Researchers have studied a variety of new approaches to improving the bone-implant interface. Some of these include other types of implant surfaces, locally applied osteoporosis medications (bisphosphonates), and locally-applied growth factors, platelet-rich plasma, and stem cells. However, costs, safety issues, complexity of administration, optimal dosing, and lack of long-term studies limit these options.

Surgeons doing an original joint replacement or implant often encourage the patient to wait until they are older to get the procedure done because of the very real possibility that in 10 to 15 years the procedure will have to be redone. Redone procedures are more complex and challenging, and have an increased risk of breakdown.

New, noninvasive strategies are needed to enhance the success of the implantation procedure by increasing bone formation around the prosthesis and lowering local inflammation, especially in cementless implants. PEMF stimulation is ideal for this. The effectiveness of PEMFs in enhancing endogenous bone repair and reducing inflammatory processes has been shown in multiple studies.

PEMFs have been studied for the ability of various materials to integrate with bone. Almost all the studies have shown that PEMF stimulation can be applied locally and can significantly enhance the integration of implant materials, including titanium, stainless steel and ceramic implants. Even nails or rods implanted into the bone marrow of long bones, such as the femur, which were movable or unstable, as would happen with surgery for fractures, improved and were integrated into the bone better.

I had an experience myself with a titanium dental implant, where the implant was integrated better into a bone graft because I was using PEMF stimulation. Even the dental surgeon was pleased, surprised, and amazed. He had apparently only seen this type of integration one other time in his 17 years of practice.

PEMFs have been studied for the osseointegration of joint replacement prostheses. There are 2 aspects to this: the treatment of loosened prostheses and the use of PEMFs after a revision.

In the first scenario (treatment of loosened prostheses) the intention is to reduce the need for a revision. In one study, 132 patients had PEMF therapy for advanced loosening of their prosthesis. Treatment was done 2-3 times a day for 40 minutes each time, for 20 weeks. Follow up was done over the course of 5 years. A revision procedure was no longer deemed necessary in 70% of patients.

In an extension of this research, PEMF therapy was administered to more than 1,000 patients with loosened artificial hips. The PEMF signal used was 30 gauss with frequencies ranging from 2 to 20 Hz. The treatment lasted for either 6 months, or until patients reported complete relief from pain and discomfort, whichever came first. Treatment was successful in 70% of the patients. Before treatment, 76% used crutches; this was reduced to 48% after the study. In more than 65% of the patients, further surgery could be avoided within a follow-up of 10 years. The treatment took an average of 16 weeks. Before treatment, 54% of the patients suffered from permanent pain; this was reduced down to 6.5% afterwards. Before PEMF treatment, 36% of patients used analgesics and after treatment only 2% did. Researchers concluded that PEMFs are best considered for patients at an early stage of aseptic loosening.

In another double-blind study using PEMFs for loosened cement hip prostheses, 37 patients completed 6 months of treatment (either active or placebo). Success was determined clinically using a Harris Hip Score greater than or equal to 80 points. Ten of the 19 active patients (53%) were considered successes, compared to two of the 18 placebo patients. This is a statistically significant and clinically relevant result. A 60% relapse rate among the active successes was seen at 14 months after stimulation, and despite maintenance therapy of one hour per day, the relapse rate increased to 90% at three years. These data suggest that for loosened cemented hip prostheses, use of PEMFs is a treatment option only to delay revision hip surgery.

Loosening in the absence of infection (aseptic) is the most common problem of hip replacements, limiting their long-term success. There was a study of PEMF treatment in 24 patients with this complication. At the end of treatment, six months and one year later, pain and hip movements improved significantly. Both bone scans and ultrasonography improved significantly, but not in plain X-ray. The decreased pain and improved function suggest that PEMF is effective in improving symptoms of patients with loose hip replacement, supported by objective improvements in bone scan and ultrasound. No improvement, however, can be expected in patients with severe pain due to gross loosening.

Another group of 30 patients undergoing hip revision with a replacement prosthesis were treated with a 20 gauss PEMF signal for 6 hours per day, starting from the 7th through 90th days after revision in a double-blind study. PEMF-treated individuals were functionally better. Postoperative bone mineral density (BMD) was 66–93% versus 40% in controls, or more than double the improvement, even at 90 days after surgery. In addition, the PEMF group had a reduction in pain of 77% compared to 40% in the control, even as far out as 90 days after the procedure. The treatment was not associated with any negative side effects; nevertheless, it must be noted that the use of the electromagnetic stimulation at the hip required considerable patient commitment. Still, this important study showed that PEMF treatment aids clinical recovery and bone restoration.

In another study, 45 patients were studied using a 75 Hz, 20 gauss PEMF stimulator for 60 days, at a minimum of 6 hours per day. Of those, 76% had good or excellent results. The more treatment that was done, the better the results were, with 80% of those who used it for more than 30 days reporting good results. But, of those who used it for more than 60 days with at least 360 hours of exposure, 92% had good results. There appears to be a dose-related effect which is possibly cumulative. No side effects of stimulation were seen.

In addition to the benefits seen with PEMFs in the treatment of loosened implants, the therapy has also been studied immediately following joint replacement surgery, with the long-term goal being extended life of the implant and prevention of loosening in the first place.

During the healing process, bone cells first proliferate, then mature, and finally deposit minerals. In the active growth phase, osteoblasts have elevated production of extracellular matrix (ECM) genes such as type I collagen (COL I). When cells enter the maturation phase, cell growth slows down and the expression of matrix formation proteins such as COL I and alkaline phosphatase (ALP) increase. The last stage involves adding minerals to the area of the injured soft tissue. Since inflammation can hinder bone repair, it is important to know whether PEMF could stimulate bone repair under conditions of inflammation. Bone implants themselves lead to inflammation, which can hinder the progress of bone repair.

Conditions of bone repair were studied in experiments simulating implant placement. On day 7, the PEMF-exposed bone culture released more nitric oxide (NO) than the control. PEMFs resulted in a significant increase in NO release. PEMF-induced NO production in macrophages takes on an oscillating pattern and peaks at 7 days. The survival of osteoblasts in a control group decreased from days 0 to 7. The PEMF-exposed osteoblasts had significantly higher survival on day 7. Osteoblasts stimulated by PEMF began to synthesize internal NO and probably developed their own protective mechanisms such as intracellular detoxifying agents and heat shock proteins to prevent NO from damaging themselves. NO subsequently promoted osteoblastic activities such as growth, viability and collagen expression.

As a result of increased collagen synthesis in the ECM, the cells produced elevated alkaline phosphatase (ALP) activity. Higher ALP activity eventually leads to more mineral deposition and superior bone repair. The high osteoblast proliferation stimulated by PEMF is the primary determinant of the rate of bone formation.

The above studies show a strong correlation between PEMF therapy and successful treatment and longevity of joint replacement implants. There appears to be a dosing effect where longer treatment times or treatments at higher intensities have higher long-term success than shorter treatment times or lower intensity treatments.

Copyright 2018 Magnus Magnetica, LLC   /  Unauthorized use or duplication is prohibited by law.

Pain relief is a very frustrating goal of both individuals and physicians. More than 100 million Americans suffer from chronic pain. There are many health disciplines devoted to helping people with their pain problems. Every approach has its merits, but it is rare for any single approach to be a cure. Pain becomes chronic only because there are no satisfactory curative treatments. Relief is often obtained, but usually only temporarily. Sometimes there is a permanent reduction in the pain but not elimination of the pain. One of the reasons for this frustration is the tremendously variable number of causes of chronic pain. Almost always, the constant component of the cause of pain is inflammation. The current options for chronic pain management include drugs, procedures, injections, surgery, manipulation, massage, various energy modalities, and acupuncture. Since I first became a physician, with most of my early emphasis in management, I recommended drugs, procedures, injections and surgery. The drugs mostly “numb and dumb” the body, often with the risk of addictions and major side effects. Procedures sometimes can be miraculous but often leave people with more problems than they started with. Unfortunately, it is very difficult to predict who is going to have problems following their procedures or surgeries.

FROM NEEDLES TO MAGNETS

I started experimenting with tiny, powerful static magnets, placed on acupuncture points. I discovered that not all acupuncture points could be easily accessed by the magnets because the magnets produced a very shallow magnetic field. However, I did learn that the magnets would stimulate certain superficial acupuncture points, as well as treating the local tissue around the magnet. I was curious on how magnets could possibly do these functions. So, I began researching all of the writings I could find on the subject of magnets and what they did to the body. In my search I discovered a large amount of information, though it was unfortunately mostly written in Eastern European and Asian languages. I was frustrated. As fortune would have it, I met a doctor from the Czech Republic who had translated much of the Eastern European literature on magnetic therapies to that time, already over 30 years of experience. He and I collaborated to produce a book, Magnetic Therapy in Eastern Europe: A Review of 30 Years of Research. The research from this book propelled me into using magnetic fields for a vast array of medical conditions, and learning all about the use of pulsed electromagnetic fields in my practice, for myself and for friends, pets and family.

MOVING FROM STATIC TO PULSED MAGNETIC FIELDS

The rest as they say is history. I had discovered that pulsed electromagnetic fields can stimulate acupuncture points and meridians as well as all the tissues in the path of the electromagnetic field. Therefore, PEMFs were more efficiently effective than just acupuncture alone. Certainly, acupuncture can be more effective, particularly with electrical stimulation, on specific points and for specific problems. PEMF stimulation of an acupuncture point may or may not always be as strong as stimulation with an acupuncture needle. However, because PEMF devices are now available commercially and can be purchased for personal use, they can be used in the home setting on a completely flexible basis, accomplishing some of the goals of acupuncture but, in addition to that, have all the benefits of individual cellular stimulation.

