Help your clients with fibromyalgia relieve their pain. Learn about this debilitating syndrome — and how massage therapists can make a tremendous impact on their clients with fibromyalgia.

Fibromyalgia, a syndrome with widespread chronic pain as its hallmark, is an enigmatic ailment with no known cause, no simple diagnostic test and no cure. While not a “cure”, massage therapy is an effective means for helping people manage their fibromyalgia. Most clients with fibromyalgia syndrome (FMS) say that they ache all over. They describe their pain in a variety of ways, such as burning, stabbing, gnawing, aching, stiffness or soreness. The American College of Rheumatology (ACR) estimates there are between three and six million people in the U.S. with fibromyalgia syndrome.

While the cause of FMS remains elusive, many believe that certain events may trigger this syndrome’s onset. Some of the trigger suspects include viral or bacterial infections, automobile accidents, rheumatoid arthritis and tragic events (physical and psychological). Many experts believe that an abnormally functioning central nervous system is at the root of FMS. Hormone and neurochemical imbalances are common findings during the medical evaluation of someone with fibromyalgia. The complexity of FMS may call for an entire medical team in the person’s care, including a rheumatologist, an endocrinologist and a neurologist.

Physicians often have difficulty diagnosing FMS because its symptoms have a high degree of variability and they overlap with a long list of other conditions. In 1990, the ACR listed two primary criteria for the classification of fibromyalgia. The first is a history of widespread pain involving all four quadrants of the body (right side, left side, above waist, below waist) for a minimum of 3 months. The second criterion which points to FMS is the presence of pain in at least 11 of 18 tender points when touched or pressed. It is suggested that a massage therapist confirm that his/her client received a diagnosis of fibromyalgia from a physician, to insure that something else isn’t the cause of the client’s maladies.

Clients with FMS not only report pain associated with specific “tender points” used for diagnosis, but also describe pain that is associated with myofascial trigger points. Pain originating from either source can fluctuate and is further aggravated by various physical, environmental and emotional factors. Fatigue, stiffness, poor sleep, and a host of other related symptoms often send fibromyalgia sufferers to seek relief from this disabling pain from a massage therapist. An ABC News/USA Today/Stanford University Medical Center April 2005 poll on chronic pain reported that more than half of Americans live with chronic or recurrent pain. According to this poll, 28 percent of Americans had tried massage therapy for relief of their chronic pain. Many fibromyalgia sufferers report massage as bringing them more relief than any other treatment prescribed by their physicians.

Massage is an excellent way to decrease pain, relax muscles, improve circulation, passively stretch muscles and create an overall feeling of well-being. In 1994, research at the Touch Research Insititute, Miami School of Medicine demonstrated that fibromyalgia responds well to massage. Rheumatologists evaluating the participants in this study found that only those receiving massage reported decreases in pain, fatigue, stiffness and improvements in their quality of sleep.

With such a high degree of variability of FMS symptoms and a client’s preferences, communication during the massage process is essential. Encourage feedback from your client, and adjust your administration to maximize his/her comfort. Starting out slowly with some moist heat application or initially warming the muscles with light strokes can allow for the client to relax into your care and guide you toward his/her needs. When the practitioner begins slowly, it is easier to assess the client’s needs, sensitivity and tolerance levels.

Many forms of massage can ease fibromyalgia pain. While gentle techniques may be favored by some FMS clients, others may benefit greatly from deep work, such as penetrating ischemic work on trigger points. For some with FMS pain, low-force or non-force techniques help them the most — without overstimulating their already overburdened nervous system. Strenuous massage that uses deep tissue and/or neuromuscular techniques may possibly trigger flare-ups of muscular pain and make some FMS sufferers feel worse, which can exacerbate other symptoms associated with fibromyalgia like sleep problems, depression, lack of concentration and fatigue.

Following treatment, FMS clients should be instructed to take it easy for awhile. Soreness may be present the day after treatment, especially if trigger points were treated. After the massage, drinking plenty of water and soaking in a warm (not hot) Epsom salts bath, with a few drops of a muscle relaxing essential oil (such as lavender, bay laurel or white birch), can provide relief from soreness and promote restful sleep. If deep work was included in the session, it is especially important for your client to consume extra water, and having water on hand for the client at the close of the treatment, or sending your client home with a bottle of water can be a nurturing physical enforcement of your instructions to him or her. You might mention to your client that the enzyme bromelain, harvested from the pineapple stem, has been shown to reduce muscle and tissue inflammation. [Note: Use caution when combining bromelain with anticoagulants (blood thinners), such as enoxaparin or warfarin. This enzyme is a natural blood thinner and may increase the medication's effect.]

