Avicenna Spine and Joint Institute

BACKGROUND: Thermal mud is a therapeutic agent widely used in the treatment of painful arthritic processes. The mechanism by which mud therapy works is still not well known. Its effect continues for months after completion of treatment. In order to verify whether thermal mud treatment brings about changes in the production of hormone peptides from proopiomelanocortin, the levels of plasma beta-endorphin and some hormones of the pituitary-adrenal glands (ACTH and cortisol) were determined in patients affected by osteoarthritis undergoing thermal mud therapy.

METHODS: The levels of plasma beta-endorphin and some hormones of the pituitary-adrenal glands (ACTH and cortisol) were assessed by radiometric methods in seventeen males affected by osteoarthritis. The patients underwent a cycle of twelve sessions of thermal mud therapy. The tests were carried out immediately before thermal treatment, immediately after the first session, twelve days after the start of treatment, and again one month after completion of the treatment.

RESULTS: beta-endorphin levels decreased significantly twelve days after the start of treatment. The level was still lower, although not significantly, even thirty days after completion of the treatment. Plasma ACTH also decreased during treatment. The decrease of this hormone was progressive and persisted after completion of treatment. Significant variations compared to baseline were found only thirty days after completion of treatment. Plasma cortisol decreased significantly after only one session of mud therapy. This hormone did not decrease any further during treatment, however, after twelve days it was still significantly lower than baseline. After completion of treatment, cortisol slightly increased, but thirty days later it was still lower, although not significantly, than baseline.

CONCLUSIONS: It may be suggested that thermal treatment, by reducing inflammation, reduced pain and therefore diminished the cause of stress.

Ann Rheum Dis 1992 Jun;51(6):820-2 Related Articles, Books, LinkOut

Controlled trial of balneotherapy in treatment of low back pain.

Konrad K, Tatrai T, Hunka A, Vereckei E, Korondi I. National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.

Three treatments for non-specific lumbar pain--balneotherapy, underwater traction bath, and underwater massage--were assessed in a randomised prospective controlled trial in 158 outpatients. Each group was treated for four weeks and patients were reviewed at the end of this period and at 12 months after entry to the trial. The prescription of analgesics and the pain score were significantly reduced in all three treated groups, but there was no difference between the three groups. No significant change occurred in spinal motion and the straight leg raising test. After one year only the analgesic consumption was significantly lower than in the control group.

Rheumatol Int 2000;19(3):77-82 Related Articles, Books, LinkOut

Immediate and delayed effects of treatment at the Dead Sea in patients with psoriatic arthritis.

Elkayam O, Ophir J, Brener S, Paran D, Wigler I, Efron D, Even-Paz Z, Politi Y, Yaron M. Department of Rheumatology, Tel Aviv Medical Center, Sackler Faculty of Medicine, University of Tel Aviv, Ichilov Hospital, Israel.

The purpose of this study was to evaluate the immediate and delayed effects of balneotherapy at the Dead Sea on patients with psoriatic arthritis (PsA). A total of 42 patients with PsA were treated at the Dead Sea for 4 weeks. Patients were randomly allocated into two groups: group 1 (23 patients) and group 2 (19 patients). Both groups received daily exposure to sun ultraviolet rays and regular bathing at the Dead Sea. Group 1 was also treated with mud packs and sulfur baths. Patients were assessed by a dermatologist and a rheumatologist 3 days before arrival, at the end of treatment, and at weeks 8, 16, and 28 from the start of treatment. The clinical indices assessed were morning stiffness, right and left hand grip, number of tender joints, number of swollen joints, Schober test, distance from finger to floor when bending forward, patient's self-assessment of disease severity, inflammatory neck and back pain and psoriasis area and severity index (PASI) score. Comparison between groups disclosed a similar statistically significant improvement for variables such as PASI, morning stiffness, patient self-assessment, right and left grip, Schober test and distance from finger to floor when bending forward. For variables such as tender and swollen joints, and inflammatory neck and back pain, improvement over time was statistically significant in group 1. Addition of mud packs and sulfur baths to sun ultraviolet exposure and Dead Sea baths seems to prolong beneficial effects and improves inflammatory back pain.

