Here is some of the information I recently shared in the July newsletter. Each newsletter has a specific focus.  This newsletter is focused on chronic pain conditions. If you would be interested in receiving my newsletters, which include links to the studies as well as special offers and sales coupons, please head over to my contact page and sign up.


  1. Aerobic exercise for pain intensity
  2. Effect of Curcumin on Neuroinflammation
  3. Melatonin moderates chronic pain, sleep architecture and immunometabolism
  4. Ketamine for treatment of chronic pain
  5. Effectiveness of MFR on pain, sleep and quality of life
  6. Effects of Vitamin D on pain severity
  7. Reflexology for Fibromyalgia
  8. Effect of acupuncture for fibromyalgia
  9. Effectiveness of reformer pilates for fibromyalgia
  10.  Infrared radiation for chronic pain


1. An article titled Aerobic Physical Exercise for Pain Intensity, Aerobic Capacity, and Quality of Life in Patients with Chronic Pain: A Systematic Review and Meta-Analysis published in Journal of Physical Activity and Health in Aug 2021 concludes: Aerobic exercise is a nonpharmacological therapeutic option for treatment (of chronic pain). Also, aerobic capacity and endurance improved when this type of exercise was prescribed, thus resulting in a substantial improvement in the quality of life of people suffering from chronic pain.

2.  An article titled Mechanistic Insight into the Effects of Curcumin on Neuroinflammation-Driven Chronic Pain, published in Pharmaceuticals  in August 2021, reviews and details the role of curcumin in microglia and astrocytes both in vitro and in vivo and how it improved pain.

3. An article titled Melatonin Moderates the Triangle of Chronic Pain, Sleep Architecture and Immunometabolic Traffic, published in Biomedicines in Aug 2021, details and reviews current literature relevant for the shared pathways of sleep, pain, and immunometabolism and elaborates the impact of melatonin on the crossroad of sleep, chronic pain, and immunometabolism.

4. A review titled Ketamine for the Treatment of Chronic Pain: A Comprehensive Review published in Health Psychology Research in 2021 highlights the use of ketamine for: neuropathic pain, fibromyalgia, complex regional pain syndrome, phantom limb pain, cancer pain, and post-thoracotomy pain syndrome.

5. A study titled Effectiveness of myofascial release on pain, sleep, and quality of life in patients with fibromyalgia syndrome: A systematic review published in Complementary Therapies in Clinical Practice in November 2021 concludes: moderate evidence for the effect of therapist-administered and self-myofascial release in improving pain, sleep subscales, and quality of life against sam and no treatment, respectively, in fibromyalgia syndrome patients

6. A study, titled  Effects of Vitamin D on Pain severity, Quality of Life, Depression and Sleep in Patients with Fibromyalgia published in Medicine International Istanbul Hastanesi in 2021 concludes: Vitamin D deficiency may be a factor associated with symptom severity, sleep and wakefulness problems, and physical function in FMS. Therefore, serum 25OHD status should be evaluated in patients with FMS and its importance in treatment management should not be ignored.

7. A study titled The effect of Reflexology in patients with Fibromyalgia, published in Signa Vitae (Anesthesiology Department, Pain and Palliative Care Center Aretaeion Hospital, University of Athens, Athens Greece) in Feb 2020 concludes:  Reflexology may be beneficial as add-on treatment in patients with Fibromyalgia who are unable to receive the recommended dosages of their medication (pregabalin).

8. A study titled The effects of acupuncture in fibromyalgia: integrative review published in April 2020 in BrJP Sao Paulo concludes: studies suggest that acupuncture is effective for the treatment of pain in patients with fibromyalgia, with improved quality of life and positive interference in sleep.

9.  A study titled Investigation of effectiveness of reformer pilates in individuals with fibromyalgia: a randomized controlled trial published in Reumatlogía Clínical in Feb 2022 concludes: reformer pilates exercises had positive effects on clinical status and muscle strength while home mat pilates exercises had positive effects on the number of painful regions, clinical status, biopsychosocial status and physical component quality of life.

10.  An article titled Infrared Radiation in the Management of Musculoskeletal Conditions and Chronic Pain: A Systematic Review published in European Journal of Investigation Health, Psychology and Education in Mar 2022 concludes: based on findings of our review, we noted a decrease in pain levels, decrease in Fibromyalgia Impact Questionnaire scores.


