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Balneotherapy for fibromyalgia at the Dead Sea

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Balneotherapy for fibromyalgia at the Dead Sea

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Abstract

The aim of this study was to evaluate the effectiveness of balneotherapy on patients with fibromyalgia (FM) at the Dead Sea. Forty-eight patients with FM were randomly assigned to a treatment group receiving sulfur baths and a control group. All participants stayed for 10 days at a Dead Sea spa. Physical functioning, FM-related symptoms, and tenderness measurements (point count and dolorimetry) were assessed at four time points: prior to arrival at the Dead Sea, after 10 days of treatment, and 1 and 3 months after leaving the spa. Physical functioning and tenderness moderately improved in both groups. With the exception of tenderness threshold, the improvement was especially notable in the treatment group and it persisted even after 3 months. Relief in the severity of FM-related symptoms (pain, fatigue, stiffness, and anxiety) and reduced frequency of symptoms (headache, sleep problems, and subjective joint swelling) were reported in both groups but lasted longer in the treatment group. In conclusion, treatment of FM at the Dead Sea is effective and safe and may become an additional therapeutic modality in FM. Future studies should address the outcome and possible mechanisms of this treatment in FM patients.

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... Finally, 24 studies met our inclusion criteria and were included in the qualitative analysis. Of these, 12 reported on HT [56][57][58][59][60][61][62][63][64][65][66][67] and 12 on BT [68][69][70][71][72][73][74][75][76][77][78][79]: 21 studies were suitable for quantitative analysis, 11 of which reported on HT and 10 on BT. Three studies had to be excluded from the quantitative analysis due to insufficient data reporting (HT: [59]; BT: [75,76]), (see Figure 1). ...
... Over 96% of the participants were women. Sixteen studies involved women only [56,57,[62][63][64][65][66][67][68][69][70][71]73,[75][76][77], and eight studies included both women and men [58][59][60][61]72,74,78,79]. The median of the mean pain baseline values reported in 20 studies was 7.1 (5.5 to 9.1). ...
... Origin of studies Two RCTs originated from Canada [59,60], eight from Turkey [57,58,69,71,72,75,77,78], two from Brazil [56,68], one from Israel (Dead sea) [70], two from Italy [73,74], one from Austria [61], three from Spain [62,66,67], one from Norway [63], two from Sweden [64,65], one from Germany [76] and one from The Netherlands [79]. ...
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Introduction: In the present systematic review and meta-analysis, we assessed the effectiveness of different forms of balneotherapy (BT) and hydrotherapy (HT) in the management of fibromyalgia syndrome (FMS). Methods: A systematic literature search was conducted through April 2013 (Medline via Pubmed, Cochrane Central Register of Controlled Trials, EMBASE, and CAMBASE). Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Results: Meta-analysis showed moderate-to-strong evidence for a small reduction in pain (SMD -0.42; 95% CI [-0.61, -0.24]; P < 0.00001; I2 = 0%) with regard to HT (8 studies, 462 participants; 3 low-risk studies, 223 participants), and moderate-to-strong evidence for a small improvement in health-related quality of life (HRQOL; 7 studies, 398 participants; 3 low-risk studies, 223 participants) at the end of treatment (SMD -0.40; 95% CI [-0.62, -0.18]; P = 0.0004; I2 = 15%). No effect was seen at the end of treatment for depressive symptoms and tender point count (TPC). Conclusions: High-quality studies with larger sample sizes are needed to confirm the therapeutic benefit of BT and HT, with focus on long-term results and maintenance of the beneficial effects.
... Fibromyalgia impacts domestic, leisure, and professional abilities [1]. Severity is related to the disease's psycho-social impact [2][3][4][5]; genetic polymorphism may modulate pain sensitivity, mood, perception and response to treatment [6][7][8][9][10][11][12][13]; depression [14] and physical or psychological trauma contribute to disease onset or continuation. Fibromyalgia, with a prevalence of 1.6% in France [15], occurs between 35 and 55 years of age and 70 to 90% of those affected are women [4,16]. ...
... Spa therapy (ST), widely prescribed in Europe, Japan, South America, and North Africa, is recommended for fibromyalgia for its analgesic, relaxing effects and supervised exercise. Randomized controlled trials suggest a benefit of ST on pain [8,[23][24][25][26][27][28][29][30][31][32][33][34][35][36], quality of life measured by the Fibromyalgia Impact Questionnaire (FIQ) [24,26,27,29,30,35,37,38] or assessed with generic scales (BDI, SF-36, VAS, PSQI, MPQ, CIS, GTPS) [24,35,38], mood [8,24,25,31,35], sleep [8,34,39], fatigue [8,25,34], gastric dyspepsia [25,34], irritable bowel syndrome [8,25], and dyspnea of respiratory origin [31]. Reviews and meta-analyses confirmed these observations but emphasized the low power of some trials [10,21,23,28,32,[40][41][42][43][44][45][46][47]. ...
... Spa therapy (ST), widely prescribed in Europe, Japan, South America, and North Africa, is recommended for fibromyalgia for its analgesic, relaxing effects and supervised exercise. Randomized controlled trials suggest a benefit of ST on pain [8,[23][24][25][26][27][28][29][30][31][32][33][34][35][36], quality of life measured by the Fibromyalgia Impact Questionnaire (FIQ) [24,26,27,29,30,35,37,38] or assessed with generic scales (BDI, SF-36, VAS, PSQI, MPQ, CIS, GTPS) [24,35,38], mood [8,24,25,31,35], sleep [8,34,39], fatigue [8,25,34], gastric dyspepsia [25,34], irritable bowel syndrome [8,25], and dyspnea of respiratory origin [31]. Reviews and meta-analyses confirmed these observations but emphasized the low power of some trials [10,21,23,28,32,[40][41][42][43][44][45][46][47]. ...
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Spa therapy is known to improve quality of life and diminish pain. We assessed the efficacy (Fibromyalgia Impact Questionnaire-FIQ) and safety at 6 months of a fibromyalgia-specific therapeutic patient education (TPE) program added to fibromyalgia-specific standardized spa therapy (SST), compared to SST alone, in a controlled randomized trial. We enrolled 157 patients, mostly women, attending spa centers in Southwest France in 2015–2016, and randomized them to SST + TPE (79) or SST (78). The intention-to-treat with “missing as failure” analysis showed a tendency toward a higher, though non-significant, benefit with TPE than without for FIQ (−9 vs. −3; p = 0.053) or pain intensity (−0.9 vs. −1.1; p = 0.58). In addition, pain relief (+3.2 vs. +4.3; p = 0.03) and fatigue (−1.6 vs. −3.7; p = 0.02) were significantly improved, and 87% patients in the SST + TPE arm still regularly practiced the physical exercises taught to them at 6 months. We suspect significant and lasting improvement from spa therapy, as well as our already well-informed and well-managed participants, to have prevented the demonstration of a significant benefit of TPE on FIQ.
... Instead balneotherapy showed a significant reduction of the pain immediately after the two weeks of treatment, but at the 12th week pain values returned near to the initial values, similarly a slight improvement of fatigue and of quality of life occurred. Discordant results were reported in literature about the long lasting effects of balneotherapy (47)(48)(49)(50)(51). Buskila et al. (47), evaluated the effectiveness of balneotherapy on patients with fibromyalgia (FM) at the Dead Sea. ...
... Instead balneotherapy showed a significant reduction of the pain immediately after the two weeks of treatment, but at the 12th week pain values returned near to the initial values, similarly a slight improvement of fatigue and of quality of life occurred. Discordant results were reported in literature about the long lasting effects of balneotherapy (47)(48)(49)(50)(51). Buskila et al. (47), evaluated the effectiveness of balneotherapy on patients with fibromyalgia (FM) at the Dead Sea. All participants stayed for 10 days at a Dead Sea spa. ...
... On the other hand, respect to the biological effects, the mud-balneo therapy appears to be the best treatment producing a statistical significant reduction of level both of neuropeptide, such as BDNF, and proteins, such as PGAM1 and AZGP-1which usually resulted up regulated in FM patients (46,60,61). In our study other factors which could contribute to the clinical improvement after a spa treatment, such as the pleasant scenery and the absence of work duties (47,51) were not considered. In fact, the patients (except two) did not stay in the spa, but they were resident in areas surrounding it, continued their work activities and the time that the patients spent in the spa center was limited to the treatment. ...
Article
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To study the effects of both balneotherapy and mud-bath therapy treatments in patients affected by primary fibromyalgia (FM) using rheumatological, psychiatric, biochemical and proteomic approaches. METHODS: Forty-one FM patients (39 females, 2 males), who fulfilled the American College of Rheumatology criteria received a 2-week thermal therapy programme consisting of therapy once daily for 6 days/week. Twenty-one patients received mud-bath treatment, while the other twenty balneotherapy. Pain, symptoms, and quality of life were assessed. Oxytocin, brain-derived neurotrophic factor (BDNF), ATP and serotonin transporter levels during therapy were assayed. Comparative whole saliva (WS) proteomic analysis was performed using a combination of two-dimensional electrophoresis (2DE) and mass spectrometry techniques. RESULTS: We observed a reduction in pain, FIQ values and improvement of SF36 in both groups of patients treated with mud-bath or balneotherapy. The improvement of the outcome measures occurred with different timing and duration in the two spa treatments. A significant decrease in BDNF concentrations was observed either after balneotherapy or mud-bath therapy when assayed after twelve weeks, while no significant change in oxytocin levels, ATP levels and serotonin transporter were detected. Significant differences were observed for phosphoglycerate mutase1 (PGAM1) and zinc alpha-2-glycoprotein 1 (AZGP1) protein expression. CONCLUSIONS: Our results showed that the thermal treatment might have a beneficial effect on the specific symptoms of the disease. In particular, while balneotherapy gives results that in most patients occur after the end of the treatment but which are no longer noticeable after 3 months, the mud-bath treatment gives longer lasting results
... Figure 1 with the PRISMA flow-chart illustrates the studies' research and selection. The present review involves twenty-one articles that, following the characteristics of the balneotherapy protocol, were grouped into four sections: five studies were included in the Balneotherapy-thermal water immersion alone section (Buskila et al., 2001;Neumann et al., 2001;Yang et al., 2018;Koçak et al., 2020;Rapolienė et al., 2020); six studies in Balneotherapy-thermal water immersion with other spa treatments section (Dönmez et al., 2005;Sekine et al., 2006;Evcik et al., 2007;Blasche et al., 2010;Koike et al., 2013;Latorre-Román et al., 2015); eight articles in Balneotherapy and physical exercise-balneotherapy and out-of-the-pool physical exercise section (Altan et al., 2006;Yurtkuran et al., 2006;Kamioka et al., 2009;Naumann et al., 2020;Stier-Jarmer et al., 2020;Özkuk and Ateş, 2020;Koç et al., 2021;Bestaş et al., 2022), and three studies in the Balneotherapy and physical exercise-balneotherapy and in-pool physical exercise section (Altan et al., 2004;Maindet et al., 2021;Bestaş et al., 2022). The study by Bestaş and colleagues (2022) has been included in two different sections since its randomization was based on three arms: 1) Balneotherapy; 2) water-based physical exercise; 3) landbased physical exercise. ...
