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Medical Applications of Pulsed Electromagnetic Fields (PEMF)

Femoral BMD predicts hip fractures (1993). Lunar News, 3-4.
Summary: "The lumbar spine is one of the least predictive sites for assessing risk of hip fracture. On the other hand, the femoral neck is almost as predictive of spine fracture as spine BMD itself."(p.3) 
Technology Evaluation: Pulsing electromagnetic Fields and Fracture Management. An Analysis of Clinical Efficacy and Safety (1988). Parsippany, NJ: EBI Medical Systems, Inc.

Aaron RK, Lennox D, Bunce GE, Ebert T (1989). The conservative treatment of osteonecrosis of the femoral head. A comparison of core decompression and pulsing electromagnetic fields. Clin Orthop, 249:209-218.
Device: single pulse configuration/380 usec.; 72 Hz; quasirectangular WF
Summary: "Both techniques [core decompression and PEMF] reduce the incidence of clinical and roentgenographic progression. Exposure to pulsing electromagnetic fields seems to be more effective in hips with Ficat II lesions than in hips with more advanced lesions."(p.209) When criteria for clinical and roentgenographic success were used, core decompression was not particularly effective, and PEMFs were."(p.212)

Altman R (1991). Classification of disease: Osteoarthritis. Semin Arthritis Rheum, 20(6)(Suppl 2):40-47.
Summary: Criteria for the classification of OA have been developed to establish uniformity in the reporting of the disease. Different criteria sets were developed for OA of the knee, hand, and hip.

Altman RD (1987). Overview of osteoarthritis. Am J Med, 83(suppl 4B):65-69. 
Summary: Symptoms and signs of OA, radiographic findings of OA, and classification of OA.

Altman RD, Fries JF, Bloch DA, Carstens J, Cooke CT, Genant H, et al. (1987). Radiographic assessment of progression in osteoartritis. Arthritis Rheum, 30(11):1214-1225.
Summary: "In OA of the hip, a single anteroprosterior radiograph assessed for joint space narrowing and cyst formation yielded the greatest sensitivity. In OA of the knee, an anteroprosterior radiograph, with weight-bearing, assessed for narrowing, spurs, and sclerosis in both the medial and lateral compartments yielded the greatest sensitivity."(p.1214)

Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt KD, et al. (1991). The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum, 34(5):505-514.
Summary: Study to develop classification criteria for symptomatic OA of the hip.

Andino RV, Feldman DS (1993). The use of pulsing electromagnetic fields to treat full thickness skin defects in the rabbit model. Proceedings of the Thirteenth Annual Meeting of the Bioelectrical Repair and Growth Society; October 10-13, 1993; Dana Point, CA. BRAGS, 49.
Device: 2.8 mT; 75 Hz; Helmholtz coils
Summary: "Results indicate that the healing rate in the PEMF stimulated animals increased by about 25-30%. The number of neurophils and macrophages were less in both the one and two week stimulated groups when compared with the controls. In the two week stimulated group, the collagen deposition was greater, more densely packed, and more aligned when compared with the control group. This was due to a greater volume fraction of fibroblasts which had migrated to and/or proliferated in the wounds. It appears as though the general effect of the PEMF stimulation was to accelerate and/or augment the naturally occurring healing process." (p 49)

Anninos PA, Tsagas N, Sandyk R, Derpapas K (1991). Magnetic stimulation in the treatment of partial seizures. Intern J Neuroscience, 60:141-171.
Summary: "We localized foci of seizure activity using the mapping technique characterized by the ISO-Spectral Amplitude (ISO-SA) on the scalp distribution of specified spectral components or frequency bands of the emitted MEG Fourier power spectrum. In addition, using an electronic device, we utilized the above recorded activity to emit back the same intensity and frequency of magnetic field to the presumed epileptic foci. Using this method we were able, over the past two years, successfully to attenuate seizure activity in a cohort of over 100 patients with various forms of epilepsy." (p141) "We considered a focus to be 'cancelled' if the magnetic power emitted from the affected brain region had returned to a value of <1000 fT/sq. rt. Hz, a power spectrum which is considered to be within normal limits."(p.150)

