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
■ Once a day BT, Sandıklı Spa
Center, Afyon
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) 45.29 41.73
(SD) (6.79) (10.63)
Mean duration 5.88 3.33
of the disease (4.20) (1.76)
(year)
(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 scores
in the middle and
at the end of the
cure.
■ No significant
difference was
observed between
the two groups.
Total Algometric Score
■ Significant
improvement was
seen in Total
Algometric Score in
the middle and at
the end of the cure.
■ No significant
difference was
observed between
the two groups.
Tender Point Count
■ Significant
reduction was seen
in Tender Point
Count in the
middle and at the
end of the cure.
■ Group I was found
significantly
different than
group II.
Beck Depression Inventory
■ Significant
improvement was
seen in Beck
Depression
Inventory in the
middle and at the
end of the cure.
■ No significant
difference was
observed between
the two groups.
Hamilton Depression Rating
Scale
■ Significant
improvement was
seen in HDRS in
the middle and at
the end of the
cure.
■ No significant
difference was
observed between
the 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