Response of pain to static magnetic fields in postpolio patients: a double-blind pilot study

Joint and Back Pain: Medications and Role of Injection Therapy for Destructive Joint

Postpolio syndrome (PPS) is a sequela with symptoms that often occur in patients who previously survived poliomyelitis. Pain is a characteristic feature of PPS. Although poliomyelitis is no longer commonly seen in the western world, there is a significant portion of patients living with PPS. Recognizing the signs of PPS is integral in developing treatment plans. Conservative management is routinely considered first-line therapy; however, alternate treatments, pharmacologic and minimally invasive, are used in more refractory cases. Approaching patients living with pain and PPS requires a holistic approach and an understanding of the efficacy of available treatment modalities.

The Analgesic Effects of Static Magnetic Fields

Pain is one of the most common reasons why people seek medical care, which is related to most disease states. Magnetic fields (MFs) can be applied locally to specific parts of human bodies with high penetration and temporal control, which have a long-debated history in folk therapy. The purpose of this review is to collect and analyze experimental data about the analgesic effects of static magnetic fields (SMFs) so that we can have a scientific understanding regarding this topic. We collected 28 studies (25 English and 3 Chinese papers) with proper sham controls that investigated the effects of SMFs on pain relief in humans or mice. We found that 64% of the human studies and all mice studies in the literature showed positive analgesic effects of SMFs, which are related to factors including SMF intensity, treatment time, and pain types. Higher intensity and/or longer treatment time, as well as some specific pain types, may have better pain relief effects. Initial mechanistic studies indicated that membrane receptors, such as capsaicin receptor VR1/TRPV1, opioid receptors, and P2X3 receptors, might be involved. By describing experimental evidence and analysis, we found that SMFs actually hold considerable promise for managing some specific types of pain if proper SMF parameters are used. More studies comprehensively evaluating the parameters of SMF and its corresponding analgesic effects on different pain types, as well as the underlying molecular mechanisms, will be necessary to further validate its therapeutic potential in pain management in the future. Bioelectromagnetics. 00:00-00, 2021. © 2021 Bioelectromagnetics Society.

Effects of a Concentric Rare-Earth Magnet on Menstrual Cycle Pain: A Parallel Group Randomized Pilot Study

Background Based on prior reports of the use of magnets to treat pain, our goal was to determine if a concentric rare-earth alternating-pole magnet reduced period pain versus a sham-magnet.  Methods Participants were females (N=36, 18 to 35 years) who regularly experienced menstrual period pain ≥ six on the numeric pain rating scale (NPRS) of 0-10. Subjects were excluded if they took pain medication on the study day or had implanted pacemakers/metallic devices or secondary dysmenorrhea. Participants were randomized to wear a concentric neodymium-iron boron active-magnet (surface-field of 0.4 Tesla) or a sham magnet. The participant and investigator applying the device were blinded to the device used. The device was placed at the abdominal location of the reported greatest pain for 40-minutes, during which time the subject was able to conduct the normal activity. Pain scores were reported prior to device wearing and afterward. Participants with post-treatment NPRS ratings reduced by ≥ 35% from their pretreatment pain ratings were scored as having reduced pain; reductions < 35% were scored as no meaningful pain change. The threshold of 35% was chosen based on a survey of 10 women as to the level of pain reduction they viewed as meaningful to them. Of the 36 women in this pilot study, 19 wore an active-magnet and 17 wore a sham-magnet. Analyses were based on chi-square and Mann-Whitney statistical tests. Results  Pre-treatment pain scores (mean ± SD) were similar for both groups. Magnet-vs-sham pre-treatment scores were, respectively, 7.16 ± 0.85 vs. 6.94 ± 1.20 (p=0.330). Corresponding median values for the magnet (N=19) and sham (N=17) groups respectively were seven pre-treatment and four post-treatment vs. six pre-treatment and six post-treatment. Post-treatment scores for magnet treated subjects (4.16 ± 2.20) were significantly less (p=0.027) than for sham-treated (5.53 ± 1.50). Of the 19 who wore a magnet, 11 experienced meaningful pain-reduction, and eight did not. Of the 17 who wore a sham, three experienced meaningful pain-reduction, and 14 did not. Magnet and sham wearing responses were statistically significant via chi-square analysis (chi-square=6.12, p=0.013). Percentage reduction in pain score was 41.8% ± 31.1% for magnet-treated vs. 20.8% ± 16.1%, for sham-treated (p<0.05). Conclusions Results suggest that short-term wearing of the magnet herein investigated, produces a meaningful menstrual-pain reduction in some women. Thus, further expanded research seems warranted to determine if longer wearing times result in even greater pain reductions.

Post-polio Syndrome: More Than Just a Lower Motor Neuron Disease

Post-polio syndrome (PPS) is a neurological condition that affects polio survivors decades after their initial infection. Despite its high prevalence, the etiology of PPS remains elusive, mechanisms of progression are poorly understood, and the condition is notoriously under-researched. While motor dysfunction is a hallmark feature of the condition, generalized fatigue, sleep disturbance, decreased endurance, neuropsychological deficits, sensory symptoms, and chronic pain are also often reported and have considerable quality of life implications in PPS. The non-motor aspects of PPS are particularly challenging to evaluate, quantify, and treat. Generalized fatigue is one of the most distressing symptoms of PPS and is likely to be multifactorial due to weight-gain, respiratory compromise, poor sleep, and polypharmacy. No validated diagnostic, monitoring, or prognostic markers have been developed in PPS to date and the mainstay of therapy centers on symptomatic relief and individualized rehabilitation strategies such as energy conservation and muscle strengthening exercise regimes. Despite a number of large clinical trials in PPS, no effective disease-modifying pharmacological treatments are currently available.

