Balneotherapy awareness and utilization in Italian patients with fibromyalgia: results from a national survey

Maccarone MC, Sarzi-Puttini P, Ariani A, Bortolotti R, Cozzi F, Gorla R, Guiducci S, Migliore A, Paolazzi G, Tirri E, Tirri R, Fioravanti A. Balneotherapy awareness and utilization in Italian patients with fibromyalgia: results from a national survey. Int J Biometeorol. 2026 Apr 28;70(5):141. doi: 10.1007/s00484-026-03212-6. PMID: 42047831.

Abstract

Fibromyalgia (FM) is a chronic condition characterized by widespread pain, fatigue, sleep disturbances, and cognitive symptoms. Pharmacological treatments often provide limited relief, underscoring the need for complementary approaches. Balneotherapy (BT), involving mineral waters, muds, and gases, has a long-standing European tradition for musculoskeletal and chronic pain conditions. While evidence suggests spa-based therapies in FM may reduce inflammation, alleviate pain, and improve function, patients’ awareness and access remain poorly investigated. To address this gap, a national survey was conducted by the Italian Fibromyalgia Association, the Italian Society of Rheumatology, and the World Hydrothermal Organization (Organizzazione Mondiale del Termalismo), exploring patients’ knowledge of BT, previous experiences, perceived benefits, and barriers to access. A total of 1,463 adults with FM completed the survey. Of these, 34.7% had previously undergone spa-based treatments, mainly BT and mud therapy. A major barrier to access was limited information and communication: 71.4% reported that their physician had never discussed BT as a treatment option, and 41.6% were unaware of potential coverage by the National Health Service (NHS). Despite these obstacles, 96.9% of participants perceived BT as potentially beneficial for FM management. Among those treated, 59.5% reported symptomatic relief and 48.6% reported psychological benefits. Some limitations were identified regarding the standard NHS-supported treatment model, with patients frequently suggesting distributing sessions over a longer timeframe to prevent excessive fatigue. These findings indicate that BT is highly appreciated by patients, providing concrete clinical and psychological benefits. However, its use remains limited due to low awareness and barriers to access.