soft tissue joint comfort range solutions tbr fibromyalgia chronic pain

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Fibromyalgia Solutions from the Field of Manual Therapy and Complementary & Alternative Medicine (CAM) Fibromyalgia Using an Integrated Approach Fibromyalgia syndrome (FMS) is one of the most commonly diagnosed nonarticular soft tissue conditions in all fields of musculoskeletal medicine. One study found, “strong evidence supports aerobic exercise and cognitive behavioral therapy. Moderate evidence supports massage, muscle strength training, acupuncture, and spa therapy (balneotherapy). Limited evidence supports spinal manipulation, movement/body awareness, vitamins, herbs, and dietary modification. Several nonpharmacologic treatments and manual-type therapies have acceptable evidentiary support in the treatment of FMS.” (Schneider,2009). 1 Clinical improvements [people felt and functioned better] and controlled trials support the use of an integrative medicine approach to fibromyalgia. People with FMS have increased quality of life with a number of forms of Complementary medicine as seen in this 2003 study from the Mayo clinic. Of the 304 patients invited to participate, 98% had used some type of CAM therapy during the previous 6 months. “The 10 most frequently used CAM treatments were exercise for a specific medical problem (48%), spiritual healing (prayers) (45%), massage therapy (44%), chiropractic treatments (37%), vitamin C (35%), vitamin E (31%), magnesium (29%), vitamin B complex (25%), green tea (24%), and weight-loss programs (20%).” (Wahner-Roedler, 2007). 2 “Some nutritional supplements (magnesium, S- adenosylmethionine) and massage therapy have the best evidence for effectiveness with fibromyalgia. Other CAM therapies such as chlorella, biofeedback, relaxation have either been evaluated in only one randomized controlled trials (RCT) with positive results.” (Sarac, 2006). 3 A 2003 review of the literature looked “across five classifications of CAM, including alternative medical systems (acupuncture, homeopathy), biological-based therapy (nutritional supplements), dietary modifications, energy therapies (magnetic therapy), and manipulative and body-based systems (chiropractic care, massage), and mind-body interventions (relaxation, biofeedback, and hypnotherapy). (Holdcraft, 2003). 4 In this issue, the focus is on evidence for the use of nutritional approaches; treatments that shift substance P plasma levels (acupuncture , massage 5 therapy ; modalities which affect the autonomic 6 nervous system (Integrative Manual Therapy; exercise , Qigong, exercises, Reiki, Chiropractic, 78 and more. Massage Therapy Addresses Fibromyalgia "Massage therapy is widely used by patients with fibromyalgia seeking symptom relief. The existing literature provides modest support for use of massage therapy in treating fibromyalgia. In massage therapy of fibromyalgia, we suggest massage be painless, its intensity should be increased gradually from session to session, in accordance with patient's symptoms; and the sessions should be performed at least 1-2 times a week." (Kalichman,2010). 9 Neurophysiology in Manual Therapy Practice During the past decade, scientific research has provided new insight into the development from an acute, localized musculoskeletal disorder towards chronic widespread pain / fibromyalgia. Chronic widespread pain is characterized by sensitization of central pain pathways. An in-depth review of basic and clinical research was performed to design a theoretical framework for manual therapy in these patients. It is explained that manual therapy might be able to influence the process of chronicity by, ” (I) limit the time course of [pain] afferent © 2010 www.VisualizeHealth.Net 1 Musculoskeletal Solutions 07

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Page 1: Soft Tissue Joint Comfort Range Solutions Tbr Fibromyalgia Chronic Pain

Fibromyalgia Solutions from the Field of Manual Therapy and

Complementary & Alternative Medicine (CAM)

Fibromyalgia Using an Integrated ApproachFibromyalgia syndrome (FMS) is one of the

most commonly diagnosed nonarticular soft tissueconditions in all fields of musculoskeletal medicine.

One study found, “strong evidence supportsaerobic exercise and cognitive behavioral therapy.Moderate evidence supports massage, musclestrength training, acupuncture, and spa therapy(balneotherapy). Limited evidence supports spinalmanipulation, movement/body awareness, vitamins,herbs, and dietary modification. Severalnonpharmacologic treatments and manual-typetherapies have acceptable evidentiary support in thetreatment of FMS.” (Schneider,2009).1

Clinical improvements [people felt andfunctioned better] and controlled trials support theuse of an integrative medicine approach tofibromyalgia.

People with FMS have increased quality of lifewith a number of forms of Complementarymedicine as seen in this 2003 study from the Mayoclinic. Of the 304 patients invited to participate,98% had used some type of CAM therapy duringthe previous 6 months. “The 10 most frequentlyused CAM treatments were exercise for a specificmedical problem (48%), spiritual healing (prayers)(45%), massage therapy (44%), chiropractictreatments (37%), vitamin C (35%), vitamin E(31%), magnesium (29%), vitamin B complex(25%), green tea (24%), and weight-loss programs(20%).” (Wahner-Roedler, 2007).2

“Some nutritional supplements (magnesium, S-adenosylmethionine) and massage therapy have thebest evidence for effectiveness with fibromyalgia.

