Background & Aims
Fibromyalgia syndrome (FMS) is a chronic pain condition, featuring widespread pain, fatigue, sleep problem, that impairs patients’ quality of life. Studies suggested that with chronic inflammation of fascia and dysfunctional healing response, nociceptors were sensitized to cause pain, and leading to dysfunction of the nervous system and central sensitization in FMS.1-4
Since fascia is interdependent and interacting with the nervous system and other body systems,5 by breaking up excessive collagen adhesions through soft-tissue and myofascial release techniques may change myofascial fibrosis.6 Bowen Therapy is a manual therapy that uses the sequences of gentle cross-fiber moves over muscles, tendons, ligaments and fascia to stimulate the flow of blood and lymph, and thus activates the body’s healing mechanisms. The aim of this randomized controlled trial (RCT) was to determine the effectiveness of Bowen Therapy in pain control, functional enhancement and quality of life for FMS.
Methods
This was a single-blinded RCT (NCT04554784) at pain clinics in Hong Kong. 80 patients diagnosed with FMS were randomized into Bowen therapy (BT) or Control group (CT) from 15/9/2020 to 22/12/2023. Subjects in BT group received 8 sessions of ISBT-Bowen Therapy, performed by the occupational therapist, over a 12-week period while those in CT group continued their usual conventional treatment. Primary outcome was change in pain score (by Numeric Rating Scale) over the study period. Other secondary outcomes included endurance strength test of upper and lower extremities, and wellness of the patients measured by SF-36 (quality of life), Hospital Anxiety and Depression Scale (psychological distress), Brief Pain Inventory (activity interference) and Jenkins Sleep Questionnaire (sleep disturbance). All outcomes were collected before and after treatment, and 12 weeks after treatment. Generalized estimating equation model was used to compare the changes of outcomes over the 3 time points.
Results
78 patients (40 in BT group; 38 in CT group) completed the study and subsequent follow-ups. The median (IQR) age was 58 (50-62) years. 68 patients (87%) were female. Baseline demographic data were similar between two groups, except for the total number of specialties seen (p=0.04). There was no significant difference in the changes of pain over time between two groups (Group*Time p=0.50). However, Bowen Therapy may improve the endurance of lower extremities and dominant arm (Group*Time p<0.01 and p=0.02, respectively) and mental health-related quality of life (Group*Time p<0.01), and reduce activity interference by pain (Group*Time p<0.01) over time between two groups.
Conclusions
Bowen Therapy may be effective in improving limbs endurance, enhancing quality of life, and reducing activity interference in patients suffering from fibromyalgia.
References
1) Woolf C.J. (2011). Central sensitization: implications for the diagnosis and treatment of pain. Pain, 152(3 Suppl), S2–S15. https://doi.org/10.1016/j.pain.2010.09.030
2) Rehm, S., Sachau, J., Hellriegel, J., Forstenpointner, J., Børsting Jacobsen, H., Harten, P., Gierthmühlen, J., & Baron, R. (2021). Pain matters for central sensitization: sensory and psychological parameters in patients with fibromyalgia syndrome. Pain reports, 6(1), e901. https://doi.org/10.1097/PR9.0000000000000901
3) Liptan G.L. (2010). Fascia: A missing link in our understanding of the pathology of fibromyalgia. Journal of bodywork and movement therapies, 14(1), 3–12. https://doi.org/10.1016/j.jbmt.2009.08.003
4) Liptan G. (2023). The widespread myofascial pain of fibromyalgia is sympathetically maintained and immune mediated. Journal of bodywork and movement therapies, 35, 394–399. https://doi.org/10.1016/j.jbmt.2023.04.081
5) Bordoni, B., Simonelli, M., & Morabito, B. (2019). The Other Side of the Fascia: Visceral Fascia, Part 2. Cureus, 11(5), e4632. https://doi.org/10.7759/cureus.4632
6) Langevin, H.M. (2008). Potential Role of Fascia in Chronic Musculoskeletal Pain. In: Audette, J.F., Bailey, A. (eds) Integrative Pain Medicine. Contemporary Pain Medicine. Humana Press. https://doi.org/10.1007/978-1-59745-344-8_6
Presenting Author
Po Chu Ng
Poster Authors
Pik Yu Chen
MSc
Prince of Wales Hospital Hospital Authority
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Fibromyalgia