Bassett CAL (1993). Beneficial effects of electromagnetic fields. J Cell Biochem, 51:387-393. 
Summary: As understanding of mechanisms expands, specific requirements for field energetics are being defined and the range of treatable ills broadened. These include nerve regeneration, wound healing, graft behavior, diabetes, and myocardial and cerebral ischemia (heart attack and stroke), among other conditions. Preliminary data even suggest possible benefits in controlling malignancy". (p. 387)

Bellamy N (1982). The Arthritis Index [WOMAC] In: Bellamy N. Osteoarthritis-an evaluative index for clinical trials. MSc Thesis. [excerpt] Hamilton, Canada: McMaster University.

Bellamy N (n.d.). An explanation of the meaning of questions in the WOMAC Osteoarthritis Index Inventory. Received from Dr. Bellamy.
Summary: Each question on the WOMAC Osteoarthritis Index inventory is explained.

Bellamy N, Buchanan WW (1984). Outcome measurement in osteoarthritis clinical trials: the case for standardization. Clin Rheum, 3(3):293-303.
Summary: "Outcome measures for clinical trials to be valid and reliable should be responsive to change." (p 293)" "It is unnecessary in evaluative research to measure every item on each dimension since the measurement objective is to detect differential change with treatment and not to exhaustively describe the individuals comprising each treatment group. Thus, a variable which is infrequently affected by the disease or which is unresponsive to change with active treatment can be confidently discarded from the list of outcome variables." (p. 299)

Bellamy N, Sothern RB, Campbell J (1990). Rhythmic variations in pain perception in osteoarthritis of the knee. J Rheumatol, 17:364-72.
Summary: "In summary, we have observed significant predictably rhythmic variation on both a daily and weekly scale in the majority of 20 patients with OA of the knee. We have found that pain ratings, on average, are highest when measured in the evening and on weekends." (p 370)

Bellamy N, Wells G, Campbell J (1991). Relationship between severity and clinical importance of symptoms in osteoarthritis. Clin Rheumatol, 10(2):138-143.
Summary: "In this study we have demonstrated that there is no difference in termination scores between blind and informed methods of administration of the WOMAC osteoarthritis Index. Although symptomatic patients regard their symptoms of similar importance regardless of severity, our observations suggest that importance and severity are little associated. We have also shown that there are no redundant items in the WOMAC Index and demonstrated a justification for deriving subscale scores by the simple addition of component items. ...At present we recommend that WOMAC subscale scores be constructed by the simple aggregation of items within each of the three different dimensions and that any comparative analysis treats each dimension as a separate entity. For the definitive studies we recommend setting the Type I error at < or = .017 to make adequate correction for multiple comparisons. When the instrument is being used for pilot studies, however, we do not recommend any correction and prefer to set the Type I error at < or = 0.05. We make this differentiation to respect the scientific rigor of a definitive study and to reflect the view of Dr. A. Feinstein that the purpose of a fishing expedition is to catch fish." (p 142)

Binder A, Parr G, Hazleman B, Fitton-Jackson S (1984). Pulsed electromagnetic field therapy of persistent rotator cuff tendinitis. Lancet, 695-698.
Summary: The study consisted of 29 patients refractory to steroid injection and other conventional measures, 5 patients had significant benefit compared with placebo treated group of 14 patients during the first 4 weeks of study. During second 4 weeks when all the patients were on active treatment, no difference in the two groups. Further observation without treatment for 8 weeks, two groups remained improved. At end of study, 19 (65%) of the 29 patients were symptomless and 5 other were improved. The value of PEMF for the treatment of persistent rotator cuff tendinitis was tested in a double-blind controlled study with 29 patients.

Bollet AJ (1968). A consideration of the reversibility of osteoarthritis. Trans Am Clin Climatol Assoc, 80:212-220.

