Pain Relief Blog

Therapeutic Role of PEMF Therapy in Chronic Low Back Pain

Author: Dr. Faisal Hayat, MBBS

What is Chronic Low Back Pain (CLBP)?

When the sensation of pain or discomfort occurs in the lower back region between the posterior lower rib margin and the horizontal gluteal fold, extending to a period of more than twelve weeks, it is called Chronic Low Back Pain (CLBP). If you suffer from chronic low back pain, you are not alone. It is the most common type of chronic pain in adults.

According to a study that was published in the year 2020 to assess the global prevalence and years lived with disability (YLDs) of low back pain (LBP) by age, sex, and region, from 1990 to 2017, concluded that the number of LBP sufferers and YLDs increased substantially from 1990 to 2017. The prevalence was higher in females than males.[1]

Chronic low back pain is the most prevalent musculoskeletal problem worldwide. It has been reported to be the most common source of disability. In addition, it is mainly associated with socioeconomic burden and psychological distress. Even if the low back pain persists for more than three months, it does not mean a severe underlying pathology. Sometimes, it becomes challenging for a clinician to treat chronic low back pain (CLBP).

What are the causes of chronic low back pain?

The low back pain can begin suddenly due to a severe injury to the spine, strenuous workout after a long time, lifting something heavy, or any other cause. The duration of symptoms makes the difference between acute and chronic types of low back pain. Any known or unknown cause can extend the period of pain and become chronic.

A clinical study concludes that approximately 33% of acute LBP patients fail to recover and develop chronic low back pain.[2]

Some common causes of chronic low back pain are the following:

Postural back pain: If no specific pathology or anatomic lesion is found.
Degenerative conditions: Lumbar spinal stenosis (narrowed lumbar spinal canal) is present in almost 6-7% of adults. It is frequently asymptomatic. Mainly it is acquired (70%) but maybe congenital or a mixture of both. Acquired factors include spondylosis, spondylolisthesis, scoliosis, trauma, Paget’s disease, spine surgery, and endocrine disorders.
Lumbar disk disease: It mostly affects L4-L5 or L5-S1 levels, but the upper lumbar region can also be involved. The pain may refer to the hip, buttock, or legs.
Spondylosis: Primarily involves the cervical and lumbosacral spine. The back pain increases with movement, are associated with stiffness, and gets better with inactivity.
Spondylolisthesis: It is the anterior slippage of the vertebral body, pedicles, and superior articular facets. It may present with low back pain and hamstring tightness.
Neoplasms: It may be constant, dull, unrelieved by rest, and worse at night. In almost 90% of cases, it is because of vertebral body metastasis. MRI, CT, and CT myelography are the studies of choice.
Autoimmune inflammatory arthritis: For example, rheumatoid arthritis, reactive arthritis, and ankylosing spondylitis.
Infections: Vertebral osteomyelitis, mostly due to staphylococci or tuberculosis.
Trauma: Vertebral fracture is diagnosed with significant history.
Metabolic causes: Osteoporosis and osteosclerosis.
Psychiatric diseases: Mostly in patients who want financial compensation.
Idiopathic: Cause is unknown.

Management options for chronic low back pain?

To manage chronic low back pain (CLBP), some conservative and surgical interventions have been used; however, optimal therapy is still debatable. Physical therapy interventions like soft tissue mobilization, neurodynamic techniques, and massage therapy were used.

Sometimes, laser and shock wave therapy, exercises, and acupuncture were tried. Some of these are effective in the short term, none of these have long-term effects on the management of CLBP.

Pharmacological interventions like NSAIDs and trammel have mild to moderate effects in reducing chronic pain.[3] Similarly, opioids, benzodiazepines, and duloxetine also relieve CLBP.[4] Since CLBP persists for a more extended period, pharmacological interventions are not suitable due to toxicity side effects, in addition to problems with tolerance and addiction.[5]

Surgical procedures have been used in some cases of CLBP with mixed outcomes.[6] Since the conservative approaches do not have an effective role in the long term, new techniques must be developed. These should be cost-effective, safe, and non-invasive.

Role of PEMF therapy in Chronic Low Back Pain

The pulsed electromagnetic field (PEMF) therapy may be an attractive option for managing chronic low back pain (CLBP). Many clinical research works have proved its efficacy and safety.

In a randomized, double-blind, placebo-controlled trial, Weintraub et al. concluded that magnetic field has a pronounced anti-nociceptive effect.[7]
In another clinical study, Selvam et al. concluded that PEFM had restored the calcium ATPase activity of the plasma membrane and anti-inflammatory effects.[8]
A randomized, double-blind placebo-controlled trial was conducted in 2020, To investigate the efficacy of pulsed electromagnetic field (PEMF) therapy combined with therapeutic exercises in treating chronic low back pain (CLBP). The treatment group experienced a more rapid improvement in both pain and disability compared with the placebo group.[9]
According to a randomized, sham treatment-controlled study with the title of “Safety and Efficacy of an Electromagnetic Field Device for the Treatment of Chronic Low Back Pain,” the PEMF is effective in the treatment of chronic LBP, and there were no serious adverse effects thought to be related to the device, treatment, or protocol.[10]
In another Randomized Controlled Trial (RCT) study, the effects of pulsed electromagnetic field (PEMF) therapy was compared to the conventional non-invasive treatment modalities in patients with chronic non-specific low back pain. The study’s findings revealed improved pain intensity and disability with the lumbar range of motion.[11]

PEMF is known to be safe, non-invasive, low cost, easy to administer, and has no known side effects in managing patients with CLBP. Improving the condition of patients with CLBP will spare the patient going through several rounds of pharmacological and non-pharmacological treatment and invasive procedures like surgery with the ultimate goal to improve the patients’ quality of life.

Reference

Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020;8(6):299.
Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389:736–47.
Majchrzycki M, Kocur P, Kotwicki T. Deep tissue massage and nonsteroidal anti-inflammatory drugs for low back pain: a prospective randomized trial. Scientific World J 2014;2014:1–7.
Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med 2015;162:276–86.
Coutinho AD, Gandhi K, Fuldeore RM, et al. Long-term opioid users with chronic noncancer pain: Assessment of opioid abuse risk and relationship with healthcare resource use. J Opioid Manag 2018;14:131–41.
Daniels CJ, Wakefield PJ, Bub GA, et al. A Narrative Review of Lumbar Fusion Surgery With Relevance to Chiropractic Practice. J Chiropr Med 2016;15:259–71.
Weintraub MI, Wolfe GI, Barohn RA, et al. Static magnetic field therapy for symptomatic diabetic neuropathy: a randomized, double-blind, placebo-controlled trial. Arch Phys Med Rehabil 2003;84:736–46.
Selvam R, Ganesan K, Narayana Raju KV, et al. Low frequency, and low intensity pulsed electromagnetic field exerts its antiinflammatory effect through restoration of plasma membrane calcium ATPase activity. Life Sci 2007;80:2403–10.
Alzayed KA, Alsaadi SM. Efficacy of Pulsed Low-Frequency Magnetic Field Therapy on Patients with Chronic Low Back Pain: A Randomized Double-Blind Placebo-Controlled Trial. Asian Spine J. 2020 Feb;14(1):33-42.
R. Harden, T. Remble, T. Houle, J. Long, M. Markov, M. Gallizzi. Prospective, randomized, single-blind, sham treatment-controlled study of the safety and efficacy of an electromagnetic field device for the treatment of chronic low back pain: a pilot study Pain Pract, 7 (2007), pp. 248-255.
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.

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