Pain and Therapy

From acute musculoskeletal pain to chronic widespread pain and
fibromyalgia: Application of pain neurophysiology in manual therapy practice.

Man Ther. 2008 May 27. [Epub ahead of print]

Nijs J, Van Houdenhove B.

Department of Human Physiology, Faculty of Physical Education and
Physiotherapy, Vrije Universiteit Brussels, Belgium; Division of
Musculoskeletal Physiotherapy, Department of Health Care Sciences,
University College Antwerp, Van Aertselaerstraat 31, B-2170 Merksem, Belgium.

PMID: 18511329


During the past decade, scientific research has provided new insight
into the development from an acute, localised musculoskeletal
disorder towards chronic widespread pain/fibromyalgia (FM). Chronic
widespread pain/FM is characterised by sensitisation of central pain
pathways. An in-depth review of basic and clinical research was
performed to design a theoretical framework for manual therapy in
these patients.

It is explained that manual therapy might be able to influence the
process of chronicity in three different ways.

(I) In order to prevent chronicity in (sub)acute musculoskeletal
disorders, it seems crucial to limit the time course of afferent
stimulation of peripheral nociceptors.

(II) In the case of chronic widespread pain and established
sensitisation of central pain pathways, relatively minor
injuries/trauma at any locations are likely to sustain the process of
central sensitisation and should be treated appropriately with manual
therapy accounting for the decreased sensory threshold. Inappropriate
pain beliefs should be addressed and exercise interventions should
account for the process of central sensitisation.

(III) However, manual therapists ignoring the processes involved in the development and maintenance of chronic widespread pain/FM may
cause more harm then benefit to the patient by triggering or
sustaining central sensitisation.

* * *

If you're looking for a massage therapist or a physical therapist, always ask about their familiarity with fibromyalgia or CFS before you sign on with them.  The wrong type of massage can cause more pain, and a personal trainer or physical therapist who believes "no pain, no gain" will likely push a CFS patient beyond her limits, which could result in permanent disability.

Your body is not normal and should not be treated in the normal manner, because it will react abnormally.  The therapist must be willing to stop when you say "ow" or "enough", because the best expert on what your body can handle is YOU.