Paper
Efficacy of Manual Therapy as a Treatment for Fibromyalgia Patients An Evaluation of the Evidence
- Authors:
- Simon Chafer; Fiona Hamilton
- Abstract
- Background: Fibromyalgia (FM) is characterized by widespread pain; however, it is not restricted to pain alone, and consequently is also referred to as fibromyalgia syndrome (FMS). Associated symptoms include joint stiffening, poor sleep hygiene, anxiety, and depression. Recent thinking regarding FM pathogenesis has focused upon central sensitization (CS), suggesting that patients have lower pain thresholds and increased sensitivity to pain. The musculoskeletal system has been suggested as a source of pain signals to the central nervous system (CNS), thus contributing to CS [2]. Presently there exists no known cure, and primary care management includes pharmacological treatment as well treatments involving manual and physical therapy. Although manual therapy is often used by FM patients to help ameliorate symptoms, particularly pain, no guidelines exist for the recommendation of such therapy, particularly manipulation, revealing a paucity of published evidence in this field. Objective: This review aims to evaluate the available evidence regarding the efficacy of some of the most common forms of manual therapy as used in a clinical setting by manual therapists and physical therapists, as a potential intervention for patients with FM. This review may hopefully be used to help inform best clinical practice with regard to manual therapy as a treatment for FM patients. Methods: A search was conducted of databases, and reference sections of original studies, as well as systematic reviews of manual therapies commonly used by physical therapists, osteopaths, chiropractors and massage therapists in the treatment of FM. The time frame for relevant literature spanned 2009 to 2014. The primary author was solely responsible for selection of studies for inclusion based on defined inclusion and exclusion criteria. Following appraisal using The Critical Appraisal Program (CASP), evidence ratings were applied to the studies using The Oxford Rating Scale developed by The Centre for Evidence-Based Medicine (CEBM) and The Scottish Intercollegiate Guidelines Network (SIGN) checklist. Results: The reviewed studies offer inconclusive support for manual therapy as a potential pain relief intervention for patients with FM. This is primarily due to the questionable quality of the studies in relation to rigor, reliability and validity. The evidence to support massage therapy is moderate at best, whereas that supporting the use of manipulation is limited. Conclusion: It is difficult to draw definite conclusions regarding the efficacy of manual therapy as a sole treatment approach for the management of FM. There are several reasons for this, including methodological constraints affecting the available studies, as well as the heterogeneity and lack of standardization with regard to available treatment programs for FM sufferers, which complicates the comparison of available studies.
- Keywords
- Fibromyalgia; Manipulation; Mobilization; Physical Therapy; Osteopathy; Chiropractic
- StartPage
- 28
- EndPage
- 38
- Doi
- 10.18005/PTHP0303001