Treating Fibromyalgia: A Multi-Level Approach with Aromatherapy and Acupressure.

Wolfgang Luckmann A.P.LMT. ( Fl. 19842 )  

“Experience is the hardest kind of teacher. It gives you the test first and then the lessons afterward” – Anonymous 

Few chronic diseases or conditions have been more complex and frustrating to massage therapists than Fibromyalgia. The word fibromyalgia   tells you, “pain involving muscle and connective tissue.” Yet it is different from the kind of muscular pain treated on a daily basis by massage therapists. When you look up the definition of fibromyalgia on the website for the National Fibromyalgia Association,  www.FMaware.org, we see that: “Fibromyalgia (FM) is an increasingly recognized chronic pain illness which is characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness , general fatigue and sleep disturbances. The most common sites of pain include the neck, back, shoulders, pelvic girdle and hands, but any part of the body can be involved. Fibromyalgia patients experience a range of symptoms of varying intensities that wax and wane over time.” The sites of pain are defined by 18 tender points, with various levels of intensity. Moreover, more in-depth studies have revealed 75 other tender points. In addition, most tender points are situated along the spine and along the Urinary Bladder channel in Traditional Chinese Medicine (TCM) theory.  Although these symptoms associated with Fibromyalgia fluctuate from person to person, there is one common symptom, experts all agree on – they ache all over. 

Location of tender points on the Urinary Bladder channel with acupressure treatment. Notice the color coding for the intensity of pain. 

In addition, there is a cluster of other seemingly unrelated pathologies and signs and symptoms that point to systemic involvement in the patient. The most important pathologies are, and this is listed randomly: Adrenal insufficiency , brain fog, Irritable Bowel Syndrome, edema of the extremities, endometriosis, painful menstruation, PMS, food sensitivities, sugar cravings, hypertension, tension headaches, migraines,  obesity, insomnia , candida, depression, fatigue, allergies, hypothyroidism, osteoarthritis, vaginal infections, Raynaud’s Syndrome. These are just some of the most important pathologies and conditions. Again, these pathologies and signs and symptoms will vary from person to person. 

When faced by this multitude of pathologies and conditions, the massage therapist might well feel overwhelmed, as so much is really outside the scope of practice of massage therapy. Furthermore, training in bodywork in most massage therapy schools tends to be Western orientated, which is based on clinical and medical massage of the body’s myofascial system. The holistic connection of mind, body, and spirit is seldom addressed directly in treatments and is more often glossed over. The emphasis in Western medical massage tends to be neuromuscular, coupled with various forms of stretches, hydrotherapy and myofascial release. 

When combined together, these modalities are very effective in treating the various signs and symptoms of pain, limited range of motion (R.O.M.) and ischemic trigger points. In addition, circulation and lymphatic drainage is enhanced, scarring and adhesions are decreased. From the benefits derived from this treatment makes it clear that a multi-disciplinary approach in treating Fibromyalgia, will obtain improvements in patients with severe manifestations of fibromyalgia. These manifestations tend to be centered on the issues of pain and energy. The question remains though, is this enough? Other questions remain unanswered like; does the Western approach get to the cause and not just the symptoms of Fibromyalgia? Also, can the benefits be accelerated by addressing the mind and spirit of the patient first in a more holistic approach? 

To answer these questions, the therapist needs to apply aromatherapy first and then acupressure. Let’s look at how aromatherapy works. Aromatherapy, works quicker than bodywork, through the sense of smell. Odor molecules affect our brain chemistry by targeting the limbic system, sometimes also called the leopard part of the brain because it is mainly associated with the sympathetic nervous system known as the “Fight or Flight” syndrome. The limbic system affects learning, emotions, and memories, as well as appetite and sexuality. The Odor molecules stimulate the limbic system, neurotransmitters, releasing endorphins which reduce pain; encephaline which promotes pleasant feelings; and serotonin which causes a calm feeling and relaxed state as well as uplifting depression. Furthermore, the sense of smell affects the hypothalamus, which controls the body’s neurochemical and hormonal regulation. This part of the brain also communicates with the sex glands and frontal lobes, which control attention and memory; and the reticular system, which brings together the body and mind.  

