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 ) .
Function of the hypothalamic adrenal axis in patients with fibromyalgia syndrome undergoing mud-pack treatment.
Fibromyalgia ( FM ) is a nonarticular rheumatological syndrome associated with diverse clinical and psychological features . One of the major complaints in FM is reduced pain tolerance , especially in tender points ( TP ) for which patients derive significant benefit from nonsteroidal antiinflammatory drugs or corticosteroids .  Patients with FM also have altered reactivity of the hypothalamic pituitary adrenal ( HPA ) axis where the predominant feature is reduced containment of the stress response system through diminished adrenocortical output and feedback resistance . Our results show that mud packs together with antidepressant treatment are able to influence the HPA axis , stimulating increased levels of adrenocorticotropic hormone , cortisol and beta-endorphin serum levels . The discharge of corticoids in the blood and the increase in beta-endorphin serum levels are followed by a reduction in pain symptoms , which is closely related to an improvement in disability , depression and quality of life . It seems that the synergic association between a pharmacological treatment ( trazodone ) and mud packs acts by helping the physiological responses to achieve homeostasis and to rebalance the stress response system . To clarify and optimize the effectiveness of this synergic association , studies involving a larger number of FM patients and a different pharmacological treatment are needed
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 ) .