Balneotherapy in medicine: A review Effectiveness of Balneotherapy in Chronic Low Back Pain – a Randomized Single-Blind Controlled Follow-up Study Effect of balneotherapy on the antioxidant system--a controlled pilot study. The effect of balneotherapy on C-reactive protein, serum cholesterol, triglyceride, total antioxidant status and HSP-60 levels The efficacy of alum-containing ferrous thermal water in the management of chronic inflammatory gynaecological disorders--a randomized controlled study. The therapeutic effects of Cserkeszölö thermal water in osteoarthritis of the knee: a double blind, controlled, follow-up study The effect of spa therapy in chronic low back pain: a randomized controlled, single-blind, follow-up study Evaluation of the effect of balneotherapy in patients with osteoarthritis of the hands: a randomized controlled single-blind follow-up study Balneotherapy in elderly patients: effect on pain from degenerative knee and spine conditions and on quality of life. Balneohydrotherapy in the treatment of chronic venous insufficiency. Does balneotherapy with low radon concentration in water influence the endocrine system? A controlled non-randomized pilot study Balneotherapy in fibromyalgia: a single blind randomized controlled clinical study The effect of the thermal mineral water of Nagybaracska on patients with knee joint osteoarthritis—a double blind study Balneotherapy for atopic dermatitis in children at Comano spa in Trentino, Italy Does addition of ‘mud-pack and hot pool treatment’ to patient education make a difference in fibromyalgia patients? A randomized controlled single blind study Randomized trial of balneotherapy associated with patient education in patients with advanced chronic venous insufficiency. [Usefulness and necessity of unsynchronized photosolotherapy and bath-PUVA--two variants of balneophototherapy--in funded ambulatory health care].
Bathing in water ( balneotherapy or spa therapy ) has been frequently and widely used in classical medicine as a cure for diseases . This paper review s the present literature on the use of balneotherapy in dermatologic , chronic musculoskeletal ( inflammatory and non-inflammatory ) , metabolic and psychological conditions . We performed a systematic review on related papers appearing in the Medline and Cochrane Library data base from 1966 to 2003 that included r and omized controlled and non-r and omized clinical trials using balneotherapy . We also determined to reflect where possible the chemical compositions of spas . The major dermatologic and musculoskeletal diseases that are frequently treated by balneotherapy with a remarkable rate of success are atopic dermatitis , psoriasis , rheumatoid arthritis ( RA ) , ankylosing spondylitis , osteoarthritis and low back pain . Moreover , the effects of spa therapy on several metabolic conditions are discussed . The mechanisms by which broad spectrums of diseases respond to spa therapy probably incorporate chemical , thermal and mechanical effects . The importance of balneotherapy either alone or as complement to other therapies should be considered after , or accompanying , orthodox medical treatments Objective : Balneotherapy , a domain of medical science , focuses on utilizing the beneficial effects of medicinal waters . Low back pain is among the most prevalent musculoskeletal disorders affecting a large proportion of the population during their lifetime . Although small in number , all controlled studies published on this subject have demonstrated the benefits of balneotherapy . This present study was undertaken to compare the effects of hydrotherapy with mineral water vs. tap water on low back pain . Patients and Methods : A single-blind clinical study was carried out to appraise the therapeutic efficacy of reduced sulphurous water on 60 patients with low back pain . 30 subjects took baths in reduced sulphurous mineral water  , whereas the other 30 patients used modified tap water of matching odor . Parameters determined at baseline , after balneo-/hydrotherapy , and at the end of the 3-month follow-up period included the results of the Visual Analogue Scale ( VAS ) score , the modified Oswestry index , mobility of the spine , antalgic posture , tenderness of the paravertebral muscles on palpation , the dose requirements for analgesics , and the efficacy assessed by the investigators and by the patients . Results : Bathing in mineral water result ed in a statistically significant improvement . This was reflected by the VAS ( p < 0.01 ) and manifested by the mitigation of muscle spasm ( p < 0.01 ) , the alleviation of local tenderness ( p < 0.01 ) , the enhanced flexion-extension and rotation of the spine ( p < 0.01 ) as well as by the improvement of the Schober ’s index ( p < 0.01 ) . All these beneficial changes persisted as long as 3 months after the completion of balneotherapy . By contrast , hydrotherapy with tap water result ed only in the temporary improvement of just a single parameter : the VAS score improved significantly ( p < 0.01 ) . Conclusions : Balneotherapy in itself can alleviate  low back pain . As demonstrated by this study , the analgesic efficacy and improvement of mobility accomplished by the use of mineral water is significantly superior to that afforded by hydrotherapy with tap water . Our results clearly establish the beneficial effects of mineral water . Moreover , it is a valuable adjunct to other forms of physical treatment as well as to pharmacotherapy BACKGROUND Balneotherapy is among the most widely used modalities of physical therapy in countries rich in mineral waters . This trial was intended to ascertain whether balneotherapy ( i.e. , therapeutic bath in mineral water ) has any influence on the antioxidant system and whether there are any differences compared to bathing in tap water . METHODS The ten subjects in Group I bathed in alkaline thermal water , Group II  used alkaline , chlorine-containing mineral water , whereas Group III  bathed in tap water .  Catalase , superoxide dismutase , malondialdehyde protein and glutathione peroxidase levels were measured at baseline and after concluding the course of balneotherapy . RESULTS Balneotherapy with either of the two mineral waters reduced the activity of all four enzymes studied . Using tap water , however , had no influence on either catalase or superoxide dismutase activity after one session or glutathione peroxidase levels after a course of ten balneotherapy treatments . CONCLUSIONS Thermal water may have a beneficial effect on the formation of free radicals . The therapeutic efficacy of mineral vs. tap water is different , although bathing in hot water itself reduces enzyme activity An increasing body of evidence substantiating the effectiveness of balneotherapy has accumulated during recent decades . In the present study , 42 ambulatory patients ( 23 males and 19 females , mean age 59.5 years ) with degenerative musculoskeletal disease were r and omised into one of two groups — bathing in tap water or in mineral water at the same temperature— and subjected to 30-min balneotherapy sessions on 15 occasions . Study parameters comprised serum levels of sensitised C-reactive protein ( CRP ) , plasma lipids , heat shock protein ( HSP-60 ) and total antioxidant status ( TAS ) . In both groups , CRP levels followed a decreasing tendency , which still persisted 3 months later . At 3 months after balneotherapy , serum cholesterol levels were still decreasing in patients who had used medicinal water , but exhibited a trend towards an increase in the control group . Triglyceride levels followed a decreasing trend in both patient groups . TAS showed a declining tendency in both groups . No changes of HSP-60 levels were observed in either group . Balneotherapy with the thermal water from Hajdúszoboszló spa had a more pronounced physiological effect compared to that seen in the control group treated with tap water in a 3 month period OBJECTIVES Treatment of gynaecological disorders is a frequent , but only barely substantiated application of balneotherapy . This study investigated potential differences between the clinical symptoms , pelvic blood flow and specific laboratory parameters of patients undergoing balneotherapy with two different types of immersion : alum-containing and tap water . STUDY DESIGN The study population comprised 40 patients ( mean age : 39.4 years ) , r and omized into two groups . All subjects took 20 min baths in 38 degrees C water every other day , for 10 occasions altogether . Study parameters were : pain relief , reduction in tissue growth , hormone levels , psychic status , and pelvic blood flow . RESULTS Thermal water improved the clinical parameters of both groups significantly . In comparison with tap water , treatment with alum-containing water accomplished significantly greater progress , as reflected by the relief of pain elicited by h and ling the uterus and improvement of psychic status . Laboratory parameters ( FSH , LH , prolactin , oestradiol and beta-endorphin serum levels ) and the Doppler index did not change in either group . CONCLUSIONS As demonstrated by our results , 3-week balneotherapy is a potentially useful adjunct for the management of chronic pelvic inflammatory disease , but further , long-term studies are notwithst and ing necessary Abstract . The effects of thermal water from Cserkeszölö in Hungary were appraised in a r and omised , double blind study conducted on 58 patients with osteoarthritis of the knee .  