What is it? -FM is the inflammation of white fibrous tissues (especially muscle sheaths). - FM is one of the main causes of Chronic Widespread Pain (CWP). Understanding CWP : -“pain for a minimum of 3 months in the axial skeleton as well as pain in the L and R side of the body and A and B the waist” (International Association for the Study of Pain). CWP affects about 20% of the adult pop. -Still very debatable whether FM is its own distinct entity or if it is apart of CWP.

What causes it? -CNS is manifested by CWP Symptoms? - Chronic fatigue syndrome, difficulties with memory and concentration, IBS, headaches and depression, PTSD, anxiety and stress attacks. American College of Rheumatology (ACR): Most recently established criteria for the classification of FM. 1) Widespread Pain Index (WPI):3-6 Symptom Severity (SS): 9 2)Symptoms must have been present at equal severity for a minimum of 3 continuous months 3)Must not already have another disorder that would otherwise explain the pain

-Globally, in 26 studies done worldwide, the mean prevalence of FM is 2.7%, and more common in women then men (3:1). -Canada showed a prevalence of 3% (5% in women and 2% in men -There is a significant association with FM with: -Cardiovascular conditions (namely hypertension) -depression -diabetes -lung diseases -asthma -liver and neurological diseases -GI disorders -episodic and chronic migraines -mental illness

1. (Progressive) resistance training vs. Aerobic training -After 8 weeks, proven that aerobic exercises were more beneficial for improving pain. -Patients with fibromyalgia can safely perform resistance exercises at moderate to high levels of intensity, with no negative repercussions. However, no improvements with multidimensional function, pain, tenderness and muscular strength and endurance. 2. (Low intensity) Resistance training vs. (static) flexibility exercises -After 12 weeks, low intensity exercises were superior to any flexibility exercises for both pain management and multidimensional function.

- Deare, et al; -Acupuncture proved to be beneficial in reducing pain and stiffness when compared to control. -Relief was temporary. - Electric Stimulation was more beneficial then needling alone, as it had positive effects on fatigue and overall wellbeing. - Combined with Additional Therapy? -If patient was enrolled in an active therapy or drug program, acupuncture was seen to enhance the effects. **Acupuncture alone was not seen to be beneficial as a therapy for FM.

-Control and Intervention groups were assessed at baseline, end of treatment (ET-12 weeks), and at a long term follow up (LT-6 months) Measures (when compared to control): 1) Pain ET: Lower score by 0.5 points LT: Lower score by 0.6 points 2) Negative Mood ET: Lower score by 0.7 points LT: Lower score by 1.3 points 3) Disability ET: Lower score by 0.7 points LT: Lower score by 1.2 points

Six RCT’s (N=208) included into a systematic review by Kalichman, et al. -Five RCT’s demonstrated statistically significant short-term benefits. -Increased benefits for the following: pain, stiffness, sleep quality, fatigue. -Two of these studies reported sustained improvements at 6 and 12 months. **The available literature provides modest support for the use of massage therapy in treating patients with fibromyalgia.