A Therapeutic Alternative in the Management of Fibromyalgia

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DOI: 10.26752/cuarzo.v23.n1.221
INTRODUCTION: Fibromyalgia is a condition that affects up to 5%
of the population and causes signicant deterioration of the quality
of life for the sufferer, so it is a therapeutic challenge. The objective
of the present study was to describe the experience of the AtlasPRO-
lax® method in patients with bromyalgia diagnosed according to
the criteria of the American College of Reumatology (ACR) 2010.
METHODOLOGY: A cross - sectional study with 63 patients with
bromyalgia was done. Patients were monitored two and six months
after applying the AtlasPROlax® method, in order to evaluate the
pain level by visual analogue scale VAS and reevaluate ACR criteria
in the follow-up appointment.
RESULTS: The average age of patients was 48.5 SD 12.6 years,
95.24% were female. 100% of patients improved pain (initial VAS
of 8 vs 4 and 3 after two and six months respectively) and these were
signicant results. A reduction of widespread pain index as well as a
reduction in the presence of symptoms such as fatigue, non-restorati-
ve sleep and cognitive disorders that are typical of bromyalgia were
also found in 46% of cases
CONCLUSION: This study has provided evidence of the effecti-
veness of the neuromuscular stimulation method of the suboccipital
musculature called AtlasPROlax® in the treatment of bromyalgia.
Randomized and controlled studies are required to demonstrate the
medium and long term effectiveness of this therapeutic alternative.
KEYWORDS: Fibromyalgia, pain, cognitive disorders, management.
A therapeutic alternative in the management of bromyalgia
Jair Malagón1; Mariana Villaveces2; Lluís Manent3
Corresponding author:
Como citar: Malagón J, Villaveces M,
Manent L. A therapeutic alternative in the
management of bromyalgia. Revista Cuarzo
2017; 23(1): 30-38.
Recibido: 21 de marzo de 2017
Aceptado: 24 de mayo de 2017
Publicado: 30 de junio de 2017
1 MD, Surcolombiana University,
trained in Alternative Medicine at Na-
tional Colombia University– Integral
Approach to Pain. Graduated course
in “Correction of Minor Intervertebral
Disorder of Atlas” at Juan N. Corpas
University Foundation
2 MD, epidemiologist, Quality Health
Manager at Rosario University
3 MD, BA Barcelona University, Natio-
nal Institute of Homeopathy
Licencia creative commons
A therapeutic alternative in the management of bromyalgia Malagón J. y cols.
L Fibromyalgia (FM) is a clinical syndrome of unk-
nown etiology characterized by the presence of chro-
nic pain related to the musculoskeletal system which is
diffused and incapacitating, and is usually accompanied
by other symptoms such as fatigue, sleep disturbances,
stiffness, migraine, irritable bowel syndrome, depression,
anxiety or paresthesia in extremities (1,2). FM affects ap-
proximately 0.5-5% of the population (3). It is a condi-
tion that generates high morbidity in those who suffer it,
with very high disability rates and the treatment is based
on giving symptomatic relief. There is currently no de-
ned treatment; various drugs (analgesics, antidepressants,
muscle relaxants, etc.) are used, as well as physical ac-
tivity and rehabilitation, psychotherapy and alternative
methods such as acupuncture, thermal therapy and osteo-
pathy, among others (4-10).
FM diagnosis is made from the proposed criteria in
2010 by the ACR (American College of Rheumatology)
criteria consisting of two different aspects: rst, wides-
pread pain index (Widespread Pain Index [WPI]) and
second, the severity scale symptoms (Symptom Severity
Score [SS-Score]); to meet the criteria, these symptoms
must be present, at a similar level, during the last three
months (See Figure 1). Additionally, in order to arrive at a
denitive diagnosis, the presence of other pathologies that
could explain the generalized pain should be ruled out.
According to the literature, these new criteria correctly
classify 88.1% of cases when compared with the criteria
proposed in 1990 and, since they are fundamentally based
on the information provided by patients, do not require a
detailed physical examination nor any specialized training
of the observer (11). It is also considered that the ACR
2010 criteria can be very useful in the quantication of
patients’ morbidity, since it allows to measure, according
to its own reference, symptoms such as chronic fatigue,
non-repairing sleep and cognitive alterations; including a
list of forty additional items (see attached Table 1), (11).
The ACR 2010 criteria have been validated previously
by several groups (12-15). Other articles and systematic
reviews have linked risk factors for the development of
bromyalgia such as traumatic history, occupation, stress
among others (16).