Other CAM therapies such as chlorella,biofeedback, relaxation have either been evaluatedin only one randomized controlled trials (RCT)with positive results.” (Sarac, 2006).3

A 2003 review of the literature looked “across

five classifications of CAM, including alternativemedical systems (acupuncture, homeopathy),biological-based therapy (nutritional supplements),dietary modifications, energy therapies (magnetictherapy), and manipulative and body-based systems(chiropractic care, massage), and mind-bodyinterventions (relaxation, biofeedback, andhypnotherapy). (Holdcraft, 2003). 4

In this issue, the focus is on evidence for the useof nutritional approaches; treatments that shiftsubstance P plasma levels (acupuncture , massage5

therapy ; modalities which affect the autonomic6

nervous system (Integrative Manual Therapy;exercise , Qigong, exercises, Reiki, Chiropractic,7 8

and more.

Massage Therapy Addresses Fibromyalgia"Massage therapy is widely used by patients

with fibromyalgia seeking symptom relief. Theexisting literature provides modest support for useof massage therapy in treating fibromyalgia. Inmassage therapy of fibromyalgia, we suggest massage be painless, its intensity should beincreased gradually from session to session, inaccordance with patient's symptoms; and thesessions should be performed at least 1-2 times aweek." (Kalichman,2010).9

Neurophysiology in Manual Therapy PracticeDuring the past decade, scientific research has

provided new insight into the development from anacute, localized musculoskeletal disorder towardschronic widespread pain / fibromyalgia. Chronicwidespread pain is characterized by sensitization ofcentral pain pathways. An in-depth review of basicand clinical research was performed to design atheoretical framework for manual therapy in thesepatients. It is explained that manual therapy mightbe able to influence the process of chronicity by, ”(I) limit the time course of [pain] afferent

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stimulation of peripheral nociceptors. (II) decreasedsensory threshold [pain tolerance]. (Nijs,2009).10

Qigong InterventionIn a study to evaluate the effect of a 7-week

Qigong intervention on subjects with FibromyalgiaSyndrome, researchers noted “significantimprovements were found for the interventiongroup, at posttreatment, regarding different aspectsof pain and psychological health and distress.Almost identical results were found for thecombined group.

The overall results show that Qigong haspositive and reliable effects regarding FMS. A highdegree of completion, 93%, and contentment withthe intervention further support the potential of thetreatment. The results of the study are encouragingand suggest that Qigong intervention could be auseful complement to medical treatment forsubjects with FMS.” (Haak,2008) and (Wisdom11 12

Healing Qigong,2010).Another study looked at aerobic exercise and

qigong. In this study, “FMS patients ages 8-18years were randomized to a 12-week exerciseintervention of either aerobics or qigong. Bothgroups participated in 3 weekly training sessions.Program adherence and safety were monitored ateach session. Data were collected at 3 testingsessions, 2 prior to and 1 after the intervention, andincluded FM symptoms, function, pain, QOL, andfitness measures.

Thirty patients participated in the trial.Significant improvements in physical function,functional capacity, QOL, and fatigue wereobserved in the aerobics group. Anaerobic function,tender point count, pain, and symptom severityimproved similarly in both groups.

Significant improvements in physical function,FM symptoms, QOL, and pain were demonstratedin both exercise groups; the aerobics groupperformed better in several measures comparedwith the qigong group.” (Stephens,2008).13

Economics and QualityIn a study on complementary medicine usage

among people with fibromyalgia, Lind et al found,“use of CAM by patients with FMS was 2.5 times

higher than in the comparison group without FMS(56% vs 21%).

CAM users had similar expenditures to nonusersamong patients with FMS ($4,638 versus $4,728).Patients with FMS who used CAM also had heavieroverall disease burdens than those not usingCAM.”Lind concluded, “CAM use is not associatedwith higher overall expenditures.” (Lind, 2007).14

Psychology and Coaching for FibromyalgiaThis article considers four broad classes of

psychological techniques and their effects onfibromyalgia pain. “Hypnotherapy and writingintervention have demonstrated mild treatmenteffects, whereas psychological treatment iseffective in fibromyalgia pain.” (Thieme,2009).15

Another study found, visual imagery withrelaxation is a mind-body intervention that may beused for symptom management in Fibromyalgiawhich is a chronic pain disorder affecting 2% of thepopulation in the United States. Another 16 millionHispanics suffer from generically identifiedrheumatic diseases that likely include FMS.

(Menzies,2008).16

These researchers said, “treatment of chronicpain has become a multidisciplinary endeavourincluding psychological interventions.

Several reviews on systematic research studiesconfirm that psychological interventions areefficacious in the treatment of chronicmusculoskeletal pain, especially back pain, thougheffect sizes are small and, in some cases, moderate.

Hypnotherapy in children and adolescents withrecurrent gastrointestinal pain, examined in a studyof high methodological quality, achieved anexceptional level of symptom relief.

Regarding different pain syndromes such aschronic back pain, headache, fibromyalgia, andtemporomandibular disorder, as well asgastrointestinal pain in children, psychologicalinterventions proved their significance for theachievement of favorable treatment outcome.”17

(Kroner,2009).

Pain and InflammationCharacteristic symptoms of fibromyalgia

syndrome include widespread pain, fatigue, sleep

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abnormalities, and distress. FMS patients showpsychophysical evidence for mechanical, thermal,and electrical hyperalgesia [heightened painsensation]. To fulfill FMS criteria, the mechanicalhyperalgesia needs to be widespread and present inat least 11 out of 18 well-defined body areas (tenderpoints). Peripheral and central abnormalities ofnociception [pain sensation] have been described.

“Interventions aimed at reducing local pain seemto be effective but need to focus less on tenderpoints but more on trigger points and other bodyareas of heightened pain and inflammation.”18

(Staud, 2006).

