Postoperative Pain

Case Studies supporting PEMF benefits for Postoperative Pain

Effects of Pulsed Electromagnetic Fields on Postoperative Pain: A Double-Blind Randomized Pilot Study in Breast Augmentation Patients

Abstract

Background: Postoperative pain may be experienced after breast augmentation surgery despite advances in surgical techniques which minimize trauma. The use of pharmacologic analgesics and narcotics may have undesirable side effects that can add to patient morbidity. This study reports the use of a portable and disposable noninvasive pulsed electromagnetic field (PEMF) device in a double-blind, randomized, placebo-controlled pilot study. This study was undertaken to determine if PEMF could provide pain control after breast augmentation.

Methods: Forty-two healthy females undergoing breast augmentation for aesthetic reasons entered the study. They were separated into three cohorts, one group (n = 14) received bilateral PEMF treatment, the second group (n = 14) received bilateral sham devices, and in the third group (n = 14) one of the breasts had an active device and the other a sham device. A total of 80 breasts were available for final analysis. Postoperative pain data were obtained using a visual analog scale (VAS) and pain recordings were obtained twice daily through postoperative day (POD) 7. Postoperative analgesic medication use was also followed.

Results: VAS data showed that pain had decreased in the active cohort by nearly a factor of three times that for the sham cohort by POD 3 (p\0.001), and persisted at this level to POD 7. Patient use of postoperative pain medication correspondingly also decreased nearly three times faster in the active versus the sham cohorts by POD 3 (p\0.001).

Conclusion: Pulsed electromagnetic field therapy, adjunctive to standard of care, can provide pain control with a noninvasive modality and reduce morbidity due to pain medication after breast augmentation surgery.

Evidence-Based Use of Pulsed Electromagnetic Field Therapy in Clinical Plastic Surgery

Abstract

Background: The initial development of pulsed electromagnetic field (PEMF) therapy and its evolution over the last century for use in clinical surgery has been slow, primarily because of lack of scientifically-derived, evidence- based knowledge of the mechanism of action.

Objective: Our objective was to review the major scientific breakthroughs and current understanding of the mechanism of action of PEMF therapy, providing clinicians with a sound basis for optimal use.

Methods: A literature review was conducted, including mechanism of action and biologic and clinical studies of PEMF. Using case illustrations, a holistic exposition on the clinical use of PEMF in plastic surgery was performed.

Results: PEMF therapy has been used successfully in the management of postsurgical pain and edema, the treatment of chronic wounds, and in facilitating vasodilatation and angiogenesis. Using scientific support, the authors present the currently accepted mechanism of action of PEMF therapy.

Conclusions: This review shows that plastic surgeons have at hand a powerful tool with no known side effects for the adjunctive, noninvasive, nonpharmacologic management of postoperative pain and edema. Given the recent rapid advances in development of portable and economical PEMF devices, what has been of most significance to the plastic surgeon is the laboratory and clinical confirmation of decreased pain and swelling following injury or surgery.

Pulsed electromagnetic fields for postoperative pain: A randomized controlled clinical trial in patients undergoing mandibular third molar extraction

Abstract

Objectives: The clinical efficacy of a wearable pulsed electromagnetic field (PEMF) therapy device was assessed in terms of pain and quality of healing after tooth extraction.

Study Design: This randomized, parallel design, placebo-controlled study involved 120 patients undergoing unilateral mandibular third molar extraction and assigned to three groups after surgery. Test and placebo patients wore enabled or disabled PEMF devices, respectively, and controls wore no device. Patients recorded pain (on the visual analog scale) and analgesic use for a week, after which healing complications were assessed.

Results: Test patients had only slightly lower visual analog scale scores and analgesic use, but significantly fewer cases of dehiscence than placebo patients.

Conclusions: PEMF therapy delivered by a wearable device improved soft tissue healing and may be a useful adjunct for pain management after oral surgery.

PEMF Therapy Rapidly Reduces Post-Operative Pain in TRAM Flap Patients

Abstract

INTRODUCTION: Autologous breast reconstruction utilizing an abdominal donor site can result in significant and prolonged post-operative pain, which prolongs surgical recovery. This study investigates whether non-invasive pulsed electromagnetic field (PEMF) therapy, shown to rapidly reduce pain after breast reduction without the cost and side effects of narcotic pain medications (1 ), can produce similar outcomes in more complex transverse rectus abdominus myocutaneous (TRAM) flap breast reconstructions.

