Tai Chi for Fibromyalgia
Mar 29, 2020
Medical Report: Fibromyalgia and Tai Chi
Eric L. Zielinski
Western lifestyle hasn’t served Americans well and we battle two extremes in our industrialized society: being sedentary and overstressing our muscles and joints due to repetitive motions like typing and factory line work. Sadly, few people are out of harm’s way. Consequently, we have encountered the arrival of several previously unseen conditions like fibromyalgia that basically came out of the blue and is now plaguing our nation. Thankfully, researchers are taking great strides to find natural solutions for people with this debilitating disease and are suggesting mind-body activities like Tai Chi as a viable symptom management tool.
Still relatively new on the scene of commonly diagnosed conditions, the term fibromyalgia was first coined in 1976 and it wasn’t until 1990 that the American College of Rheumatology first developed diagnostic criteria for doing fibromyalgia research. Subsequently, it wasn’t until after 1990 that the term fibromyalgia gained wide usage. Since then the American College of Rheumatology has recently updated the criteria so that if the following three conditions are met, then a diagnosis of fibromyalgia can be made.
- Widespread pain index (WPI) ≥7 and symptom severity (SS) scale score ≥5 or WPI 3 - 6 and SS scale score ≥9.
- Symptoms have been present at a similar level for at least 3 months.
- The patient does not have a disorder that would otherwise explain the pain.
In spite of the six million Americans that are affected by this painful condition, fibromyalgia still confounds physicians and the research community. According to the Centers for Disease Control and Prevention (CDC), “Fibromyalgia is a disorder of unknown etiology characterized by widespread pain, abnormal pain processing, sleep disturbance, fatigue and often psychological distress.” Other symptoms include:
- Morning stiffness.
- Tingling or numbness in hands and feet.
- Headaches, including migraines.
- Irritable bowel syndrome.
- Problems with thinking and memory (sometimes called "fibro fog").
- Painful menstrual periods and other pain syndromes.
Furthermore, the CDC has determined interesting epidemiological data stating the following:
- Most people with fibromyalgia are women (7:1 ratio to men).
- Most people are diagnosed during middle age and prevalence increases with age.
- Working age women with fibromyalgia hospitalized for occupational musculoskeletal disorders were almost 10 times less likely to return to work and four times less likely to retain work at 1-year post hospitalization.
- Working adults with fibromyalgia average almost 17 days of missed work per year compared to six days for persons without fibromyalgia.
- Fibromyalgia has also been associated with lower levels of health-related quality of life and work productively loss.
In summary, causes and risk factors for fibromyalgia remain unknown. Although, some claim it is related to stressful or traumatic events, repetitive injuries, viral infections, genetic dispositions and certain diseases like rheumatoid arthritis, chronic fatigue syndrome and obesity
Medical Research and Management
With the expressed purpose of developing “evidence-based recommendations for the management of fibromyalgia syndrome,” a multidisciplinary task force was formed representing 11 European countries in the mid-2000s. After a systematic review of 39 pharmacological intervention studies and 59 non-pharmacological studies, researchers from King’s College London came up with the following recommendations for the management of fibromyalgia syndrome:
- Analgesics – cetaminophen (Tylenol, etc.), tramadol (Ultram) and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin, etc.) or naproxen sodium (Aleve, etc.).
- Antidepressants – duloxetine (Cymbalta, milnacipran (Savella), and fluoxetine (Prozac).
- "Other pharmacological” – anti-seizure medications Gabapentin (Neurontin) and pregabalin (Lyrica).
- Exercise – anything that is tolerable to the patient.
- Cognitive behavioral therapy – pain-related group sessions and individual counseling with a trained professional
- Education – learning what triggers the pain and making the necessary lifestyle changes.
- Dietary interventions – eating an anti-inflammatory diet slow in processed foods, sugars, grains, and fried foods.
- “Other non-pharmacological" – which could mind-body exercises like Tai Chi.
The list of side effects for the medical therapies listed above are quite varied and include severe complications like liver damage, heart failure and death. It is only with extreme caution that someone battling fibromyalgia should take drugs that are so potentially harmful; particularly, when there are proven, natural ways of managing the condition like Tai Chi.
Research showing Tai Chi’s ability to help people with fibromyalgia
Similar to many mind-body interventions, Tai Chi has helped people with pain disorders like fibromyalgia for centuries. It wasn’t until the 20th century, however, that science has focused on its effects in a clinically controlled setting.
