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. Effects of Stanger bath therapy on fibromyalgia Inaccuracy in the diagnosis of fibromyalgia syndrome: analysis of referrals. Fitness and perceived exertion in patients with fibromyalgia syndrome. Efficacy and Safety of Medicinal Plants or Related Natural Products for Fibromyalgia: A Systematic Review Elevated cerebrospinal fluid levels of substance P in patients with the fibromyalgia syndrome. Management of patients with fibromyalgia using biofeedback: a randomized control trial. Phytothermotherapy: a possible complementary therapy for fibromyalgia patients. 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 Effects of T’ai Chi Exercise on Fibromyalgia Symptoms and Health-Related Quality of Life Integrating Virtual Reality With Activity Management for the Treatment of Fibromyalgia: Acceptability and Preliminary Efficacy Adjuvant use of melatonin for treatment of fibromyalgia. Sodium oxybate relieves pain and improves function in fibromyalgia syndrome: a randomized, double-blind, placebo-controlled, multicenter clinical trial. Economic cost and epidemiological characteristics of patients with fibromyalgia claims. The London Fibromyalgia Epidemiology Study: the prevalence of fibromyalgia syndrome in London, Ontario. Familial aggregation of depression in fibromyalgia: a community-based test of alternate hypotheses Action potential simulation (APS) in patients with fibromyalgia syndrome (FMS): a controlled single subject experimental design Efficacy of the "body movement and perception" method in the treatment of fibromyalgia syndrome: an open pilot study. The health effects of at-home written emotional disclosure in fibromyalgia: A randomized trial
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 The purpose of this study was to assess the effectiveness of Stanger bath on the treatment of fibromyalgia ( FM ) . Fifty women with FM were r and omly divided into two groups . The first group ( n=25 ) was treated with amitriptyline , 10 mg/day for 8 weeks , and Stanger bath , 20 min daily for ten sessions . The second group ( n=25 ) only had amitriptyline , 10 mg/day for 8 weeks . In the first group the assessment parameters were measured before ( t1 ) , at the end ( t2 ) , and 2 months after the hydrotherapy ( t3 ) . In the second group these parameters were examined before ( T1 ) and 2 months after the treatment ( T2 ) . Patients were evaluated by number of tender points and Fibromyalgia Impact Question naire ( FIQ ) scores . There was significant improvement in number of tender points between t1 and t2 ( P<0.01 ) and t1 and t3 ( P<0.001 ) in the Stanger bath group . In addition , there was significant improvement in FIQ scores between t1 and t2 ( P<0.001 ) and t1 and t3 ( P<0.01 ) in the Stanger bath group . In the second group we observed significant improvement in FIQ scores and tender point numbers between T1 and T2 ( P=0.00 ) . We did not find any difference between groups in tender point number percent change ( p=0.074 ) . However , we observed statistically significant improvement in percent change of FIQ scores  in Stanger bath group ( −30±16.7 ) when compared to group 2 ( −19.3±13 ) ( p=0.016 ) . We conclude that Stanger bath therapy when combined with amitriptyline has a long lasting effect and better outcome in FM patients OBJECTIVE To examine prospect ively the accuracy of an initial diagnosis for fibromyalgia ( FM ) . METHODS All patients newly referred for rheumatology consultation in a 6-month period were evaluated prospect ively for either a preceding , current or subsequent diagnosis of FM . Clinical characteristics , previous and subsequent management and health care utilization were assessed . The final diagnosis at 6 months was verified and accuracy regarding the diagnosis of FM was assessed . RESULTS Seventy six ( 12 % ) of all new patients were either referred with a question of FM or finally diagnosed with FM . At the final evaluation the accuracy of the diagnosis regarding FM by either the referring physician or by the rheumatologist at the time of the initial visit was correct in 34 % of patients . The FM group in comparison with those with some other rheumatological diagnosis had more tender points ( 12.5 vs 4 ) and were more fatigued . In contrast , prolonged early morning stiffness and limitation of lumbar spinal mobility in more than one plane was more common in the non-FM group . CONCLUSION There is a disturbing inaccuracy , mostly observed to be overdiagnosis , in the diagnosis of FM by referring physicians . This finding may help explain the current high reported rates of FM and caution physicians to consider other diagnostic possibilities when addressing diffuse musculoskeletal pain OBJECTIVE The aim of this study was to evaluate the cardiorespiratory fitness and perceived exertion of female patients with fibromyalgia syndrome ( FMS ) compared with that of healthy female subjects . DESIGN AND SUBJECTS This was design ed as a cross-sectional case-control study , with a consecutive sample of 30 female patients with FMS and an age-matched control group of 67 healthy female subjects . SETTING This study was conducted at the multidisciplinary pain center of a university hospital in a city of more than 1 million inhabitants . OUTCOME MEASURES A cardiorespiratory fitness index ( PWC65%/kg ) and an original perceived exertion index ( B65 % ) were obtained from the  heart rates and perceived exertions scored on a 10-point Borg scale during a submaximal cycle ergometer test .  