Spa therapy and peripheral serotonin and dopamine function: a systematic review.

Spa therapy consists of multiple techniques based on the healing effects of water, including hydrotherapy, balneotherapy, and mud therapy, often combined with therapeutic exercises, massage, or physical therapy. Balneotherapy is a clinically effective complementary approach in the treatment of low-grade inflammation- and stress-related pathologies, especially rheumatic conditions due to its anti-inflammatory properties. The main objective of this investigation was to conduct a systematic review analyzing the available evidence on the effect of spa therapy on serotonin and dopamine function. The databases PubMed, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were used from June to July 2023. Exclusion criteria were (1) articles not written in English, (2) full text not available, (3) article not related to the objective of the review. JADAD scale was used for methodological quality evaluation. Four studies were included in the systematic review. Two studies were related to serotonin in healthy individuals, one to serotonin in fibromyalgia, and one to dopamine in healthy individuals. One of the studies evaluated hydrotherapy, another one balneotherapy and mud-bath therapy, and the other two assessed balneotherapy interventions. Studies were very heterogeneous, and their methodological quality was low, making it difficult to draw clear conclusions regarding the effect of spa therapy on peripheral serotonin and dopamine function. The findings of this review highlight the lack of studies evaluating these neurotransmitters and hormones in the context of spa therapy. Further research is needed to evaluate the potential effects of these therapies on serotonin or dopamine function.

Effect of hydrotherapy, balneotherapy, and spa therapy on blood pressure: a mini-review.

Hypertension (high blood pressure) is one of the most common health conditions. When your blood pressure is high for a long term, it can cause health problems, such as heart disease. In addition to the main methods of treatment, there are various methods of adjuvant therapy, one of the most common of which is hydrotherapy. In this review study, we examined the effects of hydrotherapy, balneotherapy, and spa therapy on blood pressure. We searched the PubMed/MEDLINE, Web of Science, Scopus, and Science Direct databases until April 2022 using related keywords. In summary, the current study shows that different hydrotherapy methods may improve blood pressure. Hydrotherapy as one of the adjunctive therapy methods can be effective in lowering blood pressure. Blood circulation is smoothed by the warmth of the water. This improvement may be achieved by regulating heart rate, releasing hormones that control blood pressure, or regulating the activity of baroreceptors or chemoreceptors. In addition to using medications, hypertension patients also use non-pharmacological approaches in their care, including hydrotherapy, balneotherapy, and warm water foot soaks performed at home. Although several lines of evidence show the potential effects of hydrotherapy, balneotherapy, and spa therapy on blood pressure, many clinical trials are needed.

Balneotherapy for osteoarthritis: a systematic review.

This systematic review is aimed to evaluate the effects of balneotherapy with thermal mineral water for managing the symptoms and signs of osteoarthritis located at any anatomical site. The systematic review was conducted according to the PRISMA Statement. The following databases were consulted: PubMed, Scopus, Web of Science, Cochrane Library, DOAJ and PEDro. We included clinical trials evaluating the effects of balneotherapy as a treatment for patients with osteoarthritis, published in English and Italian language, led on human subjects. The protocol was registered in PROSPERO. Overall, 17 studies have been included in the review. All of these studies were performed on adults or elderly patients suffering from osteoarthritis localized to knees, hips, hands or lumbar spine. The treatment assessed was always the balneotherapy with thermal mineral water. The outcomes evaluated were pain, palpation/pressure sensibility, articular tenderness, functional ability, quality of life, mobility, deambulation, ability to climb stairs, medical objective and patients' subjective evaluation, superoxide dismutase enzyme activity, serum levels of interleukin-2 receptors. The results of all the included studies agree and demonstrated an improvement of all the symptoms and signs investigated. In particular, pain and quality of life were the main symptoms evaluated and both improved after the treatment with thermal water in all the studies included in the review. These effects can be attributed to physical and chemical-physical properties of thermal mineral water used. However, the quality of many studies resulted not so high due and, consequently, it is necessary to perform new clinical trial in this field using more correct methods for conducting the study and for processing statistical data.

Efficacy of hydrotherapy, spa therapy, and balneotherapy on sleep quality: a systematic review.

