1
|
Ferragina F, Caruso D, Barca I, Kallaverja E, Arrotta A, Cristofaro MG. Efficacy of Pulsed Electromagnetic Field Therapy for Pain Management After Impacted Mandibular Third Molar Surgery. A Randomized Clinical Trial. J Oral Maxillofac Surg 2024; 82:692-698. [PMID: 38453135 DOI: 10.1016/j.joms.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Postoperative pain and swelling associated with the removal of the third molar (M3) adversely affect the patient's quality of life. PURPOSE The study aims to measure pain reduction and analgesic use in patients treated with pulsed electromagnetic field (PEMF) therapy following M3 removal and compares it to patients who did not receive PEMF. STUDY DESIGN, SETTING, SAMPLE The single-center study was designed as a randomized, prospective, controlled, double-blinded trial on a sample of patients with impacted mandibular M3 ascertained by x-ray orthopantomography and computed tomography. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLES The predictor variable is postoperative pain management. It was assigned randomly to each subject who received either PEMF or standard therapy. MAIN OUTCOME VARIABLES The pain was quantified using a 100 mm visual analog scale and the number of analgesics taken. Each subject kept a daily clinical diary for 7 days, recording the amount of pain using the visual analog scale and the number of analgesic tablets taken. COVARIATES The study covariates were age, sex, tobacco use, and Pell and Gregory's classification of M3s. ANALYSES Student's t test was used, placing the statistical significance for P value < .05. The primary planned analysis was a 2-group, continuity-corrected, χ2 test of equality of proportions. RESULTS The study sample included 90 patients, 47 men and 43 women, with an average age of 32.43 ± 8.80 years. PEMF was statistically associated with improved pain reduction (2.08 vs 5.04 with a P value = .0002) and consumption of fewer analgesics than the control group (2.6 vs 5.8 with a P value = .0062). CONCLUSIONS AND RELEVANCE The study's results attest to the effectiveness of PEMF therapy in pain control after M3 surgery.
Collapse
Affiliation(s)
- Francesco Ferragina
- Department of Experimental and Clinical Medicine, Unit of Maxillofacial Surgery, "Magna Graecia" University, Catanzaro, Italy.
| | - Davide Caruso
- Department of Experimental and Clinical Medicine, Unit of Maxillofacial Surgery, "Magna Graecia" University, Catanzaro, Italy
| | - Ida Barca
- Department of Experimental and Clinical Medicine, Unit of Maxillofacial Surgery, "Magna Graecia" University, Catanzaro, Italy
| | - Elvis Kallaverja
- Department of Experimental and Clinical Medicine, Unit of Maxillofacial Surgery, "Magna Graecia" University, Catanzaro, Italy
| | - Antonella Arrotta
- Department of Medicine and Surgery Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Maria Giulia Cristofaro
- Department of Experimental and Clinical Medicine, Unit of Maxillofacial Surgery, "Magna Graecia" University, Catanzaro, Italy
| |
Collapse
|
2
|
Bahmanpour A, Ghoreishian SM, Sepahvandi A. Electromagnetic Modulation of Cell Behavior: Unraveling the Positive Impacts in a Comprehensive Review. Ann Biomed Eng 2024:10.1007/s10439-024-03519-8. [PMID: 38652384 DOI: 10.1007/s10439-024-03519-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
There are numerous effective procedures for cell signaling, in which humans directly transmit detectable signals to cells to govern their essential behaviors. From a biomedical perspective, the cellular response to the combined influence of electrical and magnetic fields holds significant promise in various domains, such as cancer treatment, targeted drug delivery, gene therapy, and wound healing. Among these modern cell signaling methods, electromagnetic fields (EMFs) play a pivotal role; however, there remains a paucity of knowledge concerning the effects of EMFs across all wavelengths. It's worth noting that most wavelengths are incompatible with human cells, and as such, this study excludes them from consideration. In this review, we aim to comprehensively explore the most effective and current EMFs, along with their therapeutic impacts on various cell types. Specifically, we delve into the influence of alternating electromagnetic fields (AEMFs) on diverse cell behaviors, encompassing proliferation, differentiation, biomineralization, cell death, and cell migration. Our findings underscore the substantial potential of these pivotal cellular behaviors in advancing the treatment of numerous diseases. Moreover, AEMFs wield a significant role in the realms of biomaterials and tissue engineering, given their capacity to decisively influence biomaterials, facilitate non-invasive procedures, ensure biocompatibility, and exhibit substantial efficacy. It is worth mentioning that AEMFs often serve as a last-resort treatment option for various diseases. Much about electromagnetic fields remains a mystery to the scientific community, and we have yet to unravel the precise mechanisms through which wavelengths control cellular fate. Consequently, our understanding and knowledge in this domain predominantly stem from repeated experiments yielding similar effects. In the ensuing sections of this article, we delve deeper into our extended experiments and research.
Collapse
|
3
|
Wang T, Zhao H, Zhang Y, Liu Y, Liu J, Chen G, Duan K, Li Z, Hui HPJ, Yan J. A novel extracellular vesicles production system harnessing matrix homeostasis and macrophage reprogramming mitigates osteoarthritis. J Nanobiotechnology 2024; 22:79. [PMID: 38419097 PMCID: PMC10903078 DOI: 10.1186/s12951-024-02324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Osteoarthritis (OA) is a degenerative disease that significantly impairs quality of life. There is a pressing need for innovative OA therapies. While small extracellular vesicles (sEVs) show promising therapeutic effects against OA, their limited yield restricts clinical translation. Here, we devised a novel production system for sEVs that enhances both their yield and therapeutic properties. By stimulating mesenchymal stem cells (MSCs) using electromagnetic field (EMF) combined with ultrasmall superparamagnetic iron oxide (USPIO) particles, we procured an augmented yield of EMF-USPIO-sEVs. These vesicles not only activate anabolic pathways but also inhibit catabolic activities, and crucially, they promote M2 macrophage polarization, aiding cartilage regeneration. In an OA mouse model triggered by anterior cruciate ligament transection surgery, EMF-USPIO-sEVs reduced OA severity, and augmented matrix synthesis. Moreover, they decelerated OA progression through the microRNA-99b/MFG-E8/NF-κB signaling axis. Consequently, EMF-USPIO-sEVs present a potential therapeutic option for OA, acting by modulating matrix homeostasis and macrophage polarization.
