Case Studies supporting PEMF benefits for Diabetic Issues
Effect of Magnetic Therapy on Balance Deficits in Patients with Diabetic Polyneuropathy: Randomized Controlled Trial
Background: Diabetes mellitus (DM) is one of the most common chronic diseases all over the world. Incidence of and complications of DM has been increased over the last decade. Diabetic polyneuropathy (DPN) plays a significant role in falling among elderly patients because of significantly impaired sensation in the feet and reduced ability to properly control balance during daily activities. The aim of this study was to evaluate the effect of low frequency pulsed magnetic therapy (LFPMT) on balance in patients with DPN.
Methods: Thirty male patient with DPN were randomly assigned into two groups G1 (Study group) and G2 (Control group). Balance was evaluated pre and post-study using the Biodex Stability System and Short Form of Berg Balance Scale (SFBBS). G1 was treated with LFPMT for 30 min in session, 3 sessions in a week, for six weeks, while G2 received identical sham sessions.
The results: Pre-study (between groups) comparison revealed that the mean values of the overall stability indices (OSI) were (1.75 ± 0.75, 2.12 ± 0.45) for G1 and G2 respectively (P=0.11), the mean values of the SFBBS were (18.8± 3.61, 19.8± 1.93) for G1 and G2 respectively (P=0.35). At the end of the study (within groups) comparison revealed that the mean values of the OSI were (1.41 ± 0.78, 2.16 ± 0.7) for G1 (P=0.02) and G2 (P= 0.77) respectively, the mean values of the SFBBS were (23.07 ± 3.61,19.6 ±1.18) for G1 (P=0.00002) and G2 (P= 0.68) respectively. Post-study (between groups) comparison revealed that there were significant differences in SFBBS (P= 0.002) and OSI (P = 0.01), but in favor of G1.
Conclusions: LFPMT is an effective therapeutic modality in improving balance in patients with DPN.
Effects of Pulsed Electromagnetic Therapy on Functional Capacity and Fall Risk in Patients with Diabetic Polyneuropathy: Randomized Controlled Trial
Background: Diabetic peripheral polyneuropathy (DPN) is a major public health problem. Pulsed low frequency electromagnetic field therapy (LFPEMFT) is a form of alternative therapies used to treat a variety of health conditions including DPN, but an understanding of the LFPEMFT therapeutic efficacy on functional aspects needs further clarification.
Objective: To evaluate the effectiveness of LFPEMFT on functional capacity (assessed through 6 minutes' walk test) and fall risk (assessed through Berg balance scale) in patients with DPN.
Methodology: Eighty-Five eligible, volunteer, patients with DPN were randomly assigned into PLFEMT and Sham Electromagnetic Therapy (SEMT) groups. Both groups received treatment twice weekly for 12 weeks. Variables were evaluated pre-study (evaluation-1) and post-study (evaluation-2).
Results: At evaluation-2; functional capacity and fall risk mean values and percentages of change were 438.49 ± 31.87 (15.73 %), 380.75 ± 42.77 (0.037 %) and 41.73 ± 3.22 (22.54 %), 34.05 ± 3.64 (2.02 %) for LFPEMFT and SEMT groups respectively (P < 0.05).
Conclusion: PLFEMT is an effective modality in improving functional capacity and fall risk in patients with DPN.
Electrical stimulation to accelerate wound healing
Background: There are several applications of electrical stimulation described in medical literature to accelerate wound healing and improve cutaneous perfusion. This is a simple technique that could be incorporated as an adjunctive therapy in plastic surgery. The objective of this review was to evaluate the results of randomized clinical trials that use electrical stimulation for wound healing.
Method: We identified 21 randomized clinical trials that used electrical stimulation for wound healing. We did not include five studies with treatment groups with less than eight subjects.
Results: Electrical stimulation was associated with faster wound area reduction or a higher proportion of wounds that healed in 14 out of 16 wound randomized clinical trials. The type of electrical stimulation, waveform, and duration of therapy vary in the literature.
