Pulsed Electromagnetic Field (PEMF) for pain management

Introduction

​In current medical practice, managing pain often means reaching for a pill bottle. While medications like aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and opioids can be effective in alleviating pain, they also come with a host of potential side effects. Long-term use of NSAIDs, for instance, may lead to gastrointestinal issues, kidney damage, and increased cardiovascular risk [1]. Steroidal anti-inflammatory drugs can suppress the immune system and contribute to osteoporosis [2], while opioids carry a well-documented risk of dependency and addiction [3]. Despite these risks, society continues to lean heavily on pharmaceuticals as the primary solution for pain management.
 
Growing awareness of side effects has led many to seek non-drug alternatives. Techniques such as physical therapy, acupuncture, mindfulness meditation, and dietary changes are gaining traction for their ability to reduce pain and improve quality of life without the risks associated with medication [4]. Among these alternatives, the use of electromagnetic stimulation has emerged as a particularly intriguing option. Devices like Transcutaneous Electrical Nerve Stimulation (TENS) units and Pulsed Electromagnetic Field (PEMF) therapy are becoming more popular for their potential to manage pain in a non-invasive and drug-free manner [5,6]. The National Center for Complementary and Integrative Health (NCCIH) provides a public fact sheet on using magnetic fields for pain management [7].
 
This blog will focus specifically on Pulsed Electromagnetic Field (PEMF) therapy, exploring how it works, its applications in pain management, and the scientific evidence supporting its use. Whether you are seeking a complementary approach to traditional treatments or an alternative to medications, PEMF therapy may offer a promising solution. Let us dive in to understand more about this innovative technology and its role in pain relief.

References

[1] Sostres, C., Gargallo, C.J. & Lanas, A. Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage. Arthritis Res Ther 15 (Suppl 3), S3 (2013). https://doi.org/10.1186/ar4175
[2] Schimmer, B. P., & Parker, K. L. (2006). Adrenocorticotropic hormone; adrenocortical steroids and their synthetic analogs. In Goodman & Gilman's The Pharmacological Basis of Therapeutics (11th ed., pp. 1587-1612). McGraw Hill.
[3] Volkow ND, Jones EB, Einstein EB, Wargo EM. Prevention and Treatment of Opioid Misuse and Addiction: A Review. JAMA Psychiatry. 2019;76(2):208–216. doi:10.1001/jamapsychiatry.2018.3126
[4] Heather Tick, Arya Nielsen, Kenneth R. Pelletier, Robert Bonakdar, Samantha Simmons, Ronald Glick, Emily Ratner, Russell L. Lemmon, Peter Wayne, Veronica Zador. Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: The Consortium Pain Task Force White Paper. Explore. 2018; 14(3): 177-211. https://doi.org/10.1016/j.explore.2018.02.001
[5] Johnson MI, Paley CA, Jones G, et al. Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a systematic review and meta-analysis of 381 studies (the meta-TENS study). BMJ Open 2022;12:e051073. doi: 10.1136/bmjopen-2021-051073
[6] Markov, M.S. Pulsed electromagnetic field therapy history, state of the art and future. Environmentalist 27, 465–475 (2007). https://doi.org/10.1007/s10669-007-9128-2
[7] Magnets For Pain: What You Need To Know

PEMF definition & basic control parameters

Distinction between static and pulsed magnetic fields: Both modalities are based on the interaction between magnetic fields and biological systems, with the objective of promoting healing, alleviating pain, and enhancing cellular function. However, there are fundamental distinctions affecting their effectiveness.
 
Static magnetic therapy (SMT) involves the use of magnets that produce a constant, unchanging magnetic field. Magnets are usually embedded in bracelets, insoles, or pads and placed on or near the body. The steady magnetic field influences the alignment of charged particles in tissues and potentially affects ion exchange processes across cell membranes. In SMT, the dose is quantified by measuring the magnetic flux density, which is typically expressed in units of Gauss (G) or Tesla (T). Most therapeutic magnets have a flux density ranging from 300 to 5000 Gauss. The depth of penetration and the effectiveness of the therapy depend on the strength of the magnet and the distance from the tissue being treated. However, definitive clinical evidence supporting SMT remains limited, with studies often yielding inconclusive or modest results.
 
Pulsed electromagnetic field, by contrast, employs time-varying magnetic fields generated by electrical currents passing through coils. These magnetic fields can penetrate deeper into the body and induce electric currents within tissues, stimulating cellular activity. The dosing in PEMF therapy is multifaceted and involves parameters such as:
 
1.Types of frequencies: the field frequency (also known as carrier frequency) within the pulse, and the pulse repetition frequency itself. The latter depending on applications could vary from a few Hz to several hundreds. The field frequency on the other hand, is usually several orders of magnitude higher, in the kHz or even MHz range.

