The aetiology of fibromyalgia remains unknown therefore effective causal treatment of this chronic pain syndrome is not available. Despite numerous therapeutic efforts all over the world the results are pretty unsatisfactory. Various and frequent symptoms experienced by fibromyalgia patients make them peregrinating from one to another medical specialist. Appropriate fibromyalgia treatment requires multidisciplinary approach and should cover i.a.:
Patient’s education is essential in each chronic disease. And in fibromyalgia, which is a chronic pain syndrome education has particular importance. Fibromyalgia patients experiences constant pain and tiredness that discourages them from undertaking any life activity. They did not meet understanding from their relatives and friends usually. They did not get the help they need from their doctors quite often and over time they come up to the conviction about seriousness of their illness and approaching disability or imminent death. Understanding the nature of fibromyalgia and that there is no life risk or sudden disability threat is the corner stone of education in particular. It is important to draw attention on the relationship between stress factors and disease course. Taking that into consideration would help the patient in setting up personal plans and also therapeutic programme.
Our health depends in 50% on our life style this means it depends on our deliberate behaviours and decisions. Due to this fact so important is health education and forming appropriate pro-health behaviours. Everyone should be aware that the health maintenance is her/his duty and medical personnel supports to achieve that only. Constant contact with medical personnel during therapeutic course gives perfect occasion to widen the patient’s health knowledge. Applying the new pro-health behaviours and practices could be also continued beyond the therapeutic course.
Information about illness may cause in patient feeling of anxiety, anger, sorrow, or protest. However, patients learn to accept this illness and adopt to new circumstances over a time. The family, friends, our close people, and medical personnel have important role supporting the patient in her/his hard way.
The treatment is not only taking pills. Patients appropriate attitude is a key question. Stress can cause various changes in the body that may interfere with therapeutic process. Working together with patient should give her/him courage, hope, and believe in her or his own capability. Psychotherapy should make possible patient’s full engagement in the treatment process.
Different methods of psychotherapy are common fibromyalgia treatment procedures in the US in particular. Cognitive-behavioural therapy* (CBT) is one of the most popular therapeutic methods in fibromyalgia. CBT addresses some of the psychological components of the fibromyalgia. CBT increases patients' belief in their ability to manage their condition, and it helps them change pessimistic thoughts and negative feelings regarding symptoms like pain, fatigue, and sleep problems. The essence of psychotherapy are following steps:
- Explanation psychological aspects of pain mechanism
- Convincing patient that she/he is able to solve pain related problems
- Forming an active life style
- Endeavour to reduce the number of sick behaviours and increase the number pro-health behaviours
- Decatastrophying pain
A specific form psychotherapeutic method is integration of fibromyalgia patients themselves and their families and close friends and volunteers into support groups. Members of support groups actively share negative and positive experiences, concerns and skills regarding how to cope in different situations and regarding their experience with various therapies, etc. A fibromyalgia patient that has certain training and skills is usually the leader of a support group in contrary to the formal therapeutic group that is managed by therapist.
Support groups, if conducted appropriately, have the potential to provide individuals with a number of benefits. First, they facilitate the exchange of information regarding a particular disease or condition between individuals who share that common illness. Next, support groups provide an outlet for the teaching and exchange of coping skills for relevant symptoms. Support groups also provide a non-judgmental and understanding environment in which individuals can talk to others about their common fears and feelings. In addition, support groups reinforce the belief that only another individual with the same condition or illness can truly understand how one feels. Support groups also provide patients with coping skills to overcome frightening symptoms. Finally, support groups allow others to enjoy the ability to help others help themselves.
The signs of support group activity could be find in internet and also in scientific meetings and conferences. The greatest number of supporting groups is in Germany and Nordic countries. One of the main advantages of the support group is the patient awareness that she or he is not alone and there are other people having similar problem. This is often big revelation and relief for the patient. The participation in support group, discussing personal questions publically might be an intimate issue and deserves discreetness and savoir-faire of all group members.
