human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The purpose of this study was to investigate the clinical effects of balneotherapy in the treatment of Fibromyalgia Syndrome ( FMS ) and to determine if balneotherapy influences serum levels of inflammation markers , IL-1 , PGE2 and LTB4 . 24 primary fibromyalgia female patients diagnosed according to American College of Rheumatology criteria were included to the study . Their ages ranged between 33 and 55 years . FMS patients were r and omly assigned in two groups as , group 1 ( n = 12 ) and group 2 ( n = 12 ) . Group 1 received 20-min bathing , once in a day for five days per week . Patients participated in the study for 3 weeks ( total of 15 sessions ) in Denizli . Group 2 did not receive balneotherapy . FMS patients were evaluated by tenderness measurements ( tender point count and algometry ) , Visual Analogue Scale , Beck ’s Depression Index , Fibromyalgia Impact Question naire .  Ten healthy women recruited group three as the controls .  Serum PGE2 , LTB4 and IL1-α levels were measured in all three groups . The biochemical measurements and clinical assessment s were performed before and at the end of general period of therapy . Statistically significant alterations in algometric score , Visual Analogue score , Beck ’s Depression Index and PGE2 levels ( P < 0.001 ) , numbers of tender points ( P < 0.01 ) and Fibromyalgia Impact Question naire score ( P < 0.05 ) were found after the balneotherapy between group 1 and 2 . Mean PGE2 level of FMS patients were higher compared to healthy control group ( P < 0.0001 ) and decreased after the treatment period , only in group 1 ( P < 0.05 ) . As in the group 2 and 3 , detectable IL-1 and LTB4 measurements were insufficient , statistical analysis was performed , only in group 1 . After balneotherapy  IL-1 and LTB4 significantly decreased in group 1 ( P < 0.05 ) . In conclusion , balneotherapy is an effective choice of treatment in patients with FMS relieving the clinical symptoms , and possibly influencing the inflammatory mediators Abstract . The aim of this study was to evaluate the effectiveness of balneotherapy on patients with fibromyalgia ( FM ) at the Dead Sea . Forty-eight patients with FM were r and omly assigned to a treatment group receiving sulfur baths and a control group .  All participants stayed for 10 days at a Dead Sea spa .  Physical functioning , FM-related symptoms , and tenderness measurements ( point count and dolorimetry ) were assessed at four time points : prior to arrival at the Dead Sea , after 10 days of treatment , and 1 and 3 months after leaving the spa . Physical functioning and tenderness moderately improved in both groups . With the exception of tenderness threshold , the improvement was especially notable in the treatment group and it persisted even after 3 months . Relief in the severity of FM-related symptoms ( pain , fatigue , stiffness , and anxiety ) and reduced frequency of symptoms ( headache , sleep problems , and subjective joint swelling ) were reported in both groups but lasted longer in the treatment group . In conclusion , treatment of FM at the Dead Sea is effective and safe and may become an additional therapeutic modality in FM . Future studies should address the outcome and possible mechanisms of this treatment in FM patients Fibromyalgia ( FM ) is a nonarticular rheumatological syndrome associated with diverse clinical and psychological features . One of the major complaints in FM is reduced pain tolerance , especially in tender points ( TP ) for which patients derive significant benefit from nonsteroidal antiinflammatory drugs or corticosteroids .  Patients with FM also have altered reactivity of the hypothalamic pituitary adrenal ( HPA ) axis where the predominant feature is reduced containment of the stress response system through diminished adrenocortical output and feedback resistance . Our results show that mud packs together with antidepressant treatment are able to influence the HPA axis , stimulating increased levels of adrenocorticotropic hormone , cortisol and beta-endorphin serum levels . The discharge of corticoids in the blood and the increase in beta-endorphin serum levels are followed by a reduction in pain symptoms , which is closely related to an improvement in disability , depression and quality of life . It seems that the synergic association between a pharmacological treatment ( trazodone ) and mud packs acts by helping the physiological responses to achieve homeostasis and to rebalance the stress response system . To clarify and optimize the effectiveness of this synergic association , studies involving a larger number of FM patients and a different pharmacological treatment are needed Abstract : Fibromyalgia ( FS ) is an idiopathic chronic pain syndrome defined by widespread non-articular musculoskeletal pain and generalised tender points . As there is no effective treatment , patients with this condition have impaired quality of life ( QoL ) . The aim of this study was to assess the possible effect of balneotherapy