The role of mineral elements and other chemical compounds used in balneology: data from double-blind randomized clinical trials
Key Findings
- Systematic review of 27 double-blind RCTs testing mineral water, mud, or peloid against tap water or a mineral-depleted control, isolating the specific contribution of chemical/mineral composition from heat or general spa effects
- 20 of the 27 trials covered rheumatology (1,118 patients: knee OA, hand OA, chronic low back pain, rheumatoid arthritis, osteoporosis)
- Mineral water/mud treatments produced better and longer-lasting improvements in pain, function, and quality of life than non-mineral control treatments across all rheumatology indications studied
- Only 4 of 20 rheumatology trials had high internal validity; heterogeneity in protocols and outcome measures precluded formal meta-analysis
- Notable included trial (Flusser et al. 2002): mineral-rich mud compresses outperformed mineral-depleted mud compresses for low back pain, directly isolating the mineral contribution from the mud's thermal/physical properties
A systematic review specifically designed to isolate the “mineral component” of balneotherapy, restricted to double-blind RCTs that compare mineral-rich water or mud against a mineral-depleted control — a design most balneotherapy trials cannot achieve, since they rarely separate chemical effects from heat or general spa-environment effects. Across knee and hand osteoarthritis, chronic low back pain, rheumatoid arthritis, and osteoporosis, mineral-rich treatments consistently outperformed non-mineral controls, though trial quality was uneven and heterogeneity prevented a formal meta-analysis. Not peat-specific — it covers mineral waters and peloids broadly — but it is the strongest available evidence design for the general principle that mineral content, not just heat, drives balneotherapy’s clinical effect.