title: Spa treatment for primary fibromyalgia syndrome: a combination of thalassotherapy, exercise and patient education improves symptoms and quality of life. Cost-effectiveness of Spa treatment for fibromyalgia: general health improvement is not for free. Patient-derived Determinants for Participation in Placebo-controlled Clinical Trials for Fibromyalgia Balneotherapy in fibromyalgia: a single blind randomized controlled clinical study Eight months of physical training in warm water improves physical and mental health in women with fibromyalgia: a randomized controlled trial. Pool exercise for patients with fibromyalgia or chronic widespread pain: a randomized controlled trial and subgroup analyses. [Inpatient aftercare in rheumatic diseases--concept, trial, and acceptance]. A pragmatic community-based intervention of multimodal physiotherapy plus deep water running (DWR) for fibromyalgia syndrome: a pilot study A warm water pool-based exercise program decreases immediate pain in female fibromyalgia patients: uncontrolled clinical trial. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Fibromyalgia: a randomised, controlled trial of a treatment programme based on self management CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomized Trials Effects of pool-based exercise in fibromyalgia symptomatology and sleep quality: a prospective randomised comparison between stretching and Ai Chi. Cost-utility of an 8-month aquatic training for women with fibromyalgia: a randomized controlled trial Effects of balneotherapy on serum IL-1, PGE2 and LTB4 levels in fibromyalgia patients Pool exercise combined with an education program for patients with fibromyalgia syndrome. A prospective, randomized study. Thalassotherapy for fibromyalgia: a randomized controlled trial comparing aquatic exercises in sea water and water pool Six-month and one-year followup of 23 weeks of aerobic exercise for individuals with fibromyalgia. Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial. Balneotherapy for fibromyalgia at the Dead Sea A randomized, controlled trial of exercise and education for individuals with fibromyalgia. Function of the hypothalamic adrenal axis in patients with fibromyalgia syndrome undergoing mud-pack treatment. The Effect of Balneotherapy at the Dead Sea on the Quality of Life of Patients with Fibromyalgia Syndrome A double-blind comparison of ibuprofen, placebo and ibuprofen with meptazinol in soft tissue rheumatism. Six- and 24-month follow-up of pool exercise therapy and education for patients with fibromyalgia Investigation of the effects of pool-based exercise on fibromyalgia syndrome [Medicinal baths for treatment of generalized fibromyalgia]. Exercise in waist-high warm water decreases pain and improves health-related quality of life and strength in the lower extremities in women with fibromyalgia. Phytothermotherapy: a possible complementary therapy for fibromyalgia patients. Effects of thermal therapy combining sauna therapy and underwater exercise in patients with fibromyalgia. Effects of mud-bath treatment on fibromyalgia patients: a randomized clinical trial Hydrotherapy and conventional physiotherapy improve total sleep time and quality of life of fibromyalgia patients: randomized clinical trial. [Intraindividual comparison of whole body cold therapy and warm treatment with hot packs in generalized tendomyopathy]. Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia. A randomized controlled trial of deep water running: clinical effectiveness of aquatic exercise to treat fibromyalgia. Effects of Stanger bath therapy on fibromyalgia Effect of a randomized, controlled trial of exercise on mood and physical function in individuals with fibromyalgia. Aquatic training and detraining on fitness and quality of life in fibromyalgia. Improvements of muscle strength predicted benefits in HRQOL and postural balance in women with fibromyalgia: an 8-month randomized controlled trial. SPA therapy in fibromyalgia: a randomised controlled clinic study The clinical application of etanercept in Chinese patients with rheumatic diseases Low-power laser treatment for shoulder pain. The effects of balneotherapy on fibromyalgia patients [The effect of Ai Chi method in fibromyalgic patients]. Balneotherapy at the Dead Sea area for patients with psoriatic arthritis and concomitant fibromyalgia. A Randomized Controlled Trial on the Effectiveness of Mild Water-filtered Near Infrared Whole-body Hyperthermia as an Adjunct to a Standard Multimodal Rehabilitation in the Treatment of Fibromyalgia
abstract: OBJECTIVES To study the effect of a combination of thalassotherapy , exercise and patient education in people with fibromyalgia . METHODS Patients with fibromyalgia , selected from a rheumatology out-patient department and from members of the Dutch fibromyalgia patient association , were pre-r and omized to receive either 2(1/2 ) weeks of treatment in a Tunisian spa resort , including thalassotherapy , supervised exercise and group education ( active treatment ) or treatment as usual ( control treatment ) . Primary outcome measure was health-related quality of life , measured with the R AND -36 question naire . Secondary measures included the Fibromyalgia Impact Question naire , the McGill Pain Question naire , the Beck Depression Inventory , tender point score and a 6-min treadmill walk test . RESULTS Fifty-eight participants receiving the active treatment reported significant improvement on R AND -36 physical and mental component summary scales . For physical health , differences from the 76 controls were statistically significant after 3 months , but not after 6 and 12 months . A similar pattern of temporary improvement was seen in the self-reported secondary measures . Tender point scores and treadmill walk tests improved more after active treatment , but did not reach significant between-group differences , except for walk tests after 12 months . CONCLUSIONS A combination of thalassotherapy , exercise and patient education may temporarily improve fibromyalgia symptoms and health-related quality of life OBJECTIVES To estimate the cost-effectiveness of an adjuvant treatment course of spa treatment compared with usual care only in patients with fibromyalgia syndrome ( FM ) . METHODS 134 patients with FM , selected from a rheumatology outpatient department and from members of the Dutch FM patient association were r and omly assigned to a 2(1/2 ) week spa treatment course in Tunisia or to usual care only . Results are expressed as quality -adjusted life years ( QALYs ) for a 6-month as well as a 12-month time horizon . Utilities were derived form the Short Form 6D ( SF-6D ) scores and the visual analogue scale ( VAS ) rating general health . Costs were reported from societal perspective . Mean incremental cost per patient and the incremental cost utility ratio ( ICER ) were calculated ; 95 % confidence intervals ( CIs ) were estimated using double-sided bootstrapping . RESULTS The data of 128 ( 55 spa and 73 controls ) of the 134 patients ( 96 % ) could be used for analysis . Improvement in general health was found in the spa group until 6 months of follow-up by both the SF-6D ( AUC 0.32 vs 0.30 , P < 0.05 ) and the VAS ( AUC 0.23 vs 0.19 , P < 0.01 ) . After 1yr no significant between-group differences were found . Mean incremental cost of spa treatment was 1311 Euro per patient ( 95 % CI 369 - 2439 ) , equalling the cost of the intervention ( thalassotherapy including airfare and lodging ) , or 885 Euro per patient based on a more realistic cost estimate . CONCLUSIONS The temporary improvement in quality of life due to an adjuvant treatment course of spa therapy for patients with FM is associated with limited incremental costs per patient Perspectives of patients with fibromyalgia influence their likelihood of participating in r and omized placebo-controlled trials and potentially clash with current , well-established methodology of r and omized controlled trial design . M and ates to use only acetaminophen for breakthrough pain and that require discontinuation of concomitant medications , especially in studies lacking an active comparator arm , could bias a trial cohort to thereby reduce the generalizability of study findings and conclusions . This study evaluates factors affecting willingness to participate in such clinical trials , including the impact of altruism , payment , study duration , forced discontinuation of specific medications , and subject demographics for patients seen by rheumatologists proficient and avidly interested in treating fibromyalgia We aim ed to evaluate the effectiveness of balneotherapy in  fibromyalgia management .  Fifty women with fibromyalgia under pharmacological treatment were r and omly assigned to either the balneotherapy ( 25 ) or the control ( 25 ) group . Four patients from the balneotherapy group and one patient from the control group left the study after r and omization . The patients in the balneotherapy group ( 21 ) had 2 thermomineral water baths daily for 2 weeks in Tuzla Spa Center . The patients in the control group ( 24 ) continued to have their medical treatment and routine daily life . An investigator who was blinded to the study arms assessed the patients . All patients were assessed four times ; at the beginning of the study , at the end of the 2nd week , the 1st month , and the 3rd month after balneotherapy . Outcome measures of the study were pain intensity , Fibromyalgia Impact Question naire ( FIQ ) , Beck Depression Inventory ( BDI ) , patient ’s global assessment , investigator ’s global assessment , SF-36 scores , and tender point count .  