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Effect of Whole Body Cryotherapy interventions on health-related quality of life in fibromyalgia patients: a randomized controlled trial

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  • Reims University Hospital
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... Recently WBC has shown effects in the treatment of FM: it reduces pain [26,27], fatigue [26] and improves health-reported quality of life [26][27][28]. Positive effects of serial WBC (10 sessions in 8 days) are still remarkable 1 month after discontinued treatment [28]. ...
... Recently WBC has shown effects in the treatment of FM: it reduces pain [26,27], fatigue [26] and improves health-reported quality of life [26][27][28]. Positive effects of serial WBC (10 sessions in 8 days) are still remarkable 1 month after discontinued treatment [28]. An effect on disease activity measured by the revised Fibromyalgia Impact Questionnaire (FIQR) has not yet been reported. ...
... In the study of Rivera et al. the cross-over design did not work because of too short wash-out periods: patients treated with WBC did not initially return to baseline with regard to VAS and FIQ, so that only results of the first sequence could be reported [27]. Vitenet Fig. 4 Patient's report on satisfaction, efficacy, and significance of WBC treatment effects of WBC 1 month after discontinued treatment [28]. The clinically beneficial effects of WBC in this study appear to be consistent with previous studies. ...
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Introduction Whole-body cryotherapy (WBC) has shown to be beneficial in the treatment of fibromyalgia (FM). There is cumulative evidence that cytokines play a crucial role in FM. It’s unknown whether clinical effects of WBC can be demonstrated at the molecular level and how long the effects last. Methods We compared effects of serial WBC (6 sessions (− 130 °C in 6 weeks) in FM patients and healthy controls (HC). Primary outcome was the change in pain level (visual analogue scale 0–100 mm) after 6 sessions. Secondary outcomes were a change in disease activity (revised Fibromyalgia Impact Questionnaire) and pain after 3 sessions and 3 months after discontinued therapy and in cytokine levels (interleukin (IL-)1, IL-6, tumor necrosis factor α (TNF-α) and IL-10). The patients’ opinions on the satisfaction, effectiveness and significance of WBC were evaluated. Results Twenty-three FM patients and 30 HC were enrolled. WBC resulted in a significant reduction in pain and disease activity after 3 and 6 sessions. No clinical benefit could be measured 3 months after discontinued treatment. Overall, probands were satisfied with WBC and considered WBC to be important and effective. FM patients had significantly different levels of IL-1, IL-6, TNF-α and IL-10 at each reading point compared to HC. Levels of IL-1, IL-6 and IL-10 were significantly altered over time in FM patients. Compared to HC FM patients showed a significantly different response of IL1, − 6 and − 10 to WBC. Conclusion Serial WBC is a fast acting and effective treatment for FM. Proven effects of WBC may be explained by changes in cytokines.
... Table S1 illustrates the search strings employed during the electronic search and the number of records retrieved, Table 1 summarizes the quality and level of evidence of the selected articles, Table 2 presents their characteristics and Table 3 summarizes their outcomes and results. Two articles used a non-controlled study design [31,36], three articles used a non-randomized controlled study design [33,37,38], five articles used a randomized controlled study design [32,34,35,39], and one of them used a crossover design [40]. Five studies were conducted in Germany [31,32,[36][37][38], two in Italy [33,34], and one each in India [39], Spain [40], and Belgium [35]. ...
... Two articles used a non-controlled study design [31,36], three articles used a non-randomized controlled study design [33,37,38], five articles used a randomized controlled study design [32,34,35,39], and one of them used a crossover design [40]. Five studies were conducted in Germany [31,32,[36][37][38], two in Italy [33,34], and one each in India [39], Spain [40], and Belgium [35]. ...
... As mentioned above, evaluation of the quality of conference abstracts [31,32,34,39] was not included due to the different type of format that would have influenced the evaluation. Pain intensity, condition, state, or level was evaluated in eight studies [32][33][34][35][36][37][38]40]. Four studies assessed physical and mental health [33,35,39,40] while only one assessed global health status [33]. ...
Article
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Currently, all available therapies for the control and management of fibromyalgia (FM) are mostly focused on relieving patients’ symptoms and improving their quality of life. The purpose of this review is to provide an up-to-date overview of the evidence supporting the beneficial effects of whole-body cryostimulation (WBC) in patients with FM and evidence-based guidance on the possible adjuvant use of WBC in the treatment of FM. We searched the most recent literature by retrieving 10 eligible studies, 4 of which were abstracts only, from a total of 263 records. Thermal stress caused by cryostimulation induces an analgesic effect, improving pain, redox balance, and inflammatory symptoms in an exercise-mimicking fashion. In addition, it reduces the feeling of fatigue, improves mood, and reduces mental health deterioration with positive consequences on depressive states and improved sleep quality. Although the studies included in this review are not of sufficient quality and quantity to draw definitive conclusions about the effectiveness of WBC in FM, initial evidence indicates WBC as a promising add-on option in the multidisciplinary treatment of FM, due to its rapid action and high patients’ compliance. The application of WBC protocols has the potential to expand therapeutic options for the treatment of FM and related disorders; however, larger, high-quality primary studies are still needed.
... To date, most studies have been focused on the effect of WBC on FM, reducing pain severity [40,53], impact of the disease [40], and improving quality of life [40,53,54]. However, preliminary evidence suggests that WBC may also improve sleep quality [42,54], physical functioning [55], and reduce depressive symptoms [41]. ...
... To date, most studies have been focused on the effect of WBC on FM, reducing pain severity [40,53], impact of the disease [40], and improving quality of life [40,53,54]. However, preliminary evidence suggests that WBC may also improve sleep quality [42,54], physical functioning [55], and reduce depressive symptoms [41]. These findings suggest that WBC may be especially beneficial for patients with obesity and FM, who have higher levels of pain severity, depressive symptoms, impact of disease, and poorer sleep quality [50,56,57]. ...
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Pain severity, depression, and sleep disturbances are key targets for FM rehabilitation. Recent evidence suggests that whole-body cryostimulation (WBC) might be an effective add-on treatment in the management of FM. The purpose of this study was to evaluate the effects of an add-on WBC intervention to a multidisciplinary rehabilitation program on pain intensity, depressive symptoms, disease impact, sleep quality, and performance-based physical functioning in a sample of FM patients with obesity. We performed a randomized controlled trial with 43 patients with FM and obesity undergoing a multidisciplinary rehabilitation program with and without the addition of ten 2-min WBC sessions at −110 °C over two weeks. According to our results, the implementation of ten sessions of WBC over two weeks produced additional benefits. Indeed, both groups reported positive changes after the rehabilitation; however, the group that underwent WBC intervention had greater improvements in the severity of pain, depressive symptoms, disease impact, and quality of sleep. On the contrary, with respect to performance-based physical functioning, we found no significant between-group differences. Our findings suggest that WBC could be a promising add-on treatment to improve key aspects of FM, such as pain, depressive symptoms, disease impact and poor sleep quality.
... Whole body cryotherapy (WBC) has been proven to be a safe and efficient form of physiotherapy in both sports medicine (e.g., skeletal disorders [1,2] and acute and chronic injuries [3]) and clinical settings (e.g., fibromyalgia [4] and neurological disorders [4]). WBC activates physiological mechanisms that maintain a constant core temperature. ...