Early on in my use of magnets I did some research with a doctor who could do nerve conduction studies. We discovered that magnets placed over acupuncture points did indeed have an impact on the flow of energy up the acupuncture meridian. At one point, I actually discovered in Dr. Robert Becker’s book, The Body Electric, from research done in his lab, that acupuncture points and meridians are part of a DC current system. If you know anything about magnetic fields and electricity, you will know that they interact with each other. That means that magnets will interact with the acupuncture points and meridians from an electrical perspective. So, one does not have to break the skin with a needle to produce an acupuncture like effect. One may simply be able to use magnets to stimulate the acupuncture points and meridians. In addition to using needles and magnets to stimulate acupuncture points, these points may also be stimulated by pressure, heat, electrical stimulation, laser, ice, and friction. In fact, electrostimulation of acupuncture points is also commonly used in North America. In fact, my UCLA training emphasized the use of electrically stimulated needles to perform acupuncture.

WHY COMBINE PEMF THERAPY AND ACUPUNCTURE?

When it comes to getting advice on Integrating PEMF therapy in an Acupuncture Practice, Dr. Pawluk writes,  “I have known for 2 decades about static magnets and acupuncture point stimulation, I assumed it to be also true for pulsed electromagnetic fields. Now we have evidence from a study published recently, indicating that PEMFs are also able to stimulate acupuncture points and therefore the associated meridian/s.

However, as I mentioned earlier, in my practice I don’t limit my use of pulsed magnetic fields specifically to acupuncture points. PEMFs are a general body therapeutic modality. Additionally, pulsed magnetic fields will get all the acupuncture points and meridians in the area of the magnetic treatment. One of the challenges of doing acupuncture is selecting the right points for the particular needs of the individual at the time.”

We learn that PEMF therapy improves the results of acupuncture treatments considerably and also improves the practice’s offerings. Thus, it’s well worth the investment into a long-term PEMF therapy system. Energy medicine practitioners will agree that hormonal balance and cellular health is the key to achieve longevity, and just like acupuncture, PEMF therapy works better and better with regular use.

Pain management is one of the most common applications for PEMFs. Current conventional medical approaches to pain management often leave much to be desired and involve heavy medications, procedures, surgeries, and physical therapy. Rarely will conventional doctors refer patients to alternative modalities like acupuncture, massage, or chiropractic therapy, let alone PEMFs.

Specialists tend to have tunnel vision. You go to a specialist for a problem and that specialist has a single approach to dealing with your problem. I like to refer to these as “parlors” – parlors of neurosurgery, orthopedics, pain management, natural medicine, massage, etc. Every doctor has a parlor, a specialty. If you end up in the wrong parlor, your problem may be addressed in the wrong way. It’s not to say that the specialists are not well-meaning (they almost always are), but that they cannot see beyond their own parlor. Only a well-informed consumer (or well-rounded, holistic practitioner) can see past the parlors and find out what other options may exist.

Most people find PEMFs at the end of a long search for an answer to their pain. Almost everyone we speak with has tried traditional medical management of their pain before they consider alternative options. It’s only once these traditional options have failed (or presented dramatic side effects) that people do their own research on alternative treatments.

Traditional Pain Management and Negative Side Effects

There are a staggering number of people in pain in this country and around the globe. In the US alone, 17% of people aged 15 or older suffer from chronic pain to such a point that it interferes with their daily life. At any given moment, 1 in 4 adults are suffering from some form of pain.

A lot of the time, pain management involves painkillers or medications to blunt the perception of pain. I call this “numbing and dumbing.” The most common medications used for pain management are anti-inflammatories, which are best used for acute problems. More than 30,000 North Americans per year die from gastric bleeding from NSAIDs like aspirin. Thousands of others have permanent kidney damage from the NSAIDs.

In January 2014, the FDA finally began to address this issue, urging physicians to warn patients of the risks of long-term or high-dose acetaminophen (found in Vicodin, Percocet, and OTC medication like Tylenol) which often lead to life-threatening liver damage.

Procedures, such as injections or surgery, should only be done when there is a great chance of eliminating the pain problem. Most doctors know that procedures tend to buy patients pain free time, but are not true long-term solutions. Procedures do not address the underlying cause of the problem. But again, if you’re speaking with a surgeon, their parlor is surgery, so that’s what they will tend to suggest.

You may recall the multistate fungal meningitis outbreak of 2013 – caused by contaminated steroid injections. So it’s not just the steroid itself which is harmful (though it is known that steroids weaken the ligaments and soft tissues into which they are injected, leading to long-term weakness of these tissues and therefore an increased risk of future damage) – but the injection itself carries many possible health risks.

Most doctors don’t tell their patient that the problem will linger and require lifetime management. So this becomes a huge disservice to the patient – they are given false hope that this approach to treatment (whether it’s surgery or an injection)  is going to truly resolve their problem. Yes, people will temporarily feel better and get on with their lives. But in 3 months, 6 months, or a year after the treatment, the problem returns, sometimes with more severity, because the underlying cause was not dealt with.

PEMF Therapy for Pain

People who have failed to find relief from other modalities will often find relief using PEMFs. Animal studies show that PEMFs reduce the pain receptors in the brain. In some research, PEMFs were found to be equivalent to 10mg of morphine – all of this aside from the natural healing responses PEMFs trigger in the body.

Our ability to relieve pain is variable and unpredictable. It depends on the source of the pain (which is many times different than the location of the pain), and whether the pain is acute or chronic. Pain mechanisms are complex and have local tissue and central nervous system aspects. Because of all these variables, pain management should be tailored to each person individually. The most effective pain management strategies require multiple concurrent approaches, especially for chronic pain. Rarely will a single approach solve the problem.

Having practiced medicine for more than 40 years, I’ve become very familiar with the different patterns of pain. Chronic pain (especially from arthritis, lumbar stenosis, injury, failed surgeries, etc.) is not expected to be fully cured because the underlying chronic problem doesn’t go away. Because of my years of experience, I resolve to find better, more helpful healing solutions that will work to resolve the underlying causes while at the same time providing safe, effective pain relief.

I frequently recommend magnetic therapies for people in chronic pain (usually before anything else) so that they can avoid complications and side effects and because PEMFs usually provide a reliable degree of pain relief through convenient treatments done at home. PEMFs have been proven in numerous studies to affect various aspects of the pain process. In my experience, almost everyone benefits from PEMF therapy and very frequently they can avoid procedures and decrease or avoid the use of medications.

Chronic pain is often perpetuated by abnormal, small nerve networks stuck in a rut of constant inflammation. PEMF stimulation (especially with high intensities) quiets down nerves and facilitates recovery from injury and inflammation. Even patients suffering from stubborn or systemic sources of pain have found pain relief using magnetic therapies.

Musculoskeletal disorders make up the vast majority of pain sources commonly treated with PEMFs. These include arthritis, tendinitis, sprains and strains, fractures, post-op pain, osteoporosis, wounds, neuralgias, neuropathies, hip disorders, muscle spasms, spinal cord injury, trauma, burns, neuromas, heel spurs, phantom pain, carpal tunnel syndrome, headaches, tennis elbow, reflex sympathetic dystrophy (RSD – now known as complex regional pain syndrome) and so on.

The tissue inflammation that accompanies the majority of traumatic and chronic injuries is essential to the healing process. But sometimes the body overresponds, and the resulting tissue swelling (edema) causes pain and delays healing. For soft tissue and musculoskeletal injuries and for postsurgical, post-traumatic chronic wounds, edema reduction must take place in order to accelerate healing and reduce associated pain.

PEMFs work to reduce pain by changing the local tissue environment from which the pain starts. Double-blind clinical studies have shown this with chronic wound repair, acute ankle sprains, and whiplash injuries. Similar studies have been done for neck pain.

A number of studies have also been done on the use of PEMFs for back pain. Just over 15% of the entire US population complains of chronic lower back pain. In the back pain studies, findings suggest that it is best to apply PEMFs on a consistent basis over an extended period of time to achieve the best results – and 95% of individuals found relief. Benefit was found for patients suffering from herniated discs, spondylosis, radiculopathy (spinal nerve compression), sciatica, spinal stenosis, and arthritis. People who have tried other modalities and failed to find relief will often find relief from PEMFs. Higher intensity PEMFs are often necessary in the more severe or chronic back pain situations.

In diabetic neuropathy, PEMFs used every day for at least 12 minutes improve pain, paresthesias and vibration sensation, and increased muscular strength in 85% of patients compared to controls.

Postherpetic neuralgia, which is often medically resistant to treatment and can be extraordinarily debilitating, has been found in research to benefit from PEMF therapy. Some patients respond in as little as 30 days, while others took upwards of 90 days or more to find relief. Often, this situation requires a fairly high intensity PEMF to provide the benefit. Used properly, PEMF therapy was effective in 80% of these individuals. In no cases was the pain made worse. Both local and whole body treatments could be used, although the individuals with local therapy appeared to benefit better, probably because local treatments tend to be of higher intensities.

Patients who suffered from headaches, and failed to respond to acupuncture and other therapies, who applied PEMFs for at least 20 minutes per day had at least a 50% reduction in the frequency or intensity of the headaches and a reduction in dependency on medication. In a somewhat surprising study, it appears that even PEMF therapy away from the head may be able to help migraines. PEMF therapy to the inner thigh, femoral artery area, can decrease headache activity. Short courses of therapy produced only about a 73% result in pain reduction versus a longer course of therapy, providing relief of about 90%. It is unknown what the combination of treating the head and peripherally would do, but may be expected to be even more effective.

