Study Finds PEMF Therapy Helps Relieve Low Back Pain. A study in Porto Biomedical Journal: November 2016 – Volume 1 – Issue 5 – p 156-163, found that PEMF therapy seems to reduce the pain intensity and enhance better functionality in individuals with low back pain.
When used alone, the PEMF seem to have great effect in reducing the pain intensity in low back patients, independently of the low back pain condition.
Here is an overview of the study:
Background: Low back pain is a worldwide prevalent musculoskeletal condition in the general population. In this sense, the pulsed electromagnetic fields (PEMF) therapy has shown significant clinical benefits in several musculoskeletal conditions.
Objective: To assess the effectiveness of the PEMF therapy in reducing pain and clinical symptomatology in patients with low back pathological conditions.
Methods: It was performed a comprehensive database search using Pubmed, Scopus, Cochrane Library and PEDro databases to assess the effectiveness of the PEMF therapy in reducing pain and clinical symptomatology in patients with low back pathological conditions. The search was performed from January 2005 to August 2015 and conducted by two independent investigators, which scrutinize the reference list of most relevant studies. The methodological quality was assessed by the PEDro scale and the level of evidence was set according Oxford Center for Evidence-Based Medicine scale.
Results: Six studies were eligible inclusion on the qualitative analysis and five into the quantitative analysis, scoring an overall 6.8 points according the PEDro scale. The studies showed heterogeneity concerning the intervention protocols. Nevertheless, the effect sizes’ indicated a clear tendency to reduction of the pain intensity favoring the PEMF groups, reaching a minimal clinically important difference.
Conclusion: PEMF therapy seems to be able to relieve the pain intensity and improve functionality in individuals with low back pain conditions. Further research is needed regarding PEMF effects on the different conditions of low back pain, with standardized protocols, larger samples and adjustment for low back pain confounders in order to achieve stronger conclusions.
The main finding of this systematic review is that PEMF therapy seems to reduce the pain intensity and enhance better functionality in individuals with low back pain.
When used alone, the PEMF seem to have great effect in reducing the pain intensity in low back patients, independently of the low back pain condition.28–30 However, when added to other standard therapies (such as, standard physiotherapy3 or analgesic therapy27) seems to do not add additional effect to the standard therapy.
Measuring the intensity of pain related to the different low back conditions plays a key role in following up the patient’s recovery. However, because of the subjective nature of pain, clinical importance is not always easy to determine.31 In an effort to overcome this variability, measures of improvement usually adjust for the individual’s baseline by calculating raw change or percent change.32
The PEMF therapy has been pointed out as an effective and relatively safe tool for conservatively treat the low back pain.4,27–30 Furthermore, it has a high potential of compliance due to its low risk of side-effects and high tolerance.29 In fact, when analyzing the pain intensity alone, the included studies effect sizes indicate a tendency to a greater reduction on pain intensity for the PEMF groups. Nevertheless, when compared to standard therapies (such as, physiotherapy3 or analgesic therapy27) seemed to produce a low effect or no effect at all. Considering the minimal clinically important difference (MCID) – minimal change in an outcome score that is clinical meaningful for the patients – all studies showed that the PEMF was able to produce a clinical meaningful pain reduction since the mean differences were higher than the minimum 2-point suggested by Childs, Piva and Fritz.33
Several scoring systems are frequently used in the clinical environment in order to measure the disability related to the low back conditions, which should be reliable, valid and sensitive to clinically relevant changes, taken into account both patients’ and physicians’ perspective and is short and practical to use.34–37 Although, impairments such as decreased range of movement or reduced straight leg raise can be clinically observed by physiotherapists, the direct observation of activity restriction is not sufficient. Therefore, the physiotherapists have the need to rely on the patient’s self-report assessment to measure the impact of low back pain on daily activities.34
Several studies have been demonstrating the PEMF effectiveness in reducing the disability related to the low back pain.27–30 Regarding the studies included in this systematic review, the disability assessment was mostly made by the Oswestry Disability Index,38 showing improvements after application of PEMF therapy, however with small effect sizes. Nevertheless, the MCID’s were above the minimum recommended by Ostelo, Deyo, Stratford, Waddell, Croft, Von Korff, Bouter and de Vet39 – between 6–10 points or 12–20 percent – indicating a meaningful improvement on the patient’s functionality. On the other hand, Omar, Awadalla and El-Latif28 showed a large effect size toward the PEMF group (d=1.54, 95% CI: 0.81, 2.21) using the Modified Oswestry Low Back Pain Disability Questionnaire, obtaining a 42% mean reduction after daily applications of PEMF therapy for 3 weeks. Still, some caution should be taken when considered this study since they used an adapted score.
Other usual subjective scores – generic and disease-specific – to evaluate the low back functionality have already been explored during the last decades and are currently available for orthopedic clinical and research practice.35 In this sense, beneficial results were reported in the included studies using different scores: Patient Specific Functional Scale3; Korean version of Roland-Morris Disability Questionnaire30; Modified version of Functional Activity Scale27; Quebec Pain and Disability Index.4 Although the studies showed improvements from the baseline to the study’s end-point, two studies did not achieved significant improvements toward the PEMF group when compared to the control group.3,4
Due to the comprehensiveness and complexity within the low back pain umbrella and allied to its associated multiple etiologies, specific attention should be directed to the characteristics of subgroups of responders.4 In this line, the studies included in our systematic review explored the PEMF therapy effectiveness in different conditions of low back pain: generalized low back pain27; acute non-specific low back pain3; discogenic lumbar radiculopathy28; lumbar myalgia30; chronic low back pain.4,29 Due to the high heterogeneity of the different low back pain conditions of the original studies included in this systematic review, and the small sample sizes (ranging from n=16 to n=40), no strong recommendations can be drawn regarding the non-specific low back pain or its several conditions.
Moreover, it was found high heterogeneity between the protocols of PEMF therapy of the different studies, differing in the devices used and its parameters (frequency, pulse rate and width, magnetic flux density, among others), duration and frequency of application (4 times a day until 3 times a week) and type of application. Hence, considerable caution should be taken when comparing the results from the different studies, highlighting the importance in achieve the most effective dosage and standardized protocol parameters. In this line, future studies should shift their focus on analyzing the different mechanisms of action (e.g., myofascial, radiculopathic, among others) and subgrouping (acute or chronic, specific or generalized, mechanical or idiopathic) the individuals with low back pain in order to evaluate the effects of PEMF therapy in these different groups of low back pain and identify the responsiveness of each specific group. Thus, it will be possible to achieve the most effective PEMF protocol to the most suitable subgroup of patients.
Generally, the studies showed a good methodological quality according the PEDro scale, with a mean of 6.3 points out of 10 possible, which is above the recommended by.40 The studies showed a good methodological quality, i.e., good external and internal validity, providing sound interpretation of the data. However, precisely in the internal validity, some limitations were found across the studies that could provide additional bias to the results: lack of “intention-to-treat” analysis; lack of randomization concealment; lack of blinding of subjects, therapists and assessors. Moreover, another important limitation was the statement of conflict of interest, where only three studies stated that had no conflict of interest at all. Two other studies did not make any statement about conflict of interest whatsoever and two studies reported funding upon the study’s conduction.
You can read this study in its entirety here.
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