Average indexes for the FMS patients and control subjects were compared . RESULTS The mean cardiorespiratory fitness index of the FMS patients was not significantly different from that of the controls . The mean perceived exertion index in the FMS patients was significantly greater than that of the controls , meaning that the FMS patients systematic ally reported higher ratings of perceived exertion during exercise . CONCLUSIONS Cardiorespiratory fitness , as expressed by a submaximal work capacity index , seems normal in female patients with FMS compared with age- and sex-matched healthy individuals . The fact that FMS patients overscore their perception of exertion may be due to a greater overlap of peripheral pain and perceived exertion perceptions during exercise . This observation should be noted when using perceived exertion scores to prescribe and monitor exercise in FMS patients 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 OBJECTIVE To measure , and seek clinical correlates with , levels of  substance P ( SP ) in the cerebrospinal fluid ( CSF ) of fibromyalgia syndrome ( FMS ) patients . METHODS CSF from 32 FMS patients and 30 normal control subjects was tested for SP by radioimmunoassay . Clinical measures included tender point examination and st and ardized question naires . RESULTS CSF SP levels were 3-fold higher in FMS patients than in normal controls ( P < 0.001 ) , but they correlated only weakly with tenderness found on examination . CONCLUSION SP is significantly elevated in FMS CSF , but other abnormalities must exist in FMS to more fully explain the symptoms 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 OBJECTIVE It is a traditional practice in the Alpine region of Trentino and Alto Adige ( Italy ) to use phytothermotherapeutic treatment with fermenting grass ( " hay baths " ) for rheumatic diseases . However , despite its long history and popularity , a clinical validation of the efficacy and tolerability of the treatment has yet to be found in current literature . Fibromyalgia syndrome ( FMS ) is characterised by generalised musculoskeletal pain , high tender point counts , sleep disturbance , fatigue , headaches , irritable bowel syndrome , frequent psychological distress and depressed mood . There is no st and ard therapy regime for FMS and the variety of medical treatments used have given limited benefits . The aim of this study was to assess the efficacy and tolerability of a cycle of phytothermotherapy through a single-blind , controlled , r and omised trial , in patients with primary FMS . METHODS Fifty-six patients with primary FMS according to the ACR criteria were r and omly allocated to two groups : 30 were su bmi tted to phytothermotherapy at the thermal resort of Garniga Terme ( Trento , Italy ) and the other 26 were considered as controls . All patients were evaluated by FIQ , Tender Points Count , HAQ and AIMS 1 at baseline , after 10 days , then after 12 and 24 weeks . RESULTS Patients su bmi tted to phytothermotherapy showed visible and significant improvement of all evaluation parameters at the end of the treatment , which persisted during the follow-up period . No significant difference was found in the control group . Regarding the tolerability , none of the patients presented side effects . CONCLUSIONS Our results suggest the efficacy and the tolerability of phytothermotherapy in patients with primary FMS 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 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 Objectives : Cognitive-behavioral therapies ( CBT ) for fibromyalgia syndrome ( FMS ) are important interventions in the management of this condition . Empirical evidence reports that although the results are promising , further research is needed to respond more appropriately to these patients . This study focuses on exploring the use of Virtual Reality ( VR ) as an adjunct to the activity management component . The aim of this study is to present the results of a small-sized r and omized controlled trial to test the preliminary efficacy and acceptability of this component . Material s and Methods : The final sample was composed of 61 women diagnosed with FMS according to the American College of Rheumatology . The sample was r and omly allocated to 2 conditions : VR treatment