at the Dead Sea area on the QoL of patients with FS . Forty-eight subjects participated in the study ; half of them received balneotherapy , and half did not . Their QoL ( using SF-36 ) , psychological well-being and FS-related symptoms were assessed prior to arrival at the spa hotel in the Dead Sea area , at the end of the 10-day stay , and 1 and 3 months later . A significant improvement was reported on most subscales of the SF-36 and on most symptoms . The improvement in physical aspects of QoL lasted usually 3 months , but on psychological measures the improvement was shorter . Subjects in the balneotherapy group reported higher and longer-lasting improvement than subjects in the control group . In conclusion , staying at the Dead Sea spa , in addition to balneotherapy , can transiently improve the QoL of patients with FS . Other studies with longer follow-up are needed to support our findings OBJECTIVE We studied whether whirl baths with plain water or with water containing pine oil or valerian have a different influence on  pain , disturbed sleep or tender point count . METHODS A r and omized , comparative and investigator-blinded study was performed . Out- patients with generalized fibromyalgia were r and omized into three treatment groups . INTERVENTIONS Therapy consisted of either whirl bath with plain water or with the addition of pine oil or valerian . The baths were carried out 10 times , three times a week . MAIN OUTCOME MEASURES General pain , change of pain intensity during the day , general well-being and occurrence of disturbed sleep were recorded before and after the therapy . The number of tender points was assessed by digital palpation , the pain threshold on the shinbone and the middle part of the deltoid muscle was measured by the dolorimeter of A. Fischer . The same instrument was used for recording pain threshold and pain tolerance of both trapezius muscles . The tissue compliance of these muscles was measured as well . RESULTS 30 out of 39 patients included in the study were evaluated statistically . After treatment with valerian bath ( n = 12 ) well-being and sleep were significantly improved and also the tender point count decreased significantly . Pine oil added to the bath water ( n = 7 ) result ed in a significant improvement of well-being , but unfortunately also in a significant decrease of pain threshold of the shinbone and the right deltoid muscle .  Whirl bath in plain water ( n = 11 ) reduced general and maximum pain intensity significantly . CONCLUSIONS Our cautious conclusion of this study is - with respect to the small number of treated patients - that different effects of whirl baths with or without medicinal bath oils can be detected in fibromyalgia patients .  Plain water baths modify the pain intensity , medicinal baths improve well-being and sleep The efficacy of balneotherapy in fibromyalgia syndrome ( FS ) has been well demonstrated , while controlled studies using mud packs are lacking . We performed a r and omized clinical trial to evaluate the effects and the tolerability of mud-bath treatment in FS patients , who are poor responders to pharmacological therapy . Eighty patients with primary FS , according to ACR criteria , were r and omly allocated to two groups : 40 were su bmi tted to a cycle of 12 mud packs and thermal baths  , and 40 were considered as controls .  At baseline , after thermal treatment and after 16 weeks , patients were evaluated by FIQ , tender points count , VAS for “ minor ” symptoms , AIMS 1 and HAQ . Control patients were assessed at the same time periods . A significant improvement of all evaluation parameters after mud-bath therapy and after 16 weeks was observed . Mud packs were well tolerated and no drop-outs were recorded . Our results suggest the efficacy and the tolerability of mud-bath treatment in primary FS BACKGROUND Balneotherapy at the Dead Sea area has been applied in various inflammatory rheumatic diseases such as rheumatoid arthritis and psoriatic arthritis . The efficacy of balneotherapy at the Dead Sea area for the treatment of degenerative rheumatic diseases has not yet been formally evaluated . OBJECTIVE To evaluate the efficacy of balneotherapy at the Dead Sea area in patients suffering from osteoarthritis of the knees . METHODS Forty patients were r and omly allocated into four groups of 10 patients . Group I was treated by bathing in a sulphur pool , group 2 by bathing in the Dead Sea , group 3 by a combination of sulphur pool and bathing in the Dead Sea , and group 4 served as the control group receiving no balneotherapy . The duration of balneotherapy was 2 weeks . RESULTS Significant improvement as measured by the Lequesne index of severity of osteoarthritis was observed in all three treatment groups , but not in the control group . This improvement lasted up to 3 months of follow-up in patients in all three treatment groups . CONCLUSION Balneotherapy at the Dead Sea area has a beneficial effect on patients with osteoarthritis of the knees , an effect that lastas at least 3 months 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 : The aim of the present study is to evaluate the effectiveness of spa therapy in the management of  fibromyalgia .  