Case Studies supporting PEMF benefits for Osteoarthritis
Effects of PEMF on patients with osteoarthritis: Results of a prospective, placebo-controlled, double-blind study.
This study aimed to evaluate effects of pulsed electromagnetic fields (PEMF) in a double blind study on patients with knee joint osteoarthritis. The MAGCELL ARTHRO electrode-less therapy delivered a sinusoidal magnetic field, varying in frequency between 4 and 12 Hz. In 1 cm tissue depth, magnetic flux density was 105 mT. A total of n = 57 patients were randomly assigned to the verum, PEMF or placebo group (placebo device). Their average age was 61.6 ± 12.0 years. According to American College of Rheumatology criteria the osteoarthritis level was 2.8 ± 0.8. Treatment was performed twice a day for 5 min over a period of 18 days. Treatment with the MAGCELL device versus control (sham exposed) showed a highly significant reduction in pain (P < 0.001), a significant reduction in stiffness (P = 0.032) and a significant reduction in disability in daily activities (P = 0.005) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scales with a good overall treatment tolerance. In the placebo group there was no evidence of a significant change between the initial and final examination in any of the three above-mentioned WOMAC scales. Results of this partly randomized placebo-controlled double-blind study show clinically at any rate, that use of PEMF lead to highly significant better results in the treatment group compared to the placebo group with regard to the total WOMAC global score and especially for visual analogue scale. Patient assessment of the "effectiveness" was rated in 29.5% as very good and good in 27.3% compared to 0.0% and 15.4% in controls. This therapy is thus a useful complementary treatment option with no side effects.
EFFECTIVENESS OF PULSED ELECTROMAGNETIC FIELD THERAPY IN THE MANAGEMENT OF OSTEOARTHRITIS OF THE KNEE: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Objective: To assess the effectiveness of pulsed electromagnetic fields compared with placebo in the management of osteoarthritis of the knee.
Data sources: A systematic review of PubMed, EMBASE, and the Cochrane Controlled Trials Register.
Methods: Randomized, controlled trials reporting on the blinded comparison of pulsed electromagnetic fields with placebo were included. Validity was tested according to the Jadad Scale. Studies were pooled using fixed-effects and random-effects models after exclusion of publication bias and assessment of heterogeneity. Sensitivity analyses and meta-regression were performed to test the stability of our findings.
Results: Nine studies, including 483 patients, were pooled. No significant difference could be shown for pain (weighted mean difference 0.2 patients; 95% confidence interval (CI): –0.4 to 0.8) or stiffness (weighted mean difference 0.3; 95% CI: –0.3 to 0.9). There was a significant effect on activities of daily living (weighted mean difference 0.8; 95% CI 0.2–1.4, p = 0.014) and scores (standardized mean difference 0.4; 95% CI: 0.05–0.8, p = 0.029). We saw only statistically insignificant differences between studies with different treatment protocols.
Conclusion: Pulsed electromagnetic fields improve clinical scores and function in patients with osteoarthritis of the knee and should be considered as adjuvant therapies in their management. There is still equipoise of evidence for an effect on pain in the current literature.
EFFECTS OF ELECTROMAGNETIC FIELDS ON CHONDROCYTES CELLS OF HUMAN SEEDED ONTO 3D COLLAGEN-PLLA SCAFFOLDS AND CHONDRO-GIDE MEMBRANE
Osteoarthritis is a common, chronic disorder of synovial joints with degenerative changes and locomotor limitations. In response to cartilage damage chondrocytes are forced to proliferate and increase matrix formation to replace the lost cartilage tissue. In this study, we aimed to investigate effects of pulsed electromagnetic field (PEMF) on SW-1353 chondrosarcoma human cells in various cell culture conditions using 3D collagen-PLLA scaffolds and Chondro-Gide membranes. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) observations were evaluated.
