Chiropractic Treatment Considerations


Fibromyalgia (FM) is a chronic condition characterized by widespread pain and tenderness in the musculoskeletal system. There are many treatment approaches available for joint and soft tissue pain management but few studies have looked at the long-term benefits of such treatments.


One study looked at both the short-term and the long-term effects of using connective tissue manipulation in combination with ultrasound (US) on 20 female patients diagnosed with FM. Outcome assessments focused on pain intensity, the degree of restorative sleep, and the impact FM had on functional activities using a 0-10 scale. Treatment included 20 sessions of daily soft tissue manipulation (muscles, joint capsules, and other connective tissues) applied to the back region. The combined US therapy was applied to the upper back region, every other session. The benefit of the treatment was evaluated initially, after the 20 sessions, and again after one year. All three issues tested (pain intensity, impact on functional activities, and complaint of non-restorative sleep) improved and remained improved at the end of one year among the participants. None of the follow-up subjects obtained additional medical and/or manipulative treatment though five (36%) began to use medications during that time period while 64% did not require any medications. Patient satisfaction averaged 7.14 on a 0-10 scale (10 = highest satisfaction).


Another study included 15 subjects who received 30 treatments of ischemic compression and spinal manipulation performed at a frequency of 2-3 times per week. The ischemic compression included thumb pressure applied to each tender point for ten seconds at progressively greater pressure to increase patient tolerance. This was repeated until the point was no longer tender using 4 kg of force or the trial ended, whichever occurred first. Spinal adjustments were applied to the neck and mid-back areas of the spine. Three methods of measuring clinical change (pain intensity, sleep quality, and fatigue) were utilized at the initial, 15th, and after the 30th treatment. A minimum of 50% improvement in score was required to be considered a good respondent. After 30 treatments, 9 were considered good respondents, while 6 were not. In the respondent group, the percent change/improvement was 77.1% in pain, 63.5% in quality of sleep, and 74.8% improvement in fatigue. A month after the final treatment, the good respondents continued to report improvements in pain severity, unlike a similar trail testing the benefits of two popular medications (amityiptyline and cyclobenzaprine).


Of interest, many of the non-respondents were older, had a more chronic/long-term illness, and had a greater intensity of symptoms with greater number of tender points at the start of the study. This suggests patients may see better outcomes if they seek treatment earlier in the course of the disease.

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