Mud Packs Research Articles

Spa therapy induces clinical improvement and protein changes in patients with chronic back pain.

This study is primarily aimed at assessing serum changes on a large panel of proteins in patients with chronic back pain following spa therapy, as well as evaluating different spa therapy regimens as a preliminary exploratory clinical study. Sixty-six patients with chronic back pain secondary to osteoarthritis were randomly enrolled and treated with daily mud packs and bicarbonate-alkaline mineral water baths, or a thermal hydrotherapy rehabilitation scheme, the combination of the two regimens or usual medication only (control group), for two weeks. Clinical variables were evaluated at baseline, after 2 and 12 weeks. One thousand serum proteins were tested before and after a two-week mud bath therapy. All spa treatment groups showed clinical benefit as determined by improvements in VAS pain, Roland Morris disability questionnaire and neck disability index at both time points. The following serum proteins were found greatly increased (≥2.5 fold) after spa treatment: inhibin beta A subunit (INHBA), activin A receptor type 2B (ACVR2B), angiopoietin-1 (ANGPT1), beta-2-microglobulin (B2M), growth differentiation factor 10 (GDF10), C-X-C motif chemokine ligand 5 (CXCL5), fibroblast growth factor 2 (FGF2), fibroblast growth factor 12 (FGF12), oxidized low density lipoprotein receptor 1 (OLR1), matrix metallopeptidase 13 (MMP13). Three proteins were found greatly decreased (≤0.65 fold): apolipoprotein C-III (Apoc3), interleukin 23 alpha subunit p19 (IL23A) and syndecan-1 (SDC1). Spa therapy was confirmed as beneficial for chronic back pain and proved to induce changes in proteins involved in functions such as gene expression modulation, differentiation, angiogenesis, tissue repair, acute and chronic inflammatory response.

The effects of Tiszas\xfcly and Kolop mud pack therapy on knee osteoarthritis: a double-blind, randomised, non-inferiority controlled study

The aim of this non-inferiority study was to evaluate and compare the effects of Tiszasüly and Kolop mud pack therapy on pain, function and quality of life in patients with knee osteoarthritis. In this double-blind, randomised, follow-up study, 60 patients with knee osteoarthritis were treated with either Tiszasüly hot mud pack (group 1) or with Kolop hot mud pack (group 2) on 10 occasions for 2 weeks (10 working days). One hundred millimetre visual analogue scale (VAS) for knee pain, the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lequesne Index for physical function and EuroQoL-5D for quality-of-life measurements were recorded at baseline, at the end of treatment (week 2) and 3 months later (week 12). In both groups, all measured parameters improved significantly from the baseline until the end of treatment and during the follow-up period (p < 0.05). There were no significant differences between the groups in terms of the WOMAC, KOOS, EQ-5D and Lequesne Index at any visits. Knee pain improved in both groups at week 2 and week 12; the only significant difference visible between the groups was at the end of the treatment in favour of the Tiszasüly mud pack group (p = 0.009). Tiszasüly and Kolop mud packs both have a favourable effect on knee pain, physical function and quality of life in patients with knee osteoarthritis. Our results proved non-inferiority of Tiszasüly mud pack.

Effect of mud pack to eyes on psychological variables in healthy volunteers: a pilot randomized controlled trial.

Background Mud pack is one of the fundamental therapeutic procedures used in naturopathy to treat various diseases. There is a lack of scientific evidence for the use of mud-pack application in psychological variables. The present study aims at evaluating the effect of mud pack to eyes on psychological variables in healthy volunteers. Materials and methods Sixty healthy individuals with the age varied from 18 to 21 years were recruited and randomly divided into either mud-pack group (n=30) or wet-pack group (n=30). Mud-pack group received mud pack to eyes and wet-pack group received wet pack to eyes for a duration of 30 min/session (a total of 15 sessions). Psychological assessments like Mindful Attention Awareness Scale (MAAS), Perservative Thinking Questionnaire (PTQ) and Positive and Negative Affect Scale (PANAS) were taken before and after the intervention. Statistical analysis was performed using statistical package for the social sciences, version 16. Results Result of this study showed a significant reduction in PTQ score and PANAS negative score in both mud-pack and wet-pack groups. But, a significant increase in MAAS score was observed only in the mud-pack group, unlike wet-pack group. However, there was no significant difference found in between group analysis. Conclusions Result suggests that though both mud pack and wet pack to eyes reduced the scores of PTQ and negative affects, only mud pack to eyes increased the state of mindfulness in healthy individuals.

Conservative therapeutic interventions for osteoarthritic finger joints: A systematic review

Study DesignSystematic review. IntroductionHand osteoarthritis (OA) is a chronic and disabling disease causing pain and functional limitations in approximately 54%-67% of the adult population aged 55 years and older. Purpose of the StudyThe objective of the study is to evaluate the evidence supporting conservative therapeutic interventions for the treatment of OA finger joints. MethodsEighteen studies dated between 1979 and 2016 were identified meeting the inclusion criteria. They were analyzed based on Structured Effectiveness for Quality Evaluation of a Study, level of evidence, and effect size. Results and ConclusionsThe current evidence varies in quality and effect sizes but generally supports the use of active range of motion and resistive exercises, joint protection, electromagnetic therapy, paraffin wax, and balneotherapy (combined and/or not combined with mud packs and magnetotherapy), and distal interphalangeal orthoses as effective treatment interventions for individuals with OA finger joints.

The effectiveness comparison of same balneotherapy applications with different frequency within different time periods in patients with fibromyalgia; a randomized controlled single blind study

Aim: To observe the short and middle term effects of intermittent and consecutive (traditional) regimens of same balneotherapy applications in patients with fibromyalgia syndrome. Material and Method: Fifty female patients who were diagnosed as fibromyalgia syndrome according to the American College of Rheumatology 2010 criteria were randomly assigned to either consecutive (group 1) or intermittent treatment (group 2) groups. After randomization 5 patients from each group dropped out from the study with different excuses. Both groups received 20 minutes of full body immersion in tap water (at 38°C) and 30 minutes of mud pack treatment (at 45°C) on back region. Treatments in group1 (n=25) were delivered 5 weekdays for 2 consecutive weeks, and for group 2 (n=25) 2 times weekly for 5 consecutive weeks (totally 10 sessions for both groups) in Hydroclimatology Therapy Unit. All patients continued to use their usual medical treatment. An investigator who was blinded to the interventions assessed all the patients before and after the treatment, at the first and the third month of follow-up. Outcome measures were pain, patient’s and physician’s global assessments on VAS, tender point count, Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Index (BDI) and the Health Assessment Questionnaire (HAQ). Results: There was a statistically significant improvement in both groups in terms of pain (VAS) and tender point count at the end of the treatment that lasted up to the 3rd month. Results were found to be the same for physician’s global assessments (VAS) except for after treatment evaluation. While there was a significant improvement in patient’s global assessment (VAS) and BDI at the 3rd month follow-up for group 1, group 2 was observed to have significant improvements during all the assessments for patient’s global assessment (VAS) and at 1st and 3rd month controls for FIQ. In between-group comparisons, group 2 was found to be superior for fatigue (at 1st month) and pain subscales (at 3rd month) of FIQ. Conclusion: The consecutive or intermittent delivery of ambulatory balneotherapy programs, consisting of full body immersion in heated tap water and mud pack treatment on back region, both are effective in the treatment of fibromyalgia. For some parameters evaluating pain and fatigue intermittent treatment seems to be superior.

The Effectiveness of Peloidotherapy and Aquatic Exercise in Knee Osteoarthritis Treatment; A Randomized Controlled Single Blind Study

The aim of the study is to observe short and medium term effects of peloidotherapy and aquatic exercise in patients with knee osteoarthritis. Seventy-six patients, with knee osteoarthritis were included. Patients were divided randomly into two groups, treatment group and control group (n=38). Six from the treatment group and one from the control group were dropped out. Treatment group received 30 minutes of aquatic exercise in a 33° C pool and 20 minutes of mud pack at 42°C on knees 5 days for 2 weeks. Control group continued medical treatment. Blind investigator assessed patients before and after the treatment, at the first and the third month of follow-up. Outcome measures were pain, patient's, and physician's global assessment, WOMAC, Lequesne knee index, health assessment questionnaire, SF-36, and timed up and go test. There was statistically significant improvements in treatment group in all parameters at the end of the treatment, the first and the third month follow up. There was no significant improvement in control group. Group comparisons, treatment group was superior to control group for all parameters. As a result in knee osteoarthritis treatment combination of peloidotherapy and aquatic exercise improves in pain, physical function and quality of life, and is superior to routine treatment.