Methods : Thirty women with fibromyalgia were r and omly assigned to either a spa therapy group or a control group . The spa therapy group ( n = 16 ) had spa treatment for 2 weeks in addition to their medical treatment . The control group ( n = 14 ) continued to have their medical treatment and /or daily exercises . An investigator who was blinded for the intervention assessed all the patients for 9 months . Improvements in Fibromyalgia Impact Question naire ( FIQ ) , pain and number of tender points were primary outcomes . Secondary outcome measures were improvement in sleep disturbance , fatigue , gastrointestinal symptoms , anxiety , Beck Depression Inventory and patient ’s global evaluation . Results : the spa group was found to be superior to the control group at the end of intervention in terms of FIQ , pain , tender point count , fatigue and patients ’ global assessment . This superiority remained for 6 months in FIQ , 1 month in pain and tender point count . Conclusion : It was concluded that the addition of spa therapy to medical therapy has both short- and long-term beneficial effects in female patients with fibromyalgia Abstract . Fibromyalgia syndrome ( FMS ) is a very common rheumatological diagnosis . There are various treatment modalities . This study was planned to investigate the effects of balneotherapy in the treatment of FMS . A total of 42 primary fibromyalgia patients diagnosed according to American College of Rheumatology criteria were included in the study . Their ages ranged between 30 and 55 years . Patients were r and omly assigned to two groups . None of them had had a cardiovascular disease before . Group 1 ( n=22 ) received 20-min bathing , once a day and five times per week . Patients participated in the study for 3 weeks ( total of 15 sessions ) . Group 2 ( n=20 ) was accepted as the control group . Patients were evaluated by the number of tender points , Visual Analogue Scale for pain , Beck 's Depression Index for depression , and Fibromyalgia Impact Question naire for functional capacity . Measurements were assessed initially , after the therapy , and at the end of the 6th month . In group 1 , there were statistically significant differences in numbers of tender points , Visual Analogue scores , Beck 's Depression Index , and Fibrom 
    Output:
    
agent
There is moderate evidence that hydrotherapy has short-term beneficial effects on pain and HRQOL in FMS patients .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The purpose of this study was to investigate the clinical effects of balneotherapy in the treatment of Fibromyalgia Syndrome ( FMS ) and to determine if balneotherapy influences serum levels of inflammation markers , IL-1 , PGE2 and LTB4 . 24 primary fibromyalgia female patients diagnosed according to American College of Rheumatology criteria were included to the study . Their ages ranged between 33 and 55 years . FMS patients were r and omly assigned in two groups as , group 1 ( n = 12 ) and group 2 ( n = 12 ) . Group 1 received 20-min bathing , once in a day for five days per week . Patients participated in the study for 3 weeks ( total of 15 sessions ) in Denizli . Group 2 did not receive balneotherapy . FMS patients were evaluated by tenderness measurements ( tender point count and algometry ) , Visual Analogue Scale , Beck ’s Depression Index , Fibromyalgia Impact Question naire .  Ten healthy women recruited group three as the controls .  Serum PGE2 , LTB4 and IL1-α levels were measured in all three groups . The biochemical measurements and clinical assessment s were performed before and at the end of general period of therapy . Statistically significant alterations in algometric score , Visual Analogue score , Beck ’s Depression Index and PGE2 levels ( P < 0.001 ) , numbers of tender points ( P < 0.01 ) and Fibromyalgia Impact Question naire score ( P < 0.05 ) were found after the balneotherapy between group 1 and 2 . Mean PGE2 level of FMS patients were higher compared to healthy control group ( P < 0.0001 ) and decreased after the treatment period , only in group 1 ( P < 0.05 ) . As in the group 2 and 3 , detectable IL-1 and LTB4 measurements were insufficient , statistical analysis was performed , only in group 1 . After balneotherapy  IL-1 and LTB4 significantly decreased in group 1 ( P < 0.05 ) . In conclusion , balneotherapy is an effective choice of treatment in patients with FMS relieving the clinical symptoms , and possibly influencing the inflammatory mediators Abstract . The aim of this study was to evaluate the effectiveness of balneotherapy on patients with fibromyalgia ( FM ) at the Dead Sea . Forty-eight patients with FM were r and omly assigned to a treatment group receiving sulfur baths and a control group .  All participants stayed for 10 days at a Dead Sea spa .  