and treatment as usual . Results : Participants in the VR condition achieved significant improvements in the primary outcome : disability measured with the FIQ . The improvement was also significant in secondary outcomes , such as perceived quality of life and some of the coping strategies included in the Chronic Pain Coping Inventory : task persistence and exercise . There were no differences in other secondary outcome measures like pain intensity and interference and depression . Participants reported high satisfaction with the VR component . Discussion : The effects were related to the psychological aspects targeted in the treatment . The component was well accepted by FMS patients referred from a public hospital . These findings show that the VR component could be useful in the CBT treatment of FMS and encourage us to continue exploring the use of integrating VR with CBT interventions for the treatment of FMS Fibromyalgia syndrome ( FMS ) is a chronic musculoskeletal disorder characterized by generalized muscular pain accompanied by fatigue and tenderness at specific anatomic sites called tender points . Although preliminary evidence indicates that melatonin may be effective in treating the pain associated with FMS , no definitive evidence supports this cl aim . This study was design ed to evaluate the significance of using different doses of melatonin , alone or in combination with fluoxetine for the management of FMS . A double-blind , placebo-controlled clinical study was performed on 101 patients ( 95 women and 6 men ) who fulfilled the criteria of the American College of Rheumatology ( ACR ) of FMS . The patients were r and omized into four groups : group A ( 24 patients ) treated with 20 mg/day fluoxetine alone ; group B ( 27 patients ) treated with melatonin 5 mg alone ; group C ( 27 patients ) treated with 20 mg fluoxetine plus 3 mg melatonin ; group D ( 23 patients ) treated with 20 mg fluoxetine plus 5 mg melatonin . Both drugs were given once daily in the morning and night time , respectively , for 8 wk . Each patient was clinical ly evaluated through direct interview with the patients using the Fibromyalgia Impact Question naire ( FIQ ) at zero time and after 8 wk . Using melatonin ( 3 mg or 5 mg/day ) in combination with 20 mg/day fluoxetine result ed in significant reduction in both total and different components of FIQ score compared to the pretreatment values . In conclusion , administration of melatonin , alone or in a combination with fluoxetine , was effective in the treatment of patients with FMS OBJECTIVE To evaluate the safety and efficacy of sodium oxybate for management of the symptoms of fibromyalgia syndrome ( FMS ) . METHODS Patients with FMS ( according to the American College of Rheumatology 1990 criteria ) were r and omized , after discontinuing their pre study medications for FMS , to receive 4.5 gm or 6 gm of sodium oxybate or matching placebo once per night for 8 weeks . The primary outcome variable ( POV ) was a composite score for changes from baseline in 3 co primary self-report measures : patient 's pain rating ( in daily electronic diaries ) on a visual analog scale ( PVAS ) , the Fibromyalgia Impact Question naire ( FIQ ) score , and the Patient Global Impression of Change ( PGI-C ) . A beneficial response rate for the POV composite score was defined as > or=20 % improvement in the PVAS and FIQ scores plus a rating of " much better " or " very much better " on the PGI-C. Secondary measures included subjective sleep outcomes ( on the Jenkins Scale for Sleep ) and quality -of-life measures . The analyses were based on an intent-to-treat ( ITT ) population . RESULTS The ITT population included 188 patients with FMS , 78 % of whom completed the trial . Significant benefit was observed with both dosages of sodium oxybate , according to changes in the POV and subjective sleep quality . Improvements in the PVAS score were significantly correlated with sleep outcomes . Sodium oxybate was well tolerated overall ; dose-related nausea ( < or=28 % of patients ) and dizziness ( < or=18 % of patients ) tended to resolve with continued therapy . CONCLUSION Sodium oxybate therapy was well tolerated and significantly improved the symptoms of FMS . Further study of sodium oxybate as a novel therapeutic option for FMS is warranted OBJECTIVE Fibromyalgia ( FM ) is characterized by widespread pain that can lead to significant patient disability , complex management decisions for physicians , and economic burden on society . We investigated the total costs of FM in an employer population . METHODS Administrative cl aims data of a Fortune 100 manufacturer were used to quantify direct ( i.e. , medical and pharmaceutical cl aims ) and indirect ( i.e. , disability cl aims and imputed absenteeism ) costs associated with FM . A total of 4699 patients with at least one FM cl aim between 1996 and 1998 were contrasted with a 10 % r and