Elusive and debilitating, chronic pain associated with FMS affects all aspects of one’s life. Individuals with FMS and experts in the field agree that those who are most successful in controlling their symptoms utilize a comprehensive approach to their healing that integrates multiple modalities. Long term massage therapy has been shown to offer the most benefits for FMS and can enable you to successfully help your clients manage their pain and get control of their fibromyalgia.

Editor’s Note: See the related article, “Fibromyalgia Part 2: Nine Massage Techniques”.

Recommended Study
Fibromyalgia and Massage

Posted by Nicole at 09:50 AM
© 2009 Institute for Integrative HealthCare Studies. This work is reproduced with the permission of the Institute. www.Integrative-Healthcare.org

With the economy struggling, and public outrage at a peak over lavish corporate expenditures, some companies are still treating their employees well. They’re doing it cheaply, right from the office by hiring massage therapists to come to their businesses and provide employees with chair massage at or near their workstations.

”The massages we provide are not the type of luxury that you might find at a resort spa,” said Alana Eve Burman, president and founder of JoyLife Therapeutics, a provider of corporate massage across the U.S. and worldwide. “The cost is much lower, and employees get a significant stress relief and morale boost.”

And these are stressful times. With corporate revenue and earnings down sharply over this prolonged recession, times have rarely been worse for corporate expenditures on employees. However, companies are finding that office massage can be a cost-effective way to reward employees and de-stress the work environment.

“We need a way to reward our employees, to show them that they are worthwhile, even if the amount of money we can spend on them to do this has been reduced,” said Diana Cortijo with World Bank, the international financing and development institution and a recent recipient of office massage. “Chair massage offers us a low-price way to bring the luxury of massage to our employees.”

Office massage, in addition to being low-cost, is also low-maintenance for companies. Generally, therapists provide their own transportation to the business, and bring their own massage chair and supplies. They then perform massage on employees on-site, with the employees fully clothed in an ergonomically relaxed, seated position. Most on-site massage happens at an impromptu station, often setup in an unused meeting room in the office.

“It really takes the stress out,” said Helene Mangones of Graf Repetti & Co, LLP, another recent office massage recipient and New York based accounting firm. “All of a sudden bigger projects seem easier to tackle. And the stress that builds up during the day is relieved, allowing for an easier finish to the day, and even the current week and month.”

This stress reduction could ultimately lead to increases in productivity and a rise in profits. Stress is one of the leading causes of lowered productivity in the workplace. One estimate puts direct stress-related costs to businesses in the US at $300 billion annually. Studies by the Touch Research Institute at the University of Miami have shown stress reduction, mood and immune system benefits from massage therapy.

“We notice that things can get a little stressed, especially given the current economic environment,” Cortijo, of World Bank, said. “Office massage helps keep our workers’ minds and bodies fresh, and doesn’t stretch our budget to do it.”

By David Robbie Two BAs; work experience at a massage office

Finishing touch
When we understand the power that touch brings, as the ancient physicians did, massage becomes a natural adjunct to treatment. The staff at the Crossroads Centre in Antigua, West Indies, recognizes this. In turn, some of the highest-rated activities clients discuss during exit interviews are the massage sessions and other holistic components of the program.
Addiction is a powerful, multifaceted disease, but as we know, it can be arrested. Clients in treatment deserve the best of all dimensions in care, so that they are optimally prepared to succeed in recovery. Massage therapy plays a role and is earning its place at the table of addiction treatment.

Joni Kosakoski, BSN, RN, CARN ( admit@crossroadsantigua.org ) has practiced nursing for more than 25 years, the last 10 specializing in addictions. She is a member of the American Holistic Nurses Association and The International Nurses Society on Addictions.

References
Collinge,W. and Duhl, L.(1997). American Holistic Health Association Complete Guide to Alternative Medicine. New York: Warner Books.
Dossey, B., Keegan, L. & Guzzetta, C. (2000) Holistic Nursing: A handbook for practice, Third edition. New York: Aspen Publishers, Inc., p.618.
Field, T. (2002). Massage therapy. Medical Clinics of North America, 86, 163-171.
Lidell, L., Thomas, S., & Beresford-Cooke, C. (2001). The Book of Massage: The Complete Step-by-Step Guide to Eastern and Western Techniques. New York: Fireside.
Montagu, A. & Matson, F. (1979). The Human Connection. New York: McGraw-Hill Book Co., pp. 89-90.
Touch Research Institute. (2003). Massage therapy database. Available: www.miami.edu/touch-research/Massage
1.html
Various authors. (December/January 2003). Massage and Bodywork, 17, 6. Selected articles on addiction and reprints available: www.massageandbodywork.com

Massage for clients’ body, mind, and spirit
Becoming aware of where one unconsciously holds the tension in the body turns into a wonderful advantage for clients working to identify and manage triggers, and learning how to deal with cravings and stress in general. Often, a part of the body or some sort of physical sensation can be the first notice one will receive as stress levels increase. Having a heightened kinesthetic sense and an improved awareness of habitual areas of tension in the body can provide the client with additional cues that not only may help prevent relapse, but also bring a growing respect and awe for the gift of our physical body, which for some exemplifies a Higher Power.