The influence of N and S poles of static magnetic field (SMF) on Candida albicans hyphal formation and antifungal activity of amphotericin B

Due to the increasing number of Candida albicans’ infections and the resistance of this pathogenic fungus to drugs, new therapeutic strategies are sought. One of such strategies may be the use of static magnetic field (SMF). C. albicans cultures were subjected to static magnetic field of the induction 0.5 T in the presence of fluconazole and amphotericin B. We identified a reduction of C. albicans hyphal length. Also, a statistically significant additional effect on the viability of C. albicans was revealed when SMF was combined with the antimycotic drug amphotericin B. The synergistic effect of this antimycotic and SMF may be due to the fact that amphotericin B binds to ergosterol in plasma membrane and SMF similarly to MF could influence domain orientation in plasma membrane (PM).

Therapeutic Effect of Superficial Acupuncture in Treating Myofascial Pain of the Upper Trapezius Muscle: A Randomized Controlled Trial

The aim of this study was to compare the treatment efficacies of superficial acupuncture and traditional acupuncture on trigger points of the upper trapezius muscle. Forty people were recruited and randomly allocated to the traditional and superficial acupuncture groups. Each subject received two treatments per week in a four-week period. Outcomes were measured by visual analogue scale (VAS), the Northwick Park neck pain questionnaire scores (NPQ), and pressure pain threshold (PPT) assessments of trigger points. Data collected before the interventions were considered as baseline. Assessments were performed after the first treatment and at the end of the second and fourth weeks of treatment. Patients reported significant (p<0.05) and immediate improvements in VAS and PPT for both superficial acupuncture and traditional acupuncture after the first treatment and after two and four weeks. Significant improvements (p<0.05) in NPQ were attained after two weeks of treatments in both groups. Because superficial acupuncture is associated with less pain while producing immediate pain relief, we recommend it for treating myofascial pain syndrome in the upper trapezius muscle.

Post-polio syndrome and the late effects of poliomyelitis: Part 2. treatment, management, and prognosis

Post-polio syndrome (PPS) is characterized by new muscle weakness and/or muscle fatigability that occurs many years after the initial poliomyelitis illness. An individualized approach to rehabilitation management is critical. Interventions may include rehabilitation management strategies, adaptive equipment, orthotic equipment, gait/mobility aids, and a variety of therapeutic exercises. The progression of muscle weakness in PPS is typically slow and gradual; however, there is also variability in both the natural history of weakness and functional prognosis. Further research is required to determine the effectiveness of selected medical treatment. Muscle Nerve 58:760-769, 2018.

Poliomyelitis

Poliomyelitis, often termed "polio," is an acute infectious disease caused by an enterovirus which damages the anterior horn cells of the spinal cord and brainstem. Progress to lower motor neurone cell death leads to disruption of motor units and subsequent muscle weakness or complete paralysis. Although the virus is mostly eradicated from the Western world, postpolio decline is prevalent among people aged 60 years and over. It is characterized primarily by fatigability and muscle weakness, but pain is also common. Reductions in lower-limb muscle strength, voluntary drive, and endurance are likely to contribute to the impaired balance control, slow gait, and dysfunctional lower-limb kinematics reported in polio survivors. Given these significant risk factors, polio survivors fall up to four times more often than their age-matched healthy peers. Interventions to improve function, reduce disability, and prevent falls in polio survivors are therefore clinically relevant but studies are lacking, limiting the evidence base. Balance training, cognitive behavioral therapy, and orthoses prescription might be recommended. Muscle-strengthening programs should be carefully designed and delivered due to their potential detrimental effects related to excessive use and potential dysfunction of motor neurones and their axons.

An Overview of Biofield Devices

Advances in biophysics, biology, functional genomics, neuroscience, psychology, psychoneuroimmunology, and other fields suggest the existence of a subtle system of "biofield" interactions that organize biological processes from the subatomic, atomic, molecular, cellular, and organismic to the interpersonal and cosmic levels. Biofield interactions may bring about regulation of biochemical, cellular, and neurological processes through means related to electromagnetism, quantum fields, and perhaps other means of modulating biological activity and information flow. The biofield paradigm, in contrast to a reductionist, chemistry-centered viewpoint, emphasizes the informational content of biological processes; biofield interactions are thought to operate in part via low-energy or "subtle" processes such as weak, nonthermal electromagnetic fields (EMFs) or processes potentially related to consciousness and nonlocality. Biofield interactions may also operate through or be reflected in more well-understood informational processes found in electroencephalographic (EEG) and electrocardiographic (ECG) data. Recent advances have led to the development of a wide variety of therapeutic and diagnostic biofield devices, defined as physical instruments best understood from the viewpoint of a biofield paradigm. Here, we provide a broad overview of biofield devices, with emphasis on those devices for which solid, peer-reviewed evidence exists. A subset of these devices, such as those based upon EEG- and ECG-based heart rate variability, function via mechanisms that are well understood and are widely employed in clinical settings. Other device modalities, such a gas discharge visualization and biophoton emission, appear to operate through incompletely understood mechanisms and have unclear clinical significance. Device modes of operation include EMF-light, EMF-heat, EMF-nonthermal, electrical current, vibration and sound, physical and mechanical, intentionality and nonlocality, gas and plasma, and other (mode of operation not well-understood). Methodological issues in device development and interfaces for future interdisciplinary research are discussed. Devices play prominent cultural and scientific roles in our society, and it is likely that device technologies will be one of the most influential access points for the furthering of biofield research and the dissemination of biofield concepts. This developing field of study presents new areas of research that have many important implications for both basic science and clinical medicine.

Treatment for postpolio syndrome

BACKGROUND

Postpolio syndrome (PPS) may affect survivors of paralytic poliomyelitis and is characterised by a complex of neuromuscular symptoms leading to a decline in physical functioning. The effectiveness of pharmacological treatment and rehabilitation management in PPS is not yet established. This is an update of a review first published in 2011.

