Tamás Bender

The effect of physical therapy on beta-endorphin levels

Beta-endorphin (βE) is an important reliever of pain. Various stressors and certain modalities of physiotherapy are potent inducers of the release of endogenous βE to the blood stream. Most forms of exercise also increase blood βE level, especially when exercise intensity involves reaching the anaerobic threshold and is associated with the elevation of serum lactate level. Age, gender, and mental activity during exercise also may influence βE levels. Publications on the potential stimulating effect of manual therapy and massage on βE release are controversial. Sauna, mud bath, and thermal water increase βE levels through conveying heat to the tissues. The majority of the techniques for electrical stimulation have a similar effect, which is exerted both centrally and—to a lesser extent—peripherally. However, the parameters of electrotherapy have not yet been standardised. The efficacy of analgesia and the improvement of general well-being do not necessarily correlate with βE level. Although in addition to blood, increased brain and cerebrospinal fluid βE levels are also associated with pain, the majority of studies have concerned blood βE levels. In general, various modalities of physical therapy might influence endorphin levels in the serum or in the cerebrospinal fluid—this is usually manifested by elevation with potential mitigation of pain. However, a causal relationship between the elevation of blood, cerebrospinal fluid or brain βE levels and the onset of the analgesic action cannot be demonstrated with certainty.

The effect of spa therapy in chronic low back pain: a randomized controlled, single-blind, follow-up study

Effect of thermal water with high mineral content on clinical parameters and quality of life of patients with chronic low back pain was studied. In this randomized controlled, single-blind, follow-up study, 60 patients with chronic low back pain were randomized into two groups. The treatment group received balneotherapy with thermal-mineral water, and the control group bathed in tap water. Changes of the followings were evaluated: visual analogue scale (VAS) for pain, range of motion for the lumbar spine, Oswestry index, EuroQol-5D and Short Form-36 questionnaires. In the treatment group, the mobility of the lumbar spine, the Oswestry index, the VAS scores and the EuroQoL-5D index improved significantly. SF-36 items improved significantly in the treated group compared with baseline except for two parameters. Our study demonstrated the beneficial effect of balneotherapy with thermal mineral versus tap water on clinical parameters, along with improvements in quality of life.

The effect of balneotherapy on antioxidant, inflammatory, and metabolic indices in patients with cardiovascular risk factors (hypertension and obesity)-A randomised, controlled, follow-up study

INTRODUCTION The primary objective of our study was to explore the changes of antioxidant, inflammatory, and metabolic parameters in obese and hypertension people patients during balneotherapy and to evaluate the safety of balneotherapy in these participants. METHODS Following randomisation, 22 obese and 20 hypertensive patients underwent balneotherapy with thermal water of 38°C temperature, in 15 sessions of 30 minutes. An additional 22 obese and 20 hypertensive patients served as controls. Antioxidant, inflammatory, and metabolic parameters were determined at baseline, as well as post-treatment and at the end of follow-up (at 15 weeks). RESULTS As regards changes observed in hypertensive patients subjected to balneotherapy, differences could be detected between baseline and post-treatment albumin and haemoglobin A(1c) levels only; however, these were no longer significant after 3 months. Although the difference between transferrin levels determined at the end of balneotherapy and 3 months later was significant, it remained within the physiological range, as well as it was accompanied by normal serum iron level and therefore, it was considered irrelevant. C-reactive protein levels of balneotherapy patients decreased significantly after treatment. In obese patients, haemoglobin A(1c) level decreased after balneotherapy, but this difference was not observed either after 3 months. Similarly, both transferrin and C-reactive protein levels changed from baseline, but not between groups. CONCLUSIONS This study contributes important information regarding the safety of balneotherapy in hypertensive and obese diabetics by showing no alterations of antioxidant, inflammatory, or metabolic indices. The findings of this study confirm that balneotherapy is not contraindicated for hypertensive or obese patients.

Study on endocronological effects of radon speleotherapy on respiratory diseases

Background: Radon, as a radioactive noble gas of natural origin, is generally present in the atmosphere of caves during the speleotherapeutic treatment of different diseases. However, the role of radon in the therapeutic effect is not fully clarified yet. Endocrine parameter levels may be influenced by radon-like endocrine levels in balneotherapeutic treatments (bath treatment). For this reason changes of these parameters were examined in this study. Patients and method: A total of 81 speleotherapy patients were involved in the survey. They spent four hours daily in Tapolca Cave, five days a week, for two weeks. In this study, the thyreoiedea stimulating hormone, free triiodine-tironin, free thyroxine, prolactine, cortisol, dehydroepiandrosterone sulphate, adrenocorticotropic hormone, and beta endorphine levels of the body were examined before and after the treatment. Results: After statistical analysis of the data a significant decrease of cortisol levels of patients was found, which was not directly correlated with radon concentration. In the case of thyroid hormones, there were no significantly detectable changes of the hormone levels except for low radon concentration levels a significant decrease in the free thyroxine and the thyreoiedea stimulating hormone level of male patients was observed. Conclusion: Speleotherapy has an effect on the level of endocrine hormones; however, no direct correlation with differences in radon level was found. For patients whose endocrine levels fell outside the normal endocrine parameter values, more striking changes in endocrine hormone levels were seen, but changes of these parameters could not be statistically analyzed due to the small number of cases.