... Only five studies showed a sample with more than one hundred participants (Sekine et al., 2006;Yang et al., 2018;Rapolienė et al., 2020;Stier-Jarmer et al., 2020;Maindet et al., 2021). The studies included in the review were on healthy or sub-healthy subjects (Sekine et al., 2006;Kamioka et al., 2009;Blasche et al., 2010;Latorre-Román et al., 2015;Stier-Jarmer et al., 2020) and patients affected by different pathologies (mainly chronic pathologies or syndromes, i.e., fibromyalgia (Buskila et al., 2001;Neumann et al., 2001;Altan et al., 2004;Dönmez et al., 2005;Maindet et al., 2021), ankylosing spondylitis (Altan et al., 2006;Bestaş et al., 2022), osteoarthritis (Yurtkuran et al., 2006;Evcik et al., 2007), musculoskeletal pain (Rapolienė et al., 2020;Özkuk and Ateş, 2020), morbid obesity (Koçak et al., 2020), mental disorders (Koike et al., 2013;Naumann et al., 2020) and subacute supraspinatus tendinopathy (Koç et al., 2021)). ...
... In fourteen out of twenty-one studies, the mean age was around 50 years; three studies involved older adults around the 70s or older (Koike et al., 2013;Latorre-Román et al., 2015;Özkuk and Ateş, 2020); three studies reported age classes 18-65 years (Sekine et al., 2006;Yang et al., 2018;Rapolienė et al., 2020), and one study did not specify the mean age of the sample (Altan et al., 2006). Except for the study by Sekine and colleagues (2006), all the studies set up a balneotherapy intervention protocol, with more than half of the studies (sixteen) showing both an intervention and control (or with other therapies excluding balneotherapy) group (Buskila et al., 2001;Neumann et al., 2001;Altan et al., 2004Altan et al., , 2006Dönmez et al., 2005;Yurtkuran et al., 2006;Kamioka et al., 2009;Yang et al., 2018;Naumann et al., 2020;Rapolienė et al., 2020;Stier-Jarmer et al., 2020;Özkuk and Ateş, 2020;Koç et al., 2021;Maindet et al., 2021;Bestaş et al., 2022), whereas the remaining studies did not randomize the study sample (Evcik et al., 2007;Blasche et al., 2010;Koike et al., 2013;Latorre-Román et al., 2015;Koçak et al., 2020). ...
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Balneotherapy and exercise are potential factors influencing sleep through several physiological pathways and relaxing effects. This review aims to assess whether balneotherapy can improve sleep quality in concomitance or not with exercise. The research was conducted on Medline , Scopus , PubMed, Web of Science , and Cochrane Library databases. The current review followed PRISMA reporting guidelines and involves twenty-one articles grouped into four sections based on the characteristics of the balneotherapy protocol: 1.a Balneotherapy–thermal water immersion alone (five studies); 1.b Balneotherapy–thermal water immersion with other spa treatments (six studies); 2.a Balneotherapy and physical exercise–balneotherapy and out-of-the-pool physical exercise (eight studies); 2.b Balneotherapy and physical exercise–balneotherapy and in-pool physical exercise (three studies). Apart from healthy or sub-healthy subjects, patients recruited in the studies were affected by fibromyalgia, ankylosing spondylitis, osteoarthritis, musculoskeletal pain, subacute supraspinatus tendinopathy, and mental disorders. Duration, number of sessions, and study protocols are very different from each other. Only one study objectively evaluated sleep, whereas the others used subjective sleep assessment methods. Eight studies considered sleep as a primary outcome and ten as secondary. Sixteen out of twenty-one studies described improvements in self-perceived sleep quality. Thus, balneotherapy associated with other spa treatments and physical exercise seems to be effective in improving self-perceived sleep quality. However, the miscellany of treatments makes it difficult to discern the isolated effects of balneotherapy and physical exercise. Future studies should consider using an objective sleep assessment method and describing the pathways and physiological mechanisms that could provoke sleep changes during balneotherapy treatments.
... Apesar de os exercícios aeróbicos serem citados como a intervenção de reabilitação física que promove maior ganho na diminuição do impacto dos sintomas da FM (8,9) , diversas modalidades terapêuticas surgiram como alternativas (terapias manuais, osteopatia, quiropraxia, acupuntura, massagens, ioga, watsu, tai chi, talassoterapia e balneoterapia) que podem contribuir no tratamento da doença (10)(11)(12)(13)(14)(15)(16) . Terapias em estâncias termais utilizando a balneoterapia e a talassoterapia são freqüentemente utilizadas em vários países da Europa e do Oriente Médio para tratamento da FM, bem como de outras doenças reumáticas, desde muitos anos (16)(17)(18)(19)(20)(21) . ...
... Apesar de os exercícios aeróbicos serem citados como a intervenção de reabilitação física que promove maior ganho na diminuição do impacto dos sintomas da FM (8,9) , diversas modalidades terapêuticas surgiram como alternativas (terapias manuais, osteopatia, quiropraxia, acupuntura, massagens, ioga, watsu, tai chi, talassoterapia e balneoterapia) que podem contribuir no tratamento da doença (10)(11)(12)(13)(14)(15)(16) . Terapias em estâncias termais utilizando a balneoterapia e a talassoterapia são freqüentemente utilizadas em vários países da Europa e do Oriente Médio para tratamento da FM, bem como de outras doenças reumáticas, desde muitos anos (16)(17)(18)(19)(20)(21) . ...
... Em reumatologia, há relatos de estudos que demonstram os benefícios da talassoterapia e da balneoterapia no tratamento de artrite reumatóide (24,25) , artrite psoriásica (26,27) , espondilite anquilosante (28,29) , osteoartrite (30,31) , algias de coluna (32,33) e FM (16,(34)(35)(36)(37)(38)(39)(40) . No entanto, evidências científicas não são suficientes para estabelecer, de maneira definitiva, a aparente eficácia da talassoterapia e da balneoterapia em doenças reumáticas. ...
Article
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Talassoterapia e balneoterapia são modalidades terapêuticas utilizadas há vários anos em outras regiões do mundo na prevenção e no tratamento de diversas enfermidades, incluindo doenças reumáticas. No entanto, só recentemente têm sido descritas na literatura em fibromialgia (FM), contribuindo para a redução da dor e de outros sintomas da doença e melhorando a qualidade de vida dos pacientes. Nesta revisão são relatados os principais estudos que avaliam a talassoterapia e/ou a balneoterapia como abordagem terapêutica na FM, abordando aspectos a serem investigados no intuito de estabelecer o valor dessa forma de tratamento. Os autores ainda destacam a necessidade da realização de estudos no Brasil, utilizando principalmente a talassoterapia, uma vez que o baixo custo, aliado ao fácil acesso de boa parte das pessoas ao litoral, podem beneficiar pacientes com FM.
... Therefore, before comparing balneotherapy with other types of treatments (pharmacological or non-pharmacological), it is reasonable to perform a study with placebo control proving that the medicinal water is more effective than the placebo control water. Implementing such a study can be challenging since the production of an indistinguishable placebo water is much more difficult than that of a placebo tablet [e.g., production of a placebo for the water of the Dead Sea (15,16) requires masking its buoyancy]. In the case of placebo tablets, it is not necessary to examine whether the patients could differentiate between the two similar tablets (real, placebo), while with medicinal waters randomized controlled trials (RCTs) are essential to validate the placebo since environmental factors (e.g., ventilation, location) and physical properties (e.g., volume, buoyancy, colour) influence the identification of the placebo water. ...
... Most of the balneotherapeutic studies abroad have never used a placebo control (15,16,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37), despite the fact that this would be one of the most important steps in proving the beneficial effects of medicinal waters. In Hungarian studies, it is more common to use a placebo control (4,7,(38)(39)(40). ...
Article
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Background/aim: To develop and validate an easy-to-use and cheap method capable of producing placebo from tap water for medicinal water efficacy trials. Patients and methods: Patients were divided into two groups, medicinal water and tap water group. A single 20-minute-long treatment was performed in bathtubs. Patients were asked four times during the bath to tell if they were treated with medicinal water, tap water, or could not decide. Patients were scored, one point was given for each correct answer. Results: A total of 174 patients were enrolled. No significant differences were found either between the average scores or the answers of the two groups. Being familiar with the Harkány medicinal water did not influence the rate of correct answers either. There was no statistically significant difference in the number of changes of opinions between the two groups. Conclusion: The used method is appropriate for producing a validated placebo from tap water.
... A sulfur bath therapy could cause a reduction in oxidative stress, alterations of superoxide dismutase (SOD) activities, and a tendency towards improvement of lipid levels. 65 Buskila To determine the efficacy of combined spa-exercise therapy in addition to standard treatment with drugs and weekly group physical therapy in patients with ankylosing spondylitis (AS). ...
... The languages of eligible publications were English [5,26e47,50e59,61e74], French [48,49], Italian [60], and Japanese [4]. Target diseases and/or symptoms ( [26,29,30,44,56,68,72,73], fibromyalgia [32,36,51,55,65,66], ankylosing spondylitis [27,53,57,58,63,67], rheumatoid arthritis [46,70,74], psoriasis [47,60], atopic dermatitis [34], hypertension and obesity [35], venous insufficiency [41], anxiety disorder [39], Parkinson's disease [61], gynecological disorder [42], and health enhancement in healthy people [4,5,54]. ...
Article
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The purpose of this study was to assess the quality of study reports on spa therapy based on randomized controlled trials by the spa therapy and balneotherapy checklist (SPAC), and to show the relationship between SPAC score and the characteristics of publication. We searched the following databases from 1990 up to September 30, 2013: MEDLINE via PubMed, CINAHL, Web of Science, Ichushi Web, Global Health Library, the Western Pacific Region Index Medicus, PsycINFO, and the Cochrane Database of Systematic Reviews. We used the SPAC to assess the quality of reports on spa therapy and balneotherapy trials (SPAC) that was developed using the Delphi consensus method. Fifty-one studies met all inclusion criteria. Forty studies (78%) were about "Diseases of the musculoskeletal system and connective)". The total SPAC score (full-mark; 19 pts) was 10.8 ± 2.3 pts (mean ± SD). The items for which a description was lacking (very poor; <50%) in many studies were as follows: "locations of spa facility where the data were collected"; "pH"; "scale of bathtub"; "presence of other facility and exposure than bathing (sauna, steam bath, etc.)"; "qualification and experience of care provider"; "Instructions about daily life" and "adherence". We clarified that there was no relationship between the publish period, languages, and the impact factor (IF) for the SPAC score. In order to prevent flawed description, SPAC could provide indispensable information for researchers who are going to design a research protocol according to each disease.