Treatment Expectations

It’s easy to apply PEMFs to various parts of the body. Sometimes, the source of the pain can be treated directly (as with wounds, tissue damage, or fractures). Nerve signals conducting pain move from the source of the pain upstream to the brain (from a foot up through the nervous system all the way to the brain, for instance). Treatment can be applied anywhere along this path. Pain may be conducted downstream as well (a hip problem can cause knee pain, for instance.) For this reason, it’s ideal to treat the source of the pain, not necessarily where the pain is felt.

Sometimes the most effective pain management is to not only treat the source of the pain, but also apply treatments at the brain or along the spine. This combination allows for management of both the cause of the pain and at the same time controlling the pain signal traffic to the brain where the pain is ultimately recognized. It’s for this reason that we frequently suggest PEMF systems that will allow for whole body and local treatments simultaneously.

Chronic and higher levels of pain do alter EEG signals. An improvement in pain will reverse these EEG changes. Even if the goal of the treatment is simply to reduce the pain level without an expectation for reducing or eliminating the cause, research shows that applying PEMFs to the brain can cause a significant decrease in pain related changes in an EEG.

Some patients get complete pain relief after only a few treatments. Sometimes it can take up to 3 hours after treatment to achieve maximum pain relief. In rare cases, short courses of treatment can produce complete or partial pain relief for upwards of 4 months after treatment. Most people experience pain relief lasting for between 8 and 72 hours. This suggests that PEMFs stimulate increased energy in the tissues, which allows the body to fulfill its healing process. Treatments should be continued until the pain is under control, and ideally should continue beyond pain relief to ensure the injury has fully healed.

Unfortunately, the longer a person waits to start treatment with PEMFs, the more challenging it is to remove the cause, which is the primary objective of using PEMF therapies. When we use PEMF therapies we are attempting to heal the tissues that are the source of the pain signal. How long it takes to achieve this depends on the tissue and the level of damage. This is the most important aspect of use of PEMFs, that is, healing the tissue, not just “numbing and dumbing” the perception of pain.

It is also important to understand expectations in pain management. Even in the best hands, pain reduction follows a spectrum from complete elimination very rapidly to gradual reduction over extended periods of time, as the body heals itself. In many patients even a 25-30% reduction in pain is gratifying. It is not infrequent that we can actually achieve even higher levels of pain reduction.

Dr. Pawluk: "I have never been a proponent of saying that PEMFs alone should be used to treat cancer. The most humbling thing I can say about the treatment of cancer is that there are no perfect solutions. I would also say there is no such thing as a cure."

No such thing as a cure

Cancer is a chronic illness. Even though you have been declared “cured” by a doctor, usually defined as surviving beyond 5 years after diagnosis, there is almost lifelong vigilance and surveillance to be sure the cancer has not come back. Yes, you can effectively be in a state of long-term remission after an original diagnosis. Unfortunately, very many people do not live beyond 5 years or for that matter beyond 10 or even 15 years after their diagnosis. So, medicine today continues to search for answers in the war on cancer, to find a cure.

To me the real issue is not necessarily to find a cure, even though that is certainly a desirable goal, but rather to find ways of making our current therapies more effective to produce longer lasting results with a better quality of life. So often, current medical therapies are brutal, making people very ill, with often poor results nonetheless. Yes, certainly, in many cases the therapies do produce long-lasting benefits, but this is often uncertain and unpredictable.

Enhancing existing therapies with PEMFs

How can we make the results of medical therapies more certain and more predictable? PEMF therapies may be one approach to enhancing the value of existing therapies. The research available to support the use of PEMFs in the setting of cancer is still far from being of great certainty. Of course, the same can be said of most existing medical therapies. So, the question is, what is the harm? The harm comes largely from uncertainty. Conventional medical therapies still have a huge level of uncertainty as well, but they are sanctioned by society and the medical community. That makes them acceptable, even though they are very often ineffective. Because PEMFs are not as acceptable and because the science is not compelling to convince most doctors or most guideline and professional bodies, they are considered to be “unacceptable.” That being said, most doctors are completely ignorant about what PEMFs do biologically and physically. And, unfortunately, they are not even willing to explore these approaches. Likewise, most doctors are not even willing to approach and consider nutritional aspects of managing cancer. As a result, the consumer and the person suffering from cancer is largely left on his/her own.

Perhaps we can shed a little bit of light on this issue with the potential use of PEMFs with 2 recent studies that have been reported. One is in humans and one is in animals. Even conventional medical oncology sometimes resorts to relying on animal studies in the absence of any available human studies. Since you can’t always conclude that the results from animal studies can be applied to humans, drawing conclusions from animal studies needs to be done with some caution. However, I’m of the belief that individuals are responsible for their own health and will ultimately make their own best personal decisions.

Human Study

In the human study, done in China, magnetic fields were studied in the treatment of patients with advanced cancers of various kinds. Unfortunately, the entire article is written in Chinese, so it is not available in complete form to us. In this study, 137 patients with advanced malignant tumors were exposed to what amounts to a sinusoidal magnetic field of approximately 7 Hz, at 4000 Gauss, for 2 hours a day, for between 30 to 50 days. The clinical benefit was 60%. 28 patients had a complete response and 54 had a partial response. The median overall survival was 12 months. The 1-year, 2-year and 3-year survival rates were 47.0%, 11.8%, 3.4%, respectively. Complications were minimal. There were no treatment related deaths. Unfortunately, the survival rates in individuals with advanced cancers normally tend to be very poor. If life can be extended comfortably, this could be a very important benefit. So, the type of PEMF used in this study seems to have improved the quality of life of these individuals and probably in many cases prolonged survival. It is well known in the medical community that people with advanced cancers do very poorly. Medical therapies in these people are largely experimental and likewise have poor results.

While we don’t have commercially available PEMFs exactly the same as those used in this study, we do have available PEMF systems that are of a comparable intensity with a similar frequency. However, these devices are often very expensive and need to be used for extended periods of time, that is, 2 hours per day, on a daily basis, for extended periods of time, for months, if not the rest of the person’s life. It is not known if treatment extended beyond the 30 to 50 days used in this study would have produced even better results. Nonetheless, these results are very impressive, despite the limited length of time the treatment was used. Since often these treatments are applied in doctors’ offices, the treatment durations are probably too short. Even if available PEMFs are not exactly comparable to those used in this study, available devices have the potential to produce similar results. In the end, there is no harm, from what this study shows, in trying. In my clinical experience, patients using PEMFs on an ongoing basis, in the home setting, long-term, with or without conventional therapies, do better and are much more comfortable.

Han JQ, Liu Q, Sun CT, Yao J, Zhao B, Wang H. Efficacy and safety of low-frequency rotary magnetic fields in the treatment of patients with advanced malignant tumors. [Article in Chinese] Zhonghua Zhong Liu Za Zhi. 2013 Jun;35(6):468-71.

Animal Study

Another study looked at the use of pulsed electric fields in breast cancer in mice. Electric fields have both an electric and magnetic aspect to them. Very short pulse length pulsed electric fields, which didn’t create heating to destroy tissue, were used. The frequency was 4 hertz. Two weeks after treatment, the growth of treated tumors was inhibited by 79%. MRI was used to assess the physical changes in the tumors. Various growth factors, including the development of new blood vessels were strongly suppressed. As a control, normal skin was treated the same way as the tumors and showed no permanent changes. So, tumors react differently to PEMFs, in a positive fashion, than normal tissue. The results suggest short pulse electromagnetic fields may be able to inhibit human breast cancer development and suppress tumor blood vessel growth and may therefore serve as a novel therapy for breast cancer.

Mechanisms and therapeutic effectiveness of pulsed electromagnetic field therapy in oncology

Abstract

Cancer is one of the most common causes of death worldwide. Available treatments are associated with numerous side effects and only a low percentage of patients achieve complete remission. Therefore, there is a strong need for new therapeutic strategies. In this regard, pulsed electromagnetic field (PEMF) therapy presents several potential advantages including non‐invasiveness, safety, lack of toxicity for non‐cancerous cells, and the possibility of being combined with other available therapies. Indeed, PEMF stimulation has already been used in the context of various cancer types including skin, breast, prostate, hepatocellular, lung, ovarian, pancreatic, bladder, thyroid, and colon cancer in vitro and in vivo. At present, only limited application of PEMF in cancer has been documented in humans. In this article, we review the experimental and clinical evidence of PEMF therapy discussing future perspectives in its use in oncology.

For balance of article, go to: Cancer Med

Wu S, Wang Y, Guo J, Chen Q, Zhang J, Fang J. Nanosecond pulsed electric fields as a novel drug free therapy for breast cancer: An in vivo study. Cancer Lett. 2013 Oct 4. S0304-3835(13)00701-5.

Conclusion

These 2 studies show us that PEMFs have significant potential in helping patients with cancer, advanced or otherwise. Obviously, a great deal more research needs to be done to discover the best signals and approaches. It remains to the individual to determine whether using PEMFs along with their conventional approaches is something they might want to consider. As a physician, I can’t tell you whether this is your best option. I feel comfortable, however, knowing what I know about PEMFs and their benefits, that PEMFs can be a very important addition to whatever approach to cancer treatment an individual may choose. At this point, suffice it to say, nobody has a perfect solution.

