Components of effective randomized controlled trials of hydrotherapy programs for fibromyalgia syndrome: A systematic review Hydrotherapy and conventional physiotherapy improve total sleep time and quality of life of fibromyalgia patients: randomized clinical trial. Serum cortisol and dehydroepiandrosterone-sulfate levels after balneotherapy and physical therapy in patients with fibromyalgia Effects of balneotherapy on serum IL-1, PGE2 and LTB4 levels in fibromyalgia patients Investigation of the effects of pool-based exercise on fibromyalgia syndrome The effects of balneotherapy on fibromyalgia patients Balneotherapy versus paroxetine in the treatment of generalized anxiety disorder. Strength training induced adaptations in neuromuscular function of premenopausal women with fibromyalgia: comparison with healthy women Balneotherapy for fibromyalgia at the Dead Sea Effectiveness of Balneotherapy in Chronic Low Back Pain – a Randomized Single-Blind Controlled Follow-up Study Does addition of ‘mud-pack and hot pool treatment’ to patient education make a difference in fibromyalgia patients? A randomized controlled single blind study Sexual and Physical Abuse in Women With Fibromyalgia Syndrome: A Test of the Trauma Hypothesis Content and Criterion Validity of the Preliminary Core Dataset for Clinical Trials in Fibromyalgia Syndrome Efficacy and Safety of Medicinal Plants or Related Natural Products for Fibromyalgia: A Systematic Review Effects of T’ai Chi Exercise on Fibromyalgia Symptoms and Health-Related Quality of Life One-Year Effectiveness of a 3-Week Balneotherapy Program for the Treatment of Overweight or Obesity Management of patients with fibromyalgia using biofeedback: a randomized control trial. An Online Mindfulness Intervention Targeting Socioemotional Regulation in Fibromyalgia: Results of a Randomized Controlled Trial Is brief psychodynamic psychotherapy in primary fibromyalgia syndrome with concurrent depression an effective treatment? A randomized controlled trial. Pain and allodynia/hyperalgesia induced by intramuscular injection of serotonin in patients with fibromyalgia and healthy individuals Mixed treatment comparison analysis provides internally coherent treatment effect estimates based on overviews of reviews and can reveal inconsistency. Balneotherapy in fibromyalgia: a single blind randomized controlled clinical study Protocol for an overview of systematic reviews of interventions to reduce unscheduled hospital admissions among adults
Aim Previous systematic review s have found hydrotherapy to be an effective management strategy for  fibromyalgia syndrome ( FMS ) .  The aim of this systematic review was to summarize the components of hydrotherapy programs used in r and omized controlled trials . Method A systematic review of r and omized controlled trials was conducted . Only trials that have reported significant FMS-related outcomes were included . Data relating to the components of hydrotherapy programs ( exercise type , duration , frequency and intensity , environmental factors , and service delivery ) were analyzed . Results Eleven r and omized controlled trials were included in this review . Overall , the quality of trials was good . Aerobic exercise featured in all 11 trials and the majority of hydrotherapy programs included either a strengthening or flexibility component . Great variability was noted in both the environmental components of hydrotherapy programs and service delivery . Conclusions Aerobic exercise , warm up and cool-down periods and relaxation exercises are common features of hydrotherapy programs that report significant FMS-related outcomes . Treatment duration of 60 minutes , frequency of three sessions per week and an intensity equivalent to 60%–80 % maximum heart rate were the most commonly reported exercise components . Exercise appears to be the most important component of an effective hydrotherapy program for FMS , particularly when considering mental health-related outcomes 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 Objectives : To investigated serum cortisol and serum dehydroepi and rosterone-sulphate ( DHEA-S ) levels between fibromyalgia ( FMS ) patients and a control group , and the effect of balneotherapy ( BT ) on these hormones . Methods : Seventy-two patients with FMS and 39 healthy volunteers were included in the study . This prospect i ve and cross-sectional study was carried out in the Medical Faculty , Physical Medicine and Rehabilitation Clinic , Cumhuriyet University , Cumhuriyet , Turkey between June 2012 and June 2013 . Patients were divided into 2 groups . There were 40 patients in the first group , consisting of BT and physical therapy ( PT ) administered patients . There were 32 FMS patients in the second group who were only administered PT .  