OBJECTIVES

To systematically review the evidence from randomised and quasi-randomised controlled trials for the effect of any pharmacological or non-pharmacological treatment for PPS compared to placebo, usual care or no treatment. 

SEARCH METHODS

We searched the following databases on 21 July 2014: Cochrane Neuromuscular Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO and CINAHL Plus. We also checked reference lists of all relevant articles, searched the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment (HTA) Database and trial registers and contacted investigators known to be involved in research in this area.

SELECTION CRITERIA

Randomised and quasi-randomised trials of any form of pharmacological or non-pharmacological treatment for people with PPS. The primary outcome was self perceived activity limitations and secondary outcomes were muscle strength, muscle endurance, fatigue, pain and adverse events.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by The Cochrane Collaboration.

MAIN RESULTS

We included 10 pharmacological (modafinil, intravenous immunoglobulin (IVIg), pyridostigmine, lamotrigine, amantadine, prednisone) and three non-pharmacological (muscle strengthening, rehabilitation in a warm climate (that is temperature ± 25°C, dry and sunny) and a cold climate (that is temperature ± 0°C, rainy or snowy), static magnetic fields) studies with a total of 675 participants with PPS in this review. None of the included studies were completely free from any risk of bias, the most prevalent risk of bias being lack of blinding.There was moderate- and low-quality evidence that IVIg has no beneficial effect on activity limitations in the short term and long term, respectively, and inconsistency in the evidence for effectiveness on muscle strength. IVIg caused minor adverse events in a substantial proportion of the participants. Results of one trial provided very low-quality evidence that lamotrigine might be effective in reducing pain and fatigue, resulting in fewer activity limitations without generating adverse events. Data from two single trials suggested that muscle strengthening of thumb muscles (very low-quality evidence) and static magnetic fields (moderate-quality evidence) are safe and beneficial for improving muscle strength and pain, respectively, with unknown effects on activity limitations. Finally, there was evidence varying from very low quality to high quality that modafinil, pyridostigmine, amantadine, prednisone and rehabilitation in a warm or cold climate are not beneficial in PPS.

AUTHORS' CONCLUSIONS

Due to insufficient good-quality data and lack of randomised studies, it was impossible to draw definite conclusions about the effectiveness of interventions for PPS. Results indicated that IVIg, lamotrigine, muscle strengthening exercises and static magnetic fields may be beneficial but need further investigation to clarify whether any real and meaningful effect exists.

Neuroprotective effect of weak static magnetic fields in primary neuronal cultures

Low intensity static magnetic fields (SMFs) interact with various biological tissues including the CNS, thereby affecting key biological processes such as gene expression, cell proliferation and differentiation, as well as apoptosis. Previous studies describing the effect of SMFs on apoptotic cell death in several non-neuronal cell lines, emphasize the importance of such a potential modulation in the case of neurodegenerative disorders, where apoptosis constitutes a major route via which neurons degenerate and die. In this study, we examine the effect of SMFs on neuronal survival in primary cortical and hippocampal neurons that constitute a suitable experimental system for modeling the neurodegenerative state in vitro. We show that weak SMF exposure interferes with the apoptotic programing in rat primary cortical and hippocampal neurons, thereby providing protection against etoposide-induced apoptosis in a dose- and time-dependent manner. Primary cortical neurons exposed to SMF (50G) for 7days exhibited a 57.1±6.3% decrease in the percentage of cells undergoing apoptosis induced by etoposide (12μM), accompanied by a marked decrease in the expression of the pro-apoptotic markers: cleaved poly ADP ribose polymerase-1, cleaved caspase-3, active caspase-9 and the phospho-histone H2A variant (Ser139) by 41.0±5.0%, 81.2±5.0%, 72.9±6.4%, 42.75±2.9%, respectively, and by a 57.2±1.0% decrease in the extent of mitochondrial membrane potential collapse. Using the L-type voltage-gated Ca(2+) channel inhibitor nifedipine, which is selective to Ca(2+) influx through Cav1.2, we found that the anti-apoptotic effect of SMFs was mediated by Ca(2+) influx through these channels. Our findings demonstrating altered Ca(2+)-influx in response to thapsigargin stimulation in SMF-exposed cortical neurons, along with enhanced inhibition of KCl-induced Ca(2+)-influx through Cav1.2 channels and enhanced expression of Cav1.2 and Cav1.3 channels, allude to the involvement of voltage- and store-operated Ca(2+) channels in various aspects of the protective effect exerted by SMFs. These findings show the potential susceptibility of the CNS to weak SMF exposure and have implications for the design of novel strategies for the treatment and/or prevention of neurodegenerative diseases.

A Birdcage Model for the Chinese Meridian System Part III: Possible Mechanism of Magnetic Therapy

Based on the electromagnetic model of the transmission line for the channel and the birdcage resonator for the meridian network, we interpret two effects, seemingly incomprehensible in terms of current Western physiology, the lasting effect and the remote effect. For the lasting effect, acupuncture enhances the amplitude of the Qi standing wave, and this increased amplitude is retained and thus is able to sustain a gradual remodeling of the extracellular matrix in interstitial connective tissues, resulting in a lasting therapeutic effect. For the remote effect (acupuncture effect far from the site of needle insertion), our model puts the mechanism of magnetic therapy on an equal footing with that of acupuncture. It may not be a coincidence that accounts of investigators in both acupuncture and magnetotherapy about the depth of the effective site — along cleavage planes between muscles, or between muscle and bone or tendon — are in accord with that of the Huang Di Nei Jing about the course of channels: "they are embedded and travel between interstitial muscles, deep and invisible." A possible magnetic field generated outside the birdcage may be manipulated to produce local areas of higher temperature or very strong fields.

