International Journal of Biometeorology

, Volume 62, Issue 5, pp 897–905 | Cite as

The effects of the calcium-magnesium-bicarbonate content in thermal mineral water on chronic low back pain: a randomized, controlled follow-up study

  • Tamás Gáti
  • Ildikó Katalin Tefner
  • Lajos Kovács
  • Katalin Hodosi
  • Tamás BenderEmail author
Original Paper


The aim of this study was to investigate the effects of balneotherapy on chronic low back pain. This is a minimized, follow-up study evaluated according to the analysis of intention to treat. The subjects included in the study were 105 patients suffering from chronic low back pain. The control group (n = 53) received the traditional musculoskeletal pain killer treatment, while the target group (n = 52) attended thermal mineral water treatment for 3 weeks for 15 occasions on top of the usual musculoskeletal pain killer treatment. The following parameters were measured before, right after, and 9 weeks after the 3-week therapy: the level of low back pain in rest and the level during activity are tested using the Visual Analog Scale (VAS); specific questionnaire on the back pain (Oswestry); and a questionnaire on quality of life (EuroQual-5D). All of the investigated parameters improved significantly (p < 0.001) in the target group by the end of the treatment compared to the base period, and this improvement was persistent during the follow-up period. There were no significant changes in the measured parameters in the control group. Based on our results, balneotherapy might have favorable impact on the clinical parameters and quality of life of patients suffering from chronic low back pain.


Balneotherapy Mineral water Chronic low back pain Controlled Randomized trial Thermal water 



We would like to thank Mrs. Judit Kleiber (Józsefváros Municipal Health Service, Budapest, Hungary) for her useful assistance.

Author contributions

Tamás Gáti and Ildikó Katalin Tefner have contributed equally to this work.


The study was sponsored by the Budapest Spas cPlc.

Compliance with ethical standards

This study was approved by the Semmelweis University Regional Scientific and Research Ethics Committee (SE TUKEB) (SE TUKEB Number: 164-1/20169). The study was also approved by the Institutional Research Committee of the Health Service of Józsefváros.

Conflict of interest

The authors declare that they have no competing interests.