... Whole body cryotherapy (WBC) has been proven to be a safe and efficient form of physiotherapy in both sports medicine (e.g., skeletal disorders [1,2] and acute and chronic injuries [3]) and clinical settings (e.g., fibromyalgia [4] and neurological disorders [4]). WBC activates physiological mechanisms that maintain a constant core temperature. ...
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This study represents a comparison of the functional interrelation of fatigue and cognitive, cardiovascular and autonomic nervous systems in a group of Chronic Fatigue Syndrome (CFS) patients compared with those in healthy individuals at different stages of analysis: at baseline and after changes induced by whole-body cryotherapy (WBC) combined with a static-stretching (SS) program. The study included 32 patients (Fukuda criteria) and 18 healthy controls. Fatigue, cognitive, cardiovascular and autonomic function and arterial stiffness were measured before and after 10 sessions of WBC with SS. In the patients, a disturbance in homeostasis was observed. The network relationship based on differences before and after intervention showed comparatively higher stress and eccentricity in the CFS group: 50.9 ± 56.1 vs. 6.35 ± 8.72, p = 0.002, r = 0.28; and 4.8 ± 0.7 vs. 2.4 ± 1, p < 0.001, r = 0.46, respectively. Before and after intervention, in the CFS group increased fatigue was related to baroreceptor function, and baroreceptor function was in turn related to aortic stiffness, but no such relationships were observed in the control group. Differences in the network structure underlying the interrelation among the four measured criteria were observed in both groups, before the intervention and after ten sessions of whole cryotherapy with a static stretching exercise.
... Whole-body cryotherapy (WBC) is the short exposure (few minutes) to dry air at cryogenic temperatures and has recently been applied for the muscle recovery after injury to counteract the inflammatory response due to overload syndrome [2,3]. Due to its antiinflammatory effects, WBC start to be used also for pathologies in which the modulation of systemic inflammation could exert beneficial effects, as in the case of rheumatoid arthritis [4,5], fibromyalgia [6,7], or ankylosing spondylitis [8,9]. Moreover, WBC is used with increasing frequency as a method of well-being [10]. ...
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The study aimed to identify the effects of whole-body cryotherapy (WBC) on immunological, hormonal, and metabolic responses of non-professional male athletes. Ten cyclists and ten middle-distance runners received 3 once-a-day sessions of WBC. Before initiating and after the final WBC session, a full set of hematologic parameters, serum chemistry profile, hormones, circulating mitochondrial (mt) DNA levels, cytokines, and chemokines concentration were evaluated. The phenotype of monocyte, T cells, and B cells was analyzed. mRNA expression of 6 genes involved in inflammasome activation (NAIP, AIM2, NLRP3, PYCARD, IL-1β, and IL-18) was quantified. WBC reduced glucose and C and S protein and increased HDL, urea, insulin-like growth factor (IGF)-1, follicle-stimulating hormone, IL-18, IL-1RA, CCL2, and CXCL8. Intermediate and non-classical monocyte percentages decreased, and the CD14, CCR5, CCR2, and CXCR4 expressions changed in different subsets. Only IL-1β mRNA increased in monocytes. Finally, a redistribution of B and T cell subsets was observed, suggesting the migration of mature cells to tissue. WBC seems to induce changes in both innate and adaptive branches of the immune system, hormones, and metabolic status in non-professional male athletes, suggesting a beneficial involvement of WBC in tissue repair.
... Vasoconstriction also inhibits cell metabolism and reduces the oxygen demand of cells, thereby preventing the production of tissue free radicals [12,13]. Moreover, cryotherapy reportedly limits the conductive capacity of nerves, decreasing the incidence of postoperative pain [14]. ...
Article
Objective: The aim of this study is to evaluate the effect of intracanal cryotherapy on the fracture resistance of endodontically treated teeth. Materials and methods: Sixty single-rooted maxillary lateral incisor teeth with single root canals were selected and randomly divided into two groups (n = 30). The specimens were immersed in distilled water, which was heated to 37 °C during the procedures. The root canals were chemomechanically prepared up to the apical size of 50 and assigned to either the control group or the cryotherapy group. The specimens in the cryotherapy group were irrigated with 20 mL sterile cold (2.5 °C) saline solution, which was delivered with an EndoVac system for 5 min, whereas the specimens in the control group received a sterile salinesolution at room temperature. The fracture resistance of the specimens was then tested with a universal testing machine. The data was analyzed using the independent sample t test with a 5% significance threshold. Results: The fracture strength of the specimens in the intracanal cryotherapy group was significantly lower than that of the control group (p< .05). Conclusions: Application of intracanal cryotherapy as a final irrigant reduced the vertical fracture resistance of prepared roots when compared to the control group.
... Since the pharmacologic background of the examined cohort is not detailed, it may be hypothesised that the combination of cryotherapy plus tranquilliser or muscle-relaxant agents would have improved the final result and avoided some of the reported side effects. Another randomised trial involving 24 FM patients, part of whom were assigned to a whole body cryotherapy group for a total of 10 sessions over a period of 8 days, reported better scores in the Medical Outcome Study Short Form-36 questionnaire, evidencing an improvement in the quality of life (51). On the other hand, due to muscle relaxation, the application of heat has given beneficial effects in FM patients. ...
Article
Fibromyalgia is characterised by chronic pain, fatigue and functional symptoms. Its aetiopathogenesis is still a matter of debate, but various pharmacological and non-pharmacological therapies are currently available for its treatment. We review the literature concerning the most recent findings related to the aetiopathogenesis, diagnosis, clinical aspects and treatment of FM Aetiopathogenesis In the time frame analysed by this review , not so many new aetiopathoge-netic hypotheses for fibromyalgia (FM) have been formulated with respect to other years (1). However, the focus of the researchers in this year was on the phenomena related to neuropathies. In 2018, Grayston et al. (2) proposed an interesting meta-analysis on the prevalence of small fibre neuropathy in FM. The researcher evaluated 935 scientific articles and underlined the prevalence of small fibre neuropathy (SFN) in 49% of FM patients. This high prevalence of SFN in FM emphasises the importance of identifying standard methods for the description of this neuropathy and understanding the processes leading to the development of SFN, to achieve better therapeutic and diagnostic strategies. Moreover, Caro et al. (3) studied for the first time large fibre involvement in FM. In the past few years, several studies have pointed to a link between small fibre neuropathy and FM, but in most of the cases these studies did not evaluate possible alterations in the large fibres. The researchers included the electro-myographic findings of 100 consecutive unselected clinical patients that met the 1990 ACR criteria for FM. After the exclusion of FM subjects with con-comitant clinical conditions that could influence the findings of the EMG (for example, family neural degenerative conditions, diabetes mellitus, vitamin B-12 deficiency, etc.) 55 FM subjects remained: 29 subjects with "FM only" and 26 subjects with FM + rheumatoid arthritis ("FM + RA"). All subjects also underwent skin ankle biopsy for the determination of the epidermal nerve fibre (ENFD). Fourteen other subjects, without FM or RA, examined by the same electromyograph, were chosen as an EMG/NCS comparison group. Ninety percent of the "FM only" subjects generated a demyelinating and/or axonal sensory-motor polyneuropathy, and 63% had SFN (ENFD ≤7 fibres/ mm), suggesting a mixed fibre neuropa-thy in most cases. In addition, 61% of The "FM-only" subjects showed suggestive EMG of non-myotomial axonal motor denervation of the lower limbs, most likely a cause of polyneuropathy, and 41% met the criteria for "possible" chronic inflammatory demyelinating polyneuropathy (CIDP). Interestingly, there was little difference in the EMG/ NCS findings between the "FM only" and the "FM+RA" groups, while in the comparison group no pathologic finding was shown, with the only exception of carpal tunnel syndrome. The results highlighted by the research group show that the electrodiagnostic characteristics of polyneuropathy, muscle dener-vation and CIDP are common in FM. These findings are often seen to coincide with SFN and are not significantly affected by the presence of RA. These results, besides helping to understand the aetiopathogenesis of FM, can also be useful for diagnostic purposes. Diagnosis The diagnosis of FM is still based on patients' reports and on clinical assessment , mainly because the pathogenesis of FM is still not well understood and
... Имеются отдельные работы, показавшие эффективность криотерапии при фибромиалгии (ФМ), АС и ОА [20][21][22][23]. ...
