Hypertherme B

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Recent Results in Experimental Balneology
Chr. Gutenbrunner Univ.-Prof. Dr.
med. Christoph Gutenbrunner, Institut für
Balneologie und Medizinische Klimatologie in der
Klinik für Physikalische Medizin und
Rehabilitation der Medizinischen Hochschule
Hannover, Carl-Neuberg-Str. 1, D-30625 Hannover,
gutenbrunner.christoph_at_mh-hannover.de
Institut Balneologie Medizinische Klimatologie
für und
Medizinische Hochschule Hannover
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Balneologic Science
? Studies on balneologic agents or methods -
Physiologic effects (healthy subjects) ? acute
effects ? long-term exffects (adaptation)
- Clinical effects (patients with defined
health conditions ICD) ? acute
effects ? long-term exffects (efficacy) ?
Studies on complex health resort treatments
(patients with defined functional deficits
ICF) - Short-term effects (before vs. after
treatment) - Long-term-effects (e.g. 6, 12, 24
month after the treatment)
Experimental Balneology
Controlled trials!
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Recent Studies
? Hanover balneological research group (Institute
for Balneology and Medical Climatoology, Hanover
Medical School Institute for Rehabilitation
Medicine and Balneology, Bad Wildungen,
Institute for Balneology and Rehabilitation
Research, Bad Nenndorf) - Effects on the
peripheral nervous system ? Pain perception
(H2S) ? Thermosensitivity (H2S, CO2) -
Effects on skeletal muscles (NaCl) - Mineral
absorption after drinking of medicinal mineral
waters (Mg) - Influence on the renal stone
formation risk (HCO3, Mg)
Experimental Balneology
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Pain Perception (Sensitivity)
? Design of the Study - Controlled study,
cross-over-design ? Patients - Healthy subjects
(n17) ? Intervention - head-out water
immersion, sulphuric water (20 mg/l, 36C, 20
min, one arm excluded) - cold-camber expositions
(-76C, 3 min, one arm thermo-isolated) -
rest (20 min) ? Main Outcome Parameters -
pressure pain threshold (styloideus radii,
bilateral) - thermal pain thresholds (forearm,
bilateral)
Experimental Balneology
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Pain Perception (Sensitivity)
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Pain Perception (Intensity)
? Design of the Study - Controlled study,
cross-over-design ? Patients - Patients
suffering from fibromyalgia (ACR-criteria
n17) ? Intervention - head-out water
immersion, sulphuric water (20 mg/l, 36C, 20
min, one arm excluded) - cold-camber expositions
(-76C, 3 min, one arm thermo-isolated) -
rest (20 min) ? Main Outcome Parameters -
pressure pain threshold (styloideus radii,
bilateral) - thermal pain thresholds (forearm,
bilateral)
Experimental Balneology
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Pain Perception (Intensity)
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Pain Perception (Intensity)
? Design of the Study - Controlled study,
cross-over-design ? Patients - Patients
suffering from rheumatoid arthritis (n17) ?
Intervention - head-out water immersion,
sulphuric water (20 mg/l, 36C, 20 min) -
head-out water immersion, plain water (36C, 20
min) ? Main Outcome Parameter - pain (Visual
Analogue Scale) - microcirculation
(laser-Doppler-flow, forearm)
Experimental Balneology
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Pain Perception (Intensity)
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Pain Perception (Intensity)
? Design of the study - Randomised controlled
study, single blind, prospective ?
Patients - Patients suffering from fibromyalgia
(ACR-criteria n32) ? Setting - serial
bathing, 12 bathes within three weeks ? Baths
- head-out water immersion, sulphuric water
(20 mg/l, 36C, 20 min) - head-out water
immersion, plain water (36C, 20 min) ? Main
outcome parameters - Pain, other complaints,
well being - Pain thresholds
Experimental Balneology
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Pain Perception (Intensity)
Experimental Balneology
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Pain Perception (Intensity)
Parameter ? Anfang-Ende ? Anfang-Spätkontrolle