Balneotherapy was delivered as a 15-day course of 30-min daily sessions performed with thermal water ( active treatment ) or tap water of similar colour and odour ( placebo treatment ) . The musculoskeletal status of participants was evaluated at baseline , at the end of the balneotherapy course , and 3 months later . Study endpoints ( initial pain , range of motion , tenderness on palpation , stair climbing , physicians ' opinion and subjective rating by patients , and ambulation ) were assessed using visual analogue scales and symptom scores . Both groups improved ; however , the magnitude of improvement was significantly greater in patients treated with thermal water from Cserkeszölö Effect of thermal water with high mineral content on clinical parameters and quality of life of patients with chronic low back pain was studied . In this r and omized controlled , single-blind , follow-up study , 60 patients with chronic low back pain were r and omized into two groups . The treatment group received balneotherapy with thermal-mineral water , and the control group bathed in tap water . Changes of the followings were evaluated : visual analogue scale ( VAS ) for pain , range of motion for the lumbar spine , Oswestry index , EuroQol-5D and Short Form-36 question naires . In the treatment group , the mobility of the lumbar spine , the Oswestry index , the VAS scores and the EuroQoL-5D index improved significantly . SF-36 items improved significantly in the treated group compared with baseline except for two parameters . Our study demonstrated the beneficial effect of balneotherapy with thermal mineral versus tap water on clinical parameters , along with improvements in quality of life Objective : To evaluate the effectiveness of thermal mineral water compared with magnetotherapy without balneotherapy as control , in the treatment of h and osteoarthritis . Design : R and omized controlled single-blind follow-up study . Setting : Rheumatology specialist clinic of Gunaras Health Spa . Subjects : Patients between 50 and 70 years of age with h and osteoarthritis , r and omly assigned into three groups . Interventions : The subjects in the first two groups bathed in thermal mineral water of two different temperatures ( 36 ° C and 38 ° C ) for three weeks five times a week for 20 minutes a day and received magnetotherapy to their h and s three times weekly . The third group received only magnetotherapy . Outcome measures : Visual analogue scale scores , h and grip strength , pinchgrip strength , the number of swollen and tender joints of the h and , the duration of morning joint stiffness , Health Assessment Question naire , and Short Form-36 question naire . The study parameters were administered at baseline , immediately after treatment and after 13 weeks . Results : The study included 63 patients . Statistically significant improvement was observed in several studied parameters after the treatment and during the follow-up study in the thermal water groups versus the control group . The 38 ° C thermal water treatment significantly improved the pinch strength of the right h and ( 0.6 ( 95 % confidence interval ( CI ) 0.2 to 1.1 ) vs. 0.03 ( 95 % CI −0.3 to 0.4 ) , P < 0.05 ) and the Health Assessment Question naire parameters ( −0.4 ( 95 % CI −0.6 to −0.2 ) vs. −0.1 ( 95 % CI −0.2 to 0.1 ) , P < 0.01 ) even in the long term . Conclusions : Balneotherapy combined with magnetotherapy  improved the pain and function as well as the quality of life in patients with h and osteoarthritis BACKGROUND Balneotherapy is an established treatment modality for musculoskeletal disease , but few studies have examined the efficacy of spa therapy in elderly patients with degenerative spine and joint diseases . OBJECTIVES To assess the effects of balneotherapy on chronic musculoskeletal pain , functional capacity , and quality of life in elderly patients with osteoarthritis of the knee or with chronic low back pain . METHODS The 81 patients in the study group underwent a 1 day course of 30 minute daily baths in mineral water . Changes were evaluated in the following parameters : pain intensity , functional capacity , quality of life , use of non-steroidal anti-inflammatory or analgesic drugs , subjective disease severity perceived by the patients , investigator-rated disease severity , and severity of pain perceived by the patients . We analyzed the results of 76 subjects as 5 did not complete the study . RESULTS Compared to baseline , all monitored parameters were significantly improved by balneotherapy in both investigated groups . Moreover , the favorable effect was prolonged for 3 months after treatment . CONCLUSIONS This study showed that balneotherapy is an effective treatment modality in elderly patients with osteoarthritis of the knee or with chronic low back pain , and its benefits last for at least 3 months after treatment BACKGROUND Physical therapy has not been evaluated much for the treatment of chronic venous insufficiency before . The question is whether balneohydrotherapy and usual care combined is superior to usual care alone . PATIENTS AND METHODS In a r and omized trial comparing spa therapy versus waiting list patients were treated on an out-patient basis in a private spa center . Patients had to be between 18 and 80 years old , with chronic venous insufficiency ( stage 3 or 4 according to the CEAP classification ) . The balneohydrotherapy group received 18 days of treatment in Aix-Les-Bains