Article
Medical rehabilitation is a set of non-drug methods aimed at reducing pain and functional disorders, restoring working ability, social activity, and mental stability in patients. This is a necessary part of treatment in patients with rheumatic diseases, which is as important as pharmacotherapy in many cases (for example, osteoarthritis, chronic nonspecific back pain, and spondyloarthritis). Unfortunately, many Russian physicians underestimate the possibilities of nondrug approaches, referring to the fact that the effectiveness of medical rehabilitation and physiotherapy methods have not been evaluated during clinical trials and their therapeutic significance has passed no serious test in the context of evidence-based medicine. This is not entirely true. This review presents data from a large number of clinical trials and related meta-analyses of studies evaluating the efficiency of the most commonly used medical rehabilitation techniques: cryotherapy, laser therapy, magnetotherapy, ultrasound therapy, percutaneous electroneuromyostimulation, acupuncture, manual therapy, massage, and therapeutic exercises.
... WBC is commonly used as a method to relieve pain and inflammation symptoms caused by various diseases, particularly those associated with rheumatic conditions. It is recommended for the treatment of arthritis [19,23] fibromyalgia [3,41] and ankylosing spondylitis [38]. WBC is also used by athletes to relieve muscle soreness after exercise [2,18,37]. ...
Article
In order to determine the required duration of whole-body exposure to extreme cold (−110 °C) in males and females for achieving the same cold-induced response, a mathematical model of skin cooling kinetics was developed. This modeling is derived from the implementation of a new experimental cryotherapy protocol to obtain continuous skin temperature maps over time. Each 3-min whole-body cryostimulation session was divided into six incremental sessions of 30 s carried out over six consecutive days. Seventeen young, healthy subjects (8 males aged 22.6 +/-3.0 years and 9 females aged 23.7 +/-4.7 years) agreed to participate in this study. The smallest sex-related difference in temperature was found in the trunk area (2.93 °C after 3 min) while the greatest temperature drop was found in the lower limbs (5.92 °C after 3 min). The largest temperature variation was observed between the trunk and the lower limbs, and peaked at 2.67 °C in males and 6.99 °C in females. For both sexes, skin cooling kinetics showed a strong transient exponential type decrease followed by linear regression behavior. It appeared that for achieving the same cold-induced response, the required duration of cryostimulation is longer for males. For example, a trunk skin cooling of −12 °C could be achieved in 125s for females vs 170s for males (+36% longer); for the lower limbs, the same skin cooling magnitude could be reached after 87s for females vs 140s for males (+62% longer).
... Cold therapy limits inflammation and reduces pain in short-term [36,37], which may explain the fact that pain reduction was only noted after 6 and 24 h. Additionally, cryotherapy decreases cellular metabolism and causes vasoconstriction, which blocks the transmission of nerve impulses caused by a drop in the local temperature below 14°C [3,15], reducing the chemical mediators responsible for pain conduction [38][39][40]. ...
Article
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Objectives To assess the influence of intracanal cryotherapy application on postoperative pain after endodontic treatment. Materials and methods A systematic review (SR) was conducted in seven databases. Articles that were published up to 04 February 2020 were included and randomized clinical trials that used a cold saline solution for final irrigation to manage postoperative endodontic pain were compared with those that used a saline solution at room temperature. Metaanalysis was performed to assess postoperative pain after 6, 24, 48, and 72 h using a random effects model, a confidence interval of 95%, and heterogeneity tested by the I² index. The certainty of evidence was rated using GRADE. Results Qualitative and quantitative analysis included eight and six studies, respectively. Individuals treated with cryotherapy presented lower means of postendodontic pain than the controls, 6 and 24 h after endodontic treatment (MD − 1.30 [− 2.32, − 0.28] p = 0.01 and SMD − 0.68 [ − 1.21, − 0.16] p = 0.01, respectively, with very low certainty of evidence). After 48 and 72 h, both groups demonstrated similar means of postendodontic pain (MD − 0.06 [− 0.18, 0.07] p = 0.38 and SMD − 0.54 [− 1.18, − 0.11] p = 0.10, with high and low certainty of evidence, respectively). Conclusions Based on the limited quality evidence, intracanal cryotherapy application reduced postoperative endodontic pain after 6 and 24 h. New clinical trials are needed to support the result of this review. Clinical significance This SR provides information about the use of intracanal cryotherapy in clinical practice, guides clinicians to make evidence-based decisions and suggests recommendations for further high-quality studies
... Cryotherapy in cryosaunas or cryochambers is the therapeutic application of extremely cold dry air, usually between −140°C and −110°C with proven virtues on a number of pathologies such as pain [1] and inflammation stemming from sports injuries and muscular recovery [2][3][4][5][6][7], fibromyalgia [8,9], rheumatoid arthritis [10], multiple sclerosis [11], sleep [12] and depressive disorders [13], or skin diseases like psoriasis and dermatitis [14]. ...
Article
Because of the scarcity of the literature on the comparative efficiency of Partial Body Cryotherapy versus Whole Body Cryotherapy, it appears that the decision to switch from the former to the latter is purely arbitrary and does not actually meet any scientifically established criterion. The motivation of this study is to draw up an objective observation of the differences between Partial Body Cryotherapy and Whole Body Cryotherapy treatments, based on the analysis of skin temperature distribution. Ten healthy subjects who engage in regular physical activity participated in the study (50% female; means ± S.D.: age 45.8 ± 5.5 years, height 168.7 ± 9,3 cm, weight 75.3 ± 13.1 kg, body fat percentage 19.3 ± 9,8). Sessions took place in a cryosauna and a cryochamber at identical temperature (−140 °C), duration of cryostimulation (3 min) and nature of the refrigerant used (liquid nitrogen vapor). It is shown that the skin temperature difference between Partial Body Cryotherapy and Whole Body Cryotherapy varies according to the vertical location of the body regions, increasingly from 15% on the lower areas of the body (no significant difference in skin temperature for legs P =.171) up to 53% for the upper areas (significant difference P < 0.001 for chest). These observations show the caution with which these two cryotherapy systems must be considered. The knowledge of the differences in cutaneous thermal response between these two systems should guide sports coaches and physicians in prescribing differentiated treatment protocols in order to achieve comparable skin temperature effects and consequently to efficiently cool tissues in the same way.