 Diagram showing the location of the three levels of thinking in humans 

 When we compare the effects of aromatherapy with the major pathologies and conditions in Fibromyalgia, we can see clearly how comprehensive and deep the benefits are. First and foremost all signs and symptoms associated with pain are addressed on a multi-level approach. Studies have revealed that Lavender increases alpha waves in the brain associated with the effect of relaxation. Alpha brain waves are predominant when the mind and body are relaxed. Those who practice meditation regularly for relaxation in whatever form will have experienced alpha waves.  Yet, the effects of Lavender do not stop there. Fibromyalgia patients also experience stress-related symptoms, like insomnia, anxiety, anger, irritability and hypertension. Lavender also induces the production of serotonin, which contributes to happiness, relaxation and the ability to get a good night’s sleep.   

Lavender should be used first to facilitate the reception of other oils by the limbic and various other systems of the body. The effects of Lavender are also enhanced when you mix Lavender, Marjoram and Neroli. These oils as a group are also known as sedatives.  

Other studies have shown that the lack of serotonin is associated with depression, anti-social behavior and hyperactivity in children. There are scents like Rose and Clary Sage that free emotional blockages caused by anger, irritability and anxiety, through the stimulation of enkephalins. These aromas also help to fight depression and moodiness. One cannot help notice, therefore, how single and blended oils cause numerous neuro-chemical changes and a whole cluster of emotional effects associated with such changes.  

Attention should be given first to treating the mind in Fibromyalgia patients. According to medical doctors, Fibromyalgia is principally and generally caused by stress. Often, Fibromyalgia is caused by a combination of shock and trauma. In keeping with the philosophy of Traditional Chinese Medicine, all ailments are essentially a disturbance of the spirit. Accordingly, it is the spirit that heals the disease. Therefore aromatherapy should not be  simply seen as a “somatic “medicine. 

On the other hand, when targeting somatic conditions like myofascial pain and inflammation, Spike Lavender can be mixed with Peppermint, Helychrysum, Clove, Thyme Linalool mixed in St John’s Wort and carrier oil. 

A major benefit of using, aromatherapy is that it works in a non-confrontational manner. This can be an issue with Fibromyalgia patients, especially on their so-called “bad days”, when any kind of bodywork seems contra-indicated. The therapist can first use a combination of Lavender and Roman Chamomile for their relaxing and sedating effects. Clary Sage and Cypress can be used for their anti-spasmodic effects, while Rose and Ylang  Ylang , or Clary Sage again can lift the mood of depression. Focusing on the mind while being non-confrontational, the therapist then includes an acupressure treatment on several strategic channels and acupressure points. Since there are several points that have multiple benefits and major functions, the number of points can be limited to a small number without having to treat the whole body in a kind of shotgun effort. . 

This would be in keeping with an important TCM principle of treatment where many diseases can be treated with one protocol. We have seen above that Fibromyalgia is viewed as a syndrome, so it makes sense to select the acupressure points that cover multiple benefits in order of importance. In addition, the essential oils themselves can also be applied directly on such points to enhance the effects.   

Application of a calming essential oil like Ylang Ylang on Governor Vessel 20 for calming the mind  

What would then be a good overall protocol that combines acupressure with essential oils? The strategy should one of moving from the general to the specific. As in aromatherapy, the general focus would refer to the mind and the specific to the more somatic points of discomfort.  

The therapist should start with the Governor Vessel points on top of the skull. The Governor Vessel governs the Qi and stagnation or blockage of Qi impedes the flow of blood and lymph creating pain, lack of energy, chronic emotional toxicity, memory loss and numerous other things.  A crucial point would be Governor Vessel 20. According to “The Systematic Classic of Acupuncture and Moxibustion “a pre-modern classic of contemporary acupuncture, (see “Chinese Medicine “– de Mourant , George – Paradigm Publications, Brookline, Massachussetts – 2004).  This point is mainly responsible for mental alertness, concentration, memory, and energy. TCM therapists also use it for getting rid of headaches; general pain, stress and achieving overall balance of the mind. Typical Fibromyalgia patients will lack mental alertness, memory, energy, and concentration. They also suffer general and specific pain as in headaches All of these attributes and symptoms will be present to a greater or lesser degree.   