2. Wave form: The shape of the electromagnetic pulse (e.g., sinusoidal, square, or sawtooth), which may influence the biological response.

3.Intensity: The strength of the magnetic field, measured in Gauss or Tesla, which varies depending on the therapeutic application.
​
4.Duration: The length of time the field is applied, often ranging from minutes to hours per session.

Dose-Response Relationship & Mechanism

PEMF influences tissues through magnetic and induced electrical fields, causing movement of ions and charged particles. Over many years of research, there is consensus that low field frequency may be more bioactive than static fields, and pulsed fields could be more effective than continuous ones. Higher pulse frequencies and magnetic flux densities lead to stronger cellular responses, especially with repeated applications over more than 10 days. When information on wave forms is available, triangle wave forms show the highest cellular response. A meta-analysis of ninety-two studies found that PEMF effects vary by cell type and origin, with osteosarcoma cells being particularly sensitive [1]. The lack of standardization in study designs and documentation, especially the documentation of wave forms and pulse duration, tends to obscure the analyses PEMF data across studies. Overcoming these caveats will improve comparisons and replications and advance the pace of research.
 
The exact mechanisms by which magnetic fields exert therapeutic effects remain a topic of research. Hypotheses include the modulation of cell membrane ion channels and receptors, especially the adenosine receptors. As a result, PEMF affects many cellular processes including apoptosis, proliferation and differentiation of osteoclasts, mesenchymal stem cells, adipose-derived stem cells and tendon stem progenitor cells. On the overall, PEMF enhances microcirculation, and stimulates cellular repair processes, not only in bone, cartilage, and tendon tissues, but in the brain as well [2].

References

[1] Pulsed Electromagnetic Fields (PEMF)—Physiological Response and Its Potential in Trauma Treatment.Flatscher J et al. Int. J. Mol. Sci. 2023, 24, 11239. https://doi.org/10.3390/ijms241411239
[2] Richard H. W. Funk, Manfred Fähnle. A short review on the influence of magnetic fields on neurological diseases. Front. Biosci. (Schol Ed) 2021, 13(2), 181–189. https://doi.org/10.52586/S561

FDA approvals

PEMF therapy has garnered over the decades robust evidence in clinical trials resulting in six FDA approvals for the following indications:
 
1.Therapy for non-union fractures, which are fractures that fail to heal properly (1979).
2.Adjunct therapy for post operative edema and pain (1987)
3.Urinary Incontinence and Muscle Stimulation (1998).
4.Adjunct therapy to Cervical Fusion Surgery in patients at elevated risk for non-fusion (2004).
5.Therapy for depression and anxiety (2006).
6.Therapy for the treatment of brain cancer (2011).
 
Additional FDA approvals are expected in the future since clinical trials based on PEMF intervention are still on-going. A review of clinicaltrials.gov indicated that to date 150 trials are registered addressing a wide range of conditions, mostly musculoskeletal disorders, neuropathies, neurological disorders, autoimmune and metabolic diseases.

NCCIH Recommendations

​FDA approvals notwithstanding, the National Center for Complementary and Integrative Health (NCCIH) also listed PEMF therapy as potentially effective for the following conditions:
 

• Osteoarthritis
• Low back pain
• Complex Regional Pain Syndrome
• Menstrual pain
• Multiple Sclerosis and paresthesia pain

 
These recommendations are based on reviews of clinical reports up to 2021.

Safety and Potential Side Effects

​Pulsed Electromagnetic Field (PEMF) therapy has gained popularity as a therapeutic tool for pain management, but like any treatment, it is essential to understand its safety and potential side effects. It is considered safe for most people as PEMF devices and associated protocols for medical applications operate below the exposure limits set by the International Commission on Non-Ionizing Radiation [1,2]. However, some individuals may experience mild and temporary side effects [3,4], such as:
 

• Tingling, warmth, or slight redness at the application site.
• Mild headaches, fatigue, or nausea.
• Temporary changes in sleep patterns.

 
These side effects are usually short-lived and often subside as the body adjusts to the therapy. It is important to listen to your body and consult with a healthcare provider if you experience any significant side effects.
 
PEMF therapy is not recommended for certain individuals [5], including:
 

• Pregnant women: Due to limited research on the effects of PEMF on fetal development.
• Organ transplant recipients: PEMF may interfere with immunosuppressant drugs.
• Individuals with implanted medical devices: Such as pacemakers or defibrillators, as PEMF can interfere with their functioning.
• People with magnetic or ferromagnetic implants: Or those deemed unsafe for MRI.
• Individuals with bleeding disorders: Or those taking blood-thinning medications.
• People with undiagnosed health concerns: It is crucial to consult a doctor before using PEMF.