... However, in literature, many review or meta-analysis suggest the positive effect of BT in FS considering the pain severity, FIQ scores, and indexes of QoL [7][8][9][10]23]. Our data are in agreement with previous RCTs, although a lot of them were methodologically flawed and had small sample sizes [24][25][26]. Neumann et al. [24] and Buskila et al. [25] reported in two different papers the beneficial effect of BT at the Dead Sea on severity and frequency of FS-related symptoms and the significant improvement of QoL indexes. Other authors referred, as observed in our trial, a decrease of FIQ at the end of BT cycle that persisted until 6 months [26,27]. ...
... Our data are in agreement with previous RCTs, although a lot of them were methodologically flawed and had small sample sizes [24][25][26]. Neumann et al. [24] and Buskila et al. [25] reported in two different papers the beneficial effect of BT at the Dead Sea on severity and frequency of FS-related symptoms and the significant improvement of QoL indexes. Other authors referred, as observed in our trial, a decrease of FIQ at the end of BT cycle that persisted until 6 months [26,27]. ...
Article
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The aim of this study was to assess the efficacy and tolerability of balneotherapy (BT) in patients with primary fibromyalgia syndrome (FS). In a prospective, randomized, controlled, double-blind trial with a 6-month follow-up, 100 FS patients were randomized to receive a cycle of BT with highly mineralized sulfate water (BT group) or with tap water (control group). Clinical assessments were performed at screening visit, at basal time, and after treatment (2 weeks, 3 and 6 months). The primary outcome measures were the change of global pain on the Visual Analogue Scale (VAS) and Fibromyalgia Impact Questionnaire total score (FIQ-Total) from baseline to 15 days. Secondary outcomes included Widespread Pain Index, Symptom Severity Scale Score, Short Form Health Survey, State-Trait Anxiety Inventory (STAI), and Center for Epidemiologic Studies Depression Scale. We performed an intent-to-treat analysis. The Kolmogorov-Smirnov test was applied to verify the normality distribution of all quantitative variables and the Student's t test to compare sample data. In the BT group, we observed a significant improvement of VAS and FIQ-Total at the end of the treatment that persisted until 6 months, while no significant differences were found in the control group. The differences between groups were significant for primary parameters at each time point. Similar results were obtained for the other secondary outcomes except for the STAI outcome. Adverse events were reported by 10 patients in the BT group and by 22 patients in the control group. Our results support the short- and long-term therapeutic efficacy of BT in FS. Trial registration: NCT02548065.
... It also interacts with oxygen radicals in the deeper layers of the epidermis, producing sulfur and disulfur hydrogen, which may be transformed into pentathionic acid; this may be the source of the antibactericidal and antifungal activity of sulfur water (Matz et al. 2003). Sulfur baths (2,000 mg/l) are recommended to patients with fibromyalgia (Buskila et al. 2001). Magnesium rich in spring water is used in the treatment for inflammatory skin diseases (Schempp et al. 2000). ...
... Four studies [25][26][27][28] about thermomineral water baths for treatment of FMS reported collectively positive results. Balneotherapy was superior to control groups regarding improvement of pain, tenderness, physical functioning, FM-related symptoms (pain, fatigue, stiffness, anxiety, sleep problems). ...
... The creation of pain management strategies took place in group therapy (28). Both dry and wet forms of thermotherapeutic methods were used (29)(30)(31). The types of physiotherapy used included both active and passive methods (32). ...
Article
Objectives: This controlled study evaluates a multi-modal pain therapy for treating severe progressions of fibromyalgia [FMS] syndrome. The aim is to establish whether the use of multi-modal therapy with inclusion of whole-body hyperthermia represents a useful therapeutic addition to inpatient therapy of FMS syndrome at a high level of chronification. Methods: The study involved 130 patients who fulfilled the criteria of the American College of Rheumatology [ACR] for FMS and whose disease showed severe progression. One group of patients [HTG] received whole-body hyperthermia, while the control group [CG] did not. The main parameters of the study were pain intensity and the mental state of the patients. Further study parameters were the diagnoses additional to FMS syndrome and the therapy density of the treatment provided in the two groups. Results: The integration of whole-body hyperthermia into the multi-modal pain therapy showed superior pain reduction [p = 0.023] and an improvement in the mental state of the patients [p = 0.055]. In addition to the primary disease, the patients presented with an average of 6.7 accompanying diseases, primarily from major diagnostic categories 8 [diseases and disturbances of the musculoskeletal system and connective tissues], 19 [mental diseases and disturbances] and 10 [endocrine, nutritional and metabolic diseases]. Analysis of the therapy density of the inpatient multi-modal pain therapy revealed a close-meshed and high-frequency therapy. Conclusions: Multi-modal pain therapy was also found to be a highly effective therapy option in the case of severely progressive FMS syndrome. Extension of the multi-modal therapy setting to include whole-body hyperthermia can be considered as a useful and effective complement for pain relief and stabilisation of the mental state.
... We will subsequently review existing data regarding the utilization of spa therapy for the treatment of FMS. Buskila and colleagues [25] evaluated the effectiveness of balneotherapy on patients with FMS at the Dead Sea (Israel). This was a randomized prospective study of a 10day treatment, including 48 patients randomized to sulfur bath ( = 24) or no treatment ( = 24). ...
Article
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Aim. To perform a narrative review of spa therapy for management of the fibromyalgia syndrome (FMS), evaluating this traditional time-honored form of therapy in a historical perspective. Methods. Medline was searched using the terms "Spa therapy," "Balneotherapy," and "Fibromyalgia" between 1990 (year of ACR fibromyalgia criteria publication) and April 2013. The Cochrane database was also searched. Publications relating to the implementation of spa therapy and related practices over the centuries were identified through references, searched, and reviewed. Results. Reports of balneotherapy were described from diverse locations throughout Europe and Asia, and various forms of water-related therapy have been incorporated for many musculoskeletal indications. In the management of FMS, spa therapy has generally been shown to be well accepted and moderately effective for symptom reduction. Conclusion. While achieving high-quality evidence-based conclusions is difficult for complex natural therapies such as spa therapy, the existing evidence indicates a positive effect in management of FMS. In view of the long history of this modality in the management of rheumatic pain as well as the inherent difficulties related to pharmacological treatment, the role of spa therapy should currently be recognized as part of a therapeutic program for FMS.
... It was also discovered that salts in hot spring water have the effect of raising body temperature longer [2], and deep seawater was utilized for the thalassotherapy in the treatment of some diseases [3,4,5]. These results indicate that hot deep seawater improves the functions of the human immune system, like bathing in the hot springs does good to one's body. ...
Article
Coffee and red ginseng are recognized for beneficial health effects. Drinking coffee lowers the risk of developing type 2 diabetes mellitus, while red ginseng displays immune-stimulatory and anti-tumor activities. However, there has been no study about the effect of a topical application of red ginseng with body wrap steam bathing (BWSB) for stress release. With respect to types of treatment provided with BWSB, these subjects were divided into three groups: caffeine, red ginseng, and the control group. The same volunteer subjects (n=15) underwent these 3 BWSB tests for three non-consecutive days, at least one week apart. Before and after having BWSB, blood samples were taken for analysis of hormones, lipid profiles inclusive of total cholesterol, high density lipoprotein, low density lipoprotein, and triglycerides. The free oxygen radicals test (FORT) and free oxygen radicals defense (FORD) test were performed to analyze circulating oxidative stress instantaneously after taking blood samples. The results of this study revealed that cortisol levels of the red ginseng group were decrease (20%) than the control group (15.4%). On the contrary, the caffeine group showed a significant increase in cortisol or catecholamine levels after BWSB. Although the lipid profiles were unaffected, triglyceride levels significantly decreased (12% reduction) after BWSB in the red ginseng group. The extent of decrease was much greater (21%) in overweight subjects, while the triglyceride levels of subjects with a normal BMI showed no change.
... It also interacts with oxygen radicals in the deeper layers of the epidermis, producing sulfur and disulfur hydrogen, which may be transformed into pentathionic acid; this may be the source of the antibactericidal and antifungal activity of sulfur water (Matz et al. 2003). Sulfur baths (2,000 mg/l) are recommended to patients with fibromyalgia (Buskila et al. 2001). Magnesium rich in spring water is used in the treatment for inflammatory skin diseases (Schempp et al. 2000). ...
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This research deals with the sulfurous spring waters flow along the course of the Euphrates River in western Iraq in the area extended between Haqlaniya and Hit within the Al-Anbar governorate. Eleven springs (3 in Haqlanya, 4 in Kubaysa and 4 in Hit) have been addressed for the purpose of water evaluation for balneology, drinking, irrigation and aquaculture (fish farming). In order to meet the objectives of this research, all springs were sampled and analyzed for the total dissolved solid, electrical conductivity, pH, temperature, major cations (Ca(2+), Mg(2+), Na(+) and K(+)), major anions (SO4 (2-), Cl(-), HCO3 (-) and CO3 (2-)), minor anions (PO4 (3-)and NO3 (-)) as well as the trace elements that included Pb, Zn, Cd, Ni, Fe, Mn, Cu, Br, F, Ba, B, Sr, Al, As, Cr, Hg and Se. The International Standards of World Health Organization are used for assessing the water quality. The results revealed that the springs belong to the tepid springs of 27-30 °C and classified as hypothermal to the thermal springs. Lithochemistry and geochemical processes clearly affected the water chemistry. The hydrogeochemical processes are responsible for the element enrichment in water by the chemical dissolution of carbonate and gypsum and evaporation as well. The results of the study indicate the possibility of using spring water for therapeutic purposes, but not allowed for drinking and aquaculture (fish farming), except those free of H2S gas. On the other hand, it can be used for irrigation with risk. However, soil type as well as proper selection of plants should be taken into consideration.
... Thermalwassertherapie unterschiedlicher Dauer auf Schmerzen, Anzahl der Tenderpoints sowie Lebensqualität in Ergänzung zur medizinischen Standardtherapie am Therapieende bzw. 1-6 Monate nach Beendigung der Therapie nachgewiesen werden [51][52][53]. Ermittelt wurde auch der Nutzen einer medizinischen Trainingstherapie über 12 Wochen im Wasser im Vergleich zur Badetherapie bzgl. Schlafqualität und Morgensteifigkeit 24 Wochen nach Therapieende [54]. ...
Article
Die physikalische Therapie muskularer Erkrankungen und Funktionsstorungen in der Rheumatologie erfordert eine besonders ausgewogene und befundorientierte Behandlungsstrategie und individuelle Therapieplanung. Art, Intensitat und Dauer der Anwendung physikalischer Therapeutika bei diesen Krankheitsbildern sind zum Teil nicht ausreichend geklart. Die Arbeit gibt einen Uberblick zu evidenzbasierten Anwendungen und Empfehlungen im Rahmen klinischer Erfahrungen.