... The control group also had a decrease in pain, but the group that received WBC had a significantly greater decrease in pain [47]. It was also found by Vitenet et al. that WBC at -110°C increased patients' self-rated quality of life as measured by the Medical Outcomes Study Short Form-36, which includes questions about disease impact on function, daily living, mental health, and pain [48]. However, a stand-alone, quantitative pain score was not one of the outcomes measured. ...
Article
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Background Cryotherapy has been used to reduce chronic pain for many years due in part to its ease of use, affordability, and simplicity. It can be applied either locally (e.g., ice packs) or non-locally (e.g., partial and whole-body cryotherapy) depending on the location of the pain.Objectives To determine the overall effectiveness of cryotherapy at reducing chronic pain by characterizing the currently available evidence supporting the use and effects of cryotherapy on chronic pain associated with chronic diseases.Study DesignA narrative review of original research studies assessing the efficacy of cryotherapy in alleviating chronic pain.MethodsA PubMed database search was performed to find human studies between the years 2000 and 2020 that included the application of cryotherapy in patients with chronic pain associated with chronic diseases. A review of the relevant references was also performed to gather more articles. Data was extracted, summarized into tables, and qualitatively analyzed.ResultsTwenty-five studies (22 randomized controlled trials, one prospective analysis, 1 one-group pretest/posttest study, and one case–control study) were included after the literature search. Both local and non-local cryotherapy applications show promise in reducing chronic pain associated with various chronic diseases including those of rheumatic and degenerative origin. Cryotherapy appears to be a safe therapy in carefully selected patients, with only minimal adverse effects reported in the literature.LimitationsMeta-analysis was not possible given the many differences between studies. Cross-study data homogenization and comparison between studies proved fairly difficult due to the lack of standardized studies, various uses and practice types of cryotherapy, and lack of control groups in some studies.Conclusions Local and non-local cryotherapy can be low-risk and easy treatment options to add in the management of chronic pain in carefully selected patients. However, long-term effects, a standardized approach, and careful study of other chronic pain syndromes should be considered in future research to further support the use of cryotherapy in the management of chronic pain.
... A WBC programme similar to that applied in the current study was shown to improve health-related quality of life in fibromyalgia patients [22]. The benefits of WBC in fatigue-related symptom reduction have been observed previously in groups of healthy subjects. ...
Article
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Background The aim of this study was to explore the tolerability and effect of static stretching (SS) and whole body cryotherapy (WBC) upon fatigue, daytime sleepiness, cognitive functioning and objective and subjective autonomic nervous system functioning in those with Chronic Fatigue Syndrome (CFS) compared to a control population. Methods Thirty-two CFS and eighteen healthy controls (HC) participated in 2 weeks of a SS + WBC programme. This programme was composed of five sessions per week, 10 sessions in total. Results A significant decrease in fatigue was noted in the CFS group in response to SS + WBC. Some domains of cognitive functioning (speed of processing visual information and set-shifting) also improved in response to SS + WBC in both CFS and HC groups. Our study has confirmed that WBC is well tolerated by those with CFS and leads to symptomatic improvements associated with changes in cardiovascular and autonomic function. Conclusions Given the preliminary data showing the beneficial effect of cryotherapy, its relative ease of application, good tolerability, and proven safety, therapy with cold exposure appears to be an approach worth attention. Further studies of cryotherapy as a potential treatment in CFS is important in the light of the lack of effective therapeutic options for these common and often disabling symptoms.
... In total ten studies met the inclusion criteria. [68][69][70][71][72][73][74][75][76][77] Not all articles provided means, SDs and correlations in their tables. Within eight months time we managed to obtain all the necessary means and SDs that were missing from the corresponding or primary authors. ...
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Objective To give an overview of the nature and methodological quality of studies on whole body cryotherapy (WBC) as add-on intervention for mental health problems. Methods A meta-analysis according to PRISMA guidelines was conducted (Prospero registration: CRD42020167443). Databases MEDLINE, PsycINFO and the Cochrane Library were searched. Risk of bias was scored according to the Cochrane ROBINS-I-tool to which an extra bias-dimension of allegiance bias was added. Within and between Hedges’ g pooled effect sizes were calculated for the main aspect of mental health measured. Treatment efficacy was examined using a random effects model. Heterogeneity was examined through identification of visual outliers and by I² statistics. Results Out of 196 articles coming up from the search, ten studies met all inclusion criteria, six of which were (randomized) controlled trials. Together these studies report on a total of 294 participants receiving WBC. The within-group pooled effect size for mental health problems is large (Hedges’ g = 1.63, CI: 1.05-2.21), with high heterogeneity (I² = 93%). Subgroup analyses on depressive symptoms and quality of life (QOL) showed a diminution of heterogeneity to moderate. Effect sizes for depressive symptoms are very large (Hedges’ g = 2.95, CI: 2.44-3.45) and for QOL medium (Hedges’ g = 0.70, CI: 0.15-1.24). The between-group pooled effect size is medium (Hedges’ g = 0.76, CI: 0.17-1.36). Conclusions Results indicate preliminary evidence for WBC as efficacious add-on intervention for mental health problems, especially depressive symptoms. Further research in the form of RCTs with larger numbers of participants is needed.
... Studies have shown that cryotherapy provides physiological, psychological, and physical benefits [2][3][4]. Cryotherapy-based methods have been developed to improve exercise recovery, relieve pain, depression and anxiety symptoms in patients with rheumatic and inflammatory diseases [5][6][7]. The difference between the two existing cryotherapy methods (whole and partial body) lies in the stimulation of the sympathetic nervous system during the session and the parasympathetic nervous system directly after the session [2,8]. ...
Article
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Partial body cryotherapy cabins most often use liquid nitrogen as their cryogenic fluid, which raises safety concerns during operation. In this study, an innovative cryotherapy cabin design is presented, featuring an electric cooling system suitable for producing cold air at −30 °C. The geometry of the designed cryotherapy cabin is evaluated by a thermodynamic modeling which aims at optimizing the circulation of cold air flows inside the cabin. The numerical study is carried out in two successive phases, the first one being necessary to model the pre-cooling phase and to estimate the time required to reach an average temperature close to the set temperature of −30 °C. The second one aims at modeling a 3-min cryotherapy session by taking into account the thermal transfers between the human body and its environment. Results demonstrate the potential benefits of the cold air injection device which has been designed to optimize the thermal transfers and homogenize the temperatures within the therapeutic enclosure. The main innovation of this study is the ability to customize cryotherapy protocols by injecting cold air at different levels through targeting of specific body areas. Further calculations would be required to determine the precise impact of zone-targeted injection on skin cooling.