METHODS: In this double-blind, randomized, placebo-controlled pilot study, 19 patients undergoing pedicled TRAM flaps received either placebo or PEMF therapy immediately post-op. The non-invasive PEMF signal was pulse-modulated 27.12 MHz, configured to modulate nitric oxide signaling (2). PEMF therapy was identical for both the abdominal donor site and the breast flap and was delivered via disposable devices (Ivivi Health Sciences, San Francisco) continuously for 15 min every 2 hours. All patients were given as needed patient-controlled analgesia for the first two days post-op, followed by oral pain medications. Pain levels were measured via visual analog scale (VAS), and narcotics were quantified as Percocet equivalents.

RESULTS: Mean VAS scores in the active cohort decreased approximately 6-fold faster (P <0.001) than those in the sham cohort during 72 hours of intermittent PEMF therapy; placebo pain scores were double those of treatment scores at 5 hours post-op, and 8-fold higher at 72 hours post-op (P<0.001)

CONCLUSION: PEMF therapy was effective in rapidly reducing post-operative pain and use of narcotic medications in TRAM patients, suggesting PEMF can be effective for pain management in both simple and complex surgeries.

Effects of Pulsed Electromagnetic Fields on Interleukin-1 β and Postoperative Pain: A Double-Blind, Placebo-Controlled, Pilot Study in Breast Reduction Patients

Abstract

Background: Surgeons seek new methods of pain control to reduce side effects and speed postoperative recovery. Pulsed electromagnetic fields are effective for bone and wound repair and pain and edema reduction. This study examined whether the effect of pulsed electromagnetic fields on postoperative pain was associated with differences in levels of cytokines and angiogenic factors in the wound bed.

Methods: In this double-blind, placebo-controlled, randomized study, 24 patients, undergoing breast reduction for symptomatic macromastia received pulsed electromagnetic field therapy configured to modulate the calmodulin-dependent nitric oxide signaling pathway. Pain levels were measured by a visual analogue scale, and narcotic use was recorded. Wound exudates were analyzed for interleukin (IL)-1β, tumor necrosis factor-, vascular endothelial growth factor, and fibroblast growth factor-2.

Results: Pulsed electromagnetic fields produced a 57 percent decrease in mean pain scores at 1 hour (p<0.01) and a 300 percent decrease at 5 hours (p<0.001), persisting to 48 hours postoperatively in the active versus the control group, along with a concomitant 2.2-fold reduction in narcotic use in active patients (p=0.002). Mean IL-1 β concentration in the wound exudates of treated patients was 275 percent lower (p < 0.001). There were no significant differences found for tumor necrosis factor-, vascular endothelial growth factor, or fibroblast growth factor-2 concentrations.

Conclusions: Pulsed electromagnetic field therapy significantly reduced postoperative pain and narcotic use in the immediate postoperative period. The reduction of IL-1β in the wound exudate supports a mechanism that may involve manipulation of the dynamics of endogenous IL-1 β in the wound bed by means of a pulsed electromagnetic field effect on nitric oxide signaling, which could impact the speed and quality of wound repair.

Case Study Reference Source:

  • 1. Effects of Pulsed Electromagnetic Fields on Postoperative Pain: A Double-Blind Randomized Pilot Study in Breast Augmentation Patients
    (Authors: Per Hede´n and Arthur A. Pilla)

  • 2. Evidence-Based Use of Pulsed Electromagnetic Field Therapy in Clinical Plastic Surgery
    (Authors: "Berish Strauch, MD", "Charles Herman, MD", "Richard Dabb, MD", "Louis J. Ignarro, PhD" and "Arthur A. Pilla, PhD")

  • 3. Pulsed electromagnetic fields for postoperative pain: A randomized controlled clinical trial in patients undergoing mandibular third molar extraction
    (Authors: "Michele Stocchero, DDS", "Luca Gobbato, DDS", "Marleen De Biagi, DDS", "Eriberto Bressan, DDS" and "Stefano Sivolella, DDS")

  • 4. PEMF Therapy Rapidly Reduces Post-Operative Pain in TRAM Flap Patients
    (Authors: "Rohde, Christine MD", "Hardy, Krista BS", "Ascherman, Jeffrey MD", "Taylor, Erin BS", "Pilla, Arthur PhD")

  • 5. Effects of Pulsed Electromagnetic Fields on Interleukin-1 β and Postoperative Pain: A Double-Blind, Placebo-Controlled, Pilot Study in Breast Reduction Patients
    (Authors: Christine Rohde, M.D. Austin Chiang, B.S. Omotinuwe Adipoju, M.D. Diana Casper, Ph.D. Arthur A. Pilla, Ph.D.)