Clin Chim Acta 1997 Dec 10;268(1-2):101-6 Related Articles, Books, LinkOut

Mud pack therapy in osteoarthrosis. Changes in serum levels of chondrocyte markers.

Bellometti S, Cecchettin M, Galzigna L. Centro Studi Termali P. d'Abano, Montegrotto Terme, Italy.

We have previously shown that thermal mud therapy is able to influence chondrocyte activity of osteoarthrosic patients by modulating the production of serum cytokines, such as interleukin 1, and this was related to the presence of an anti-inflammatory principle in mature thermal mud. Mud therapy influences many biochemical processes of the body, independently of the thermic stimulation alone and the present paper documents specific increases of insulin growth factor 1 and decreases of tumor necrosis factor alpha in serum of osteoarthrosic patients after 12 days of mud pack application.

Med Care 1998 Sep;36(9):1309-14 Related Articles, Books, LinkOut Comment in: Med Care. 1998 Sep;36(9):1303-5

Use of spa therapy to improve the quality of life of chronic low back pain patients.

Constant F, Guillemin F, Collin JF, Boulange M. School of Public Health, Institute of Hydrology, University Henri Poincare, Faculty of Medicine, Nancy, France. OBJECTIVES: This study assessed the effectiveness of adding spa therapy to usual drug treatment in chronic low back pain patients. METHODS: A total of 224 patients were assigned randomly to either a treatment (n=128) or a control (n=96) group. Subjects in both groups received usual drug therapy. Those in the treatment group also underwent spa therapy in Vittel, France, for 6 days a week for 3 consecutive weeks. Effectiveness was assessed using a quality-of-life scale (the Duke Health Profile), clinical measures, and the Roland and Morris disability questionnaire. Groups were compared using an analysis of variance with repeated measures. RESULTS: At both 3 weeks and 3 months, patients in the treatment group exhibited significant improvement in measures of: physical and mental dimensions of quality of life, anxiety, depression, pain duration, pain intensity, and functional disability. CONCLUSION: This study suggests that spa therapy is an effective treatment for chronic low back pain patients.

J Rheumatol 1995 Jul;22(7):1315-20 Related Articles, Books, LinkOut

Effectiveness of spa therapy in chronic low back pain: a randomized clinical trial.

Constant F, Collin JF, Guillemin F, Boulange M. Institute of Hydrology, University of Nancy I, Faculty of Medicine, France. OBJECTIVE. To assess the overall effectiveness of spa therapy compared with usual routine drug therapy in chronic low back pain (LBP). METHODS. One hundred and twenty-one patients were randomly allocated to treatment (n = 59) and control (n = 62) groups. In the treatment group, patients underwent routine drug therapy and spa therapy 6 days/week for 3 consecutive weeks in Saint-Nectaire, France. In the control group, patients received routine drug therapy. Effectiveness was assessed based on clinical measures, duration and intensity of pain, Roland and Morris' disability questionnaire, the patient's overall evaluation of back health, and drug consumption (analgesic and antiinflammatory). Groups were compared using analysis of covariance with repeated measures. RESULTS. At 3 weeks, patients in the treatment group had significant improvement in all outcome variables (p < 0.0001) except for the Schober index and analgesic and antiinflammatory drug consumption. At 6 months, improvement was still significant for the same outcome variables (p < 0.0001), plus a significant reduction in analgesic consumption. CONCLUSION. This study suggests both immediate and 6 month effectiveness of spa therapy in chronic LBP. Spa therapy may be beneficial in the management of chronic LBP. Joint Bone Spine 2000;67(4):296-304 Related Articles, Books Comment in: Joint Bone Spine. 2000;67(4):262-3 Magnitude and duration of the effects of two spa therapy courses on knee and hip osteoarthritis: an open prospective study in 51 consecutive patients. Forestier R. OBJECTIVE: To evaluate the effects of spa therapy on knee and hip osteoarthritis by studying patients given the same treatment on two different occasions. PATIENTS AND METHODS: A prospective study of two medically-supervised, 3-week spa therapy courses performed at an interval of about 1 year in 51 consecutive patients with knee and/or hip osteoarthritis, most of whom were overweight (mean body mass index, 30 +/- 5 kg/m2). Mean age was 66 years. Study data were collected over a 17-month period. RESULTS: Lequesne's algofunctional index was significantly improved 5 and 8 months after the first course (by 1.74 +/- 2.2, P < 0.0001; and by 0.89 +/- 2.4, P = 0.017; respectively) and 5 months after the second course (by 1.26 +/- 3, P = 0.008). Walking distance showed comparable improvements. The decrease in medication use was not significant. No significant differences were found between the effects of the two courses after 20 days and 5 months. The advantages and drawbacks of the repeated treatment design used in this study are discussed. CONCLUSION: Although some sources of bias could not be eliminated, our data suggest that spa therapy may be effective in knee and hip osteoarthritis. The repeated treatment design may prove useful for evaluating treatments to which patients cannot be blinded.