The prevalence of FM in the population has been es-
timated between 1 and 5% (3,20-22). As for gender, it is
women who suffer most from the disease with a ratio of
9: 1 with respect to men (20); age of onset is between 35
and 55 years (23). It is a disease that affects the biologi-
cal, psychological and social spheres of the patient and
it is considered to be a major health problem because of
its prevalence, high morbidity and high rate of utilization
and consumption of health resources (24).
Given the above, it is important to nd new treatments
for the management of this important disease; one of the-
se treatments is the AtlasPROlax® method
The AtlasPROlax® method is a set of deep releasing
neuromuscular techniques, developed between 1993 and
1996 by the Swiss René-Claudius Schümperli (17). This
method is based on the hypothesis of occipito-atlanto-
axial joint dysfunction; is focused on specically norma-
lizing suboccipital musculature, and thereby largely re-
covering articular tensegrity at the Co-C1-C2 region. In
general terms, the method is usually applied only once
in life and because of its high effectiveness, it allows the
reconguration of the body at the myofascial level (18),
while conducting the natural reconstitution of neuro-
FIGURE 1. Widespread pain index WPI
From: Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz
RS, Mease P, Russell AS, Russell IJ, Wineld JB, Yunus MB. The
American College of Rheumatology preliminary diagnostic criteria
for bromyalgia and measurement of symptom severity. Arthritis Care
Vol. 23 No. 1
Revista Cuarzo - Fundación Universitaria Juan N. Corpas
vascular structures linked to the cranial- spinal junction
(brain stem, bulbomedullary junction, dura mater and
vertebro-dural bridge). From a biomechanical point of
view, it facilitates the reversal of deformations and alte-
rations in most myofascial chains, improving the static,
dynamic, and biomechanical distortion in the body (18).
This allows a greater natural tendency to symmetry in the
scapular and pelvic girdles, as well as in plantar support.
Also, this method is aimed at restoring the tensegritical
balance of structures, both soft and rigid of the craniocer-
vical junction, being a method based on the combination
of kinesiology and biophysics. Thus, using specic proto-
cols and an apparatus for neuromuscular stimulation with
vibropressure, there is a direct effect on the normalization
TABLE 1. Diagnostic criteria for bromyalgia ACR 2010.
A patient meets diagnostic criteria for bromyalgia if the following three conditions are present:
1) Generalized Pain Index (Widespread Pain Index - WPI) ≥ 7 and Symptom Severity Index (Symptom Severity Score - Score SS) ≥ 5 or WPI
3-6 and SS ≥ 9.
2) The symptoms have been present, at a similar level, during the last three months.
3) The patient has no other pathology that can explain the pain.
1) WPI: List the number of areas where the patient has had pain during the last week. In how many areas have you had pain? The value must
be between 0 and 19.
Areas: Left Scapular Waist, Right Scapular Waist, Left Lower Leg, Right Lower Leg, Upper Left Arm, Upper Right Arm, Left Jaw, Right Jaw,
Left Lower Arm, Lower Arm Right, Chest (Abdomen), Hip (gluteal / trochanter) Left, Hip (gluteal / trochanter) Right, Neck (nape and fore-
head), Upper Back, Back
Lower, Upper Left Leg, and Upper Right Leg.
2) SS Score:
• Fatigue
• Unrefreshing sleep
• Cognitive symptoms
For each of the three indicated symptoms, choose the severity level during the last week, based on the following scale:
0 = No problem
1 = Light, almost always light or intermittent.
2 = Moderate, produces considerable problems, almost always present at a moderate level.
3 = Severe, persistent, continuous affectation, great affectation of the quality of life.
Consider somatic symptoms in general, indicating if the patient has: *
0 = Asymptomatic (0 symptoms)
1 = Few symptoms (between 1 and 10)
2 = Moderate number of symptoms (between 11 and 24)
3 = A large accumulation of symptoms (25 or more)
The SS score is the sum of the severity of the three symptoms (fatigue, non-restorative sleep, and cognitive symptoms) plus the value of somatic
symptoms. The nal score should be between 0 and 12.
* Muscle pain, irritable bowel syndrome, fatigue / exhaustion, problems of comprehension or memory, muscle weakness, headache, abdominal
cramps, numbness / tingling, dizziness, insomnia, depression, constipation, epigastric pain, nausea, anxiety, chest pain, blurred vision, diarr-
hoea, dry mouth, itching, wheezing, Raynaud Phenomenon, urticaria, tinnitus, vomiting, stomach acidity, oral thrush, loss or changes in taste,
seizures, dry eye, shortness of breath, loss of appetite, rash / rash, sun intolerance, hearing disorders, frequent ecchymosis, hair loss, frequent
urination, painful urination, bladder spasms.
