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“As
long as there is breath in my body
Scientific Articles and Abstracts
The Effect of Pulsed Electromagnetic Fields in the Treatment of Osteoarthritis of the Knee and Cervical Spine. Report of Randomized, Double-Blind, Placebo Controlled Trials. OBJECTIVE. We conducted a randomized, double blind clinical trial
to determine the effectiveness of pulsed electromagnetic fields (PEMF)
in the treatment of osteoarthritis (OA) of the knee and cervical spine.
METHODS. A controlled trial of 18 half-hour active or placebo treatments
was conducted in 86 patients with OA of the knee and 81 patients with
OA of the cervical spine, in which pain was evaluated using a 10 cm
visual analog scale, activities of daily living using a series of questions
(answered by the patient as never, sometimes, most of the time, or
always), pain on passive motion (recorded as none, slight, moderate,
or severe), and joint tenderness (recorded using a modified Ritchie
scale). Global evaluations of improvement were made by the patient
and examining physician. Evaluations were made at baseline, midway,
end of treatment, and one month after completion of treatment. Low-amplitude, extremely low frequency magnetic fields for the treatment of osteoarthritic knees: a double-blind clinical study. CONTEXT: Non-invasive magneto-therapeutic approaches
to bone healing have been successful in past clinical studies. OBJECTIVE:
To determine the effectiveness of low-amplitude, extremely low frequency
magnetic fields on patients with knee pain due to osteoarthritis.
DESIGN: Placebo-controlled, randomized, double-blind clinical study.
SETTING: 4 outpatient clinics. PARTICIPANTS: 176 patients were randomly
assigned to 1 of 2 groups, the placebo group (magnet off) or the active
group (magnet on). INTERVENTION: 6-minute exposure to each magnetic
field signal using 8 exposure sessions for each treatment session,
the number of treatment sessions totalling 8 during a 2-week period,
yielded patients being exposed to uniform magnetic fields for 48 minutes
per treatment session 8 times in 2 weeks. The magnetic fields used
in this study were generated by a resonator, which consists of two
18-inch diameter (46-cm diameter) coils connected in series, in turn
connected to a function generator via an attenuator to obtain the
specific amplitude and frequency. The range of magnetic field amplitudes
used was from 2.74 x 10(-7) to 3.4 x 10(-8) G, with corresponding
frequencies of 7.7 to 0.976 Hz. OUTCOME MEASURES: Each subject rated
his or her pain level from 1 (minimal) to 10 (maximal) before and
after each treatment and 2 weeks after treatment. Subjects also recorded
their pain intensity in a diary while outside the treatment environment
for 2 weeks after the last treatment session (session 8) twice daily:
upon awakening (within 15 minutes) and upon retiring (just before
going to bed at night). RESULTS: Reduction in pain after a treatment
session was significantly (P < .001) greater in the magnet-on group
(46%) compared to the magnet-off group (8%). CONCLUSION: Low-amplitude,
extremely low frequency magnetic fields are safe and effective for
treating patients with chronic knee pain due to osteoarthritis. Pulsed Electromagnetic Field Therapy, PEMT. How does it work? All living cells within the body possess potentials between the inner
and outer membrane of the cell, which, under normal healthy circumstances,
are fixed. Different cells, e.g. Muscle cells and Nerve cells, have
different potentials of about -70 mV respectively. When cells are
damaged, these potentials change such that the balance across the
membrane changes, causing the attraction of positive sodium ions into
the cell and negative trace elements and proteins out of the cell.
The net result is that liquid is attracted into the interstitial area
and swelling or oedema ensues. The application of pulsed magnetic
fields has, through research findings, been shown to help the body
to restore normal potentials at an accelerated rate, thus aiding the
healing of most wounds and reducing swelling faster. The most effective
frequencies found by researchers so far, are very low frequency pulses
of a 50Hz base. These, if gradually increased to 25 pulses per second
for time periods of 600 seconds (10 minutes), condition the damaged
tissue to aid the natural healing process.
Magnetic pulse treatment for knee osteoarthritis: a randomised, double-blind, placebo-controlled study. We assessed the efficacy and tolerability of low-frequency pulsed
electromagnetic fields (PEMF) therapy in patients with clinically symptomatic
knee osteoarthritis (OA) in a randomised, placebo-controlled, double-blind
study of six weeks' duration. While the treated group demonstrated
improvement over different indices to the contrary, the control group
demonstrated none. There were no clinically relevant adverse effects
attributable to active treatment. These results suggest that the unipolar
magnetic devices are beneficial in reducing pain and disability in
patients with knee OA resistant to conventional treatment in the absence
of significant side effects. Electrochemical therapy of pelvic pain: effects of pulsed electromagnetic fields (PEMF) on tissue trauma. Unusually effective and long-lasting relief of pelvic pain of gynaecological
origin has been obtained consistently by short exposures of affected
areas to the application of a magnetic induction device. Treatments
are short, fasting-acting, economical and in many instances have obviated
surgery. This report describes typical cases such as dysmenorrhoea,
endometriosis, ruptured ovarian cyst, acute lower urinary tract infection,
post-operative haematoma, and persistent dyspareunia in which pulsed
magnetic field treatment has not, in most cases, been supplemented
by analgesic medication. Of 17 female patients presenting with a total
of 20 episodes of pelvic pain, 16 patients representing 18 episodes
(90%) experienced marked, even dramatic relief, while two patients
representing two episodes reported less than complete pain.
