M. H. Pittler, M. Z. Karagulle, M. Karagulle, E. Ernst

Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK, Department of Medical Ecology and Hydro-Climatology, Istanbul Medical Faculty, University of Istanbul, Istanbul, Turkey

M.H.Pittler@exeter.ac.uk

Low back pain is a major public health concern and complementary treatments are frequently used for this condition. The objective of this systematic review and meta-analysis was to assess the evidence for or against the effectiveness of spa-therapy and balneotherapy for treating low back pain.

Systematic searches were conducted on Medline, Embase, Amed Cochrane Central, the UK National Research Register and Clinical Trials.gov (all until July 2005). Hand searches were performed and experts contacted. Methodological quality was assessed using a standard scale.

Five randomized clinical trials met all inclusion criteria. Quantitative data synthesis was performed. The data for spa therapy, assessed on a 100mm visual analogue scale (VAS), suggest significant beneficial effects compared with waiting list control groups (weighted mean difference 26.6mm, 95% confidence interval 20.4 — 32.8, n=442) for patients with chronic low back pain. For balneotherapy the data, assessed on a 100mm VAS, also suggest beneficial effects compared with control groups (weighted mean difference 18.8mm, 95% confidence interval 10.3 — 27.3, n=138).

Even though the data are scarce, there is encouraging evidence suggesting that spa therapy and balneotherapy may be effective for treating patients with low back pain. These data are not compelling but warrant rigorous large-scale trials.