Therapeutic Management of Fibromyalgia Syndrome (FMS)

ACSM Exercise Management for Person with Chronic Diseases and Disabilities Human Kinetics, 2009;

• Aerobic Exercises, for example, walking, cycling
• Intensity- low to moderate (RPE; 9-12/20). Very slow progression as tolerated
• Frequency- 2 times/week to start with progressing to 3-5/week
• Duration- to tolerance; start with 5 min/session initially progressing to 40-60 minutes

• Stretching exercises to maintain flexibility
• Resistance training to tolerance to improve or maintain muscle strength
• Encourage to stay active. Maintain individualized functional activities.

Aquatic therapy

• Ideal to improve circulation, to reduce pain, reduce spasms and to increase cardiovascular conditioning and strength.
• Ideal water temperature is 82 -84 ⁰F

Avoid exertion

• Both therapists and patients need to be aware that it could be very tiresome to start the exercise in the beginning. Start slowly and progress slowly. Individuals should reduce exercise when symptoms are increased or not be feeling great.

 Activity pacing techniques:

• Balancing between activity level and rest
• Use of assistive devices if using rather than pushing hard for not using or use of machinery equipment over manual ones
• Scheduling high demand activities during periods of high energy

 Manual therapy

• Connective tissue massage, trigger point release techniques
• Joint mobilizations. Studies have shown the benefits of spinal manipulations especially when there is back pain.
• TENS, Ultrasound

Cognitive Behavioral Therapy

• Mainly, cognitive behavioral therapy has been found to help improve the quality of sleep and overall general conditions.

Stress management

• Relaxation techniques like meditation, yoga
• Referral to support group

References

Goodman, Catherine and Fuller Kendra. Pathology: Implications for the Physical Therapist. Philadelphia, WB Saunders. 4th edition (Goodman & Fuller), 2014. (pp. 310-317)

Wolfe F, Clauw D, Yunus M, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care & Research [serial online]. May 2010;62(5):600-610. Available from: MEDLINE, Ipswich, MA. Accessed April 2, 2017.

Moseley GL. Widespread brain activity during an abdominal task markedly reduced after pain physiology education: fMRI evaluation of a single patient with chronic low back pain. Aust J Physiother. 2005;51:49–52.

Brosseau L, Wells G, Veilleux L, et al. Ottawa Panel evidence-based clinical practice guidelines for aerobic fitness exercises in the management of fibromyalgia: part 1. Physical Therapy [serial online]. July 2008;88(7):857-871. Available from: CINAHL, Ipswich, MA. Accessed April 4, 2017.

Skyba DA, Radhakrishnan R, Rohlwing JJ, et al. Joint manipulation reduces hyperalgesia by activation of monoamine receptors but not opioid or GABA receptors in the spinal cord. Pain. 2003;106:159–168.

Mannerkorpi K, Nordeman L, Ericsson A, et al. Pool exercise for patients with fibromyalgia or chronic widespread pain: a randomized controlled trial and subgroup analyses. J Rehabil Med. 2009;41:751–760.

Carville SF, Arendt-Nielsen S, Bliddal H, et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis. 2008;67:536–541.