Pain Relief Blog

The Role of Pulsed Electromagnetic Field (PEMF) Therapy in the Management of Non-specific Low Back Pain (NLBP)

Author: Dr. Faisal Hayat, MBBS

Introduction

Low back pain (LBP) is a sensation of pain typically located between the lower rib margins and the buttock creases. It possesses a significant burden worldwide. Usually, the pain is musculoskeletal in origin. It is a widespread symptom in people of all ages without any discrimination of gender.

In 2015, low back pain worldwide prevalence was about 7.3%. [1]
It affects around 23% of the population worldwide, with 24-80% recurrence within one year.[2]

Low back pain is called non-specific if the specific nociceptive pathology remains unidentified. Non-specific low back pain (NLBP) is the most common type of low back pain representing about 90–95% of LBP cases.

The point prevalence of non-specific LBP is estimated at 18%.[3]

Background of interventions for non-specific LBP management

A range of different classes of interventions has been developed and tested clinically in patients with non-specific LBP (NLBP).

But recent clinical trials have emphasized that initially, it is compulsory to distinguish the patients with severe or non-spinal disorders from those with the pain of musculoskeletal origin, especially with red flags. The red flags in this disorder are weight loss, history of tumor, night pain, age >50 years, trauma, fever, saddle anesthesia, difficulty with micturition, iv drug misuse, progressive neurological disturbances, and use of systemic steroids.
Once these red flags or severe disorders have been ruled out, the next step is to identify patients with radicular pain. Almost all the guidelines for the management of low back pain discourages imaging as the first-line modality.
The current clinical practice guidelines recommend non-pharmacologic treatment options as first-line therapies.[4] The non-pharmacologic treatment options include manual therapies like massage, mobilization, manipulations, and heat. Acupuncture, spinal manipulation, yoga, and different exercises are included.
PEMF, TENS, and CBT are also included in the non-pharmacological treatment options.
Pharmacologic therapies are also commonly used and have some side effects like sedation in case of opioid intake. Pharmacological interventions include antidepressants, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and paracetamol.

Clinical trials conducted in different settings

In a randomized, parallel-group study, the effect of a PEMF device was assessed in patients with pain and disability with non-specific low back pain (NLBP). The PEMF device used in this study was “MDcure, Aerotel Ltd., Holon, Israel, and Aerotel Inc. USA, New York, NY, USA.” It is an FDA Class 1 listed therapeutic device that delivers a highly low-intensity electromagnetic field (nT; 10-9) at a set of low (range 1–100 Hz) frequencies. The participants have shown more significant improvement in low back pain LBP at six weeks follow-up. Adverse effects were infrequent and non-serious.[5]
In another Randomized Controlled Trial (RCT) study, the effects of pulsed electromagnetic field (PEMF) therapy with the frequency were compared to conventional non-invasive treatment modalities in patients with chronic non-specific low back pain. It concluded that combination PEMF with the conventional physical therapy protocol relieved pain.[6]

Pulsed Electromagnetic Field (PEMF) Therapy

Pulsed electromagnetic field (PEMF) therapy is a low-frequency electromagnetic current with an extended range of frequencies. The mechanism of PEMF therapy in reducing pain and inflammation is still unclear, and there are many theories present.

It increases the permeability of the cell membrane and stimulates many intracellular functions.[7]
One theory is that it may produce Eddy currents in the body tissues.
Another one is a gate control theory induced by applying electrical stimulation. It may inhibit pain signals to some extent by apparent alteration of the nervous system or maybe by inhibitory sensory neurons’ motivation.[8]
Recent theory suggests that PEMF therapy may alter the gene aspect that comprises genes of pain courses like endogenous opioids and eicosanoid enzyme courses.[9]
Furthermore, PEMF has increased proliferation and enhanced osteogenic differentiation of mesenchymal stem cells (MSCs) isolated from the human bone in several in vitro studies. [10,11]
Several in vitro trials document evident biochemical pathways stimulated by electromagnetic impulses, including stimulating osteoblast growth activity, neo-vasculogenesis, the release of growth factors, and improved blood supply.
The proangiogenic effect of PEMF might be the main reason for pain and disability reduction. In this context, clinical trials showed increased tissue blood flow in the lumbopelvic region and improved lumbopelvic stability after core training among patients with chronic non-specific low back pain.[12]

Conclusion

The FDA approves PEMF devices to fuse broken bones, reduce tissue and joint pain, and support muscle function. Nowadays, PEMF therapy has several advantages in treating different clinical manifestations as relief of pain, accelerated wound healing, edema resolution, inflammation therapy, and osteoarthritis.