Many cells in the body produce nitric oxide; however, its production by the vascular endothelium is particularly important in the regulation of blood flow. Abnormal production of nitric oxide, as occurs in different disease states, can adversely affect blood flow and other vascular functions. Nitric oxide is one of the few gaseous signalling molecules known and is additionally exceptional due to the fact that it is a radical gas. It is a key vertebrate biological messenger, playing a role in biological processes.
The March/April 2009 Aesthetic Surgery Journal published a study: “Evidence-Based Use of Pulsed Electromagnetic Field Therapy in Clinical Plastic Surgery” that summarizes the evolution in the understanding of the physiological effects of PEMF therapy on cells and tissues. Studies emerged suggesting that PEMF could modulate the production of growth factors and began to focus on enzyme systems with well-characterized calcium (Ca2+) dependence. By the mid-1990's, researchers were investigating the effects of electrical and PEMF signalling on intracellular Ca2+, specifically the binding of Ca2+ to calmodulin (CaM), using the knowledge that CaM dependent cascades were involved in tissue repair. The most recent studies of the PEMF transduction pathway have concentrated upon the Ca/CaM-dependent nitric oxide cascades, the growth factor cascades involved in tissue healing. It is within this system that the effectiveness of PEMF is now understood to function. PEMFs modulate the calcium binding kinetics to calmodulin. Calcium/calmodulin (Ca/CaM) then activates nitric oxide synthase (NOS) in several different isoforms. When injury occurs, large amounts of nitric oxide are produced by long-lived inducible nitric oxide synthase (iNOS). In this cascade, tissue levels of nitric oxide persist, and the prolonged presence of this free radical is pro-inflammatory, which accounts for the leaky blood vessels associated with pain and swelling. In contrast, the endothelial and neuronal nitric oxide synthase isoforms (respectively eNOS and nNOS) produce nitric oxide in short bursts that can immediately relax blood and lymph vessels. These short bursts of nitric oxide also lead to the production of cyclic guanosine monophosphate (cGMP), which in turn drives growth factor production. Interestingly, iNOS is not dependent on CaM, while the constitutive or cNOS (eNOS or nNOS) cascade is dependent on the binding of Ca/CaM.

Therapies that could accelerate Ca/CaM binding, therefore, should impact all phases of tissue repair, from initial pain and swelling to blood vessel growth, tissue regeneration, and remodeling. As shown in the diagram to the left, this mechanism has been proposed as a working model for PEMF therapeutics.

Nitric oxide, known as the endothelium-derived relaxing factor or EDRF, is biosynthesized endogenously from L-arginine, oxygen and NADPH by various nitric oxide synthase (NOS) enzymes. Dr. Richard E. Klabunde explains the synthesis of nitric oxide from the amino acid L-arginine by the enzymatic action of nitric oxide synthase (NOS). There are two endothelial forms of NOS: constitutive NOS (cNOS; type III) and inducible NOS (iNOS; type II). In addition to endothelial NOS, there is a neural NOS (nNOS; type I) that serves as a transmitter in the brain and in different nerves of the peripheral nervous system, such as non-adrenergic, non-cholinergic (NANC) autonomic nerves that innervate penile erectile tissues and other specialized tissues in the body to produce vasodilation.

The endothelium (inner lining) of blood vessels uses nitric oxide to signal the surrounding smooth muscle to relax, thus resulting in vasodilation and increasing blood flow. Under normal conditions, nitric oxide is continually being produced by cNOS in the blood vessels. The activity of cNOS is Ca/CaM-dependent and produces vascular relaxation when the endothelium is intact. The activation of the other isoform of endothelial NOS is iNOS and is not calcium-dependent. Under normal conditions, the activity of iNOS is very low. The activity of iNOS is stimulated during inflammation by bacterial endotoxins or cytokines such as tumor necrosis factor (TNF) and interleukins. During inflammation, the amount of nitric oxide produced by iNOS may be a 1,000-fold greater than that produced by cNOS.

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When nitric oxide forms, it is highly reactive (having a lifetime of a few seconds) yet diffuses freely across membranes, primarily because superoxide anion has a high affinity for nitric oxide. Superoxide and its products can have vasoactive activities in addition to their tissue damaging effects; superoxide anion has another property that makes it very important in cardiovascular pathology and pathophysiology. Superoxide anion, with its unpaired electron, very rapidly binds to nitric oxide, which also has an unpaired electron. Because nitric oxide is a very important vasodilator substance, the reaction between superoxide and nitric oxide effectively scavenges nitric oxide thereby reducing its bioavailability. This leads to vasoconstriction, increased platelet endothelial cell adhesion, platelet aggregation and thrombus formation, increased leukocyte-endothelial cell adhesion, and morphologic changes in blood vessels, such as cell proliferation. Nitric oxide also avidly binds to hemoglobin (in red blood cells) and the enzyme guanylyl cyclase, which is found in vascular smooth muscle cells and most other cells of the body.

When nitric oxide is formed by vascular endothelium, it rapidly diffuses into the blood where it binds to hemoglobin and is subsequently broken down. It also diffuses into the vascular smooth muscle cells adjacent to the endothelium where it binds to and activates guanylyl cyclase. This enzyme catalyzes the 16 dephosphorylation of GTP to cGMP, which serves as a second messenger for many important cellular functions, particularly for signalling smooth muscle relaxation.

Because of the central role of cGMP in nitric oxide mediated vasodilation, drugs (e.g., Viagra®) that inhibit the breakdown of cGMP (cGMP-dependent phosphodiesterase inhibitors) are used to enhance nitric oxide mediated vasodilation, particularly in penile erectile tissue in the treatment of erectile dysfunction. Increased cGMP also has an important anti-platelet, anti-aggregatory effect.

(Cardiovascular Physiology Concepts by Richard E. Klabunde, PhD, published in 2005, www.cvphysiology.com updated in 2008)

In the discussion in a study entitled “Pulsed Electro-Magnetic Fields Affect Local Factor Production and Connexin 43 Protein Expression in MLO-Y4 Osteocyte-like cells and ROS17/2.8 Osteoblasts like Cells”, Lohman C.H. et al. state: “This study shows that PEMF affects gap junction formation, local production of nitric oxide, TGF-B1 and PGE2. Osteocytes potentially regulate the bone remodeling through signalling molecules like nitric oxide and PGE2 but also through the local release of TGF-B1.”

The above studies demonstrate that PEMF therapy affects many transduction pathways and, in particular, the Ca/CaM-dependent nitric oxide cascades. The CaM dependent cascades are involved in tissue repair. By modulating the calcium-binding kinetics to calmodulin (intracellular Ca2+/CaM), the endothelial and neuronal nitric oxide synthase isoforms (respectively eNOS and nNOS) produce nitric oxide in short bursts that can immediately relax blood and lymph vessels. As a highly reactive gaseous molecule, nitric oxide makes an ideal transient paracrine (between adjacent cells) and autocrine (within a single cell) signalling molecule that has direct and indirect vascular action, including the following:

• Direct vasodilation (flow dependent and receptor mediated)

• Indirect vasodilation by inhibiting vasoconstrictor influences

• Anti-thrombotic effect - inhibits platelet adhesion to the vascular endothelium

• Anti-inflammatory effect - inhibits leukocyte adhesion to vascular endothelium; scavenges superoxide anion

• Anti-proliferative effect - inhibits smooth muscle hyperplasia.

By increasing the production of nitric oxide when its production is impaired or its bioavailability is reduced, PEMF therapy can successfully help improve conditions and diseases, including those associated with vasoconstriction (e.g., coronary vasospasm, elevated systemic vascular resistance, hypertension), thrombosis due to platelet aggregation and adhesion to vascular endothelium, inflammation due to upregulation of leukocyte and endothelial adhesion molecules, vascular hypertrophy and stenosis, and consequently hypertension, obesity, dyslipidemias (particularly hypercholesterolemia and hypertriglyceridemia), diabetes (both type I and II), heart failure, atherosclerosis, tissue repair and aging.

A recent study on postoperative recovery led to the conclusion that PEMF therapy significantly reduced postoperative pain and narcotic use in the immediate postoperative period by means of a PEMF effect on nitric oxide signalling, which could impact the speed and quality of wound repair (Rohde et al., June 2009, Plastic & Reconstructive Surgery, Columbia, NY).

Nitric oxide is one of the few gaseous signalling molecules and a key vertebrate biological messenger that plays a role in a variety of biological processes. Recent studies uncover how PEMF therapy stimulates and rebalances many of these processes. The mechanisms by which nitric oxide has been demonstrated to affect the biology of living cells are numerous and include oxidation of iron-containing proteins such as ribonucleotide reductase and aconitase, activation of the soluble guanylate cyclase, a single transmembrane protein, ADP (adenosine diphosphate) ribosylation of proteins, a process of protein modification involved in cell signalling and the control of many cell processes including DNA repair, protein sulfhydryl group nitrosylation, another protein modification process, and iron regulatory factor activation. Having a lifetime of a few seconds, nitric oxide is highly reactive and diffuses freely across cell membranes. These attributes make nitric oxide an ideal transient paracrine (between adjacent cells) and autocrine (within a single cell) signalling molecule. PEMF therapy is proven to effectively stimulate paracrine and autocrine communication.

Nitric oxide is also generated by phagocytes (monocytes, macrophages, and neutrophils) and, as such, is part of the human immune response. Nitric oxide has been demonstrated to activate NF-kB in peripheral blood mononuclear cells, an important protein complex that controls the transcription of DNA and a transcription factor in iNOS gene expression in response to inflammation.

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The arterial and venal blood vessels are intimately associated with the lymphatic system. As the blood and lymphatic vessels bring oxygen and nutrients to the cells and remove their waste products, they are nourishing and detoxifying the cells, tissues and body. As PEMF therapy mechanically stimulates blood vessels and blood flow, the blood vessels pump blood and oxygen into the cells. Simultaneously, PEMF therapy
mechanically stimulates the lymphatic vessels and waste products are hauled away from the cells more efficiently. PEMF therapy supports immune health by mechanically stimulating lymphatic drainage and blood flow.