Effects of local mud pack and saline bath therapy in hand osteoarthritis; randomized single-blind study

Hand osteoarthritis is a degenerative disease of hyaline cartilage which harms the hand joints. It affects the entire structure of the joints and causes a significant disability. In its etiology, gender, genetics, obesity and trauma play a crucial role. The prevalence increases with age, and although no difference is observed in its occurrence between men and pre-menopausal women, it is frequently seen in postmenopausal women. As it was claimed in the evidence based recommendations for the management of hand osteoarthritis Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics and Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip, and Knee; thermal therapies are among the treatment options of hand osteoarthritis. In our trial we aim to prove how and of hands into thermomineral are beneficial on patient's pain and functioning, and to investigate which method is more effective. We have compared the immersion of hands into thermomineral water and the local peloidotherapy methods. 70 patients who have been observed at Istanbul University, Istanbul Medical Faculty, Medical Ecology and Hydroclimatology Department and diagnosed with hand osteoarthritis according to the ACR criteria were included to our trial. The participants have been divided into two groups by computer-based randomization. The method of immersion of hands into the 38°C thermomineral has been applied to one group and the method of application of 42°C peloid has been applied to the other group. The treatment has been applied in cures to the patients in both groups for 2 weeks in total, 20 minutes every day for ten days. Patients have been examined by a blind doctor four times: before the treatment, after the treatment, three and six months after the beginning of the treatment. They were examined by Visual Analog Scale (VAS) (pain, patient's overall assessment, physicians global assessment), Australian/Canadian (AUSCAN) Index (pain, stiffness, and function), Health Assessment Questionnaire (HAQ), Duruoz Hand Index (DHI), Grip strength by Jamar hand dynamometer. When the results have been analyzed it has been observed that both treatment groups have reached statistically significant results for improvements of pain and function which show parallelism. These improvements have also been observed in their 3rd and 6th month follow-up controls. In this trial, it has been demonstrated that two different balneological methods – of hands into thermomineral and of hands – have similar positive effects on pain and function and that these effects continue for a long time.

Efficacy of balneotherapy, peloidotherapy and group exercises in the management of Ankylosing Spondylitis

The objective of this study is to determine the efficacy of balneological treatment consisting of hydrotherapy and peloidotherapy and group exercise therapy in the management of ankylosing spondylitis (AS). 40 AS patients fromthe Department of Medical Ecology and Hydroclimatology Istanbul Faculty of Medicinewere randomized into two groups. In group1 patients prescribed 15 sessions of hot water pool hydrotherapy and peloidotherapy with local mud pack application for 3 weeks duration at the Balneological Treatment Outpatient Unit of the Department. At the last session, they had given home based exercise program instructions and brochure for ankylosing spondylitis. In Group 2 patients attended15 sessions of group exercise therapy supervised by a physiotherapist at Cerrahpasa Medical Faculty, Physical Medicine and Rehabilitation Exercise Unit, for 3 weeks duration. At the last session, they had given the same home-based exercise program and brochure for ankylosing spondylitis. The patients were examined before therapy, after completing the all treatment sessions and 3th and 6th months afterwards. Outcome measures were pain intensity (visual analog scale, VAS), patient's general evaluation (VAS), physician's general evaluation (VAS), Health Assessment Questionnaire (HAQ), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Lumbar Schober index (cm), finger-floor distance(cm), occiput-wall distance(cm) and chest expansion (cm). Statistically significant improvement on pain-VAS scores was seen in Group 1, in all assessments. In Group 2, statistically significant decrease in pain-VAS was only seen after the therapy. But decrease in pain at 3rd and 4th measurement weren't significant.In group comparisons, metrological indexes were found statistically significant in exercise group patients except chest expansion outcomes which were seen significant in both groups, in all short-term and long-term assessments. Besides improving pain ambulatory balneological treatment and exercise therapy seem to improve inspiratory function and mobility in AS patients. This type of treatment may be added in the overall treatment program as an effective nonpharmacological modality considering the beneficial effects on respiratory system and spine mobility as well as on pain and function in AS patients.