Conclusion: : Electrical stimulation has been shown to accelerate wound healing and increase cutaneous perfusion in human studies. Electrical stimulation is an adjunctive therapy that is underutilized in plastic surgery and could improve flap and graft survival, accelerate postoperative recovery, and decrease necrosis following foot reconstruction.
Evaluation of the efficacy of pulsed electromagnetic field in the management of patients with diabetic polyneuropathy
AIM: The study was carried out to evaluate and compare the effect of low power, low frequency pulsed electromagnetic field (PEMF) of 600 and 800 Hz, respectively, in management of patients with diabetic polyneuropathy.
SETTINGS AND DESIGNS: The study was a randomized controlled trial performed in Guru Nanak Dev University and Medical College, Amritsar, India with different subject experimental design.
MATERIALS AND METHODS: Thirty subjects within an age group of 40–68 years with diabetic polyneuropathy stages N1a, N1b, N2a were randomly allocated to groups 1, 2, 3 with 10 subjects in each. Group 1 and 2 were treated with low power 600 and 800-Hz PEMF for 30 min for 12 consecutive days. Group 3 served as control on usual medical treatment of diabetic polyneuropathy (DPN). The subjects with neuropathy due to any cause other than diabetes were excluded. The pain and motor nerve conduction parameters (distal latency, amplitude, nerve conduction velocity) were assessed before and after treatment.
STATISTICAL ANALYSIS: Related t-test and unrelated t-test were used for data analysis.
RESULTS: Significant reduction in pain and statistically significant (P<0.05) improvement in distal latency and nerve conduction velocity were seen in experimental group 1 and 2.
CONCLUSIONS: Low-frequency PEMF can be used as an adjunct in reducing neuropathic pain as well as for retarding the progression of neuropathy in a short span of time.
Pulsed electromagnetic field (PEMF) promotes collagen fibre deposition associated with increased myofibroblast population in the early healing phase of diabetic wound
The present study evaluated the effects of PEMF on collagen fibre deposition, collagen fibril alignment and collagen fibre orientation. The potential relationships between collagen fibre deposition and myofibroblast population in diabetic wound healing were also examined. Forty young male streptozotocin-induced diabetic Sprague–Dawley rats were randomly assigned to PEMF group or control group. 2 cm 9 2 cm square wounds were made at their back. The PEMF group received daily exposure of PEMF to the wounds, while control group was handled in the same manner except that the PEMF device was not activated. Wound tissues harvested on post-wounding day 7, 10 and 14 were fixed, processed and sectioned. The abundance, fibril alignment and fibre orientation of type I collagen were quantified with picro-sirius polarization method and image analysis software (Nikon NIS Element AR). Myofibroblast population data were adopted from our previous study. Correlation between myofibroblast population and collagen fibre deposition was examined. There was significantly greater abundance of type I collagen fibre in the PEMF group than in the control on day 7 (P = .013), but not on day 10 or 14. No significant between-group differences were found in collagen fibril alignment and collagen fibre orientation at any measured time points. Positive correlation was found between collagen fibre deposition and myofibroblast population only on day 7 (r = .729, P = .007). In conclusion, PEMF can significantly increase collagen fibre in the early phase of diabetic wound healing, which is associated with the enhancement of myofibroblast population.
Pulsed Magnetic Field Therapy in Refractory Neuropathic Pain Secondary to Peripheral Neuropathy: Electrodiagnostic Parameters - Pilot Study
Context: Neuropathic pain (NP) from peripheral neuropathy (PN) arises from ectopic firing of unmyelinated C-fibers with accumulation of sodium and calcium channels. Because pulsed electromagnetic fields (PEMF) safely induce extremely low frequency (ELF) quasirectangular currents that can depolarize, repolarize, and hyperpolarize neurons, it was hypothesized that directing this energy into the sole of one foot could potentially modulate neuropathic pain.
Objective: To determine if 9 consecutive 1-h treatments in physician’s office (excluding weekends) of a pulsed signal therapy can reduce NP scores in refractory feet with PN.
