webcast.
STUDIES, ARTICLES, AND RESOURCES
I receive a weekly update on anything published anywhere on the internet that includes information about fibromyalgia and chronic pain. If you have any problems with the links, please let me know, or if you come across any information that you think would be good to share, please also feel free to pass that information along: info@holistichealingarts.net
1. A study titled"Effectiveness of different styles of massage therapy in fibromyalgia: a systematic review and meta-analysis by Yuan, Matsutani & Marques and publish in Apr 2015 in Man Ther concluded: “myofascial release had large, positive effects on pain and medium effects on anxiety and depression in contrast with placebo…myofascial release also improves fatigue, stiffness and quality of life. Connective tissue massage improves depression and quality of life; manual lymphatic drainage is superior to connective tissue massage regarding depression and quality of life; Shiatsu improves pain, pressure pain threshold, fatigue, sleep and quality of life: and Swedish massage does not improve outcomes.
2. In a study in Sci Rep 2016 titled “Efficacy of cupping therapy in patients with the fibromyalgia syndrome-a randomized placebo-controlled trial” concluded: Five cupping treatments were more effective than usual care to improve pain intensity and quality of life. However, the effects were small and cupping was not superior to sham cupping treatments, further research is warranted.
3. In a paper by Larimer Moseley, “Reconceptualizing Pain According to Modern Pain Science, published through the University of South Australia at BodyinMind.org, he argues that “the biology of pain is never really straightforward, even when it appears to be. It is proposed that understanding what is currently known about the biology of pain requires a reconceptualization of what pain actually is, and how it serves our livelihood. He suggests there are four key points:
4. A short summary of an article by John Quintner, titled “Evolution, Stress, and Fibromyalgia” adapted from Lyon P, Cohen M, Quinter J. An evolutionary stress-response hypothesis for Chronic Widespread Pain (Fibromyalgia Syndrome). Pain Med 2011;12:1167-1178 suggests a Stress Response and Substance P response in combination may explain the disparity in symptoms and why many treatments have not been effective.
5. A follow-up article to the above reference, titled “How did fibromyalgia ever become a brain disease? Disentangling conjecture and truth, by John Quintner, debunks the Central sensitivity syndromes theories.
6. A study published in Scientific Reports titled Functional Brain Network mechanism of Hypersensitivity in Chronic Pain, and summarized by Haley Otman at Medical press, titled Does an exploding brain network cause chronic pain? suggests “as opposed to the normal process of gradually linking up different centers in the brain after a stimulus, chronic pain patients have conditions that predispose them to linking up in an abrupt, explosive manner.”
7. A study titled “Effectiveness of Therapeutic Exercise in Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials", published in Biomed Res Int 2017, concludes: aerobic and muscle-strengthening exercises are the most effective way of reducing pain and improving global well-being in people with fibromyalgia and that stretching and aerobic exercises increase health-related quality of life.
8. A narrative article, published in Minerva Anestesiol Jan 2018, titled "The role of cannabinoids in pain control: the good, the bad and the ugly” concluded: cannabinoids appear to be most effective in controlling neuropathic pain, allodynia, medication-rebound headache, and chronic non cancer pain, but do not seem to offer any advantage over nonopioid analgesics for acute pain. Cannabinoids seem to work no better than placebo for visceral pain and conferred only modest analgesic effect in cancer pain.
9. A study published in Turk J Med Sci Dec 2017, titled “Does fibromyalgia have an effect on hearing loss in women?” concludes: results point to a pathophysiologic link between fibromyalgia and the development of audiological abnormalities in these patients.
10. A study published in Complement Ther Med Feb 2018 titled “Effect of whole body cryotherapy interventions on health-related quality of life in fibromyalgia patients: a randomized controlled trial” concludes: Whole body cryotherapy can be recommended as an effective clinically adjuvant approach in the improvement of health-related quality of life in fibromyalgia patients.”
Alternative Health Arena
1. A study, titled “Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial", published Mar 2018 in BMJ, concludes: Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise…for a variety of outcomes for patients with fibromyalgia. Longer duration of tai chi showed greater improvement.”
2. A study, titled “Reiki is better than placebo and has broad potential as a complementary health therapy", published in J Evid Based Complementary Altern Med Oct 2017, concludes: found reasonably strong evidence for Reiki being more effective than placebo.”
