Non-farmakolojik Kombine Tedavi Yöntemlerinin Fibromiyaljili Hastalarda Serum Beta-Endorfin Düzeyi, Ağrı, Depresyon, Uyku Kalitesi ve Fonksiyonel Durum Üzerine Etkisi

Year 2021, , 354 - 359, 15.12.2021

Fahrettin Bostancı Ahmet Karadağ Halef Okan Doğan

https://doi.org/10.54005/geneltip.1036557

Abstract

Amaç: Bu çalışmanın amacı FMS tedavisinde kullanılan non-farmakolojik kombine tedavi metodlarının etkinliğini serum β–Endorfin, ağrı, depresyon, uyku kalitesi ve fonksiyonel durumu değerlendirerek karşılaştırmaktır.

Yöntemler: Çalışmaya FMS tanısı almış 60 kadın hasta ve 30 sağlıklı kadın gönüllü dahil edildi. FMS'li hastalar rastgele 30 kişiden oluşan iki eşit gruba ayrıldı. İlk hasta grubuna fizik tedavi ve balneoterapi uygulanırken, ikinci gruba fizik tedavi, balneoterapi ve aerobik egzersiz programı uygulandı. FMS hastaları tedavi öncesi ve sonrası, ağrı için Görsel Analog Skala (GAS), Fibromiyalji Etki Anketi (FEA), Beck Depresyon Ölçeği (BDÖ) ve Pittsburgh Uyku Kalitesi İndeksi (PUKİ) anketleriyle değerlendirildi. Serum β-Endorfin seviyeleri, sağlıklı kontrol grubunda bir kez, FMS hastalarında tedavi öncesi ve sonrası iki kez ölçüldü.

Bulgular: FMS’li hasta gruplarında β-Endorfin düzeyi sağlıklı kontrol grubuna göre daha düşüktü ve bu istatistiksel olarak anlamlıydı (p<0.001). Fizik tedavi ve balneoterapi alan FMS’li grubunun ve fizik tedavi, balneoterapi ve aerobik egzersiz tedavisi alan FMS’li grubunun tedavi sonrası β-Endorfin düzeyleri tedavi öncesine göre daha yüksekti ve bu fark istatistiksel olarak anlamlıydı (p<0.001). Bununla birlikte fizik tedavi, balneoterapi ve aerobik egzersiz tedavisi alan FMS’li grupta fizik tedavi ve balneoterapi alan FMS’li gruba oranla tedavi sonrası β-Endorfin düzeyi daha yüksekti ve bu istatistiksel olarak anlamlıydı (p<0.001). Her iki hasta grubunda, tedavi sonrası FEA, GAS, BDÖ ve PUKİ değerini tedavi öncesine göre azalmıştı ve bu istatistiksel olarak anlamlıydı (p<0.001).

Tartışma: FMS hastalarında serum β-Endorfin düzeyleri daha düşük bulundu. FMS tedavisinde aerobik egzersiz ve balneoterapi etkili yöntemlerdir. Bu sonuçlar, FMS etiyopatogenezi ve tedavisi ile ilgili ileri klinik çalışmalar için yol gösterici olabilir.

Keywords

Fibromyalji, aerobik egzersiz, balneoterapi, fizik tedavi, tedavi

The Effect of Non-pharmacological Combine Treatment Methods on Serum Beta-Endorphin Level, Pain, Depression, Sleep Quality and Functional Status in Patients with Fibromyalgia

Abstract

Abstract

Objective: This study aims to compare the effectiveness of non-pharmacological combined treatment methods used in Fibromyalgia syndrome (FMS) treatment by evaluating serum β -Endorphine, pain, depression, sleep quality and functional status.

Methods: The study included 60 patients diagnosed with FMS and 30 healthy female volunteers. The patients with FMS were divided into two equal groups of 30 subject. The first group of patients received physical therapy and balneotherapy, while the second group received physical therapy, balneotherapy and aerobic exercise program. FMS patients evaluated before and after treatment, by Visual Analogue Scale for Pain (VAS), Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Scale (BDI) and Pittsburgh Sleep Quality Index (PSQI) questionnaires. Serum β-Endorphin levels were measured once in the healthy control group and twice before and after treatment in FMS patients.

Results: The β-Endorfin level was lower in both FMS groups than the control group and this was statistically significant (p <0.001). Post-treatment β-Endorphin levels were high in the both FMS group and this difference was statistically significant (p <0.001). However, in the FMS group receiving physical therapy, balneotherapy and aerobic exercise, post-treatment β-Endorphin levels were higher than the FMS group receiving physical therapy and balneotherapy, and this was statistically significant (p <0.001). In both groups, we found that the scores of FIQ, VAS, BDI and PSQI after treatment were decreased compared to pretreatment and this was statistically significant (p <0.001).

Conclusion: The serum β-Endorphin levels were found to be lower in the FMS patients. Aerobic exercise and balneotherapy are effective methods in the treatment of FMS. These results can be of guidance for further clinical studies of the etiopathogenesis and treatment of FMS.

