Aim: To assess the levels of scientific evidence on spa interventions for chronic pain in rheumatology.

Materials and methods: A literature search was performed on Medline database: (a) meta-analysis; and (b) randomized clinical trials (RCTs), with (a) an assessment of pain; (b) the number of patients per group > 25; (c) inter-group comparison; and (d) middle- to long-term follow up.

Results: We identified 27 RCTs corresponding to 28 evaluations (one RCT evaluated both low back pain and knee osteoarthritis): 7 RCTs on chronic low back pain, 1 on chronic neck pain, 11 on knee osteoarthritis, 3 on hand osteoarthritis, 2 on fibromyalgia, 2 on rheumatoid arthritis (RA), and 2 on ankylosing spondylitis (AS). Three meta-analyses on chronic low back pain, knee osteoarthritis, and fibromyalgia were identified. The level of evidence was better for chronic low back pain and knee osteoarthritis; the results were in favor of reduction in analgesic consumption over several months after spa treatment, and improvement in function and quality of life. There were few RCTs on hand osteoarthritis, fibromyalgia, RA, and AS; and these also showed a persistent beneficial effect on symptomatic chronic pain.

Conclusion: There is a high level of evidence that spa interventions reduce chronic pain and analgesic consumption and improve function and quality of life, in chronic low back pain and knee osteoarthritis cases. But, the level of evidence was lower for hand osteoarthritis, fibromyalgia, RA, and AS. Further RCTs are needed for the conditions that have low level of evidence.