Fibromyalgia Syndrome and The Need for Integrative Care

Despite what many gurus, vitamin peddlers, and book sellers say, there is no cure for fibromyalgia. There are so many co-morbid illnesses tied with fibromyalgia that it has turned into a syndrome (FMS) as opposed to a single chronic pain entity. These symptoms include pain, brain fog, chronic fatigue, irritable bowel syndrome, and headaches. That is a wide variety of symptoms for one illness, and each have their own physiology behind it.

From that stand point, it wouldn’t make sense to try to have a one treatment fits all strategy to a condition like FMS.

Conventional treatment focuses on medications, progressive exercise, sleep disorder treatment, and psychotherapy to help control the pain of fibromyalgia. Exercise in particular has a strong track record for therapeutic benefit in FMS.

However, one of the things that I’ve seen after spending time hundreds of patients with fibromyalgia is that they find the mere thought of doing exercise to be overwhelming. Patients also find the idea of getting psychological therapy to be condescending to their condition despite the evidence that it is helpful.

The Addition of Upper Cervical Manipuluative therapy in the treatment of patients with Fibromyalgia: A Randomized Controlled Trial

A clinical trial was published in the journal Rheumatology International. The authors looked at the addition of upper cervical spinal manipulation to a comprehensive fibromyalgia treatment regiment to see if it any effect on outcomes.

The standard treatment for fibromyalgia includes cognitive behavioral therapy, light exercise recommendations, and pain education. This study compared standard treatment alone and compared it to when standard treatment included manipulation of the upper neck. The patients were treated for about 12 weeks and had a follow up appointment in a year.

They measured changes in pain, sleep, anxiety, posture, and quality of life.

Results

Interestingly enough, the group that received upper cervical manipulation didn’t have a significantly better outcome than the standard treatment group after 12 weeks. Both groups improved in their symptoms, but there wasn’t much difference between the 2 groups. On a good note, the postural measurements of the upper cervical group did improve quite a bit.

Here’s where the magic is: At a one year follow up, the upper cervical manipulation group continued to show better control of their pain, sleep, anxiety, and posture even though they stopped getting manipulations. On the other side, the control group actually started to regress towards their original scores.

Important Notes

1. The study used a physical therapy technique called the Maitland Concepts. It’s not a chiropractic technique, but has elements of high velocity, low amplitude manipulation commonly found in chiropractic.
2. The patients continued to get better even after they stopped getting manipulation. A common knock against manual techniques is that you need to keep getting adjustments in order to feel better. The multi-modal approach used in this study suggests that patients can continue to get better even after treatment is done.
3. The authors showed that manipulating the neck created widespread changes in the patients’ posture measurements including the low back, shoulders, etc. They attribute this to the fact that the upper neck is a critical element to controlling the posture of the body.

Conclusions

You all know my biases as a chiropractor that uses a niche technique. The truth is, I don’t care about what techniques I end up using, or whether the technique was created by a chiropractor, physical therapist, or a marine biologist. All that matters is that people get great outcomes!

I love this study because it shows that changing the physical structure of the body can happen through the neck, and doing this can get people a great long term outcome from an illness that makes millions of people miserable.