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Effects of 15 consecutive cryotherapy sessions on the clinical output of fibromyalgic patients


Fibromyalgia is a chronic widespread pain disorder in which, the neurogenic origin of the pain, featured by allodynia and hyperalgesia, results from an imbalance in the levels of neurotransmitters and consequently of the peripheral pro- and anti-inflammatory mediators. Whole body cryotherapy is a peculiar physical therapy known to relieve pain and inflammatory symptoms characteristics of rheumatic diseases, through the regulation of the cytokine expression. The aim of this study was to qualitatively evaluate the effects of cryotherapy on the clinical output of fibromyalgic patients. A total of 100 fibromyalgic patients (age range 17–70 years) were observed; 50 subjects were addressed to cryotherapy, while the second group (n = 50) did not underwent to the cryotherapic treatment. All subjects kept the prescribed pharmacological therapy during the study (analgesic and antioxidants). The referred health status pre- and post-observation was evaluated with the following scales: Visual Analogue Scale, Short Form-36, Global Health Status and Fatigue Severity Scale. Fibromyalgic patients treated with cryotherapy reported a more pronounced improvement of the quality of life, in comparison with the non-cryo treated fibromyalgic subjects, as indicated by the scores of the qualitative indexes and sub-indexes, that are widely recognized tools to assess the overall health status and the effect of the treatments. We speculate that this improvement is due to the known direct effect of cryotherapy on the balance between pro- and anti-inflammatory mediators having a recognized role in the modulation of pain.

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  1. 1.

    Arnold LM, Clauw DJ, Dunegan LJ, Turk DC (2012) A framework for fibromyalgia management for primary care providers. Mayo Clin Proc 87(5):488–496. doi:1016/j.mayocp.2012.02.010

  2. 2.

    Clauw DJ, Arnold LM, McCarberg BH (2011) The science of fibromyalgia. Mayo Clin Proc 86(9):907–911. doi:10.4065/mcp.2011.0206

  3. 3.

    Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB (2010) The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 62(5):600–610. doi:10.1002/acr.20140

  4. 4.

    McBeth J, Mulvey MR (2012) Fibromyalgia: mechanisms and potential impact of the ACR 2010 classification criteria. Nat Rev Rheumatol 8(2):108–116. doi:10.1038/nrrheum.2011.216

  5. 5.

    Gracely RH, Petzke F, Wolf JM, Clauw DJ (2002) Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum 46(5):1333–1343. doi:10.1002/art.10225

  6. 6.

    Ablin K, Clauw DJ (2009) From fibrositis to functional somatic syndromes to a bell-shaped curve of pain and sensory sensitivity: evolution of a clinical construct. Rheum Dis Clin North Am 35(2):233–251. doi:10.1016/j.rdc.2009.06.006

  7. 7.

    Seidel MF, Herguijuela M, Forkert R, Otten U (2010) Nerve growth factor in rheumatic diseases. Semin Arthritis Rheum 40(2):109–126. doi:10.1016/j.semarthrit.2009.03.002

  8. 8.

    Bazzichi L, Rossi A, Massimetti G, Giannaccini G, Giuliano T, De Feo F, Ciapparelli A, Dell'Osso L, Bombardieri S (2007) Cytokine patterns in fibromyalgia and their correlation with clinical manifestations. Clin Exp Rheumatol 25(2):225–230

  9. 9.

    Sarzi-Puttini P, Atzeni F, Mease PJ (2011) Chronic widespread pain: from peripheral to central evolution. Best Pract Res Clin Rheumatol 25(2):133–139. doi:10.1016/j.berh.2011.04.001

  10. 10.

    Marques AP, Ferreira EA, Matsutani LA, Pereira CA, Assumpcao A (2005) Quantifying pain threshold and quality of life of fibromyalgia patients. Clin Rheumatol 24(3):266–271. doi:10.1007/s10067-004-1003-7

  11. 11.

    Banfi G, Lombardi G, Colombini A, Melegati G (2010) Whole-body cryotherapy in athletes. Sports Med 40(6):509–517. doi:10.2165/11531940-000000000-000005

  12. 12.