Effects of pulsed electromagnetic fields on articular hyaline cartilage: review of experimental and clinical studies
Osteoarthritis (OA) is the most common disorder of the musculoskeletal system and is a consequence of mechanical and biological events that destabilize tissue homeostasis in articular joints. Controlling chondrocyte death and apoptosis, function, response to anabolic and catabolic stimuli, matrix synthesis or degradation and inflammation is the most important target of potential chondroprotective treatment, aimed to retard or stabilize the progression of OA. Although many drugs or substances have been recently introduced for the treatment of OA, the majority of them relieve pain and increase function, but do not modify the complex pathological processes that occur in these tissues. Pulsed electromagnetic fields (PEMFs) have a number of well-documented physiological effects on cells and tissues including the upregulation of gene expression of members of the transforming growth factor b super family, the increase in glycosaminoglycan levels, and an antiinflammatory action. Therefore, there is a strong rationale supporting the in vivo use of biophysical stimulation with PEMFs for the treatment of OA. In the present paper some recent experimental in vitro and in vivo data on the effect of PEMFs on articular cartilage were reviewed. These data strongly support the clinical use of PEMFs in OA patients.
Low dose short duration pulsed electromagnetic field effects on cultured human chondrocytes: An experimental study
Background: Pulsed electromagnetic field (PEMF) is used to treat bone and joint disorders for over 30 years. Recent studies demonstrate a significant effect of PEMF on bone and cartilage proliferation, differentiation, synthesis of extracellular matrix (ECM) and production of growth factors. The aim of this study is to assess if PEMF of low frequency, ultralow field strength and short time exposure have beneficial effects on invitro cultured human chondrocytes.
Materials and Methods: Primary human chondrocytes cultures were established using articular cartilage obtained from knee joint during joint replacement surgery. Post characterization, the cells were exposed to PEMF at frequencies ranging from 0.1 to 10 Hz and field intensities ranging from 0.65 to 1.95 μT for 60 min/day for 3 consecutive days to analyze the viability, ECM component synthesis, proliferation and morphology related changes post exposure. Association between exposure doses and cellular effects were analyzed with paired 't’ test.
Results: : Invitro PEMF exposure of 0.1 Hz frequency, 1.95 μT and duration of 60 min/day for 3 consecutive days produced the most favorable response on chondrocytes viability (P < 0.001), ECM component production (P < 0.001) and multiplication. Exposure of identical chondrocyte cultures to PEMFs of 0.65 μT field intensity at 1 Hz frequency resulted in less significant response. Exposure to 1.3 μT PEMFs at 10 Hz frequency does not show any significant effects in different analytical parameters.
Conclusions: Short duration PEMF exposure may represent a new therapy for patients with Osteoarthritis (OA).
Non-invasive electromagnetic field therapy produces rapid and substantial pain reduction in early knee osteoarthritis: a randomized double-blind pilot study
This study examined whether a non-thermal, non-invasive, pulsed electromagnetic field (PEMF), known to modulate the calmodulin (CaM)-dependent nitric oxide (NO)/cyclic guanosine monophosphate (cGMP) signaling pathway, could reduce pain in early knee OA. This randomized, placebo-controlled, double-blind pilot clinical study enrolled 34 patients. Patient selection required initial VAS C4, 2 h of standing activity per day, and no recent interventions such as cortisone injections or surgery. Results showed VAS pain score decreased in the active cohort by 50 ± 11 % versus baseline starting at day 1 and persisting to day 42 (P\0.001). There was no significant decrease in VAS versus baseline at any time point in the sham cohort (P = 0.227). The overall decrease in mean VAS score for the active cohort was nearly threefold that of the sham cohort (P\0.001). The results suggest that nonthermal, non-invasive PEMF therapy can have a significant and rapid impact on pain from early knee OA and that larger clinical trials are warranted.
Pulsed electromagnetic field therapy for management of osteoarthritis-related pain, stiffness and physical function: clinical experience in the elderly
Background: Pulsed electromagnetic field (PEMF) therapy has shown promising therapeutic effectiveness on bone- and cartilage-related pathologies, being also safe for management of knee osteoarthritis.
Aim: The aim of this study was to investigate the clinical efficacy of a PEMF device for management of knee osteoarthritis in elderly patients.
