Current Pharmaceutical Design, 2006 12, 29-35 29 1381-6128/06 $50.00+.00 © 2006 Bentham Science Publishers Ltd. Physical Therapy Modalities in Management of Fibromyalgia Ali Gur * Department of Physical Medicine and Rehabilitation, Medical Faculty, Dicle University, 21280 Diyarbakir / Turkey Abstract: The etiology of fibromyalgia syndrome (FM) is uncertain and the prognosis for symptomatic recovery is generally poor. A wide variety of interventions are used in the management of FM. There is, however, no clear consensus on the treatment of choice and FM remains relatively refractory to treatment. Therefore, prevention, causal therapy and rehabilitation are not possible. FM patients frequently use alternative therapies, indicating dissatisfaction or ineffectiveness of traditional medical therapy. Alternative therapies are generally perceived to be more “natural” and as a result, to have fewer adverse effects. Despite the positive results found, the number of publications related to the application of physical therapy modalities such as acupuncture, transcutaneous electrical stimulation, laser, biofeedback, electrotherapy and magnetic field is still scant, especially concerning FM treatment. The demonstration of a long-term effective intervention for managing the symptoms associated with FM is needed. Multidisciplinary approaches to management include physical and medical therapeutic strategies. Treatment modalities should be individualised for patients based on target symptoms and impairment in functioning. Patience and positive attitude on part of the physician and active involvement of patients and their families in treatment are likely to enhance improvement. It can be concluded that there is a need for larger, more systematic and methodologically sound randomised controlled clinical trials to evaluate the effectiveness of physical therapy modalities of managing FM. We will review some of the existing studies of physical therapy relevant in the treatment of FM and give some practical advice for their use. Key Words: Fibromyalgia Syndrome, Alternative Medicine, Physical Therapy, Acupuncture, Laser, Biofeedback, Transcutaneous electrical stimulation, Ultrasound, Electrotherapy, Magnetotherapy. INTRODUCTION Fibromyalgia (FM) is a disorder or condition character- ised by widespread, chronic musculoskeletal aching and stiffness and pressure hyperalgesia at characteristic sites, called soft tissue tender points. The etiology of FM is uncertain and the prognosis for symptomatic recovery is generally poor [1, 2]. Some current etiologic hypotheses are that FM is a rheumatoid-like disease or a disorder of muscular abnormality or repair; that it results from aberrant mechanisms of peripheral pain; that it is a psychoneuro- endocrine-immune disorder, a psychomatic disorder or a psychiatric disorder related to major depression [3, 4]. There are, however, few studies that examine the inflammatory response system and cytokines in FM [5-8]. It has been suggested that a subgroup of FM patients suffer from a low grade inflammatory process [9] or from exaggerated neuro- genic inflammatory responses [10]. A wide variety of interventions are used in the manage- ment of FM [11]. There is, however, no clear consensus on the treatment of choice and FM remains relatively refractory to treatment. Therefore, prevention, causal therapy and reha- bilitation are not possible. Currently, therapy is polyprag- matic and is aimed at reducing the pain and other symptoms associated with this condition. Therapy consists of drug treatment, physical exercises, psychological interventions *Address correspondence to this author at the Department of Physical Medicine and Rehabilitation, Medical Faculty, Dicle University, 21280 Diyarbakir, Turkey; Tel: 00 90 412 2488001; Fax: 00 90 412 2488579; E-mail: alig@dicle.edu.tr and other symptomatically oriented therapies, such as acu- puncture and laser [12-14]. Effective interventions that last for more than a year have not yet been shown. Research is increasing exponentially in this field, to help us better understand the reasons why this disease develops [15]. Considering current knowledge there are virtually no specific treatments which are based on pathophysiological mechanisms underlying fibromyalgia. However, there is an array of treatment strategies in targeting disease consequen- ces. While medication mainly focuses on pain reduction, physical therapy is aimed at pain, fatigue, deconditioning, muscle weakness and sleep disturbances and other disease consequences [16]. Rehabilitation plays a crucial role in the treatment of FM, particularly among patients more severely disabled by their chronic painful condition [15]. Patients seek alternatives to prescribed medications that are ineffective or have unpleasant side-effects. Alternative therapies are generally perceived to be more “natural” and as a result, to have fewer adverse effects. In addition, comple- mentary approaches address symptoms that are often ignored by conventional therapeutic regimens, including fatigue and cognitive dysfunction. The percentage of patients with rheu- matologic disorders using alternative therapies ranges from 33% to 100%, with 91% of patients with FM using comple- mentary and alternative medicine over a 12-month period [17]. We will review some of the existing studies of physical therapy relevant in the treatment of FM and give some practical advice for their use.