Hydrotherapy and crenotherapy in the treatment of pain: integrative review

Juliane de Macedo Antunes Donizete Vago Daher Vania Maria de Araújo Giaretta Maria Fernanda Muniz Ferrari Maria Belén Salazar Posso About the authors

ABSTRACT

BACKGROUND AND OBJECTIVES:

The Integrative and Complementary Practices were implemented in the Unified Health System as adjunctive modalities in the treatment of pain. This article focuses on crenotherapy and hydrotherapy, whose agents are the natural mineral waters and common for the rehabilitation of functional alterations. The scarcity of these practices for the treatment of pain in the literature justifies this review. This study aimed to check the scientific productions about the efficacy of balneology/balneotherapy/crenotherapy and hydrotherapy in the treatment of pain.

CONTENTS:

It is an integrative review, carried out in May 2018, searching in the electronically available scientific articles, in full, in the LILACS, Pubmed, BVS and CINAHL database in periodicals published in the last 10 years focusing on crenotherapy and hydrotherapy for pain relief, in the Portuguese, English and Spanish language. The descriptors used were: "Pain", "Balneology", "Crenotherapy", "Hydrotherapy" "Efficacy"; "Effectiveness" in the three languages, combined with the Boolean expressions AND/Y/E and OR/O/U/OU, finding 2306 articles, of which 111 were identified, and only 27 met the inclusion criteria, analyzed and incorporated the evidence that emerged in pain relief.

CONCLUSION:

This study showed that most of the evidence emerged from the studies analyzed regarding the efficacy of hydrotherapy and balneology in pain pictures focused on levels 1 to 3. Of the 27 studies, 18 showed the efficacy of hydrotherapy and eight of balneology in the pain symptomatology and one in relation to the lack of knowledge of the use of these complementary therapies in pain relief.

Keywords:
Balneology; Balneotherapy; Crenotherapy; Efficacy; Hydrotherapy; Pain

RESUMO

JUSTIFICATIVA E OBJETIVOS:

As Práticas Integrativas e Complementares foram institucionalizadas no Sistema Único de Saúde como modalidades coadjuvantes no tratamento da dor. Este artigo focalizou a utilização de crenoterapia e hidroterapia, cujos agentes são as águas minerais naturais, comum para a reabilitação de alterações funcionais. A escassez da literatura dessas práticas no tratamento da dor, justifica esta revisão. O objetivo deste estudo foi verificar a produção cientifica sobre a eficácia da balneologia/balneoterapia/crenoterapia e da hidroterapia no tratamento da dor.

CONTEÚDO:

Revisão integrativa, realizada em maio de 2018, cuja busca de artigos científicos disponíveis eletronicamente e na íntegra, na base de dados, LILACS, Pubmed, BVS e CINAHL em periódicos publicados nos últimos 10 anos enfocaram a crenoterapia e hidroterapia para o alívio da dor nos idiomas Português, Inglês e Espanhol. Os descritores utilizados foram: Dor, Balneologia, Crenoterapia, Hidroterapia, Eficácia; nos três idiomas, combinados com as expressões booleanas AND/Y/E e OR/O/U/OU encontrando 2306 artigos, identificados 111 e destes, apenas 27 atenderam aos critérios de inclusão, analisados e incorporadas as evidências emergidas no alívio da dor.

CONCLUSÃO:

Este estudo mostrou que a maioria das evidências emergidas dos trabalhos analisados quanto à eficácia da hidroterapia e crenoterapia em processos álgicos concentraram-se nos níveis 1 a 3. Dos 27 estudos, 18 mostraram a eficácia da hidroterapia e oito da balneoterapia e crenoterapia nos sintomas dolorosos, e um em relação ao desconhecimento do uso dessas práticas integrativas no alívio da dor.

Descritores:
Balneologia; Balneoterapia; Crenoterapia; Dor; Eficácia; Hidroterapia

INTRODUCTION

In 2002, the World Health Organization (WHO)11 World Health Organization. Traditional medicine strategy 2002-2005. Geneva: World Health Organization; 2002. established the Pain Management Protocol for the relief of pain and in the document "WHO Traditional Medicine Strategy 2002-2005" recognizing the importance, efficacy, and quality of Complementary Medicine, encouraging the integration of their knowledge to those of the Western Medicine in health systems. The text of this Strategy continues with the encouragement of the use of Integrative and Complementary Practices (PICS) for the development of access policies, for rational, responsible, safe practice and at the same time, recommending the development of studies that validate them11 World Health Organization. Traditional medicine strategy 2002-2005. Geneva: World Health Organization; 2002..

The PICS were institutionalized in the Unified Health System (SUS) by the National Policy on Integrative and Complementary Practices (PNPIC), approved by Ordinance GM/MS No. 971/5/3/200622 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Práticas Integrativas e Complementares no SUS - PNPIC SUS. Brasília: Ministério da Saúde; 2006..

The purpose of the Ministry of Health (MS)22 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Práticas Integrativas e Complementares no SUS - PNPIC SUS. Brasília: Ministério da Saúde; 2006. is to offer the Brazilian population access to PICS by standardizing them to meet the demands of the public health network, being transversal in its actions in the Unified Health System (SUS), and present at all levels of health care, making available to the population modalities to follow: aromatherapy, art therapy, ayurveda, biodance, bioenergetics, family constellation, chromotherapy, circular dance, geotherapy, hypnotherapy, homeopathy, imposition of hands, anthroposophic medicine/anthroposophy, applied to health, Traditional Chinese Medicine - acupuncture, auriculotherapy, meditation, music therapy, naturopathy, osteopathy, ozone therapy, phytotherapy, chiropractic, reflexotherapy, reiki, shantala, integrative community therapy, floral therapy, social thermalism/cryotherapy and yoga22 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Práticas Integrativas e Complementares no SUS - PNPIC SUS. Brasília: Ministério da Saúde; 2006.. Except for acupuncture, that is minimally invasive; the others are characterized by non-invasive interventions and an important rebalancing of the physical, mental, and emotional energies.

These PICS help the pharmacological treatment and alleviate the suffering caused by pain, considered one of the great public health problems, improving the quality of life (QoL)33 Schveitzer MC, Esper MV, Silva MJ. Práticas Integrativas e Complementares na Atenção Primária em Saúde: em busca da humanização do cuidado. O Mundo da Saúde, São Paulo. 2012;36(3):442-51.,44 Araujo LC, Romero B. Dor: avaliação do 5º sinal vital. Uma reflexão teórica. Rev Dor. 2015;16(4):291-6.. Pain is a symptom frequently present in the patient and requires physical, psychosocial, and psychoemotional evaluation determining the agent of his/her suffering by the multiprofessional team33 Schveitzer MC, Esper MV, Silva MJ. Práticas Integrativas e Complementares na Atenção Primária em Saúde: em busca da humanização do cuidado. O Mundo da Saúde, São Paulo. 2012;36(3):442-51.

