Evaluation of pulsed electromagnetic field therapy in the management of patients with discogenic lumbar radiculopathy

Regenerative Medicine in Orthopedic Surgery: Expanding Our Toolbox

Regenerative medicine leverages the body's inherent regenerative capabilities to repair damaged tissues and address organ dysfunction. In orthopedics, this approach includes a variety of treatments collectively known as orthoregeneration, encompassing modalities such as prolotherapy, extracorporeal shockwave therapy, pulsed electromagnetic field therapy, therapeutic ultrasound, and photobiomodulation therapy, and orthobiologics like platelet-rich plasma and cell-based therapies. These minimally invasive techniques are becoming prominent due to their potential for fewer complications in orthopedic surgery. As regenerative medicine continues to advance, surgeons must stay informed about these developments. This paper highlights the current state of regenerative medicine in orthopedics and advocates for further clinical research to validate and expand these treatments to enhance patient outcomes.

[Physiotherapy in rehabilitation of patients with degenerative disk diseases from positions of evidence-based medicine: a literature review]

Back pain is one of the most urgent problems of rehabilitation. Patients with this pathology have a leading place among neurological patients in terms of the number of days of disability. The high economic costs in society are explained by the need for lumbar surgery (discectomy, spinal fusion and disc prosthesis) and rehabilitation after it. The effectiveness of rehabilitative measures is determined both by the patient's rehabilitative potential and by the choice of rehabilitative methods.

OBJECTIVE

To evaluate the effectiveness of physiotherapy in patients with degenerative disk diseases from positions of evidence-based medicine according to the scientific and technical literature.

MATERIAL AND METHODS

The analysis of scientific and technical literature sources and the study of materials of meta-analyses, systematic reviews (depth of search was 20 years) on the evaluation of effectiveness of physiotherapeutical methods in the rehabilitation of patients with degenerative disk diseases have been conducted.

RESULTS

The ability of pulsed magnetic field to reduce the intensity of pain and improve the functional capacities of the spine in patients with low back pain has been identified. There was a pronounced analgesic end-point of low-level laser therapy in acute and chronic back pain at short and medium-term (up to 12 months) observation, as well as the ability of the method to reduce temporary disability in degenerative disk diseases.

CONCLUSION

The use of magnetotherapy and low-level laser therapy can be recommended for the treatment of patients with degenerative disk diseases (C grade of recommendations, 3rd level of evidence). The recommendation is based on the results of 10 RCTs (1.111 patients with degenerative disk diseases), 3 meta-analyses, 1 systematic review and 1 Cochrane review (a total of 3.431 patients).

Effects of non-pharmacological interventions on sleep in chronic low back pain: A systematic review and meta-analysis of randomised controlled trials

Low back pain is a leading cause of disability worldwide and adults with chronic low back pain (≥12weeks) commonly experience sleep impairments (e.g., insomnia, sleep disturbance). This study examined the effects of non-pharmacological interventions on sleep in adults with chronic low back pain. Six databases (PubMed, CINAHL, SPORTDiscus, PsycINFO, EMBASE, CENTRAL) were searched from inception to 2 June 2021 for randomised controlled trials. Pairwise random-effect meta-analysis estimated standardised mean difference (Hedges' g) at end-of-intervention follow-up. Nineteen studies (participants: 1348) were included. When compared to control, non-pharmacological interventions improved sleep (g [95%CI]: -0.33 [-0.56, -0.11], p = 0.004, small effect, I² = 59.3%; n = 879; studies: n = 13; GRADE: low). This small improvement in sleep was associated with a moderate reduction in pain intensity (-0.69 [-1.00, -0.38], p < 0.001, I² = 75.3%; n = 812; studies: n = 12; GRADE: very low) and no changes in back-related disability (-0.50 [-1.13, 0.14], p = 0.129, I² = 91.4%; n = 517; studies: n = 6; GRADE: low). Notably, all eligible studies reported interventions primarily aimed to reduce pain, although our search criteria were not limited to pain interventions. Key limitations were data paucity and high risk of bias. Future research should investigate sleep-based interventions (i.e., those purposely designed to improve sleep) using subjective and objective measures across a range of sleep domains (CRD42021275227).

