A combination therapy of massage and stretching increases parasympathetic nervous activity and improves joint mobility in patients affected by fibromyalgia — Oak Academic Publishing
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A combination therapy of massage and stretching increases parasympathetic nervous activity and improves joint mobility in patients affected by fibromyalgia
Objective: to investigate how therapeutic mas-sage, combined with stretching, can really con-tribute to the treatment of fibromyalgia (FM) symptoms. Design: Feasibility study. Setting: A single center. Participants: Twenty women having a preexisting diagnosis of FM based on American College of Rheumatology criteria were recruited. Intervention: Subjects received a total of 18 sessions of light massage administered by a physical therapist twice a week and then performed passive stretching exercises. Main out-come measures: heart rate (HR) and Heart Rate variability (HRV), the assessment of joint flexi-bility through elettrogoniometer, the Fibromyal-gia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI), and the Borg scale or Rating of Perceived exertion (RPE). Evalua-tions were conducted at the screening visit (T0), immediately at the end of the session of mas-sage (T1) and after completion of 18 sessions (T2). Results: HRV showed an improvement in terms of decreased sympathetic tone and in-crease of parasympathetic tone at the end of treatment. Also joint flexibility showed a sig-nificant improvement at T2 compared with the screening. FIQ, PSQI, RPE did not change. Conclusions: the findings highlight the excellent compliance of FM patients to the combined therapy of massage and stretching, showing an amelioration of muscle stiffness and an improvement of autonomic nervous system with a decrease of sympathetic tone and an increase of parasympathetic tone. The questionnaires did not show any ameliorations, probably because in these patients the perception of quality of life is distorted compared with more objective pa-rameters, such as muscle rigidity, the articular mobility and the autonomic nervous system.
Wolfe, F., Smythe Smythe, H.A., Yunus, M.B., Bennett, R.M., Bombardier, C., Goldenberg, D.L., Tugwell, P, Campbell, S.M., Abeles, M., Clark, P., Fam, A.G., Farber, S.J., Fiechtner, J.J., Franklin, C.M., Gatter, R.A., Hamaty, D., Lessard, J., Lichtbroun, A.S,. Masi, A.T., McCain, G.A., Reynolds, J., Romano, T.J., Russell, I.J. and Sheon, R.P. (1990) The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Re-port of the multicenter criteria committee. Arthritis Rheum, 33(2),
Ablin, J., Neumann, L. and Buskila, D. (1999) Patho-genesis of fibromyalgia—a review. Joint Bone Spine 2008, 75(3), 273-279.
Berman, B.M., Ezzo, J., Hadhazy, V. and Swyers, J.P. (1999) Is acupuncture effective in the treatment of fi-bromyalgia? Journal of Family Practice, 48(3), 213-218.
Blunt, K.L., Rajwani, M.H. and Guerriero, R.C. (1997) The effectiveness of chiropractic management of fi-bromyalgia patients. Journal of Manipulative and Phy- siological Therapeutics, 20(6), 389-399.
Buckelew, S.P., Conway, R., Parker, J., Deuser, W.E., Read, J., Witty, T.E., Hewett, J.E., Minor, M, Johnson, J.C., Van Male, L., McIntosh, M.J., Nigh, M. and Kay, D.R. (1998) Biofeedback/relaxation training and exercise interventions for fibromyalgia. Arthritis Care & Research, 11(3), 196-209.
Busch, A., Schachter, C.L., Peloso, P.M. and Bombardier, C. (2003) Exercise for treating fibromyalgia syndrome. Evidence-Based Nursing, 6, 50-51.
Singh, B.B., Berman, B.M. and Creamer, P. (1998) A pilot study of cognitive behavioral therapy in fibromyal-gia. Alternative Therapies in Health and Medicine, 4(2), 67-70.
Williams, D.A. (2003) Psychological and behavioral therapies in fibromyalgia and related syndromes. Best Practice & Research Clinical Rheumatology, 17(4), 649- 665.
Field, T.M. (1998) Massage therapy effects. American Psychologist, 53(12), 1270-1281.
Tsao, J.C. (2007) Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review. Evidence- Based Complement Alternative Medicine, 4(2), 165-179.
Hassett, A.L., Radvanski, D.C., Vaschillo, E.G., Vaschillo, B., Sigal, L.H., Karavidas, M.K. Buyske, S. and Lehrer, P.M. (2007) A pilot study of the efficacy of heart rate variability (HRV) biofeedback in patients with fi-bromyalgia. Applied Psychophysiology & Biofeedback, 32, 1-10.