Balneotherapy was found to be superior at the end of the cure period in terms of pain intensity , FIQ , Beck Depression Inventory , patient ’s global assessment , investigator ’s global assessment scores , and tender point count as compared to the control group . The superiority of balneotherapy lasted up to the end of the 3rd month , except for the Beck Depression Inventory score and the investigator ’s global assessment score . Significant improvements were observed in PF , GH , and MH subscales of SF-36 during the study period in the balneotherapy group ; however , no such improvement was observed in the control group . Balneotherapy was superior only in VT subscale at the end of therapy and at the end of the third month after the therapy as compared to the controls . It was concluded that balneotherapy provides beneficial effects in patients with fibromyalgia OBJECTIVE To evaluate the feasibility of 8 months of supervised exercise therapy in warm water and its effects on the impact of fibromyalgia on physical and mental health and physical fitness in affected women . METHODS Thirty women with fibromyalgia were r and omly assigned to an exercise therapy group ( n = 15 ) or a control group ( inactive ) ( n = 15 ) . The impact of fibromyalgia on physical and mental health was assessed using the Fibromyalgia Impact Question naire and the anxiety state with State-Trait Anxiety Inventory . Physical fitness was measured using the following tests : Canadian Aerobic Fitness ; h and -grip dynamometry ; 10-metre walking ; 10-step stair-climbing and blind 1-leg stance . RESULTS After 8 months of training , the exercise therapy group improved compared with the control group in terms of physical function ( 20 % ) , pain ( 8 % ) , stiffness ( 53 % ) , anxiety ( 41 % ) , depression ( 27 % ) , Fibromyalgia Impact Question naire total scores ( 18 % ) , State-Trait Anxiety Inventory score ( 22 % ) , aerobic capacity ( 22 % ) , balance ( 30 % ) , functional capacity for walking ( 6 % ) , stair-climbing with no extra weight ( 14 % ) and stair-climbing 10 kg-weighted ( 25 % ) . CONCLUSION Eight months of supervised exercise in warm water was feasible and led to long-term improvements in physical and mental health in patients with fibromyalgia at a similar magnitude to those of shorter therapy programmes OBJECTIVE To evaluate the effects of pool exercise in patients with fibromyalgia and chronic widespread pain and to determine characteristics influencing the effects of treatment . METHODS A total of 134 women with fibromyalgia and 32 with chronic widespread pain were r and omized to a 20-session pool exercise and a 6-session education programme or to a control group undertaking the same education programme . The primary outcomes were the Fibromyalgia Impact Question naire ( FIQ ) total score and the 6-minute walk test ( 6MWT ) . FIQ Pain and other health variables were included . RESULTS The FIQ total ( p = 0.04 ) improved in the intervention group , with an effect size of 0.32 . Patients who had participated in at least 60 % of the exercise sessions improved in the FIQ total ( effect size 0.44 ) , the 6MWT ( effect size 0.43 ) and FIQ Pain ( effect size 0.69 ) compared with controls ( p < 0.05 ) . Long-term follow-up revealed lasting , but small , improvement ( effect size < 0.29 ) in the 6MWT among the active participants ( p < 0.05 ) . Analyses within the subgroups showed that patients with milder stress , pain or depression improved most by treatment on the FIQ total ( effect size > 0.50 , p < 0.05 ) compared with controls . CONCLUSION The exercise-education programme showed significant , but small , improvement in health status in patients with fibromyalgia and chronic widespread pain , compared with education only . Patients with milder symptoms improved most with this treatment BACKGROUND A one-week booster group treatment in rheumatic diseases ( rheumatoid arthritis , spondylarthropathies , fibromyalgia ) was developed in order to stabilize rehabilitation effects after medical rehabilitation . The program took place in an inpatient setting 3 - 5 months after rehabilitation , aim ed at refreshing and deepening already learnt contents as well as teaching new subjects ( e. g. about dietetics ) . Training and educational elements are given priority in this concept . METHOD A total of 140 patients participated in 19 booster weeks  . At the end of each booster week the acceptance was assessed by question naire and in a round-table discussion . RESULTS Comprehensibility and group atmosphere were judged very positively . The course was also considered very helpful , helpfulness being rated with marks about 2 ( 1 = very helpful , 6 = not at all helpful ) . Participants especially appreciated the course 's framework as a group setting emphasising the exchange of experience with co- patients . At the same time , however , participants wished more individualized treatment such as physiotherapy or massage . With regard to the quantity of the various therapy elements , participants would have preferred more traditional spa therapy , more medical treatment by a physician , more group physiotherapy and sports . They would also have liked more breaks . In general fewer psychological elements , less discussion and reflection but more physical activity was wished for . Little difference was found between the various diagnoses , but the program was rated slightly more positively by the patients with spondylarthropathies . CONCLUSION Overall , the great number of people participating in the program and their acceptance of the booster week are positive . Patients appreciated the group setting and the possibilities of exchanging experience on a high level . But it was difficult to change patients ' traditional expectations concerning medical rehabilitation to a behaviour-orientated course like ours . It is worth thinking about whether this concept should play a greater role in traditional medical inpatient rehabilitation programming Evidence -based recommendations support the use of multimodal therapy and hydrotherapy for fibromyalgia syndrome ; however , there is little st and ardisation of such programmes . The aim of the study was to assess the effectiveness of a pool-based exercise using deep water running ( DWR ) as part of a multimodal physiotherapy programme for patients with fibromyalgia syndrome . For a non-r and omised clinical study , 44 patients diagnosed with fibromyalgia were recruited from primary care . Patients in the experimental group received a multimodal programme incorporating pool-based exercise using DWR three times a week for an 8-week period . The control group received a leaflet containing advice and continued with normal activities . Patients were evaluated for physical function ( Fibromyalgia Impact Question naire , FIQ ) , pain , general health ( Short Form-12 Health Survey ) and quality of life ( European Quality of Life Scale-5D ) pre- and post intervention . Statistically significant results were found for the experimental group for FIQ total score , incorporating physical function , pain , fatigue , stiffness and psychological variables ( p < 0.05 ) . Statistically significant differences between the experimental group and control were also found for general health ( p < 0.05 ) and quality of life ( p < 0.05 ) . The results of this pilot study and the high level of compliance and adherence and low level of attrition suggest that this multimodal programme incorporating DWR is a safe and effective intervention for fibromyalgia syndrome that is acceptable to patients Fibromyalgia is characterized by chronic and extended musculoskeletal pain . The combination of exercise therapy with the warm water may be an appropriate treatment . However , studies focusing on the analysis of immediate pain during and after an exercise session are rare . This study aim ed to determine the immediate changes of a warm water pool-based exercise program ( 12 weeks ) on pain ( before vs. after session ) in female fibromyalgia patients . 