Collapse
Affiliation(s)
- Tianqi Wang
- Departments of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hongqi Zhao
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yi Zhang
- School of Public Health, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Yanshi Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Jialin Liu
- Department of Oral Implantology, The Affiliated Stomatology Hospital of Southwest Medical University, Luzhou, Sichuan, 64600, China
| | - Ge Chen
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Ke Duan
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, China
| | - Zhong Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Hoi Po James Hui
- Departments of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
- Tissue Engineering Program, Yong Loo Lin School of Medicine, Life Sciences Institute, National University of Singapore, Singapore, 117597, Singapore
| | - Jiyuan Yan
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China.
| |
Collapse
|
4
|
Kull P, Keilani M, Remer F, Crevenna R. Efficacy of pulsed electromagnetic field therapy on pain and physical function in patients with non-specific low back pain: a systematic review. Wien Med Wochenschr 2023:10.1007/s10354-023-01025-5. [PMID: 37999784 DOI: 10.1007/s10354-023-01025-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/25/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Non-specific low back pain is a common and clinically significant condition with substantial socioeconomic implications. Pulsed electromagnetic field (PEMF) therapy has shown benefits in pain reduction and improvement of physical function in patients with pain-associated disorders like osteoarthritis. However, studies had heterogeneous settings. The aim of this study was to assess the effects of PEMF on pain and function on patients with non-specific low back pain. METHODS A systematic literature search of randomized controlled trials in PubMed, MEDLINE, EMBASE, Cochrane Library, and PEDro was performed (from inception until 15/5/2023). Outcome measures assessed pain and function. RESULTS Nine randomized controlled trials with 420 participants (n = 420) were included. The studies compared PEMF vs. placebo-PEMF, PEMF and conventional physical therapy vs. conventional physical therapy alone, PEMF and conventional physical therapy vs. placebo-PEMF and conventional physical therapy, PEMF vs. high-intensity laser therapy (HILT) vs. conventional physical therapy, and osteopathic manipulative treatment (OMT) and PEMF vs. PEMF alone vs. placebo-PEMF vs. OMT alone. Five of the nine included studies showed statistically significant pain reduction and improvement in physical function in comparison to their control groups (p < 0.05). There was substantial heterogeneity among the groups of the study, with a wide range of duration (10-30 min), treatments per week (2-7/week), applied frequencies (3-50 Hz), and intensities (2mT-150mT). No serious adverse event had been reported in any study. The included studies showed solid methodological quality, with an overall score of 7.2 points according to the PEDro scale. CONCLUSION PEMF therapy seems to be a safe and beneficial treatment option for non-specific low back pain, particularly if used as an addition to conventional physical therapy modalities. Future research should focus on standardized settings including assessment methods, treatment regimens, frequencies, and intensities.
Collapse
Affiliation(s)
- Philipp Kull
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Mohammad Keilani
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Franziska Remer
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna, Austria.
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
5
|
Han J, Ma Q, An Y, Wu F, Zhao Y, Wu G, Wang J. The current status of stimuli-responsive nanotechnologies on orthopedic titanium implant surfaces. J Nanobiotechnology 2023; 21:277. [PMID: 37596638 PMCID: PMC10439657 DOI: 10.1186/s12951-023-02017-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/21/2023] [Indexed: 08/20/2023] Open
Abstract
With the continuous innovation and breakthrough of nanomedical technology, stimuli-responsive nanotechnology has been gradually applied to the surface modification of titanium implants to achieve brilliant antibacterial activity and promoted osteogenesis. Regarding to the different physiological and pathological microenvironment around implants before and after surgery, these surface nanomodifications are designed to respond to different stimuli and environmental changes in a timely, efficient, and specific way/manner. Here, we focus on the materials related to stimuli-responsive nanotechnology on titanium implant surface modification, including metals and their compounds, polymer materials and other materials. In addition, the mechanism of different response types is introduced according to different activation stimuli, including magnetic, electrical, photic, radio frequency and ultrasonic stimuli, pH and enzymatic stimuli (the internal stimuli). Meanwhile, the associated functions, potential applications and developing prospect were discussion.
Collapse
Affiliation(s)
- Jingyuan Han
- Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Oral Implants, School of Stomatology, The Fourth Military Medical University, Xi’an, 710032 China
- School of Stomatology, Heilongjiang Key Lab of Oral Biomedicine Materials and Clinical Application, Experimental Center for Stomatology Engineering, Jiamusi University, Jiamusi, 154007 China
| | - Qianli Ma
- Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, Geitmyrsveien, Oslo, 710455 Norway
| | - Yanxin An
- Department of General Surgery, The First Affiliated Hospital of Xi’an Medical University, Xi’an, China
| | - Fan Wu
- Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Oral Implants, School of Stomatology, The Fourth Military Medical University, Xi’an, 710032 China
- School of Stomatology, Heilongjiang Key Lab of Oral Biomedicine Materials and Clinical Application, Experimental Center for Stomatology Engineering, Jiamusi University, Jiamusi, 154007 China
| | - Yuqing Zhao
- Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Oral Implants, School of Stomatology, The Fourth Military Medical University, Xi’an, 710032 China
- School of Stomatology, Heilongjiang Key Lab of Oral Biomedicine Materials and Clinical Application, Experimental Center for Stomatology Engineering, Jiamusi University, Jiamusi, 154007 China
| | - Gaoyi Wu
- School of Stomatology, Heilongjiang Key Lab of Oral Biomedicine Materials and Clinical Application, Experimental Center for Stomatology Engineering, Jiamusi University, Jiamusi, 154007 China
| | - Jing Wang
- Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, Department of Oral Implants, School of Stomatology, The Fourth Military Medical University, Xi’an, 710032 China
| |
Collapse
|
6
|
Chang M, Takahashi Y, Miyahira K, Omuro Y, Montagne K, Yamada R, Gondo J, Kambe Y, Yasuno M, Masumoto N, Ushida T, Furukawa KS. Simultaneous Hydrostatic and Compressive Loading System for Mimicking the Mechanical Environment of Living Cartilage Tissue. MICROMACHINES 2023; 14:1632. [PMID: 37630168 PMCID: PMC10456493 DOI: 10.3390/mi14081632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/05/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
In vivo, articular cartilage tissue is surrounded by a cartilage membrane, and hydrostatic pressure (HP) and compressive strain increase simultaneously with the compressive stress. However, it has been impossible to investigate the effects of simultaneous loading in vitro. In this study, a bioreactor capable of applying compressive stress under HP was developed to reproduce ex vivo the same physical loading environment found in cartilage. First, a HP stimulation unit was constructed to apply a cyclic HP pressure-resistant chamber by controlling a pump and valve. A compression-loading mechanism that can apply compressive stress using an electromagnetic force was implemented in the chamber. The synchronization between the compression and HP units was evaluated, and the stimulation parameters were quantitatively evaluated. Physiological HP and compressive strain were applied to the chondrocytes encapsulated in alginate and gelatin gels after applying high HP at 25 MPa, which induced damage to the chondrocytes. It was found that compressive stimulation increased the expression of genes related to osteoarthritis. Furthermore, the simultaneous application of compressive strain and HP, which is similar to the physiological environment in cartilage, had an inhibitory effect on the expression of genes related to osteoarthritis. HP alone also suppressed the expression of osteoarthritis-related genes. Therefore, the simultaneous hydrostatic and compressive stress-loading device developed to simulate the mechanical environment in vivo may be an important tool for elucidating the mechanisms of disease onset and homeostasis in cartilage.