Fibromyalgia like Criminal Law?In an article comparing Multiple Sclerosis and

Fibromyalgia, Hellstrom, et al. discussed, “thedifference between the two concepts health andabsence-of-disease” saying, “the diagnosis of MSis similar to a scientific discovery, whereas thediagnosis of fibromyalgia is constructed more likecriminal law. Consequently, diagnosis-baseddisease prevention and health promotion have tocomply with a wide range of reality.” (Hellstrom,19

1995).

Elimination fo XenobioticsIn this case researchers describe a 28-year-old

woman, who had been suffering for more than “5years from severe fatigue, myofascial pain,obstipation, obesity of trunk, abdominal striae,oedema, tinnitus, folliculitis, facial swelling andsecondary adrenocortical insufficiency. Therapyconsisted of dietary advise, chelating agents,supplements, and acupuncture. The patient becamecompletely symptom-free.” (Mutter, 2007).20

International Agreement on AcupunctureEvidence

Using the Fibromyalgia Impact Questionnaire,SF-12, Catastrophe Index, and the Beck Depressionitems as evaluation tools, researchers concluded,“acupuncture treatment as delivered was effectiveat reducing FMS symptoms in this outcomestudy.” (Singh, 2006). 21

Another paper said, “general internationalagreement has emerged that acupuncture appears tobe effective for postoperative dental pain,

postoperative nausea and vomiting, andchemotherapy-related nausea and vomiting.

For migraine, low-back pain, and TMJ jawdisorders the results are considered positive bysome and difficult to interpret by others.

For a number of conditions such asfibromyalgia, osteoarthritis of the knee, and tenniselbow the evidence is considered promising, butmore and better quality research is needed.”22

(Birch, 2004).“Acupuncture treatment of FMS patients was

associated with decreased pain levels and fewerpositive tender points. This was accompanied bydecreased serotonin concentration in platelets andan increase of serotonin and substance P (pain-modulating substances) levels in serum. (Sprott,23

1998). In a study to systematically review the efficacy

of acupuncture in fibromyalgia syndrome (FMS),researchers noted, "strong evidence for thereduction of pain was found at post-treatment."24

(Langhorst,2010). In this study to evaluate the clinical effect of

combination of acupuncture, cupping and medicinefor treatment of fibromyalgia syndrome,researchers found, “the therapeutic effect ofcombination of acupuncture, cupping and medicineon fibromyalgia syndrome is superior to that of thesimple acupuncture combined with cupping or thesimple medicine. (Jang,2010).25

Strength and Premature AgingThis study looked at strength and premature

aging in women with fibromyalgia, women withoutFMS, and older women. “Women with FMS andolder women who are healthy have similar lower-body strength and functionality.” FMS potentiallyenhances the risk for premature age-associateddisability (Panton, 2006).

26

Before and After Evaluation“The Fibromyalgia Impact Questionnaire (FIQ)

developed by clinicians at Oregon Health &Science Univ is an attempt to capture the totalspectrum of problems related to fibromyalgia andresponses to therapy. First published in 1991, it hasbeen shown to have a credible construct validity,

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reliable test-retest characteristics and a goodsensitivity in demonstrating therapeuticchange.” (Bennett, 2005). 27

Manual Lymph Drainage TherapyThis study analyzed and compared the effects of

manual lymph drainage therapy (MLDT) andconnective tissue massage (CTM) in women withprimary fibromyalgia (PFM).

The Fibromyalgia Impact Questionnaire (FIQ)and Nottingham Health Profile were used todescribe health status and health-related quality oflife (HRQoL).

In both groups, significant improvements werefound regarding pain intensity, pain pressurethreshold, and HRQoL The results indicate thatthese manual therapy techniques might be used inthe treatment of FMS. However, MLDT was foundto be more effective than CTM according to somesubitems of FIQ (morning tiredness and anxiety)and FIQ total score. (Ekici,2009).28

Homeostasis and the ANS“The main component of the stress response

network is the autonomic nervous system (ANS).FMS is proposed to be a sympathetically [fight orflight] maintained neuropathic pain syndrome, andgenomic data support this contention. Autonomicdysfunction may also explain other FMS featuresnot related to pain.” (Martinez-Lavin, 2007). 29

A number of approaches have been successful inchanging signs and symptoms of autonomicnervous system dysfunction including Reiki ,30

Myofascial Massage , Muscle Energy & other31 32

biomechanical approaches , Integrative Manual33

Therapy , Manual Lymph Massage & Lymphatic34 35

techniques , , Traditional Chinese Medicine &36 37

Acupuncture , Chiropractic , Rolfing ,Cranial38 39 40 41

Therapy , Lavender essential oils and hot foot42

bath ,Exercise and Yoga .43 44 45

Mars and Venus in the MixTalking about the difference between men and

women, researchers in this study considered,“puberty or menopause, the unique differences inthe prevalence of autoimmune diseases anddisorders (Sjogren's syndrome, Hashimoto'sdisease), differences in the onset and progression of

osteoporosis and osteoarthritis, differences inresponse to radiation and chemotherapy, and thedifferences in chronic facial pain, chronic fatiguesyndrome, and fibromyalgia.” (Slavkin, 2002). 46

Exercise, Psychology and Health Coaching“Recent pharmacological treatment studies have

focused on selective serotonin and norepinephrinereuptake inhibitors, which enhance serotonin andnorepinephrine neurotransmission in thedescending pain pathways.

