Balneotherapy: Clinical Spa Therapy in Europe and What Trials Found
What balneotherapy and spa therapy are, how European thermal programs work, and what Cochrane and other reviews found for arthritis, fibromyalgia, back pain and skin problems.
Content last updated . This page has not been medically reviewed.
What is Balneotherapy (Spa Therapy) good for?
What the body uses it for, and how strong the evidence is. A normal job in the body is not proof that extra supplements add benefit; each card says which.
Fibromyalgia
Preliminary or mixedA meta-analysis of 11 randomized trials with 672 people found very low to moderate certainty evidence that balneotherapy can help pain and quality of life; effects on tenderness and depression varied. The authors call for larger, longer trials.
Supplements: Promising but limited; low-certainty evidence.
Low back pain (crenobalneotherapy)
Preliminary or mixedA review of 26 trials with 2,695 patients found some good-quality trials allow considering it a potential treatment, but the role of the mineral water itself remains uncertain.
Supplements: Promising but limited.
Osteoarthritis
Preliminary or mixedThe older Cochrane review (7 trials, 498 people) found silver-level evidence of benefit for mineral baths versus no treatment, but weak study quality. A 2023 systematic review of 17 studies found all reported improvement, with quality often not high.
Supplements: Promising but limited; quality weak.
Rheumatoid arthritis
Not enough evidenceThe Cochrane review (9 studies, 579 people, most at unclear risk of bias) found evidence insufficient to show balneotherapy beats no treatment, other bath types, mudpacks, exercise or relaxation.
Supplements: Insufficient evidence.
Spondyloarthritis
Not enough evidenceA systematic review of nine trials, only two with high validity, said the evidence is not sufficient to prove efficacy.
Supplements: Insufficient evidence.
Skin conditions (eczema, psoriasis, itch)
Not enough evidenceA French dermatology paper by an author affiliated with a thermal spa lists eczema, psoriasis, chronic itch and wound healing problems as main indications. No independent trials were read for this item.
Supplements: Proper evidence not found in the sources we read.
Quality of spa therapy trials
Not enough evidenceA 2014 review of 51 spa therapy trials scored their reporting a mean of 10.8 out of 19 on a checklist; details such as the care provider's qualification were often missing.
Supplements: Weak reporting means results should be read cautiously.
Mineral water: which part helps is unclear
Lab or animal research onlyReviewers credit the physical and chemical properties of mineral water, but the low back pain review says the role of the mineral water remains uncertain. A program bundles warm water, minerals, exercise and rest.
Supplements: Mechanism proposed, not established.
Connected topics
Open a group to see how each topic connects and how strong the evidence is.
Health goals (1)
- Joint SupportPreliminary or mixed
Osteoarthritis evidence promising but weak in quality.
Body systems (3)
- Bones, Joints & MusclesPreliminary or mixed
Promising but limited for osteoarthritis, fibromyalgia and low back pain; insufficient for rheumatoid arthritis.
- Musculoskeletal SystemPreliminary or mixed
Joint and back conditions: promising but limited.
- Pain & InflammationPreliminary or mixed
Pain outcomes improved in fibromyalgia and back pain reviews with low-certainty evidence.
Body parts (2)
Functional actions (2)
- Joint SupportPreliminary or mixed
Osteoarthritis reviews promising but weak.
- Pain ReliefPreliminary or mixed
Pain improved in fibromyalgia and back pain reviews; certainty low.
Conditions & symptoms (3)
- Chronic OsteoarthritisPreliminary or mixed
Cochrane silver-level evidence versus no treatment, weak trial quality.
- FibromyalgiaPreliminary or mixed
Meta-analysis of 11 trials: benefit for pain and quality of life, very low to moderate certainty.
- Low Back PainPreliminary or mixed
26 trials; some good-quality trials support it as a potential treatment; role of mineral water uncertain.
Documented risks and interactions (1)
- Adverse events are poorly reported. The Cochrane osteoarthritis review says adverse events were not measured or found in the included trials; the Cochrane rheumatoid arthritis review says most included studies did not report withdrawals due to adverse events or serious adverse events.
What it is
Cochrane reviewers define balneotherapy as bathing in natural mineral or thermal waters (for example mineral, sulphur or Dead Sea baths), using mudpacks, or both [1]. A review of back pain trials describes "crenobalneotherapy" as a treatment commonly used in Europe and the Middle East that uses mineral water, sometimes combined with other hydrotherapy techniques [2]. The terms are compared in hydrotherapy, balneotherapy and spa therapy compared. As used in the trials below, balneotherapy is a treatment program, which is different from a wellness day at a spa.What a program looks like
One French dermatology paper says a thermal stay is based on a program of daily care over about three weeks at a thermal station [3]. Programs differ by country and condition, and trials used varied water types, durations, temperatures and ingredients [4]. We give no personal duration or temperature, because limits depend on the person. A caution on that dermatology paper: its author is listed as a medical adviser to a thermal spa, and it describes thermalism as having well-documented benefits [3]. Treat it as an insider view, not independent evidence.How it is thought to work
This is proposed, not established. Reviewers attribute effects to the physical and chemical properties of thermal mineral water [5], but when low back pain trials were reviewed the role of the mineral water remained uncertain [2]. Spa programs bundle several things, such as warm water, minerals, exercise and rest, so a trial of a whole program cannot show which part helped.What trials found
Evidence here is for specific conditions, not a general cure. Water trials cannot be blinded, so self-reported pain may reflect expectation.| Condition | What the source found | Strength |
|---|---|---|
| Rheumatoid arthritis | Cochrane (9 studies, 579 people, unclear bias in most domains): evidence insufficient to show balneotherapy beats no treatment or exercise, or that one bath type beats another [1]. A less strict 2012 review of Dead Sea studies was more positive, concluding that Dead Sea mud and balneotherapy were beneficial in rheumatoid arthritis, but those studies are whole Dead Sea programs (sun, water, mud), so the effect of the bath alone cannot be separated [10]. | Insufficient evidence (Cochrane trial review); a Dead Sea program review is more positive |
| Osteoarthritis | An older Cochrane review (7 trials, 498 people) found silver-level evidence for mineral baths against no treatment, but weak study quality [6]. A 2023 review of 17 studies found all reported improvement, with quality often not high [5]. | Promising but limited |
| Fibromyalgia | A meta-analysis of 11 trials (672 people) found benefit for pain and quality of life, with very low to moderate certainty and varied regimens [4]. | Promising but limited |
| Low back pain | A review of 26 trials (2695 patients): some good-quality trials support it as a potential treatment, but the role of mineral water is uncertain [2]. | Promising but limited |
| Spondyloarthritis | Nine trials, only two with high validity. The review says it is not sufficient to prove efficacy [7]. | Insufficient evidence |
Study quality is itself a limit. A 2014 review of 51 spa-therapy trials gave their reporting a mean score of 10.8 out of 19 on a checklist, with details often missing, including the qualification and experience of the care provider [8].