Efficacy of pulsed electromagnetic field on pain and physical function in patients with low back pain: A systematic review and meta-analysis

Objective

To assess the effectiveness of pulsed electromagnetic field (PEMF) on pain and physical function in patients with low back pain.

Data sources

A search of PubMed, Embase, Cochrane Library, and Web of Science was conducted up to December 2021.

Methods

We included randomized controlled trials that investigated the effectiveness of PEMF in patients with low back pain. The primary outcome was pain intensity and the secondary outcome was physical function, both were evaluated by assessment scales. Standardized mean difference (SMD) and 95% confidence interval (CI) were calculated for the summary statistics analysis. The registration number of this systematic review in PROSPERO is CRD42020213829.

Results

Fourteen trials involving 618 participants were included. The PEMF treatment showed more significant pain alleviation than placebo or other therapy alone in patients with low back pain (SMD = −1.01, 95% CI −1.42 to −0.6, P < 0.001, I2 = 31%; SMD = −0.36, 95% CI −0.62 to −0.11, P = 0.005, I2 = 37%, respectively.) In addition, a significant difference in pain alleviation was observed in patients with chronic low back pain (SMD = −0.6, 95%CI − 0.94 to −0.25, p < 0.001, I2 = 67%), whereas no significant difference was observed in patients with acute low back pain (SMD = −0.46, 95%CI − 0.99 to 0.07, p = 0.09, I2 = 0%). PEMF did not improve physical function compared with the control treatment (SMD = −0.45, 95% CI − 0.98 to 0.07, p = 0.09, I2 = 86%).

Conclusion

PEMF is beneficial for alleviating pain in patients with chronic low back pain despite having no advantage in improving physical function.

Pulsed Electromagnetic Field Affects the Development of Postmenopausal Osteoporotic Women with Vertebral Fractures

Background

Postoperative pain, dysfunction, and significant bone loss may occur after vertebral fractures, which will lead to the occurrence of refractures and shorten the survival time, so postoperative rehabilitation is very important. Pulsed electromagnetic field therapy is noninvasive, pain-relieving, and beneficial to reduce bone loss and is an important treatment for patients to recover after surgery. Therefore, this study analyzed the effect of postmenopausal women's vertebral fracture rehabilitation after pulsed electromagnetic field treatment.

Method

This study uses a randomized controlled study, respectively, in the pulsed electromagnetic field treatment group (40 cases) and the control group (42 cases), respectively. We studied the results of health-related quality of life scores (HRQOL), back pain, body function, hip bone density, bone microstructure of tibia, and radius after 1 month and 3 months after surgery.

Results

Compared with the control group, the pulsed electromagnetic field treatment group (PEMF) can improve significantly the psychological score, 6-minute walk test, and Chair Sit-and-Reach one month after the operation. And at 3 months after surgery, the pulsed electromagnetic field treatment group can improve significantly in health-related quality of life scores (HRQOL), back pain, and body function. Regarding the effect of changes in bone mass, compared with the control group, pulsed electromagnetic field treatment had no significant effect on changes in hip bone density. As a result of changes in bone microstructure, pulsed electromagnetic field treatment can significantly improve the bone microstructure of the radius and tibia three months after vertebral fractures.

Conclusion

Pulsed electromagnetic field therapy has positive significance for improving pain, body functional changes, and bone loss after vertebral fracture surgery.

Evaluation of the Analgesic Efficacy of a Bioelectronic Device in Non-Specific Chronic Low Back Pain with Neuropathic Component. A Randomized Trial

Low energy pulsed electromagnetic signals (PEMS) therapy, in the field of bioelectronics, has been suggested as a promising analgesic therapy with special interest in treating conditions with poor response to pharmacotherapy. This study evaluated the effectiveness of PEMS therapy on the treatment of chronic low back pain patients with a neuropathic component. A group of 64 individuals with such condition was allocated to a 2-week treatment period (10 twenty-minute sessions on consecutive days) with an active PEMS therapy device or an inactive device in random order. The pain was assessed on a visual analog scale, and the functional status was assessed using the SF-12 questionnaire. The visual analog scale scores were lower after treatment than at baseline but only in the group treated with the active device. According to the DN4 score, neuropathic pain decreased in both experimental groups with respect to baseline, but this was only significant for the group treated with the active device. Similarly, an improvement in the SF-12 and Medical Outcomes Study (MOS) sleep scale components was reported. The study demonstrated that low-energy PEMS therapy was efficient in reducing pain and improving function in chronic low back pain patients with a neuropathic component.