spa center continuing their usual care . The control group continued their usual care as well during the study . The balneohydrotherapy program consisted of Kneipp therapy ( 10 minutes ) , walking 10 minutes in a special mineral water pool with underwater jets at 23 ° C , massage and bathing in a mineral water tub at 34 ° C . The main outcome criterion was the number of patients with 20 % self assessed improvement on the Chronic Venous Insufficiency Question naire at three months after therapy . RESULTS 192 patients were assessed for eligibility , 99 were r and omized 5 retired drew back their consent and were not included in the intention to treat analysis . None were lost to follow up . After three months 32 ( 66 % ) patients improved in the balneohydrotherapy group and 13 ( 28 % ) in the control group . The difference between groups was significant ( odd ratio 5.08 [ 1.94 - 13.55 ] , relative risk reduction 2.33 [ 1.42 - 3.84]).There were no serious side effects .  CONCLUSIONS Balneohydrotherapy seems to improve quality of life of patients with chronic venous insufficiency Radon bath is a well-established modality of balneotherapy for the management of degenerative musculoskeletal disorders . The present study was conducted to ascertain whether baths of relatively low ( 80 Bq/l ) radon concentration have any influence on the functioning of the endocrine system . In the study , a non-r and omized pilot study , 27 patients with degenerative musculoskeletal disorders received 30-min radon baths ( of 31–32 ° C temperature and 80 Bq/l average radon concentration ) daily , for 15 days . Twenty-five patients with matching pathologies were subjected to balneotherapy according to the same protocol , using thermal water with negligible radon content ( 6 Bq/l ) . Serum thyroid stimulating hormone , prolactin , cortisol , adrenocorticotropic hormone , and dehydroepi and rosterone levels were measured before and after a balneotherapy course of 15 sessions . Comparison of the accumulated data using the Wilcoxon test did not reveal any significant difference between pre- and post-treatment values or between the two patient groups . It is noted that while the beneficial effects of balneotherapy with radon-containing water on degenerative disorders is widely known , only few data have been published in the literature on its effect on endocrine functions . The present study failed to demonstrate any substantial effect of thermal water with relatively low radon content on the functioning of the endocrine system We aim ed to evaluate the effectiveness of balneotherapy in  fibromyalgia management .  Fifty women with fibromyalgia under pharmacological treatment were r and omly assigned to either the balneotherapy ( 25 ) or the control ( 25 ) group . Four patients from the balneotherapy group and one patient from the control group left the study after r and omization . The patients in the balneotherapy group ( 21 ) had 2 thermomineral water baths daily for 2 weeks in Tuzla Spa Center . The patients in the control group ( 24 ) continued to have their medical treatment and routine daily life . An investigator who was blinded to the study arms assessed the patients . All patients were assessed four times ; at the beginning of the study , at the end of the 2nd week , the 1st month , and the 3rd month after balneotherapy . Outcome measures of the study were pain intensity , Fibromyalgia Impact Question naire ( FIQ ) , Beck Depression Inventory ( BDI ) , patient ’s global assessment , investigator ’s global assessment , SF-36 scores , and tender point count .  Balneotherapy was found to be superior at the end of the cure period in terms of pain intensity , FIQ , Beck Depression Inventory , patient ’s global assessment , investigator ’s global assessment scores , and tender point count as compared to the control group . The superiority of balneotherapy lasted up to the end of the 3rd month , except for the Beck Depression Inventory score and the investigator ’s global assessment score . Significant improvements were observed in PF , GH , and MH subscales of SF-36 during the study period in the balneotherapy group ; however , no such improvement was observed in the control group . Balneotherapy was superior only in VT subscale at the end of therapy and at the end of the third month after the therapy as compared to the controls . It was concluded that balneotherapy provides beneficial effects in patients with fibromyalgia To study the effect of thermal mineral water of Nagybaracska ( Hungary ) on patients with primary knee osteoarthritis in a r and omized , double-blind clinical trial , 64 patients with nonsurgical knee joint osteoarthritis were r and omly selected either into the thermal mineral water or into the tap water group in a non-spa resort village . The patients of both groups received 30-min sessions of bathing , 5 days a week for four consecutive weeks . The patients were evaluated by a blind observer immediately before and at the