Abstract
Fibromyalgia is an illness or disorder that affects about 2-5 % of the world’s population and that that is characterized by musculoskeletal pain and general muscle stiffness. One of the suggested methods of treating this disorder is massage therapy. This paper aims to conduct a comprehensive literature review on the use of massage therapy as an effective intervention technique of Fibromyalgia. The paper will commence with a brief introduction that explains the basics of the disorder. This will then be followed by a comprehensive literature review of various article publications that have touched on the subject. The review will incorporate the methodology, findings and basic theoretical elements written in these publication. The final part of the review will be the conclusion that will also identify any literature gaps on the issue that might require filling in the future.
Introduction
Fibromyalgia refers to an illness or disorder that is characterized by musculoskeletal pain and general muscle stiffness. This muscle pain and stiffness is accompanied by extreme tiredness or fatigue, sleep problems as well as other issues related to mood and memories. People who have this disorder are, usually, in a continuous state of psychological distress. Some of the other symptoms that are displayed by individuals suffering from this disorder include morning stiffness, irritable bowel syndrome, painful menstruations, headaches, numbness or tingling in the hands or the feet and finally thinking problems. There is no official cure for fibromyalgia, but various strategies of mitigating the disorder as well as medication for controlling the symptoms have been suggested by medical experts and scholars. One of the suggested methods of reducing or controlling the signs and symptoms of fibromyalgia is massage. Studies into the disorder and possible intervention techniques such as massage therapy is of extreme importance because fibriomyalgia as a disease affects 2-5 % of the total world population. This paper aims to conduct a literature review of publications that explore the concept of massage as a medical tool for reducing the signs and symptoms of fibromyalgia. The literature review of these publications will help to answer whether massage aid in actual sense helps in the reduction of fibromyalgia. Some of the databases that have utilized in this literature review include Google scholar, NCBI, CINAHL, PubMed, EBSCO and Science Direct. The primary keywords in searching for relevant literature include fibromyalgia, massage, connective tissue massage, massage, soft tissue manipulation, massotherapy, self-massage, fibromyalgia, myofascial pain, and fibrositis.
In a study conducted by Ekici et al (2009), a sample of 50 women all having the fibromyalgia disorder were subjected to 2 different types of medical intervention to gauge the impact of these intervention using a randomized control trial study design. The first group of 25 women were subjected to manual lymph drainage therapy while the other sample, also comprised of 25 women was subjected to connective tissue massage. This program was carried out for a total of three weeks (with 5 treatments per week). The pain on the subjects was then evaluated using a visual analogue scale and algometry. The results showed that in both groups of study, there were significant improvements in regards to pain pressure threshold, pain intensity and health-related quality of life (Ekici et al. 2009). The conclusion drawn was that both manual lymph drainage therapy and connective tissue massage are effective tools that can be used to mitigate the problems brought about by the fibromyalgia because they bring about improvements in regard to health status and pain. One of the rationales given for the observed effect is that connective tissue massage results in the stimulation of mechanoreceptors that ultimately closes the “pain gate” (Ekici et al. 2009). This is through both presynaptic and postsynaptic inhibition. In addition, massage therapy induces the release of ‘endogenous opiates”. This type of massage leads to a reduction of tension in the body’s autonomous nervous system and increases circulation that gives muscle relaxation, a sense of warmth and pain relief (Ekici et al. 2009).
The shown impact of connective tissue massage is further supported in a study conducted by Li et al. (2014). Li et al. conducted a systematic review of literature published before June 2013 to evaluate the evidence regarding the effectiveness of massage therapy for patients suffering from fibromyalgia. The authors conducted a comprehensive research on electronic databases to identify related studies on the subjects. The authors used several outcome measures that included anxiety, pain, sleep disturbance and depression. The bias of the identified studies was assessed using Cochrane tools and standard mean differences, confidence level intervals were calculated using a conservative random effects model (Li et al. 2014). The heterogeneity of the studies’ results was also calculated. Out of the studies identified, nine of them that comprised of randomized controlled trials involving a total of 404 patients were found to have met the inclusion criteria. However, the main finding from this systematic review was that massage therapy administered to the patients for more than five weeks significantly improved the patient’s pain, anxiety and depression (Li et al. 2014). However, there was no much effect in the sleep disturbance pattern in the patients. The conclusion drawn from this study, therefore, is that massage therapy lasting more than five weeks has immediate beneficial impact on the patient (Li et al. 2014). There is a great improvement in terms of pain depression and anxiety to patients when they are subjected to this therapy for the mentioned period. This study, therefore, significantly proves that massage therapy plays a huge part in reducing symptoms related to fibromyalgia. What is the rationale behind this effect however? According to Li et al. (2014), the effects arise from a complex interaction of both psychological and physical patterns. The delivery of massage therapy to soft and connective tissues leads to a stimulation of local biochemical changes occurs. These changes help in improving muscle flexibility, modulation of local blood as well as lymph circulation. This then results in the reabsorption of inflammatory and nociceptive mediators (Li et al. 2014). Some of the studies reviewed shows that the reduction of pain after massage therapy was as result of modulation of serotonin levels in fibromyalgia patients (Li et al. 2014). Local effects may also alter neural activity at the segmental level of the spinal cord that is responsible for pain and mood perception (Li et al. 2014). In a nutshell, the study by Li et al. (2009), presents conclusive evidence that massage therapy does indeed help in the reduction of fibromyalgia symptoms.
