The role of mineral elements and other chemical compounds used in balneology: data from double-blind randomized clinical trials

Abstract

The aims of this study were to conduct a systematic literature review on balneotherapy about the specific therapeutic role of mineral elements and other chemical compounds of mineral waters and derivate peloids/muds and to discuss the study methods used to evaluate it (in musculoskeletal conditions). We searched Medline by PubMed using the following key words: "spa therapy" "balneotherapy" "mud" "peloid" "mud pack Therapy" in combination with "randomized controlled trial" "double blind trial." We also reviewed the reference list of articles retrieved by the Medline search. We selected the double-blind randomized clinical trials that assessed the effects of mineral water or mud treatments compared to tap water, attenuated peloid/mud therapy or similar treatments without the specific minerals or chemical compounds of the treatment group ("non-mineral"). We evaluated the internal validity and the quality of the statistical analysis of these trials. The final selection comprised 27 double-blind randomized clinical trials, 20 related to rheumatology. A total of 1118 patients with rheumatological and other musculoskeletal diseases were evaluated in these studies: 552 of knee osteoarthritis, 47 of hand osteoarthritis, 147 chronic low back pain, 308 of reumathoid arthritis, and 64 of osteoporosis; 293 of these participants were assigned to the experimental groups of knee osteoarthritis, 24 in hand osteoarthritis, 82 of low back pain, 152 with reumathoid arthritis, and 32 with osteoporosis. They were treated with mineral water baths and/or mud/peloid (with or without other forms of treatment, like physical therapy, exercise…). The rest were allocated to the control groups; they received mainly tap water and/or "non-mineral" mud/peloid treatments. Mineral water or mud treatments had better and longer improvements in pain, function, quality of life, clinical parameters, and others in some rheumatologic diseases (knee and hand osteoarthritis, chronic low back pain, rheumatoid arthritis, and osteoporosis) compared to baseline and non-mineral similar treatments. Internal validity and other limitations of the study's methodology impede causal relation of spa therapy on these improvements. Randomized clinical trials are very heterogeneous. Double-blind randomized clinical trials seem to be the key for studying the role of mineral elements and other chemical compounds, observing enough consistency to demonstrate better and longer improvements for mineral waters or derivate compared to tap water; but due to heterogeneity and gaps on study protocol and methodology, existing research is not sufficiently strong to draw firm conclusions. Well-designed studies in larger patients' population are needed to establish the role of minerals and other chemical compounds in spa therapy.

Variations in the Texture Profile Analysis (TPA) Properties of Clay/Mineral-Medicinal Water Mixtures for Pelotherapy: Effect of Anion Type

“…Peloids are semisolid systems with a solid phase often rich in clay minerals dispersed in mineral or sea water [2,3]. The main factors controlling the characteristics of a peloid are the clay's composition and grain-size distribution and the mineral water used in the mixture [4][5][6][7][8][9].…”

Benefits of balneotherapy in the management of fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials

“…Physiologically, heat application leads to increased blood circulation, like BT and heat application to inflamed tissue induces a reduction in circulating nociceptive elements; fresh oxygen introduced after free oxygen free radicals removal enhances the repair of the inflamatory tissue [33,34]. In different musculoskeletal diseases, the effect of BT on pain and function is significantly better and longer than that of tap water bath at the same temperature [35]. The minerals which are dissolved in the water play an important part in the mechanism of action of BT.…”

Geothermal water for health state improvement: randomised controlled study

“…The scientific literature from 2002 to 2013 has shown that health resort medical treatment is associated with clinical improvement in the diseases of the skin, respiratory, circulatory, digestive and nervous systems, cancer, nutritional and metabolic disorders, mental disorders, diseases of the ear, endocrine diseases, female genital diseases and nutritional deficiencies (17). Scientists believe that mineral water treatment methods compared to non-mineral similar treatments had better and longer improvements in pain, function, quality of life, clinical parameters, and others (18).…”