Design/setting/patients: 24 consecutive patients with refractory and symptomatic PN from diabetes, chronic inflammatory demyelinating polyneuropathy (CIDP), pernicious anemia, mercury poisoning, paraneoplastic syndrome, tarsal tunnel, and idiopathic sensory neuropathy were enrolled in this nonplacebo pilot study. The most symptomatic foot received therapy. Primary endpoints were comparison of VAS scores at the end of 9 days and the end of 30 days followup compared to baseline pain scores. Additionally, Patients’ Global Impression of Change (PGIC) questionnaire was tabulated describing response to treatment. Subgroup analysis of nerve conduction scores, quantified sensory testing (QST), and serial examination changes were also tabulated. Subgroup classification of pain (Serlin) was utilized to determine if there were disproportionate responses.
Intervention: Noninvasive pulsed signal therapy generates a unidirectional quasirectangular waveform with strength about 20 gauss and a frequency about 30 Hz into the soles of the feet for 9 consecutive 1-h treatments (excluding weekends). The most symptomatic foot of each patient was treated.
Results: All 24 feet completed 9 days of treatment. 15/24 completed follow-up (62%) with mean pain scores decreasing 21% from baseline to end of treatment (P = 0.19) but with 49% reduction of pain scores from baseline to end of follow-up (P < 0.01). Of this group, self-reported PGIC was improved 67% (n = 10) and no change was 33% (n = 5). An intentto- treat analysis based on all 24 feet demonstrated a 19% reduction in pain scores from baseline to end of treatment (P = 0.10) and a 37% decrease from baseline to end of follow-up (P < 0.01). Subgroup analysis revealed 5 patients with mild pain with nonsignificant reduction at end of follow-up. Of the 19 feet with moderate to severe pain, there was a 28% reduction from baseline to end of treatment (P < 0.05) and a 39% decrease from baseline to end of follow-up (P < 0.01). Benefit was better in those patients with axonal changes and advanced CPT baseline scores. The clinical examination did not change. There were no adverse events or safety issues.
Conclusions: These pilot data demonstrate that directing PEMF to refractory feet can provide unexpected shortterm analgesic effects in more than 50% of individuals. The role of placebo is not known and was not tested. The precise mechanism is unclear yet suggests that severe and advanced cases are more magnetically sensitive. Future studies are needed with randomized placebo-controlled design and longer treatment periods.
Case Study Reference Source:
1. Effect of Magnetic Therapy on Balance Deficits in Patients with Diabetic Polyneuropathy: Randomized Controlled Trial
(Authors: Waheed Ali Hasan Abu-Mansour Filimban, Amir Abdel-Raouf El-Fiky, Omar Farouk Farahat Helal, Ashraf Abdelaal Mohamed Abdelaal)
2. Effects of Pulsed Electromagnetic Therapy on Functional Capacity and Fall Risk in Patients with Diabetic Polyneuropathy: Randomized Controlled Trial
(Authors: Ashraf Abdelaal Mohamed Abdelaal, Abdelgalil Allam Abdelgalil)
3. Electrical stimulation to accelerate wound healing
(Authors: "Gaurav Thakral, MD", "Javier LaFontaine, DPM, MS", "Bijan Najafi, PhD", "Talal K. Talal, DPM", "Paul Kim, DPM" and "Lawrence A. Lavery, DPM, MPH")
4. Evaluation of the efficacy of pulsed electromagnetic field in the management of patients with diabetic polyneuropathy
(Authors: Vinay Graak, Sarika Chaudhary, B. S. Bal, and J. S. Sandhu)
5. Pulsed electromagnetic field (PEMF) promotes collagen fibre deposition associated with increased myofibroblast population in the early healing phase of diabetic wound
(Authors: Ming-Chun Choi1, Kwok-Kuen Cheung1, Xiaohui Li1, Gladys Lai-Ying Cheing)
6. Pulsed Magnetic Field Therapy in Refractory Neuropathic Pain Secondary to Peripheral Neuropathy: Electrodiagnostic Parameters—Pilot Study
(Authors: Michael I. Weintraub and Steven P. Cole)