RESEARCH SUPPORTS THE FIBRO FIVE FIBROMYALGIA TREATMENT PROGRAM

The Fibro Five program is based on several key pieces of research into fibromyalgia and chronic pain. These studies suggest that five treatments, within a certain time period, using certain techniques, along with understanding how pain works, can have positive effect on the lives of fibromyalgia and chronic pain patients.

PREVIOUS STUDIES SUGGESTED MASSAGE THERAPY DIDN’T HELP

hgThe effect of massage on fibromyalgia has been studied before, with mixed results. In fact, there have been a great number of studies, with differing numbers of patients involved, all looking at slightly different aspects of either fibromyalgia, or massage (such as different techniques, differing amounts of treatment). Unsurprisingly, these studies all returned different results - some saying massage helped a little, some saying massage didn’t really make any difference. For instance, this one from 2012, by a scientist called Winkleman, said that “moderate exercise” was good, and massage - as well as other techniques - was “not recommended”.

A 2014 REVIEW STUDY FOUND THAT ACTUALLY, RESEARCH SHOWED MASSAGE THERAPY COULD HELP…BUT YOU NEED TO HAVE AT LEAST FIVE WEEKS TREATMENT.

However, in 2014, a team of scientists led by Yan-hui Li, carried out a “review and analysis study” to try and amalgamate all the research. They looked at studies going all the way back to 1996, but carefully selected which research to look at. Some research had tried to combine massage therapy and other treatments like chiropractic treatment. These studies were rejected - Li’s team only wanted to look at research where massage alone was tried.

Much of the research Li’s team looked at seemed to suggest that massage wouldn’t help - or would only help a little.

Li’s team re-examined all the findings, and found that actually, what all the research showed when looked at together, was that “massage therapy with duration of (equal to or more than) 5 weeks had beneficial immediate effects on improving pain, anxiety and depression in patients with FM.” (fibromyalgia).

What Li’s team realised was that when massage techniques other than “Swedish massage” were looked at, and a number of treatments were looked at, there was an improvement.

In fact, Li’s team thought the improvement was so great that they said “massage therapy should be one of the viable complementary and alternative treatments for FM

You can read Li’s study here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/

NOT ALL TYPES OF MASSAGE MAKE A DIFFERENCE…AND SWEDISH MASSAGE DOESN’T HELP AT ALL

This is a really important study, and links to what Li’s team found.

In 2015, a team of researchers led by S Yuan looked at studies into massage and fibromyalgia. Their study was much more recent than the studies that had been carried out by people like Winkleman. They found that only some types of massage helped.

The first type of massage that Yuan’s team discussed was myofascial release. They said had it had “large, positive effects on pain and medium effects on anxiety and depression at the end of treatment”, and also that “effects on pain and depression were maintained in the medium and short term, respectively”.

The second type of massage that Yuan’s team discussed was connective tissue massage. They found this could help with stiffness, depression and quality of life.

The third type of massage that Yuan’s team discussed was manual lymphatic drainage massage - which they thought was better than connective tissue massage (this might be because connective tissue massage can be quite an uncomfortable experience).

Yuan’s team were very dismissive of Swedish massage (this is the type of relaxing massage you might get in a spa, or offered by low quality / poorly trained massage therapists as “sports massage”). They said, very bluntly: “Swedish massage does not improve outcomes.

You can read a summary of Yuan’s study here: https://www.ncbi.nlm.nih.gov/pubmed/25457196

ANOTHER STUDY AGREED THAT DIFFERENT TYPES OF MASSAGE HAD DIFFERENT EFFECTS

Yuan’s team weren’t the first people to suggest that different types of massage had different effects. In 2013, a study by a doctor named Ginevra Liptan and their team had tested both Swedish massage on one group of patients with fibromyalgia, and myofascial release on another group. While both groups reported feeling better, only the myofascial release group reported “consistent pain reductions in the neck and upper back regions”. There were no consistent results with the Swedish massage group.

