The effect of balneotherapy and physical therapy applied to patients with chronic lack pain on pain intensity, quality of life, disability and mental symptoms

Abstract

Aims: The aim of present study was to evaluate effects of balneotherapy and physical therapy combination against only physical therapy on pain, guality of life, disability and psychological symptoms in chronic low back pain. Methods: Sixty patients with chronic low back pain were included in the study. Patients were divided into two groups: Balneotherapy and physical therapy group (n=30) and physical therapy group (n=30). Balneotherapy group hospitalized for 20 minutes a day every day for 3 weeks to balneotherapy sessions with 40°C thermomineral water and 5 days a week for 3 weeks to 15 sessions of physical therapy session. Physical therapy group recieved 5 days a week for 3 weeks to 15 sessions of physical therapy session in the treatment unit Both groups recieved ultrason treatment which has 1.5W/cm 2 dose and 1MHz frequency for 6 minutes, Transcutaneous Electrical Nerve Stimulation (TENS) (50-100 Hz) for 20 minutes and hot pack for 20 minutes as physical therapy. Patients in both groups were given a patient-based standardized lumbar exercise in addition to physical therapy. The following parameters were measured: Visual Analog Scale (VAS) for pain intensity, Short Form-36 (SF-36) to evaluate guality of life, Oswestry Disability lndex (ODI) to evaluate functional disability and Symptom Check List-90 to query psychological symptoms. First evaluations were done at the beginning of treatment and second evaluations were done at the end of treatment before and after treatment. Results: We observed more significant decrease in VAS scores in the group administered balneotherapy (FT+BT) and physical therapy compared with the group treated only physical therapy (FT) (p0,05). At the end of treatment in FT+BT group subscale of guality of life; Physical role limitations, mental health, pain and general health were significantly higher than the FT group (p0,05). In FT+BT group except social functioning and in FT group except vitality and general health, ali other dimensions of guality of life showed significant improvement (p0,05). Although pretreatment disability rate of FT+BT is more, in this group decline of scores were more (30.4% to 14.2%). When compared to before and after treatment scores on the SCL-90 sub-parameters in FT+BT individuals were significantly different in ali the sub-parameters but in FT group except phobic anxiety and paranoid ideation, found significant differences in other parameters (p0,05). In addition the decline of statistically significant decrease in the parameters was observed lesser extent in FT group compares to FT+BT group. Conclusions: In present study we observed that balneotherapy in addition to physical therapy against routin physical treatment program showed more decline in pain and functional disability, more increase in guality of life and more improvements in psychological symptoms in addition relationship between psychologic symptom scores and disability is stronger than the relationship between psychologic symptom scores and pain scores.