*Cognitive-behavioural therapy is a psycho-social intervention that is the most widely used evidence-based practice for improving mental health. Guided by empirical research, CBT focuses on the development of personal coping strategies that target solving current problems and changing unhelpful patterns in cognitions (e.g. thoughts, beliefs, and attitudes), behaviors, and emotional regulation. It was originally designed to treat depression, and is now used for a number of mental health conditions.
One can read more on VeryWell health service → Cognitive Behavioral Therapy for Fibromyalgia
Physiotherapy is a field of contemporary clinical medicine that applies various forms of energy for therapy, rehabilitation and prophylaxis. It stems from the natural therapy originally that has been originated in historical methods that are scientifically proven and significantly developed in modern times. Physiotherapy could be an autonomous therapeutic method or can complement other therapies e.g. pharmacotherapy and surgery or may constitute a basis for rehabilitation and prophylaxis. In other words, physiotherapy constitutes therapy by nonspecific stimuli targeting recovery of state of equilibrium.
The methods applied in physiotherapy belong to so called natural healing/treatment methods due to reasons: they act on natural and physiological mechanisms of a homeostasis and they constitute natural element/component of an environment. There are different name of physiotherapy in literature, like physiatry, physicotherapy, physical medicine, or physical therapy. All these terms come from Greek language where φύσις = phusis means nature and θεραπεία = therapeīa means cure or healing.
Physiotherapy should be a constant element of fibromyalgia treatment plan. One of main tasks of physiotherapy is protection from muscles weakness and/or atrophy by applying its various types. The muscles are typically affected in fibromyalgia due to low physical activity and reluctance for physical exercise as a result of constant pain and tiredness. It is extremely important to tailor physiotherapy programme and methods for each fibromyalgia patient individually. The some type of physiotherapy could give relief to one patient and exacerbation to the other.
Among various types of physiotherapy one should list mostly following:
- KINESIOTHERAPY (therapy by movement – it is the core element of physiotherapy. Motion (physical activity) has eminent impact on the whole body and constitutes basis for other forms of physiotherapy and rehabilitation).
- PHYSICAL THERAPY (electrotherapy, magnetic field therapy, phototherapy, therapeutic ultrasound)
- THERMOTHERAPY COLD and/or WARM (should be matched individually)
- SPA TREATMENT and CLIMATE THERAPY i.a. with use of peat baths and natural healing waters (so called peloid therapy) and climate therapy, is based on use of the natural environment. Air-baths, sun-baths, sea-baths, inhalation of sea aerosols belong to that.
The optimal model of fibromyalgia treatment seems to be a combination of light physical exercises and whole body cryotherapy (WBC), which shows distinct pain reducing effect. However, this optimal model has to be set up together with an active use of fibromyalgia patients.
Kinesiotherapy or Kinesitherapy or kinesiatrics, from Greek κίνησις = kinēsis means movement and θεραπεία = therapeīa means cure or healing, is the therapeutic treatment of disease by passive and active muscular movements (as by massage) and of exercise. It is the core element of physiotherapy. Movement, as a therapeutic mean, has an impact on all body's organs and tissues as natural therapeutic stimuli.
The role of therapeutic movement and physical exercises was appreciated in ancient China, Egypt, Greece and India. Hypocrites, except of the famous "primum non nocere" said also that the medical knowledge rests on two pillars that are physical exercise and dietetics.
Kinesiotherapy (treatment by movement) is also described as rehabilitation by movement, medical training, therapeutic exercise, and as physiotherapy, recently.
The kinesiotherapy techniques comprise of passive forms of movement – passive kinesiotherapy and active forms of motion – active kinesiotherapy. The choice of an appropriate technique is based on functional status of a patient, location of disease process, illness or injury. The therapeutic exercises could be divided depending on their range of impact into limited range of movement – local kinesiotherapy, e.g. increase in knee joint movement and/or general kinesiotherapy – a general motion having impact on the patient general physical performance, improving circulatory system, respiratory system and also engaging musculoskeletal and nerve (kinetic) system.
Amoung various methods of physical therapy we can list the most common:
- Hydrotherapy also called water cure, is a part of naturopathy that involves the use of water for pain relief and treatment. The term encompasses a broad range of approaches and therapeutic methods that take advantage of the physical properties of water, such as temperature and pressure, for therapeutic purposes, to stimulate blood circulation and treat the symptoms of certain diseases.