Evaluation of electromagnetic fields in the treatment of pain in patients with lumbar radiculopathy or whiplash syndrome. Back pain and whiplash syndrome are very common diseases involving
tremendous costs and extensive medical effort. A quick and effective
reduction of symptoms, especially pain, is required. In two prospective
randomized studies, patients with either lumbar radiculopathy in the
segments L5/S1 or whiplash syndrome were investigated. Electromagnetic
devices are pulsed field (PEMF) and constant wave (CW) types. These
studies indicate both are effective, PEMF usually more quickly than
CW. Pulsed magnetic fields appear to have a considerable and statistically
significant potential for reducing pain in cases of lumbar radiculopathy
and whiplash syndrome.
We assessed the efficacy and tolerability of low-frequency pulsed electromagnetic fields (PEMF) therapy in patients with clinically symptomatic knee osteoarthritis (OA) in a randomised, placebo-controlled, double-blind study of six weeks' duration. Patients with radiographic evidence and symptoms of OA (incompletely
relieved by conventional treatments), according to the criteria of
the American College of Rheumatology, were recruited from a single
tertiary referral centre. 75 Patients fulfilling the above criteria
were randomised to receive active PEMF treatment by unipolar magnetic
devices or placebo. Six patients failed to attend after the screening
and were excluded from analysis. The primary outcome measure was reduction
in overall pain assessed on a four-point Likert scale ranging from
nil to severe. Secondary outcome measures included the WOMAC Osteoarthritis
Index (Likert scale) and the EuroQol (Euro-Quality of Life, EQ-5D).
Baseline assessments showed that the treatment groups were equally
matched. Although there were no significant differences between active
and sham treatment groups in respect of any outcome measure after
treatment, paired analysis of the follow-up observations on each patient
showed significant improvements in the actively treated group in the
WOMAC global score (p = 0.018), WOMAC pain score (p = 0.065), WOMAC
disability score (p = 0.019) and EuroQol score (p = 0.001) at study
end compared to baseline. In contrast, there were no improvements
in any variable in the placebo-treated group. There were no clinically
relevant adverse effects attributable to active treatment. These results
suggest that PEMF magnetic devices are beneficial in reducing pain
and disability in patients with knee OA resistant to conventional
treatment in the absence of significant side-effects. Further studies
using different types of magnetic devices, treatment protocols and
patient populations are warranted to confirm the general efficacy
of PEMF therapy in OA and other conditions.
Pulsed magnetic field therapy and the physiotherapist The therapeutic effect of the application of pulsed magnetic field
therapy (PMFT) has at last received world-wide recognition, although
for a long time many practitioners saw it only as an aid to fracture
union. Research has now shown that it has the potential to improve
a wide range of conditions, although few understood just how it achieved
its effectiveness. Extensive research has since been carried out to
determine the mechanism by which this occurs. For the physiotherapist,
presented with a wide range of clinical problems, PMFT is an invaluable
aid to the clinic.
Treatment of migraine with pulsing electromagnetic fields: a double-blind, placebo-controlled study. The effect of exposure to pulsing electromagnetic fields on migraine
activity was evaluated by having 42 subjects (34 women and 8 men),
who met the International Headache Society's criteria for migraine,
participate in a double-blind, placebo-controlled study. During the
first month of follow-up, 73% of those receiving actual exposure,
reported decreased headaches (45% substantial decrease, 14% excellent
decrease) compared to half of those receiving the placebo (15% worse,
20% good, 0% excellent). Ten of the 22 subjects who had actual exposure
received 2 additional weeks of actual exposure, after their initial
1-month follow-up. All showed decreased headache activity (50% substantial,
38% excellent). Eight of the subjects in the placebo group elected
to receive 2 weeks of actual exposure after the initial 1-month follow-up
with 75% showing decreased headache activity (38% substantial, 38%
excellent). In conclusion, exposure to pulsing electromagnetic fields
for at least 3 weeks is an effective, short-term intervention for
migraine.
Fundamental and practical aspects of therapeutic uses of pulsed electromagnetic fields (PEMFs). The beneficial therapeutic effects of selected low-energy, time-varying
magnetic fields, called PEMFs, have been documented with increasing
frequency since 1973. Initially, this form of athermal energy was
used mainly as a salvage for patients with long-standing juvenile
and adult nonunions. Many of these individuals were candidates for
amputation. Their clearly documented resistance to the usual forms
of surgical treatment, including bone grafting, served as a reasonable
control in judging the efficacy of this new therapeutic method, particularly
when PEMFs were the sole change in patient management. More recently,
the biological effectiveness of this approach in augmenting bone healing
has been confirmed by several highly significant double-blind and
controlled prospective studies in less challenging clinical circumstances.
Furthermore, double-blind evidence of therapeutic effects in other
clinical disorders has emerged. These data, coupled with well-controlled
laboratory findings on pertinent mechanisms of action, have begun
to place PEMFs on a therapeutic par with surgically invasive methods
but at considerably less risk and cost. As a result of these clinical
observations and concerns about electromagnetic "pollution",
interactions of nonionizing electromagnetic fields with biological
processes have been the subject of increasing investigational activity.
Over the past decade, the number of publications on these topics has
risen exponentially. They now include textbooks, speciality journals,
regular reviews by government agencies, in addition to individual
articles, appearing in the wide spectrum of peer-reviewed, scientific
sources. In a recent editorial in Current Contents, the editor reviews
the frontiers of biomedical engineering focusing on Science Citation
Index methods for identifying core research endeavors. Dr. Garfield
chose PEMFs from among other biomedical engineering efforts as an
example of a rapidly emerging discipline. Three new societies in the
bioelectromagnetics, bioelectrochemistry, and bioelectrical growth
and repair have been organized during this time, along with a number
of national and international committees and conferences. These activities
augment a continuing interest by the IEEE in the U.S. and the IEE
in the U.K. This review focuses on the principles and practice behind
the therapeutic use of "PEMFs". This term is restricted
to time-varying magnetic field characteristics that induce voltage
waveform patterns in bone similar to those resulting from mechanical
deformation. These asymmetric, broad-band pulses affect a number of
biologic processes athermally. Many of these processes appear to have
the ability to modify selected pathologic states in the musculoskeletal
and other systems.