33 Spanish women with fibromyalgia were selected to participate in a 12 weeks ( 2 sessions/week ) low-moderate intensity warm water pool-based program . We assessed pain by means of a Visual Analogue Scale before and after each single session ( i. e. , 24 sessions ) . We observed immediate benefits on pain with a mean decrease ~15 % in all sessions , except in the fourth one . There was an association of pain difference ( pre-post ) session with pain pre session ( p=0.005 ; β=0.097±0.034 ) and with age ( p<0.001 ; β=0.032±0.008 ) . There were no significant accumulative differences on pain , pre session , post session , and pre-post changes ( all p>0.05 ) . Therefore this study showed that a warm water pool-based exercise program for 12 weeks ( 2 times/week ) led to a positive immediate decrease in level of pain in female patients with fibromyalgia . Improvements were higher in older women and in those with more intense pain Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objective : To evaluate the efficacy of a treatment programme for patients with fibromyalgia ( FM ) based on self management , using pool exercises and education . Methods : R and omised controlled trial with a 6 month follow up to evaluate an outpatient multidisciplinary programme ; 164 patients with FM were allocated to an immediate 6 week programme ( n = 84 ) or to a waiting list control group ( n = 80 ) . The main outcomes were changes in quality of life , functional consequences , patient satisfaction and pain , using a combination of patient question naires and clinical examinations . The question naires included the Fibromyalgia Impact Question naire ( FIQ ) , Psychological General Well-Being ( PGWB ) index , regional pain score diagrams , and patient satisfaction measures . Results : 61 participants in the treatment group and 68 controls completed the programme and 6 month follow up examinations . Six months after programme completion , significant improvements in quality of life and functional consequences of FM were seen in the treatment group as compared with the controls and as measured by scores on both the FIQ ( total score p = 0.025 ; fatigue p = 0.003 ; depression p = 0.031 ) and PGWB ( total score p = 0.032 ; anxiety p = 0.011 ; vitality p = 0.013 , ) . All four major areas of patient satisfaction showed greater improvement in the treatment than the control groups ; between-group differences were statistically significant for “ control of symptoms ” , “ psychosocial factors ” , and “ physical therapy ” No change in pain was seen . Conclusion : A 6 week self management based programme of pool exercises and education can improve the quality of life of patients with FM and their satisfaction with treatment . These improvements are sustained for at least 6 months after programme completion The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . OBJECTIVE To evaluate the effectiveness and tolerability of two pool-based physical therapies , stretching and Ai Chi , in fibromyalgia symptomatology and sleep quality . METHODS Eighty-one patients , r and omly assigned to stretching ( n=39 ) or Ai Chi ( n=42 ) , received 18 physiotherapy sessions  and were evaluated at baseline , at treatment termination , and after 4 and 12 weeks of follow-up . Main outcome measures were the Fibromyalgia Impact Question naire ( FIQ ) and the Pittsburgh Sleep Quality Index ( PSQI ) . Secondary outcome measures included the Beck Depression Inventory ( BDI ) , the State and Trait Anxiety Inventory ( STAI ) , and the SF-12 Health Survey ( SF-12 ) . Data analysis was done with repeated measures ANOVA and effect size estimation . RESULTS No differences were found between groups but significant reduction in the FIQ and the PSQI scores were observed in Ai Chi but not in stretching group , with larger effect sizes and longer effect duration on sleep measures . BDI scores decreased in stretching but not in Ai Chi group with small effect sizes . Trait-anxiety scores decreased in both groups also with small effect sizes . The mental component summary of the SF-12 increased only in stretching group with effect sizes moderate to large . CONCLUSIONS Although no global differences were found between groups , Ai Chi significantly improved fibromyalgia symptomatology and sleep quality , whereas stretching only improved subjects ' psychological well-being Introduction Physical therapy in warm water has been effective and highly recommended for persons with fibromyalgia , but its efficiency remains largely unknown . Should patients or health care managers invest in this therapy ? The aim of the current study was to assess the cost-utility of adding an aquatic exercise programme to the usual care of women with fibromyalgia . Methods Costs to the health care system and to society were considered in this study that included 33 participants , r and omly assigned to the experimental group ( n = 17 ) or a control group ( n = 16 ) . The intervention in the experimental group consisted of a 1-h , supervised , water-based exercise sessions , three times per week for 8 months . The main outcome measures were the health care costs and the number of quality -adjusted life-years ( QALYs ) using the time trade-off elicitation technique from the EuroQol EQ-5D instrument . Sensitivity analyses were performed for variations in staff salary , number of women attending sessions and time spent going to the pool . The cost effectiveness acceptability curves were created using a non-parametric bootstrap technique . Results The mean incremental treatment costs exceeded those for usual care per patient by € 517 for health care costs and € 1,032 for societal costs . The mean incremental QALY associated with the intervention was 0.131 ( 95 % CI : 0.011 to 0.290 ) . Each QALY gained in association with the exercise programme cost an additional € 3,947/QALY ( 95 % CI : 1,782 to 47,000 ) for a health care perspective and € 7,878/QALY ( 3,559 to 93,818 ) from a societal perspective . The curves showed a 95 % probability that the addition of the water-based programme is a cost-effective strategy if the ceiling of inversion is € 14,200/QALY from a health care perspective and € 28,300/QALY from a societal perspective . Conclusion The addition of an aquatic exercise programme to the usual care regime for fibromyalgia in women  is cost effective in terms of both health care costs and societal costs . However , the characteristics of facilities ( distance from the patients ' homes and number of patients that can be accommo date d per session ) are major determinants to consider before investing in such a programme . Trial registration Current controlled trials IS RCT N53367487 The purpose of this study was to investigate the clinical effects of balneotherapy in the treatment of Fibromyalgia Syndrome ( FMS ) and to determine if balneotherapy influences serum levels of inflammation markers , IL-1 , PGE2 and LTB4 . 24 primary fibromyalgia female patients diagnosed according to American College of Rheumatology criteria were included to the study . Their ages ranged between 33 and 55 years . FMS patients were r and omly assigned in two groups as , group 1 ( n = 12 ) and group 2 ( n = 12 ) . Group 1 received 20-min bathing , once in a day for five days per week . Patients participated in the study for 3 weeks ( total of 15 sessions ) in Denizli . Group 2 did not receive balneotherapy . FMS patients were evaluated by tenderness measurements ( tender point count and algometry ) , Visual Analogue Scale , Beck ’s Depression Index , Fibromyalgia Impact Question naire .  Ten healthy women recruited group three as the controls .  Serum PGE2 , LTB4 and IL1-α levels were measured in all three groups . The biochemical measurements and clinical assessment s were performed before and at the end of general period of therapy . Statistically significant alterations in algometric score , Visual Analogue score , Beck ’s Depression Index and PGE2 levels ( P < 0.001 ) , numbers of tender points ( P < 0.01 ) and Fibromyalgia Impact Question naire score ( P < 0.05 ) were found after the balneotherapy between group 1 and 2 . Mean PGE2 level of FMS patients were higher compared to healthy control group ( P < 0.0001 ) and decreased after the treatment period , only in group 1 ( P < 0.05 ) . As in the group 2 and 3 , detectable IL-1 and LTB4 measurements were insufficient , statistical analysis was performed , only in group 1 . After balneotherapy  IL-1 and LTB4 significantly decreased in group 1 ( P < 0.05 ) . In conclusion , balneotherapy is an effective choice of treatment in patients with FMS relieving the clinical symptoms , and possibly influencing the inflammatory mediators OBJECTIVE To evaluate the effects of 6 months of pool exercise combined with a 6 session education program for patients with fibromyalgia syndrome ( FM ) . METHODS The study population comprised 58 patients , r and omized to a treatment or a control group . Patients were instructed to match the pool exercises to their threshold of pain and fatigue . The education focused on strategies for coping with symptoms and encouragement of physical activity . The primary outcome measurements were the total score of the Fibromyalgia Impact Question naire ( FIQ ) and the 6 min walk test , recorded at study start and after 6 mo . Several other tests and instruments assessing functional limitations , severity of symptoms , disabilities , and quality of life were also applied . RESULTS Significant differences between the treatment group and the control group were found for the FIQ total score ( p = 0.017 ) and the 6 min walk test ( p < 0.0001 ) . Significant differences were also found for physical function , grip strength , pain severity , social functioning , psychological distress , and quality of life . CONCLUSION The results suggest that a 6 month program of exercises in a temperate pool combined with education will improve the consequences of FM The aim of this study was to evaluate the effectiveness of aerobic exercise in water pool compared with aerobic exercise performed in sea by women with fibromyalgia ( FM ) . A total of 46 patients were r and omly allocated into two groups : pool group ( 23 patients ) and sea group ( 23 patients ) that performed the same aerobic exercise program . Patients were evaluated baseline and after 12 weeks using : VAS , number of tender points , FIQ , SF-36 , PSQI , and BDI . Both groups improved significantly in post-treatment for all the evaluated variables . There were no significant differences between two groups , except for BDI ( F = 2.418 , P < 0.0001 ) . Aerobic exercise program performed in water ( pool or sea ) was effective for patients with FM . However , sea water exercises have been shown to bring more advantages related to emotional aspects . Then , exercise performed sea water ( thalassotherapy ) is an option for effective treatment with low cost for patients with FM OBJECTIVE To measure mood and physical function of individuals with fibromyalgia , 6 and 12 months following 23 weeks of supervised aerobic exercise . METHODS This is a followup report of individuals who were previously enrolled in 23 weeks of l and -based and water-based aerobic exercise classes .  