Bullough PG (1981). The geometry of diarthrodial joints, its physiologic maintenance, and the possible significance of age-related changes in geometry-to-load distribution and the development of osteoarthritis. Clin Orthop, 156:61-66.
Summary: "The normal health function of a diarthrodial joint depends on a number of factors, two of which are stability and an equitable distribution of load across the joint surfaces. These two factors in turn depend upon two structural features of the joint: First, the geometry of the articulating surfaces; second, the material properties [i.e., the strength, resilience and elasticity] of the articular cartilage and underlying subchondral bone which go into making up the articulation." (p61) "The increasing maldistribution of load, with age, it is proposed, mechanically overtaxes the previously underloaded and, presumably, atrophic cartilage. Overtaxing the cartilage in turn leads to further depletion of proteoglycans, collagen fraying and eventually osteoarthritis." (p. 65)

Callahan LF, Brooks RH, Summey JA, Pincus T (1987). Quantitative pain assessment for routine care of RA patients using a pain scale based on activities of daily living and a visual analog pain scale. Arthritis Rheum, 30:630-636.
Summary: The Activities of Daily Living (ADL) pain scale and the visual analog scale described here require 5 minutes for completion and may be a useful approach to quantitative assessment of pain in RA.

Chu C, McManus AT, Matylevich NP, Mason AD, Pruitt BA (1993). Direct current (DC) reduces burn wound edema following full thickness injury in rats. Proceedings of the Thirteenth Annual Meeting of the Bioelectrical Repair and Growth Society; October 10-13, 1993; Dana Point, CA. BRAGS, 50.
Summary: "In the present study, we have investigated the effects of DC on the accumulation of wound edema following scald injury in rats. ...Anodal currents of 4 and 40 uA were examined. ...In the first set of experiments, less edema was found in DC treated wounds than in the controls throughout the study interval. In the second set, the decrease in edema accumulation was inversely related to the duration of treatment delay; this effect was observed with the treatment beginning as late as 36 hr postburn. These observations suggest that edema reduction may in part explain previously observed improvements in tissue survival and wound repair." (p. 50)

Cruess RL, Kan K, Bassett CAL (1983). The effect of pulsing electromagnetic fields on bone metabolism in experimental disuse osteoporosis. Clin Orthop, 173:245-250.
Device: 2 vertically mounted Helmholtz-aiding "O" shaped coils; 65 Hz, quasirectangular WF
Summary: Treatment of rats with PEMF increased the rate of synthesis of proteoglycan (PG) and collagen and diminished the rate of bone resorption. Thus, the data indicate that PEMFs diminish abnormal rates of resorption in disuse osteoporosis and increase rates of bone formation. Davis MA, Ettinger WH, Neuhaus JM, Barclay JD, Segal MR (1992). Correlates of knee pain among US adults with and without radiographic knee osteoarthritis. J Rheumatol, 19:1943-49.
Summary: "Our results indicate that correlates of reported knee pain among persons with knee OA are more similar to correlates of pain reporting among persons without knee OA, than with correlates of radiographic knee OA per se. Known risk factors for knee OA (age, sex, race, BMI) were generally not associated with reporting knee pain either for persons with radiographic knee OA or those without. Thus, our findings add to the growing body of evidence to suggest that known risk factors for radiographic knee OA (age, sex, race, obesity) may not be the same as factors associated with the reporting of knee pain in those with radiographic knee OA."(pp. 1946-1947)

Dedrick DK, Flechtenmacher J, Chata AS, Aisen AM, Taylor R, Ike RW, et al. (1992). Detection of osteoarthritis (OA) of the knee using magnetic resonance imaging, needle and standard arthroscopy with histologic correlation. Arthritis Rheum, 35(suppl to No. 9):S134.
Summary: "The arthroscopes do correctly identify cartilage lesions with more accuracy than the MR scanner, although neither system was infallible. In this testing situation, the results of both arthroscopes were similar, although the maneuverability of the smaller instrument was an advantage in these cadaver knees. Needle arthroscopy may be a sensitive method for the diagnosis and follow-up of OA of the knee." (p. S134)