  1. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G, On behalf of the COST B13 Working Group on Guidelines for Chronic Low Back Pain (2006) Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 15 Suppl 2:S192–S300.
  2. Balagué F, Mannion AF, Pellisé F, Cedraschi C (2012) Non-specific low back pain. Lancet Lond Engl 379(9814):482–491. CrossRefGoogle Scholar
  3. Balogh Z, Ordögh J, Gász A et al (2005) Effectiveness of balneotherapy in chronic low back pain—a randomized single-blind controlled follow-up study. Forsch Komplementarmedizin Klass Naturheilkunde Res Complement Nat Class Med 12(4):196–201. CrossRefGoogle Scholar
  4. Becker BE (2009) Aquatic therapy: scientific foundations and clinical rehabilitation applications. PM R 1(9):859–872. CrossRefGoogle Scholar
  5. Bender T, Bálint G, Prohászka Z, Géher P, Tefner IK (2014) Evidence-based hydro- and balneotherapy in Hungary—a systematic review and meta-analysis. Int J Biometeorol 58(3):311–323. CrossRefGoogle Scholar
  6. Bender T, Karagülle Z, Bálint GP et al (2005) Hydrotherapy, balneotherapy, and spa treatment in pain management. Rheumatol Int 25(3):220–224. CrossRefGoogle Scholar
  7. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, Fu R, Dana T, Kraegel P, Griffin J, Grusing S, Brodt ED (2017) Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med 166(7):493–505. CrossRefGoogle Scholar
  8. Dandinoglu T, Dandin O, Ergin T, Tihan D, Akpak YK, Aydın OU, Teomete U (2017) Can balneotherapy improve the bowel motility in chronically constipated middle-aged and elderly patients? Int J Biometeorol 61(6):1139–1148. CrossRefGoogle Scholar
  9. Dogan M, Sahin O, Elden H, Hayta E, Kaptanoglu E (2011) Additional therapeutic effect of balneotherapy in low back pain. South Med J 104(8):574–578. CrossRefGoogle Scholar
  10. Dubois O, Salamon R, Germain C, Poirier MF, Vaugeois C, Banwarth B, Mouaffak F, Galinowski A, Olié JP (2010) Balneotherapy versus paroxetine in the treatment of generalized anxiety disorder. Complement Ther Med 18(1):1–7. CrossRefGoogle Scholar
  11. Dziura JD, Post LA, Zhao Q et al (2013) Strategies for dealing with missing data in clinical trials: from design to analysis. Yale J Biol Med 66:343–356Google Scholar
  12. Ebadi S, Henschke N, Nakhostin Ansari N, Fallah E, van Tulder MW, Cochrane Back and Neck Group (2014) Therapeutic ultrasound for chronic low-back pain. Cochrane Database Syst Rev:CD009169.
  13. Enthoven WTM, Roelofs PDDM, Deyo RA et al (2016) Non-steroidal anti-inflammatory drugs for chronic low back pain. Cochrane Database Syst Rev 2:CD012087. CrossRefGoogle Scholar
  14. Fairbank JC, Pynsent PB (2000) The Oswestry Disability Index. Spine 25(22):2940–2952; discussion 2952. CrossRefGoogle Scholar
  15. Fioravanti A, Cantarini L, Guidelli GM, Galeazzi M (2011) Mechanisms of action of spa therapies in rheumatic diseases: what scientific evidence is there? Rheumatol Int 31(1):1–8. CrossRefGoogle Scholar
  16. Fioravanti A, Giannitti C, Cheleschi S, Simpatico A, Pascarelli NA, Galeazzi M (2015) Circulating levels of adiponectin, resistin, and visfatin after mud-bath therapy in patients with bilateral knee osteoarthritis. Int J Biometeorol 59(11):1691–1700. CrossRefGoogle Scholar
  17. Furlan AD, Giraldo M, Baskwill A et al (2015) Massage for low-back pain. Cochrane Database Syst Rev:CD001929.
  18. Kalpakcioglu B, Candir F, Bernateck M, Gutenbrunner C, Fischer MJ (2009) Does local immersion in thermo-neutral bath influence surface EMG measurements? Results of an experimental trial. J Electromyogr Kinesiol Off J Int Soc Electrophysiol Kinesiol 19(6):e550–e553. CrossRefGoogle Scholar
  19. Karagülle M, Kardeş S, Karagülle O, Dişçi R, Avcı A, Durak İ, Karagülle MZ (2017) Effect of spa therapy with saline balneotherapy on oxidant/antioxidant status in patients with rheumatoid arthritis: a single-blind randomized controlled trial. Int J Biometeorol 61(1):169–180. CrossRefGoogle Scholar
  20. Kesiktas N, Karakas S, Gun K, Gun N, Murat S, Uludag M (2012) Balneotherapy for chronic low back pain: a randomized, controlled study. Rheumatol Int 32(10):3193–3199. CrossRefGoogle Scholar
  21. Khadilkar A, Odebiyi DO, Brosseau L, Wells GA (2008) Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database Syst Rev:CD003008.
  22. Kulisch A, Bender T, Németh A, Szekeres L (2009) Effect of thermal water and adjunctive electrotherapy on chronic low back pain: a double-blind, randomized, follow-up study. J Rehabil Med 41(1):73–79. CrossRefGoogle Scholar