In June 2004, The Faseb Journal states: “PEMF therapy has been shown to be clinically beneficial in repairing bones and other tissues, but the mechanism in action is unclear. The results of a study done at the New York University Medical Center (Institute of Reconstructive Plastic Surgery, NY, NY, USA) demonstrates that electromagnetic fields increased angiogenesis, the growth of new blood vessels, in vitro and in vivo through the endothelial release of FGF-2, fibroblast growth factor-2. The delivery of PEMF therapy in low doses identical to that currently in clinical use significantly increased endothelial cell proliferation and tubulization, which are both important processes for vessel formation. The ability of PEMF to increase cell proliferation was unique to endothelial cells, which seemed to be the primary target of PEMF stimulation, releasing a protein in a paracrine fashion (or signalling to adjacent cells and other types of cells) to induce changes in neighboring cells and tissues.

Since direct stimulation did not produce significant changes in osteoblast proliferation, the ability of PEMF therapy to enhance the healing of complicated fractures is likely the result of increased vascularity rather than a direct effect on osteogenesis as previously believed. The coordinated release of FGF-2 suggests that PEMF therapy may facilitate healing by augmenting the interaction between osteogenesis and blood vessel growth. As such, PEMF therapy may offer distinct advantages as a non-invasive and targeted modality that is able to release several growth factors to achieve therapeutic angiogenesis.

The fibroblast and endothelial cells are made to go embryonic due to drastic changes in ionic concentrations in the cells’ cytoplasm and therefore the cells’ nuclei. These ionic concentrations react with the cell DNA opening up some gene sets and closing down others. It is apparently the rapid onset of a strong-pulsed electric field generated by the pulsed magnetic field, which causes some cell ion gate types to open and be force fed ions by the same electric field.” As demonstrated in the following study entitled: “Impulse magnetic-field therapy for erectile dysfunction: a double-blind, placebo-controlled study,” increased microcirculation leads to improvements in macrocirculation. The study by Pelka et al. (Universitat der Bundeswehr Munchen, Munich, Germany) assessed the efficacy of three weeks of PEMF therapy for erectile dysfunction. In the active treatment group, all efficacy endpoints were significantly improved at study end with 80% reporting increases in intensity and duration of erection, frequency of genital warmth, and general well-being. In contrast, only 30% of the placebo group noted some improvement in their sexual activity; 70% had no change. No side effects were reported. PEMF therapy has proven efficacious at increasing the flow of ions and nutrients into the cells and at stimulating blood and interstitial fluid circulation. With increased lymphatic drainage and blood flow, cells receive more oxygen and nutrients, and eliminate toxins faster. Cells are therefore able to function better and tissues repair themselves more efficiently. Through the same processes, vital organs such as the liver, kidneys and colon are able to rid themselves of impurities thus detoxifying the body and allowing better organ functionality.

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As early as 1940, it was suggested that magnetic fields affect the TMP and the flow of ions in and out of the cells and might therefore influence cellular membrane permeability. It has since been established that magnetic fields can influence ATP (Adenosine Tri-phosphate) production; increase the supply of oxygen and nutrients via the vascular and lymphatic systems; improve the removal of waste via the lymphatic system; and help rebalance the distribution of ions across the cell membrane. Healthy cells in tissue have a voltage difference between the inner and outer membrane referred to as the membrane resting potential that ranges from -70 to -80 mV. This causes a steady flow of ions through its voltage-dependant ion channels. In a damaged cell, the potential is raised and an increased sodium inflow occurs. As a result, interstitial fluid is attracted to the inner cellular space, resulting in swelling and edema.

The application of PEMF to damaged cells accelerates the reestablishment of normal potentials (Sanseverino, 1999) increasing the rate of healing and reducing swelling. In biology, depolarization is a change in a cell's TMP, making it more positive or less negative. In neurons and some other cells, a large enough depolarization may result in an action potential. Hyperpolarization is the opposite of depolarization and inhibits the rise of an action potential. If a cell has a resting potential of -70mV and the membrane potential rises to -50mV, then the cell has been depolarized. Depolarization is often caused by influx of cations, e.g., Na+ through Na+ channels, or Ca2+ through Ca2+ channels. On the other hand, efflux of K+ through K+ channels inhibits depolarization, as does influx of Cl- (an anion) through Cl- channels. If a cell has K+ or Cl- currents at rest, then inhibition of those currents will also result in a depolarization. As the magnetic field created fluctuates, it induces an electron flow or a current in one direction through the living tissue. As electrons always flow from a negative (cathode) to a positive (anode) potential, when the magnetic field vanishes, the direction of the electron flow is reversed. Therefore such induced polarized currents stimulate the exchange of ions across the cell membrane. As the electromagnetic field pulses temporarily hyperpolarize and depolarize the membrane, the ion channels open and close allowing a more efficient ion exchange, as with the sodium-potassium (Na+, K+) pump, thus increasing cellular oxygenation and nutrition as sodium export stimulates several secondary active transporters.

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A study entitled “Modulation of collagen production in cultured fibroblasts by a low-frequency pulsed magnetic field” by Murray et al. (Biochim Biophys Acta) shows that the total protein synthesis was increased in confluent cells treated with a pulsed magnetic field for the last 24 h of culture as well as in cells treated for a total of 6 days. However, in 6-day-treated cultures, collagen accumulation was specifically enhanced as compared to total protein, whereas after short-term exposure, collagen production was increased only to the same extent as total protein. These results indicate that a pulsed magnetic field can specifically increase collagen production, the major differentiated function of fibroblasts, possibly by altering cyclic AMP metabolism.
PEMF therapy successfully increases membrane flexibility by increasing the synthesis of collagen, a crucial protein that supports membrane elasticity, within the fibroblasts. In doing so, PEMF therapy increases tissue and muscle flexibility thereby expanding the user’s range of motion.

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DNA synthesis is linked to pulsed, low-intensity magnetic fields (Liboff et al., 1984; Rosch et al., 2004). Proteins are conductors of electricity. When exposed to strong fields, proteins are subject to electrophoresis. The Ribonucleic Acid (“RNA”) messengers that are synthesized from a Deoxyribonucleic Acid (“DNA”) template during transcription mediate the transfer of genetic information from the cell nucleus to ribosomes in the cytoplasm and serve as a template for protein synthesis.
Since RNA mechanically influences the DNA and encoded proteins influence RNA, the flow of information to and from genes may be linked to changing magnetic fields (Einstein, 1977; Goodman et al., 1983).
Since magnetic fields interact with changing electrical charges and recent studies (Dandliker et al., 1997) show that DNA conducts electrons along the stacked bases within the DNA double helix, electromagnetic fields may initiate transcription of the precursor mRNA by accelerating electrons moving within the DNA helix (McLean et al., 2003).

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The many intra- and intercellular processes and activity stimulated by PEMF therapy lead to faster cellular and tissue regeneration. This fact is shown by the results of many studies on a variety of tissues, including bones, spine, cartilage, intestines, blood vessels, nerves, brain, and muscles.
In December 2004, the Swiss Medical Tribune stated that PEMF therapy provided: “improvement of blood circulation, relief from pain, improvement of bone healing and the stimulation of nerve cells. Not only is the PEMF therapy effective in disease condition: it is an excellent means of preventing stress, assisting regeneration and recovery after sports exertion ... Through metabolic activation and blood circulation more nutrients and oxygen are available to muscle cells, less damage is experienced, and efficiency is improved.”

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Several factors may contribute to inflammation including injury, tissue damage, a poor localized circulation with the formation of edema. Inflammation causes pain. Swelling and bruising is an inflammation and discoloration of soft tissue caused by an impact injury or trauma. It can also result from surgery.

Tissue cells are inherently like tiny, electrically charged machines. When a cell is traumatized, the cell’s electrical charge is diminished; this causes normal cell functions and operations to shut down. Cells that are scarred or fibrotic with adhesions have a TMP charge of approximately -15 mV, degenerative or immune-compromised cells average -30 mV, both low TMPs. With the raised TMP, the body releases chemical signals that cause inflammation swelling and bruising resulting in pain and inhibiting the cell communication pathways necessary for healing to begin. Numerous clinical studies have demonstrated that PEMF therapy has been successful in reducing inflammation. PEMF therapy treats the cellular source of swelling by recharging the cells with a mild electromagnetic current. This stops the release of pain and inflammatory mediators, reduces inflammatory fluids and allows an increase in blood flow, therefore increased oxygen intake, to help the cells heal faster with less swelling, pain and bruising.

The effect of wound healing electromagnetic fields on inflammatory cytokine gene expression in rats was studied by Jasti et al. in 2001 who state: “Inflammation is characterized by massive infiltration of T lymphocytes, neutrophils and macrophages into the damaged tissue. These inflammatory cells produce a variety of cytokines, which are the cellular regulators of inflammation.” In a study on Low frequency PEMF-a viable alternative therapy for arthritis published in 2009, Ganesan et al. (Department of Biotechnology, Chennai, India) declare: “PEMF for arthritis cure has conclusively shown that PEMF not only alleviates the pain in the arthritis condition but it also affords chondroprotection, exerts anti-inflammatory action and helps in bone remodeling, and this could be developed as a viable alternative for arthritis therapy.”
Damaged cells are also energy deficient; thus they have low oxygen levels, are high in sodium levels, and have a faltered electrochemical gradient. By inducing a mild electrical current into damaged cells, PEMF therapy slows or stops the release of pain and inflammatory mediators, increases blood flow, and reestablishes normal cell interaction. PEMF stimulates and restores the electrochemical gradient, the cell starts pumping sodium out, potassium enters the cell, the swelling resolves, oxygen starts flowing back in, and pain improves. Due to the density of the cell tissue, change requires stronger pulsed magnetic fields to be able to restore the healthy TMP to its optimal -70 mV. 
Several factors influence tissue inflammation and the processes by which PEMF therapy operates to reduce inflammation include complex mechanical, chemical, electrical and magnetic processes along with increased circulation, oxygenation and cellular activity. With reduced inflammation, pain decreases and faster tissue healing occurs.

