Balneotherapy helps Fibromyalgia?

Head to your nearest thermal mineral water spa !

 

selfmanagechronicpain with balneotherapy

Enjoying the Therapeutic effects of Balneotherapy and Hydrotherapy

Therapeutic Effect of Balneotherapy and Hydrotherapy in the Management of Fibromyalgia Syndrome

Fibromyalgia syndrome (FMS) is a debilitating condition of almost unknown etiology and pathogenesis that is characterised by widespread musculoskeletal pain and tenderness, as well as secondary symptoms like fatigue, depression, irritable bowel syndrome and sleep disturbances.

A standard therapy regimen is lacking. Patient-tailored approaches are emphasised recommending non-pharmacological and pharmacological interventions according to individual symptoms. Self-management strategies involving active patient participation should be an integral component of the therapeutic plan.

Balneotherapy (thermal mineral water spas) and Hydrotherapy are commonly used interventions.

A qualitative systematic review and meta-analysis of randomised controlled trials showed that:

For Hydrotherapy with exercise, at the end of treatment, there was:

  • Moderate-to-strong evidence for a small reduction in pain
  • Moderate-to-strong evidence for a small improvement in health related quality of life (HRQOL)
  • No effect seen for depressive symptoms and Tender Point Count (TPC).
  • Follow-up data provided moderate evidence for maintenance of improvement with regard to pain.
  • No group difference was found when comparing water-based exercise to land-based exercise.

For Balneotharapy in mineral / thermal water, at end of treatment, there was:

  • Moderate evidence for medium-to-large size reduction in pain and TPC
  • Moderate evidence given for a medium improvement of HRQOL
  • No significant effect was found for depressive symptoms.
  • Moderate evidence for maintenance of improvements was found at follow-up, with smaller effects.

Pain may be relieved by the hydrostatic pressure of the water and the effects of the temperature on the nerve endings, as well as by muscle relaxation. It has been shown that thermal mud baths increase plasma levels of beta-endorphin, which explains their analgesic and anti-spastic effect.

The beneficial effects of water treatments are probably the result of a combination of specific (for example, buoyancy, aquatic resistance, heat) and unspecific effects (for example, change of environment, spa-scenery).

Source:

Therapeutic Benefit of Balneotherapy and Hydrotherapy in the Management of Fibromyalgia Syndrome: Johannes Naumann, Catharina Sadaghiani

Arthritis Res Ther. 2014; 16(R141) © 2014 BioMed Central, Ltd. http://medscape.com

 

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What Is The Most Effective Weapon For Fibromyalgia?

Aerobic Exercise !

aerobic exercise is the most effective ‘weapon’ that we have

People with fibromyalgia benefit from continuous physical exercise.

 

A recent article in www.medscape.com by Alice Goodman summarised an overview of research on fibromyalgia treatment that was presented at the Paris 2014 European League Against Rheumatism Congress.

Winfried Häuser MD, from Technische Universität Munchen is an expert in the field of fibromyalgia. He believes that treatment for people with fibromyalgia should be individualised and include non pharmacalogical approaches, as these are often more effective than drugs. He explained that aerobic exercise is the most effective ‘weapon’ that we have and both healthy people and people with fibromyalgia benefit from continuous physical exercise.

He and his colleagues recently published a network meta-analysis which was an indirect comparison of all available therapies for fibromyalgia. They were unable to find any significant differences in effectiveness between drug and non-drug therapies. While the effects of drugs are lost once the patient stops taking them, the effects of aerobic exercise and multicomponent therapy are sustained but declining at 1 or 2 years.

Dr Häuser advocates a graduated approach to treating fibromyalgia.

Mild fibromyalgia: can be managed with reassurance from the doctor and encouragement to engage in regular physical and mental activities.

Moderate fibromyalgia: should be managed with aerobic exercise and the temporary limited use of drugs.

Severe fibromyalgia: can be managed with aerobic exercise, drugs and the psychological and/or psychopharmalogic treatment of mental comorbidities.

Dr Mary-Ann Fitzcharles, a rheumatologist at McGill University in Montreal who treats people with fibromyalgia, agreed with the patient-tailored approach outlined by Dr Häuser. She cautioned about overmedicating people, and keeping them on continued medications which have side effects. Non Pharmalocological therapies have no risks, she explained.

Dr Fitzcharles went on to say that non pharmacologic therapies are probably the most important ones for people with fibromyalgia. In her experience, every person with fibromyalgia should be managed with exercise, promotion of an internal locus of control and education.

Activity pacing is the key, in order to not overdo or avoid exercise.

Non Pharmacological therapies include:

  • Aerobic exercise
  • Acupuncture
  • Psychotherapy

Pharmacologic / drug therapies include:

  • GABA analogues
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs)
  • Tricyclic antidepressants
  • Serotonin-specific reuptake inhibitors (SSRIs)

References:

  1. Aerobic Exercise ‘Most effective weapon’ for Fibromyalgia. Medscape. June19, 2014. Annals of the Rheumatic Diseasesard.bmj.com
  1. Comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia syndrome: network meta-analysis

          Eveline Nüesch, Winfried Häuser, Kathrin Bernardy, Jürgen Barth, Peter Jüni

               Ann Rheum Dis 2013;72:955-962 doi:10.1136/annrheumdis-2011-201249

 

 

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Positioned for Success – Poor Posture Influences Movement and Chronic Pain

functional posture

Our posture helps to position us for success and prevent chronic fatigue and pain

Are You Positioned For Success?

