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Effects of 15 consecutive cryotherapy sessions on the clinical output of fibromyalgic patients

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Abstract

Fibromyalgia is a chronic widespread pain disorder in which, the neurogenic origin of the pain, featured by allodynia and hyperalgesia, results from an imbalance in the levels of neurotransmitters and consequently of the peripheral pro- and anti-inflammatory mediators. Whole body cryotherapy is a peculiar physical therapy known to relieve pain and inflammatory symptoms characteristics of rheumatic diseases, through the regulation of the cytokine expression. The aim of this study was to qualitatively evaluate the effects of cryotherapy on the clinical output of fibromyalgic patients. A total of 100 fibromyalgic patients (age range 17-70 years) were observed; 50 subjects were addressed to cryotherapy, while the second group (n = 50) did not underwent to the cryotherapic treatment. All subjects kept the prescribed pharmacological therapy during the study (analgesic and antioxidants). The referred health status pre- and post-observation was evaluated with the following scales: Visual Analogue Scale, Short Form-36, Global Health Status and Fatigue Severity Scale. Fibromyalgic patients treated with cryotherapy reported a more pronounced improvement of the quality of life, in comparison with the non-cryo treated fibromyalgic subjects, as indicated by the scores of the qualitative indexes and sub-indexes, that are widely recognized tools to assess the overall health status and the effect of the treatments. We speculate that this improvement is due to the known direct effect of cryotherapy on the balance between pro- and anti-inflammatory mediators having a recognized role in the modulation of pain.
ORIGINAL ARTICLE
Effects of 15 consecutive cryotherapy sessions on the clinical
output of fibromyalgic patients
Lorenzo Bettoni &Felice Giulio Bonomi &Viviana Zani &
Luigia Manisco &Annamaria Indelicato &
Patrizia Lanteri &Giuseppe Banfi &Giovanni Lombardi
Received: 31 October 2012 /Revised: 26 March 2013 / Accepted: 19 April 2013 / Published online: 2 May 2013
#Clinical Rheumatology 2013
Abstract Fibromyalgia is a chronic widespread pain disor-
der in which, the neurogenic origin of the pain, featured by
allodynia and hyperalgesia, results from an imbalance in the
levels of neurotransmitters and consequently of the peripheral
pro- and anti-inflammatory mediators. Whole body cryotherapy
is a peculiar physical therapy known to relieve pain and inflam-
matory symptoms characteristics of rheumatic diseases, through
the regulation of the cytokine expression. The aim of this study
was to qualitatively evaluate the effects of cryotherapy on the
clinical output of fibromyalgic patients. A total of 100
fibromyalgic patients (age range 1770 years) were observed;
50 subjects were addressed to cryotherapy, while the second
group (n=50) did not underwent to the cryotherapic treatment.
All subjects kept the prescribed pharmacological therapy during
the study (analgesic and antioxidants). The referred health status
pre- and post-observation was evaluated with the following
scales: Visual Analogue Scale, Short Form-36, Global Health
Status and Fatigue Severity Scale. Fibromyalgic patients treated
with cryotherapy reported a more pronounced improvement of
the quality of life, in comparison with the non-cryo treated
fibromyalgic subjects, as indicated by the scores of the qualita-
tive indexes and sub-indexes, that are widely recognized tools to
assess the overall health status and the effect of the treatments.
We speculate that this improvement is due to the known direct
effect of cryotherapy on the balance between pro- and anti-
inflammatory mediators having a recognized role in the modu-
lation of pain.
Keywords Fibromyalgia .Pain .Quality of life .Whole
body cryotherapy
Introduction
Fibromyalgia (FM) is a chronic widespread pain disorder
estimated to affect 0.5 to 5 % of adult Western populations
[1]. It is a persistent and debilitating condition with poten-
tially devastating effect on people's quality of life, limiting
their daily activities and, thus, imposing large economic
burdens on society [2].
In 2010, the American College of Rheumatology (ACR)
adopted new clinical criteria for diagnosing FM, based on a
widespread pain index and a symptom severity scale and
improved the previously used tender point examination [3,4].
The most important symptom of FM is represented by the
chronic widespread pain, and recent researches showed its
neurogenic origin; moreover, neuroimaging studies showed
that FM is associated with aberrant processing of painful
stimuli in the central nervous system [5]. Indeed it has been
postulated that the pain sense is the result of a neurochemical
L. Bettoni :L. Manisco
Reumatologia/CT, Ospedale di Manerbio,
A.O Desenzano del Garda, Italy
F. G. Bonomi
Dipartimento Cardio-vascolare, U.O. Cardiologia,
Humanitas Gavazzeni, Bergamo, Italy
F. G. Bonomi :V. Zani
Centro di Crioterapia Sistemica, Poliambulatorio Bongi,
Orzinuovi, Italy
A. Indelicato
Direzione Sanitaria, A.O Desenzano del Garda, Italy
P. Lanteri :G. Banfi :G. Lombardi (*)
Laboratory of Experimental Biochemistry and Molecular Biology,
I.R.C.C.S. Istituto Ortopedico Galeazzi, Via R. Galeazzi, 4,
20161, Milan, Italy
e-mail: giovanni.lombardi@grupposandonato.it
G. Banfi
Dipartimento di Scienze Biomediche per la Salute,
Università degli Studi di Milano, Milan, Italy
Clin Rheumatol (2013) 32:13371345
DOI 10.1007/s10067-013-2280-9
imbalance in the central nervous system that leads to a central
amplificationof pain perception, with consequent allodynia
(heightened sensitivity to stimuli that are not normally painful)
and hyperalgesia (increased response to painful stimuli) [2]. At
the molecular level, this imbalance is due to a relative change in
the level of neurotransmitters and their receptors leading to a
hyperactivation of the ascending (pro-nociceptive) pathways
and, consequently, a depression of the descending (anti-
nociceptive) pathways [6]. In FM patients have been found
high cerebrospinal fluid levels of neurotrophins, i.e. nerve
growth factor, and tachykinins, i.e. substance P, which are
known to enhance the sensitivity of nociceptors and are also
involved in the inflammatory regulation [7]. Consequently,
high levels of the pro-inflammatory cytokines interleukin
(IL)-6, IL-8 and those of the anti-inflammatory IL-1ra, have
been found in the peripheral blood and skin of FM patients [8].
Particularly, IL-8 activates the sympathetic branch of the
nervous system and it increases nociceptive sensitivity [9].
Studies on pain showed that FM patients complain pain
at a lower threshold than healthy controls in response to
pressure (dolorimetry) on some body area [2,10].
Cold-based therapies are commonly used for relieving
pain symptoms, particularly in case of inflammatory dis-
eases, injuries and overuse symptoms, and in these two
latter cases, mainly in the field of sports medicine [11]. A
peculiar form of cold therapy or stimulation, namely whole
body cryotherapy (WBC), was proposed 30 years ago for
the treatment of rheumatic diseases: it consists of a brief
exposure (2 to 3 min) to very cold air (110 to 160 °C) in
special temperature-controlled cryochambers, preceded by a
30-s-long preconditioning at 60 °C [11,12].