Here is some of the information I recently shared in the July newsletter. Each newsletter has a specific focus.  This newsletter is focused on chronic pain. If you would be interested in receiving my newsletters, which include links to the studies as well as special offers and sales coupons, please head over to my contact page and sign up.


  1. Sleep disturbances and pain outcomes in veterans
  2. Acupuncture effects on Fibromyalgia
  3. Cryotherapy for chronic pain
  4. Underwater exercise effects on postmenopausal Fibromyalgia symptoms
  5. Cryotherapy alleviates symptoms in chronic pelvic pain
  6. Effects of hydrotherapy on chronic lumbar pain
  7. Effectiveness of serial whole-body cryotherapy in Fibromyalgia
  8. Comparison of muscle conduction abnormality in Fibromylagia and chronic fatigue
  9. Efficacy of Vitamin D3 treatment for Fibromylagia
  10. COmparison of Prolotherapy and facet joint injection for chronic low back pain


1. An article titled The influence of sleep disturbances and sleep disorders on pain outcomes among veterans: A systematic scoping review, published in Sleep Medicine Reviews in April 2021 concludes: Sleep disturbances and sleep disorders were associated with worse pain outcomes among veterans with chronic pain. Treatment-induced sleep improvements ameliorated pain outcomes in veterans with sleep disorders and sleep disturbances.

2.  An article titled Greater somatosensory afferent with acupuncture increases primary somatosensory connectivity and alleviates Fibromyalgia pain via insular y-aminobutyric acid: A randomized neuroimaging trial published in Arthritis & Rheumatology in December 2020 concludes:  Fibromyalgia patients who received electroacupuncture therapy experienced a greater reduction in pain severity compared to patients who received mock laser acupuncture.

3. An article titled Use of cryotherapy for managing chronic pain: An evidence-based narrative, published in Pain and Therapy in Dec 2020, concludes:  Both local (ice packs) and non-local (partial and whole body cryotherapy) show promise in reducing chronic pain associated with various chronic diseases including those of rheumatic and degenerative origin. Cryotherapy appears to be a safe therapy in carefully selected patients with only minimal adverse effects reported in the literature.

4. A study titled Effect of underwater exercises on treating postmenopausal Fibromyalgia symptoms, published in European Journal of Molecular & Clinical Medicine in Sept 2020 concludes: underwater exercises are very effective in treating Fibromyalgia postmenopausal symptoms.

5. A study titled Cryotherapy alleviates symptoms in chronic prostatitis/chronic pelvic pain syndrome published in Andrologia in Dec 2020 concludes: cryotherapy could alleviate voiding symptoms, ameliorate pain and improve the quality of life in people with CP/CPPS.

6. A study titled Effect of Hydrotherapy on chronic pain in the lumbar region published in Journal of IMAB in Oct 2020 found: physiotherapy includes hydrotherapy with a water temperature of 36-37 C and magnetotherapy with a duration of 30-35 minutes treatment of the paravertebral muscle in the lumbar region, gluteus and lower limbs for 3 times a week for 1 month resulting in a reduction of the neurological and pain symptoms and the restoration of neurodynamics of n.ischiadicus.

7. A study, titled Serial whole-body cryotherapy in Fibromyalgia is effective and alters cytokine profiles, published in Advances in Rheumatology in January 2021 concludes: Whole body cryotherapy is effective in FM and reduces the burden of disease. The effects of serial WBC are strongest during application and are diminished 3 months after WBC treatment.

8.  A study titled Chronic fatigue syndrome: Abnormally fast muscle fiber conduction in the membranes of motor units at low static force load, published in Clinical Neurophysiology in Apr 2021 concludes: in chronic fatigue patients, muscle conduction increases abnormally with force, surface EMG can elicit abnormalities in both Fibromyalgia and chronic fatigue, and the surface EMG abnormalities in Fibromyalgia and chronic fatigue differ.

9. A study titled Efficacy and safety of weekly vitamin D3 in patients with Fibromyalgia: 12-week, double-blind, randomized, controlled placebo trial, published in Clinical Rheumatology in Feb 2021, concludes: there is no evidence of a trend in favor of vitamin D treatment, since we did not observe improvement in the VAS of pain or FIQ.

10.  A study titled Comparison of the effectiveness of Prolotherapy and facet joint injection in the treatment of chronic low back pain: a retrospective study, published in Turkiye Klinkeri Journal of Medical Sciences in Jan 2021 concludes: facet joint injection is considered more effective at relieving symptoms of back pain early in the condition, but Prolotherapy provided more benefit, according to long-term VAS scores.