Pulsed electromagnetic fields promote collagen production in bone marrow fibroblasts via athermal mechanisms. Primary and passaged cultures of fibroblasts (RBMFs) raised from the
bone marrow stroma of young rabbits were treated with pulsed electromagnetic
fields (PEMFs) from the start of each culture until 1 week after they
became confluent. The PEMF treatment had no effect on cell proliferation,
estimated by phase contrast microscopy, by 3H-thymidine incorporation
into DNA, or by total DNA assay. Collagen production, estimated by
conversion of 3H-proline to 3H-hydroxyproline in nondialyzable material
was markedly elevated in postconfluent cultures, but not in cultures
that had only just reached confluence. About 65 of 3H-hydroxyproline
was in low molecular weight form, and a correlation between collagen
breakdown and cyclic AMP (cAMP) levels in RBMFs was demonstrated by
adding dibutyryl cAMP or prostaglandin E3 (PGE2) to the culture medium
concurrently with 3H-proline. The PEMF apparatus caused an insufficient
temperature rise (less than 0.1 degree C) to account for these results.
We propose that the rise in collagen production is consistent with
the hypothesis that PEMFs act by reducing cAMP levels in RBMFs, and
that thermal effects are insignificant.
Modulation of collagen production in cultured fibroblasts by a low-frequency pulsed magnetic field. Primary cultures of chicken tendon fibroblasts have been exposed for
various periods to a low-frequency, pulsed magnetic field, and the
effects on protein and collagen synthesis have been examined by radioisotopic
incorporation. Total protein synthesis was increased in confluent
cells treated with a pulsed magnetic field for the last 24 h of culture
as well as in cells treated for a total of 6 days. However, in 6 day-treated
cultures, collagen accumulation was specifically enhanced as compared
to total protein, whereas after short-term exposure, collagen production
was increased only to the same extent as total protein. Levels of
cyclic AMP were significantly decreased after 6-day pulsed magnetic
field treatment, probably as a consequence of diminished adenylate
cyclase activity. Exposure to pulsed magnetic field had no effect
on cell proliferation or collagen phenotype. These results indicate
that a pulsed magnetic field can specifically increase production
of collagen, the major differentiated function of fibroblasts, possibly
by altering cyclic-AMP metabolism.
Results of pulsed electromagnetic fields (PEMFs) in ununited fractures after external skeletal fixation. Of 147 patients with fractures of the tibia, femur and humerus, in
whom an average of 3.3 operations had failed to produce union, all
were treated with external skeletal fixation in situ and pulsed electromagnetic
fields (PEMFs). Of the 147, 107 patients united for an overall success
rate of 73%. Union of the femur occurred in 81% and the tibia in 75%.
Only five of 13 humeri united. Failure to achieve union with PEMFs
was most closely associated with very wide fracture gaps and insecure
skeletal fixation devices.
Osteonecrosis of the femoral head treated by pulsed electromagnetic fields (PEMFs): a preliminary report. This has been a preliminary report with a short-term follow-up of a
small number of observations (28 hips of 24 patients). The follow-ups
ranged from 6 to 36 months, with an average of 17.8 months. Only eleven
hips (in eleven patients) were followed an average of 8 months after
cessation of the treatment. It should be emphasized that this was
a "pilot" study, in which no control series was used to
determine the natural course of the disease in a comparable clinical
setting. Of note was the pain relief, in 19 of 23 patients with moderate
to severe pretreatment pain. Also there was an improved function,
which suggests that at least in approximately two thirds of the patients
there was some clinical benefit from this mode of treatment. In eight
hips, clinical conditions did not change; and in two they worsened,
requiring further treatment. Eighteen remaining hips were thought
to have benefited by the treatment. Six femoral heads that had already
developed varying degrees of collapse (Ficat Type III) collapsed further
(1 to 2 mm), and two round heads (Ficat II) progressed to off-round
(Ficat III). This preliminary study suggests that further exploration
of pulsed electromagnetic fields (PEMFs) is warranted in the treatment
of osteonecrosis of the femoral head.
Treatment of therapeutically resistant non-unions with bone grafts and pulsing electromagnetic fields. This study reviews the cases of eighty-three adults with ununited fractures
who were treated concomitantly with bone-grafting and pulsed electromagnetic
fields. An average of 1.5 years had elapsed since fracture and the
use of this combined approach. Nearly one-third of the patients had
a history of infection, and an average of 2.4 prior operations had
failed to produce bone union. Thirty-eight patients who were initially
treated with grafts and pulsed electromagnetic fields for ununited
fractures with wide gaps, synovial pseudarthrosis, and malalignment
achieved a rate of successful healing of 87 per cent. Forty-five patients
who had initially been treated unsuccessfully with pulsing electromagnetic
fields alone had bone-grafting and were re-treated with pulsing electromagnetic
fields. Ninety-three per cent of these fractures healed. The residual
failure rate after two therapeutic attempts, one of which was operative,
was 1.5 per cent. The median time to union for both groups of patients
was four months.
