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The Pain Truth
Spas can provide life-changing relief for clients battling fibromyalgia.
Chronic pain. Sleeplessness and fatigue. Digestive troubles. Put them all together, and they’re a set of symptoms that may point to fibromyalgia, a baffling and potentially devastating syndrome that can severely affect quality of life. With no proven cause or treatment to guide them, people with fibromyalgia must manage their symptoms any way they can. Fortunately, spas have much to offer them. Menu staples such as massage and hydrotherapy, as well as specialized services such as acupuncture, can turn your spa into an essential care facility for a fibromyalgia client.
Ten million Americans, and as much as 3% to 6% of the world’s population, currently have the syndrome, according to the National Fibromyalgia Association (FMA, fmaware.org), and 75% to 90% of those sufferers are women. According to the FMA, fibromyalgia commonly occurs as widespread pain in all four quadrants of the body for a minimum duration of three months, with pain in at least 11 of the 18 designated tender points (see illustration, page 92). The pain may be classified as stabbing, shooting, aching, throbbing or twitching.
In recent years, physicians have loosened the diagnosis criteria if, for example, a patient has persistent pain in only a few of the tender points or in only half of the body. However, fibromyalgia is still a difficult syndrome to identify because the symptoms overlap with those of many other maladies. “It’s been a garbage pail kind of diagnosis, one that doctors settle on when they’ve ruled out other things, so that insurance companies will cover it,” says Tracy Whynot, licensed acupuncturist and co-owner of Place 360 Health + Spa in Del Mar, California.
As for causes, theories abound: infection, virus, genetics, stress and trauma have all been identified as potential culprits. For years, many experts doubted that fibromyalgia really existed at all. “It used to be thought of as an ‘all in your head’ problem,” Whynot says. However, it’s now generally understood that the syndrome is real, and physicians usually opt for symptomatic treatment, such as medication, to manage the pain. However, “standard Western medicine works for some people and not others,” Whynot points out. “And that’s where spa services come in.”
For clients living with the chronic pain fibromyalgia brings, massage therapy can be a godsend. Some clients benefit from a soft, cranial-sacral approach; others can tolerate more manipulation. Some may get enhanced relief with the use of heat; others with cold. For many sufferers, the pain comes and goes and its severity varies, so effective communication with the therapist is essential.
Dr. Jacob Teitelbaum, medical director of the Fibromyalgia & Fatigue Centers, with 16 locations throughout the U.S., views the syndrome in holistic terms. “It’s a human energy crisis,” he says. “The hypothalamus gland is the body’s main circuit and with fibromyalgia it blows a fuse. Because these patients have an energy crisis, their muscles are shortened. Muscles need energy to relax, just like it takes a force of energy for a spring to stretch.” To help stretch those constricted muscles, a massage therapist may employ myofascial release techniques. Since massage therapy prompts cells to produce endorphins and serotonins that counteract pain signals from the brain, it also helps to increase the blood flow and flexibility often compromised in fibromyalgia patients. Some clients may benefit from lymphatic drainage or trigger point modalities, or from Rolfing and Trager work.
For clients living with the chronic pain fibromyalgia brings, massage therapy can be a godsend.
To counteract the “adrenal overdrive” that Teitelbaum associates with fibromyalgic patients, he suggests that therapists teach these clients to slow down internally. Massage combined with music is often helpful in distracting a client’s mind from her pain, allowing her to release it. Teitelbaum also suggests guided progressive relaxation. “Keep things soft,” he advises. “Use soft lighting. What’s soothing to the soul is soothing to the body.”
People with fibromyalgia almost always have sleep problems, and they tend to awake unrefreshed. Research points to bursts of awake-like brain activity in fibromyalgia patients that limit the amount of time spent in stage four deep sleep. Aromatherapy massage, especially with lavender, may promote better sleep. On the flip side, fibromyalgia often manifests in a foggy brain and a treatment using essences like citrus might counteract that effect. Even within the limited realm of massage, one treatment does not fit all.
Beyond the Knead
There are a number of in-spa treatments besides massage that can help fibromyalgia clients. Hydrotherapy can be deeply healing, says Teitelbaum, although special care should be taken to make sure clients don’t become dizzy or lightheaded, and to keep them hydrated with plenty of cool drinking water. “Dry sauna is very relaxing and helps build immunity,” says Michelle Reed, owner of Valencia Day Spa & Therapy Center in Frisco, Texas. “Steam is effective, too.”
Fibromyalgia clients may also appreciate receiving facials, for several reasons: 1) Medication can cause changes to the skin; 2) A debilitating illness like this may result in loss of work and personal relationships, and the facial services can provide a needed dose of self-confidence and well-being; 3) The musculature of the face may be a source of pain that facial massage can relieve.
If your spa offers classes in yoga, tai chi or qi gong you may consider steering your fibromyalgia clients toward these.
“It’s all about finding out what the client can handle,” says Reed. “Some can’t take a regular facial, so we modify it. Some can’t handle waxing. Even when doing nails, we take a health history to make sure we know about any sensitivities.”
Gentle exercise is also recommended. If your spa offers classes in yoga, tai chi or qi gong you may consider steering your fibromyalgia clients toward these. Even incorporating range of motion into a massage may alleviate pain. Nutritional counseling might be extremely helpful, as diet seems to have a critical effect on the frequency and severity of symptoms. For example, most sources say it’s a good idea to avoid sugar, and Whynot advises fibro clients to steer clear of caffeine and limit carbohydrates. According to Teitelbaum, increasing salt intake may bring relief for some people.
Hypnotherapy, homeopathy and herbal remedies may help with the pain, sleep disturbances and digestive problems that are sometimes experienced with the syndrome. Acupuncture also provides many benefits. “We can retrain the body and ease the adrenal exhaustion and fatigue,” says Whynot. “And with acupuncture we can change the response to pain.”
Living the Life
As with other chronic ailments for which there are treatments but no cure, fibromyalgia calls for a daily, multifaceted approach. On the conventional medicine side, physicians may prescribe the neuropathic pain reliever pregabalin (Lyrica) or the antidepressant duloxetine (Cymbalta). However, because no one medication protocol has been proven to help all patients, other medications may be used. Hormonal support and nutritional supplements are also sometimes needed.
And spa visits can become part of a regular fibro-fighting regime. Work with clients to design a schedule that consistently assuages their symptoms yet fits into their budget. “I have one client who can’t function without a massage every week. It helps her with the pain, the fog and the sleep,” says Reed. Some of her clients receive reimbursement from their health insurance companies for spa treatments, or use their personal flex care and health savings accounts to offset the expense of massage therapy. “Clients are getting creative about how to pay for treatments,” she notes. “Some say it’s worth it to cut back on eating out or buying clothing.”
In and of itself, the loving touch and encouragement that a therapist gives can produce a cognitive change in these clients. “Fibromyalgia patients need to stop spending more energy than they produce,” says Teitelbaum. “They need to say no to what feels bad and yes to what feels good. This syndrome is treatable. What helps the most is when they learn to follow their bliss.” •