A moderate-intensity static magnetic field enhances repair of cartilage damage in rabbits

BACKGROUND AND AIMS

Electromagnetic fields have been proposed to enhance healing of cartilage defects by stimulation of chondrocyte proliferation, proteoglycan synthesis as well as decreasing pain and improving motion in osteoarthritic patients. However, the effects of a moderate-intensity static magnetic field on cartilage repair have not been investigated. This study tries to determine the effects of a moderate-intensity permanent magnetic field of 40 mT on cartilage repair.

METHODS

Defects of 3 mm in diameter and 6 mm in depth were made on the weight bearing surface of the right medial femoral condyle of 30 rabbits. The animals were divided randomly into three equal groups (magnet, sham and control). In the magnet group, cylindrical permanent magnets were implanted subcutaneously medial to the medial femoral condyle, while in the sham group the cylindrical ceramic were not magnetized, and nothing was implanted in controls. After 12 weeks of observation, Mankin's microscopic scoring was done on all specimens, and irregularity of surface characteristics, cell colonization, hypocellularity, cartilage matrix formation, and presence of empty lacunae were investigated.

RESULTS

Each of these characteristics showed significant differences in magnet group relative to control and sham groups (p <0.05). Mankin's score was 1.6 ± 0.6 in magnet group, 7.2 ± 1.6 in sham group and 7.7 ± 1 in control group (p <0.001).

CONCLUSIONS

[corrected] In this animal study, microscopic Mankin's scoring depicted histological improvement in cartilage of magnet group.

[Medical relevance of magnetic fields in pain therapy]

BACKGROUND

Magnetic and electromagnetic fields have been accepted as real physical entities in medicine and are believed to achieve pain relief. Magnetic field therapy has been acknowledged as a non-invasive, safe and simple method for treatment of the site of injury, source of pain or inflammation, or other types of illnesses and pathologies. However, a consensus regarding the statistical relevance of the effects has not been established.

MATERIALS AND METHODS

A detailed literature research was performed and the results were evaluated. Inclusion criteria were that the studies had to be randomized, double-blind and placebo-controlled, and no additional forms of treatment other than magnetic effects were allowed to be used.

RESULTS

The evaluation of 17 studies with static magnetic fields showed on average no significant difference in pain relief between the group treated with magnetic fields and the placebo group. All studies using magnetic fields showed that forms of treatment conducted over a period of 30 min and at intervals of 1 week have no effects. In 10 studies with dynamic magnetic fields different effects were registered, which ranged from no effect to significant differences regarding pain relief between the treated and the control groups.

CONCLUSIONS

Static magnetic fields are ineffective with respect to pain therapy. Dynamic magnetic fields show diverse effects. Hence, this therapy should be researched in depth.

Treatment for postpolio syndrome

BACKGROUND

Postpolio syndrome (PPS) may affect survivors of paralytic poliomyelitis and is characterised by a complex of neuromuscular symptoms leading to a decline in physical functioning. The effectiveness of pharmacological treatment and rehabilitation management in PPS is not yet established.

OBJECTIVES

To review systematically the effects of any treatment for PPS compared to placebo, usual care or no treatment.  

SEARCH STRATEGY

We searched the following databases on 1 October 2010: Cochrane Neuromuscular Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO and CINAHL Plus from inception to September 2010.

SELECTION CRITERIA

Randomised and quasi-randomised trials of any form of pharmacological or non-pharmacological treatment for people with PPS. The primary outcome was self-perceived activity limitations and secondary outcomes were muscle strength, muscle endurance, fatigue, pain and adverse events.

DATA COLLECTION AND ANALYSIS

Two authors independently selected eligible studies, assessed risk of bias and extracted data.

MAIN RESULTS

Nine pharmacological (modafinil, intravenous immunoglobulin, pyridostigmine, lamotrigine, amantadine, prednisone) and three non-pharmacological (muscle strengthening, rehabilitation in a warm climate (i.e. temperature ± 25°C, dry and sunny) and a cold climate (i.e. temperature ± 0°C, rainy or snowy), static magnetic fields) studies were included in this review. None of the included studies was completely free from any risk of bias and the most prevalent risk of bias was lack of blinding.There is moderate quality evidence that intravenous immunoglobulin has no beneficial effect on activity limitations and there is inconsistency in the evidence for effectiveness on muscle strength and pain. Results of one trial provide very low quality evidence that lamotrigine might be effective in reducing pain and fatigue, resulting in fewer activity limitations. Data from two single trials suggest that muscle strengthening of thumb muscles (very low quality evidence) and static magnetic fields (moderate quality evidence) are beneficial for improving muscle strength and pain, respectively, with unknown effects on activity limitations. Finally, there is evidence varying from very low quality to high quality that modafinil, pyridostigmine, amantadine, prednisone and rehabilitation in a warm or cold climate are not beneficial in PPS.

AUTHORS' CONCLUSIONS

Due to insufficient good quality data and lack of randomised studies it is impossible to draw definite conclusions on the effectiveness of interventions for PPS. Results indicate that IVIG, lamotrigine, muscle strengthening exercises and static magnetic fields may be beneficial but need further investigation.

Strontium hexaferrite nanomagnets suspended in a cosmetic preparation: a convenient tool to evaluate the biological effects of surface magnetism on human skin

BACKGROUND/PURPOSE

Magnetic therapy has been popular for ages, but its therapeutic abilities remain to be demonstrated. We aimed to develop a homogeneous, stable dispersion of magnetic nanoparticles in a skin-care preparation, as a tool to analyze the biological and physiological effects of superficial magnetism in skin.

METHODS

SrFe(12)O(19) nanoparticles were generated by ultrasound, dispersed in glycerol, stabilized in Dermud cream and permanently magnetized. The magnetic cream was applied on the epidermis of human skin organ cultures. The effects on UV-induced cell toxicity, apoptosis and inflammatory cytokine expression were analyzed. A clinical test was performed to check skin moisturization.