Effects of a pulsed electromagnetic field on a mixed chondroblastic tissue culture. A mixed tissue culture predominantly composed of chondroblastic tissue
was perturbed by a pulsed electromagnetic field (PEMF). Some cultures
were nonconfluent, and purposely retarded in growth to resemble an
atrophic nonunion, while others were grown to confluence in about
one-half the time as a model for a hypertrophic nonunion. These two
groups tested the effect of growth rate upon the products of cell
proliferation and differentiation. The slowly growing cultures were
stimulated to synthesize hydroxyproline. The rapidly growing cultures
showed a large increase in lysozyme activity, and increase in hyaluronate
and DNA, and a decrease in glycosaminoglycan. Exogenous lysozyme further
decreased the glycosaminoglycan synthesis in the presence of PEMF.
Chitotriose, a specific lysozyme inhibitor abolished this effect.
Cycloheximide, a protein synthesis inhibitor, did not abolish the
activation of lysozyme found in the matrix. Thus lysozyme appears
to be activated by PEMF. These observations of the rapidly growing
confluent cultures are consistent with events described in the normal
healing of a bone fracture or endochrondral growth. Thus, PEMF appears
to promote normal healing, probably by altering cartilaginous lysozyme
activity in the matrix, and possibly the sequence of events leading
to calcification.
Biological effects of magnetic fields: studies with microorganisms. Five bacteria and one yeast were grown in magnetic fields of 50-900
gauss with frequencies of 0-0.3 HZ and square, triangular, or sine
waveform. Growth of these microorganisms could be stimulated or inhibited
depending upon the field strength and frequency of the pulsed magnetic
field. Spore germination and mutation frequency were unaffected by
the magnetic fields used in this study.
Influence of magnetic fields on calcium salts crystal formation: an explanation of the 'pulsed electromagnetic field' technique for bone healing. In the search for a mechanism by means of which a magnetic field deparalyses
non-unions and enhances bone tissue formation, the influence of continuous
magnetic fields on the formation of calcium phosphate crystal seeds
has been investigated. From this perspective, an explanation is given
of a working mode in conventional equipment for pulsed electromagnetic
field treatment; this is compared with multifunction equipment.
Spine fusion for discogenic low back pain: outcome in patients treated with or without pulsed electromagnetic field stimulation. Sixty-one randomly selected patients who underwent lumbar fusion surgeries
for discogenic low back pain between 1987 and 1994 were retrospectively
studied. All patients had failed to respond to preoperative conservative
treatments. Forty-two patients received adjunctive therapy with pulsed
electromagnetic field (PEMF) stimulation, and 19 patients received
no electrical stimulation of any kind. Average follow-up time was
15.6 months postoperatively. Fusion succeeded in 97.6% of the PEMF
group and in 52.6% of the unstimulated group (P < .001).
Beneficial effects of electromagnetic fields. Selective control of cell function by applying specifically configured,
weak, time-varying magnetic fields has added a new, exciting dimension
to biology and medicine. Field parameters for therapeutic, pulsed
electromagnetic field (PEMFs) were designed to induce voltages similar
to those produced, normally, during dynamic mechanical deformation
of connective tissues. As a result, a wide variety of challenging
musculoskeletal disorders have been treated successfully over the
past two decades. More than a quarter million patients with chronically
ununited fractures have benefitted, worldwide, from this surgically
non-invasive method, without risk, discomfort, or the high costs of
operative repair. Many of the athermal bioresponses, at the cellular
and subcellular levels, have been identified and found appropriate
to correct or modify the pathologic processes for which PEMFs have
been used. Not only is efficacy supported by these basic studies but
by a number of double-blind trials. As understanding of mechanisms
expands, specific requirements for field energetics are being defined
and the range of treatable ills broadened. These include nerve regeneration,
wound healing, graft behavior, diabetes, and myocardial and cerebral
ischemia (heartattack and stroke), among other conditions. Preliminary
data even suggest possible benefits in controlling malignancy.
Therapeutic effects of pulsed magnetic fields on joint diseases. The present paper describes the effects of pulsed magnetic fields (PMF)
on diseases of different joints, in chronic as well as acute conditions
where the presence of a phlogistic process is the rule. Optimal parameters
for PMF applications were sought at the beginning of the study and
then applied for 11 years; a technical modification in the PMF generator
was introduced 5 years ago to satisfy the requirement of a hypothesis
advanced to understand the mechanism of PMF treatment.
Modification of biological behavior of cells by Pulsing Electromagnetic fields, (PMFT) On the major part of the calcified mass of adult bone there are no
changes in bone mass, however there is a part on which bone is being
formed and a part on which bone is being resorbed. Decalcification
occurs when bone resorption is greater than bone formation. Bone formation
comprises two steps, the laying down of the extra-cellular matrix
and the deposition therein of bone salts. The dynamic processes of
formation and destruction of bone are under cellular control. Bone
formation is controlled by single nuclear cells called Osteoblasts,
and bone resorption by multinuclear giant cells are called Osteoclasts.
Bone is a specialized connective tissue, in which a matrix consisting
of collagen fibers and a large variety of other proteins and ground
substance are impregnated with a solid mineral. The bone matrix is
responsible for the resistance of bone to tractional and torsional
forces. The collagen forms more than 25 % of the bones and is synthesized
by osteoblasts. On the bone surface collagen fibers are normally arranged
in concentric rings of hard calcified matrix.
How can pulsed electromagnetic field therapy assist in the healing of bones and ligaments? Bone is essentially calcium structure which contains trace elements.
One particular element recently identified is Alpha Quartz. This is
the same type of material used in computers and digital or electronic
watches. When this material is compressed, it develops a voltage across
its two compressive faces, a phenomenon known as the piezoelectric
effect. The old crystal pickups on record players used this effect
to generate electrical sound signals. Gas appliances and some cigar
lighters also utilize the same effect to generate a spark for ignition.