There is also evidence to support exercise,cognitive behavioral therapy, education, and socialsupport in the management of FMS.” (Arnold,47

2006) and (Rossy 1999).48

Another study stressed the importance of activeparticipation. “Non-pharmacological treatmentsinvolving active participation of patients, such asexercise and psychotherapy, seem to be moreeffective than those that involve passive physicalmeasures, including injections and operations.”49

(Henningsen, 2007). Other researchers reported several important

findings. “First, there was strong evidence thatmind-body therapies were more effective for self-efficacy (a measurement of an individual’s beliefthat she or he can cope effectively with achallenging situation) than waiting list or treatmentas usual controls. (Burckhardt,1994) and 50 51

(Vlaeyen,1996). Second, there was strong evidence that exercise

was more effective than mind-body therapies forshort-term improvement in pain intensity or tenderpo in t pa in th resho ld and phys i ca lfunction. (Martin,1996)& (Wigers, 1996). 52 53

The evidence on the effect of exercise onsymptoms of fibromyalgia would tend torecommend any manual therapy treatment thatenabled the client to get back to regular exerciseand the support of a health coach to help with goalsetting and accountability..

The Touch Research Institute - MassageTherapy Studies

“Massage therapy helped to improve sleeppatterns, decrease pain, fatigue, anxiety, depressionand cortisol levels in adults with fibromyalgia.”54

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(Sunshine, 1996). “FMS patients slept better (showed lower

activity levels suggesting more deep sleep), hadlower substance P levels and less pain following amonth of biweekly massages.” (Field, Delage, et55

al. 2003) and (Field, 2002).56

In another study researchers looked at “40patients with FMS randomly assigned to amovement/massage therapy group or a relaxationcontrol group 2x/wk for 3 weeks. Themovement/massage group showed decreaseddepressed mood, state anxiety and regional painimmediately after the first and last sessions of thestudy” (Field, 2002). 57

Neurotransmitter Substance P“Substance P (SP), a neurotransmitter stored

within the afferent nociceptive fibers, is likely to beinvolved in the pathogenesis of musculoskeletalpain,” said investigators of “SP immunoreactive(SP-ir) nerve fibers in the upper trapezius ofpatients with FMS and myofascial pain syndrome(MPS) by immunochemistry. Our results point toa peripheral hyperactivity of the peptidergicnervous system in FMS as well as in MPS.Findings support the notion of pathogeneticinvolvement of the afferent nervous system in thedevelopment and perception of myofascialpain. (DeStefano, 2000).58

Nociception & OpiodsThe mechanism of nociceptive [pain sensation]

dysfunction and potential roles of opioidneurotransmitters are unresolved in the chronic painof FMS and chronic low back pain. FMS wasdistinguished by higher cerebrospinal fluid Met-enkephalin-Arg6-Phe7, systemic complaints, andmanual tender points, and lower pain thresholdscompared to the low back pain and normalgroups. (Baraniuk, 2004). 59

Neurofascial Process and Pain“Sharon Giammatteo, PhD, PT developed

Integrative Manual Therapy, a comprehensivesystem of healing for body, soul and spirit.

Neurofascial Process exercises involve placingone's hands over specific parts of one's body forextended periods of time, and simply "being-with"

what comes to consciousness while doing so.This healing modality has seen some dramatic

results with chronic back pain, fibromyalgia, spinalcord injuries, migraines, brain injuries, cerebralpalsy and ADD.

Organized into easy to understand sections, thebook includes a step-by-step protocols used topromote healing. (OmegaBookCentre, 2005).60

Spa Therapy“This study investigates possible effects of a

combined spa and physical therapy program onpain and hemodynamic responses in variouschronic diseases.

The patients with ankle arthrosis, fibromyalgiaand cervical disc herniation reported the highestVisual Analog Scale (VAS) score before treatment.After the therapy program, VAS scores were seento decrease.

To decrease pain and high blood pressurewithout hemodynamic risk, a combined of spa andPT program may help to decrease pain and improvehemodynamic response in patients with irreversiblepathologies.” (Cimbiz, 2005). 61

Osteopathic Manual Therapy (OMT)

“Twenty-four female patients were randomlyassigned to one of four treatment groups.Participants' pain perceptions were assessed by useof pain thresholds measured at each of 10 bilateraltender points using a 9-kg dolorimeter, the ChronicPain Experience Inventory, and the Present PainIntensity Rating Scale. Patients' affective responseto treatment was assessed.

Significant findings between the four treatmentgroups on measures of pain threshold, perceivedpain, attitude toward treatment, activities of dailyliving, and perceived functional ability were found.

This study found OMT combined with standardmedical care was more efficacious in treating FMSthan standard care alone. (Gamber, 2002)62

Integrative Manual TherapyThis article discusses a 46 year old woman with

complaints of total body pain and fibromyalgia. Shewas treated with Integrative Manual Therapy (IMT)with a focus on the immune system and lymphaticdrainage. Also treated with Endermologie (LPG,63

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2004), the woman had significant improvementsincluding a decrease in her medications and fatiguelevels. IMT therapists find treating the structuralcomponents of the body and improving lymphdrainage will improve the detoxification process,positively affect the autonomic nervous system, andthereby improve a client’s function and quality oflife.

The anticipated treatment outcome is twofold: 1)subjective reports of decreased pain with improvedfunction, and 2) objective improvementsdocumented in range of motion, posture, gait, andcardiovascular endurance.

Post treatment, the Physical Therapists reported “a reduction of all medications by two-thirdsincluding a reduction of Neurontin from 900mg/day to 200 mg/day secondary to decreased pain.

