Effectiveness of different styles of massage therapy in fibromyalgia: A systematic review and meta-analysis

doi:10.1016/j.math.2014.09.003

Manual Therapy

Volume 20, Issue 2, April 2015, Pages 257-264

https://doi.org/10.1016/j.math.2014.09.003 Get rights and content

Abstract

The systematic review aimed to evaluate the effectiveness of massage in fibromyalgia. An electronic search was conducted at MEDLINE, SCiELO, EMBASE, ISI, PEDro, SPORTDiscus, CINAHL, Cochrane CENTRAL and LILACS (Jan 1990–May 2013). Ten randomized and non-randomized controlled trials investigating the effects of massage alone on symptoms and health-related quality of life of adult patients with fibromyalgia were included. Two reviewers independently screened records, examined full-text reports for compliance with the eligibility criteria, and extracted data. Meta-analysis (pooled from 145 participants) shows that myofascial release had large, positive effects on pain and medium effects on anxiety and depression at the end of treatment, in contrast with placebo; effects on pain and depression were maintained in the medium and short term, respectively. Narrative analysis suggests that: 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. There is moderate evidence that myofascial release is beneficial for fibromyalgia symptoms. Limited evidence supports the application of connective tissue massage and Shiatsu. Manual lymphatic drainage may be superior to connective tissue massage, and Swedish massage may have no effects. Overall, most styles of massage therapy consistently improved the quality of life of fibromyalgia patients.

Section snippets

Protocol and registration

The protocol of this systematic review was registered at International Prospective Register of Systematic Reviews (PROSPERO), number CRD42012003022.

Eligibility criteria

Eligibility criteria were as follows. (1) Types of studies: randomised or non-randomised, controlled clinical trials; control treatment in non-pharmacological trials could be placebo, usual care, active treatment or waiting list (Boutron et al., 2008). (2) Type of participants: adults (≥18 years) with medical diagnosis of fibromyalgia. (3) Types of

Study selection

A total of 532 titles were identified through database searches and other sources; 147 duplicates were removed, 203 articles were excluded after preliminary screening, and 182 articles were assessed for eligibility. Of 168 excluded articles, 145 did not report a randomised or non-randomised controlled trial, four did not cover the population of interest, and 19 did not include an intervention that could be characterised as massage. A total of ten studies reported in 14 articles were included (

Discussion

The aim of this systematic review was to appraise the effectiveness of massage therapy on pain, tenderness and other important fibromyalgia outcomes such as fatigue, stiffness, anxiety, depression, sleep and HRQoL. There is currently consensus that clinically meaningful response to treatment should not be defined by pain alone in fibromyalgia, which is characterised by multiple symptoms (Mease, 2005). The comprehensive perspective provided by assessing a set of outcomes contributes

Conclusion

There is moderate evidence that myofascial release has positive effects on multiple fibromyalgia symptoms, especially pain, anxiety and depression, for which the effect sizes are clinically relevant. Effects on pain and depression were observed in the medium and short terms, respectively. When comparing connective tissue massage or shiatsu with educational approaches, limited evidence supports the application of these styles of massage. Manual lymphatic drainage might be superior to connective

References (33)

L.M. Arnold et al.
Improving the recognition and diagnosis of fibromyalgia
Mayo Clin Proc
(2011)
I. Boutron et al.
Blinding was judged more difficult to achieve and maintain in nonpharmacologic than pharmacologic trials
J Clin Epidemiol
(2004)
J.C. Branco et al.
Prevalence of fibromyalgia: a survey in five European countries
Semin Arthritis Rheum
(2010)
G. Brattberg
Connective tissue massage in the treatment of fibromyalgia
Eur J Pain
(1999)
G. Ekici et al.
Comparison of manual lymph drainage therapy and connective tissue massage in women with fibromyalgia: a randomized controlled trial
J Manip Physiol Ther
(2009)
G.L. Liptan
Fascia: a missing link in our understanding of the pathology of fibromyalgia
J Bodyw Mov Ther
(2010)
G. Liptan et al.
A pilot study of myofascial release therapy compared to Swedish massage in Fibromyalgia
J Bodyw Mov Ther
(2013)
I. Lund et al.
Corticotropin releasing factor in urine–a possible biochemical marker of fibromyalgia. Responses to massage and guided relaxation
Neurosci Lett
(2006)
L. Terhorst et al.
Complementary and alternative medicine in the treatment of pain in fibromyalgia: a systematic review of randomized controlled trials
J Manip Physiol Ther
(2011)
S.L. Yuan et al.
Effects of shiatsu in the management of fibromyalgia symptoms: a controlled pilot study
J Manip Physiol Ther
(2013)

M.N.Y. Alnigenis et al.

