PDF(Pubmed)
Abstract：
The present case study describes the long-term symptomatic remission in a patient with fibromyalgia (FM) after multimodal spinal manipulation. A 44-year-old woman presented with a chronic headache, severe neck pain, shoulder pain, and back pain lasting for 2 years after experiencing domestic violence. She had sleep disorders, fatigue, and depressive mood. Her primary care physician diagnosed her with FM and comorbid depression. Despite treatment with non-steroidal anti-inflammatory drugs, muscle relaxants, anti-depressants, anti-epileptics, acupuncture, and aqua-therapy, she experienced no appreciable relief from her symptoms. The patient then sought a chiropractic evaluation and potential treatment for her symptoms. At presentation, widespread tenderness was palpable over the neck, shoulder, back, anterior chest, abdominal wall, and buttock. Radiographs showed loss of cervical lordosis, widespread degenerative spondylosis, and osteitis pubis. Surface electromyography (sEMG) revealed neck and thoracic paraspinal muscular spasms. The patient was diagnosed with FM based on the American College of Rheumatology diagnostic criteria and the associated comorbidities. Multimodal chiropractic approaches, which consisted of spinal manipulation, massage, and intermittent motorized cervical traction, were used twice weekly to relieve soft-tissues and intervertebral joints and stretch core musculatures. The patient\'s physical and mental complaints were mostly resolved near the end of 9 months of treatment. Her symptom alleviation was associated with corresponding change in normalized sEMG signal and cervical spine realignment at the 16th- and 26th-month follow-ups. Widespread pain in FM can lead to confused thinking and a lack of awareness of cervical spondylosis. In this example, it is assumed that the noxious cervical inputs triggered an ongoing FM process. Chiropractic treatment blocked noxious inputs coming from pain sources, corrected pain thresholds, and lowered excitability, thereby eradicating FM symptoms.
摘要：
本病例研究描述了多模式脊柱操纵后纤维肌痛（FM）患者的长期症状缓解。一名44岁的女性出现慢性头痛，严重的颈部疼痛,肩膀疼痛,经历家庭暴力后，背部疼痛持续2年。她有睡眠障碍,疲劳,和抑郁情绪。她的初级保健医生诊断她患有FM和并发抑郁症。尽管用非甾体抗炎药治疗，肌肉松弛剂,抗抑郁药,抗癫痫药,针灸,和水疗法，她的症状没有明显的缓解。然后，患者寻求脊椎指压疗法评估和潜在的症状治疗。在介绍时,广泛的压痛在脖子上是明显的，肩膀,回来,前胸,腹壁,还有屁股.射线照片显示宫颈前凸丧失,广泛的退行性脊椎病，和耻骨骨炎.表面肌电图（sEMG）显示颈部和胸部椎旁肌痉挛。根据美国风湿病学会诊断标准和相关的合并症，患者被诊断为FM。多模式脊椎指压疗法，包括脊柱操纵，按摩,间歇性电动颈椎牵引，每周两次用于缓解软组织和椎间关节并拉伸核心肌肉。患者的身体和精神不适大部分在9个月的治疗结束后得到解决。在第16个月和第26个月的随访中，她的症状缓解与标准化sEMG信号和颈椎重新对齐的相应变化有关。FM中广泛的疼痛会导致思维混乱和缺乏对颈椎病的认识。在这个例子中，假设伤害性宫颈输入触发了正在进行的FM过程。整脊治疗阻断了来自疼痛源的有害输入，纠正疼痛阈值，降低了兴奋性，从而根除FM症状。
