Therapeutic benefit of balneotherapy and hydrotherapy in the management of fibromyalgia syndrome: a qualitative systematic review and meta-analysis of randomized controlled trials

Abstract

IntroductionIn 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).MethodsA systematic literature search was conducted through April 2013 (Medline via Pubmed, Cochrane Central Register of Controlled Trials, EMBASE, and CAMBASE). Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using a random-effects model.ResultsMeta-analysis showed moderate-to-strong evidence for a small reduction in pain (SMD −0.42; 95% CI [−0.61, −0.24]; P < 0.00001; I2 = 0%) with regard to HT (8 studies, 462 participants; 3 low-risk studies, 223 participants), and moderate-to-strong evidence for a small improvement in health-related quality of life (HRQOL; 7 studies, 398 participants; 3 low-risk studies, 223 participants) at the end of treatment (SMD −0.40; 95% CI [−0.62, −0.18]; P = 0.0004; I2 = 15%). No effect was seen at the end of treatment for depressive symptoms and tender point count (TPC).BT in mineral/thermal water (5 studies, 177 participants; 3 high-risk and 2 unclear risk studies) showed moderate evidence for a medium-to-large size reduction in pain and TPC at the end of treatment: SMD −0.84; 95% CI [−1.36, −0.31]; P = 0.002; I2 = 63% and SMD −0.83; 95% CI [−1.42, −0.24]; P = 0.006; I2 = 71%. After sensitivity analysis, and excluding one study, the effect size for pain decreased: SMD −0.58; 95% CI [−0.91, −0.26], P = 0.0004; I2 = 0. Moderate evidence is given for a medium improvement of HRQOL (SMD −0.78; 95% CI [−1.13, −0.43]; P < 0.0001; I2 = 0%). A significant effect on depressive symptoms was not found. The improvements for pain could be maintained at follow-up with smaller effects.ConclusionsHigh-quality studies with larger sample sizes are needed to confirm the therapeutic benefit of BT and HT, with focus on long-term results and maintenance of the beneficial effects.

EULAR revised recommendations for the management of fibromyalgia

“…There was a significant improvement in pain (−0.78; −1.42 to −0.13) at the end of therapy, maintained in the longer term (median 14 weeks), although the review authors noted that no trials conducted an ITT analysis. There was consistency with regard to the evidence for hydrotherapy and balneotherapy, although little evidence to suggest superiority of one over the other 77 . Hydrotherapy evaluation: weak for (93% agreement) .…”

Current Understanding of Fibromyalgia: Diagnosis, Treatment, and Theories About Causes

“…36 A systematic review and meta-analysis of 8 RCTs (overall N = 462) of the therapeutic benefit of hydrotherapy (water treatments) for FM provided moderate-to-strong evidence for a small improvement in HRQoL at the end of treatment, but not in depression or tender-point count. 37 Five RCTs (overall N = 177) of balneotherapy (spa treatments in mineral/thermal water) produced moderate evidence for a moderate-to-large reduction in pain and tender-point count at the end of treatment; a smaller effect on pain was maintained at follow-up.…”

Improvement in Pensioners Quality of Life after Treatment with Mineral-Rich Medicinal Waters

“…Various other scientific studies, mainly in people with fibromyalgia [19,20], osteoarthritis [21][22][23][24][25][26][27][28][29][30], chronic low back pain [31,32] and chronic venous insufficiency [33,34], have found that balneotherapy and undergoing such treatments resulted in an improved quality of life in regard to health.…”