Rheum Dis Clin North Am 1999 Nov;25(4):883-97 Related Articles, Books, LinkOut

The role of spa therapy in various rheumatic diseases.

Sukenik S, Flusser D, Abu-Shakra M. Department D, Soroka University Hospital, Beer-Sheva, Israel. Ssukenik@bgumail.bgu.ac.il Spa therapy seems to have a role in the treatment of a broad range of joint diseases. It cannot substitute for conventional therapy but can complement it. The improvement reported in some of the studies is of short duration, lasting for months. It should be considered for patients suffering from various types of inflammatory arthritides or noninflammatory arthritides who are symptomatic, despite accepted medical therapy and conservative physiotherapy, if they can afford the expense. The patients should be told that the effectiveness and success of this therapy cannot be predicted in advance. Because we have no way to date, of curing most rheumatic diseases, clinical trials of alternative therapeutic methods are justified. These methods may alleviate patient suffering and are almost totally devoid of serious adverse effects. No studies have been reported that evaluate their cost-effectiveness.

Isr J Med Sci 1996 Jul;32 Suppl:S16-9 Related Articles, Books

Balneotherapy for rheumatic diseases at the Dead Sea area.

Sukenik S. Department of Medicine D, Soroka Medical Center, Beer Sheva, Israel. The Dead Sea region is the major spa area in Israel for patients with various types of arthritis. The unique climatic conditions in this area, and the balneologic therapy-which is based primarily on mud packs and bathing in sulfur baths and in Dead Sea water-combine to alleviate the symptoms of arthritis. Controlled studies conducted over the last 10 years have demonstrated that treatments provided at the Dead Sea have a positive effect on patients with inflammatory arthritides such as rheumatoid and psoriatic arthritis, and on non-inflammatory arthritides such as osteoarthritis. In addition, the use of mud packs and Dead Sea salts dissolved in regular bath water outside the Dead Sea region are also effective, although to a lesser degree than when applied at the Dead Sea area itself.

Int J Clin Pharmacol Res 2000;20(3-4):69-80 Related Articles, Books, LinkOut

Mud bath therapy influences nitric oxide, myeloperoxidase and glutathione peroxidase serum levels in arthritic patients.