Into the chamber, subjects are minimally dressed by
wearing shorts (bathing suit), socks, clogs or shoes,
surgical mask, gloves, and a hat (or headband) covering
the auricles to avoid frostbite and they are invited to
move their fingers while walking and avoid holding
their breath [11].
The treatment is applied to relieve pain and inflammatory
symptoms caused by numerous disorders, particularly those
associated with rheumatic conditions, and it is recommended
for the treatment of arthritis, fibromyalgia and ankylosing
spondylitis. WBC has been shown to be not deleterious nei-
ther to lung function [13] nor to circulatory function [14].
Despite the wealth of literature on rehabilitation techniques,
published data on WBC in physiology or rehabilitation
programmes are very poor.
Conventional pharmacological treatments for FM are
based to chronic or cyclical assumption of anti-inflammatory
drugs to relieve symptoms associated with neuromodulatory
agents (i.e. tertiary amine tricyclics) acting at the central
nervous system level by diminishing the nociceptive signal-
ling [15]. Parallel, non-pharmacological treatment, mainly
based on the association of physical activity and cognitive-
behavioural therapy have garnered good evidence of effec-
tiveness in relieving pain symptoms [16].
Cold exposure has an immunostimulating effect due to
the enhanced noradrenaline response to cold which is de-
pendent on the relationship between core temperature de-
crease and duration of exposure. Limited are, instead, the
evidences of immunosuppression from short- or long-term
cold exposure [17]. WBC seems to act on the paracrine
signalling rather than on systemic immune functions. In fact,
WBC treatment is associated with an increase in the anti-
inflammatory cytokine IL-10, and a decrease in the pro-
inflammatory cytokines IL-2 and IL-8, supported by the
decrease in intercellular adhesion molecule 1 (ICAM-1).
The observation of a parallel decrease in prostaglandin E2,
synthesized at sites of inflammation where it induces vaso-
dilation and the increase of vascular permeability, confirmed
the anti-inflammatory protection [18]. Lubkowska and col-
leagues demonstrated that following ten consecutive WBC
sessions increases in leukocytes number, IL-6 levels, total
oxidative and antioxidative status occurred, indicating that
cryotherapy increases immunity [19]. More recently, the
same group confirmed the finding on IL-6 and on the
positive anti-inflammatory effects of WBC [20].
To our knowledge, there are very few works analysing
the possible beneficial effects of WBC treatment on FM. In
a 12-year-old review, Offenbächer and G. Stucki [21]
reported the results of two studies in which, besides the
different temperatures used, 150 °C [22]and67 °C
[23], the cold therapy ameliorate symptoms better than
hot-based therapies. However, some considerations need to
be taken into account about these studies: the optimal dura-
tion of the treatment (number of exposures) and temperature
of exposure.
According to this background, with this study, we aimed
to evaluate the eventual beneficial effects of a cycle of
exposure to cryotherapy in a group of FM patients on a
series of qualitative parameters indexes of morbidity and of
quality of life.
Material and methods
Subjects and treatment protocol
The subjects involved in this study were submitted to the
treatment as specifically prescribed by their physician.
The study population was composed of 100 consecutive
subjects (94 females and 6 males), age range 1770 years;
all patients had a primary diagnosis of FM (in agreement
with the ACR 2010 criteria[3,4]). Two homogeneous
groups were constituted based on the medical prescription
to WBC or not: the first, named WBC+, was composed of
50 subjects (46 females and 4 males; age range, 1767 years)
1338 Clin Rheumatol (2013) 32:13371345
who underwent WBC while the second, named WBC,was
composed of 50 subjects (46 females and 4 males; age range,
1970 years) who did not underwent to the WBC treatment.
The WBC treatment protocol consisted of 15 sessions
consecutive sessions of WBC, as prescribed, performed in a
period of time of 3 weeks. The cryochamber functioning
was based on a heat exchanger cooling the air (previously
dehumidified) by using liquid nitrogen. Every single session
consisted of a preconditioning of 30 s at 60 °C and a 3-
min-long exposure at 140 °C. During the exposure, the
subjects were minimal clothed and to avoid frostbite they
wore shorts (bathing suit), socks, clogs or shoes, surgical
mask, gloves, and hat (or headband) covering the auricles.
Any sweat was dried before entering the cryochamber,
where the air was clear and dry. While in the cryochambers,
subjects were asked to walk within the chamber, to maintain
the fingers in motion and to avoid breath holding. The system
was automatically controlled, and security personnel was
always present. Each treatment was compulsorily followed
by 30 min of aerobic exercise (cycloergometer or treadmill).
During the study, all subjects were allowed to continue
the treatments (pharmacologic and/or antioxidants) they
were subjected to, before the observation.
The clinical features of the two groups of patients and the
WBC treatment protocol are summarized in Table 1.
Qualitative indexes
The following qualitative indexes were used to evaluate the
clinical output of the patients.
Visual Analogue Scale (VAS) is a well recognized tool
measuring the chronic pain intensity [24], visually representing
the amplitude of pain that the subject believed to warn.
A qualitative score of physical and mental health of FM
patients, at recruitment and following or not to WBC, was
obtained with the Short Form (SF)-36 (Medical Outcomes
Trust, Boston, MA), Italian version 1.6, a multipurpose,
short-form health survey composed of 36 questions, yield-
ing an eight-scale profile of scores on the quality of life [25].
Global Health Status (GH) is a self-assessment of the
healthy status based on a visual analogue score (0 = best,
100=worst) used to calculate the Disease Activity Score
for various rheumatic diseases [26].
The Fatigue Severity Scale (FSS) [27] is addressed to
evaluate, through 9 items and 7 levels of agreement, phys-
ical, social, or cognitive effects of fatigue (e.g., function,
work, motivation).
Statistical analysis
Statistical analysis was performed by GraphPad Prism v5.0
software (GraphPad Software Inc., La Jolla, CA, USA).
Normally distributed values, in the descriptive analysis, are
expressed as the mean ± SD while not parametric values are
described by median and range (5th95th percentile). Nor-
mal distribution of values were assayed by Kolmogorov
Smirnov normality test. The within-group comparisons (pre-
treatment vs. post-treatment) and between-groups compari-
sons (WBC treated vs. not treated for both time-points) were
performed by two-tailed paired ttest for normally distribut-
ed values, while Wilcoxons matched pairs test was used for
not-normally distributed values.
The significance level was set at 0.05.
Results
First of all, the two groups (WBC+ and WBC) were not
significant different for mean age. The median VAS score at
the start of the study was 90.0 (76.0100.0) in the whole
population while it was 90.0 (78.5100.0) in the WBC+
group and 90.0 (75.0100.0) in the WBCgroup, without
evidencing any difference (p=0.086). At the second time-
point both group showed a decrease in VAS (p<0.0001).