RESULTS

Nanomagnets were found to be homogenously and stably dispersed. After magnetization, the preparation generated a magnetic field of 1-2 G. Upon cream application, no cytotoxicity and no impairment of cellular vitality were found after 24 and 48 h, respectively. The anti-apoptotic and anti-inflammatory properties of Dermud were not modified, but its long-term effect on moisturization in vivo was slightly increased.

CONCLUSION

Nanomagnetic Dermud cream can be used as a tool to analyze the biological effects of nanomagnets dispersed on the skin surface at the cellular and molecular levels, thus allowing to explore the possible therapeutic uses of superficial magnetism for skin care.

A Lorentz model for weak magnetic field bioeffects: part II--secondary transduction mechanisms and measures of reactivity

In Part I it was shown that the thermal component of the motion of a charged particle in an oscillator potential, that is, within a molecular binding site, rotates at the Larmor frequency in an applied magnetic field. It was also shown that the Larmor angular frequency is independent of the thermal noise strength and thus offers a mechanism for the biological detection of weak (microT-range) magnetic fields. Part II addresses the question of how the Larmor trajectory could affect biological reactivity. The projection of the motion onto a Cartesian axis measures the nonuniformity of the Larmor trajectory in AC and combined AC/DC magnetic fields, suggesting a means of assessing resonances. A physically meaningful measure of reactivity based upon the classical oscillator trajectory is suggested, and the problem of initial conditions is addressed through averaging over AC phases. AC resonance frequencies occur at the Larmor frequency and at other frequencies, and are dependent upon the ratio of AC/DC amplitudes and target kinetics via binding lifetime. The model is compared with experimental data reported for a test of the ion parametric resonance (IPR) model on data from Ca2+ flux in membrane vesicles, neurite outgrowth from PC-12 cells and a cell-free calmodulin-dependent myosin phosphorylation system, and suggests Mg2+ is the target for these systems. The results do not require multiple-ion targets, selection of isotopes, or additional curve fitting. The sole fitting parameter is the binding lifetime of the target system and the results shown are consistent with the literature on binding kinetics.

Magnetic Field Therapy: A Review

There is increasing interest in using permanent magnets for therapeutic purposes encouraged by basic science publications and clinical reports. Magnetotherapy provides a non invasive, safe, and easy method to directly treat the site of injury, the source of pain and inflammation, and other types of disease. The physiological bases for the use of magnetic fields for tissue repair as well as physical principles of dosimetry and application of various magnetic fields are subjects of this review. Analysis of the magnetic and electromagnetic stimulation is followed by a discussion of the advantage of magnetic field stimulation compared with electric current and electric field stimulation.

Magnets applied to acupuncture points as therapy - a literature review

OBJECTIVES

To summarise the acu-magnet therapy literature and determine if the evidence justifies further investigation of acu-magnet therapy for specific clinical indications.

METHODS

Using various search strategies, a professional librarian searched six electronic databases (PubMed, AMED, ScienceDirect College Edition, China Academic Journals, Acubriefs, and the in-house Journal Article Index maintained by the Oregon College of Oriental Medicine Library). English and Chinese language human studies with all study designs and for all clinical indications were included. Excluded were experimental and animal studies, electroacupuncture and transcranial magnetic stimulation. Data were extracted on clinical indication, study design, number, age and gender of subjects, magnetic devices used, acu-magnet dosing regimens (acu-point site of magnet application and frequency and duration of treatment), control devices and control groups, outcomes, and adverse events.

RESULTS

Three hundred and eight citations were retrieved and 50 studies met our inclusion criteria. We were able to obtain and translate (when necessary) 42 studies. The language of 31 studies was English and 11 studies were in Chinese. The 42 studies reported on 32 different clinical conditions in 6453 patients from 19862007. A variety of magnetic devices, dosing regimens and control devices were used. Thirty seven of 42 studies (88%) reported therapeutic benefit. The only adverse events reported were exacerbation of hot flushes and skin irritation from adhesives.

CONCLUSIONS

Based on this literature review we believe further investigation of acu-magnet therapy is warranted particularly for the management of diabetes and insomnia. The overall poor quality of the controlled trials precludes any evidence based treatment recommendations at this time.

Static magnetic field therapy: dosimetry considerations

The widespread use of static magnetic field (SMF) therapy as a self-care physical intervention has led to the conduct of numerous randomized controlled trials (RCTs). A recent systematic review of SMF trials for pain reduction concluded that the evidence does not support the use of permanent magnets for pain relief. We argue that this conclusion is unwarranted if the SMF dosage was inadequate or inappropriate for the clinical condition treated. The purpose of this communication is to (1) provide a rationale and an explanation for each of 10 essential SMF dosing parameters that should be considered when conducting trials of SMF therapy, and (2) advocate for the conduct of Phase I studies to optimize SMF dosimetry for each condition prior to implementing a large-scale RCT. A previous critical review of SMF dosimetry in 56 clinical studies found that reporting SMF dosages in a majority of those studies was of such poor quality that the magnetic field exposure at the target tissue could not be characterized. Without knowing what magnetic field actually reached the target, it is impossible to judge dosage adequacy. In order to quantify SMF exposure at the site of pathology (target tissue/s), that site must be clearly named; the distance of the permanent magnet surface from the target must be delineated; the physical parameters of the applied permanent magnet must be described; and the dosing regimen must be precisely reported. If the SMF dosimetry is inadequate, any inferences drawn from reported negative findings are questionable.

Longitudinal changes in the disability level of the elders with low back pain after auriculotherapy

OBJECTIVE

To evaluate the longitudinal changes in the disability level of elders with LBP after receiving auriculotherapy.

DESIGN

Randomized controlled trial.

SETTINGS

Sixty participants who were 60 years old or above and who were suffering from LBP were recruited from five hostels for the elders in Hong Kong.

