Student Work: Case study - Fibromyalgia/Sjogren's Syndromes by Thomas Fonder

Michelle Burns
October 25, 2016

During the course of attending massage school at A New Beginning School of Massage, students are given a number of assignments that requiring research and writing. Some of these assignments result in very insightful and  well thought out information and  decision-making outcomes. I am happy to share some of their assignments for you to enjoy.


The condition your client reported on the intake form or during the interview.

new-purple-butterfly-scroll-mdFibromyalgia and Sjogren's syndrome. The diagnosis has not been definitive. There may be overlap. Or it may be one or the other according to his doctors.

Why you chose to write up this case report--why this condition or client.

The client is my brother-in-law. He lives in Austin and I live in Fredericksburg, so the frequency with which I have been able to work on him has been once per month. Still, I have had access to him more than any other client with a condition (other than just the usual complaints of muscle tightness).


The client suffers from muscle aches/pain, chronic fatigue, dryness of eyes, mouth and nose. The pain and inflexbility in the joints, his doctors believe, is from the Sjogren's, which is believed to be a genetic predispostion. (His mother suffered from similar symptoms that suggested she had Sjogren's, but it was never medically diagnosed). He suffers from gastrointestinal issues (constipation and bloating). Finding it difficult to sleep is also a problem.

Because he has gradually limited his interactions with others, and essentially isolated himself, he is also being treated for clinical depression.

Intervention Overview

Your understanding of the conditon - the causes, symptoms, pathology, etc., that are relevant.

Fibromylagia is not a psychological condition. While the exact cause is still not known, it is believed to have a biological cause. Recent research suggests that changes in the central nervous system (brain, spinal cord, and nerves), may be responsible. It is believed that there may be a number of factors working together.

Physical and emotional trauma have been linked to fibromyalgia. The genes you inherit from your parents may increase the likelihood of developing fibromyalgia (a family hsitory). There is some evidence to suggest that certain illnesses can act as a trigger (infections). People with autoimmune diseases, such as rheumatoid arthritis, are more likely to develop fibromyalgia.

There are still many aspects of fibromyalgia that are not understood. Because of the complexity of the condition, it can be difficult to diagnose. But an accurate diagnosis is critical in managing these cases. If the condition is not diagnosed and treated early, symptoms can go on indefinitely, or they may disappear for months and then recur.

Fibromyalgia involves widespread muscle pain and tenderness. It is a chronic condition that can last for years or be a lifelong issue. It can't really be cured but treatment may help.

Symptoms include chronic muscle pain, muscle spasms, or tightness, moderate or severe fatigue and decreased energy, insomnia or waking up feeling just as tired as when you went to sleep, stiffness upon waking or after staying in one position for too long, difficulty remembering, concentrating, and performing simple mental tasks ("fibro fog"). Other symptoms include abdominal pain, bloating and constipation alternating with diarrhea (irritable bowel syndrome), tension or migraine headaches, jaw and facial tenderness, sensitivity to one or more of the following: odors, noise, bright lights, medications, certain foods, and cold. The individual may be feeling anxious or depressed, and experience numbness or tingling in the face, arms, hands, legs, or feet, increase in urinary urgency or frequency (irritable bladder), reduced tolerance for exercise and muscle pain after exercise, and a feeling of swelling (without actual swelling) in the hands and feet.

Fibromyalgia symptoms may intensify depending on the time of day (morning, late afternoon, and evening tend to be the worst times). Symptoms may also get worse with fatigue, tension, inactivity, changes in the weather, cold or drafty conditions, overexertion, hormonal fluctuations (such as before periods or during menopause, stress, depresion, or other emotional factors.

Like Fibromylagia, the cause of Sjogren's syndrome is unknown. Researchers think that a combination of environmental and genetic factors determines who develops the disease. While there are certain genes that increase a person's risk for Sjogren's, the genes do not act alone. It is believed that in order for a person to develop Sjogren's, the immune system must be activated by some sort of trigger, such as a viral or bacterial infection, that sends the immune system into overdrive.

