Physical Therapy Combo for Fibromyalgia
Weekly Ultrasound Plus TENS Cuts Pain in Half
The two most common treatments for musculoskeletal pain used by physical therapists are ultrasound and transcutaneous electrical nerve stimulation (TENS). Ultrasound works by emitting sound waves from a hand-held wand that penetrates between 1 and 2 inches deep into soft tissue, such as your muscles. These sound waves can increase heat and improve circulation in the region, relax muscles, and heal tissues. TENS units work by applying two pads placed on the skin across a painful area. The small unit emits an electric signal believed to ease discomfort by activating the natural opioid pain relieving system in the spinal cord.
A research team led by Felipe Azevendo Moretti, P.T., of the Universidade Federal in Sao Paulo, has found the combination of both therapies have been somewhat successful at reducing the muscle aches and disturbed sleep of fibromyalgia.* However, this is based on using this combination therapy during 12 session in a one month period. Each of the two treatments was applied for two minutes at each painful tender point (typically averaging 14 per patient), making this approach very time-consuming. As for the insurance companies, they may not approve such frequent visits.
But the real question answered by the Moretti’s recent study was to determine any difference in effectiveness if the sessions were once or twice weekly over a duration of 12 weeks. This means one group of 25 fibromyalgia patients received 12 treatments while the other group (also 25 patients) received 24 treatments. Moretti looked at the pain, sleep and physical function measures before and after the 12 weeks, and found the effects of combined ultrasound plus TENS was the same regardless of whether it was given once or twice weekly.
Before the current study, patients were asked to rate their level of pain the first day of the study and over the past week, their sleep, and overall quality of life. They also noted their number of tender points (one group averaged 15 while the other averaged 14).
After 12 weeks of treatment to tender points, patients scores in all areas dropped dramatically. Those receiving treatment once a week reported pain in half as many tender points, and pain scores fell from 7.6 (on 10 a point scale in which 10 represents worse possible pain) to 3.1. Pain experienced over the first seven days compared to the last seven days of the study dropped from 9.5 to 3.3. Sleep problems and quality of life scores also improved at least 35 percent. Similar changes in scores were obtained by the twice weekly study group.
“Based on these results, we can observe that the combined therapy was effective not just in the improvement of the musculoskeletal symptoms, but also helped the patients with sleep and quality of life,” said Moretti. “Once the patients have a reduction in the number of tender points, the subjective feeling of pain is diminished.”
A greater than 50 percent drop in the painful symptoms of fibromyalgia in patients not taking any medications or using other treatments is substantial. In addition, none of the patients experienced intolerable side effects, which can be a turnoff when trying a new drug or other approaches.
Moretti believes this combination therapy along with medications and other forms of treatment, such as water exercise or walking, can be added to each patient’s care to create more substantial benefits. How long the combo ultrasound plus TENS therapy lasts beyond the three-month treatment was not determined by this study. Regardless of its lasting effects, this approach can certainly help patients increase activity levels while minimizing the potential for added discomfort.
“This study helps professionals who work with fibromyalgia patients know that it is possible to obtain symptom improvement with only one weekly application of the ultrasound and TENS therapies,” said the physical therapist. “Clearly, it is important to offer the most efficient treatment solution for the least amount of money.”
* Moretti FA, et al. Physiother Res Int Nov 24, 2011, doi: 10.1002/pri.525. [Epub ahead of print]