Outcomes included the 6-minute walk test , Beck Depression Inventory ( BDI ) , State-Trait Anxiety Inventory , Arthritis Self-Efficacy Scale ( ASES ) , Fibromyalgia Impact Question naire ( FIQ ) , tender point count , patient global assessment score , and exercise compliance . Outcomes were measured at the start and end of the exercise classes and 6 and 12 months later . RESULTS Analyses were conducted on 29 ( intent-to-treat ) or 18 ( efficacy ) subjects .  Six-minute walk distances and BDI total scores were improved at followup ( all analyses ) . BDI cognitive/affective scores were improved at the end of 23 weeks of exercise ( both analyses ) and at the 12-month followup ( efficacy analysis only ) . BDI somatic scores were improved at 6-month ( both analyses ) and 12-month followup ( intent-to-treat only ) . FIQ and ASES function were improved at all followup points . ASES pain was improved in efficacy analyses only ( all followup points ) . Tender points were unchanged after 23 weeks of exercise and at followup . Exercise duration at followup ( total minutes of aerobic plus anaerobic exercise in the preceding week ) was related to gains in physical function ( 6- and 12-month followup ) and mood ( 6-month followup ) . CONCLUSION Exercise can improve physical function , mood , symptom severity , and aspects of self efficacy for at least 12 months . Exercising at followup was related to improvements in physical function and perhaps mood OBJECTIVES To evaluate the effects of a 16-week exercise therapy in a chest-high pool of warm water through applicable tests in the clinical practice on the global symptomatology of women with fibromyalgia ( FM ) and to determine exercise adherence levels . DESIGN A r and omized controlled trial . SETTING Testing and training were completed at the university . PARTICIPANTS Middle-aged women with FM ( n=60 ) and healthy women ( n=25 ) . INTERVENTION A 16-week aquatic training program , including strength training , aerobic training , and relaxation exercises . MAIN OUTCOME MEASURES Tender point count ( syringe calibrated ) , health status ( Fibromyalgia Impact Question naire ) ; sleep quality ( Pittsburgh Sleep Quality Index ) ; physical ( endurance strength to low loads tests ) , psychologic ( State Anxiety Inventory ) , and cognitive function ( Paced Auditory Serial Addition Task ) ; and adherence 12 months after the completion of the study . RESULTS For all the measurements , the patients showed significant deficiencies compared with the healthy subjects . Efficacy analysis ( n=29 ) and intent-to-treat analysis ( n=34 ) of the exercise therapy was effective in decreasing the tender point count and improving sleep quality , cognitive function , and physical function . Anxiety remained unchanged during the follow-up . The exercise group had a significant improvement of health status , not associated exclusively with the exercise intervention . There were no changes in the control group . Twenty-three patients in the exercise group were exercising regularly 12 months after completing the program . CONCLUSIONS An exercise therapy 3 times a week for 16 weeks in a warm pool could improve most of the symptoms of FM and cause a high adherence to exercise in unfit women with heightened FM symptomatology . The therapeutic intervention 's effects can be assessed through applicable tests in the clinical practice Abstract . The aim of this study was to evaluate the effectiveness of balneotherapy on patients with fibromyalgia ( FM ) at the Dead Sea . Forty-eight patients with FM were r and omly assigned to a treatment group receiving sulfur baths and a control group .  All participants stayed for 10 days at a Dead Sea spa .  Physical functioning , FM-related symptoms , and tenderness measurements ( point count and dolorimetry ) were assessed at four time points : prior to arrival at the Dead Sea , after 10 days of treatment , and 1 and 3 months after leaving the spa . Physical functioning and tenderness moderately improved in both groups . With the exception of tenderness threshold , the improvement was especially notable in the treatment group and it persisted even after 3 months . Relief in the severity of FM-related symptoms ( pain , fatigue , stiffness , and anxiety ) and reduced frequency of symptoms ( headache , sleep problems , and subjective joint swelling ) were reported in both groups but lasted longer in the treatment group . In conclusion , treatment of FM at the Dead Sea is effective and safe and may become an additional therapeutic modality in FM . Future studies should address the outcome and possible mechanisms of this treatment in FM patients OBJECTIVE To evaluate the efficacy of a 6-week exercise and educational program for patients with fibromyalgia . METHODS Forty-one subjects were r and omly assigned to the program or served as waiting list controls . Program outcome was assessed with a 6-minute walk test , the Fibromyalgia Impact Question naire , a Self-Efficacy Scale , and a " knowledge " question naire ( based on information provided during the educational sessions ) . Waiting list control subjects subsequently completed the program . Program outcome was reassessed 3 or 6 months post-program . RESULTS The program produced significant improvements in 6-minute walk distance , well-being , fatigue , self-efficacy ( for controlling pain and other symptoms ) , and knowledge . At followup , immediate gains in walk distance , well-being , and self-efficacy were maintained , but gains in fatigue and knowledge were lost . CONCLUSION Short-term exercise and educational programs can produce immediate and sustained benefits for patients with fibromyalgia . The benefits of our program may be due to exercise or education since both interventions were given Fibromyalgia ( FM ) is a nonarticular rheumatological syndrome associated with diverse clinical and psychological features . One of the major complaints in FM is reduced pain tolerance , especially in tender points ( TP ) for which patients derive significant benefit from nonsteroidal antiinflammatory drugs or corticosteroids .  Patients with FM also have altered reactivity of the hypothalamic pituitary adrenal ( HPA ) axis where the predominant feature is reduced containment of the stress response system through diminished adrenocortical output and feedback resistance . Our results show that mud packs together with antidepressant treatment are able to influence the HPA axis , stimulating increased levels of adrenocorticotropic hormone , cortisol and beta-endorphin serum levels . The discharge of corticoids in the blood and the increase in beta-endorphin serum levels are followed by a reduction in pain symptoms , which is closely related to an improvement in disability , depression and quality of life . It seems that the synergic association between a pharmacological treatment ( trazodone ) and mud packs acts by helping the physiological responses to achieve homeostasis and to rebalance the stress response system . To clarify and optimize the effectiveness of this synergic association , studies involving a larger number of FM patients and a different pharmacological treatment are needed Abstract : Fibromyalgia ( FS ) is an idiopathic chronic pain syndrome defined by widespread non-articular musculoskeletal pain and generalised tender points . As there is no effective treatment , patients with this condition have impaired quality of life ( QoL ) . The aim of this study was to assess the possible effect of balneotherapy at the Dead Sea area on the QoL of patients with FS . Forty-eight subjects participated in the study ; half of them received balneotherapy , and half did not . Their QoL ( using SF-36 ) , psychological well-being and FS-related symptoms were assessed prior to arrival at the spa hotel in the Dead Sea area , at the end of the 10-day stay , and 1 and 3 months later . A significant improvement was reported on most subscales of the SF-36 and on most symptoms . The