When talking about Fibromyalgia, you have to first realize that there are two basic forms of Fibromyalgia, primary and secondary. Primary Fibromyalgia is defined as occuring in the absence of any other diagnosed condition. Secondary Fibromyalgia is diagnosed in conjuction with another, and probably pre-existing, condition. Often, people who are diagnosed with certain forms of arthritis, lupus, MS, and a host of other chronic conditions, will have a degree of secondary fibromyalgia. There are resources that will state that the discomfort of a Lupus flare is actually a Fibromyalgia flare. Which ever the case may be, the approaches will be the same.
As you are probably already aware, Fibromyalgia, is defined as a connective tissue condition. But, the latest research has pointed more to a central nervous system disorder. The decreased levels of seratonin coupled with the increased levels of Substance P in the spinal fluid result in increased sensitivity and sensory responses. Or described another way, the action of the afferent nervous activity has been corrupted into a sensation of pain. It's not an example of the pain sensors being over stimulated. It is the sensation of touch, motion, heat, cold, and the response of the nerves which provide feedback on muscular activity that are being translated as pain. The feedback system itself is the problem. The result is, hypertonicity in the tissue resulting in constriction of the connective tissues of the body, reduced blood flow into muscles, increased output of epinephrine and cortisol.
One of the most commonly reported symptoms is insomnia. This impares the repair and recovery of tissue after it has been under duress.
From a sensory level, clients with Fibromyalgia have varying degrees of alodynia. This touch sensitivity may present a wide range of discomfort. It may only be occasional discomfort with being touched or it may result in exquisite pain just from the weight of their clothing. If the room is too cold, they aren't just shivering, they may be in pain. The pain/sensation may be joint deep searing pain, to a mild tingly sensation. Many report feeling a burning along the skin similar to holding their arm close to a light bulb.
Fibromyalgia also presents itself differently from day to day. One day, there may be not symptoms at all. The next day, everything hurts.
This is important to remember when working with a fibromyalgia patient. One day, they may request very deep work, yet, the next day, they may feel uncomfortable from the lightest work. It is imperative that the therapist check in with the patient regularly during the massage and only work within their level of comfort.
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