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Mindbody methods for Fibromyalgia

David McQuillan —

How might mindbody techniques including massage therapy help people with fibromyalgia?

Humans are social creatures. We are wired for social connection, and positive social interaction is one of the most effective buffers of stress. People living with fibromyalgia often report becoming socially isolated, partly because the pain and fatigue of fibromyalgia can be disabling, and partly due to social withdrawal as a strategy to avoid the risk of being seen as unreliable or a burden. The condition is rarely visibly apparent, symptoms fluctuate, and people living with fibromyalgia often need support. Given that stress is a contributing factor to fibromyalgia, this lack of social enjoyment can result in a vicious cycle. When individuals don’t receive the relief of social interaction, negative feelings can intensify.

Fibromyalgia is characterised by chronic, widespread pain and tenderness. Pharmacological treatments only provide a modest reduction in symptoms, which is often not long-lasting, so there is a need to find efficacious non-pharmacological treatments. David McQuillan undertook a literature review to explore using mindbody and massage therapy methods in treating fibromyalgia. A broad search strategy was used, then refined to 26 articles that were most relevant to the proposed clinical methodology were selected, with priority being given to systematic reviews and randomised controlled trials, except when research findings were novel or specifically covered the relationship of trigger point phenomena to fibromyalgia syndrome.

Mindfulness, breath retraining, and relaxation therapies all show reasonable promise in the management of fibromyalgia. There is strong evidence for the use of cardiovascular and strengthening exercises to reduce pain, and improve function for fibromyalgia syndrome clients, however the type of exercise is important. For the exercise to be beneficial, the intensity must not be too low, but higher intensity exercise can produce pain flare-ups. Intensity should be gradually increased over time. Mindful exercise groups (for example, yoga, tai chi) show promise as they combine movement, mindfulness and socialisation.

This review informed David's development of a clinical protocol for working with fibromyalgia clients. This protocol involves four main elements:

  • Client induction: This includes the client providing information about functioning and a wellness self-assessment.
  • Foundations: The foundations stage involves training in basic mindfulness methods, the establishment of anchors and the establishment of a home programme.
  • Myofascial release: This is the main bodywork method, and includes the identification and treatment of trigger points.
  • Somatic unwinding: Developed by David, this involves helping the client to get in touch with painful emotions that have in the past been avoided through dissociation, developing tolerance and acceptance of those emotions, then integrating new ways of being in the world which are uninhibited by historical fear-based avoidance responses.

The whole process is designed to take place over ten face-to-face sessions in a clinical environment. The protocol could also be used with clients who present with sensitisation (that is, any chronic pain) but do not meet the diagnostic criteria for fibromyalgia.