Materials and methods: A total of 33 patients were screened, and 28 patients, aged between 60 and 83 and affected by bilateral knee osteoarthritis, were enrolled in this study. They received PEMF therapy on the right leg for a total of three 30-minute sessions per week for a period of 6 weeks, while the left leg did not receive any treatment and served as control. An intravenous drip containing ketoprofen, sodium clodronate, glucosamine sulfate, calcitonin, and ascorbic acid, for a total volume of 500 mL, was administered during PEMF therapy. At baseline and 3 months post-PEMF therapy, Visual Analog Scale (VAS) was used to assess knee pain and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) was used to measure knee pain, stiffness and physical function.
Results: Changes in VAS and WOMAC scores were calculated for both knees as baseline minus post-treatment. A two sample Student’s t-test, comparing change in knee-related VAS pain for PEMF-treated leg (49.8 ± 2.03) vs control leg (11 ± 1.1), showed a significant difference in favor of PEMF therapy (P , 0.001). A two sample Student’s t-test comparing change in knee-related WOMAC pain, stiffness, and physical function for PEMF-treated leg (8.5 ± 0.4, 3.5 ± 0.2, 38.5 ± 2.08, respectively) vs control leg (2.6 ± 0.2; 1.6 ± 0.1; 4.5 ± 0.5 respectively), also showed a significant difference in favor of PEMF therapy (P , 0.001). No adverse reactions to therapy were observed.
Conclusion: The present study shows that PEMF therapy improves pain, stiffness and physical function in elderly patients affected by knee osteoarthritis.
Pulsed electromagnetic fields in knee osteoarthritis: a double blind, placebo-controlled, randomized clinical trial
Objectives: This trial aimed to test the effectiveness of a wearable pulsed electromagnetic fields (PEMF) device in the management of pain in knee OA patients.
Methods: In this randomized [with equal randomization (1:1)], double-blind, placebo-controlled clinical trial, patients with radiographic evidence of knee OA and persistent pain higher than 40 mm on the visual analog scale (VAS) were recruited. The trial consisted of 12 h daily treatment for 1 month in 60 knee OA patients. The primary outcome measure was the reduction in pain intensity, assessed through VAS and WOMAC scores. Secondary outcomes included quality of life assessment through the 36item Medical Outcomes Study Short Form version 2 (SF36 v2), pressure pain threshold (PPT) and changes in intake of NSAIDs/analgesics.
Results: Sixty six patients were included, and 60 completed the study. After 1 month, PEMF induced a significant reduction in VAS pain and WOMAC scores compared with placebo. Additionally, pain tolerance, as expressed by PPT changes, and physical health improved in PEMF treated patients. A mean treatment effect of −0.73 (95% CI − 1.24 to − 0.19) was seen in VAS score, while the effect size was −0.34 (95% CI − 0.85 to 0.17) for WOMAC score. Twenty six per cent of patients in the PEMF group stopped NSAID/analgesic therapy. No adverse events were detected.
Conclusion: These results suggest that PEMF therapy is effective for pain management in knee OA patients and also affects pain threshold and physical functioning. Future larger studies, including head to head studies comparing PEMF therapy with standard pharmacological approaches in OA, are warranted.
The effect of pulsed electromagnetic fields in the treatment of cervical osteoarthritis: a randomized, double-blind, sham-controlled trial
The purpose of this study was to evaluate the effect of electromagnetic field therapy (PEMF) on pain, range of motion (ROM) and functional status in patients with cervical osteoarthritis (COA). Thirty-four patients with COA were included in a randomized, double-blind study. PEMF was administrated to the whole body using a mat 1.8•0.6 m in size. During the treatment, the patients lay on the mat for 30 min per session, twice a day for 3 weeks. Pain levels in the PEMF group decreased significantly after therapy (p<0.001), but no change was observed in the placebo group. The active ROM, paravertebral muscle spasm and neck pain and disability scale (NPDS) scores improved significantly after PEMF therapy (p<0.001) but no change was observed in the sham group. The results of this study are promising, in that PEMF treatment may offer a potential therapeutic adjunct to current COA therapies in the future.
Treatment of knee osteoarthritis with pulsed electromagnetic fields: a randomized, double-blind, placebo-controlled study
Objective: The investigation aimed at determining the effectiveness of pulsed electromagnetic fields (PEMF) in the treatment of osteoarthritis (OA) of the knee by conducting a randomized, double-blind, placebo-controlled clinical trial.