... A few studies have shown improvements in depression and anxiety syndromes (7), in functional status and fatigue in patients with multiple sclerosis (8), and in quality of sleep (9). WBC is widely used as a recovery technique after physical exercise in elite athletes (10) and positive effects of 10 serial WBC sessions have been registered one month after discontinued treatment (11). To the best of our knowledge, no studies have so far investigated the effects of WBC on post-Covid symptoms. ...
... Such stimulus induces pain and inflammatory status reduction in different conditions [15][16][17][18] and induces improvements in depression, anxiety [19], functional status and fatigue [20], and quality of sleep [21]. It is widely used as a recovery technique after physical exercise in elite athletes [22] and the positive effects of 10 serial WBC sessions on PCC patients have been reported 1 month after discontinued treatment [23]. The broader existing evidence of clinical and functional benefits following WBC in musculoskeletal and neurological conditions provides a rationale for prescribing WBC for post-COVID symptoms. ...
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Given the severity and prevalence of post-COVID-19 symptoms in the general population, the identification of boosters for rehabilitation programs appears to be of paramount importance. The purpose of this case series is to provide some preliminary evidence about the role of whole-body cryostimulation (WBC) as an effective adjuvant for the recovery of patients with the post-COVID-19 condition (PCC). We recruited seven patients with previously confirmed SARS-CoV-2 infection and symptoms of PCC of different severities for a comprehensive rehabilitation program, including WBC. The main symptoms were dyspnea, chronic and muscular fatigue, chronic pain, and poor sleep quality. Moreover, some patients presented high levels of hematological markers of inflammation. Because we provided a range of interventions, including nutritional and psychological support along with physical exercise and physiotherapy, we could not determine to what extent WBC may per se have accounted for the clinical and functional improvements. However, for all reported cases, it was observed that the introduction of WBC sessions represented a turning point in the patient’s subjective and objective improvements related to health and functioning.
Article
Cold therapy is commonly used to relieve pain and inflammation and to aid in muscle recovery after exercise in human medicine. A number of applications have also been observed in veterinary practice. In this article, a critical evaluation of equine protocol applied with a new commercial concept of equine whole-body cryostimulation (WBC) was made. With this new concept of WBC, the protocol usually utilized for relieving pain and discomfort in humans has been extended to horses. The investigations described herein focus on the reduction of horse skin temperature when applying human WBC protocols. Based on infrared thermography measurements, results show that exposing a horse for 3 minutes to a temperature of −140°C, which are conventional parameters used for humans, does not induce sufficient skin thermal gradients in horses. Consequently, beneficial cold reflexes such as vasomotor, neuroconduction, and biochemical reactions cannot be triggered. Further investigations should therefore be carried out to design an adequate protocol specifically aimed at horses.
Article
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is an intractable disease. This study aimed to assess the efficacy of cryotherapy in the therapy of CP/CPPS. One hundred and seventy‐two patients with CP/CPPS were randomised to receive cryotherapy or sham cryotherapy. The follow‐up assessments were done at weeks 4, 12 and 24 using Visual Analogue Scale (VAS), International Prostate Symptom Score (IPSS) and National Institutes of Health‐developed Chronic Prostatitis Symptom Index. The per‐protocol analysis was performed. Eighty‐two patients in the cryotherapy group and 76 patients in the sham group completed the treatment. The most obvious improvement (67%) of the VAS was observed in the cryotherapy group after 4 weeks, and although the improvement slightly weakened by 24 weeks (62.6%), a significant improvement from the treatment remained apparent. IPSS improved by 75% after 4 weeks and remained stable after 24 weeks. The response rates were 78.0%, 73.2% and 70.1% at weeks 4, 12 and 24 in the cryotherapy group, which were higher than 17.1%, 13.2% and 10.5% in the sham group (each p < .001). These results indicated that cryotherapy could alleviate voiding symptoms, ameliorate pain and improve the quality of life in people with CP/CPPS. It holds promise as a novel strategy to treat CP/CPPS.
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Cryotherapy is a therapeutic technique using ice or cold water applied to the skin to reduce bleeding, inflammation, pain, and swelling following soft tissue trauma and injury. While beneficial, there are some side effects such as pronounced vasoconstriction and tissue ischemia that are sustained for hours post-treatment. This study tested the hypothesis that this vasoconstriction is mediated by 1) the Rho-kinase pathway and/or 2) elevated oxidative stress. 9 subjects were fitted with a commercially available cryotherapy unit with a water perfused bladder on the lateral portion of the right calf. Participants were instrumented with three microdialysis probes underneath the bladder. One site received lactated ringers (control site), one received the Rho-Kinase inhibitor Fasudil, and one received Ascorbic Acid. Skin temperature (Tskin) and cutaneous vascular conductance (CVC) was measured at each site. Subjects had 1°C water perfused through the bladder for 30min, followed by passive rewarming for 90min. Tskin fell from ~34°C to ~18.0°C during active cooling across all sites and this response was similar for all sites (P>0.05 for all comparisons). During passive rewarming Tskin rose to a similar degree in all sites (P>0.05 relative to the end of cooling). %CVC was reduced during active cooling in all sites; however, the magnitude of this response was blunted in the Fasudil site relative to control (P<0.001 for all comparisons) and min 25 and 30 of cooling in the Ascorbic Acid site (P<0.05). During passive rewarming %CVC at the control and Ascorbic Acid sites did not change such that values were similar to the end of cooling (P>0.05 for each comparison). %CVC at the Fasudil site remained elevated during passive rewarming such that values were higher compared to the control and Ascorbic Acid sites throughout the 90min of passive rewarming (P<0.001 main effect of Fasudil). These findings indicate that the Rho-kinase pathway contributes to pronounced vasoconstriction during cryotherapy as well as the sustained vasoconstriction during the subsequent rewarming period post treatment.
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Saliva represents a low stress, not-invasively collected matrix that allows steroid hormone monitoring in athletes by reflecting type, intensity and duration of exercise. Whole body cryotherapy (WBC) consists of short whole-body exposures to extremely cold air (-110° to -140°C) which, despite being initially used to treat inflammatory diseases, is currently acquiring increasing popularity in sports medicine. Cryostimulation practice is now widely accepted as an effective treatment to accelerate muscle recovery in rugby players. The aim of this work was to study the changes of steroid hormones in saliva of rugby players after both 2 and 14 consecutive WBC sessions, in order to investigate the effects of the treatment on their salivary steroid hormonal profile. Twenty-five professional rugby players, belonging to the Italian National Team, underwent a 7-day cryotherapy protocol consisting of 2 daily sessions. Saliva samples were taken in the morning prior to the start of the WBC, in the evening after the end of the second WBC, and in the morning of the day after the last WBC session. The samples were analyzed for cortisol, DHEA, testosterone and estradiol using competitive enzyme-linked immunosorbent assays. Cortisol and DHEA showed a reduction already after the 2 WBC sessions of the first day; after 14 consecutive WBC sessions cortisol, DHEA, and estradiol levels decreased, while testosterone increased as did the testosterone to cortisol ratio. These results were confirmed by the fact that the majority of subjects showed variations exceeding the critical difference (CD). In conclusion, we found that WBC acutely affects the salivary steroid hormone profile, and the results are evident already after only one twice-daily session. Most significantly, after one-week of consecutive twice-daily WBC sessions, all the hormones were modified. This is the first experimental report that links changes in the hormonal asset to WBC.