4 Araujo LC, Romero B. Dor: avaliação do 5º sinal vital. Uma reflexão teórica. Rev Dor. 2015;16(4):291-6.
-55 Amaral HA, Cantista AP. Evidências Científicas da Medicina Termal - CT. Universidade de Porto. dissertação de mestrado; 2010..

This article will specifically focus on the use of hydrotherapy (HT) (common water) and crenotherapy (CT) (thermal water) for pain relief, which have water as an essential element. The different modes of therapeutical application of water receive the names of social thermalism, balneotherapy (BT), thalassotherapy, CT, and HT22 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Práticas Integrativas e Complementares no SUS - PNPIC SUS. Brasília: Ministério da Saúde; 2006..

The BT/CT designation refers to the therapeutic use of natural mineral waters whose chemical composition can be classified as sulphurated, radioactive, bicarbonate, ferruginous, among others, for the prevention, treatment, and rehabilitation of various diseases. It is a millenary practice introduced in Brazil by the Portuguese empire for the treatment of several organic signs and symptoms of patients, as a complementary therapy to other treatments22 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Práticas Integrativas e Complementares no SUS - PNPIC SUS. Brasília: Ministério da Saúde; 2006.,55 Amaral HA, Cantista AP. Evidências Científicas da Medicina Termal - CT. Universidade de Porto. dissertação de mestrado; 2010..

HT consists of the external and therapeutic use of common water with different application and temperature forms. It is an important resource for the rehabilitation of functional alterations, having as a principle the physical, chemical, physiological, and kinesiological effects obtained by immersion of the body in swimming pool66 Candeloro JM, Caromano FA. Efeito de um programa de hidroterapia na flexibilidade e na força muscular de idosas. Rev Bras Fisioter. 2007;11(4):303-9.,77 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Ministério da Saúde inclui 10 novas práticas integrativas no SUS. Disponível em: http://portalms.saude.gov.br/noticias/agencia-saude/42737-ministerio-da-saude-inclui-10-novas-praticas-integrativas-no-sus. Acesso 6/10/2018.
http://portalms.saude.gov.br/noticias/ag...
, usually heated. Exercises in the heated water improve joint movement, relaxation, reduction of muscle tension, muscular spasms, an increase of muscle strength and endurance66 Candeloro JM, Caromano FA. Efeito de um programa de hidroterapia na flexibilidade e na força muscular de idosas. Rev Bras Fisioter. 2007;11(4):303-9., besides benefiting the venous return, improving peripheral circulation and favoring the decrease of pain66 Candeloro JM, Caromano FA. Efeito de um programa de hidroterapia na flexibilidade e na força muscular de idosas. Rev Bras Fisioter. 2007;11(4):303-9.,77 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Ministério da Saúde inclui 10 novas práticas integrativas no SUS. Disponível em: http://portalms.saude.gov.br/noticias/agencia-saude/42737-ministerio-da-saude-inclui-10-novas-praticas-integrativas-no-sus. Acesso 6/10/2018.
http://portalms.saude.gov.br/noticias/ag...
.

HT and CT do not present associated risks, being a convenient method, but they must be used with discretion, responsibility, and performed by trained professionals22 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Práticas Integrativas e Complementares no SUS - PNPIC SUS. Brasília: Ministério da Saúde; 2006.,66 Candeloro JM, Caromano FA. Efeito de um programa de hidroterapia na flexibilidade e na força muscular de idosas. Rev Bras Fisioter. 2007;11(4):303-9.,77 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Ministério da Saúde inclui 10 novas práticas integrativas no SUS. Disponível em: http://portalms.saude.gov.br/noticias/agencia-saude/42737-ministerio-da-saude-inclui-10-novas-praticas-integrativas-no-sus. Acesso 6/10/2018.
http://portalms.saude.gov.br/noticias/ag...
. HT and CT, although they are millenarian therapeutic methods, like PICS used for the treatment of pain, seem to have been little contemplated in scientific studies in the national and international literature. This study aimed to evaluate the efficacy of CT and HT in the treatment of pain through an integrative review of the literature.

CONTENTS

It is an integrative review that allows the search, the critical evaluation, the synthesis, analysis, and incorporation of the evidence of the national and international scientific productions emerged from the subject investigated88 Mendes KD, Silveira RC, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm. 2008;17(4):758-64.,99 Galvão CM, Sawada NO, Mendes IA. [In search of the best evidence]. Rev Esc Enferm USP. 2003;37(4):43-50. Portuguese., with a retrospective temporal cut, respecting the copyright of the literature used, according to Law No. 9610/1998 of the Ministry of Education and Culture (MEC)1010 Brasil. Ministério da Educação e Cultura. Lei nº 9.610, de 19 de fevereiro de 1998. Altera, atualiza e consolida a legislação sobre direitos autorais e dá outras providências. MEC.19/02/1998..

After, the following steps were followed: 1. establishment of the guiding question; 2. objective; 3. criteria for inclusion and exclusion of articles; 4. information extracted from selected articles; 5. analysis and presentation of the studies88 Mendes KD, Silveira RC, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm. 2008;17(4):758-64.,99 Galvão CM, Sawada NO, Mendes IA. [In search of the best evidence]. Rev Esc Enferm USP. 2003;37(4):43-50. Portuguese.. The guiding question was: "How does national and international scientific production evaluate the efficacy of HT and BT/CT in pain therapy"?

The databases used were: Latin American and Caribbean Health Sciences Literature (LILACS), Virtual Health Library (VHL); Cumulative Index to Nursing and Allied Health Literature (CINAHL) and National Library of Medicine (Pubmed) using controlled descriptors from the Health Sciences Descriptors (DeCS) and the Medical Subject Headings (MeSH), "dor (pain,) (dolor); eficácia (efficacy/effectiveness), (eficácia); BT/CT (balneology) (crenotherapy) and (hydrotherapy) (HT). Also used an uncontrolled descriptor: hidrotherapy (crenotherapy) two or more DeCS/MeSH among those mentioned were combined and the Boolean expressions E/AND/Y/ and OU/OR/O/U (Table 1)

Table 1
Combination of descriptors with Boolean expressions used in the search strategy (EB)

The review period was from May 2008 to May 2018, seeking to cover more recent studies of CT and HT and its efficacy in pain relief. The inclusion criteria were: scientific papers in English, Spanish and Portuguese available electronically and excluded editorials, letters, theses, dissertations, monographs, manuals, abstracts of congresses; articles duplicated in more than one database, counting only one; or that did not address the research question, the objective and descriptors.

