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Physical medicine & rehabilitation approaches to the management of myofascial pain & fibromyalgia (FM) syndromes

  [ 64 votes ]   [ Discuss This Article ] • November 3, 1994

In summary, we have presented the physical medicine and
rehabilitation medicine approaches for treating patients with
fibromyalgia and the myofascial pain syndromes. The importance
of approaching these patients from a holistic and
multidisciplinary standpoint has been stressed, paying
attention to the physical, emotional, spiritual and
behavioural components of the presentation. Although
fibromyalgia and the myofascial pain syndromes are two
distinct conditions, they often overlap, and when they do the
myofascial component should be treated first. However, the
clinician should remember that pain, tissue dysfunction and
disability from pain are all separate issues and should be
treated as such. Treatment in all cases should be
individualized and comprehensive. It is imperative to make the
patient an active participant in his care and to establish
mutually agreed upon goals at the outset of treatment. It is
important to establish an adequate and appropriate home
exercise programme to supplement formal treatment. A good home
exercise programme should stress both stretching and
strengthening. Formal treatment programmes should not be
geared to pain relief alone but rather to restoration of
function, and return to functioning lifestyles. The clinician
has available a wide array of modalities and tools to control
pain, but the major goal of all treatment programmes is to
restore individuals to functional lifestyles and to promote
both physical and emotional flexibility, balance and
'wellness'. It is often necessary to involve the family unit
as an inherent and critical part of the treatment team,
particularly with the patient who continues to be
dysfunctional despite apparently appropriate treatment.
Although treatment always starts at the tissue level, a good
treatment programme must always be holistic in nature and
treat the tissues, the patient as a whole, and his or her
environmental stressors and contingencies as well.

Rosen NB

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