Mentally and emotionally, attitudes and feelings can be difficult to change or even access for the newly sober individual. Being in denial, intellectualizing, and avoiding emotions frequently hinder a full surrender to the recovery process. Referring clients to massage and bodywork can help therapists gain access to the most mentally defended individual, as massage directs attention away from the familiar region of the mind to physical realms with which they are less familiar and therefore less able to defend. Emotional release can commonly occur with massage, which provides a safe, non-threatening opportunity to begin the process of recovering long-buried emotions and memories. In this way, psychotherapeutic interventions can be greatly enhanced within the treatment setting.

Spiritually, the deep relaxation and gentle touch provided by massage can be the beginning of reconnecting with the self and ending the painful isolation every addicted person experiences. The touch of the massage therapist can powerfully, yet subtly allow a person both the opportunity to feel grounded or centered for the first time and the ability to truly be in the present moment. It also presents the opportunity to gain new insights and a deeper understanding of psychological issues and can be a valuable component of anyone’s self-care regimen. To allow oneself to surrender to the practitioner’s hands — to breathe fully and easily, to acknowledge and receive the gifts of nurturing, surrender, and relaxation — is a precious part of living the human experience and an invaluable addition to the newly recovering person’s repertoire of relapse-prevention skills.

Joni Kosakoski, BSN, RN, CARN ( admit@crossroadsantigua.org ) has practiced nursing for more than 25 years, the last 10 specializing in addictions. She is a member of the American Holistic Nurses Association and The International Nurses Society on Addictions.

References
Collinge,W. and Duhl, L.(1997). American Holistic Health Association Complete Guide to Alternative Medicine. New York: Warner Books.
Dossey, B., Keegan, L. & Guzzetta, C. (2000) Holistic Nursing: A handbook for practice, Third edition.
New York: Aspen Publishers, Inc., p.618.
Field, T. (2002). Massage therapy. Medical Clinics of North America, 86, 163-171.
Lidell, L., Thomas, S., & Beresford-Cooke, C. (2001). The Book of Massage: The Complete Step-by-Step Guide to Eastern and Western Techniques. New York: Fireside.
Montagu, A. & Matson, F. (1979). The Human Connection. New York: McGraw-Hill Book Co., pp. 89-90.
Touch Research Institute. (2003). Massage therapy database. Available: www.miami.edu/touch-research/Massage
1.html
Various authors. (December/January 2003). Massage and Bodywork, 17, 6. Selected articles on addiction and reprints available: www.massageandbodywork.com

Massage in addiction treatment
In order to more fully understand the place that massage therapy holds in the treatment of addictions during the detoxification phase, it is important to look at the biochemistry of addiction in the brain. Much attention has been directed to the mesolimbic reward system, the so-called “pleasure pathway” of the brain. The area is activated in part by the release of the neurotransmitter dopamine, the chemical messenger responsible for making us feel good when we engage in any pleasurable activity. It is well known that dopamine is significantly involved in addiction and that dopamine levels are lower than average during the withdrawal process and into early recovery until brain chemistry normalizes. Therefore, any measure, such as massage, that can naturally increase the level of dopamine is a welcome addition to the standard pharmacological interventions most commonly used during the detoxification process. In addition, massage promotes the circulation of both blood and lymphatic fluid so that more nutrients are brought to the tissues and organ systems and toxins and other waste products are more rapidly eliminated.

All systems of the body function more efficiently with improved circulation and a reduction in tension of the soft tissues and musculature; this improvement has a positive effect on the mind and emotions as well. Psychologically, the withdrawal process can be a frightening, overwhelming experience. Massage can provide a sense of comfort, safety, and connection, and can begin to build trust in order to establish the therapeutic alliance so crucial in addiction treatment. Through massage, it seems possible to decrease the number of people who fail to complete treatment. Of course, massage therapy sessions must be individualized, taking into account each person’s prior history of touch and past touch therapy experience. The practitioner must always be highly sensitive to the particular needs of each person and their cultural perspectives.

