Balneotherapy

BALNEOTHERAPY IN
FIBROMYALGIA: A SINGLE
BLIND RANDOMIZED
CONTROLLED CLINICAL STUDY
Septiandry Ade Putra

Fibromyalgia
■ Fibromyalgia (FM) is a common nonarticular rheumatical

disorder.
■ It is characterized by widespread musculoskeletal pain and
tenderness in previously defined tender point sites.
Basic Features
■ Generalized pain
■ Fatique
■ Sleep disturbance
■ Skinfold tenderness
■ Cold intolerance
■ Stiffness
Associated with
■ Irritable bowel syndrome

■ Chronic fatique syndrome
■ Depression and anxiety disorders
■ Temporomandibular disorders
■ Tension and migraine headache
■ Interstitial cystitis
Diagnosis
■ Widespread pain in
combination with
■ Tenderness at 11 or
more of the 18 spesific
tender point sites
Treatment Modalities
■ Patient education
■ Psychotherapy
■ Exercises
■ Medical treatment
■ Balneotherapy
■ TENS
■ Local injection
■ Acupuncture
■ Massage
■ Local ice/heat etc.
Spa Treatment
■ Spa treatment has been applied

amprically in our country in ancient
times.
■ Contemporary spa treatment is a
method, in which thermomineral
water, peloid and climate are used
for prevention and rehabilitation of
the chronic illness.
Traditional Spa Therapy in FM
In this study,
■ We aimed to determine the effect
of Balneotherapy and
Peloidotherapy in patients with FM.
■ We evaluated the effectiveness of
traditional cure for eight days.
Water Analysis
(Sandıklı Spa Center, Afyon)
■ PH:6.32
■ T (C°):65
■ LF:47 FrS
■ CO2:264 mg/l
■ Free H2S: (-)
■ Total Mineralizations: 1562.220 mg/l
■ Main components: Na, Ca, HCO3, SO4
Study groups
Group I Group II
■ Balneotherapy (BT) ■ Balneotherapy
(BT)(n:15)
+
■ Twice a day BT
Peloidotherapy (PT)
(n:17) ■ 8 days stay at Sandıklı
Spa Center, Afyon
■ Once a day BT,
once a day PT
■ 8 days stay at Sandıklı
Spa Center, Afyon
Patients
Group I Group II
(BT+PT) (BT)
Number of the 17 15
patients
Sex (F:Female, 17F 15F
M:male)
Mean age (year) (SD) 45.29 41.73
(6.79) (10.63)
Mean duration of the 5.88 3.33
disease (year) (4.20) (1.76)
(SD)
Group I
(BT+PT)
■ Full peloid bath for 10-15 minutes on

45-47 C° in the morning for eight days
■ Thermomineral water bath for 15-20
minutes on 39-40 C° in the evening for
eight days
Group II
(BT)
■ Thermomineral water baths for 15-20

minutes on 39-40 C° twice a day for
eight days
Outcome Measures
■ 1.) Assessment of pain

a. VAS index (1-10)
b. Total Algometric score (kg/cm2)
c. Tender point count
■ 2.) Assessment of depression
a. Beck Depression Inventory
b. Hamilton Depression Rating Scale
Assessments
■ Before spa therapy (first day)

■ In the middle of spa therapy (fourth day)
■ After spa therapy (eighth day)
■ Mann Whitney-U and Wilcoxon signed rank test was performed to
compare the parameters.
Pain-VAS
■ Significant reduction
was seen in Pain-VAS
90
80
scores in the middle
70
60
and at the end of the
50
40
Group I
Group II
cure.
30
20 ■ No significant
difference was
10
0
Before Middle After
observed between the

two groups.
Total Algometric Score
■ Significant
improvement was seen
70
60
in Total Algometric
50 Score in the middle
40
30
Group I
Group II
20 cure.
10
0
Before Middle After
■ No significant
difference was
two groups.
Tender Point Count
■ Significant reduction
was seen in Tender
16
14
Point Count in the
12
10
middle and at the end
8 Group I
Gorup II
of the cure.
6
2
■ Group I was found
0
Before Middle After
significantly different
than group II.
Beck Depression Inventory
■ Significant
30
in Beck Depression
Inventory in the middle
25
20
15 Group I
Group II
10
cure.
5
0
Before After
■ No significant
difference was
two groups.
Hamilton Depression Rating Scale
■ Significant
25
in HDRS in the middle
20
cure.
15
Group I
Group II
10
5 ■ No significant
0
Before After
difference was
two groups.
32 Patients with FM
■ Group I: 17 Patients : 2 baths / day (8 days)
■ Group II: 15 Patients : 1 bath + 1 full peloid / day (8 days)
Group I Group II Group I / II
Pain
(Before-8. Days) p<0.0001 p<0.0001 NS
Tender point count

(Before-8. Days) p<0.0001 p<0.007 p<0.00
Total Algometric score

(Before-8. Days) p<0.001 p<0.001 NS
Beck Depression Inventory

(Before-8. days) p<0.034 p<0.0001 NS
Hamilton Depression Rating Scale

(Before-8. Days) p<0.001 p<0.001 NS
Discussion
■ Balneotherapy has been used to relieve muscle spasm, increase the
circulation and decrease the mental stress of the patients in the
treatment of FM.
■ Sulphur spring water, acratothermal water, radon bath, salined water
bath and peloid can be used in the treatment of FM.
Discussion
■ We believe that pain relief and decreased muscle spasm with

subsequent improvement of psychological complaints of the patients
may have resulted from the effects of the physical, thermic and
chemical properties of the thermomineral water, peloid and climate of
the region.
Discussion
-Effective mechanisms of the Balneotherapy:

■ Pain and muscle spasm may be improved by counter-
stimulation effect of balneotherapy.
■ Thermal stimulus may effect the pain sensation.
■ Heating effect of balneotherapy results in vasodilatation
which reduces muscle ischemia and pain.
Conclusion
■ Our results have shown that Balneotherapy is effective in the treatment
of FM which is a common chronic pain syndrome.
■ Moreover, we found that both traditional cure modalities were effective
in patients with FM. Peloid and Thermomineral water bath cures once a
day were superior to Thermomineral water bath cure twice a day in
terms of tender point count additionally.
Conclusion
■ However, we need further

comprehensive studies to determine
whether there is any difference
between these cure modalities in terms
of the duration of application and
longer efficiency.
THANK YOU

Balneotherapy

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BALNEOTHERAPY IN

Septiandry Ade Putra

■ Fibromyalgia (FM) is a common nonarticular rheumatical

■ Irritable bowel syndrome

■ Spa treatment has been applied

■ Full peloid bath for 10-15 minutes on

■ Thermomineral water baths for 15-20

■ 1.) Assessment of pain

■ Before spa therapy (first day)

observed between the

Tender point count

Total Algometric score

Beck Depression Inventory

Hamilton Depression Rating Scale

■ We believe that pain relief and decreased muscle spasm with

-Effective mechanisms of the Balneotherapy:

■ However, we need further

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