 
It is always best to consult with a healthcare provider before starting any new therapy to ensure it's appropriate for your specific health needs.

References

[1] Guidelines for limiting exposure to electromagnetic fields (100 kHz to 300 GHz). International Commission on Non-Ionizing Radiation Protection (ICNIRP). Health Phys. 2020, 118(5), 483–524. DOI: 10.1097/HP.0000000000001210
[2] ICNIRP: RF EMF Guidelines 2020
[3] Pulse PEMF: PEMF Therapy Side Effects: What You Need To Know.
[4] Neuro Launch: PEMF Therapy Side Effects: Understanding the Risks and Benefits of Electromagnetic Treatment.
[5] PEMF Advisor: PEMF Therapy Precautions: Safety Guidelines and Risks

Access to PMEF Therapy

Individuals considering PEMF therapy for pain management have several options: seeing a qualified professional, seeking special treatment centers, or trying the self-help path.
 
Seeing a doctor: The following healthcare professionals are more likely to be practitioners of PEMF therapy:
 

• Orthopedic Surgeons: Specialists in bone and joint health.
• Chiropractors: Often use PEMF therapy as part of their treatment plans.
• Pain Management Specialists: Focus on treating chronic pain conditions.
• Sports Medicine Doctors: Use PEMF therapy to aid in the recovery of sports-related injuries.

 
You can find PEMF therapy doctors through resources like WebMD and the Association of PEMF Practitioners (AOPP)
 
Special Treatment Centers: There are specialized centers that offer PEMF therapy, often as part of a broader range of integrative and regenerative treatments. Some notable ones include:
 

• Pulse PEMF Centers: These centers are certified and offer professional PEMF therapy. You can find a location near you using their location map.
• The Osteopathic Center: Offers PEMF therapy along with other integrative treatments. They have locations in Miami, Knoxville, Jupiter, and Jacksonville. More details can be found on their website.
• Health Mat Review Directory: Lists over 580 locations across the USA where PEMF therapy is available. You can find a practitioner near you using their directory.

 
Self-Help Devices and Operating Procedures: If you prefer to use PEMF therapy at home, there are several devices available for direct consumer purchase. Some selected options include:
 
Oxford Medical Instruments (OMI) offers an entire range of devices for spot and whole-body treatment
DC Cure PEMF Therapeutic Device offers a specialized product for low back pain.
Sota Magnetic Pulser is small affordable and portable device for spot treatment
 
Many others are compared and reviewed at health-related websites: Healthline, HealthNews, PMEF Therapy Hub and Medical News Today. PEMF therapy can be a versatile and effective treatment option for various conditions. Whether you choose to see a doctor, visit a specialized center, or use a self-help device, it's important to consult with a healthcare professional to determine the best approach for your specific needs.

Personal Self-Help Experience with PEMF Therapy

I was introduced to PEMF therapy while visiting a patient in Switzerland, terminally ill with liver cancer and who used it extensively for relief of abdominal pain. During the visit I happened to mention annoying neck pain following the long overnight cross Atlantic flight. My neck pain tends to be recurrent because of poor posture during sleep and lasts two to three days before subsiding. The patient offered PEMF treatment by his device, for which I had little information, except that it was powerful and expensive. It was made in Germany and cost the equivalent of $8000. The duration of treatment would only be half an hour with a wand applied directly to the site of pain. I took the offer and to my astonishment the pain felt much better just 12 hours after treatment.
 
Returning home and upon much reflection, I decided to try PEMF therapy but not necessarily with an expensive and powerful device. I opted instead for the Sota Magnetic Pulser, Model MP6 (shown below), purchased from Amazon in 2020 for $395 excluding tax and shipping.

​The device comes with a wand for spot application. It could be used in two modes with the following output specifications:

Mode	Magnetic Field Intensity (Gauss)	Pulse Duration (milliseconds)	Pulses per Cycle
Regular	6000	2.5	255
Fast	2500	2.5	1400

​I uniquely used the regular mode to obtain relief within 12-24 hours not only for neck pain, but for other ailments including:
 

• Sciatic nerve pain by applying the wand directly onto the lumbar and lower buttock area of the leg involved.
• Minor sporting injuries like back-shoulder and muscle pain following a long session of archery practice, and knee pain following a long hike uphill.

 
PEMF therapy with the Sota Magnetic Pulser was effective for my case. Irrespective of its mechanism of action, my quality of life has been better since its purchase in 2020.