The purpose of this article was to review and assess the results obtained from human studies on the effects of hydrotherapy, balneotherapy, and spa therapy on sleep disorders. In this study, databases such as Pubmed, Embase, Web of Science, Google Scholar, Cochrane, Scopus, and sciences direct database were searched from the beginning to September 2022. All human studies that examined the effect of hydrotherapy, balneotherapy, and spa therapy on sleep disorders were published in the form of a full article in English. In the end, only 18 of the 189 articles met the criteria for analysis. Most studies have shown that balneotherapy, spa therapy, and hydrotherapy may by affecting some hormones such as histamine, serotonin, sympathetic nerves, and regulating body temperature led to increased quality and quantity of sleep. Also, the results obtained from Downs and Black show that 3 studies were rated as very good, 7 studies as good, 7 studies as fair, and 1 study as weak. The results of studies also showed that hydrotherapy leads to an improvement in the PSQI score index. Nevertheless, more clinical trials are needed to determine the mechanism of action of hydrotherapy on sleep disorders.

Comparative analysis of balneotherapy in European public health systems: Spain, France, Italy, and Portugal.

Balneotherapy comprises the use of natural mineral waters for health and/or well-being purposes. When balneotherapy is offered by the public health system, some countries with Latin-based languages call it social thermalism. The aim of this study is to compare balneotherapy in health systems of Spain, France, Italy, and Portugal. The study involves a qualitative systematic review of the literature using the systematic search flow method. Twenty-two documents, from 2000 to 2022, were included and its findings were described in seven categories: the first outlines the historical characterization of social thermalism in the systems analyzed and the others outline the components of the health systems: coverage/access, health financing, workforce, inputs and techniques, organization and regulation, and network provision of services. The models of insurance and social security that cover part of the thermal treatment are highlighted. Doctors with competence in medical hydrology constitute the majority of the workforce. Similarities regarding inputs and techniques are observed, with variation in the number of days of the balneotherapy treatment cycle. In the regulation of services, the Ministry of Health of each country is prominent. The provision of services is mainly performed in specialized care in accredited balneotherapy establishments. Despite the limitations of the method, the comparisons made may serve to support public policies for balneotherapy.

Efficacy of hydrotherapy, spa therapy, and balneotherapy for psoriasis and atopic dermatitis: a systematic review.

BACKGROUND: Atopic dermatitis (AD) and psoriasis are chronic inflammatory diseases that have significant skin complications. OBJECTIVE: The purpose of this systematic study was to evaluate the evidence obtained from human studies on the effects of hydrotherapy, spa therapy, and balneotherapy in psoriasis and atopic dermatitis. METHODS: The present systematic review was conducted according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statements. Also, for this study databases such as Embase, PubMed, Scopus ProQuest, and sciences direct database were searched from the beginning to April 2021. RESULTS: All human studies that examined the effect of balneotherapy, spa therapy, and hydrotherapy on psoriasis and atopic dermatitis were published in the form of a full article in English. In the end, only 22 of the 424 articles met the criteria for analysis. Most studies have shown that balneotherapy, spa therapy, and hydrotherapy may reduce the effects of the disease by reducing inflammation and improving living conditions. In addition, the results of the Downs and Black score show that seven studies received very good scores, three studies received good scores, nine studies received fair scores, and three studies received poor scores. CONCLUSIONS: The results of studies also showed that hydrotherapy leads to an improvement in the PASI score index. Nevertheless, more clinical trials are needed to determine the mechanism of action of hydrotherapy on these diseases.

The use of radon baths in the rehabilitation of patients with osteochondrosis.

OBJECTIVE: One of the most common methods of rehabilitation for this disease is balneotherapy. Radon therapy is one of the types of balneotherapy based on radon radiation (Rn) for therapeutic, prophylactic, and rehabilitation purposes. A significant number of authors report a positive effect of radon baths on the condition of patients with osteochondrosis. Some authors report the absence of a real therapeutic effect when using radon therapy. The work aimed at investigating the therapeutic efficacy of radon baths in patients suffering from osteochondrosis. PATIENTS AND METHODS: We examined 40 patients with osteochondrosis of various parts of the spine with radicular syndrome. The patients were randomly divided into two groups of 20 people with an equal number of men and women. The study group received a course of balneotherapy using radon water (general baths at a temperature of 34-36°C, duration 10-15 minutes, every other day, No. 10). The control group received balneotherapy using ordinary tap water in the same regimen to decrease placebo effects. RESULTS: Decreased pain and movement difficulties were observed only in the study group. These changes refer only to the spine but not to the joints of the extremities. CONCLUSIONS: Our studies have shown that using radon baths helps to reduce pain and increase the mobility of the spine in patients with osteochondrosis. These data substantiate the prospects for further research of this technique in the complex rehabilitation of osteochondrosis.