The Elsevier Journal of Biomedicine & Pharmacotherapy (2005) publication:
Effects of pulsed electromagnetic fields on articular hyaline cartilage: review of experimental and clinical studies by M. Fini. G. Giavaresi, A. Carpi, A. Nicolini, S. Setti, R. Giardino (Experimental Surgery Department, Research Institute Codivilla-Putti-Rizzoli, Orthopedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy, Department of Reproduction and Aging, University of Pisa, Pisa, Italy, Department of Internal Medicine, University of Pisa, Pisa, Italy, igea SRL, Carpi, Modena, Italy) states:  “Newer concepts on osteoarthritis (OA) pathogenesis are related to the role of inflammation that is now well accepted as a feature in OA. Synovitis is common in advanced age involving infiltration of activated B cells and T lymphocytes and the expression of pro-inflammatory cytokines and chemokines is observed in patients with OA in the joints of OA patients and animals. With regards to this, IL-1, TNFæ, IL-6, IL-18, IL-17 and leukemia inhibitory factor (LIF) appear to be more relevant to the disease. These catabolic cytokines lead to the destruction of joint tissue by stimulating cartilage PG resorption, MMP synthesis and nitric oxide production. The purine base adenosine has been shown to limit inflammation through receptor (i.e. A2a)-mediated regulation and suppressing pro-inflammatory cytokines synthesis (TNFæ, IL-8, IL-2, IL-6). Adenosine has been reported to reduce inflammation and swelling in several in vivo models of inflammation and also in adjuvant-induced and septic arthritis in animals. So, a therapy combining an anabolic effect on chondrocytes, a catabolic cytokine blockage, a stimulatory effect on anabolic cytokine production and one that is able to counteract the inflammatory process would be extremely useful for OA treatment. In vitro studies showed that chondrocyte proliferation and matrix synthesis are significantly enhanced by PEMF stimulation, when investigating also the conditions affecting the PEMF action. A part the importance of physical properties of the fields used (intensity, frequency, impulse amplitude, etc.) and the exposure time, the availability of growth factors, environmental constrictions and the maintenance of the native-cell matrix interactions seem to be fundamental in driving the PEMF-induced stimulation. In particular, the interaction between cell membrane receptors and mitogens seems to be one of the molecular events affected by PEMFs. These data are in agreement with results of in vivo studies with a decalcified bone matrixinduced endochondral ossification model and showing that the stimulation of TGF-1 may be a mechanism through which PEMFs affect complex tissue behavior and through which the effects of PEMFs may be amplified. In addition, PEMFs are reported to up-regulate mRNA levels for, and protein synthesis of, growth factors resulting in the synthesis of ECM proteins and acceleration of tissue repair. As far as inflammation is concerned, IL-1 is present in high amounts in OA cartilage and is considered to be one of the main catabolic factors involved in the cartilage matrix degradation associated with OA. As previously mentioned, PEMFs in vitro were able to counterbalance efficiently the cartilage degradation induced by the catabolic cytokine”.

As cited above, many studies lead to the conclusion that PEMF therapy is effective and reduces inflammation.

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In a study on Chronic Fatigue Syndrome and Electro-medicine, Thomas Valone, Ph.D, showed that damaged or diseased cells present an abnormally low TMP, about 80% lower than healthy cells. This signifies a greatly reduced metabolism and, in particular, impairment of the electrogenic Na+/ K+ pump activity associated with reduced ATP (Adenosine Tri-Phosphate) production.

The Na+/ K+ pump within the membrane forces a ratio of 3Na+ ions out of the cell for every 2K+ ions pumped in for proper metabolism. The sodium-potassium pump uses energy derived from ATP to exchange sodium for potassium ions across the membrane. An impaired Na+/ K+ pump results in edema (cellular water accumulation) and a tendency toward fermentation, a condition known to be favorable toward cancerous activity. French researcher Louis C. Kervran demonstrated that Sodium plus Oxygen plus Energy (ex: magnetic) nuclearly transmutes into Potassium as follows: 11 Na23 + 8 O16 + energy = 19 K39 This nuclear process is accomplished with low heat, in a low rate of thermal decomposition, which is the most important and commonly occurring phenomenon of Nuclear Fusion in Biology. As a result, utilization of oxygen in the cells increases, and the body increases production of its own energy supplier (ATP). The organism becomes more stable and efficient; toxins and waste products are more rapidly broken down. The body's natural regulatory mechanisms are reinforced and healing processes accelerated. Free radical proliferation is linked to pathological changes that cause cellular malfunction or mutation (i.e., cancer) as well as protein degradation. Free radicals also play a large role in causing damage to all cells of the body but particularly that of the immune system. According to studies, free radicals also “deplete cellular energy” by interfering with mitochondrial function and contribute to a shortened lifespan. Cellular energy generation in the mitochondria is both a key source and a key target of oxidative stress in the cells. Seeking an electron to complete the radical, free radicals cause chain reactions as electrons are ripped from molecules, creating another free radical. Antioxidants such as vitamin A, vitamin E, selenium and coenzyme Q10 supply free electrons and are usually prescribed to provide limited relief in counteracting free radical ravages. However, electronic antioxidants produced by PEMF therapy can also satisfy and terminate free radicals by abundantly supplying the key ingredient usually found only in encapsulated antioxidant supplements…the electron (Thomas Valone, Ph.D. on Bioelectromagnetics, 2003). On the biophysical level, as PEMF therapy increases the circulation of electrons across the cell membrane, a parallel phenomenon seems to occur, the acceleration of ATP synthesis and of other aspects of the cellular biochemical anabolism. As electrons are drawn to the inner membrane, they increase the ionic charge inside the cell and, thus, the TMP.

In 1976, Nobel Prize winner Dr. Albert Szent-Gyorgi established that structured proteins behave like diodes or rectifiers. A diode passes electricity in only one direction. He proposed that cell membranes can rectify an induced voltage and this rectifying property of cell membranes can cause changes in the ion concentration of the inner and outer surfaces of the cell membrane in such a way as to increase the TMP and effectively stimulate the activity of the Na+/ K+ pump. Cell health is directly affected by the health of the Na+/ K+ pump, which is directly proportional to the TMP. Based on these biophysical principles, an endogenous high voltage EMF potential of sufficient strength will theoretically stimulate the TMP, normal cell metabolism, the sodium pump, ATP production and healing. Electro-medicine appears to connect to and recharge the storage battery of the TMP. Dr. Albert Szent-Gyorgi summarizes: “TMP is proportional to the activity of this pump and thus to the rate of healing.” Furthermore, “increases in the TMP have also been found to increase the uptake of amino acids.” This is important, as increasing the supply of nutrients is also an effective aid to cell repair. This is particularly true in trauma where circulation has been impaired by crushed or severed blood vessels, or by the inflammation and swelling that compresses capillaries, blocking the flow to both the injured and uninjured cells.

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Many studies have demonstrated the positive effects of PEMF therapy on patients with pain, even as opposed to receiving traditional treatment as well as against a placebo group getting no treatment. Some studies focused on the rapid, short-term relief while others demonstrate the long-term effects. The effectiveness of PEMF therapy has been demonstrated in a wide variety of painful conditions. A study entitled: ”Double-blind, placebo-controlled study on the treatment of migraine with PEMF,” Sherman et al. (Orthopedic Surgery Service, Madigan Army Medical Center, Tacoma, WA, USA) evaluated 42 subjects who met the International Headache Society's criteria. During the first month of follow-up with exposure to PEMF, 73% of those receiving actual exposure reported decreased headaches with 45% a substantial decrease and 14% an excellent decrease. Ten of the 22 subjects who had received actual exposure received two additional weeks of actual exposure after their initial month. All showed decreased headache activity with 50% a substantial decrease and 38% an excellent decrease. Sherman R. et al. concluded that exposure to PEMF for at least 3 weeks is an effective, short-term intervention for migraine. Jorgensen et al. (1994 International Pain Research Institute, Los Angeles, CA, USA) studied the effects of PEMF on tissue trauma and concluded: “Unusually effective and long-lasting relief of pelvic pain of gynecological origin has been obtained consistently by short exposures of affected areas to the application of a magnetic induction device. Treatments are short, fasting-acting, economical, and in many instances have obviated surgery.” Patients with typical cases such as dysmenorrhea, endometriosis, ruptured ovarian cyst, acute lower urinary tract infection, postoperative hematoma, and persistent dyspareunia who had not received analgesic medication were treated with pulsed magnetic field treatment and evaluated. The results showed that 90% of the patients experienced marked, even dramatic relief, while 10% reported less than complete pain.

