Lifestyle.physio

 Fibromyalgia and Chronic Pain Case Study: Improved Function and Pain Control

SS presented to Lifestyle Therapies with a long history of fibromyalgia and chronic pain affecting the cervical, thoracic and lumbar spine.

Her pain was widespread, with symptoms radiating into both arms and both legs. She had previously tried various forms of treatment and reported that hands-on therapy often aggravated her symptoms.

This was clinically important. In patients with fibromyalgia and persistent widespread pain, manual treatment can sometimes be poorly tolerated when the nervous system is highly sensitised. The initial treatment approach therefore needed to be gentle, carefully monitored and guided by reassessment.

This case study outlines SS’s presentation, assessment findings, treatment approach and early progress with physiotherapy care and adjunctive static magnetic field placement.

Clinical History

SS had a long history of fibromyalgia with pain affecting multiple spinal regions.

Her symptoms involved:

• neck pain
• thoracic spine pain
• lower back pain
• pain radiation into both arms
• pain radiation into both legs
• restricted spinal movement
• high pain levels
• poor tolerance to hands-on treatment

She reported that previous hands-on treatment had aggravated her symptoms, suggesting a heightened pain response and reduced tolerance to mechanical input.

From a physiotherapy perspective, this presentation was consistent with features often seen in chronic widespread pain, including central sensitisation, protective guarding, reduced movement confidence and increased sensitivity to normal physical stimuli.

Initial Assessment Findings

On assessment, SS demonstrated restricted range of motion in both the cervical and lumbar spine.

Her pain level was recorded as 8/10 on a visual analogue scale.

The main clinical findings included:

• restricted cervical spine movement
• restricted lumbar spine movement
• widespread spinal pain
• pain referral into the upper and lower limbs
• high pain sensitivity
• poor tolerance to hands-on treatment
• functional limitation associated with pain

The initial treatment goal was not to apply strong manual therapy or aggressive exercise. The first priority was to reduce pain sensitivity enough to improve movement tolerance and provide a foundation for self-management.

Clinical Reasoning

SS’s presentation required a cautious treatment strategy.

Because she had previously reacted poorly to hands-on treatment, it was important to avoid provoking the nervous system further. In fibromyalgia and chronic widespread pain, treatment needs to be paced carefully because too much physical input can increase symptoms rather than reduce them.

The clinical reasoning was therefore based on three priorities:

• reduce pain sensitivity
• improve spinal range of motion
• support self-management between appointments

Adjunctive Q magnet placement was selected as part of this approach because it allowed treatment to be applied without heavy manual pressure. The aim was to assess whether targeted placement over relevant spinal regions would be associated with measurable changes in pain and movement.

Treatment Approach

Treatment began with central placement of Q magnet devices over the cervical and upper thoracic region.

One QF28-3 Q magnet was placed centrally over C4. Two QF20-3 devices were then placed approximately 2.5 cm to the left and right of the C7 spinous process.

Following this placement, cervical spine rotation improved from approximately half range to full range to both the right and left.

SS also reported pain in the lumbosacral region. A QF28-6 device was taped centrally over the L4/5 intervertebral space, with two QF28-3 devices placed bilaterally, one over each posterior superior iliac spine.

After the lumbar placement, reassessment showed an increase of approximately 20 degrees in lumbar flexion, with reduced pain through range.

These immediate changes were clinically useful because they provided objective markers to guide treatment. The improvement in range of motion and reduction in pain through movement suggested that the placement was appropriate for SS’s presentation at that time.

Early Treatment Response

SS was encouraged to continue wearing the devices day and night for the following week, provided they remained comfortable and did not aggravate symptoms.

A follow-up phone call was made after one week. SS reported that her pain had reduced considerably and that she was managing well with the devices during both day and night use.

This early response was clinically important because SS had previously reported poor tolerance to hands-on treatment. In this case, the treatment approach appeared to provide a way of reducing pain sensitivity without provoking the same aggravation response.

The reduction in pain also created an opportunity for improved movement, function and self-management.

Follow-Up Assessment

The following week, SS returned for reassessment and physiotherapy treatment.

She continued to wear the devices in both the cervical and lumbar placements. She reported that her pain was now at a manageable level, with greater function and improved freedom of movement.

One of the most meaningful changes was that she was waking in the morning free of pain for the first time in many years.

For a patient with long-standing fibromyalgia and chronic pain, this represented an important improvement in daily quality of life. Morning pain can strongly influence mood, energy, movement confidence and activity levels across the rest of the day.

Two-Month Follow-Up

At a further follow-up two months later, SS reported that her pain episodes were becoming less frequent.

She had also developed a self-management strategy. Rather than wearing the devices continuously, she reported applying the Q magnets at the onset of a pain episode.

As pain became less of a dominant issue in her life, she also noticed improvement in other fibromyalgia-related symptoms.

This was a clinically useful outcome because SS had moved from being highly limited by pain to having a practical strategy she could use independently when symptoms began to increase.

Clinical Interpretation

SS’s case highlights several important principles in the management of fibromyalgia and chronic widespread pain.

First, patients with fibromyalgia may have reduced tolerance to hands-on treatment, particularly when the nervous system is sensitised. In these cases, physiotherapy management needs to be gentle, adaptable and guided by response.

Second, small objective changes can be clinically meaningful. In SS’s case, cervical rotation improved from half range to full range, and lumbar flexion improved by approximately 20 degrees after placement. These changes provided useful movement-based markers rather than relying only on pain reporting.

Third, the goal of treatment was not simply short-term pain reduction. The more important outcome was improved function, reduced symptom frequency and better self-management.

It is not possible to attribute SS’s improvement to one factor alone. Fibromyalgia is complex, and responses vary between individuals. However, in this case, targeted Q magnet placement was associated with improved range of motion, reduced pain through movement and improved ability to manage symptoms over time.

Clinical Reflection

This case demonstrates how a carefully paced physiotherapy approach may support patients with fibromyalgia and chronic pain when conventional hands-on treatment is poorly tolerated.

SS presented with widespread spinal pain, restricted cervical and lumbar movement, high pain intensity and a history of symptom aggravation with manual therapy.

After targeted cervical and lumbar placement, she demonstrated immediate improvements in movement and later reported reduced pain, improved function, pain-free mornings and better self-management.

For clinicians, this case reinforces several practical points:

• fibromyalgia management should be paced and response-guided
• hands-on treatment may need to be modified when sensitivity is high
• central sensitisation can affect tolerance to normal mechanical input
• objective range-of-motion reassessment can help guide treatment decisions
• symptom reduction is most valuable when it improves function and self-management
• adjunctive therapies should support broader clinical goals rather than replace rehabilitation

Outcome Summary

SS attended only two in-clinic appointments before being able to continue managing her symptoms more independently.

Her reported outcomes included:

• reduced pain intensity
• improved cervical rotation
• improved lumbar flexion
• reduced pain through movement
• improved freedom of movement
• waking without pain for the first time in many years
• reduced frequency of pain episodes over time
• improved confidence with self-management

These changes were meaningful because they affected daily function, not just symptom scores.

Takeaway

SS’s case shows that improvement may still be possible in long-standing fibromyalgia and chronic pain when treatment is carefully matched to the patient’s sensitivity and tolerance.

In this case, a gentle, targeted approach was associated with improved spinal movement, reduced pain and greater self-management capacity.

For SS, the most important outcome was not simply that her pain reduced. It was that pain became more manageable, movement became easier, and she gained a practical strategy to use when symptoms began to return.