PEMF: An innovative treatment or a waste of money?

Pulsed-electromagnetic field therapy (PEMF) is a form of physical therapy used in the physiotherapeutic field that utilizes the properties of magnetic or electromagnetic fields to reduce the symptoms of muscular inflammatory states and traumatic or chronic bone conditions. This article summarizes PEMF’s operation principles, biological mechanisms, and health considerations that should be considered before applying it, as well as its most common clinical applications.

PEMF, also known as low-field magnetic stimulation (LFMS), is a non-invasive treatment that uses electromagnetic fields to improve aspects of overall health and well-being. PEMF is based on the principle that electromagnetic fields may aid in the treatment of bone fractures by promoting the synthesis of skeletal extracellular matrix. As a result, it is proposed that PEMF can reduce inflammation and pain and promote tissue repair by enhancing the ability of skeletal cells to facilitate fracture healing. In fact, PEMF therapy has been approved by the Food and Drug Administration (FDA) since 1979 for treating orthopedic conditions, such as bone fractures, non-unions (broken bones that fail to heal), osteoarthritis, etc.

PEMF therapy is performed by specific devices that produce intermittent (not continuous) current-pulse generated magnetic field waves to the respective bodily tissue over a short time frame using a pulse repetition frequency. Due to the short pulse duration and the low application plus repetition frequency, the electromagnetic field is activated only for a small part of the therapy time. The therapeutic exposure times may vary from a few minutes up to several hours, depending on the condition. Moreover, PEMF can be categorized by the electromagnetic frequencies applied into Ultra Low Frequency (ULF) that uses frequencies below 3Hz, Extremely Low Frequency (ELF) that uses frequencies between 3 Hz and 30 kHz, and Very Low Frequency (VLF) that uses frequencies between 30kHz and 300kHz.

 

PEMF biological mechanisms

PEMF activates calcium membrane ion channels, resulting in calcium release and thus affecting processes such as cell metabolism, apoptosis, proliferation, and inflammation. Moreover, PEMF has been shown to stimulate membrane receptors of adenosine, a purine nucleoside with various roles in biological processes, such as cell proliferation and activation of osteoclasts (cells that degrade bone and mediate bone loss). PEMF exposure on osteoblasts (cells that form new bones and heal existing bones) stimulates the increase of nitric oxide, potentially inhibiting apoptosis and improving cell viability. PEMF’s elicited apoptotic effects may hold great clinical significance in the case of cancer and malignant cells as this type of therapy could be used in new combination treatment strategies in combination with chemotherapeutics. However, many questions remain regarding this association, meaning PEMF application in cancer therapy is still very limited.

Cell differentiation is another primary mechanism through which PEMF is considered to exert its health effects. Studies have shown that PEMF exposure triggers the expression of osteogenic markers, such as osteopontin and collagen, promoting the differentiation of stem cells, meaning cells that can self-renew and differentiate, to osteoblasts, thus triggering bone and cartilage formation. In fact, due to this exact stimulatory effect on osteoblastic differentiation, PEMF may be especially useful in preventing and treating osteoporosis.

 

Health considerations

The biological interactions that could possibly be caused by PEMF application depend on the electromagnetic field frequency used. Harmful effects are not common at low-level magnetic fields, including ULF and ELF. For strong static magnetic fields, nausea, vertigo, and a metallic taste have been reported. Moreover, strong magnetic fields have been linked to carcinogenic effects. Therefore, using PEMF in frequencies as low as reasonably achievable is recommended to ensure the avoidance of any serious health complication.

 

The following sections will review the most common clinical applications of PEMF.

 

Orthopedics
PEMF stimulation can be used to promote bone regeneration. Its application may pertain to early acute fractures and non-union established fractures that have failed to heal over an extended period of time. PEMF can increase healing rates and reduce pain with an astonishing cure rate between 60% and 88%, with a treatment duration of 3-20 hours per day over 8-29 weeks in the treatment of non-healing tibial fractures.

Osteoarthritis
Osteoarthritis is a degenerative, debilitating joint disease in which the tissues in the joint break down over time. Numerous studies have demonstrated that PEMF applied for at least four weeks significantly relieves osteoarthritis-related pain, reduces stiffness, increases physical function, and has a protective effect on disease progression, especially in patients < 45 years old.

 

Osteopenia
Osteopenia is a precursor to osteoporosis, in which bone mineral density decreases, leading to a higher fracture risk. PEMF treatment has been shown to be a promising choice for pain relief in these patients, at least in the short term. Not only does PEMF improve bone mineral density, but it also stimulates osteogenesis, as shown by bone biomarkers. Although the FDA has not approved PEMF for the treatment of osteoporosis, data show that it can be a rather effective adjunct to the main treatment. 

 

Wound healing
Data suggests that PEMF can relieve pain and reduce swelling after plastic and reconstructive surgery. The effect of PEMF has also been studied in chronic diabetic foot ulcers, where a treatment consisting of 14 sessions over three weeks resulted in an 18% decrease in wound size.

 

Overall, PEMF-generated magnetic fields can penetrate all tissues, causing cellular and physiological responses in many parts of the human body. Although PEMF is mainly applied to treat fractures or slow the progression of osteoarthritis, it can also be used as an adjunct therapy to osteoporosis and wound healing after surgery. Especially in terms of fractures, avoiding complicated fracture healing can have enormous savings potential for health insurance funds since this non-invasive and comparatively inexpensive treatment tool can positively contribute to treating these conditions.

 

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