A summary of Liptan’s study is at: https://www.sciencedirect.com/science/article/pii/S1360859212002409

IT’S NOT A ONE SIZE FITS ALL SOLUTION…AND ADDING OTHER TECHNIQUES MIGHT HELP

As far back as 2005, the Journal of Rheumatology was suggesting that, when it came to fibromyalgia, complementary therapies, including “exercise, physical therapy, massage, acupuncture, and cognitive behavioral therapy, can be helpful”, although the author was quick to state that the studies didn’t suggest clear cut benefits (possibly because effects could not be “accurately” measured)

However, the Journal went on to say that “multimodal individualized treatment programs may be necessary to achieve optimal outcomes in patients with this syndrome.” - or in other words, fibromyalgia patients need individualised programs that cover a variety of treatments.

You can read the brief article from the Journal here: https://www.ncbi.nlm.nih.gov/pubmed/16078356

The Annals Of The New York Academy Of Sciences felt the same five years later, saying “it is useful if not essential to tailor the choice of treatment components to the needs of individual patients.”

You can read the article from them here: https://www.ncbi.nlm.nih.gov/pubmed/20398013

PEOPLE WITH FIBROMYALGIA FEEL PAIN DIFFERENTLY FROM OTHER PEOPLE

Studies in animals have repeatedly shown that when animals get stressed, they feel less pain; this is called stress-induced analgesia (SIA). However, until 2019, this hadn’t been tried on people with chronic musculoskeletal pain (like fibromyalgia). Researchers put both people with and without chronic musculoskeletal pain under “cognitive stress”, and found (perhaps unsurprisingly) that after being stressed, people in the chronic pain group felt more pain than people in the other group.

You can read this study from 2019 here: https://arxiv.org/abs/1902.07795#

This is similar to what was found by researchers looking at the effects of exercise on fibromyalgia. In people without chronic pain conditions, exercise causes an effect called exercise induced hypoalglasia (EIH), which is a reduced sensitivity to pain. It’s not difficult to imagine how useful that would be for patients with chronic pain. A team of researchers led by David Rice examined carried out a review of research into chronic pain and EIH.

Rice’s review found that people with chronic pain either felt no reduction in pain, or an increase in pain, upon exercising. Unsurprisingly, these people would then stop exercising.

…BUT THEY CAN FEEL A REDUCTION IN PAIN WHEN THINGS ARE EXPLAINED

Importantly, however, Rice’s team also discovered that the research showed that if subjects were made aware of the fact it might hurt, understood why this was, but also understood that it might stop hurting if they could carry on through, then they would often experience EIH…as well as other benefits from exercise such as improved fitness and mental well being. As is very common with chronic pain, once again the best effects seem to follow when things are explained!

You can read the full study at https://www.jpain.org/article/S1526-5900(18)30456-5/fulltext

PAIN ISN’T JUST ABOUT WHAT YOU FEEL, IT’S WHAT YOU THINK, TOO.

In 2010, a scientist named Bussing looked at strategies for coping with chronic pain in conjunction with how people viewed their lives with chronic pain. This would have been a bold study in 2010!

Busssing concluded his study by saying: “apart from effective pain management, a comprehensive approach is needed which enhances the psycho-spiritual well-being, i.e. self-awareness, coping and adjusting effectively with stress, relationships, sense of faith, sense of empowerment and confidence, and living with meaning and hope.”

Of course, there is often a problem with effective pain management for people with chronic pain, but his study is useful for how it links physical pain, stress and “living with meaning”. You can read his study here: https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-10-507

THE IMPORTANCE OF PAIN SCIENCE TO CHRONIC PAIN

While some scientists have looked at how pain affects the body, other scientists have started to look at how pain affects the brain, and what pain actually is. This branch of research is known as “pain science”, and it’s findings have been quite startling.

Pain used to be seen as a sign that something (a muscle, a joint, some tissues) was damaged. Pain science shows us that actually, pain is an incredibly sensitive protection mechanism used by your brain to stop you from hurting yourself. Essentially, if the brain thinks part of you is in danger, it makes that part hurt in order to protect you - and you don’t have any control over that.