Balneotherapy in spondyloarthropathy: A systematic review.

AIM OF THE STUDY: To evaluate the effectiveness of balneotherapy on spondyloarthritis. METHODS: Two authors independently searched the CENTRAL, MEDLINE, SCOPUS, EMBASE and WEB OF SCIENCE databases until July 2017, for randomized controlled trials published in French or English, that included participants, and interventions: adults with spondyloarthritis, treated by balneotherapy program or one of its components and compared with any other intervention or no treatment. Internal validity, external validity, quality of the statistical analysis, and publication bias were systematically evaluated. We report the best level of evidence. RESULTS: Nine articles were selected; the internal validity was high in two studies, average in one study, and low in six studies. With high internal validity, one study found a difference for pain between immersion in radon-rich water and tap water for the whole population or rheumatic disease, but the BASFI is not improved for the subgroup of patients with spondyloarthritis. The other study with high validity reported a significant 28-week improvement in quality of life and a composite index. In a study with moderate internal validity involving ankylosing spondylitis patients with associated with inflammatory bowel disease, a balneotherapy program demonstrated a relevant clinical improvement when compared to patients on waiting list. With low internal validity, TNFa inhibitors+spa therapy were found to be superior to a treatment with TNFa inhibitors alone in patients with psoriatic arthritis. CONCLUSIONS: Two trials with high validity demonstrated improvements, but this systematic review is not sufficient to prove the efficacy of balneotherapy in spondyloarthritis. More trials are needed with larger sample size to confirm the preliminary results observed and conclusively determine the benefits of balneotherapy.

Water therapies (hydrotherapy, balneotherapy or aqua therapy) for patients with cancer: a systematic review.

BACKGROUND: Water therapies as hydrotherapy, balneotherapy or aqua therapy are often used in the relief of disease- and treatment-associated symptoms of cancer patients. Yet, a systematic review for the evidence of water therapy including all cancer entities has not been conducted to date. PURPOSE: Oncological patients often suffer from symptoms which in patients with other diseases are successfully treated with water therapy. We want to gather more information about the benefits and risks of water therapy for cancer patients. METHOD: In May 2020, a systematic search was conducted searching five electronic databases (Embase, Cochrane, PsychInfo, CINAHL and PubMed) to find studies concerning the use, effectiveness and potential harm of water therapy on cancer patients. RESULTS: Of 3165 search results, 10 publications concerning 12 studies with 430 patients were included in this systematic review. The patients treated with water therapy were mainly diagnosed with breast cancer. The therapy concepts included aqua lymphatic therapy, aquatic exercises, foot bathes and whole-body bathes. Outcomes were state of lymphedema, quality of life, fatigue, BMI, vital parameters, anxiety and pain. The quality of the studies was assessed with the AMSTAR2-instrument, the SIGN-checklist and the IHE-Instruments. The studies had moderate quality and reported heterogeneous results. Some studies reported significantly improved quality of life, extent of lymphedema, neck and shoulder pain, fatigue and BMI while other studies did not find any changes concerning these endpoints. CONCLUSION: Due to the very heterogeneous results and methodical limitations of the included studies, a clear statement regarding the effectiveness of water therapy on cancer patients is not possible.

Non-pharmacological intervention for rehabilitation of post-stroke spasticity: A protocol for systematic review and network meta-analysis.

