Clinical efficacy of peloidotherapy on pain, sleep quality, and central sensitization-related symptoms in chronic low back pain: a comparative analysis.
Yılmaz N & Özkuk K • International journal of biometeorology • 2026
Both peloidotherapy and electrotherapy significantly improved pain and central sensitization-related measures in chronic low back pain, but peloidotherapy demonstrated significantly superior outcomes in pain intensity, sleep quality, and health status, though no specific superior effect on central sensitization inventory scores was demonstrated compared to electrotherapy.
Key Findings
Results
Both the Peloidotherapy Group and Electrotherapy Group showed significant within-group improvements in most clinical outcomes after 15 sessions of treatment.
74 patients were randomized into two groups in a prospective, randomized, single-blind study design.
Electrotherapy Group (EG) received hot pack + TENS + exercise; Peloidotherapy Group (PG) received peloidotherapy + TENS + exercise.
Treatments were administered 5 days per week for 3 weeks (15 sessions total).
Within-group improvements were significant for most outcomes (all p < 0.001) in both groups.
The exception was the EQ-5D index in the Electrotherapy Group, which did not show significant within-group improvement.
Results
Peloidotherapy demonstrated significantly superior post-treatment pain intensity reduction compared to electrotherapy.
Between-group comparison using ANCOVA adjusted for baseline values and pain duration showed significant superiority of PG over EG on VAS scores (p = 0.006).
Adjusted delta score analysis confirmed significantly greater improvement in VAS in the PG compared to EG (p = 0.026).
Pain was assessed using the Visual Analog Scale (VAS).
Both groups received TENS and exercise as shared components, suggesting the peloid component drove the differential improvement.
Results
Peloidotherapy resulted in significantly superior improvements in sleep quality compared to electrotherapy.
ANCOVA-adjusted between-group comparison showed significant superiority of PG over EG on Pittsburgh Sleep Quality Index (PSQI) scores (p = 0.044).
Adjusted delta score analysis also confirmed significantly greater improvement in PSQI in the PG compared to EG (p = 0.044).
Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI).
The PSQI measures overall sleep quality, with higher scores indicating worse sleep.
Results
Peloidotherapy produced significantly superior improvements in health-related quality of life as measured by the EQ-5D index compared to electrotherapy.
ANCOVA-adjusted between-group comparison showed significant superiority of PG over EG on EQ-5D index scores (p = 0.004).
Adjusted delta score analysis confirmed significantly greater improvement in EQ-5D index in the PG compared to EG (p = 0.004).
The EQ-5D index improvement was not significant within the EG group alone.
No significant between-group difference was observed for the EQ-5D VAS component (p > 0.05).
Results
No significant between-group differences were found for central sensitization inventory scores, disability, fatigue, or the EQ-5D VAS.
No significant between-group differences were observed for Central Sensitization Inventory (CSI), Quebec Back Pain Disability Scale (QBPDS), FACIT-Fatigue, or EQ-5D VAS scores (all p > 0.05).
Both treatments improved central sensitization-related measures, which the authors attribute to shared thermal effects.
The authors concluded that 'no specific superior effect on CSI scores was demonstrated compared to electrotherapy.'
Disability was measured with the Quebec Back Pain Disability Scale (QBPDS) and fatigue with the FACIT-F.
Discussion
The authors attribute shared improvements in central sensitization-related measures across both groups to common thermal mechanisms.
Both groups received thermal input: the EG via hot packs and the PG via peloidotherapy.
The authors suggest that 'both treatments improved pain and central sensitization-related measures, likely due to shared thermal effects.'
This interpretation was used to explain the lack of between-group difference on CSI scores despite both groups showing within-group improvements.
TENS was a shared component in both groups and may also have contributed to overlapping outcomes.
What This Means
This research studied whether mud therapy (peloidotherapy) is more effective than standard electrotherapy for people with chronic low back pain. Seventy-four patients were randomly assigned to receive either mud therapy combined with electrical nerve stimulation (TENS) and exercise, or hot packs combined with TENS and exercise, for three weeks. Researchers measured pain, sleep quality, fatigue, disability, sensitivity to pain signals (central sensitization), and overall quality of life before and after treatment.
Both groups improved significantly across most measures after treatment. However, patients who received mud therapy showed meaningfully greater improvements in three specific areas: pain intensity, sleep quality, and overall health status as measured by a standardized quality-of-life tool. For measures of central sensitization, disability, and fatigue, both groups improved similarly, and there was no significant difference between them. The authors suggest that improvements in central sensitization seen in both groups may be explained by the heat component that both treatments share.
This research suggests that peloidotherapy — a traditional spa therapy using heated mineral-rich mud — may offer additional benefits over conventional electrotherapy for reducing pain and improving sleep in people with chronic low back pain. This is clinically relevant because sleep disturbance and persistent pain are closely linked, and treatments that address both simultaneously could be especially valuable. However, since both treatments share some components (TENS and exercise), future research with larger samples and longer follow-up periods would help clarify which specific elements drive these benefits.
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Yılmaz N, Özkuk K. (2026). Clinical efficacy of peloidotherapy on pain, sleep quality, and central sensitization-related symptoms in chronic low back pain: a comparative analysis.. International journal of biometeorology. https://doi.org/10.1007/s00484-026-03225-1