Dieppe PA, Cushnaghan J, Shepstone L (1997). The Bristol 'OA500' study: progression of osteoarthritis (OA) over 3 years and the relationship between clinical and radiographic changes at the knee joint. Osteoarthritis Cartilage, 5(2):87-97. 
Summary: "However there was no correlation between radiographic and clinical changes. It is concluded that radiographic change may not be a good surrogate for clinical outcome in OA". (p. 87)

Dieppe PA, Cushnaghan J, Young PJ, Kirwan JR (1993). Predicting the progression of joint space narrowing in osteoarthritis of the knee by bone scintigraphy. Ann Rheum Dis, 52: 557-563.
Summary: "Scintigraphy predicts subsequent loss of joint space in patients with established OA of the knee joint. This is the first description of a powerful predictor of change in this disease. The finding suggests that the activity of the subchondral bone may determine loss of cartilage." (p 557)

Dindar H, Zeybek N, Yucesan S, Barlas M, Yurtaslani Z, Yazgan E, Konkan R. Ozguner IF, Gokcora IH. Augmentation of mucosal adaptation following small-bowel resection by electromagnetic field stimulation in rats. Tokai J Exp Clin Med. 1993 Jun; 18 (1-2): 39-47. Device: 43.20 G
Summary: Survival following massive resection of the small intestine is often possible due to substantial hyperplasia of the mucosal surface in the remaining small intestine. We evaluated the ability of electromagnetic field stimulation to augment mucosal hyperplasia following massive small bowel resection in the rat. The first group received EMF stimulation for ten days at a dosage of 43.20 G. EMF stimulation appears to augment mucosal hyperplasia following massive small bowel resection in the rat, in the proximal and distal small intestine.

Doyle DV, Dieppe PA, Scott J, Huskisson EC (1981). An articular index for the assessment of osteoarthritis. Ann Rheum Dis, 40:75-78.
Summary: "Tenderness was scored on a 4-point scale as in the Ritchie index (0=no tenderness, 1=patient complained of pain, 2=patient complained of pain and winced, 3=patient complained of pain, winced and withdrew the joint."(p.75) "The articular index of Ritchie et al. is widely used in the assessment of rheumatoid arthritis, and many studies have shown that it is altered by drug therapy. This study has shown that a similar index is useful in osteoarthritis. No weighting system was used to favor large-joint involvement, as the purpose of the index is to reflect changes in joint tenderness occurring during the natural course of the disease or during treatment. It is not intended as a measure of the severity of osteoarthritis. Measurements were highly reproducible, and the index was sufficiently sensitive to indicate differences between treatments.... The reproducibility of the measurements was greater with a single observer, and the use of multiple observers in any experiment would increase the error."(p.78)

G, Hurlbert RJ, Tator CH (1992). An examination of direct current fields for the treatment of spinal cord injury. Proceedings of The First World Congress for Electricity and Magnetism in Biology and Medicine, June 14-19, 1992, (X-4)67-68.
Summary: "With a 14 uA DC field (cathode caudal) applied immediately after injury and maintained for 8 weeks, we observed significant recovery of clinical neurological function as assessed by the inclined plane technique and recovery of descending axonal function as determined by motor evoked potential (MEP) recording." (p 68)

Felson DT, Anderson JJ, Boers M, Bombardier C, Chernoff M, Fried B, et al. (1993). The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. Arthritis Rheum, 36(6):729-740.
Summary: "The core set of disease activity measures consists of a tender joint count, swollen joint count, patient's assessment of pain, patient's and physician's global assessments of disease activity, patient's assessment of physical function, and laboratory evaluation of 1 acute-phase reactant. ...Many of them predict other important long-term outcomes in RA, including physical disability, radiographic damage, and death. Other disease activity measures frequently used in clinical trials were not chosen for any one of several reasons, including insensitivity or change or duplication of information provided by one of the core measures (e.g., tender joint score and tender joint count). The committee also proposes specific ways of measuring each outcome." (p.729)