Physical functioning , FM-related symptoms , and tenderness measurements ( point count and dolorimetry ) were assessed at four time points : prior to arrival at the Dead Sea , after 10 days of treatment , and 1 and 3 months after leaving the spa . Physical functioning and tenderness moderately improved in both groups . With the exception of tenderness threshold , the improvement was especially notable in the treatment group and it persisted even after 3 months . Relief in the severity of FM-related symptoms ( pain , fatigue , stiffness , and anxiety ) and reduced frequency of symptoms ( headache , sleep problems , and subjective joint swelling ) were reported in both groups but lasted longer in the treatment group . In conclusion , treatment of FM at the Dead Sea is effective and safe and may become an additional therapeutic modality in FM . Future studies should address the outcome and possible mechanisms of this treatment in FM patients Fibromyalgia ( FM ) is a nonarticular rheumatological syndrome associated with diverse clinical and psychological features . One of the major complaints in FM is reduced pain tolerance , especially in tender points ( TP ) for which patients derive significant benefit from nonsteroidal antiinflammatory drugs or corticosteroids .  Patients with FM also have altered reactivity of the hypothalamic pituitary adrenal ( HPA ) axis where the predominant feature is reduced containment of the stress response system through diminished adrenocortical output and feedback resistance . Our results show that mud packs together with antidepressant treatment are able to influence the HPA axis , stimulating increased levels of adrenocorticotropic hormone , cortisol and beta-endorphin serum levels . The discharge of corticoids in the blood and the increase in beta-endorphin serum levels are followed by a reduction in pain symptoms , which is closely related to an improvement in disability , depression and quality of life . It seems that the synergic association between a pharmacological treatment ( trazodone ) and mud packs acts by helping the physiological responses to achieve homeostasis and to rebalance the stress response system . To clarify and optimize the effectiveness of this synergic association , studies involving a larger number of FM patients and a different pharmacological treatment are needed Abstract : Fibromyalgia ( FS ) is an idiopathic chronic pain syndrome defined by widespread non-articular musculoskeletal pain and generalised tender points . As there is no effective treatment , patients with this condition have impaired quality of life ( QoL ) . The aim of this study was to assess the possible effect of balneotherapy at the Dead Sea area on the QoL of patients with FS . Forty-eight subjects participated in the study ; half of them received balneotherapy , and half did not . Their QoL ( using SF-36 ) , psychological well-being and FS-related symptoms were assessed prior to arrival at the spa hotel in the Dead Sea area , at the end of the 10-day stay , and 1 and 3 months later . A significant improvement was reported on most subscales of the SF-36 and on most symptoms . The improvement in physical aspects of QoL lasted usually 3 months , but on psychological measures the improvement was shorter . Subjects in the balneotherapy group reported higher and longer-lasting improvement than subjects in the control group . In conclusion , staying at the Dead Sea spa , in addition to balneotherapy , can transiently improve the QoL of patients with FS . Other studies with longer follow-up are needed to support our findings OBJECTIVE We studied whether whirl baths with plain water or with water containing pine oil or valerian have a different influence on  pain , disturbed sleep or tender point count . METHODS A r and omized , comparative and investigator-blinded study was performed . Out- patients with generalized fibromyalgia were r and omized into three treatment groups . INTERVENTIONS Therapy consisted of either whirl bath with plain water or with the addition of pine oil or valerian . The baths were carried out 10 times , three times a week . MAIN OUTCOME MEASURES General pain , change of pain intensity during the day , general well-being and occurrence of disturbed sleep were recorded before and after the therapy . The number of tender points was assessed by digital palpation , the pain threshold on the shinbone and the middle part of the deltoid muscle was measured by the dolorimeter of A. Fischer . The same instrument was used for recording pain threshold and pain tolerance of both trapezius muscles . The tissue compliance of these muscles was measured as well . RESULTS 30 out of 39 patients included in the study were evaluated statistically . After treatment with valerian bath ( n = 12 ) well-being and sleep were significantly improved and also the tender point count decreased significantly . Pine oil added to the bath water ( n = 7 ) result ed in a significant improvement of well-being , but unfortunately also in a significant decrease of pain threshold of the shinbone and the right deltoid muscle .  