Fibromyalgia and massage therapy

You can find the video after the text

Some people with fibromyalgia think that their pain is due to tense or stiff muscles. To relax the muscles they try massage therapy. However, massage therapy aggravates the pain for many with fibromyalgia. In this video, I’ll tell you why.

My name is Andreas Persson and I am a physiotherapist and specialist in pain and pain rehabilitation. What I say in the film can be found in text form together with references to the scientific literature that the things I say are based on. The link is in the description.

Many people who work in healthcare and even some who have long-term pain themselves, believe that the pain in fibromyalgia and other long-term pain conditions is due to tense muscles. Recent years’ research shows, however, that pain has other causes, namely various changes in the body’s pain regulation system.(1)

Some people with fibromyalgia experience that their muscles feel stiff and tense.(2-4) In most cases, this feeling is probably created by changes in the pain system, in the central nervous system, and not by the fact that the joints and muscles are stiff or tense. Studies have been done where mobility in the joints and muscle activity of those with fibromyalgia and other similar pain conditions have been measured. In the studies, it has not been possible to see that those affected are stiffer or have more activated or tense muscles in general than pain-free controls. (5-7)

It is still common for people with fibromyalgia to get a massage. And for some, it feels better. They feel more relaxed, less stressed, and may even get some pain relief. But for others, the treatment results in more pain, both during the treatment and afterward.

To explain why some people get more pain, we need to look at Åke and his pain system. Here we can see what happens if an apple falls on the arm so that it hurts. Signals are sent via specific pain nerves in the body, into the spinal cord, are switched over to knew nerves, and are forwarded to the brain stem and the brain, which creates the experience of pain.

To see more clearly what is happening, we have to look at this somewhat more abstract model of the nervous system. In this model, we see how pain signals enter the spinal cord, are forwarded to the brainstem and the brain.

But when it comes to lighter stimulation of the body that does not normally hurt. For example, touch is sent through other nerve fibers in the body than the pain signals. These nerve fibers also send nerve signals to the spinal cord where they are forwarded through other pathways to other places in the brainstem and brain which creates the experience of touch, cold or heat.

Here we see how pain signals travel up into the brain in the model of the pain system. And here we see how the sensory signal travels up through other nerve fibers and other nerve pathways. The reason why massage hurts for those with fibromyalgia is that the sensory signal is transferred over to the pain pathways in the spinal cord which gives the experience of pain in addition to the experience of touch.

As we see here, there are intermediate nerve cells that can both attenuate pain signaling and amplify or initiate pain signals.(8,9) In most people who do not have fibromyalgia, massage provides pain relief because the sensory signaling has a dampening effect on the pain pathways. But in fibromyalgia, the attenuating pathways have reduced function and the amplifying pathways increased function, which explains why many people with fibromyalgia get more pain from the massage.

Does this mean that I advise everyone with fibromyalgia to stop going for massage? No, I do not. If you have fibromyalgia and feel that massage has a predominantly positive effect on your mood and your symptoms, then you should continue. But if you just get more pain, it is often not a good idea to continue, even if someone has said that you have tense muscles and that massage is good for you.

You may have heard that there are softer types of massage that are better suited for those with fibromyalgia. Softer massage certainly works for more people with fibromyalgia than more powerful treatment, but the same applies even then. If you mainly get more pain, there is no point in continuing.

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Referenses

1. Littlejohn G, Guymer E. Key Milestones Contributing to the Understanding of the Mechanisms Underlying Fibromyalgia. Biomedicines. 2020;8(7):223.
2. Hedin PJ, Harnne M, Burckhardt CS, Engström-Laurent A. The Fibromyalgia Impact Questionnaire, a Swedish Translation of a New Tool for Evaluation of the Fibromyalgia Patient. Scand J Rheumatol. 1995;24(2):69-75. 
3. Dierick F, Detrembleur C, Trintignac G, Masquelier E. Nature of passive musculoarticular stiffness increase of ankle in female subjects with fibromyalgia syndrome. Eur J Appl Physiol. 2011;111(9):2163-71. 
4. Kendall SA, Elert J, Ekselius L, Gerdle B. Are perceived muscle tension, electromyographic hyperactivity and personality traits correlated in the fibromyalgia syndrome? J Rehabil Med. 2002;34(2):73-9. 
5. Góes SM, Leite N, Stefanello JMF, Homann D, Lynn SK, Rodacki ALF. Ankle dorsiflexion may play an important role in falls in women with fibromyalgia. Clin Biomech (Bristol, Avon). 2015;30(6):593-8. 
6. Zidar J, Bäckman E, Bengtsson A, Henriksson KG. Quantitative EMG and muscle tension in painful muscles in fibromyalgia. Pain. 1990;40(3):249-54. 
7. Simons GD, Mense S. Understanding and measurement of muscle tone as related to clinical muscle pain. Pain. 1998;75(1):1-17. 
8. Peirs C, Williams SPG, Zhao X, Walsh CE, Gedeon JY, Cagle NE, et al. Dorsal Horn Circuits for Persistent Mechanical Pain. Neuron. 2015;87(4):797-812. 
9. Duan B, Cheng L, Bourane S, Britz O, Padilla C, Garcia-Campmany L, et al. Identification of Spinal Circuits Transmitting and Gating Mechanical Pain. Cell. 2014;159(6):1417-32.