Decreased pain specifically: upper back pain (decreased from 12/10 to 0/10); wrist pain (10/10 to3/10); bilateral lower extremity pain (7/10 to 2/10),based on a 0-10 subjective pain scale. Increasedendurance to complete work activities / duties anda report of being more alert at work.

The client also had decreased swelling and fluidreduction, as evidenced by a decrease in clothessize by 1 full size, despite no diet change. Therewas also a decrease in girth measurements: waist atumbilicus from 53 to 48 inches and bilateral thighsfrom 26 to 24 inches. (Koch & Lunn, 2004).64

Energy MedicineThe National Institutes of Health (NIH) is

funding numerous Energy Healing (EH) studiesexamining its effects on conditions including TMJdisorders, wrist fractures, cardiovascular health,cancer, wound healing, neonatal stress, pain,fibromyalgia, and AIDS (NIH, 2004a). It is alsosuggested that EH may have positive effects onvarious orthopaedic conditions, including fracturehealing, arthritis, muscle and connectivetissue. (DiNucci, 2005). 65

TMJ and FibromyalgiaThe purpose of this study was to determine the

comorbidity of temporomandibular disorders and

other stress-associated conditions in patients withchronic fatigue syndrome and fibromyalgia.

The clinical overlap between conditions mayreflect a shared underlying pathophysiologic basisinvolving dysregulation of the hypothalamic-pituitary-adrenal stress hormone axis.Multidisciplinary clinical approach to TMJdisorders would improve diagnosis andoutcomes. (Korszun, 1998).66

Resistance Training, Chiropractic andFibromyalgia

The objective of this study was to evaluateresistance training (RES) and RES combined withchiropractic treatment (RES-C) on fibromyalgia(FMS) impact and functionality in women withFM.

Both groups completed 16 weeks of RESconsisting of 10 exercises performed two times perweek. RES-C received RES plus chiropractictreatment two times per week.

Strength was assessed using one repetitionmaximum for the chest press and leg extension.FMS impact was measured using the FMS impactquestionnaire, myalgic score, and the number ofactive tender points. Functionality was assessedusing the 10-item Continuous Scale PhysicalFunctional Performance test. Analyses of variancewith repeated measures compared groups beforeand after the intervention.

Both groups improved in the strength domains;however, only RES-C significantly improved in thepre- to postfunctional domains of flexibility,balance and coordination, and endurance.

In women with FMS, resistance trainingimproves strength, FMS impact, and strengthdomains of functionality. The addition ofchiropractic treatment improved adherence anddropout rates to the resistance training andfacilitated greater improvements in the domains offunctionality.” (Panton,2009).67

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References1. Schneider, M., H. Vernon, et al. (2009). "Chiropractic management of fibromyalgia syndrome:asystematic review of the literature." J Manipulative Physiol Ther 32(1): 25-40. [Medline Abstract].2. Wahner-Roedler, D., P. Elkin, et al. (2007). "Use of complementary and alternative medical therapiesby patients referred to a fibromyalgia treatment program at a tertiary care center." Mayo-Clin-Proc. 2005Jan; 80(1): 55-60 IBIDS: International Bibliographic Information on Dietary Supplements: fromhttp://grande.nal.usda.gov/ibids/index.php.3. Sarac, A., A. Gur, et al. (2006). "Complementary and alternative medical therapies in fibromyalgia."Curr Pharm Des. 12(1): 47-57(IBIDS: International Bibliographic Information on Dietary Supplements):from http://grande.nal.usda.gov/ibids/index.php.4. Holdcraft LC, Assefi N, Buchwald D. Complementary and alternative medicine in fibromyalgia andrelated syndromes. Best Pract Res Clin Rheumatol. 2003;17:667–683. doi:10.1016/S1521-6942(03)00037-8.5. Sprott, H., S. Franke, et al. (1998). "Pain treatment of fibromyalgia by acupuncture." Rheumatol Int18(1): 35-6.6. Field, T., J. Delage, et al. (2003). "Movement and massage therapy reduces fibromyalgia pain." Journalof Bodywork annd Movement Therapies 7, 49-52., 11-17.7. Martin L, Nutting A, MacIntosh BR, Edworthy SM, Butterwick D, Cook J. An exercise program in thetreatment of fibromyalgia. J Rheumatol. 1996;23:1050–1053.8. Wigers SH, Stiles TC, Vogel PA. Effects of aerobic exercise versus stress management treatment infibromyalgia. Scand J Rheumatol. 1996;25:77–86.9. Kalichman, L. (2010). "Massage therapy for fibromyalgia symptoms." Rheumatol Int 30(9): 1151-1157.[Medline Abstract].10. Nijs, J. and B. Van Houdenhove (2009). "From acute musculoskeletal pain to chronic widespread painand fibromyalgia: application of pain neurophysiology in manual therapy practice." Man Ther 14(1): 3-12.[Medline Abstract].11. Haak, T. and B. Scott (2008). "The effect of Qigong on fibromyalgia (FMS): a controlled randomizedstudy." Disabil Rehabil 30(8): 625-633. [Medline Abstract].12. Wisdom Healing Qigong (2010) http://www.qifieldtherapy.com/zqg.html13. Stephens, S., B. M. Feldman, et al. (2008). "Feasibility and effectiveness of an aerobic exerciseprogram in children with fibromyalgia: results of a randomized controlled pilot trial." Arthritis Rheum59(10): 1399-1406. [Medline Abstract].14. Lind, B. K., W. E. Lafferty, et al. (2007). "Use of complementary and alternative medicine providersby fibromyalgia patients under insurance coverage." Arthritis Rheum 57(1): 71-6.15. Thieme, K. and R. H. Gracely (2009). "Are psychological treatments effective for fibromyalgia pain?"Curr Rheumatol Rep 11(6): 443-450. [Medline Abstract].16. Menzies, V. and S. Kim (2008). "Relaxation and guided imagery in Hispanic persons diagnosed withfibromyalgia: a pilot study." Fam Community Health 31(3): 204-212. [Medline Abstract].17. Kroner-Herwig, B. (2009). "Chronic pain syndromes and their treatment by psychologicalinterventions." Curr Opin Psychiatry 22(2): 200-204. [Medline Abstract].18. Staud, R. (2006). "Are tender point injections beneficial: the role of tonic nociception in fibromyalgia."Curr Pharm Des 12(1): 23-7.19. Hellstrom, O. W. (1995). "Health promotion and clinical dialogue." Patient Educ Couns 25(3): 247-56.20. Mutter, J., J. Naumann, et al. (2007). "Elimination of xenobiotics in a female patient with fibromyalgia,chronic fatigue, and trunk obesity." Forsch Komplementarmed 14(1): 39-44.21. Singh, B. B., W. S. Wu, et al. (2006). "Effectiveness of acupuncture in the treatment of fibromyalgia."

