A Prospective “Study by Correspondence” on the Effects of Kneipp Hydrotherapy in Patients with Complaints due to Peripheral Neuropathy

Paresthesia and other malfunction of sense are typical complaints of peripheral neuropathy (PNP) which are most often located symmetrically in the lower limbs. In more severe forms, there are also paresis, muscular atrophy and trophical changes of the skin. The prevalence of PNP is estimated at 1:2500 inhabitants in Germany. Etiologic relations include metabolic diseases, intoxications, infections and immunological diseases, yet in many patients their etiology remains unclear. The diagnosis is based on anamnesis, neurological examinations, particularly on nerve conduction velocity [1]. The therapy focusses on the underlying disease, provided there is one, and consists of supplementation of neurotrophic vitamins and α-liponic acid, the latter mainly for patients with diabetes mellitus [2]. Other symptomatic treatments with drugs include calcium channel blockers in patients with muscle cramps, antiphlogistics, analgetics and antidepressants as well as topically applied capsicum extract standardized to capsaicin [3]. Various methods of physiotherapy are also used for the treatment of the symptoms of polyneuropathy, also hydrotherapy is recommended. There are no systematic investigations about hydrotherapy. Hydrotherapeutic applications in the tradition of Sebastian Kneipp (1821–97) are administered locally as cold stimulus with short duration, thereby inducing a local reactive hyperemia, involving neuronal, vegetative, endocrinal and immunological systems [4]. Long-term treatment with a series of hydrotherapeutic measures Background: Kneipp hydrotherapy is often recommended to reduce symptoms of peripheral neuropathy on the basis that the cold stimulus could influence neuronal networking and that improvement of circulation and metabolism could improve local neuronal function. However, no data on clinical effectiveness are available. Aim of the Study: To evaluate the effectiveness of and compliance with hydrotherapeutic self-treatment in patients with peripheral neuropathy (PNP). Design of the Study: Preliminary open prospective observational “study by correspondence”: Patients received written information, instructions and questionnaires without direct contact with the study physician. Methods: Patients with interest in participation were enrolled from self-help groups and by TV and internet and were given instructions. They were asked to self treat at home daily using at least two out of four Kneipp hydrotherapeutic applications (knee affusion, cold foot-bath, alternating foot-bath, wet socks). After 8 weeks of treatment, patients returned their diaries with self-ratings of complaints before and after each application as well as their judgments before the cure and at its end. Results: We received completed forms from 27 patients (15 females, 12 males; mean age 68.2 years). Patients reported a significant decrease in dysesthesia from a mean of 3.4 (baseline) to 2.9 (t-test, 2p<0.04) after the cure. Hypesthesia (numbness) improved from 3.5 to 3.1 (2p<0.12). There were no significant changes for total pain (2.6 to 2.5) and paresis (0.8 to 0.8). Acute relief of symptoms was reported after 30–62% of applications with an increasing trend during the cure versus acute impairments only after 5 to 9% of applications. Conclusions: Our results give hints for effectiveness of self-treatment with hydrotherapy in patients with PNP – at least in a subgroup of them. Yet, there are limitations of the interpretation of the results of this uncontrolled study. Efficacy might be better after detailed and personal instruction on the hydrotherapeutic procedures. Conducting a prospective “study by correspondence” seems to be appropriate at least for generating preliminary data for natural healing self-treatments under realistic everyday conditions.