Thirty-nine healthy volunteers were enrolled as a control group . Result : Cortisol was observed to be lower in FMS patients compared with the controls ( 10.10±4.08 μg/dL and 11.78±3.6 μg/dL ; p=0.033 ) . Serum DHEA-S level was observed to be lower in FMS patients compared with the controls ( 89.93±53.96 μg/dL and 143.15±107.92 μg/dL ; p=0.015 ) . Average serum cortisol levels of patients receiving BT were determined to be 9.95±3.20 μg/dL before treatment and 9.06±3.77μg/dL after treatment ; while average serum DHEA-S levels were 77.60±48.05 μg/dL before treatment , and 76.84±48.71 μg/dL after treatment . No significant changes were determined in serum cortisol and DHEA-S levels when measured again after BT and PT . Conclusion : Low levels of serum cortisol and DHEA-S were suggested to be associated with the physiopathology of FMS 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 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 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 INTRODUCTION Preliminary studies have suggested that balneotherapy ( BT ) is an effective and well-tolerated treatment for  generalized anxiety disorder ( GAD ) and psychotropic medication withdrawal syndrome .  We carried out a study in 4 spa resorts to assess the efficacy of BT in GAD . METHOD We compared BT to paroxetine in terms of efficacy and safety in a r and omized multicentre study lasting 8 weeks . Patients meeting the diagnostic criteria of GAD ( DSM-IV ) were recruited . Assessment s were conducted using the Hamilton Rating Scale for Anxiety ( HAM-A ) and other scales , by a specifically trained and independent physician . The primary outcome measure was the change in the total HAM-A score between baseline and week 8 . RESULTS A total of 237 out patients were enrolled in four centres ; 117 were assigned r and omly to BT and 120 to paroxetine .  The mean change in HAM-A scores showed an improvement in both groups with a significant advantage of BT compared to paroxetine ( -12.0 vs -8.7 ; p<0.001 ) . Remission and sustained response rates were also significantly higher in the BT group ( respectively 19 % vs 7 % and 51 % vs 28 % ) . CONCLUSION BT is an interesting way of treating GAD . Due to its safety profile it could also be tested in resistant forms of generalized anxiety and in patients who do not tolerate or are reluctant to use pharmacotherapies OBJECTIVE To investigate the effects of 21 weeks ' progressive strength training on neuromuscular function and subjectively perceived symptoms in premenopausal women with fibromyalgia ( FM ) . METHODS Twenty one women with FM were r and omly assigned to experimental ( FMT ) or control ( FMC ) groups . Twelve healthy women served as training controls ( HT ) . The FMT and HT groups carried out progressive strength training twice a week for 21 weeks . The major outcome measures were muscle strength and electromyographic ( EMG ) recordings . Secondary outcome measures were pain , sleep , fatigue , physical function capacity ( Stanford Health Assessment Question naire ) , and mood ( short version of Beck 's depression index ) . RESULTS Female FMT subjects increased their maximal and explosive strength and EMG activity to the same extent as the HT group . Moreover , the progressive strength training showed immediate benefits on subjectively perceived fatigue , depression , and neck pain of training patients with FM . CONCLUSIONS The strength training data indicate comparable trainability of the neuromuscular system of women with FM and healthy women .  Progressive strength training can safely be used in the treatment of FM to decrease the impact of the syndrome on the neuromuscular system , perceived symptoms , and functional capacity . These results confirm the opinion that FM syndrome has a central rather than a peripheral or muscular basis 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 : Balneotherapy , a domain of medical science , focuses on utilizing the beneficial effects of medicinal waters . Low back pain is among the most prevalent musculoskeletal disorders affecting a large proportion of the population during their lifetime . Although small in number , all controlled studies published on this subject have demonstrated the benefits of balneotherapy . This present study was undertaken to compare the effects of hydrotherapy with mineral water vs. tap water on low back pain . Patients and Methods : A single-blind clinical study was carried out to appraise the therapeutic efficacy of reduced sulphurous water on 60 patients with low back pain . 