end of the trial using Western Ontario and McMaster Osteoarthritis ( WOMAC ) indices and follow-up assessment 3 months later . Twenty-seven patients of the 32 patients who received thermal mineral water and 25 of the 32 of those treated with tap water completed the trial . The WOMAC activity , pain , and total scores improved significantly in the thermal mineral-water-treated group . The improvement remained also at the end of the 3-month follow-up . The WOMAC activity , pain , and total scores improved significantly also in the tap water group at the end of the treatment course , but no improvement was detected at the end of the 3-month follow-up period . The treatment with the thermal mineral water of Nagybaracska significantly improved activity , pain , and total WOMAC scores of patients with nonsurgical OA of the knee . Even after 3 months , significant improvement was observed compared to the scores before the treatment or to tap water treatment Abstract Background : No controlled studies have investigated whether balneotherapy is effective in  atopic dermatitis ( AD ) .  Objectives : To investigate the efficacy and safety of balneotherapy performed at Comano spa ( Trentino , Italy ) compared to topical corticosteroids ( TCS ) in the treatment of AD . Methods : This was an open , r and omized , clinical trial including 104 children ( aged 1–14 years ) with mild to moderate AD who were assigned either to balneotherapy ( n = 54 ) or TCS ( n = 50 ) once daily for 2 weeks . AD severity and quality of life were measured using the SCORAD , investigator global assessment ( IGA ) , patients ' self global assessment ( PSGA ) , children 's dermatology life quality index ( CDLQI ) and family dermatitis impact question naire ( FDIQ ) . Subjective measures were re-evaluated 4 months after the end of therapy . Results : Balneotherapy and TCS result ed in a significant reduction of all parameters at week 2 . TCS were more effective than balneotherapy  regarding SCORAD ( 46 % ± 7.71 vs 26 % ± 9.4 , mean ± SD ; p < 0.03 ) . In contrast , IGA , PSGA , CDLQI and FDIQ improvement was similar . At month 4 , the number and duration of relapses were less in patients treated with balneotherapy compared to those treated with TCS ( p < 0.0001 ) . Conclusions : Balneotherapy at Comano spa appears to be beneficial in children with mild to moderate AD The aim of this r and omized controlled single-blind study is to explore whether addition of mud-pack and hot pool treatments to patient education make a significant difference in short and mild term outcomes of the patients with fibromyalgia . Seventy women with fibromyalgia syndrome were r and omly assigned to either balneotherapy with mud-pack and hot pool treatments ( 35 ) or control ( 35 ) groups . After r and omization , five patients from  balneotherapy group and five patients from control group were dropped out from the study with different excuses . All patients had 6-h patient education programme about fibromyalgia syndrome and were given a home exercise programme . The patients in balneotherapy group had heated pool treatment at 38 ° C for 20 min a day , and mud-pack treatment afterwards on back region at 45 ° C . Balneotherapy was applied on weekdays for 2 weeks . All patients continued to take their medical treatment . An investigator who was blinded to the intervention assessed all the patients before and after the treatment , at the first and the third months of follow-up . Outcome measures were FIQ , BDI and both patient ’s and physician ’s global assessment s.  Balneotherapy group was significantly better than control group at after the treatment and at the end of the first month follow-up assessment s in terms of patient ’s and physician ’s global assessment , total FIQ score , and pain intensity , fatigue , non-refreshed awaking , stiffness , anxiety and depression subscales of FIQ . No significant difference was found between the groups in terms of BDI scores . It is concluded that patient education combined with 2 weeks balneotherapy application has more beneficial effects in patients with fibromyalgia syndrome as compared to patient education alone OBJECTIVES Except for compression therapy , physical therapy has scarcely been evaluated in the treatment of chronic venous disorders ( CVD ) .  