Whirl bath in plain water ( n = 11 ) reduced general and maximum pain intensity significantly . CONCLUSIONS Our cautious conclusion of this study is - with respect to the small number of treated patients - that different effects of whirl baths with or without medicinal bath oils can be detected in fibromyalgia patients .  Plain water baths modify the pain intensity , medicinal baths improve well-being and sleep The efficacy of balneotherapy in fibromyalgia syndrome ( FS ) has been well demonstrated , while controlled studies using mud packs are lacking . We performed a r and omized clinical trial to evaluate the effects and the tolerability of mud-bath treatment in FS patients , who are poor responders to pharmacological therapy . Eighty patients with primary FS , according to ACR criteria , were r and omly allocated to two groups : 40 were su bmi tted to a cycle of 12 mud packs and thermal baths  , and 40 were considered as controls .  At baseline , after thermal treatment and after 16 weeks , patients were evaluated by FIQ , tender points count , VAS for “ minor ” symptoms , AIMS 1 and HAQ . Control patients were assessed at the same time periods . A significant improvement of all evaluation parameters after mud-bath therapy and after 16 weeks was observed . Mud packs were well tolerated and no drop-outs were recorded . Our results suggest the efficacy and the tolerability of mud-bath treatment in primary FS BACKGROUND Balneotherapy at the Dead Sea area has been applied in various inflammatory rheumatic diseases such as rheumatoid arthritis and psoriatic arthritis . The efficacy of balneotherapy at the Dead Sea area for the treatment of degenerative rheumatic diseases has not yet been formally evaluated . OBJECTIVE To evaluate the efficacy of balneotherapy at the Dead Sea area in patients suffering from osteoarthritis of the knees . METHODS Forty patients were r and omly allocated into four groups of 10 patients . Group I was treated by bathing in a sulphur pool , group 2 by bathing in the Dead Sea , group 3 by a combination of sulphur pool and bathing in the Dead Sea , and group 4 served as the control group receiving no balneotherapy . The duration of balneotherapy was 2 weeks . RESULTS Significant improvement as measured by the Lequesne index of severity of osteoarthritis was observed in all three treatment groups , but not in the control group . This improvement lasted up to 3 months of follow-up in patients in all three treatment groups . CONCLUSION Balneotherapy at the Dead Sea area has a beneficial effect on patients with osteoarthritis of the knees , an effect that lastas at least 3 months 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 : The aim of the present study is to evaluate the effectiveness of spa therapy in the management of  fibromyalgia .  Methods : Thirty women with fibromyalgia were r and omly assigned to either a spa therapy group or a control group . The spa therapy group ( n = 16 ) had spa treatment for 2 weeks in addition to their medical treatment . The control group ( n = 14 ) continued to have their medical treatment and /or daily exercises . An investigator who was blinded for the intervention assessed all the patients for 9 months . Improvements in Fibromyalgia Impact Question naire ( FIQ ) , pain and number of tender points were primary outcomes . Secondary outcome measures were improvement in sleep disturbance , fatigue , gastrointestinal symptoms , anxiety , Beck Depression Inventory and patient ’s global evaluation . Results : the spa group was found to be superior to the control group at the end of intervention in terms of FIQ , pain , tender point count , fatigue and patients ’ global assessment . This superiority remained for 6 months in FIQ , 1 month in pain and tender point count . Conclusion : It was concluded that the addition of spa therapy to medical therapy has both short- and long-term beneficial effects in female patients with fibromyalgia Abstract . Fibromyalgia syndrome ( FMS ) is a very common rheumatological diagnosis . There are various treatment modalities . This study was planned to investigate the effects of balneotherapy in the treatment of FMS . A total of 42 primary fibromyalgia patients diagnosed according to American College of Rheumatology criteria were included in the study . Their ages ranged between 30 and 55 years . Patients were r and omly assigned to two groups . None of them had had a cardiovascular disease before . Group 1 ( n=22 ) received 20-min bathing , once a day and five times per week . Patients participated in the study for 3 weeks ( total of 15 sessions ) . Group 2 ( n=20 ) was accepted as the control group . Patients were evaluated by the number of tender points , Visual Analogue Scale for pain , Beck 's Depression Index for depression , and Fibromyalgia Impact Question naire for functional capacity . Measurements were assessed initially , after the therapy , and at the end of the 6th month . In group 1 , there were statistically significant differences in numbers of tender points , Visual Analogue scores , Beck 's Depression Index , and Fibrom 
    Output:
    