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as treatment under speci c circumsAbstract

Balneotherapy in Elderly Patients: Effect on Pain from DegenerativeKnee and Spine Conditions and on Quality of Life

Jnos Gal MD PhD1, Jzsef Varga PhD

2, Zoltn Szekanecz MD PhD DSci

3, Julia Kurk MD

3

Andrea Ficzere MD PhD 4, Edit Bodolay MD PhD DSci 5 and Tams Bender MD PhD 6,7

1Department o Rheumatology, Kenzy Gyula County Hospital, Debrecen, Hungary2Department o Nuclear Medicine, University o Debrecen, Medical and Health Science Center, Debrecen, Hu33rd Depar tment o Internal Medicine, Rheumatology Division, University o Debrecen, Medical and Health S

Debrecen, Hungary4 Aquaticum Ltd., Balneotherapy Unit, Debrecen, Hungary53rd Depar tment o Internal Medicine, Division o Immunology, University o Debrecen, Medical and Health

Hungary6Polyclinic o the Hospitaller Brothers o St. John o God in Budapest, and 7University o Szeged, DepartmenSzeged, Hungary

Key words: balneotherapy, advanced age, low back pain, osteoarthritis

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diological or clinical and laboratory) [7], low back pain o atleast 3 months duration i potential underlying causes (tumor,infammation, congenital abnormality, metabolic disorder) couldbe ruled out, and endorsement o the in ormed consent orma ter the subject read and understood the patient in ormationleafet. In the case o patients with osteoarthritis o the knee,inclusion was assured i the patient had knee pain, sti ness

or less than 30 minutes, crepitation, tenderness/enlargemento the bone without heat, erythrocyte sedimentation rate lessthan 40 mm/h, and negativity or serum rheumatoid actor. Ithe patient re used to undergo laboratory tests, anteroposteriorknee radiographs were obtained in the ully extended standingposition. We were compelled to take knee X-rays in 15 o the41 osteoarthritic patients. I X-rays revealed osteophytes insymptomatic patients (pain, crepitation, less than 30 minutesmorning sti ness) they were also included in the study. Inpatients with chronic low back pain, anteroposterior and laterallumbar spine radiographs and laboratory tests were per ormed.I radiography did not demonstrate elevated erythrocyte sedi-mentation rate, C-reactive protein with normal blood count ordegenerative changes, the patient was included in the study.

4 weeks a ter visit 0, visit 2 within therapy, and visit 3 (the nal visit) betthe end o spa therapy. An experienca detailed physical examination in allwas indicated by an increase in knedecrease in pain during the physical eance was considered adequate i thethe prescribed 15 balneotherapy sessi

The patients were allowed to tainfammatory or analgesic drug o threcorded in each patient at the start study protocol was approved by theUniversity o Debrecen, Medical and ment # 2364-2005).

The study endpointsThe primary endpoints were: a) chango patients using WOMAC (patienknee) and Oswestry Low Back Paiwith chronic low back pain) questiothe patients quality o li e, using t

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in asignthe pvisit

o wereat vmm)(SD reduinterwas < 0.o iwerevisit at vimm

W VASinten

Figure 1. Changes in WOMAC scores duringthe periods between control visits

Figure 2. Changes in the Oswestry Index during theperiods between control visits

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[11] reported avorable outcomes in an open ollow-up study[11], and Tishler and team [12] ound a clinical improvement inpatients undergoing a 6 week course o weekly balneotherapysessions or osteoarthritis o the knee.

Similar to balneotherapy, mudpacks also exert a bene ciale ect in patients with gonarthrosis. Prolonged mud-packingsuppresses the synthesis o prostaglandin E2 and leukotrieneB4-I [13]. Mud has a avorable e ect on cartilage-destroyingcytokines and binds tumor necrosis actor [14]. The NaiadProject investigated the magnitude o cost-savings a orded bybalneotherapy. Patients with osteoarthritis were ollowed or 2consecutive years. The study was conducted in a population o11,437 patients with primary or secondary osteoarthritis, but only6111 (53.4%) remained in the study during the second year. Allpatients underwent a course o balneotherapy and mudpacksonce a year. Subjects were ree to receive treatment in any othe 98 collaborating Italian spas, which use a variety o medicinalwaters (containing sulphur, sodium chloride, bromine, iodine,sulphate, or bicarbonate). The results con rmed the clinical e -cacy o balneotherapy or osteoarthritis; the treatment was highlye ective in mitigating the symptoms caused by osteoarthritis o

[25]. Although this treatment is not abe an invaluable add-on to traditional

Study limitations

The main limitation o this study walation. It is very di cult to maintain the physicochemical properties (color,mineral water signi cantly di er roeasily be discerned by patients.

Conclusions

Our study showed that a 15 day comineral water rom thermal sprinHungary) improves unctional capacin quality o li e, substantially reddiminishes the intensity o perceivedisease severity assessed by patientsknee or chronic low back pain, anddisease activity in patients with advane ects persisted or 3 months aour study con rm the clinical e c

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12. Tishler M, Rosenberg O, Levy O, Elias I, Amit-Vazina M. The e -ect o balneotherapy on osteoarthritis. Is an intermittent regimen

e ective?Eur J Intern Med2004;15:936.13. Bellometti S, Galzigna L. Serum levels o a prostaglandin and a

leukotriene a ter thermal mud pack therapy. J Investig Med1998;

46:1405.14. Bellometti S, Galzigna L, Richelmi P, Gregotti C, Bert F. Both

serum receptors o tumor necrosis actor are infuenced by mudpack treatment in osteoarthrotic patients. Int J Tissue React2002;24:5764.

15. Fioravanti A, Valenti M, Altobelli E, et al. Clinical e cacy and cost-e ectiveness evidence o spa therapy in osteoarthritis. The resultso the Naiade Italian Project.Panminerva Med2003;45:21117.

16. Kappel M, Gyhrs A, Galbo H, Pedersen BK. The response on glu-coregulatory hormones o in vivo whole body hyperthermia. Int JHypertherm1997;13:41321.

17. Kubota K, Kurabayas hi H, Tamura K, Kawada E, Tamura J.Transient rise in plasma beta-endorphin a ter a traditional 47degrees C hot-spring bath in Kusatsu-spa, Japan. Life Sci1992;51:187780.

18. Kuczera M, Kokot F. E ect o spa therapy on the endocrine sys-tem. I. Stress reaction hormones Pol Arch Med Wewn1996;95:1120.

19. Kuczera M, Kokot F. The infuence o spa therapy on the endo-crine system. II. Erythropoietin Pol Arch Med Wewn1996;95:218.

20. Shani J, Barak S, Levi D, et al. Skpsoriatics and guinea-pigs bathing Pharmacol Res Commun1985;17:5011

21. Halevy S, Giryes H, Friger M, et alpsoriatic patients undergoing balneo

salt. IMAJ 2001;3:82832.22. Ganz DA, Chang JT, Roth CP, et a

or community-dwelling older adults23. Kamioka H, Nakamura Y, Yazaki T

education combining hot spa bathin middle-aged and elderly womendomized controlled trial o three- J Epidemiol2006;16:3544.

24. Bender T, Karaglle Z, Blint GPSukenik S. Hydrotherapy, balneothpain management [Review]. Rheuma

25. Moses SW, David M, Goldhammer Sea, a unique natural health resort [R

Correspondence: Dr. J. Gal, Dept. oHospital 2-26 Bartk Bla str., DebrecePhone: (36-52) 511-777Fax: (36-52) 511-833email: gaalja@ reemail.hu