Transcript The Effectiveness of Traditional Spa Therapy in Patients with Fibromyalgia Ufuk Şen

The Effectiveness of Traditional
Spa Therapy in Patients with
Fibromyalgia
Ufuk Şen
M Zeki Karagülle
Fibromyalgia
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Fibromyalgia (FM) is a common nonarticular
rheumatical disorder.
It is characterized by widespread musculoskeletal
pain and tenderness in previously defined tender
point sites.
Basic Features
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Generalized pain
Fatique
Sleep disturbance
Skinfold tenderness
Cold intolerance
Stiffness
Associated with
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Irritable bowel syndrome
Chronic fatique syndrome
Depression and anxiety disorders
Temporomandibular disorders
Tension and migraine headache
Interstitial cystitis
Diagnosis
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Widespread pain in
combination with
Tenderness at 11 or
more of the 18 spesific
tender point sites
Treatment Modalities
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Patient education
Psychotherapy
Exercises
Medical treatment
Balneotherapy
TENS
Local injection
Acupuncture
Massage
Local ice/heat etc.
Spa Treatment
 Spa
treatment has been applied
amprically in our country in ancient
times.
 Contemporary spa treatment is a
method, in which thermomineral
water, peloid and climate are used for
prevention and rehabilitation of the
chronic illness.
Traditional Spa Therapy in FM
In this study,
 We aimed to determine the effect of
Balneotherapy and Peloidotherapy in
patients with FM.
 We evaluated the effectiveness of
traditional cure for eight days.
Water Analysis
(Sandıklı Spa Center, Afyon)
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PH:6.32
T (C°):65
LF:47 FrS
CO2:264 mg/l
Free H2S: (-)
Total Mineralizations: 1562.220 mg/l
Main components: Na, Ca, HCO3, SO4
Study groups
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Group I
Balneotherapy (BT)
+
Peloidotherapy (PT)
(n:17)
Once a day BT,
once a day PT
8 days stay at Sandıklı
Spa Center, Afyon
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Group II
Balneotherapy (BT)(n:15)
Twice a day BT
8 days stay at Sandıklı
Spa Center, Afyon
Patients
Group I
(BT+PT)
Group II
(BT)
Number of the
patients
17
15
Sex (F:Female,
M:male)
17F
15F
Mean age (year) (SD)
45.29
(6.79)
41.73
(10.63)
Mean duration of the
disease (year)
(SD)
5.88
(4.20)
3.33
(1.76)
Group I
(BT+PT)
Full peloid bath for 10-15 minutes on 4547 C° in the morning for eight days
 Thermomineral water bath for 15-20
minutes on 39-40 C° in the evening for
eight days
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Group II
(BT)
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Thermomineral water baths for 15-20
minutes on 39-40 C° twice a day for eight
days
Outcome Measures
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1.) Assessment of pain
a. VAS index (1-10)
b. Total Algometric score (kg/cm2)
c. Tender point count
2.) Assessment of depression
a. Beck Depression Inventory
b. Hamilton Depression Rating Scale
Assessments
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Before spa therapy (first day)
In the middle of spa therapy (fourth day)
After spa therapy (eighth day)
Mann Whitney-U and Wilcoxon signed rank test
was performed to compare the parameters.
Pain-VAS
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90
80
70
60
50
Group I
Group II
40
30
20
10
0
Before
Middle
After
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Significant reduction was
seen in Pain-VAS scores
in the middle and at the
end of the cure.
No significant difference
was observed between
the two groups.
Total Algometric Score
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70
60
50
40
Group I
Group II
30
20
10
0
Before
Middle
After
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Significant improvement
was seen in Total
Algometric Score in the
middle and at the end of
the cure.
No significant difference
was observed between
the two groups.
Tender Point Count
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16
14
12
10
Group I
Gorup II
8
6
4
2
0
Before
Middle
After
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Significant reduction was
seen in Tender Point
Count in the middle and
at the end of the cure.
Group I was found
significantly different
than group II.
Beck Depression Inventory
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30
25
20
Group I
Group II
15
10
5
0
Before
After
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Significant improvement
was seen in Beck
Depression Inventory in
the middle and at the end
of the cure.
No significant difference
was observed between
the two groups.
Hamilton Depression Rating Scale
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25
20
15
Group I
Group II
10
5
0
Before
After
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Significant improvement
was seen in HDRS in the
middle and at the end of
the cure.
No significant difference
was observed between
the two groups.
32 Patients with FM
 Group I: 17 Patients : 2 baths / day (8 days)
 Group II: 15 Patients : 1 bath + 1 full peloid / day (8 days)
Group I
Group II
Group I / II
Pain
(Before-8. Days)
p<0.0001
p<0.0001
NS
p<0.0001
p<0.007
p<0.00
p<0.001
p<0.001
NS
p<0.034
p<0.0001
NS
p<0.001
NS
Tender point count
(Before-8. Days)
Total Algometric score
(Before-8. Days)
Beck Depression Inventory
(Before-8. days)
Hamilton Depression Rating Scale
(Before-8. Days)
p<0.001
Discussion
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Balneotherapy has been used to relieve muscle
spasm, increase the circulation and decrease the
mental stress of the patients in the treatment of
FM.
Sulphur spring water, acratothermal water, radon
bath, salined water bath and peloid can be used
in the treatment of FM.
Discussion
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We believe that pain relief and decreased muscle
spasm with subsequent improvement of
psychological complaints of the patients may
have resulted from the effects of the physical,
thermic and chemical properties of the
thermomineral water, peloid and climate of the
region.
Discussion
-Effective mechanisms of the Balneotherapy:
 Pain and muscle spasm may be improved by
counter-stimulation effect of balneotherapy.
 Thermal stimulus may effect the pain sensation.
 Heating effect of balneotherapy results in
vasodilatation which reduces muscle ischemia
and pain.
Conclusion
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Our results have shown that Balneotherapy is
effective in the treatment of FM which is a
common chronic pain syndrome.
Moreover, we found that both traditional cure
modalities were effective in patients with FM.
Peloid and Thermomineral water bath cures
once a day were superior to Thermomineral
water bath cure twice a day in terms of tender
point count additionally.
Conclusion
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However, we need further comprehensive
studies to determine whether there is any
difference between these cure modalities in
terms of the duration of application and
longer efficiency.