The Effectiveness of The Effectiveness of Traditional Spa Therapy Traditional Spa Therapy

in Patients with in Patients with FibromyalgiaFibromyalgia

Ufuk ŞenUfuk Şen

M Zeki KaragülleM Zeki Karagülle

Fibromyalgia Fibromyalgia

Fibromyalgia (FM) is a common Fibromyalgia (FM) is a common nonarticular rheumatical disorder.nonarticular rheumatical disorder.

It is characterized by widespread It is characterized by widespread musculoskeletal pain and tenderness musculoskeletal pain and tenderness in previously defined tender point in previously defined tender point sites.sites.

Basic FeaturesBasic Features

Generalized painGeneralized pain FatiqueFatique Sleep disturbanceSleep disturbance Skinfold tendernessSkinfold tenderness Cold intolerance Cold intolerance StiffnessStiffness

Associated withAssociated with

Irritable bowel syndromeIrritable bowel syndrome Chronic fatique syndromeChronic fatique syndrome Depression and anxiety disordersDepression and anxiety disorders Temporomandibular disordersTemporomandibular disorders Tension and migraine headacheTension and migraine headache Interstitial cystitisInterstitial cystitis

DiagnosisDiagnosis

Widespread pain in Widespread pain in combination withcombination with

Tenderness at 11 Tenderness at 11 or more of the 18 or more of the 18 spesific tender spesific tender point sitespoint sites

Treatment ModalitiesTreatment Modalities Patient educationPatient education PsychotherapyPsychotherapy ExercisesExercises Medical treatmentMedical treatment BalneotherapyBalneotherapy TENSTENS Local injectionLocal injection AcupunctureAcupuncture MassageMassage Local ice/heat etc.Local ice/heat etc.

Spa TreatmentSpa Treatment

Spa treatment has been applied Spa treatment has been applied amprically in our country in amprically in our country in ancient times.ancient times.

Contemporary spa treatment is a Contemporary spa treatment is a method, in which thermomineral method, in which thermomineral water, peloid and climate are used water, peloid and climate are used for prevention and rehabilitation for prevention and rehabilitation of the chronic illness.of the chronic illness.

Traditional Spa Therapy Traditional Spa Therapy in FMin FM

In this study, In this study, We aimed to determine the effect We aimed to determine the effect

of Balneotherapy and of Balneotherapy and Peloidotherapy in patients with Peloidotherapy in patients with FM.FM.

We evaluated the effectiveness of We evaluated the effectiveness of traditional cure for eight days.traditional cure for eight days.

Water AnalysisWater Analysis(Sandıklı Spa Center, (Sandıklı Spa Center,

Afyon)Afyon) PH:6.32PH:6.32 T (CT (C°°):65):65 LF:47 FrSLF:47 FrS CO2:264 mg/lCO2:264 mg/l Free H2S: (-)Free H2S: (-) Total Mineralizations: 1562.220 mg/lTotal Mineralizations: 1562.220 mg/l Main components: Na, Ca, HCO3, Main components: Na, Ca, HCO3,

SO4SO4

Study groupsStudy groups

Group IGroup I Balneotherapy (BT)Balneotherapy (BT)

+ +

Peloidotherapy (PT) Peloidotherapy (PT) (n:17)(n:17)

Once a day BT, Once a day BT,

once a day PTonce a day PT 8 days stay at 8 days stay at

Sandıklı Spa Center, Sandıklı Spa Center, AfyonAfyon

Group IIGroup II Balneotherapy Balneotherapy

(BT)(n:15)(BT)(n:15) Twice a day BTTwice a day BT 8 days stay at 8 days stay at

Sandıklı Spa Sandıklı Spa Center, AfyonCenter, Afyon

PatientsPatients

Group I Group I

(BT+PT)(BT+PT)Group IIGroup II

(BT)(BT)

Number of the Number of the patientspatients

1717 1515

Sex (F:Female, Sex (F:Female, M:male)M:male)

17F17F 15F15F

Mean age (year) Mean age (year) (SD)(SD)

45.29 45.29

(6.79)(6.79)41.7341.73

(10.63)(10.63)

Mean duration Mean duration of the disease of the disease (year)(year)

(SD)(SD)

5.885.88

(4.20)(4.20)3.333.33

(1.76)(1.76)

Group IGroup I(BT+PT)(BT+PT)

Full peloid bath for 10-15 Full peloid bath for 10-15 minutes on 45-47 Cminutes on 45-47 C°° in the in the morning for eight daysmorning for eight days

Thermomineral water bath for Thermomineral water bath for 15-20 minutes on 39-40 C15-20 minutes on 39-40 C°° in the in the evening for eight daysevening for eight days

Group IIGroup II(BT)(BT)

Thermomineral water baths for Thermomineral water baths for 15-20 minutes on 39-40 C15-20 minutes on 39-40 C°° twice twice a day for eight daysa day for eight days

Outcome MeasuresOutcome Measures

1.) Assessment of pain1.) Assessment of pain

a. VAS index (1-10)a. VAS index (1-10)

b. Total Algometric score (kg/cm2)b. Total Algometric score (kg/cm2)

c. Tender point countc. Tender point count 2.) Assessment of depression2.) Assessment of depression

a. Beck Depression Inventorya. Beck Depression Inventory

b. Hamilton Depression Rating Scaleb. Hamilton Depression Rating Scale

AssessmentsAssessments

Before spa therapy (first day)Before spa therapy (first day) In the middle of spa therapy (fourth day)In the middle of spa therapy (fourth day) After spa therapy (eighth day)After spa therapy (eighth day) Mann Whitney-U and Wilcoxon signed Mann Whitney-U and Wilcoxon signed

rank test was performed to compare the rank test was performed to compare the parameters.parameters.

