Written By Nicola Jenkins, Principal, The Tisserand Institute

About Fibromyalgia

Formerly referred to as Fibrositis until research showed that inflammation did not appear to exist in the muscle fibres of sufferers, Fibromyalgia is a condition involving widespread muscle pain and fatigue with no apparent cause. Although the symptoms share a great deal of common ground with Chronic Fatigue, a medical diagnosis of Fibromyalgia is dependent on the client experiencing widespread pain (usually described as a deep muscular pain which is throbbing, burning or stabbing) often worse in the morning, that this pain lasts for at least three months and gets worse when the weather is cold or humid, or if they experience stress, depression, anxiety or the hormonal changes associated with premenstrual syndrome or the menopause. Eighteen tender points have been identified as part of the diagnostic examination and a client who has pain in 11 out of the 18 points is said to have the condition.

Given this, our role as aromatherapists must be to concentrate not only on reducing pain, but also to address the other symptoms common to Fibromyalgia sufferers:

• Sleep disorders, including bruxism, restless leg syndrome, and periodic limb movement, are found in close to 100% of all Fibromyalgia cases, leading to daily fatigue and lethargy. Researchers have indicated that those with Fibromyalgia have no difficulty falling asleep but are unable to go into the deep sleep required to achieve full rest.
• Severe muscle pain and stiffness, especially in the morning and after exercise.
• Irritable bowel syndrome - between 40-70% of sufferers experience IBS, constipation, diarrhoea, abdominal pain or nausea. Clients experience problems absorbing certain nutrients, especially magnesium, potassium and vitamins B3 and B6, all involved in muscle contraction and healthy nerve functioning. There is also a marked tendency towards food intolerances.
• Chronic headaches (both migraines and muscle tension headaches) in 50% of cases.
• Jaw pain and facial tenderness (as a result of TMJ dysfunction or bruxism)
• Lack of concentration and poor memory (usually fatigue-driven). Dysmenorrhoea.
• Skin and multiple chemical sensitivities in 50% of cases.
• History of depression in up to 70% of cases.

Why does Fibromyalgia develop?

Although the medical establishment has yet to determine a root cause for the
condition, it appears that Fibromyalgia can be triggered by injury, accidents or the development of certain autoimmune conditions where a genetic predisposition exists. One theory suggests that this genetic predisposition relates to the way that neurotransmitters, especially serotonin and nor adrenalin are produced and released. Studies have indicated that generally someone with Fibromyalgia will have significantly lower levels of serotonin than other individuals. Fluctuations in both the endocrine and immune system functioning, as well as patterns of sleep are also the subject of debate, with Cortisol levels and growth hormone coming under close scrutiny, especially given Cortisol's involvement in the stress response.

Medical treatment

Medical treatment of this condition tends to focus on pain relief, improving sleep and increasing serotonin levels through the use of NSAIDs. It should be noted in particular that common painkillers such as aspirin and ibuprofen don't work for Fibromyalgia and that the stronger painkillers often have side effects including constipation, nausea or depression, which, if they already exist for your client, will get worse.

Adapting your massage treatment

Given the levels of pain involved, it is often necessary to limit your massage to a very gentle effleurage occasionally supported by gentle petrissage and kneading in some areas. Strong or deep tissue massage will not be well received and is pretty much contra indicated, nor will this help to reduce the pain or release muscle adhesions. Particular care needs to be taken around the elbows, knees, gluteals, neck, shoulders and upper back, as some of the key trigger points used to identify the condition arc located in these areas. For instance, in the supraspinatus, and trapezius muscles, two common points of tension which arc often associated with headaches. Neuromuscular technique and passive gentle stretching following work in a tender area will also aid recovery and provide significant pain relief.

I have found aromatherapy facial massage of particular benefit to my clients with fibromyalgia; not only was the facial treatment able to reduce jaw pain, but it was also an effective aid to sleep, even when this was the only area that could be touched during a flare up. If you are working with facial treatments, I would suggest that you work with the jaw both closed and opened, using a gentle petrissage over the masseter, temporalis, buccinator and platysma muscles working as much as possible along the muscle fibres (from origin to insertion).

Effective essential oils

Patch testing in advance of treatment is strongly advised given the wide range of symptoms and the predominance of both chemical and skin sensitivities. Once this has been done, it is generally acceptable to work with blends in the region of 2-3% in solution.

Your choice of essential oils will naturally vary with the strength of the symptoms your client is facing and the emphasis they wish to seek in the course of the treatment. What I have found to be effective in my own practice is to select a combination of oils which meet the following criteria:

• Strong analgesics that are also antispasmodic - I will usually provide the client with two blends for home use as well - one for morning use that emphasises pain relief, and one for evening use that is primarily sedating. Basil, Black Pepper, Clove, German Chamomile, Ginger, Marjoram, Rosemary, Nutmeg. Peppermint, Tumeric and Carrot seed have all been helpful, particularly the Basil, Marjoram and Carrot Seed. Whilst Valerian ought to be included in this list as a strong painkiller and sedative, I have found that it is not effective with fibromyalgia - it seems to make sleep less restful and increased any depressive tendencies in my clients.
• Sedating oils - improving the quality of sleep is vital to the success of the treatment process. Roman Chamomile, Carrot Seed, Damiana and Lavender are all beneficial, with Damiana being particularly so, which is a shame as this essential oil is getting more and more difficult to find. Roman Chamomile and cither Marjoram or Carrot Seed together provide an effective substitute.
• Hormone regulating oils - the majority of Fibromyalgia sufferers are female and, as symptoms tend to be worse when hormones are fluctuating, the use of these oils forms a central part of the blend. Jasmine, Geranium, Damiana, Rose Otto or Pine have all been helpful, especially the Jasmine and Rose, given their uplifting qualities, although the Pine was in some cases more useful, usually when there was a pronounced need for antifungal properties as well.
• Essential oils that mimic serotonin and which are particularly euphoric and sedating, lifting client's spirits during the treatment process such as Roman Chamomile, Chamomile Maroc (Ormenis multicaulis). Clary Sage, Lavender, Marjoram, May Chang, Melissa, Neroli, Petitgrain, Rose Otto, Vetiver or Sandalwood. This has been the area which I have varied most according to the presenting symptoms of the client.
• Antifungal oils - there is some evidence that fungal infections will trigger the digestive complaints that often go alongside fibromyalgia, in particular any bloating, inflammation or spasms of the digestive tract, and may even be linked to the disorder developing in the first place. Rosewood, Tea Tree, Manuka and Pine are effective, with the Rosewood and Manuka being particularly beneficial.

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