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Physical Therapy can help Fibromyalgia suffers.

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Fibromyalgia is a syndrome characterized by chronic widespread pain and tenderness in at least 11 of 18 predefined tender points.  Its prevalence rates between 0.5% to 6% of the general population.  Other disorders like chronic fatigue syndrome and mental disorders including depression and anxiety disorders often occur in patients with Fibromyalgia.  Fibromyalgia in not only a chronic pain syndrome but also consists of a range of symptoms including effort intolerance and stress intolerance as well as hypersensitivity for pain and other sensory stimuli.

Fibromyalgia syndrome is characterized by sensitization of the central nervous system, more specifically defined as an augmentation of responsiveness of central neurons.  This alteration is called top down as it starts in the brain and descends to the extremities.  This includes altered sensory processing in the brain, malfunctioning of descending pain receptor mechanisms, increased activity of pain facilitatory pathways, wind-up or “summation of pain”.  There is a bottom up mechanism as well: repetitive musculoskeletal injuries and traumas may provide enough increased input at the pain receptors to move toward it towards the central nervous system.  Once central sensitization is established little pain input is needed to maintain it.  Over time increased responsiveness may develop to pressure, chemical substances, light, sound, cold, heat and electrical stimuli.  Abnormal functioning of the stress system may occur in the aftermath of a long period of overburdening by physical and emotional stressors.

Physical Therapy can help initially with patient education regarding pain management via modification of lifestyle, teaching patients to manage daily activities in accordance with their decreased load tolerance.  It is important for people with Fibromyalgia to pace their activities and respect their physical and mental limitations.  This involves a balance between activity and rest in order to avoid exacerbating their symptoms.

According to the American Pain Society, moderate evidence supports the use of trigger point injections, joint mobilization and myofascial release techniques in the management of Fibromyalgia.  Joint mobilization is able to activate descending pain inhibitory mechanisms and thus desensitize the central nervous system for short periods of time.  Biofeedback may be used to teach stress management techniques.

Much research has been completed regarding Physical Therapists using exercise to treat patients with Fibromyalgia.  Strong evidence, according to the American Pain Society supports aerobic exercise and moderate evidence supports muscle strength training.  Poor physical fitness is common among patients with Fibromyalgia.  Physical exercise may be difficult for many patients with Fibromyalgia due to activity induced pain.  Patients may be instructed to use warm baths, stretching and relaxation at home to decrease any exercise induced pain.  Patients with milder symptoms appear to receive the best effects of exercise.  Physical Therapists should caution against any treatment triggering more pain which may sustain the process of central sensitization.

The information from this article was obtained from the PT journal “Primary Care Physical Therapy in People with Fibroymalyia” December 2010 Vol 90, No 12.  Mary Boyd, MS, PT is a member of the Sandpoint Wellness Council  can be reached at 290-5575 for questions.

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