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| Division of Occupational Therapy - OT Connect Fibromyalgia
Fibromyalgia is a widespread musculoskeletal pain and fatigue disorder affecting up to 5% of the population. It is a chronic condition characterized by widespread pain in the muscles, ligaments and tendons – the fibrous tissues in the body. A person with this condition may feel like their muscles have been pulled or overworked. The muscles affected most are in the shoulders, buttocks, neck, and lower back. Sometimes the muscles twitch and at other times they burn. Pain is present in the soft fibrous tissues of the body including the muscle, ligaments, and tendons. Individuals will also experience pain in 11 or more of 18 recognized tender points when pressed. The diagram above, illustrates common tender points. These tender places occur symmetrically on both sides of the body. This condition can affect people of all ages including children. It is not a progressive disease (Fibromyalgia network, 2003). Fibromyalgia can be aggravated by environmental and emotional conditions. Common aggravating factors are: Changes in weather, cold or drafty environments, hormonal changes during premenstrual, pregnancy, and menopausal states, stress, depression, anxiety and over-exertion can all contribute to flare-ups. Typically, symptoms are worse during periods of cold damp weather, at the beginning and end of the day, and during periods of emotional stress. Common Symptoms/Course of disease
Fibromyalgia network, 2003 Sex Bias: Women are seven times more likely to be diagnosed with Fibromyalgia than men (Arthritis Foundation, 2003). Current Medical Treatment: The treatment that an individual needs will be dependent on the severity of his or her condition. The traditional treatment of Fibromyalgia is aimed at decreasing pain and increasing the quality of sleep of the individual. The deep level of sleep or stage 4, is commonly disrupted in individuals with this diagnosis. This deep level of sleep is crucial for tissue repair, the production of antibodies, and the regulation of neurotransmitters, hormones, and chemicals involved in the immune system. Medications are commonly prescribed to help individuals achieve this level of sleep. Muscle relaxants and pain relievers are also used with these patients. Another medical intervention include injections of lidocaine at the trigger points. Treatment may include an Occupational Therapist to work on strengthening, endurance, range of motion and pain management in order to enhance activities of daily living. Accupuncture, acupressure, relaxation/biofeedback techniques, osteopathic manipulation, and chiropractic care, therapeutic message are also recognized treatment methods (Mayo Clinic, 2003). Occupational Therapy Involvement Occupational therapy (OT) is an important component of treatment of an individual who has fibromyalgia. OT works on improving an individual’s daily functioning and increased exercise tolerance. Other common treatment goals include pain reduction or management, energy conservation and stress management. In a study by Sin and Adams (2003) predictors of outcome to therapy were considered to be largely psychosocial, rather than physical, in nature. OT provides:
References
How OT Makes a Difference: Evidence-Based Practice Brown, G. and Greenwood-Klein, J. (2001). Juvenile fibromyalgia syndrome: The role for occupational therapists. Australian Occupational Therapy Journal, 48(2): 54 This paper provides an excellent literature review and overview of research on juvenile fibromyalgia syndrome and trends in diagnosis, assessment, and research. These authors find that suggested treatments include medication, moderate exercise, proper sleep, lifestyle counselling, and cognitive-behavioural techniques (e.g. progressive relaxation, guided imagery). They also report that JFS can have a negative impact on paediatric clients' functional independence, self-esteem, locus of control, physical abilities, psychological adjustment, pain-coping strategies, and developmental skill achievement. These authors state that "Given the potential physical, psychological, and developmental difficulties a child or adolescent diagnosed with JFS may experience, occupational therapists have an important role in the clinical management of this paediatric client group". Suggested Occupational Therapy Interventions for Children with Fibromyalgia from Brown and Greenwood-Klein (2001):
SueEllen, a 57-year-old woman was diagnosed with fibromyalgia about 10 years ago. In the past 10 years, she has been referred for both physical therapy and occupational therapy services. She explained to me that the physical therapy has helped with the pain that she experiences with her diagnosis of rheumatoid arthritis. Occupational therapy has been able to help her problem solve specific daily problems. In her work as a medical technologist there were many tasks that needed to be done in a standing position and many repetitive hand and arm movements used. The occupational therapist recommended some ergonomic adaptations to the workplace and energy conservation techniques that SueEllen credits with making it possible for her to continue to work. With the support of her OT, SueEllen has begun practicing yoga to help her relax and to assist in the health of her tendons and joints. She enjoys the social nature of the yoga classes, and is encouraged to get out more. SueEllen has missed far fewer workdays due to her condition since beginning yoga and completing the environmental adaptations in her home and her workplace that the occupational therapist recommended.
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