Nonarticular Rheumatism/Regional Pain Syndrome Follow-up

  • Author: Daniel Muller, MD, PhD; Chief Editor: Herbert S Diamond, MD   more...
 
Updated: May 24, 2011
 

Further Outpatient Care

  • Aerobic exercise
    • Exercise helps decrease the symptoms of fibromyalgia syndrome; however, too much exercise results in increased symptoms that are often severe. This can lead to a cycle of muscle disuse.
    • In one study, 9 of 16 patients worsened or reported no change after a 14-week aerobic training intervention; however, 3 of the 16 patients were able to maintain a program of aerobic exercise; 4 years later, none of these patients fulfilled criteria for fibromyalgia.[26]
    • Aerobic therapy in a warm-water pool may be helpful, particularly for severe cases.[27]
    • Hoffman recently published a detailed program of graded exercise for fibromyalgia.[16]
  • Physical therapy
    • Restoration of muscle balance, stretching, and local therapy with heat and cold can be helpful. In 1996, Sheon et al published an excellent discussion of physical treatment modalities for fibromyalgia syndrome, tendonitis, and bursitis.[28]
    • Transcutaneous electrical nerve stimulation (TENS) may provide symptomatic relief in some cases.[29]
  • Subcutaneous tender-point injections of lidocaine may be mildly helpful, although dry needling or sodium chloride solution may also work. Corticosteroids should be avoided in fibromyalgia.
  • EMG biofeedback and hypnotherapy have been helpful in controlled studies.[30, 31]
  • Psychotherapy: Fibromyalgia and all chronic tendonitis-bursitis disorders (tension-myalgia syndromes) may be conditions in which patients substitute physical pain for emotional pain, as advocated in the book by John Sarno, MD, The Mindbody Prescription: Healing the Body, Healing the Pain. Nancy Selfridge, MD, and Franklynn Peterson wrote Freedom from Fibromyalgia: The 5-Week Program Proven to Conquer Pain, a book using Dr. Sarno's and other techniques that some patients have found helpful.
  • Stress management: In one study, 10 of 15 patients responded to a 14-week cognitive-behavioral and relaxation-training intervention; however, none remained improved after a 4-year follow-up.[26] Stress reduction combined with cognitive-behavioral therapy may be helpful.[32]
  • Eye movement desensitization and reprocessing (EMDR) has been found to be useful in patients with posttraumatic stress disorder (PTSD).[33] Because the pathophysiology of fibromyalgia is similar to that of PTSD[34] , some practitioners have been using EMDR with anecdotal success.
  • Meditation has been shown to be helpful.[35] Recommended is a mindfulness meditation program developed by Jon Kabat-Zinn, PhD, Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness.[36]
  • Complementary and alternative methods of treatment include the following:
    • Acupuncture has been shown to be helpful in some trials.[37] However, a recent study found acupuncture to be no better than placebo.[38]
    • Few controlled trials of herbal or homeopathic treatments have been performed.[39, 40] Many anecdotal cases report short-term benefit that wanes with time.
    • A controversial placebo-controlled trial of a homeopathic treatment (Rhus toxicodendron 6c) decreased tender points.[40] A recent trial of individualized homeopathic treatment showed modest benefits.[39]
    • A combination of malic acid (200 mg) and magnesium (50 mg) (Super Malic) in high doses did not have an effect in the controlled portion of the trial but was found to be useful in the subsequent open-label study.[41]
    • A recent multicenter trial showed modest salutary effects of acetyl L-carnitine using a combination of daily oral (1000 mg/d) and intramuscular (500 mg/d) treatment for 2 weeks, followed by oral treatment (1500 mg/d) for 8 weeks.[42]
    • For further information on integrative treatment, see the chapter “Fibromyalgia Syndrome” by Muller and Selfridge in Integrative Medicine (2007).[43]
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Deterrence/Prevention

  • Prevention of bursitis and tendonitis depends on proper body mechanics at work and at play. Avoiding overuse and gradual increases in exercise is the best means for prevention. Warm-up and cool-down exercises and stretching are recommended. Balancing aerobics with strength training and stretching, particularly yoga, can be helpful.
  • No methods have been proven to prevent fibromyalgia. An overall program of stress reduction that combines mindfulness, meditation, and vigorous exercise, as well as avoiding injury, may offer the best chance for prevention.
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Prognosis

  • Fibromyalgia and multiple bursitis-tendonitis syndrome
    • In one study, 65% of patients improved with therapy. A similar percentage reported feeling poor or fair 3 years after diagnosis.
    • About 10-30% of patients are disabled because of fibromyalgia. Most patients function well but continue to report chronic pain.
    • Better response to treatment is observed in patients of younger age with continued employment, supportive families, an absence of affective disorders, and without involvement in litigation.[44]
    • One study showed that the level of disease activity did not change significantly over an average of 6.4 years that patients were studied. These findings suggest that current conventional medical treatment is unsatisfactory and does not alter the prognosis in fibromyalgia.
    • Complete remissions are uncommon.
  • Regional and local bursitis, tendonitis, neurovascular entrapment, and structural syndromes
    • Most patients do well with therapy.
    • Exacerbations are common but respond well to treatment.
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Patient Education

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Contributor Information and Disclosures
Author

Daniel Muller, MD, PhD  Department of Internal Medicine, Section of Rheumatology, Associate Professor, University of Wisconsin at Madison

Daniel Muller, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American College of Rheumatology, and American Holistic Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert E Wolf, MD, PhD  Professor Emeritus, Department of Medicine, Louisiana State University Health Sciences Center at Shreveport; Chief, Rheumatology Section, Medical Service, Overton Brooks Veterans Administration Medical Center of Shreveport

Robert E Wolf, MD, PhD is a member of the following medical societies: American College of Rheumatology, Arthritis Foundation, and Society for Leukocyte Biology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

Elliot Goldberg, MD  Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine

Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD  Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa

Disclosure: Merck Ownership interest Other; Smith Kline Ownership interest Other; Zimmer Ownership interest Other

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The spectrum of nonarticular myofascial pain syndromes.
Possible factors that lead to myofascial pain syndromes.
 
 
 
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