by Nancy Walsh, Senior Staff Writer, MedPage Today
July 10, 2014
Various types of hydrotherapy and spa balneotherapy are popular among patients with fibromyalgia, and a systematic review and meta-analysis suggested that these types of therapy may be helpful for pain and quality of life.
There was moderate to strong evidence in several studies supporting a small decrease in pain with hydrotherapy, with a standardized mean difference (SMD) of -0.42 (95% CI minus 0.61-minus 0.24, P<0.00001, I2=0%), according to Johannes Naumann, PhD, and Catharina Sadaghiani, PhD, of the University of Freiburg in Germany.
The meta-analysis also found moderate evidence that balneotherapy was associated with a large decrease in pain and number of tender points (SMD -0.84, 95% CI minus 1.36-minus 0.31, P=0.002, I2=63%) the researchers reported online in Arthritis Research and Therapy.
Current treatment for fibromyalgia includes both pharmacologic and nonpharmacologic modalities focusing on the individual patient’s symptoms such as pain, fatigue, and depression.
One survey found that more than one-quarter of patients with fibromyalgia use some type of pool therapy and three-quarters use heat, such as with hot packs or immersion in warm water. German and Israeli treatment guidelines favor short-term use of both hydrotherapy and balneotherapy, which differs from hydrotherapy in that it usually involves the use of mineral waters, mud, and natural gases as part of the therapy program.
To examine the evidence for efficacy of these modalities, Naumann and Sadaghiani searched the literature for randomized clinical trials, identifying 12 studies of hydrotherapy and 12 for balneotherapy. Most were conducted in Europe.
Median age of patients in the studies was 45, and median disease duration was slightly over 8 years. Almost all were women.
For hydrotherapy, the meta-analysis showed moderate to strong evidence for a small degree of improvement in health-related quality of life (SMD -0.40, 95% CI minus 0.62 -minus 0.18, P=0.0004, I2=15%), but no benefit for tender point count or depressive symptoms.
For balneotherapy in mineral or thermal water, there was moderate evidence for a medium degree of benefit in health-related quality of life (SMD -0.78, 95% CI minus1.13-minus 0.43, P<0.0001, I2=0%).
There also was moderate evidence indicating large improvements in tender point counts (SMD -0.83, 95% CI minus 1.42-minus 0.24, P=0.006, I2=71%).
But again, no effect was seen for depression.
For the studies that included longer-term follow-up, slight reductions in pain continued after hydrotherapy (SMD -0.25, 95% CI minus 0.50-minus 0.01, P=0.04) and after balneotherapy (SMD -0.30, 95% CI minus 0.53-minus 0.07, P=0.01).
Beneficial effects of balneotherapy also were maintained on health-related quality of life and tender point counts.
For these types of treatment overall, the researchers wrote, “Taking into account all available studies, regardless of treatment modality, meta-analysis provided moderate evidence for a medium reduction of pain at the end of treatment (SMD -0.57, 95% CI minus 0.77-minus 0.38, P<0.00001, I2=45%).”
The authors noted that they weren’t able to analyze the effects of several different types of balneotherapy, such as Stanger baths, thalassotherapy, sulfur baths, or mud baths, because the meta-analysis included only one study of each of these types of therapy.
They also acknowledged that their analysis was underpowered and could have had a risk of bias.
“Given the popularity of balneotherapy and hydrotherapy among patients with fibromyalgia, further studies with high methodology are warranted to demonstrate and confirm the therapeutic benefits,” they concluded.