Abstract
Introduction:
Fibromyalgia (FM) is a common disorder associated with symptoms of anxiety and depression. Microphysiotherapy (MPT) is a novel alternative and complementary technique used to treat emotional disturbs using bodywork.
Aim:
To analyze the effects of MPT in patients with FM.
Materials and Methods:
Of 30 subjects selected, 18 were excluded and included 12 patients. All patients received three sessions of MPT. They were evaluated at preintervention and after 3 months of MPT treatment. Beck inventories evaluated demographic data, anxiety, depression, sleep quality using the Pittsburgh scale, and dysbiosis symptoms.
Results:
Mean age was 50.8 ± 11.8 years old. Mean disease duration was 2 years (ranging from 3 months to 10 years). After 3 months of MPT, analysis of the parameters revealed no changes in the physical and psychological parameters, including the Beck anxiety and depression questionnaires, tender point counting, dysbiosis questionnaire, and Pittsburgh evaluation scale.
Conclusion:
Treatment with MPT in patients with FM does not seem to improve this disease. More studies are, however, necessary to confirm these features.
Introduction
Fibromyalgia (FM) is a rheumatic disease characterized by widespread pain, nonrestful sleep, severe fatigue, and the presence of the 11 out of 18 tender points.1,2 The FM prevalence is between 0.2% and 6.6%; it is more frequent in women than in men, especially in those subjects between 35 and 60 years old. 3 Furthermore, comorbidities such as symptoms of anxiety, irritability, insomnia, and depression are extremely common in these patients. 4
FM therapy involves using analgesics and antidepressant drugs.3,4 However, physical therapy and psychotherapy are mandatory therapies for FM. Unfortunately, drug therapy fails in ∼30–40% of cases, and several patients have several side effects. 4 Therefore, thinking more about new therapeutic modalities, including microphysiotherapy (MPT), is logical.
MPT is a manual physiotherapy technique created on the belief that the body becomes accustomed to, preserves, and cures itself in response to stressful, emotive, toxic, environmental, or infectious injuries. If an injury is superior to the capacity of the tissue to defend itself, the vigor of that tissue is changed. MPT looks for such changes through a physical micropalpatory technique that evaluates soft tissue vitality. Manual stimulation is then executed on the injured tissues to stimulate self-healing to recover the function.
The theoretical ideas of MPT are based on human embryology. It is proposed that, as the visceral and muscle tissues have the exact embryological origin, the muscle lesion may be associated with a related visceral pathology. 5 Nevertheless, MPT is an innovative methodology, and as such, there are little data available in the scientific literature.
Nonetheless, MPT has positive effects on painful conditions, including sympathetic dystrophy, 6 lower back pain, 7 and in a few studies on FM.8,9 In this line, two articles were found about this technique in FM patients in Academic Google. No report was found in PubMed, Medline, Scielo, and Lilacs. In one randomized double-blinded controlled trial, the authors verified an enhancement in quality of life in 20 FM patients but with no differences regarding interleukin-8 serum levels. 8
In the other article, a cross-sectional study including 15 FM subjects verified the heart frequency variability after two MPT sessions in FM. 9 No investigation was found on depression, anxiety, sleep, or dysbiosis in FM patients. As the authors discovered that MPT might be an alternative approach for pain-related conditions, it was sought whether MPT could be effective in treating FM's physical and psychological symptoms.
Therefore, this herein study aimed to assess the effects of three sessions on MPT FM patients, specifically the effects on depression, anxiety, sleep disorders, and dysbiosis symptoms.
Materials and Methods
This study is an open-label single-arm interventional prospective study that included 12 FM female subjects over 18 years old. All these patients fulfilled the 2010 American College of Rheumatology (ACR) criteria. 2
Inclusion criteria were FM diagnosis, age equal to or above 18 years old, and female gender. In addition, exclusion criteria included antidepressants, anxiolytics, hypnotics, or sleep inductors in the past 3 months. Using alternative and complementary therapies was not permitted to confirm the specific action of the MPT.
The evaluation of standardized ACR tender points tested was done by digital pressure, and they were positive if at least 11 of the 18 pre-established points were found. 2 The tender points were used to help determine the FM diagnosis and measure before and after the treatment. The depressive assessment was considered using the Beck depression inventory, a standard questionnaire to screen for depression and normal values <10. When values are >10, there is possibly the presence of depression symptoms. 10 The Beck anxiety inventory evaluated anxiety, and the expected values were those <8. 10 The Visual Analog Scale for pain quantification is widely used in research.
Values vary from 0 to 10 mm, lower scores represent low pain levels, and higher scores are related to higher pain levels. 11 Sleep quality was measured by the Pittsburgh Sleep Quality Index, the normal values of which are those <7.12,13 The following tests were performed on FM patients to exclude the presence of other diseases, and they included cell blood count and blood biochemistry, erythrocyte sedimentation rate, C-reactive protein, protein electrophoresis, creatine kinase, and thyroid hormones. All patients were normal for these tests.
Patients were evaluated at preintervention and 3 months after MPT treatment. All patients received three sessions of MPT, one session per month.
