Effects of Manual Therapy in Fibromyalgia Syndrome
Condition: Fibromyalgia; Manual Therapies
MeSH terms: Fibromyalgia; Myofascial Pain Syndromes
Study type: Interventional

Summary: 
      Fibromyalgia syndrome (FMS) is among the most difficult diseases that restrict physical
      functions of patients due to persistent aches,sleep problems,psychological problems and
      decrease the quality of life. The aim of this study was to investigate the efficacy of manual
      therapy (MT) in the treatment of FMS patients.
    

Detailed description: 
      Fibromyalgia syndrome (FMS) etiology is a chronic musculoskeletal system characterized by
      widespread pain and hyperalgesia in the body that is not yet known. At the same time, FMS
      patients are accompanied by functional emotional disorders including persistent muscle
      soreness, muscle spasms, mood disorders such as chronic fatigue, sleep disturbances,
      paresthesia, morning stiffness, depression, and cognitive disorders. The prevalence in the
      general population in the world between 2-4%, but reaching up to 7% between 50-80 years of
      age the prevalence of a study conducted in Turkey were found to be 3.6%. Frequently seen in
      women between the ages of 40-60, the quality of life of patients with FMS falls because of
      generalized pain in their bodies, accompanied by stress in 30-45% of patients.

      According to Chaitow, there are 3 factors in the etiology of the dysfunctional model of FMS
      syndrome (biochemical, biomechanical, psychosocial) : (1) Negative emotional state may cause
      specific biochemical change, weakening of immune functions and change in muscle tone (2)
      Hyperventilation, blood oxygenation at the neural level, general anxiety and anxiety state,
      change in the structural components of the thoracic and cervical region (3) Chemical changes
      in blood flow may cause emotional and structural changes. The neuroendocrine hypothalamic
      pituitary that controls primer stress response may have abnormal release of corticotropin
      releasing hormone, adrenocorticotropic hormone, and cortisol, which are part of the adrenal
      axis. Hypothalamic corticotropin releasing hormone delays corticotropin release by
      insufficiency of interleukin-6 regulation in the neuronal function defect. Although the
      pathophysiology is not yet fully understood, it is thought to be related to environmental and
      genetic factors. The basal autonomic status of FMS patients is characterized by increased
      sympathetic system and reduced parasympathetic system. The most basic complaints of patients
      are generalized pain. For this reason, peripheral and central nociceptive pathways are
      dominant in the view of being active in FMS patients. Intramuscular connective tissue
      dysfunction, myofascial tissue inflammation and fibroblasts and release of pro-inflammatory
      cytokines cause chronic peripheral sensitization in these patients. Some authors have
      reported that trigger points have central sensitization-inducing effects, while others have
      indicated that such a situation is not the case because the patient with each trigger point
      is not FMS. In recent biopsy studies, it has been found that the level of collagen in the
      endomyositis of the FMS muscles is increased, the production of N-carboxymethylsine, which is
      the oxidative stress marker, is increased, and the tissue damage is increased and the CD-68
      positive macrophage levels in the interstitial tissue are increased in the muscles. The
      disturbance in the peripheral and central mechanisms leads to impairment of the postural
      control and therefore the increase in the frequency of falls with equilibrium losses. In the
      treatment of these symptoms, it was reported that the application of myofascial relaxation
      techniques had positive effects on patients' quality of life, sleep patterns, joint
      stiffness, neck and back pain.

      Myofascial release therapy Myofascial relaxation restores pain relief by restoring soft-touch
      dysfunctions. Behind the therapeutic effects of myofascial relaxation is the effect on the
      connective tissue, that is, the fascia, one of the structures that play a fundamental role in
      the musculoskeletal functions. According to this theory, the facial system makes a great
      contribution to the different functions spreading from head to foot and to the dynamic
      movements of the body through its ability to move. Hardened and shortened facial tissue (due
      to recurrent micro trauma or acute injury), loss of functional capacity and pain due to
      reduced ability to shear. Myofascial relaxation therapy can also restore the mobility and
      pain sensation in the joints by stretching, loosening to the myofascial tissue. Myofascial
      relaxation therapy is a combination of manual traction and long stretching maneuvers to open
      facial adhesions. There are two basic myofascial release techniques, direct and indirect. In
      the direct relaxation technique, the therapist uses a hand or device to apply slight
      pressures (for 90-120 seconds) directly on the restricted tissue. The direct technique also
      includes self myofascial relaxation techniques. In the indirect technique, the myofascial
      complex is extended for a longer time under less load. With myofascial relaxation,
      normalization of the morphological and inflammatory responses of fibroblasts injured in the
      context of recurrent strains is possible.

      The aim of this study was to investigate the efficacy of myofascial relaxation and
      mobilization techniques in the treatment of FMS patients on pain, trigger point number, FMS
      effect score, spinal mobility, sleep quality, anxiety and depression.
    

Intervention name(s): Treatment
Intervention type(s): Other
Intervention description(s): In the study group, a total of 15 sessions of a manual therapy program including myofascial release and mobilization techniques were applied for 60-minute session for 3 weeks(5/wk).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Patients were randomly divided into 2 groups of 20 people. A randomized list is prepared in a computer environment by a statistician for randomization. In this list, the odd numbers for the control group and the MT group were given double numbers. The group identification is printed on sequentially numbered cards placed in sealed envelopes. After enrollment, the numbered envelope was opened by the patient and the blind investigator. For the study group, manual therapy (MT) was given and the home exercise program was given and for the control group only home exercise program was given. In the study group, a total of 15 sessions of a manual therapy program including myofascial release and mobilization techniques were applied for 60-minute session for 3 weeks(5/wk). The treatment program has been implemented by a physiotherapist who specializes in this area.
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: Fibromyalgia syndrome; Manual Therapies; Pain