How Effective Are Alternative Therapies in Fibromyalgia?
The term "fibromyalgia" is derived from New Latin term fibro-, meaning "fibrous tissues", Greek term “myo”-"muscle", and Greek term “algos”-"pain". Hence, the term fibromyalgia literally means "muscle and connective tissue pain". It is a disorder where the person suffers from widespread musculoskeletal pain along with fatigue, sleep disturbances, memory, and mood issues. Widespread pain is defined as left- and right-sided pain, pain in the upper and lower segment of the body and axial pain.
Since symptoms of Fibromyalgia are not only limited to pain, an alternative term (Fibromyalgia Syndrome) is being used.
Although there isn’t any definite cure or treatment for fibromyalgia, and treatment plan which is made typically depends on symptom management. Advancements in the understanding of the factors responsible for the development of fibromyalgia syndrome has led to improvements in the available treatments, which includes conventional medication, physical therapy, aerobic exercise, patient education, cognitive-behavioral therapy, relaxation techniques, and other forms of complementary and alternative medicine therapies for Fibromyalgia. Read further to know the effectiveness of these alternative therapies in treating Fibromyalgia.
Signs And Symptoms Of Fibromyalgia Syndrome
The most common symptoms of fibromyalgia are the presence of widespread pain. Other symptoms include:
- Debilitating fatigue 1
- Sleep disturbance
- Joint stiffness 2
- Difficulty in swallowing
- Bowel and bladder problems
- Numbness and tingling, and
- Cognitive dysfunction.
Fibromyalgia is very often associated with various psychiatric conditions like anxiety, depression3 and stress-related disorders viz., posttraumatic stress disorder (Buskila and Cohen, 2007). However, the associated signs and symptoms are not experienced by all patients with fibromyalgia. Researchers suggest that fibromyalgia increases sensations of pain by altering the way pain signals that get processed in the brain.
Types Of Fibromyalgia Syndrome
Many differences in autonomic nervous system and psychological profiles among the patients have been noted. Müller, Schneider and Stratz (2007) divide individuals with fibromyalgia into four groups and also include a "mixed types":
- "extreme sensitivity to pain but no associated psychiatric conditions"
- "fibromyalgia and comorbid, pain-related depression"
- "depression with concomitant fibromyalgia syndrome"
- "fibromyalgia due to somatization"
Causes For The Onset Of Fibromyalgia
The exact cause of Fibromyalgia is not yet known. Dr. Frederick Wolfe (1990) stated that the Fibromyalgia causes "are controversial in a sense" and "there are many factors that produce these symptoms – some are psychological and some are physical and it does exist on a continuum."
Many a times symptoms have its onset after a surgery, physical trauma, chronic infection or a significant psychological stress, or at times they slowly accumulate with time and in the absence of any single triggering event.
Fibromyalgia approximately affects 2–8% of the population (Clauw, 2014) with a female to male ratio that lies somewhere between 7:1 and 9:1 (Bartels et.al, 2009) (Hawkins, 2013).
How Effective Are Alternative Therapies In Fibromyalgia?
Berman and Swyers (1999) found that among the many complementary and alternative medicine therapies that are widely used by patients with fibromyalgia, statistical research data supports the widespread use of three types: (1) mind–body therapies, (2) acupuncture, and (3) manual therapies for treating fibromyalgia. The strongest data exist for the use of mind–body techniques (e.g. biofeedback, cognitive behavioral therapy and hypnosis), mostly when it is used as part of a integrative approach to treatment. The weakest data exist for manipulative techniques (e.g. chiropractic and massage). The data supporting the use of acupuncture for fibromyalgia are moderate in nature. Also, for some fibromyalgia patients, acupuncture can increase the pain symptoms, while creating further complications for the treatment and management.
Mathilda Pioro-Boisset, John M. Esdaile, and Mary-Ann Fitzcharles (2005) stated that alternative medicine interventions were being used extensively by rheumatology patients, especially by Fibromyalgia Syndrome (FMS) patients. Compared to the control group patients with fibromyalgia syndrome often opted for various alternative therapies. Almost two-thirds of the patients using alternative therapies used multiple intervention techniques.
Brief outline about various alternative therapy practices for treating Fibromyalgia are given below.