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This is a field study realized during basketball preparation tournaments for the European championship 2013 with men and women French team. During these competitions, athletes used Whole-Body Cryostimulation (WBC) exposures to enhance their recovery. The aim of this work was to investigate the effects of WBC on the quality of sleep (QS) in athletes during the night following the exposure. The preparation took place during one week in a training camp followed by three international matches in three days (one per day). The study was performed with high standard level athletes men and women of the basketball French teams. 27 basketball players participated fully in the study (12 females, 11 males, age: 25.8±3.5 years; weight: 88.5±15.7 kg; height: 192.5±11.8 cm). The WBC treatment was 3-min exposure between -110°C and -150°C in the morning or/and in the evening after a training or match session. The QS was assessed every day before the exposure with a perceptual scale graduated from 1 "bad sleep" to 5 "restful sleep" adapted from Spiegel's questionnaire. The data were analyzed using paired t-test. An improvement in the QS was observed in the night following WBC (3.7±0.7 vs 3.2±0.9, P<.05) compared with what was observed the night without previous WBC. Athletes experienced better sleep quality after WBC exposure. Even if the night duration was short during this period, they expressed they had a deeper, quieter and less disturbed sleep. The improvement of the QS during both competition and heavy training load periods appears of importance to enhance athletes' recovery. Such situation may lead to 1) a better standing of the training load, 2) less fatigue before the matches and 3) a decrease of the injury risks.
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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.
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Fibromyalgia syndrome (FM) is a common chronic pain condition that affects at least 2% of the adult population. Chronic widespread pain is the defining feature of FM, but patients may also exhibit a range of other symptoms, including sleep disturbance, fatigue, irritable bowel syndrome, headaches, and mood disorders. The etiology of FM is not completely understood and the syndrome is influenced by factors such as stress, medical illness, and a variety of pain conditions. Establishing diagnosis may be difficult because of the multifaceted nature of the syndrome and overlap with other chronically painful conditions. A unifying hypothesis is that FM results from sensitization of the central nervous system; this new concept could justify the variety of characteristics of the syndrome. FM symptoms can be musculoskeletal, non-musculoskeletal, or a combination of both; and many patients will also experience a host of associated symptoms or conditions. The ACR classification criteria focus only on pain and disregard other important symptoms; but three key features, pain, fatigue and sleep disturbance, are present in virtually every patient with FM. Several other associated syndromes, including circulatory, nervous, digestive, urinary and reproductive systems are probably a part of the so called central sensitivity or sensitization syndrome. A minority subgroup of patients (30-40%) has a significant psychological disturbance. Psychological factors are an important determinant of any type of pain, and psychological comorbidity is frequent in FM. Psychiatric disorders most commonly described are mood disorders, but psychiatric illness is not a necessary factor in the etiopathogenesis of FM.
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The aim of the present study was to examine the in-depth application of the Short-Form-(SF)-36 Health Survey to score the general well-being in fibromyalgia syndrome (FS) patients. Quality of life was evaluated in 12 patients with FS. With respect to mental well-being (social functioning, role limitation due to emotional health problems, and mental health), two distinguished groups were found concerning psychological functioning. One group (n = 8) demonstrated psychological dysfunction, whereas the other (n = 4) showed normal psychological scores. Physical well-being scores (physical functioning, role limitation due to physical health problems, bodily pain, general health, and vitality) did not differ between FS patients but were altogether below the normal range. Regarding the psychological scores of the two groups of patients, SF-36 can be used to differentiate between patients with and without psychological dysfunction independent of pain. Therefore, we propose that the SF-36 could be of help to provide the most adequate therapy to achieve an optimal outcome in patients with FS and psychological disturbances.
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Ware JE, Jr.: SF-36 Health Survey Update, in Maruish M (ed): The Use of Psychological Testing for Treatment Planning and Outcome Assessment, Volume 3. Mahwah, New Jersey: Lawrence Erlbaum Associates; 2004, pages 693-718. ISBN 0805843310, 9780805843316.
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To determine the impact of the application of cryotherapy on nerve conduction velocity (NCV), pain threshold (PTH) and pain tolerance (PTO). A within-subject experimental design; treatment ankle (cryotherapy) and control ankle (no cryotherapy). Hospital-based physiotherapy laboratory. A convenience sample of adult male sports players (n = 23). NCV of the tibial nerve via electromyogram as well as PTH and PTO via pressure algometer. All outcome measures were assessed at two sites served by the tibial nerve: one receiving cryotherapy and one not receiving cryotherapy. In the control ankle, NCV, PTH and PTO did not alter when reassessed. In the ankle receiving cryotherapy, NCV was significantly and progressively reduced as ankle skin temperature was reduced to 10 degrees C by a cumulative total of 32.8% (p<0.05). Cryotherapy led to an increased PTH and PTO at both assessment sites (p<0.05). The changes in PTH (89% and 71%) and PTO (76% and 56%) were not different between the iced and non-iced sites. The data suggest that cryotherapy can increase PTH and PTO at the ankle and this was associated with a significant decrease in NCV. Reduced NCV at the ankle may be a mechanism by which cryotherapy achieves its clinical goals.
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Objective: Fibromyalgia is a pathological entity characterized by chronic widespread musculoskeletal pain and the presence of "tender points". It constitutes a significant health problem because of its prevalence and economic impact. The aim of the present study was to determine the therapeutic benefits of low impact aerobic exercise alone or in combination with music therapy in patients with fibromyalgia. Methods: A single-blind randomized controlled pilot trial was performed. Thirty-five individuals with fibromyalgia were divided into three groups: (G1) therapeutic aerobic exercise with music therapy (n=13); (G2) therapeutic aerobic exercise at any rhythm (n=13) and (CG) control (n=9). The intervention period lasted eight weeks. Depression, quality of life, general discomfort and balance were assessed before and after intervention. Results: At post-intervention, group G1 improved in all variables (depression (p=0.002), quality of life (p=0.017), general discomfort (p=0.001), and balance (p=0.000)), while group G2 improved in general discomfort (p=0.002). The change observed in balance was statistically different between groups (p=0.01). Conclusion: Therapeutic aerobic exercise is effective in improving depression and general discomfort in individuals with fibromyalgia. However, effectiveness is higher when combined with music therapy, which brings about further improvements in quality of life and balance.
