REHABILITATION OF FIBROMYALGIA
Fibromyalgia (FM) is an illness belonging to a group of pathologies involving chronic musculoskeletal pain (pain expressed in the patient for more than 3 months’ duration), but with a variable that makes it complex: the fact that it is a ‘diffuse’ type of pain, decreasing the pain threshold. The aetiology is also complex in that it is dependent on several factors, determining the combination of musculoskeletal pain in various parts of the body, including the upper and lower parts of the body. It is associated with emotional engagement (depression and anxiety), sleep disorders, and fatigue. All of this compromises the quality of life of the patients. (1)(2)
FM affects approximately 4.2% of the female and 0.2% of the male population. The percentage varies according to the diagnostic criteria included (3). Although 25% recover, 75% live with persistent chronic pain (4).
According to the criteria of the American Academy of Rheumatology of 1990, the pain is the main symptom, described as chronic disseminated pain (2). The pain may also be migratory pain that becomes chronic over time (longer than 3 months’ duration) (2) and generally requires a combination of several different drugs. However, complete relief of the symptoms is not always achieved and in 75% of patients the condition remains chronic and persistent over time.
There are two main strategies for non-pharmacological treatment of FM. First, those that are self-assisted for general management such as stretching exercises and education, cognitive therapy and healthy behaviour. Alternatively, we can find treatments directed by a therapist such as massage, acupuncture (1), hypnotherapy, hydrotherapy, Qi gong or Tai chi, use of transcutaneous electrical nerve stimulation (TENS), biofeedback, balneotherapy and chiropractic (7,8).
Performing rehabilitation that includes predominantly aerobic exercises helps to alleviate the concomitant symptoms of FM such as fatigue, sleep disturbances and depression, as well as tolerance to chronic pain, its function and quality of life. Currently the exercises are considered a non-pharmacological treatment recommended for patients with FM. ‘Gold’ level evidence has been published which indicates that supervised aerobic exercise training has beneficial effects on the physical capacity and symptoms of FM. (Cochrane 2008).
Shockwave therapy is a technology applied for approximately 20 years in the field of chronic pain and various musculoskeletal conditions, the effectiveness of which has been demonstrated and approved by the Food and Drug Administration (FDA) for various different musculoskeletal conditions of soft tissues such as enthesopathy (plantar fasciitis (9,10), rotator cuff tendinitis, epicondylitis, amongst others) as well as for pseudoarthrosis and delayed consolidations. Several studies have been published regarding its effectiveness on focal pain in myofascial syndrome (12-14).
- Onose,G; y CIA; “Extracorporeal shock wave therapy – A new “wave” also in Physiatry?”; Practica Medicala,2011.
- Ritz, J; y CIA; “Tratamiento de afecciones musculo – esqueléticas con ondas de choque extracorporeas”; Reumatologia 2007. (Ritz, J; y CIA; ‘Treatment of musculoskeletal conditions with extracorporeal shockwaves’; Rheumatology 2007.)
- Wolfe, F; y CIA; The American College of Rheumatology 1990 criteria for the classification of Fibromyalgia: Report of the multicenter criteria comitee”; Arthritis Rheumatology 1990.
- Alegre de Miquel,C; y CIA; “Documento de Consenso Interdisciplinar para el tratamiento de fibromialgia”; Actas Esp Psiquiatr 2010. (Alegre de Miquel, C; and CIA; ‘Interdisciplinary Consensus Document for the treatment of fibromyalgia’; Actas Españolas de Psiquiatría 2010.)
- Sanz,J; y CIA; “Fiabilidad , validez y datos normativos del inventario para la depresión de Beck”; phicothema 1998. (Sanz, J; and CIA; ‘Reliability, validity and normative data of the inventory for Beck’s depression’; phicothema 1998.)
- Serrano,M; y CIA; “Valoracion del dolor II”; Rev. Soc. Esp de dolor 2002. (Serrano, M; and CIA; Assessment of pain II’, Journal of the Spanish Society of Pain 2002.)
- Monterde, S.;y CIA; “ Validación de la version Espanola de Fibromyalgia Impact Questionnaire”; Rev. Esp. de Reum. 2004. (Monterde, S; and CIA; ‘Validation of the Spanish version of the Fibromyalgia Impact Questionnaire’, Spanish Journal of Rheumatology 2004.)
- Cuestionario de evaluación del estado de salud (R808-NP2-Spanish) Copyright: Health report services. firstname.lastname@example.org (Health Status Assessment Questionnaire)
- Alonso J, Prieto L, Anto JM. La versión española del SF-36 Health Survey (Cuestionario de Salud SF-36): un instrumento para la medida de los resultados clínicos. Med Clin (Barc) 1995; 104: 771-6. (Alonso J, Prieto L, Anto JM. The Spanish version of the SF-36 Health Survey: an instrument for measuring clinical results. Med Clin (Barc) 1995; 104: 771-6.)
- Revision actualizada: Vilagut,G; y CIA; “El cuestionario de salud SF-36 español: una década de experiencia y nuevos desarrollos”; Gaceta Sanitaria 2005. (Updated review: Vilagut G; and CIA; the SF-36 Spanish Health Survey: a decade of experience and new developments’; Gac Sanit 2005.)
- “Guia de práctica clinica para el manejo de pacientes con trastornos de ansiedad en atencion primaria”; Guias de practices clinicas en el SNS, Ministerio de Sanidad y consumo 2008. (‘Clinical practice guide for the management of patients with anxiety disorders in primary care’; Clinical practice guides in the SNS, Ministry of Health and consumption 2008.)
- JiHM and CIA; “Extracorporeal shock wave therapy in myofascial pain syndrome of upper trapezius”; Ann Rehabil Med; 2012
- Jeon JH1, Jung YJ, Lee JY, Choi JS, Mun JH, Park WY, Seo CH, Jang KU. The effect of extracorporeal shock wave therapy on myofascial pain syndrome. Ann Rehabil Med. 2012 Oct;36(5):665-74. doi: 10.5535/arm.2012.36.5.665. Epub 2012 Oct 31.
- S Ramon-Rona; M Gleitz; L Hernandez-Sierra; L Romero-Tabares. Update on shockwave efficacy in myofascial pain and fibromialgia”. International Journal of Surgery 2015 Sep 10. pii: S1743-9191(15) 1195-4.