The therapist will first apply one drop of an essential oil like Ylang Ylang , Geranium or Lavender and rotate the thumb in a counter-clockwise rotation on that point with gentle pressure.  Rotating your finger counter-clockwise calms, centers and grounds the patient. The pressure applied should be minimal. On a scale of 1 – 10 where 10 represents extreme pressure and 1 minimal pressure (the weight of a quarter coin), then 1 - 2 is appropriate. From now on, any mention of “minimal acupressure “in the article shall mean pressure on a scale of 1 – 2 out of 10. The duration of the treatment on each acupressure point should be a minute or more or until the pain is reduced substantially. Care should be taken, not to spend too much time with a stubborn pain area but move on, as all areas are interlinked by channels.  Removing stagnation of Qi in any part of the channel will allow the Qi to flow along the whole channel much easier. It’s like removing a dam of debris of obstacles on a stream. Acupressure is all about connecting energetically and not trying to force any pain away by being confrontational. 

A good follow-up is to perform acupressure down the mid - sagittal line on the head of the patient where the pathway of the Governor Vessel is located. Pressure should be minimal again and the therapist can linger on points for three to four seconds. The therapist starts on the hairline in front and finishes just below the position of Governor Vessel 20, or just below the apex of the head. This procedure should be repeated 10 times.  Treating these points on the head is also a good way to address insomnia successfully according to standard textbooks of TCM bodywork (Chinese Bodywork – A Complete Manual of Therapeutic Massage – Sung Chengmen – Pacific View Press, Berkeley, California – 1995)  

 Acupressure down the Governor Vessel for insomnia and calming the mind and grounding 

 Next, the therapist should treat Liver 3 on top of the foot. A calming essential oil like Lavender, or any of the aforementioned oils should be used. The therapist can also use several oils on one acupressure point in layers. First the essential oil is rubbed in counterclockwise until it is absorbed. Good oils only take seconds to be absorbed through the skin.  

This is an extremely important point, since in myofascial pain issues, it releases pain and tension in the tendons in the body and tension related headaches. In addition, this point is always used in treating migraine headaches as well.  On an emotional level, it disperses anger and lifts up depression. From a gynecological viewpoint, it helps release PMS and painful menstruation. The therapist first holds these points for 5 seconds with minimal pressure. Then rotate each finger counterclockwise for 19 seconds each.  

Acupressure on Liver 3 for myofascial pain, headaches, PMS and much more.  

Those who do Chakra balancing and Polarity Therapy will have noticed how we have moved from one opposite pole to the next.  Only now should the therapist do specific acupressure on painful sites. The Urinary Bladder Channel now comes to mind as most tender points are situated on or near it in Fibromyalgia patients.   Acupressure is performed down the entire Urinary Bladder channel  with both thumbs next to one another at least 10 times. Initial pressure on the first sweep down is minimal with each sweep down increasing to 4 - 5 out of 10. The therapist should linger on specific tender points for up to ten seconds or more and then move on. Then rotate on that point in a counterclockwise fashion with minimal pressure.   

 Acupressure down the Urinary Bladder channel for myofascial back pain 

 Color coding can be applied to mark pain intensity. 

 Finally, areas of the body can be targeted sequentially which are hurting most at the time of the patient’s visit. It should be mentioned that Fibromyalgia patients always have specific areas that hurt most at any given time on top of being sore all the time. Speculation is rife about the reasons for this phenomenon. Some doctors state that this can be weather-related; or caused by muscle-strain, psychological or physical trauma; or depression, anger and so on. A practical reason for focusing primarily on that particular problematic area as opposed to doing a general overall treatment is time. Massage therapy sessions generally lasts an hour to an hour and a half. Also the patient may not have the stamina to endure a full hour of general massage or acupressure. 

