Fibromyalgia and Chiropractic

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Overview of Chiropractic

The focus of chiropractic care is on disorders of the musculoskeletal and nervous systems within the body, and the impact that these disorders have on overall health and wellbeing. It utilizes a drug-free, hands-on approach that involves examination, diagnosis, and treatment. Chiropractic care is frequently used to treat ailments such as back and neck pain, and pain in the elbows, knees, and hips. It can also be used to treat headaches. Practitioners are referred to as Doctors of Chiropractic, chiropractors, or chiropractic physicians.

Spinal manipulation (also referred to as “chiropractic adjustment”) is one of the most common therapeutic procedures performed by chiropractors. The idea behind this type of treatment is to restore the natural mobility of the joints through the manual application of controlled force. Spinal manipulation is used when joints experience restricted movement due to injury to the surrounding tissues. This injury can be the result of a trauma, such as improperly lifting something heavy, or through repetitive stress, such as lying in an awkward position or constant poor posture. Regardless of the cause, when tissues are injured they undergo physical and chemical changes that cause inflammation, pain and reduced functioning. By adjusting the joints, mobility is restored, alleviating pain and tightness and allowing the surrounding tissues to heal.

In addition to spinal manipulation, some chiropractors also utilize other methods of treatment, including muscle therapy, acupuncture, and dietary therapies as part of a comprehensive approach to treat the musculoskeletal problems of their patients.

In some circles of the medical community, chiropractic is regarded as inferior to traditional medicine. Conversely, some physicians recommend chiropractic as an additional layer of treatment for patients with certain conditions, and frequently involve chiropractic as part of a multidisciplinary approach to treat illness and injury. Individual testimonies for and against chiropractic abound, with some people obtaining substantial relief from symptoms while others have received little or no benefit. Although the true benefit of chiropractic therapy is not universally accepted, many individuals do experience relief from their symptoms, including some individuals with Fibromyalgia. As such, it is important to weigh the usefulness of chiropractic as a component of therapy for Fibromyalgia patients.

Research Studies Regarding the Effectiveness of Chiropractic to Treat Fibromyalgia

The mission of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) is to “provide consistent and widely adopted chiropractic practice information, to perpetually distribute and update these data as necessary, so that consumers and others have reliable information on which to base informed health care decisions.” (CCGPP Clinical Practice Recommendations).

As part of a large effort to evaluate and report on the available evidence regarding the use of chiropractic in the treatment of Fibromyalgia, the CCGPP reviewed 55 studies on a variety of non-drug therapies for Fibromyalgia, including chiropractic, acupuncture, nutritional/health supplements, and massage. The findings were reported in a 2009 article by Schneider et al. Based on their comprehensive review of the available studies, the researchers determined that there is strong evidence to support the use of aerobic exercise and cognitive behavioral therapy as treatments for Fibromyalgia. Cognitive behavioral therapy is a type of psychological therapy that helps patients understand how their thoughts and feelings affect their behavior and associated conditions. The researchers discovered that there is moderate evidence to support the use of massage therapy, muscle strength training (i.e., lifting weights, etc.), acupuncture, and spa therapy as treatment for Fibromyalgia. Finally, they found that there was very minimal evidence in the literature that suggested chiropractic, vitamins, herbs, and diet modifications were effective means of treating Fibromyalgia.

A review by Ernst in 2009 reviewed randomized clinical trials (a study design regarded as the “gold standard” for research studies) that evaluated how effective chiropractic was as a means of treatment for Fibromyalgia. Although the author found no evidence in any of the three studies reviewed to support the use of chiropractic for treatment of Fibromyalgia, he did note that the methodologies of the studies were flawed, which may have had an impact on their ability to demonstrate effectiveness. In addition, as with any literature review, the studies he examined were required to meet certain inclusion criteria, therefore some research was not included in the review. Regardless, the author concluded that there is insufficient evidence to support the use of chiropractic to treat Fibromyalgia (Ernst, 2009).

A recent (2011) review by Terry et al. sought to critically evaluate other systematic reviews of “complementary and alternative medicine” (CAM) therapies used as treatment for Fibromyalgia. After excluding those reviews that did not meet the inclusion criteria, five review articles were evaluated. These articles encompassed evaluations of homoeopathy, chiropractic, acupuncture, hydrotherapy, and massage. Evidence was found to support all therapies except chiropractic as treatment for Fibromyalgia.

Despite the fact that many individual studies do not support the use of chiropractic as a treatment for Fibromyalgia, some studies have demonstrated the effectiveness of chiropractic as a treatment for conditions that are closely linked to Fibromyalgia, including Myofascial pain syndrome (increased pain, muscle tenderness, and decreased range of motion in the head, neck, arms, legs, shoulder and lower back). Furthermore, many chiropractors also utilize massage therapy, acupressure, and other complementary and alternative therapies that do have evidence to support their use for Fibromyalgia. As such, the ability to review the effectiveness of chiropractic therapy in a general sense is complicated, and makes generalizing support for or against its use in Fibromyalgia problematic. Individuals should make their own judgment with regard to incorporating chiropractic into their treatment plans. If you have questions regarding the findings from these or any other chiropractic study, be sure and voice them to your chiropractor so that he or she can address them.

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References

1.        http://www.ccgpp.org/downloads/chiropractic_management_Fibromyalgia.pdf

2.        Schneider M, Vernon H, Ko G, Lawson G, Perera J. Chiropractic management of Fibromyalgia syndrome: a systematic review of the literature. J Manip Phys Therap. 2009;23(1):25-40.

3.        Ernst E. Chiropractic treatment for Fibromyalgia: a systematic review. Clin Rheumatol. 2009;28(10);1175-1178.

4.   Terry R, Perry R, Ernst E. An overview of systematic reviews of complementary and alternative medicine for

       Fibromyalgia. Clin Rheumatol. 2011;May26. Epub ahead of print.\

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