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differences in levels of patient-perceived pain and therapist-assessed pain as well as differences in patient-assessed and therapist-assessed function ratings. These differences are suspected to be due to the psychological component of chronic pain that may impact patients’ perceptions of pain and function. The individualized MRMT® approach was successful in evaluating these differences, and helped guide treatment appropriately to reduce pain, improve function and increase activity. Treatments also resulted in improved control of diabetes, as measured by HbA1C levels and reduction in antidiabetic medication. This case study provides evidence that a care ful assessment of a patient’s condition (i.e., pain level and physical function), together with hands-on therapy and a patient education approach, can improve a patient’s ability to self-manage medical conditions through a targeted intervention that reduces pain and increases physical function. Keywords Pain assessment, Pain management, Fibromyalgia, Diabetes, Pain treatment Short communication Check for updates Introduction Fibromyalgia (FM) is characterized by chronic, widespread pain attributed to abnormal pain processing [1,2]. The prevalence of FM varies worldwide from 0.2% of the total population of Venezuela to 6.4% of the total population of the U.S. [3], and the healthcare costs for patients seeking relief from FM-related pain can be substantial [4-6]. One of the major issues in treating FM patients, however, is that symptoms can vary with each patient, and the cause for the disease is usually unknown [7,8]. FM is characterized by numerous palpation-specific tender points and generalized musculoskeletal pain [3]. DOI: 10.23937/2469-5793/1510086 ISSN: 2469-5793 Bowyer et al. J Fam Med Dis Prev 2018, 4:086 • Page 2 of 6 • from one session to another; the techniques used will depend entirely on the results of the assessment. These hands-on passive pain management techniques are combined with active restorative function techniques that are meant to not only alleviate pain by bringing the structure of the body into balance and alignment, but also to work with the patient through personalized patient education to help him or her implement self-care strategies for long-term benefits. Each treatment session, including the assessment, lasts 60 minutes. There are six components of this therapist-led MRMT® assessment: Observation, history, inspection, palpation, auditing range of motion, and specialized tests (OHIPAS). This 6-part MRMT® assessment process is presented in greater detail in Figure 1 and explained further next. As the first step, the therapist assesses the patient’s pain levels by observing dynamic posture, including gait and mobility, and static posture. While observing, the therapist asks the patient to describe his or her pain using a list of words (Figure 2). The patient’s physical function is then assessed by examining the patient’s active range of motion. He or she is asked to use the same descriptive words when a movement elicits pain. Twenty-eight motions of the neck, shoulders, spine, hips, knees, and ankles are assessed by a trained MRMT Among several forms of treatment available [9], one of the most effective ways to relieve fibromyalgia pain is through exercise [6,10,11]. However, many FM patients are afraid that movement will exacerbate their pain [12], leading them to avoid exercise. In addition, 67.8% of patients with FM report having at least one comorbid condition [13], making it even more difficult to increase physical activity among these patients. One of these comorbid conditions is Type 2 diabetes, with approximately 21% of patients with Type 2 diabetes reporting that they also have FM [14]. Since increased physical activity is effective in relieving fibromyalgia pain, the challenge is to find a treatment approach that helps a patient overcome their fear of exercise, as well as other health-related barriers to physical activity. We conducted a case study of a novel treatment modality, Medical Restorative Massage Therapy (MRMT®), which is a comprehensive, patient-centered, and assessment-based approach to treating chronic pain. MRMT® focuses on improving physical and structural alignment, as
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