Prevention of osteoporosis by pulsed electromagnetic fields. Using an animal model, we examined the use of pulsed electromagnetic
fields, induced at a physiological frequency and intensity, to prevent
the osteoporosis that is concomitant with disuse. By protecting the
left ulnae of turkeys from functional loading, we noted a loss of
bone of 13.0 per cent compared with the intact contralateral control
ulnae over an eight-week experimental period. Using a treatment regimen
of one hour per day of pulsed electromagnetic fields, we observed
an osteogenic dose-response to induced electrical power, with a maximum
osteogenic effect between 0.01 and 0.04 tesla per second. Pulse power
levels of more or less than these levels were less effective. The
maximum osteogenic response was obtained by a decrease in the level
of intracortical remodeling, inhibition of endosteal resorption, and
stimulation of both periosteal and endosteal new-bone formation. These
data suggest that short daily periods of exposure to appropriate electromagnetic
fields can beneficially influence the behavior of the cell populations
that are responsible for bone-remodeling and that there is an effective
window of induced electrical power in which bone mass can be controlled
in the absence of mechanical loading.
A double-blind trial of pulsed electromagnetic fields for delayed union of tibial fractures. A total of 45 tibial shaft fractures, all conservatively treated and
with union delayed for more than 16 but less than 32 weeks were entered
in a double-blind multi-centre trial. The fractures were selected
for their liability to delayed union by the presence of moderate or
severe displacement, angulation or comminution or a compound lesion
with moderate or severe injury to skin and soft tissues. Treatment
was by plaster immobilisation in all, with active electromagnetic
stimulation units in 20 patients and dummy control units in 25 patients
for 12 weeks. Radiographs were assessed blindly and independently
by a radiologist and an orthopaedic surgeon. Statistical analysis
showed the treatment groups to be comparable except in their age distribution,
but age was not found to affect the outcome and the effect of treatment
was consistent for each age group. The radiologist's assessment of
the active group showed radiological union in five fractures, progress
to union in five but no progress to union in 10. In the control group
there was union in one fracture and progress towards union in one
but no progress in 23. Using Fisher's exact test, the results were
very significantly in favour of the active group (p = 0.002). The
orthopaedic surgeon's assessment showed union in nine fractures and
absence of union in 11 fractures in the active group. There was union
in three fractures and absence of union in 22 fractures in the control
group. These results were also significantly in favour of the active
group (p = 0.02). It was concluded that pulsed electromagnetic fields
significantly influence healing in tibial fractures with delayed union.
A randomized double-blind prospective study of the efficacy of pulsed electromagnetic fields for interbody lumbar fusions. A randomized double-blind prospective study of pulsed electromagnetic
fields for lumbar interbody fusions was performed on 195 subjects.
There were 98 subjects in the active group and 97 subjects in the
placebo group. A brace containing equipment to induce an electromagnetic
field was applied to patients undergoing interbody fusion in the active
group, and a sham brace was used in the control group. In the active
group there was a 92% success rate, while the control group had a
65% success rate (P greater than 0.005). The effectiveness of bone
graft stimulation with the device is thus established.
Treatment of nonunion using pulsed electromagnetic fields: a retrospective follow-up study. Pulsed electromagnetic fields (PEMF) are a useful means of treating
cases of fracture nonunion. In 67.7% of nonunions with a disability
time of at least 24 months, complete consolidation was obtained. This
success rate is increased to 76.6% if we exclude nonunion, that presented
contraindications for treatment with PEMF. The disability time had
no effect on the success rate. Lesions of the humerus and atrophic
nonunion had an unfavorable prognosis.
Effects of pulsed electromagnetic fields on Steinberg ratings of femoral head osteonecrosis. 95 Patients with femoral head osteonecrosis met the protocol for treatment
of 118 hips with selected pulsed electromagnetic fields (PEMFs). Etiologies
included trauma (17), alcohol (9), steroid use (46), sickle cell disease
(2), and idiopathy (44). The average age was 38 years, and the average
follow-up period since the onset of symptoms was 5.3 years. PEMF treatment
had been instituted an average of 4.1 years earlier. By the Steinberg
quantitative staging method of roentgenographic analysis, none of
the 15 hips in Stages 0-III showed progression, and grading improved
in nine of 15. Eighteen of 79 hips (23%) with Stage IV lesions progressed
and none improved. In the Stage V category, one of 21 hips (5%) worsened
and none improved. Three Stage VI lesions were unchanged. The overall
rate of quantified progression for the 118 hips, 87% of which had
collapse present when entering the program, was 16%. This value represents
a reversal of the percentage of progression reported recently by other
investigators using conservative and selected surgical methods. PEMF
patients also have experienced long-term improvements in symptoms
and signs, together with a reduction in the need for early joint arthroplasty.
Stimulation of experimental endochondral ossification by low-energy pulsing electromagnetic fields. Pulsed electromagnetic fields (PEMFs) of certain configuration have
been shown to be effective clinically in promoting the healing of
fracture nonunions and are believed to enhance calcification of extracellular
matrix. In vitro studies have suggested that PEMFs may also have the
effect of modifying the extracellular matrix by promoting the synthesis
of matrix molecules. This study examines the effect of one PEMF upon
the extracellular matrix and calcification of endochondral ossification
in vivo. The synthesis of cartilage molecules is enhanced by PEMF,
and subsequent endochondral calcification is stimulated. Histomorphometric
studies indicate that the maturation of bone trabeculae is also promoted
by PEMF stimulation. These results indicate that a specific PEMF can
change the composition of cartilage extracellular matrix in vivo and
raises the possibility that the effects on other processes of endochondral
ossification (e.g., fracture healing and growth plates) may occur
through a similar mechanism. Role of pulsed electromagnetic fields in recalcitrant non-unions. Twenty-nine patients of recalcitrant nonunion of long bones were treated
by pulsed electromagnetic fields in an attempt to bring about osteogenesis.