As treatment progresses and the individual completes his or her detoxification period, massage can then be an excellent tool for increasing the client’s self awareness on all levels and continuing enhanced production of dopamine and other crucial neurotransmitters. It takes time for the body’s neurochemistry to normalize. People in early stages of recovery are generally lacking in self-esteem, self-discipline, and self-care and impatiently want to “be well, right NOW!” They are woefully separated from their body and mind, and often troubled with anxiety, depression, and insomnia. Incorporating massage into their treatment schedules — and allowing them to experience regularly what the relaxation response feels like — is time well spent. Massage offers clients awareness of how the body naturally provides pleasurable feelings and responses without the use of chemicals or addictive behaviors. This knowledge can be enlightening and positively influence their outlook toward a sober future.

References
Collinge,W. and Duhl, L.(1997). American Holistic Health Association Complete Guide to Alternative Medicine. New York: Warner Books.
Dossey, B., Keegan, L. & Guzzetta, C. (2000) Holistic Nursing: A handbook for practice, Third edition. New York: Aspen Publishers, Inc., p.618.
Field, T. (2002). Massage therapy. Medical Clinics of North America, 86, 163-171.
Lidell, L., Thomas, S., & Beresford-Cooke, C. (2001). The Book of Massage: The Complete Step-by-Step Guide to Eastern and Western Techniques. New York: Fireside.
Montagu, A. & Matson, F. (1979). The Human Connection. New York: McGraw-Hill Book Co., pp. 89-90.
Touch Research Institute. (2003). Massage therapy database. Available: www.miami.edu/touch-research/Massage
1.html
Various authors. (December/January 2003). Massage and Bodywork, 17, 6. Selected articles on addiction and reprints available: www.massageandbodywork.com

Types and effects of massage
With so many different types of massage therapy and bodywork from which to choose, practitioners often blend several styles to fit their own individual philosophy, training, and intent (for an excellent, thorough review of massage therapy, see the ç chapter in Collinge & Duhl, 1997). Some massage techniques focus less on the manipulation of musculature and soft tissue and more on the integration and structure of all body parts. Oriental styles incorporate the principles of Chinese medicine and serve to maintain the flow of energy, or chi, through meridians, the energy circuits of the body. In addition, there are other energy-based modalities, such as therapeutic touch, where it is not always necessary to touch the body for positive responses, following the principle that the human energy field extends 2 to 4 inches beyond the skin and can be balanced by the actions and the intent of the practitioner.
Complementary medicine of all varieties is becoming increasingly more mainstream, a trend that will most likely continue. Unfortunately, limited research has been done in this area. This fact is changing, due in part to the National Center for Complementary and Alternative Medicine (NCCAM). Founded in 1992 by the National Institutes of Health in response to public interest, NCCAM (formerly the Office of Alternative Medicine) is now scientifically researching and evaluating alternative health modalities and funding independent research grants. Currently, many studies are also being conducted at the Miami, Florida-based Touch Research Institute (TRI), the only center in the world today devoted solely to the scientific exploration of touch and its application in healing disease.

Since TRI was established in 1991 by the University of Miami School of Medicine, the Institute has been responsible for research that has yielded significant scientific findings regarding massage and its effects on the body, among them: decreased pain, diminished autoimmune responses, enhanced immune response, increased alertness and performance, and enhanced growth in premature infants. Many of the effects appear to be related to the reduction in stress hormones, most notably cortisol, which occurs as the result of massage therapy (Field, 2002; TRI 2003). Several TRI studies completed in the past five years involve massage and addictions — specifically nicotine, bulimia, and cocaine-exposed newborns. These studies positively document the ability of massage to decrease anxiety, agitation, and cravings as well as improve sleep and lessen feelings of depression (TRI, 2003).

Joni Kosakoski, BSN, RN, CARN ( admit@crossroadsantigua.org ) has practiced nursing for more than 25 years, the last 10 specializing in addictions. She is a member of the American Holistic Nurses Association and The International Nurses Society on Addictions.

References
Collinge,W. and Duhl, L.(1997). American Holistic Health Association Complete Guide to Alternative Medicine. New York: Warner Books.
Dossey, B., Keegan, L. & Guzzetta, C. (2000) Holistic Nursing: A handbook for practice, Third edition. New York: Aspen Publishers, Inc., p.618.
Field, T. (2002). Massage therapy. Medical Clinics of North America, 86, 163-171.
Lidell, L., Thomas, S., & Beresford-Cooke, C. (2001). The Book of Massage: The Complete Step-by-Step Guide to Eastern and Western Techniques. New York: Fireside.
Montagu, A. & Matson, F. (1979). The Human Connection. New York: McGraw-Hill Book Co., pp. 89-90.
Touch Research Institute. (2003). Massage therapy database. Available: www.miami.edu/touch-research/Massage
1.html
Various authors. (December/January 2003). Massage and Bodywork, 17, 6. Selected articles on addiction and reprints available: www.massageandbodywork.com