Fibromyalgia patients often experience a variation in the therapeutic approach strongly dependent on their doctor’s opinion on the cause of the disorder. In fact, the origins of fibromyalgia remain unknown, and the attempts to explain their pathogenic causes are still too weak to establish a standard evidence-based treatment. Unfortunately, this situation leads to frequent changes of doctor, which is very harmful for a successful therapy. Plus, patients do not always believe that great part of the therapeutic potential lies in themselves.
In order to evaluate the therapeutic importance of cold, it is assumed that fibromyalgia is mainly related to a stress and pain management disorder whose characteristics are:
● Chronic development
● Pain of variable intensity throughout the body
● The possibility of a variety of vegetative, functional and mental disorders.
Main symptoms of fibromyalgia
● Spontaneous musculoskeletal pain for more than three months near the spine, between the muscles surrounding the joints, and low pain threshold.
● General increase of tactile sensitivity or when moving the aching areas.
● Memory disturbances.
● Fatigue and asthenia.
● Sleep disorders.
● Morning joint stiffness.
● Headache and migraine.
● Casual depressive mood and state of anxiety.
● Decrease of stress tolerance.
A multi-modal approach is always pursued when treating fibromyalgia. It includes several parts which are not to be forgotten when Whole-body Cryotherapy is used, such as:
- Finding the possible somatic or psychosocial causes.
- Physical therapy.
- Moderate activity.
- Relaxation therapy.
- Therapies to overcome pain and stress.
- Pharmacological treatment.
Whole-body Cryotherapy has been successfully used for some time now to treat fibromyalgia, but it is only to be used if the patient tolerates it and it does not affect negatively their overall status. However, patients that have gone through heat treatments are often reluctant to believe in therapeutic cold. Nevertheless, people usually change their mind after a test session.
Whole-body Cryotherapy can be objectively proved as better than heat treatments through methods such as the measurement of pain, since chronic pain is the main symptom of fibromyalgia.
Pain in soft parts comes first, and it is often quite severe. There is also a tendency to muscle fatigue. The result: restrictions on joint mobility. After 20 or 30 exposures to cold, great improvements can be achieved. The success rate ranges between 40% and 80 %. These oscillations depend on the possibility of developing a memory for pain. In the interest of a sustainable success, Whole-body Cryotherapy should be combined, if possible, with activation treatments. It is recommended to practice gymnastic exercises within the 3 hours following the cold session. This will slowly increase physical activity and avoid pain. The tension and stretching of muscles should not last long. It must be kept in mind that pain and tension can interfere in the muscle groups to varying degrees. The result is often a cautious attitude towards these muscle groups at the expense of others. The gymnastics have the aim of achieving a balance between these differences. A moderate and controlled endurance exercise can complement the therapeutic exercise program. It is of vital importance to find your own limits and try not to overdo competition exercises, respect fatigue, write down your improvements without pain and admit your results with a positive attitude.
Therefore, Whole-body Cryotherapy can help regulate the level of the affected areas activity. This has a positive influence on sleep disorders that usually come with fibromyalgia, as well as on the depressive mood occasionally observed. Both sleep disorders and depressive mood are usually caused by chronic pain. Thanks to the decrease of pain and balancing effect of cold, it is possible to reach a state of restful sleep after a few days. The effects of the combination of Whole-body Cryotherapy and progressive muscle relaxation by Jacobson have been proved. This technique, along with the interaction with the resulting process of emotional balance, allows appreciating the state of muscle tension and relaxation.
The strong stimulus of cold throughout the body has a regulating effect of the state of capillary walls tension on a superficial level. This, coupled with a physical activity adapted to the capacities of each patient, leads to better mood.
The increase of irrigation of muscles described after the exposure to cold throughout the body might also lead to a regulation of metabolism in musculature and thus to a decrease of general malaise.
Finally, according to a medical study carried out at the Meprysa Polyclinic, endorsed by Dr. Armando Fernández Sánchez on 13 patients suffering from fibromyalgia, the following experimental conclusions were reached:
- Effects on the sympathetic system: Since the first session, patients have noticed an increase in their sense of wellness, feeling less depressed and more active. They say that this antidepressant and invigorating effect is very noticeable in their personal and family life. Some patients comment that they have been able to carry out sports and social activities that they previously avoided.
- Effects at the psychopathic level: patients themselves relate the improvement in their mental well-being with the treatment. After the sessions, they comment on a certain feeling of euphoria.
- Effects at the motor level: They show greater mobility and physical activity. They comment that they have felt less pain and muscle spasms.
- Effects at the dermatological level: From the third session they present better appearance of the skin.
- General effects: They refer needing less medication, such as analgesics and anti-inflammatories.
In conclusion, it can be said that the improvement is faster and more important, outbreaks diminish in users who have done more sessions more and more followed in time.