improvement in physical aspects of QoL lasted usually 3 months , but on psychological measures the improvement was shorter . Subjects in the balneotherapy group reported higher and longer-lasting improvement than subjects in the control group . In conclusion , staying at the Dead Sea spa , in addition to balneotherapy , can transiently improve the QoL of patients with FS . Other studies with longer follow-up are needed to support our findings The administration of ibuprofen potentiates and prolongs the analgesic effect of  meptazinol  when the two drugs are given simultaneously to mice . A double-blind three-way crossover study of placebo , ibuprofen ( 1600 mg/day ) and ibuprofen ( 1600 mg/day ) plus meptazinol ( 400 mg/day ) was carried out in 45 patients with soft tissue rheumatism to see if the same potentiation could be demonstrated in man . Treatment order was r and omized and each regimen was given for 2 weeks preceded by 1 week on paracetamol alone . Assessment s were made , on entry and after each treatment period , of pain parameters using visual analogue or verbal rating scales . Patients ' overall impression and final preference showed both active treatments to be better than placebo and demonstrated a slight preference for the combination Objective . To follow patients with fibromyalgia six and 24 months after they finished a six-month treatment programme . The programme comprised pool exercise therapy , adjusted to the patients ' limitations , and education based on their health problems . Methods . Twenty-six patients were examined six and 24 months after the completion of the treatment programme  with the Fibromyalgia Impact Question naire ( FIQ ) , SF-36 , the 6-minute walk test , and the Grippit measure . The values obtained at the follow-up examinations were compared with the baseline and post-treatment values . Results . As compared with baseline , symptom severity ( FIQ , SF-36 ) , physical function ( FIQ , SF-36 , 6-minute walk test ) and quality of life ( SF-36 ) still showed improvements six months after the completion of treatment ( p<0.05 ) . Pain ( FIQ , SF-36 ) , fatigue ( FIQ , SF-36 ) , walking ability , and social function ( SF-36 ) still showed improvements 2 years after the completion of the programme as compared with the baseline values ( p<0.05 ) . No significant changes were found for these variables , when the values obtained at the two follow-up examinations were compared with those of the post-treatment examination . Conclusions . Improvements in symptom severity , physical function and social function were still found six and 24 months after the completed treatment programme Objective The aim of this study was to compare pool-based exercise and balneotherapy in fibromyalgia syndrome ( FMS ) patients . Methods Fifty female patients diagnosed with FMS according to the American College of Rheumatism ( ACR ) criteria were r and omly assigned to two groups : group 1 ( n=25 ) with pool-based exercise , and in group 2 ( n=25 ) balneotherapy was applied in the same pool without any exercise for 35 min three times a week for 12 weeks . In both groups , pre- ( week 0 ) and post-treatment ( weeks 12 and 24 ) evaluation was performed by one of the authors , who was blind to the patient group . Evaluation parameters included pain , morning stiffness , sleep , tender points , global evaluation by the patient and the physician , fibromyalgia impact question naire , chair test , and Beck depression inventory . Statistical analysis was done on data collected from three evaluation stages . Results Twenty-four exercise and 22 balneotherapy patients completed the study . Pretreatment ( week 0 ) measurements did not show any difference between the groups . In group 1 , statistically significant improvement was observed in all parameters ( P<0.01 ) except for the chair test at both weeks 12 and 24 . In group 2 , week 12 measurements showed significant improvement in all parameters ( P<0.01 ) except for the chair test and Beck depression inventory . Week 24 evaluation results in group 2 showed significant improvements in pain and fatigue according to visual analogue scale ( VAS ) , 5-point scale , number of tender points , algometric and myalgic scores , and patient and physician global evaluation ( P<0.01 and P<0.05 , respectively ) , while improvements were nonsignificant in morning stiffness , sleep , fibromyalgia impact question naire ( FIQ ) , chair test , and Beck depression inventory parameters in this group . Comparison of the two groups based on the post-treatment ( weeks 12 and 24 ) percent changes and difference scores relative to pretreatment ( week 0 ) values failed to show a significant difference between the groups for any parameter except Beck depression inventory ( P<0.01 ) . Conclusion The results of our study showed that pool-based exercise had a longer-lasting effect on some of the FMS symptoms , but statistical analysis failed to show a significant superiority of pool-based exercise over balneotherapy without exercise . While we believe that exercise is a gold st and ard in FMS treatment , we also suggest in light of our results that balneotherapy is among the valid treatment options in FMS , and further research regarding the type and duration of the exercise programs is necessary OBJECTIVE We studied whether whirl baths with plain water or with water containing pine oil or valerian have a different influence on  pain , disturbed sleep or tender point count . METHODS A r and omized , comparative and investigator-blinded study was performed . Out- patients with generalized fibromyalgia were r and omized into three treatment groups . INTERVENTIONS Therapy consisted of either whirl bath with plain water or with the addition of pine oil or valerian . The baths were carried out 10 times , three times a week . MAIN OUTCOME MEASURES General pain , change of pain intensity during the day , general well-being and occurrence of disturbed sleep were recorded before and after the therapy . The number of tender points was assessed by digital palpation , the pain threshold on the shinbone and the middle part of the deltoid muscle was measured by the dolorimeter of A. Fischer . The same instrument was used for recording pain threshold and pain tolerance of both trapezius muscles . The tissue compliance of these muscles was measured as well . RESULTS 30 out of 39 patients included in the study were evaluated statistically . After treatment with valerian bath ( n = 12 ) well-being and sleep were significantly improved and also the tender point count decreased significantly . Pine oil added to the bath water ( n = 7 ) result ed in a significant improvement of well-being , but unfortunately also in a significant decrease of pain threshold of the shinbone and the right deltoid muscle .  Whirl bath in plain water ( n = 11 ) reduced general and maximum pain intensity significantly . CONCLUSIONS Our cautious conclusion of this study is - with respect to the small number of treated patients - that different effects of whirl baths with or without medicinal bath oils can be detected in fibromyalgia patients .  Plain water baths modify the pain intensity , medicinal baths improve well-being and sleep OBJECTIVE To evaluate the short- and long-term efficacy of exercise therapy in a warm , waist-high pool in women with fibromyalgia . METHODS Thirty-four women ( mean + /- SD tender points 17 + /- 1 ) were r and omly assigned to either an exercise group ( n = 17 ) to perform 3 weekly sessions of training including aerobic , proprioceptive , and strengthening exercises during 12 weeks , or to a control group ( n = 17 ) . Maximal unilateral isokinetic strength was measured in the knee extensors and flexors in concentric and eccentric actions at 60 degrees /second and 210 degrees /second , and in the shoulder abductors and adductors in concentric contractions .  