Bellometti S, Poletto M, Gregotti C, Richelmi P, Berte F. P. d'Abano Scientific Research Centre, Via P. d'Abano 11, 35031 Abano T., PD, Italy. terme@studitermali.org Nitric oxide (NO) has recently been proposed as an important mediator in inflammatory phases and in loss of cartilage. In inflammatory arthritis NO levels are correlated with disease activity and articular cartilage is able to produce large amounts of NO with the appropriate inducing factors such as cytokines and/or endotoxin. Neutrophils also play an important role in inflammatory reactions and the level of myeloperoxidase, a constituent of neutrophil granules, is related to the intensity of the inflammation. Because there is evidence that suggests that mud packs influence the main cytokines involved in cartilage damage, we tried to determine whether NO and myeloperoxidase are involved in the mechanisms of action of mud bath treatment. We enrolled 37 subjects and randomly assigned them to two groups: 19 patients underwent mud bath treatment (group A) while 18 patients underwent bath treatment alone. Blood samples were obtained before and after the treatment cycles to assay serum levels of NO, myeloperoxidase (MPO) and glutathione (GSH)-peroxidase. The results showed a statistically significant decrease in NO and myeloperoxidase serum values in groups A and B, while GSH-peroxidase was not significantly increase in either of the groups; no correlation was found between NO, myeloperoxidase and GSH-peroxidase serum values. Mud bath treatment can exert beneficial effects on cartilage homeostasis and inflammatory reactions, influencing NO and decreasing myeloperoxidase serum values. The increase in GSH-peroxidase was not correlated with the reduction of other biochemical markers, suggesting that mud bath treatment has different mechanisms of action.

Well-Being, CNS

Forsch Komplementarmed Klass Naturheilkd 2000 Dec;7(6):269-74 Related Articles, Books, LinkOut

The change of well-being associated with spa therapy.

Strauss-Blasche G, Ekmekcioglu C, Klammer N, Marktl W. Department of Physiology, University of Vienna, Schwarzspanierstrasse 17, A-1090 Wien, Austria. gerhard.strauss-blasche@univie.ac.at

OBJECTIVE: The present exploratory study sought to examine the changes of well-being associated with 3 weeks of resort based spa therapy. This is a traditional form of health enhancement incorporating balneotherapy, physical therapies, and health education in an inpatient setting.

PATIENTS AND METHOD: Subjects were spa patients (n = 153, mean age 58 years) with chronic pain and other age related complaints of moderately higher than normal prevalence. The well-being variables were vegetative complaints, pain, fatigue, positive and negative mood, and health satisfaction assessed at the beginning and end of spa treatment as well as 5 weeks and 12 months thereafter.

RESULTS: Well-being improved significantly in all variables during spa therapy, the improvement continuing with a slight deterioration at 5 weeks after the stay. After 12 months, vegetative complaints and fatigue had again reached pre-spa levels, whereas pain, positive and negative mood as well as health satisfaction remained improved. Both patients with high and low levels of pain increase their well-being, although pain patients showed greater improvements in some of the measures. Subjects not responding to spa therapy were older and showed less health satisfaction.

CONCLUSIONS: The results suggest that spa therapy may be a powerful tool in enhancing well-being in progressed middle aged adults with common health impairments.

Vopr Kurortol Fizioter Lech Fiz Kult 1997 Jul-Aug;(4):25-7 Related Articles, Books, LinkOut

The effect of contrast baths on central nervous system function in patients with a disordered menstrual function.

Ushakova OE, Davydova OB, Iarustovskaia OV, Filina LF, Lebedeva OD, Iazykova TA.

EEG, REG, psychoemotional tests have been performed in 26 females of reproductive age suffering from neuroendocrine syndrome with dysmenorrhea. The findings were indicative of defects in cerebral function and circulation. This confirms contribution of the central nervous system to the onset of their disease. The treatment with contrast baths resulted in recovery of mechanisms of cerebral regulation as seen from attenuation of clinical symptoms, positive changes in psychoemotional status, EEG and REG.

Vascular, Cardiovascular System

Vopr Kurortol Fizioter Lech Fiz Kult 1998 Sep-Oct;(5):13-7 Related Articles, Books

The use of sodium chloride baths in the treatment of diabetic patients with micro- and macroangiopathies.

Davydova OB, Turova EA, Grishina EV.

Patients suffering from insulin-dependent or non-insulin-dependent diabetes mellitus with micro- and macroangiopathy took sodium chloride baths of diverse concentration (30 and 50 g/l). A control group consisted of patients who had taken "neutral" baths. The response to sodium chloride baths was registered in carbohydrate and lipid metabolism, microcirculation, hemorheology, lower limbs circulation, exercise tolerance. Baths with sodium chloride concentrations 50 g/l have advantages, especially in patients with insulin-dependent diabetes mellitus.