Every month I send out a newsletter to subscribers with the most recent evidence and studies on specific body work topics. The newsletter may include summaries and links to studies and articles, videos that provide support information about exercises, new techniques or lectures. There are five main focuses for the newsletters and each newsletter is repeated twice a year. The six main focuses for the newsletters are: Shoulder and rotator cuff, fibromyalgia, fascia and trigger points, upper cross and neck, cupping and lymphatic drainage and business/ethics. If you would like to receive the newsletters with more complete information than is found in the excerpts, please sign up to receive the newsletter on my contact page.
PLEASE NOTE: This is the last edition of the Fibromyalgia newsletter. This newsletter will be converted to a newsletter with a focus on chronic pain conditions rather than the narrow focus of fibromyalgia.
A study titled “A pilot study of myofascial release therapy compared to Swedish massage in Fibromyalgia” by Liptan, Mist, Wright, Arzt & Jones, published in Journal of Bodywork and Movement Therapies concluded: between-group differences in symptoms and physical function did not reach statistical significance. There were no consistent focal areas of improvement for the Swedish massage group while the MFR group reported consistent pain reductions in the neck and upper back regions. A larger randomized controlled trial is called for.
In a study in Man Ther 2015 by Yuan, Matsutani & Marques, titled “Effectiveness of different styles of massage therapy in fibromyalgia: a systematic review and meta-analysis”, the authors concluded: myofascial release had large, positive effects on pain and medium effects on anxiety and depression at the end of treatment; myofascial release also improves fatigue, stiffness and quality of life; connective tissue massage improves depression and quality of life; manual lymphatic drainage is superior to connective tissue massage regarding stiffness, depression and quality of life; Shiatsu improves pain, pressure pain threshold, fatigue, sleep and quality of life; and Swedish massage does not improve outcomes.
In a study, published in Rheumatol Int. 2017 titled “A comparison of the effects of exercises plus connective tissue massage to exercises alone in women with fibromyalgia syndrome: a randomized controlled trial” concluded: exercises with and without connective tissue massage might be effective for decreasing pain, fatigue and sleep problem whereas increasing health status and quality of life. However, exercises with CTM might be superior in improving pain, fatigue, sleep problem, and role limitations due to physical health compared to exercise alone.
A study, published in J Pain Res. 2017, titled “Caffeine as an opioid analgesic adjuvant in fibromyalgia” concluded: caffeine consumption was associated with decreased pain and symptom severity in opioid users, but not in opioid nonusers, indicating caffeine may act as an opioid adjuvant in fibromyalgia-like chronic pain patients. This data suggest that caffeine consumption concomitant with opioid analgesics could provide therapeutic benefits not seen with opioids or caffeine alone.
A study published in Complement Ther Clin Prati in Aug 2017, titled “Effects of whole-body vibration therapy in pain, function and depression of the patients with fibromyalgia” concluded: Whole body vibration therapy is found to be effective in reducing symptoms of fibromyalgia.
A study published in Clin Biomech titled “Effects of a 16-week hydrotherapy program on three-dimensional scapular motion and pain of women with fibromyalgia: a single-arm study” concluded: Hydrotherapy was effective to improve quality of life, pain intensity and fibromyalgia impact on women. However, scapular kinematics did not change after the period of treatment. Although symptoms improved, the lack of changes in scapular kinematics may indicate these women have an adaptive movement pattern due to their chronic painful condition.
During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and well thought out information and decision-making outcomes. I am happy to share some of their assignments for you to enjoy.
Introduction:
Fibromyalgia and Sjogren's syndrome. The diagnosis has not been definitive. There may be overlap. Or it may be one or the other according to his doctors.
The client is my brother-in-law. He lives in Austin and I live in Fredericksburg, so the frequency with which I have been able to work on him has been once per month. Still, I have had access to him more than any other client with a condition (other than just the usual complaints of muscle tightness).
The client suffers from muscle aches/pain, chronic fatigue, dryness of eyes, mouth and nose. The pain and inflexbility in the joints, his doctors believe, is from the Sjogren's, which is believed to be a genetic predispostion. (His mother suffered from similar symptoms that suggested she had Sjogren's, but it was never medically diagnosed). He suffers from gastrointestinal issues (constipation and bloating). Finding it difficult to sleep is also a problem.
