Context: Fibromyalgia is a prevalent musculoskeletal disorder associated with widespread mechanical tenderness, fatigue, non-refreshing sleep, depressed mood and pervasive dysfunction of the autonomic nervous system: tachycardia, postural intolerance, Raynaud’s phenomenon and diarrhoea.
Objective: To determine the effects of craniosacral therapy on sensitive tender points and heart rate variability in patients with fibromyalgia.
Design: A randomized controlled trial.
Subjects: Ninety-two patients with fibromyalgia were randomly assigned to an intervention group or placebo group.
Interventions: Patients received treatments for 20 weeks. The intervention group underwent a craniosacral therapy protocol and the placebo group received sham treatment with disconnected magnetotherapy equipment.
Main measures: Pain intensity levels were determined by evaluating tender points, and heart rate variability was recorded by 24-hour Holter monitoring.
Results: After 20 weeks of treatment, the intervention group showed significant reduction in pain at 13 of the 18 tender points (P < 0.05). Significant differences in temporal standard deviation of RR segments, root mean square deviation of temporal standard deviation of RR segments and clinical global impression of improvement versus baseline values were observed in the intervention group but not in the placebo group. At two months and one year post therapy, the intervention group showed significant differences versus baseline in tender points at left occiput, left-side lower cervical, left epicondyle and left greater trochanter and significant differences in temporal standard deviation of RR segments, root mean square deviation of temporal standard deviation of RR segments and clinical global impression of improvement.
Conclusion: Craniosacral therapy improved medium-term pain symptoms in patients with fibromyalgia.
Get full access to this article
View all access options for this article.
References
1.
BennetRM. Emerging concepts in the neurobiologic of chronic pain: evidence of abnormal sensory processing in fibromyalgia. Mayo Clin Proc1999; 74: 385–98.
2.
StaudRVierckCJCannonRL. Abnormal sensitization and temporal summation of second pain (wind-up) in patients with fibromyalgia syndrome. Pain2001; 91: 165–75.
3.
BennetR. Rheumatic disease clinics of North America. Philadelphia: Saunders, 2002.
4.
SharpeMCarsonA. ‘Unexplained’ somatic symptoms, functional syndromes, and somatization: do we need a paradigm shift?Ann Intern Med2001; 134: 926–30.
5.
RusellIJOrrMDLittmanB. Elevated cerebrospinal fluid levels of substance P in patients with fibromyalgia syndrome. Arthritis Rheum1994; 37: 1593–601.
6.
Martínez-LavínMHermosilloAG. Autonomic nervous system dysfunction may explain the multisystem features of fibromyalgia. Semin Arthritis Rheum2000; 29: 197–9.
7.
RajSRBrouillardDSimpsonCS. Dysautonomia among patients with fibromyalgia: a noninvasive assessment. J Rheumatol2000; 27: 2660–5.
8.
KarasBGrubbBPBoehmKKipK. The posural orthostatic tachycardia syndrome: a potentially treatable cause of chronic fatigue, exercise tolerance, and cognitive impairment in adolescents. Pacing Clin Electrophysiol2000; 23: 344–51.
9.
CohenHNeumannLShoreM. Autonomic dysfunction in patients with fibromyalgia: application of power spectral analysis of heart rate variability. Semin Arthritis Rheum2000; 29: 217–27.
10.
CohenHNeumannLAlhosshleA. Abnormal sympathovagal balance in men with fibromyalgia. J Rheumatol2001; 28: 581–9.
11.
Martínez-LavínMHermosilloAGRosasMSotoME. Circadian studies of autonomic nervous balance in patients with fibromyalgia. A heart rate variability analysis. Arthritis Rheum1998; 41: 1966–71.
12.
StaudR. Heart rate variability as a biomarker of fibromyalgia syndrome. Fut Rheumatol2008; 3: 475–83.
13.
VaeroyHQiaoZMorkridLForreO. Altered sympathetic nervous system response in patients with fibromyalgia. J Rheumatol1989; 16: 1460–5.
14.
ElamMJohanssonGWallinBG. Do patients with primary fibromyalgia have an altered muscle sympathetic nerve activity?Pain1992; 48: 371–5.
15.
BluntKLRajwarriMHGuerrieroRC. The effectiveness of chiropractic management of fibromyalgia patients: a pilot study. J Manip Physiol Ther1997; 20: 389–99.
16.