INTERVENTIONS

The participants were randomly allocated to receive a 3-week session of auriculotherapy using either semen vaccariae (control group=30) or magnetic pellets (experimental group=30). Seven auricular acupoints that are expected to have an effect on LBP were selected.

MAIN OUTCOME MEASURES

Assessment data were collected at five points of time: (i) baseline, (ii) about 1.5 weeks of treatment, (iii) 3 weeks of treatment, (iv) 2 weeks post-treatment, and (v) 4 weeks post-treatment using the modified Aberdeen low back pain disability scale (Chinese).

RESULTS

When the rate of change was compared between the two groups at each point of time starting from the baseline, those in the experimental group demonstrated significant improvement in the overall disability level, pain/sensation, and physical and functional abilities at 1.5 weeks of treatment (p<0.001), 3 weeks of treatment (p<0.001), 2 weeks post-treatment (p<0.001), and 4 weeks post-treatment (p<0.001).

CONCLUSION

Longitudinal changes in the improvement of disability level were found among the elders with low back pain after receiving auriculotherapy using magnetic pellets.

Static magnetic field therapy: a critical review of treatment parameters

Static magnetic field (SMF) therapy, applied via a permanent magnet attached to the skin, is used by people worldwide for self-care. Despite a lack of established SMF dosage and treatment regimens, multiple studies are conducted to evaluate SMF therapy effectiveness. Our objectives in conducting this review are to:(i) summarize SMF research conducted in humans; (ii) critically evaluate reporting quality of SMF dosages and treatment parameters and (iii) propose a set of criteria for reporting SMF treatment parameters in future clinical trials. We searched 27 electronic databases and reference lists. Only English language human studies were included. Excluded were studies of electromagnetic fields, transcranial magnetic stimulation, magnets placed on acupuncture points, animal studies, abstracts, posters and editorials. Data were extracted on clinical indication, study design and 10 essential SMF parameters. Three reviewers assessed quality of reporting and calculated a quality assessment score for each of the 10 treatment parameters. Fifty-six studies were reviewed, 42 conducted in patient populations and 14 in healthy volunteers. The SMF treatment parameters most often and most completely described were site of application, magnet support device and frequency and duration of application. Least often and least completely described were characteristics of the SMF: magnet dimensions, measured field strength and estimated distance of the magnet from the target tissue. Thirty-four (61%) of studies failed to provide enough detail about SMF dosage to permit protocol replication by other investigators. Our findings highlight the need to optimize SMF dosing parameters for individual clinical conditions before proceeding to a full-scale clinical trial.

Low intensity permanent magnets in the treatment of chronic lumbar radicular pain

We assessed the pain-relieving efficacy of static magnetic fields produced by 200 Gauss (G) magnets compared with 50G magnets in a double-blind, randomized, two-phase crossover study in patients with chronic lumbar radicular pain. The surface field strengths of the magnets were 200 and 50G. Phase I included four random periods of two-week duration: two periods with 200G, one period with 50G, and one period of "no treatment." The magnets were positioned either vertically or horizontally in standard lumbosacral elastic corsets. Phase II consisted of two five-week periods with the most effective magnet from Phase I and its corresponding 50 or 200G device. The primary outcome was average daily leg pain score (0-10 scale) in each period of Phase II. Thirty-eight of 40 randomized patients completed Phase I, and 28 of 31 Phase II participants completed the study. In Phase I, pain scores did not differ significantly between 200 and 50G magnets. Phase II average leg pain scores tended to be lower with 200 vs. 50G magnets (3.2+/-2.1 for 200G vs. 3.9+/-2.2 for 50G magnets [P=0.08]) after excluding one unblinded patient. The relative treatment effect of the 200G magnets appeared to increase throughout the five-week period. Although these data cannot rule out a chance effect, the positive trends suggest that larger, longer-duration, sham-controlled trials with 200G magnets be considered in patients with chronic lumbar radicular pain.

Static magnets for reducing pain: systematic review and meta-analysis of randomized trials

BACKGROUND

Static magnets are marketed with claims of effectiveness for reducing pain, although evidence of scientific principles or biological mechanisms to support such claims is limited. We performed a systematic review and meta-analysis to assess the clinical evidence from randomized trials of static magnets for treating pain.

METHODS

Systematic literature searches were conducted from inception to March 2007 for the following data sources: MEDLINE, EMBASE, AMED (Allied and Complementary Medicine Database), CINAHL, Scopus, the Cochrane Library and the UK National Research Register. All randomized clinical trials of static magnets for treating pain from any cause were considered. Trials were included only if they involved a placebo control or a weak magnet as the control, with pain as an outcome measure. The mean change in pain, as measured on a 100-mm visual analogue scale, was defined as the primary outcome and was used to assess the difference between static magnets and placebo.

RESULTS

Twenty-nine potentially relevant trials were identified. Nine randomized placebo-controlled trials assessing pain with a visual analogue scale were included in the main meta-analysis; analysis of these trials suggested no significant difference in pain reduction (weighted mean difference [on a 100-mm visual analogue scale] 2.1 mm, 95% confidence interval -1.8 to 5.9 mm, p = 0.29). This result was corroborated by sensitivity analyses excluding trials of acute effects and conditions other than musculoskeletal conditions. Analysis of trials that assessed pain with different scales suggested significant heterogeneity among the trials, which means that pooling these data is unreliable.

INTERPRETATION

The evidence does not support the use of static magnets for pain relief, and therefore magnets cannot be recommended as an effective treatment. For osteoarthritis, the evidence is insufficient to exclude a clinically important benefit, which creates an opportunity for further investigation.

Prospective, Randomized, Single-Blind, Sham Treatment-Controlled Study of the Safety and Efficacy of an Electromagnetic Field Device for the Treatment of Chronic Low Back Pain: A Pilot Study

OBJECTIVES

To evaluate the efficacy and safety of therapeutic electromagnetic fields (TEMF) on chronic low back pain. Secondary objectives included the investigation of the effects of TEMF on psychometric measures.