... Evidence for acupuncture is contradictory, 168,169 as is evidence for the efficacy of biofeedback [170][171][172] and balneotherapy. [173][174][175] Local injections in muscular areas of pain are also commonly employed by rheumatologists. The authors surveyed rheumatologists regarding the use of injections and found them to be used frequently, in agreement with others. ...
... Positive effects have been mentioned in the treatment of psoriasis as well. 10 Exercise in warm (tap) water is usually called "hydrotherapy" or "aquatic therapy". This Cochrane review focuses on balneotherapy only, which consists of bathing in natural mineral or thermal waters, using mudpacks or doing both. ...
Article
in pain or in physical disability (very low level of evidence) between groups. We found no statistically significant differences in pain intensity at eight weeks, but some benefit of mineral baths in overall improvement at eight weekscompared to Cyclosporin A (1 study; N.=57; low level of evidence). Conclusion. Overall evidence is insufficient to show that balneotherapy is more effective than no treatment ; that one type of bath is more effective than another or that one type of bath is more effective than exercise or relaxation therapy. Clinical Rehabilitation Impact. We were not able to assess any clinical relevant impact of balneotherapy over placebo, no treatment or other treatments.
... This improvement was greater in the balneotherapy group and lasted longer. Similar results (specially improvements in the physical and functional condition, as well as a reduction in the number of TP) were observed in different studies, which recalled the effectiveness of balneotherapy on patients with fibromyalgia at the Dead Sea [38,39]. ...
Article
Fibromyalgia (FM) is an incurable common syndrome of non-articular origin, and with no effective treatment by now. A great deal of research has sought to assess the efficacy of different therapies, especially non-pharmacological and low-cost ones, in the reduction of the intensity of symptoms. Despite the availability of a wide range of alternative therapies nowadays, there is little scientific evidence of the potential benefits of most of them, with results being contra-dictories. The purpose of this paper is to review some of the less well known alternative therapies in FM treatment, to describe the more relevant clinical studies published in this matter, and to analyze the potential effects of the main alternative therapies, in order to verify their efficacy.
... No between-group analyses were performed which limits the findings of the study. Buskila et al. 88 randomly assigned patients to either to balneotherapy (n = 24) or to a no treatment control (n = 24). Despite improvements in outcome measures, the no-treatment group also improved over the period of study on physical and psychosocial outcomes, a finding which could be attributed to the effects of staying in a spa resort. ...
Article
This paper reviews fibromyalgia syndrome (FMS), and examines the evidence for non-pharmacological interventions for the management of the condition. This follows from a previous systematic review carried out by the authors by focusing on the use of complementary and alternative therapies and their integration within clinical practice. The strength of evidence for the effectiveness of complementary and alternative medicine (CAM) interventions for FMS is presented. Best evidence was found to exist for a combined management programme incorporating exercise, education and aspects of CAM therapies. In terms of specific CAM therapies, results were found to be inconclusive due to methodological difficulties, though moderate evidence was found to exist for balneotherapy and acupuncture and some evidence was found for the effectiveness of massage, holistic movement therapies and chiropractic. Implications for service users and practitioners are discussed.
... The beneficial effect of treatments using natural mineral waters (NMW) has been recognized for decades with water from several resorts in France and Europe recommended for various diseases of the gastrointestinal tract, such as gastric dyspepsia [1][2][3] and irritable bowel syndrome [2,4]. The spa doctors' clinical experience investigates also the interest of such thermo-mineral treatments for some aspects of inflammatory bowel disease (IBD) and also observes an improvement of digestive symptoms in patients with IBD spondylitis ...
Article
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Natural mineral water (NMWs) intake has been traditionally used in the treatment of various gastrointestinal diseases. We investigated the effect of two French NMWs, one a calcium and magnesium sulphate, sodium chloride, carbonic, and ferruginous water (NMW1), the other a mainly bicarbonate water (NMW2) on the prevention of intestinal inflammation. Intestinal epithelial cells stimulated with heat inactivated Escherichia coli or H2O2 were treated with NMWs to evaluate the anti-inflammatory effects. Moderate colitis was induced by 1% dextran sulfate sodium (DSS) in Balbc/J mice drinking NMW1, NWW2, or control water. General signs and histological features of colitis, fecal lipocalin-2 and pro-inflammatory KC cytokine levels, global mucosa-associated microbiota, were analyzed. We demonstrated that both NMW1 and NMW2 exhibited anti-inflammatory effects using intestinal cells. In induced-colitis mice, NMW1 was effective in dampening intestinal inflammation, with significant reductions in disease activity scores, fecal lipocalin-2 levels, pro-inflammatory KC cytokine release, and intestinal epithelial lesion sizes. Moreover, NMW1 was sufficient to prevent alterations in the mucosa-associated microbiota. These observations, through mechanisms involving modulation of the mucosa-associated microbiota, emphasize the need of investigation of the potential clinical efficiency of such NMWs to contribute, in human beings, to a state of low inflammation in inflammatory bowel disease.
... Four studies [25][26][27][28] about thermomineral water baths for treatment of FMS reported collectively positive results. Balneotherapy was superior to control groups regarding improvement of pain, tenderness, physical functioning, FM-related symptoms (pain, fatigue, stiffness, anxiety, sleep problems). ...
Article
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Fibromyalgia syndrome (FMS) is a complex chronic condition, the treatment of which still poses many challenges. Complementary therapies (CT) have gained increasing popularity among FMS patients. Past reviews evaluating effectiveness of CT for treatment of FMS revealed some potential benefits arising from certain modalities. However, with the data available, it becomes difficult to formulate a unique opinion about this matter. In the present paper, the authors propose some guidelines to conciliate the expectations of patients with the lack of solid evidence, in a practicable yet responsible way. Many items should be considered before prescribing, proscribing, or tolerating a CT, besides results from randomized controlled trials, such as efficacy (mechanisms of action); effectiveness (effect in practice); efficiency (cost-benefit ratio); safety; risk-benefit ratio; legislation; healthcare service involvement; practitioner characteristics; objective (purpose); and the potential of combination with conventional treatment.
... In total, 13 RCT studies eventually satisfied the eligibility criteria, and 11 were included for this meta-analysis. After the initial screening, one study was excluded, given that the means and standard deviation of post-test data were not reported and could not be calculated [23]. Another study was excluded because the exercises in the pool were used as therapy, and not only the bath [24]. ...
Article
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Background: The efficiency of balneotherapy (BT) for fibromyalgia syndrome (FMS) remains elusive. Methods: Cochrane Library, EMBASE, MEDLINE, PubMed, Clinicaltrials.gov, and PsycINFO were searched from inception to 31 May 2020. Randomized controlled trials (RCTs) with at least one indicator were included, i.e., pain, Fibromyalgia Impact Questionnaire (FIQ), Tender Points Count (TPC), and Beck’s Depression Index (BDI). The outcome was reported as a standardized mean difference (SMD), 95% confidence intervals (CIs), and I2 for heterogeneity at three observational time points. GRADE was used to evaluate the strength of evidence. Results: Amongst 884 citations, 11 RCTs were included (n = 672). Various BT regimens were reported (water types, duration, temperature, and ingredients). BT can benefit FMS with statistically significant improvement at different time points (pain of two weeks, three and six months: SMD = -0.92, -0.45, -0.70; 95% CI (-1.31 to -0.53, -0.73 to -0.16, -1.34 to -0.05); I2 = 54%, 51%, 87%; GRADE: very low, moderate, low; FIQ: SMD = -1.04, -0.64, -0.94; 95% CI (-1.51 to -0.57, -0.95 to -0.33, -1.55 to -0.34); I2 = 76%, 62%, 85%; GRADE: low, very low; TPC at two weeks and three months: SMD = 􀀀0.94, 􀀀0.47; 95% CI (-1.69 to -0.18, -0.71 to -0.22); I2 = 81%, 0; GRADE: very low, moderate; BDI at six months: SMD = 􀀀0.45; 95% CI (-0.73 to -0.17); I2 = 0; GRADE: moderate). There was no statistically significant effect for the TPC and BDI at the remaining time points (TPC at six months: SMD = 􀀀0.89; 95% CI (-1.85 to 0.07); I2 = 91%; GRADE: very low; BDI at two weeks and three months: SMD = -0.35, -0.23; 95% CI (-0.73 to 0.04, -0.64 to 0.17); I2 = 24%, 60%; GRADE: moderate, low). Conclusions: Very low to moderate evidence indicates that BT can benefit FMS in pain and quality-of-life improvement, whereas tenderness and depression improvement varies at time phases. Established BT regimens with a large sample size and longer observation are needed.
... When choosing the design and adjusting the measurement periods and washout, other works were analyzed; all of them were RCTs of parallel groups, since, as we have mentioned previously, we could not find studies with a crossover design that could serve us as a model. The consulted works carried out measurements 3 months after the intervention Buskila et al. 2001;Altan et al. 2004;Nugraha et al. 2011;Özkurt et al. 2012;Bağdatlı et al. 2015), 4 months (Fioravanti et al. 2007), and 6 months (Evcik et al. 2002;Koçyiğit et al. 2016;Fioravanti et al. 2018), and only in one study, the measurements were repeated 9 months later (Dönmez et al. 2005). In all these studies, it was possible to maintain a 3-month therapeutic effect mainly, reaching a maximum of 6 months in those mentioned above. ...
Article
The layout of this study, designed as a randomized crossover clinical trial, is to evaluate the efficacy of an intervention with mineral-medicinal water from As Burgas (Ourense) in patients suffering from fibromyalgia. This sample was randomly divided into two groups: group A and group B. In phase 1, group A had 14 baths in thermal water for a month and standard pharmacological treatment; group B, standard pharmacological treatment. Washout period is 3 months. In phase 2, group A had standard treatment and group B had 14 baths in thermal water for a month plus standard treatment. The Fibromyalgia Impact Questionnaire (FIQ) was used; this grades the impact of the illness from 1 (minimum) to 10 (maximum), which was measured in both phases. Twenty-five patients were included in each group and the study was concluded with 20 patients in group A and 20 in group B. The intervention group obtained, once the baths finished, a mean score of 60.3 (± 11.8) and the control group of 70.8 (± 13.0) (p < 0.001). Three months later, the intervention group presented a mean score of 64.4 (± 10.6) and the control group of 5.0 (± 11.3) (p < 0.001). We can therefore conclude that the simple baths with mineral-medicinal water from As Burgas can make an improvement on the impact caused by fibromyalgia.
... On a pu retenir six essais [30][31][32][33][34][35] ...