After the critical and careful reading of the abstracts and, a posteriori, of the complete articles, the information was organized and recorded in a specially structured form, composed to identify title, author, year of publication, objectives, methods and results of articles analyzed, including or excluding them for the analysis, presentation of the main results and classification of the emerging evidence.

The precepts of the PRISMA checklist, 20091111 Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336-41. were considered to analyze meta-analyzes and systematic reviews that guide the eligibility, inclusion of articles, and the level of scientific evidence (LE), favoring the preparation of figure 1.

Figure 1
Flowchart with eligibility representation and inclusion of articles

The search was carried out independently by 2 reviewers who after the refinement of the searches, classified the quality, scientific validity, and reliability of the articles by the Level of Evidence (LE)1212 Galvão CM. Níveis de evidência. Editorial. Acta Paul Enferm. 2006;19(2):V.,1313 Melnyk BM, Fineout-Overholt E. Making the case for evidence-based practice. In: Melnyk BM, Fineout-Overholt E. Evidence based practice in nursing & healthcare. A guide to best practice. Philadelphia: Lippincot Williams & Wilkins; 2005. 3-24p., that is, level 1: the evidence from systematic review or meta-analysis of relevant randomized controlled trials or from clinical guidelines based on systematic reviews of randomized controlled trials; level 2, evidence derived from at least one well-delineated randomized controlled trial; level 3, evidence obtained from well-delineated non-randomized controlled trials; level 4, evidence from well-delineated cohort and case-control studies; level 5, evidence originating from a systematic review of descriptive and qualitative studies; level 6, evidence derived from a single descriptive or qualitative study; level 7, evidence from the opinion of authorities and/or report of expert committees"1212 Galvão CM. Níveis de evidência. Editorial. Acta Paul Enferm. 2006;19(2):V.,1313 Melnyk BM, Fineout-Overholt E. Making the case for evidence-based practice. In: Melnyk BM, Fineout-Overholt E. Evidence based practice in nursing & healthcare. A guide to best practice. Philadelphia: Lippincot Williams & Wilkins; 2005. 3-24p..

The analysis of table 2 shows that of the 1,160 articles screened in the databases, 1,049 were excluded because they did not meet the inclusion criteria, with 111 articles remaining eligible. After the evaluation of the full text, 84 were excluded, of which only 27 were included. One article (3.7%) was found in VHL (IBEC), and five articles (18.5%) were found in LILACS, none in CINAHL database and 21 (77.8%) in Pubmed from a total of 27 analyzed.

Table 2
Summarized registry of titles, author, periodical, year, database, objectives, method, and results

The critical analysis of the results (Table 2) showed that LEs ranged from 1 to 5, with 8 (29.6%) three meta-analyzes1818 Matsumoto H, Higino H, Hayashi K, Ideno Y, Wada T, Ogata T, et al. The effect of balneotherapy on the relief of pain, stiffness and physical function in patients with osteoarthritis of the knee: a meta-analysis. Clin Rheumatol. 2017;36(8):1839-47.,2525 Chen B, Zhan H, Chung M, Lin X, Zhang M, Pang J, et al. Chinese herbal bath therapy for the treatment of knee osteoarthritis: meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2015;2015;949172.,3232 Bender T, Bálint G, Prohászka Z, Géher P, Tefner IK. Evidence-based hydro- and balneotherapy in Hungary--a systematic review and meta-analysis. Int J Biometeorol. 2014;58(3):311-23., five systematic reviews of RCTs (SRRCT)2424 Forestier R, Erol Forestier FB, Francon A. Spa therapy and knee osteoarthritis: a systematic review. Ann Phys Rehabil Med. 2016;59(3):216-26.,2727 Cornejo JL, Reffers DG, Vergara DA, Maldonado EA, Munõz SR, Lara MJ. Effectiveness of hydrotherapy to reduce pain and improve quality of life and physical function in adults with knee osteoarthritis: a systematic review. Rev Soc Esp Dolor. 2015;22(4):168-74.,2828 Karagülle M, Karagülle MZ. Efficacy of balneotherapy and spa therapy for the treatment of chronic low back pain: a review of the most recent evidence. Clin Rheumatol. 2015;34(2):207-14.,3333 Larmer PJ, Bell J, O'Brien D, Dangen J, Kersten P. Hydrotherapy outcome measures for people with arthritis: a systematic review. N Zealand J Physiother. 2014;42(2):54-67.,3535 Cechetti F, Fabro AQ, Martini DR. Reabilitação aquática como recurso de tratamento da osteoartrose de quadril e joelho. Fisioter Bras. 2012;13(5):384-9. and 6 (22.2%) randomized clinical trials (RCT)1414 Ceylan SS, Bollşlk B. Effects of swaddled and sponge bathing methods on signs of stress and pain in premature newborns: implications for evidence-based practice. Worldviews Evid Based Nurs. 2018;15(4):296-303.,2020 Koyuncu E, Ökmen BM, Özkuk K, Taşoğlu Ö, Özgirgin N. The effectiveness of balneotherapy in chronic neck pain. Clin Rheumatol. 2016;35(10):2549-55.,2121 Branco M, Rêgo NN, Silva PH, Archanjo IE, Ribeiro MC, Trevisani VF. Bath thermal waters in the treatment of knee osteoarthritis: a randomized controlled clinical trial. Eur J Phys Rehabil Med. 2016;52(4):422-30.,3030 Baena-Beato PÁ, Artero EG, Arroyo-Morales M, Robles-Fuentes A, Gatto-Cardia MC, Delgado-Fernández M. Aquatic therapy improves pain, disability, quality of life, body composition and fitness in sedentary adults with chronic low back pain. A controlled clinical trial. Clin Rehabil. 2014;28(4):350-60.,3434 Lee SL, Liu CY, Lu YY, Gau ML. Efficacy of warm showers on labor pain and birth experiences during the first labor stage. J Obstet Gynecol Neonatal Nurs. 2013;42(1):19-28.,3939 Silva LE, Valim V, Pessanha AP, Oliveira LM, Myamoto S, Jones A, et al. Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial. Phys Ther. 2008;88(1):12-21 were found in LE 1 and 2 respectively; non-randomized controlled trials (NRCT)1515 Avila MA, Camargo PR, Ribeiro IL, Albuquerque-Sendín F, Zamunér AR, Salvini TF. Effects of a 16-week hydrotherapy program on three-dimensional scapular motion and pain of women with fibromyalgia: a single-arm study. Clin Biomech. 2017,49:145-54.