30 subjects took baths in reduced sulphurous mineral water  , whereas the other 30 patients used modified tap water of matching odor . Parameters determined at baseline , after balneo-/hydrotherapy , and at the end of the 3-month follow-up period included the results of the Visual Analogue Scale ( VAS ) score , the modified Oswestry index , mobility of the spine , antalgic posture , tenderness of the paravertebral muscles on palpation , the dose requirements for analgesics , and the efficacy assessed by the investigators and by the patients . Results : Bathing in mineral water result ed in a statistically significant improvement . This was reflected by the VAS ( p < 0.01 ) and manifested by the mitigation of muscle spasm ( p < 0.01 ) , the alleviation of local tenderness ( p < 0.01 ) , the enhanced flexion-extension and rotation of the spine ( p < 0.01 ) as well as by the improvement of the Schober ’s index ( p < 0.01 ) . All these beneficial changes persisted as long as 3 months after the completion of balneotherapy . By contrast , hydrotherapy with tap water result ed only in the temporary improvement of just a single parameter : the VAS score improved significantly ( p < 0.01 ) . Conclusions : Balneotherapy in itself can alleviate  low back pain . As demonstrated by this study , the analgesic efficacy and improvement of mobility accomplished by the use of mineral water is significantly superior to that afforded by hydrotherapy with tap water . Our results clearly establish the beneficial effects of mineral water . Moreover , it is a valuable adjunct to other forms of physical treatment as well as to pharmacotherapy The aim of this r and omized controlled single-blind study is to explore whether addition of mud-pack and hot pool treatments to patient education make a significant difference in short and mild term outcomes of the patients with fibromyalgia . Seventy women with fibromyalgia syndrome were r and omly assigned to either balneotherapy with mud-pack and hot pool treatments ( 35 ) or control ( 35 ) groups . After r and omization , five patients from  balneotherapy group and five patients from control group were dropped out from the study with different excuses . All patients had 6-h patient education programme about fibromyalgia syndrome and were given a home exercise programme . The patients in balneotherapy group had heated pool treatment at 38 ° C for 20 min a day , and mud-pack treatment afterwards on back region at 45 ° C . Balneotherapy was applied on weekdays for 2 weeks . All patients continued to take their medical treatment . An investigator who was blinded to the intervention assessed all the patients before and after the treatment , at the first and the third months of follow-up . Outcome measures were FIQ , BDI and both patient ’s and physician ’s global assessment s.  Balneotherapy group was significantly better than control group at after the treatment and at the end of the first month follow-up assessment s in terms of patient ’s and physician ’s global assessment , total FIQ score , and pain intensity , fatigue , non-refreshed awaking , stiffness , anxiety and depression subscales of FIQ . No significant difference was found between the groups in terms of BDI scores . It is concluded that patient education combined with 2 weeks balneotherapy application has more beneficial effects in patients with fibromyalgia syndrome as compared to patient education alone Objectives : According to the trauma hypothesis , women with fibromyalgia syndrome ( FMS ) are more likely to report a history of sexual and /or physical abuse than women without FMS . In this study , we rely on a community sample to test this hypothesis and the related prediction that women with FMS are more likely to have posttraumatic stress disorder than women without FMS . Methods : Eligibility for the present study was limited to an existing community sample in which FMS and major depressive disorder were prevalent . The unique composition of the original sample allowed us to recruit women with and without FMS from the community . A total of 52 female participants were enrolled in the present FMS group and 53 in the control ( no FMS ) group .  Sexual and physical abuse were assessed retrospectively using a st and ardized telephone interview . Results : Except for rape , sexual and physical abuse were reported equally often by women in the FMS and control groups . Women who reported rape were 3.1 times more likely to have FMS than women who did not report rape ( P < 0.05 ) . There was no evidence of increased childhood abuse in the FMS group . Women with FMS were more likely to have posttraumatic stress disorder symptoms ( intrusive thoughts and arousal ) as well as posttraumatic stress disorder diagnosis ( P < 0.01 ) . Discussion : With the exception of rape , no self-reported sexual or physical abuse event was associated with FMS in this community sample . In accord with the trauma hypothesis , however , posttraumatic stress disorder was more prevalent in the FMS group . Chronic stress in the form of posttraumatic stress disorder but not major depressive disorder may mediate the relationship between rape and FMS Objective . Increasing research interest and emerging new therapies for treatment of fibromyalgia ( FM ) have led to a need to develop a consensus on a core set of outcome measures that should be assessed and reported in all clinical trials , to facilitate interpretation of the