om sample of the overall beneficiary population . Employee-only subsets of both sample s also were drawn . RESULTS Medical utilization , receipt of prescription drugs , and annual total costs were proportionately similar yet significantly greater among FM cl aim ants than the overall sample ( all p < 0.0001 ) . Total annual costs for FM cl aim ants were $ 5945 versus $ 2486 for the typical beneficiary ( p < 0.0001 ) . Six percent of these costs were attributable to FM-specific cl aims . The prevalence of disability was twice as high among FM employees than overall employees ( p < 0.0001 ) . For every dollar spent on FM-specific cl aims , the employer spent another $ 57 to $ 143 on additional direct and indirect costs . CONCLUSION Hidden costs of disability and comorbidities greatly increase the true burden of FM . Regardless of the clinical underst and ing of FM , when a cl aim for FM is present , considerable costs are involved . Findings suggest that within the management of FM there may be large cost-offset opportunities for reductions in patient , physician , and employer burdens OBJECTIVE To estimate the point prevalence of fibromyalgia syndrome ( FM )  among noninstitutionalized Canadian adults ; and to assess the effect of demographic variables on the odds of having FM . METHODS A screening question naire was administered via telephone to a r and om community sample of 3395 noninstitutionalized adults residing in London , Ontario . Individuals screening positive were invited to be examined by a rheumatologist to confirm or exclude FM using the 1990 American College of Rheumatology classification criteria . RESULTS One hundred confirmed cases of FM were identified , of whom 86 were women . Mean age among FM cases was 49.2 years among women , 39.3 years among men ( p < 0.02 ) . FM affects an estimated 4.9 % ( 95 % CI 4.7 % , 5.1 % ) of adult women and 1.6 % ( 1.3 % , 1.9 % ) of adult men in London , for a female to male ratio of roughly 3 to one . In women , prevalence rises steadily with age from < 1 % in women aged 18 - 30 to almost 8 % in women 55 - 64 . Thereafter , it declines . The peak prevalence in men also appears to be in middle age ( 2.5 % ; 1.1 % , 5.7 % ) . FM affects 3.3 % ( 3.2 % , 3.4 % ) of noninstitutionalized adults in London . Female sex , middle age , less education , lower household income , being divorced , and being disabled are associated with increased odds of having FM . CONCLUSION FM is a common musculoskeletal disorder among Canadian adults , especially among women and persons of lower socioeconomic status & NA ; Numerous studies report that fibromyalgia ( FM ) , a syndrome characterized by widespread pain and generalized tender points , is comorbid with major depressive disorder ( MDD ) . The current study tests two alternate explanations for their comorbidity using a family study methodology . The first is that FM is a depression spectrum disorder . The second is that depression is a consequence of living with FM . We recruited potential prob and s by initially screening by telephone for FM and MDD among women in the NY/NJ metropolitan area , r and omly selecting telephone numbers from a list of households with women . Eligible women were invited for second stage physical examinations for FM diagnosis and psychiatric interviews for MDD diagnosis . All available adult , first‐degree relatives received psychiatric interviews . Relatives of prob and s were divided into four groups on the basis of the prob and s ' FM and MDD diagnoses ( FM+/MDD+ ( n=156 ) , FM+/MDD− ( n=51 ) , FM−/MDD+ ( n=351 ) and FM−/MDD− ( n=101 ) ) . Results indicated that rates of MDD in the relatives of prob and s with FM but without personal histories of MDD were virtually identical to rates of MDD in relatives of prob and s with MDD themselves . This outcome is consistent with the hypothesis that FM is a depression spectrum disorder , in which FM and MDD are characterized by shared , familially mediated risk factors . The implication s of these findings for a stress‐vulnerability model of FM are discussed Objectives Action potential simulation ( APS ) is becoming a popular method of pain reduction . Nevertheless , little is known about the efficacy of this relatively new treatment . The aim of this study was to investigate whether APS helps to reduce pain , improves patients ’ perception of daily functioning and social participation in patients with fibromyalgia syndrome ( FMS ) . Material s and methods Ten patients with FMS according to the American College of Rheumatology ( ACR ) criteria entered this double blind crossover single-case study . In a period of 20 weeks , the patients underwent two treatment periods of 4 weeks , one with verum and one with placebo , at r and om , in a double blind fashion . Outcome measures were evaluated on a weekly basis . Primary outcome measure was pain measured with the Fibromyalgia Impact Question naire ( FIQ ) questions 4 and 5 , the number of tender points and the total tender point pain intensity score . Both visual inspection and statistical analysis were done to analyse the data from this single-subject design . Results Performing visual inspection and statistical analysis , no positive results of the APS treatment were found in this study . Remarkable is the fact that placebo APS had significantly better results than verum APS . Conclusions In this single-case study with ten patients ( all female ) , APS was not a helpful method to reduce pain , to improve patients ’ perception of daily functioning and social participation in patients with FMS OBJECTIVES Group exercises may be useful in fibromyalgia syndrome ( FMS ) .  