Collapse
Affiliation(s)
- Minki Chang
- Department of Bioengineering, Graduate School of Engineering, University of Tokyo, Tokyo 113-8656, Japan; (M.C.); (Y.O.)
| | - Yosuke Takahashi
- Department of Mechanical Engineering, Graduate School of Engineering, University of Tokyo, Tokyo 113-8656, Japan; (Y.T.); (K.M.); (K.M.); (R.Y.); (J.G.); (Y.K.); (T.U.)
| | - Kyosuke Miyahira
- Department of Mechanical Engineering, Graduate School of Engineering, University of Tokyo, Tokyo 113-8656, Japan; (Y.T.); (K.M.); (K.M.); (R.Y.); (J.G.); (Y.K.); (T.U.)
| | - Yuma Omuro
- Department of Bioengineering, Graduate School of Engineering, University of Tokyo, Tokyo 113-8656, Japan; (M.C.); (Y.O.)
| | - Kevin Montagne
- Department of Mechanical Engineering, Graduate School of Engineering, University of Tokyo, Tokyo 113-8656, Japan; (Y.T.); (K.M.); (K.M.); (R.Y.); (J.G.); (Y.K.); (T.U.)
| | - Ryusei Yamada
- Department of Mechanical Engineering, Graduate School of Engineering, University of Tokyo, Tokyo 113-8656, Japan; (Y.T.); (K.M.); (K.M.); (R.Y.); (J.G.); (Y.K.); (T.U.)
| | - Junki Gondo
- Department of Mechanical Engineering, Graduate School of Engineering, University of Tokyo, Tokyo 113-8656, Japan; (Y.T.); (K.M.); (K.M.); (R.Y.); (J.G.); (Y.K.); (T.U.)
| | - Yu Kambe
- Department of Mechanical Engineering, Graduate School of Engineering, University of Tokyo, Tokyo 113-8656, Japan; (Y.T.); (K.M.); (K.M.); (R.Y.); (J.G.); (Y.K.); (T.U.)
| | - Masashi Yasuno
- Department of Mechanical Engineering, Faculty of Fundamental Engineering, Nippon Institute of Technology, Saitama 345-8501, Japan; (M.Y.); (N.M.)
| | - Noriyasu Masumoto
- Department of Mechanical Engineering, Faculty of Fundamental Engineering, Nippon Institute of Technology, Saitama 345-8501, Japan; (M.Y.); (N.M.)
| | - Takashi Ushida
- Department of Mechanical Engineering, Graduate School of Engineering, University of Tokyo, Tokyo 113-8656, Japan; (Y.T.); (K.M.); (K.M.); (R.Y.); (J.G.); (Y.K.); (T.U.)
| | - Katsuko S. Furukawa
- Department of Bioengineering, Graduate School of Engineering, University of Tokyo, Tokyo 113-8656, Japan; (M.C.); (Y.O.)
- Department of Mechanical Engineering, Graduate School of Engineering, University of Tokyo, Tokyo 113-8656, Japan; (Y.T.); (K.M.); (K.M.); (R.Y.); (J.G.); (Y.K.); (T.U.)
| |
Collapse
|
7
|
Jorge DDMF, Huber SC, Rodrigues BL, Da Fonseca LF, Azzini GOM, Parada CA, Paulus-Romero C, Lana JFSD. The Mechanism of Action between Pulsed Radiofrequency and Orthobiologics: Is There a Synergistic Effect? Int J Mol Sci 2022; 23:ijms231911726. [PMID: 36233026 PMCID: PMC9570243 DOI: 10.3390/ijms231911726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/07/2022] [Accepted: 09/16/2022] [Indexed: 12/04/2022] Open
Abstract
Radiofrequency energy is a common treatment modality for chronic pain. While there are different forms of radiofrequency-based therapeutics, the common concept is the generation of an electromagnetic field in the applied area, that can result in neuromodulation (pulsed radiofrequency—PRF) or ablation. Our specific focus relates to PRF due to the possibility of modulation that is in accordance with the mechanisms of action of orthobiologics. The proposed mechanism of action of PRF pertaining to pain relief relies on a decrease in pro-inflammatory cytokines, an increase in cytosolic calcium concentration, a general effect on the immune system, and a reduction in the formation of free radical molecules. The primary known properties of orthobiologics constitute the release of growth factors, a stimulus for endogenous repair, analgesia, and improvement of the function of the injured area. In this review, we described the mechanism of action of both treatments and pertinent scientific references to the use of the combination of PRF and orthobiologics. Our hypothesis is a synergic effect with the combination of both techniques which could benefit patients and improve the life quality.
Collapse
Affiliation(s)
| | - Stephany Cares Huber
- Orthoregen International Course—Avenida Presidente Kennedy, 1386, Cidade Nova I, Indaiatuba 13334-170, Brazil
| | - Bruno Lima Rodrigues
- Orthoregen International Course—Avenida Presidente Kennedy, 1386, Cidade Nova I, Indaiatuba 13334-170, Brazil
| | - Lucas Furtado Da Fonseca
- Orthopaedic Department, Universidade Federal de São Paulo, 715 Napoleão de Barros St-Vila Clementino, São Paulo 04024-002, Brazil
| | - Gabriel Ohana Marques Azzini
- Department of Orthopaedics, Brazilian Institute of Regenerative Medicine, Cidade Nova I, Indaiatuba 13334-170, Brazil
| | - Carlos Amilcar Parada
- Laboratory of Study of Pain, Department of Structural and Functional Biology, University of Campinas, Rua Monteiro Lobato, 255, Campinas 13083-862, Brazil
| | - Christian Paulus-Romero
- American Academy of Regenerative Medicine, 14405 West Colfax Avenue, #291, Lakewood, CO 80401, USA
| | - José Fábio Santos Duarte Lana
- Orthoregen International Course—Avenida Presidente Kennedy, 1386, Cidade Nova I, Indaiatuba 13334-170, Brazil
- Department of Orthopaedics, Brazilian Institute of Regenerative Medicine, Cidade Nova I, Indaiatuba 13334-170, Brazil
| |
Collapse
|
8
|
Rigoni M, Raggi M, Speri L. A New "Denervation" Technique for Painful Arthritic Wrist. J Wrist Surg 2021; 10:359-366. [PMID: 34381642 PMCID: PMC8328562 DOI: 10.1055/s-0040-1720966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/15/2020] [Indexed: 10/22/2022]
Abstract
Wrist denervation is, by the way, one of the most performed and long-lasting surgical technique for wrist arthritis. Despite many progresses in upper extremity joint arthroplasty, wrist arthritis remains difficult to treat specially in young patients and heavy manual workers. The aim of this technical article is to describe a new outpatient's procedure in which applying pulsed radio frequency on nerve structure of the wrist could achieve similar clinical results of a wrist denervation without surgical incision.