The decrease was significantly greater in WBC+ than in
WBC(p<0.0001).
The median FSS and GH scores were 57.5 (44.063.0)
and 90.0 (85.0100.0), respectively, for the whole popula-
tion, 58.0 (44.063.0) and 90.0 (87.3100.0) in the WBC+
and 57.0 (48.063.0) and 90.0 (85.0100.0) in the WBC,
without any difference between the two groups (p= 0.757
and p=0.630). Following the treatment, in the WBC+
group, both scores recorded significant decreases, to 27.0
(15.038.0), p<0.0001, the FSS, and to 30.0 (5.060.0),
p<0.0001, the GH; the same was for the WBCgroup
(FSS: 46.0 (38.056.0), p<0.0001; GH: 80.0(55.095.0),
p<0.0001). However, the decreases in the WBC+ were
significantly greater (p<0.0001 for both scores). The
trends in VAS, FSS and GH scores are summarized in
Fig. 1.
The SF-36 score kept the same tendency toward improve-
ment for almost all the items: a substantial homogeneity
between the two groups at recruitment, an improvement in
the scores, for both groups, at the second time-point, a better
improvement in the WBC+ group observed after the treat-
ment. A summary of the trends in the SF-36 items is
reported in Fig. 2.
Discussion
Physiologically, the perception of pain involves two groups
of neural pathways. the ascending pathways through, the
peripheral nerves, transmit sensory signals, including noci-
ceptive signals, to the spinal and, thus, to the brain for
processing. Nociceptive signals are emitted by nociceptors,
Clin Rheumatol (2013) 32:13371345 1339
Table 1 Clinical features of the patients
WBC+ group WBCgroup
ID Age Gender Diagnosis Secondary diagnosis ID Age Gender Diagnosis Secondary diagnosis
1 43 F FM Pollinosis, disc hernia 1 49 M FM Arthrosis, cephalgia
2 45 F FM / 2 33 F FM /
3 55 F FM Arthrosis, diabetes, hypertrophic arthritis
arterial hypertension
3 56 F FM Arthrosis, hypothyroidism
4 33 M FM Spondyloarthropathy, disc hernia 4 46 F FM Hypothyroidism
5 49 F FM Arthrosis, osteoporosis 5 53 F FM Hypothyroidism
6 50 F FM CFS 6 58 F FM CFS
7 52 F FM Sicca syndrome, lactose intolerance 7 32 F FM CFS
8 44 F FM Arthrosis, hypothyroidism 8 66 F FM Hypothyroidism, arthrosis
9 42 F FM Hypothyroidism 9 56 F FM /
10 58 F FM Arthrosis, cephalgia 10 45 F FM /
11 30 F FM Cephalgia 11 52 F FM Arthrosis
12 53 F FM Hypothyroidism 12 19 F FM Hypothyroidism
13 61 F FM MCS, spondyloarthropathy 13 45 F FM Spondyloarthropathy
14 28 F FM / 14 33 M FM Seronegative oligoarthritis
15 17 F FM / 15 26 F FM /
16 49 F FM Lactose intolerance, discopathy 16 30 F FM /
17 32 F FM / 17 56 F FM Radiculopathy
18 36 F FM / 18 56 F FM /
19 60 F FM GER, seronegative oligoarthritis 19 45 M FM Arterial hypertension hypertrophic
arthritis
20 57 F FM Diabetes, CFS, arterial hypertension
hypertrophic arthritis
20 38 F FM /
21 34 M FM / 21 62 F FM Arterial hypertension hypertrophic
arthritis
22 21 F FM Seronegative oligoarthritis 22 23 F FM /
23 57 F FM / 23 49 F FM Arthrosis
24 67 F FM Osteoporosis, nasal polyposis 24 70 F FM Discopathy
25 52 F FM Undifferentiated connectivities 25 59 F FM Arterial hypertension hypertrophic
arthritis, osteoporosis
26 58 M FM Arthrosis, chronic gastropathy 26 24 F FM /
27 52 F FM Arterial hypertension hypertrophic arthritis 27 26 F FM /
28 37 F FM Bronchial asthma 28 32 F FM CFS
29 64 F FM Arterial hypertension hypertrophic arthritis 29 35 F FM Arterial hypertension hypertrophic
arthritis
30 18 F FM / 30 45 F FM /
31 35 F FM / 31 44 F FM Diabetes
32 60 F FM / 32 41 F FM /
33 40 F FM / 33 43 F FM /
34 39 F FM / 34 49 F FM Arthrosis
35 42 F FM CFS 35 48 F FM Hypothyroidism, arthrosis
36 37 M FM / 36 50 F FM Diabetes
37 58 F FM Arterial hypertension hypertrophic arthritis 37 54 F FM /
38 41 F FM / 38 56 F FM /
39 49 F FM / 39 48 F FM Hypertrophic arthritis
40 53 F FM Hypothyroidism, arterial hypertension
hypertrophic arthritis
40 47 F FM MCS
41 54 F FM / 41 45 F FM /
42 56 F FM / 42 32 M FM Celiac disease
43 46 F FM Hypothyroidism 43 46 F FM /
1340 Clin Rheumatol (2013) 32:13371345
specialized receptors in the peripheral nerves, are acti-
vated by physical stimuli (i.e., changes in temperature,
pressure, impact). Descending pathways send modulato-
ry signals (facilitatory and/or inhibitory) from the brain
throughout the spinal cord to the periphery, tuning the
ascending nociceptive signals reaching the brain. A
number of neurotransmitters and neurochemicals are
involved in these signal transmission (e.g., norepineph-
rine, serotonin) [28,29].
In FM, these two pathways operate abnormally, resulting
in central amplification of pain signals, a phenomenon
named central sensitization. Indeed, many studies of FM-
related pain and hyperalgesia advocated the involvement of
spinal mechanisms, accordingly to the finding of enhanced
responses to somatic and cutaneous stimuli throughout the
pain matrix of the brain, including the thalamus, in FM [30,
31]. The pathogenesis of the pain amplification process is
not fully understood but is certain to be multifactorial.
An important role is surely played by the peripheral
nociceptors, but a number of findings strongly suggested
a central nervous system involvement that is or becomes
largely independent of peripheral nociceptive input [2].
However, it is still unclear whether these are due to
facilitating mechanisms within the brain (central amplifi-
cation), spinal sensitisation maintained by the input of
tonic impulses from somatic tissues, or abnormal mech-
anisms of descending facilitation from the brain toward
periphery [9]. Central amplification is likely determined
at least partially by genetics and modified by environ-
mental influences [32].
While in general population, perception of pain displays
a normal distribution on a bell curve, in FM population it is
skewed to the right: the more one moves to the right along
this distribution, the higher the volume control settingand
pain intensity becomes, irrespective of peripheral nociceptive
input [2,6].