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Aim: Rehabilitation slows the progress of rheumatoid arthritis (RA) and prevents progression of disability. This study aimed to compare the impact of two rehabilitation programmes on pain, disease activity, locomotor function, global health and work ability forecast in RA patients. Materials and methods: Sixty-four employed women aged 24-65 years participated in the study. All patients underwent individual and instrumental kinesiotherapy. Thirty-two patients underwent cryogenic chamber therapy and local cryotherapy as well as non-weight-bearing, instrumental and individual kinesiotherapy. The remaining 32 patients received traditional rehabilitation in the form of electromagnetic and instrumental therapy, individual and pool-based non-weight-bearing kinesiotherapy. Rehabilitation lasted 3 weeks. Patients were examined three times: prior to rehabilitation, after 3 weeks of therapy and 3 months after completion of rehabilitation. The following study instruments were used: to assess disease activity: DAS-28; functional impairment: HAQ-DI; pain severity: VAS; patients' overall well-being: a scale from 0 to 100 (Global Health Index); and patients' own prognosis of fitness for work: the 6th question from Work Ability Index (WAI). Statistical analysis of data was performed using the STATISTICA 8.0 package. Mixed-design two-way analysis of variance was used for hypothesis testing. Results: All patients improved after rehabilitation. The group of patients those who underwent cryotherapy had improved DAS-28, HAQ-DI, VAS and global health scores immediately following the 3-week rehabilitation programme (p < 0.001, p = 0.001, p = 0.007 and p < 0.001, respectively), as well as at the 3-month follow-up (p < 0.001, p < 0.001, p = 0.009 and p < 0.001, respectively). Rehabilitation using cryotherapy resulted in greater improvement in disease activity DAS-28 [F(2,105) = 5.700; p = 0.007; η(2) = 0.084] and HAQ-DI locomotor function scores [F(2,109) = 6.771; p = 0.003; η(2) = 0.098] compared to traditional rehabilitation. The impact of both forms of rehabilitation on patients' own prognosis of work ability in the next 2 years was not significant. Results of patients who underwent traditional approach showed decreased disease activity following the initial 3-week period; however, this improvement did not sustain to the end of follow-up, 3 months later. Conclusions: Complex rehabilitation in RA has a positive effect on patients' clinical condition. The rehabilitation programme that includes cryotherapy overtops traditional rehabilitation, particularly as regards improvement in locomotor function, disease activity and sustaining willingness to continue working and exerts long-lasting effect. Implications for Rehabilitation Rehabilitation using cryotherapy is more effective in improving locomotor function, decreasing disease activity and sustaining willingness to continue working compared to traditional rehabilitation. Rehabilitation using cryotherapy significantly reduces the intensity of pain experienced by patients with RA, and this positive effect is maintained at 3 months post-rehabilitation. Complex rehabilitation, particularly treatment using cryotherapy, improves patients' subjective assessment of their overall well-being and perception of their disease. Complex rehabilitation in rheumatoid arthritis has a positive effect on patients' clinical condition.
Article
Background Coping with the complex nature of fibromyalgia symptoms (FMS) still remains a challenge for patients. Taking into account the possible adverse events of pharmacological treatments patients often seek additional treatments for the management of fibromyalgia and turn towards complementary and alternative medicine (CAM). Objective In this review, we aimed to investigate the current state of literature of homeopathy in the treatment of FMS. Methods We searched Medline, the Cochrane Register of Controlled Trials, Embase, AMED, PsycInfo and CAMbase for the terms “fibromyalgia AND homeopath$” through February 2013. In addition we searched Google Scholar, the library of the Carstens Foundation and that of the Deutsche Homöopathische Union (DHU). Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated and meta-analysed using the generic inverse variance method. Results We found 10 case-reports, 3 observational studies, 1 non-randomised and 4 randomised controlled trials (RCTs) on homeopathy for fibromyalgia. Both, case reports and observational studies are naturally predominated by the use of qualitative and not validated outcome measures. Meta-analyses of CCTs revealed effects of homeopathy on tender point count (SMD = -0.42; 95%CI -0.78,-0.05; P = 0.03), pain intensity (SMD = -0.54; 95%CI -0.97,-0.10; P = 0.02), and fatigue (SMD = -0.47; 95%CI -0.90,-0.05; P = 0.03) compared to placebo. Conclusion The results of the studies as well as the case reports define a sufficient basis for discussing the possible benefits of homeopathy for patients suffering from fibromyalgia syndrome although any conclusions based on the results of this review have to be regarded as preliminary.
Article
Aims. – Whole body cryotherapy (WBC) at -110 °C has been in use since the eighties, essentially in Northern Europe, for the treatment of rheumatism diseases and also in sports medicine and traumatology. The objective of this work is to measure the effects of a WBC session on skin and core body temperatures, based on the medical protocol that we have been using on sportsmen and sportswomen for nearly two years, on a daily basis.Method. – Eleven sportspersons were included in the study, 10 men and 1 woman. Skin temperatures were measured in various places on the body using a laser thermometer, 5 minutes before the session and then immediately afterwards and 5, 10 and finally 20 minutes later. The core body temperature was measured using an ear thermometer. The cryotherapy session lasted 4 minutes.Results. – On exiting the cold chamber, the lowest temperatures were measured on the shin, with an average value of less than 10 °C. The skin temperatures rose very quickly, but the measured values remained lower than the reference temperatures after 20 minutes. As far as the core body temperature is concerned, we observed a significant decrease, but the value observed was both deferred and transient: 0.63 °C observed after 5 minutes. The difference was no longer significant after 20 minutes.
Article
Fibromyalgia (FM) is a common chronic widespread pain disorder. Our understanding of FM has increased substantially in recent years with extensive research suggesting a neurogenic origin for the most prominent symptom of FM, chronic widespread pain. Neurochemical imbalances in the central nervous system are associated with central amplification of pain perception characterized by allodynia (a heightened sensitivity to stimuli that are not normally painful) and hyperalgesia (an increased response to painful stimuli). Despite this increased awareness and understanding, FM remains undiagnosed in an estimated 75% of people with the disorder. Clinicians could more effectively diagnose and manage FM if they better understood its underlying mechanisms. Fibromyalgia is a disorder of pain processing. Evidence suggests that both the ascending and descending pain pathways operate abnormally, resulting in central amplification of pain signals, analogous to the "volume control setting" being turned up too high. Patients with FM also exhibit changes in the levels of neurotransmitters that cause augmented central nervous system pain processing; levels of several neurotransmitters that facilitate pain transmission are elevated in the cerebrospinal fluid and brain, and levels of several neurotransmitters known to inhibit pain transmission are decreased. Pharmacological agents that act centrally in ascending and/or descending pain processing pathways, such as medications with approved indications for FM, are effective in many patients with FM as well as other conditions involving central pain amplification. Research is ongoing to determine the role of analogous central nervous system factors in the other cardinal symptoms of FM, such as fatigue, nonrestorative sleep, and cognitive dysfunction.
Article
Many chronic pain syndromes are associated with hypersensitivity to painful stimuli and with reduced endogenous pain inhibition. These findings suggest that modulation of pain-related information may be linked to the onset or maintenance of chronic pain. The combination of heightened pain sensitivity and reduced pain inhibition seems to predispose individuals to greater risk for increased acute clinical pain. It is unknown whether such pain processing abnormalities may also place individuals at increased risk for chronic pain. Psychophysical methods can be used for the evaluation of pain sensitivity and pain inhibition. Long-term prospective studies that could yield insight into the role of heightened pain sensitivity and pain disinhibition for the development of chronic pain disorders like fibromyalgia in the general population are lacking, however.