Because he has gradually limited his interactions with others, and essentially isolated himself, he is also being treated for clinical depression.
Fibromylagia is not a psychological condition. While the exact cause is still not known, it is believed to have a biological cause. Recent research suggests that changes in the central nervous system (brain, spinal cord, and nerves), may be responsible. It is believed that there may be a number of factors working together.
Physical and emotional trauma have been linked to fibromyalgia. The genes you inherit from your parents may increase the likelihood of developing fibromyalgia (a family hsitory). There is some evidence to suggest that certain illnesses can act as a trigger (infections). People with autoimmune diseases, such as rheumatoid arthritis, are more likely to develop fibromyalgia.
There are still many aspects of fibromyalgia that are not understood. Because of the complexity of the condition, it can be difficult to diagnose. But an accurate diagnosis is critical in managing these cases. If the condition is not diagnosed and treated early, symptoms can go on indefinitely, or they may disappear for months and then recur.
Fibromyalgia involves widespread muscle pain and tenderness. It is a chronic condition that can last for years or be a lifelong issue. It can't really be cured but treatment may help.
Symptoms include chronic muscle pain, muscle spasms, or tightness, moderate or severe fatigue and decreased energy, insomnia or waking up feeling just as tired as when you went to sleep, stiffness upon waking or after staying in one position for too long, difficulty remembering, concentrating, and performing simple mental tasks ("fibro fog"). Other symptoms include abdominal pain, bloating and constipation alternating with diarrhea (irritable bowel syndrome), tension or migraine headaches, jaw and facial tenderness, sensitivity to one or more of the following: odors, noise, bright lights, medications, certain foods, and cold. The individual may be feeling anxious or depressed, and experience numbness or tingling in the face, arms, hands, legs, or feet, increase in urinary urgency or frequency (irritable bladder), reduced tolerance for exercise and muscle pain after exercise, and a feeling of swelling (without actual swelling) in the hands and feet.
Fibromyalgia symptoms may intensify depending on the time of day (morning, late afternoon, and evening tend to be the worst times). Symptoms may also get worse with fatigue, tension, inactivity, changes in the weather, cold or drafty conditions, overexertion, hormonal fluctuations (such as before periods or during menopause, stress, depresion, or other emotional factors.
Like Fibromylagia, the cause of Sjogren's syndrome is unknown. Researchers think that a combination of environmental and genetic factors determines who develops the disease. While there are certain genes that increase a person's risk for Sjogren's, the genes do not act alone. It is believed that in order for a person to develop Sjogren's, the immune system must be activated by some sort of trigger, such as a viral or bacterial infection, that sends the immune system into overdrive.
The signs and symptoms of Sjogren's syndrome, to some extent, overlap with fibromyalgia. Dry eyes and mouth (also known as sicca syndrome) are the most common signs of Sjogren's, but the disease may affect other parts of the body. It can also cause swollen or painful joints, muscle pain or weakness, dry skin, loss of sense of taste, rashes, brain fog (poor concentration or memory), numbness and tingling sensations in the arms and legs due to nerve involvement, heartburn, kidney problems, and swollen lymph nodes.
My intent is not to exacerbate my client's symptoms by being too aggresive. So pressure and intent principles are taken into consideration. I will work lighter and gentler instead of deeper. Massage has shown some benefit for relieving pain, improving the quality of sleep, improving mood, reducing anxiety, all with an emphasis on good self-care. If I decide to massage my client during a flare-up, gentle pressure is all I can use without worsening the condition. Also, I need to be aware of increased tenderness in and around the spine. Since Sjogren's can lead to joint pain and inflexibility, gentle stretching can be helpful, but I want to keep it within a pain-free range so as not to cause further injury. Also, Sjogren's can make it uncomfortable to lay in a face cradle because of the dryness in the eyes, nose and mouth. When working on the client, I always keep bottled water on hand because remaining hydrated can lessen the severity of some of the symptoms.
As with all chronic pain conditions, I'm aware that clinical depression and chronic pain go hand in hand. His doctors have encouraged him to attend group therapy sessions for people suffering from fibromyalgia/chronic pain.
My client's sedentary liefstyle (as an at-home computer programmer), also adds a difficult component to any treatment plan. I have encouraged him to attend gentle stretching classes for example, tai chi, yoga or chi gong, to try to improve circulation and possibly help with the depression brought on by his condition and lack of contact with the otuside worls.