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A l t e r n T h e r H e a l t h M e d 1 2 ( 2 ) : 3 4 - 4 1 . [ F u l l T e x t ] .http://www.immunesupport.com/library/showarticle.cfm/ID/707722. Birch, S., J. K. Hesselink, et al. (2004). "Clinical research on acupuncture. Part 1. What have reviewsof the efficacy and safety of acupuncture told us so far?" J Altern Complement Med 10(3): 468-80.23. Sprott, H., S. Franke, et al. (1998). "Pain treatment of fibromyalgia by acupuncture." Rheumatol Int18(1): 35-6.24. Langhorst, J., P. Klose, et al. (2010). "Efficacy of acupuncture in fibromyalgia syndrome--a systematicreview with a meta-analysis of controlled clinical trials." Rheumatology (Oxford) 49(4): 778-788.[Medline Abstract]25. Jang, Z. Y., C. D. Li, et al. (2010). "[Combination of acupuncture, cupping and medicine for treatmentof fibromyalgia syndrome: a multi-central randomized controlled trial]." Zhongguo Zhen Jiu 30(4):265-269. [Medline Abstract].26. Panton, L. B., J. D. Kingsley, et al. (2006). "A comparison of physical functional performance andstrength in women with fibromyalgia, age- and weight-matched controls, and older women who arehealthy." Phys Ther 86(11): 1479-88.27. Bennett, R. (2005). "The Fibromyalgia Impact Questionnaire (FIQ): a review of its development,current version, operating characteristics and uses." Clin Exp Rheumatol 23(5 Suppl 39): S154-62 fromwww.myalgia.com/FIQ/Bennett%20FIQ%20review.pdf and http://www.myalgia.com/FIQ/FIQ_B.htm28. Ekici, G., Y. Bakar, et al. (2009). "Comparison of manual lymph drainage therapy and connectivetissue massage in women with fibromyalgia: a randomized controlled trial." J Manipulative Physiol Ther32(2): 127-133. [Medline Abstract].29. Martinez-Lavin, M. (2007). "Biology and therapy of fibromyalgia. Stress, the stress response system,and fibromyalgia." Arthritis Res Ther 9(4): 216.30. Mackay, N., S. Hansen, et al. (2004). "Autonomic nervous system changes during Reiki treatment: apreliminary study." J Altern Complement Med 10(6): 1077-81.31. Delaney, J. P., K. S. Leong, et al. (2002). "The short-term effects of myofascial trigger point massagetherapy on cardiac autonomic tone in healthy subjects." J Adv Nurs 37(4): 364-71.32. McNamara, M. E., D. C. Burnham, et al. (2003). "The effects of back massage before diagnosticcardiac catheterization." Altern Ther Health Med 9(1): 50-7.33. Beard, J. P., W. H. Wade, et al. (1996). "Sacral insufficiency stress fracture as etiology of positionalautonomic dysreflexia: case report." Paraplegia 34(3): 173-5.34. Giammatteo, T., & Weiselfish-Giammatteo, S. (1997). Integrative manual therapy for the autonomicnervous system and related disorders : utilizing advanced strain and counterstrain technique. Berkeley,Calif.: North Atlantic Books.35. Wheeler, L. (2004). Advanced Strain Counterstrain. Massage Therapy Journal, 43 Winter(4), fromwww.amtamassage.org/journal/winter05_journal/mtjWinter05.html36. Crowell, T. (2005). The relationship between bone bruises and lymphedema after fracture: a cases t u d y . T o w n s e n d L e t t e r f o r D o c t o r s a n d P a t i e n t s , J a n [ F u l l T e x t ] .http://www.findarticles.com/p/articles/mi_m0ISW/is_258/ai_n8592733).37. Trettin, H. (1992). "[Neurologic principles of edema in inactivity]." Z Lymphol 16(1): 14-6.38. Wong, R. and S. Sagar (2006). "Acupuncture treatment for chemotherapy-induced peripheralneuropathy--a case series." Acupunct Med 24(2): 87-91.39. Longbottom, J. (2005). "A case report of postulated 'Barre Lieou syndrome'." Acupunct Med 23(1):34-8.40. Cuthbert, S. C. (2003). "Applied Kinesiology and the Myofascia." Collected Papers InternationalCollege of Applied Kinesiology, 2002-2003;1:95-103.