Jentoft, E.S., Kvalvik, A.G. and Mengshoel, A.M. (2001) Effects of pool-based and land-based aerobic exercise on women with fibromyalgia/chronic widespread muscle pain. Arthritis & Rheumatism, 45(1), 42-47.
Sunshine, W., Field, T.M., Quintino, O., Fierro, K., Kuhn, C., Burman, I. and Schanberg, S. (1996) Fibromyalgia benefits from massage therapy and transcutaneous elec-trical stimulation. Journal of Clinical Rheumatology, 2(1), 18-22.
Lund, I., Lundeberg, T., Carleson, J., S?nnerfors, H., Uhrlin, B. and Svensson, E. (2006) Corticotropin releas-ing factor in urine—a possible biochemical marker of fi-bromyalgia. Responses to massage and guided relaxation. Neuroscience Letter, 403(1-2), 166-171.
Field, T., Diego, M., Cullen, C., Hernandez-Reif, M. Sun-shine, W. and Douglas, S. (2002) Fibromyalgia pain and substance P decrease and sleep improves after massage therapy. Journal of Clinical Rheumatology, 8(2), 72-76.
Ekici, G., Bakar, Y., Akbayrak, T. and Yuksel, I. (2009) Comparison of manual lymph drainage therapy and con-nective tissue massage in women with fibromyalgia: A randomized controlled trial. Journal of Manipulative and Physiological Therapeutics, 32(2), 127-133.
Brattberg, G. (1999) Connective tissue massage in the treatment of fibromyalgia. European Journal of Pain, 3(3), 235-244.
Gordon, C., Emiliozzi, C. and Zartarian, M. (2006) Use of a mechanical massage technique in the treatment of fibromyalgia: A preliminary study. Archives of Physical Medicine and Rehabilitation, 87(1), 145-147.
Takamoto, K., Sakai, S., Hori, E., Urakawa, S., Umeno, K., Ono, T. and Nishijo, H. (2009) Compression on trig-ger points in the leg muscle increases parasympathetic nervous activity based on heart rate variability. Journal of Physiological Science, 59(3), 191-197.
Cohen, H., Neumann, L., Shore, M., Amir, M., Cassuto, Y. and Buskila, D. (2000) Autonomic dysfunction in pa-tients with fibromyalgia: Application of power spectral analysis of heart rate variability. Seminars in Arthritis and Rheumatism, 29(4), 217-227.
Martínez-Lavín, M., Hermosillo, A.G., Rosas, M. and Soto, M.E. (1998) Circadian studies of autonomic nerv-ous balance in patients with fibromyalgia: A heart rate variability analysis. Arthritis & Rheumatism, 41(11), 1966-1971.
Vaer?y, H., Qiao, Z.G., M?rkrid, L. and F?rre, O. (1989) Altered sympathetic nervous system response in patients with fibromyalgia(fibrositis syndrome). Journal of Rheu- matology, 16(11), 1460-1465.
Borg, G. (1998) Borg’s perceived exertion and pain scales. Human Kinetics, Stockholm.
Kurz, T. (1994) Stretching Scientifically: A Guide to Flexibility Training. 3rd Edition, Stadion Publishing, Is-land Pond.
Alter, M. (1988) Science of Stretching. Leisure Press, West Point.
Alter, M. (1990) Sport Stretch. Leisure Press, West Point.
Cohen, H., Matar, M.A., Kaplan, Z. and Kotler, M. (1999) Power Spectral analysis of heart rate variability in psy-chiatry. Psychotherapy and Psychosomatics, 68(2), 59- 66.
Kamath, M.V. and Fallen, E.L. (1993) Power spectral analysis of heart rate variability: A noninvasive signature of cardiac autonomic function. Critical Reviews in Bio-medical Engineering, 21(3), 245-311.
Malik, M. and Camm, A.J. (1990) Heart rate variability. Clinical Cardiology, 13, 570-576.
Van Ravenswaaij-Arts, C.M.A., Kollèe, L.A.A., Hopman, J.C.V., Stoelinga, G.B.A. and Van Geijn, H.P. (1993) Heart rate variability. Annals of Internal Medicine, 118, 436-447.
Keary, T.A., Hughes, J.W. and Palmieri, P.A. (2009) Women with posttraumatic stress disorder have larger decreases in heart rate variability during stress tasks. In-ternational Journal of Psychophysiology, 73(3), 257-264.