data and underst and ing of the disease . This aligns with the key objective of the Outcome Measures in Rheumatology ( OMERACT ) initiative to improve outcome measurement through a data driven , interactive consensus process . Methods . Through patient focus groups and Delphi processes , working groups at previous OMERACT meetings identified potential domains to be included in the core data set . A systematic review has shown that instruments measuring these domains are available and are at least moderately sensitive to change . Most instruments have been vali date d in multiple language s. This pooled analysis study aims to develop the core data set by analyzing data from 10 r and omized controlled trials ( RCT ) in FM . Results . Results from this study provide support for the inclusion of the following in the core data set : pain , tenderness , fatigue , sleep , patient global assessment , and multidimensional function/health related quality of life . Construct validity was demonstrated with outcome instruments showing convergent and divergent validity . Content and criterion validity were confirmed by multivariate analysis showing R square values between 0.4 and 0.6 . Low R square value is associated with studies in which one or more domains were not assessed . Conclusion . The core data set was supported by high consensus among attendees at OMERACT 9 . Establishing an international st and ard for RCT in FM should facilitate future metaanalyses and indirect comparisons To assess the effects of medicinal plants ( MPs ) or related natural products ( RNPs ) on fibromyalgia ( FM ) patients , we evaluate the possible benefits and advantages of MP or RNP for the treatment of FM based on eight r and omized placebo-controlled trials ( RCTs ) involving 475 patients . The method ological quality of all studies included was determined according to JADAD and “ Risk of Bias ” with the criteria in the Cochrane H and book for Systematic Review s of Interventions 5.1.0 . Evidence suggests significant benefits of MP or RNP in sleep disruption , pain , depression , joint stiffness , anxiety , physical function , and quality of life . Our results demonstrated that MP or RNP had significant effects on improving the symptoms of FM compared to conventional drug or placebo ; longer tests are required to determine the duration of the treatment and characterize the long-term safety of using MP , thus suggesting effective alternative therapies in the treatment of pain with minimized side effects Background Fibromyalgia ( FM ) , one of the most common musculoskeletal disorders , is associated with high levels of impaired health and inadequate or limited symptom relief . The cause of this complex syndrome is unknown , and there is no known cure . Numerous research results indicate that a combination of physical exercise and mind-body therapy is effective in symptom management .  T’ai Chi , an ancient Chinese exercise , combines physical exercise with mind-body therapy . Purpose To investigate the effects of T’ai Chi exercise on FM symptoms and health-related quality of life . Design Pilot study , one group pre-to-post posttest design . Methods Participants with FM ( n = 39 ) formed a single group for 6 weeks of 1-hour , twice weekly T’ai Chi exercise classes .  FM symptoms and health-related quality of life were measured before and after exercise . Findings Twenty-one participants completed at least 10 of the 12 exercise sessions . Although the dropout rate was higher than expected , measurements on both the Fibromyalgia Impact Question naire ( FIQ ) ( Buckhardt , Clark , & Bennett , 1991 ) and the Short Form-36 ( SF-36 ) ( Ware & Sherbourne , 1992 ) revealed statistically significant improvement in symptom management and health-related quality of life . Implication s for Nursing Research Knowledge of interventions to enhance health for the patient with musculoskeletal problems is a National Association of Orthopaedic Nurses priority . T’ai Chi is potentially beneficial to patients with FM . Further research is needed to support evidence -based practice Objective . To assess the one-year effectiveness on weight loss of a 3-week balneotherapy program ( BT ) . Method . A Zelen double consent r and omised controlled trial to compare one-year BMI loss between a 3-week  BT program versus usual care ( UC ) for overweight or obese patients ( BMI : 27–35 kg/m2 ) , associated or not with a dietary motivational interview ( DMI )  during the follow-up , using a 2 × 2 factorial design . Main analysis was a per protocol analysis comparing patients attending BT to patients managed by UC , matched on sex , overweight or obese status , DMI r and omisation and a propensity score to attend BT or to be managed by UC . Results . From the 257 patients who completed the follow-up , 70 patients of each group could be matched . Mean BMI loss was 1.91 kg/m2 [ 95%CI : 1.46 ; 2.35 ] for the BT patients and 0.20 