Fiorani M, Biagiarelli B, Vetrano F, Guidi G, Dacha M, Stocchi V. In vitro effects of 50 Hz magnetic fields on oxidatively damaged rabbit red blood cells. Bioelectromagnetics. 1997; 18 (2): 125-31.
Device: 50 Hz (0.2-0.5 mT)
Summary: The results reported in this study demonstrate that the effects of the magnetic fields investigated are able to potentiate the cellular damage induced in vitro by oxidizing agents.

Gabriel SE, Crowson CS, Campion ME, O'Fallon WM (1997). Direct medical costs unique to people with arthritis. J Rheumatol. 24:719-725.
Summary: "Our results show that people with both RA and OA incur substantial incremental direct medical costs, not only for arthritis care but also for psychiatric, gastrointestinal, cardiac, respiratory, and other conditions compared to nonarthritic subjects". (p. 723) "The average cost per year for the OA was $2,654.51". (p. 719)

Giczi J, Guseo A (1988). Treatment of headache by pulsating electromagnetic field: A preliminary report. J Bioelectricity, 7(1):125-126.

Lee EW, Maffulli N, Li CK, Chan KM. Pulsed magnetic and electromagnetic fields in experimental Achilles tendonitis in the rat: a prospective randomized study. Arch Phys Me Rehabil. 1997 Apr; 78 (4): 399-404.
Device: PMF of 17 Hz or 50 Hz, or PEMF of 15 Hz or 46 Hz
Summary: The object of the study was to investigate the effects of pulsed magnetic fields (PMF) and pulsed electromagnetic fields (PEMF) on healing in experimental Achilles tendon inflammation. The conclusion was that the tendon returned to histological normality in all groups, but the PMF 17 Hz group showed better collagen alignment by the end of the study. PMF 17 Hz resulted in a greater reduction of inflammation, with a better return of the tendon to histological normality.

Patino O, Grana D, Bolgiani A, Prezzavento G, Mino J, Merlo A, Benaim F. Pulsed electromagnetic fields in experimental cutaneous wound healing in rats. J Burn Care Rehabil. 1996 Nov-Dec; 17 (6 Pt 1): 528-31.
Device: 20 mT
Summary: The objective of this work was to study the effect of pulsed electromagnetic fields on wound healing in rats. The PEMF group had 35 min treatments 2 times per day (20 mT). The results suggest a significant beneficial stimulation in the wound healing process in rats treated with PEMF.

Sandyk R (1994). Alzheimer's disease: improvement of visual memory and visuoconstructive performance by treatment with picotesla range magnetic fields. Intern J Neuroscience, 76:185-225.
Summary: "The rapid improvement in cognitive functions in response to EMF suggests that some of the mental deficits of AD are reversible being caused by a functional (i.e., synaptic transmission) rather than a structural (i.e., neuritic plaques) disruption of neuronal communication in the central nervous system". (p.185)

Sisken BF, Walker J, Orgel M (1993). Prospects on clinical applications of electrical stimulation for nerve regeneration. J Cell Biochem, 52:404-409.
Summary: "We present a review of studies using electromagnetic fields that provide evidence for the enhancement of regeneration following nerve injury". (p.404)

Sisken BF (1990). Developments for stimulation and analysis of nerve regeneration. In: O'Connor ME, Bentall RHC, Monahan JC, eds. Emerging Electromagnetic Medicine. New York: Springer-Verlag, 159-169. 
Summary: ''In this report we describe experiments using noninvasive PEMF on a crush nerve model showing that the results obtained with this technique are equal to the results with any chemical method.'' (p.159)

Teofoli PO, Benci M, Lotti T (1994). Intrastructural study of hyaluronic acid before and after the use of a pulsed electromagnetic field, electrorydesis, in the treatment of wrinkles. Int J Dermatol, 33(9): 661-663.



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