- For example, in 2010, BMC Complementary and Alternative Medicine published an article from Tufts University School of Medicine researchers that systematically reviewed the effects of Tai Chi on common fibromyalgia-related conditions like stress, anxiety, depression and mood disturbance in eastern and western populations. In total, of the 29 articles they found, Tuft researchers evaluated 19 studies highlighting the anxiety-reducing ability of Tai Chi. Of significant interest is an eight-study group reflecting data from 359 participants with “symptomatic osteoarthritis, healthy adults, elderly with cardiovascular disease risk factors, individuals with fibromyalgia, and adolescents with ADHD found that Tai Chi practiced 2 to 4 times a week (30 to 60 minutes/time) for 5 to 24 weeks was associated with a significant reduction in anxiety.” For one activity (i.e. Tai Chi) to affect such a wide variety of health concerns points to the unbelievable, global benefits Tai Chi has on the body. This point cannot be stressed enough as there are not many things that can do this, especially in regards to people battling fibromyalgia!
- To evaluate the effects Tai Chi training has on women with fibromyalgia, 32 women were recruited to participate in a 28-week program in which they practiced Tai Chi three times per week. As a result, University of Granada researchers were able to prove that, “Patients showed improvements on pain threshold, total number of tender points and algometer score. The intervention was effective on 6-min walk, back scratch, handgrip strength, chair stand, chair sit & reach, 8 feet up & go and blind flamingo tests.” In addition, the Tai-Chi group improved the fibromyalgia impact questionnaire total score and six subscales: stiffness, pain, fatigue, morning tiredness, anxiety, and depression. The intervention was also effective in six Short Form Health Survey 36 subscales: bodily pain vitality, physical functioning, physical role, general health, and mental health. The researchers concluded, “A 28-week Tai-Chi intervention showed improvements on pain, functional capacity, symptomatology and psychological outcomes in female [fibromyalgia] patients.”
- To determine its effects on tenderness, functional capacity, symptomatology, and quality of life in men with fibromyalgia, researchers from Spain and Sweden took six middle-aged male volunteers with fibromyalgia and had them participate in a four-month Tai Chi program. The data, printed in American Journal of Men’s Health showed “a significant improvement after the intervention period for the chair sit and reach test was found, such improvement was maintained after the detraining phase.” What’s fascinating about this article is that it proves the long-lasting effects of Tai Chi. Further studies need to be conducted to describe this in more detail, as no one knows for certain how far-reaching these benefits can be.
- In 2010, the New England Journal of Medicine printed a random-control trial in which 66 participants were split into three groups; one experimental group consisting of 33 people engaged in classic yang-style Tai Chi twice a week for 12 weeks lasting 60 minutes per session twice a week; two control groups where people engaged in stretches for the treatment of fibromyalgia and another in which people sat through wellness education. The primary outcomes measure was a change in the Fibromyalgia Impact Questionnaire (FIQ) score in which scores range from 0 to 100, where 0 indicates no symptoms and 100 indicates the worst symptoms imaginable. Secondary outcome measures included summary scores on the physical and mental components of the Short-Form Health Survey (SF-36) in which scores also range from 0 being the lowest to 100 being the highest, however, these results indicate overall mental and physical wellness not pain or symptoms. The results were extraordinary. The Tai Chi group’s average FIQ score went from 62.9 (at the beginning of the study, before they started the program) down to 35.1 (at the end of the 12-week program) signifying a considerable drop in pain and related symptoms. Comparatively, the health education and stretching group only experienced a 9.4-point drop from 68.0 to 58.6. Concerning SF-36 physical component, the Tai Chi group experienced a significant increase from 28.5 to 37.0 in comparison to the control groups only going from 28.0 to 29.4. Likewise, the SF-36 mental component scores for the Tai Chi experimental group increased from 42.6 to 50.3 in comparison to the health education and stretching control groups who only experienced a 37.8 to 39.4 increase. Fascinatingly, the Tai Chi group continued to experience an increase in their FIQ score as indicated by an 18.3-point drop measured 12 weeks after Tai Chi was discontinued. The long-standing and continual benefits of Tai Chi are particularly highlighted in this study.
Much remains unknown about fibromyalgia and researchers have been diligent to find natural solutions for the horrible symptoms millions of Americans suffer with daily due to it. Although, only a handful of studies have connected Tai Chi’s ability to help decrease the pain and debilitating issues related to fibromyalgia, physicians should feel confident recommending it their patients. Tai Chi is one of the few safe, free, and effective interventions proven to help people overcome this painful disorder. As such, the government and research foundations should focus more monies to study the how’s and why’s behind its ability to help so many people.