title: A combined ischemic compression and spinal manipulation in the treatment of fibromyalgia: a preliminary estimate of dose and efficacy.
abstract: OBJECTIVE
  To provide preliminary information on whether a regimen of 30 chiropractic treatments that combines ischemic compression and spinal manipulation effectively reduces the intensity of pain, sleep disturbance, and fatigue associated with fibromyalgia. In addition, to study the dose-response relation and identify the baseline characteristics that may serve as predictors of outcome.
  
  
  METHODS
  Subjects were assessed with self-administered questionnaires taken at baseline, after 15 and 30 treatments, and 1 month after the end of the treatment trial.
  
  
  METHODS
  Private practice.
  
  
  METHODS
  Participating subjects were adult members of a regional Fibromyalgia Association. Participating subjects had fibromyalgia for more than 3 months. They received 30 treatments including ischemic compression and spinal manipulation. The 3 outcomes being evaluated were pain intensity, fatigue level, and sleep quality. A minimum 50 improvement in pain intensity from baseline to the end of the treatment trial was needed to include the patient in the respondent category.
  
  
  RESULTS
  Fifteen women (mean age 51.1 years) completed the trial. A total of 9 (60) patients were classified as respondents. A statistically significant lessening of pain intensity and corresponding improvement in quality of sleep and fatigue level were observed after 15 and 30 treatments. After 30 treatments, the respondents showed an average lessening of 77.2 (standard deviation = 12.3) in pain intensity and an improvement of 63.5 (standard deviation = 31.6) in sleep quality and 74.8 (standard deviation = 23. 1) in fatigue level. The improvement in the 3 outcome measures was maintained after 1 month without treatment. Subjects with less than 35 improvement after 15 treatments did not show a satisfactory response after 30 treatments. A trend, determined as not statistically significant, suggests that older subjects with severe and more chronic pain and a greater number of tender points respond more poorly to treatment.
  
  
  CONCLUSIONS
  This study suggests a potential role for chiropractic care in the management of fibromyalgia. A randomized clinical trial should be conducted to test this hypothesis.
authors.affiliation: Private practice of chiropractic, Trois-Rivières, Quebec, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Hains
authors.forename: F
authors.initials: F
authors.lastname: Hains
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D019245:Compressive Strength; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011336:Probability; D012494:Sampling Studies; D016896:Treatment Outcome