Pulsed electromagnetic field therapy

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Drolet's 1990 Rhumart system, a PEMF device.

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.[1] In the case of bone healing, PEMF uses directed pulsed magnetic fields through injured tissue to stimulate cellular repair. The FDA has cleared several such stimulation devices.[2][3]

History[edit]

Electromagnetic field therapy has been in use since the invention of electricity. It was widely adopted in East and Western Europe but its use was restricted to animals in North America until recently.[4] Veterinarians became the first health professionals to use PEMF therapy, usually to heal broken legs in racehorses. Professional sports doctors then decided to experiment with veterinarian devices off label on professional athletes which ultimately led to legal FDA licensed devices in 1979 to stimulate bone growth.[5]

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.[5] On 10/13/2015 the FDA reclassified PEMF devices from their existing Class 3 category to a Class 2 status. PEMF devices that have been FDA cleared to make health claims require a doctors prescription for use.

Use of PEMF in Wellness Devices

The original PEMF devices consisted of a Helmholtz coil and your body is placed inside the magnetic field to get a treatment. Today, the majority of PEMF wellness devices resemble a typical yoga mat in dimensions but are slightly thicker to house several flat spiral Tesla coils to produce an even electromagnetic field. A frequency generator is then used to energize the coils to create a "pulsed" electromagnetic field. Today, there is a wide variety of professional and consumer PEMF devices that are sold and marketed on the internet as FDA registered wellness devices. The majority are manufactured in Germany, Austria and Switzerland and are imported into North America as electric massagers or full body electric yoga mats. They are either placed on a massage table for clinical use or directly on the floor in the home to practice simple yoga postures. The companies that sell and manufacture them make no medical claims as to their effectiveness in treating disease mainly to bypass FDA clearance medical device regulations and approvals.[6]

Use[edit]

Delayed- and non-union fractures[edit]

An old fracture with nonunion of the fracture fragments.

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.[7][8] While PEMF therapy may offer some benefit in the treatment of fractures, the evidence is inconclusive and is insufficient to inform current clinical practice.[9]

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.[10] 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 [11][12][13][14] 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.[15][16]

Depression[edit]

Transcranial magnetic stimulation is FDA approved since 2011 for use on patients that failed to respond to antidepressants.[17] Weak magnetic stimulation of the brain is often called transcranial pulsed electromagnetic field (tPEMF) therapy.[18] Early hints of efficacy of tPEMF as antidepressant came from observations that bipolar patients improved their mood after a magnetic resonance spectrogram, an approach which has been labeled LFMS.[19] Studies in rodents have shown behavioural effects of tPEMF that are consistent with antidepressant effects.[20][21][22] In humans, the treatment is usually given once or twice daily for two or more weeks.[18]

References[edit]

