This study was undertaken to determine whether 30 treatments combining ischemic compression and spinal manipulation could effectively reduce levels of pain intensity, sleep disturbance, and fatigue associated with fibromyalgia. In addition, the researchers wanted to identify which baseline characteristics may be predictors of outcome, and to study the dose-response relation.
Fifteen women, all members of a regional fibromyalgia association completed the trial. All subjects had experienced fibromyalgia for longer than three months. Subjects received thirty treatments including spinal manipulation and ischemic compression. Levels of improvement in pain intensity, fatigue, and sleep quality were evaluated after fifteen treatments, after the completion of the full thirty treatments, and at one month after the study. Pain intensity had to improve by at least 50% by the end of treatment for a patient to be classified as a responder; nine patients qualified as responders.
60% of the patients reported an average improvement of 77.1% in pain intensity. Quality of sleep improved by 63.5%, and fatigue level by 74.8%. The researchers theorize that sleep quality and fatigue improved because those symptoms were aggravated, at least in part, by pain. Lowered pain levels were maintained during the month-long follow-up period. This suggests that the effects of chiropractic treatment continued to help patients, even though the actual treatments had ended. Previous studies of drug treatments for fibromyalgia have shown that medications cease to be effective once drug intake stops.
The authors found that it may be possible to predict which patients are more likely to respond well to chiropractic care. Those more likely to respond poorly to treatment were older, had greater intensity of symptoms, more tender points and a more chronic illness. Those patients that showed a less than 35% improvement in pain intensity after fifteen treatments did not show satisfactory improvement after thirty treatments.
This study is of limited usefulness for several reasons. The sample size is small, self-selected, a single treating physician was used, and no control group or appropriate blinding procedures were used. However, this study does suggest that chiropractic care may play a role in the management of fibromyalgia. The authors conclude:
"Most subjects with fibromyalgia appear to have responded favorably to a course of 30 chiropractic treatments including spinal manipulation and ischaemic compression therapy. Fifteen treatments seem to be an adequate cutoff point to determine if a significant improvement in pain has occurred and if further care is warranted. Chiropractic care appears to provide benefits for at least 1 month after stopping therapy. A placebo-controlled randomized clinical trial is recommended in the near future to test these hypotheses."
Hains G, Hains F. Combined ischemic compression and spinal manipulation in the treatment of fibromyalgia: a preliminary estimate of dose and efficacy. Journal of Manipulative and Physiological Therapeutics 2000;23(4):225-230.