Collapse
Affiliation(s)
- Massimo Rigoni
- Azienda Provinciale per i Servizi Sanitari, Trento, Trentino-Alto Adige, Italy
| | - Massimiliano Raggi
- Azienda Provinciale per i Servizi Sanitari, Trento, Trentino-Alto Adige, Italy
| | - Luca Speri
- Azienda Provinciale per i Servizi Sanitari, Trento, Trentino-Alto Adige, Italy
| |
Collapse
|
9
|
de Teresa C, Varela-López A, Rios-Álvarez S, Gálvez R, Maire C, Gracia-Villar S, Battino M, Quiles JL. Evaluation of the Analgesic Efficacy of a Bioelectronic Device in Non-Specific Chronic Low Back Pain with Neuropathic Component. A Randomized Trial. J Clin Med 2021; 10:jcm10081781. [PMID: 33923872 PMCID: PMC8072836 DOI: 10.3390/jcm10081781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
Low energy pulsed electromagnetic signals (PEMS) therapy, in the field of bioelectronics, has been suggested as a promising analgesic therapy with special interest in treating conditions with poor response to pharmacotherapy. This study evaluated the effectiveness of PEMS therapy on the treatment of chronic low back pain patients with a neuropathic component. A group of 64 individuals with such condition was allocated to a 2-week treatment period (10 twenty-minute sessions on consecutive days) with an active PEMS therapy device or an inactive device in random order. The pain was assessed on a visual analog scale, and the functional status was assessed using the SF-12 questionnaire. The visual analog scale scores were lower after treatment than at baseline but only in the group treated with the active device. According to the DN4 score, neuropathic pain decreased in both experimental groups with respect to baseline, but this was only significant for the group treated with the active device. Similarly, an improvement in the SF-12 and Medical Outcomes Study (MOS) sleep scale components was reported. The study demonstrated that low-energy PEMS therapy was efficient in reducing pain and improving function in chronic low back pain patients with a neuropathic component.
Collapse
Affiliation(s)
- Carlos de Teresa
- Functional and Sports Medicine Service, Quirónsalud Hospital, 29004 Malaga, Spain; (C.d.T.); (S.R.-Á.)
| | - Alfonso Varela-López
- Biomedical Research Centre, Institute of Nutrition and Food Technology “José Mataix Verdú”, Department of Physiology, University of Granada, Avenida del Conocimiento s/n., 24560 Granada, Spain;
| | - Susana Rios-Álvarez
- Functional and Sports Medicine Service, Quirónsalud Hospital, 29004 Malaga, Spain; (C.d.T.); (S.R.-Á.)
| | - Rafael Gálvez
- Pain Universitario Virgen de las Nieves University Hospital, 18012 Granada, Spain; (R.G.); (C.M.)
| | - Coralie Maire
- Pain Universitario Virgen de las Nieves University Hospital, 18012 Granada, Spain; (R.G.); (C.M.)
| | - Santos Gracia-Villar
- Research Center for Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, 39011 Santander, Spain;
- Research Center for Foods, Nutritional Biochemistry and Health, Universidad Internacional Iberoamericana, Campeche 24560, Mexico
| | - Maurizio Battino
- Department of Clinical Sicences, Università Politecnica delle Marche, 60131 Ancona, Italy;
- International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China
| | - José L. Quiles
- Biomedical Research Centre, Institute of Nutrition and Food Technology “José Mataix Verdú”, Department of Physiology, University of Granada, Avenida del Conocimiento s/n., 24560 Granada, Spain;
- Research Group on Food, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, 39011 Santander, Spain
- Correspondence:
| |
Collapse
|
10
|
Cho HK, Park GY, Sung WJ, Kawk SG, Jung WB. Effects of intra-articular pulsed radiofrequency current administration on a rabbit model of rheumatoid arthritis. Exp Ther Med 2020; 20:29. [PMID: 32952620 PMCID: PMC7480132 DOI: 10.3892/etm.2020.9157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/17/2020] [Indexed: 11/05/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by synovial proliferation and inflammation. Intra-articular corticosteroid injections are commonly used for the treatment of arthritis affecting one or two joints. Although corticosteroid injections are fast-acting, repeated usage can result in severe adverse events. Recently, intra-articular pulsed radiofrequency (PRF) stimulation has been proposed to treat arthritis. The aim of the present study was to compare the effectiveness of intra-articular PRF with corticosteroid injection based on histopathological and motion analysis of an ovalbumin (OVA)-induced RA rabbit model. RA was induced in the right knee joint of 18 rabbits via OVA injection. The rabbits were randomly allocated into a PRF, an intra-articular corticosteroid injection or a sham PRF stimulation group. Movement was assessed in the rabbits before treatment, then at 2, 4 and 8 weeks after treatment using walking distance, fast walking time and mean walking speed. Histopathological evaluation of the distal femur and synovium was conducted 2, 4 and 8 weeks after treatment. Motion analysis demonstrated that changes in all movement variables showed significant group and time interaction as well as group effect among the three groups. The semiquantitative score based on the histopathological findings for the distal femoral condyle decreased 2 and 4 weeks after both the PRF and steroid groups, compared with the sham PRF group. Moreover, in the synovium, the semiquantitative histological score in the PRF and steroid groups tended to be lower compared with the sham PRF group, although this result was not statistically significant. Thus, intra-articular PRF stimulation may delay cartilage destruction and improve functional motion in RA.
Collapse
Affiliation(s)
- Hee Kyung Cho
- Department of Physical Medicine and Rehabilitation, Catholic University of Daegu School of Medicine, Daegu 42472, Republic of Korea
| | - Gi-Young Park
- Department of Physical Medicine and Rehabilitation, Catholic University of Daegu School of Medicine, Daegu 42472, Republic of Korea
| | - Woo Jung Sung
- Department of Pathology, Catholic University of Daegu School of Medicine, Daegu 42472, Republic of Korea
| | - Sang Gyu Kawk
- Department of Medical Statistics, Catholic University of Daegu School of Medicine, Daegu 42472, Republic of Korea
| | - Won Bin Jung
- Department of Physical Medicine and Rehabilitation, Seongju Moo Gang Hospital, Seongju 40026, Republic of Korea
| |
Collapse
|
11
|
Pulsed Electromagnetic Field Stimulation of Bone Healing and Joint Preservation: Cellular Mechanisms of Skeletal Response. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e1900155. [PMID: 33970582 PMCID: PMC7434032 DOI: 10.5435/jaaosglobal-d-19-00155] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The US FDA has approved pulsed electromagnetic fields (PEMFs) as a safe and effective treatment for nonunions of bone. Despite its clinical use, the mechanisms of action of electromagnetic stimulation of the skeleton have been elusive. Recently, cell membrane receptors have been identified as the site of action of PEMF and provide a mechanistic rationale for clinical use. This review highlights key processes in cell responses to PEMF as follows: (1) signal transduction through A2A and A3 adenosine cell membrane receptors and (2) dose-response effects on the synthesis of structural and signaling extracellular matrix (ECM) components. Through these actions, PEMF can increase the structural integrity of bone and cartilage ECM, enhancing repair, and alter the homeostatic balance of signaling cytokines, producing anti-inflammatory effects. PEMFs exert a proanabolic effect on the bone and cartilage matrix and a chondroprotective effect counteracting the catabolic effects of inflammation in the joint environment. Understanding of PEMF membrane targets, and of the specific intracellular pathways involved, culminating in the synthesis of ECM proteins and reduction in inflammatory cytokines, should enhance confidence in the clinical use of PEMF and the identification of clinical conditions likely to be affected by PEMF exposure.