An imbalance of pro- and anti-inflammatory cyto-
kines is assumed to play a role in the induction and
maintenance of pain. IL-1, IL-6, and IL-8 are pro-
inflammatory cytokines are known to mediate induction
and maintenance of pain and also in pain syndromes
[33], whereby IL-8 promotes sympathetic pain and IL-6
induces hyperalgesia, fatigue, and depression [34].
Therefore, it is likely that FM patients, who suffer from
generalized pain, may have an innate or acquired im-
balance in cytokine production and secretion.
A recently published systematic review of the literature
revealed that, even with some uncertainness, FM patients
had higher serum levels of IL-1ra, IL-6, and IL-8, and
higher plasma levels of IL-8, compared to controls [35]. In
two recent papers, Lubkowska and colleagues demonstrated
that WBC affects the inflammatory status by inducing an
imbalance towards the anti-inflammatory side. Particularly,
consecutive sessions of cryotherapy increased IL-6 and IL-
10 levels and lowered the IL-1αlevels [19,20]. Although
IL-6 is generally considered a pro-inflammatory cytokine, it
is known to induce the expression of anti-inflammatory
mediator (i.e. IL-1ra, IL-10) [19]. Furthermore, the authors
reported an increased leukocytes count and an improved
oxidative status after WBC, indicating an overall immune
activation [19].
Based on the link between the central pain with the
imbalance between pro- and anti-inflammatory molecules
and, thus, with the general referred status of the subject,
parallel to the know anti-inflammatory effects of WBC [11],
we speculated that consecutive sessions of cryotherapy
could have a positive impact on the referred qualitatively
measured pain.
Another possible explanation of the positive effects of
WBC, on the referred pain sensation, could be attributed to
changes in the nerve conduction induced by cryogenic tem-
peratures. It has been, indeed, postulated that cold therapy
could reduce pain via an alteration in nerve conduction
velocity. In their protocol setting, Algafly and George [36],
analyzed the effects of ice bath on nerve conduction and
pain sensation in healthy sportsmen. The results indicated
Table 1 (continued)
WBC+ group WBCgroup
44 50 F FM Arthrosis 44 40 F FM Diabetes
45 51 F FM Seronegative oligoarthritis 45 55 F FM /
46 47 F FM / 46 45 F FM /
47 31 F FM Seronegative oligoarthritis 47 34 F FM /
48 35 F FM / 48 45 F FM /
49 43 F FM / 49 23 F FM /
50 30 F FM / 50 47 F FM Arthrosis, hypothyroidism
FM fibromyalgia, CFS chronic fatigue syndrome, MCS multiple chemical sensitivity, GER gastro-esophageal reflux
Clin Rheumatol (2013) 32:13371345 1341
that the data suggest that cryotherapy can increase PTH and
PTO at the ankle and this was associated with a significant
decrease in NCV.
The SF-36 measure physical, mental and social function-
ing. It is generic health status instruments that permit com-
parisons across groups with different health conditions and
they have been widely applied in studies worldwide [37].
SF-36 can currently be considered the most confidently
recommended qualitative scale to measure physical function
in rheumatoid arthritis for most research purposes even if it
has recognized limited content coverage [38]. It is important
to understand the health status burden of people with FM.
Health status data quantify impairments in physical, mental
and social functioning.
Such information can highlight areas where people with
FM experience particular difficulty and where healthcare
providers may be able to effect change in clinical status [39].
The VAS is the simplest method for assessing pain and
fatigue and was clinically relevant in more than 76 % of
patients with FM [40].
In our study, we found, despite a certain homogeneity
between the two groups at recruitment, a more pronounced
improvement of all the scores in the groups submitted to
WBC compared to the WBCgroup. Particularly, the
perception of pain and fatigue, scored by the VAS scale,
decreased of 58 % in the WBC+ group while only
22 % in the WBCgroup. Reductions of the same
magnitudes were manifest for FSS and GH scores.
For what concern the SF-36 scores, the same tendency
was overall evident.
The item 3 group (A to J), giving a score for the physical
functioningby analysing the daily activities, was improved
in both groups with the WBC+ group showed a better
output. However, the median scores of the two groups
already differed at recruitment: 23.0 (17.029.0) for
WBC+ and 24.0 (20.030.0) for WBC. The item 4 group
(A to D) assign the role-physicalscore and they followed
the trend of item 3, as for items 7 (pain-magnitude) and
8 (pain-interface), grouped as bodily painscores.
The items 1 and 11 are intended to evaluate the general
health: item 1 (EVGFP scale), indicating if the patient
health is excellent, very good, good, fair, or poor, and items
11C (health to get worse) and 11B (health excellent) signif-
icantly differed between the time-points in both groups and
between the groups at the second time-point; item 11A, sick
easier, ameliorated only in the WBC+ group, after the treat-
ment, even if the two groups were not significantly different
at both time-point; item 11B, as healthy, never changed.
Items 1, 3, 4, 7, 8 and 11 are used to evaluate the overall
physical health; the other items are, instead, intended to
the definition of the mental health.
Vitality is defined by the items 9A (full of life), 9E
(energy), 9G (worn out), 9I (tired): all of them did not
differed between the groups at recruitment, were improved
at the second evaluation with a greater positive effect in the
WBC+ group. Social functioning, items 6 (social-extent)
and 10 (social-time) showed an identical trend, as well as
the item 5 group (A, B, C) analysing the role-emotional
and the mental healthitem 9 group (B, C, D, F, H), even if
in the case of items 9C and 9D the starting point was already
different in the two groups, in favour of the WBC+ group.
In conclusion, with this study we found a positive effects
of WBC on the quality of life of a group of FM patients as
indicated by the improvement of a number of qualitative
Fig. 1 Trends in VAS, FSS and GH scores. The figure shows the scores
differences between the two groups pre- and post-observation and the
score modification between the two observations. Asterisks indicate the
level of statistical significance (*p<0.05; **p<0.01; ***p<0.001)
1342 Clin Rheumatol (2013) 32:13371345
Fig. 2 Trends in the SF-36
items. The figure shows the SF-
36 scores differences between the
two groups pre- and post-
observation and the score
modification between the two
observations. Asterisks indicate
the level of statistical significance
(*p<0.05; **p<0.01;
***p<0.001)
Clin Rheumatol (2013) 32:13371345 1343
indexes and sub-indexes, that are widely recognized tools to
assess the overall health status and the effect of the treat-
ments. Possible mechanisms by which WBC reduces the
pain sensation and fatigue, in FM patients, could reside in
the improvement of the balance between pro- and anti-
inflammatory mediators, having a recognized role in the
modulation of pain, and in the reduction of nerve conduc-
tion velocity of nociceptive ways.
Disclosures None.
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Clin Rheumatol (2013) 32:13371345 1345
... The majority of research to date has focused on how WBC affects FM, decreasing pain intensity [37,38], disease impact [37], and improving quality of life [37][38][39]. Indeed, preliminary evidence suggests that WBC may also positively affect sleep quality [39,40] and physical functioning [41], and may reduce depressive symptoms [28]. ...
