Miniaturization prompts reconsideration of PEMF therapy

[Guest guest]

Biomechanics Magazine September 2006

Miniaturization prompts reconsideration of PEMF therapy

http://biomech.com/showArticle.jhtml?articleID=193000647

By: Z. Metzger, DPM, MBA

Although more clinical trials of its efficacy are needed, the

potential uses for this therapy remain high.

For decades physicians, nurses, physical therapists, and trainers

have recognized the usefulness of pulsed electromagnetic field

therapy to reduce inflammation of soft tissue.

The generated electromagnetic field pulses, on for 100 microsecondsec

and off for 900 microsecondsec, avoid the heat buildup that

accompanies diathermy. However, the size and cost of a unit and the

requirement that it be used in an office setting have made it

difficult and expensive as a standard of care.

The development of a dermal patch capable of delivering PEMF therapy

means practitioners can now provide their patients with a portable

device the size of a 2 x 2-inch or 4 x 4-inch gauze pad. This patch

contains a battery, a microchip, and an antenna, which will deliver

therapeutic pulsed electromagnetic therapy to the area of the body

under it.

When soft tissue is injured, the body's well-documented reaction is

the inflammatory response, which consists of a rapid-onset tissue-

destruction phase followed by a longer tissue repair phase. The

initial destruction phase is evidenced by redness, heat, swelling,

and pain in the involved area of tissue injury. To enhance the

healing of traumatic but noninfected injuries, the therapeutic goal

of PEMF is to induce the tissue to pass through this inflammatory

process phase rapidly and move quickly into the tissue repair mode.

Extensive research on the mechanism of action of PEMF has

demonstrated that the modality achieves its effects through specific

actions at the inter- and intracellular levels.1 While it was

suggested decades ago that magnetic fields might influence membrane

permeability, that magnetic fields can influence ATP (adenosine

triphosphate) production has since been established.1,2 PEMF also

increases the supply of oxygen and nutrients via the vascular system

to the injured tissues and improves the removal of waste via the

lymphatic system, while helping to rebalance the distribution of ions

across cell membranes.1,2

The electropotential of healthy cells causes a steady flow of ions

across the cell membrane. In an unhealthy or damaged cell, sodium

inflow is increased, attracting interstitial fluid to the area, which

results in swelling and edema.1 Studies have shown that the

application of PEMF to damaged cells accelerates the reestablishment

of normal potentials, increasing the rate of healing, reducing

swelling, and helping to reduce bruising.2

Because the size of the traditional equipment and requirements of the

treatment make PEMF therapy inconvenient for treating soft tissue

injuries, the majority of practitioners have been aware of the

modality only as an aid to healing fractures; i.e., the widely

utilized bone growth stimulator. Those units are small and convenient

enough that they can be used in the home setting.

Relative effectiveness

Initially, a major clinical concern was whether the dermal patch was

as effective as the larger units in treating soft tissue injuries.

Research conducted at the Albert Einstein College of Medicine3 has

investigated whether:

ActiPatch provides an adequate dose of electromagnetic energy to

treat soft tissue, power at the skin level is equivalent to

traditional higher power devices the cumulative effect of continuous

delivery provides greater therapeutic benefit than the intermittent

doses available with stationary devices; and the ActiPatch therapy

power level is six to nine orders of magnitude higher than that

required to demonstrate a biological effect.

Practitioners now have the option of treating an ever-widening

assortment of soft tissue injuries, both acute and chronic, with the

dermal unit ActiPatch. It is expected that future clinical trials

will substantiate that belief.

Indications

Several categories of injury not previously considered for PEMF

treatment may now be indicated.

Postoperative therapy. Although previous studies have been limited to

the large units, anecdotal reports have noted that by incorporating

the device into dressings applied in the OR, the amount of bruising

and swelling can be reduced.

Ankle sprains. Applying ActiPatch to acute ankle sprains within 48

hours reduces the healing time and decreases the associated swelling

and bruising.4 Because of its size, ActiPatch can be incorporated

into many treatment protocols, such as within an Unna boot, under a

fracture boot like the AirCast, or even under a cast. A study

published in Military Medicine4 concluded that the use of PEMF

therapy with grade I and II ankle sprains resulted in decreased edema

and a faster return to activity. Because of this measurable reduction

in the time needed to return to normal activity, I believe that

ActiPatch will likely encourage better compliance from athlete

patients, who are always impatient to get back to their sport of

choice.