Collapse
|
12
|
Zhang B, Xie Y, Ni Z, Chen L. Effects and Mechanisms of Exogenous Electromagnetic Field on Bone Cells: A Review. Bioelectromagnetics 2020; 41:263-278. [PMID: 32159242 DOI: 10.1002/bem.22258] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 02/25/2020] [Indexed: 12/16/2022]
Abstract
Osteoporosis, fractures, and other bone diseases or injuries represent serious health problems in modern society. A variety of treatments including drugs, surgeries, physical therapies, etc. have been used to prevent or delay the progression of these diseases/injuries with limited effects. Electromagnetic field (EMF) has been used to non-invasively treat bone diseases, such as fracture and osteoporosis, for many years. However, because a variety of cellular and molecular events can be affected by EMF with various parameters, the precise bioeffects and underlying mechanisms of specific EMF on bone cells are still obscure. Here, we summarize the common therapeutic parameters (frequency and intensity) of major types of EMF used to treat bone cells taken from 32 papers we selected from the PubMed database published in English from 1991 to 2018. Briefly, pulse EMF promotes the proliferation of osteoblasts when its frequency is 7.5-15 Hz or 50-75 Hz and the intensity is 0.40-1.55 mT or 3.8-4 mT. Sinusoidal EMF, with 0.9-4.8 mT and 45-60 Hz, and static magnetic field with 0.1-0.4 mT or 400 mT, can promote osteoblast differentiation and maturation. Finally, we summarize the latest advances on the molecular signaling pathways influenced by EMF in osteoblasts and osteoclasts. A variety of molecules such as adenosine receptors, calcium channels, BMP2, Notch, Wnt1, etc., can be influenced by EMF in osteoblasts. For osteoclasts, EMF affects RANK, NF-κB, MAPK, etc. We speculate that EMF with different frequencies and intensities exert distinct bioeffects on specific bone cells. More high-quality work is required to explore the detailed effects and underlying mechanisms of EMF on bone cells/skeleton to optimize the application of EMF on bone diseases/injuries. Bioelectromagnetics. 2020;41:263-278 © 2020 Bioelectromagnetics Society.
Collapse
Affiliation(s)
- Bin Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Wound Repair and Rehabilitation, Center of Bone Metabolism and Repair, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China.,Center of Rehabilitation, Xingcheng Sanatorium of PLA Strategic Support Force, Xingcheng, China
| | - Yangli Xie
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Wound Repair and Rehabilitation, Center of Bone Metabolism and Repair, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhenhong Ni
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Wound Repair and Rehabilitation, Center of Bone Metabolism and Repair, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lin Chen
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Wound Repair and Rehabilitation, Center of Bone Metabolism and Repair, Trauma Center, Research Institute of Surgery, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| |
Collapse
|
13
|
Escobar JF, Vaca-González JJ, Guevara JM, Vega JF, Hata YA, Garzón-Alvarado DA. In Vitro Evaluation of the Effect of Stimulation with Magnetic Fields on Chondrocytes. Bioelectromagnetics 2019; 41:41-51. [PMID: 31736106 DOI: 10.1002/bem.22231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 11/01/2019] [Indexed: 12/11/2022]
Abstract
Magnetic fields (MFs) have been used as an external stimulus to increase cell proliferation in chondrocytes and extracellular matrix (ECM) synthesis of articular cartilage. However, previously published studies have not shown that MFs are homogeneous through cell culture systems. In addition, variables such as stimulation times and MF intensities have not been standardized to obtain the best cellular proliferative rate or an increase in molecular synthesis of ECM. In this work, a stimulation device, which produces homogeneous MFs to stimulate cell culture surfaces was designed and manufactured using a computational model. Furthermore, an in vitro culture of primary rat chondrocytes was established and stimulated with two MF schemes to measure both proliferation and ECM synthesis. The best proliferation rate was obtained with an MF of 2 mT applied for 3 h, every 6 h for 8 days. In addition, the increase in the synthesis of glycosaminoglycans was statistically significant when cells were stimulated with an MF of 2 mT applied for 5 h, every 6 h for 8 days. These findings suggest that a stimulation with MFs is a promising tool that could be used to improve in vitro treatments such as autologous chondrocyte implantation, either to increase cell proliferation or stimulate molecular synthesis. Bioelectromagnetics. 2020;41:41-51 © 2019 Bioelectromagnetics Society.
Collapse
Affiliation(s)
- Juan Felipe Escobar
- Biomimetics Laboratory, Instituto de Biotecnología, Universidad Nacional de Colombia, Bogotá, Colombia.,Numerical Methods and Modeling Research Group (GNUM), Universidad Nacional de Colombia, Bogotá, Colombia
| | - Juan Jairo Vaca-González
- Biomimetics Laboratory, Instituto de Biotecnología, Universidad Nacional de Colombia, Bogotá, Colombia.,Nefertiti, Wellness and New Technologies, Surgical Instrumentation Department, Fundación Universitaria del Área Andina, Bogotá, Colombia
| | - Johana Maria Guevara
- Institute for the Study of Inborn Errors of Metabolism, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jose Félix Vega
- Electromagnetic Compatibility Research Group (EMC-UN), Universidad Nacional de Colombia, Bogotá, Colombia
| | - Yoshie Adriana Hata
- Biomimetics Laboratory, Instituto de Biotecnología, Universidad Nacional de Colombia, Bogotá, Colombia.,Numerical Methods and Modeling Research Group (GNUM), Universidad Nacional de Colombia, Bogotá, Colombia
| | - Diego Alexander Garzón-Alvarado
- Biomimetics Laboratory, Instituto de Biotecnología, Universidad Nacional de Colombia, Bogotá, Colombia.,Numerical Methods and Modeling Research Group (GNUM), Universidad Nacional de Colombia, Bogotá, Colombia
| |
Collapse
|
14
|
Abdelhalim NM, Samhan AF, Abdelbasset WK. Short-Term impacts of pulsed electromagnetic field therapy in middle-aged university's employees with non-specific low back pain: A pilot study. Pak J Med Sci 2019; 35:987-991. [PMID: 31372129 PMCID: PMC6659051 DOI: 10.12669/pjms.35.4.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: Non-specific low back pain (non-specific LBP) is common problem between office-work employees. This study aimed to evaluate the short-term impacts of Pulsed Electromagnetic Field (PEMF) therapy in the treatment of non-specific LBP symptoms as pain, back mobility, LBP disabilities, and Health–Related Quality of Life (HRQOL). Methods: Forty-two University’s employees with non-specific LBP and aged from 35 to 55 years who participated in this study from January to June 2018 were divided into two groups: group A; received PEMF therapy and group B; received sham treatment. The outcome measures were; numerical rating scale, Modified Oswestry LBP Disability Score, Modified Schober test, and the Short Form-36 questionnaire. Evaluations were performed for both groups before and after finishing treatment. Results: All outcome measures were significantly improved statistically in the experimental group at the end of the intervention (p<0.05). On the other hand, there were non-significant differences in all outcome measures in the sham group (p>0.05). Conclusions: PEMT therapy may decrease pain, LBP disability, increase lumbar spine mobility, and improve HRQOL in middle-aged university’s employees with nonspecific LBP.