The pulse used was rectangular, equal mark space wave in the astable,
continuous mode operating at a frequency of 40 Hertz. The success
rate was 82.5%. The result was not dependent on the age, sex, time
of nonunion or the presence of infection. However, the results were
uniformly poor when infection and fracture instability were coexistent
in the same patient.
In vitro low frequency electromagnetic field effect on fast axonal transport. The objective of this study was to evaluate the effects of a low frequency
electromagnetic field on fast axonal transport for future neuroprosthetic
applications. Changes in speeds and densities of retrograde fast organelle
transport in rat sciatic nerve preparations were measured in vitro
upon exposure to 15 and 50 Hz pulsed magnetic fields with peak intensities
of 4.4 and 8.8 mT. Maximum current density of the induced eddy current
was calculated to be about 40 microA/cm2. Video enhanced differential
interference contrast microscopy was used to record axons supporting
active organelle transport. Strong effects were observed in myelinated
axons (cessation of transport in up to 10 min). Such effects may eventually
be used as part of a neuroprosthesis to noninvasively modify or couple
to various parts of the nervous system.
Effects of pulsed extremely-low-frequency magnetic fields on skin wounds in the rat. Rats with skin-wounds surgically created on their backs were exposed
immediately after surgery and every 12 h thereafter to pulsed, extremely-low-frequency
magnetic fields. The shape of the pulse was a positive triangle (50
Hz, 8 mT peak). The rate of healing of skin wounds was evaluated macroscopically
and by light and electron microscopy at 6, 12, 21, and 42 days after
the operation. A significant increase in the rate of wound contraction
was found in rats treated with magnetic fields. Forty-two days after
surgery all treated animals show fully closed wounds, while control
rats at the same time intervals still lacked a final 6% of the wound
surface to be covered. Treated rats showed earlier cellular organization,
collagen formation and maturation, and a very early appearance of
newly formed vascular network.
Treatment of delayed union and nonunion of the tibia by pulsed electromagnetic fields. A retrospective follow-up. The results of a clinical follow-up of 57 tibial lesions treated with
pulsed electromagnetic fields at least six months after the primary
lesion occurred proved that this noninvasive method can be a valuable
alternative to other commonly accepted modes of therapy. The overall
success rate was 75% but could be improved to 81% when the proper
indications were met.
Enhanced responsiveness to parathyroid hormone and induction of functional differentiation of cultured rabbit costal chondrocytes by a pulsed electromagnetic field. Pulsed electromagnetic fields promote healing of delayed united and
ununited fractures by triggering a series of events in fibrocartilage.
We examined the effects of a pulsed electromagnetic field (recurrent
bursts, 15.4 Hz, of shorter pulses of an average of 2 gauss) on rabbit
costal chondrocytes in culture. A pulsed electromagnetic field slightly
reduced the intracellular cyclic adenosine 3',5'-monophosphate (cAMP)
level in the culture. However, it significantly enhanced cAMP accumulation
in response to parathyroid hormone (PTH) to 140% of that induced by
PTH in its absence, while it did not affect cAMP accumulation in response
to prostaglandin E1 or prostaglandin I2. The effect on camp accumulation
in response to PTH became evident after exposure of the cultures to
the pulsed electromagnetic field for 48 h, and was dependent upon
the field strength. cAMP accumulation in response to PTH is followed
by induction of ornithine decarboxylase, a good marker of differentiated
chondrocytes, after PTH treatment for 4 h. Consistent with the enhanced
cAMP accumulation, ornithine decarboxylase activity induced by PTH
was also increased by the pulsed electromagnetic field to 170% of
that in cells not exposed to a pulsed electromagnetic field. Furthermore,
stimulation of glycosaminoglycan synthesis, a differentiated phenotype,
in response to PTH was significantly enhanced by a pulsed electromagnetic
field. Thus, a pulsed electromagnetic field enhanced a series of events
in rabbit costal chondrocytes in response to PTH. These findings show
that exposure of chondrocytes to a pulsed electromagnetic field resulted
in functional differentiation of the cells.
Impulse magnetic-field therapy for erectile dysfunction: a double-blind, placebo-controlled study. This double-blind, placebo-controlled study assessed the efficacy of
3 weeks of pulsing magnetic-field therapy for erectile dysfunction
(ED). In the active-treatment group, all efficacy endpoints were significantly
improved at study end (P < or = .01), with 80% reporting increases
in intensity and duration of erection, frequency of genital warmth,
and general well-being. Only 30% of the placebo group noted some improvement
in their sexual activity; 70% had no change. No side effects were
reported.
Comparison of electromagnetic field stimulation on the healing of small and large intestinal anastomoses. Magnetic fields have been shown to affect biologic processes. Accordingly,
an experimental study was designed to investigate the effect of electromagnetic
field therapy on intestinal healing and to compare small and large
intestinal anastomoses. Conclusions: Electromagnetic field stimulation
provided a significant gain in anastomotic healing in both small and
large intestine. The study demonstrated a significant increase in
both biochemical and mechanical parameters.