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The data of 33 randomized controlled trials suggest that chronic pain of patients with chronic low back pain, knee osteo-arthritis, fibromyalgia is significantly improved by balneotherapy and significantly better improved than by control treatments. For chronic low back pain (10 RCT, 1192 patients) pain was better improved in balneotherapy group and the weighted mean of the differential improvement was 19.66 (95% CI: 16,6; 22.8) and the effect size was 1.1 (95 %CI: 0.82; 1.38) favouring balneotherapy. For knee osteo-arthritis pain (17 RCT, 1428 patients) pain was better improved in balneotherapy group and the weighted mean of the differential improvement was 13.24 (95% CI: 5.52; 20.96) and the effect size was 0.72 (95 %CI: 0.51; 0.93) favouring balneotherapy. For fibromyalgia (6 RCT, 398 patients) pain was better improved in balneotherapy group and the weighted mean of the differential improvement was 19.32 (95% CI: 10,62; 29.2) and the effect size was 0.79 (95 %CI: 0.27; 1.31) favouring balneotherapy. Mineral waters and healing muds appear to have a more powerful analgesic action: 13 RCT (701 patients) compared mineral water bathing to tap water bathing or peloid application to hot-apcks or neutral muds application: the effect size was 0.75 (95% CI:0.71; 0.79) favouring balneotherapy. Balneotherapy is a safe treatment as only 1 %of the patients receiving balneotherapy had to interrupt the treatment. However several methodological biases were observed in many trials, mainly a lack of statistical power due to a limited enrolment ofpatients, an insufficient duration offollow-up, an inhomogeneity of treatments. The clinical benefit has to be confirmed by stronger data of evidence but these data are sufficient to perform a more complete scientific analysis (meta-analysis); but further clinical investigations with a better methodological quality remain necessary.
Objective: To assess whether Legionella pneumophila serogroup 1 and serogroup 6, Escherichia coli, and Staphylococcus aureus can survive in Japan Sea Proper Water (JSPW). Methods: The inhibitory effects of JSPW, surface seawater (SSW), phosphate buffer solution with 3.5% NaCl of pH 7.0 (3.5%NaClPBS), and the 102- and 104-fold dilute solutions with purified water or phosphate buffer solution of pH 7.0, and purified water were investigated. Survival cells were counted immediately after the water and the bacteria were mixed, and at 1, 3, 5, and 7 days after incubation at 37° C. If the number of surviving cells was decreased more than 2 log units compared with the starting value, we judged the medium to have had an inhibitory effect on the growth of the bacteria. Results: The survival cells of the bacteria in JSPW had decreased more than 2 log units compared with the starting value at 1 day after incubation. After 1 day of incubation, the cells of Legionella pneumophila serogroup 6 and Staphylococcus aureus were found to have decreased more than 2 log units in purified water (PW) used as a control. Furthermore, Legionella pneumophila serogroup 1 in the 102-fold dilute solution of JSPW was only 1.04 log units lower than the starting value at 7 days after incubation. In the 102- and 104-fold dilute solutions of JSPW, Escherichia coli survived for 7 days after incubation. These results were almost similar to the results in SSW and 3.5%NaClPBS. Conclusions: The present findings demonstrate that Legionella pneumophila serogroup 1 and Escherichia coli cannot survive in undiluted JSPW for over a day at 37° C, suggesting the inhibitory effects may be due to the sodium chloride contained in JSPW.
Article
Objective. Description of number of physiotherapists actually working in Spanish spa centers and obtain by entraty information through medical directors about knowing if the presence of a physiotherpist in the team increases or could increase the welfare quality. Materials and method.Observance descriptive study in which the information in a prospective form has been picked up. The field of study have been the spa centers in all the Spanish autonomus communitiesOutcome. A total of 88 spa centers have been identified in our country. La Rioja is the Autonomous Community with a largest number of physiotherapist by spa center: l2/l, while Cataluña is the one having a largest number of doctors with: 14 (20%) and bath masseur-assistants: 42 (33,l%). The opinion of the medical directors and/or managers about if the presence of a physiotherapist increases or could increase the welfare quality has been clearly positive as well in the Galician Autonomous Community as in the other parts of the country. Conclusions. From the outcome of our study we can infer that only a small number of physiotherapists perform his professional work in Spanish spa centers, especially when you compare with the other groups (bathmasseur–assistants).
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Fatigue is a disabling, multifaceted symptom that is highly prevalent and stubbornly persistent. Although fatigue is a frequent complaint among patients with fibromyalgia, it has not received the same attention as pain. Reasons for this include lack of standardized nomenclature to communicate about fatigue, lack of evidence-based guidelines for fatigue assessment, and a deficiency in effective treatment strategies. Fatigue does not occur in isolation; rather, it is present concurrently in varying severity with other fibromyalgia symptoms such as chronic widespread pain, unrefreshing sleep, anxiety, depression, cognitive difficulties, and so on. Survey-based and preliminary mechanistic studies indicate that multiple symptoms feed into fatigue and it may be associated with a variety of physiological mechanisms. Therefore, fatigue assessment in clinical and research settings must consider this multi-dimensionality. While no clinical trial to date has specifically targeted fatigue, randomized controlled trials, systematic reviews, and meta-analyses indicate that treatment modalities studied in the context of other fibromyalgia symptoms could also improve fatigue. The Outcome Measures in Rheumatology (OMERACT) Fibromyalgia Working Group and the Patient Reported Outcomes Measurement Information System (PROMIS) have been instrumental in propelling the study of fatigue in fibromyalgia to the forefront. The ongoing efforts by PROMIS to develop a brief fibromyalgia-specific fatigue measure for use in clinical and research settings will help define fatigue, allow for better assessment, and advance our understanding of fatigue.
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Hintergrund Die planmäßige Aktualisierung der S3-Leitlinie zum Fibromyalgiesyndrom (FMS; AWMF-Registernummer 041/004) wurde ab März 2011 vorgenommen. Material und Methoden Die Leitlinie wurde unter Koordination der Deutschen Interdisziplinären Vereinigung für Schmerztherapie (DIVS) von 9 wissenschaftlichen Fachgesellschaften und 2 Patientenselbsthilfeorganisationen entwickelt. Acht Arbeitsgruppen mit insgesamt 50 Mitgliedern wurden ausgewogen in Bezug auf Geschlecht, medizinischen Versorgungsbereich, potenzielle Interessenkonflikte und hierarchische Position im medizinischen bzw. wissenschaftlichen System besetzt. Die Literaturrecherche erfolgte über die Datenbanken Medline, PsycInfo, Scopus und Cochrane Library (bis Dezember 2010). Die Graduierung der Evidenzstärke erfolgte nach dem Schema des Oxford Center of Evidence Based Medicine. Die Formulierung und Graduierung der Empfehlungen erfolgte in einem mehrstufigen, formalisierten Konsensusverfahren. Die Leitlinie wurde von den Vorständen der beteiligten Fachgesellschaften begutachtet. Ergebnisse und Schlussfolgerung Ausdauer- und Krafttraining geringer bis mittlerer Intensität werden stark empfohlen. Chirotherapie, Lasertherapie, Magnetfeldtherapie, Massage und transkranielle Magnetstimulation werden nicht empfohlen.
Article
Les effets thermo-mécaniques de l’eau ont toujours été utilisés pour soigner les maux les plus variés. De croyances en sciences, voyons les indications de la balnéothérapie au sein de la littérature.
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Objective: The purpose of this study was to systematically review the literature for randomized trials of complementary and alternative medicine (CAM) interventions for fibromyalgia (FM). Methods: A comprehensive literature search was conducted. Databases included the Cochrane library, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health, Natural Medicines Comprehensive Database Manual, Alternative and Natural Therapy Index System (MANTIS), Index for Chiropractic Literature, and Allied and Complementary Medicine (AMED). Inclusion criteria were (a) subjects were diagnosed with fibromyalgia and (b) the study design was a randomized controlled trial that compared a CAM therapy vs a control group. Studies were subgrouped by CAM treatment into 11 categories. Evidence tables and forest plots were organized to display quality ratings and effect sizes of each study. Results: The literature search yielded 1722 results; 102 abstracts were selected as potential articles for inclusion. Sixty studies met criteria and were rated by 2 reviewers; 18 were rated as good quality; 20, moderate; 18, low; and 4, very low. Synthesis of information for CAM categories represented by more than 5 studies revealed that balneotherapy and mindbody therapies were effective in treating FM pain. This study analyzed recent studies and focused exclusively on randomized controlled trials. Despite common use of manual therapies such as massage and manipulation to treat patients with FM, there is a paucity of quality clinical trials investigating these particular CAM categories. Conclusion: Most of these studies identified were preliminary or pilot studies, thus had small sample sizes and were likely underpowered. Two CAM categories showed the most promising findings, balneotherapy and mind-body therapies. Most of the other CAM categories showed a trend favoring the treatment group. It appears that several CAM therapies show some preliminary treatment effect for FM pain, but larger trials that are more adequately powered are needed. (J Manipulative Physiol Ther 2011;34:483-496) Key Indexing Terms: Fibromyalgia; Complementary and Alternative Medicine; Randomized Controlled Trials; Systematic Review
Article
There are seven randomized, controlled studies made in Ataturk Balneotherapy and Rehabilitation Center (ABRC). In the present writing, we have the objective of making a review of these seven studies reported in international journals. Methods: Spa therapy in thermal water has been applied to patients with osteoarthritis, rheumatoid arthritis, fibromyalgia syndrome, low back pain and osteoporosis with different times of durations and water temperature for each disease. Results and conclusion: These studies show the superiority of the water or water-exercise combination in the improvement of pain and other clinical parameters, to exercise alone.
Article
Balneotherapy's role in treating patients with arthritic disease is much debated. More common in treating patients with rheumatoid arthritis, balneotherapy's efficacy for patients with osteoarthritis needs further exploration. Our systematic review included three randomized controlled trials examining the effects of various types of balneotherapy on osteoarthritis of the knee. Thermal water balneotherapy showed clinical benefit but no statistical significance for pain relief. Combination hot sulphur and Dead Sea baths were more statistically significant and clinically effective than single bath treatments for short-term measures of pain and function. A combination bath regime also had a significant effect on pain severity at onemonth follow-up. No significant long-term (three months) benefits were observed for pain or function. We conclude that balneotherapy in the form of combination baths has short-term benefits for pain relief and function, which suggests that balneotherapy may require a standard treatment regime for optimal efficacy.
Article
SUMMARY Objectives: This paper focuses on nonpharmacologic approaches to fibromyalgia treatment. Descriptions of the most well researched strategies, such as exercise, cognitive-behavioral therapy, and multidisciplinary treatment using multiple treatment components, along with novel treatments for which evidence is beginning to emerge, are compared and evaluated. Findings: Evidence for the pain reduction benefits of moderate intensity exercise is strong. Both cognitive-behavioral therapy as a stand-alone treatment and multicomponent strategies that incorporate exercise and cognitive-behavioral or education strategies have significant benefits to patients mainly in enhanced self-efficacy and physical capacity and decreased pain. Novel therapies such as acupuncture, biofeedback, balneotherapy, therapeutic massage, movement therapy, vegetarian diets and supplements, and magnets all demonstrate therapeutic benefits in small clinical trials. There is some evidence that discernible characteristics may differentiate responders from nonresponders to many therapies. Conclusions: Overall, there is moderate to strong evidence of the effectiveness of some nonpharmacologic approaches to fibromyalgia treatment. Novel treatments from a wide group of practitioners and health perspectives are beginning to emerge as legitimate strategies. An individualized approach that incorporates patient's abilities, preferences, physical and psychological characteristics is critical to the success of treatment.
Article
Purpose: This study aims to investigate the role of additional balneotherapy in fibromyalgia patients receiving conventional physical therapy. Materials and Methods: 107 female patients diagnosed with fibromyalgia for the first time were studied in two groups. Group 1 included those patients receiving Transcutaneous Electrical Nerve Stimulation, physical therapy modalities including superficial hot and therapeutic ultrasound. Group 2 consisted of patients applied balneotherapy in addition to therapeutic modalities given to the first group. All patients went through a 10-session treatment program. Evaluation was based on Fibromyalgia Impact Questionnaire (FIQ), Visual Analogue Scale (VAS), Pittsburgh Sleep Quality Index (PSQI), Quality of Life Short Form-36 (SF-36) before and after the treatment. The total amount of paracetamol tablets consumed was also recorded. Results: In both groups, there was significant improvement in post-treatment pain VAS, FIQ and PSQI scores compared to prior to treatment, but they were more pronounced after the balneotherapy. With balneotherapy, drug consumption was also significantly lower and patients expressed better general health and social function scores of SF-36. Conclusion: In the treatment of fibromyalgia, combination of balneotherapy with the conventional physical modalities can be considered as an effective treatment option as it positively contributes to the patients' pain, functional status, quality of life and sleep, and drug consumption.
Article
Background: No cure for rheumatoid arthritis (RA) is known at present, so treatment often focuses on management of symptoms such as pain, stiffness and mobility. Treatment options include pharmacological interventions, physical therapy treatments and balneotherapy. Balneotherapy is defined as bathing in natural mineral or thermal waters (e.g. mineral baths, sulphur baths, Dead Sea baths), using mudpacks or doing both. Despite its popularity, reported scientific evidence for the effectiveness or efficacy of balneotherapy is sparse. This review, which evaluates the effects of balneotherapy in patients with RA, is an update of a Cochrane review first published in 2003 and updated in 2008. Objectives: To perform a systematic review on the benefits and harms of balneotherapy in patients with RA in terms of pain, improvement, disability, tender joints, swollen joints and adverse events. Search methods: We searched the Cochrane 'Rehabilitation and Related Therapies' Field Register (to December 2014), the Cochrane Central Register of Controlled Trials (2014, Issue 1), MEDLIINE (1950 to December 2014), EMBASE (1988 to December 2014), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to December 2014), the Allied and Complementary Medicine Database (AMED) (1985 to December 2014), PsycINFO (1806 to December 2014) and the Physiotherapy Evidence Database (PEDro). We applied no language restrictions; however, studies not reported in English, Dutch, Danish, Swedish, Norwegian, German or French are awaiting assessment. We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing and recently completed trials. Selection criteria: Studies were eligible if they were randomised controlled trials (RCTs) consisting of participants with definitive or classical RA as defined by the American Rheumatism Association (ARA) criteria of 1958, the ARA/American College of Rheumatology (ACR) criteria of 1988 or the ACR/European League Against Rheumatism (EULAR) criteria of 2010, or by studies using the criteria of Steinbrocker.Balneotherapy had to be the intervention under study, and had to be compared with another intervention or with no intervention.The World Health Organization (WHO) and the International League Against Rheumatism (ILAR) determined in 1992 a core set of eight endpoints in clinical trials concerning patients with RA. We considered pain, improvement, disability, tender joints, swollen joints and adverse events among the main outcome measures. We excluded studies when only laboratory variables were reported as outcome measures. Data collection and analysis: Two review authors independently selected trials, performed data extraction and assessed risk of bias. We resolved disagreements by consensus and, if necessary, by third party adjudication. Main results: This review includes two new studies and a total of nine studies involving 579 participants. Unfortunately, most studies showed an unclear risk of bias in most domains. Four out of nine studies did not contribute to the analysis, as they presented no data.One study involving 45 participants with hand RA compared mudpacks versus placebo. We found no statistically significant differences in terms of pain on a 0 to 100-mm visual analogue scale (VAS) (mean difference (MD) 0.50, 95% confidence interval (CI) -0.84 to 1.84), improvement (risk ratio (RR) 0.96, 95% CI 0.54 to 1.70) or number of swollen joints on a scale from 0 to 28 (MD 0.60, 95% CI -0.90 to 2.10) (very low level of evidence). We found a very low level of evidence of reduction in the number of tender joints on a scale from 0 to 28 (MD -4.60, 95% CI -8.72 to -0.48; 16% absolute difference). We reported no physical disability and presented no data on withdrawals due to adverse events or on serious adverse events.Two studies involving 194 participants with RA evaluated the effectiveness of additional radon in carbon dioxide baths. We found no statistically significant differences between groups for all outcomes at three-month follow-up (low to moderate level of evidence). We noted some benefit of additional radon at six months in terms of pain frequency (RR 0.6, 95% CI 0.4 to 0.9; 31% reduction; improvement in one or more points (categories) on a 4-point scale; moderate level of evidence) and 9.6% reduction in pain intensity on a 0 to 100-mm VAS (MD 9.6 mm, 95% CI 1.6 to 17.6; moderate level of evidence). We also observed some benefit in one study including 60 participants in terms of improvement in one or more categories based on a 4-point scale (RR 2.3, 95% CI 1.1 to 4.7; 30% absolute difference; low level of evidence). Study authors did not report physical disability, tender joints, swollen joints, withdrawals due to adverse events or serious adverse events.One study involving 148 participants with RA compared balneotherapy (seated immersion) versus hydrotherapy (exercises in water), land exercises or relaxation therapy. We found no statistically significant differences in pain on the McGill Questionnaire or in physical disability (very low level of evidence) between balneotherapy and the other interventions. No data on improvement, tender joints, swollen joints, withdrawals due to adverse events or serious adverse events were presented.One study involving 57 participants with RA evaluated the effectiveness of mineral baths (balneotherapy) versus Cyclosporin A. We found no statistically significant differences in pain intensity on a 0 to 100-mm VAS (MD 9.64, 95% CI -1.66 to 20.94; low level of evidence) at 8 weeks (absolute difference 10%). We found some benefit of balneotherapy in overall improvement on a 5-point scale at eight weeks of 54% (RR 2.35, 95% CI 1.44 to 3.83). We found no statistically significant differences (low level of evidence) in the number of swollen joints, but some benefit of Cyclosporin A in the number of tender joints (MD 8.9, 95% CI 3.8 to 14; very low level of evidence). Physical disability, withdrawals due to adverse events and serious adverse events were not reported. Authors' conclusions: Overall evidence is insufficient to show that balneotherapy is more effective than no treatment, that one type of bath is more effective than another or that one type of bath is more effective than mudpacks, exercise or relaxation therapy.
Article
Fibromyalgia (FM) is currently classified as a chronic pain syndrome. Its main features are chronic widespread pain in the presence of tender points (TPs) upon physical examination, sleep disturbances and fatigue, although patients also report a variety of other complaints. Many therapies have been proposed over recent years with mixed results, including various pharmacological therapies for the treatment of symptoms; but there is still no effective drug treatment for the syndrome itself. Non-pharmacological therapies are an important part of the treatment, and there is evidence supporting a number of interventions, including aerobic exercise, strength and stretching training, cognitive-behavioural therapy, and patient education. Complementary and alternative medicine (CAM) techniques have not yet been fully acknowledged by scientific medicine because little is known about their mechanisms of action and usefulness. The aim of this wide-ranging review of the literature is to analyse the types of CAM techniques used to treat FM and their effectiveness, highlighting the disagreements among the authors of more specialised reviews.
Article
This chapter collects and synthesizes up-to-date information about the complex etiologic theories and treatment regimens associated with fibromyalgia (FM) and its association with depressive syndromes. There are many overlapping pain and depression comorbidities, and we have specifically chosen to review depression and FM for a few reasons. First, FM has been a controversial illness with several proposed etiologies. Second, FM may be more of a neuropathic pain condition with organic and functional etiologic overlap with depression pathology. Third, in the last year we have gathered two new FDA approvals for treating this pain disorder. Fourth, many of the neuropathic and nociceptive treatment options that we discuss can easily be applied to other pain conditions associated with depression. We first review current epidemiologic and etiologic theories regarding pain disorders and depression. Again, we will be using FM as a prototype overlap of pain and depression, but other interactions between pain and depression cer-tainly occur, and the same neurologic principles apply. A formal literature review is next presented to allow the reader to understand the evidence base that sup-ports treatment of this disorder. A thorough MEDLINE search was utilized to collect many papers dedicated to this topic spanning 1970 to 2008. The relevant papers were divided on the basis of intervention used for the treatment of FM (pharmacologic vs. nonpharmacologic). Below, we will first review current epi-demiologic and etiologic theories regarding pain disorders and depression. Then, we will comment on the treatment of FM and its comorbidity with depression in the context of pharmacodynamics and other management strategies. Outside FM and depression, there are similar pathways and interactions between other chronic painful conditions and depression. In a review, Leo et al. suggest that headaches, temporal mandibular joint (TMJ) syndrome, irritable bowel syndrome (IBS), post-stroke central pain, multiple sclerosis, Parkinson's disease, osteoarthritis, and rheumatoid arthritis are all diseases and syndromes that often present with pain in psychiatric practice (1). Conversely there seems to be an inordinate amount of patients with depression, anxiety, substance misuse, and personality disorder that present with painful conditions as well. Altered pain perception and tolerability in controlled laboratory settings has also been demonstrated in patients with schizophrenia, bipolar disorder, anxi-ety, depression, and borderline personality disorder (2–5). Chronic pain may be a risk factor for suicidal thinking and attempts. Pain may be a risk factor for suicidal behavior, independent of baseline presence of mental illness or not.
Article
Background: Low back pain (LBP) is chronic disease without a curative therapy. Alternative and complementary therapies are widely used in the management of this condition. Objectives: To evaluate the efficacy of home application of Dead Sea mud compresses to the back of patients with chronic LBP. Methods: Forty-six consecutive patients suffering from chronic LBP were recruited. All patients were followed at the Soroka University Rheumatic Diseases Unit. The patients were randomized into two groups: one group was treated with mineral-rich mud compresses, and the other with mineral-depleted compresses. Mud compresses were applied five times a week for 3 consecutive weeks. The primary outcome was the patient's assessment of the overall back pain severity. The score of the Ronald & Morris questionnaire served as a secondary outcome. Results: Forty-four patients completed the therapy and the follow-up assessments: 32 were treated with real mud packs and 12 used the mineral-depleted packs. A significant decrease in intensity of pain, as described by the patients, was observed only in the treatment group. In this group, clinical improvement was clearly seen at completion of therapy and was sustained a month later. Significant improvement in the scores of the Roland & Morris questionnaire was observed in both groups. Conclusions: The data suggest that pain severity was reduced in patients treated with mineral-rich mud compresses compared with those treated with mineral-depleted compresses. Whether this modest effect is the result of a "true" mud effect or other causes can not be determined in this study.