A therapeutic alternative in the management of bromyalgia Malagón J. y cols.
of the cranio-cervical junction at the myofascial, articular,
vascular and neurological levels. (17,19)
Since this technique is a novel and easy method to im-
plement (18), it is possible to take this into account as an
additional resource in the multidisciplinary approach to
the treatment of FM. About six years ago, it was imple-
mented as part of FM management and therefore, the stu-
dy presents the experience of a cohort of patients in order
to demonstrate the benets of this therapeutic resource,
which is not invasive, is devoid of risks, complications
and can modify the course and forecast of FM.
Materials and methods
A cross-sectional study was carried out; including a
series of patients seen at personal consultations, diagno-
sed with FM. AtlasPROlax® was applied to all patients
during the rst consultation.
The diagnosis of FM was made with the ACR 2010
criteria as follows: 1) Wide Pain Index WPI ≥ 7 and
symptom severity index -SS Score ≥ 5; or the presence of
a WPI between 3 and 6 and SSS ≥ 9. 2) That the symp-
toms have been present, at a similar level, during the last
three months. 3) that the patient has no other pathology
that can explain the pain (See Table 1).
All patients were given the same questionnaire to as-
sess these indices at the initial consultation and again at
2 and 6 months, together with the measurement of pain
using an analogous scale VAS (25).
All results were descriptively analyzed according to
the nature of the variables, prior evaluation of normality
distribution of the population by the Kolmogorov – Smir-
nov test (because it is a sample bigger than n = 50). When
the data is qualitative, it will be presented in terms of fre-
quencies and proportions. When the data is quantitative
it will be presented in terms of measures of central ten-
dency and dispersion. Sociodemographic variables, WPI,
SSS and pain level were evaluated using the analogous
visual scale VAS at the initial consultation, at two months
and at six months afterwards. The use of analgesics like
acetaminophen, ibuprofen, diclofenac, naproxen, opiates
and pregrabalin among others was also evaluated. To de-
ne the difference between pain values before and after
treatment, p was calculated by means of a difference test,
all values below p = 0.05 were considered signicant.
This study has informed each patient, prior to data
collection consent. Consecutive sampling and follow up
was carried out for three years.
In the period from 2014 to 2016, a total of 63 patients
with FM were treated with the AtlasPROlax® method,
and followed-up at 6 months. When evaluating the distri-
bution of the population, it was evidenced that it meets
normality criteria (p = 0.49)
The average age was 48.5 SD 12.6 years old with a mi-
nimum age of 17 and maximum age of 74 years. 95.24%
of the patients were female. In terms of labour status,
34.9% were employed, 31.75% were self-employed,
15.87% were housewives and 17.48% were pensioners,
students, traders, and unemployed. Regarding the level of
schooling, the majority of the patients had a university
education (41.27% compared to high school students with
23.81% and technical / technological training 19.05%
(See Table 2)).
66.6% of the patients live in or around Bogotá.
79.37% reported some type of traumatic antecedent.
With respect to the ndings of the initial consultation,
49 patients (77.78%) reported a pain greater than or equal
to 8 on the analogue visual scale for pain, 100% of the pa-
tients who entered the study were diagnosed by the WPI
criterion ≥ 7 SS ≥ 5, 46.03% of patients had a WPI ≥ 14
(See Table 3).
65.08% used analgesics, among which 27/41 used
NSAIDs, 5/41 NSAIDs + opiates, and to a lesser extent
NSAIDs with naproxen, local inltrations, dipyrone, cor-
ticoid, and pregrabalin with piroxicam; 9.5% used opioids
for pain control, one patient presented analgesic abuse.
After applying the studied method in the initial consul-
tation, a noticeable decrease in pain was reported by the
patients. At the medical check-up at 2 months, all patients
had decreased pain, with an average of 4/10 on the VAS
scale and 3/10 at 6 months. The difference in pain at the
beginning and at the end of the follow-up was statistically
signicant (p = 0.03). The average pain index at baseline
was 13 points, at 2 months it was 7 and at 6 months was 5
on the WPI scale. The difference in pain at the beginning
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Revista Cuarzo - Fundación Universitaria Juan N. Corpas
tention, concentration and short-term memory problems,
46.03% of the patients rated it as grade 2 (n = 25), and
4% of patients as grade 3 at the beginning of the study
treatment and evaluation grade 2 20.6% of patients and
grade 3 0% at six months (p = 0.03).
As the incidence-prevalence of FM is increasing
(1,2,18) and the social, clinical and economic impact is
increasing, as is the complexity of its treatment, it is vi-
tal to make new resources and therapeutic approaches.