The signs and symptoms of Sjogren's syndrome, to some extent, overlap with fibromyalgia. Dry eyes and mouth (also known as sicca syndrome) are the most common signs of Sjogren's, but the disease may affect other parts of the body. It can also cause swollen or painful joints, muscle pain or weakness, dry skin, loss of sense of taste, rashes, brain fog (poor concentration or memory), numbness and tingling sensations in the arms and legs due to nerve involvement, heartburn, kidney problems, and swollen lymph nodes.

Your treatment plan for the client as a result of this condition

My intent is not to exacerbate my client's symptoms by being too aggresive. So pressure and intent principles are taken into consideration. I will work lighter and gentler instead of deeper. Massage has shown some benefit for relieving pain, improving the quality of sleep, improving mood, reducing anxiety, all with an emphasis on good self-care. If I decide to massage my client during a flare-up, gentle pressure is all I can use without worsening the condition. Also, I need to be aware of increased tenderness in and around the spine. Since Sjogren's can lead to joint pain and inflexibility, gentle stretching can be helpful, but I want to keep it within a pain-free range so as not to cause further injury. Also, Sjogren's can make it uncomfortable to lay in a face cradle because of the dryness in the eyes, nose and mouth. When working on the client, I always keep bottled water on hand because remaining hydrated can lessen the severity of some of the symptoms.

As with all chronic pain conditions, I'm aware that clinical depression and chronic pain go hand in hand. His doctors have encouraged him to attend group therapy sessions for people suffering from fibromyalgia/chronic pain.

My client's sedentary liefstyle (as an at-home computer programmer), also adds a difficult component to any treatment plan. I have encouraged him to attend gentle stretching classes for example, tai chi, yoga or chi gong, to try to improve circulation and possibly help with the depression brought on by his condition and lack of contact with the otuside worls.

Presently my client is only taking antidepressants because he has been allergic to all of the other standard medications.

The explanation for why you chose that treatment plan -- justification.

I believe gentle massage will be beneficial for his condittion. Gently working and relaxing the muscles while increasing circulation should provide symptomatic relief.

The expected outcome from your treatment plan.

My desire is to offer my client symptom relief and, as a result, hopefully affect, in some manner, the anxiety and depression. Realisticaly, that is all that I believe I can hope to achieve.

Literature Review

Research synopsis from a massage journal, article or research site that supports your treatment plan for this condition.

Fibromyalgia: Massage Techniques. Institute for Integrative Healthcare. Nicole Cutler L.Ac., Jan 24, 2006

This article was an overview of fibromyalgia's signs and symptoms and the indications and contraindications for massage therapy. It discussed the various techniques, how to utilize them, and what bodyworkers need to be aware of when handling clients with fibromyalgia. Also covered were the biopsychosocial implications of the condition.


The actual outcome from your treatment plan

Sometimes massage helps the client and sometimes it has no significant effect. I'm not able to work on him often enough to note any real change with his condition, so we just go for temporary symptomatic relief. He states that following massage sessions, he usually sleeps better that night. In my client's case, the chronic pain, stiffness and other symptoms, has led him to isolate himself to some extent. Personal time and attention help relieve the sense of detachment from a lack of human contact. He has stated that just knowing someone cares enough to try to help and to understand what he is going through, can and does provide relief.

Appropriately cited reference for research material.
  1. Massage for Fibromyalgia: A Therapist's Point of View. Sharon Muzio. The National Fibromyalgia & Chronic Pain Association.
  2. Treating Fibromyalgia: Massage Therapy as a Beneficial Tool. Ross Turchaninov and Boris Prilutsky. Massage & Bodywork Magazine, February/March 2004.
  3. Easing the Constant Pain. Karta Purkh, Singh Khalsa. American Massage Therapy Association. March 21, 2010
  4. 5 Benefits of Massage for Fibromyalgia Patients.Jimm Gialelis, L.M.T., B.C.T.M.B., Massage Magazine, May 11, 2016. Issue 06.
  5. Dry Eyes, Dry Mouth: Sjogren's Syndrome. Ruth Werner. Massage Today. June, 2009, Vol 09, Issue o6.
  6. The Mangement of Sjogren's Syndrome. Mavragani, C.P., et al. Nat Clin Pract Rheumatol, 2006;2 (5): 252-61
  7. Fibromyalgia: Massage Techniques. Institute for Integrative Healthcare. Nicole Cutler L.Ac., Jan 24, 2006.



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