Complementarity of medical care and posturology in the management of Fibromyalgia Syndrome

Abstract

Fibromyalgia Syndrome (FMS) is a chronic and multi-faceted disease with an unknown aetiology. Clinical symptoms consisting of widespread pain, generalized muscular hypertonia, fatigue, sleep disturbances, impaired cognition and poor physical fitness compromise the autonomy, function and independence of these patients [1] . Postural control is affected and balance is impaired, leading to a greater risk and frequency of falls [2] . Pain in FMS may be associated with hyperexcitability of the nociceptive system and reduced opponent non nociceptive sensory process [3] . Although the pathophysiology of pain is unclear, an involvement of the thinly myelinated Aδ and the unmyelinated C-nerve fibers has been reported. An abnormal peripheral C nociceptor ongoing activity and increased mechanical sensitivity could contribute to the pain and tenderness suffered by patients with FMS. Routine engagement in physical exercise is strongly recommended for pain management in musculoskeletal conditions such as FMS. Adherence to exercise in patients with FMS is poor and the majority of them are sedentary. Prolonged sedentary behaviour may contribute to physical deconditioning and a loss of confidence in one's ability to participate in physical activity, which reinforces the cycle of pain and disability. Understanding the factors involved in pain mechanism and postural control is important to maximize therapeutic intervention effectiveness. In this context, posturologist could implement new evaluation and procedural strategies for patients with FMS. Through the evaluation of muscular hypertonia and the quantification of stabilometric parameters, posturology offers a complementary systemic approach in the management of FMS. A precise clinical investigation allows a therapeutic strategy closer the aetiology of postural disorders and pain, which combines plantar neuro-stimulation and manual neurosensory therapy. In this context, posturologist brings perspectives in the management of patients with FMS, complementing medical care.