In a study, PEMF therapy was established to decrease pain, increase back mobility (flexion & extension), reduce low back pain (LBP), and disability in middle-aged university employees with non-specific LBP. Also, there were no critical adverse or side effects reported after applying PEMF therapy.[13]
These are selected low-frequency electromagnetic fields without ionizing or thermal effects.[14]
The pulsed electromagnetic field (PEMF) therapy plays a vital role in pain relief since it is drug-free, nonthermal, safe, and low risk to enhance cellular activity healing and repair. Therefore, it could be an option to the non-steroidal anti-inflammatory drugs (NSAIDs) medication, avoiding several potential side-effects from chronic NSAIDs usage in non-specific low back pain.[15]

References

Global Burden of Disease, Injury Incidence, Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1545–602
El-Sayed AM, Hadley C, Tessema F, Tegegn A, Cowan JA Jr, Galea S. Back and neck pain and psychopathology in rural Sub-Saharan Africa: evidence from the Gilgel Gibe Growth and Development Study, Ethiopia
Ekman, M., Johnell, O., and Lidgren, L. (2005). The economic cost of low back pain in Sweden in 2001. Acta Orthop. 76, 275–284.
Qaseem A, Wilt TJ, McLean RM, Forciea MA, Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514–30.
Lisi, A. J., Scheinowitz, M., Saporito, R., &Onorato, A. (2019). A Pulsed Electromagnetic Field Therapy Device for Non-Specific Low Back Pain: A Pilot Randomized Controlled Trial. Pain and Therapy, 8(1), 133–140.
Atya AM, Ahmed GM. Pulsed magnetic field versus ultrasonic in treatment of patients with chronic mechanical low back pain. Bullet Facul Phys Ther. 2008;13:2.
Takamoto K, Bito I, Urakawa S, Sakai S, Kigawa M, Ono T, et al. Effects of compression at myofascial trigger points in patients with acute low back pain: A randomized controlled trial. Eur J Pain. 2015;19(8):1186–96.
Moayedi M, Davis KD. Theories of pain: from specificity to gate control. J Neurophysiol. 2013;109(1):5–12.
Moffett J, Fray LM, Kubat NJ. Activation of endogenous opioid gene expression in human keratinocytes and fibroblasts by pulsed radiofrequency energy fields. J Pain Res. 2012;5:347–357.
Kaivosoja E, Sariola V, Chen Y, Konttinen YT. The effect of pulsed electromagnetic fields and dehydroepiandrosterone on viability and osteoinduction of human mesenchymal stem cells. Journal of tissue engineering and regenerative medicine. 2015;9:31-40.
Jansen JH, van der Jagt OP, Punt BJ, et al. Stimulation of osteogenic differentiation in human osteoprogenitor cells by pulsed electromagnetic fields: an in vitro study. BMC musculoskeletal disorders. 2010;11:188.
Paungmali A, Henry LJ, Sitilertpisan P, Pirunsan U, Uthaikhup S. Improvements in tissue blood flow and lumbopelvic stability after lumbopelvic core stabilization training in patients with chronic non-specific low back pain. Journal of physical therapy science. 2016;28:635-640.
Fini M1, Giavaresi G, Carpi A, Nicolini A, Setti S, Giardino R. Effects of pulsed electromagnetic fields on articular hyaline cartilage: a review of experimental and clinical studies. Biomed Pharmacother. 2005;59:388–394.
Moayedi M, Davis KD. Theories of pain: from specificity to gate control. J Neurophysiol.2013;109(1):5–12.
Krammer A, Horton S, Tumilty S. Pulsed electromagnetic energy as an adjunct to physiotherapy for the treatment of acute low back pain: a randomized controlled trial. N Z J Physiother. 2015;43:16—22.

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