Health-related quality of life ( HRQOL ) was assessed using the EQ-5D question naire ; pain was assessed on a visual analog scale . All were measured at baseline , posttreatment , and after 6 months . RESULTS The strength of the knee extensors in concentric actions increased by 20 % in both limbs after the training period , and these improvements were maintained after the de-training period in the exercise group . The strength of other muscle actions measured did not change . HRQOL improved by 93 % ( P = 0.007 ) and pain was reduced by 29 % ( P = 0.012 ) in the exercise group during the training , but pain returned close to the pretraining level during the subsequent de-training . However , there were no changes in the control group during the entire period . CONCLUSION The therapy relieved pain and improved HRQOL and muscle strength in the lower limbs at low velocity in patients with initial low muscle strength and high number of tender points . Most of these improvements were maintained long term OBJECTIVE It is a traditional practice in the Alpine region of Trentino and Alto Adige ( Italy ) to use phytothermotherapeutic treatment with fermenting grass ( " hay baths " ) for rheumatic diseases . However , despite its long history and popularity , a clinical validation of the efficacy and tolerability of the treatment has yet to be found in current literature . Fibromyalgia syndrome ( FMS ) is characterised by generalised musculoskeletal pain , high tender point counts , sleep disturbance , fatigue , headaches , irritable bowel syndrome , frequent psychological distress and depressed mood . There is no st and ard therapy regime for FMS and the variety of medical treatments used have given limited benefits . The aim of this study was to assess the efficacy and tolerability of a cycle of phytothermotherapy through a single-blind , controlled , r and omised trial , in patients with primary FMS . METHODS Fifty-six patients with primary FMS according to the ACR criteria were r and omly allocated to two groups : 30 were su bmi tted to phytothermotherapy at the thermal resort of Garniga Terme ( Trento , Italy ) and the other 26 were considered as controls . All patients were evaluated by FIQ , Tender Points Count , HAQ and AIMS 1 at baseline , after 10 days , then after 12 and 24 weeks . RESULTS Patients su bmi tted to phytothermotherapy showed visible and significant improvement of all evaluation parameters at the end of the treatment , which persisted during the follow-up period . No significant difference was found in the control group . Regarding the tolerability , none of the patients presented side effects . CONCLUSIONS Our results suggest the efficacy and the tolerability of phytothermotherapy in patients with primary FMS Fibromyalgia syndrome ( FMS ) is a chronic disorder that is characterized by widespread pain with localized tenderness . We aim ed to investigate whether thermal therapy combining sauna therapy and underwater exercise improved pain , symptoms , and quality of life ( QOL ) in FMS patients . Forty-four female FMS patients who fulfilled the American College of Rheumatology ( ACR ) criteria received 12-week thermal therapy program comprising sauna therapy once daily for 3 days/week and underwater exercise once daily for 2 days/week . Pain , symptoms , and QOL were assessed using a pain visual analog scale ( VAS ) , a fibromyalgia impact question naire ( FIQ ) , and a short form 36-item question naire ( SF-36 ) , respectively . All of the patients reported significant reductions in pain and symptoms of 31 - 77 % after the 12-week thermal therapy program , which remained relatively stable ( 28 - 68 % ) during the 6-month follow-up period ( that is , the thermal therapy program improved both the short-term and the long-term VAS and FIQ scores ) . Improvements were also observed in the SF-36 score .  Thermal therapy combining sauna therapy and underwater exercise improved the QOL as well as the pain and symptoms of FMS patients The efficacy of balneotherapy in fibromyalgia syndrome ( FS ) has been well demonstrated , while controlled studies using mud packs are lacking . We performed a r and omized clinical trial to evaluate the effects and the tolerability of mud-bath treatment in FS patients , who are poor responders to pharmacological therapy . Eighty patients with primary FS , according to ACR criteria , were r and omly allocated to two groups : 40 were su bmi tted to a cycle of 12 mud packs and thermal baths  , and 40 were considered as controls .  At baseline , after thermal treatment and after 16 weeks , patients were evaluated by FIQ , tender points count , VAS for “ minor ” symptoms , AIMS 1 and HAQ . Control patients were assessed at the same time periods . A significant improvement of all evaluation parameters after mud-bath therapy and after 16 weeks was observed . Mud packs were well tolerated and no drop-outs were recorded . Our results suggest the efficacy and the tolerability of mud-bath treatment in primary FS OBJECTIVE To compare hydrotherapy ( HT ) and conventional physiotherapy ( CP ) in the treatment of fibromyalgia ( FM ) , regarding quality of life ( QOL ) , total sleep time ( TST ) , and total nap time ( TNT ) . METHODS Fifty out patients , all female , 30 - 60 years old , diagnosed with FM , were r and omly assigned to two groups to carry out 3 weeks of treatment with HT or CP . In the beginning and in the end of treatment , patients were evaluated with the SF-36 question naire to measure QOL and the sleep diary for TST and TNT . Data analyses were blind . RESULTS All 24 HT patients increased 1h in TST compared to 19 CP patients . TNT decreased in the HT group . QOL improved for the two groups in all domains when pre- and post-intervention were compared , but there was no difference between groups . CONCLUSION HT is more effective than CP to improve TST and to decrease TNT in FM patients In a cross-over study , the short-term efficacy of whole-body cold therapy and hot mud packs in patients with generalized tendomyopathy ( fibromyalgia ) was compared . As a pain assessment , visual analog scale and so-called pain score were measured ; dolorimetry of the 24 tender points and eight control points was performed as well . Using these methods , we found that there is a significant improvement of all parameters examined during a 2-h period of measurements after cold application , and a marked improvement was also detectable 24 h after this therapy . In contrast , only pain score values showed a slight decrease immediately after hot mud-pack therapy , and no significant differences were found in visual analog scale and pressure tenderness as measured dolorimetrically . Central inhibition of nociceptors as a result of an activation of A-delta system as well as a blockade of gamma-motoneurons are discussed to be a mechanism of action of whole-body cold therapy , result ing in a decrease in muscle tonus . Long-term studies are needed to determine , if there is any enduring effect of whole-body cold therapy on pain  in the patients with generalized tendomyopathy OBJECTIVES To compare the cognitive function performance in patients with fibromyalgia ( FM ) with respect healthy controls and to evaluate the short-term efficacy of exercise therapy in a warm , chest-high pool on pain and cognitive function in women with FM . METHODS Sixty middle-aged women with FM were r and omly assigned to either an exercise training group ( n = 35 ) to perform 3 sessions per week of aquatic training ( 32 degrees C ) including mobility , aerobic , strengthening , and relaxation exercises for 16 weeks , or a control group ( n = 25 ) . Twenty-five healthy women matched for age , weight , body mass index , and educational and physical activity levels were recruited .  Pain was assessed in patients using a syringe calibrated like a pressure dolorimeter , and a visual analog scale . The severity of FM was evaluated using the Fibromyalgia Impact Question naire . Cognitive function was measured in healthy individuals and patients using several st and ardized neuropsychological tests . All patients were measured at baseline and post-treatment . RESULTS At baseline , the healthy group evidence d cognitive performance that was significantly superior to the group of patients with FM in all of the neuropsychological tests . The exercise group significantly improved their pain threshold , tender point count , self-reported pain , severity of FM , and cognitive function , while in the control group the differences were not significant . CONCLUSION An exercise therapy three times per week for 16 weeks in a warm-water pool is an adequate treatment to decrease the pain and severity of FM well as to improve cognitive function in previously unfit women with FM and heightened painful symptomatology OBJECTIVE To compare the clinical effectiveness of aerobic exercise in the water with walking/jogging for women with fibromyalgia ( FM ) . METHODS Sixty sedentary women with FM , ages 18 - 60 years , were r and omly assigned to either deep water running ( DWR ) or l and -based exercises ( LBE ) . Patients were trained for 15 weeks at their anaerobic threshold .  