Pulsed electromagnetic field therapy
||This article may present fringe theories, without giving appropriate weight to the mainstream view, and explaining the responses to the fringe theories. (December 2013)|
Pulsed electromagnetic field therapy (PEMFT), also called pulsed magnetic therapy, pulse magnetotherapy, or PEMF, is a reparative technique most commonly used in the field of orthopedics for the treatment of non-union fractures, failed fusions, congenital pseudarthrosis and depression. In the case of bone healing, PEMF uses directed pulsed magnetic fields through injured tissue. This is believed to stimulate cellular repair. The FDA has approved several such stimulation devices. These devices provide a complimentary solution that may aid in bone repair.
Although electromagnetic therapy became widely adopted in Western Europe, its use was restricted to animals in North America. Veterinarians became the first health professionals to use PEMF therapy, usually to heal broken legs in race horses. Professional sports doctors then decided to experiment with veterinarian devices off label on professional athletes which ultimately led to legally licensed devices for human use in the United States - but under strict stipulations that it was only to be used for non-union bone fractures under a medical prescription from a licensed doctor.
In 1979 the FDA approved non-invasive devices using pulsed electromagnetic fields designed to stimulate bone growth.
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.
The use of PEMF stimulation has been found to be safe. 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.
Today, there is a wide variety of professional and consumer PEMF devices that are sold on the internet as wellness devices. The companies that sell and manufacture them make no claims as to their effectiveness mainly to bypass medical device regulations and approvals. They often consist of full body mats and pillows that contain coils of wire that are energized by controller units that will "pulse" magnetic fields through the body - in much the same way the early tesla coils did over 100 years ago.
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. While PEMF therapy may offer some benefit in the treatment of fractures, the evidence is inconclusive and is insufficient to inform current clinical practice.
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 provided evidence of electricity’s effect in promoting osteogenesis (bone growth), particularly in long bone non-unions. 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  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.
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. 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.
In 2002, Health Canada certified the use of PEMF to treat severe depression. In 2011, the FDA approved a TMS Therapy system  for use if the patient failed to respond to antidepressants. This treatment, known as transcranial pulsed electromagnetic therapy uses a strong electromagnetic field that is pulsed into the patients head. The treatment usually consists of two 15-minute treatments each day for two weeks.
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- "Electrical stimulation of the spine as an adjunct to spinal fusion procedures". 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."
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- Bassett CA, Pilla AA, Pawluk RJ (1977). "A non-operative salvage of surgically-resistant pseudarthroses and non-unions by pulsing electromagnetic fields. A preliminary report". Clin Orthop 124 (124): 128–43. PMID 598067.
- Bassett CA, Mitchell SN, Norton L, Pilla A (1978). "Repair of non-unions by pulsing electromagnetic fields". Acta Orthop Belg 44 (5): 706–24. PMID 380258.[unreliable medical source?]
- Mackenzie, Donald, Francis D Veninga (2004). "Reversal of delayed union of anterior cervical fusion treated with pulsed electromagnetic field stimulation: case report". Southern Medical Journal 97 (5): 519–524. doi:10.1097/00007611-200405000-00021. PMID 15180031.[unreliable medical source?]
- Bose, B (2001). "Outcomes after posterolateral lumbar fusion with instrumentation in patients treated with adjunctive pulsed electromagnetic field stimulation". Advances in Therapy 18 (1): 12–20. doi:10.1007/BF02850247. PMID 11512529.[unreliable medical source?]
- Dante Dallari et al. (2009). "Effects of pulsed electromagnetic stimulation on patients undergoing hip revision prostheses: A randomized prospective double-blind study,". Bioelectromagnetics 30 (6): 423–430. doi:10.1002/bem.20492. PMID 19384914.
- 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.
- Simmons, James W, Jr, Vert Mooney, and Ike Thacker. (2004). "Pseudarthrosis after lumbar spine fusion: nonoperative salvage with pulsed electromagnetic fields". American Journal of Orthopedics 33 (1): 27–30. PMID 14763594.
- NeuroStar TMS Therapy system