BACKGROUND: Post-stroke spasticity (PSS) is a major worldwide health problem, and timely and effective rehabilitation is associated with the risk of diabetes development; there are a variety of non-pharmacological interventions applied to the rehabilitation of PSS in these treatments; however, the relative efficacy and safety of different therapies remain uncertain, and we will conduct a systematic review and network meta-analysis to evaluate different non-pharmacological interventions. The relative efficacy and safety of intervention in PSS rehabilitation, thus providing evidence to support the optimization of the PSS rehabilitation program. METHODS: We searched the following databases electronically, including four English literature databases (i.e., PubMed, Medline, Embase, and Cochrane Library) and two Chinese literature databases (i.e., China National Knowledge Infrastructure and VIP). We will also search for randomized controlled trials on non-pharmacological interventions for post-stroke spasticity, and the search time limit is from its establishment to May 2020. Two reviewers working independently will screen the titles, abstracts, and full papers. Data extraction will be completed by two independent authors. The primary outcome was the motor function. The secondary outcome was the assessment of daily living ability. We will use RevMan V.5.3 software to compute the data synthesis carefully when a meta-analysis is allowed. We will conduct Bayesian network meta-analysis using the Markov Chain Monte Carlo random effects model in Aggregate Data Drug Information System version 1.16.8 (Drugis, Groningen, NL). RESULTS: This study provides a high-quality synthesis to assess the effectiveness and safety of non-pharmacological interventions for patients with PSS. CONCLUSION: The results of this study will provide evidence to judge whether non-pharmacological interventions are effective interventions for patients with post-stroke spasticity. ETHICS AND DISSEMINATION: The results of this meta-analysis and meta-regression will be disseminated through publication in a peer-reviewed journal and presented at a relevant conference. The data used in the network meta-analysis did not contain individual patient data. Therefore, ethical approval was not required. INPLASY REGISTRATION NUMBER: INPLASY202140059.

The effect of thermal mineral waters on pain relief, physical function and quality of life in patients with osteoarthritis: A systematic review and meta-analysis.

BACKGROUND: To evaluate the effectiveness and safety of thermal mineral waters therapy for pain relief, and functional improvement, and quality of life (QoL) in patients with osteoarthritis (OA). METHODS: Cochrane Library, Web of science, EMBASE, ClinicalTrials.gov and PubMed were systematically searched for randomized controlled trials. Study inclusion criteria included assessment of the visual analog scale and Western Ontario and McMaster Universities scores and the lequesne index to evaluate the effects of thermal mineral waters on pain relief and functional improvement. Also, studies that used the European quality of life 5-dimension scale and health assessment questionnaire to assess the impact of thermal mineral waters therapy on improving QoL were included. RESULTS: Sixteen studies were included. A meta-analysis showed that thermal mineral waters therapy could significantly reduce pain as measured visual analog scale and Western Ontario and McMaster Universities assessments (P < .001). Thermal mineral waters significantly reduced the lequesne index (P < .001) and improved joint function. Finally, compared with a control group, European quality of life 5-dimension scale and health assessment questionnaire improved significantly in patients with OA receiving thermal mineral waters therapy (P  < .05). There is no evidence that thermal mineral waters is unsafe for treating OA. CONCLUSION: Thermal mineral waters therapy is a safe way to relieve pain, improve physical functions, and QoL in patients with OA.

The short-term effects of balneotherapy on pain, disability and fatigue in patients with chronic low back pain treated with physical therapy: A randomized controlled trial.

OBJECTIVE: This study aimed to compare whether there are positive effects of balneotherapy(BT) on pain, quality of life and disability of individuals receiving physical therapy(PT) for chronic low back pain and to examine the effect of body mass index(BMI) on treatment. MATERIALS AND METHOD: This prospective, controlled, single blind study was conducted. Patients were randomized into two groups through a simple randomization in a 1:1 ratio. The clinician and biostatistics expert were blinded. PT group was applied PT, BT + PT group was applied PT + BT. All patients were included in the study for 3 weeks (total of 15 sessions, 5 days per week). All patients applied hot pack, transcutaneous electrical nerve stimulation and ultrasound. Patients in the BT + PT group applied BT in thermo mineralized water pool (20 min at 38-40 °C). Assessments were made using Pain-Visual Analog Scale(VAS), EQ-5D-3 L Scale(EQ5), EQ-VAS, Functional Assessment of Chronic Illness Therapy-Fatigue(FACIT-F), Roland-Morris Disability Questionnaire(RMDQ) and Quebec Back Pain Disability Scale(QBPDS) at the beginning (W0) and end (W3) of treatment. While performing statistical analysis, patients were divided into 3 categories of BMI1(18.5-24.9 kg/m2), BMI2 (25.0-29.9 kg/m2) and BMI3(≥30.0 kg/m2). RESULTS: 270 patients were randomized. 129 patients in PT group and 133 patients in PT + BT group completed the study. In the BT + PT group, there were increases in the EQ5 and EQ-VAS variables and decreases in all other variables compared to the PT group which were found to be statistically significant (for QBPDS p < 0.05, the others p < 0.01). The differences in all variables W0 and W3 were at least half reductions and increases which were found to be statistically significant (p < 0.01). In terms of BMI, there were significant differences for all groups, especially BMI3 had higher means for all variables apart from EQ5 and EQ-VAS than the other two categories. BMI1 was the BMI category with highest means for EQ5 and EQ-VAS. The Group × Time interaction was found to be statistically significant for Pain-VAS, EQ5, EQ-VAS, FACIT-F, QBPDS and RMDQ(p < 0.01). For Pain-VAS, the effect of the Group × Time × BMI interaction was found to be statistically significant(p < 0.05). CONCLUSION: BT plus PT was more effective than PT. BT may have positive contributions to reducing pain, functionality of patients, quality of life, fatigue and disability status.