Collapse
Affiliation(s)
- Nermeen Mohamed Abdelhalim
- Nermeen Mohamed Abdelhalim, Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj City, Saudi Arabia
| | - Ahmed Fathy Samhan
- Ahmed FathySamhan, Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj City, Saudi Arabia
| | - Walid Kamal Abdelbasset
- Walid Kamal Abdelbasset Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj City, Saudi Arabia
| |
Collapse
|
15
|
Vaca-González JJ, Guevara JM, Moncayo MA, Castro-Abril H, Hata Y, Garzón-Alvarado DA. Biophysical Stimuli: A Review of Electrical and Mechanical Stimulation in Hyaline Cartilage. Cartilage 2019; 10:157-172. [PMID: 28933195 PMCID: PMC6425540 DOI: 10.1177/1947603517730637] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Hyaline cartilage degenerative pathologies induce morphologic and biomechanical changes resulting in cartilage tissue damage. In pursuit of therapeutic options, electrical and mechanical stimulation have been proposed for improving tissue engineering approaches for cartilage repair. The purpose of this review was to highlight the effect of electrical stimulation and mechanical stimuli in chondrocyte behavior. DESIGN Different information sources and the MEDLINE database were systematically revised to summarize the different contributions for the past 40 years. RESULTS It has been shown that electric stimulation may increase cell proliferation and stimulate the synthesis of molecules associated with the extracellular matrix of the articular cartilage, such as collagen type II, aggrecan and glycosaminoglycans, while mechanical loads trigger anabolic and catabolic responses in chondrocytes. CONCLUSION The biophysical stimuli can increase cell proliferation and stimulate molecules associated with hyaline cartilage extracellular matrix maintenance.
Collapse
Affiliation(s)
- Juan J. Vaca-González
- Biomimetics Laboratory, Instituto de Biotecnología, Universidad Nacional de Colombia, Bogota, Colombia
- Numerical Methods and Modeling Research Group (GNUM), Universidad Nacional de Colombia, Bogota, Colombia
| | - Johana M. Guevara
- Institute for the Study of Inborn Errors of Metabolism, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Miguel A. Moncayo
- Biomimetics Laboratory, Instituto de Biotecnología, Universidad Nacional de Colombia, Bogota, Colombia
- Numerical Methods and Modeling Research Group (GNUM), Universidad Nacional de Colombia, Bogota, Colombia
| | - Hector Castro-Abril
- Biomimetics Laboratory, Instituto de Biotecnología, Universidad Nacional de Colombia, Bogota, Colombia
- Numerical Methods and Modeling Research Group (GNUM), Universidad Nacional de Colombia, Bogota, Colombia
| | - Yoshie Hata
- Biomimetics Laboratory, Instituto de Biotecnología, Universidad Nacional de Colombia, Bogota, Colombia
| | - Diego A. Garzón-Alvarado
- Biomimetics Laboratory, Instituto de Biotecnología, Universidad Nacional de Colombia, Bogota, Colombia
- Numerical Methods and Modeling Research Group (GNUM), Universidad Nacional de Colombia, Bogota, Colombia
| |
Collapse
|
16
|
Abstract
INTRODUCTION The aim of this study was to examine whether the use of an internal electrostimulator could improve the results obtained with core decompression alone in the treatment of osteonecrosis of the femoral head. METHODS We performed a retrospective study of 41 patients (55 hips) treated for osteonecrosis of the femoral head between 2005 and 2014. Mean follow-up time was 56 (12-108) months. We recorded 3 parameters: time to recurrence of pain, time to conversion to arthroplasty and time to radiographic failure. Survival was estimated using the Kaplan-Meier method. The equality of the survival distributions was determined by the Log rank test. RESULTS Implanted electrostimulator was a factor that increased the survival of hips in a pre-op Steinberg stage of II or below, while it remained unchanged if the stage was III or higher. CONCLUSIONS The addition of an internal electrostimulator provides increased survival compared to core decompression alone at stages below III.
Collapse
|
17
|
Chiu CH, Lei KF, Yeh WL. Development of a co-culture device for the study of human tenocytes in response to the combined stimulation of electric field and platelet rich plasma (PRP). Biomed Microdevices 2018; 19:69. [PMID: 28779376 DOI: 10.1007/s10544-017-0214-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
One of the objectives of rotator cuff repairs is to achieve biological healing and recovery in the tendon-bone zone. Some clinical evaluations reported the feasibility of tendon healing based on the stimulations of electric field and platelet-rich plasma (PRP). However, because of lack of appropriate tool for in vitro primary culture under complicated conditions, the efficacy and standard protocol of these healing approaches are still controversial among clinical experts. In this study, a novel co-culture device was developed for the study of tenocytes proliferation under single and combined stimulations of electric field and PRP. The device was a culture well divided into three sub-chambers separated by a barrier and embedded with a pair of parallel plate electrodes. Tenocytes and PRP gel could be respectively loaded into the sub-chambers and cultured with interlinked medium. Hence, tenocytes could concurrently receive a uniform electric field and platelet-derived growth factors by diffusion. Results revealed that the proliferation of tenocytes could be significantly enhanced by these stimulations. The device provides a precise and practical approach for the in vitro study of tendon healing, especially for PRP study. Moreover, optimization of the conditions of electric field and PRP could be determined by in vitro screening procedure before surgery to provide a personalized therapy.
Collapse
Affiliation(s)
- Chih-Hao Chiu
- Bone and Joint Research Center, Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Orthopedic Surgery, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan.,PhD Program in Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Kin Fong Lei
- Graduate Institute of Medical Mechatronics, Chang Gung University, Taoyuan, Taiwan. .,Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Wen-Ling Yeh
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Musculoskeletal Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| |
Collapse
|
18
|
Adenosine Receptors as a Biological Pathway for the Anti-Inflammatory and Beneficial Effects of Low Frequency Low Energy Pulsed Electromagnetic Fields. Mediators Inflamm 2017; 2017:2740963. [PMID: 28255202 PMCID: PMC5309410 DOI: 10.1155/2017/2740963] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/12/2017] [Indexed: 12/22/2022] Open
Abstract
Several studies explored the biological effects of low frequency low energy pulsed electromagnetic fields (PEMFs) on human body reporting different functional changes. Much research activity has focused on the mechanisms of interaction between PEMFs and membrane receptors such as the involvement of adenosine receptors (ARs). In particular, PEMF exposure mediates a significant upregulation of A2A and A3ARs expressed in various cells or tissues involving a reduction in most of the proinflammatory cytokines. Of particular interest is the observation that PEMFs, acting as modulators of adenosine, are able to increase the functionality of the endogenous agonist. By reviewing the scientific literature on joint cells, a double role for PEMFs could be hypothesized in vitro by stimulating cell proliferation, colonization of the scaffold, and production of tissue matrix. Another effect could be obtained in vivo after surgical implantation of the construct by favoring the anabolic activities of the implanted cells and surrounding tissues and protecting the construct from the catabolic effects of the inflammatory status. Moreover, a protective involvement of PEMFs on hypoxia damage in neuron-like cells and an anti-inflammatory effect in microglial cells have suggested the hypothesis of a positive impact of this noninvasive biophysical stimulus.
