Complex balneo-physiatric treatment in fibromyalgia: A pilot study

摘要

19 patients meeting CDC criteria for fibromyalgia (FM) were treated. The treatment consisted of warm water hydrotherapy performed in bathtub with hydrojets, dry CO2 bathes, pulsed magnetotherapy, ultrasonotherapy applying capsaicin ointment and manual techniques for 2 weeks. All the mayor fibromyalgia impact questionnaire, McGill short questionnaire and additional variables improved at high statistical significance level. Up to date the worst improvement period lasted for 4 months. The most difficult cases were those, where cervical spondylitis was diagnosed together with FM. The mechanism of action of factors applied is discussed. Introduction Fibromyalgia (FM) has been defined as rheumatic disease characterized by at least 3 months lasting pain in all 4 body quadrants with at least 11 from 18 specific points painful to palpation with force of about 4 kp (1) . Alarming results in NMR imaging were published (2) about cortical gray matter hypodensity and degeneration with severity correlated to the fibromyalgia duration resembling premature brain aging. Similar changes were observed in striatum (3) . A lot of papers have appeared showing hypoperfusion in thalamus, cuadate nucleus and anterior cingulate cortex (4,5,6,7,8) .The pharmacological treatment in spite of great effort is not quite satisfactory. It seems that physiatric approach is better (9,10,11,12,13,14) , and above all balneology with more complex and intensive treatment gives more long-lasting results (15,16,17,18,19) . The problem with balneological treatment is its high prize (20) and necessity to stay for a couple of weeks in a specific place with given climatic and geological features that differ significantly. That means that at any spa approaches are different and hardly can be compared.Physiatric procedures generally applied are based mainly on active exercising. However, for a FM patient physical activity quite common for healthy person represents an overload followed by amplification of pains. If exercising is not led by especially trained persons knowing well the pathology and patients limits the results may be catastrophic. This fact explains reported low adherence to exercising (21) .We decided to apply a selection of 5 passive cheap and simple procedures derived from european balneological practice to prove if those may improve patients conditions as a preparation for consequent active treatment.The study was performed as open as except of ultrasound no one of factors applied can not be even single blinded. Form those reasons this study should be understood as pilot one showing certain possibilities only. Moreover, we wanted to verify whether unpublished results from Czech and Slovak spas might be repeated in harder climate zone without corresponding natural resources. Form those reasons this study should be understood as pilot one showing certain possibilities only. Localization and climate San Pedro is localized in subtropical zone of Misiones Province in the NE of Argentinean territory with geographical coordinates: 26°50' S and 54°15' W, 505 meters above sea level. The climate is continental subtropical with average winter temperature 17 o C (range 0 - 28 o C), summer average temperature 25 o C (range 15 - 40 o C). Humidity varies from 30% up to 100% with marked season, day-to-day and daily instability. Patients and methods 19 outpatients, 3 males (M) and 16 females (F) meeting the CDC criteria for the fibromyalgia (1) .Age (years): 23 - 62, median 41, lower quartile (LQ) 30, upper quartile (UQ) 48.Professions: 5 rural workers (F), 2 drivers (M), 1 carpenter (M), 1 cashier (F), 1 teacher (F), 2 nurses (F), 1 cosmetologist (F), 1 accountant (F), 1 administrative worker (F), 1 shop owner (M), 2 housewives, 1 retired (F).Disease history (years elapsed since the FM was diagnosed): 1 - 37, median 5, LQ 2.5, UQ 9.5. Note: the female patient with the largest history had been diagnosed as FM in Switzerland before the CDC definition.Allodyniae were reported