Managing Fibromyalgia: Chronic Pain of the Soft Tissue
by Stacey Berger, PT
Fibromyalgia (FM) is commonly thought of as a women’s health
condition. Eighty percent of individual’s diagnosed are women.
Characteristic symptoms include diffuse chronic pain, fatigue, and sleep
disturbance. These symptoms can influence a women’s ability to
function at a level that allows her to enjoy and pursue a full life.
Studies have suggested that Fibromyalgia is a syndrome not a disease.
A syndrome is defined as a group of characteristic symptoms in the
absence of a known cause. Fibromaylgia is defined as a form of
non-critical rheumatism with diffuse musculoskeletal aches, pains, and
stiffness. It is associated with exaggerated tenderness at specific
locations known as tender points. This definition may not fully explain
the symptoms predominately found. Fibromyalgia, fibrositis and
fibromyositis are all used to describe the same condition.
Lab studies (enzymes, sedimentation rate, thyroid
function) usually are within normal limits and physical exam is
positive for specific tender points. Common symptoms include the
- chronic pain/soft tissue ache with multiple tender points(see
- fatigue and sleep disturbance
- symptoms come and go; good and bad days
- feelings of stiffness
- chronic headaches
Secondary symptoms may include a variety of symptoms including
irritable bowel or bladder, low stress tolerance, temperature/humidity
sensitivity, eye problems, pelvic pain and dysmenorrhea.
Fibromyalgia appears to have possible causes including; genetic,
immunologic abnormalities and possibility of neurohormonal dysfunction.
The latter is directly linked with women in that symptoms can be
exacerbated by adolescence, pregnancy, and childbirth. In addition there
appears to be precipitating factors/events that may flare up initial
symptoms such as physical trauma, emotional stress, life changes, and
illness. The condition can worsen seasonally, most pronounced in spring
and fall. Symptoms usually begin at 20-50 years of age.
Clinical management can vary from medication, psychology services to
therapy services. As a physical therapist, I have found the best
approach is to encompass use the mind/body connection. This allows the
individual to understand, take control and manage their symptoms more
effectively. The individual must first have their symptoms validated by
a health professional. Since symptoms are diffuse, vary and not
diagnostically proven through lab tests, this can become frustrating for
the individual to endure.
Proper management should start with patient education. This includes
discussions on pain management, body mechanics, pacing activity, diet,
stress management and exercise. Therapy often consists of gentle
stretching and aerobics, modalities to reduce the intensity of pain and
trigger point symptoms, and soft tissue techniques like massage to
reduce soft tissue irritability. Assessment of posture, and body
mechanics in home and work activities helps to train individuals in
proper techniques to avoid aggravating symptoms. Strategies to help
manage symptoms must be discussed following thorough assessment of
patient’s lifestyle needs. This can be as basic as eliminating
caffeine and incorporating quiet time activities like a relaxation tape
1 hour before bedtime for managing sleep disturbances. Aquatic exercises
significantly contribute to effective management in that they provide a
comfortable medium for an individual to stretch, strengthen and
condition oneself. Once properly trained by a therapist, an individual
can independently perform exercises in a healthclub and/or other
NRH-Network provides comprehensive services to assist in managing
Fibromyalgia. We promote the mind/body connection in our approach. Our
services include therapeutic exercise, aquatics, patient education,
stress management, nutritional consultation and incorporation of
wellness services to provide a holisitic environment from a group of
skilled and specialized women’s health clinicians. For more
information on our women’s health services, please call Stacey
Berger, PT ; (603)893-2900, ext 204.