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Craniosacral Therapy in Patients with Fibromyalgia
been administered to fibromyalgia patients to treat sleep disorders and pain symptoms (4). Review of the literature on the association between fibromyalgia and depression reveals two divergent research lines. Hudson and others (5) believe that a direct association cannot be established between fibromyalgia and depression, whereas Gruber and others (1996) (6) propose a common etiology for fibromyalgia and depression. Significant differences in psychological state between patients with fibromyalgia and depression were reported in a study on fibromyalgia, pain intensity and duration and psychological alterations; the results of depression and anxiety questionnaires indi- cated that the somatic expression of depression differed between the two patient groups (7). The relationship between depression and fibromyalgia remains controver- sial. Although antidepressants can reduce pain and fati- gue in fibromyalgia, the effects of these drugs vary in degree and duration among patients (7).
Various authors have indicated that patients with fibromyalgia are more depressed than healthy controls and that their perception of psychological distress or depression is similar to that of depressed patients (8,9). Moreover, levels of psychological distress (depres- sion, anxiety) have been correlated with cognitive find- ings in both groups of patients (fibromyalgia and depression) (10–12).
accompanied by paresthesias and allodynia, which are characteristic of patients with fibromyalgia (16).
Patients frequently report sleeping disorders as well as depression, and both factors are known to have a strong association with cognitive disruption (17,18) and to play an important role in the reduced quality of life reported by fibromyalgia patients. There is a high prevalence of sleeping problems in this population. In many cases, pain and fatigue disappear with sleep. However, paradoxically, patients with fibromyalgia awake with intensified muscle rigidity, pain and marked fatigue (19,20). Shaver et al. (21) described a vicious circle of pain, poor sleep, fatigue and increased pain in overt fibromyalgia. Bigatti et al. (22) concluded that sleep predicts subsequent pain in these patients but may be related to depression due to pain and physical dysfunction.
The quality of life of patients with fibromyalgia is espe- cially impaired in relation to physical function, intellec- tual activity and emotional state, influencing their working capacity and social relationships (23). Backman (24) affirmed that psychosocial factors are related to two dimensions of experience: psychological (cognitive, affec- tive) and social (interacting with others, performing daily activities). According to this author, psychosocial factors influence the perception of pain, which in turn influences psychological wellbeing and social participation.
Garland (13) observed a higher degree of anxiety in fibromyalgia patients than in healthy controls or other groups of patients with painful disease, e.g. rheumatoid arthritis. Anxious individuals usually have a respiratory dysfunction that generates more work in the upper chest, and the resulting minimum diaphragmatic activity may exacerbate symptoms in patients with fibromyalgia or chronic fatigue syndromes. Although anxiety is known to be an immediate symptom of hyperventilation, it is controversial whether or not hyperventilation and anxiety in patients with fibromyalgia result from a broader alteration. In this context, Peter et al. (14) reported that education to reduce the effects of hyperventilation can reduce fibromyalgia symptoms, including pain, fatigue and emotional distress.
Dysfunction of the autonomic nervous system may explain the different clinical manifestations of fibromyal- gia. The hyperactive sympathetic nervous system of these patients becomes incapable of responding to different stressing stimuli, which would explain the continuous tiredness and the morning rigidity of these patients (15). Likewise, incessant sympathetic activity may explain the sleeping disorders, anxiety, pseudo Raynaud’s phenom- enon, dry syndrome and intestinal irritability (2,15). The other defining characteristics of fibromyalgia such as diffuse pain, painful sensitivity to palpation and par- esthesia may also be explained by ‘sympathetically main- tained pain’. This neuropathic pain is characterized by a perception of pain regardless of the presence of stimuli,
Various studies have demonstrated the efficacy of bio- feedback acupuncture to reduce pain symptoms in fibro- myalgia (25–28). However, we could find no studies that address the effects of manual therapy on the autonomic nervous system or the possible benefit of this type of alternative therapies as a complement to pharmaceutical treatment of hyperautonomic alterations and derived disorders (anxiety and depression). With this background, the objective of this study was to determine the effects of craniosacral therapy on anxiety, depression, pain, sleep quality and quality of life in fibromyalgia patients up to 1-year post-treatment.
Setting and Participants
Patients with fibromyalgia syndrome undergoing pharma- ceutical therapy were recruited from among members of the Almeria Fibromyalgia Association with clinical records at the Torrecardenas Hospital Complex (Almeria, Spain). Inclusion criteria were: diagnosis of fibromyalgia (by rheumatology specialist), age of 16–65 years and agreement to attend afternoon therapy ses- sions. Exclusion criteria were: presence of physical disease, psychological disease, infection, fever, hypoten- sion or skin disorders or respiratory alterations that would limit the application of the treatments.
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