The ' Body movement and perception ' ( BMP ) method is based on low impact exercises , awareness of body perception and relaxation , aim ed at treating small groups of patients following the Resseguier method ( RM ) and integrating RM with exercises derived from soft gymnastics . We assessed the effects of BMP method on FMS . METHODS 40 women with FMS ( age and disease duration : 51.7±7.2 and 4.9±3.8 years ) participated in an open pilot study . BMP sessions were performer twice a week ( 50 minutes each ) for 8 weeks . Patients were assessed at enrolment ( T0 ) and at the end of the study ( T1 ) by a self-administered question naire ( temporal characteristics of pain , pain interference in working and recreational activities and in night-time rest , awareness of pain , fatigue , irritability , well-being , quality of movement , ability to focus on perception and to perceive whole body , postural selfcontrol , ability to relax ) and a clinical evaluation ( tender points , assumption of analgesics/NSAIDs , distribution of pain , pain in sitting and st and ing position , pain during postural passages and gait , postural body alignment , muscular contractures ) . RESULTS At T1 , FMS patients significantly improved with respect to T0 in pain , fatigue , irritability , well-being , quality of movement , postural self-control , ability to relax mind and body , movement perception , tender point scores , assumption of analgesic/NSAIDs , body alignment and muscle contractures ( p<0.05 for all the comparisons T1 versus T0 ) . CONCLUSIONS In FMS patients , rehabilitation with BMP  improves pain and well being , reduces the number of tender points and muscle contractures , thus it is useful in FMS management Background : The presence and severity of the chronic pain syndrome fibromyalgia ( FM ) is associated with unresolved stress and emotional regulation difficulties . Written emotional disclosure is intended to reduce stress and may improve health of people with FM . Purpose : This study tests the effects of at-home , written emotional disclosure about stressful experiences on the health of people with FM and uses multiple follow-ups to track the time course of effects of disclosure . Methods : Adults with FM ( intention-to-treat , n = 83 ; completers , n = 72 ) were r and omized to write for 4 days at home about either stressful experiences ( disclosure group ) or neutral time management ( control group ) . Group differences in immediate mood effects and changes in health from baseline to 1-month and 3-month follow-ups were examined . Results : Written disclosure led to an immediate increase in negative mood , which did not attenuate across the 4 writing days . Repeated- measures analyses from baseline to each follow-up point were conducted on both intention-to-treat and completer sample s , which showed similar outcomes . At 1 month , disclosure led to few health benefits , but control writing led to less negative affect and more perceived support than did disclosure . At 3-month follow-up , these negative affect and social support effects disappeared , and written disclosure led to a greater reduction in global impact , poor sleep , health care utilization , and ( marginally ) physical disability than did control writing . Interpretation of these apparent benefits needs to be made cautiously , however , because the disclosure group had somewhat poorer health than controls at baseline and the control group showed some minor worsening over time . Conclusions : Written emotional disclosure can be conducted at home , and there is tentative evidence that disclosure benefits the health of people with FM . The benefits , however , may be delayed for several months after writing and may be of limited clinical significance
Positive outcomes were reported for pain , health-status and tender point count .
There is strong evidence for the use of hydrotherapy in the management of FMS
Hydrotherapy is often used in the treatment of  fibromyalgia syndrome ( FMS ) , however there has been limited evaluation of its effectiveness .
The aim of this systematic review was therefore to examine the effectiveness of hydrotherapy in the management of FMS .