Collapse
|
19
|
Andrade R, Duarte H, Pereira R, Lopes I, Pereira H, Rocha R, Espregueira-Mendes J. Pulsed electromagnetic field therapy effectiveness in low back pain: A systematic review of randomized controlled trials. Porto Biomed J 2016; 1:156-163. [PMID: 32258569 DOI: 10.1016/j.pbj.2016.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 09/23/2016] [Indexed: 12/13/2022] Open
Abstract
Background Low back pain is a worldwide prevalent musculoskeletal condition in the general population. In this sense, the pulsed electromagnetic fields (PEMF) therapy has shown significant clinical benefits in several musculoskeletal conditions. Objective To assess the effectiveness of the PEMF therapy in reducing pain and clinical symptomatology in patients with low back pathological conditions. Methods It was performed a comprehensive database search using Pubmed, Scopus, Cochrane Library and PEDro databases to assess the effectiveness of the PEMF therapy in reducing pain and clinical symptomatology in patients with low back pathological conditions. The search was performed from January 2005 to August 2015 and conducted by two independent investigators, which scrutinize the reference list of most relevant studies. The methodological quality was assessed by the PEDro scale and the level of evidence was set according Oxford Center for Evidence-Based Medicine scale. Results Six studies were eligible inclusion on the qualitative analysis and five into the quantitative analysis, scoring an overall 6.8 points according the PEDro scale. The studies showed heterogeneity concerning the intervention protocols. Nevertheless, the effect sizes' indicated a clear tendency to reduction of the pain intensity favoring the PEMF groups, reaching a minimal clinically important difference. Conclusion PEMF therapy seems to be able to relieve the pain intensity and improve functionality in individuals with low back pain conditions. Further research is needed regarding PEMF effects on the different conditions of low back pain, with standardized protocols, larger samples and adjustment for low back pain confounders in order to achieve stronger conclusions.
Collapse
Affiliation(s)
- Renato Andrade
- Faculty of Sports, University of Porto, Porto, Portugal.,Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal
| | - Hugo Duarte
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rogério Pereira
- Faculty of Health Sciences, University of Fernando Pessoa, Porto, Portugal.,Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal
| | - Isabel Lopes
- Physical Medicine and Rehabilitation Department, Centro Hospitalar São João EPE, Porto, Portugal.,Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal
| | - Hélder Pereira
- Orthopaedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal.,3B's Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, Guimarães, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Ripoll y De Prado Sports Clinic FIFA Medical Centre of Excellence, Murcia-Madrid, Spain.,Dom Henrique Research Centre, Porto, Portugal
| | - Rui Rocha
- Orthopaedic Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal.,Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal
| | - João Espregueira-Mendes
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,3B's Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, Guimarães, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Orthopaedics Department of Minho University, Minho, Portugal
| |
Collapse
|
20
|
Xu H, Zhang J, Lei Y, Han Z, Rong D, Yu Q, Zhao M, Tian J. Low frequency pulsed electromagnetic field promotes C2C12 myoblasts proliferation via activation of MAPK/ERK pathway. Biochem Biophys Res Commun 2016; 479:97-102. [PMID: 27629357 DOI: 10.1016/j.bbrc.2016.09.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 09/09/2016] [Indexed: 01/16/2023]
Abstract
Low frequency pulsed electromagnetic field (PEMF) has been shown to affect the activity of various cell types and promote them proliferation. However, its effect on skeletal muscle cells remains to be determined. In our study, we confirmed that PEMF (100 Hz, 1 mT) could promote C2C12 myoblasts proliferation by using Cell Counting Kit-8 (CCK-8) and 5-Ethynyl-2'-deoxyuridine (EdU) assays, yet hardly any distinction was found in the rate of cell apoptosis between PEMF and control groups by flow cytometry (Annexin V-FITC/PI double staining method). To further study the mechanism of action of PEMF, Western blot was utilized to detect the mitogen-activated protein kinase (MAPK) signaling pathways. After exposing C2C12 myoblasts to PEMF, we found the phosphorylation level of extracellular signal-regulated kinase (ERK) was significantly increased, while p38 MAPK and c-Jun N-terminal kinase (JNK) pathways were not affected. Pretreating the cells with the ERK kinase1/2 (MEK1/2) inhibitor U0126 obviously inhibited the proliferation of C2C12 cells. Taken together, our research for the first time demonstrated that PEMF promoted C2C12 myoblasts proliferation via activating MAPK/ERK pathway.
Collapse
Affiliation(s)
- Haixia Xu
- Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Haizhu, Guangzhou 510280, China
| | - Jie Zhang
- Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Haizhu, Guangzhou 510280, China
| | - Yutian Lei
- Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Haizhu, Guangzhou 510280, China
| | - Zhongyu Han
- Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Haizhu, Guangzhou 510280, China
| | - Dongming Rong
- Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Haizhu, Guangzhou 510280, China
| | - Qiang Yu
- Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Haizhu, Guangzhou 510280, China
| | - Ming Zhao
- Department of Pathophysiology, Basic Medical College, Southern Medical University, Baiyun, Guangzhou 510515, China
| | - Jing Tian
- Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, 253 Industrial Avenue, Haizhu, Guangzhou 510280, China.
| |
Collapse
|
21
|
Wang W, Li W, Song M, Wei S, Liu C, Yang Y, Wu H. Effects of electromagnetic fields on the metabolism of lubricin of rat chondrocytes. Connect Tissue Res 2015; 57:152-60. [PMID: 26631347 DOI: 10.3109/03008207.2015.1121249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Electromagnetic fields (EMFs) can improve pain, stiffness and physical function in osteoarthritis (OA) patients and have been proposed for the treatment of OA. However, the precise mechanisms involved in this process are still not fully understood. In the present study, we investigated the effects of exposure for different durations with 75 Hz, 2.3 mT sinusoidal EMFs (SEMFs) on the metabolism of lubricin of rat chondrocytes cultured in vitro. Our results showed that SEMFs exposure promoted lubricin synthesis in a time-dependent manner, and the expression of transforming growth factor (TGF)-β1 was also enhanced after SEMFs treatment. The up-regulation effect of the expression of lubricin under SEMF was partly reduced by SB431542, an inhibitor of TGF-RI kinase. The Smad pathway was also investigated in our study. Smad2 synthesis was higher in EMF-exposed condition than in controls, whereas no effects were observed on inhibitory Smads (Smad6 and Smad7) production. Altogether, these data suggest that SEMF exposure can promote lubricin synthesis of rat chondrocytes in a time-dependent manner and that the TGF-β/Smads signaling pathway plays a partial role.