Vopr Kurortol Fizioter Lech Fiz Kult 1998 May-Jun;(3):26-8 Related Articles, Books

The effect of contrast baths on the hemostatic function of patients with ischemic heart disease.

Sorokina EI, Ali O.

Contrast baths effects on hemostasis were studied in 72 patients with postinfarction cardiosclerosis and stable angina pectoris. Hemostasis was assessed by recalcification time, blood plasma tolerance to heparin, fibrinolytic activity, functional activity of antithrombin, soluble fibrin-monomeric complex, platelet count and aggregation. The results were compared to those in patients exposed to laser irradiation. Hydrotherapy with contrast baths was hemostatically effective in 70.9% of patients. Blood coagulation and platelet aggregation improved, the risk of intravascular microthrombogenesis diminished. Contrast baths had more pronounced beneficial effects on coagulation in ischemic heart disease of NYHA functional class II.

Altern Ther Health Med 2000 Nov;6(6):46-53 Related Articles, Books

The effect of balneotherapy on ambulatory blood pressure.

Ekmekcioglu C, Strauss-Blasche G, Feyertag J, Klammer N, Marktl W. University of Vienna Medical School, Department of Medical Physiology.

CONTEXT: Balneotherapy, a treatment that includes carbon dioxide and mud baths as well as massages and physical therapy, is successfully used in the treatment of rheumatic pain and other disorders such as cardiovascular and gynecological disease.

OBJECTIVE: To study the effect of a 3-week treatment of balneotherapy on 24-hour ambulatory blood pressure in 35 patients.

DESIGN: Balneotherapeutic applications were applied between 2 and 5 times a week and had a duration of 20 minutes. The mean 24-hour blood pressure, daytime blood pressure (7 AM to 10 PM), nighttime blood pressure (10 PM to 6 AM), nighttime dipping, and 24-hour blood pressure variability were measured. The effect of balneotherapy was evaluated using analysis of variance. In addition, the circadian variation of blood pressure was calculated using a cosinor analysis.

SETTING: The Austrian spa resort Bad Tatzmannsdorf.

PARTICIPANTS: 35 balneotherapy patients (15 men, 20 women).

INTERVENTION: Balneotherapy.

MAIN OUTCOME MEASURES: 24-hour ambulatory blood pressure was measured with an ambulatory monitor using an oscillometric method.

RESULTS: The results indicated that the 24-hour blood pressure and day- and nighttime blood pressure of patients with medium and high initial values decreased significantly (P < .05) after 3 weeks of balneotherapy, whereas patients with low blood pressure showed almost no change. The 24-hour blood pressure variation pattern of patients with medium values remained nearly unchanged during the balneotherapy. In contrast, a clear improvement in the circadian variation variables of patients with high initial blood pressure could be detected at the end of balneotherapy.

CONCLUSION: Patients with medium and, especially, higher initial blood pressure values seem to benefit from balneotherapy.

Fibromyalgia Clin Rheumatol 2001;20(1):15-9 Related Articles, Books, LinkOut

The effect of balneotherapy at the Dead Sea on the quality of life of patients with fibromyalgia syndrome.

Neumann L, Sukenik S, Bolotin A, Abu-Shakra M, Amir M, Flusser D, Buskila D. Soroka Medical Center, Faculty of Health Sciences and Faculty of Humanities and Social Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. lily@bgumail.bgu.ac.il

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.

Forsch Komplementarmed 1999 Apr;6(2):80-5 Related Articles, Books, LinkOut

Medicinal baths for treatment of generalized fibromyalgia.

Ammer K, Melnizky P. Ludwig Boltzmann Forschungsstelle fur Physikalische Diagnostik, Wien, Osterreich.

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 randomized, comparative and investigator-blinded study was performed. Out-patients with generalized fibromyalgia were randomized 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) resulted 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.

<>Home <>Feedback <>