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The peloid has been using as thermotherapy in health resorts centers obtaining the best results in musculoskeletal and skin diseases. However studies have demonstrated also that fangotherapy lowers the levels of inflammatory mediators (interleukin-1 β [IL-1 β], tumour necrosis factor-α [TNF-α], prostaglandin E2 [PGE2] and leukotriene B4 [LTB4]) and has a positive effect on the anti oxidant condition (metalloproteinases [MMPs], nitric oxide [NO]) and chondrolysis (metalloproteinase [MMP-3] and adiponectin decrease, insulin-like growth factor 1 [IGF1] increase). Recent investigations on the action mechanism of these products explaining the reason why they haves been used since ages empirically has been looked into. KEY WORDS: Mud, Peloid, Pelotherapy, Fangotherapy, Health Resort Medicine
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The aim of this randomized controlled single-blind study is to explore whether addition of mud-pack and hot pool treatments to patient education make a significant difference in short and mild term outcomes of the patients with fibromyalgia. Seventy women with fibromyalgia syndrome were randomly assigned to either balneotherapy with mud-pack and hot pool treatments (35) or control (35) groups. After randomization, five patients from balneotherapy group and five patients from control group were dropped out from the study with different excuses. All patients had 6-h patient education programme about fibromyalgia syndrome and were given a home exercise programme. The patients in balneotherapy group had heated pool treatment at 38 °C for 20 min a day, and mud-pack treatment afterwards on back region at 45 °C. Balneotherapy was applied on weekdays for 2 weeks. All patients continued to take their medical treatment. An investigator who was blinded to the intervention assessed all the patients before and after the treatment, at the first and the third months of follow-up. Outcome measures were FIQ, BDI and both patient's and physician's global assessments. Balneotherapy group was significantly better than control group at after the treatment and at the end of the first month follow-up assessments in terms of patient's and physician's global assessment, total FIQ score, and pain intensity, fatigue, non-refreshed awaking, stiffness, anxiety and depression subscales of FIQ. No significant difference was found between the groups in terms of BDI scores. It is concluded that patient education combined with 2 weeks balneotherapy application has more beneficial effects in patients with fibromyalgia syndrome as compared to patient education alone.
Article
Fibromyalgia is a common syndrome of unknown etiology characterized by chronic widespread pain and polysymptomatic autonomic disturbances and often mental features. The American College of Rheumatology’s classification criteria define fibromyalgia by widespread pain and 11 of 18 tender points. Fibromyalgia is a diagnosis of exclusion as long as stand none laboratory or technical tests. The major role in pathogenesis appears to be central and involves the subcortical pain modulation, psychical stress especially in early childhood, endocrinological and genetic factors. There is no evidence of abnormalities in muscle and tendon. The goal of therapy in fibromyalgia is pain, reduced physical function and sleep disturbance. Actual evidence of effects of pharmacological and nonpharmacological interventions are summarized. Tricyclic agents, aerobic exercises, patient education and combined therapies can reduce effectively symptoms and disability.
Article
Treatment options for rheumatoid arthritis (RA) include pharmacological interventions, physical therapy treatments and balneotherapy. To evaluate the benefits and harms of balneotherapy in patients with RA. A systematic review POPULATION: Studies were eligible if they were randomised controlled trials consisting of participants with definitive or classical RA. We searched various databases up to December 2014.Balneotherapy had to be the intervention under study, and had to be compared with another intervention or with no intervention. We considered pain, improvement, disability, tender joints, swollen joints and adverse events among the main outcome measures. We excluded studies when only laboratory variables were reported as outcome measures.Two review authors independently selected trials, performed data extraction and assessed risk of bias. This review includes nine studies involving 579 participants. Most studies showed an unclear risk of bias in most domains. We found no statistically significant differences on pain or improvementbetween mud packs versus placebo (1 study; n=45; hand RA; very low level of evidence).Concerning the effectiveness of additional radon in carbon dioxide baths, we found no statistically significant differences between groups for all outcomes at three-month follow-up (2 studies;n=194; low to moderate level of evidence). We noted some benefit of additional radon at six months in pain (moderate level of evidence). One study (n=148) compared balneotherapy (seated immersion) versus hydrotherapy (exercises in water), land exercises or relaxation therapy. We found no statistically significant differences in pain or in physical disability (very low level of evidence) between groups. We found no statistically significant differences in pain intensity at eight weeks, but some benefit of mineral baths in overall improvement at eight weekscompared toCyclosporin A (1 study; n=57; low level of evidence). Overall evidence is insufficient to show that balneotherapy is more effective than no treatment; that one type of bath is more effective than another or that one type of bath is more effective than exercise or relaxation therapy. We were not able to assess any clinical relevant impact of balneotherapy over placebo, no treatment or other treatments.
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This is the story of the Syrian captain Naaman whose disease was treated by Jordan water as prescribed by the prophet Elisha. The Jordan River is in Southwest Asia, which flows and is the only major water source of the Dead Sea. The water of Jordan River already in biblical times has been used to heal patients from various diseases. This research therefore examines what kind of disease afflicted Naaman and various health effects of the Dead Sea.
Article
A review was undertaken of the investigations carried out on peloids and pelotherapy considering only the publications in English. More than 300 publications including articles, books and chapters of the books related to this theme were reviewed. Of them, a total of 198 have been chosen to be cited in the two papers related with this review (Part I and Part II), and 164 published in the period between 1990–2019 have been considered in this paper. In this work the publications related to mineralogy, chemistry, physical and physiochemical properties are included. In addition, studies concerning the presence of radioactive isotopes, peloid interstitial liquid, cation release and toxicity are also included. A historical background about peloids and pelotherapy, its definition and classification, application methods and the process of maturation are also considered. The organic compounds, microbiology and medical applications of peloids are reviewed in the paper: Clays in pelotherapy. A review. Part II: Organic compounds, microbiology and medical applications (Carretero, 2020). The studies have been classified into two blocks: i) studies about peloids which are known for their use in therapeutic purposes; and ii) a study of clays and other materials for its possible use in pelotherapy. Within this last block, the papers have been classified into: i) a study of clays and other materials without maturation (raw materials). ii) Studies of materials with seawater and salt lake water natural maturation, but which are not used up to now for therapeutic purposes, iii) Studies of clays with minero-medicinal water or seawater maturation at different times, and iv) Studies of peloids from spas and their raw materials with medicinal mineral water maturation at different times. Peloids that are used for therapeutic purposes in 18 countries have been considered. Peloids are formed mainly by phyllosilicates, quartz and feldspars. Most of them have also calcite and in some cases dolomite. As minor phases, gypsum, halite, aragonite and zeolites mainly appear. Mineral phases such as pyrite, alunite, Fe-oxides, sulfur and opal are also detected in peloids that come from a volcanic environment. The principal phyllosilicates are smectites, kaolinite, illite, illite–smectite mixed layer and chlorite. It is not possible to make a variability range of the physical and physicochemical properties of the peloids used for therapeutic purposes because there are not enough publications in which they determine the properties of them. In addition, those publications only study some of the properties, and the same properties are not in every publication. The studies concerning the suitability of clays for their possible use for therapeutic purposes show that the smectites are more considered than other phyllosilicates for pelotherapic applications. The specific heat depends on the quantity of water that the mixture of clay and water has. The mineralogical modifications, crystal chemistry and properties with the maturation period depend on the type of minero-medicinal water employed and they depend on the phyllosilicates and the minority minerals or traces that make up the clays. The more common period of maturation is between 2 and 3 months (maximum 6 months), although this result must be checked with the studies of the therapeutic efficacy of these peloids.
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This chapter will mainly focus on the general assets and applications of sulfur- or H2S-bearing thermal mineral waters on a world scale. It deals with basic information on hydrogen sulfide properties, on biological effects, and on the therapies traditionally used in medical hydrology as treatment for skin, respiratory, and musculoskeletal disorders. The authors provide information on additional therapeutic benefits of sulfurous waters in diseases such as myalgia (muscle pain), rheumatic diseases (osteoarthritis, rheumatoid arthritis, fibromyalgia), respiratory diseases (upper and lower respiratory tracts), dermatological/skin diseases, cardiovascular diseases, and other diseases (cancer, wound healing in diabetic patients). Possible side effects or situations of diseases for which sulfurous thermal waters are contraindicated are reported too.
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Fibromyalgia is a highly heterogeneous condition, but the most common symptoms are widespread pain, fatigue, poor sleep, and low mood. Non-pharmacological interventions are recommended as first-line treatment of fibromyalgia. However which interventions are effective for the different symptoms is not well understood. The objective of this study was to assess the efficacy of non-pharmacological interventions on symptoms and disease specific quality of life (QoL). Seven databases were searched from their inception until 1st June 2020. Randomised controlled trials (RCTs) comparing any non-pharmacological intervention to usual care, waiting list or placebo in people with fibromyalgia aged >16 years were included without language restriction. Fibromyalgia Impact Questionnaire (FIQ) was the primary outcome measure. Standardised mean difference (SMD) and 95% confidence interval (CI) were calculated using random effects model. The risk of bias (RoB) was evaluated using modified Cochrane tool. Of the 16,251 studies identified, 167 RCTs (n=11,012) assessing 22 non-pharmacological interventions were included. Exercise, psychological treatments, multi-disciplinary modality, balneotherapy and massage improved FIQ. Subgroup analysis of different exercise interventions found that all forms of exercise improved pain (ES -0.72 to -0.96) and depression (ES -0.35 to -1.22) except for flexibility-exercise. Mind-body and strengthening exercises improved fatigue (ES -0.77 to -1.00), whereas aerobic and strengthening exercises improved sleep (ES -0.74 to -1.33). Psychological treatments including cognitive behavioural therapy and mindfulness improved FIQ, pain, sleep, and depression (ES -0.35 to -0.55) but not fatigue. The findings of this study suggest that non-pharmacological interventions for fibromyalgia should be individualised according to the predominant symptom.