kg/m2 [ −0.24 ; 0.64 ] for the UC patients ( P < 0.001 ) , corresponding to a significant BT benefit of 1.71 kg/m2 [ 1.08 ; 2.33 ] . There was no significant effect of DMI and no interaction with BT or UC . No adverse reaction was observed for patients attending BT . Conclusion . A 3-week BT program provided a significant one-year benefit over the usual GP dietary advice for overweight and obese patients OBJECTIVE Fibromyalgia syndrome ( FMS ) is a chronic rheumatological condition which could be characterized by generalized pain and fatigue . Cognitive and behavioral therapy has been found to be a suitable technique in the management of FMS . This study intends to evaluate the efficacy of electromyography ( EMG ) biofeedback to reduce pain in patients with FMS . MATERIAL S AND METHODS A r and omized controlled trial involving two groups of FMS patients , one receiving EMG biofeedback and the other a sham biofeedback  , was carried out . The assessment tools included in the study were fibromyalgia impact question naire ( FIQ ) , visual analogue scale ( VAS ) , six-minute walk test ( SMWT ) and number of tender points ; and tenderness of each tender point was done for both the groups . STATISTICS A Student 's ' t ' test was used to study the test for significance . RESULTS After using biofeedback , the mean VAS scores and the mean number of tender points were found to be 3 out of 10 and 6 out of 18 respectively . Subjective analysis from both groups showed improvement in physical and psychological realms . Statistical significance . CONCLUSION Biofeedback as a treatment modality reduces pain in patients with FMS , along with improvements in FIQ , SMWT and the number of tender points Background Patients with fibromyalgia ( FM ) experience pain as well as deficits in positive affect and social relations that are not explicitly addressed in most behavioral treatments . Purpose The purpose of this study is to compare the effects of a 12-module online intervention targeting socioemotional regulation via mindful awareness/acceptance ( MSER ) with those of an attention-control treatment , healthy lifestyle tips ( HT ) . Methods Seventy-nine FM patients were r and omly assigned to MSER or HT , with outcomes assessed via online diary reports of pain , coping efficacy , affect , and social relations . Multilevel analyses revealed greater improvements in social functioning , positive affect , and coping efficacy for pain and stress ( all ps < .05 ) in MSER versus HT across the 6-week trial . Conclusions FM patients experience increases in self-efficacy for coping with pain and positive engagement in relationships , marginal increases in positive affect , and decreases in relationship stress from an automated online intervention that targets socioemotional regulation skills . Findings highlight the potential utility of widely accessible , low-cost intervention methods for fibromyalgia ( Clinical trials.gov number NCT01748786 ) OBJECTIVE There are no studies investigating the efficacy of short-term psychodynamic psychotherapy in primary fibromyalgia syndrome ( FMS ) . We conducted a r and omized controlled trial evaluating an adapted form of individual short-term psychodynamic psychotherapy ( ASTPP ) versus primary care management ( TAU ) . The study focused on FMS patients with psychiatric comorbidity . METHODS Forty-six female patients with FMS and an International Classification of Diseases , 10th Revision diagnosis of a comorbid depression or anxiety disorder were recruited in a hospital setting . Participants were r and omized to receive either ASTPP ( 25 sessions , 1 session/week ) or TAU ( 4 consultations/6 months ) . Outcome measures included the Fibromyalgia Impact Question naire ( FIQ ) , the Hospital Anxiety and Depression Scale ( HADS ) , the Pain Disability Index , the Symptom Checklist 27 and the health-related quality of life . Primary endpoints of the outcome assessment were the FIQ total score and the HADS depression scale at 12-month follow-up . RESULTS Both treatments were effective in reducing the FIQ total score ( ES=0.56 and ES=0.75 , respectively ) . Intent-to-treat analyses failed to provide evidence suggesting a marked superiority of individual psychodynamic psychotherapy as compared to TAU . CONCLUSIONS A high-st and ard routine treatment focusing on the improvement of health behavior and including antidepressant and analgesic medication is equally effective as a short-term individual psychodynamic psychotherapy in improving fibromyalgia-related symptoms Abstract The aim of this study was to investigate the effect of injection of serotonin ( 5‐HT ) into the masseter muscle on pain and allodynia/hyperalgesia .  Twelve female patients with fibromyalgia ( FM ) and 12 age‐matched female healthy individuals ( HI ) participated in the study . The current pain intensity ( CPI ) and the pressure pain threshold ( PPT ) of the superficial masseter muscles were assessed bilaterally . 