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

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