Electromagnetic Field Therapy: A Rehabilitative Perspective in the Management of Musculoskeletal Pain - A Systematic Review

Electromagnetic fields (EMFs) provide a non-invasive, safe, and easy method to treat pain with respect to musculoskeletal diseases. The purpose of this systematic review was to describe the use of electromagnetic therapy in the rehabilitation field by investigating the efficacy in acute and chronic pain in the musculoskeletal disorders. A database search was conducted using the following resources: PubMed, Cochrane, PEDro, SCOPUS, and WoS. The following MESH terms were used: [Electromagnetic field AND/OR Rehabilitation], [Electromagnetic field AND/OR Pain], [Pulsed Magnetic field AND/OR Rehabilitation] and [Pulsed Magnetic field AND/OR Pain], [Pulsed Electromagnetic field AND/OR Rehabilitation] and [Pulsed Electromagnetic field AND/OR Pain], per the guidelines of the PRISMA statement. Articles published between January 1, 2009 and December 31, 2018 were included as assessment of musculoskeletal pain conditions, randomized clinical trial including crossover and prospective design studies, full English text available, population age > 18 years; instead were excluded neurological randomized clinical trials, transcranial magnetic stimulation application, neuropathic pain, animal/in vitro studies, and articles without English abstract or English full text. Three independent investigators (AMC, NG, and LP) retrieved all the information. Twenty-one RTC (N=21) were considered for the inclusion and exclusion criteria. The results showed as pulsed magnetic fields at low intensity and frequency (from 1 Hz up to 100 Hz) are commonly used with efficacy in resolving musculoskeletal pain. EMFs therapy is a well tolerated, effective with no negative side effects, which can be integrated with rehabilitation for the treatment of chronic and acute pain in musculoskeletal diseases, but further studies are needed to examine the use of more standardized protocols.

Translational Insights into Extremely Low Frequency Pulsed Electromagnetic Fields (ELF-PEMFs) for Bone Regeneration after Trauma and Orthopedic Surgery

The finding that alterations in electrical potential play an important role in the mechanical stimulation of the bone provoked hype that noninvasive extremely low frequency pulsed electromagnetic fields (ELF-PEMF) can be used to support healing of bone and osteochondral defects. This resulted in the development of many ELF-PEMF devices for clinical use. Due to the resulting diversity of the ELF-PEMF characteristics regarding treatment regimen, and reported results, exposure to ELF-PEMFs is generally not among the guidelines to treat bone and osteochondral defects. Notwithstanding, here we show that there is strong evidence for ELF-PEMF treatment. We give a short, confined overview of in vitro studies investigating effects of ELF-PEMF treatment on bone cells, highlighting likely mechanisms. Subsequently, we summarize prospective and blinded studies, investigating the effect of ELF-PEMF treatment on acute bone fractures and bone fracture non-unions, osteotomies, spinal fusion, osteoporosis, and osteoarthritis. Although these studies favor the use of ELF-PEMF treatment, they likewise demonstrate the need for more defined and better controlled/monitored treatment modalities. However, to establish indication-oriented treatment regimen, profound knowledge of the underlying mechanisms in the sense of cellular pathways/events triggered is required, highlighting the need for more systematic studies to unravel optimal treatment conditions.

Efficacy of Pulsed Low-Frequency Magnetic Field Therapy on Patients with Chronic Low Back Pain: A Randomized Double-Blind Placebo-Controlled Trial

Study Design

A randomized double-blind placebo-controlled trial.

Purpose

To investigate the efficacy of pulsed electromagnetic field (PEMF) therapy combined with therapeutic exercises in the treatment of chronic low back pain (CLBP).

Overview of Literature

Low back pain (LBP) is the most common musculoskeletal pain disorder. Most available interventions for CLBP have modestly beneficial outcomes. Despite the potential effect of PEMF therapy on LBP, there have been few studies regarding its effectiveness.

Methods

Forty-two patients (22 males, 20 females), were randomized into either the treatment group (PEMF and therapeutic exercises) or placebo group (sham PEMF and exercises). Primary outcome measures were pain intensity on the 10-point Numeric PainRating Scale and disability measured by the Roland-Morris Disability Questionnaire. The patients were assessed at baseline, during the treatment period (weeks 3, 6, and 9), and after treatment (week 13).

