A Prospective Observational Study of a 2-Week Integrative Inpatient Therapy on Patients with Fibromyalgia Syndrome.

The short version

This prospective observational study followed 101 adults with long-standing fibromyalgia syndrome (FMS) through a two-week integrative inpatient stay in Bamberg, Germany, with no control group. FMS is a chronic condition marked by widespread pain, fatigue, sleep problems, anxiety and depression, and the authors describe it as the third most common rheumatic disease. The program was built on classical European naturopathy: water-based therapies and heat, exercise, plant-based nutrition or medical fasting, herbal remedies and mind-body practices such as relaxation. The question was whether such a combined approach would ease symptoms at discharge and six months later. Of 134 patients who joined (127 women, ages 22 to 80), 101 returned questionnaires on admission, at discharge and after six months. During the stay they took part in meditative movement, physical therapy, hydrotherapy, lectures and cooking classes, and some had whole-body heat sessions or a 5-day fast on under 300 kcal a day. Pain, fatigue, anxiety, depression, stress and quality of life were measured with standard questionnaires (such as the HADS for anxiety and depression and the MFI-20 for fatigue) and compared over time with repeated-measures statistics. Overall pain intensity dropped from 71.5 to 63.0 on a 0-100 scale at discharge (a moderate effect, dz = 0.62) and was still lower at six months (64.4). Current pain fell sharply during the stay (6.56 to 4.37 out of 10) but crept back to 5.96 at six months. Fatigue improved from 71.1 to 63.3 and then partly returned (68.0). Anxiety and depression scores each fell by roughly 2.5 points at discharge and were still lower than baseline at six months. Stress and feelings of helplessness improved mainly after discharge, and mental quality of life rose between discharge and follow-up. Patients who fasted kept their pain gains at six months (p = 0.006), whereas non-fasters did not (p = 0.062), although this difference was borderline (interaction p = 0.050) and not randomised. The results come from an uncontrolled, single-centre sample in which a quarter of the participants did not complete the six-month questionnaire, so the changes cannot be attributed to the program alone. More than half the patients reported obstacles to continuing the methods at home, such as lack of time and exhaustion. The authors call for randomised trials with long-term follow-up and propose a follow-up day-clinic programme to help consolidate the learned self-management skills and everyday routines.

Key findings

• This study followed 101 adults with long-standing fibromyalgia (a condition of widespread pain, fatigue and low mood) through a two-week hospital program that combined water and heat therapy, exercise, nutrition or medical fasting, herbal remedies and relaxation training.
• Overall pain scores fell from 71.5 to 63.0 (on a 0-100 scale) by discharge, and were still lower (64.4) six months later; fatigue, anxiety and depression also improved at discharge and stayed below their starting levels at six months.
• Some benefits faded after discharge: current pain rose back to 5.96 out of 10 (from 4.37 at discharge, against 6.56 at the start), while perceived stress, helplessness and mental quality of life improved mainly in the months after leaving the clinic.
• People who chose medical fasting (a supervised low-calorie period) kept their pain improvement at six months (p = 0.006), but people who did not fast did not (p = 0.062); the difference was borderline (interaction p = 0.050) and was not randomised.
• There was no comparison group and a quarter of participants did not complete the six-month questionnaire, so the study cannot show that the program itself caused the improvements; more than half the participants reported obstacles to continuing the methods at home.

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