Spa treatment is a popular way to administer physical therapy for CVD in France , but its efficacy has not been evaluated yet . This study aim ed to assess the efficacy of balneotherapy associated with patient education , as performed in the spa resort of La Léchère , in patients with advanced chronic venous insufficiency ( CEAP clinical classes C4/C5 ) . METHODS The study was a r and omized controlled trial , spa therapy being administered on top of the usual medical care . Evaluation was by a blinded independent investigator . Subjects were patients with primary or post-thrombotic CVD with skin changes but no active ulcer ( C4a , C4b , or C5 ) , living in Grenoble area , and willing to undergo a spa treatment course in La Léchère . The treated group had the three week spa treatment course in La Léchère , soon after r and omization ; the control group also had a spa treatment , but starting at day 365 . The treatment consisted of four balneology sessions per day , six days a week during three weeks , and three educational workshops . An independent follow-up was performed in Grenoble hospital every three months for 15 months . The main outcome criterion was the severity of the skin changes , as evaluated by means of malleolar chromametry . Quality of life , as measured by the Chronic Venous Insufficiency Question naire 2 scale , a visual analog scale ( VAS ) for leg symptoms , and the occurrence of leg ulcers were used as secondary criteria . The year after spa treatment in the treated group was compared with the year before spa treatment in the control group . RESULTS Fifty-nine subjects were enrolled ( 29 in the treatment group and 30 in the control group ) . No statistically significant difference between groups was found at study onset regarding age , sex , etiology , CEAP " C " class , and the outcome variables . After treatment , chromametry showed significantly decreased pigmentation and erythema in the treatment group compared with the controls ( P < .01 ) . Quality of life ( P < .01 ) and symptoms ( P < .001 ) also improved significantly . These differences remained significant after one year follow-up . The control patients improved similarly after their own spa treatment ( day 450 ) . CONCLUSION This study shows that spa therapy , associating balneotherapy and patient education , is able to improve significantly the skin trophic changes of the CVD patients and their CVD related quality of life and symptoms . This effect is of large magnitude and remains significant one year after the treatment course The St and ing Committee of Statutory Health Insurance Physicians and Sickness Funds is the legal body that makes decisions on reimbursement for health care services in the German ambulatory health care sector . In 1994 the committee declined the reimbursement of balneophototherapy . Balneophototherapy comprises a bath in a saline solution followed by ( " non-synchronous " ) or simultaneous ( " synchronous " ) UVB-irradiation . Photochemotherapy with bath-water delivery of psoralens combined with UVA light is also covered by the term balneophotherapy . The main indication for both procedures is serious psoriasis .  Bath PUVA was also recommended for atopic dermatitis , pityriasis lichenoides , lichen ruber and mycosis fungoides . An effectiveness study sponsored by the sickness funds with rather poor method ological design and conduct was not able to show an unbiased effect of balneophototherapy despite inclusion of thous and s of patients . On the contrary , a poor adherence of patients and doctors was documented , since 63 % of patients suffering from psoriasis and treated with  saline bath followed by UVB-irradiation stopped early or used additional therapies like cortisone or vitamin D3 derivatives . Only 43 % of patients suffering from psoriasis and treated by bath PUVA  did not stop the initial therapy and did not receive additional therapy ( UVB , cortisone ) . In addition , the committee also conducted a thorough review of the literature , guidelines and status in other health care systems . Finally the two modifications of balneophototherapy were again declined from reimbursement in the German ambulatory health care sector . There were no controlled clinical trials showing efficacy of saline bath followed by UVB irradiation . Up to now bath PUVA was only evaluated in small equivalence trials which despite the fact that a drug was tested did not apply basic ICH st and ards ( international conference on harmonisation ) for equivalence trials . Additionally , the long-term cancer risk inherent to the application of psoralenes must be considered . Since the definition of " severe psoriasis " is not trivial a wide use of bath PUVA in ambulatory health care has to be based on the results of rigorously conducted clinical trials showing the effectiveness , safety and appropriateness in comparison to other treatment modalities . In reaction to the decision of of the committee two r and omised controlled trials for the evaluation of the efficacy of balneophototherapy are planned
A similar effect has been found in chronic pelvic inflammatory disease .
The review also revealed that  balneotherapy has some beneficial effects on antioxidant status , and on metabolic and inflammatory parameters .
Based on the results , we conclude that balneotherapy with Hungarian thermal-mineral waters is an effective remedy for  lower back pain  , as well as for knee and h and osteoarthritis
Balneotherapy is appreciated as a traditional treatment modality in medicine .
Hungary is rich in thermal mineral waters .
Balneotherapy has been in extensive use for centuries and its effects have been studied in detail .