... The majority of research to date has focused on how WBC affects FM, decreasing pain intensity [37,38], disease impact [37], and improving quality of life [37][38][39]. Indeed, preliminary evidence suggests that WBC may also positively affect sleep quality [39,40] and physical functioning [41], and may reduce depressive symptoms [28]. ...
... The use of WBC in alleviating pain and improving health-related quality of life in FM patients has been previously investigated in the literature [36][37][38]. A recent study by our research group [9] analysed the effects of WBC in patients with FM and obesity, showing that the addition of 10 WBC sessions within a multidisciplinary rehabilitation program resulted in greater benefits in pain severity, depressive symptomatology, disease impact, and sleep quality at discharge as compared to the control group undergoing only the rehabilitation program. ...
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Recent evidence suggests that whole-body cryostimulation (WBC) may be beneficial for patients with fibromyalgia (FM), but little is known about the duration of such effects. The purpose of this study was to verify the duration of clinical–functional benefits after one cycle of WBC. We conducted a follow-up study on the medium and long-term effects of WBC on well-being, use of pain-relieving/anti-inflammatory medications, pain level, fatigue, sleep quality, and psychological aspects such as mood and anxiety. Twelve months after discharge, we administered a 10 min follow-up telephone interview with FM patients with obesity who had undergone ten 2 min WBC sessions at −110 °C as part of a multidisciplinary rehabilitation program (n = 23) and with patients who had undergone rehabilitation alone (n = 23). Both groups reported positive changes after the rehabilitation program, and similar results regarding fatigue, mood, and anxiety scores; however, the implementation of ten sessions of WBC over two weeks produced additional benefits in pain, general well-being status, and sleep quality with beneficial effects lasting 3–4 months. Therefore, our findings suggest that adding WBC to a rehabilitation program could exert stronger positive effects to improve key aspects of FM such as general well-being, pain level, and sleep quality.
... 10,11 • Cryochambers commonly consist of 2 -3 chambers, the initial chamber(s) at -60 degrees Celsius (or if two initial chambers, at -10 and -60 degrees Celsius respectively) and one main chamber with temperatures ranging from -110 degrees Celsius to -160 degrees Celsius. 13,14 Patients will enter the first one (or two) chambers to briefly acclimate (around 30 seconds) and then will proceed to the main chamber where the duration of treatment ranges from 1 to 4 minutes. 10,11 Clinical Uses for Cryotherapy • Anxiety and depression: In the literature, WBC at temperatures between -60 degrees Celsius and -110 degrees Celsius has been shown to be a valuable treatment when used in supplement to other mental health interventions such as pharmacotherapy and cognitive behavioral therapy. ...
Conference Paper
SARS-CoV-2, which causes coronavirus disease 2019 (COVID-19), was first discovered in December 2019 in Wuhan, China when adults began presenting with severe pneumonia of an unknown cause. SARS-CoV-2 can cause a wide range of clinical manifestations. SARS-CoV-2 can penetrate the olfactory mucosa and may enter the brain through the cribriform plate along the olfactory tract, through vagal or trigeminal pathways, or pass through the blood-brain barrier. Once inside the brain, levels of inflammatory cytokines are increased and can lead to altered learning, memory, neuroplasticity, hallucinations, nightmares, cognitive and attention deficits, new-onset anxiety and depression, and psychosis. A theoretical treatment for long COVID syndrome, whole body cryotherapy, involves exposing the entire body, including the head, to ultra-low temperatures for a brief time using an enclosed space referred to as a whole-body cryochamber. This literature review evaluates the efficacy of whole body cryotherapy on long COVID syndrome and its current clinical uses.
... WBC has repeatedly demonstrated analgesic effects, not only among healthy athletes but also on various medical conditions [32][33][34], including OA. In a study by Chruściak et al., among OA patients, pain perception, its frequency, and the number of taken analgesic medications were reduced [35]. ...
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Background/Objectives: Whole-body cryotherapy (WBC) is widely recognized for its analgesic and anti-inflammatory effects. Despite growing interest in its therapeutic potential, the impact of WBC on functional performance, pain perception, sleep quality, and quality of life among individuals with multiple sclerosis (MS) remains underexplored. This study aimed to assess the effects of a 10-session WBC protocol on functional and psychological parameters in patients with MS and compare them with individuals without neurological disorders. Methods: A total of 73 participants divided into two groups, non-neurological individuals (non-MS, n = 43) and patients with MS (MS, n = 30), underwent 10 WBC sessions (−120 °C to −130 °C) over 2 weeks. Assessments included the Numerical Rating Scale (NRS), 30-Second Chair Stand Test (30CST), Timed Up and Go (TUG) test, and Pittsburgh Sleep Quality Index, with the WHOQOL-BREF conducted pre-treatment, post-treatment, and at a 10-day follow-up. Results: In the MS group, significant improvements were observed post-treatment in the NRS, 30CST, WHOQOL-1, and PSQI. However, only the CST and WHOQOL-3 maintained improvements during follow-up. In the non-MS group, statistically significant improvements were observed post-treatment across most parameters, except for the NRS and WHOQOL-3, with most effects diminishing by the follow-up. No deterioration in any assessed parameters was observed in either group. Conclusions: WBC demonstrates potential benefits for managing MS symptoms, particularly pain and sleep quality, with no observed deterioration in parameters and some effects emerging only during follow-ups, underscoring its safety and the need for further research on long-term outcomes.
... Physical exercise has a positive effect on the reduction of pain in patients with FMS [57], at the same time, it should be emphasized that post-exercise pain and fatigue are the most important features of FMS. For this reason, low intensity exercises can be used as a basic element of therapy [58], additionally supplemented with cold therapy, which has an analgesic effect [59,60]. ...
Article
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Pain in the course of fibromyalgia (FMS) is a serious therapeutic problem of modern medicine. Patients experience generalized pain within the musculoskeletal system, which significantly reduces the perceived level of quality of life. The aim of the study was to analyze the impact of therapeutic massage on the alleviation of pain in fibromyalgia and the change in HRQoL after the use of this type of therapy, including the classic and tensegration massage. The study group consisted of 41 people suffering from FMS (F:21; M:20). The mean age of all the studies people was 40 ± 9.6 years. All studied people participated in two short therapeutic series consisting of three procedures. The interval between the therapeutic series was two months. The series included: a single series of the classic massage and the tenseg-ration massage, respectively. Before and after each of the therapeutic series, the patients completed a survey questionnaire, based on the EQ-5D-5L standard. The analysis for independent variables was carried out using the Mann-Whitney U test, the Wilcoxon pair order test for dependent variables, and the Spearman rank coefficient was determined. The assumed level of significance was p ≤ 0.05. A greater effectiveness of the tensegration massage compared to the classic massage was confirmed by analyzing the results of EQ-5D-5L. Analysis of the relationship between the first and second measurement in each of the EQ-5D-5L domains before and after the massage indicated significant relationships in the case of the tensegration massage (p ≤ 0.05 in each domain except the self-care domain p = 0.116). In the case of classical massage, a significant relationship was noted only in the domains of: pain and discomfort (p = 0.045) and anxiety and depression (p = 0.012). A significantly higher average level on the EQ-VAS scale was confirmed after the applied tensegration massage (I-TM:76.3 ± 16.9; II-TM:87.9 ± 13.6; p < 0.001). In addition, the beneficial effect of physical activity and BMI on the effectiveness of fibromyalgia treatment and the level of HRQoL was demonstrated. Massage is an effective therapeutic method in fibromyalgia, allowing to improve health and thus HRQoL. Factors such as physical activity and BMI are also important.
