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23Central Asian Journal of Medical Hypotheses and Ethics
2020; Vol 1 (2)
© 2020 by the authors. This work is licensed under Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/
eISSN: 2708-9800 https://doi.org/10.47316/cajmhe.2020.12.05
CLINICAL MEDCINE
HYPOTHESIS
PATHOPHYSIOLOGICAL MECHANISMS OF BALNEOTHERAPY WITH POTENTIAL IMPLICATIONS FOR CENTRAL ASIAN SPAS AND SANATORIUMS
Received: Oct. 28, 2020 Accepted: Dec. 03, 2020
Sinan Karde§ 1* https://orcid.org/0000-0002-6311-8634 Mine Karagülle1 https://orcid.org/0000-0002-8060-970X
1 Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih, 34093, Istanbul, Turkey
Corresponding author:
Sinan Karde§, Department of Medical Ecology and Hydroclimatology, Istanbul Faculty of Medicine, Istanbul University, Capa-Fatih, 34093, Istanbul, Turkey; E-mail: sinan.kardes@istanbul.edu.tr
Abstract
Spa therapy includes all modalities/ treatments based on evidence that are administered in spas or sanatoriums. Balneotherapy, the immersion in mineral water, is the main balneological modality in spa therapy programs. Clinical trials performed in Europe, Turkey, and Israel have shown clinical benefits of spa therapy/ balneotherapy in several diseases mainly pertaining to rheumatic and musculoskeletal diseases and dermatological diseases as well. However, mechanisms by which balneotherapy may improve the clinical symptoms of patients have been less evaluated/ documented in the literature. Although the literature on mechanisms of action of balneotherapy has still been evolving and accumulating, some evidence from preliminary studies paves the way for generating a hypothesis that balneotherapy has an influence on physiological mechanisms, immune system, inflammation, and oxidative stress. Extrapolation of the evidence-based clinical practice and scientific experience of Europe, Turkey, and Israel to Central Asian spas and sanatoriums is although possible; future studies investigating clinical efficacy, safety profile, and possible mechanisms of action of balneotherapy of regional spas are needed to better understand the role of balneotherapy and whether it has any local differences.
Keywords: Spa therapy, Balneotherapy, Immune system, Inflammation, Oxidative stress, Central Asia How to cite: Karde§ S, Karagulle M. Pathophysiological mechanisms of balneotherapy with potential implications for Central Asian spas and sanatoriums. Cent Asian J Med Hypotheses Ethics 2020; 1 (2):131 —135. https://doi.org/10.47316/cajmhe.2020.1.2.05
INTRODUCTION
Spa therapy includes all modalities/ treatments based on evidence that are administered in spas or sanatoriums
[1]. Balneotherapy, the immersion in mineral water, is the main balneological modality in spa therapy programs.
[2]. Some spa resorts or sanatoriums also include the other spa therapy modalities in their spa therapy programs, such as peloid therapy; thalassotherapy; hydrotherapy; and climatotherapy [1-5]. In addition, physical therapy modalities and exercise are included in
some spa resorts or sanatoriums [1-3]. In this article, we focused on balneotherapy because it is the central intervention in spa or sanatorium programs. When generating, structuring, and discussing our hypothesis, we followed the instructions and guidance of an elegant article entitled "Scientific hypotheses: writing, promoting, and predicting implications" by Gasparyan et al. [6].
The systematic reviews evaluating the clinical efficacy of spa therapy/ balneotherapy in several diseases mainly
pertaining to rheumatic and musculoskeletal diseases generally conclude that most of the included studies have shown a clinical efficacy of spa therapy/ balneotherapy; however, more high-quality studies are needed to draw firm conclusions [3, 7-11]. Some evidence exists on mechanisms by which balneotherapy may improve the clinical symptoms of patients [12-15]. Notably, in some spa therapy studies, all the clinical benefits could not only be attributed to balneotherapy, as complex spa therapy programs include the other balneological treatments, physical therapy modalities, and/ or exercise. Furthermore, if a patient traveled to and stayed in a health resort, climatotherapeutic effects, the changes in the environmental milieu, or escaping from daily/ work responsibilities might contribute to clinical benefits [16]. In the literature, the observed clinical benefits of balneotherapy have been attributed to a number of factors, namely, thermal, mechanical, and chemical effects [12-15]. The thermal effects, which are associated with the temperature of the water, cause vasodilation, enhance muscle relaxation, decrease pain by the gate control theory, or induce some immune mechanisms [12, 13, 17-21]. The mechanical effects, which are associated with the hydrostatic pressure and buoyancy of the water, may induce some physiological reactions such as an increase in diuresis, and cardiac output [22, 23]. The chemical effects, which are associated with the chemical composition of the water, may induce some biological activities (increase or decrease in immune mechanisms, inflammation, and/ or oxidative stress) [12-15, 24-28]. Although there is increased attention to the effects of salt, sulfur, radon, and carbon dioxide [29-32], the evidence on their specific biological effects is not yet conclusive. Overall, evidence on mechanisms of action of balneotherapy is still evolving and accumulating; therefore, further studies evaluating the hypothesis that balneotherapy has an influence on physiological mechanisms, immune system, inflammation, and oxidative stress are required to confirm/ verify/ expand pathophysiological mechanisms of balneotherapy demonstrated in preliminary studies up to now.