  23. Melzack R, Wall PD (1965) Pain mechanisms: a new theory. Science 150(3699):971–979. CrossRefGoogle Scholar
  24. Molnar FJ, Hutton B, Fergusson D (2008) Does analysis using “last observation carried forward” introduce bias in dementia research? CMAJ 179(8):751–753. CrossRefGoogle Scholar
  25. Murray CJL, Vos T, Lozano R et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet Lond Engl 380(9859):2197–2223. CrossRefGoogle Scholar
  26. O’Hare JP, Heywood A, Summerhayes C et al (1985) Observations on the effect of immersion in bath spa water. Br Med J Clin Res Ed 291(6511):1747–1751. CrossRefGoogle Scholar
  27. Onat ŞŞ, Taşoğlu Ö, Güneri FD, Özişler Z, Safer VB, Özgirgin N (2014) The effectiveness of balneotherapy in chronic low back pain. Clin Rheumatol 33(10):1509–1515. CrossRefGoogle Scholar
  28. Oosterveld FG, Rasker JJ (1994) Treating arthritis with locally applied heat or cold. Semin Arthritis Rheum 24(2):82–90. CrossRefGoogle Scholar
  29. Ormos G, Szabó C, Korányi Á, Csiki J (2003) Betegség specifikus funkciócsökkenési indexek hazai validálásaGoogle Scholar
  30. Pascarelli NA, Cheleschi S, Bacaro G, Guidelli GM, Galeazzi M, Fioravanti A (2016) Effect of mud-bath therapy on serum biomarkers in patients with knee osteoarthritis: results from a randomized controlled trial. Isr Med Assoc J IMAJ 18(3-4):232–237Google Scholar
  31. Pittler MH, Karagülle MZ, Karagülle M, Ernst E (2006) Spa therapy and balneotherapy for treating low back pain: meta-analysis of randomized trials. Rheumatol Oxf Engl 45(7):880–884. CrossRefGoogle Scholar
  32. Pöyhönen T, Avela J (2002) Effect of head-out water immersion on neuromuscular function of the plantarflexor muscles. Aviat Space Environ Med 73(12):1215–1218Google Scholar
  33. Rubinstein SM, van Middelkoop M, Kuijpers T, Ostelo R, Verhagen AP, de Boer MR, Koes BW, van Tulder MW (2010) A systematic review on the effectiveness of complementary and alternative medicine for chronic non-specific low-back pain. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 19(8):1213–1228. CrossRefGoogle Scholar
  34. Saragiotto BT, Machado GC, Ferreira ML et al (2016) Paracetamol for low back pain. Cochrane Database Syst Rev:CD012230.
  35. Scott NW, McPherson GC, Ramsay CR, Campbell MK (2002) The method of minimization for allocation to clinical trials. A review. Control Clin Trials 23(6):662–674. CrossRefGoogle Scholar
  36. Shani J, Barak S, Levi D, Ram M, Schachner ER, Schlesinger T, Robberecht H, van Grieken R, Avrach WW (1985) Skin penetration of minerals in psoriatics and guinea-pigs bathing in hypertonic salt solutions. Pharmacol Res Commun 17(6):501–512. CrossRefGoogle Scholar
  37. 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(10):3163–3169. CrossRefGoogle Scholar
  38. Treasure T, MacRae KD (1998) Minimisation: the platinum standard for trials?. Randomisation doesn’t guarantee similarity of groups; minimisation does. BMJ 317(7155):362–363. CrossRefGoogle Scholar
  39. van Tulder M, Koes B, Bombardier C (2002) Low back pain. Best Pract Res Clin Rheumatol 16(5):761–775. CrossRefGoogle Scholar
  40. van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM, Cochrane Back Review Group (2003) Muscle relaxants for nonspecific low back pain: a systematic review within the framework of the cochrane collaboration. Spine 28(17):1978–1992. CrossRefGoogle Scholar
  41. White AP, Arnold PM, Norvell DC, Ecker E, Fehlings MG (2011) Pharmacologic management of chronic low back pain: synthesis of the evidence. Spine 36(21 Suppl):S131–S143. CrossRefGoogle Scholar
  42. WHO Scientific Group on the Burden of Musculoskeletal Conditions at the Start of the New Millennium (2003) The burden of musculoskeletal conditions at the start of the new millennium. World Health Organ Tech Rep Ser 919:i–x, 1–218, back coverGoogle Scholar
  43. Whynes DK, TOMBOLA Group (2008) Correspondence between EQ-5D health state classifications and EQ VAS scores. Health Qual Life Outcomes 6(1):94. CrossRefGoogle Scholar

Copyright information

© ISB 2018

Authors and Affiliations

  • Tamás Gáti
    • 1
    • 2
  • Ildikó Katalin Tefner
    • 2
  • Lajos Kovács
    • 3
  • Katalin Hodosi
    • 4
  • Tamás Bender
    • 1
    • 5
    Email author
  1. 1.Polyclinic of the Hospitaller Brothers of St. John of GodBudapestHungary
  2. 2.Józsefváros Municipal Health ServiceBudapestHungary
  3. 3.Musculoskeletal Rehabilitation CenterMezőkövesdHungary
  4. 4.Department of Internal Medicine, Faculty of MedicineUniversity of DebrecenDebrecenHungary
  5. 5.Budai Irgalmasrendi KórházBudapestHungary

Personalised recommendations