16 Batten M, Stevenson E, Zimmermann D, Isaacs C. Implementation of a hydrotherapy protocol to improve postpartum pain management. J Midwifery Womens Health. 2017;62(2):210-4.
-1717 Cipriano P, Oliveira C. Influência da bandagem elástica kinesio tape e da hidroterapia na dor pélvica posterior e na funcionalidade nas atividades diárias de gestantes. Fisioter Bras. 2017;18(1):2-11.,2222 Kümpel C, Saadeddine I, Porto EF, Borba RG, Castro AA. Impacto de um programa estruturado de hidrocinesioterapia em pacientes com osteoartrite de joelho. Acta Fisiátr. 2016;23(2):51-6.,2323 Fonseca LB, Brito CJ, Silva RJ, Silva-Grigoletto ME, da Silva WM Junior, Franchini E. Use of cold-water immersion to reduce muscle damage and delayed-onset muscle soreness and preserve muscle power in Jiu-Jitsu athletes. J Tthl Train. 2016;51(7):540-9.,2626 Ezheltha Suji SD, Sharmila Jansi Rani SS. Effectiveness of hot foot bath versus exercises on reducing pain among patients with osteoarthritis. Int J Nurs Educ. 2015;7(3):70-5.,2929 Liu Y, Liu Y, Huang X, Du C, Peng J, Huang P, et al. A comparison of maternal and neonatal outcomes between water immersion during labor and conventional labor and delivery. BMC Pregnancy Childbirth. 2014;14:160.,3131 Baena-Beato PÁ, Delgado-Fernández M, Artero EG, Robles-Fuentes A, Gatto-Cardia MC, Arroyo-Morales M. Disability predictors in chronic low back pain after aquatic exercise. Am J Phys Med Rehabil. 2014;93(7):615-23.,3737 Stark MA, Miller MG. Barriers to the use of hydrotherapy in labor. J Obstet Gynecol Neonatal Nurs. 2009;38(6):667-75.-3838 Ferreira LR, Pestana PR, Oliveira J, Ferrari RA. Efeitos da reabilitação aquática na sintomatologia e qualidade de vida de portadoras de artrite reumatóide. Fisioter Pesqui. 2008;15(2):136-41.,4040 Silva TF, Suda EY, Marçulo CA, Paes FH, Pinheiro GT. Comparação dos efeitos da estimulação elétrica nervosa transcutânea e da hidroterapia na dor, flexibilidade e qualidade de vida de pacientes com fibromialgia. Fisioter Pesqui. 2008;15(2):118-24. 11 (40.7%) (LE 3); a Cohort1919 Vanderlaan J. Retrospective cohort study of hydrotherapy in labor. J Obstet Gynecol Neonatal Nurs. 2017;46(3):403-10. (3,7%) in LE 4; in LE 5 only one (3.7%) qualitative and quantitative descriptive study was identified3636 Marques LA, Vale F, Vieira VR, Nogueira VA, Mialhe FL, Silva LC. Atenção farmacêutica e práticas integrativas e complementares no SUS: conhecimento e aceitação por parte da população. são joanense. Physis. 2011;21(2):663-74. and none in the LE 6 and 7. Therefore, the studies focused on the hierarchical levels of evidence 1 to 31212 Galvão CM. Níveis de evidência. Editorial. Acta Paul Enferm. 2006;19(2):V.,1313 Melnyk BM, Fineout-Overholt E. Making the case for evidence-based practice. In: Melnyk BM, Fineout-Overholt E. Evidence based practice in nursing & healthcare. A guide to best practice. Philadelphia: Lippincot Williams & Wilkins; 2005. 3-24p. considered high and moderate and when related to the quality of strong and sufficient evidence levels1313 Melnyk BM, Fineout-Overholt E. Making the case for evidence-based practice. In: Melnyk BM, Fineout-Overholt E. Evidence based practice in nursing & healthcare. A guide to best practice. Philadelphia: Lippincot Williams & Wilkins; 2005. 3-24p., respectively, demonstrating that the PICS studied appear to be effective in pain control. However, they should be further explored and studied scientifically to validate them academically.

Regarding the type of study, adding the meta-analysis1818 Matsumoto H, Higino H, Hayashi K, Ideno Y, Wada T, Ogata T, et al. The effect of balneotherapy on the relief of pain, stiffness and physical function in patients with osteoarthritis of the knee: a meta-analysis. Clin Rheumatol. 2017;36(8):1839-47.,2525 Chen B, Zhan H, Chung M, Lin X, Zhang M, Pang J, et al. Chinese herbal bath therapy for the treatment of knee osteoarthritis: meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2015;2015;949172.,3232 Bender T, Bálint G, Prohászka Z, Géher P, Tefner IK. Evidence-based hydro- and balneotherapy in Hungary--a systematic review and meta-analysis. Int J Biometeorol. 2014;58(3):311-23. (11.1%) and SRRCT2424 Forestier R, Erol Forestier FB, Francon A. Spa therapy and knee osteoarthritis: a systematic review. Ann Phys Rehabil Med. 2016;59(3):216-26.,2727 Cornejo JL, Reffers DG, Vergara DA, Maldonado EA, Munõz SR, Lara MJ. Effectiveness of hydrotherapy to reduce pain and improve quality of life and physical function in adults with knee osteoarthritis: a systematic review. Rev Soc Esp Dolor. 2015;22(4):168-74.,2828 Karagülle M, Karagülle MZ. Efficacy of balneotherapy and spa therapy for the treatment of chronic low back pain: a review of the most recent evidence. Clin Rheumatol. 2015;34(2):207-14.,3333 Larmer PJ, Bell J, O'Brien D, Dangen J, Kersten P. Hydrotherapy outcome measures for people with arthritis: a systematic review. N Zealand J Physiother. 2014;42(2):54-67.,3535 Cechetti F, Fabro AQ, Martini DR. Reabilitação aquática como recurso de tratamento da osteoartrose de quadril e joelho. Fisioter Bras. 2012;13(5):384-9. (18.5%) and RCT1414 Ceylan SS, Bollşlk B. Effects of swaddled and sponge bathing methods on signs of stress and pain in premature newborns: implications for evidence-based practice. Worldviews Evid Based Nurs. 2018;15(4):296-303.,2020 Koyuncu E, Ökmen BM, Özkuk K, Taşoğlu Ö, Özgirgin N. The effectiveness of balneotherapy in chronic neck pain. Clin Rheumatol. 2016;35(10):2549-55.,2121 Branco M, Rêgo NN, Silva PH, Archanjo IE, Ribeiro MC, Trevisani VF. Bath thermal waters in the treatment of knee osteoarthritis: a randomized controlled clinical trial. Eur J Phys Rehabil Med. 2016;52(4):422-30.,3030 Baena-Beato PÁ, Artero EG, Arroyo-Morales M, Robles-Fuentes A, Gatto-Cardia MC, Delgado-Fernández M. Aquatic therapy improves pain, disability, quality of life, body composition and fitness in sedentary adults with chronic low back pain. A controlled clinical trial. Clin Rehabil. 2014;28(4):350-60.,3434 Lee SL, Liu CY, Lu YY, Gau ML. Efficacy of warm showers on labor pain and birth experiences during the first labor stage. J Obstet Gynecol Neonatal Nurs. 2013;42(1):19-28.,3939 Silva LE, Valim V, Pessanha AP, Oliveira LM, Myamoto S, Jones A, et al. Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial. Phys Ther. 2008;88(1):12-21 (22.2%) had a total of (51.8%) higher than the number of non-randomized clinical trials (NRCT)1515 Avila MA, Camargo PR, Ribeiro IL, Albuquerque-Sendín F, Zamunér AR, Salvini TF. Effects of a 16-week hydrotherapy program on three-dimensional scapular motion and pain of women with fibromyalgia: a single-arm study. Clin Biomech. 2017,49:145-54.