Licht, C.M., de Geus, E.J., van Dyck, R. and Penninx, B.W. (2009) Association between Anxiety Disorders and Heart Rate Variability in The Netherlands Study of De-pression and Anxiety (NESDA). Psychosomatic Medi-cine, 71, 508-518.
Miu, A.C., Heilman, R.M. and Miclea, M. (2009) Re-duced heart rate variability and vagal tone in anxiety: Trait versus state, and the effects of autogenic training. Autonomic Neuroscience, 145(1-2), 99-103.
Yeragani, V.K., Pohl, R., Berger, R., Balon, R., Ramesh, C., Glitz, D., Srinivasan, K. and Weinberg, P. (1993) De-creased heart rate variability in panic disorder patients: A study of power-spectral analysis of heart rate. Psychiatry Research, 46(1), 89-103.
Jeong, I., Jun, S., Park, S., Jung, S., Shin, T. and Yoon, H. (2008) A Research for evaluation on stress change via thermotherapy and massage. Conference Proceedings of IEEE Engineering in Medicine and Biology Society, 4820-4823.
(1996) Task Force of the European Society of Cardiology and the North American Society of Pacing and Electro-physiology: Heart rate variability. Standards of meas-urement, physiological interpretation, and clinical use. Circulation, 93, 1043-1065.
Burckhardt, C.S., Clark, S.R. and Bennett, R.M. (1991) The fibromyalgia impact questionnaire: Development and validation. Journal of Rheumatology, 18(5), 728- 733.
Sarzi-Puttini, P., Atzeni, F., Fiorini, T., Panni, B., Randisi, G., Turiel, M. and Carrabba, M. (2003) Validation of an Italian version of the Fibromyalgia Impact Questionnaire (FIQ-I). Clinical Experimental Rheumatology, 21(4), 459-464.
Buysse, D.J., Reynolds, C.F. 3rd, Monk, T.H., Berman, S.R. and Kupfer, D.J. (1989) The Pittsburgh Sleep Qual-ity Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213.
Ryf, C. and Weymann, A. (1999) AO neutral-O- method. Thieme, Stuttgart.
Bengtsson, A. and Bengtsson, M. (1988) Regional sym-pathetic blockade in primary fibromyalgia. Pain, 33(2), 161-167.
Cohen, H., Neumann, L., Shore, M., Amir, M., Cassuto, Y. and Buskila, D. (2000) Autonomic dysfunction in pa-tients with fi- bromyalgia: application of power spectral analysis of heart rate variability. Seminars in Arthritis and Rheumatism, 29(4), 217-227.
Lund, N., Bengtsson, A. and Thorborg, P. (1986) Muscle tissue oxygen pressure in primary fibromyalgia. Scandi-navian Journal of Rheumatology, 15(2), 165-173.
Bengtsson, A., Henriksson, K.G. and Larsson, J. (1986) Reduced high-energy phosphate levels in the painful muscles of patients with primary fibromyalgia. Arthritis & Rheumatism, 29(7), 817-821.
Lefkowitz, R., Hoffman, B. and Taylor, P. (1991) Neu-rohumoral transmission: The autonomic and somatic nervous system. In: Goodman-Gilman Arall, T., Ed. The pharmacological basis of therapeutics. International Edi-tion, McGraw-Hill, New York, 84-121.
Yeragani, V.K., Pohl, R., Berger, R., Balon, R., Ramesh, C., Glitz, D., Srinivasan, K. and Weinberg, P. (1993) De-creased heart rate variability in panic disorder patients: A study of power-spectral analysis of heart rate. Psychiatry Research, 46(1), 89-103.
Rechlin, T., Weis, M., Spitzer, A. and Kaschka, W.P. (1994) Are affective disorders associated with alterations of heart rate variability? Journal of Affective Disorders, 32(4), 271-275.
Rechlin, T., Weis, M. and Kaschka, W.P. (1995) Is diur-nal variation of mood associated with parasympathetic activity? Journal of Affective Disorders, 34(3), 249-255.
Cohen, H., Kotler, M., Matar, M.A., Kaplan, Z., Mio-downik, H. and Cassuto, Y. (1997) Power spectral analy-sis of heart rate variability in posttraumatic stress disor-der patients. Biological Psychiatry, 41(5), 627-629.
Reed, B.V. and Held, J.M. (1988) Effects of sequential connective tissue massage on autonomic nervous system of middle-aged and elderly adults. Physical Therapy, 68(8), 1231-1234.
Nielens, H., Boisset, V. and Masquelie, E. (2000) Fitness and Perceived Exertion in Patients with Fibromyalgia Syndrome. Clinical Journal of Pain, 16(3), 209-213.