with fibromyalgia. At 6 months after a 25-week treatment period, patients in the intervention group showed a
significant improvement in trait anxiety, pain, quality quality index.
their levels of state anxiety, of life and Pittsburgh sleep
In comparative studies,
patients with fibromyalgia
have higher levels of depression in comparison to other patients with chronic diseases. Bennet (41) found that 30% of patients with fibromyalgia present with depres- sion at the first consultation and 60% at some time in their clinical history. These patients reported a diffuse non-localized pain that tended to increase their level of depression.
Recent investigations have not considered depression to be a primary symptom of fibromyalgia, establishing that the degree of depression measured by the Beck question- naire is closely related to the level of pain suffered by the patient (42,43). Nonetheless, a variable percentage of fibromyalgia patients (30–70%) suffer depression, which is also present to some degree in any chronic disease that courses with pain (44). In multicenter studies, symptoms of major depression appear in 22–68% of patients affected by fibromyalgia, anxiety in 16% and simple phobias in 12–16% (45). It has not been estab- lished whether these psychological disorders are second- ary to predominant fibromyalgia symptoms or are primary symptoms of the fibromyalgia syndrome itself, regardless of the remaining symptoms (46–48).
Quality of life results showed a significant post- therapeutic improvement in the physical role, body pain and social function of the intervention group. These find- ings are consistent with multidisciplinary studies in patients with fibromyalgia, which have underlined the importance of motivation in achieving the participation of patients in the different therapy programs (49–52).
The improvement in physical function achieved by our craniosacral therapy protocol was similar to that obtained by aerobic exercise programs in combination with other exercise modalities and educational programs (53,54). Likewise, the improvement obtained in the majority of SF-36 dimensions was similar to that achieved after a 3-month hydrotherapy program, which obtained a 40% reduction in the ‘body pain’ dimension, although the mechanisms underlying this improvement have not been elucidated (55,56).
The improvement in the SF-36 questionnaire of quality of life shown by intervention group patients was lesser than their improvement in VAS score. This may be explained by the greater sensitivity of the ‘body pain’ dimension of the SF-36 to detect painful changes in com- parison to the VAS. Redondo et al. (56) also reported significant differences in the results obtained by these two measures of body pain.
At the end of the treatment period, the intervention and placebo groups differed significantly in overall Pittsburgh subjective sleep quality index score and in habitual sleep
7 of 9
efficiency and sleep disturbance items. However, at one month after therapeutic intervention, significant differ- ences were also found in sleep latency and duration. These results are in agreement with those published by Hains and Hains (57), who also found significant differ- ences in sleep quality at one month after a spinal com- pression and manipulation protocol despite finding no changes in fatigue or pain immediately after the treat- ment. An improvement in sleep quality persisted for 1 year after a 20-session course of manual therapy involv- ing conjunctive tissue manipulation (58). The release of fascial restrictions may improve sleep quality by correct- ing visceral fascial dysfunction and thereby favoring the secretion of platelet serotonin. A study of the gut neurological system found that a high proportion of fibromyalgia patients had intestinal disorders, probably due to neuro-endocrinal causes, which may affect seroto- nin secretion (59).
Studies on the effects of aerobic exercise programs in fibromyalgia patients found no significant difference in the number of nights per week with sleep disturbances (60–62). However, multidisciplinary therapeutic programs were reported to significantly improve anxiety, depres- sion, wellbeing and sleep quality (43).
One of the limitations of the study was the inability to study 25 of the 376 patients in the accessible population before the randomized selection of the study group, due to incompatibility with their work schedules. A further limitation is related to the disparity between males and females diagnosed with fibromyalgia, which may be con- ditioned by the cultural setting. It is also possible that subjects with less severe pain were able to improve more rapidly.
The present study shows that craniosacral therapy improves the quality of life of patients with fibromyalgia, reducing their perception of pain and fatigue and improving their night rest and mood, with an increase in physical function. Our craniosacral therapy protocol also reduces anxiety levels, partially improving the depressive state. This manual therapy modality must be considered as a complementary therapy within a multi- disciplinary approach to these patients, also including pharmaceutical, physiotherapeutic, psychological and social treatments.
Merayo-Alonso LA, Cano-Garcıa FJ, Franco LR, Ariza-Ariza R, Navarro-Sarabia F. Un acercamiento bibliometrico a la investiga- cion en fibromialgia (A bibliometric approach to research into fibromyalgia). Reumatol Clin 2007;3:55–62 (in Spanish).
Tan S, Tillisch K, Mayer E. Functional somatic syndromes: emer- ging biomedical models and traditional Chinese medicine. eCAM 2004;1:35–40.
Downloaded from http://ecam.oxfordjournals.org at Goteborg University on September 8, 2010