HamsGHamsF. A combined ischemic compression and spinal manipulation in the treatment of fibromyalgia: a preliminary estimate of dose and efficacy. J Manip Physiol Ther.2000; 23: 225–30.
17.
SinghBBWuWSHwangSH. Effectiveness of acupuncture in the treatment of fibromyalgia. Altern Ther Health Med2006; 12: 34–41.
18.
MasseyPB. Reduction of fibromyalgia symptoms through intravenous nutrient therapy: results of a pilot clinical trial. Altern Ther Health Med2007; 13: 32–4.
19.
SinghBBKhorsanRVinjamurySP. Influence of comorbidities on improvement of fibromyalgia symptoms when treated with acupuncture: a short report. Altern Ther Health Med2008; 14: 24–5.
20.
HackGKoritzerRRobinsonW. Anatomic relationship between rectus capitis posterior minor muscle and the dura mater. Spine (Phila Pa 1976)1995; 20: 2484–6.
21.
ChaitowL. Fibromyalgia syndrome. A practitioneŕs guide to treatment. London: Churchill Livingstone, 2003.
22.
UpledgerJ. Your inner physician and you: craniosacral therapy and somato emotional release. Seattle: Publishers Group West, 1997.
SmytheH. The Symptom Intensity Scale, fibromyalgia, and the meaning of fibromyalgia like symptoms. A review. J Rheumatol2006; 33: 2113–14.
27.
MenseSSimonsD. Muscle pain. Philadelphia: Lippincott, Williams and Wilkins, 2001.
28.
ArnoldLMLuYCroffordLJ. A double-blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Arthritis Rheum2004; 50: 2974–84.
29.
ZijlstraTRVan de LaarMAFJBernelot MoensHJ. Spa treatment for primary fibromyalgia syndrome: a combination of thalassotherapy, exercise and patient education improves symptoms and quality of life. Rheumatology (Oxford)2005; 44: 539–46.
30.
MasonLWGoolkasianPMcCainGA. Evaluation of a multimodal treatment programme for fibromyalgia. J Behav Med1998; 21: 163–78.
31.
BuckelewSPHuyserBHewettJE. Self-efficacy predicting outcome among fibromyalgia subjects. Arthritis Care Res1996; 9: 97–104.
32.
FitzcharlesMAAlmahreziAWareMA. Clinical profile of rheumatic disease patients referred to a multidisciplinary pain center. J Rheumatol2004; 31: 359–63.
33.
HoldcraftLCAssefiNBuchwaldD. Complementary and alternative medicine in fibromyalgia and related syndromes. Best Pract Res Clin Rheumatol2003; 17: 667–83.
34.
Matarán-PeñarrochaGACastro-SánchezAMGarcíaGC. Influence of craniosacral therapy on anxiety, depression and quality of life in patients with fibromyalgia. Evid Based Complement Alternat Med2009, doi: 10.1093/ecam/nep125.
35.
BaranowskyJKlosePMusialF. Qualitative systemic review of randomized controlled trials on complementary and alternative medicine treatments in fibromyalgia. Rheumatol Int2009; 30: 1–21.
36.
FrancoJAPecciC. Physician–patient relationship, scientific medicine and alternative therapies. Medicina (B Aires)2003; 63: 111–18.
37.
TravellJGSimonsDG. Myofascial pain and dysfunction: the trigger point manual. Baltimore: William and Wilkins, 1983.
38.
HainsGHainsF. Combined ischemic compression and spinal manipulation in the treatment of fibromyalgia: a preliminary estimate of dose and efficacy. J Manip Physiol Ther2000; 23: 225–30.
39.
StrobelESWildJMüllerW. Interdisciplinary group therapy for fibromyalgia. Z Rheumatol1998; 57: 89–94.
40.
BerkerEDincerN. Chronic pain and rehabilitation. Agri2005; 17: 10–16.
41.
AstinJABermanBMBausellB. The efficacy of mindfulness meditation plus Qigong movement therapy in the treatment of fibromyalgia: a randomizedcontrolled trial. J Rheumatol2003; 30: 2257–62.
42.
MasonLWGoolkasianPMcCainGA. Evaluation of a multimodal treatment programme for fibromyalgia. J Behav Med1998; 21: 163–78.
43.
LemstraMOlszynskiWP. The effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia. Clin J Pain2005; 21: 166–74.
44.
DinlerMDiracogluDKasikciogluE. Effect of aerobic exercise training on oxygen uptake and kinetics in patients with fibromyalgia. Rheumatol Int2009; 30: 281–4.
