The Therapeutic Effect of Balneotherapy: Evaluation of the Evidence from Randomised Controlled Trials

M. E. Falagas; E. Zarkadoulia; P. I. Rafailidis


Int J Clin Pract. 2009;63(7):1068-1084. 

In This Article

Abstract and Background


Study Design: Systematic review.
Summary of Background Data: There is widespread popular belief that balneotherapy is effective in the treatment of various ailments.
Methods: We searched PubMed (1950-2006), Scopus and Cochrane library for randomised controlled trials (RCTs), examining the clinical effect of balneotherapy (both as a solitary approach and in the context of spa) on various diseases.
Results: A total of 203 potentially relevant articles were identified. In all, 29 RCTs were further evaluated; 22 of them (75.8%) investigated the use of balneotherapy in rheumatological diseases and eight osteoarthritis, six fibromyalgia, four ankylosing spondylitis, four rheumatoid arthritis and three RCTs (10.3%) in other musculoskeletal system diseases (chronic low back pain). In addition, three relevant studies focused on psoriasis and one on Parkinson's disease. A total of 1720 patients with rheumatological and other musculoskeletal diseases were evaluated in these studies. Balneotherapy did result in more pain improvement (statistically different) in patients with rheumatological diseases and chronic low back pain in comparison to the control group in 17 (68%) of the 25 RCTs examined. In the remaining eight studies, pain was improved in the balneotherapy treatment arm, but this improvement was statistically not different than that of the comparator treatment arm(s). This beneficial effect lasted for different periods of time: 10 days in one study, 2 weeks in one study, 3 weeks in one study, 12 weeks in 2 studies, 3 months in 11 studies, 16-20 weeks in one study, 24 weeks in three studies, 6 months in three studies, 40 weeks in one study and 1 year in one study.
Conclusion: The available data suggest that balneotherapy may be truly associated with improvement in several rheumatological diseases. However, existing research is not sufficiently strong to draw firm conclusions.


There is widespread popular belief that balneotherapy is effective in the treatment of various diseases. Balneotherapy is defined as the use of baths containing thermal mineral waters from natural springs at a temperature of at least 20 °C and with a mineral content of at least 1 g/l.[1] More so, it is more common that the temperature of the thermal water is approximately 34°. Balneotherapy has been used not only in the ancient years in the treatment of various illnesses but also in modern times.

Under the broad term balneotherapy (in contrast to the strict definition given above), various treatment methods are included: Dead Sea salt or mineral baths, sulphur baths, radon-carbon dioxide baths.[2,3] Balneotherapy is either provided as the solitary component of the therapeutic approach or in the context of spa therapy. Spa therapy additionally to balneotherapy employs various modalities such as physiotherapy, and even the change in environment and lifestyle per se may contribute to the changes seen in patient outcome measurements, i.e. the therapeutic result may not be attributed to the balneotherapy alone. Thus, while some researchers have regarded balneotherapy and spas as more or less interchangeable terms,[4] others disagree.[5] More so one has to acknowledge that the composition of the mineral water differs in its content in cations and anions, and thus assessing which is the specific therapeutic component is difficult. We sought to review the existing evidence regarding randomised controlled trials (RCTs), examining the clinical effects of balneotherapy.


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