- Thermotherapy it a treatment that uses termal energy. The energy can be delivered to the body (warm treatment) as well as it can be received (cold treatment). The particular type of cold treatment is cryotherapy. Cryotherapy is widely used to relieve muscle pain, sprains and swelling either via soft tissue damage or postoperative swelling. It can be a range of treatments from the very low technology application of ice packs or immersion in ice baths (generally known as cold therapy) to the use of cold chambers (whole body or partial body cryotherapy) and or face masks or body cuffs with controlled temperature, sometimes called hilotherm.
- Therapeutic Ultrasoud is a modality that has been used by physiotherapists since the 1940s. Ultrasound is a method of stimulating the tissue beneath the skin's surface using very high frequency sound waves, between 800,000 Hz and 2,000,000 Hz, which cannot be heard by humans. It is applied using the head of an ultrasound probe that is placed in direct contact with your skin via a transmission coupling gel.
- Electrotherapy is the use of electrical energy as a medical treatment. In medicine, the term electrotherapy can apply to a variety of treatments, including the use of electrical devices such as deep brain stimulators for neurological disease. The term has also been applied specifically to the use of electric current to speed wound healing. Additionally, the term "electrotherapy" or "electromagnetic therapy" has also been applied to a range of alternative medical devices and treatments.
Among various form of electrotherapy it is worth to mention TENS (Transcutaneous Electrical Nerve Stimulation) with low voltage current. This therapeutic method is based on gate control theory. TENS is done with a small, battery-powered machine about the size of a pocket radio. Usually, two electrodes are conected (wires that conduct electrical current) from the machine to skin. The electrodes are often placed on the area of pain or at a pressure point, creating a circuit of electrical impulses that travels along nerve fibers. When the current is delivered, some people experience less pain. This may be because the electricity from the electrodes stimulates the nerves in an affected area and sends signals to the brain that block or "scramble" normal pain signals. Another theory is that the electrical stimulation of the nerves may help the body to produce natural painkillers called endorphins, which may block the perception of pain.
- Magnetic Field Therapy uses different kinds of magnets on the body to help boost your overall health. It may also help treat certain conditions. There are several types, including: Static magnetic field therapy – in this, magnet touches skin somehow. You might wear a magnetic bracelet or other magnetized jewelry. It could be a bandage with a magnet in it, or you may wear a magnet as a shoe insole. You could also sleep on a special mattress pad with a magnet in it. Electrically charged magnetic therapy (electromagnetic therapy): The magnets you use here have an electric charge. Treatment with electromagnetic therapy usually comes through an electric pulse.
- Therapuetic Massage it is defined as the mobilisation of soft tissue (such as muscle, fascia and body fluids) to restore normal systemic and biomechanical/functional use. It can be used to assist in the treatment of most musculo-skeletal and associated problems, and regular therapeutic massage results in improved circulatory, lymphatic and neurological functioning. There are many types of massage therapy, from classics like Swedish and deep tissue to more exotic styles like shiatsu. One can read more on VeryWell health service → Nine popular types of massage
It is very important to take into consideration the individual patient situation and preferences when deciding upon physiotherapeutic method. The physiotherapeutic method that gives very positive results in one patient may give adverse results to other, it may even aggravate symptoms.
Many doctors and therapists recommend tryptophan rich diet for people suffering from fibromyalgia. Results of studies evaluating effects of such diet are ambivalent and should be confirmed by decent clinical studies. One that would like to get familiar with this subject should go to bookmark ⇒ diet and fibromyalgia.
Some dietary supplements (e.g. Myalgan) might be also helpful in dietetic management of fibromyalgia. Some studies from Poland, Norway and Sweden may indicate their beneficial effect and safety. Myalgan was developed in the USA at Irvine University for Hamida Pharma Inc. in the late nineties of the twentieth century.