Hedén P., Pilla AA. (2008 Department of Plastic Surgery, Stockholm, Sweden) studied the Effects of pulsed electromagnetic fields on postoperative pain in breast augmentation patients. She notes: “Postoperative pain may be experienced after breast augmentation surgery despite advances in surgical techniques, which minimize trauma. The use of pharmacological analgesics and narcotics may have undesirable side effects that can add to patient morbidity.” This study was undertaken to determine if PEMF could provide pain control after breast augmentation. Postoperative pain data were obtained and showed that pain had decreased in the treated patient group by nearly a factor of three times that for the control group. Patient use of postoperative pain medication correspondingly also decreased nearly three times faster in the active versus the sham groups.  Hedén P. and Pilla AA. concluded: “Pulsed electro-magnetic field therapy, adjunctive to standard of care, can provide pain control with a noninvasive modality and reduce morbidity due to pain medication after breast augmentation surgery.” The Clinical Rheumatology Journal, volume 26-1, January 2007 (Springer London) reported on the Effectiveness of PEMF therapy in lateral epicondylitis by Kaan Uzunca, Murat Birtane and Nurettin Ta’tekin (Trakya University Medical Faculty Physical Medicine and Rehabilitation Department, Edirne, Turkey): “We aimed to investigate the efficacy of PEMF in lateral epicondylitis comparing the modality with sham PEMF and local steroid injection.” Patients with lateral epicondylitis were randomly and equally distributed into three groups. One group received PEMF, another sham PEMF, and the third group a corticosteroid + anesthetic agent injection. Pain levels during rest, activity, nighttime, resisted wrist dorsiflexion, and forearm supination were investigated with visual analog scale (VAS). Pain threshold on elbow was determined with an algometer. All patients were evaluated before treatment, at the third week and the third month. Pain levels were significantly lower in the group treated with the local steroid at the third week but the group treated with PEMF had lower pain during rest, activity and nighttime than the group receiving steroids at the third month. Lau (School of Medicine, Loma University, USA) reported on the application of PEMF therapy to the problems of diabetic retinopathy. Patients were treated over a 6-week period, 76% of the patients had a reduction in the level of numbness and tingling. All patients had a reduction of pain, with 66% reporting that they were totally pain free. Sanseverino et al. (1999, Universita di Bologna, Italy) studied the therapeutic effects of PEMF on joint diseases in chronic and acute conditions of more than 3,000 patients over a period of 11 years. Follow-up was pursued as constantly as possible. Pain control, recovery of joint mobility and maintenance of the improved conditions represented the parameters for judging the results as good or poor. The chi-square test was applied in order to evaluate the probability that the results are not casual. A general average value of 78.8% of good results and 21.2% of poor results was obtained. The high percentage of good results obtained and the absolute absence of both negative results and undesired side effects led to the conclusion that PEMF treatment is an excellent physical therapy in cases of joint diseases. A hypothesis is advanced that external magnetic fields influence transmembrane ionic activity. In a 2008 randomized clinical trial to determine if a physics-based combination of simultaneous static and time-varying dynamic magnetic field stimulation to the wrist can reduce subjective neuropathic pain and influence objective electrophysiologic parameters of patients with carpal tunnel syndrome, Weintraub et al. report: ”PEMF exposure in refractory carpal tunnel syndrome provides statistically significant short- and long-term pain reduction and mild improvement in objective neuronal functions.”  In a 2009 evidence-based analysis on the use of PEMF therapy in clinical plastic surgery, Strauch et al. (Einstein College of Medicine, Bronx, NY, USA) explain: “Our objective was to review the major scientific breakthroughs and current understanding of the mechanism of action of PEMF therapy.” The results show that PEMF therapy has been used successfully in the management of postsurgical pain and edema, the treatment of chronic wounds, and in facilitating vasodilation and angiogenesis … with no known side effects for the adjunctive, noninvasive, non-pharmacologic management of postoperative pain and edema … Given the recent rapid advances in development of PEMF devices what has been of most significance to the plastic surgeon is the laboratory and clinical confirmation of decreased pain and swelling following injury or surgery.” Because of the interaction between the biological systems and natural magnetic fields, PEMFs can affect pain perception in many different ways.

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PEMF therapy has shown to be effective at reducing pain both in the short-term and in the long-term. The ways by which PEMF therapy relieves pain include pain blocking, decreased inflammation, increased cellular flexibility, increased blood and fluids circulation, and increased tissue oxygenation. The transmembrane potential (TMP) is the voltage difference (or electrical potential difference) between the interior and exterior of a cell. An electrochemical gradient results from a spatial variation of both an electrical potential and a chemical concentration across a membrane. Both components are often due to ion gradients, particularly proton gradients, and the result is a type of potential energy available for cellular metabolism.

This can be calculated as a thermodynamic measure, an electrochemical potential that combines the concepts of energy stored in the form of chemical potential, which accounts for an ion's concentration gradient across a cellular membrane, and electrostatics, which accounts for an ion's tendency to move relative to the TMP.

Differences in concentration of ions on opposite sides of a cellular membrane produce the TMP. The largest contributions usually come from sodium (Na+) and chloride (Cl-) ions, which have high concentrations in the extracellular region, and potassium (K+) ions, which along with large protein anions have high concentrations in the intracellular region. Opening or closing of ion channels for ion transport (Na+, Ca2+, K+, Cl-) in and out of cells at one point in the membrane produces a local change in the TMP, which causes an electric current to flow rapidly to other points in the membrane that occurs with the movement of electrons.
 

In electrically excitable cells such as neurons, the TMP is used for transmitting signals from one part of a cell to another. In non-excitable cells and in excitable cells in their baseline states, the TMP is held at a relatively stable value, called the resting potential. For neurons, typical values of the resting potential range from -70 to -80 mV (mill Volts); that is, the interior of a cell has a negative baseline voltage. Each axon has its characteristic resting potential voltage, and in each case, the inside is negative relative to the outside.

Opening and closing of ion channels can induce a departure from the resting potential, called a depolarization if the interior voltage rises (say from -70 mV to -65 mV) or a hyper polarization if the interior voltage becomes more negative (for example, changing from -70 mV to -80 mV). In excitable cells, a sufficiently large depolarization can evoke a short-lasting, all-or-nothing event called an action potential in which the TMP very rapidly undergoes a large change, often reversing its sign. Special types of voltage-dependent ion channels that generate action potentials but remain closed at the resting TMP can be induced to open by a small depolarization.

In a lecture on Pain Reduction, Dr. D. Laycock, Ph.D. Med. Eng. MBES, MIPEM, B.Ed., inspired by the works of Adams et al. (1997) explains how PEMF therapy affects pain transmission at the levels of the neurons. “It is necessary to understand the mechanism of pain transmission to understand how pain blocking can take place with PEMF therapy.  Pain is transmitted along the nerve cells by an electric signal. This signal encounters synaptic gaps at intervals.  The pain signals are transmitted along nerve cells to pre-synaptic terminals. At these terminals, channels in the cell alter due to a movement of ions. The TMP changes, causing the release of a chemical transmitter from a synaptic vesicle contained within the membrane. The pain signal is chemically transferred across the synaptic gap to chemical receptors on the post-synaptic nerve cell. This all happens in about 1/2000th of a second, as the synaptic gap is only 20 to 50 nm (nanometers) wide. As the pain signal, in chemical form, approaches the post-synaptic cell, the membrane changes and the signal is transferred. During quiescent times, cells possess a small charge of about 70mV between the inner and outer membranes.  When a pain signal arrives, it temporarily depolarizes the nociceptive cell and raises the cell TMP to +30mV.  This increase is sufficient to open channels in the cell membrane allowing the exchange of the sodium (Na+) and potassium (K+) ions.”

When an action potential begins, the channels that allow crossing of the Na+ ions open up. When the Na+ channels open, the depolarization occurs. The Na+ rushes in because both of the greater concentration of Na+ on the outside and the more positive voltage on the outside of the axon. The flow of positively charged ions into the axon leads the axon to become positively charged relative to the outside. With each positively charged Na+ ion that enters the axon, another positive charge is inside and one fewer negative charge is outside the axon. Thus, together the inside grows increasingly more positive and the relative concentration of Na+ inside the axon relative to outside the axon grows greater. This initial phase of the action potential is called the depolarization phase. Now as the depolarization phase progresses, the status of the two physical forces that have been discussed changes.

At the end of the depolarization phase, the voltage of the inside of the axon relative to the outside is positive, and the relative concentration of Na+ ions inside the axon is greater than at the beginning of the action potential. The inside of the axon becomes sufficiently positive, about +30 mV as an average value, the Na+ channels close. This closing of the Na+ channels will greatly limit the ability of Na+ ions to enter the axon. In addition to the Na+ channels closing, the potassium (K+) channels open. Now K+ ions are free to cross the channels and now leave the axon due both to the greater concentration of K+ on the inside and the reversed voltage levels. The action potential is therefore not the movement of voltage or ions but the flow of these ion channels opening and closing moving down the axon.  

This movement of the ion channels explains why the action potential is transferred slowly relative to the normal flow of electricity. The normal flow of electricity is the flow of electrons in an electrical field, and the electrons travel at the speed of light while the movement of these ion channels opening and closing is considerably slower. These are mechanical movements that cannot move as fast as the speed of light. The exchange of the sodium (NA+) and potassium (K+) ions then triggers exocytosis of neurotransmitters via synaptic vesicles.  These neurotransmitters diffuse into the synaptic gap. Once this process has occurred, the cell depolarizes back to its previous level of 70mV. Research by Warnke established that the application of PEMF therapy has an effect on the quiescent potential of the neuronal synaptic membrane (Warnke, 1983; Warnke et al. 1997).  It suggested that the effect is to lower the potential to a hyperpolarized level of 90mV.  When a pain signal is received, the TMP has to be raised again in order to fire an action potential via neurotransmitters, but it only achieves to raise the cell TMP to an approximate +10mV. This potential is well below the threshold of +30mV necessary to release the relevant neurotransmitters into the synaptic cleft, and the pain signal is effectively blocked.