16 Batten M, Stevenson E, Zimmermann D, Isaacs C. Implementation of a hydrotherapy protocol to improve postpartum pain management. J Midwifery Womens Health. 2017;62(2):210-4.
-1717 Cipriano P, Oliveira C. Influência da bandagem elástica kinesio tape e da hidroterapia na dor pélvica posterior e na funcionalidade nas atividades diárias de gestantes. Fisioter Bras. 2017;18(1):2-11.,2222 Kümpel C, Saadeddine I, Porto EF, Borba RG, Castro AA. Impacto de um programa estruturado de hidrocinesioterapia em pacientes com osteoartrite de joelho. Acta Fisiátr. 2016;23(2):51-6.-2323 Fonseca LB, Brito CJ, Silva RJ, Silva-Grigoletto ME, da Silva WM Junior, Franchini E. Use of cold-water immersion to reduce muscle damage and delayed-onset muscle soreness and preserve muscle power in Jiu-Jitsu athletes. J Tthl Train. 2016;51(7):540-9.,2626 Ezheltha Suji SD, Sharmila Jansi Rani SS. Effectiveness of hot foot bath versus exercises on reducing pain among patients with osteoarthritis. Int J Nurs Educ. 2015;7(3):70-5.,2929 Liu Y, Liu Y, Huang X, Du C, Peng J, Huang P, et al. A comparison of maternal and neonatal outcomes between water immersion during labor and conventional labor and delivery. BMC Pregnancy Childbirth. 2014;14:160.,3131 Baena-Beato PÁ, Delgado-Fernández M, Artero EG, Robles-Fuentes A, Gatto-Cardia MC, Arroyo-Morales M. Disability predictors in chronic low back pain after aquatic exercise. Am J Phys Med Rehabil. 2014;93(7):615-23.,3737 Stark MA, Miller MG. Barriers to the use of hydrotherapy in labor. J Obstet Gynecol Neonatal Nurs. 2009;38(6):667-75.-3838 Ferreira LR, Pestana PR, Oliveira J, Ferrari RA. Efeitos da reabilitação aquática na sintomatologia e qualidade de vida de portadoras de artrite reumatóide. Fisioter Pesqui. 2008;15(2):136-41.,4040 Silva TF, Suda EY, Marçulo CA, Paes FH, Pinheiro GT. Comparação dos efeitos da estimulação elétrica nervosa transcutânea e da hidroterapia na dor, flexibilidade e qualidade de vida de pacientes com fibromialgia. Fisioter Pesqui. 2008;15(2):118-24. (40.7%), ratifying the quality of evidence raised regarding the efficacy of BT/CT and HT in relieving pain of various symptoms.

This study showed that the focus of 18 (66.66%) articles focused on the efficacy of HT in the pain of several etiologies and eight (29.6%) in CT in pain. Among these 18 articles, 11 (61.1%) are NRCT1515 Avila MA, Camargo PR, Ribeiro IL, Albuquerque-Sendín F, Zamunér AR, Salvini TF. Effects of a 16-week hydrotherapy program on three-dimensional scapular motion and pain of women with fibromyalgia: a single-arm study. Clin Biomech. 2017,49:145-54.