Myalgan provides six active ingredients; four plant extracts and two amino acids:
❶ Olive seed extract
❷ Daisy leaf extract
❸ Grapevine leaf extract
❹ Pineapple fruit extract
Among dietary supplements that may also be used in fibromyalgia following are listed:
- Vitamin D – new research finds achieving healthy vitamin D levels helps relieve symptoms of chronic widespread pain. Furthermore, several trials have concluded that vitamin D has an antidepressant effect.
- Fish Oil – Omega 3 fatty acids act as precursors to chemicals that help reduce pain and inflammation. By contrast Omega 6 fatty acids can increase inflammation and create chronic pain.
- S-Adenosyl l-Methionine (SAMe) – Jacobsen at al have found oral S-adenosylmethionine beneficial in primary fibromyalgia in double blind clinical evaluation. Scand J Rheumatol. 1991;20(4):294-302.
- d-Ribose – it is a pentose simple sugar (monosaccharide with five carbon atoms), which after phosphorylation helps cells produce i.a. tryptophan. Teitelbaum and Johnson have found in a pilot study that d-ribose significantly reduces clinical symptoms in patients suffering from fibromyalgia and chronic fatigue syndrome. J Altern Complement Med. 2006 Nov;12(9):857-62.
- Magnesium – some studies suggest that topical application of magnesium may help in easing fibromyalgia symptoms, such as tender points. Some authors postulated that low magnesium levels in muscle cells may be a factor in fibromyalgia development.
- Brown Seaweed Extract – 1,000 mg of brown seaweed extract daily can reduce joint pain and stiffness by 52%, according to a 2011 study from Australia’s Center of Health and Wellbeing, published in the journal Biologics.
There are also many other supplements having more or less documented positive effect in fibromyalgia. However, if you have doubts whether they will suit you it is important to consult your doctor before taking them.
Immune System Support
It is believed that some dysfunction of immune mechanisms occurs in the background of majority of fibromyalgia cases. Two auto-antibodies anti-68/48 kD and anti-45 kD are taken into consideration as markers of the primary fibromyalgia and chronic fatigue syndrome. The rise of anti-polymer antibodies level has been found in fibromyalgia patients. Thirty percent of fibromyalgia patients has anti-nuclear antibodies (ANA), from which 75% shows mottled pattern. The studies have shown increased levels of IL-10, IL-8 and IL-6 and TNF-alpha as compared to health subjects. IL-8 promotes sympathetic pain and IL-6 indices tiredness, depression, hyperesthesia, and pain perception.
Breakthrough research at College of Medicine of University of Illinois at Chicago published recently should give more light into nature of fibromyalgia syndrome. This study has compared fibromyalgia patients and healthy subjects and revealed that certain dysfunction of immune system might be the underlying background of fibromyalgia. The identification of the immune path of fibromyalgia has been awarded with the prize for Outstanding Research in Clinical and Diagnostic Immunology by the American Association for Clinical Chemistry in 2012 and also brings hope for development of an objective diagnostic test for fibromyalgia†.
It is worth to take into consideration immunomodulating‡ preparations in fibromyalgia treatment. We recommend our Immulina a modern immune-supplement that has positive impact on immune health.
*Sympathetic pain – pain related to muscle tension disorder after stroke and spastic paresis.
†Interview with Dr. Bruce Gillis, CEO of the EpicGenetics Inc.: Fibromyalgia Diagnosis
‡Immunomodulation - is modulation (regulatory adjustment) of the immune system. It has natural and human-induced forms, and as part of immunotherapy, in which immune responses are induced, amplified, attenuated, or prevented according to therapeutic goals.
Alternative (Complemetary) Medicine / Non-conventional Medicine
Complementary medicine (CM) or integrative medicine (IM) is when alternative medicine is used together with functional medical treatment, in a belief that it improves the effect of treatments. However, significant drug interactions caused by alternative therapies may instead negatively influence treatment, making treatments less effective. Both terms refer to use of alternative medical treatments alongside conventional medicine, an example of which is use of acupuncture (sticking needles in the body to influence the flow of a supernatural energy), along with using science-based medicine, in the belief that the acupuncture increases the effectiveness or "complements" the science-based medicine.