Spa Therapy and Balneotherapy in Fibromyalgia

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Spa Therapy and Balneotherapy in Fibromyalgia

• Arif Dönmez

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FIBROMYALGIA

• Fibromyalgia syndrome is a chronic disorder
  characterized by widespread musculoskeletal pain
  and tenderness in previously defined tender point
  sites.
• MAIN FEATURES
• generalized pain
• fatigue
• sleep disturbances

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DIAGNOSIS

• Widespread pain in combination with
• tenderness at 11 or more of the 18 specific
  tender point sites
• (Wolfe F, et al. The American College of
  Rheumatology 1990 Criteria for the Classification
  of Fibromyalgia. Report of the Multicenter
  Criteria Committee.  Arthritis   Rheum
  199033(2)160-172.)

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COMMON CO-MORBID CLINICAL CONDITIONS

• Chronic fatigue syndrome
• Irritable bowel syndrome
• Depression and anxiety disorders
• Tension and migraine headache
• Temporomandibular disorder
• Interstitial cystitis

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NON-PHARMACOLOGICAL INTERVENTION

• Exercise
• Patient education
• Cognitive behavioral therapy
• Multidisciplinary therapy
• Balneotherapy
• Relaxation training
• Biofeedback
• Acupuncture,
• Electrotherapy
• Massage therapy
• ........................

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Outcome measures for FM

• Pain
• Tender points
• Physical function
• Cardio respiratory fitness
• Self reported physical function
• Musculoskeletal performance
• Global well being or perceived improvement
• Self-efficacy
• Fatigue and sleep
• Psychological function

(Busch A, Schachter CL, Peloso PM, Bombardier C.
Exercise for treating fibromyalgia syndrome.
(Cochrane Review). In The Cochrane Library,
Issue 3, 2003. Oxford
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BALNEOTHERAPY STUDIES WITH FM

• One bath effects
• Observational studies
• Studies with control groups
• Studies in outpatient settings
• Studies in spa centers
• Balneotherapy group in a spa center /
• Controls in daily living area

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ONE SULPHUR BATH
Gutenbrunnner Chr, Englert G, Neues-Lahusen M,
Gehrke A Analgetische Wirkungen von Natürlichen
Schwefelbaedern und Kaeltekammerexpositionen bei
Fibromyalgie. Phy Rehab Kur Med 9 (1999) 56-62
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OBSERVATIONAL STUDY

• 28 patients with PsAFM
• Every other day sulphur bath ( 37oC, 20 min )
• Every other day peloid packing on 4 extremity and
  back (40-42oC, 20 min)
• Heliotherapy from 2 X (10 min) up to 6 hours
• Bath on Dead Sea
• Before After
• Tender points 12,9 7,4 plt0.001
• Morning stiffness 33,2 min 12,8 min plt0.002
• inflamed joints 18,4 9.0 plt0.001

Sukenik S et al Balneotherapy at the Dead Sea
for patients with psoriatic arthritis and
concomitant fibromyalgia. IMAJ 20013147-50
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STUDIES WITH CONTROL GROUPS

• Studies in outpatient settings
• Balneotherapy (Evcik D, Altan L)
• Balneotherapy exercise / exercise (Yurtkuran M)
• Studies in spa centers
• Both Balneotherapy and Control groups are in the
  same spa center (Sukenik S, Buskila D, Neumann L)
• Balneotherapy with different application
  modalities in a spa center (Sen U)
• Balneotherapy in the spa center, controls in
  daily living area (Dönmez A, Kesiktas N)

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Out-patient
Yurtkuran M, Celiktas M A randomized, controlled
trial of balneotherapy in the treatment of
patients with primary fibromyalgia syndrome.
Phys Rehab Kur Med 1996109-112
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Out-patient
Evcik D et alThe effects of balneotherapy on
fibromyalgia patients. Rheumatol Int. 2002
Jun22(2)56-9
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Out-patient
Altan L et alInvestigation of the effects of
pool-based exercise on fibromyalgia syndrome.
Rheumatol Int. 2003 Published online 24.09.03
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Spa center
Buskila D et al Balneotherapy for fibromyalgia
at Dead Sea. Rheumatol Int 2001105-108
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Spa center
Neumann L et al The effect of balneotherapy at
the Dead Sea on the quality of life of patients
with fibromyalgia. Clin Rheumatol 200115-19
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Sen U et al(2002) Comparison of the efficacy of
two different traditional spa regimens in
patients with fibromyalgia syndrome. PTT
Hastanesi Tip Dergisi 2478-81
Spa center

• 32 Patients with FMS
• Group I 17 Patients 2 baths / day (8 days)
• Group II 15 Patients 1 bath 1 peloid
  packing/ day (8 days)  
• Group I Group II
  Group I / II
• Pain
• (Before-8. Days) plt0.0001 plt0.0001 NS
• Tender point count
• (Before-8. Days) plt0.0001 plt0.007 plt0.00
• Total Algometric scour
• (Before-8. Days) plt0.001 plt0.001 NS
• Beck Depression Inventory
• (Before-8. days) plt0.034 plt0.0001 NS
• Hamilton Depression Rating Scale
• (Before-8. Days) plt0.001 plt0.001 NS

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Spa center
Dönmez A et al Spa therapy in fibromyalgia A
Randomised controlled clinic study (Unpublished
data)
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• Improvement in all study variables in the spa
  group in short- and middle-term
• Improvements in spa group are superior to the
  controls
• FIQ (until 6th month)
• Pain (until 1st month)
• Tender point count (until 1st month)
• Patients global assessment (end-of-treatment
  evaluation)
• Fatigue (end-of-treatment evaluation)

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Kesiktas N et alThe short and long time
evaluations of some therapy modalities the
patients with fibromyalgia syndrome.(4.Turkish-Ger
man Balneology and Climatology Congress 2000)

• Balneotherapy Electrotherapy(16) After
  therapy and up to 6. months
• Pain (VAS) ?
• Tender points count ?
• Total algometric score
• Beck Depression Inventory (BDI) ?
• Hamilton Depression Rating Scale (HDRS) ?
• Electrotherapy (20) After therapy and up to 6.
  months
• Pain (VAS) ? ( Only after therapy)
• Hassas nokta ? (Only after therapy)
• Total algometric score NS 
• BDI ? (Only after therapy)
• HDRS ? (Only after therapy)
• Hydrotherapy Electrotherapy (20) After therapy
  and up to 6. months
• Pain (VAS) ?
• Tender points count ?
• Total algometric score
• BDI ? (Only after therapy)
• HDRS? (Only after therapy)

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MECHANISM ?

• Heat
• Relaxation of muscle spasm
• Gate control theory
• Peripheral vasodilatation
• Increase of beta endorphin level
• Rest
• Environment change
• Stay with other FM patients