The efficacy of un-united tibial fracture treatment using pulsing electromagnetic fields: relation to biological activity on non-union bone ends. Thirty un-united tibial fractures with a median time since injury of
18+/-9 months were treated by electrical stimulation using pulsing
electromagnetic field therapy. Union was achieved in 25 cases (83.3%)
in a median interval of 8.6+/-3.2 months. Patient age, gender, the
presence of surgical hardware, length of disability, and the number
of surgical procedures did not affect the outcome. Un-united fractures
that appeared to be hypertrophic or sclerotic, indicating a good blood
supply to the bone ends, all healed.. Pulsing electromagnetic field
therapy is an effective treatment for un-united tibial fractures with
good blood supply to the bone ends.
Ultrastructural study of hyaluronic acid before and after the use of a pulsed electromagnetic field, electrorydesis, in the treatment of wrinkles. BACKGROUND. Treatment of wrinkles has become an increasing problem
for dermatologists. Hyaluronic acid is a component of the family of
glycosaminoglycans (GAGS, substances known for their property of retaining
water), that significantly decreases with aging and in wrinkles. A
new technique that uses a specific pulsed electromagnetic field, electrorydesis,
has been introduced in the treatment of wrinkles associated with aging.
The treatment is based on the reported in vitro effects of specific
electromagnetic fields on fibroblast cultures (e.g., an increase in
DNA synthesis and in the production of collagen and presumably also
of GAGS). METHODS. The in vivo effects of the electromagnetic field
on aged skin (3 subjects aged 50, 56 and 60 years), with particular
focus on the ultrastructural modifications and GAGS amount before
and after the treatment, were evaluated by electron microscope. RESULTS.
The ultrastructural study (tissue stained with alcian blue) showed
after treatment a significant increase (p < 0.005) of the electron-dense
granules (corresponding to hyaluronic acid), located in collagen elastic
fibers, and in the soluble matrix. This presumably leads to subsequent
edema that was clinically evident after the treatment. CONCLUSIONS.
These data suggest that the increased levels of GAGS and the subsequent
edema of the dermis could explain at least in part the clinical changes
observed after electrorydesis treatment (e.g., swelling and "disappearance"
of the wrinkle).
Optimization of electric field parameters for the control of bone remodeling: exploitation of an indigenous mechanism for the prevention of osteopenia. The discovery of piezoelectric potentials in loaded bone was instrumental
in developing a plausible mechanism by which functional activity could
intrinsically influence the tissue's cellular environment and thus
affect skeletal mass and morphology. Using an in vivo model of osteopenia,
we have demonstrated that the bone resorption that normally parallels
disuse can be prevented or even reversed by the exogenous induction
of electric fields. Importantly, the manner of the response (i.e.,
formation, turnover, resorption)
Pulsed magnetic fields improve osteoblast activity during the repair of an experimental osseous defect. The influence of pulsed low-frequency electromagnetic fields (PEMFs)
on bone formation was investigated in studies of the healing process
of transcortical holes, bored at the diaphyseal region of metacarpal
bones of six adult horses, exposed for 30 days to PEMFs (28 G peak
amplitude, 1.3 ms rise time, and 75 Hz repetition rate). A pair of
Helmholtz coils, continuously powered by a pulse generator, was applied
for 30 days to the left metacarpal bone, through which two holes,
of equal diameter and depth, had been bored at the diaphyseal region.
Two equal holes, bored at the same level in the right metacarpal and
surrounded by an inactive pair of Helmholtz coils, were used as controls.
All horses were given an intravenous injection of 25-30 mg/kg of tetracycline
chloride on the 15th and again on the 25th day after the operation
and were killed 5 days later. The histomorphometric analysis indicated
that both the amount of bone formed during 30 days and the mineral
apposition rate during 10 days (deduced from the interval between
the two tetracycline labels) were significantly greater (p <0.01
and p < 0.0001, respectively) in the PEMF-treated holes than in
the controls. As did a previous investigation, these preliminary findings
indicate that PEMFs at low frequency not only stimulate bone repair
but also seem to improve the osteogenic phase of the healing process,
at least in our experimental conditions.
Use of pulsed electromagnetic fields in treatment of loosened cemented hip prostheses. A double-blind trial. A double-blind trial of pulsed electromagnetic fields (PEMFs) for loosened
cemented hip prostheses was conducted at two centers. Of the 40 patients
who enrolled, 37 met entry criteria and were available for analysis.
All patients completed six months of treatment (either active or control
units). Success was determined clinically by a Harris hip score greater
than or equal to 80 points (or an increase of ten points if initially
greater than or equal to 70 points). Ten of the 19 active units were
successes (53%), whereas two of the 18 controls (11%) exhibited a
placebo effect, a statistically significant and clinically relevant
result. A 60% relapse rate among the active successes was seen at
14 months poststimulation, and despite maintenance therapy of one
hour per day, the relapse rate increased to 90% at three years. These
data suggest that for loosened cemented hip prostheses, use of PEMFs
is a treatment option to delay revision hip surgery.
The effect of low-frequency electrical fields on osteogenesis. An in vivo animal model of disuse osteopenia was used to determine
the osteogenic potential of specific components of electrical fields.
The ability of a complex pulsed electrical field to inhibit loss of
bone was compared with the remodeling response generated by extremely
low-power, low-frequency (fifteen, seventy-five, and 150-hertz) sinusoidal
electrical fields. The left ulnae of thirty adult male turkeys were
functionally isolated by creation of distal and proximal epiphyseal
osteotomies and then were exposed, for one hour each day, to an electrical
field that had been induced exogenously by means of magnetic induction.
After a fifty-six-day protocol, the remodeling response was quantified
by a comparison of the cross-sectional area of the mid-part of the
diaphysis of the functionally isolated ulna with that of the intact
contralateral ulna. Disuse resulted in a 13 per cent mean loss of
osseous tissue, which was not significantly different than the 10
per cent loss that was caused by disuse treated with inactive coils.