Plantar fasciitis. Plantar fasciitis is one of the most frequently

encountered clinical conditions faced by practitioners. Acute

treatment has long consisted of anti-inflammatory medication

(delivered orally or by injection), ice, stretching, and rest. While

the anti-inflammatories, steroids or NSAIDS, have been the mainstay

of these protocols, recent research noting untoward side effects has

caused many practitioners to rethink their use.

Wounds. Although there are many factors to consider in the possible

use of PEMF therapy to treat diabetic ulcers (presence of infection,

diminished circulation, necrotic tissue, etc.), there is evidence

that, in at least some cases, the use of PEMF therapy will be a

positive adjunct to a treatment protocol.5 Here again it is necessary

to rely on studies using the traditional equipment and to extrapolate

from studies on pressure and venous stasis ulcers. At least one such

study concluded that PEMF can reduce the healing time of stage II

pressure ulcers. Faster healing times can provide significant cost

savings and improved patient care.6,7 Data suggest that the effect of

the electromagnetic field lasts even when the actual stimulation is

completed.8

In a preliminary study, researchers at Temple University demonstrated

that using the ActiPatch to deliver PEMF therapy is an effective

adjunct in improving the healing of recalcitrant chronic foot

wounds.5 In this pilot study, the modality facilitated the wound

healing process in both diabetic and pressure ulcers. Additional

double-blinded studies will be conducted to further test this theory.

Pain management. PEMF devices have been used extensively to treat

many medical conditions, including rheumatic disorders.9 PEMF has

also produced significant reduction of pain, improvement of spinal

function, and reduction of paravertebral spasms. There are reports

that treating diabetic neuropathy with about 12 minutes of PEMF every

day improves pain, paresthesias, and vibration sensation and

increases muscular strength in as many as 85% of patients, compared

to controls.10,11

It is possible that the use of a dermal patch for delivery of pulsed

electromagnetic field therapy to treat a wide range of disorders will

become a standard of care in the future. However, to be fully

accepted, more double-blinded studies must be performed. The areas of

musculoskeletal injuries and diseases and wound healing should be

addressed as soon as possible.

Z. Metzger, DPM, MBA, is the founder of Innovative Healthcare

Resources and is currently based in Houston.

References

1. Laycock DC. Pulsed electromagnetic field therapy, PEMT. How does

it work? Lecture abstract, www.curatronic.com/scientific.html,

accessed 8/16/06.

2. Laycock DC. Pulsed magnetic field therapy and the physiotherapist.

www.curatronic.com/scientific.html, accessed 8/16/06.

3. Glassman LS, McGrath MH, Bassett CA. Effect of external pulsing

electromagnetic fields on the healing of soft tissue. Ann Plast Surg

1986;16(4):287-295.

4. Pennington GM, Danley DL, Sumko MH, et al. Pulsed non-thermal,

high frequency electromagnetic energy (diapulse) in the treatment of

grade I and grade II ankle sprains. Mil Med 1993;58(2):101-104.

5. Vlahovic TC. Low pulsed electromagnetic therapy (ActiPatch) as a

useful and effective adjunct for the healing of recalcitrant wounds.

White paper for BioElectronics, developer/marketer of ActiPatch; 2004.

6. Tung S, Khaski A, Milano E, Kay C. The application of Diapulse in

the treatment of decubitus ulcers: case reports. Contemporary Surgery

1995;47(1):27-32.

7. Salzberg CA, -Vastola SA, F, et al. The effects of non-

thermal pulsed electromagnetic energy on wound healing of pressure

ulcers in spinal cord-injured patients: a randomized, double-blind

study. Ostomy Wound Manage 1995;41(3):42-44, 46, 48.

8. Mercola JM, Kirsch DL. The basis for microcurrent electrical

therapy in conventional medical practice. J Adv Med 1995;8(2):107-120.

9. Shupak NM, McKay JC, Nielson WR, et al. Exposure to a specific

pulsed low-frequency magnetic field: a double-blind placebo-

controlled study of effects on pain ratings in rheumatoid arthritis

and fibromyalgia patients. Pain Res Manag 2006;11(2):85-90.

10. Musaev AV, Guseinova SG, Imamverdieva SS. The use of pulsed

electromagnetic fields in treatment of patients with diabetic

polyneuropathy. Neurosci Behav Physiol 2003;33(8):745-752.

11. Lefaucheur JP, Drouot X, Nguyen JP. Interventional

neurophysiology for pain control: duration of pain relief following

repetitive transcranial magnetic stimulation of the motor cortex.

Neurophysiol Clin 2001;31(4):247-252.

[Guest guest]

Gretchen,

This is fascinating. I think this might one day help my son recover from his

frequent twisted ankles.

I am very thankful to have found this board and you, Gretchen, with your

thoughtful postings.

Barbara