16 Batten M, Stevenson E, Zimmermann D, Isaacs C. Implementation of a hydrotherapy protocol to improve postpartum pain management. J Midwifery Womens Health. 2017;62(2):210-4.
-1717 Cipriano P, Oliveira C. Influência da bandagem elástica kinesio tape e da hidroterapia na dor pélvica posterior e na funcionalidade nas atividades diárias de gestantes. Fisioter Bras. 2017;18(1):2-11.,2222 Kümpel C, Saadeddine I, Porto EF, Borba RG, Castro AA. Impacto de um programa estruturado de hidrocinesioterapia em pacientes com osteoartrite de joelho. Acta Fisiátr. 2016;23(2):51-6.-2323 Fonseca LB, Brito CJ, Silva RJ, Silva-Grigoletto ME, da Silva WM Junior, Franchini E. Use of cold-water immersion to reduce muscle damage and delayed-onset muscle soreness and preserve muscle power in Jiu-Jitsu athletes. J Tthl Train. 2016;51(7):540-9.,2626 Ezheltha Suji SD, Sharmila Jansi Rani SS. Effectiveness of hot foot bath versus exercises on reducing pain among patients with osteoarthritis. Int J Nurs Educ. 2015;7(3):70-5.,2929 Liu Y, Liu Y, Huang X, Du C, Peng J, Huang P, et al. A comparison of maternal and neonatal outcomes between water immersion during labor and conventional labor and delivery. BMC Pregnancy Childbirth. 2014;14:160.,3131 Baena-Beato PÁ, Delgado-Fernández M, Artero EG, Robles-Fuentes A, Gatto-Cardia MC, Arroyo-Morales M. Disability predictors in chronic low back pain after aquatic exercise. Am J Phys Med Rehabil. 2014;93(7):615-23.,3737 Stark MA, Miller MG. Barriers to the use of hydrotherapy in labor. J Obstet Gynecol Neonatal Nurs. 2009;38(6):667-75.-3838 Ferreira LR, Pestana PR, Oliveira J, Ferrari RA. Efeitos da reabilitação aquática na sintomatologia e qualidade de vida de portadoras de artrite reumatóide. Fisioter Pesqui. 2008;15(2):136-41.,4040 Silva TF, Suda EY, Marçulo CA, Paes FH, Pinheiro GT. Comparação dos efeitos da estimulação elétrica nervosa transcutânea e da hidroterapia na dor, flexibilidade e qualidade de vida de pacientes com fibromialgia. Fisioter Pesqui. 2008;15(2):118-24.; six (33.3%) of RCT1414 Ceylan SS, Bollşlk B. Effects of swaddled and sponge bathing methods on signs of stress and pain in premature newborns: implications for evidence-based practice. Worldviews Evid Based Nurs. 2018;15(4):296-303.,2020 Koyuncu E, Ökmen BM, Özkuk K, Taşoğlu Ö, Özgirgin N. The effectiveness of balneotherapy in chronic neck pain. Clin Rheumatol. 2016;35(10):2549-55.,2121 Branco M, Rêgo NN, Silva PH, Archanjo IE, Ribeiro MC, Trevisani VF. Bath thermal waters in the treatment of knee osteoarthritis: a randomized controlled clinical trial. Eur J Phys Rehabil Med. 2016;52(4):422-30.,3030 Baena-Beato PÁ, Artero EG, Arroyo-Morales M, Robles-Fuentes A, Gatto-Cardia MC, Delgado-Fernández M. Aquatic therapy improves pain, disability, quality of life, body composition and fitness in sedentary adults with chronic low back pain. A controlled clinical trial. Clin Rehabil. 2014;28(4):350-60.,3434 Lee SL, Liu CY, Lu YY, Gau ML. Efficacy of warm showers on labor pain and birth experiences during the first labor stage. J Obstet Gynecol Neonatal Nurs. 2013;42(1):19-28.,3939 Silva LE, Valim V, Pessanha AP, Oliveira LM, Myamoto S, Jones A, et al. Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial. Phys Ther. 2008;88(1):12-21 and one of SRRCT2424 Forestier R, Erol Forestier FB, Francon A. Spa therapy and knee osteoarthritis: a systematic review. Ann Phys Rehabil Med. 2016;59(3):216-26.,2727 Cornejo JL, Reffers DG, Vergara DA, Maldonado EA, Munõz SR, Lara MJ. Effectiveness of hydrotherapy to reduce pain and improve quality of life and physical function in adults with knee osteoarthritis: a systematic review. Rev Soc Esp Dolor. 2015;22(4):168-74.,2828 Karagülle M, Karagülle MZ. Efficacy of balneotherapy and spa therapy for the treatment of chronic low back pain: a review of the most recent evidence. Clin Rheumatol. 2015;34(2):207-14.,3333 Larmer PJ, Bell J, O'Brien D, Dangen J, Kersten P. Hydrotherapy outcome measures for people with arthritis: a systematic review. N Zealand J Physiother. 2014;42(2):54-67.,3535 Cechetti F, Fabro AQ, Martini DR. Reabilitação aquática como recurso de tratamento da osteoartrose de quadril e joelho. Fisioter Bras. 2012;13(5):384-9. (5.6%) predominating those of osteoarticular origin, being (62.5%) of LE 1 and three (37.5%) of LE 2 of musculoskeletal origin, confirming the scientific rigor of the studies and the PICS are recommended for the treatment of these types of pain problem. An SRRCT2828 Karagülle M, Karagülle MZ. Efficacy of balneotherapy and spa therapy for the treatment of chronic low back pain: a review of the most recent evidence. Clin Rheumatol. 2015;34(2):207-14. has shown that evidence from RCTs on the efficacy of BT/CT in chronic low back pain is encouraging and reflects the consistency of previous evidence. Moreover, the authors2828 Karagülle M, Karagülle MZ. Efficacy of balneotherapy and spa therapy for the treatment of chronic low back pain: a review of the most recent evidence. Clin Rheumatol. 2015;34(2):207-14. suggest that well-designed, conducted and reported RCTs are needed to test short- and long-term effects to control pain and to demonstrate broader beneficial effects.

The PICS in question were included in PNPIC11 World Health Organization. Traditional medicine strategy 2002-2005. Geneva: World Health Organization; 2002. in 2006 in Brazil, whose scientific studies in the country are still incipient. However, "therapies are present in 9,350 establishments in 3,173 municipalities, of which 88% are offered in basic care. In 2017, 1.4 million individual visits were recorded in PIC. In addition to the collective activities, the estimate is that about 5 million people per year participate in these practices in the SUS. Scientific evidence has shown the benefits of integrated treatment between conventional medicine and PICS"1313 Melnyk BM, Fineout-Overholt E. Making the case for evidence-based practice. In: Melnyk BM, Fineout-Overholt E. Evidence based practice in nursing & healthcare. A guide to best practice. Philadelphia: Lippincot Williams & Wilkins; 2005. 3-24p..

The three meta-analyzes1818 Matsumoto H, Higino H, Hayashi K, Ideno Y, Wada T, Ogata T, et al. The effect of balneotherapy on the relief of pain, stiffness and physical function in patients with osteoarthritis of the knee: a meta-analysis. Clin Rheumatol. 2017;36(8):1839-47.,2525 Chen B, Zhan H, Chung M, Lin X, Zhang M, Pang J, et al. Chinese herbal bath therapy for the treatment of knee osteoarthritis: meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2015;2015;949172.,3232 Bender T, Bálint G, Prohászka Z, Géher P, Tefner IK. Evidence-based hydro- and balneotherapy in Hungary--a systematic review and meta-analysis. Int J Biometeorol. 2014;58(3):311-23. analyzed (LE1) evidenced the efficacy and beneficial results of CT(2) and HT(1) for pain control in knee osteoarthritis (OAK) and hand (OAH), chronic low back pain, chronic pelvic pain, degenerative joint and spinal diseases, antioxidant occurrences, metabolic and inflammatory parameters, increasing blood flow and muscle relaxation. Also, HT with Chinese herbs2525 Chen B, Zhan H, Chung M, Lin X, Zhang M, Pang J, et al. Chinese herbal bath therapy for the treatment of knee osteoarthritis: meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2015;2015;949172. may be effective in reducing OAK pain when compared to standard western treatment. Similarly, the five (27.7%) SRRCT2424 Forestier R, Erol Forestier FB, Francon A. Spa therapy and knee osteoarthritis: a systematic review. Ann Phys Rehabil Med. 2016;59(3):216-26.,2727 Cornejo JL, Reffers DG, Vergara DA, Maldonado EA, Munõz SR, Lara MJ. Effectiveness of hydrotherapy to reduce pain and improve quality of life and physical function in adults with knee osteoarthritis: a systematic review. Rev Soc Esp Dolor. 2015;22(4):168-74.,2828 Karagülle M, Karagülle MZ. Efficacy of balneotherapy and spa therapy for the treatment of chronic low back pain: a review of the most recent evidence. Clin Rheumatol. 2015;34(2):207-14.,3333 Larmer PJ, Bell J, O'Brien D, Dangen J, Kersten P. Hydrotherapy outcome measures for people with arthritis: a systematic review. N Zealand J Physiother. 2014;42(2):54-67.,3535 Cechetti F, Fabro AQ, Martini DR. Reabilitação aquática como recurso de tratamento da osteoartrose de quadril e joelho. Fisioter Bras. 2012;13(5):384-9. solidly demonstrated the efficacy of CT(2) and HT(5), when combined or even isolated, in labor pain, in the low back pain, arthritis and OAK, and in the hip and ankle.