Presently my client is only taking antidepressants because he has been allergic to all of the other standard medications.
I believe gentle massage will be beneficial for his condittion. Gently working and relaxing the muscles while increasing circulation should provide symptomatic relief.
My desire is to offer my client symptom relief and, as a result, hopefully affect, in some manner, the anxiety and depression. Realisticaly, that is all that I believe I can hope to achieve.
Fibromyalgia: Massage Techniques. Institute for Integrative Healthcare. Nicole Cutler L.Ac., Jan 24, 2006
This article was an overview of fibromyalgia's signs and symptoms and the indications and contraindications for massage therapy. It discussed the various techniques, how to utilize them, and what bodyworkers need to be aware of when handling clients with fibromyalgia. Also covered were the biopsychosocial implications of the condition.
Sometimes massage helps the client and sometimes it has no significant effect. I'm not able to work on him often enough to note any real change with his condition, so we just go for temporary symptomatic relief. He states that following massage sessions, he usually sleeps better that night. In my client's case, the chronic pain, stiffness and other symptoms, has led him to isolate himself to some extent. Personal time and attention help relieve the sense of detachment from a lack of human contact. He has stated that just knowing someone cares enough to try to help and to understand what he is going through, can and does provide relief.
Every month I send out a newsletter to subscribers with the most recent evidence and studies on specific body work topics. The newsletter may include summaries and links to studies and articles, videos that provide support information about exercises, new techniques or lectures. There are five main focuses for the newsletters and each newsletter is repeated twice a year. The five main focuses for the newsletters are: Shoulder and rotator cuff, fibromyalgia, fascia and trigger points, upper cross and neck, and business/ethics. If you would like to receive the newsletters with more complete information than is found in the excerpts, please sign up to receive the newsletter on my contact page.
Here is a brief summary of information I recently shared in my January newsletter. Each newsletter has a specific focus. This month is focused on fibromyalgia information. If you would be interested in receiving my newsletters, please head over to my contact page and sign up.
TIDBITS & UPDATES
Hyperbaric Oxygen Therapy Can Diminish Fibromyalgia Syndrome-Prospective Clinical Trial has shown some promising results.
Fibromyalgia is frequent in obstructive sleep apnea and responds to CPAP therapy
A study at the Monash Alfred Psychiatry Research Centre in Australia is looking at the possibility of using Transcranial Magnetic Stimulation for treatment.
A new study shows that fibromyalgia can cause car crashes
Treatments of low dose of growth hormone show promise
Fibromyalgia Tied to Hysterectomy, Gynecologic Disease.
Study shows the incidence of fibromyalgia after acute whiplash is very low.
STUDIES, ARTICLES, and RESOURCES
Women with Fibromyalgia Have Lower Levels of Calcium, Magnesium, Iron and Manganese in Hair Mineral Analysis
Beyond pain in fibromyalgia: insights into the symptom of fatigue
Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment
Children with fibromyalgia experienced significant improvements in pain and function without medications after an intensive program of physical therapy (PT), occupational therapy (OT), and psychosocial services, according to a new study
A randomized, double-blind, placebo-controlled phase III trial of duloxetine in Japanese fibromyalgia patients
No unusual activity with lactic acid seen in patients with fibromyalgia, migraine
A new study analyzed multiple areas of fibromyalgia including pain, brain characteristics, and medication efficacy, which resulted in some very telling conclusions. The authors behind the new research, published in the latest issue of The Journal of Pain, had several predictions
In the Alternative Health Care Arena
Several double blind studies suggest that Melatonin might also help in combating Fibromyalgia pain.
Food intake assessment and quality of life in women with fibromyalgia
In a recent Cochrane review, which captured the most updated evidence on the topic, the researchers found that resistance training improves multidimensional function, pain, tenderness, and muscle strength in women with FM.
A new study reveals increasing activity levels helped the women reduce their pain.
During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and well thought out information and decision-making outcomes. I am happy to share some of their assignments for you to enjoy.
Condition: Fibromyalgia 
Reason for Choosing: I chose this client because this was one of my more challenging situations in my internship and challenged my creativity to modify massage. The client requested that her legs be avoided and she also requested no oil. I also chose this client because my ultimate goal in massage is to work with patients with chronic diseases.