- Alternative Therapy Using Biofeedback Techniques For Fibromyalgia- EMG-BFD (electromyography biofeedback) is most commonly used alternative therapy treatment of Fibromyalgia or FMS. In electromyograph (EMG) surface electrodes are used to identify action potentials of the muscles from the underlying skeletal muscles that stimulate muscle contraction. Ferraccioli et. al. (1987) found 56% long-lasting clinical benefit after training sessions of EMG-BFD among fibromyalgia patients. A regular biofeedback session can help the fibromyalgia patient understand under which situation their muscles are tensed and how could they manage it. Once they learn to do activities without stressing the muscles out, a lot of pain symptoms of fibromyalgia could go.
- Alternative Treatment Therapy of Relaxation Techniques and Hypnosis For Fibromyalgia- As stated previously, there is a high level of comorbidity of anxiety with fibromyalgia. There are also theories which propose that psychological processes like anxiety and depression give rise to FMS. Muscle tension, anxiety and pain are said to reduce when a person is relaxed. Castel et.al. in 2006 found that hypnosis followed by relaxation suggestion was as effective as relaxation training. However, hypnosis followed by analgesia suggestion was more effective than hypnosis followed by relaxation suggestion. Relaxation techniques like deep breathing, meditation, progressive muscle relaxation technique can be of great help in treating fibromyalgia.
- Alternative Therapy Using Cognitive Behavior Therapy (CBT) For Fibromyalgia- Cognitive Behavior Therapy or CBT focuses on changing the thought process of an individual as well as his/her behavior pattern. The aim is to modify emotional appraisal and core beliefs through these processes. White and Nielson (1995) found that Cognitive Behavior Therapy or CBT as an alternative therapy for Fibromyalgia was effective in short term as well as in long term among FMS patients.
- Alternative Therapy of Acupressure and Acupuncture For Fibromyalgia- These are regularly used in the treatment of FMS. Mayhew and Ernst in 2006 conducted a review of randomized control trials where acupuncture has been used to treat FMS. However, none of the rigorous clinical trials provide evidence to support the idea of acupuncture being an effective alternative treatment for fibromyalgia.
- Chiropractic Therapy- Is an effective alternative therapy which involves spinal manipulation for relieving pain. It is also called spinal adjustment. The careful, controlled force and manipulation on the joint ranges from gentle to strong at times, and from rapid to slow. Sometimes other joints of the body are also worked on to help treat the spine. The aim of a chiropractic therapy is to increase joint movements and for relaxation of the muscles. Some chiropractic therapists prefer the usage of heat, ultrasound, or electrical stimulation to relax the muscles before doing spinal manipulation. Chiropractic management improved FMS patients' cervical and lumbar ranges of motion, straight leg raise and reported pain levels (Blunt et. al. ,1997)
- Spiritual Practices- Wahner-Roedler and others in 2005 found that 45% of studied FMS patients had resorted to spiritual healing practices during the previous six months.
- Exercise- Various forms of exercise (like aerobic, flexibility training, strengthening exercise types) have been used in treating fibromyalgia syndrome. Martin et.al. (1996) revealed that exercise is helpful in the management of FMS in the short term. Redondo and others’ study in 2004 showed that functional capacity remained significantly better one year later among fibromyalgia patients undergoing exercise therapy.
- Massage Therapy- Brattberg in 2012 found that continuous sessions of 15 treatments with connective tissue massage provides an effectiveness of 37%, and helps in lowering the usage of analgesics, reduces depression and its symptoms, and improves the quality of life of Fibromyalgia patients. However, after three months, the pain relieving effect was down by 30% and at the end of the 6 moths, almost 90% of the pain was back to its original and basic state.
- Movement Therapies For Fibromyalgia- Various available movement therapies including yoga, dance movement therapy, aerobic exercises, Tai Chi, Qigong etc. are effective in lowering the intensity of the pain. A sedentary lifestyle can increase the pain in patients with fibromyalgia. Thus movement therapies are extremely effective in this regard since it increases flexibility, reduces the stiffness in the body that can again cause some pain and some help in relaxation as well.
As a direct cause and effect relationship is yet to be established for fibromyalgia syndrome, one can only resort to a trial and error technique and find out which form of alternative treatment suits one best. Combining various forms of therapy has been found to be more effective than single modes of alternative therapy. Many new types of alternative therapies are coming in vogue. Further research needs to be undertaken to find out which form of alternative therapy is most effective in the short term and maintains the gains in the long term for the management of fibromyalgia.