Article
To determine whether abnormalities of peripheral and central nociceptive sensory input processing exist outside areas of spontaneous pain in patients with fibromyalgia (FM) as compared with controls, by using quantitative sensory testing (QST) and a neurophysiologic paradigm independent from subjective reports. A total of 164 outpatients with FM who were attending a self-management program were invited to participate in the study. Data for 85 patients were available and were compared with those for 40 non-FM controls matched for age and sex. QST was performed using thermal, mechanical, and electrical stimuli at locations of nonspontaneous pain. Pain assessment was 2-fold and included use of subjective scales and the spinal nociceptive flexion reflex (NFR), a specific physiologic correlate for the objective evaluation of central nociceptive pathways. Questionnaires regarding quality of life and the impact of FM were available. Participants were mainly middle-aged women, with a mean disease duration of 8 years. Between-group differences were significant for neurophysiologic, clinical, and quality of life measures. In patients with FM, peripheral QST showed significantly altered cold and heat pain thresholds, and tolerance to cold pain was radically reduced. The median NFR threshold in patients with FM (22.7 mA [range 17.5-31.7]) was significantly decreased compared with that in controls (33 mA [range 28.1-41]). A cutoff value of <27.6 mA for NFR provided sensitivity of 73% and specificity of 80% for detecting central allodynia in the setting of FM. Our results strongly, although indirectly, point to a state of central hyperexcitability of the nociceptive system in patients with FM. The NFR can be used to assess central allodynia in FM. It may also help discriminate patients who may benefit from use of centrally acting analgesics.
Article
To evaluate the morbidity from chronic pelvic pain after pelvic inflammatory disease (PID). A total of 547 women were studied as part of the PID Evaluation and Clinical Health (PEACH) Study. Chronic pelvic pain was defined as pelvic pain reported at two or more consecutive interviews conducted every 3 to 4 months through 32 months and was graded as mild to moderate (low pain intensity) or moderate to severe (high pain intensity). Mean Medical Outcomes Study Short Form (SF-36) scores at 32 months were compared by chronic pelvic pain categories. The mean (+/- standard deviation) physical health composite scores and mental health composite scores from the SF-36 were progressively lower among women with increasing grade of chronic pelvic pain (physical health composite scores: no chronic pelvic pain = 87.3 +/- 10.7, mild to moderate chronic pelvic pain = 79.1 +/- 14.6, moderate to severe chronic pelvic pain = 73.6 +/- 16.0, P < .01; mental health composite scores: no chronic pelvic pain = 78.7 +/- 13.6, mild to moderate chronic pelvic pain = 69.1 +/- 15.8, moderate to severe chronic pelvic pain = 67.5 +/- 17.1, P < or = .01). Individual physical function, bodily pain, general health, vitality, social function, and mental health scores were also significantly lower among women with chronic pelvic pain and by increasing grade of pain intensity. Chronic pelvic pain after PID is associated with reduced physical and mental health.
Article
Fibromyalgia syndrome (FM) is a common chronic pain condition that affects at least 2% of the adult population in the USA and other regions in the world where FM is studied. Prevalence rates in some regions have not been ascertained and may be influenced by differences in cultural norms regarding the definition and attribution of chronic pain states. Chronic, widespread pain is the defining feature of FM, but patients may also exhibit a range of other symptoms, including sleep disturbance, fatigue, irritable bowel syndrome, headache, and mood disorders. Although the etiology of FM is not completely understood, the syndrome is thought to arise from influencing factors such as stress, medical illness, and a variety of pain conditions in some, but not all patients, in conjunction with a variety of neurotransmitter and neuroendocrine disturbances. These include reduced levels of biogenic amines, increased concentrations of excitatory neurotransmitters, including substance P, and dysregulation of the hypothalamic-pituitary-adrenal axis. A unifying hypothesis is that FM results from sensitization of the central nervous system. Establishing diagnosis and evaluating effects of therapy in patients with FM may be difficult because of the multifaceted nature of the syndrome and overlap with other chronically painful conditions. Diagnostic criteria, originally developed for research purposes, have aided our understanding of this patient population in both research and clinical settings, but need further refinement as our knowledge about chronic widespread pain evolves. Outcome measures, borrowed from clinical research in pain, rheumatology, neurology, and psychiatry, are able to distinguish treatment response in specific symptom domains. Further work is necessary to validate these measures in FM. In addition, work is under way to develop composite response criteria, intended to address the multidimensional nature of this syndrome. A range of medical treatments, including antidepressants, opioids, nonsteroidal antiinflammatory drugs, sedatives, muscle relaxants, and antiepileptics, have been used to treat FM. Nonpharmaceutical treatment modalities, including exercise, physical therapy, massage, acupuncture, and cognitive behavioral therapy, can be helpful. Few of these approaches have been demonstrated to have clear-cut benefits in randomized controlled trials. However, there is now increased interest as more effective treatments are developed and our ability to accurately measure effect of treatment has improved. The multifaceted nature of FM suggests that multimodal individualized treatment programs may be necessary to achieve optimal outcomes in patients with this syndrome.
Article
To compare skin-surface cooling caused by the application of an ice bag (15min) and the projection of carbon dioxide microcristals (2min) under high pressure (75 bar) and low temperature (-78 degrees C), a modality called hyperbaric gaseous cryotherapy. Randomized controlled trial with repeated measure. Laboratory experiment. Twelve healthy male subjects (mean +/- standard deviation, 22.9+/-1.8y). Ice bag and hyperbaric gaseous cryotherapy were randomly applied on the skin of the nondominant hand. Skin temperature of the cooled (dorsal and palmar sides) and contralateral (dorsal side) hands were continuously measured with thermistor surface-contact probes before, during, and after (30min) cooling. Hyperbaric gaseous cryotherapy projection induced a large decrease (P<.05) of the dorsal skin temperature of the cooled hand (from 32.5 degrees +/-0.5 degrees C to 7.3 degrees +/-0.8 degrees C) and a significant decrease of the skin temperature of the palmar side and of the contralateral hand. The skin temperature of the dorsal side of the cooled hand was decreased with an ice bag (from 32.5 degrees +/-0.6 degrees C to 13.9 degrees +/-0.7 degrees C, P<.05). However, the lowest temperature was significantly higher than during hyperbaric gaseous cryotherapy, and no significant changes in the other skin temperatures were observed. Rewarming was equal after the 2 modalities, highlighting a more rapid increase of the skin temperature after hyperbaric gaseous cryotherapy. Hyperbaric gaseous cryotherapy projection decreased the skin temperature of the cooled and contralateral hand, suggesting a systemic skin vasoconstriction response. On the other hand, the vascular responses triggered by ice pack cooling appeared limited and localized to the cooled area.
Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia
  • R H Gracely
  • F Petzke
  • J M Wolf
  • D J Clauw
Gracely RH, Petzke F, Wolf JM, Clauw DJ. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheumatol. 2002;46(5):1333-1343.
Physiologie humaine, les mécanismes de fonctionnement de l'organisme. 4ème éd Paris-Maloine editor
  • J Vander
  • J H Sherman
  • D S Luciano
Vander J, Sherman JH, Luciano DS. Physiologie humaine, les mécanismes de fonctionnement de l'organisme. 4ème éd Paris-Maloine editor; 2004.
Self-rated physical health (1.a) and mental health (1.b) as a function of group and time
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Fig. 2. Self-rated physical health (1.a) and mental health (1.b) as a function of group and time.
  • M Vitenet
M. Vitenet et al. Complementary Therapies in Medicine 36 (2018) 6-8