Chiropractic Treatment Considerations for Fibromyalgia

Fibromyalgia (FM) is a chronic condition characterized by widespread pain and tenderness in the musculoskeletal system. Patients with FM suffer from a multitude of complaints that may include not only widespread muscle aches and pains but also complaints such as those related to the digestive system (stomach complaints, bowel problems, etc.). There are many treatment approaches available for joint and soft tissue management but few have looked at the long-term benefits.

One study included both the short and the long term effects using connective tissue manipulation and the combination of ultrasound (US) with high-voltage electrical stimulation. The level of pain, the degree of restorative sleep, and the impact FM has on functional activities using a 0-10 scale, were followed with 20 female patients diagnosed with FM. Treatments included 20 sessions of daily soft tissue manipulation (muscles, joint capsules, and other connective tissues) applied to the back region. The combined US therapy was applied to the upper back region, every other session. The benefit of the treatment was evaluated initially, after the 20 sessions, and again after one year. All three issues tested (pain intensity, impact on functional activities, and complaint of non-restorative sleep) improved and remained improved at the end of 1-year. The benefits from the treatment lasted, at minimum, 3 months and 21% of the participants (3 subjects) were still pain free after 1 year. None of the follow-up subjects obtained additional medical and/or manipulative treatment though 5 (36%) began to use medications during that time period while 64% did not require any medications. Patient satisfaction using the 0-10 scale was high, reported at 7.14 (10 = highest satisfaction).

Another study utilized 15 subjects with 30 treatments, performed at a 2-3x/wk frequency, of ischemic compression and spinal manipulation. The ischemic compression included thumb pressure applied to each tender point for 10 seconds applying progressively greater pressure up to patient tolerance. This was repeated until the point was no longer tender using 4kg of force or, the trial ended, whichever occurred first. Spinal adjustments were applied to the neck and mid back area of the spine. Three methods of measuring clinical change (pain intensity, sleep quality, and fatigue) were utilized at the initial, 15th and after the 30th treatment. A minimum of 50% improvement in score was required to be considered a good respondent. After 30 treatments, 9 were considered good respondents, while 6 were not. In the respondent group, the percent change/improvement was 77.1% in pain, 63.5% in quality of sleep, and 74.8% improvement in fatigue. At a 1-month follow-up, continued pain reduction was reported, unlike a similar trail testing the benefits of two popular medications (amityiptyline and cyclobenzaprine).

Of interest, many of the non-respondents were older, had a more chronic/long term illness, and had a greater intensity of symptoms with greater number of tender points at the start of the study.