Abstract
The aim of this prospective observational study was to evaluate the efficacy of a cycle of sulfate-arsenical-ferruginous mud bath therapy on pain, function, and sleep quality in patients with chronic low-back pain (CLBP). One hundred twenty-three patients treated at Levico Spa Center (Italy) with 12 daily local mud packs and generalized thermal baths were included in this experience. General medical assessments were performed before starting the therapy, at the end of the treatment, and 3 months later. Pain intensity and stiffness were measured by a 0 to 10 cm visual analogue scale (VAS); the range of mobility of the lumbar spine was evaluated using the Schober test and functional disability by the Roland-Morris Disability Questionnaire (RMDI). The Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality. The VAS score for pain and stiffness showed a significant reduction (p < 0.0001) at the end of the treatment persisting for 3 months of follow-up. Similarly, a significant improvement was found for the Schober test and RMDQ. Finally, we showed a significant decrease of PSQI score at the end of the cycle of mud bath and at 3 months of follow-up. The Spearman analysis showed a significant positive correlation between the score of PSQI and VAS pain, VAS stiffness, and RMDQ. In conclusion, this preliminary study confirms the beneficial and long-term efficacy of balneotherapy on pain and function and, for the first one, shows the positive effect on quality of sleep in patients with CLBP treated with a cycle of mud bath therapy.
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Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
Alsaadi SM, McAuley JH, Hush JM, Maher CG (2011) Prevalence of sleep disturbance in patients with low back pain. Eur Spine J 20:737–743. https://doi.org/10.1007/s00586-010-1661-x
Bai R, Li C, Xiao Y, Sharma M, Zhang F, Zhao Y (2019) Effectiveness of spa therapy for patients with chronic low back pain: an updated systematic review and meta-analysis. Medicine (baltimore) 98:e17092. https://doi.org/10.1097/MD.0000000000017092
Balogh Z, Ördögh J, Gász A, Német L, Bender T (2005) Effectiveness of balneotherapy in chronic low back pain – a randomized single-blind controlled follow-up study. Forsch Komplementärmed Klass Naturheilkd 12:196–201. https://doi.org/10.1159/000086305
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213. https://doi.org/10.1016/0165-1781(89)90047-4
Campanini MZ, González AD, Andrade SM et al (2022) Bidirectional associations between chronic low back pain and sleep quality: a cohort study with schoolteachers. Physiol Behav 1(254):113880. https://doi.org/10.1016/j.physbeh.2022.113880
Castelli L, Galasso L, Mulè A et al (2022) Sleep and spa therapies: what is the role of balneotherapy associated with exercise? A Syst Rev Front Physiol 13:964232. https://doi.org/10.3389/fphys.2022.964232
Cheleschi S, Tenti S, Seccafico I, Gálvez I, Fioravanti A, Ortega E (2022) Balneotherapy year in review 2021: focus on the mechanisms of action of balneotherapy in rheumatic diseases. Environ Sci Pollut Res Int 29:8054–8073. https://doi.org/10.1007/s11356-021-17780-0
Forestier R, Fioravanti A, Bender T et al (2022) Crenobalneotherapy for low back pain: systematic review of clinical trials. Int J Biometeorol 66:13–23. https://doi.org/10.1007/s00484-021-02188-9
Gálvez I, Fioravanti A, Ortega E (2024) Spa therapy and peripheral serotonin and dopamine function: a systematic review. Int J Biometeorol 68:153–161. https://doi.org/10.1007/s00484-023-02579-0
Heffner KL, France CR, Trost Z, Ng HM, Pigeon WR (2011) Chronic low back pain, sleep disturbance, and interleukin-6. Clin J Pain 27:35–41. https://doi.org/10.1097/ajp.0b013e3181eef761
Jess MA, Hamilton S, Ryan CG, Wellburn S, Martin D (2019) Exploring the origin of low back pain sub-classification: a scoping review protocol. JBI Database Syst Rev Implement Rep 17:1600–1606. https://doi.org/10.11124/JBISRIR-2017-003805
Mao S, Xiao K, Zhou W, Xu H, Zhang S (2023) The impact of hot spring hydrotherapy on pain perception and dysfunction severity in patients with chronic low back pain: a systematic review and meta-analysis. J Pain Res 16:3925–3944. https://doi.org/10.2147/JPR.S438744
Markman JD, Czerniecka-Foxx K, Khalsa PS, Hayek SM, Asher AL, Loeser JD, Chou R (2020) AAPT diagnostic criteria for chronic low back pain. J Pain 21:1138–1148. https://doi.org/10.1016/j.jpain.2020.01.008
Nguyen M, Revel M, Dougados M (1997) Prolonged effects of 3 weeks therapy in a spa resort on lumbar spine, knee and hip arthritis: follow-up after 6 months. A randomized controlled trial. Br J Rheum 36:77–81. https://doi.org/10.1093/rheumatology/36.1.77
Nguyen C, Boutron I, Rein C, Baron G, Sanchez K, Palazzo C et al (2017) Intensive spa and exercise therapy program for returning to work for low back pain patients: a randomized controlled trial. Sci Rep 7:17956. https://doi.org/10.1038/s41598-017-18311-z
Oliveira CB, Maher CG, Pinto RZ et al (2018) Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J 27:2791–2803. https://doi.org/10.1007/s00586-018-5673-2
Price DD, McGrath PA, Rafii A, Buckingham B (1983) The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 17:45–56. https://doi.org/10.1016/0304-3959(83)90126-4
Roland M, Morris R (1983) A study of the natural history of low-back pain part II development of guidelines for trials of treatment in primary care. Spine 8:145–150. https://doi.org/10.1097/00007632-198303000-00005
Silva J, Martins J, Nicomédio C et al (2023) A novel approach to assess balneotherapy effects on musculoskeletal diseases-an open interventional trial combining physiological indicators, biomarkers, and patients’ health perception. Geriatrics (basel) 8:55. https://doi.org/10.3390/geriatrics8030055
Tefner IK, Németh A, Lászlófi A, Kis T, Gyetvai G, Bender T (2012) The effect of spa therapy in chronic low back pain: a randomized controlled, single-blind, follow-up study. Rheumatol Int 32:3163–3169. https://doi.org/10.1007/s00296-011-2145-y
Wu A, March L, Zheng X et al (2020) Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med 8:299. https://doi.org/10.21037/atm.2020.02.175
Yücesoy H, Dönmez A, Atmaca-Aydın E et al (2021) Effects of balneological outpatient treatment on clinical parameters and serum cytokine levels in patients with chronic low back pain: a single-blind randomized controlled trial. Int J Biometeorol 65:1367–1376. https://doi.org/10.1007/s00484-021-02109-w
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Conception and design of the work, PM and AF; acquisition of data, JC and PM; analysis of data for the work, RP; interpretation of data, AF and AA; drafting the work, AF.
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Manica, P., Claudatus, J., Pertile, R. et al. Efficacy of balneotherapy on pain, function, and sleep quality in patients with chronic low-back pain: a prospective observational study. Int J Biometeorol (2024). https://doi.org/10.1007/s00484-024-02626-4
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DOI: https://doi.org/10.1007/s00484-024-02626-4