Fibromyalgia (FM) is a chronic condition which causes pain throughout the body. Other symptoms include fatigue, poor sleep quality, anxiety and depression (Antunes and Marques, 2022). The cause of chronic pain in patients with FM is associated with the hypersensitivity of the central nervous system resulting in hyperalgesia and potentially allodynia. The symptoms of fatigue and exhaustion can be explained by the hyporesponsiveness of the hypothalamus-pituitary- adrenal mechanisms in patients with FM (Mengshoel, 2013). Recently, more research is being conducted into the role of physiotherapy in FM and has shown to reduce pain, improve quality of life and function.
Exercise has been shown to improve psychological well-being and a reduction in pain, fatigue and other comorbidities (which is common in patients with FM). The combination of exercise and pain education have been proven to be the most effective intervention for FM (Mengshoel,2013) and also reduce medication consumption. Interestingly, addressing central sensitization and the neuroscience of pain in-person with patients has been shown to be the most successful form of pain education when improving compliance with exercise. However, there is insufficient data on what type of exercises is the most effective (Antunes and Marques, 2022).
Hydrotherapy and land exercise has been shown to be equally effective, although being immersed in water can have an analgesia effect. The heat and the increase of buoyancy causes the release of endorphins, increased capillarization and oxygen consumption. Moderate to high intensity resistance training has shown to reduce fear avoidance and improve neuromuscular ability which is especially important for menopausal and postmenopausal women. However, research demonstrates aerobic exercise to be more tolerated by patients (Antunes and Marques, 2022).
Physiotherapists regularly use massage and manual therapy for pain relief in patients with FM. Unfortunately, there are only a few studies addressing the effects of massage in FM (Antunes and Marques, 2022). Other modalities, such as TENS, have been proven to be effective in modifying pain and in turn an increased activity levels for patients with FM (Mengshoel, 2009).
There is conflicting evidence on the optimum treatment for patients with FM, however it is important to incorporate a multi-faceted approach that addresses the patients’ needs and goals.
Antunes, Mateus Dias, and Amélia Pasqual Marques. “The Role of Physiotherapy in Fibromyalgia: Current and Future Perspectives.” Frontiers in Physiology, vol. 13, no. 13, 16 Aug. 2022, p. 968292, www.ncbi.nlm.nih.gov/pmc/articles/PMC9424756/, https://doi.org/10.3389/fphys.2022.968292.
Mengshoel, Anne Marit. “Physiotherapy and Fibromyalgia: A Literature Review.” Advances in Physiotherapy, vol. 1, no. 2, Jan. 1999, pp. 73–82, https://doi.org/10.1080/140381999443456. Accessed 10 Dec. 2020.
—. “Physiotherapy Management of Fibromyalgia: What Do We Know and How May This Affect Clinical Practice?” Physical Therapy Reviews, vol. 5, no. 2, June 2000, pp. 85–91, https://doi.org/10.1179/ptr.2000.5.2.85. Accessed 17 Nov. 2020.