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41. Cottingham, J. T., S. W. Porges, et al. (1988). "Shifts in pelvic inclination angle and parasympathetictone produced by Rolfing soft tissue manipulation." Phys Ther 68(9): 1364-70.42. Sergueef, N., K. E. Nelson, et al. (2002). "The effect of cranial manipulation on theTraube-Hering-Mayer oscillation as measured by laser-Doppler flowmetry." Altern Ther Health Med 8(6):74-6.43. Saeki, Y. (2000). "The effect of foot-bath with or without the essential oil of lavender on the autonomicnervous system: a randomized trial." Complement Ther Med 8(1): 2-7.44. Tsai, M. W., W. C. Chie, et al. (2006). "Effects of exercise training on heart rate variability aftercoronary angioplasty." Phys Ther 86(5): 626-35.45. Singh, S., V. Malhotra, et al. (2004). "Role of yoga in modifying certain cardiovascular functions intype 2 diabetic patients." J Assoc Physicians India 52: 203-6.46. Slavkin, H. C. (2002). "Distinguishing Mars from Venus: emergence of gender biology differences inoral health and systemic disease." Compend Contin Educ Dent 23(10 Suppl): 29-31.47. Arnold, L. M. (2006). "Biology and therapy of fibromyalgia. New therapies in fibromyalgia." ArthritisRes Ther 8(4): 212.48. Rossy LA, Buckelew SP, Dorr N, Hagglund KJ, Thayer JF, McIntosh MJ, Hewett JE, Johnson JC. Ameta-analysis of fibromyalgia treatment interventions. Ann Behav Med. 1999;21:180–19149. Henningsen, P., S. Zipfel, et al. (2007). "Management of functional somatic syndromes." Lancet369(9565): 946-55.50. Burckhardt CS, Mannerkorpi K, Hedenberg L, Bjelle A. A randomized, controlled clinical trial ofeducation and physical training for women with fibromyalgia. J Rheumatol. 1994;21:714–720.51.Vlaeyen JW, Teeken-Gruben NJ, Goossens ME, Rutten-van Molken MP, Pelt RA, van Eek H, HeutsPH. Cognitive-educational treatment of fibromyalgia: a randomized clinical trial. I. Clinical effects. JRheumatol. 1996;23:1237–1245.52. Martin L, Nutting A, MacIntosh BR, Edworthy SM, Butterwick D, Cook J. An exercise program inthe treatment of fibromyalgia. J Rheumatol. 1996;23:1050–1053.53. Wigers SH, Stiles TC, Vogel PA. Effects of aerobic exercise versus stress management treatment infibromyalgia. Scand J Rheumatol. 1996;25:77–86.54. Sunshine, W., T. Field, et al. (1996). "Fibromyalgia benefits from massage therapy and transcutaneouselectrical stimulation." Journal of Clinical Rheumatology 2, 18-22.55. Field, T., J. Delage, et al. (2003). "Movement and massage therapy reduces fibromyalgia pain." Journalof Bodywork annd Movement Therapies 7, 49-52., 11-17.56. Field, T., M. Diego, et al. (2002). "Fibromyalgia Pain and Substance P Decrease and Sleep ImprovesAfter Massage Therapy." J Clin Rheumatol 8(2): 72-76.57. Field, T., Diego, M., Cullen, C., Hernandez-Reif, M., Sunshine, W., & Douglas, S. (2002).Fibromyalgia pain and substance P decrease and sleep improves after massage therapy. Journal of ClinicalRheumatology, 8, 72-76.58. De Stefano, R., E. Selvi, et al. (2000). "Image analysis quantification of substance P immunoreactivityin the trapezius muscle of patients with fibromyalgia and myofascial pain syndrome." J Rheumatol 27(12):2906-10.59. Baraniuk, J. N., G. Whalen, et al. (2004). "Cerebrospinal fluid levels of opioid peptides in fibromyalgiaand chronic low back pain." BMC Musculoskelet Disord 5: 48.60. Omega Book Centre (2005). Body Wisdom Book Review: Light Touch for Optimal Health By SharonGiammatteo, Ph.D. $27.95. 210p. Soft. ISBN 1-55643-356-5 North Atlantic Books. www.CenterIMT.com61. Cimbiz, A., V. Bayazit, et al. (2005). "The effect of combined therapy (spa and physical therapy) onpain in various chronic diseases." Complement Ther Med 13(4): 244-50.

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62. Gamber, R. G., J. H. Shores, et al. (2002). "Osteopathic manipulative treatment in conjunction withmedication relieves pain associated with fibromyalgia syndrome: results of a randomized clinical pilotproject." J Am Osteopath Assoc 102(6): 321-5.63. Endermologie (LPG) www.endermologie.com/ and http://health.einnews.com/news/fibromyalgia64. Koch, T. S. and L. Lunn (2004). "The Treatment of a Client Diagnosed with Fibromyalgia SyndromeUtilizing Integrative Manual Therapy." Connecticut School of Integrative Manual Therapy e-Journal: fromwww.centerimt.com/e-journal/articles/ej00010.htm.65. DiNucci, E. M. (2005). "Energy healing: a complementary treatment for orthopaedic and otherconditions." Orthop Nurs 24(4): 259-69.66.Korszun, A., E. Papadopoulos, et al. (1998). "The relationship between temporomandibular disordersand stress-associated syndromes." Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86(4): 416-20.67. Panton, L. B., A. Figueroa, et al. (2009). "Effects of resistance training and chiropractic treatment inwomen with fibromyalgia." J Altern Complement Med 15(3): 321-328. [Medline Abstract]