SETTING

Pain Research center in an Urban Academic Rehabilitation Facility.

DESIGN

Prospective, randomized, single-blind, placebo (sham) treatment-controlled design in which participants were evaluated over a 6-week period. A total of 40 subjects were randomly assigned: 20 subjects to 15 milliTESLA (mT) treatment using a prototype electromagnetic field device and 20 to sham treatment.

INTERVENTIONS

After a 2-week baseline period, eligible individuals were randomized to one of the treatment groups (sham or 15 mT) for six 30-minute treatments over 2 weeks, then a 2-week follow-up period.

OUTCOME MEASURES

The primary outcome measure was the self-report of pain severity using a 100 mm visual analog scale collected using a twice daily McGill Pain Questionnaire-Short Form. Several secondary measures were assessed.

RESULTS

Both groups (15 mT and sham) improved over time (P < 0.05). Although groups were similar during the treatment period, treated subjects (TEMF of 15 mT) improved significantly over sham treatment during the 2-week follow-up period (20.5% reduction in pain; F(1,34) = 10.62, P = 0.003). There were no reported serious adverse events.

CONCLUSIONS

This study demonstrates that TEMF may be an effective and safe modality for the treatment of chronic low back pain disorders. More studies are needed to test this hypothesis.

Regional myofascial pain: diagnosis and management

This chapter defines and describes the condition that is known by the term myofascial trigger point pain syndrome. An outline is given of the current state of knowledge of the pathophysiology of myofascial trigger points, including the latest details from needle microdialysis in near real-time. The clinical features of this pain syndrome are summarised in general terms and the reliability of the clinical diagnosis is discussed. The clinical evidence for and against the common therapeutic interventions used in the management of myofascial pain is reviewed in detail and some tentative conclusions are reached with respect to needling therapies.

Static magnetic therapy does not decrease pain or opioid requirements: a randomized double-blind trial

A growing multibillion dollar industry markets magnetic necklaces, bracelets, bands, insoles, back braces, mattresses, etc., for pain relief, although there is little evidence for their efficacy. We sought to evaluate the effect of magnetic therapy on pain intensity and opioid requirements in patients with postoperative pain. We designed a randomized, double-blind, controlled trial. One-hundred-sixty-five patients older than 12 yr of age were randomized to magnetic (n = 81) or sham therapy (n = 84) upon reporting moderate-to-severe pain in the postanesthesia care unit. Devices were placed over the surgical incision and left in place for 2 h. Patients rated their pain intensity on a 0-10 scale every 10 min and received incremental doses of morphine until pain intensity was < or =4 of 10. Pain intensity levels were similar in both groups. The magnet group had on average 0.04 U more pain intensity (95% confidence interval, -0.4 to 0.5) than the sham group. Opioid requirements also were similar in both groups. The active magnet group required 1.5 mg more morphine (95% confidence interval, -1.8 to 4.0) than the sham magnet group. Magnetic therapy lacks efficacy in controlling acute postoperative pain intensity levels or opioid requirements and should not be recommended for pain relief in this setting.

Efficacy of static magnetic field for locomotor activity of experimental osteopenia

In order to examine the effectiveness of applying a static magnetic field (SMF) for increasing bone mineral density (BMD), we assessed the degree of osteopenia by dual-energy X-ray absorptiometry (DEXA), the metabolism measuring system, and histological examination of bone tissue in an ovariectomized (OVX) rat model. Thirty-six female Wistar rats (8 weeks old, 160–180 g) were divided into three groups. The rats in the OVX-M group were exposed to SMF for 12 weeks after ovariectomy. The ovariectomized rats in the OVX-D group were not exposed to SMF as a control. The rats in the normal group received neither ovariectomy nor exposure to SMF. Twelve-week exposure to SMF in the OVX-M group inhibited the reduction in BMD that was observed in the OVX-D group. Moreover, in the OVX rats, before exposure to SMF, there was no clear difference in the level of locomotor activity between the active and resting phases, and the pattern of locomotor activity was irregular. After exposure of OVX rats to SMF, the pattern of locomotor activity became diphasic with clear active and resting phases, as was observed in the normal group. In the OVX-M group, the continuity of the trabecular bone was maintained more favorably and bone mass was higher than the respective parameters in the OVX-D group. These results demonstrate that exposure to SMF increased the level of locomotor activity in OVX rats, thereby increasing BMD.

Physical agents used in the management of chronic pain by physical therapists

Evidence supporting the use of specific physical agents in the management of chronic pain conditions is not definitive; it is largely incomplete and sometimes contradictory. However, the use of agents in chronic pain management programs is common. Within the broad use of physical agents, they are rarely the sole modality of treatment. A 1995 American Physical Therapy Association position statement asserts that "Without documentation which justifies the necessity of the exclusive use of physical agents/modalities, the use of physical agents/modalities, in the absence of other skilled therapeutic or educational intervention, should not be considered physical therapy". Physical agents may serve as useful adjunctive modalities of pain relief or to enhance the effectiveness of other elements in therapy geared toward resolution of movement impairments and restoration of physical function. Given that a conclusive aggregate of findings is unlikely to exist for all permutations of patient conditions, combined with interacting therapeutic modalities, an evidence-based approach to pain management is not always possible or beneficial to the patient. In the face of inconclusive evidence, a theory-based approach may help determine if the therapeutic effect ofa given physical agent has the possibility of being a useful clinical tool in the context of treating a particular patient's mechanism of pain generation. Until controlled efficacy findings are definitive, careful individual patient response monitoring of thoughtful theoretical application of adjunctive physical agents may be a prudent approach to the management of chronic pain.

Effect of magnetic vs sham-magnetic insoles on nonspecific foot pain in the workplace: a randomized, double-blind, placebo-controlled trial

OBJECTIVE

To determine whether magnetic insoles are effective for relieving nonspecific subjective foot pain in the workplace, resulting in improved job satisfaction.