Nitrodi thermal water downregulates protein S­nitrosylation in RKO cells.

Balneotherapy and spa therapy have been used in the treatment of ailments since time immemorial. Moreover, there is evidence to suggest that the beneficial effects of thermal water continue for months following the completion of treatment. The mechanisms through which thermal water exerts its healing effects remain unknown. Both balneological and hydroponic therapy at 'the oldest spa in the world', namely, the Nitrodi spring on the Island of Ischia (Southern Italy) are effective in a number of diseases and conditions. The aim of the present study was to investigate the molecular basis underlying the therapeutic effects of Nitrodi spring water in low­grade inflammation and stress­related conditions. For this purpose, an in vitro model was devised in which RKO colorectal adenocarcinoma cells were treated with phosphate­buffered saline or phosphate­buffered saline prepared with Nitrodi water for 4 h daily, 5 days a week for 6 weeks. The RKO cells were then subjected to the following assays: 3­(4,5­Dimethylthiazol­2­yl)­2,5­diphenyl­2H­tetrazolium bromide assay, Transwell migration assay, western blot analysis, the fluorimetric detection of protein S­nitrosothiols and S­nitrosylation western blot analysis. The results revealed that Nitrodi spring water promoted cell migration and cell viability, and downregulated protein S­nitrosylation, probably also the nitrosylated active form of the cyclooxygenase (COX)­2 protein. These results concur with all the previously reported therapeutic properties of Nitrodi spring water, and thus reinforce the concept that this natural resource is an important complementary therapy to traditional medicine.

Balneotherapy decreases mechanical hyperalgesia by reversing BDNF and NOS2 immunocontent in spinal cord of mice with neuropathic pain.

In the last decades, balneotherapy or thermalism has been used for health promotion and in the treatment of inflammatory and chronic processes. We found that balneotherapy reduced mechanical hyperalgesia, as well the increase of BDNF and NOS2 levels in the spinal cord, while increased BDNF and NOS1 in the paw. The data presented herein demonstrated for the first time in a murine model of neuropathic pain, the analgesic effect of balneotherapy with the water from the natural springs of Santo Amaro da Imperatriz-Brazil. Nevertheless, future clinical trials should be conducted to test the effectiveness of balneotherapy in neuropathic pain patients.

Spa therapy with physical rehabilitation is an alternative to usual spa therapy protocol in symptomatic knee osteoarthritis.

The objective of the study was to demonstrate the non-inferiority of low-frequency spa therapy combined with rehabilitation (Spa-rehab) versus standard spa therapy at 6 months for symptomatic knee osteoarthritis (KOA). A prospective, randomized, monocenter, non-inferiority trial with recruitment of community-based symptomatic KOA patients was performed. Standard spa therapy comprised standardized spa treatment, 6 days a week for 3 weeks, and Spa-rehab therapy comprised spa sessions, 3 days a week for 3 weeks, followed by a dedicated rehabilitation program, 3 days a week for 3 weeks. The primary endpoint was achieving at 6 months a minimal clinically important improvement (MCII) for pain on a visual analog scale and/or an MCII for function on the WOMAC index and no knee surgery (composite MCII). Secondary endpoints were composite MCII at 3 months and achieving a Patient Acceptable Symptom State (PASS) for pain and function at 3 and 6 months. Among 283 patients included, 145 were allocated to standard spa therapy and 138 to Spa-rehab therapy. We could not demonstrate the non-inferiority of Spa-rehab therapy for the primary endpoint: difference for responders - 0.08 [90% CI (- 0.18 to 0.02), p = 0.14]. However, the difference test between the groups was not significant (p = 0.18). Spa-rehab therapy was not inferior to standard spa therapy for the composite MCII at 3 months or the PASS at 3 and 6 months. Spa-rehab therapy can reasonably be proposed to patients with symptomatic KOA. This protocol may be more cost-effective than standard spa therapy and avoid absenteeism from work and accommodation costs for patients who live close to a centre.