... Some studies have reported the positive effects of WBC in FM. Bettoni et al., in their clinical trial involving 100 patients, showed benefits after 10 WBC sessions in terms of pain perception and quality of life compared to the control group (no WBC); similar results were found by Rivera and colleagues studying 60 patients in a randomised, open-label crossover trial (WBC-no WBC group) at a 1-month follow-up [52,56]. ...
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Central sensitisation is defined as a multifactorial etiopathogenetic condition involving an increase in the reactivity of nociceptive neurons and alterations in pain transmission and perception in the central nervous system. Patients may present with widespread chronic pain, fatigue, sleep disturbance, dizziness, psychological (e.g., depression, anxiety, and anger) and social impairment. Pain can be spontaneous in onset and persistence, characterised by an exaggerated response and spread beyond the site of origin, and sometimes triggered by a non-painful stimulus. Whole-body cryostimulation (WBC) could be an adjuvant therapy in the management of this type of pain because of its global anti-inflammatory effect, changes in cytokines and hormone secretion, reduction in nerve conduction velocity, autonomic modulation, and release of neurotransmitters involved in the pain pathway. In several conditions (e.g., fibromyalgia, rheumatoid arthritis, and chronic musculoskeletal pain), WBC affects physical performance, pain perception, and psychological aspects. Given its multiple targets and effects at different organs and levels, WBC appears to be a versatile adjuvant treatment for a wide range of conditions of rehabilitation interest. Further research is needed to fully understand the mechanisms of analgesic effect and potential actions on pain pathways, as well as to study long-term effects and potential uses in other chronic pain conditions.
... Together with the latter, the increase in parasympathetic tone results in reduced fatigue, muscle tension and soreness, improved mood, and symptoms of depression, ultimately leading to a reduction in pain perception [12]. For all these reasons, cycles of WBC have led to improved rehabilitation outcomes in patients with conditions such as multiple sclerosis [13], post-COVID-19 condition [14], rheumatoid arthritis [15], ankylosing spondylitis [16], polymyalgia rheumatica [17], and fibromyalgia [18][19][20][21]. Despite its 40-year-long use worldwide, WBC is associated with rare and mostly transient adverse effects. ...
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Functional neurological disorders (FNDs) are complex disabling conditions requiring a multiple rehabilitation intervention. Here, we propose a new use of whole-body cryostimulation (WBC) that was implemented in a multidisciplinary rehabilitation programme in a wheelchair-ridden woman diagnosed with FND and other comorbidities. WBC is a promising adjuvant treatment in various conditions of rehabilitation interest, mainly because of its wide range of rapid effects, from anti-inflammatory to pain and autonomic modulating effects. The 4-week program included physiotherapy, nutritional intervention, psychological support, and WBC (−110 °C for 2 min). Questionnaires to assess disease impact, pain level, fatigue and sleep quality were administered. At discharge, improvements in body composition, haematological biomarkers, physical performance, and questionnaire scores were observed. The patient was able to walk independently with a walker for medium distances and reported unprecedented improvements, particularly in functional parameters and questionnaire scores. Although the extent to which WBC per se contributed to the measured improvements cannot be ascertained, subjective reports and our clinical observations indicate that WBC, the only intervention not previously experienced by the patient, acted as a booster for the rehabilitation interventions. Further research will be necessary to rule out any possible placebo effect and to confirm the effects of WBC on FND.
... The WBC and PBC were first used to relieve rheumatic and inflammatory diseases such as rheumatoid arthritis (Hirvonen, Mikkelsson, Kautiainen, Pohjolainen, & Leirisalo-Repo, 2006), fibromyalgia (Bettoni et al., 2013) or ankylosing spondylitis (Stanek et al., 2015). These therapies are also being used in psychiatry to improve mental well-being. ...
Conference Paper
The aim of this study is to measure the difference in skin temperature variation between males and females during a 4-min whole-body cryotherapy (WBC) exposure. Nine males (31 ± 13 years, 175 ± 5 cm, 76 ± 9 kg, and 17 ± 13 % BF) and nine females (31 ± 14 years, 167 ± 1 cm, 59 ± 10 kg, and 24 ± 4 % BF) volunteered to participate at this study. Their skin temperatures were measured pre, during and after the exposure with a thermal infrared camera. The results showed a difference in skin temperature in function of the time and the gender. For a same cold dosage, there are differences in skin response in function of gender.
Chapter
Whole-body cryostimulation (WBC) is known to be effective in reducing pain and inflammatory status, improving several metabolic parameters such as thermogenesis, lipid profile, insulin sensitivity and glucose utilisation but also depression, anxiety and sleep quality. Cycles of WBC have been shown to reduce fatigue, disease activity and pain in patients with rheumatic, metabolic, neurological and post-coronavirus disease 2019 (COVID-19) conditions. Despite important limitations of the available studies, growing scientific evidence indicates that WBC effectively reduces fibromyalgia (FM) symptoms, particularly due to its rapid anti-inflammatory effect. In addition, preliminary data seems to suggest that the positive effects of WBC on pain, fatigue, sleep and psychological aspects (mood and anxiety) may last on average 3–4 months after treatment discontinuation. For this reason, WBC has the potential to boost rehabilitation programmes in achieving functional outcomes in FM patients, which seems attractive in terms of the cost-effectiveness of rehabilitation. Moreover, the high compliance and highly positive perception of the treatment reported by FM patients in most studies seem to make WBC a preferred component of the rehabilitation programme, which appears crucial in the long-term management of this chronic condition.