Regarding the RCTs1414 Ceylan SS, Bollşlk B. Effects of swaddled and sponge bathing methods on signs of stress and pain in premature newborns: implications for evidence-based practice. Worldviews Evid Based Nurs. 2018;15(4):296-303.,2020 Koyuncu E, Ökmen BM, Özkuk K, Taşoğlu Ö, Özgirgin N. The effectiveness of balneotherapy in chronic neck pain. Clin Rheumatol. 2016;35(10):2549-55.,2121 Branco M, Rêgo NN, Silva PH, Archanjo IE, Ribeiro MC, Trevisani VF. Bath thermal waters in the treatment of knee osteoarthritis: a randomized controlled clinical trial. Eur J Phys Rehabil Med. 2016;52(4):422-30.,3030 Baena-Beato PÁ, Artero EG, Arroyo-Morales M, Robles-Fuentes A, Gatto-Cardia MC, Delgado-Fernández M. Aquatic therapy improves pain, disability, quality of life, body composition and fitness in sedentary adults with chronic low back pain. A controlled clinical trial. Clin Rehabil. 2014;28(4):350-60.,3434 Lee SL, Liu CY, Lu YY, Gau ML. Efficacy of warm showers on labor pain and birth experiences during the first labor stage. J Obstet Gynecol Neonatal Nurs. 2013;42(1):19-28.,3939 Silva LE, Valim V, Pessanha AP, Oliveira LM, Myamoto S, Jones A, et al. Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial. Phys Ther. 2008;88(1):12-21 of LE2, the six (22.2%) analyzed the efficacy of CT(2) and HT(4) concerning pain in labor, as in of the newborn (NB), musculoskeletal and osteoarticular. All showed a significantly better effect not only on the intensity of pain and stress but also on other parameters evaluated in comparison to the baseline condition of each one, demonstrating that these PICS are economical, harmless, effective and safe.

Analyzing the 11 NRCT1515 Avila MA, Camargo PR, Ribeiro IL, Albuquerque-Sendín F, Zamunér AR, Salvini TF. Effects of a 16-week hydrotherapy program on three-dimensional scapular motion and pain of women with fibromyalgia: a single-arm study. Clin Biomech. 2017,49:145-54.

16 Batten M, Stevenson E, Zimmermann D, Isaacs C. Implementation of a hydrotherapy protocol to improve postpartum pain management. J Midwifery Womens Health. 2017;62(2):210-4.
-1717 Cipriano P, Oliveira C. Influência da bandagem elástica kinesio tape e da hidroterapia na dor pélvica posterior e na funcionalidade nas atividades diárias de gestantes. Fisioter Bras. 2017;18(1):2-11.,2222 Kümpel C, Saadeddine I, Porto EF, Borba RG, Castro AA. Impacto de um programa estruturado de hidrocinesioterapia em pacientes com osteoartrite de joelho. Acta Fisiátr. 2016;23(2):51-6.,2323 Fonseca LB, Brito CJ, Silva RJ, Silva-Grigoletto ME, da Silva WM Junior, Franchini E. Use of cold-water immersion to reduce muscle damage and delayed-onset muscle soreness and preserve muscle power in Jiu-Jitsu athletes. J Tthl Train. 2016;51(7):540-9.,2626 Ezheltha Suji SD, Sharmila Jansi Rani SS. Effectiveness of hot foot bath versus exercises on reducing pain among patients with osteoarthritis. Int J Nurs Educ. 2015;7(3):70-5.,2929 Liu Y, Liu Y, Huang X, Du C, Peng J, Huang P, et al. A comparison of maternal and neonatal outcomes between water immersion during labor and conventional labor and delivery. BMC Pregnancy Childbirth. 2014;14:160.,3131 Baena-Beato PÁ, Delgado-Fernández M, Artero EG, Robles-Fuentes A, Gatto-Cardia MC, Arroyo-Morales M. Disability predictors in chronic low back pain after aquatic exercise. Am J Phys Med Rehabil. 2014;93(7):615-23.,3737 Stark MA, Miller MG. Barriers to the use of hydrotherapy in labor. J Obstet Gynecol Neonatal Nurs. 2009;38(6):667-75.,3838 Ferreira LR, Pestana PR, Oliveira J, Ferrari RA. Efeitos da reabilitação aquática na sintomatologia e qualidade de vida de portadoras de artrite reumatóide. Fisioter Pesqui. 2008;15(2):136-41.,4040 Silva TF, Suda EY, Marçulo CA, Paes FH, Pinheiro GT. Comparação dos efeitos da estimulação elétrica nervosa transcutânea e da hidroterapia na dor, flexibilidade e qualidade de vida de pacientes com fibromialgia. Fisioter Pesqui. 2008;15(2):118-24. all investigated HT in several painful situations, as in pain in fibromyalgic women1515 Avila MA, Camargo PR, Ribeiro IL, Albuquerque-Sendín F, Zamunér AR, Salvini TF. Effects of a 16-week hydrotherapy program on three-dimensional scapular motion and pain of women with fibromyalgia: a single-arm study. Clin Biomech. 2017,49:145-54.,4040 Silva TF, Suda EY, Marçulo CA, Paes FH, Pinheiro GT. Comparação dos efeitos da estimulação elétrica nervosa transcutânea e da hidroterapia na dor, flexibilidade e qualidade de vida de pacientes com fibromialgia. Fisioter Pesqui. 2008;15(2):118-24.; in puerperae1616 Batten M, Stevenson E, Zimmermann D, Isaacs C. Implementation of a hydrotherapy protocol to improve postpartum pain management. J Midwifery Womens Health. 2017;62(2):210-4.; in the pelvic pain of pregnant women1717 Cipriano P, Oliveira C. Influência da bandagem elástica kinesio tape e da hidroterapia na dor pélvica posterior e na funcionalidade nas atividades diárias de gestantes. Fisioter Bras. 2017;18(1):2-11.; in osteoarticular and musculoskeletal pain2222 Kümpel C, Saadeddine I, Porto EF, Borba RG, Castro AA. Impacto de um programa estruturado de hidrocinesioterapia em pacientes com osteoartrite de joelho. Acta Fisiátr. 2016;23(2):51-6.,2323 Fonseca LB, Brito CJ, Silva RJ, Silva-Grigoletto ME, da Silva WM Junior, Franchini E. Use of cold-water immersion to reduce muscle damage and delayed-onset muscle soreness and preserve muscle power in Jiu-Jitsu athletes. J Tthl Train. 2016;51(7):540-9.,2626 Ezheltha Suji SD, Sharmila Jansi Rani SS. Effectiveness of hot foot bath versus exercises on reducing pain among patients with osteoarthritis. Int J Nurs Educ. 2015;7(3):70-5.,3838 Ferreira LR, Pestana PR, Oliveira J, Ferrari RA. Efeitos da reabilitação aquática na sintomatologia e qualidade de vida de portadoras de artrite reumatóide. Fisioter Pesqui. 2008;15(2):136-41.,4040 Silva TF, Suda EY, Marçulo CA, Paes FH, Pinheiro GT. Comparação dos efeitos da estimulação elétrica nervosa transcutânea e da hidroterapia na dor, flexibilidade e qualidade de vida de pacientes com fibromialgia. Fisioter Pesqui. 2008;15(2):118-24., pain during labor2929 Liu Y, Liu Y, Huang X, Du C, Peng J, Huang P, et al. A comparison of maternal and neonatal outcomes between water immersion during labor and conventional labor and delivery. BMC Pregnancy Childbirth. 2014;14:160.,3737 Stark MA, Miller MG. Barriers to the use of hydrotherapy in labor. J Obstet Gynecol Neonatal Nurs. 2009;38(6):667-75., all of which are effective in improving painful symptoms.