Pain-VASPain-VAS

0

10

20

30

40

50

60

70

80

90

Before Middle After

Group IGroup II

Significant Significant reduction was seen reduction was seen in Pain-VAS scores in Pain-VAS scores in the middle and in the middle and at the end of the at the end of the cure.cure.

No significant No significant difference was difference was observed between observed between the two groups.the two groups.

Total Algometric ScoreTotal Algometric Score

0

10

20

30

40

50

60

70

Before Middle After

Group IGroup II

Significant Significant improvement was improvement was seen in Total seen in Total Algometric Score in Algometric Score in the middle and at the middle and at the end of the cure.the end of the cure.

No significant No significant difference was difference was observed between observed between the two groups.the two groups.

Tender Point CountTender Point Count

0

2

4

6

8

10

12

14

16

Before Middle After

Group IGorup II

Significant Significant reduction was seen reduction was seen in Tender Point in Tender Point Count in the Count in the middle and at the middle and at the end of the cure.end of the cure.

Group I was found Group I was found significantly significantly different than different than group II.group II.

Beck Depression Beck Depression InventoryInventory

0

5

10

15

20

25

30

Before After

Group IGroup II

Significant Significant improvement was improvement was seen in Beck seen in Beck Depression Depression Inventory in the Inventory in the middle and at the middle and at the end of the cure.end of the cure.

No significant No significant difference was difference was observed between observed between the two groups.the two groups.

Hamilton Depression Hamilton Depression Rating ScaleRating Scale

0

5

10

15

20

25

Before After

Group IGroup II

Significant Significant improvement was improvement was seen in HDRS in seen in HDRS in the middle and at the middle and at the end of the the end of the cure. cure.

No significant No significant difference was difference was observed between observed between the two groups. the two groups.

3232 Patients with Patients with FMFM Group I:Group I: 17 17 PatientsPatients : 2 ba : 2 bathsths / / dayday (8 days(8 days) ) Group II: 15 Patients : 1 Group II: 15 Patients : 1 babathth + + 1 full 1 full peloid peloid / / dayday (8 days(8 days))   

Group IGroup I Group II Group II Group I / IIGroup I / II

PainPain(Before-8. Days)(Before-8. Days) p<0.0001p<0.0001 p<0.0001 p<0.0001 NS NS

Tender point countTender point count(Before-8. Days) (Before-8. Days) p<0.0001 p<0.0001 p<0.007 p<0.007 p<0.00p<0.00

Total Algometric scorTotal Algometric scoree(Before-8. Days)(Before-8. Days) p<0.001p<0.001 p<0.001 p<0.001 NS NS

Beck Depression InventoryBeck Depression Inventory(Before-8. days)(Before-8. days) p<0.034p<0.034 p<0.0001p<0.0001 NS NS

Hamilton Depression Rating ScaleHamilton Depression Rating Scale (Before-8. Days) (Before-8. Days) p<0.001p<0.001 p<0.001p<0.001 NS NS

DiscussionDiscussion

Balneotherapy has been used to relieve Balneotherapy has been used to relieve muscle spasm, increase the circulation muscle spasm, increase the circulation and decrease the mental stress of the and decrease the mental stress of the patients in the treatment of FM.patients in the treatment of FM.

Sulphur spring water, acratothermal Sulphur spring water, acratothermal water, radon bath, salined water bath water, radon bath, salined water bath and peloid can be used in the treatment and peloid can be used in the treatment of FM.of FM.

DiscussionDiscussion

We believe that pain relief and decreased We believe that pain relief and decreased muscle spasm with subsequent muscle spasm with subsequent improvement of psychological complaints improvement of psychological complaints of the patients may have resulted from of the patients may have resulted from the effects of the physical, thermic and the effects of the physical, thermic and chemical properties of the chemical properties of the thermomineral water, peloid and climate thermomineral water, peloid and climate of the region.of the region.

DiscussionDiscussion

-Effective mechanisms of the -Effective mechanisms of the Balneotherapy:Balneotherapy:

Pain and muscle spasm may be improved Pain and muscle spasm may be improved by counter-stimulation effect of by counter-stimulation effect of balneotherapy.balneotherapy.

Thermal stimulus may effect the pain Thermal stimulus may effect the pain sensation.sensation.

Heating effect of balneotherapy results in Heating effect of balneotherapy results in vasodilatation which reduces muscle vasodilatation which reduces muscle ischemia and pain.ischemia and pain.

ConclusionConclusion Our results have shown that Our results have shown that

Balneotherapy is effective in the Balneotherapy is effective in the treatment of FM which is a common treatment of FM which is a common chronic pain syndrome.chronic pain syndrome.

Moreover, we found that both traditional Moreover, we found that both traditional cure modalities were effective in patients cure modalities were effective in patients with FM. Peloid and Thermomineral with FM. Peloid and Thermomineral water bath cures once a day were water bath cures once a day were superior to Thermomineral water bath superior to Thermomineral water bath cure twice a day in terms of tender point cure twice a day in terms of tender point count additionally.count additionally.

ConclusionConclusion

However, we need further However, we need further comprehensive studies to comprehensive studies to determine whether there is any determine whether there is any difference between these cure difference between these cure modalities in terms of the duration modalities in terms of the duration of application and longer efficiency.of application and longer efficiency.