Balneotherapy for Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis

Chun-Feng Cao; Kun-Long Ma; Qian-Lu Li; Fu-Jun Luan; Qun-Bo Wang; Ming-Hua Zhang; Omar Viswanath; Dariusz Myrcik; Giustino Varrassi; Hai-Qiang Wang

doi:10.3390/jcm10071493

Balneotherapy for Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis

J Clin Med. 2021 Apr 3;10(7):1493. doi: 10.3390/jcm10071493.

Authors

Chun-Feng Cao¹, Kun-Long Ma¹, Qian-Lu Li², Fu-Jun Luan¹, Qun-Bo Wang¹, Ming-Hua Zhang¹, Omar Viswanath^{3

4

5

6}, Dariusz Myrcik⁷, Giustino Varrassi⁸, Hai-Qiang Wang⁹

Affiliations

¹ Department of Orthopedics, The Yongchuan Hospital of Chongqing Medical University, 439# Xuanhua Road, Yongchuan, Chongqing 402160, China.
² Department of Neurology, The Yongchuan Hospital of Chongqing Medical University, 439# Xuanhua Road, Yongchuan, Chongqing 402160, China.
³ Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE 68114, USA.
⁴ Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85003, USA.
⁵ Department of Anesthesiology, Louisiana State University Shreveport, Shreveport, LA 71106, USA.
⁶ Department of Pain Management, Valley Pain Consultants-Envision Physician Services, Phoenix, AZ 85003, USA.
⁷ Department of Internal Medicine, Medical University of Silesia, Katowice, 42-600 Bytom, Poland.
⁸ Department of Research, Polo Procacci Foundation, via Tacito 7, 00193 Roma, Italy.
⁹ Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi'an 712046, China.

Abstract

(1) Background: The efficiency of balneotherapy (BT) for fibromyalgia syndrome (FMS) remains elusive. (2) Methods: Cochrane Library, EMBASE, MEDLINE, PubMed, Clinicaltrials.gov, and PsycINFO were searched from inception to 31 May 2020. Randomized controlled trials (RCTs) with at least one indicator were included, i.e., pain, Fibromyalgia Impact Questionnaire (FIQ), Tender Points Count (TPC), and Beck's Depression Index (BDI). The outcome was reported as a standardized mean difference (SMD), 95% confidence intervals (CIs), and I² for heterogeneity at three observational time points. GRADE was used to evaluate the strength of evidence. (3) Results: Amongst 884 citations, 11 RCTs were included (n = 672). Various BT regimens were reported (water types, duration, temperature, and ingredients). BT can benefit FMS with statistically significant improvement at different time points (pain of two weeks, three and six months: SMD = -0.92, -0.45, -0.70; 95% CI (-1.31 to -0.53, -0.73 to -0.16, -1.34 to -0.05); I² = 54%, 51%, 87%; GRADE: very low, moderate, low; FIQ: SMD = -1.04, -0.64, -0.94; 95% CI (-1.51 to -0.57, -0.95 to -0.33, -1.55 to -0.34); I² = 76%, 62%, 85%; GRADE: low, low, very low; TPC at two weeks and three months: SMD = -0.94, -0.47; 95% CI (-1.69 to -0.18, -0.71 to -0.22); I² = 81%, 0; GRADE: very low, moderate; BDI at six months: SMD = -0.45; 95% CI (-0.73 to -0.17); I² = 0; GRADE: moderate). There was no statistically significant effect for the TPC and BDI at the remaining time points (TPC at six months: SMD = -0.89; 95% CI (-1.85 to 0.07); I² = 91%; GRADE: very low; BDI at two weeks and three months: SMD = -0.35, -0.23; 95% CI (-0.73 to 0.04, -0.64 to 0.17); I² = 24%, 60%; GRADE: moderate, low). (4) Conclusions: Very low to moderate evidence indicates that BT can benefit FMS in pain and quality-of-life improvement, whereas tenderness and depression improvement varies at time phases. Established BT regimens with a large sample size and longer observation are needed.

Keywords: balneotherapy; fibromyalgia; meta-analysis; musculoskeletal disease; systematic review.

Publication types

Review