The Effectiveness of Traditional Spa Therapy in Patients with Fibromyalgia

1. The Effectiveness of Traditional Spa Therapy in Patients with Fibromyalgia Ufuk Şen M Zeki Karagülle

2. Fibromyalgia • Fibromyalgia (FM) is a common nonarticular rheumatical disorder. • It is characterized by widespread musculoskeletal pain and tenderness in previously defined tender point sites.

3. Basic Features • Generalized pain • Fatique • Sleep disturbance • Skinfold tenderness • Cold intolerance • Stiffness

4. Associated with • Irritable bowel syndrome • Chronic fatique syndrome • Depression and anxiety disorders • Temporomandibular disorders • Tension and migraine headache • Interstitial cystitis

5. Diagnosis • Widespread pain in combination with • Tenderness at 11 or more of the 18 spesific tender point sites

6. Treatment Modalities • Patient education • Psychotherapy • Exercises • Medical treatment • Balneotherapy • TENS • Local injection • Acupuncture • Massage • Local ice/heat etc.

7. 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.

8. 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.

9. Water Analysis(Sandıklı Spa Center, Afyon) • 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

10. Group I Balneotherapy (BT) + Peloidotherapy (PT) (n:17) Once a day BT, once a day PT 8 days stay at Sandıklı Spa Center, Afyon Group II Balneotherapy (BT)(n:15) Twice a day BT 8 days stay at Sandıklı Spa Center, Afyon Study groups

11. Patients

12. Group I(BT+PT) • Full peloid bath for 10-15 minutes on 45-47 C° in the morning for eight days • Thermomineral water bath for 15-20 minutes on 39-40 C° in the evening for eight days

13. Group II(BT) • Thermomineral water baths for 15-20 minutes on 39-40 C° twice a day for eight days

14. Outcome Measures • 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

15. Assessments 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.

16. Pain-VAS • 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.

17. Total Algometric Score • 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.

18. Tender Point Count • 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.

19. Beck Depression Inventory • 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.

20. Hamilton Depression Rating Scale • 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.

21. 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 IGroup II Group I / II Pain (Before-8. Days) p<0.0001 p<0.0001 NS Tender point count (Before-8. Days) p<0.0001 p<0.007 p<0.00 Total Algometric score (Before-8. Days) p<0.001 p<0.001 NS Beck Depression Inventory (Before-8. days) p<0.034 p<0.0001 NS Hamilton Depression Rating Scale (Before-8. Days) p<0.001 p<0.001 NS

22. Discussion • 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.

23. Discussion • 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.

24. 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.

25. Conclusion • 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.

26. Conclusion • 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.

27. thank you for your attention