Health professionals are trained to objectively analyse presenting signs and symptoms, in order to offer possible solutions to all manner of ‘conditions’. Today I have been exploring Posture, and the role it generally plays in our daily functional activities, and specifically, in chronic pain presentations.

Why is this interesting?

Because we need to be Positioned For Success!

The way we habitually hold ourselves influences all our movements and ultimately affects how we go about accomplishing our everyday activities – whether we are working, playing sport or a musical instrument, relaxing or sleeping.

I did a bit of research around the topic of being positioned for success by being Cognitively/Mindfully and Behaviourally aware of our posture, and the influences we could pay more attention to.

It has been observed that poor posture is widespread in the general population. It appears to be an adaptive, self- perpetuating trait that most people lack the cognitive ability or desire to correct by themselves. (2)

Studies have shown that people in occupations that include prolonged periods of sitting may experience a high incidence of Low Back Pain. (1)

Commonly adopted relaxed postures are often passive in nature with a predisposition to “sway” standing and slumped sitting which can exacerbate pain. (4)

Increased pain does not leave us positioned for success.

Recent studies conclude that

  • Forward head posture is the most common form of poor posture related to a multitude of myofascial pain disorders and cervical dysfunction. (2) This posture requires the person to flex the lower part of the neck forward and bend the upper portion of the neck backwards.
  • Adopting passive postures such as sway standing and slump sitting can exacerbate pain in individuals with low back pain. Lumbopelvic stabilising musculature is active in maintaining optimally aligned erect postures, and are less active during adoption of passive postures. The muscles of the lumbopelvic region become deactivated and deconditioned, which increases the load on the lumbar discs and ligaments which in turn could leave the lumbopelvic region vulnerable to strain, instability or injury. (4)
  • Back pain intensity and referred leg pain could be significantly reduced after sitting with a lordotic posture, demonstrating that a change in posture could have a positive effect on pain location. Centralisation (a change in distribution of referred symptoms from distal to a more central location) was brought about by certain lumbar movements and positioning. (1)
  • Erect postural alignment in weight bearing positively facilitated the stabilising muscles of the lumbopelvic region. (4) Immediately we are better positioned for success in performing our daily activities.
We are not Positioned For Success when we adopt postures that are not energy efficient and structurally sustainable.

We are not Positioned For Success when we adopt postures that are not energy efficient and structurally sustainable.

Postural Training (being Positioned for Success) works on the assumption that an optimally aligned skeletal system reduces stress in its structures.  It is recommended as one of the Interdisciplinary treatment components of Cognitive Behavioural Therapy (CBT) for chronic pain.

  • It usually involves exercises performed repetitively to stretch structures that poor posture tends to shorten
  • Strengthens structures that poor posture tends to weaken
  • Creates awareness of desirable posture (2)

 

Cognitive Behavioural treatment methods have been applied to the most common chronic pain conditions. Posture correction in daily life, by its very nature, is considered Behavioural Therapy as the individual is required to continually monitor his / her improved conditioned posture for success. (2, 3)

These CBT Programmes usually involve multiple components, including

  • Information to increase knowledge and awareness of the factors influencing the nature and typical course of chronic pain conditions
  • Basics of pain physiology with the emphasis on chronic pain
  • Biomedical and bio-behavioural management of the condition
  • How to self-monitor the signs and symptoms of the condition
  • Cognitive and behavioural therapies aimed at increasing physical and functional activities and adaptive responses to pain
  • Skill training such as the use of relaxation, biofeedback, hypnosis and other self-control strategies to modify the perception of pain and related body sensations
  • Information on the relationship between muscle fatigue, muscle tension and the psycho-physiologic aspect of stress
  • Introduction to cognitive and behavioural pain and stress-coping strategies (3)

 

Instructions for Posture Correction to be positioned for success may include

Sitting

  • Don’t slouch when sitting on a chair
  • Don’t sit with legs crossed
  • Don’t rest chin on hand
  • If sitting on the floor, sit upright by sitting on folded legs
My sitting posture may prevent me from being Positioned For Success

My sitting posture may prevent me from being Positioned For Success

 

My sitting posture may prevent me from being Positioned For Success

 Standing

  • Rest weight on both feet evenly
  • Don’t lean against a wall

 Sleeping

  • Sleep on a firm mattress
  • Sleep on your back
  • Keep your neck straight by supporting on a low pillow or flattened towel

 Eating

  • Bring food to mouth without tilting head forward
  • Chew looking straight ahead, not downward

 Walking

  • Walk with long even strides while swinging your arms

 Others

  • Don’t carry a heavy package with one hand
  • Don’t thrust head forward

Ref (3)

With this information in mind, we could be more mindful to ensure we are better Positioned For Success, without compromising our Postural efficiency.

 

References

1. A comparison of the effects of two sitting postures on back and referred pain     M M Williams, J A Hawley, R A McKenzie, P M van Wijmen Spine Vol 16, No 10,  Oct 1991; 1185-1191

2. Usefulness of posture training for patients with temporomandibular disorders  E F Wright, M A Domenech, J R Fischer Jr  J Am Dent Assoc 2000; 131; 202-210

3. Posture correction as part of behavioural therapy in treatment of myofascial pain with limited opening  O Komiyana, M Kawara, M Arai, T Asano,  K Kobayashi J Oral Rehab May 1999; Vol 26; No 5;428-435

4. The effect of different standing and sitting postures on trunk muscle activity in a pain-free population  P B O’Sullivan, K M Grahamslaw, M Kendell, S C Lapenskie, N E Moller, K V Richards Spine 2002; Vol 27; No 11; 1238-1244

 Which strategies do you employ to ensure you are Positioned For Success?

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