Massage therapy in the management of fibromyalgia: a pilot study

J Musculoskelet Pain

(2001)

J. Baranowsky et al.

Qualitative systemic review of randomized controlled trials on complementary and alternative medicine treatments in fibromyalgia

Rheumatol Int

(2009)

I. Boutron et al.

Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration

Ann Intern Med

(2008)

S.F. Carville et al.

EULAR evidence-based recommendations for the management of fibromyalgia syndrome

Ann Rheum Dis

(2008)

A.M. Castro-Sanchez et al.

Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: a randomized controlled trial

Clin Rehabil

(2011)

A.M. Castro-Sanchez et al.

Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia

Evid Based Complement Altern Med

(2011)

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Although immune system modulation may become an important treatment tool in FM, direct manual treatments that lessen myofascial inflammation and tension must not be neglected. Myofascial release therapy significantly reduces FM pain, with residual benefits even after the conclusion of treatment. Self-myofascial release techniques and gentle stretching programs also ease fibromyalgia pain, as do trigger point injections and dry-needling.
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Establishing a diagnosis improves the patient's coping with the disease and reduces healthcare costs. NSAIDs, strong opioids and benzodiazepines should be avoided due to side effects. There is no good evidence to justify the association of several drugs. There is also no good evidence to recommend any complementary medicine. Surgeries show a greater number of complications and a lower degree of patient satisfaction and therefore should be avoided if the surgical indication is not clearly established.
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Fibromyalgia (FM) syndrome is a common illness characterized by chronic widespread pain, sleep problems, fatigue, and cognitive difficulties. Dysfunctional neurotransmitter systems that influence the body’s endogenous stress response systems are thought to underlie many of the major FM-related symptoms. A model of FM pathogenesis suggests biological and psychosocial variables interact to influence the genetic predisposition, but the precise mechanisms remain unclear. The Polyvagal Theory provides a theoretical framework from which to investigate potential biological mechanisms. The vagus nerve (VN) has anti-inflammatory properties via its afferent and efferent fibers. A low vagal tone (as assessed by low heart rate variability), has been observed in painful and inflammatory diseases, including FM, while the ventral branch of the VN is linked to emotional expression and social engagement. These anti-inflammatory and psychological (limbic system) properties of the VN may possess therapeutic potential in treating FM. This review paper summarizes the scientific literature regarding the potential role of the VN in transducing and/or therapeutically managing FM signs and symptoms.

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Systematic reviewEffectiveness of different styles of massage therapy in fibromyalgia: A systematic review and meta-analysis

Abstract

Section snippets

Protocol and registration

Eligibility criteria

Study selection

Discussion

Conclusion

Mayo Clin Proc

J Clin Epidemiol

Semin Arthritis Rheum

Eur J Pain

J Manip Physiol Ther

J Bodyw Mov Ther

J Bodyw Mov Ther

Neurosci Lett

J Manip Physiol Ther

J Manip Physiol Ther

Massage therapy in the management of fibromyalgia: a pilot study

J Musculoskelet Pain

Qualitative systemic review of randomized controlled trials on complementary and alternative medicine treatments in fibromyalgia

Rheumatol Int

Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration

Ann Intern Med

EULAR evidence-based recommendations for the management of fibromyalgia syndrome

Ann Rheum Dis

Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: a randomized controlled trial

Clin Rehabil

Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia

Evid Based Complement Altern Med

Systematic review
Effectiveness of different styles of massage therapy in fibromyalgia: A systematic review and meta-analysis