Familiar ochronotic arthropathy–caused by a gene mutation traced three hundred years

Authors trace an ochronotic Hungarian family, which moved from Slovakia to Hungary 300 years ago. As the family members lived in a relatively close village community the gene mutation had been survived silently for ages before the clinical symptoms developed. Family tree analysis could detect with the use of allele specific PCR amplification-the p.G161R mutation of the homogentisic acid 1,2-dioxygenase (HGD) gene, which resulted in a specific genotype appearing in the Slovak population. We found a heterozygote member of this family who has children with an alkaptonuria-homozygote and known-heterozygote genotypes so there would be a high risk of alkaptonuria in their offsprings. Therefore genetic counselling is highly recommended to minimize the risk factors.

Beta endorphin-like immunoreactivity in human aqueous humor and crystalline lens

We measured the concentration of beta-endorphin (beta-End) in plasma, as well as in aqueous humor and crystalline lens removed during cataract surgery. beta-End was detected both in the aqueous humor and in the crystalline lens. The concentration of beta-End in the aqueous humor corresponded to almost the half of the plasma level (2.18 fmol/l and 4.55 fmol/l). Endogenous beta-End is presumed to enter the intraocular structures by passive diffusion.

Effect of plasmapheresis on serum beta-endorphin levels

Objectives: The aim of this study was to examine the effects of plasmapheresis on serum β-endorphin (BE) levels. Method: The serum BE levels of 12 patients with various autoimmune or hematological disorders were monitored during plasmapheresis therapy. Results: BE levels increased after the initial session in 8 of 12 patients; in the remaining 4 patients no change (n = 2) or a decline (n = 2) in BE levels was found. However, no further changes were observed during subsequent therapy. During the last session, an elevation in the BE level was detected in 5 patients, with no change in 1 and a decrease in BE level in another 5 patients. Conclusion: Our findings suggest that although plasmapheresis results in an elevation in serum BE levels initially, this change does not persist during subsequent sessions.

Adaptation of the osteoarthritis-specific quality of life scale (the OAQoL) for use in Germany, Hungary, Italy, Spain and Turkey

The Osteoarthritis Quality of Life scale (OAQoL) is specific to individuals with osteoarthritis. The present study describes the adaptation of the OAQoL for use in the following five European languages: German, Hungarian, Italian, Spanish and Turkish. The study involved three stages in each language; translation, cognitive debriefing (face and content validity) and validation. The validation stage assessed internal consistency (Cronbach’s alpha), reproducibility (test–retest reliability using Spearman’s rank correlations), convergent and divergent validity (correlations with the Health Assessment Questionnaire, The Western Ontario and McMaster Universities Index of osteoarthritis and Nottingham Health Profile) and known group validity. The OAQoL was successfully translated into the target languages with minimal problems. Cognitive debriefing interviewees found the measures easy to complete and identified few problems with content. Internal consistency ranged from 0.94 to 0.97 and test–retest reliability (reproducibility) from 0.87 to 0.98. These values indicate that the new language versions produce very low levels of measurement error. Median OAQoL scores were higher for patients reporting a current flare of osteoarthritis in all countries. Scores were also related, as expected, to perceived severity of osteoarthritis. The OAQoL was successfully adapted for use in Germany, Hungary, Italy, Spain and Turkey. The addition of these new language versions will prove valuable to multinational clinical trials and to clinical practice in the respective countries.

Alkaline Mineral Supplementation Decreases Pain in Rheumatoid Arthritis Patients: A Pilot Study

The aim of this pilot study was to investigate the efficacy of an alkaline mineral supplement as a means of sup- pressing disease activity in rheumatoid arthritis (RA) patients, and to check whether any change occurs in the circulating beta-endorphin concentration. Thirty-seven patients with moderately active RA of at least two years duration, who were receiving stable pharmacological treatment, participated in a 12-week study. All patients were randomly allocated to a supplemented group (30g of an alkaline mineral supplement daily) or to an unsupplemented group. Their usual diet and medication was maintained. Disease activity, pain, and health-associated status were recorded (DAS 28 - Disease Activity Score 28, VAS - visual analogue scale for pain, HAQ - Health Assessment Questionnaire). Plasma immunoreactive en- dorphin (ir-EP) was measured in the study groups and also in healthy subjects. DAS 28 and VAS decreased in the sup- plemented group, whereas there was no change in these parameters during the trial in the control group. The functions (HAQ) of the supplemented patients improved. The ir-EP levels increased in both groups but to a higher degree in the supplemented group. During the trial, medication (NSAIDs and steroids) could be reduced in the supplemented group only. Conclusion: This study suggests that an alkaline supplement may improve function and pain in rheumatoid arthritis and may represent an easy and safe addition to the usual treatment of RA patients.

Correction to: The effects of the calcium-magnesium-bicarbonate content in thermal mineral water on chronic low back pain: a randomized, controlled follow-up study

The original article mistakenly displays each set of author names in the wrong order, i.e., first names as last names and vice versa. The author correct names are: Tamás Gáti, Ildikó Katalin Tefner, Lajos Kovács, Katalin Hodosi, Tamás Bender. The original article has been corrected.