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Author Topic: Hot sand baths (psammotherapy): A systematic review  (Read 305 times)

YanTing

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Hot sand baths (psammotherapy): A systematic review
« on: March 26, 2019, 09:38:11 AM »

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Complementary Therapies in Medicine
Volume 42, February 2019, Pages 1-6

Hot sand baths (psammotherapy): A systematic review
MicheleAntonelli (a,b), DavideDonelli (a)

a Terme di Monticelli, Via delle Terme, Monticelli Terme (Parma), 43022, Italy
b Institute of Public Health, Department of Medicine and Surgery, University of Parma, Via Volturno 39, Parma, 43125, Italy

Abstract

Introduction: Psammotherapy is a traditional practice in which hot sand baths are employed for therapeutic purposes. This systematic review aims to investigate the potential efficacy of psammotherapy in the treatment of any disease.
Methods: Medline via PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar were searched for articles describing studies on the efficacy of psammotherapy in patients with different health conditions. Articles were screened by the two author independently and, in case of disagreements, items were discussed until consensus was reached. All relevant clinical outcomes (symptom and pain relief, modifications in any functional and laboratory parameter, changes in drug consumption, variations of quality of life) were extracted from included studies.
Results: After article screening and selection, three studies were included in the review. One study involved patients with chronic obstructive pulmonary disease, while in the other two studies patients with rheumatoid arthritis were recruited. Included trials indicate that psammotherapy might be useful for the management of studied diseases.
Discussion: Based on available data, no conclusions can be driven on the clinical efficacy of psammotherapy. However, very limited evidence suggests that hot sand baths might be useful in improving symptoms and functionality of patients with some rheumatic and respiratory chronic illnesses. Further studies are encouraged to better assess the clinical efficacy of hot sand baths.

Free full text:
https://www.sciencedirect.com/science/article/pii/S0965229918309695


Excerpts:

"Psammotherapy is a traditional therapeutic practice in which baths with hot sand are used for the treatment of several chronic conditions, mainly rheumatic musculoskeletal diseases.1,2 Psammotherapy is defined as an 'external thermal therapy that uses dry heat' 2 and may be classified as a balneological intervention, along with balneotherapy, mud therapy, and hay baths.3 Psammotherapy has long been practiced in several coastal and desert regions, mainly depending on local traditions and availability of sand as a natural resource, and evidence of its use dates back to ancient Rome.4 Sand baths are still practiced today in several countries, including Italy,5 Portugal,6 Japan,7 China,8 Iran,9 Morocco,10 and Egypt.11

"Psammotherapy is a multicomponent treatment which combines the action of high-temperature thermal therapy with the effects of a chemo-physical and bioclimatic therapy.1,2 Sand baths are often administered outdoor and each session lasts 20–40 min, followed by a resting 'reaction' period of 20 min.1,2 Patients lay in 2 x 1 m sand holes with a depth of 20–30 cm and are covered with a 3–7 cm layer of dry hot sand which is ready to use when its temperature under the surface reaches 50–60°C due to solar heating.1 Head, neck and sometimes even the anterior part of the thorax are not covered with sand.1,11 Psammotherapy is sometimes combined with other spa treatments such as thalassotherapy, namely sea water baths, even thanks to the availability of both hot sand and sea water in maritime regions.1,2,6 Sand composition varies according to geologic and environmental characteristics, although it is usually rich in silicate and carbonate minerals containing elements like calcium, potassium, sodium, aluminum, silicon, magnesium, and iron.1,6

"Although few studies have been carried out to assess the efficacy of psammotherapy, its traditional indications are osteoarthritis, traumatic injury outcomes, articular or extra-articular chronic rheumatic conditions, osteoporosis, gout, and fibromyalgia syndrome,1,26"

"Globally, included studies indicate that psammotherapy may be useful for the management of two chronic diseases, namely rheumatoid arthritis and chronic obstructive pulmonary disease."

"Available evidence on psammotherapy is therefore very limited and, although encouraging, doesn’t allow to precisely determine whether hot sand baths are effective for treating any health condition. However, psammotherapy might be useful in some rheumatic or respiratory chronic diseases.

"Important factors which can determine the effects of psammotherapy on the cutaneous, musculoskeletal, cardiovascular and neuro-vegetative systems are hypothesized to be the chemo-physical characteristics of different types of sand, electric charges of single elements, solar ray absorption, reflection and filtration by sand crystals, and skin brushing of sand grains.1, 2 Interaction between sand and skin microbiome may play a role too. Placebo effects, namely the patient-physician relationship, the rituality of the treatment, and characteristics of the setting, can also be important in enhancing the overall therapeutic effect of sand baths.20, 21

"Studies with animal models seem to confirm that sand baths may be useful in the treatment of chronic rheumatic diseases, promoting blood circulation and decreasing joint inflammation in rabbits with knee osteoarthritis.22 Further evidence from studies about physiological changes induced by psammotherapy highlight that hot sand baths can significantly improve body temperature, blood flow and reduce peripheral arterial resistance,8,15,23 therefore hypothesizing potential benefits for patients with diseases like knee osteoarthritis.25, 26 Moreover, psammotherapy can ease the diffusion of sand minerals to deeper skin layers, where they can exert their action, and facilitate their absorption, thanks to the capability of hot and occlusive sand baths of increasing skin permeability.27, 28 In fact, it is hypothesized that, during psammotherapy, the acidic body sweat can dissolve sand carbonate bioclasts and calcareous algae, thus enriching the liquid biofilm at the body-sand interface with elements like calcium and magnesium, whose absorption is improved by hot seawater baths which usually follow psammotherapy sessions.29 Beneficial effects on respiratory illnesses of sand baths may also depend on their broncho-dilating and anti-inflammatory effects11 and on the patient exposure to marine aerosol, naturally rich in vaporized seawater, ions and other volatile compounds.1,2,30

"Given that psammotherapy can be considered as a balneological intervention3 and that scarce evidence has been collected on its specific mechanisms of action, it can be useful to refer to studies about biochemical effects of spa therapy with hot mineral waters and muds, especially in patients affected by rheumatic diseases.31, 32, 33 Spa therapy seems capable of increasing plasma ß-endorphin levels,31 and modulate cortisol levels in such a way as to improve stress resilience 34, 35 without disrupting its circadian rhythm.36 Mud therapy can also reduce inflammatory mediators such as prostaglandin E2 (PGE2), leukotriene B4 (LTB4), interleukin-1ß (IL-1ß), and tumour necrosis factor-a (TNF-a)."

"During each session of psammotherapy, the patient’s body temperature (measured from the right axilla) tends to rise by approximately 1°C (from 37°C to 38°C), then it decreases due to sweating and usually recovers 10 min after each treatment.16 Recent studies have highlighted the role of whole body hyperthermia in the treatment of diseases like major depressive disorder.38 From this point of view, sand bath tubs may be engineered in order to keep the body and sand temperature under control over time, thus transforming psammotherapy into a whole body hyperthermia treatment."

"Included studies involved a limited number of participants, were at unclear-to-high risk of bias, and were highly heterogeneous in terms of study design and characteristics of intervention. Evidence on the topic is scarce and, although all efforts were made to retrieve all relevant data, full texts of some articles were not available. Therefore, publication bias cannot be excluded."

"Overall, evidence from included articles is very limited and, although encouraging, doesn’t actually allow to draw any conclusion on the efficacy of this traditional therapy in clinical practice. However, considering results of all studies discussed in the review, it can be hypothesized that psammotherapy might be useful in some health conditions, mainly chronic illnesses such as rheumatic and respiratory diseases."
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