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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., (© 2023. The Author(s) under exclusive licence to International Society of Biometeorology.)

This study systematically reviews the current state of aquatic treatment of neck pain and assesses the scientific evidence of its benefits. The databases PubMed, Scopus, Web of Science and PEDro were searched for relevant reports published from January 1, 2008, to November 7, 2017, using the keywords "neck pain" in addition to "balneotherapy", "spa treatment", "spa", "thalassotherapy", "hydrotherapy", "aquatic therapy" or "aquatic". Inclusion criteria were full-text articles published in journals included in Journal Citation Reports in English and Spanish describing human studies. Case studies, letters to the editor and meeting presentations or other contributions were excluded. Of 367 articles identified, only 13 fulfilled the inclusion criteria: 5 randomized trials, 1 single blind controlled study, 2 pilot studies, 2 observational retrospective studies, 1 prospective study, 1 clinical study and 1 not specified. Participants were 658 subjects with chronic neck pain. Main symptoms and signs treated were neck pain, disability, cervical disc herniation and compromised quality of life. Evidence that aquatic treatment improves quality of life in affected individuals was good in four studies, fair in eight and weak in one. Treatment of neck pain using different waters and techniques reduced pain and disability, and improved functional capacity, quality of life, joint mobility, balance, relaxation and mood.

Osteoarthritis of the knee joint is a public health concern with considerable social impacts and related-costs. Among the treatments available, several benefits of bathing in natural mineral water have been proposed: (1) to identify possible health benefits (in terms of effects on dimensions of pain, functionality, emotional and social aspects, and quality of life) of a 3-week balneotherapy intervention in patients with knee osteoarthritis; (2) to assess the clinical relevance of any benefits detected; and (3) to determine if these effects persist. Participants of this randomized controlled trial (RCT) were 120 patients randomly assigned to (1) an experimental group (3 weeks of balneotherapy consisting of daily whirlpool baths, hydrokinesitherapy sessions, and knee shower/massages) or (2) control group in which no form of treatment apart from their usual analgesia medication was given. Treatment benefits were assessed using the following tools: (1) visual analogue scale (VAS) of pain, (2) Timed Up & Go Test (TUG), (3) WOMAC osteoarthritis questionnaire, and (4) SF 36 health survey questionnaire. In the experimental group, these tests were conducted immediately before treatment, immediately after treatment, and at 3 months of follow-up. Patients assigned to the control group were assessed at the study start and 3 months later. Data processing and statistical analysis were performed using the SPSS (Statistical Package for Social Science) version 22.0. Out of 60 patients in the experimental group, 45 were found to benefit from the treatment intervention in terms of pain relief among other aspects, and also when test scores were compared to those obtained in the control group. Improvements were often clinical relevant and in most patients persisted 3 months after treatment onset.

In Health Resort Medicine, both balneotherapy and thalassotherapy, salt waters and their peloids, or mud products are mainly used to treat rheumatic and skin disorders. These therapeutic agents act jointly via numerous mechanical, thermal, and chemical mechanisms. In this review, we examine a new mechanism of action specific to saline waters. When topically administered, this water rich in sodium and chloride penetrates the skin where it is able to modify cellular osmotic pressure and stimulate nerve receptors in the skin via cell membrane ion channels known as "Piezo" proteins. We describe several models of cutaneous adsorption/desorption and penetration of dissolved ions in mineral waters through the skin (osmosis and cell volume mechanisms in keratinocytes) and examine the role of these resources in stimulating cutaneous nerve receptors. The actions of salt mineral waters are mediated by a mechanism conditioned by the concentration and quality of their salts involving cellular osmosis-mediated activation/inhibition of cell apoptotic or necrotic processes. In turn, this osmotic mechanism modulates the recently described mechanosensitive piezoelectric channels.

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.