Skin conditions
A paper by a spa-affiliated French dermatologist lists the main indications as eczema, psoriasis, chronic itch and wound healing disorders [3]. We did not find independent trials in the records we read. See hydrotherapy for skin conditions.Insurance and coverage
Rules differ by country and are not described in the sources we read. A 2026 economic study used French national health insurance data and reports 441,776 patients had rheumatology-oriented spa treatment in France in 2024 [9]. Its authors include the chair of a scientific council of a thermal research association and a former delegate of the national council of thermal establishments, so it is not an independent source [9]. Rules on who is covered, for how long and at what cost: Proper evidence not found. We searched PubMed and the web for European coverage rules, the French national insurer's page returned an access error and the web results were tourism and tax sites. See insurance and coverage for aquatic and spa therapy and cochrane and guideline views on balneotherapy. We give no prices.Who should seek conventional care first
Anyone with new, worsening or unexplained joint pain, back pain with numbness or weakness, or skin changes should see a clinician first. Balneotherapy is at most an add-on.Related pages
Hot springs and thermal baths, hydrotherapy for osteoarthritis and rheumatoid arthritis and Japanese onsen.Frequently asked questions
What is balneotherapy?
Bathing in natural mineral or thermal waters, with or without mudpacks, as a treatment [1].
Does balneotherapy work for arthritis?
For rheumatoid arthritis, Cochrane found evidence insufficient [1]. For osteoarthritis, evidence is promising but weak in quality [6][5].
Does it help fibromyalgia or back pain?
A meta-analysis found benefit for fibromyalgia with low certainty [4]. Back pain trials are mixed in quality, and the role of mineral water is uncertain [2].
Is it covered by insurance?
It depends on the country and program. We did not find coverage rules in sources we could read [9].
Is it safe?
In the osteoarthritis trials Cochrane reviewed, adverse events were not measured or found, so safety is not well described [6]. Heat cautions still apply.
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
Safety first
Side effects and safety
Training and regulation
References
- Verhagen AP et al. Balneotherapy (or spa therapy) for rheumatoid arthritis. Cochrane Database Syst Rev 2015;(4):CD000518. PubMed 25862243 Read 2026-10-22.
- Forestier R et al. Crenobalneotherapy for low back pain: systematic review of clinical trials. Int J Biometeorol 2022;66(1):13-23. PubMed 34625843 Read 2026-10-22.
- Guerrero D. La cure thermale en dermatologie, mode d'emploi (Use of thermal cures in dermatology). Ann Dermatol Venereol 2020;147(1S):1S44-1S48. PubMed 31986298 Read 2026-10-22 (abstract; author affiliated with a thermal spa).
- Cao CF et al. Balneotherapy for fibromyalgia syndrome: a systematic review and meta-analysis. J Clin Med 2021;10(7):1493. PubMed 33916744 Read 2026-10-22.
- Protano C et al. Balneotherapy for osteoarthritis: a systematic review. Rheumatol Int 2023;43(9):1597-1610. PubMed 37301799 Read 2026-10-22.
- Verhagen A et al. Balneotherapy for osteoarthritis: a Cochrane review. J Rheumatol 2008;35(6):1118-1123. PubMed 18464302 Read 2026-10-22.
- Forestier R, Bugnard A, Thomas T. Balneotherapy in spondyloarthropathy: a systematic review. Therapie 2022;77(6):723-730. PubMed 35606192 Read 2026-10-22.
- Kamioka H et al. Assessing the quality of study reports on spa therapy based on randomized controlled trials by the spa therapy checklist (SPAC). Complement Ther Clin Pract 2014;20(4):317-333. PubMed 25179406 Read 2026-10-22.
- Montastruc JL, Bouvier CE. Impact of balneotherapy on drug consumption: a systematic review and an economic evaluation of drug deprescribing. Int J Biometeorol 2026;70(6):186. PubMed 42268419 Read 2026-10-22 (authors declare ties to thermal organisations).
- Katz U, Shoenfeld Y, Zakin V, Sherer Y, Sukenik S. Scientific evidence of the therapeutic effects of Dead Sea treatments: a systematic review. Semin Arthritis Rheum 2012;42(2):186-200. PubMed 22503590 (abstract read via Europe PMC) Read 2026-10-24.