Visual analog scale of pain , Fibromyalgia Impact Question naire ( FIQ ) , Beck Depression Inventory , Short Form 36 Health Survey ( SF-36 ) , and a patient 's global assessment of response to therapy ( PGART ) were measured at baseline , week 8 , and week 15 . Statistical analysis included all patients . RESULTS Four patients dropped out from each group . Both groups improved significantly at week 15 compared with baseline , with an average 36 % reduction in pain intensity . For PGART , 40 % of the DWR group and 30 % of the LBE group answered " much better " at posttreatment . FIQ total score and FIQ depression improvements in the DWR group were faster ( week 8) than the LBE group and kept improving ( week 15 ; P < 0.05 ) . Only the DWR group showed improvements in SF-36 role emotional ( P = 0.006 ) . No significant between-group differences were observed for peak oxygen uptake and other outcomes . CONCLUSION DWR is a safe exercise that has been shown to be as effective as LBE regarding pain . However , it has been shown to bring more advantages related to emotional aspects . Aerobic gain was similar for both groups , regardless of symptom improvement . Therefore , DWR could be studied as an exercise option for patients with FM who have problems adapting to LBE or lower limbs limitations The purpose of this study was to assess the effectiveness of Stanger bath on the treatment of fibromyalgia ( FM ) . Fifty women with FM were r and omly divided into two groups . The first group ( n=25 ) was treated with amitriptyline , 10 mg/day for 8 weeks , and Stanger bath , 20 min daily for ten sessions . The second group ( n=25 ) only had amitriptyline , 10 mg/day for 8 weeks . In the first group the assessment parameters were measured before ( t1 ) , at the end ( t2 ) , and 2 months after the hydrotherapy ( t3 ) . In the second group these parameters were examined before ( T1 ) and 2 months after the treatment ( T2 ) . Patients were evaluated by number of tender points and Fibromyalgia Impact Question naire ( FIQ ) scores . There was significant improvement in number of tender points between t1 and t2 ( P<0.01 ) and t1 and t3 ( P<0.001 ) in the Stanger bath group . In addition , there was significant improvement in FIQ scores between t1 and t2 ( P<0.001 ) and t1 and t3 ( P<0.01 ) in the Stanger bath group . In the second group we observed significant improvement in FIQ scores and tender point numbers between T1 and T2 ( P=0.00 ) . We did not find any difference between groups in tender point number percent change ( p=0.074 ) . However , we observed statistically significant improvement in percent change of FIQ scores  in Stanger bath group ( −30±16.7 ) when compared to group 2 ( −19.3±13 ) ( p=0.016 ) . We conclude that Stanger bath therapy when combined with amitriptyline has a long lasting effect and better outcome in FM patients OBJECTIVE To evaluate the effect of exercise on mood and physical function in individuals with fibromyalgia . METHODS Subjects were r and omly assigned to an exercise ( EX ) or control ( CTL ) group . EX subjects participated in 3 30-minute exercise classes per week for 23 weeks . Subjects were tested at entry and at 6 , 12 , and 23 weeks . Tests included the Beck Depression Inventory ( BDI ) , 6-minute walk , State-Trait Anxiety Inventory ( STAI ) , Mental Health Inventory ( MHI ) , Fibromyalgia Impact Question naire ( FIQ ) , Arthritis Self-Efficacy Scale ( ASES ) , and a measure of tender points and knee strength . RESULTS Fifty subjects ( 27 EX , 23 CTL ) completed the study , and 31 ( 15 EX , 16 CTL ) met criteria for efficacy analyses . In efficacy analyses , significant improvements were seen for EX subjects in 6-minute walk distances , BDI ( total , cognitive/ affective ) , STAI , FIQ , ASES , and MHI ( 3 of 5 subscales ) scores . These effects were reduced but remained during intent-to-treat analyses . CONCLUSION Exercise can improve the mood and physical function of individuals with fibromyalgia PURPOSE To evaluate the effects of a 12-wk period of aquatic training and subsequent detraining on health-related quality of life ( HRQOL ) and physical fitness in females with fibromyalgia . METHODS Thirty-four females with fibromyalgia were r and omly assigned into two groups : an exercise group , who exercised for 60 min in warm water , three times a week ( N = 17 ) ; and a control group , who continued their habitual leisure-time activities ( N = 17 ) . HRQOL was assessed using the Short Form 36 question naire and the Fibromyalgia Impact Question naire . Physical fitness was measured using the following tests : Canadian Aerobic Fitness , h and grip dynamometry , 10-m walking , 10-step stair climbing , and blind one-leg stance . Outcomes were measured at baseline , after treatment , and after 3 months of detraining . RESULTS After 12 wk of aquatic exercise , significant positive effects of aquatic training were found in physical function , body pain , general health perception , vitality , social function , role emotional problems and mental health , balance , and stair climbing . After the detraining period , only the improvements in body pain and role emotional problems were maintained . CONCLUSION The present water exercise protocol improved some components of HRQOL , balance , and stair climbing in females with fibromyalgia , but regular exercise and higher intensities may be required to preserve most of these gains OBJECTIVE To evaluate whether changes in muscle strength due to 32 weeks of supervised aquatic training predicted improvements on health-related quality of life ( HRQOL ) . METHODS Thirty women with FM aged 50.8 + /- 8.7 years were r and omly assigned to an experimental group ( n = 15 ) , performing 3 weekly sessions of 60 min of warm-water exercise ; or to a control group ( n = 15 ) . HRQOL was evaluated using the Short Form 36 Health Survey ( SF-36 ) . Maximal unilateral isokinetic strength was measured at 60 degrees/s and 210 degrees/s in the knee extensors and flexors in concentric action and at 60 degrees/s in knee extensors eccentric action . Postural balance was evaluated using the one-leg stance , eyes closed . RESULTS After 32 weeks of water exercise therapy , statistically significant improvements occurred in concentric knee flexors and extensors strength at 60 degrees/s , in eccentric knee extensors and in postural balance . The treatment led to additional improvements in physical function , role physical problems , body pain , general health , vitality , role emotional problems and mental health dimensions of SF-36 . Gains in the concentric knee flexors strength predicted improvements in role of physical problems , whereas those in concentric knee extensors did the same for mental health and role emotional problems . Gains in eccentric knee extensors strength predicted improvements in postural balance . CONCLUSIONS A long-lasting exercise therapy in warm water produced relevant gains in muscle strength at low velocities of movements , some of which predicted improvements in physical problems , emotional problems , mental health and balance . TRIAL REGISTRATION International St and ard R and omized Controlled Trial Number IS RCT N53367487 , information available in http://www.controlled-trials.com/IS RCT N53367487 Objective : The aim of the present study is to evaluate the effectiveness of spa therapy in the management of  fibromyalgia .  Methods : Thirty women with fibromyalgia were r and omly assigned to either a spa therapy group or a control group . The spa therapy group ( n = 16 ) had spa treatment for 2 weeks in addition to their medical treatment . The control group ( n = 14 ) continued to have their medical treatment and /or daily exercises . An investigator who was blinded for the intervention assessed all the patients for 9 months . Improvements in Fibromyalgia Impact Question naire ( FIQ ) , pain and number of tender points were primary outcomes . Secondary outcome measures were improvement in sleep disturbance , fatigue , gastrointestinal symptoms , anxiety , Beck Depression Inventory and patient ’s global evaluation . Results : the spa group was found to be superior to the control group at the end of intervention in terms of FIQ , pain , tender point count , fatigue and patients ’ global assessment . This superiority remained for 6 months in FIQ , 1 month in pain and tender point count . Conclusion : It was concluded that the addition of spa therapy to medical therapy has both short- and long-term beneficial effects in female patients with fibromyalgia Over a 2-year period , to evaluate the efficacy and safety of biologic agents , etanercept ( 25 mg twice per week , s.c . ) was used to treat 57 rheumatoid arthritis ( RA ) patients , 9 ankylosing spondylitis ( AS ) patients , 6 psoriatic arthritis ( PSA ) patients , and 4 juvenile rheumatoid arthritis ( JRA ) patients . In addition to inflammatory arthritis , I have used this tumor necrosis factor ( TNF ) blocker in other rheumatic diseases including idiopathic thrombocytopenic purpura ( ITP ) , Behçet 's disease with intractable oral ulcer , fibromyalgia syndrome , and systemic lupus erythematosis with intractable pleural effusion and acute lumbar disc herniation . For RA , after 6 months of etanercept treatment , all the parameters including number of swollen joints , number of tender joints , disease activity score , erythrocyte sedimentation rate , C-reactive protein , and global health status were rapidly improved ( P < 0.001 or P < 0.0001 ) . The anticyclic citrullinated peptide ( anti-CCP ) antibody and rheumatoid factor also significantly declined . For spondyloarthropathy , it also gave a similar effect as to RA . Both Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index also improved . One of the two cases with Behçet 's disease with intractable oral ulcer had a long-term remission after etanercept . The other Behçet 's disease patient with oral ulcer and another with ITP obtained a good response temporarily . The short-term use of etanercept ( <3 months ) did not bring a significant effect for cases of fibromyalgia syndrome , pleural effusion , and lumbar disc herniation . In conclusion , a dramatic and rapid clinical response in different kinds of arthritis patients can be achieved by etanercept . Moreover , the TNF-α inhibitor also can treat other severe rheumatic-related symptoms . In general , except for a few cases with infection and two cases with malignancy , etanercept was safe in our arthritis patients . We need to study a larger number of patients in order to better underst and the efficacy and