SUBJECTS AND METHODS

A prospective, randomized, double-blind, placebo-controlled study of health care employees who experienced nonspecific foot pain for at least 30 days, which occurred more days than not, was conducted between February 2001 and January 2002 at the Mayo Clinic in Rochester, Minn. Participants were asked to wear either magnetic or sham-magnetic cushioned insoles for at least 4 hours daily, 4 days per week for 8 weeks. The primary outcome variable was reported foot pain (by categorical response of change from baseline and by visual analog scale) at 4 and 8 weeks. Secondary outcome variables included graded intensity of pain experienced during various daily activities and the effect of insoles on job performance and enjoyment.

RESULTS

Among 89 enrolled participants, 6 either withdrew before wearing insoles or were noncompliant with follow-up questionnaires; 83 participants remained for full statistical analysis. Participants in both treatment groups reported improvements in foot pain during the study period. No significant differences in categorical response to pain or pain intensity were seen with use of magnetic vs sham-magnetic insoles.

CONCLUSIONS

The magnetic insoles used in this study by a heterogeneous population with chronic nonspecific foot pain were not clinically effective. Findings confirmed that nonspecific foot pain significantly interferes with some employees' ability to enjoy their jobs and that treatment of that pain improves job satisfaction.

Pulsed electromagnetic field therapy and osteoarthritis of the knee: Synthesis of the literature

Knee joint osteoarthritis is a painful disorder, often resulting in progressive functional impairment and disability. One modality used in the treatment of knee osteoarthritis is pulsed electromagnetic field therapy. This article examines the evidence base that details the rationale for and the outcomes of applying pulsed electromagnetic fields to the osteoarthritic knee joint.

The related English language literature was reviewed to examine whether pulsed electromagnetic fields applied to an osteoarthritic knee joint are likely to be efficacious, and if so why. Although limitations to the published literature on this topic exist, the available basic and seven randomized clinical research studies in this field support the value of continuing to explore the potential of applying pulsed electromagnetic fields to ameliorate pain and dysfunction associated with the osteoarthritic knee joint.

Further clinical research to validate the use of pulsed electromagnetic fields in lessening osteoarthritic knee joint pain and facilitating function and joint repair is indicated.

Complementary and Alternative Pain Therapy in the Emergency Department

One primary reason patients go to emergency departments is for pain relief. Understanding the physiologic dynamics of pain, pharmacologic methods for treatment of pain, as well CAM therapies used in treatment of pain is important to all providers in emergency care. Asking patients about self-care and treatments used outside of the emergency department is an important part of the patient history. Complementary and alternative therapies are very popular for painful conditions despite the lack of strong research supporting some of their use. Even though evidenced-based studies that are double blinded and show a high degree of interrater observer reliability do not exist, patients will likely continue to seek out CAM therapies as a means of self-treatment and a way to maintain additional life control. Regardless of absolute validity of a therapy for some patients, it is the bottom line: "it seems to help my pain." Pain management distills down to a very simple endpoint, patient relief, and comfort. Sham or science, if the patient feels better, feels comforted, feels less stressed, and more functional in life and their practices pose no health risk, then supporting their CAM therapy creates a true wholistic partnership in their health care.CAM should be relatively inexpensive and extremely safe. Such is not always the case, as some patients have discovered with the use of botanicals. It becomes an imperative that all providers be aware of CAM therapies and informed about potential interactions and side effects when helping patients manage pain and explore adding CAM strategies for pain relief. The use of regulated breathing, meditation, guided imagery, or a massage for a pain sufferer are simple but potentially beneficial inexpensive aids to care that can be easily employed in the emergency department. Some CAM therapies covered here, while not easily practiced in the emergency department, exist as possibilities for exploration of patients after they leave, and may offer an improved sense of well-being and empowerment in the face of suffering and despair. The foundations of good nutrition, exercise, stress reduction, and reengagement in life can contribute much to restoring the quality of life to a pain patient. Adding nondrug therapies of physical therapy, cognitive-behavioral therapy, TENS, hypnosis, biofeedback, psychoanalysis, and others can complete the conventional picture. Adding in simple mind/body therapies, touch therapies, acupuncture, or others may be appropriate in select cases, and depending on the circumstances, may effect and enhance a conventional pain management program. Armed with an understanding of pain dynamics and treatments, practitioners can better meet patient needs, avoid serious side effects, and improve care when addressing pain management in the emergency department.

Static magnetic fields neither prevent nor diminish symptoms and signs of delayed onset muscle soreness

OBJECTIVE

To determine whether application of a commercially available static magnetic field would alter the signs and/or symptoms of delayed onset muscle soreness (DOMS) produced by exhaustive eccentric exercise.

DESIGN

A double-blinded, randomized, and placebo-controlled study, with subjects serving as their own controls.

SETTING

An outpatient physical therapy and performance center.

PARTICIPANTS

Twenty-three healthy volunteers (18 women; mean age, 30 y; range, 18-40 y; 5 men; mean age, 29 y; range, 19-39 y).

INTERVENTION

After exhaustive eccentric exercise of both the right and left elbow flexor muscle groups, subjects received daily treatment with either a 350G magnet or a placebo device for 5 consecutive days.

MAIN OUTCOME MEASURES

Outcome variables, including anthropometric measurements, perceived discomfort, and muscle force production, were compared using linear mixed models.

RESULTS

Arm circumference, relaxed elbow flexion angle, and pain increased, whereas active elbow flexion angle and maximal isometric torque decreased transiently before returning to near baseline. No significant difference in outcome variables existed between the treated and control arms. Participants reported less pain in both treated and control arms after each session, suggesting a placebo effect.

CONCLUSIONS

Static magnetic fields were no more effective than placebo in preventing DOMS.