Protocols and self-checking plans for the safety of post-COVID-19 balneotherapy.

During the COVID-19 pandemics, balneotherapic establishments were closed in Italy like in the rest of Europe. The Italian Foundation for Research in balneotherapy (FoRST) was asked to prepare a safety protocol to be proposed to the National Health Authorities to allow the establishments to restart their activity when possible, under safe conditions (the so-called Phase-2). The group of experts proposed the following hygienic and sanitary protocols of risk management for the initial reopening of the balneology settings in Italy. The plan aims to define the operating procedures to be implemented at the balneology establishments for the beginning of Phase-2 and to keep them constantly updated in the different periods that will characterize Phase-2 in relation to the trends of the disease. To this end the procedures, defined on the basis of the scientific state-of-the-art available today, will be updated and revised from time to time whenever further scientific evidence and directives from the Health Authorities make it necessary and/or useful.

Balneotherapy in the Treatment of Chronic Shoulder Pain: A Randomized Controlled Clinical Trial.

CONTEXT: To date, the number of studies investigating the effects of balneotherapy (BT) on chronic shoulder pain is small. OBJECTIVE: This study intended to investigate the effects of BT on pain, disability, and quality of life for patients with chronic shoulder pain. DESIGN: The research team designed a prospective, randomized, controlled, single-blinded study. SETTING: The study took place in the Department of Medical Ecology and Hydroclimatology at the Bolu Izzet Baysal Physical Medicine and Rehabilitation Training and Research Hospital (Bolu, Turkey). PARTICIPANTS: Participants were 60 patients with shoulder pain who were admitted to the outpatient clinic at the hospital between April 2016 and September 2016. INTERVENTION: Participants were divided randomly into 2 groups: a control group receiving physical therapy (PT) only, the PT group, and an intervention group receiving PT plus BT, the BT group. All participants received 3 wk of treatment. OUTCOME MEASURES: The study measured pain, disability, and quality of life using a visual analogue scale (VAS), the Shoulder Pain and Disability Index (SPADI), and the Nottingham Health Profile (NHP) at baseline, immediately postintervention, and at 1 mo postintervention. RESULTS: Statistically significant improvements were found on the VAS, SPADI, and NHP at both postintervention timepoints for both groups compared with baseline (P < .05). When the difference scores were compared between the groups, the BT group showed significantly greater improvements at both postintervention timepoints for the VAS and SPADI compared with the PT group (P < .05). For the NHP, the BT group showed significantly greater improvements compared with the PT group immediately postintervention for the pain and energy level subscales and for the total score (P < .05). At 1 mo postintervention, the BT group again showed significantly greater improvements on the NHP compared the PT group for the pain, physical activity, energy level, and sleep subscales and for the total score (P < .05). CONCLUSION: The results of the study suggest that BT can have positive effects on pain and disability. BT may be an alternative for patients with chronic shoulder pain.

Short-term benefits of balneotherapy for patients with chronic pelvic pain: a pilot study in Korea.