Results

The treatment group experienced a more rapid improvement in both pain and disability compared with the placebo group. The analysis showed a significant improvement in the pain intensity and disability scores in the treatment group at week 3 (p<0.05), whereas an improvement in the placebo group was detected at week 6. The significant improvement in both groups was sustained for weeks 6, 9, and 13. There was no difference between the groups in scores of pain intensity and disability at weeks 6 and 13.

Conclusions

PEMF therapy improved pain and disability in patients with CLBP. However, it does not seem to be superior to other treatment options.

Abstracts of low back pain trials are poorly reported, contain spin of information and are inconsistent with the full text: An overview study

OBJECTIVE

To investigate trials abstracts evaluating treatments for low back pain with regards to completeness of reporting, spin (i.e., interpretation of study results that overemphasizes the beneficial effects of the intervention), and inconsistencies in data with the full text.

DATA SOURCES

The search was performed on Physiotherapy Evidence Database (PEDro) in February 2016.

STUDY SELECTION

This is an overview study of a random sample of 200 low back pain trials published between 2010 and 2015. The languages of publication were restricted to English, Spanish and Portuguese.

DATA EXTRACTION

Completeness of reporting was assessed using the CONSORT for Abstracts checklist (CONSORT-A). Spin was assessed using a SPIN-checklist. Consistency between abstract and full text were assessed by applying the assessment tools to both the abstract and full text of each trial and calculating inconsistencies in the summary score (paired t test) and agreement in the classification of each item (Kappa statistics). Methodological quality was analyzed using the total PEDro score.

DATA SYNTHESIS

The mean number of fully reported items for abstracts using the CONSORT-A was 5.1 (SD 2.4) out of 15 points and the mean number of items with spin was 4.9 (SD 2.6) out of 7 points. Abstract and full text scores were statistically inconsistent (P=0.01). There was slight to moderate agreement between items of the CONSORT-A in the abstracts and full text (mean Kappa 0.20 SD 0.13) and fair to moderate agreement for items of the SPIN-checklist (mean Kappa 0.47 SD 0.09).

CONCLUSIONS

The abstracts were incomplete, with spin and inconsistent with the full text. We advise health care professionals to avoid making clinical decisions based solely upon abstracts. Journal editors, reviewers and authors are jointly responsible for improving abstracts, which could be guided by amended editorial policies.

Effects of pulsed low-frequency magnetic field therapy on pain intensity in patients with musculoskeletal chronic low back pain: study protocol for a randomised double-blind placebo-controlled trial

INTRODUCTION

The aim of the present study is to investigate the effectiveness of pulsed low-frequency magnetic field (PLFMF) on the management of chronic low back pain (CLBP).

METHODS AND ANALYSIS

A randomised double-blinded controlled clinical trial will be conducted, involving 200 patients with CLBP. Participants will be randomised in a 1:1 ratio to receive either active PLFMF (experimental arm) or sham treatment (control arm) using a permuted-block design which will be stratified according to three subtypes of musculoskeletal CLBP (nociceptive, peripheral neuropathic or central sanitisation). The intervention consists of three sessions/week for 6 weeks. The primary outcome is the percentage change in Numerical Rating Scale (NRS) pain at week 24 after treatment completion with respect to the baseline. Secondary outcomes include percentage NRS pain during treatment and early after treatment completion, short form 36 quality of life, Roland and Morris Disability Questionnaire; Depression Anxiety Stress Scale 21, Patient Specific Functional Scale, Global perceived effect of condition change, Pittsburgh Sleep Quality Index and Modified Fatigue Impact Scale. Measures will be taken at baseline, 3 and 6 weeks during the intervention and 6, 12 and 24 weeks after completing the intervention. Adverse events between arms will be evaluated. Data will be analysed on an intention-to-treat basis.

ETHICS AND DISSEMINATION

The study is funded by Imam Abdulrahman Bin Faisal University (IAU). It has been approved by the institutional review board of IAU (IRB- 2017-03-129). The study will be conducted at King Fahd Hospital of the University and will be monitored by the Hospital monitoring office for research and research ethics. The trial is scheduled to begin in September 2018. Results obtained will be presented in international conferences and will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ACTRN12618000921280, prospectively.

[Rehabilitation of the patients presenting with the operated spine syndrome during the complicated postoperative period after discectomy]

This article presents an analytical review of the literature concerning the problem of rehabilitation of the patients following the surgical treatment of hernias of intervertebral disks. The relevance of this problem and the importance of the related research activities in the context of neurorehabilitation are beyond any doubt. Despite the obvious progress in the modernization of the methods and technologies for medical rehabilitation, the number of re-operations in connection with the recurrences of herniated discs remains too high and the overall success thus far achieved in this field falls short of expectations. The authors discuss in detail the need for and the contemporary approaches to the rehabilitative treatment of the patients undergoing vertebral microdiscectomy including medication therapy, physiotherapy an therapeutic physical exercises. The variants of the application of magnetic stimulation during the early period of the rehabilitative treatment of the patients following the minimally invasive interventions for discogenic radiculopathy are considered.

Pulsed electromagnetic field therapy effectiveness in low back pain: A systematic review of randomized controlled trials

Background

Low back pain is a worldwide prevalent musculoskeletal condition in the general population. In this sense, the pulsed electromagnetic fields (PEMF) therapy has shown significant clinical benefits in several musculoskeletal conditions.

Objective

To assess the effectiveness of the PEMF therapy in reducing pain and clinical symptomatology in patients with low back pathological conditions.

Methods

It was performed a comprehensive database search using Pubmed, Scopus, Cochrane Library and PEDro databases to assess the effectiveness of the PEMF therapy in reducing pain and clinical symptomatology in patients with low back pathological conditions. The search was performed from January 2005 to August 2015 and conducted by two independent investigators, which scrutinize the reference list of most relevant studies. The methodological quality was assessed by the PEDro scale and the level of evidence was set according Oxford Center for Evidence-Based Medicine scale.

Results

Six studies were eligible inclusion on the qualitative analysis and five into the quantitative analysis, scoring an overall 6.8 points according the PEDro scale. The studies showed heterogeneity concerning the intervention protocols. Nevertheless, the effect sizes' indicated a clear tendency to reduction of the pain intensity favoring the PEMF groups, reaching a minimal clinically important difference.

Conclusion

PEMF therapy seems to be able to relieve the pain intensity and improve functionality in individuals with low back pain conditions. Further research is needed regarding PEMF effects on the different conditions of low back pain, with standardized protocols, larger samples and adjustment for low back pain confounders in order to achieve stronger conclusions.

Pulsed electromagnetic field (PEMF) treatment reduces expression of genes associated with disc degeneration in human intervertebral disc cells

BACKGROUND CONTEXT

Pulsed electromagnetic field (PEMF) therapies have been applied to stimulate bone healing and to reduce the symptoms of arthritis, but the effects of PEMF on intervertebral disc (IVD) biology is unknown.

PURPOSE

The purpose of this study was to determine how PEMF affects gene expression of IVD cells in normal and inflammatory environments.

STUDY DESIGN/SETTING

This was an in vitro human cell culture and microarray gene expression study.

METHODS

Human annulus fibrosus (AF) and nucleus pulposus (NP) cells were separately encapsulated in alginate beads and exposed to interleukin 1α (IL-1α) (10 ng/mL) to stimulate the inflammatory environment associated with IVD degeneration and/or stimulated by PEMF for 4 hours daily for up to 7 days. RNA was isolated from each treatment group and analyzed via microarray to assess IL-1α- and PEMF-induced changes in gene expression.

RESULTS

Although PEMF treatment did not completely inhibit the effects of IL-1α, PEMF treatment lessened the IL-1α-induced upregulation of genes expressed in degenerated IVDs. Consistent with our previous results, after 4 days, PEMF tended to reduce IL-1α-associated gene expression of IL-6 (25%, p=.07) in NP cells and MMP13 (26%, p=.10) in AF cells. Additionally, PEMF treatment significantly diminished IL-1α-induced gene expression of IL-17A (33%, p=.01) and MMP2 (24%, p=.006) in NP cells and NFκB (11%, p=.04) in AF cells.

CONCLUSIONS

These results demonstrate that IVD cells are responsive to PEMF and motivate future studies to determine whether PEMF may be helpful for patients with IVD degeneration.