By causing a hyperpolarized state at the neuronal membrane, PEMF therapy effectively blocks pain as it prevents the threshold necessary to transmit the pain signal to be reached. In the same way, PEMF therapy effectively increases the TMP of damaged cells thus allowing them to recover their functions, heal and improve their metabolism. The Encyclopedia of Nursing and Allied Health define the use of “Electrotherapy” for pain relief as effective to manage both acute and chronic pain. In the Gate Model of pain, the neural fibers that carry the signal for pain and those that carry the signal for proprioception (body and limb position) are mediated through the same central junction. Because signal transmission along pain fibers is slower than transmission along proprioception fibers, the Gate Model suggests that intense stimulation of proprioception fibers can block the slower-moving pain signals.

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For most individuals, aside from the multiple benefits of the therapy, one of the most relevant effects of PEMF therapy is the improvement of painful conditions regardless of their origin. Pain mechanisms are complex and have peripheral and central nervous system aspects.

During the last 100 years, theories of pain mechanism have evolved from specificity and summation models to the popular Gate Control Theory. The latter pain theory, proposed by Melzack/Wall/Casey (Wall and Melzack, 1989), has become the most important development in the field of pain management. Pain perception is no longer a straightforward afferent transmission of pain signal.

In biology, signal transduction is a mechanism that converts a mechanical or chemical stimulus to a cell into a specific cellular response. Signal transduction starts with a signal to a receptor, and ends with a change in cell behaviour.

Transmembrane receptors move across the cell membrane with half of the receptor outside the cell and the other half inside the cell. The signal, such as a chemical signal, binds to the outer half of the receptor, which changes its shape and conveys another signal inside the cell. Sometimes there is a long cascade of signals, one after the other. Eventually, the signal creates a change in the cell, either in the DNA of the nucleus or the cytoplasm outside the nucleus. In the chronic pain state, pain signal generation can actually occur in the central nervous system without peripheral noxious stimulation. In pain management, modulation of the pain signal transmission is a far better choice than neural destruction, and this can be achieved with PEMF. Scientific evidence shows that acute persistent pain eventually sensitizes wide dynamic neurons in the dorsal horn of the spinal cord, the wind-up phenomenon, constituting the basis of developing chronic pain syndromes (Kristensen, 1992). Persistent and excessive pain has no biological good or necessary function. It is actually harmful to our well-being. Therefore, pain needs to be treated as early and as completely as possible and not to be left alone (Adams et al. 1997). The primary symptom in most patients with disorders affecting the soft tissue is pain. In many patients, daily activities are limited as inflammation causes pain and, with it, a restriction of the range of movements. Causes of soft tissue pain can be depicted as musculoskeletal, neurologic, vascular, and referred visceral-somatic or articular (Cailliet, 1991). Early reports of applying electrical current to treat pain date back to before 1800 (Ersek, 1981). PEMF therapy has successfully been used for the control of pain associated with rotator cuff tendonitis, multiple sclerosis, carpal tunnel syndrome, and periarthritis (Battisti et al., 1998; Lecaire et al., 1991). An improvement was observed in 93% of patients suffering from carpal tunnel pain and in 83% in cases of rotator cuff tendonitis. PEMF therapy was also used for treatment of migraine, chronic pelvic pain, neck pain, and whiplash injuries (Rosch et al., 2004). In a March 2003 publication on Pain Management with PEMF Treatment, Dr. William Pawluk explains: “Magnetic fields affect pain perception in many different ways. These actions are both direct and indirect.

●    Direct effects of magnetic fields are: neuron firing, calcium ion movement, membrane potentials, endorphin levels, nitric oxide, dopamine levels, acupuncture actions and nerve regeneration.
●    Indirect benefits of magnetic fields on physiologic function are on: circulation, muscle, edema, tissue oxygen, inflammation, healing, prostaglandins, cellular metabolism and cell energy levels.”  

Short-term effects are thought to be due to a decrease in cortisol and noradrenaline and an increase in serotonin, endorphins and enkephalins. Longer term effects may be due to CNS and/or peripheral nervous system biochemical and neuronal effects in which correction of pain messages occur, and the pain is not just masked as in the case of medication.

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At the subatomic level, as the pulsed fields expand and collapse through a tissue, the protein molecules, such as the cytochromes in the cells' mitochondria, gain electrons and, in doing so, store energy. Even though the instantaneous peak magnetic energy amplitudes are very high, the average magnetic amplitudes generated by PEMF therapy remain low, the average total energy transmitted to the tissues is not powerful enough to create heat within the cells, nor for the cells' atoms to vibrate much and cause a thermal increase, nor for an electron to jump to a higher orbit and emit heat as it returns to its orbit of origin. There is only sufficient average energy for the electron spin to be increased; thus, energy gets stored in the cells’ mitochondria by converting ADP (Adenosine Di-Phosphate) to ATP molecules more rapidly by the addition of the phosphate radical to the ADP. The ATP molecules store and transport the energy that is then used in the many chemical processes within the cell that participate in all the metabolic functions of living cells. This phenomenon is referred to as the electron transport chain and is described in the diagram below.      

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As demonstrated by the many studies cited herein, it is clear that PEMF treatment stimulates many aspects of cellular metabolism and activity by increasing the TMP and flow of ions across the cell membrane, growth factors, tissue repair and healing. PEMF therapy increases blood circulation in and around damaged tissue, and effectively helps damaged cells heal by bringing more oxygen into the cells. Effects that are observed when the TMP is increased include: enhanced cellular energy (ATP) production, increased oxygen uptake, changes in entry of calcium, movement of sodium out of the cell, movement of potassium into the cell, changes in enzyme and biochemical activity, and changes in cellular pH which will stimulate large amounts of lymphatic vessels to pump and drain lymph fluid which, in turn, supports immune health. This effect involves a chain of processes in the human body, which leads to the improvement of health without side effects including:

• Increased production of nitric oxide

• Improved microcirculation

• Increased supply of oxygen, ions and nutrients to cells

• Increased partial oxygen pressure

• Increased ATP production by excitation of electrons

• Stimulation of RNA and DNA production

• Accelerated protein biosynthesis by electron and energy transfer

• Anti-oxidation regulation with increased circulation of available electrons

• Increased calcium transport and absorption for stronger bones, joints and muscles

• Enhanced cellular and tissue elasticity with increased collagen production

• Increased cellular genesis promoting bone, cartilage, tendon and soft tissue growth

• Stimulation of cellular repair mechanisms

• Enhanced macrocirculation by mechanically de-clumping blood cells, alternately dilating and constricting vessels, and through angiogenesis, the growth of new blood vessels

• Increased absorption of nutrients and pharmaceuticals

• Accelerated detoxification of cells and organs

• Decreased swelling, inflammation and pain

• Boosting of the immune system, the body's defenses, by improving the rolling and adhesion behaviour of white blood cells

• Supporting the body's internal self-regulating mechanisms by activating cellular and molecular processes.

Beyond its complex mechanisms, PEMF therapy offers many health benefits. PEMFs help the natural body healing processes by delivering a non-invasive form of repetitive electrical stimulation that requires no direct contact with the skin surface. Magnetic fields have been shown to affect biologic processes and be effective in a wide range of medical conditions. PEMF therapy has proven beneficial in stimulating cellular metabolism, blood and fluids circulation, tissue regeneration and immune system response. Through these processes, cells are able to function better and tissues repair themselves more efficiently. Through the same processes, vital organs such as the liver, kidneys and colon are able to rid themselves of impurities thus detoxifying the body and allowing better organ functionality. PEMF treatment is effective at increasing bone formation and bone density, healing fractures and osteotomies, recovery from wounds and trauma, graft and postsurgical behavior, recovery from myocardial and brain ischemia (heart attack and stroke), tendonitis, osteoarthritis, and impaired neural function or spasticity from central nervous system diseases such as multiple sclerosis and spinal cord damage. PEMF stimulation offers a safer and more comfortable alternative for urinary incontinence than prior treatments. PEMF therapy improves sports performance and simply helps to maintain good health. It stimulates muscles, connective tissues, intestines, tendons and cartilage, the brain and peripheral nerve sites. In doing so, PEMF therapy promotes healing and a return to higher activity levels. Functions that were lost begin to recover.

Extensive research has been carried out to determine the mechanisms by which this occurs, but for the physiotherapist or other medical professional presented with a wide range of clinical problems, PEMF therapy is an invaluable aid to the clinic. PEMF therapy leaves you feeling relaxed, energized, renewed and with a sense of well-being.

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It is no surprise that the medical and research communities have embraced PEMF technology, performing thousands of university double-blind studies on its application regarding a myriad of medical issues. The US FDA accepted the use of PEMF Devices in the healing of non-union bone fractures in 1979, urinary incontinence and muscle stimulation in 1998, and depression and anxiety in 2006.

The National Institute of Health (NIH) provides an online resource for hundreds of thousands of case studies for all types of medical treatments. Specifically, case studies for the application of PEMF technology utilized in treatments may be found at the NIH site called www.PubMed.gov. At this site you may review research abstracts by simply typing into the search bar any medical indication and the word “PEMF” or “Pulsed Electro-Magnetic Field.” All the studies found on www.Pubmed.gov use low-powered PEMF Devices.

The following are some of the most researched indications often yielding positive outcomes: Arthritis - Circulation - Carpal Tunnel - Depression - Endometritis - Healing - Hypertension - Lymphatic Circulation - Migraines - Multiple Sclerosis - Nerve Repair - Osteoporosis - Pain - Parkinson’s - Plantar Faciitis - Vision Impairment.

The following PDF documents are papers, extensive research and studies on PEMF: