Adding Spinal Manipulation to Pharmacologic Management of Fibromyalgia

Elderly woman in pain massaging her shoulder

Fibromyalgia (FM) is a chronic condition that is characterized by widespread pain, decreased pain threshold, fatigue, sleep disturbances, cognitive dysfunction, and other somatic symptoms. FM patients are typically provided a combination of pharmacological and nonpharmacological treatments, including analgesics, antiepileptics, antidepressants, exercise, cognitive behavioral therapy, physical therapies, relaxation techniques, and patient education.
 
It has been suggested that FM patients have difficulties processing pain and other sensations in the central nervous system, and it has been shown that associated maladaptive plastic changes occur in the central nervous system, known as central sensitization. Our chiropractic colleague Dr. Carlos Gevers-Montoro and colleagues have proposed that spinal manipulation may be useful in the treatment of FM by normalizing these maladaptive changes. Nevertheless, spinal manipulation was not recommended for FM by the European Alliance of Associations for Rheumatology in 2016 because of low quality research and studies completed after these recommendations were published were also considered to be of low quality.
 
Studies that use a “nonintervention group” as a control rather than a sham or placebo group are inherently biased in favor of the intervention arm. Therefore, this randomized trial used a unique sham treatment to test the true therapeutic and nonspecific effects of spinal manipulation on FM.
 
The study’s hypothesis was that spinal manipulation is an effective additional treatment for pain intensity in FM and the effect has a true therapeutic component that is superior to placebo. The effectiveness of spinal manipulation on several secondary outcomes was also evaluated, including tenderness, functionality, extent of pain, and severity of the disease.

Comment from Dr. Thistle:

Fibromyalgia is a complex condition, and it is unlikely that these patients will find a singular treatment method that works wonders for them. So, as we see in practice all the time, it is normally a multimodal approach that helps these patients the most. The results of this study suggest that SMT could be a valuable addition to usual, pharmacological care, and that longer treatment trials are warranted to better reflect how we would normally manage this condition over the longer term.

RESEARCH REVIEW: Effectiveness of Spinal Manipulation Combined with Pharmacological Treatment for Fibromyalgia

This paper was published in PM&R 2023

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