By Sunny Cooper, M.S., M.Ed., Diplomate in Asian Bodywork Therapy (NCCAOM)
Fibromyalgia Syndrome (FMS) is a frustrating and complicated condition for the patient to live with and for the practitioner to work with. Most patients have several very common symptoms, including widespread body pain (joints, muscles, internal organs); severe fatigue; sleep disorders such as sleep apnea, urogenital problems; digestive disturbances; cognitive impairment such as memory loss, confusion, and reduced reading comprehension; and emotional imbalances including depression and anxiety. Any of these can be mild or severe, and it is common for new complaints to arise frequently. Some patients are unable to function well enough to hold a job or carry out duties of family life. Approximately 80% of the patients are women.
Many patients suffer with the syndrome for years before they are diagnosed with fibromyalgia. The cause is unknown, and there is no cure. Doctors will usually prescribe antidepressants, sleep medication, and pain medication to give patients better functioning. Not surprisingly, many FMS sufferers turn to complementary therapies in their quest for answers and relief. Massage and bodywork therapy are helpful approaches for patients.
In my practice I have seen many medically-referred FMS patients. I have developed a two-part approach which seems to help patients regain much of their functionality and resume normal living. I implement these two approaches simultaneously, and they are 1) hands-on massage & acupressure therapy during office visits and 2) education and skills development for the patient and her family to better manage the illness on their own.
HANDS-ON THERAPY
Stage 1: Beginning Treatments. The first 4 to 6 sessions are directed at assessment and full-body treatment. In this stage the goal is to "get things up and moving". In the first visit I spend 90 minutes with the patient; half the time is used in taking a history and doing an assessment, and the other half of the time is spent with hands-on massage and pressure point work.
When the patient makes her first appointment, I ask her to write a chronological list of significant health events (accidents, illnesses, surgeries, pregnancies, and emotional traumas) and bring it to the first visit. I go through the list with the patient, filling in gaps in the information and clarifying the sequence of the items listed. My questions are guided by my understanding of Chinese medicine, I also answer the patient's questions about the work I do, and explain the course of therapy which I have found to work best. I carefully check for tender points along the energy pathways, evaluate the craniosacral system, and check for areas of lymphatic pooling. I am chiefly interested in the "big picture" at this stage, and this careful intake and assessment gives me an understanding of the client's history, including stress levels.
I recommend to have weekly sessions at first. During the first 4-6 visits the techniques I employ are primarily a) full-body massage shiatsu directed at opening and balancing the superficial meridians; b) releasing restrictions in the craniosacral system; d) activating the lymphatic system and e) abdominal shiatsu. These are all root-level approaches aimed at the deeper underlying disharmonies of the body rather than symptoms. I verbally and nonverbally encourage the patient to develop heightened awareness during these sessions.
Stage 2: Working with specific complaints. This stage of therapy begins when the patient is experiencing increased energy and comfort. Often, there is a lessening of many of their other symptoms at this time, but there are usually still many complaints. It is appropriate to do a thorough re-assessment at this time, emphasizing the energy system of the body with 5-Elements and traditional Chinese medicine (TCM). There is always at least one significant deficiency pattern, and Damp condition is ubiquitous. In this phase of treatment I believe it is extremely important to address the insomnia that is so common with FMS, and begin to do specific scar-release work on old surgical sites. Most FMS patients have had abdominal surgery. This phase of treatment can be as few as 4 one-hour sessions, but it it is more typical for Phase 2 to last for several months. Weekly sessions are preferred, but some patients choose to come every 2 or 3 weeks for financial reasons. As symptoms improve, I schedule the sessions further apart unless the patient desires weekly visits.
Stage 3: Maintenance phase. This phase begins when the patient is having significant improvement in the most bothersome symptoms. I suggest a schedule of visits every 3-4 weeks, with extra visits in the event of flare-up of symptoms or during times of high stress. In this phase treatments feature full body massage and shiatsu sessions aimed at meridian balancing, continuing to release restrictions, and symptom relief. By this time, the patient has usually developed some self-care skills.
PATIENT EDUCATION AND SKILLS DEVELOPMENT
I encourage FMS patients to develop awareness and adopt simple lifestyle changes in several areas. It is important to introduce changes gradually as the patient becomes able to comply, and to offer alternatives from which the patient can choose.
Most patients will do something in one or more of the areas mentioned below, but if they are not motivated, do not push the issue; many patients have discontinued therapy with overzealous therapists who insist on massive changes prematurely. It is important to encourage self-directed activities that the patient and her family are interested in when they are receptive and curious. The areas I employ are the following:
A. Nutrition. It is important to keep food recommendations simple. Encourage shifting to more whole foods, while reducing processed foods, sugar, dairy, and red meats. Many patients have no interest in eating differently at first, but may become curious about the benefits later. Let them go at their own pace. When they are ready, make it easy for them by sharing whole-foods recipes and preparation methods, or guide them to a good whole foods cookbook or class.
B. Stretching and Movement. Many patients report that simple stretching at home is very helpful. Be sure to demonstrate the stretches and have the patient do them with you to make sure they understand. If possible, give them a printed sheet showing the stretches, or recommend a video, book or other instructional material to help them. Encourage some type of gentle daily exercise also, starting at whatever capacity they have. Some have difficulty climbing one flight of stairs. Five minutes of stretching or walking is as much as many can handle at first. Outdoors is best.
C. Breathing. Most FMS patients breathe shallowly, and are therefore under-oxygenated. During my sessions I do simple facilitated breathing exercises with them so they can have an experience of deeper breathing. I instruct them to spend a few minutes 2-3 times a day breathing. I have them start with "6 mindful breaths" and practice with them during office visits.
D. Cognitive awareness and self exploration. It is valuable and important for patients to develop an understanding of the cognitive, behavioral, and emotional patterns that contribute to their health status. Many have very little knowledge about their illness, and that is a good place to start. Stress management is very important. There are numerous excellent self-help and discovery books available in every bookstore or library. Support groups and professional counseling are also excellent avenues for patients to gain cognitive and emotional skills.
Massage offers tools and techniques which can help FMS patients recover their functionality and live a normal life. In working this way, we honor the centuries-old tradition of the practitioner as role model and facilitator of healing.
You may also enjoy the article on Fibromyalgia for Patients
Sunny Cooper practices and teaches massage and shiatsu in the Minneapolis area.
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