Conference Paper
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Cold application is one of the simplest and oldest treatment methods generally used in sports injuries, acute musculoskeletal pain, inflammatory diseases, overuse injuries. Cryotherapy is a term used to describe therapeutic processes that usually involve local or systemic cold applications. Cold application has many different physiological effects on the body. Decreasing the temperature of the damaged tissue can induce vasoconstriction, reducing local metabolism, inflammation, pain, and muscle spasm. The use of cold application for various purposes was included in the Edwin Smith Papyrus in the 16th century BC, and treatment protocols including this application developed over time as ICE, RICE, PRICE, POLICE and PEACE&LOVE. Cryotherapy has various application modalities such as cold water immersion, whole body cryotherapy, partial body cryotherapy, cold packs, cold compress machines, ice massage, neurocryostimulation. Many studies have been carried out on this subject to date, and research is still ongoing. However, there is no consensus on which of the cryotherapy modalities is more effective, the ideal treatment duration, and the advantages and disadvantages of its use in injuries. The aim of this review is to reveal the historical development of cold application, application modalities and treatment agents, physiological effects and its use in soft tissue injuries in the light of current literature. Keywords: cold application, injury, cryotherapy, cold application in injuries, mechanism of action. Soğuk uygulama genellikle spor yaralanmaları, akut kas-iskelet sistemi ağrıları, inflamatuar hastalıklar, aşırı kullanımdan kaynaklı yaralanmalarda kullanılan basit ve en eski tedavi yöntemlerinden biridir. Kriyoterapi, genellikle lokal ya da sistemik soğuk uygulamaları içeren terapötik süreçleri tanımlamak için kullanılan bir terimdir. Soğuk uygulama vücutta birçok farklı fizyolojik etkiye sahiptir. Hasarlı dokunun sıcaklığının düşürülmesi vazokonstriksiyona neden olarak lokal metabolizmayı, inflamasyonu, ağrıyı ve kas spazmını azaltabilir. Soğuk uygulamanın çeşitli amaçlarla kullanımı MÖ 16. yüzyılda Edwin Smith Papirüsünde yer almış, bu uygulamayı içeren tedavi protokolleri zaman içerisinde ICE, RICE, PRICE, POLICE ve PEACE&LOVE olarak gelişmiştir. Kriyoterapinin soğuk suya daldırma, tüm vücut kriyoterapisi, kısmi vücut kriyoterapisi, soğuk paketler, soğuk kompres cihazları, buz masajı, nörokriyostimülasyon gibi çeşitli uygulama modaliteleri bulunmaktadır. Günümüze kadar bu konu hakkında birçok çalışma yapılmış ve araştırmalar halen devam etmektedir. Bununla birlikte kriyoterapi modalitelerinin hangisinin daha etkili olduğu, ideal tedavi süresi ve yaralanmalarda kullanımının avantaj ve dezavantajları konusunda fikir birliği yoktur. Bu derlemenin amacı soğuk uygulamanın tarihsel gelişimi, uygulama modaliteleri ve tedavi ajanları, fizyolojik etkileri ve yumuşak doku yaralanmalarında kullanımını güncel literatür eşliğinde ortaya koymaktır. Anahtar Kelimeler: soğuk uygulama, yaralanma, kriyoterapi, yaralanmalarda soğuk uygulama, etki mekanizması.
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Athletes, military personnel, fire fighters, mountaineers and astronauts may be required to perform in environmental extremes (e.g. heat, cold, high altitude and microgravity). Exercising in hot versus thermoneutral conditions (where core temperature is ≥1°C higher in hot conditions) augments circulating stress hormones, catecholamines and cytokines with associated increases in circulating leukocytes. Studies that have clamped the rise in core temperature during exercise (by exercising in cool water) demonstrate a large contribution of the rise in core temperature in the leukocytosis and cytokinaemia of exercise. However, with the exception of lowered stimulated lymphocyte responses after exercise in the heat, and in exertional heat illness patients (core temperature >40°C), recent laboratory studies show a limited effect of exercise in the heat on neutrophil function, monocyte function, natural killer cell activity and mucosal immunity. Therefore, most of the available evidence does not support the contention that exercising in the heat poses a greater threat to immune function (vs thermoneutral conditions). From a critical standpoint, due to ethical committee restrictions, most laboratory studies have evoked modest core temperature responses (<39°C). Given that core temperature during exercise in the field often exceeds levels associated with fever and hyperthermia (>39.5°C) field studies may provide an opportunity to determine the effects of severe heat stress on immunity. Field studies may also provide insight into the possible involvement of immune modulation in the aetiology of exertional heat stroke (core temperature >40.6°C) and identify the effects of acclimatisation on neuroendocrine and immune responses to exercise-heat stress. Laboratory studies can provide useful information by, for example, applying the thermal clamp model to examine the involvement of the rise in core temperature in the functional immune modifications associated with prolonged exercise. Studies investigating the effects of cold, high altitude and microgravity on immunity and infection incidence are often hindered by extraneous stressors (e.g. isolation). Nevertheless, the available evidence does not support the popular belief that short- or long-term cold exposure, with or without exercise, suppresses immunity and increases infection incidence. In fact, controlled laboratory studies indicate immuno-stimulatory effects of cold exposure. Although some evidence shows that ascent to high altitude increases infection incidence, clear conclusions are difficult to make because of some overlap with the symptoms of acute mountain sickness. Studies have reported suppressed cell-mediated immunity in mountaineers at high altitude and in astronauts after re-entering the normal gravity environment; however, the impact of this finding on resistance to infection remains unclear.
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Purpose. To validate our hypothesis that a bisphosphonate (BP) having a nitrogen-containing heterocyclic ring on the side chain, and with no hydroxyl on the geminal carbon would possess increased activity, and better oral bioavailability due to enhanced solubility of its calcium complexes/salts and weaker Ca chelating properties. Methods. A novel BP, 2-(2-aminopyrimidinio)ethylidene-l,l-bisphosphonic acid betaine (ISA-13-1) was synthesized. The physicochemical properties and permeability were studied in vitro. The effects on macrophages, bone resorption (young growing rat model), and tumor-induced osteolysis (Walker carcinosarcoma) were studied in comparison to clinically used BPs. Results. The solubility of the Ca salt of ISA-13-1 was higher, and the log Ca: BP stability constant and the affinity to hydroxyapatite were lower than those of alendronate and pamidronate. ISA-13-1 exhibited effects similar to those of alendronate on bone volume, on bone osteolysis, and on macrophages, following delivery by liposomes. ISA-13-1 was shown to have 1.5–1.7 times better oral absorption than the other BPs with no deleterious effects on the tight junctions of intestinal tissue. Conclusions. The similar potency to clinically used BPs, the increased oral absorption as well as the lack of effect on tissue tight junction of ISA-13-1 warrant its further consideration as a potential drug for bone diseases.
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Fibromyalgia is a disorder characterized by chronic widespread pain in the presence of widespread tenderness, and multiple somatic symptoms. Since the publication of the American College of Rheumatology (ACR) 1990 classification criteria for fibromyalgia, research has proliferated and, in a relatively short period, investigators have begun to unravel the etiology and long-term impact of this complex condition. Although the ACR 1990 criteria have been central to fibromyalgia research during the past two decades, a number of practical and philosophical objections have been raised in relation to them. Principally these objections have centered on the use (or lack thereof) of the tender point examination, the lack of consideration of associated symptoms, and the observation that fibromyalgia might represent the extreme end of a pain continuum. In developing the ACR 2010 criteria, experts have sought to address these issues and to simplify clinical diagnosis. An implicit aim was to facilitate more rigorous study of etiology. The purpose of this Review is to summarize research to date that has described the epidemiology, pathology and clinical course of fibromyalgia, and to assess the probable impact of the ACR 2010 criteria on future research efforts.