Here is some of the information I recently shared in a December newsletter. Each newsletter has a specific focus.  This newsletter is focused on chronic pain and fibromyalgia. If you would be interested in receiving my newsletters, please head over to my contact page and sign up.


  1. Fibromyalgia linked to gut bacteria
  2. Relationship between serum magnesium, inflammation and chronic pain
  3. Effectiveness of low-pressure hyperbaric oxygen and physical exercise in fibromyalgia
  4. Aquatic therapy versus land-based therapy in reducing pain in fibromyalgia
  5. Association between low vitamin D levels and impact of fibromyalgia
  6. Pressure-induced referred pain a biomarker of pain sensitivity
  7. Manual therapy versus therapeutic exercise
  8. Hypnotic intervention in people with fibromyalgia
  9. Impact of animal-assisted activity session
  10. Intramuscular pressure is almost three times higher in fibromyalgia


1. An article, titled Fibromyalgia Linked to Gut Bacteria for First Time published in Neuroscience News & Research in Jun 2019, states: In a paper published today in the journal Pain, a Montreal-based research team has shown, for the first time, that there are alterations in the bacteria in the gastrointestinal tracts of people with fibromyalgia.

2.  A study, titled Exploring the relationship between serum magnesium, inflammation, and chronic pain in a Vermont primary care population, published in Current Developments in Nutrition Jun 2020, concludes: For adults seen in primary care, lower serum magnesium levels are associated with chronic pain. This inverse relationship is not explained by random noise, including age and gender. The complex relationship between serum magnesium, C-reactive protein, and pain is complex and requires further exploration. 

3. A study titled Comparative study of the effectiveness of a low-pressure hyperbaric oxygen treatment and physical exercise in women with fibromyalgia: randomized clinical trial, published in Therapeutic Advances in Musculoskeletal Disease in 2020 concludes: low-pressure hyperbaric oxygen therapy and physical exercise improve pressure pain threshold, endurance and functional capacity, as well as physical performance. Induced fatigue and perceived pain at rest significantly improved only with low-pressure hyperbaric oxygen therapy.

4. An abstract of a study titled Is aquatic therapy more effective than land-based therapy in reducing pain of women with fibromyalgia? published in Ann Rheum Dis in 2020 concludes:  Both physiotherapy interventions showed to be effective in reducing pain in patients with fibromyalgia. However, aquatic therapy was more effective in improving quality of sleep and decreasing pain intensity at six weeks of follow-up than land-based therapy. It seems that the therapeutic effects achieved in post-treatment were maintained for a longer time in the aquatic therapy group. Even so, in order to maintain the benefits obtained with the interventions, continuous physiotherapy treatment seems to be necessary.

5. A study titled Association between low vitamin D levels and the Greater impact of fibromyalgia, published in J Clinical Med Res in 2020 concludes: Fibromyalgia patients did not present higher prevalence of vitamin D deficiency or insufficiency than healthy individuals, although low vitamin D concentrations could indicate more severe disease impacts.

6. A study titled Pressure-induced referred pain as a biomarker of pain sensitivity in fibromyalgia, published in Pain Physician in Jul 2020 concludes: referred pain induced by applying a suprathreshold pressure of 120% Pain Pressure Threshold can be a useful biomarker to assess sensitized pain mechanisms in patients suffering from Fibromyalgia.

7. A study titled Manual therapy versus therapeutic exercise in non-specific chronic neck pain: a randomized controlled trial, published in Trials in Jul 2020 concludes: manual therapy achieves a faster reduction in pain perception than therapeutic exercise. Therapeutic exercise reduces disability faster than manual therapy.

8. A study titled Hypnotic intervention in people with fibromyalgia: a randomized controlled trial, published in American Journal of Clinical Hypnosis in Aug 2020 concludes: the self-administered audio-recorded hypnotic intervention significantly decreased the intensity and interference of pain and fatigue, as well as the depressive symptomatology.

9. A study title The Impact of a 20-minute animal-assisted activity session on the physiological and emotional states in patients with fibromyalgia, published in Mayo Clinic Proceedings in Nov 2020 showed a decrease in heart rate, an increase in heart rate variability, an increase in well-being survey scores, an increase in salivary oxytocin, and subsequent tympanic membrane temperature changes, suggesting that participants were in a more positive emotional-physiologic state as a result of the session. 