The effectiveness of massage therapy is further proven in a study Hernandez et al. (2001). In this study, the researchers used a randomized study design to evaluate the effectiveness of massage therapy vs. the effectiveness of chronic low back pain which is one of the symptoms of fibromyalgia. The researchers evaluated the two types of treatments against outcome measures of pain, anxiety, stress management, sleeplessness and depression. The study utilized a sample of twenty-four women all who were suffering from fibromyalgia and whose pronounced symptom of the disorder was lower chronic back pain and who had experienced such pain for the preceding six months. The minimum age for the participants was 39. 6 years. The sample of 24 women was then subdivided into two distinct groups comprising of 12 participants each. One group was subjected to massage therapy while the other was subjected to progressive muscle relaxation. The program lasted for a total of five weeks where the participants were subjected to two 30 minute treatments per week. To assess the impact of the two different study programs, the participants filled a questionnaire during the beginning and after the program, provided urine samples and were also assessed for motion range. At the end of the research, it was found that members of the group that had been subjected to massage therapy reported reduced depression, less pain and anxiety as well as improved sleep patterns (Hernandez eta al., 2001). These participants also exhibited improved pain flexion performance. The dopamine and serotonin levels of these participants were also higher than those of their counterparts who had been subjected to progressive relaxation. The main conclusion that can therefore be drawn from this study is that massage therapy is a significantly effective tool in the reduction of pain, depression, anxiety and stress, wall which are symptoms of fibromyalgia (Hernandez eta al., 2001). The study by Hernandez et al is very conclusive and leaves no doubt that massage therapy is indeed a very effective tool for mitigating the symptoms of fibromyalgia
Kalichman (2010) also conducted a systematic review of literature to investigate whether massage therapy is indeed an effective tool that that help to reduce the symptoms of fibromyalgia. According to Kalichman (2010), massage therapy is widely used by fibromyalgia patients who are seeking symptom relief. Kalichman conducted an extensive review of studies related to the subject with particular focus on randomized control trial to establish whether massage therapy is indeed a viable treatment tool for the symptoms related to fibromyalgia. Kalichman found that literature supports the use of massage therapy as an intervention tool for fibromyalgia. Kalichman however states that additional research is required to prove that massage therapy is indeed a safe as well as an effective mode of intervention for the symptoms of fibromyalgia. Kalichman goes on to suggest that the massage being administered to a patient should be painless and that its intensity should be increased gradually from one session to the next. This should be in accordance with the symptoms of the patient. Finally, if massage therapy is to achieve any recognizable result, it has to be administered ate least once or twice a week.
Brattberg (1999) also conducted a study to determine the effectiveness of connective tissue massage in treating fibromyalgia. His study adopted a randomized controlled design and the found that the administration of connective tissue massage help to relieve pain by up to 37%. Brattberg also shows that connective tissue management also reduces depression and generally improves one’s quality of life. The administration of the massage therapy should be continuous because if it’s started and then stopped, there is a high likelihood of the pain going back to its initial high level. For instance, Brattberg (1999) shows that thirty percent of the relieving effect of pain disappears three months after discontinuation of massage therapy. After six, months the initial pain goes back to about ninety percent of its basic or initial value (Brattberg, 1999). Although Brattberg advocates for the provision of this mode of treatment to patients suffering from fibromyalgia, he however states that further studies are required to fully establish the mechanism that are behind the effects exhibited by this form of treatment.
Conclusion
Intensive research has been conducted to evaluate the effectiveness and appropriateness of massage therapy as an intervention technique for fibromyalgia, a disease that is characterized by musculoskeletal pain and general muscle stiffness. Most of the literature suggests that massage therapy is indeed an effective technique that can significantly improve the outcomes of people suffering from the disorder. This is if the therapy is administered to the patient using a consistent time pattern, for instance twice to five times a week. One particular gap in literature or perhaps an area that requires more research is the rationale or the mechanism for the observed effects. Some of the presented rationale by authors such as Esici et al. and Li et al are not conclusive enough, and it is clear that this is an area that requires further research.
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