Clinical trials performed in Europe, Turkey, and Israel have shown clinical benefits of spa therapy/
REFERENCES
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FUNDING
None.
AUTHOR CONTRIBUTIONS
Conception and design of the hypothesis: SK, MK; drafting the manuscript: SK; critical revision of the article: SK, MK; approval of the final version to be submitted: SK, MK.
CONFLICT OF INTEREST
The authors have no conflict of interest in this study.
ACKNOWLEDGMENTS
The authors thank Armen Yuri Gasparyan (Teaching Trust of the University of Birmingham, UK) for his help in conceiving the study topic.
ETHICS APPROVAL
Not applicable.
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ОРТАЛЫК АЗИЯ КУРОРТТАРЫ МЕН САНАТОРИЙЛЕР1 YШIН БАЛНЕОТЕРАПИЯНЫН ПАТОФИЗИОЛОГИЯЛЫК МЕХАНИЗМ1Н1Н ПОТЕНЦИАЛДЫ МYМКIНДIКТЕРI ТYйiндеме
Курортты терапия дэлелдi медицинага непзделген жэне курортты; жерлерде немесе санаторийлерде ;олданылатын процедуралар мен емдiк к-шараларды ;амтиды. Минералды суга батырылатын бальнеотерапия курортты; емдеу багдарламаларындагы негiзгi бальнеологиялы; эдiс болып табылады. Еуропада, Туркияда жэне Израильде жYргiзiлген клиникалы; зерттеулер бальнеотерапияныц тиiмдiлiгiн кейбiр ауруларда керсеттк негiзiнен ревматизммен, тарек-;имыл аппараты ауруларында, сондай-а; дерматологиялы; аурулар кезiнде. Эдебиетте бальнеотерапияныц пациенттердiц жащайын жа;сарту механизмдерi аз сипатталган жэне толы; зерттелмеген. Алайда алдын-ала ЖYргiзiлген зерттеулердiц кейбiр деректерi бальнеотерапия организмнiц физиологиялы; процестерше, иммунды; жYйеге/ ;абыну жэне тотыгу процестерiне эсер етедi деген гипотезаны тужырымдауга мYмкiндiк бередi. ^азiргi уа;ытта Еуропаныц, ТYркияныц жэне Израильдiц клиникалы; практикасы мен гылыми тэжiрибесiн Орталы; Азияныц курорттары мен санаторийлерiне экстраполяциялауга MYмкiндiк бар. Алайда, Орталы; Азиядагы курорттар мен санаторийлердiц аймацтык; жащайларында бальнеотерапияны ;олданудыц клиникалы; тиiмдiлiгi/ ;аушаздМ жэне механизмдерi туралы зерттеулер ;ажет.
ТYйiн сездер: спа-терапиясы, бальнеотерапия, иммунды; жYйе/ ;абыну, тотыгу стрессi/ Орталы; Азия
Дэйексез Yшiн: Кардес С., Карагюле М. Орталы; азия курорттары мен санаторийлерi Yшiн балнеотерапияныц патофизиологиялы; механизмшщ потенциалды мYмкiндiктерi. Медициналы; гипотеза мен этиканыц Орта Азиялы; журналы. 2020; 1(2): 131-135. https://doi.Org/10.47316/caimhe.2020.1.2.05
ПОТЕНЦИАЛЬНЫЕ ВОЗМОЖНОСТИ ПАТОФИЗИОЛОГИЧЕСКИХ МЕХАНИЗМОВ БАЛЬНЕОТЕРАПИИ ДЛЯ КУРОРТОВ И САНАТОРИЕВ ЦЕНТРАЛЬНОЙ АЗИИ
Резюме
Курортная терапия включает в себя процедуры и методы лечения, основанные на доказательной медицине и используемые в курортных зонах или санаториях. Бальнеотерапия, представляющая собой погружение в минеральную воду, является основным бальнеологическим методом в программах санаторно-курортного лечения. Клинические испытания, проведенные в Европе, Турции и Израиле показали эффективность бальнеотерапии при некоторых заболеваниях: главным образом, связанных с ревматизмом, при заболеваниях опорно-двигательного аппарата, а также при дерматологических заболеваниях. Механизмы, с помощью которых бальнеотерапия улучшает состояние больных недостаточно описаны в литературе и плохо изучены. Однако некоторые данные предварительных исследований позволяют сформулировать гипотезу о том, что бальнеотерапия оказывает воздействие на физиологические процессы организма, иммунную систему, воспалительные и окислительные процессы. На данный момент есть возможность экстраполяции клинической практики и научного опыта Европы, Турции и Израиля на курорты и санатории Центральной Азии. Однако необходимы исследования клинической эффективности, безопасности и механизмов использования бальнеотерапии в региональных условиях курортов и санаториев Центральной Азии.
Ключевые слова: спа-терапия, бальнеотерапия, иммунная система, воспаление, окислительный стресс, Центральная Азия
Для цитирования: Кардес С., Карагюле М. Потенциальные возможности патофизиологических механизмов бальнеотерапии для курортов и санаториев Центральной Азии. Центральноазиатский журнал медицинских гипотез и этики. 2020; 1(2): 131-135. https:// doi.org/10.47316/cajmhe.2020.1.2.05