10. A study titled Intramuscular Pressure is almost three times higher in fibromyalgia patients: a possible mechanism for understanding the muscle pain and tenderness, published in J Rheum in Dec 2020 concludes; pressure in the trapezius muscle of patients with Fibromyalgia is remarkably elevated and may be an intrinsic feature of FMS that could be monitored as part of the diagnostic evaluation. The burden of the pressure abnormality may help explain the diffuse muscle pain of FMS. Therefore, FMS as a disorder of exclusively central pain processing should be revisited. Therapeutically, the reduction of muscle pressure may change the clinical picture significantly.

What Hurting Looks Like: Photographer Translates Pain Into Visceral Still Life  provides visual and verbal descriptions of pain. Originally published on NPR

Here is some of the information I recently shared in my July newsletter. Each newsletter has a specific focus.  This month is focused on fibromyalgia and Chronic Pain information. If you would be interested in receiving my newsletters, please head over to my contact page and sign up.

Tidbits, Updates and Resources:

1.Five myths about pain that many manual therapists are sick of Hearing by Nick Ng (can be found in Massage & Fitness Magazine).

2.  3 steps to be an even more effective pain relief therapist by Irene Diamond--a 45 minutes video of a webcast.


I receive a weekly update on anything published anywhere on the internet that includes information about fibromyalgia and chronic pain. If you have any problems with the links, please let me know, or if you come across any information that you think would be good to share, please also feel free to pass that information along:

1. A study titled"Effectiveness of different styles of massage therapy in fibromyalgia: a systematic review and meta-analysis by Yuan, Matsutani & Marques and publish in Apr 2015 in Man Ther concluded: “myofascial release had large, positive effects on pain and medium effects on anxiety and depression in contrast with placebo…myofascial release also improves fatigue, stiffness and quality of life. Connective tissue massage improves depression and quality of life; manual lymphatic drainage is superior to connective tissue massage regarding depression and quality of life; Shiatsu improves pain, pressure pain threshold, fatigue, sleep and quality of life: and Swedish massage does not improve outcomes.

2. In a study in Sci Rep 2016 titled “Efficacy of cupping therapy in patients with the fibromyalgia syndrome-a randomized placebo-controlled trial” concluded: Five cupping treatments were more effective than usual care to improve pain intensity and quality of life. However, the effects were small and cupping was not superior to sham cupping treatments, further research is warranted.

3. In a paper by Larimer Moseley, “Reconceptualizing Pain According to Modern Pain Science, published through the University of South Australia at, he argues that “the biology of pain is never really straightforward, even when it appears to be. It is proposed that understanding what is currently known about the biology of pain requires a reconceptualization of what pain actually is, and how it serves our livelihood. He suggests there are four key points:

  1. That pain does not provide a measure of the state of the issues
  2. That pain is modulated by many factors from across somatic, psychological and social domains
  3. That the relationship between pain and the state of the tissues becomes less predictable as pain persists
  4. That pain can be conceptualized as a conscious correlate of the implicit perception that tissue is in danger.

4. A short summary of an article by John Quintner, titled “Evolution, Stress, and Fibromyalgia” adapted from Lyon P, Cohen M, Quinter J. An evolutionary stress-response hypothesis for Chronic Widespread Pain (Fibromyalgia Syndrome). Pain Med 2011;12:1167-1178  suggests a Stress Response and Substance P response in combination may explain the disparity in symptoms and why many treatments have not been effective.

5. A follow-up article to the above reference, titled “How did fibromyalgia ever become a brain disease? Disentangling conjecture and truth, by John Quintner, debunks the Central sensitivity syndromes theories.

6. A study published in Scientific Reports titled Functional Brain Network mechanism of Hypersensitivity in Chronic Pain, and summarized by Haley Otman at Medical press, titled Does an exploding brain network cause chronic pain? suggests “as opposed to the normal process of gradually linking up different centers in the brain after a stimulus, chronic pain patients have conditions that predispose them to linking up in an abrupt, explosive manner.”

7.  A study titled “Effectiveness of Therapeutic Exercise in Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials", published in Biomed Res Int 2017, concludes: aerobic and muscle-strengthening exercises are the most effective way of reducing pain and improving global well-being in people with fibromyalgia and that stretching and aerobic exercises increase health-related quality of life.

