Pulsed Electro-magnetic Field Therapy for Musculoskeletal Pain

Pulsed electro-magnetic field (PEMF) science has evolved over the years, and dedicated research on this topic, specifically as it applies to pain management, has been growing. Independent research on PEMF has consistently demonstrated meaningful physiological treatment effects in three areas: pain, inflammation, and perfusion.

Similar results have been replicated over many years and many studies with a precise mechanism of action being more elusive to identify.^2-5

Possible Pathways

Basic science studies have identified several biochemical pathways activated by PEMF, some of which are critical in pain and inflammation and could be associated with meaningful epigenetic influences. Pathways activated by PEMF include those activated by calcium ions (Ca2+) and subsequently by nitric oxide (NO) and CGMP at the cellular level.⁶

Bone Stimulation for Osteoarthritis

The use of pulsed EMF is most prevalent in knee osteoarthritis (OA), with research supporting several key therapeutic benefits on knee joint tissue including increasing PEMF signaling that modulates calmodulin-dependent nitric oxide (NO) signaling cascades in particular chondrocytes.^8,9

PEMF is well known to stimulate bone growth and is used in many of today’s bone stimulation devices. PEMF has been shown to accelerate the removal of inflammatory substances as well as the proliferation of chondrocytes. The chondroprotective effects of PEMF treatments in knee OA have been shown consistently in studies over the years.¹⁰

Another intriguing physiological effect of PEMF treatment is the increase in perfusion associated with acute PEMF exposure. It is understood that PEMF induces vascularization, which leads to better perfusion and increased oxygenation of tissue which is especially important in the diabetic foot with non-healing ulcerations^11,12

However, diabetes-related ulcerations are not the only lesions that improve and resolve with improved perfusion/oxygenation. There is an entire category of ischemic type lesions that could potentially benefit from these effects including neuropathic problems. The key to improved tissue perfusion seems to be the effects PEMF has on circulating levels of NO, which is a known vasodilator substance and, when increased can lead to improved tissue oxygenation and a lowering of blood pressure.¹³

The use of PEMF is ubiquitous across the globe and this form of energy has been recognized for many years.

For practitioners treating musculoskeletal (MSK) pain, the use of energy in its various forms – sound, light, electricity, mechanical, and electro-magnetic – can be used for strains, sprains, bursitis, epicondylitis, etc, seen in various etiologies. For instance, PEMF may be used to aid in the treatment of traumatic injury, repetitive strain disorders, and age-related changes, such as postural strain, fatigue, deformity, and disc degeneration.

We also recognize that there are both specific and general effects associated with energy-based modalities, and it is the more specific and arguably important effects, that differentiate between devices in the same categories or class.

PEMF science has matured to the point where the “bench to bedside” continuum is relatively complete and basic science aligns well with practitioner observations.

It is within this context of translational research that the authors conducted a study of a 4-month course of PEMF on key quality-of-life (QoL) indicators in a patient population with chronic MSK pain.¹⁴

Pre-intervention scores in these five biopsychosocial domains were recorded by patient care coordinators followed by six data collection time points over a 4-month period. A repeated measures multivariate analysis of variance (MANOVA) was used to test the significance of group differences. The analysis demonstrated significant differences between pre- and post- EMF exposures at each time point and across all five dependent variables.

A Spearman’s correlation analysis was performed to identify the strength of the correlation between all variable pairs and found a positive correlation (moderate to high) between all paired variables with pain being the most influential variable.

The authors believe the significance of this investigation is two-fold. First, it supports the use of PEMF for a broad array of chronic MSK pain conditions. Second, the results link the pain reduction experience to a broader group of QoL attributes within a larger biopsychosocial framework.

The notion that reducing pain levels could impact other important life domains should not be a surprise to clinicians or patients, yet there is a dearth of research evidence to support this connection within the wide range of chronic MSK conditions.

Pain is a complex, multifaceted experience that is unique to the individual. Recent investigations using a safe and non-invasive intervention (pulsed electro-magnetic fields) also lend support the bidirectionality of key biopsychosocial factors that co-vary with pain.

Reducing pain can lead to improved mood, reduced stress, increased physical activity, and better sleep. The use of PEMF has consistently demonstrated clinically significant pain reduction in myriad MSK pain conditions, and this recent presented study re-affirms the value of PEMF in a large recalcitrant group of veteran patients with chronic musculoskeletal pain.

*Disclosures: Tiziano A Marovino DPT, MPH, DAAIPM is a medical device industry consultant and is currently a key opinion leader (KOL) for Regenesis Biomedical Inc., which provided the medical grade PEMF technology used in the study. Dr. Marovino wrote the data analyses and manuscript of this unpublished study.

Erica E. Tassone, PhD, is the executive director of life sciences at Regenesis Biomedical Inc. She is responsible for study design, data collection and assistance in manuscript write-up.