 The therapist locates the area, which may or may not be near a classical acupressure point. The classic TCM text “The Yellow Emperor’s Guide to Internal Diseases” states that “…wherever there is pain, there is an acupuncture point.” Then, a calming oil is applied  and followed up with acupressure . The protocol is exactly like the one performed on the head and spine, with the exception that it is done once and only repeated 2 times as a follow up, after first moving on to other sites and then only returning to the first sites to check up.  

 Acupressure on the anterior deltoid near Large Intestine 15, a classic tender point in Fibromyalgia patients. 

After dealing with myofascial pain and mental stress, what remains, are the issues of constant fatigue and depression. In TCM, lack of motivational energy, depression is caused by insufficient Qi not moving the blood and lymph. The insufficient Qi could have been caused partially by pain and trigger points that are the result of blocked or congested Qi. Now the therapist has to proceed from the narrow focus of treating the patient specifically for pain syndromes to the more general emphasis of boosting overall Qi and blood and lymph flow. For this, acupressure points and channels that tonify and strengthen organs need to be treated.  

A good formula would be a combination of Kidney 1 and 3 with Spleen 6 and Stomach 36 bilaterally. This is followed by Large Intestine 4. Finally, Governor Vessel 20 should be treated by rotating the thumb clockwise now for more energy, focus and strengthening of all organs. The duration of treatment should be a minute each on these points.  

Essential oils for energy are: Peppermint, Black Pepper, and Lemon which can be used individually on the acupressure points. The therapist should use one drop each per point and rub them in clockwise. This treatment should only follow after the initial use of calming oils. 

 Acupressure on Spleen 6 and Kidney 3 (marked by the yellow dot) for more Qi and blood flow  

 There is one major reason why acupressure should be used prior to or instead of a full body massage. There is now a huge body of scientific evidence ( see among others,  Plain Talk about Acupuncture – Mitchell E. – Whitehall – New York – 1997, Trick or Treatment: Alternative Medicine on Trial – Singh, Ernst – Bantam Books – London – 2001 )  ) that proves that acupressure or acupuncture taps into the endocrine system and releases endorphins, enkephalins , dopamine, serotonin and other hormones that among other things, act as natural opiates, stabilize mood, lift depression, increase focus and overall well-being.  In retrospect then, acupressure also repeats the effects of aromatherapy and therefore augments the overall treatment effect on the Fibromyalgia patient.  

In conclusion, the use of non-confrontational therapies like aromatherapy and acupressure together, create a deep and lasting effect on the Fibromyalgia patient.  There are two main reasons for this. First from a TCM viewpoint, the universal life force of Qi is unblocked and strengthened resulting in harmonious and balanced energy flow. Without sufficient Qi, there is no blood and lymph flow. The mind and spirit is thus calmed.  Secondly, from a Western physiological viewpoint, both the central nervous system and endocrine system are in a manner of speaking, ”switched” over from a sympathetic, fight or flight mode (originating in the limbic  part of the brain) to a parasympathetic or calm mode. This deep and lasting effect is therefore caused by re-establishing the body-mind- spirit connection in the Fibromyalgia patient.  

 

REFERENCES: 

  1. Chinese Bodywork – A complete Manual of therapeutic Massage – Sung Chengnan – Pacific View Press, Berkeley, California – 1995 
  1. Chinese Medicine – de Mourant, George – Paradigm Punlocations, brooline, Massachussetts – 2004 
  1. Myofascial Pain and Dysfunction – Simon Dave and Travell, Jennifer – Williams and Wilkins – Baltimore, Md. – 1983 
  1. The Illustrated Encyclopedia of Essential Oils – Lawless, Julia – Barnes & Noble Books – New York – 1993 
  1. Trick or Treatment: Alternative Medicine on Trial – Singh, Ernst – Bantam Books – London — 2001 
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