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

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.

Balneological outpatient treatment for patients with knee osteoarthritis; an effective non-drug therapy option in daily routine?

This study aims to compare the effects of balneological treatments applied at consecutive and intermittent sessions without interfering with their daily routine in patients with knee osteoarthritis. This is a randomized, controlled, single-blind clinical trial. Fifty patients diagnosed with knee osteoarthritis were included. The patients were divided into two groups. All patients were given a total of ten sessions of balneological treatment consisting of hydrotherapy and mud pack therapy. Group 1 received consecutive treatment for 2weeks, while group 2 received intermittent treatment for 5weeks. Local peloid packs at 45°C were applied for 20min, after a tap water (38°C) bath. Evaluations were conducted before, after treatment, and at 12th week of post-treatment by Pain (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-36 (SF-36). Both balneological treatment regimens of knee osteoarthritis had statistically significant clinical effects as well as effects on the quality of life. Patients' well-being continued at 3months, except for joint stiffness (WOMAC), role-emotional (SF-36), and vitality (SF-36) in group 1 and for mental health (SF-36) in both groups. Both patient groups had improved compared to baseline. However, at 3months after the treatment, the well-being of group 2 was unable to be maintained in terms of role-physical (SF-36) parameter, while the well-being of group 1 was unable to be maintained in terms of pain, WOMAC (pain, physical functions, total), and SF-36 (physical functioning, role-physical, pain, role-emotional, and mental health) variables, compared to data obtained immediately after treatment. Our study suggests that traditional and intermittent balneological therapies have similar efficacy in patients with knee osteoarthritis.

Treatment of knee OSTEOARTHRITIS in Spa Health resorts: where do we stand?

Osteoarthrosis (OA) includes degenerative joint disorders that affect articular cartilage in the first instance, followed by changes of all components of the joint. The disease is detected in a proportion of 33% by X-ray in patients aged over 60 years. Knee OA (KOA) ranks first among chronic diseases from the point of view of patient disability. This article is a review of guidelines and articles regarding arthrosis, balneotherapy, and balneotherapy in KOA treatment. These were accessed on the Pubmed site in the period March-April 2015. The components of balneo-therapy to which the selected articles refer include mud packs, mineral waters, climate change. These are evaluated in association or in comparison with other methods used in the rehabilitation specialty area for the treatment of KOA: kinesitherapy, intra-articular infiltrations, hydrothermotherapy. The changes induced by these therapies on clinical evolution (pain relief, tenderness, functionality, quality of life, depression symptoms) or certain serum parameters (biomarkers of oxidative stress, inflammation and cartilage destruction, vitamin D and other serum metabolites) were recorded. The results of our review are consistent with the studies focused on spa modalities in all types of OA. All these data helped defining the role of balneotherapy as part of the rehabilitation program for the treatment of KOA, through the benefits specific to it. Conclusion: Balneotherapy has beneficial effects on patients with KOA, both clinically and serologic improvements. Further studies are needed to quantify these effects using KOA specific markers, to establish a hierarchy of balneotherapy methods based on their effects on KOA, as well as to refine indications depending on the stage of the disease.

Effectiveness of balneotherapy and spa therapy for the treatment of chronic low back pain: a review on latest evidence.

In most European countries, balneotherapy and spa therapy are widely prescribed by physicians and preferred by European citizens for the treatment of musculoskeletal problems including chronic low back pain (LBP). We aimed to review and evaluate the recent evidence on the effectiveness of balneotherapy and spa therapy for patients with LBP. We comprehensively searched data bases for randomized controlled trials (RCTs) published in English between July 2005 and December 2013. We identified all trials testing balneotherapy or spa therapy for LBP that reported that the sequence of allocation was randomized. We finally included total of eight RCTs: two on balneotherapy and six on spa therapy. All reviewed trials reported that balneotherapy was superior in long term to tap water therapy in relieving pain and improving function and that spa therapy combining balneotherapy with mud pack therapy and/or exercise therapy, physiotherapy, and/or education was effective in the management of low back pain and superior or equally effective to the control treatments in short and long terms. We used Jadad scale to grade the methodological quality. Only three out of total eight had a score of above 3 indicating the good quality. The data from the RCTs indicates that overall evidence on effectiveness of balneotherapy and spa therapy in LBP is encouraging and reflects the consistency of previous evidence. However, the overall quality of trials is generally low. Better quality RCTs (well designed, conducted, and reported) are needed testing short- and long-term effects for relieving chronic back pain and proving broader beneficial effects.