Exposure to the pulsed electrical fields prevented this osteopenia
and stimulated a 10 per cent mean increase in the bone area. The osteogenic
influence of the sinusoidal electrical fields was strongly dependent
on the frequency; the 150, seventy-five, and fifteen-hertz sinusoidal
fields, respectively, generated a -3 per cent, + 5 per cent, and +
20 per cent mean change in the bone area. These results suggest a
tissue sensitivity that is specific to very low-frequency sinusoidal
electrical fields and they imply that the induced electrical fields
need not have complex waveforms to be osteogenic. Since the frequency
and intensity range of the sinusoidal fields producing the greatest
osteogenic response are similar to the levels produced intrinsically
by normal functional activity, these results support the hypothesis
that electricity plays a role in the retention of the normal remodeling
balance within mature bone.
Treatment of ununited tibial fractures: a comparison of surgery and pulsed electromagnetic fields (PEMF). The use of pulsed electromagnetic fields (PEMF) is gaining acceptance
for the treatment of ununited fractures. The results of 44 articles
published in the English language literature have been compiled to
assess the effectiveness of PEMF vs surgical therapy. For ununited
tibial fractures, 81% of reported cases healed with PEMF vs 82% with
surgery. After multiple failed surgeries, the success rate of PEMF
is reported to be greater than with surgery; this discrepancy increases
with additional numbers of prior surgeries. In infected nonunions,
the results of surgical treatment decreased by 21% and were less than
the results utilizing PEMF (69% vs 81%). In open fractures, surgical
healing exceeded PEMF (89% vs 78%), whereas in closed injuries PEMF
cases healed more frequently (85% vs 79%). In general, PEMF treatment
of ununited fractures has proved to be more successful than noninvasive
traditional management and at least as effective as surgical therapies.
Given the costs and potential dangers of surgery, PEMF should be considered
an effective alternative. Experience supports its role as a successful
method of treatment for ununited fractures of the tibia.
Long-term pulsed electromagnetic field (PEMF) results in congenital pseudarthrosis. Ninety-one patients with congenital pseudarthrosis of the tibia have
been treated with pulsed electromagnetic fields (PEMFs) since 1973
and all except 4 followed to puberty. Lesions were stratified by roentgenographic
appearance. Type I and type II had gaps less than 5 mm in width. Type
III were atrophic, spindled, and had gaps in excess of 5 mm. Overall
success in type I and II lesions was 43 of 60 (72%). Of those 28 patients
seen before operative repair had been attempted, 7 of 8 type I lesions
healed (88%), whereas 16 of 20 type II lesions healed (80%) on PEMFs
and immobilization alone. Only 19% (6 of 31) type III lesions united,
only one of which did not require surgery. Sixteen of 91 limbs (18%)
were ultimately amputed, most before treatment principles were fully
defined in 1980. Fourteen of these 16 patients (88%) had type III
lesions. Refracture occurred in 22 patients, most as the result of
significant trauma, in the absence of external brace support. Twelve
of the 19 refractures, retreated with PEMFs and casts, healed on this
regime. Episodic use of PEMFs proved effective in controlling stress
fractures in several patients until they reached puberty. PEMFs, which
are associated with no known risk, appear to be an effective, conservative
adjunct in the management of this therapeutically challenging, congenital
lesions.
Protection against focal cerebral ischemia following exposure to a pulsed electromagnetic field. There is evidence that electromagnetic stimulation may accelerate the
healing of tissue damage following ischemia.. Exposure to pulsed electromagnetic
field attenuated cortical ischemia edema on MRI at the most anterior
coronal level by 65% (P < 0.001). On histologic examination, PEMF
exposure reduced ischemic neuronal damage in this same cortical area
by 69% (P < 0.01) and by 43% (P < 0.05) in the striatum. Preliminary
data suggest that exposure to a PEMF of short duration may have implications
for the treatment of acute stroke.
The effect of pulsed electromagnetic fields (PEMFs) on bone loss associated
with disuse was investigated by applying 1.5 Hz repetitions of 30
ms bursts of asymmetric pulses, varying from +2.5 to -135 mV, to bones
deprived of their normal functional loading. The proximal portion
of one fibula in each of a group of ovariectomised adult female beagle
dogs was isolated from functional loading in vivo by proximal and
distal osteotomies. Comparison of these prepared bones with their
intact contralateral controls after 12 weeks, showed a 23% reduction
in cross-sectional area. In similarly prepared bones exposed to PEMFs
for 1 h per day, 5 days per week, this bone loss was substantially
and significantly reduced to 9% (p = 0.029). There was no evidence
of any new bone formation on the periosteal surface of prepared fibulae
in treated or untreated situations. PEMF treatment was not associated
with any significant change in number of osteons per mm2 formed within
the cortex of the bones, their radial closure rate, or their degree
of closure. The modulation in loss of bone area associated with exposure
to PEMFs can, therefore, be inferred to be due to a reduction in resorption
on the bone surface.
Treatment of chronic varicose ulcers with pulsed electromagnetic fields: a controlled pilot study. To evaluate the efficacy of pulsed electromagnetic fields (PEMF) in healing of chronic varicose ulcers, 19 patients with this condition were included in a double-blind controlled clinical trial. All patients received standard ulcer therapy throughout the duration of the study and were randomly divided into two groups to receive either active or inactive PEMF therapy. Active therapy was provided by the use of a pait of Helmholtz coils on a twice weekly basis over a five week period and inactive therapy was provided on an identical regimen with identical coils wound so that no magne |
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