FIBROMYALGIA
Fibromyalgia is a difficult disorder for patients to
fully recover from. Most patients will try a variety of
alternative treatments, including chiropractic care. One
study (Wahner-Roedler, et. al. Mayo Clinic Proc
2005;80:55-60) showed that 37% had used chiropractic
care.
Because spinal joint pain is such a common co-morbidity
in fibromyalgia, it seems reasonable to try chiropractic
care, since it is one of the most studied treatments for
low back pain and carries minimal risk for adverse
reactions. Although the evidence for efficacy for
manipulation is only modest, many patients may want to
reduce their need for prescription/OTC medications, so
patient preference is also a consideration.
As far as specific trials evidence for manipulation in
fibromyalgia, the literature is scant. One pilot study
(Blunt KL, et. al. J Manipulative Physiol Ther 1997;
20:389) showed that chiropractic management improved
pain levels, increased cervical and lumbar ranges of
motion, and improved straight-leg raising capability.
Also a preliminary randomized cross-over trial (Citak-Karakaya
I, et. al. J Manipulative Physiol Ther 2006;29:524)
showed that connective tissue manipulation and
ultrasound, improved pain intensity, complaints of
non-restorative sleep, and impact on functional
activities in patients with fibromyalgia.
If you refer a patient with fibromyalgia to my
office, I rule out certain fractures or comorbidities
such as joint laxity e.g. (SLE). You may inquire about
the techniques of spinal examination and the thrust
procedures I use. I do not find these questions prying
and want you to feel comfortable when referring your
patient.
Patients generally respond quickly, so there should not
be months of treatment before deciding if chiropractic
care is helpful. Ten to twelve treatments in a month
often show improvement in frequency and intensity of
pain. If your patient positively responds, then this is
a rationale to continue with treatment. Chiropractic
care is not a substitute for exercise, so the patient
should also be increasing their activity levels during
this time. I generally include weight-loss counseling,
and home exercise approaches to overall care to enhance
the clinical response. The addition of chiropractic care
may make a patient prone to joint pain under exercise
loading, to continue their active regimen. The adjustive
interventions should gradually decrease in frequency as
the patient responds to care. |
