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Fibromyalgia

Fibromyalgia Syndrome (FMS) is a chronic condition characterized by pain, stiffness and tenderness of the muscles, tendons and joints.1 Although FMS can be disabling, tissue damage and deformity do not occur.1,2 Pain is widespread and chronic. The symptoms, which affect quality of life, tend to wax and wane but do not affect lifespan.3

Signs & Symptoms may include

  • Widespread pain lasting > three months4,5
  • Tenderness to palpation in areas on both sides of the body above and below the waist.4  The physician may or may not palpate tender points; older diagnostic guidelines (1990) included tender point palpation.
  • Fatigue5
  • Waking unrefreshed5
  • Cognitive symptoms5 (e.g. problems remembering)
  • Physical symptoms5  (e.g. headaches, weakness)

Pain Mechanisms

Evidence suggests that those with FMS may suffer from a disorder of the sensory nervous system.6,7 Pain processing is altered, causing amplification of sensory signals. For example, pressure may be interpreted as painful and the ability to regulate pain may be blunted.6 

Symptoms are also associated with7

  • Psychological distress/stress
  • Sleep disturbance
  • Genetic susceptibility
  • Lifestyle factors (low levels of activity, overweight, smoking)
  • Social factors such as socioeconomic status

Physical Therapy Treatment

  • Pain Education- Your therapist may describe how components of the pain experience may relate to your individual situation8,9.
  • Aerobic Exercise- Tailored to the needs of the individual11
  • Strengthening Exercise- Tailored to the needs of the individual11

A balance between activity and rest as well as identification of stress and stress management may be beneficial10. Passive treatments such as massage, manual therapy, moist heat and electrical stimulation may be used.  

Your physician must make a proper diagnosis of fibromyalgia. Medical or multidisciplinary management may involve therapies such as medication, dietary management, and cognitive behavioral therapy.12,13 Along with medical management or as part of a multidisciplinary approach physical therapy may help improve function and well-being in those with FMS10.

Disclaimer: The views discussed on this website are for educational purposes only. Should you have any questions please consult your physician or physical therapist. Copyright© Kinesis Physical Therapy. All Rights Reserved.

References

1. Jahan, Firdous, et al. “Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management.” Oman Medical Journal 27.3 (2012): 192.

2. Williams, David A., and Stephen Schilling. “Advances in the assessment of fibromyalgia.” Rheumatic diseases clinics of North America 35.2 (2009): 339.

3. University of Texas, School of Nursing, Family Nurse Practitioner Program. Management of fibromyalgia syndrome in adults. Austin (TX): University of Texas, School of Nursing; 2009 Austin, Texas. [University of Texas, Fibromyalgia Treatment Guideline]

4. Wolfe, Frederick, et al. “The American College of Rheumatology 1990 criteria for the classification of fibromyalgia.” Arthritis & Rheumatism 33.2 (2005): 160-172.

5. Wolfe, Frederick, et al. “The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.”Arthritis care & research 62.5 (2010): 600-610.

6. Yunus, Muhammad B. “Role of central sensitization in symptoms beyond muscle pain, and the evaluation of a patient with widespread pain.” Best Practice & Research Clinical Rheumatology 21.3 (2007): 481-497.

7. McBeth, John, and Matthew R. Mulvey. “Fibromyalgia: mechanisms and potential impact of the ACR 2010 classification criteria.” Nature Reviews Rheumatology 8.2 (2012): 108-116.

8. Lempp, Heidi K., et al. “Patients’ experiences of living with and receiving treatment for fibromyalgia syndrome: a qualitative study.” BMC musculoskeletal disorders 10.1 (2009): 124.

9. Carville, S. F., et al. “EULAR evidence-based recommendations for the management of fibromyalgia syndrome.” Annals of the Rheumatic Diseases67.4 (2008): 536-541.

10. Nijs, Jo, et al. “Primary care physical therapy in people with fibromyalgia: opportunities and boundaries within a monodisciplinary setting.” Physical therapy 90.12 (2010): 1815-1822.

11. Busch, Angela J., et al. “Exercise therapy for fibromyalgia.” Current pain and headache reports 15.5 (2011): 358-367.

12.Goldenberg, Don L. “Multidisciplinary modalities in the treatment of fibromyalgia.” The Journal of clinical psychiatry 69 (2008): 30.

13. Arranz, Laura-Isabel, Miguel-Ángel Canela, and Magda Rafecas. “Fibromyalgia and nutrition, what do we know?.” Rheumatology international 30.11 (2010): 1417-1427.