1. Spa Therapy and Balneotherapy for Fibromyalgia in Turkey A Dönmez

2. Patients' issues Intractable illness If there is no known cause, I can't get better No one believes me I can't exercise or do my work Goldenberg D L : Office management of fibromyalgia. Rheum Dis Clin North Am 2002;2:28

3. Rheumatologists' issues We are not pain doctors Fibromyalgia is a psychiatric illness Nothing works Patients don't want to get better Goldenberg D L : Office management of fibromyalgia. Rheum Dis Clin North Am 2002;2:28

4. Outcome measures for FM studies Pain Tender points Physical function Global well being or perceived improvement Self-efficacy Fatigue and sleep Psychological function

5. Yurtkuran M, Celiktas M: A randomized, controlled trial of balneotherapy in the treatment of patients with primary fibromyalgia syndrome. Phys Rehab Kur Med 1996:109-112

6. Kesiktaş N, Karagülle,Erdogan N, Özer N:The short and long time evaluations of some therapy modalities the patients with fibromyalgia syndrome. (Presented in 4. Turkish-German Balneology and Climatology Congress, 2000)

7. Evcik D, Kızılay B, Gökçen E:The effects of balneotherapy on fibromyalgia patients. Rheumatol Int. 2002 Jun;22 (2):56-9

8. Şen U, Karagülle MZ, Karagülle M, Dönmez A, Şen C (2002) Comparison of the efficacy of two different traditional spa regimens in patients with fibromyalgia syndrome. PTT Hastanesi Tıp Dergisi 24:78-81

9. Altan L, Bingöl Ü, Aykaç M, Koç Z, Yurtkuran M (2003) Investigation of the pool based exercises on fibromyalgia syndrome. Rheumatol Int Published online: 24 September2003

10. Dönmez A, Karagülle MZ, Tercan N, Dinler M, İşsever H, Karagülle M, Turan M: Spa therapy in fibromyalgia: a randomized controlled clinic study (In press)

11. A. Dönmez, M. Zeki Karagülle, M.Turan, E. Odaba şı (Turkey): The effect of spa therapy on health related quality of life in fibromyalgia

12. A. Dönmez, M. Zeki Karagülle, S. Özkurt: Spa therapy for Fibromyalgia in Gönen; an observational study

13. General Results Spa therapy or balneotherapy are effective on FIQ and nearly all of the parameters Pain Tender point count Physical function Global well being or perceived improvement Fatigue and sleep Psychological function the patients with FM

14. Action mechanisms Heat Buoyancy Muscle tonus decrease Gate-control theory Peripheral vasodilatation ß-endorphin level Environment change Non-competitive atmosphere Absence of work duties

15. THANK YOU FOR YOUR ATTENTION