8.  A narrative article, published in Minerva Anestesiol Jan 2018, titled  "The role of cannabinoids in pain control: the good, the bad and the ugly” concluded: cannabinoids appear to be most effective in controlling neuropathic pain, allodynia, medication-rebound headache, and chronic non cancer pain, but do not seem to offer any advantage over nonopioid analgesics for acute pain. Cannabinoids seem to work no better than placebo for visceral pain and conferred only modest analgesic effect in cancer pain.

9.  A study published in Turk J Med Sci Dec 2017, titled “Does fibromyalgia have an effect on hearing loss in women?” concludes: results point to a pathophysiologic link between fibromyalgia and the development of audiological abnormalities in these patients.

10.  A study published in Complement Ther Med Feb 2018 titled “Effect of whole body cryotherapy interventions on health-related quality of life in fibromyalgia patients: a randomized controlled trial” concludes: Whole body cryotherapy can be recommended as an effective clinically adjuvant approach in the improvement of health-related quality of life in fibromyalgia patients.”

Alternative Health Arena

1. A study, titled “Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial", published Mar 2018 in BMJ, concludes: Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise…for a variety of outcomes for patients with fibromyalgia. Longer duration of tai chi showed greater improvement.”

2.  A study, titled “Reiki is better than placebo and has broad potential as a complementary health therapy", published in J Evid Based Complementary Altern Med Oct 2017, concludes: found reasonably strong evidence for Reiki being more effective than placebo.”

Every month I send out a newsletter to subscribers with the most recent evidence and studies on specific body work topics. The newsletter may include summaries and links to studies and articles, videos that provide support information about exercises, new techniques or lectures. There are five main focuses for the newsletters and each newsletter is repeated twice a year. The six main focuses for the newsletters are: Shoulder and rotator cuff, fibromyalgia, fascia and trigger points, upper cross and neck, cupping and lymphatic drainage and business/ethics. If you would like to receive the newsletters with more complete information than is found in the excerpts, please sign up to receive the newsletter on my contact page.

PLEASE NOTE: This is the last edition of the Fibromyalgia newsletter. This newsletter will be converted to a newsletter with a focus on chronic pain conditions rather than the narrow focus of fibromyalgia.


Tips & Tidbits

  1. Patients with fibromyalgia show significantly lower levels of serum vitamin D than those of a control group.
  2. Here is a link to the Revised Fibromyalgia Impact Questionnaire (FIQR)

Studies, Articles, and Resources

  1. A study titled “A pilot study of myofascial release therapy compared to Swedish massage in Fibromyalgia” by Liptan, Mist, Wright, Arzt & Jones, published in Journal of Bodywork and Movement Therapies concluded: between-group differences in symptoms and physical function did not reach statistical significance. There were no consistent focal areas of improvement for the Swedish massage group while the MFR group reported consistent pain reductions in the neck and upper back regions. A larger randomized controlled trial is called for.

  2. In a study in Man Ther 2015 by Yuan, Matsutani & Marques, titled “Effectiveness of different styles of massage therapy in fibromyalgia: a systematic review and meta-analysis”, the authors concluded: myofascial release had large, positive effects on pain and medium effects on anxiety and depression at the end of treatment; myofascial release also improves fatigue, stiffness and quality of life; connective tissue massage improves depression and quality of life; manual lymphatic drainage is superior to connective tissue massage regarding stiffness, depression and quality of life; Shiatsu improves pain, pressure pain threshold, fatigue, sleep and quality of life; and Swedish massage does not improve outcomes.

  3. In a study, published in Rheumatol Int. 2017 titled “A comparison of the effects of exercises plus connective tissue massage to exercises alone in women with fibromyalgia syndrome: a randomized controlled trial” concluded: exercises with and without connective tissue massage might be effective for decreasing pain, fatigue and sleep problem whereas increasing health status and quality of life. However, exercises with CTM might be superior in improving pain, fatigue, sleep problem, and role limitations due to physical health compared to exercise alone.

  4. A study, published in J Pain Res. 2017, titled “Caffeine as an opioid analgesic adjuvant in fibromyalgia” concluded: caffeine consumption was associated with decreased pain and symptom severity in opioid users, but not in opioid nonusers, indicating caffeine may act as an opioid adjuvant in fibromyalgia-like chronic pain patients. This data suggest that caffeine consumption concomitant with opioid analgesics could provide therapeutic benefits not seen with opioids or caffeine alone.