Keywords

Fibromyalgia, aerobic exercise, balneotherapy, physical therapy, treatment

References

• Karadag A, Hayta E, Celik VK, Bakir S. Serum vascular endothelial growth factor and vascular endothelial growth factor receptor-1 levels in patients with fibromyalgia syndrome. Arch Rheumatol 2019;34:414-18.
• Korucu RU, Karadağ A, Taş A et al. Serum Calcitonin Gene-Related Peptide and Receptor Protein Levels in Patients With Fibromyalgia Syndrome: A Cross-Sectional Study. Arch Rheumatol 2020;35:463-67.
• Kocak I, Hizmetli S, Tas A, Karadag A et al. High levels of cathepsin S and cystatin C in patients with fibromyalgia syndrome. Int J Rheum Dis 2020;23:966-69.
• Adler GK, Kinsley BT, Hurwitz S, Mossey CJ, Goldenberg DL. Reduced hypothalamic-pituitary and sympathoadrenal responses to hypoglycemia in women with fibromyalgia syndrome. Am J Med 1999;106:534–43.
• Semiz EA, Hizmetli S, Semiz M et al. Serum cortisol and dehydroepiandrosterone-sulfate levels after balneotherapy and physical therapy in patients with fibromyalgia Saudi Med J 2016;375:544-50.
• Fichna J, Janecka A, Costentin J, Rego do J. The Endomorphin System and Its Evolving. Pharmacol reviwes 2007;591:88–3.
• Goldfarb AH, Jamurtas AZ. Beta-endorphin response to exercise. An Updat Sport Med 1997;24:8–16.
• Paulev PE, Thorbøll JE, Nielsen U et al. Opioid involvement in the perception of pain due to endurance exercise in trained man. Physiol. 1989;39:67–4
• Schmidt-Wilcke T, Clauw DJ. Fibromyalgia: From pathophysiology to therapy. Nat Rev Rheumatol 2011;7:518–7.
• Karadağ A, Canbaş M, Parlak M. Balneoterapinin fibromiyalji hastalarında ağrı ve yaşam kalitesine etkisi. Mustafa Kemal Üniversitesi Tıp Dergisi 2018;9:114-20.
• Grisel JE, Bartels JL, Allen SA, Turgeon VL. Influence of β-Endorphin on anxious behavior in mice : interaction with EtOH. Psychopharmacology 2008;200:105-5.
• Rod K. Dishman PJO. Lessons in exercise neurobiology: The case of endorphins. Ment Health Phys Act 2009;2:4–9.
• Bender T, Bariska J, Vághy R, et al. Effect of balneotherapy on the antioxidant system--a controlled pilot study. Arch Med Res 2007;38:86-9.
• Karadağ A, Doğan HO. Serum paraoxonase enzyme activity after balneotherapy in patients with fibromyalgia. Medical Science and Discovery 2020;7:429-2.
• Bellometti S GL. Function of the hypothalamic adrenal axis in patients with fibromyalgia syndrome undergoing mud-pack treatment. Int J Clin Pharmacol Res 1999;19:27–3.
• Fioravanti A, Cantarini L, Guidelli GM, Galeazzi M. Mechanisms of action of spa therapies in rheumatic diseases: what scientific evidence is there? Rheumatol Int 2011;31:1–8.
• Wolfe F, Clauw DJ, Fitzcharles MA et al. The American Collage of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care & Research 2010;6:600-10.
• Sarmer S, Ergin S YG. The validity and reliability of the Turkish version of the Fibromyalgia Impact Questionnaire. Rheumatol In. 20:9–12.
• Ağargün Y, Kara H, Anlar Ö. Pittsburgh Uyku Kalitesi İndeksinin Geçerliği ve Güvenirliği. Türk Psikiyatr Derg. 1996;7:2
• Hisli N. Beck Depresyon Envanteri'nin geçerliliği üzerine bir çalışma. Psikoloji Dergisi. 1988;6:118–122.
• Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–1.
• Topbas M, Cakirbay H, Gulec H et al. The prevalence of fibromyalgia in women aged 20-64 in Turkey. Scand J Rheumatol 2005;34:140-4.
• Sarzi-Puttini P, Giorgi V, Marotto D, Atzeni F. Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Nat Rev Rheumatol 2020;16:645-60.
• Bidari A, Ghavidel-Parsa B, Rajabi S, Sanaei O, Toutounchi M. The acute effect of maximal exercise on plasma beta-endorphin levels in fibromyalgia patients. Korean J Pain. 2016;29:249-4
• Panerai AE, Vecchiet J, Panzeri P et al. Peripheral blood mononuclear cell beta-endorphin concentration is decreased in chronic fatigue syndrome and fibromyalgia but not in depression: preliminary report Clin J Pain 2002;18:270-3.
• Araújo FMS, DeSantana JM. Physical therapy modalities for treating fibromyalgia. F1000Res 2019;8:20-30.
• Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 2017;76:318–28.
• San˜udo B, Carrasco L, de Hoyo M M. Effects of Exercise Training and Detraining in Patients with Fibromyalgia Syndrome. Am J Phys Med Rehabil 2012;1:561–3.
• Baptista A, Luiza Villela A, Jones A, Natour J. Effectiveness of dance in patients with fibromyalgia: A randomised, single-blind, controlled study. Clinical and experimental rheumatology 2012;30:18-23.
• Neumann L, Sukenik S, Bolotin A et al. Original Article The Effect of Balneotherapy at the Dead Sea on the Quality of Life of Patients with Fibromyalgia Syndrome 2001;15–9.
• Ardıç F, Merih A, Hülya Ö et al. Effects of balneotherapy on serum IL-1, PGE 2 and LTB 4 levels in F bromyalgia patients 2007;441–6.
• Kurt EE, Koçak FA, Erdem HR, Tuncay F, Kelez F. Which Non-Pharmacological Treatment is More Effective on Clinical Parameters in Patients With Fibromyalgia: Balneotherapy or Aerobic Exercise? Arch Rheumatol 2016;31:162-9.