Although to date there are no clinical studies that use the
AtlasProlax® method for the treatment of FM, this re-
search managed to establish that there is a signicant re-
duction of pain, from 8/10 to 4/10 at two months and 3/10
at six months as measured by the VAS scale, as well as the
reduction in the number of painful areas assessed by the
ACR criteria: WPI of 13, WPI of 7 to 2 months and WPI
TABLE 2. Socio-demographic characteristics of the population
Age Average 48.53 SD 12.6 years
Min-max 17-74
Gender Female 60 95.24
Male 3 4.76
Work status Independent 20 31.75
Unemployed 6 9.52
Home / Housewife 10 15.87
Employee 22 34.92
Pensioner 3 4.76
Student 1 1.59
Merchant 1 1.59
Scholarship Primary 5 7.94
Incomplete Bachelor 2 3.17
Bachelor 15 23.81
Technical/Technological 12 19.05
College 26 41.27
Postgraduate 3 4.76
and at the end of follow-up was statistically signicant (p
= 0.01). The SSS severity index was 8 on average before
the intervention, dropping down to 5 after 2 months and
down to 4 after 6 months (p 0.05). (See Table 4).
At the sixth month after applying the method, all pa-
tients presented on average WPI and SS scores of 5 and
4, respectively, which are not sufcient to meet FM diag-
nostic criteria.
Regarding the evaluation of the fatigue sensation,
measured according to the ACR 2010 criteria, 46.3% of
patients rated this symptom as 3 (highest) before recei-
ving the intervention, in contrast to 1.59% (1 patient) in
the evaluation at 6 months. In the assessment of unrefres-
hing sleep, the 46.03% of patients assessed this symptom
as 3 (maximum degree) before receiving the intervention,
in contrast to 3.17% in the evaluation at six months (p =
0.01). Concerning cognitive disorders, referred to as at-
A therapeutic alternative in the management of bromyalgia Malagón J. y cols.
Results EVA, WPI and SSS initial consultation
VAS 4 1 1.59
5 1 1.59
6 6 9.52
7 6 9.52
8 20 31.75
9 21 33.33
10 8 12.70
WPI 7 3
8 3
9 4
10 8
11 4
12 6
13 6
14 7
15 5
16 2
17 3
18 4
19 8
Severity index score 3
Sum of severity 5
Vol. 23 No. 1
Revista Cuarzo - Fundación Universitaria Juan N. Corpas
TABLE 4. Relationship of the evolution of patients after receiving treatment.
TABLE 5. Relationship of evolution of patients’ symptoms after receiving treatment.
Severity Index
SSS Score
Sum of severity
Unrefreshing sleep
Cognitive disorders
Min- max
Min- max
Min- max
Min- max
7 - 19
9.52% (6)
77.78% (49)
12.70% (8)
5 - 12
% (N)
3.17 (2)
7.94 (5)
42.86 (27)
46.03 (29)
1.59 (1)
6.35 (4)
46.03 (29)
9.52 (6)
19.05 (12)
46.03 (29)
25.40 (16)
0 - 10
0 - 16
1 - 7
61.90% (39)
30.16 % 19)
1.59% (1)
2 - 11
% (N)
4.76 (3)
34.92 (22)
50.79 (32)
3.17 (2)
9.52 (6)
42.86 (27)
39.68 (25)
0.00 (0)
19.05 (12)
34.92 (22)
34.92 (22)
4.76 (3)
0 - 8
0 - 19
0 - 8
87.30% (55)
11.11% (7)
0.00% (0)
1 - 10
% (N)
11.11 (7)
53.97 (34)
31.75 (20)
1.59 (1)
12.70 (8)
66.67 (42)
15.87 (10)
3.17 (2)
23.81 (15)
53.97 (34)
20.63 (13)
00.00 (0)
* * 4 patients did not attend the 2nd consultation ** 1 patient did not attend the last consultation at 6 months
A therapeutic alternative in the management of bromyalgia Malagón J. y cols.
of 5 to 6 months, as well as the reduction of annoying
symptoms such as fatigue, not repairing sleep, cognitive
alterations, among others.
Unlike the AtlasProlax method, which is a non-inva-
sive, risk-and-complication-friendly method that requires
only one intervention, other treatments such as physio-
therapy, acupuncture and symptomatic treatment have not
presented such clear and promising results (26-28).
A study by Navas (18), with 151 patients, demonstra-
ted the effect of the Atlasprolax® method on the symp-
toms related to temporomandibular dysfunction, bruxism
and other mandibular deviations, nding that this therapy
reduced the symptoms related to this dysfunction in more
than 70% of patients. The study also revealed a reduction
in midline deviation in occlusion and opening (18).