  5. A study published in Complement Ther Clin Prati in Aug 2017, titled “Effects of whole-body vibration therapy in pain, function and depression of the patients with fibromyalgia” concluded: Whole body vibration therapy is found to be effective in reducing symptoms of fibromyalgia.

  6. A study published in Clin Biomech titled “Effects of a 16-week hydrotherapy program on three-dimensional scapular motion and pain of women with fibromyalgia: a single-arm study” concluded: Hydrotherapy was effective to improve quality of life, pain intensity and fibromyalgia impact on women. However, scapular kinematics did not change after the period of treatment. Although symptoms improved, the lack of changes in scapular kinematics may indicate these women have an adaptive movement pattern due to their chronic painful condition.


During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and  well thought out information and  decision-making outcomes. I am happy to share some of their assignments for you to enjoy.


The condition your client reported on the intake form or during the interview.

new-purple-butterfly-scroll-mdFibromyalgia and Sjogren's syndrome. The diagnosis has not been definitive. There may be overlap. Or it may be one or the other according to his doctors.

Why you chose to write up this case report--why this condition or client.

The client is my brother-in-law. He lives in Austin and I live in Fredericksburg, so the frequency with which I have been able to work on him has been once per month. Still, I have had access to him more than any other client with a condition (other than just the usual complaints of muscle tightness).


The client suffers from muscle aches/pain, chronic fatigue, dryness of eyes, mouth and nose. The pain and inflexbility in the joints, his doctors believe, is from the Sjogren's, which is believed to be a genetic predispostion. (His mother suffered from similar symptoms that suggested she had Sjogren's, but it was never medically diagnosed). He suffers from gastrointestinal issues (constipation and bloating). Finding it difficult to sleep is also a problem.

Because he has gradually limited his interactions with others, and essentially isolated himself, he is also being treated for clinical depression.

Intervention Overview

Your understanding of the conditon - the causes, symptoms, pathology, etc., that are relevant.

Fibromylagia is not a psychological condition. While the exact cause is still not known, it is believed to have a biological cause. Recent research suggests that changes in the central nervous system (brain, spinal cord, and nerves), may be responsible. It is believed that there may be a number of factors working together.

Physical and emotional trauma have been linked to fibromyalgia. The genes you inherit from your parents may increase the likelihood of developing fibromyalgia (a family hsitory). There is some evidence to suggest that certain illnesses can act as a trigger (infections). People with autoimmune diseases, such as rheumatoid arthritis, are more likely to develop fibromyalgia.

There are still many aspects of fibromyalgia that are not understood. Because of the complexity of the condition, it can be difficult to diagnose. But an accurate diagnosis is critical in managing these cases. If the condition is not diagnosed and treated early, symptoms can go on indefinitely, or they may disappear for months and then recur.

Fibromyalgia involves widespread muscle pain and tenderness. It is a chronic condition that can last for years or be a lifelong issue. It can't really be cured but treatment may help.

Symptoms include chronic muscle pain, muscle spasms, or tightness, moderate or severe fatigue and decreased energy, insomnia or waking up feeling just as tired as when you went to sleep, stiffness upon waking or after staying in one position for too long, difficulty remembering, concentrating, and performing simple mental tasks ("fibro fog"). Other symptoms include abdominal pain, bloating and constipation alternating with diarrhea (irritable bowel syndrome), tension or migraine headaches, jaw and facial tenderness, sensitivity to one or more of the following: odors, noise, bright lights, medications, certain foods, and cold. The individual may be feeling anxious or depressed, and experience numbness or tingling in the face, arms, hands, legs, or feet, increase in urinary urgency or frequency (irritable bladder), reduced tolerance for exercise and muscle pain after exercise, and a feeling of swelling (without actual swelling) in the hands and feet.

Fibromyalgia symptoms may intensify depending on the time of day (morning, late afternoon, and evening tend to be the worst times). Symptoms may also get worse with fatigue, tension, inactivity, changes in the weather, cold or drafty conditions, overexertion, hormonal fluctuations (such as before periods or during menopause, stress, depresion, or other emotional factors.

Like Fibromylagia, the cause of Sjogren's syndrome is unknown. Researchers think that a combination of environmental and genetic factors determines who develops the disease. While there are certain genes that increase a person's risk for Sjogren's, the genes do not act alone. It is believed that in order for a person to develop Sjogren's, the immune system must be activated by some sort of trigger, such as a viral or bacterial infection, that sends the immune system into overdrive.