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The analgesic effects of natural, thermoindifferent H2S full baths (20.4 mg H2S/l, 20 min) and cryochamber therapy (-67 C, 1-3 min) were compared with a shorn test without application in 17 patients with identified fibromyalgia syndromes (ACR criteria). Parameters measured were tenderness, heat pain and cryalgesia thresholds (pressure algometry, Peltier thermode) as well as actual pain intensity and general well-being (VAS). The pain thresholds were determined by comparing both forearms with one not being bathed or exposed to coldness. Following the natural sulphur bath, pain sensitivity was significantly or even very significantly increased in all qualities tested. Analogous effects were also observed after cryochamber therapy with a significantly slighter rise of the heat-pain threshold (p<0.05). The analgesic effects of the sulphurated bath could be demonstrated on the not bathed extremity as well, whereas they did not occur on the isolated arm in the cryochamber. After both applications, actual pain intensity and general well being were improved with high significance (- 12 to - 32%). Altogether it can be stated that both natural sulphur baths and cryochamber expositions are analgesically effective in fibromyalgia, the sulphur baths apparently acting systematically, the cryochamber mainly topically.
Article
In a cold air chamber with pre- and main chamber patients are treated in bathing suits with covered ears, hands, feet and an operation mask for 1/2 min up to 3 min at -110°C. Therapeutic effects are lowering of pain, improvement of joint function, as well as improvement of well being. Heartbeat and blood pressure will be influenced only very little in persons with normal RR. Admittance to the cold air chamber is possible when hypertension is well under control. Bronchospasm will decrease. Stenocardia was not observed. The cold air chamber treatment does not provoke stress. Neither ACTH nor cortisone or adrenalin increase after treatment. They rather decrease. The noradrenalin level is on the other hand increasing in serum. In rheumatoid arthritis T-helper lymphocytes decrease over more than 3 hours, while T-suppressor lymphocytes increase during that period. Indications for the whole body cryotherapy are chronic joint inflammation and chronic inflammation of the cervical spine, fibrositis and fibromyositis, connective tissue diseases and autoimmune diseases.
Article
Die analgetischen Wirkungen von natürlichen thermoindifferenten H2S-Vollbädern (20,4 mg H2S/I, 20 min) und Kältekammerexpositionen (-67°C, 1-3 min) wurden bei 17 Patienten mit nachgewiesenem Fibromyalgie-Syndrom (ACR-Kriterien) vergleichend zu einem Leerversuch ohne Anwendung geprüft, Meßparameter waren Druck-, Hitze- und Kälteschmerzschwellen (Pressure-Algometrie, Peltier-Thermode) sowie aktuelle Schmerzintensität und allgemeines Wohlbefinden (VAS). Die Schmerzschwellen wurden jeweils am Unterarm im Seitenvergleich bestimmt, wobei ein Arm nicht gebadet bzw. der Kälte ausgesetzt wurde. Nach dem Schwefelbad war die Schmerzempfindlichkeit in allen geprüften Qualitäten signifikant bzw. hochsignifikant angehoben. Analoge Wirkungen zeigten sich auch nach Kältekammertherapie, wobei die Anhebung der Hitzeschmerzschwelle signifkant schwächer war (p<0.05). Die analgetischen Effekte des Schwefelbades waren auch an der nichtgebadeten Extremität nachweisbar, während sie am kälteisolierten Arm in der Kältekammer nicht auftraten. Die aktuelle Schmerzintensität und das allgemeine Wohlbefinden wurden nach beiden Anwendungen hochsignifikant verbessert (-12 bis -32%). Insgesamt kann festgestellt werden, daß sowohl natürliche Schwefelbäder als auch die Kältekammerexposition bei Fibromyalgie analgetisch wirksam sind, wobei die Schwefelbäder offenbar systemisch, die Kältekammer überwiegend lokal wirken.
Article
Fibromyalgia is a chronic widespread pain disorder commonly associated with comorbid symptoms, including fatigue and nonrestorative sleep. As in the management of other chronic medical disorders, the approach for fibromyalgia management follows core principles of comprehensive assessment, education, goal setting, multimodal treatment including pharmacological (eg, pregabalin, duloxetine, milnacipran) and nonpharmacological therapies (eg, physical activity, behavioral therapy, sleep hygiene, education), and regular education and monitoring of treatment response and progress. Based on these core management principles, this review presents a framework for primary care providers through which they can develop a patient-centered treatment program for patients with fibromyalgia. This proactive and systematic treatment approach encourages ongoing education and patient self-management and is designed for use in the primary care setting.
Article
Cytokines are soluble proteins secreted mainly by immune cells and are key players in the induction and maintenance of pain. Pro-inflammatory cytokines are mostly algesic, while anti-inflammatory cytokines have analgesic properties. After the role of cytokines was shown in diverse animal models of pain, interest arose in the systemic and local regulation of cytokines in human pain states. Most clinical studies give evidence for an imbalance between pro- and anti-inflammatory cytokines in neuropathic and other pain states with pronounced pro-inflammatory cytokine profiles. Anti-cytokine treatment gives encouraging preliminary results and supports the notion of a crucial role of cytokines also in human pain states. Further research is needed for a better understanding of the mechanisms linking altered cytokine profiles to the sensation of pain.
Article
Cryotherapy is commonly used as a procedure to relieve pain symptoms, particularly in inflammatory diseases, injuries and overuse symptoms. A peculiar form of cold therapy or stimulation was proposed 30 years ago for the treatment of rheumatic diseases. The therapy consists in the exposure to very cold air in special cryochambers. The air is maintained at temperatures between -110 and -160°C. The treatment was named whole-body cryotherapy (WBC). It consists in a brief exposure to extreme cold in a temperature-controlled chamber. It is applied to relieve pain and inflammatory symptoms caused by numerous disorders, particularly those associated with rheumatic conditions, and it is recommended for the treatment of arthritis, fibromyalgia and ankylosing spondylitis. The aim of this study was to investigate the effects of different treatment of WBC on blood pressure (BP) and heart rate (HR) parameters in adult subjects characterized from non-pathological values of BP. Eighty subjects (36 females, 44 males, age range 19-80 years) submitted to 4-17 WBC applications for a total of 816 treatments were recruited. Immediately before and after each WBC application systolic and diastolic BP and HR were measured and recorded. We did not find significant differences in BP and HR (p > 0.05). WBC seems to be safe with respect to unwanted BP and HR alterations for adult patients. An individual monitoring of subjects is recommended over the treatment, but pathological changes of circulatory parameters can be considered rare and occasional.