Client Condition: The client receives massage on a regular basis and was able to communicate her needs clearly. She has had Fibromyalgia for many years and is in touch with her needs in regards to her condition. On the day of the massage she was experiencing good energy but her legs were very sensitive to touch and she requested they be avoided. She also requested deep massage on the rest of her body and indicated that feet and head could be massaged.
Understanding of Fibromyalgia: Fibromyalgia Syndrome (FMS) is a chronic disease that presents as tenderness and stiffness in muscles and joints. There are many clinical manifestations of FMS and diagnosis is confirmed after a 3-month history of widespread pain and other manifestations. It is important to rule out other conditions before diagnosing FMS as many of the symptoms are also present in other diagnoses.
The cause of FMS is a lower pain threshold that may be due to elevated levels of Substance P which is associated with pain signal transmission. FMS may also be caused by psychological trauma, local or generalized infection, medications, physical trauma and excessive use of aspartame. Some people also show a genetic disposition and other family members are affected.
The most common symptom is an aching, burning or gnawing pain in the muscles that begins in a localized area and then becomes more generalized with most women reporting fatigue and pain for 90% of their waking hours. Other symptoms include visual disturbances, mental and physical fatigue, sleep disturbances, morning stiffness, mitral valve prolapse, anxiety, cognitive problems, irritable Bowel Syndrome, headaches, inflammatory bowel disease, hypersensitivity to heat, cold, noise, and odors, depression, urinary frequency or urgency and TMJ dysfunction.
Treatment for FMS includes stress reduction and regular physical activity. Medications may also be used to manage symptoms and reduce pain, assist with sleep and manage depression. Massage can be a very beneficial treatment to manage pain.
Treatment Plan and Justification: The client came in with very specific requests on her treatment plan. She stated that she wanted no oil to be used and that her legs were to be avoided due to tenderness and pain. Her goal of the session was to relax. I reviewed other potential areas to avoid and discovered that her gluteal region and feet could be massaged. I modified treatment to include more gentle compression and focused more on her back with slow, rhythmic effleurage and gentle petrissage. I started with lighter pressure to warm the muscles and skin and checked in as I deepened the pressure. I also focused time on her feet, arms and head.
The reason I chose the treatment plan was to ensure that I did not create any pain and that the client was able to relax knowing her requests would be honored. I started with light pressure and increased slowly allowing the client to control the massage and to avoid the inflammation response. Compression allowed me to offer a variety of strokes and the slow rhythmic strokes allowed my hands to move over the body without oil and provided relaxation to my client. My client was not having any other issues with her condition that day, except for leg pain and tenderness, so no other modification was needed.
Expected and Actual Outcome of Treatment Plan: The outcome I expected from this treatment plan was to provide the client with the massage she requested and leave her relaxed and satisfied without exacerbating her FMS or creating an inflammation response.
The actual outcome met those goals. The client verbally confirmed that she enjoyed the massage and felt very relaxed, She also appeared to be more relaxed than when she came in. The new treatment plant for her next visit would depend upon where the client was at that day with her FMS symptoms. FMS changes daily and the local contraindications would be different on her return. I would need to be prepared to modify my massage to meet her needs that day.
Research Article: I reviewed the article "Massage Therapy for Fibromyalgia: A Systemic Review and Meta-Analysis of Randomized Control Trials." This article reviewed nine randomized control trials that met the criteria set forth for this review and included outcome measures of pain, anxiety, depression, and sleep disturbance. There were a total of 404 patients that met the includsion criteria, which included a diagnosis according to the American College of Rheumatology criteria. The reviewed studies also had to meet criteria of only massage being used as a treatment for Fibromyalgia and had some type of control intervention.
The conclusion of the article is that massage therapy administered to Fibromyalgia patients with duration greater than or equal to five weeks, reduced pain, anxiety and depression but had little effect on sleep disturbances. The authors of this article discussed the physical and psychologial effects of massage therapy on Fibromyalgia patients and proposed that biochemical changes would occur. These biochemical changes would improve muscle flexibility and modulate blood and lymph circulation. The result of these changes may be that local nociceptive and inflammatory mediators may be reabsorbed. Some studies also showed that serotonin levels were increased in patients with Fibromyalgia and may change neural activity at the spinal level.
The article can be found here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706