spa therapy and balneotherapy for fibromyalgia in turkey a dönmez
TRANSCRIPT
Spa Therapy and Balneotherapy for Fibromyalgia in Turkey
A Dönmez
Patients' issues
•Intractable illness •If there is no known cause, I can't get better •No one believes me •I can't exercise or do my work
Goldenberg D L : Office management of fibromyalgia. Rheum Dis Clin North Am 2002;2:28
Rheumatologists' issues•We are not pain doctors •Fibromyalgia is a psychiatric illness •Nothing works •Patients don't want to get better
Goldenberg D L : Office management of fibromyalgia. Rheum Dis Clin North Am 2002;2:28
Outcome measures for FM studies
Pain Tender pointsPhysical functionGlobal well being or perceived improvementSelf-efficacyFatigue and sleepPsychological function
Groups Effectiveness
20 women 2 weeks 37oC 20 minutes bath +
Relaxation Exercise
Pain ↓ Pressure pain tolerance scores ↑
Yurtkuran M
1996
FMS
40
20 women 2 weeks Relaxation Exercise
Pain ↓
Yurtkuran M, Celiktas M: A randomized, controlled trial of balneotherapy in the treatment of patients with primary fibromyalgia syndrome. Phys Rehab Kur Med 1996:109-112
Groups Effectiveness
Kesiktaş N 2000
FMS 16
Balneotherapy (Total 15 full baths 37oC, 20 min) + Electrotherapy 3 weeks in inpatient setting
After therapy and 6th months Pain (VAS) ↓ Tender points ↓ Total algometric score ↑ BDI ↓ HDI ↓
FMS 20
Hidrotherapy + Electrotherapy 3 weeks in inpatient setting
After therapy and 6th months Pain (VAS) ↓ Tender points ↓ Total algometric score ↑ BDI ↓ (Only after therapy) HDI ↓ (Only after therapy)
FMS 20
Electrotherapy 3 weeks in inpatient setting
After therapy Pain (VAS) ↓ (Only after therapy) Tender points ↓ (Only after therapy) BDI ↓ (Only after therapy) HDI ↓ (Only after therapy) Total algometric score NS
Kesiktaş N, Karagülle,Erdogan N, Özer N:The short and long time evaluations of some therapy modalities the patients with fibromyalgia syndrome. (Presented in 4. Turkish-German Balneology and Climatology Congress, 2000)
Evcik D, Kızılay B, Gökçen E:The effects of balneotherapy on fibromyalgia patients. Rheumatol Int. 2002 Jun;22 (2):56-9
Groups Effectiveness
22 patients:
3 weeks (Total 15 full baths)
37oC, 20 min
Evcik D et al
2002
FMS
42
20 patients:
Standart medical care
After balneotherapy
and 6th months
Pain (VAS) ↓
Tender points ↓
FIQ ↓
(Up to 6 months)
BDI ↓
(Only after therapy)
Groups Effectiveness
17 patients:
2 pool-bath / day
(1 weeks)
39oC, 15 min
Şen U. et al
2002
FMS
32
15 patients:
1 pool bath + 1peloid
packung (full) / day
(1 week)
45oC, 15 min
In both group 4. and 8. days
Pain (VAS) ↓
Tender points ↓
Total algometric Score ↑
BDI ↓
Hamilton Depression Scale ↓
Şen U, Karagülle MZ, Karagülle M, Dönmez A, Şen C (2002) Comparison of the efficacy of two different traditional spa regimens in patients with fibromyalgia syndrome. PTT Hastanesi Tıp Dergisi 24:78-81
Groups Effectiveness
25 patients:
3 / week (12 weeks)
37oC, 35 min
pool-based exercise
Altan L et al
2003
FMS
50
25 patients:
3 / week (12 weeks)
37oC, 35 min
pool bath
In both group
12. and 24 weeks
Pain (VAS) ↓
Tender points ↓
FIQ ↓
Fatigue ↓
BDI ↓
Global evaluation ↑
Altan L, Bingöl Ü, Aykaç M, Koç Z, Yurtkuran M (2003) Investigation of the pool based exercises on fibromyalgia syndrome. Rheumatol Int Published online: 24 September2003
Groups Effectiveness
16 women 2 weeks 37oC 20 minutes pool bath (every day) + Pressured shower (every other day) + Classical massage (every other day) in Balcova Spa Center
Dönmez A FMS
29
13 women (1 withdraw after randomization) 2 weeks standard medical care in daily living area
•Improvement in all study variables in the spa group in short- and middle-term •Improvements in spa group are superior to the controls –FIQ (until 6th month) –Pain (until 1st month) –Tender point count (until 1st month) –Patient’s global assessment (end-of-treatment evaluation) –Fatigue (end-of-treatment evaluation)
Dönmez A, Karagülle MZ, Tercan N, Dinler M, İşsever H, Karagülle M, Turan M: Spa therapy in fibromyalgia: a randomized controlled clinic study (In press)
A. Dönmez, M. Zeki Karagülle, M.Turan, E. Odabaşı (Turkey): The effect of spa therapy on health related quality of life in fibromyalgia
Groups Outcome
measurements
16 women 2 weeks 37oC 20 minutes pool bath (every day) + Pressured shower (every other day) + Classical massage (every other day) in Balcova Spa Center
Dönmez A FMS
29
13 women 2 weeks standard medical care in daily living area
SF-36 Physical functioning Role limitation Bodily pain Social functioning General mental health Role limitations-
emotional problems Vitality,energy or
fatigue General health
perception FIQ
Groups Outcome Measurements
Dönmez A FMS
23
19 women 4 men 37oC 20 minutes bath
(every day)
2 weeks
in Gönen Spa Center
FIQ
Physical functioning Days of feeling good Missed days of work Difficulty with work Pain severity Tiredness Awoke very tired Stiffness Nervous or anxious Depression
Pain (VAS)
Patient’s global assessment
BDI
A. Dönmez, M. Zeki Karagülle, S. Özkurt: Spa therapy for Fibromyalgia in Gönen; an observational study
General Results
Spa therapy or balneotherapy are effective on FIQ and nearly all of the parameters Pain Tender point count Physical function Global well being or perceived improvement Fatigue and sleep Psychological function
the patients with FM
Action mechanisms Heat Buoyancy Muscle tonus decrease Gate-control theory Peripheral vasodilatation ß-endorphin level Environment change Non-competitive atmosphere Absence of work duties
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