Evidence-based balneotherapy inHungary

Pannonian basin – crust 10 km thinner 50 °C / km (world average – 26 °C / km)

Thermal water underground – 70-80%

Physical:
Cardiovascular Pulmonal Renal Endocrine Neuromuscular Hematologic Water depth Posture Buoyancy Temperature
Szucs et al. 1989 Double blind RCT Kovacs and Bender 2002 Double blind RCT
3 weeks
15 weeks
Greater improvement in thermal water group (in all parameters) All parameters improved sign. Effect prolonged for 3 months after treatment
Follow-up Results period
15 weeks
Mobility of the lumbar spine, Oswestry index, VAS, EuroQol5D, SF-36 items improved sign. Sign. improvement in all parameters (doctor’s opinion, Schober’s sign, Oswestry’s index, pain at rest, patient’s opinion); control group – less substantial
Sign. decrease in analgesic consumption and pain scores in G A,B,C. After 1 year only analgesic consumption was sign. lower All parameters improved sign. Effect prolonged for 3 months after treatment
Gaal et al. 2008
Prospective study
10-14 weeks
Trial Horvath et al. 2012
Study design Randomised, single-blind, controlled trial
Treatment
G1: thermal mineral water, 38° C, 20 min, 5x a week for 3 weeks + standard pulsed magnetic field therapy 3x a week, over 3 weeks G2: same, but 36° C G3: pulsed magnetic field therapy G1: thermal mineral water, 37° C, 20 min, 15x, over 3 weeks G2: tap water, same temperature
Follow-up period 3 months
Results
WOMAC activity, pain improved sign. + follow-up sign. Same in tap water, no improvement end of follow-up Pain, tenderness decreased
13 weeks
Balogh et al. 2005
Konrad et al. 1992
RCT singleblind
G1: 36°water, 30 min, 15x, except Sundays G2: heated tap water
3 months
Sign. improvement VAS, mitigation of muscle spasm, local tenderness, enhanced felxion-extension and rotation of the spine, Schober’s index

Head-out immersion in mineral water Mud- or peloid-packs to body regions Exposure to gases during bathing and by inhalation Drinking mineral water


ห้องสมุดไป่ตู้
Chronic pelvic inflammatory disease Post-operative rehabilitation Infertility Juvenile bleeding disorders Menopause complaints Pelvipathia vegetativa Endometriosis Carbonyl sulphide and hydrogen sulphide

Musculoskeletal Gynaecological Dermatological conditions (psoriasis) Peripheral vascular diseases, etc.

Used empirically for centuries 18th century – chemical analyses – inorganic salts only Recent decades – studies, clinical trials
Improvement more pronounced in G1, sign. difference immediately and after 3 months: pain VAS, EQVAS. Same with AUSCAN after 3 months, HAQ after 3 and 6 months
12 months
Gaal et al. 2008
Prospective study
10-14 weeks
Trial
Study design Treatment
FollowResults up period
Olah et al. 2008
Controlled, nonrandomised follow-up study
Antioxidants, antibacterial, antimycotic Muscle relaxant, vasodilator, anti-inflammatory, beta-endorphin


Trial Zá mbóet al. 2008
Study design Randomised, double-blind


Chemical:

Absorption through the skin (limited data)

Other:

Antioxidant Immunologic


Started in the 19th century The Hungarian Balneological Society was founded in 1891
3 months
Sign. improvement of all study parameters, still present 3 months later. Among controls, sign. improvement of a single parameter in patients with lumbar, and of two parameters in those with cervical disc disease.


Balneotherapy defined as the use of:

Natural mineral waters Natural peloids and mud Natural sources of different gases (CO2, H2S, Rn222)

Implemented as/by:
Hungary: Rich in thermal-mineral waters > 1300 thermal wells 270 qualified medicinal water, 275 qualified mineral water

Geothermal conditions – geothermal gradient
Trial Balint et al. 2007
Study design Double blind RCT
Treatment
G1: mineral water, 34° C, 30 min, 5 days a week for 4 weeks G2: heated tap water G1: thermal mineral water, 36° C, daily 20 min, 18x G2: tap water G1: thermal mineral water, 36° C, daily 30 min, over 15 days G2: mixture of tap and thermal 33° C water, daily 30 min, 15x
Katalin Szendi M.D., Ph.D. Department of Public Health Medicine, Universitiy of Pécs, Pécs, Hungary

Balneotherapy: