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

Efficacy of pulsed electromagnetic field therapy on pain and physical function in patients with non-specific low back pain: a systematic review

INTRODUCTION

Non-specific low back pain is a common and clinically significant condition with substantial socioeconomic implications. Pulsed electromagnetic field (PEMF) therapy has shown benefits in pain reduction and improvement of physical function in patients with pain-associated disorders like osteoarthritis. However, studies had heterogeneous settings. The aim of this study was to assess the effects of PEMF on pain and function on patients with non-specific low back pain.

METHODS

A systematic literature search of randomized controlled trials in PubMed, MEDLINE, EMBASE, Cochrane Library, and PEDro was performed (from inception until 15/5/2023). Outcome measures assessed pain and function.

RESULTS

Nine randomized controlled trials with 420 participants (n = 420) were included. The studies compared PEMF vs. placebo-PEMF, PEMF and conventional physical therapy vs. conventional physical therapy alone, PEMF and conventional physical therapy vs. placebo-PEMF and conventional physical therapy, PEMF vs. high-intensity laser therapy (HILT) vs. conventional physical therapy, and osteopathic manipulative treatment (OMT) and PEMF vs. PEMF alone vs. placebo-PEMF vs. OMT alone. Five of the nine included studies showed statistically significant pain reduction and improvement in physical function in comparison to their control groups (p < 0.05). There was substantial heterogeneity among the groups of the study, with a wide range of duration (10-30 min), treatments per week (2-7/week), applied frequencies (3-50 Hz), and intensities (2mT-150mT). No serious adverse event had been reported in any study. The included studies showed solid methodological quality, with an overall score of 7.2 points according to the PEDro scale.

CONCLUSION

PEMF therapy seems to be a safe and beneficial treatment option for non-specific low back pain, particularly if used as an addition to conventional physical therapy modalities. Future research should focus on standardized settings including assessment methods, treatment regimens, frequencies, and intensities.

The positive effect of pulse electromagnetic field therapy on pain and disability in chronic low back pain: a comparative study

BACKGROUND

Low back pain that lasts longer than three months is called chronic low back pain. Chronic low back pain is among the most common problems in the world, causing severe disability and loss of employment in patients.

OBJECTIVE

To investigate the effect of pulse electromagnetic field therapy (PEMFT) added to routine physical therapy on pain and functional status in patients with chronic low back pain.

METHODS

This retrospective comparative study included 69 patients with chronic low back pain. The patients were divided into two groups: those who received lumbar transcutaneous electrical nerve stimulation, infrared, and ultrasound treatments, and those who additionally received PEMFT. The files of patients with chronic low back pain were reviewed, and those who had been evaluated using the Quebec Back Pain Disability Scale (QBPDS) in terms of functional capacity and effects of low back pain and the Visual Analogue Scale (VAS) for pain both before and after treatment were included in the study.

RESULTS

No significant difference was detected between the two groups' pretreatment VAS and QBPDS scores (p > 0.05). The second-and-third measurement scores of both groups were significantly lower than their first-measurement VAS and QBPDS scores (p ˂ 0.001), but there was no significant difference between their second- and third-measurement scores (p > 0.05). According to the inter-group comparison of the VAS and QBPDS scores, the second and third-measurement scores of the PEMFT group were significantly lower than those of the control group (p ˂ 0.001).

CONCLUSIONS

PEMFT seems to be able to alleviate pain intensity and ameliorate disability in patients with chronic low back pain. PEMFT can be considered an effective and safe option that can be added to routine physical therapy modalities for relieving chronic low back pain frequently encountered in clinical practice. Further studies validating the effectiveness of PEMFT could strengthen its position in the management of chronic low back pain.

Evaluation of deep oscillation therapy for the treatment of lumbar pain syndrome using motion capture systems: A systematic review

Low back pain is a painful disorder that prevents normal mobilization, increases muscle tension and whose first-line treatment is usually non-steroidal anti-inflammatory drugs, together with non-invasive manual therapies, such as deep oscillation therapy. This systematic review aims to investigate and examine the scientific evidence of the effectiveness of deep oscillation therapy in reducing pain and clinical symptomatology in patients with low back pain, through the use of motion capture technology. To carry out this systematic review, the guidelines of the PRISMA guide were followed. A literature search was performed from 2013 to March 2022 in the PubMed, Elsevier, Science Director, Cochrane Library, and Springer Link databases to collect information on low back pain, deep oscillation, and motion capture. The risk of bias of the articles was assessed using the Cochrane risk of bias tool. Finally, they were included 16 articles and 5 clinical trials which met the eligibility criteria. These articles discussed the effectiveness of deep oscillation therapy in reducing pain, eliminating inflammation, and increasing lumbar range of motion, as well as analyzing the use of motion capture systems in the analysis, diagnosis, and evaluation of a patient with low back pain before, during and after medical treatment. There is no strong scientific evidence that demonstrates the high effectiveness of deep oscillation therapy in patients with low back pain, using motion capture systems. This review outlines the background for future research directed at the use of deep oscillation therapy as a treatment for other types of musculoskeletal injuries.

The Effects of "Physical BEMER® Vascular Therapy" on Work Performed During Repeated Wingate Sprints

Purpose: The purpose of this study was to investigate the effects of Bio-Electro-Magnetic-Energy-Regulation (BEMER) on recovery and performance parameters in anaerobic exercise compared to active and passive recovery. Method: Fifteen recreationally active participants completed four sessions separated by 2-5 days between each session. The first visit involved one Wingate Anaerobic Test (WAnT; 30-s cycling sprint on a Monark ergometer) to familiarize participants with testing procedures. The three subsequent sessions involved four repeated WAnTs. Each sprint was followed by 4 min of either passive recovery (laying supine), active recovery (pedaling at 50 rpm at 20% of sprint workload), or BEMER recovery (laying supine on the BEMER body pad at intensity level "5-Plus."). The same recovery method was used within each testing session, and recovery method order was randomized across participants. Results: There was no difference in peak power, average power, fatigue index, or average work performed between recovery conditions. Active recovery resulted in a statistically significant decrease in ratings of pain intensity (M = -0.767, SD = 0.928) and pain unpleasantness (M = -0.608, SD = 0.915), from the first minute to the fourth minute of recovery, compared to both BEMER (Intensity: M = 0.675, SD = 0.745, Unpleasantness: M = 1.125, SD = 0.862) and passive (Intensity: M = 0.542, SD = 0.774, Unpleasantness: M = 1.018, SD = 0.872) recoveries, where pain ratings increased. Conclusions: Although no recovery method resulted in increased performance, active recovery led to a more comfortable exercise experience while still allowing comparable exercise performance.

The effect of bio-electro-magnetic-energy-regulation therapy on sleep duration and sleep quality among elite players in Norwegian women's football

The current study investigated if physical loads peak on game days and if Bio-Electro-Magnetic-Energy-Regulation (BEMER) therapy is affecting sleep duration and sleep quality on nights related to game nights among elite players in Norwegian women's elite football. The sample included 21 female football players from an elite top series club with a mean age of ~24 years (± 2.8). Sleep was measured every day over a period of 273 consecutive days with a Somnofy sleep monitor based on ultra-wideband (IR-UWB) pulse radar and Doppler technology. The current study was conducted as a quasi-experiment, where each player was their own control based on a control period that lasted for 3 months, and an experimental period that lasted for 5 months. Accordantly, the time each player spent with BEMER therapy was used as a control variable. Multivariate analyses of variance using FFMANOVA and univariate ANOVA with False Discovery Rate adjusted p-values show that physical performance (total distance, distance per minute, sprint meters >22.5 kmh, accelerations and decelerations) significantly peak on game day compared with ordinary training days and days related to game days. The results also show that sleep quantity and quality are significantly reduced on game night, which indicate disturbed sleep caused by the peak in physical load. Most sleep variables significantly increased in the experiment period, where BEMER therapy was used, compared to the control period before the introduction of BEMER therapy. Further, the analyses show that players who spent BEMER therapy >440 h had the most positive effects on their sleep, and that these effects were significantly compared to the players who used BEMER therapy <440 h. The findings are discussed based on the function of sleep and the different sleep stages have on recovery.

Performance, Detection, Contamination, Compliance, and Cointervention Biases in Rehabilitation Research: What Are They and How Can They Affect the Results of Randomized Controlled Trials? Basic Information for Junior Researchers and Clinicians

ABSTRACT

Bias is a systematic error that can cause distorted results leading to incorrect conclusions. Intervention bias (i.e., contamination bias, cointervention bias, compliance bias, and performance bias) and detection bias are the most common biases in rehabilitation research. A better understanding of these biases is essential at all stages of research to enhance the quality of evidence in rehabilitation trials. Therefore, this narrative review aims to provide insights to the readers, clinicians, and researchers about contamination, cointervention, compliance, performance, and detection biases and ways of recognizing and mitigating them. The literature selected for this review was obtained mainly by compiling the information from several reviews looking at biases in rehabilitation. In addition, separate searches by biases and looking at reference lists of selected studies as well as using Scopus forward citation for relevant references were used.This review provides several strategies to guard against the impact of bias on study results. Clinicians, researchers, and other stakeholders are encouraged to apply these recommendations when designing and conducting rehabilitation trials.

Primary Benign Tumors of the Spinal Canal

Benign tumors that grow in the spinal canal are heterogeneous neoplasms with low incidence; from these, meningiomas and nerve sheath tumors (neurofibromas and schwannomas) account for 60%-70% of all primary spinal tumors. Benign spinal canal tumors provoke nonspecific clinical manifestations, mostly related to the affected level of the spinal cord. These tumors present a challenge for the patient and healthcare professionals, for they are often difficult to diagnose and the high frequency of posttreatment complications. In this review, we describe the epidemiology, risk factors, clinical features, diagnosis, histopathology, molecular biology, and treatment of extramedullary benign meningiomas, osteoid osteomas, osteoblastomas, aneurysmal bone cysts, osteochondromas, neurofibromas, giant cell tumors of the bone, eosinophilic granulomas, hemangiomas, lipomas, and schwannomas located in the spine, as well as possible future targets that could lead to an improvement in their management.

Efficacy of the cognitive functional therapy (CFT) in patients with chronic nonspecific low back pain: a study protocol for a randomized sham-controlled trial

Background

Chronic low back pain is a public health problem, and there is strong evidence that it is associated with a complex interaction of biopsychosocial factors. Cognitive functional therapy (CFT) is a promising new intervention that deals with potentially modifiable multidimensional aspects of pain (e.g., provocative cognitive, movement, and lifestyle behaviors).

Methods

To investigate the efficacy of CFT compared with a sham intervention for pain intensity and disability post-intervention (immediately after the last session) in patients with non-specific chronic low back pain (CLBP). This study is a randomized controlled trial in which 152 (18–60 years old) patients with CLBP will be enrolled. The patients will be randomly allocated to receive (1) CFT intervention or (2) sham intervention. The experimental group will receive individualized CFT in a pragmatic manner (5 to 7 sessions) based on the clinical progression of the participants. The sham group will attend six sessions: consisting of 30 min of photobiomodulation using a detuned device and more than 15 min of talking about neutral topics. Patients from both groups also will receive an educational booklet (for ethical reasons). Participants will be assessed pre and post-intervention, 3 months, and 6 months after randomization. The primary outcomes will be pain intensity and disability post-intervention. The secondary outcomes will be: pain intensity and disability at 3- and 6-month follow-up, as well as self-efficacy, global perceived effect of improvement, and functioning post-intervention, 3-, and 6-month follow-up. The patients and the assessor will be blinded to the treatment administered (active vs. sham).

Statistical analysis

The between-group differences (effects of treatment), as well as the treatment effect for the primary and secondary outcomes, and their respective 95% confidence intervals will be calculated by constructing linear mixed models.

Discussion

To the best of our knowledge, the current study will be the first to compare CFT vs. sham intervention. Sham-controlled RCTs may help to understand the influence of non-specific factors on treatment outcomes. Considering complex interventions as CFT, it is imperative to understand the impact of contextual factors on outcomes.

Trial registration

ClinicalTrials.gov NCT04518891. First Posted: August 19, 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06466-8.

Icariin regulates stem cell migration for endogenous repair of intervertebral disc degeneration by increasing the expression of chemotactic cytokines

Background

Icariin (ICA) can promote the migration and bone formation of bone marrow mesenchymal stem cells. This study explored a potential role of ICA in recruiting stem cell niches (SCNs) within the intervertebral disc region (ISN)-derived stem cells (ISN-SCs) to treat intervertebral disc degeneration (IVDD).

Materials and methods

EdU staining, transwell, and wound healing tests were used to analyze the function of ICA on ISN-SCs proliferation and migration ability. Simultaneously, the IVDD rat model was constructed by the acupuncture and divided into Sham, Sham + ICA, IVDD, and IVDD + ICA groups. H&E and PAS staining were performed to detect the pathological changes of IVDD tissues. Immunofluorescence was performed to discover relevant marker expression on the surface of stem cells in the IVDD tissues. Western blot and qPCR were executed to find the protein and mRNA expression of related cytokines in the IVDD tissues.

Results

ISN-SCs treated with 1 μM ICA obtained the better ability of proliferation and migration. H&E staining showed that the annulus fibrosus in the IVDD group was obviously hyperplasia with cavities and fissures; the nucleus pulposus was reduced. PAS staining showed that the content of polysaccharides was significantly reduced in the nucleus pulposus of IVDD group. However, the ICA treatment alleviated the pathological trends of the IVDD tissues. Simultaneously, ICA treatment increased significantly the expression of stem cells and IGF-1, TGF-β, SDF-1, CCL-5, Collagen I, Collagen II, Aggrecan, and SOX9 in IVDD tissues.

Conclusions

ICA treatment promoted the migration of stem cell in IVDD by increasing the expression of chemotactic cytokines, including IGF-1, TGF-β, SDF-1, and CCL-5.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-022-03544-x.

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.

Emerging and Adjunctive Therapies for Spinal Cord Injury Following Acute Canine Intervertebral Disc Herniation

Some dogs do not make a full recovery following medical or surgical management of acute canine intervertebral disc herniation (IVDH), highlighting the limits of currently available treatment options. The multitude of difficulties in treating severe spinal cord injury are well-recognized, and they have spurred intense laboratory research, resulting in a broad range of strategies that might have value in treating spinal cord-injured dogs. These include interventions that aim to directly repair the spinal cord lesion, promote axonal sparing or regeneration, mitigate secondary injury through neuroprotective mechanisms, or facilitate functional compensation. Despite initial promise in experimental models, many of these techniques have failed or shown mild efficacy in clinical trials in humans and dogs, although high quality evidence is lacking for many of these interventions. However, the continued introduction of new options to the veterinary clinic remains important for expanding our understanding of the mechanisms of injury and repair and for development of novel and combined strategies for severely affected dogs. This review outlines adjunctive or emerging therapies that have been proposed as treatment options for dogs with acute IVDH, including discussion of local or lesion-based approaches as well as systemically applied treatments in both acute and subacute-to-chronic settings. These interventions include low-level laser therapy, electromagnetic fields or oscillating electrical fields, adjunctive surgical techniques (myelotomy or durotomy), systemically or locally-applied hypothermia, neuroprotective chemicals, physical rehabilitation, hyperbaric oxygen therapy, electroacupuncture, electrical stimulation of the spinal cord or specific peripheral nerves, nerve grafting strategies, 4-aminopyridine, chondroitinase ABC, and cell transplantation.

Pulsed Electromagnetic Field Therapy as a Complementary Alternative for Chronic Pelvic Pain Management in an Interstitial Cystitis/Bladder Pain Syndrome Patient

Interstitial cystitis/bladder pain syndrome is a chronic pelvic pain condition with no known etiology that affects millions of women and men in the United States. Current management can be aggressive for individuals who are refractory to less invasive options, often resulting in the use of opioid narcotics and/or surgical procedures under general anesthesia, with higher risks and side effects to patients. Pulsed electromagnetic field therapy is a noninvasive therapeutic strategy that is thought to reduce inflammation and pain via alteration of cellular function and microcirculation. This therapy has demonstrated efficacy in management of other chronic pain syndromes including fibromyalgia and chronic low back pain. Herein, we describe a case of pulsed electromagnetic field therapy for management of interstitial cystitis/bladder pain syndrome that resulted in decreases in pelvic pain, burning with bladder filling, and other nonpelvic pain symptoms. This case provides support for a formal clinical trial to evaluate the efficacy of pulsed electromagnetic field therapy for the management of chronic pelvic pain in interstitial cystitis/bladder pain syndrome.