Pulsed Electromagnetic Field Therapy

Pulsed Electromagnetic Field Therapy
Drolet's 1990 Rhumart System, a PEMF device.

Pulsed Electromagnetic Field Therapy (PEMFT), also called Pulsed Magnetic Therapy, is a reparative technique most commonly used in the field of orthopedics for the treatment of non-union fractures, failed fusions, and congenital pseudarthrosis. PEMF uses electrical energy to direct a series of magnetic pulses through injured tissue whereby each magnetic pulse induces a tiny electrical signal that stimulates cellular repair. Many studies have also demonstrated the effectiveness of PEMF in healing soft-tissue wounds; suppressing inflammatory responses at the cell membrane level to alleviate pain, and increasing range of motion. The value of pulsed electromagnetic field therapy has been shown to cover a wide range of conditions, with well documented trials carried out by hospitals, rheumatologists and physiotherapists. There are several electrical stimulation therapy devices, approved by the FDA, that are widely available to patients for use. These devices provide an additive solution that aid in bone growth and repair.[1][2]

Contents

History

The use of magnetic field therapy in clinical applications dates back over 500 years. In the 15th century, Swiss physician and alchemist Paracelsus used lodestones, or naturally magnetized pieces of the mineral magnetite, to treat conditions such as epilepsy, diarrhea, and hemorrhage. He believed that the ability of magnets to attract iron could be replicated by attracting disease away from the body. In the late 18th century, the Austrian physician Franz Anton Mesmer, who originated the idea of "animal magnetism", described the healing properties of passing magnets over the open veins of patients.[3] In the mid-19th century, magnetic ointments produced in New York were introduced as remedies for a whole spectrum of illnesses such as headaches, inflammation of the bowels, burns, fever sores, rheumatism, gout, and toothache.

Although electricity’s potential to aid bone healing was reported as early as 1841, it was not until the mid-1950s that scientists seriously studied the subject. Fukada’s and Yasuda’s discovery of the electric potential of bone provides evidence of electricity’s effect in promoting osteogenesis (bone growth), particularly in long bone non-unions.[4] During the 1970s, Bassett and his team introduced a new approach for the treatment of delayed fractures, a technique that employed a very specific biphasic low frequency signal [5][6][7][8] to be applied for non-union/delayed fractures. The use of electrical stimulation in the lumbosacral region was first attempted by Alan Dwyer of Australia. In 1974, he reported successful initiation of graft incorporation in 11 of 12 fusion patients. Since that time, electrical stimulation has been shown to significantly increase the probability of bony arthrodesis in spinal fusions.[9][10]

In 1979 the FDA approved non-invasive devices using pulsed electromagnetic fields designed to stimulate bone growth.[11]

In 2004, pulsed electromagnetic field system was approved by FDA as an adjunct to cervical fusion surgery in patients at high risk for non-fusion.[12]

The use of PEMF stimulation has been found to be safe.[13] It has also been proven safe and effective in treatment of delayed union in long bone fractures and patients at a risk of non-union following spinal fusion surgeries.[14]

Use

Delayed- and Non-Union Fractures

In 1974 it was demonstrated that a pulsed magnetic field applied across the site of a bone fracture can accelerate the healing process (BASSETT et al., 1974). The mechanism of osteogenesis is not clear, however the use of PEMF therapy as an adjuvant therapy for delayed- and non-union fractures was supported by empirical evidence collected through clinical studies.[15][16] While PEMF therapy may offer some benefit in the treatment of fractures, the evidence is inconclusive and is insufficient to inform current clinical practice.[17]

PEMF therapy has been suggested to enhance healing of fractures that occur in patients with diseases such as diabetes, vascular insufficiency, and osteoporosis, and those taking medications such as steroids and non-steroidal anti-inflammatory drugs (NSAIDs). The exact mechanism for fracture healing is unclear; however, it is thought that PEMF therapy causes biochemical changes at the cellular level to accelerate bone formation.

Post-Operative Pain and Edema

There are few clinical trials that have demonstrated PEMF therapy as an effective treatment for tissue trauma, particularly in the early stages of inflammation.[18][19] Electrical stimulation has been shown to significantly increase the probability of bony arthrodesis in spinal fusions. The use of low-energy, time-varying magnetic fields (commonly referred to as pulsed electromagnetic fields or PEMF) has been successful when used adjunctively to fresh fusions and in the case of treating a failed fusion, PEMF bone growth stimulation is a successful method which avoids a revision surgery.[20]

Chronic pain

Based on a 2007 clinical trial, Thomas et al. conclude,

PEMF may be a novel, safe and effective therapeutic tool for use in at least certain subsets of patients with chronic, nonmalignant pain.[21]