    Fricke R (1989) Ganzokorpekaltetherapie in einer Kaltekammer mit Temperaturen um −110 °C. Z PhysMed Baln Med Klim 18:1–10

  13. 13.

    Smolander J, Westerlund T, Uusitalo A, Dugue B, Oksa J, Mikkelsson M (2006) Lung function after acute and repeated exposures to extremely cold air (−110 degrees C) during whole-body cryotherapy. Clin Physiol Funct Imaging 26(4):232–234. doi:10.1111/j.1475-097X.2006.00675.x

  14. 14.

    Bonomi FG, De Nardi M, Fappani A, Zani V, Banfi G (2012) Impact of different treatment of whole-body cryotherapy on circulatory parameters. Arch Immunol Ther Exp (Warsz) 60(2):145–150. doi:10.1007/s00005-012-0163-4

  15. 15.

    Mease PJ, Dundon K, Sarzi-Puttini P (2011) Pharmacotherapy of fibromyalgia. Best Pract Res Clin Rheumatol 25(2):285–297. doi:10.1016/j.berh.2011.01.015

  16. 16.

    Hassett AL, Williams DA (2011) Non-pharmacological treatment of chronic widespread musculoskeletal pain. Best Pract Res Clin Rheumatol 25(2):299–309. doi:10.1016/j.berh.2011.01.005

  17. 17.

    Walsh NP, Whitham M (2006) Exercising in environmental extremes : a greater threat to immune function? Sports Med 36(11):941–976

  18. 18.

    Jansky L, Pospisilova D, Honzova S, Ulicny B, Sramek P, Zeman V, Kaminkova J (1996) Immune system of cold-exposed and cold-adapted humans. Eur J Appl Physiol Occup Physiol 72(5–6):445–450

  19. 19.

    Lubkowska A, Szyguła Z, Klimek A, Torii M (2010) Do sessions of cryostimulation have influence on white blood cells count, level of IL6 and the total oxidative and antioxidative status in healthy men. Eur J Appl Physiol 109(1):67–72

  20. 20.

    Lubkowska A, Szyguła Z, Chlubek D, Banfi G (2011) The effect of prolonged whole-body cryostimulation treatment with different amounts of sessions on chosen pro- and anti-inflammatory cytokines in healthy men. Scand J Clin Lab Invest 71(5):419–425

  21. 21.

    Offenbacher M, Stucki G (2000) Physical therapy in the treatment of fibromyalgia. Scand J Rheumatol Suppl 113:78–85

  22. 22.

    Samborski W, Stratz T, Sobieska M, Mennet P, Muller W, Schulte-Monting J (1992) Intraindividual comparison of whole body cold therapy and warm treatment with hot packs in generalized tendomyopathy. Z Rheumatol 51(1):25–30

  23. 23.

    Gutenbrunner C, Englert G, Neues-Lahusen M, Gehrke A (1999) Analgetic effects of natural sulphur baths and coldchamber expositions in Fibromyalgia. Phys Rehab Kur Med 9:56–62

  24. 24.

    Bijur PE, Silver W, Gallagher EJ (2001) Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med 8(12):1153–1157

  25. 25.

    Ware JE Jr (2000) SF-36 health survey update. Spine (Phila Pa 1976) 25(24):3130–3139

  26. 26.

    Villaverde V, Balsa A, Cantalejo M, Fernandez-Prada M, Madero MR, Munoz-Fernandez S, Gijon-Banos J, Martin-Mola E (2000) Activity indices in rheumatoid arthritis. J Rheumatol 27(11):2576–2581

  27. 27.

    Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus Arch Neurol 46(10):1121–1123

  28. 28.

    Russell IJ, Larson AA (2009) Neurophysiopathogenesis of fibromyalgia syndrome: a unified hypothesis. Rheum Dis Clin North Am 35(2):421–435. doi:10.1016/j.rdc.2009.06.005

  29. 29.