This review also included a qualitative and quantitative cross-sectional study3636 Marques LA, Vale F, Vieira VR, Nogueira VA, Mialhe FL, Silva LC. Atenção farmacêutica e práticas integrativas e complementares no SUS: conhecimento e aceitação por parte da população. são joanense. Physis. 2011;21(2):663-74. that investigated the knowledge and acceptance of PICs by SUS physicians and users to show the lack of knowledge of users and professionals, and also considering that such article could stimulate further research since 100% of the respondents ignored the existence of most PICS. This study finds resonance in another, eight years later, that verified the knowledge, and the use of PICS for pain control by the population of the larger cities of Vale do Paraíba Paulista41 with similar results, since of 100 respondents, only 17.5% knew and 82.5% did not know them. The population still does not know the PICs that the SUS offers, using in greater number the older therapy, acupuncture, which was already part of the SUS, which shows the importance of studying, explaining, disseminating and presenting the PICS and its advantages the community. Therefore, systematic, randomized and controlled studies are needed that result in high, strong and sufficient evidence1313 Melnyk BM, Fineout-Overholt E. Making the case for evidence-based practice. In: Melnyk BM, Fineout-Overholt E. Evidence based practice in nursing & healthcare. A guide to best practice. Philadelphia: Lippincot Williams & Wilkins; 2005. 3-24p. of PICS in the treatment of pain, which render people partially or totally disabled, transiently or permanently, triggering stress, suffering, and loss of quality of life (QoL)44 Araujo LC, Romero B. Dor: avaliação do 5º sinal vital. Uma reflexão teórica. Rev Dor. 2015;16(4):291-6.,

The limiting factors for the actual realization of the use of PICS are the scarce scientific evidence of a strong and sufficient level1313 Melnyk BM, Fineout-Overholt E. Making the case for evidence-based practice. In: Melnyk BM, Fineout-Overholt E. Evidence based practice in nursing & healthcare. A guide to best practice. Philadelphia: Lippincot Williams & Wilkins; 2005. 3-24p. and the lack of knowledge about their use by health professionals. However, even limited, it seems correct to say that this study showed the efficacy of CT and HT in the treatment of pain in organic changes such as the knee, hand and ankle osteoarthritis; the musculoskeletal; those of obstetric origin. It also warns of the need for further research on how PICS may contribute to pain relief and reiterates that it is now mandatory to measure, control and record it by EAS health professionals as the Fifth Vital Sign. Given the above, including PICs in the treatment of pain, is an important issue to ensure comprehensive health care.

CONCLUSION

Most of the evidence emerged from the studies analyzed focused on levels 1 to 3 regarding the effective use of PICS, CT, and HT. Of the 18 articles on the efficacy of HT, eight on CT in the pain charts of knee, hand and ankle and musculoskeletal osteoarthritis and one in obstetric pain.

In most studies, evidence for the efficacy of PICS, CT, and HT was focused on levels 1 to 3. The efficacy of HT was demonstrated in 18 articles: five in labor pains, two in fibromyalgia, ten musculoskeletal and pain caused by osteoarthritis of the knee, hand, hip and ankle, and in an article concerning the pain of newborns. The efficacy of CT was evidenced in eight articles of musculoskeletal pain due to knee, hand, hip and ankle osteoarthritis; and a qualitative article that shows the lack of knowledge of users and professionals about the use of PICS in SUS. It also showed that there are few scientific subsidies to scientifically substantiate the use of HT and CT in the treatment of pain, needing to increase the knowledge of these PICs with actions of permanent education, and at the same time, stimulate the increase of the scientific production by the health professionals for the effective use of these PICS.

  • Sponsoring sources: none.

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Publication Dates

  • Publication in this collection
    19 June 2019
  • Date of issue
    Apr-Jun 2019

History

  • Received
    04 July 2018
  • Accepted
    02 May 2019
Sociedade Brasileira para o Estudo da Dor Av. Conselheiro Rodrigues Alves, 937 Cj2 - Vila Mariana, CEP: 04014-012, São Paulo, SP - Brasil, Telefones: , (55) 11 5904-2881/3959 - São Paulo - SP - Brazil
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