Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

• How effective is Balneotherapy—the therapeutic use of mineral and thermal waters -- for improving the mobility of patients suffering from chronic diseases such as rheumatoid arthritis, fibromyalgia, low back pain, and resulting depression from pain & reduced quality of life

compared to allopathic /pharmacological interventions?

• What is the effectiveness of using Balneotherapy in combination with pharmacological interventions?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

?Balneotherapy versus allopathic/ pharmacological interventions.

?Balneotherapy in combination with pharmacological interventions.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

• People with chronic diseases including rheumatoid arthritis, fibromyalgia and low back pain.
• Rheumatoid arthritis currently affects 1.3 million Americans, of which 2/3 of the patients are women.
• Minorities are disproportionally affected by arthritis
• The typical patient age is between 40-60 years

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

• Elderly
• Women
• Minorities

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

• Alleviation of chronic pain
• Mobility enhancement
• Reduced Depression
• Improved quality of life

Describe any health-related risks, side effects, or harms that you are concerned about.

• Conditions involving high fevers
• Extreme Hypertension
• Malignant tumors and cancerous conditions
• Extreme Liver, kidney, or circulation disorders
• Conditions presenting the risk of hemorrhaging
• Anemic Conditions

Pregnancy

• Congestive heart failure, recent stroke, or recent heart attack

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Arthritis and nontraumatic joint disorders
• Depression and other mental health disorders
• Functional limitations and disability

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Balneotherapy has been used consistently in countries around the world to address rheumatoid arthritis, fibromyalgia and chronic low back pain.

Balneotherapy doctors complete specialization courses that cover the curative values of the different kinds of mineral waters, which include bathing & drinking mineral water therapies, as well as using medicinal mud applications.

There is a significant body of literature of double blind studies that can be found through MEDLINE, that has proven that natural mineral water’s have a definitive curative effect that is significantly higher than simply using drugs or bathing in ordinary tap water.

Additionally, Balneotherapy has been shown to reduce dependency on pharmacological interventions, improving health outcomes and reducing side effects of treatment. It thus has the potential to significantly reduce costs of medical care and improve outcomes.

Balneotherapy also is a “green” medicine intervention as it is a renewable and natural resource, and widely & cheaply available to the public.

There have been extensive studies of the harmful impacts of excessive amounts of pharmaceutical drugs now in our fresh water supplies, as well as entering into the oceans which is changing the biology of our children and numerous other species. Balneotherapy could potentially reduce the flow of pharmacological agents into our water supply and reduce the environmental impact of drug use.

Today, the US has a rapidly growing aging population and chronic illness is a growing component of medical costs and demand for services.

Our contemporary medical system primarily uses drug therapy to treat chronic illnesses, and it is expensive. The long-term use of drugs to alleviate chronic pain, especially anti-inflammatory, has serious medical consequences to the patient.

The combined annual medical costs for osteoarthritis and other joint diseases is $34 billion. Back pain costs as much as $50 billion a year for medical car

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Balneotherapy is widely used as an efficacious medical practice in countries around the world, however, today in the United States it is not recognized thus it is not a reimbursable service under public and most private insurance plans.

As members of “BANA: The Balneotherapy Association of Northern America”, a non-profit organization, our mission is to re-establish Balneotherapy and its corollary practices of Crounutherapy, Peliotherapy and Climatherapy-- as a fully recognized medical practice & profession here in the U.S.

We are committed to supporting the research on the health benefits of natural mineral waters, as well as highlighting additional benefits of being safe, effective, inexpensive, and a greener alternative that should be made widely available to the American public.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Yes. Practitioners are often at a loss to treat pain associated with chronic illnesses with interventions and typically turn to pharmacologic choices because it is currently the primary venue available. In addition to posing an economic burden on consumers, particularly for those on fixed incomes, drugs associated with pain reduction often cause side effects; they can be toxic to the liver and tissues when used for long periods of time and they can increase the body’s natural resistance to medication and promote the need for higher doses or stronger medication.

Arthritis, fibromyalgia, low back pain and the subsequent depression that results from chronic pain, can be debilitating illnesses that significantly impair the activities of daily living and reduce quality of life. Balneotherapy is an inexpensive, accessible and safe intervention that has demonstrated effectiveness to reduce pain and increase mobility

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

There is currently a growing interest in the United States in the field of Balneotherapy among people suffering from chronic pain, as well as within the alternative medical practitioners & natural mineral water spa owners. If this research reveals the benefits of Balneotherapy, it would serve to stimulate increased use of natural mineral waters, which would lead to the development of a new medical field, and ultimately led to a more cost effective way to treat people suffering from these diseases.

Describe the timeframe in which an answer to your question is needed.

As soon as possible

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Arthritis and fibromyalgia disproportionately affect minorities, women & the elderly

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

There is currently a growing interest in the United States in the field of Balneotherapy among people suffering from chronic pain, as well as within the alternative medical practitioners & natural mineral water spa owners. If this research reveals the benefits of Balneotherapy, it would serve to stimulate increased use of natural mineral waters, which would lead to the development of a new medical field, and ultimately led to a more cost effective way to treat people suffering from these diseases.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program