The aim of this study was to evaluate whether balneotherapy might be effective in patients with chronic pelvic pain (CPP) in the short term. This was an open and prospective pilot study. The balneotherapy programme was performed in a spa resort located in Wando Island, Republic of Korea from August 26 2018 to September 1 2018. It consisted of 10 heated seawater baths (38 °C, 20 minutes) and 10 mud-pack applications (40 °C, 10 minutes) for five days. Sixteen patients were enrolled. Upon analysing responses from a patient questionnaire, we found improvement in parameters such as pain, bladder irrigation symptoms and quality of life after balneotherapy. Inflammatory marker IL-1 and TNF-α was significantly decreased after treatment compared to baseline. There were no adverse events during treatment. Our data suggest that five-day balneotherapy can be beneficial for patients with CPP in the short term.Impact statementWhat is already known on this subject? The majority of articles in the field of balneotherapy discuss the treatment of rheumatic or dermatological disease. However, data on the effectiveness of balneotherapy for chronic pelvic pain are very limited.What the results of this study add? Our study suggests that balneotherapy can be beneficial for patients with CPP in the short-term. The duration of balneotherapy was five days, which is shorter than that of the European studies. Intuitively, it may be doubtful whether short-term therapy has any practical effect. As most people living in Korea have a vacation period of about one week each in summer and winter, the choice of a five-day programme in our study reflects the reality of vacation schedules.What the implications are of these findings for clinical practice and/or further research? Further studies are necessary to demonstrate the persistence of these benefits on the long term, as well as their existence in appropriate control group and different duration of treatment.

Spa environments in central Serbia: Geothermal potential, radioactivity, heavy metals and PAHs.

This study aims to estimate geothermal potential, radioactivity levels, and environmental pollution of six most popular spas in Central Serbia (Ovcar, Gornja Trepca, Vrnjacka, Mataruska, Bogutovacka and Sokobanja), as well as to evaluate potential exposure and health risks for living and visiting population. Thermal possibilities of the studied spas showed medium and low geothermal potential with total thermal power of 0.025 MW. Gamma dose rates in air varied from 63 to 178 nSv h-1. Specific activities of natural radionuclides (226Ra, 232Th and 40K) and 137Cs in soil were measured; annual effective doses and excess lifetime cancer risk from radionuclides were calculated. Radon concentration in thermal-mineral waters from the spas ranged between 1.5 and 60.7 Bq L-1 (the highest values were measured in Sokobanja). The annual effective dose from radon due to water ingestion was calculated. The analyzed soils had a clay loam texture. The presence of As, Cr, Cu, Fe, Mn, Ni, Pb, Cd, Zn, and Hg in soil was investigated. The concentrations of As, Cr, Ni, and Hg exceeded the regulatory limits in many samples. Soil samples from Mataruska spa were generally the most contaminated with heavy metals, while the lowest heavy metal concentrations were observed in Sokobanja. Health effects of exposure to heavy metals in soil were estimated by non-carcinogenic risk and carcinogenic risk assessment. Total carcinogenic risk ranged between 6 × 10-4 and 137 × 10-4 for children and between 0.1 × 10-4 and 2.2 × 10-4 for adults. The sum of 16 PAHs analyzed in soil samples varied from 92 to 854 µg kg-1.

Short- and long-term beneficial effects of medicinal mineral water administration.

Medicinal mineral water, being provided by recognized immunosuppressive properties, results useful for treating many pathological conditions. A well-known source of sulfurous and oligomer medicinal mineral waters is located in Caramanico Terme (Pescara, Italy). Caramanico Terme is a small town in the Majella's National Park, and its precious and peculiar environment offers a medicinal mineral water (also known as cures or crenotherapy), that since 1576 is administrated to a large number of patients (around 15,000 per year). However, no scientific conclusions on the efficacy of Caramanico's Terme medicinal mineral water properties are available. Therefore, we have carried out an epidemiological study, enrolling a population of 370 subjects that have received crenotherapy. Such a population has been also compared to a control group of individuals (untreated, N = 287), never undergone any medicinal mineral water administration. Detailing the geomorphological characteristics of Caramanico Terme environment, we have also analyzed the results of the study that showed that pathology-relapses, as well as related manifestations of symptoms and drug employments, were largely reduced after one or more cycles of crenotherapy. On the other hand, a sub-group of subjects receiving crenotherapy for more than 5 years (N = 166) presented a highly reduced prevalence of a large spectrum of pathologies (cardiovascular, inflammatory, neurological and cancer diseases), with respect to an overlapping population (in terms of age and genders) of untreated subjects. We have also clarified the role of aging and long-term effects of medicinal mineral-water administration. Altogether, these data indicated that the clinical employment of Caramanico's Terme medicinal mineral water produces short- as well as long-term beneficial effects, both with respect to the amelioration of life quality of patients and in reducing the probability to develop major disabling pathologies (i.e., cardiovascular, cancer and neurological diseases). Therefore, these data will open novel strategies for a larger application of crenotherapy.