Balneotherapy

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Balneotherapy is a technique of bathing in warm to hot mineral water or tap water baths with different minerals or bath salts added for the purposes of improving health. The exact mixtures or contents added to the bath for therapeutic purposes can vary depending on different methodologies and depending on the specific health issues being targeted. Balneotherapy may be offered through different spas, or practitioners may conduct their own sessions in their bath at home.

Water has been used therapeutically for thousands of years by many different cultures, however the current use of balneotherapy can be linked to the development of water-based cure spas that emerged in Europe in the 1800s. Many different theories have been suggested to explain how balneotherapy works to promote healing, and they usually differ based on the individual water therapy that is used. Some purport to act in a detoxifying manner, while others suggest the promotion of blood circulation, immune system function, and improved digestion. It is also believed that warm water emersion may function to aid the absorption of minerals through the skin.

A number of studies have investigated the use of balneotherapy for the treatment of fibromyalgia symptoms. Altan et al. (2004) compared the effects of pool-based exercise on fibromyalgia symptoms versus a control group that received only balneotherapy. The 25 patients in the exercise group participated in 35 minutes of warm-water exercise three times a week for 12 weeks. Those in the control group received only balneotherapy for 35 minutes, three times a week for 12 weeks. They were instructed not to perform any exercise. The same pool was used for both groups of participants, therefore each were exposed to identical mineral content in the water. The study found nearly identical, yet significant, effects of both pool-based exercise and balneotherapy on pain, fatigue, morning stiffness, sleep, and overall functioning. Those in the exercise group had slightly greater improvements in depression when compared to those who participated in only balneotherapy (Altan et al., 2004).

A 2001 study evaluated 48 fibromyalgia patients who each stayed for 10 days at a spa on the Dead Sea. Twenty-four patients were randomly assigned to receive daily 20 minute baths in a warm sulphur pool, while those in the control group did not receive the treatment. The water in the sulfur bath was drawn from the Dead Sea, which has a 30% salt content. At the conclusion of the study, all patients were found to have experienced relief for a majority of their fibromyalgia-related symptoms, including pain, fatigue, stiffness, and anxiety; however, the improvements were found to last longer for those who received the balneotherapy than for those in the control group (Buskila et al., 2001; Neumann et al., 2001). A similar study conducted in 2005 also investigated the use of two weeks of spa-based therapy in 30 patients with fibromyalgia. This study by Donmez et al. utilized not only balneotherapy (consisting of thermal pool baths for 20 minutes a day, six days a week), but also pressured showers with thermal water or classical massage every other day.  Control participants received no spa therapy during the course of the study but were guaranteed a spa course of therapy the following year. This study found significant improvements in pain for both groups of patients, however tender point counts only improved among those who received the spa therapy. Fatigue, depression, sleep disturbances, and anxiety were also more improved among those in the spa group than among controls (Donmez et al., 2005). Evcik et al., (2002) also reported similar findings.

A recent review article of various complementary and alternative medical therapies frequently utilized in the treatment of fibromyalgia included balneotherapy studies as part of its assessment. The authors graded the studies they reviewed as “good,” “moderate,” “low,” and “very low,” based on a modified version of pre-existing research grading criteria as published by the Cochrane Handbook for Systematic Reviews of Interventions, Version 5.0.1. The grading was based on a points system, and studies received points for randomization, blinding, missing data and dropouts, and completeness of the outcomes that were measured. Points were also awarded for the integrity of the study methodology (i.e., the way in which the research study was executed).

Of the research studies described in summary above, the studies published by Buskila, Evcik, and Neumann were all cited as being of low-grade. All others received a grade of “good” in the review by Terhorst and colleagues (2011). It is important to note that the authors also considered several other modalities of water-based therapy in their categorical review of balneotherapy-related studies, including electromagnetic baths, mud baths, and phytothermotherapy (traditional use of fermenting grass), however none of these studies demonstrated evidence to suggest that their methods were successful at improving pain among fibromyalgia patients. Among all the complementary and alternative therapies reviewed in this article, the authors concluded that balneotherapy and mind-body therapies (such as guided imagery and hypnosis) showed the most promise for treating fibromyalgia symptoms (Terhorst et al., 2011).

Other studies not reviewed by Terhorst et al. have also found balneotherapy to be useful at improving pain intensity, depression, and tender point counts among fibromyalgia patients (Ozkurt et al., 2011). In addition, other researchers have found that balneotherapy administered in conjunction with physical therapy improves respiratory symptoms of fibromyalgia patients, as well as improvements in pain (Kesiktas et al., 2011). Balneotherapy has also been demonstrated to be associated with decreased markers of systemic inflammation among fibromyalgia patients (Ardic et al., 2007).

All of this research support for balneotherapy as an effective treatment option for Fibromyalgia is interestingly similar to other research studies showing the effectiveness of other water based therapies such as warm water exercise programs. It appears that while different methods of utilizing water based therapies may offer varying degrees of treatment effectiveness, overall the evidence in support for water based therapies is quite convincing. As with most Fibromyalgia treatment options, effectiveness will differ from individual to individual but balneotherapy is a treatment option Fibromyalgia patients should consider testing.

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References

1.        Rheumatoid Arthritis and CAM. National Center for complementary and Alternative Medicine. Last updated October 2010; Accessed April 24, 2012.

2.        Altan L, Bingol U, Aykac M, Koc Z, Yurtkuran M. Investigation of the effects of pool-based exercise on fibromyalgia syndrome. Rheumatol Int. 2004;24:272-277.

3.        Buskila D, Abu-Shakra M, Neumann L, Odes L, Shneider E, Flusser D, Sukenik S. Balneotherapy for fibromyalgia at the Dead Sea. Rheumatol Int. 2001;20:105-108.

4.        Neumann L, Sukenik S, Bolotin A, Abu-Shakra M, Amir M, Flusser D, Buskila D. The effect of balneotherapy at the Dead Sea on the quality of life of patients with fibromyalgia syndrome. Clin Rheumatol. 2001;20:15-19.

5.        Donmez A, Karagulle MZ, Tercan N, Dinler M, Issever H, Karagulle M, Turan M. SPA therapy in fibromyalgia: a randomized controlled clinic study. Rheumatol Int. 2005;26:168-172.

6.        Evcik D, Kizilay B, Gokcen E. The effects of balneotherapy on fibromyalgia patients. Rheumatol Int. 2002;22:56-59.

7.        Terhorst L, Schneider MJ, Kim KH, Goozdich LM, Stilley CS. Complementary and alternative medicine in the treatment of pain and fibromyalgia: a systematic review of randomized controlled trials. J Manipulative Physiol Ther. 2011;34(7):483-496.

8.        Ozkurt S, Donmez A, Zeki Karagulle M, Uzunoglu E, Turan M, Erdogan N. Balneotherapy in fibromyalgia: a single blind randomized controlled clinical study. Rheumatol Int. 2011. April 2. Epub ahead of print

9.        Kesiktas N, Karagulle Z, Erdogan N, Yazicioglu K, Yilmaz H, Paker N. The efficacy of balneotherapy and physical modalities on the pulmonary system of patients with fibromyalgia. J Back Musculoskelet Rehabil. 2011;24(1):57-65.

10.     Ardic F, Ozgen M, Aybek H, Rota S, Cubukcu D, Gokgoz A. Effects of balneotherapy on serum IL-1, PGE2 and LTB4 levels in fibromyalgia patients. Rheumatol Int. 2007;27(5):441-446.

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