Physical therapy in the treatment of fibromyalgia

Fibromyalgia (FM) is a syndrome of unknown etiology characterized by chroni c wide spread pain, increased tenderness to palpation and additional sympto ms such as disturbed sleep, stiffness, fatigue and psychological distress. While medication mainly focus on pain reduction, physical therapy is aimed at disease consequences such as pain, fatigue, deconditioning, muscle weakn ess and sleep disturbances and other disease consequences. We systematically reviewed current treatment options in the treatment of fi bromyalgia. Based on evidence from randomized controlled trials cardiovascular fitness training importantly improves cardiovascular fitness, both subjective and o bjective measures of pain as well as subjective energy and work capacity an d physical and social activities. Based on anecdotal evidence or small observational studies physiotherapy ma y reduce overloading of the muscle system, improve postural fatigue and pos itioning, and condition weak muscles. Modalities and whole body cryotherapy may reduce localized as well as generalized pain in short term. Trigger po int injection may reduce pain originating from concomitant trigger points i n selected FM patient. Massage may reduce muscle tension and may be prescri bed as a adjunct with other therapeutic interventions. Acupuncture may redu ce pain and increase pain threshold. Biofeedback may positively influence s ubjective and objective disease measures. TENS may reduce localized musculo sceletal pain in fibromyalgia. While there seems to be no single best treatment option, physical therapy s eem to reduce disease consequences. Accordingly a multidisciplinary approac h combining these therapies in a well balanced program may be the most prom ising strategy and is currently recommended in the treatment of fibromyalgi a.