On the other hand, the general opinion of patients about Whole Body Cryotherapy, which within the different therapeutic alternatives they have tried (pain unit, acupuncture…) is the most satisfactory and effective.
Immune-mediated inflammatory disorders
Immune-mediated inflammatory disorders are those in which the autoimmune processes have been identified as a cause of the disease. The experience in cryotherapy includes great number of these disorders: rheumatoid arthritis, ankylosing spondylitis, psoriasis (with or without arthritis) and multiple sclerosis.
What causes these diseases?
The immune system has highly specialized cells and proteins called cytokines. Under certain physiological conditions and after having detected harmful factors, they develop important functions to protect the human organism and defend it from agents that they destroy using a process of acute inflammation.
The potential to recognize harmful elements for the organism (antigens) appears during the embryonic development. It becomes an effective defense after having faced different pathogens throughout life. Nevertheless, it seems that it might stop working properly due to root causes (endogenous) or secondary causes (acquired). This would produce a loss of some of these specific properties leading to immune tolerance or absence of response to proper and foreign antigens, as well as self-aggressive immune reactions manifested by a chronic primary inflammation that destroys tissue. The cause of this phenomenon is still unknown, but genetic research is helping understand how immunology works. In this context, it has been recently discovered that a fault in chromosome 6 is responsible for the development of autoimmune diseases, including rheumatoid arthritis and multiple sclerosis. A risk gene for Crohn’s disease has been found in chromosome 16. This is a chronic inflammatory disease of the intestine that also produces self- aggression.
Although autoimmune diseases are systemic diseases (the entire body is affected), they also have very specific target organs, body areas where they affect specifically and manifestly. These are:
- Joints (rheumatoid arthritis).
- Spine (ankylosing spondylitis, mainly).
- Central nervous system (multiple sclerosis).
- Skin and joints (psoriasis, with arthritis).
- Intestine (Crohn’s disease).
Cytokine TNF-α (tumor necrosis factor alpha) plays an obvious main role in these processes. The over-production of this protein by cells from the immune system triggers a chain reaction of inflammatory processes that foment self-aggressive function of immune cells. New cytokines are released and activated, and the walls of the blood vessels become permeable to the aggressive immune cells, allowing them to enter the target zone or target organ. These immunological discoveries, especially the destructive effect of TNF-α, have allowed the development of highly efficient treatments for these diseases.
The pathological processes of this autoimmune disease appear mainly in joints. The membrane that covers the joint capsule is inflamed and the structures of cartilage and bone are destroyed. New principles have been adopted for treating this disease (blocking the TNF-α), but the treatment still requires a complex procedure, since rheumatoid arthritis is basically a systemic disease that weakens the whole organism. Then, the medicine or surgical treatment, or eventually kynesiotherapy, physical therapy -use of heat or cold- or psychological support have to be linked to the personal coping strategies of the patients and be coordinated.
An excellent and extensive bibliography about this topic has been published by relevant self-help organizations.
Rheumatoid arthritis is a systemic, chronic and progressive disease whose cure is yet to be found despite all the therapeutic advances. Therefore, this treatment aims to produce a decrease of intensity of the symptoms in order to stop or slow their progression.
Whole-body Cryotherapy must be understood in this context as an additive physiotherapy that can help achieve the objective of the treatment if it is used correctly. It has not been conceived to replace other tested treatments, but the experience and research have shown that it usually helps reduce the medicine intake.
Whole-body Cryotherapy should be used within the framework of a clinical treatment, inpatient, two sessions per day (or three when there is great activity) during 2-3 weeks. Medical evaluations about the progress of the treatment should take place every 2-3 days.
Nevertheless, in outpatient cases, 10-15 sessions of exposure to cold are usually sufficient even when there is a high degree of inflammatory activity. This causes a relief of the symptom picture in terms of pain reduction and movement restrictions.
Therapeutic activities related to movement (kynesiotherapy, physiotherapy…) will not be abandoned under any circumstances during the cryotherapy cycles. Exercise enhances the synovial fluid in joints and benefit the nutrient supply to joint cartilage, which fights muscular atrophy caused by inactivity that would ultimately produce secondary damages, for example to the skeleton.
In essence, a cryotherapy program is advantageous in two different levels:
- It improves general mobility as well as joint capacity in up to 60 % of the patients.
- It reduces medicine intake (corticosteroids and anti-inflammatory medication) in 35 to 40% of the patients.
Pain relief can be kept by increasing the length of time of the cycle regime. The improvement in joint mobility is a long-term result whose effects can be observed during a long period after therapy.
On balance, Whole-body Cryotherapy enhances the state of health, reduces pain and signs of inflammation, improves general mobility and allows reducing medicine intake.