Gesamteffekt p 0,003 p 0,472

Schmerzscore n. Lautenschläger p 0,012 p 0,170
Körperliche Beschwerden p 0,011 --
Erschöpfungsgefühl p 0,001 --
Thermische Schmerztoleranz p 0,040 p 0,369
Druckschmerzschwelle p 0,068 p 0,203
Experimental Balneology
Prospektive kontrollierte Studie Patienten mit
Fibromyalgiesyndrom n 19 (Studiengruppe), n
13 (Kontrollgruppe) U1 vor der Bäderserie, U2
nach dem Bäderserie, U3 4 Monate nach der
Bäderserie
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Muscle Tension
? Study design - Controlled study in
cross-over design ? Patients - 21
patients with cLBP lasting at least for 6 weeks
(10 men, 11 women, age 47,3 2,9 years) ?
Intervention - A single brine (6 NaCl,
Solequelle Bad Münder) or tap water plain bath
(360C, 16 min) respectively ? Outcome
parameters - IEMG activity on defined
muscles (M. erector sp. cervicales et
lumbales, M. trapezius, M. ext. carpi radialis,
M. rect. abd.) - Pain intensity (VAS) -
Subjective muscle tension (Chromatic Analogue
Scale)
Experimental Balneology
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Muscle Tension
Experimental Balneology
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Muscle Tension
intervals 2-1 3-1 4-1 5-4
M. errect. spin. lumbalis (?) ? ? (?)
M. rectus abdominis ? ? (?) ?
M. ext. carpi radialis ? ? ? ?
M. trapezius pars desc. ? ? ? ?
M. errect. spin. cervicalis ? ? ? ?
under water surface
Periods 1 Lying before the bath, 2 During
immersion, 3 Lying after the bath, 4 Standing
before the bath, 5 standing after the bath,
Significance plt0,05 plt0,01
plt0,001
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Thermal Comfort (H2S)
? Design of the Study - Controlled study,
cross-over-design ? Patients - Patients
suffering from fibromyalgia (ACR-criteria
n17) ? Intervention - head-out water
immersion, sulphuric water (20 mg/l, 36C, 20
min, one arm excluded) - cold-camber expositions
(-76C, 3 min, one arm thermo-isolated) -
rest (20 min) ? Main Outcome Parameters -
pressure pain threshold (styloideus radii,
bilateral) - thermal pain thresholds (forearm,
bilateral)
Experimental Balneology
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Thermal Comfort (H2S)
Experimental Balneology
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Thermal Comfort (CO2)
? Design of the study - controlled study,
cross-over-design ? Patients - healthy subjects
(n17) ? Intervention - forearm baths with
CO2-water (16 min, 18C, 3.500 mg CO2/l)
- forearm bath with tap water (16 min,
18C) ? Main outcome parameters -
Microcirculation of the skin - Pressure- and
thermal pain thresholds - temperature
perception, local thermal comfort
Experimental Balneology
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Thermal Comfort (CO2)
Experimental Balneology
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Thermal Comfort (CO2)
Experimental Balneology
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Mineral Absorption
? Design of the study - Cross over-study,
double blind ? Patients - Healthy subjects
(n22) ? Setting - Over-night-fasting,
standardized breakfast ? Intervention - 500 ml
Mg-mineral water (281 mg Mg/l) - 500 ml
Mg-mineral water (120 mg Mg/l) - 500 ml
low-mineralized water (8 mg Mg/l) - magnesium
tablet (150 mg Mg) ? main outcome parameters -
Magnesium in plasma and urine
Experimental Balneology
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Mineral Absorption
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Mineral Absorption
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Mineral Absorption
? Design of the study - Cross over-study,
single blind ? Patients - Healthy subjects
(n10) ? Setting - Over-night-fasting,
standardised breakfast ? Intervention - 600 ml
Mg mineral water (252,5 mg Mg/l) - 800 ml Mg
mineral water (186,7 mg Mg/l) - magnesium
tablet (150 mg Mg) ? main outcome parameters -
Magnesium in plasma and urine
Experimental Balneology
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Mineral Absorption
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Renal Stone Formation Risk
? Design of the Study - Controlled study,
cross-over-design ? Patients - Patients with
multi-episodic CaOx-urolithiasis (n32) ?
Setting - Everyday activities, nutrition
protocol ? Intervention - 1,5 l/d bicarbonated
water (2.673 mg HCO3/l) - 1,5 l/d
low-mineralized water (98 mg HCO3/l) ? Main
Outcome Parameters - urinary pH, magnesium- and
citrate excretion - CaOx supersaturation
Experimental Balneology
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Renal Stone Formation Risk
Experimental Balneology
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Renal Stone Formation Risk
Experimental Balneology
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Renal Stone Formation Risk
Super-saturation CaOx Super-saturation Uric acid Super-saturation CaPO4
Controls Baseline 3,41 0,31 1,22 0,13 1,33 0,19
Controls Drinking 2,44 0,28 0,70 0,07 1,01 0,15
Bicarbonate Water Baseline 3,39 0,34 1,03 0,12 1,44 0,23
Bicarbonate Water Drinking 2,42 0,29 0,24 0,04 2,01 0,24
p (controls vs. bicarbonate water) p (controls vs. bicarbonate water) 0,958 0,000 0,001
p (baseline vs. Drinking) Controls 0,001 0,000 0,014
p (baseline vs. Drinking) Bi-carbonate Water 0,000 0,000 0,000
Experimental Balneology
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Summary
? In experimental trials relevant physiological
effects of medicinal mineral waters can be
shown, e.g. - elevation of thermal thresholds
(H2S) ? increase of thermal tolerance (H2S,
CO2) - good absorbability of relevant
electrolytes (Mg) ? In experimental trials
relevant clinical effects of medicinal mineral
waters can be shown, e.g. - analgetic effects
(H2S) - Muscle relaxation (NaCl) -
Reduction of the renal stone formation risk
(HCO3, Mg)
Experimental Balneology
Thank you!