PAIN SCIENCE DOESN’T SAY “PAIN IS IN YOUR HEAD”

That’s not the same as saying that pain isn’t real, or “it’s in your head” - if you can feel the pain then it’s real! For people with chronic pain, science has also found out that if the brain is exposed to pain for a long time, the brain becomes more sensitive to danger, seeing it in more places. Your brain goes on to lower your sensitivity to pain so that you feel pain earlier, because it becomes more worried about further injury being caused.

Some scientists took the approach that if pain was a protective mechanism, perhaps the brain could learn not to be as protective, and started studying this idea. What they discovered was that if people understood how their pain worked, they would - over time - feel less pain. One particular study from 2011, by scientists in Australia led by A Louw, found that “for chronic MSK (musculoskeletal) pain disorders, there is compelling evidence that an educational strategy addressing neurophysiology and neurobiology of pain can have a positive effect on pain, disability, catastrophization, and physical performance.”

Louw’s study used a book called “Explain Pain”, and it is the Explain Pain approach that the Fibro Five program uses. You can read Louw’s 2011 study here: https://www.ncbi.nlm.nih.gov/pubmed/22133255

COMBINING PAIN SCIENCE AND MANUAL THERAPY PRODUCES BETTER OUTCOMES

Science can move quite slowly sometimes, but in 2016 some more studies were carried out. A literature review carried out by Puentedura and Flynn looked at what happened if you combined pain science education with manual therapy. They found “that as well as producing local mechanical effects, providing manual therapy within a PNE (pain education) context can be seen as meeting or perhaps enhancing patient expectations, and also refreshing or sharpening body schema maps within the brain. Ideally, all of this should lead to better outcomes in patients with CLBP (chronic lower back pain)”.

You can find Puentedura and Flynn’s review here: https://www.ncbi.nlm.nih.gov/pubmed/27362980.

Louw also carried out another study in 2016, where his results were very similar to his 2011 study. This time he said that “current evidence supports the use of PNE (pain education) for chronic MSK (musculoskeletal) disorders in reducing pain and improving patient knowledge of pain, improving function and lowering disability, reducing psychosocial factors, enhancing movement, and minimizing healthcare utilization”.

You can read Louw’s 2016 study here: https://www.ncbi.nlm.nih.gov/pubmed/27351541

Lowe’s 2016 study mentions “psychosocial factors”. This is part of the new model of pain put forward by pain scientists. They suggest that rather than pain being influenced purely by the body (biological), it is also influenced by psychological and social factors, and that it is in the intersection between the biological, the psychological and the social that health exists.

Once again, this might seem to come perilously close to the suggestion of “it’s all in your head”. One leading pain scientist, Professor Moseley, puts forward the example that if you were being chased by a tiger, you wouldn’t be paying attention to your back pain - and this demonstrates the idea pretty well. Or perhaps you might prefer to think - if your numbers came up on the lottery, would your painful knee stop you from running to the phone to call Camelot to tell them you had the winning ticket?

MOVING TO A BIOPSYCHOSOCIAL MODEL OF PAIN HELPS YOU LIVE A BETTER LIFE

It is not always easy to move to a biopsychosocial model of understanding pain. It means turning a lot of what we think we “know” about pain on it’s head, and changing these thoughts can be a slow process. But research shows us that it is a vital part of living well with chronic or persistent pain.

For more information about how this all works, the best place to start reading is the Body In Mind website, which is all about how the body understands pain.

UNDERSTANDING PAIN WON’T CURE CHRONIC PAIN

It is important to be realistic. Moving to a biopsychosocial model of pain, adapting and re-framing your thinking, using mindfulness and coaching to become more positive about your pain won’t stop you from having flare ups….but it can minimise them. The Fibro Five program won’t cure your fibromyalgia or chronic pain, but science suggests that for most people, it can help you have better days more often, and your flare ups occur less, and be less debilitating when they do.