The signs and symptoms of Sjogren's syndrome, to some extent, overlap with fibromyalgia. Dry eyes and mouth (also known as sicca syndrome) are the most common signs of Sjogren's, but the disease may affect other parts of the body. It can also cause swollen or painful joints, muscle pain or weakness, dry skin, loss of sense of taste, rashes, brain fog (poor concentration or memory), numbness and tingling sensations in the arms and legs due to nerve involvement, heartburn, kidney problems, and swollen lymph nodes.

Your treatment plan for the client as a result of this condition

My intent is not to exacerbate my client's symptoms by being too aggresive. So pressure and intent principles are taken into consideration. I will work lighter and gentler instead of deeper. Massage has shown some benefit for relieving pain, improving the quality of sleep, improving mood, reducing anxiety, all with an emphasis on good self-care. If I decide to massage my client during a flare-up, gentle pressure is all I can use without worsening the condition. Also, I need to be aware of increased tenderness in and around the spine. Since Sjogren's can lead to joint pain and inflexibility, gentle stretching can be helpful, but I want to keep it within a pain-free range so as not to cause further injury. Also, Sjogren's can make it uncomfortable to lay in a face cradle because of the dryness in the eyes, nose and mouth. When working on the client, I always keep bottled water on hand because remaining hydrated can lessen the severity of some of the symptoms.

As with all chronic pain conditions, I'm aware that clinical depression and chronic pain go hand in hand. His doctors have encouraged him to attend group therapy sessions for people suffering from fibromyalgia/chronic pain.

My client's sedentary liefstyle (as an at-home computer programmer), also adds a difficult component to any treatment plan. I have encouraged him to attend gentle stretching classes for example, tai chi, yoga or chi gong, to try to improve circulation and possibly help with the depression brought on by his condition and lack of contact with the otuside worls.

Presently my client is only taking antidepressants because he has been allergic to all of the other standard medications.

The explanation for why you chose that treatment plan -- justification.

I believe gentle massage will be beneficial for his condittion. Gently working and relaxing the muscles while increasing circulation should provide symptomatic relief.

The expected outcome from your treatment plan.

My desire is to offer my client symptom relief and, as a result, hopefully affect, in some manner, the anxiety and depression. Realisticaly, that is all that I believe I can hope to achieve.

Literature Review

Research synopsis from a massage journal, article or research site that supports your treatment plan for this condition.

Fibromyalgia: Massage Techniques. Institute for Integrative Healthcare. Nicole Cutler L.Ac., Jan 24, 2006

This article was an overview of fibromyalgia's signs and symptoms and the indications and contraindications for massage therapy. It discussed the various techniques, how to utilize them, and what bodyworkers need to be aware of when handling clients with fibromyalgia. Also covered were the biopsychosocial implications of the condition.


The actual outcome from your treatment plan

Sometimes massage helps the client and sometimes it has no significant effect. I'm not able to work on him often enough to note any real change with his condition, so we just go for temporary symptomatic relief. He states that following massage sessions, he usually sleeps better that night. In my client's case, the chronic pain, stiffness and other symptoms, has led him to isolate himself to some extent. Personal time and attention help relieve the sense of detachment from a lack of human contact. He has stated that just knowing someone cares enough to try to help and to understand what he is going through, can and does provide relief.

Appropriately cited reference for research material.
  1. Massage for Fibromyalgia: A Therapist's Point of View. Sharon Muzio. The National Fibromyalgia & Chronic Pain Association.
  2. Treating Fibromyalgia: Massage Therapy as a Beneficial Tool. Ross Turchaninov and Boris Prilutsky. Massage & Bodywork Magazine, February/March 2004.
  3. Easing the Constant Pain. Karta Purkh, Singh Khalsa. American Massage Therapy Association. March 21, 2010
  4. 5 Benefits of Massage for Fibromyalgia Patients.Jimm Gialelis, L.M.T., B.C.T.M.B., Massage Magazine, May 11, 2016. Issue 06.
  5. Dry Eyes, Dry Mouth: Sjogren's Syndrome. Ruth Werner. Massage Today. June, 2009, Vol 09, Issue o6.
  6. The Mangement of Sjogren's Syndrome. Mavragani, C.P., et al. Nat Clin Pract Rheumatol, 2006;2 (5): 252-61
  7. Fibromyalgia: Massage Techniques. Institute for Integrative Healthcare. Nicole Cutler L.Ac., Jan 24, 2006.



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