Balneotherapy after Kidney Transplantation - A Friend or a Foe?

Health-Related Quality of Life (HRQL) is increasingly recognised as an important outcome following kidney transplantation (KTx). Balneotherapy (BT) has a potential to become a relevant part of rehabilitation process for transplanted patients, however it is not without a risk. In daily practice we recommend our patients to avoid bath tubs and whirpools as much as possible not to contract urinary tract infection (UTI). Publications on both issues are very scarce. Aim: to evaluate the benefit of balneotherapy after kidney transplantation in comparision to the risk of UTI. Methods: A retrospective study comparing 3 groups of patients. Group A: 58 Ps (37 women) after KTx, median age 51 years (24-64),median time after Tx 9 months (3-12). Group B: 106 Ps (87 women) with chronic cystitis (risky for UTI but without immunosuppression and operation), median age 58 years (30-87). Group C: 101 Ps (87 women) with spine pain (no risk of UTI), median age 56 years (20-75). All patients treated in bath tubes and whirpools for 15 minutes daily during 20-22 days. Bathing was combined with other treatments, such as physical exercise, aquatic exercise in pool with thermal chlorinated water, mud packs, massages and electro- or magnetotherapy. Results: Symptoms of de novo acute UTI arised in 3 Ps of group A (5.2%), in 11 patients group of B (10.4%) and in 0 patient of group C. Group A vs B: p=0.3823, RR 0.5844 [95%CI: 0.2097 to 1.629], group A vs C: p=0.0469, RR 2.836 [95%CI: 2.293 to 3.509]. In women only, respective data were 3Ps group A (8.8%), 10 Ps group B (11.5%) and 0 Ps group C. Group A vs B: p= 0.7531, RR 0.7534 [95%CI: 0.2686 to 2.113], group A vs C: p= 0.0251, RR 3.559 [95%CI: 2.676 to 4.733]. Two Ps with UTI group A and 1 Ps group B were discharged from spa early, all other cases of UTI were mild blader infections, well responding to peroral antibiotic therapy. At the dismissal, all patients after KTx with completed spa treatment reported lesser fatigue and bodily pain, improved muscle strenght in upper and lower extremities, raised well-being, vitality and energy as well as better involvement in social life. Conclusion: Balneotherapy together with physical rehabilitation significantly increased HRQL patients after KTx. The incidence of feared UTI was significantly higher in comparison to control group of Ps with spine pain, however it was not increased in comparison to other nephrologic/urologic patients at risk of UTI but without immunosuppression and operation.

The effect of Neydharting mud-pack therapy on knee osteoarthritis: a randomized, controlled, double-blind follow-up pilot study

The aim of this study was to evaluate the effects of Neydharting mud-pack therapy on the clinical parameters and quality of life in patients with knee osteoarthritis. In this double-blind, randomized, follow-up study on 53 patients with knee osteoarthritis, one group received hot mud-pack therapy, whereas the other (control) group was treated with hot packs of a substance manufactured on 10 occasions for 2 weeks. Western Ontario and McMaster Universities Arthritis Index (WOMAC), EuroQoL-5D quality-of-life measure and need for analgesics and non-steroidal anti-inflammatory drugs were recorded before treatment, at the end of treatment (at Week 2), and at Weeks 6 and 12. The WOMAC and the EQ5D quality-of-life scores improved from the baseline to the end of treatment in both groups, and further improvement was observed during the follow-up period (p < 0.001, respectively, in both groups). The need for medications for knee joint pain improved in both groups, and these changes were significant only in the mud-treated group (p < 0.001), but not in the control group (p = 0.106) compared to baseline. The number of patients requiring medications for knee joint pain showed a continuous downward trend at the subsequent post-treatment visits by the mud-treated group, and these changes became significant by Visit 4 compared to baseline (p = 0.016). The control group showed only temporary and not significant decrease. The difference was not significant between the groups in any of the outcome parameters at any visits. The Neydharting mud pack has a favorable effect on the clinical parameters, quality of life, and need for medications in patients with knee osteoarthritis. To evaluate the chemical effect, the number of patients should be increased.