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Transformational Shift ModuleMusculoskeletal Solutions

Kimberly Burnham, PhDMatrix Energetics Practitioner CertifiedIntegrative Manual Therapy Certifiedwww.KimberlyBurnhamPhD.com

www.VisualizeHealth.net1. General2. Knee Joint3. Hip Joint4. Shoulder Joint5. Wrist Joint6. Bone Health7. Fibromyalgia

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Musculoskeletal HealthTransformational Shift Modules from Visualize Health can be used in many ways

1. As Informational Modules on complementary and alternative medicine (CAM) approaches for a particular condition or body system. These are 4‐10 pages of research from The Burnham Review on what the allopathic (traditional) medical system and others are saying about Integrative Medicine approaches for a particular condition. This creates a morphic field around what is useful and accessible from complementary and alternative medicine.

2. As a ME Modules to shift and notice what is different about a particular condition, set of symptoms or way of viewing health. These modules containing an energetic download and can be used by Matrix Energetics practitioners for themselves, their family or clients or they can be used by an individual.  Use multiple selves to work with each of the images, two pointing, time travel to before the symptoms.

3. As a Ho’oponopono Clearing Device. The images are designed as Ho’oponopono clearing devices embodied with the energies of  “I am sorry, Please forgive me, I thank you and I love you.”

4. As a Frequency or Motility  for practitioners adept at feeling energies, frequencies & motilities. 

5. As a Health Coaching Tool. The Health Coaching wheel focuses on various aspects of the specific conditions and what health would look like at a perfect 10. This wheel can be discusses with your Health Coach, used in visualizing what each aspect of your life at a perfect 10; used in a Matrix Energetics two point way or dropping the pebble or used as a dowsing tool to find aspects in your life or body that can shift.

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Hea

lth C

oach

ing

for

Mus

cle

sSys

tem

Peptidergic Nervous System Oscillation

Biof

eedb

ack

and

Med

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Transformation of M

usculoskeletal System

Jt Blood Flow 

Prayer

Ext

race

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r M

atri

x B

alan

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Acupuncture Reflexes

CranioSacral Rhythms

Soft Tissue Synchronizers

Integrative Manual Therapy

Now

 in th

e Nervous System

Visualizing Bone Health

Firs

t d

o n

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arm

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Musculoskeletal Reflex Points 

Matrix Energetics Frequency 4 for the Joint Structure

Soft Tissue & Joint Health Morphic Field

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igong

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aveCognitive behavioral coaching

Movement

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Serotonin 

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tration in 

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Massage TherapyJoint function&Quality of

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Neu

romuscular Function

Arnica TaumeelHomeopathyHealthy Clean Food & Environment

NeuroFascial Process

Green TeaAe

robic

exerc

iseM

itochon

driaSt

reng

thspa therapy 

(balneotherapy)Substance P 

Neurotransmitter balance

Energy

Respiratory Function Motor ImageryMuscle Strength Training

vitamin C, vita

min E, m

agne

sium

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plex, green

 tea

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Integrative Medicine Module Panel

Kimberly Burnham, PhDMatrix Energetics CertifiedIntegrative Manual Therapy Certifiedwww.KimberlyBurnhamPhD.comwww.VisualizeHealth.netWellness@VisualizeHealth.net

Ho’oponoponoI  Love you

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Visualization Client Centered 

Practice

Polarity Therapy

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Feldenkrais

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Reiki Energy Symbols

Herbal Therapy

Osteopathic  Manual 

TreatmentWisdom Healing 

Qigong Form Formlessness

Acupuncture Meridians Tapping 

Reflex Points

Integrative Manual Therapy (IMT)

Shiatsu Acupressure

Complementary & Alternative Medicine 

(CAM) Experts

Health, Wellness, Recovery & 

Consciousness

Transformational Shift Downloads

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Page 16: Soft Tissue Joint Comfort Range Solutions Tbr Fibromyalgia Chronic Pain

Musculoskeletal Health 7

www.VisualizeHealth.net

10You are 

Here

Health Coaching Wheel Transformational Shift Module

0

Comfortable Movement

Strength, Endurance and Quick Recovery Times

Relaxed, Well developed muscle tone

Ideal Digestive Function

Flexible

Neuromuscular Communication

Rapid Eye Movement Sleep

Bone, Connective Tissue, Muscle Integrity

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The Wheel Of __________________Kimberly Burnham, PhD & Visualize Health

Call 860‐221‐8510 or visit www.VisualizeHealth.net or www.HealthCoachingU.com

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Musculoskeletal Health 7

www.VisualizeHealth.netME Transformational Shift Module

Multiple Support & Resources

Walking Running Jumping Window Homeopathic 

Dropper Traumeel

Healing Super powers

Gratitude Practice

Super Circulation

Joint Nutrition

HopNow

2242

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MoveNow

Connective Tissue 

Nutrition

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Musculoskeletal Health 7www.VisualizeHealth.net

Ho’oponopono Clearing Device Transformational Shift Module

Healing Super powers

I Love You

I am Sorry

Please Forgive Me 

Ideal  Connective Tissuse Flow

I Thank You

I Thank You I Love  

You

I Love  You

I Thank You

Energy Systems

Vitamins

Healthy Food & Elimination Process

Noticing & Observing

Active Life

What is Different??

I am Sorry

Now

Energetics

Awesome Life

Time & Space Enough