References

  1. ^ Markov, Marko S. "Expanding Use of Pulsed Electromagnetic Field Therapies." Electromagnetic Biology & Medicine 26.3 (2007): 257-274. Academic Search Complete. EBSCO. Web. 10 June 2010.
  2. ^ Mooney, V. "A randomized double-blind prospective study of the efficacy of pulsed electromagnetic fields for interbody lumbar fusions." Spine 15.7 (1990): 708-712. MEDLINE. EBSCO. Web. 10 June 2010.
  3. ^ CHAPLIN, Joyce E. The first scientific American; Benjamin Franklin and the pursuit of genius. Perseus, Basic Books. 421 p. illus. notes, index, c2006.0-465-00956-5.
  4. ^ Inoue, S, et al. "Electret induced callus formation in the rat." Clinical Orthopaedics And Related Research 124 (1977): 57-58. MEDLINE. EBSCO. Web. 10 June 2010
  5. ^ Bassett CA, Pawluk RJ, Pilla AA. Acceleration of Fracture Repair by Electromagnetic Fields. A Surgically Noninvasive Method. Ann N Y Acad Sci 1974;238:242-62.
  6. ^ Bassett CA, Pawluk RJ, Pilla AA. Augmentation of Bone Repair by Inductively Coupled Electromagnetic Fields. Science 1974;184:575-7.
  7. ^ Bassett CA, Pilla AA, Pawluk RJ. A non-operative salvage of surgically-resistant pseudarthroses and non-unions by pulsing electromagnetic fields. A preliminary report. Clin Orthop 1977;124:128-43.
  8. ^ Bassett CA, Mitchell SN, Norton L, Pilla A. Repair of Non-Unions by Pulsing Electromagnetic Fields. Acta Orthop Belg 1978;44:706-24.
  9. ^ Mackenzie, Donald, and Francis D Veninga. "Reversal of delayed union of anterior cervical fusion treated with pulsed electromagnetic field stimulation: case report." Southern Medical Journal 97.5 (2004): 519-524. MEDLINE. EBSCO. Web. 10 June 2010.
  10. ^ Bose, B. "Outcomes after posterolateral lumbar fusion with instrumentation in patients treated with adjunctive pulsed electromagnetic field stimulation." Advances In Therapy 18.1 (2001): 12-20. MEDLINE. EBSCO. Web. 10 June 2010.
  11. ^ Blue Cross & Blue Shield of Mississippi: "Pulsed electromagnetic field systems with FDA PMA include the EBI Bone Healing System from Electrobiology, Inc., which was first approved in 1979 and indicated for nonunions, failed fusions, and congenital pseudarthroses; and the Cervical-Stim from Orthofix, which was approved in 2004 as an adjunct to cervical fusion surgery in patients at high risk for non-fusion."
  12. ^ Blue Cross & Blue Shield of Mississippi: "Pulsed electromagnetic field systems with FDA PMA include the EBI Bone Healing System from Electrobiology, Inc., which was first approved in 1979 and indicated for nonunions, failed fusions, and congenital pseudarthroses; and the Cervical-Stim from Orthofix, which was approved in 2004 as an adjunct to cervical fusion surgery in patients at high risk for non-fusion."
  13. ^ Foley KT et al., Randomized, prospective, and controlled clinical trial of pulsed electromagnetic field stimulation for cervical fusion Spine J, vol. 8, 436 - 442, 2008
  14. ^ Simmons, James W, Jr, Vert Mooney, and Ike Thacker. "Pseudarthrosis after lumbar spine fusion: nonoperative salvage with pulsed electromagnetic fields." American Journal Of Orthopedics (Belle Mead, N.J.) 33.1 (2004): 27-30. MEDLINE. EBSCO. Web. 10 June 2010
  15. ^ Boopalan, PRJVC et a., Pulsed electromagnetic field (PEMF) treatment for fracture healing, Current Orthopaedic Practice. 20(4):423-428, August 2009. doi: 10.1097/BCO.0b013e318198e8b2
  16. ^ REC Rose, BA Bryan-Frankson: Is There Still A Role For Pulsed Electromagnetic Field in the Treatment of Delayed Unions and Nonunions. The Internet Journal of Orthopedic Surgery. 2008. Volume 10 Number 1.
  17. ^ Griffin XL, Costa ML, Parsons N, Smith N. Electromagnetic field stimulation for treating delayed union or non-union of long bone fractures in adults. Cochrane Database of Systematic Reviews 2011, Issue 4. Art. No.: CD008471. DOI: 10.1002/14651858.CD008471.pub2.
  18. ^ Dante Dallari et al., Effects of pulsed electromagnetic stimulation on patients undergoing hip revision prostheses: A randomized prospective double-blind study, Bioelectromagnetics, 30-6 [423-430], 2009 DOI: 10.1002/bem.20492
  19. ^ Masieri, Federica Francesca (2009) New Insights and Possible Therapeutic Implications of Adenosine Analogs and Pulsed Electromagnetic Fields (PEMFs) in Osteoarticular pathologies. PhD thesis, Università degli studi di Ferrara.
  20. ^ Simmons, James W, Jr, Vert Mooney, and Ike Thacker. "Pseudarthrosis after lumbar spine fusion: nonoperative salvage with pulsed electromagnetic fields." American Journal Of Orthopedics (Belle Mead, N.J.) 33.1 (2004): 27-30. MEDLINE. EBSCO. Web. 10 June 2010
  21. ^ Thomas, AW; Graham, K; Prato, FS; McKay, J; Forster, PM; Moulin, DE; Chari, S (2007). "A randomized, double-blind, placebo-controlled clinical trial using a low-frequency magnetic field in the treatment of musculoskeletal chronic pain". Pain research & management : the journal of the Canadian Pain Society = journal de la societe canadienne pour le traitement de la douleur 12 (4): 249–58. PMC 2670735. PMID 18080043. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2670735.  edit

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