safety of etanercept OBJECTIVE The objective of this study is to investigate the effect of low-power gallium-arsenide laser treatment on the patients with shoulder pain . BACKGROUND DATA Low-energy laser therapy has recently been popularized in the treatment of various rheumatologic , neurologic , and musculoskeletal disorders such as osteoarthritis , rheumatoid arthritis , fibromyalgia , carpal tunnel syndrome , rotator cuff tendinitis , and chronic back pain syndromes . METHODS A total of 40 patients who applied to our clinic with shoulder pain and complied with the selection criteria were included in the study . The patients were r and omly assigned into Group I ( n = 20 , laser treatment ) and Group II ( n = 20 , control ) . In Group I , patients were given laser treatment and an exercise protocol for 10 sessions during a period of 2 weeks . Laser was applied over tuberculum majus and minus , bicipital groove , and anterior and posterior faces of the capsule , regardless of the existence of sensitivity , for 1 min at each location at each session with a frequency of 2000 Hz using a GaAs diode laser instrument ( Rol and Serie Elettronica Pagani , wavelength 904 nm , frequency range of 5 - 7000 Hz , and maximum peak power of 27 W , 50 W , or 27 x 4 W ) . In Group II , placebo laser and the same exercise protocol was given for the same period . Patients were evaluated according to the parameters of pain , palpation sensitivity , algometric sensitivity , and shoulder joint range of motion before and after treatment . RESULTS Analysis of measurement results within each group showed a significant posttreatment improvement for some active and passive movements in both groups , and also for algometric sensitivity in Group I ( p < 0.05 - 0.01 ) . Posttreatment palpation sensitivity values showed improvement in 17 patients ( 85 % ) for Group I and six patients ( 30 % ) for Group II . Comparison between two groups showed superior results ( p < 0.01 and p < 0.001 ) in Group I for the parameters of passive extension and palpation sensitivity but no significant difference for other parameters . CONCLUSIONS The results of our study have shown better results in palpation sensitivity and passive extension , but no significant improvement in pain , active range , and algometric sensitivity in laser treatment group compared to the control group in the patients with shoulder pain Abstract . Fibromyalgia syndrome ( FMS ) is a very common rheumatological diagnosis . There are various treatment modalities . This study was planned to investigate the effects of balneotherapy in the treatment of FMS . A total of 42 primary fibromyalgia patients diagnosed according to American College of Rheumatology criteria were included in the study . Their ages ranged between 30 and 55 years . Patients were r and omly assigned to two groups . None of them had had a cardiovascular disease before . Group 1 ( n=22 ) received 20-min bathing , once a day and five times per week . Patients participated in the study for 3 weeks ( total of 15 sessions ) . Group 2 ( n=20 ) was accepted as the control group . Patients were evaluated by the number of tender points , Visual Analogue Scale for pain , Beck 's Depression Index for depression , and Fibromyalgia Impact Question naire for functional capacity . Measurements were assessed initially , after the therapy , and at the end of the 6th month . In group 1 , there were statistically significant differences in numbers of tender points , Visual Analogue scores , Beck 's Depression Index , and Fibromyalgia Impact Question naire scores after the therapy program ( P<0.001 ) . Also , 6 months later in group 1 , there was still an improvement in the number of tender points ( P<0.001 ) , Visual Analogue scores , and Fibromyalgia Impact Question naire ( P<0.005 ) . But there was not a statistical difference in Beck 's Depression Index scores compared to the control group ( P>0.05 ) . Patients with FMS mostly complain about pain , anxiety , and the difficulty in daily living activities . This study shows that balneotherapy is effective and may be an alternative method in treating fibromyalgia patients The objective of this article is to show the effect of the Ai Chi method , as an alternative form of hydrotherapeutic approach in fibromyalgia syndrome patients . Ten patients were studied , four were part of the experiment group and five of the control group , with one desistance . The patients were evaluated through the Fibromyalgia Impact Question naire ( QIF ) and Scale of Intensity and Index of pain in Sensible Points . Two evaluations were performed , before and after the treatment . The patients were su bmi tted to ten sessions of the Ai Chi method during 40 minutes . The scale of intensity of pain in sensible points presented an improvement in the intensity of pain after the intervention , while quality of life remained without alteration . Regarding the quality of life , it was observed that the groups had similar results , because of the fact that patients had not presented improvement at depressive state . It was also verified a difference in the index of the sensible points between the groups ; the explanation for this difference might be because of the benefits of the immersion in warm water and the effect of the Ai Chi method . There was no significant difference between the groups , which can be attributed to its limitations . In this way , new studies referring to the application of the Ai Chi method in patients carrying fibromyalgia syndrome become relevant BACKGROUND Balneotherapy has been successfully used to treat various rheumatic diseases , but has only recently been evaluated for the treatment of fibromyalgia . Since no effective treatment exists for this common rheumatic disease , complementary methods of treatment have been attempted . OBJECTIVES To assess the effectiveness of balneotherapy at the Dead Sea area in the treatment of patients suffering from both fibromyalgia and psoriatic arthritis . METHODS Twenty-eight patients with psoriatic arthritis and fibromyalgia were treated with various modalities of balneotherapy at the Dead Sea area . Clinical indices assessed were duration of morning stiffness , number of active joints , a point count of 18 fibrositic tender points , and determination of the threshold of tenderness in nine fibrositic and in four control points using a dolorimeter . RESULTS The number of active joints was reduced from 18.4 + /- 10.9 to 9 + /- 8.2 ( P < 0.001 ) . The number of tender points was reduced from 12.6 + /- 2 to 7.1 + /- 5 in men ( P < 0.003 ) and from 13.1 + /- 2 to 7.5 + /- 3.7 in women ( P < 0.001 ) . A significant improvement was found in dolorimetric threshold readings after the treatment period in women ( P < 0.001 ) . No correlation was observed between the reduction in the number of active joints and the reduction in the number of tender points in the same patients ( r = 0.2 ) . CONCLUSIONS Balneotherapy at the Dead Sea area appears to produce a statistically significant substantial improvement in the number of active joints and tender points in both male and female patients with fibromyalgia and psoriatic arthritis . Further research is needed to eluci date the distinction between the benefits of staying at the Dead Sea area without balneotherapy and the effects of balneotherapy in the study population Objectives To evaluate whether mild water-filtered near infrared whole-body hyperthermia ( NI-WBH ) produces an additional benefit when applied as an adjunct to a st and ard multimodal rehabilitation ( MR ) compared with MR only in patients with fibromyalgia ( FM ) . Methods One hundred thirty-nine patients of a German inpatient rehabilitation hospital meeting the ACR 1990 criteria for FM were r and omly allocated to NI-WBH ( heating-up to 38.1 degrees C body core temperature followed by a 15 min heat retention period ) and MR or MR only , twice a week over 3 weeks . Main outcome measures were affective and sensory pain assessed by a German version of the McGill Pain Question naire , measured at baseline , postintervention , 3 and 6 months postintervention and analyzed by intention to treat . Results Repeated measures analysis of covariance showed significant differences between groups for both primary outcome measures in favor of NI-WBH and MR compared with MR only ( P<0.001 for affective pain , P=0.001 for sensory pain ) . Secondary analyses on pain intensity , FM-related quality of life and tender point assessment yielded similar results . Moderate effect sizes were observed for all outcome measures considered ( range , 0.41 to 0.75 ) . NI-WBH  related side effects were observed in 14 of 69 participants ( 20 % ) but all disappeared in less than 30 minutes . Discussion The study indicates that NI-WBH is a worthwhile adjunct to MR in the treatment of FM
target: A significant effect on depressive symptoms was not found .
  The improvements for pain could be maintained at follow-up with smaller effects .
background: Introduction In the present systematic review and meta- analysis , we assessed the effectiveness of different forms of balneotherapy ( BT ) and hydrotherapy ( HT ) in the management of fibromyalgia syndrome ( FMS ) .