Design: The trial consisted of 2 h daily treatment 5 days per week for 6 weeks in 83 patients with knee OA. Patient evaluations were done at baseline and after 2 and 6 weeks of treatment. A follow-up evaluation was done 6 weeks after treatment. Activities of daily living (ADL), pain and stiffness were evaluated using the Western Ontario and McMaster Universities (WOMAC) questionnaire.
Results: Within group analysis revealed a significant improvement in ADL, stiffness and pain in the PEMF-treated group at all evaluations. In the control group there was no effect on ADL after 2 weeks and a weak significance was seen after 6 and 12 weeks. Significant effects were seen on pain at all evaluations and on stiffness after 6 and 12 weeks. Between group analysis did not reveal significant improvements over time. Analysis of ADL score for the PEMF-treated group revealed a significant correlation between less improvement and increasing age. Analysis of patients !65 years using between group analysis revealed a significant improvement for stiffness on treated knee after 2 weeks, but this effect was not observed for ADL and pain.
Conclusions: Applying between group analysis we were unable to demonstrate a beneficial symptomatic effect of PEMF in the treatment of knee OA in all patients. However, in patients !65 years of age there is significant and beneficial effect of treatment related to stiffness.
Case Study Reference Source:
1. Effects of PEMF on patients with osteoarthritis: Results of a prospective, placebo-controlled, double-blind study. (Authors: Wuschech H, von Hehn U, Mikus E, Funk RH)
2. EFFECTIVENESS OF PULSED ELECTROMAGNETIC FIELD THERAPY IN THE MANAGEMENT OF OSTEOARTHRITIS OF THE KNEE: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS (Authors: "Patrick Vavken, MD, MSc, FRSPH", "Ferdi Arrich, MD", "Othmar Schuhfried, MD" and "Ronald Dorotka, MD")
3. EFFECTS OF ELECTROMAGNETIC FIELDS ON CHONDROCYTES CELLS OF HUMAN SEEDED ONTO 3D COLLAGEN-PLLA SCAFFOLDS AND CHONDRO-GIDE MEMBRANE (Authors: Berivan Cecena, Didem Kozacib, Tulin Boyluc, Nurten Kurtd, Diler Erdemlia, Mithat Yüksele Hasan Havitcioglua)
4. Effects of pulsed electromagnetic fields on articular hyaline cartilage: review of experimental and clinical studies (Authors: M. Fini a, G. Giavaresi, A. Carpi, A. Nicolini, S. Setti, R. Giardino)
5. Low dose short duration pulsed electromagnetic field effects on cultured human chondrocytes: An experimental study (Authors: Selvam Anbarasan, Ulaganathan Baraneedharan, Solomon FD Paul, Harpreet Kaur, Subramoniam Rangaswami, and Emmanuel Bhaskar)
6. Non-invasive electromagnetic field therapy produces rapid and substantial pain reduction in early knee osteoarthritis: a randomized double-blind pilot study (Authors: Fred R. Nelson, Raimond Zvirbulis, Arthur A. Pilla)
7. Pulsed electromagnetic field therapy for management of osteoarthritis-related pain, stiffness and physical function: clinical experience in the elderly (Authors: Tommaso Iannitti, Gregorio Fistetto, Anna Esposito, Valentina Rottigni, Beniamino Palmieri)
8. Pulsed electromagnetic fields in knee osteoarthritis: a double blind, placebo-controlled, randomized clinical trial (Authors: Gian Luca Bagnato, Giovanni Miceli, Natale Marino, Davide Sciortino and Gian Filippo Bagnato)
9. The effect of pulsed electromagnetic fields in the treatment of cervical osteoarthritis: a randomized, double-blind, sham-controlled trial (Authors: Serap Tomruk Sutbeyaz, Nebahat Sezer Belma Fusun Koseoglu)
10. Treatment of knee osteoarthritis with pulsed electromagnetic fields: a randomized, double-blind, placebo-controlled study (Authors: G. Thamsborg M.D., A. Florescu M.D., P. Oturai M.D., E. Fallentin M.D., K. Tritsaris Ph.D. and S. Dissing Dr.Sci.)