    Williams DA, Clauw DJ (2009) Understanding fibromyalgia: lessons from the broader pain research community. J Pain 10(8):777–791. doi:10.1016/j.jpain.2009.06.001

  30. 30.

    Cazzola M, Sarzi-Puttini P, Stisi S, Di Franco M, Bazzichi L, Carignola R, Gracely RH, Salaffi F, Marinangeli F, Torta R, Giamberardino MA, Buskila D, Spath M, Biasi G, Cassisi G, Casale R, Altomonte L, Arioli G, Alciati A, Marsico A, Ceccherelli F, Leardini G, Gorla R, Atzeni F (2008) Italian fibromyalgia network. Fibromyalgia syndrome: definition and diagnostic aspects. Reumatismo 60(suppl 1):3–14

  31. 31.

    Stisi S, Cazzola M, Buskila D, Spath M, Giamberardino MA, Sarzi-Puttini P, Arioli G, Alciati A, Leardini G, Gorla R, Marsico M, Ceccherelli F, Bazzichi L, Carignola R, Gracely RH, Salaffi F, Altomonte L, Atzeni F (2008) Italian fibromyalgia network. Etiopathogenetic mechanisms of fibromyalgia syndrome. Reumatismo 60(suppl 1):25–35

  32. 32.

    Staud R (2009) Abnormal pain modulation in patients with spatially distributed chronic pain: fibromyalgia. Rheum Dis Clin North Am 35(2):263–274. doi:10.1016/j.rdc.2009.05.006

  33. 33.

    Uceyler N, Sommer C (2008) Cytokine regulation in animal models of neuropathic pain and in human diseases. Neurosci Lett 437(3):194–198. doi:10.1016/j.neulet.2008.03.050

  34. 34.

    Wallace DJ, Linker-Israeli M, Hallegua D, Silverman S, Silver D, Weisman MH (2001) Cytokines play an aetiopathogenetic role in fibromyalgia: a hypothesis and pilot study. Rheumatology (Oxford) 40(7):743–749

  35. 35.

    Uceyler N, Hauser W, Sommer C (2011) Systematic review with meta-analysis: cytokines in fibromyalgia syndrome. BMC Musculoskelet Disord 12:245. doi:10.1186/1471-2474-12-245

  36. 36.

    Algafly AA, George KP (2007) The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med 41(6):365–369. doi:10.1136/bjsm.2006.031237

  37. 37.

    Cohen H, Alferiev IS, Mönkkönen J, Seibel MJ, Pinto T, Ezra A, Solomon V, Stepensky D, Sagi H, Ornoy A, Patlas N, Hägele G, Hoffman A, Breuer E, Golomb G (1999) Synthesis and preclinical pharmacology of 2-(2-aminopyrimidinio) ethylidene-1,1-bisphosphonic acid betaine (ISA-13-1)-a novel bisphosphonate. Pharm Res 16(9):1399–1406

  38. 38.

    Oude Voshaar MA, ten Klooster PM, Taal E, van de Laar MA (2011) Measurement properties of physical function scales validated for use in patients with rheumatoid arthritis: a systematic review of the literature. Health Qual Life Outcomes 9:99. doi:10.1186/1477-7525-9-99

  39. 39.

    Hoffman DL, Dukes EM (2008) The health status burden of people with fibromyalgia: a review of studies that assessed health status with the SF-36 or the SF-12. Int J Clin Pract 62(1):115–126. doi:10.1111/j.1742-1241.2007.01638.x

  40. 40.

    Casale R, Rainoldi A (2011) Fatigue and fibromyalgia syndrome: clinical and neurophysiologic pattern. Best Pract Res Clin Rheumatol 25(2):241–247. doi:10.1016/j.berh.2011.01.016

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Correspondence to Giovanni Lombardi.

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Bettoni, L., Bonomi, F.G., Zani, V. et al. Effects of 15 consecutive cryotherapy sessions on the clinical output of fibromyalgic patients. Clin Rheumatol 32, 1337–1345 (2013).

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  • Fibromyalgia
  • Pain
  • Quality of life
  • Whole body cryotherapy