Short- and long-term effects of mud-bath treatment on hand osteoarthritis: a randomized clinical trial

The aim of this study was to evaluate both the short-term and the long-term effectiveness of spa therapy in patients with primary hand osteoarthritis (OA). This was a prospective randomized, single blind controlled trial. Sixty outpatients with primary bilateral hand OA were included in the study and randomized to one of two groups. One group (n = 30) was treated with 12 daily local mud packs and generalized thermal baths with a sulfate-calcium-magnesium-fluorides mineral water added to usual treatment. The control group (n = 30) continued regular outpatient care routine (exercise, NSAIDs and/or analgesics). Each patient was examined at baseline, after 2weeks, and after 3, 6, 9 and 12months. Primary outcome measures were global spontaneous hand pain on a visual analogue scale (VAS) and the functional index for hand osteoarthritis (FIHOA) score; secondary outcomes were health assessment questionnaire (HAQ), duration of morning stiffness, medical outcomes study 36-item short form (SF-36) and symptomatic drugs consumption. Our results demonstrated that the efficacy of spa therapy was significant in all the assessed parameters, both at the end of therapy and after 3months; the values of FIHOA, HAQ and drugs consumption continued to be significantly better after 6months in comparison with baseline. There were no significant modifications of the parameters throughout the follow-up in the control group. Differences between the two groups were significant for all parameters at the 15th day and at 3months follow-up; regarding FIHOA, HAQ, and symptomatic drugs consumption, the difference between the two groups persisted and was significant at 6month follow-up. Tolerability of spa therapy seemed to be good. In conclusion, our results confirm that the beneficial effects of spa therapy in patients with hand OA last over time.

Efficacy of certain yogic and naturopathic procedures in premature ejaculation: A pilot study

Context:Premature ejaculation (PE) is the most common sexual disorder of young males. Even though there are number of treatment options available for PE, patient's satisfaction and drug side effects remain to be a problem. Non-pharmacological treatment options like Yoga and Naturopathy have been implicated in sexual fulfillment, pleasure and efficacy of some of these approaches has been established in previous studies.Aim:To assess the efficacy of certain yogic and naturopathic procedures in the management of PE.Materials and Methods:A total of 12 patients with PE satisfying the DSM IV TR diagnostic criteria were selected and allotted into two groups, Yoga group and Naturopathic group by following the randomization method. In the Yoga group, various asanas, mudra, bandha and pranayama were practiced 1 hour daily for 21 days. In the Naturopathy group, lower abdomen massage and steam bath, hip bath and lingasnana, mud pack on lower abdomen, and acupressure were done 1 hour daily for 21 days. Criteria of assessment were based on the scoring of Premature Ejaculation Severity Index (PESI). Statistical analysis was done by using paired and unpaired “t” tests.Results:In the Yoga group (n = 6), 7.3% relief was observed (P < 0.01) and in the Naturopathy group (n = 6), 2.4% of relief was observed (P > 0.05) on the total score of PESI. There was no significant difference (P > 0.05) found in between the two groups.Conclusion:Both Yoga and Naturopathic procedures didn’t provide relief (<25%) on total score of PESI.

Clinical effectiveness of mud pack therapy in knee osteoarthritis

The main objective of this study was to systematically review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA. One hundred and fifteen publications were identified through an electronic and manual search and 20 of those studies were chosen based on the inclusion criteria: randomized clinical trials, systematic reviews or meta-analyses whose objective was to analyse the effect of mud pack therapy on perceived pain, function and quality of life, with a sample size of ≥20 subjects, published since 2000 and showing conclusive results. In the studies that met the inclusion criteria, 12 analyse functionality, 17 perceived pain, 5 quality of life and all showed a significant improvement in the three analysed variables. The methodological quality of the studies had a moderate risk of bias. Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA. Studies with better methodology are needed to prove its scope.

