Balneotherapy for osteoarthritis.

Balneotherapy for osteoarthritis.

I certainly hope that the first question that you are asking yourself is the very same question that I asked myself when I came across this very recent study... The question that came to my mind was, "what on earth is balneotherapy?"

Balneotherapy, to my recent understanding is a broadly defined term encompassing the various types of therapy pertaining to spas. In this recent cochrane review, they attempted to review various clinical trials which were conducted on varying forms of mineral bath treatments for arthritis.

One challenge with randomized clinical trials that evaluate unconventional treatment forms is that it is often difficult to create an adequate placebo. For example, with a clinical trial involving tablet type medication, you can make a placebo tablet that looks, tastes, and feels exactly the same as the medication tablet. However, whether the clinical trial is attempting to evaluate a treatment method such as tai chi, spa baths, or meditation, these types of treatment options do not fit into the conventional evaluation methods preferred by physicians.

Just try to imagine what type of placebo comparision one would actually use for a randomized clinical trial for tai chi. A group of people engaged in fake tai chi? Well, actually no. Current comparison methods include people that are on a waiting list for a treatment who do not receive any treatment interventions. The problem with using a waiting list of patients as a comparison group is that the trial is no longer blinded. The people who are conducting the clinical trial know exactly which group received the intervention and which group did not. As well, the people that are in the trial themselves also know that they are receiving an intervention. Further, many of these types of trials have the additional problem that people who enroll in the study will simply drop out if they are not randomized to the tai chi group, for example. All of these problems as well as others create bias in evaluating these types of treatments.

When I think back to my childhood, I can recall playing with a toy which I believe is made by Fisher-Price. It was a spherical piece of plastic with various shaped holes built into the hollow sphere. The toy came with correspondingly shaped objects with the ultimate goal of fitting these little pieces of plastic into the sphere. Though the attempt to evaluate unconventional treatment options with our current type of clinical trials is noble, much like trying to place the star shaped object into the square hole of the toy that I played with when I was a toddler, it simply just doesn't fit and the efforts to make it fit are fruitless. Here is an example of the fruitless efforts of the esteemed cochrane collaboration in evaluating several clinical trials on balneotherapy:

"AUTHORS' CONCLUSIONS: We found silver level evidence (www.cochranemsk.org) concerning the beneficial effects of mineral baths compared to no treatment. Of all other balneological treatments no clear effects were found. However, the scientific evidence is weak because of the poor methodological quality and the absence of an adequate statistical analysis and data presentation. Therefore, the noted "positive findings" should be viewed with caution." (Verhagen et al, 2007).

What is the alternative method for evaluating alternative treatments? Common sense! Provided that the alternative treatment is safe, has no contraindications, you have no medical reason for not trying it, and that it isn't excessively expensive, give it a try and if it works for you, keep doing it--if it doesn't work, then stop.

So if you are one of my blog readers who suffers from arthritis, you can consider many options--sign up for a tai chi class, throw some mineral salts into a warm hot bath, if you find that helps to relieve your arthritic pain, maybe keep doing it, if it doesn't then stop. It's that simple!


Reference:
Verhagen A, Bierma-Zeinstra S, Boers M, Cardoso J, Lambeck J, de Bie R, de Vet H. Balneotherapy for osteoarthritis. Cochrane Database Syst Rev. 2007 Oct 17;4:CD006864.