  1. ^ Bassett CA, Schink-Ascani M, Lewis SM (September 1989). "Effects of Pulsed Electromagnetic Fields on Steinberg Ratings of Femoral Head Osteonecrosis". Columbia Presbyterian Medical Center. 
  2. ^ Markov, Marko S (2007). "Expanding Use of Pulsed Electromagnetic Field Therapies". Electromagnetic Biology & Medicine 26 (3): 257–274. doi:10.1080/15368370701580806. PMID 17886012. 
  3. ^ Mooney, V (1990). "A randomized double-blind prospective study of the efficacy of pulsed electromagnetic fields for interbody lumbar fusions". Spine 15 (7): 708–712. doi:10.1097/00007632-199007000-00016. PMID 2218718. 
  4. ^ Ross Roeser; Michael Valente (2007). AUDIOLOGY, 3-Volume Set: Diagnosis, Treatment and Practice Management. 342: Thieme. p. 2000. ISBN 1604066970. 
  5. ^ a b "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. 
  6. ^ "FDA Executive Summary - Orthopaedic and Rehabilitation Devices Panel" (PDF). Fda.gov. Retrieved 13 May 2014. 
  7. ^ Boopalan, PRJVC; et al. (August 2009). "Pulsed electromagnetic field (PEMF) treatment for fracture healing". Current Orthopaedic Practice 20 (4): 423–428. doi:10.1097/BCO.0b013e318198e8b2. 
  8. ^ REC Rose, BA Bryan-Frankson (2008). "Is there still a role for pulsed electromagnetic field in the treatment of delayed unions and nonunions". The Internet Journal of Orthopedic Surgery 10 (1). 
  9. ^ Griffin, XL; Costa, ML; Parsons, N; Smith, N (13 April 2011). "Electromagnetic field stimulation for treating delayed union or non-union of long bone fractures in adults.". The Cochrane database of systematic reviews (4): CD008471. doi:10.1002/14651858.CD008471.pub2. PMID 21491410. 
  10. ^ Inoue, S.; et al. (1977). "Electret induced callus formation in the rat". Clinical Orthopaedics and Related Research 124 (124): 57–58. doi:10.1097/00003086-197705000-00008. PMID 598094. 
  11. ^ Bassett CA, Pawluk RJ, Pilla AA; Pawluk; Pilla (1974). "Acceleration of fracture repair by electromagnetic fields. A surgically noninvasive method". Ann N Y Acad Sci 238: 242–62. Bibcode:1974NYASA.238..242B. doi:10.1111/j.1749-6632.1974.tb26794.x. PMID 4548330. 
  12. ^ Bassett CA, Pawluk RJ, Pilla AA; Pawluk; Pilla (1974). "Augmentation of Bone Repair by Inductively Coupled Electromagnetic Fields". Science 184 (4136): 575–7. Bibcode:1974Sci...184..575B. doi:10.1126/science.184.4136.575. PMID 4821958. 
  13. ^ Bassett CA, Pilla AA, Pawluk RJ; Pilla; Pawluk (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. doi:10.1097/00003086-197705000-00017. PMID 598067. 
  14. ^ Bassett CA, Mitchell SN, Norton L, Pilla A; Mitchell; Norton; Pilla (1978). "Repair of non-unions by pulsing electromagnetic fields". Acta Orthop Belg 44 (5): 706–24. PMID 380258.  [unreliable medical source?]
  15. ^ Mackenzie, Donald, Francis D Veninga; 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?]
  16. ^ 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?]
  17. ^ NeuroStar TMS Therapy system
  18. ^ a b Martiny K, Lunde M, Bech P.; Lunde; Bech (2010). "Transcranial low voltage pulsed electromagnetic fields in patients with treatment-resistant depression". Society of Biological Psychiatry 68 (2): 163–9. doi:10.1016/j.biopsych.2010.02.017. PMID 20385376. 
  19. ^ Rohan M, Parow A, Stoll AL, Demopulos C, Friedman S, Dager S, Hennen J, Cohen BM, Renshaw PF (2004). "Low-field magnetic stimulation in bipolar depression using an MRI-based stimulator". Am J Psychiatry 161 (1): 93–8. doi:10.1176/appi.ajp.161.1.93. PMID 14702256. 
  20. ^ Aksoz E, Aksoz T, Bilge SS, Ilkaya F, Celik S, Diren HB (2008). "Antidepressant-like effects of echo-planar magnetic resonance imaging in mice determined using the forced swimming test". Brain Res. 1236: 194–9. doi:10.1016/j.brainres.2008.08.011. PMID 18755160. 
  21. ^ Rokni-Yazdi H, Sotoudeh H, Akhondzadeh S, Sotoudeh E, Asadi H, Shakiba M (2007). "Prog Neuropsychopharmacol". Biol Psychiatry 31 (2): 503–9. doi:10.1016/j.pnpbp.2006.11.021. PMID 17218047. 
  22. ^ Carlezon WA Jr; Rohan ML; Mague SD; Meloni EG; Parsegian A; Cayetano K; Tomasiewicz HC; Rouse ED; Cohen BM; Renshaw PF. (2005). "Antidepressant-like effects of cranial stimulation within a low-energy magnetic field in rats.". Biol Psychiatry 57 (6): 571–6. doi:10.1016/j.biopsych.2004.12.011. PMID 15780843. 

Further reading[edit]