The ndings of the present study are presented as a
starting point for new studies, to demonstrate the effecti-
veness of this method on a large scale. Since it is a des-
criptive study, by its nature it does not allow denitive
conclusions to be drawn in the management as a single
therapy in patients with bromyalgia, but it is proposed as
a line of research for new studies that include, for exam-
ple, other measurement elements such as algometers in
pain points.
The AtlasProlax ® method, applied in a single inter-
vention, improves FM pain in 100% of patients, with a
statistically signicant difference.
Randomized controlled trials are required to demons-
trate effectiveness on a large scale.
The author expresses his appreciation to the work
Conicts of interest: The authors report that there are
no conicts of interest
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    (1) To assess the degree of convergence between the 1990 and 2010 American College of Rheumatology (ACR) diagnostic criteria; (2) To evaluate the validity and reliability of the 2010 ACR criteria; (3) To validate the Spanish version of the Fibromyalgia Survey Questionnaire (FSQ); and (4) To assess the utility of the FSQ to differentiate fibromyalgia (FM) subgroups by disease severity. In the first study, agreement between the 1990 and 2010 ACR criteria for FM diagnosis was analyzed in a sample of 80 FM patients and 59 healthy controls. Algometry (mean threshold and tender points count) and the 2010 ACR indices [Symptom Severity Scale (SSS), Widespread Index (WPI) and Polysymptomatic Distress Scale (PSD)] were correlated with the key symptoms of FM and with indices of disease interference and quality of life. In a second study, we evaluated the validity and internal consistency of the Spanish version of the FSQ, as well as its ability to discriminate between groups of FM patients with low and high symptom severity. There is good agreement between the 1990 and 2010 ACR criteria for FM diagnosis. The 2010 ACR indices (SSS, WPI and PSD) demonstrated very adequate construct validity and appeared to be useful in the assessment of disease severity and global impact of FM. The FSQ had good internal consistency and validity and showed 100 % concordance with 2010 ACR criteria applied by a clinician. In addition, the FSQ proved to be useful in differentiating FM severity subgroups.
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    La fibromialgia (FM) es una enfermedad cronica y compleja que provoca dolores extensos que pueden llegar a ser invalidantes, y afecta a la esfera biologica, psicologica y social del paciente. La FM es un problema de salud dada su elevada prevalencia y morbilidad, su alto indice de frecuentacion y el elevado consumo de recursos sanitarios que provoca 1 . El Pla de Salut de Catalunya 1996-1998 ya recoge este problema, fruto del cual se elaboraron unos Criterios Comunes Minimos para la Atencion de Enfermos con Fibromialgia. Debido a la evolucion de los conocimientos que ha acontecido en los ultimos anos y a la confirmacion de su alta prevalencia y morbilidad, se ha constituido un grupo de trabajo multidisciplinario con la voluntad de redactar un documento orientativo, a modo de guia de practica clinica, que estructure y homogeneice los conceptos y actitudes que se pueden aplicar a estos pacientes.
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    Objective: To know the experiences and expectations of persons with fibromyalgia towards the health system and its professionals. Methods: Qualitative study with three focal groups. The first focal group included patients with fibromyalgia, 20 women and 1 man, receiving care in the public health system, with different assistance paths and progression. Informed Consent was required. Content analysis was done. Results: Patients describe a difficult experience, with symptoms that may involve incapacity for daily activities. Until knowing their diagnosis, they feel a lack of understanding and also loneliness. They develop different coping strategies, as looking for information or association. From the health system they expect: attention and a fast diagnosis, accessibility to consultations, medical exams and therapies or an impulse for research. They want trained professionals, proactive attitudes, interest, empathy and information. Discussion: Qualitative methods seem suitable for delving into patient experience. Health assistance must improve patients' quality of life, facilitating their assistance process and offering companionship, interest, comprehension and support.
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    Fibromyalgia is a common disorder occurring in approximately 2-5% of most populations, with female patients outnumbering males by up to nine to one. The two essential components of fibromyalgia, experienced in conjunction, are widespread pain and widespread abnormal bodily tenderness, although other common features of the syndrome include fatigue, muscle stiffness, poor-quality sleep and emotional distress. The clinical features result from complex changes of pain-related neurophysiological function in the brain and spinal cord, particularly through the neurophysiological process of sensitization. Management of fibromyalgia is directed to the inputs to this process, through a combination of education, exercise and psychological strategies. A number of drugs can also target this mechanism. With use of selected combinations of these strategies, the prognosis of fibromyalgia is now much improved.