Potential Treatment of Inflammatory and Proliferative Diseases by Ultra-Low Doses of Ionizing Radiations

Ultra-low doses and dose- rates of ionizing radiation are effective in preventing disease which suggests that they also may be effective in treating disease. Limited experimental and anecdotal evidence indicates that low radiation doses from radon in mines and spas, thorium-bearing monazite sands and enhanced radioactive uranium ore obtained from a natural geological reactor may be useful in treating many inflammatory conditions and proliferative disorders, including cancer. Optimal therapeutic applications were identified via a literature survey as dose-rates ranging from 7 to 11μGy/hr or 28 to 44 times world average background rates. Rocks from an abandoned uranium mine in Utah were considered for therapeutic application and were examined by γ-ray and laser-induced breakdown fluorescence spectroscopy. The rocks showed the presence of transuranics and fission products with a γ-ray energy profile similar to aged spent uranium nuclear fuel (93% dose due to β particles and 7% due to γ rays). Mud packs of pulverized uranium ore rock dust in sealed plastic bags delivering bag surface β,γ dose-rates of 10-450 μGy/h were used with apparent success to treat several inflammatory and proliferative conditions in humans.

Comparing the efficacy of mature mud pack and hot pack treatments for knee osteoarthritis

The objective of this study is to compare the efficacy of mature mud pack and hot pack therapies on patients with knee osteoarthritis. This study was designed as a prospective, randomized-controlled, and single-blinded clinical trial. Twenty-seven patients with clinical and radiologic evidence of knee osteoarthritis were randomly assigned into two groups and were treated with mature mud packs (n 15) or hot packs (n=12). Patients were evaluated for pain [based on the visual analog scale (VAS)], function (WOMAC, 6 min walking distance), quality of life [Short Form-36 (SF-36)], and serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and insulin-like growth factor-1 (IGF-1) at baseline, post-treatment, and 3 and 6~months after treatment. The mud pack group shows a significant improvement in VAS, pain, stifness, and physical function domains of WOMAC. The difference between groups of pain and physical activity domains is significant at post-treatment in favor of mud pack. For a 6 min walking distance, mud pack shows significant improvement, and the difference is significant between groups in favor of mud pack at post-treatment and 3 and 6 months after treatment. Mud pack shows significant improvement in the pain subscale of SF-36 at the third month continuing until the sixth month after the treatment. Significant improvements are found for the social function, vitality/energy, physical role disability, and general health subscales of SF-36 in favor of the mud pack compared with the hot pack group at post-treatment. A significant increase is detected for IGF-1 in the mud pack group 3 months after treatment compared with the baseline, and the difference is significant between groups 3 months after the treatment. Mud pack is a favorable option compared with hotpack for pain relief and for the improvement of functional conditions in treating patients with knee osteoarthritis.

The effects of combined spa therapy and rehabilitation on patients with ankylosing spondylitis being treated with TNF inhibitors

Despite advances in pharmacological therapy, physical treatment continues to be important in the management of ankylosing spondylitis (AS). The objective of the present study was to evaluate the effects and tolerability of combined spa therapy and rehabilitation in a group of AS patients being treated with TNF inhibitors. Thirty AS patients attending the Rheumatology Unit of the University of Padova being treated with TNF inhibitors for at least 3 months were randomized and assessed by an investigator independent from the spa staff: 15 were prescribed 10 sessions of spa therapy (mud packs and thermal baths) and rehabilitation (exercises in a thermal pool) and the other 15 were considered controls. The patients in both groups had been receiving anti-TNF agents for at least three months. The outcome measures utilized were BASFI, BASDAI, BASMI, VAS for back pain and HAQ. The evaluations were performed in all patients at the entry to the study, at the end of the spa treatment, and after 3 and 6 months. Most of the evaluation indices were significantly improved at the end of the spa treatment, as well as at the 3 and 6 months follow-up assessments. No significant alterations in the evaluation indices were found in the control group. Combined spa therapy and rehabilitation caused a clear, long-term clinical improvement in AS patients being treated with TNF inhibitors. Thermal treatment was found to be well tolerated and none of the patients had disease relapse.