5‐HT in one of three r and omized concentrations ( 10−3 , 10−5 , 10−7 M ) or isotonic saline was then injected into either of the two masseter muscles in a double‐blind manner . After the injections the CPI and PPT were recorded ten times during 30 min . The injections were repeated twice with the other concentrations of 5‐HT after 1 and 2 weeks , respectively . In the FM‐group there was a non‐significant increase of CPI after injection that lasted during the entire 30‐min period irrespective of whether 5‐HT or saline was injected . Neither did the PPT change significantly . In the HI‐group pain developed significantly after injection irrespective of whether 5‐HT or saline was injected , but significantly more so after 5‐HT at 10−3 M than saline injection . CPI decreased quickly and then remained on a very low level for most of the experiment . 5‐HT at both 10−5 M and 10−3 M caused a significantly greater decrease of PPT than saline . In conclusion , our results show that 5‐HT injected into the masseter muscle of healthy female subjects  elicits pain and allodynia/hyperalgesia , while no such responses occur in patients with fibromyalgia OBJECTIVES To propose methods for mixed treatment comparisons ( MTC ) based on pooled summaries of the type produced in overviews of review s. STUDY DESIGN AND SETTING Overviews of review s ( umbrella review s ) summarize the results of multiple systematic review s into a single document . They report the summary estimates from the original pairwise meta-analyses and discuss them in narrative form , with the intention of identifying the most effective treatment . We present methods for MTC synthesis , tailored for use with overviews of review s. These generate a single internally consistent summary of all the relative treatment effects and assessment s of whether the summary is consistent with the data . These methods are applied to a published overview of treatments for childhood nocturnal enuresis . We apply the methods to both fixed-effect ( FE ) and r and om-effects ( RE ) meta-analyses of the original trials . RESULTS The summary relative risks based on FE meta-analyses , as originally published , were highly inconsistent . Those based on RE meta-analyses were consistent and could , given st and ard assumptions on comparability of treatment effects in meta- analysis , form a basis for coherent decision making . CONCLUSION Along with the summaries from systematic review s , MTC methods should be used in overviews to provide a single coherent analysis of all treatment comparisons and to check for evidence consistency 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 Introduction Unscheduled hospital admissions are an increasing burden on health systems worldwide . To date , initiatives to reduce admissions have had limited success as it is unclear which strategies effectively reduce admissions and are supported by a strong evidence -base . Therefore , we will conduct an overview to find , assess and summarise all published peer- review ed systematic review s of r and omised controlled trials that examine the effect of an intervention on  unplanned admissions among adults . Methods and analysis This is a protocol for a systematic overview of review s. We will search four data bases : Ovid MEDLINE , PubMed , Cochrane Data base of Systematic Review s and the Cochrane Data base of Abstract s of Review s of Effects . We will consider systematic review s and meta-analyses of r and omised controlled trials in adults ( ≥16 years old ) evaluating the effect of any intervention on unscheduled hospital admissions including those to treat , monitor , diagnose or prevent a health problem . We will only include review s that identified unscheduled hospitalisations as a prespecified outcome . Two authors will independently screen articles for inclusion using a priori criteria . We will assess the quality of included review s and extract ratings of the quality of evidence from within each review . We will create a hierarchical list of interventions based on estimates of absolute admission reductions and the quality of the evidence . Presentation of results will align with guidelines in the Cochrane H and book of Systematic Review s of Interventions and the Preferred Reporting Items for Systematic Review s and Meta- Analysis statement . Ethics and dissemination Ethics approval is not required . We will su bmi t the results of this study for peer- review publication . The results will inform future research and could be used by healthcare managers , administrators and policymakers to guide re source allocation decisions and inform local implementation and optimisation of interventions to reduce unscheduled hospital admissions
A significant effect on depressive symptoms was not found .
The improvements for pain could be maintained at follow-up with smaller effects .
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 ) .