Application of MPT
Three sessions of MPT were conducted, with a period of 30 days for each session. MPT was conducted globally. The sessions lasted, on average, 30–45 min, during which the therapist performed a micropalpation technique to identify the origin of the pain and stimulate self-healing. However, each patient displayed a specific principal etiology. This primary cause triggered a trauma cascade involving numerous levels. Glandular, neurologic, and musculoskeletal tissues were often associated with a single cause. After modifying the actual etiology involved, the tissues' vitality was re-established by micropalpation. All data were obtained before and after 1 month of the third intervention. MPT sessions were always conducted by the same physiotherapist. 14
Statistical analysis
Results are presented as means ± standard deviation or percentages. Statistical analysis was executed using GraphPad InStat version 2.00 software, and a Mann–Whitney t-test was used to compare the values. Significant results were considered when p < 0.05.
Results
Of the 30 patients screened, 18 were excluded since they used antidepressants, anxiolytics, or sleep drugs. Twelve FM patients were included in this study. The mean age was 50.8 ± 11.8 years old. The FM duration had a median time of 2 years (from 3 months to 10 years). Black/Mulatto/African descendant was seen in 75%, and 25% were Caucasians (Table 1).
Demographic Data from the Studied Fibromyalgia Patients
Two (50%) patients had these alterations regarding medical comorbidities: one had dyslipidemia and the other had systemic arterial hypertension and dyslipidemia.
At the moment of the first evaluation, all FM patients had 18 positive tender points. Furthermore, Beck's anxiety questionnaire had a mean value of 21.2 ± 8.8, and Beck's inventory of 18.6 ± 7.2. The dysbiosis questionnaire revealed 13.3 ± 7.3 points, and the Pittsburgh scale was 12.4 ± 4.1.
Analysis of the parameters after 3 months revealed no significant differences in Beck anxiety questionnaire (21.3 ± 8.8 vs. 18.7 ± 11.7, p = 0.57), tender point counting (18 ± 0.0 vs. 17.0 ± 4.5, p = 0.35), in Beck depression questionnaire (18.6 ± 7.2 vs. 18.1 ± 6.0, p = 0.86), dysbiosis questionnaire (13.3 ± 5.7 vs. 15.7 ± 5.9, p = 0.38), and also Pittsburgh evaluation scale (12.0 ± 3.0 vs. 12.4 ± 4.1, p = 0.82) (Table 2).
Beck Anxiety and Depression, Pittsburg, and Dysbiosis Questionnaires Compare Fibromyalgia Patients Pre- and Postmicrophysiotherapy
Data are presented as mean ± standard deviation.
Mann–Whitney t-test was used to compare the values.
MPT, microphysiotherapy.
Interestingly, however, one of the patients significantly improved her clinical picture after MPT. She had a marked reduction of tender points from 18 to 2, normalization of the Beck anxiety questionnaire from 10 to 6, a decrease in the Beck depression scale from 18 to 13, dysbiosis counting from 13 to 8, and Pittsburgh evaluation scale from 14 to 8.
Discussion
This study evaluated for the first time the use of MPT in FM patients and did not find significant differences after this treatment.
The benefits of this study were the exclusive inclusion of FM patients who met the international FM criteria. 2 In addition, only women were included in this trial. In this manner, it is known that FM affects a more significant number of women than the other gender, thus corroborating the results found.
The MPT principles are based on human embryology. The experts in this field believe that as the visceral and muscle tissues originated from the same embryological structures, the muscular lesion is always associated with a related visceral disease and vice versa. 14
Furthermore, MPT is a technique that intends to recognize the significant origin of a symptom or disease and stimulate its self-healing. Micropalpations may mobilize and stimulate different body tissues. Both hands execute movements of light approach and separation to investigate the perception between the hands. Using the tenderness of the palpation and the body's position, it is possible for the therapist to note whether the life rhythm is healthy or not. The authors believe that physical therapists can differentiate the type of aggression involved in a particular symptom.
A pathologic scar occupies the place when the aggression is intense, leading to memorizing the injury. A correction gesture is applied to the pathologic scar. Micropalpation can then perceive the alterations and perform the needed corrections that lead to the cure of the pathologic process. 14
Interestingly, satisfactory and meaningful therapeutic responses could not attained within three concise sections of MPT treatment. Therefore, the patients did not note a significant improvement in their psychological symptoms of depression and anxiety, and also dysbiosis symptoms did not improve. Some possibilities are that MPT does not work specifically in FM patients or the profile of patients included is not adequate for this technique. Regarding the patient who expressively improved, other explanations for these results out of MPT are possible, although they could not be found in this patient. It might include natural history with rare-to-see FM patients with spontaneous remission, or even she had received another treatment and did not tell us.
This study had a few limitations, including the relatively small number of patients and the exceptionally short observation period of 3 months. In this regard, further studies, including many FM patients, need to be done shortly to confirm the results. In addition, the inclusion of the patients at the very early beginning of the disease may have a different effect.
This study has found, for the first time, to the best of the authors' knowledge, that MPT does not seem to be efficient in FM patients regarding the treatment of depression, anxiety, sleep disorders, and dysbiosis symptoms. However, more studies with a more significant number of participants are required to endorse these results.
Ethical Statement
The authors declare that they followed Helsinki's World Medical Association Declaration in this study. Informed consent was obtained from the patients for publication of their cases. No image of them is used. The ethical committee from the Federal University of Bahia approved this study.
Footnotes
Authors' Contributions
T.D.R.d.M. contributed to data collection and revision. J.F.d.C. was involved in conception of the study, data analysis, writing, revision, and submission.
Author Disclosure Statement
None of the authors has any conflicts of interest to declare.
Funding Information
No funding was received for this article.