Benefits of balneotherapy in the management of fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials

Abstract

Objective To assess the effectiveness of balneotherapy (BT) in the management of fibromyalgia syndrome (FMS). Methods The Cochrane Library, EMBASE, MEDLINE, and PubMed were thoroughly searched for relevant studies with a pre-specified searching strategy (from their inception to May 31 st , 2019), to identify randomized controlled trials (RCTs) evaluating BT in FMS management. The primary outcomes were pain, Fibromyalgia Impact Questionnaire (FIQ), Tender Points Count (TPC), Beck's Depression Index (BDI). A meta-analysis was performed to identify risk ration (RR) or standardized mean difference (SMD) where appropriate, 95%CI with random-effect and consistent models. Results Ten RCT studies with 611 participants were included. Pooled results showed that BT can benefit FMS with significant improvement reflected as, pain (SMD= -0.90, 95%CI [−1.37 to −0.42] I 2 =86%), FIQ (SMD= −0.81, 95% CI [−1.24 to −0.38] I 2 =84%), TPC (SMD= −0.88, 95% CI [−1.63 to −0.14] I 2 =91%) and BDI (SMD= −0.29, 95% CI [−0.53 to −0.05] I 2 =22%) at the end of treatment. However, there was no significant effect on BDI (SMD= −0.57, 95% CI [−1.40 to 0.26]) at follow up. Conclusion Based on 12 to 48 weeks observation, pooled evidence from RCTs indicates BT may reduce pain and improve the quality of life of patients with FMS. Definitive, large-sample studies are needed, with focus on long-term results and maintenance of the beneficial effects.