Article
Fibromyalgia typically presents in young or middle-aged females as persistent widespread pain, stiffness, fatigue, disrupted unrefreshing sleep, and cognitive difculties, often accompanied by multiple other unexplained symptoms, anxiety and/or depression, and functional impairment of daily living activities. Management of Fibromyalgia at the present time is very difcult as it has multiple etiological factors and psychological predispositions; however, a patient centered approach is essential to handle this problem. Many adjunctive interventions have been implemented in bromyalgia treatment, but few are supported by controlled trials. Only three drugs, pregabalin, duloxetine, and milnacipran are currently FDAapproved for Fibromyalgia treatment, but many other agents have been tested over the years, with varying efcacy
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ABSTRACT Objective: To evaluate safety of mud-bath therapy in mild-moderately rheumatoid arthritis [RA]. Methods: We planned a randomized, double-blinded, placebo-controlled trial in patients with moderate active RA, treated with active or placebo mud applied for 15 to 20 minutes at 39 to 40°C and followed by a shower and thermal bath at 37 to 38°C for 10 to 12 minutes. The first 50 patients were evaluated for an interim analysis and considered “treated patients” without blinding breakdown. Patients were evaluated before treatment [visit 1], at the end of the treatment [visit 2], after four weeks [visit 3], and after six months [visit 4, end of the study] for flare, Disease Activity Score [DAS], C-reactive protein, swollen joints, Health Assessment Questionnaire, and adverse reactions. As a control group, 50 matched RA patients were enrolled at the same outpatient clinic and evaluated four weeks apart. Results: The baseline characteristics of the two groups were similar. No significant differences were noted as for disease flares. Thirty-three [66 percent] treated and 12 [24 percent] control patients had an improvement of more than 0.6 on the DAS [p<.001]. Concerning the treated patients, DAS, C-reactive protein, swollen joints, and the Health Assessment Questionnaire showed a significant reduction at visit 2 when compared to the baseline, lasting until visit 4. No significant side effects were noted. Conclusions: A negative effect of hot application in mild to moderately active RA seems to be excluded. The observed improvement in disease activity should be the subject of further studies.
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An instrument has been developed to assess the current health status of women with the fibromyalgia syndrome. The Fibromyalgia Impact Questionnaire (FIQ) is a brief 10-item, self-administered instrument that measures physical functioning, work status, depression, anxiety, sleep, pain, stiffness, fatigue, and well being. We describe its development and validation. This initial assessment indicates that the FIQ has sufficient evidence of reliability and validity to warrant further testing in both research and clinical situations.
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Forty patients with classical or definite rheumatoid arthritis in a stage of active disease were treated for two weeks at a spa hotel. The patients were divided into four groups of 10. Group I was treated with daily mud packs, group II with daily hot sulphur baths, group III with a combination of mud packs and hot sulphur baths, and group IV served as a control group. The patients were assessed by a rheumatologist who was blinded to the treatment modalities. Statistically significant improvement for a period of up to three months was observed in the three treatment groups in most of the clinical indices. Improvement in the control group was minor in comparison and not statistically significant. No significant improvement was observed in any of the laboratory variables measured. Except for three mild cases of thermal reaction there were no side effects.
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To evaluate the effectiveness of balneotherapy (mud packs and sulfur baths) on patients with psoriasis and psoriatic arthritis (PsA). One hundred and sixty-six patients with psoriasis and PsA were treated at the Dead Sea for a period of 3 weeks. The patients were divided into 2 groups. Both groups had the regular regimen of bathing in Dead Sea water and exposure to the sun's ultraviolet rays. The study group, which consisted of 146 patients also was treated with mud packs and sulfur baths. The control group, which had no additional therapy, consisted of 20 patients. The main clinical variables assessed were duration of morning stiffness, grip strength, activities of daily living, subjective patient assessment of disease severity, number of active joints, number of effluent joints. Ritchie index, psoriasis area and severity index score, cervical, thoracic, and lumbar spine pain and limitations of movement. Statistically significant improvement was found in most variables in both groups. However, better results were observed in the study group. In 2 variables, reduction of spinal pain and range of movement in the lumbar spine, significant improvement (p < 0.001 and p = 0.022, respectively) was observed in the study group only. Treatment of psoriasis and PsA at the Dead Sea area is very efficacious and the addition of balneotherapy can have additional beneficial effects on patients with PsA. Other controlled studies with longer followup periods are needed to verify our results.
Article
Over 100 papers describing and utilizing the Stanford Health Assessment Questionnaire (HAQ) have been published since 1980. A brief overview of the HAQ is presented along with a guide to the accumulated literature. The topics covered include: studies using the disability, pain, economic, and drug side effect dimensions of the HAQ; reliability and validity studies; applications to various rheumatic diseases; language adaptations; modifications and derivative scales; studies correlating the HAQ with sociodemographic, health status, laboratory, and physical measures; and randomized controlled trials and observational studies using the HAQ. A few comments regarding future directions for research are also presented.
Article
Twenty-eight patients with classical or definite rheumatoid arthritis were randomly divided into two groups of fourteen patients each. All patients were treated once a day with mud packs derived from the Dead Sea heated to 40 degrees C and applied over the four extremities, neck and back for 20 minutes. Group 1 was treated with the true mud packs and Group 2 with washed out and less concentrated mud packs. The study was double blind and of two weeks duration. All patients were evaluated by one rheumatologist both before treatment and two weeks later at the end of the treatment period. Follow-up evaluations were made one and three months after conclusion of the treatment. The clinical indices evaluated included duration of morning stiffness, hand-grip strength, activities of daily living, patient's own assessment of disease activity, number of active joints and the Ritchie index. A statistically significant improvement (p less than 0.01 or p less than 0.05) was observed in Group 1 only in most of the clinical indices, lasting between 1 to 3 months.
Article
Thirty patients with classical or definite rheumatoid arthritis were randomly divided into two groups of fifteen patients each of similar age, sex, duration and severity of disease, and medical treatment. All patients were treated once a day with bath salts heated to 35 degrees C for twenty minutes. Group I received Dead Sea bath salts and Group II, the control group, received sodium chloride (NaCl). The study was double-blind and of two weeks' duration. All patients were evaluated by one rheumatologist both before treatment, and two weeks later at the end of the treatment period. Follow-up evaluations were made one and three months after conclusion of the treatments. The clinical parameters evaluated included duration of morning stiffness, fifteen meter walk time, hand-grip strength, activities of daily living, circumference of proximal interphalangeal joints, number of active joints, Ritchie index and the patient's own assessment of disease activity. The laboratory parameters evaluated included erythrocyte sedimentation rate and serum levels of amyloid A, rheumatoid factor, sodium, potassium, calcium and magnesium. A statistically significant improvement (p less than 0.01 or p less than 0.05) was observed in Group I only, in most of the clinical parameters assessed. Maximal therapeutic effect was obtained at the end of the treatment and lasted up to one month.
Article
To validate a translated version of the Fibromyalgia Impact Questionnaire (FIQ) to be used by Hebrew speaking populations. We administered the FIQ to 100 women with fibromyalgia (FM). The FIQ measures physical functioning, work status, depression, anxiety, sleep, pain, stiffness, fatigue, and well being. All patients were asked about the presence and severity (assessed by visual analog scale) of relevant FM symptoms (pain, fatigue, anxiety, etc.); a count of 18 tender points was conducted by thumb palpation, and tenderness thresholds were assessed by dolorimetry. Test-retest reliability was assessed using Spearman correlations. Internal consistency was evaluated with Cronbach's alpha coefficient of reliability. To assess content validity a cutoff criterion of > or = 25% impairment responses was set to indicate a valid item. Construct validity of the FIQ was evaluated by correlating the physical functioning score as well as the separate items with measures of symptom severity, count of tender points, and tenderness thresholds. Test-retest reliability was r = 0.96 for physical functioning, and 0.80-0.96 for other items of FIQ. Internal consistency was alpha = 0.93 at Time 1 and 0.86 at Time 2. Seventeen of 19 items of the FIQ met the > or = 25% criterion. Significant moderate to high correlations were obtained between the FIQ items and severity symptoms, point count, and tenderness threshold. The FIQ is a reliable and valid instrument for measuring functional disability and health status in Israeli women with FM.
Article
Evidence suggest that the Dead Sea has been known for its therapeutic advantages from ancient times. With the establishment of the State of Israel, scientific articles relating to various fields of medicine started to appear showing that the Dead Sea region, and the Dead Sea itself, has a beneficial effect on skin, joint, respiratory, eye, and other disorders. The purpose of this article is to summarize scientific studies published to date by Israeli and other investigators showing the Dead Sea is not only alive but bring about significant remissions in diseases such as psoriasis, psoriatic, rheumatoid arthritis and osteoarthritis.
Article
To record the prevalence, extent, cost, and satisfaction with use of alternative medicine practices by patients with fibromyalgia syndrome (FMS), compared to control rheumatology patients. An interviewer-based questionnaire was administered to 221 consecutive rheumatology patients and 80 FMS patients. Alternative medicine interventions were currently being used extensively by rheumatology patients overall, and by FMS patients in particular. All categories of alternative practices were used more often by FMS patients, compared to controls, including overall use 91% versus 63% (P = 0.0001), over-the-counter products 70% versus 54% (NS), spiritual practices 48% versus 37% (NS), and alternative practitioners 26% versus 12% (P = 0.003), respectively. Two-thirds of patients using alternative medicine practices were concurrently using multiple interventions. Patient satisfaction ratings were highest for spiritual interventions. Alternative medicine practices were currently being used by almost all FMS patients. This observation might indicate that traditional medical therapies are inadequate in providing symptomatic relief to FMS patients.
Article
Patients with fibromyalgia syndrome (FM) are high consumers of alternative medical interventions and frequently consult nonphysician practitioners. Although individuals may express satisfaction with alternative treatment methods, their effect upon symptoms and outcome of FM is not known. We compare symptom reporting and functional status in patients with FM being treated or not being treated by nonphysician practitioners. 82 patients with FM enrolled in a cross sectional study were divided into current users (n = 33) and nonusers (n = 49) of nonphysician practitioner treatment over the preceding 6 months. Included were treatments by physiotherapists and psychologists, as well as all categories of alternative practitioners. The measurements studied were a patient global assessment of disease severity on a 100 mm visual analog scale (VAS), a physician global assessment on a 100 mm VAS, the Health Assessment Questionnaire (HAQ), and the Fibromyalgia Impact Questionnaire (FIQ). There were no differences for the FIQ, HAQ, or patient or physician global severity scores for users and nonusers of nonphysician practitioner treatments. The total number of health care professional visits in the preceding 6 months was higher for users than nonusers (27.0 vs 9.3; p < 0.001), although physician visits did not differ (9.0 vs 9.3). Patients with FM who had been treated by nonphysician practitioners during the preceding 6 months reported similar pain and functional impairment to those not receiving treatments.
Article
Despite significant efforts devoted to understanding the etiopathogenesis of fibromyalgia, its treatment still presents a challenge to practicing clinicians, who must recognize the disorder and quantify the different symptoms in order to treat it. This article discusses recent research to identify sensitive and reliable measures for determining response to treatment among patients with FM, and the elements of therapeutic programs (pharmacologic and nonpharmacologic) for patients with FM along with the empirical or theoretical basis for their use. Future directions, including the need for systematic, controlled outcome studies of therapies and evaluation of variables which may mediate the effects of treatment, as well as demonstration that the effects produced in outcome studies generalize to settings beyond those in which the studies are initially conducted, are also discussed.
The American College of Rheu-matology 1990 criteria for the classi®cation of ®bromyalgia
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