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Institut Balneologie Medizinische Klimatologie

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,

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Institut Balneologie Medizinische Klimatologie

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  1. 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@mh-hannover.de Institut Balneologie Medizinische Klimatologie für und Medizinische Hochschule Hannover

  2. 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!

  3. 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

  4. Design of the Study: - Controlled study, cross-over-design  Patients: - Healthy subjects (n=17)  Intervention: - head-out water immersion, sulphuric water (20 mg/l, 36°C, 20 min, one arm excluded) - cold-camber expositions (-76°C, 3 min, one arm thermo-isolated) - rest (20 min)  Main Outcome Parameters: - pressure pain threshold (styloideus radii, bilateral) - thermal pain thresholds (forearm, bilateral) Pain Perception (Sensitivity) Experimental Balneology

  5. Pain Perception (Sensitivity)

  6. Design of the Study: - Controlled study, cross-over-design  Patients: - Patients suffering from fibromyalgia (ACR-criteria; n=17)  Intervention: - head-out water immersion, sulphuric water (20 mg/l, 36°C, 20 min, one arm excluded) - cold-camber expositions (-76°C, 3 min, one arm thermo-isolated) - rest (20 min)  Main Outcome Parameters: - pressure pain threshold (styloideus radii, bilateral) - thermal pain thresholds (forearm, bilateral) Pain Perception (Intensity) Experimental Balneology

  7. Pain Perception (Intensity)

  8. Design of the Study: - Controlled study, cross-over-design  Patients: - Patients suffering from rheumatoid arthritis (n=17)  Intervention: - head-out water immersion, sulphuric water (20 mg/l, 36°C, 20 min) - head-out water immersion, plain water (36°C, 20 min)  Main Outcome Parameter: - pain (Visual Analogue Scale) - microcirculation (laser-Doppler-flow, forearm) Pain Perception (Intensity) Experimental Balneology

  9. Pain Perception (Intensity)

  10.  Design of the study: - Randomised controlled study, single blind, prospective  Patients: - Patients suffering from fibromyalgia (ACR-criteria; n=32)  Setting: - serial bathing, 12 bathes within three weeks  Baths: - head-out water immersion, sulphuric water (20 mg/l, 36°C, 20 min) - head-out water immersion, plain water (36°C, 20 min)  Main outcome parameters: - Pain, other complaints, well being - Pain thresholds Pain Perception (Intensity) Experimental Balneology

  11. Pain Perception (Intensity) Experimental Balneology

  12. Pain Perception (Intensity) 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

  13.  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) Muscle Tension Experimental Balneology

  14. Muscle Tension Experimental Balneology

  15. Muscle Tension = 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: * = p<0,05; ** = p<0,01; *** = p<0,001

  16. Design of the Study: - Controlled study, cross-over-design  Patients: - Patients suffering from fibromyalgia (ACR-criteria; n=17)  Intervention: - head-out water immersion, sulphuric water (20 mg/l, 36°C, 20 min, one arm excluded) - cold-camber expositions (-76°C, 3 min, one arm thermo-isolated) - rest (20 min)  Main Outcome Parameters: - pressure pain threshold (styloideus radii, bilateral) - thermal pain thresholds (forearm, bilateral) Thermal Comfort (H2S) Experimental Balneology

  17. Thermal Comfort (H2S) Experimental Balneology

  18. Thermal Comfort (CO2)  Design of the study: - controlled study, cross-over-design  Patients: - healthy subjects (n=17)  Intervention: - forearm baths with CO2-water (16 min, 18°C, 3.500 mg CO2/l) - forearm bath with tap water (16 min, 18°C)  Main outcome parameters: - Microcirculation of the skin - Pressure- and thermal pain thresholds - temperature perception, local thermal comfort Experimental Balneology

  19. Thermal Comfort (CO2) Experimental Balneology

  20. Thermal Comfort (CO2) Experimental Balneology

  21.  Design of the study: - Cross over-study, double blind  Patients: - Healthy subjects (n=22)  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 Mineral Absorption Experimental Balneology

  22. Mineral Absorption

  23. Mineral Absorption

  24. Mineral Absorption  Design of the study: - Cross over-study, single blind  Patients: - Healthy subjects (n=10)  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

  25. Mineral Absorption

  26. Design of the Study: - Controlled study, cross-over-design  Patients: - Patients with multi-episodic CaOx-urolithiasis (n=32)  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 Renal Stone Formation Risk Experimental Balneology

  27. Renal Stone Formation Risk Experimental Balneology

  28. Renal Stone Formation Risk Experimental Balneology

  29. Renal Stone Formation Risk Experimental Balneology

  30. 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!

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