LAUSR

Chronic low back pain (CLBP) is one of the most important causes of workplace absenteeism with deleterious social and economic consequences. Several factors are involved in CLBP development, such as lumbar spine osteoarthritis that is a degenerative process characterized by functional limitations, and significant psychological distress with a negative effect on Quality of Life (QOL) [1]. There is the literature that reports that mood disorders, such as anxiety and depression, are often associated with CLBP caused by lumbar spine osteoarthritis [2], which, in turn, might cause insomnia [3]. Given the very high prevalence of CLBP, physicians are interested in testing feasible therapeutic interventions, including those representing complementary medicine, such as sulphurous mud-bath therapy, a salus per aquam (spa) treatment, commonly prescribed to contrast CLBP caused by lumbar spine osteoarthritis [4]. This technique includes mud made up by a combination of clay and sulphurous mineral water, leaving on 6–8 months until maturation. Nowadays, data on the efficacy of such approach on psychological discomfort and insomnia, often present in the patients suffering from CLBP caused by lumbar spine osteoarthritis, are very scarce. Starting from this evidence, the aim of the present study was to investigate whether sulphurous mud-bath therapy modifies the components of the CLBP, including pain perception and tuning, disability function, depression, and insomnia that all together affect the QOL of patients suffering from CLBP associated with lumbar spine osteoarthritis. A prospective, longitudinal, observational study was conducted at the Telese spa (Telese Terme—Benevento, Italy) on 47 Caucasian patients (40% male, mean age 63 ± 9 years and BMI range 21.6–41) with CLBP treated with one cycle of 12 applications of sulphurous mud packs (with 5 cm height of the mud layer), one a day, in the morning, preferably in fasting condition, applied to the lumbo-sacral region of the spine for 15 min. at 44 °C, followed by a cleansing shower and a thermal bath in sulphurous mineral water at 38 °C for 10 min. The control group was represented by 10 patients (30% male, mean age 58 ± 9 years and BMI range 20–35) who had tap water baths only, at 38 °C for 10 min. one a day for 2 weeks. All the recruited subjects were referred to the center as outpatients. Nobody underwent any other pharmacological or instrumental treatment beyond those foreseen by the protocol (mud therapy or bath in tap water for the control group). The study was conducted in accordance with the guidelines of the Declaration of Helsinki and its amendments and all participants provided their informed consent. Moreover, it was compliant with the standards for the reporting of interventional trials assessing spa therapy, and was written according to the SPAC checklist developed using the Delphi consensus method [5]. All enrolled patients received a diagnosis of lumbar spine osteoarthritis, assessed by clinical and radiological Maria Costantino and Valeria Conti These authors equally contributed to the article.