Collapse
Affiliation(s)
- Wei Wang
- a Department of Orthopedics, Tongji Hospital , Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China.,b Department of Orthopedics, WuHan Orthopedics Hospital/Puai Hospital , Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Wenkai Li
- a Department of Orthopedics, Tongji Hospital , Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Mingyu Song
- a Department of Orthopedics, Tongji Hospital , Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Sheng Wei
- a Department of Orthopedics, Tongji Hospital , Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Chaoxu Liu
- a Department of Orthopedics, Tongji Hospital , Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Yong Yang
- a Department of Orthopedics, Tongji Hospital , Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| | - Hua Wu
- a Department of Orthopedics, Tongji Hospital , Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China
| |
Collapse
|
22
|
Intra-articular Pulsed Mode Radiofrequency for Hip Pain: Inoperable Coxarthrosis Case. W INDIAN MED J 2015; 63:526-7. [PMID: 25781295 DOI: 10.7727/wimj.2013.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 10/16/2013] [Indexed: 11/18/2022]
|
23
|
Abstract
Articular cartilage is a unique load-bearing connective tissue with a low intrinsic capacity for repair and regeneration. Its avascularity makes it relatively hypoxic and its unique extracellular matrix is enriched with cations, which increases the interstitial fluid osmolarity. Several physicochemical and biomechanical stimuli are reported to influence chondrocyte metabolism and may be utilized for regenerative medical approaches. In this review article, we summarize the most relevant stimuli and describe how ion channels may contribute to cartilage homeostasis, with special emphasis on intracellular signaling pathways. We specifically focus on the role of calcium signaling as an essential mechanotransduction component and highlight the role of phosphatase signaling in this context.
Collapse
Affiliation(s)
- Holger Jahr
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany
- The D-BOARD European Consortium for Biomarker Discovery, Surrey, UK
| | - Csaba Matta
- The D-BOARD European Consortium for Biomarker Discovery, Surrey, UK
- Department of Veterinary Preclinical Sciences, School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Duke of Kent Building, Guildford, Surrey GU2 7XH UK
- Department of Anatomy, Histology and Embryology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032 Hungary
| | - Ali Mobasheri
- The D-BOARD European Consortium for Biomarker Discovery, Surrey, UK
- Department of Veterinary Preclinical Sciences, School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Duke of Kent Building, Guildford, Surrey GU2 7XH UK
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Arthritis Research UK Pain Centre, Medical Research Council and Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
- Center of Excellence in Genomic Medicine Research (CEGMR), King Fahd Medical Research Center (KFMRC), King AbdulAziz University, Jeddah, 21589 Kingdom of Saudi Arabia
| |
Collapse
|
24
|
Brady MA, Waldman SD, Ethier CR. The Application of Multiple Biophysical Cues to Engineer Functional Neocartilage for Treatment of Osteoarthritis. Part I: Cellular Response. TISSUE ENGINEERING PART B-REVIEWS 2015; 21:1-19. [DOI: 10.1089/ten.teb.2013.0757] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Mariea A. Brady
- Department of Bioengineering, Imperial College London, South Kensington, London, United Kingdom
| | | | - C. Ross Ethier
- Department of Bioengineering, Imperial College London, South Kensington, London, United Kingdom
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| |
Collapse
|
25
|
Cook JJ, Summers NJ, Cook EA. Healing in the new millennium: bone stimulators: an overview of where we've been and where we may be heading. Clin Podiatr Med Surg 2015; 32:45-59. [PMID: 25440417 DOI: 10.1016/j.cpm.2014.09.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Electromagnetic fields and their uses in bone healing have been fairly well studied, with most results showing improvement in healing of both bone and cartilage. Most supportive data are found in relation to the spine, femur, and tibia, but there is increasing evidence for its use in the foot and ankle for treatment of nonunions and as an adjunctive device in arthrodeses, particularly in high-risk populations. There are varying data and a significant variety of quality in the current research and publications concerning the use of electrical bone stimulation in the treatment of the foot and ankle. Thus, there is a definite need for further investigation and high-quality study designs to determine the most effective treatment modalities and pathologies best used with bone stimulation. Bone stimulation should be viewed as an adjunctive procedure in which the surgeon optimizes the high-risk patient both medically or surgically whenever possible. But when used appropriately, bone stimulation has the potential to influence outcomes and aid in bone healing when complications arise and in high-risk populations.
Collapse
Affiliation(s)
- Jeremy J Cook
- Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Harvard Medical School, 330 Mount Auburn Street, Cambridge, MA 02138, USA
| | - N Jake Summers
- Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Harvard Medical School, 330 Mount Auburn Street, Cambridge, MA 02138, USA.
| | - Emily A Cook
- Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Harvard Medical School, 330 Mount Auburn Street, Cambridge, MA 02138, USA
| |
Collapse
|
26
|
Wang J, Tang N, Xiao Q, Zhang L, Li Y, Li J, Wang J, Zhao Z, Tan L. Pulsed electromagnetic field may accelerate in vitro endochondral ossification. Bioelectromagnetics 2014; 36:35-44. [PMID: 25358461 DOI: 10.1002/bem.21882] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 08/13/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Jue Wang
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Na Tang
- Stomatology Department of Sichuan Medical Science Academy; Sichuan Provincial People's Hospital; Chengdu China
| | - Qiang Xiao
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Li Zhang
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Yu Li
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Juan Li
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Jun Wang
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Zhihe Zhao
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
| | - Lijun Tan
- State Key Laboratory of Oral Diseases; West China Hospital of Stomatology; Sichuan University; Chengdu China
| |
Collapse
|
27
|
Brady MA, Waldman SD, Ethier CR. The application of multiple biophysical cues to engineer functional neocartilage for treatment of osteoarthritis. Part II: signal transduction. TISSUE ENGINEERING PART B-REVIEWS 2014; 21:20-33. [PMID: 25065615 DOI: 10.1089/ten.teb.2013.0760] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The unique mechanoelectrochemical environment of cartilage has motivated researchers to investigate the effect of multiple biophysical cues, including mechanical, magnetic, and electrical stimulation, on chondrocyte biology. It is well established that biophysical stimuli promote chondrocyte proliferation, differentiation, and maturation within "biological windows" of defined dose parameters, including mode, frequency, magnitude, and duration of stimuli (see companion review Part I: Cellular Response). However, the underlying molecular mechanisms and signal transduction pathways activated in response to multiple biophysical stimuli remain to be elucidated. Understanding the mechanisms of biophysical signal transduction will deepen knowledge of tissue organogenesis, remodeling, and regeneration and aiding in the treatment of pathologies such as osteoarthritis. Further, this knowledge will provide the tissue engineer with a potent toolset to manipulate and control cell fate and subsequently develop functional replacement cartilage. The aim of this article is to review chondrocyte signal transduction pathways in response to mechanical, magnetic, and electrical cues. Signal transduction does not occur along a single pathway; rather a number of parallel pathways appear to be activated, with calcium signaling apparently common to all three types of stimuli, though there are different modes of activation. Current tissue engineering strategies, such as the development of "smart" functionalized biomaterials that enable the delivery of growth factors or integration of conjugated nanoparticles, may further benefit from targeting known signal transduction pathways in combination with external biophysical cues.
Collapse
Affiliation(s)
- Mariea A Brady
- 1 Department of Bioengineering, Imperial College London , London, United Kingdom
| | | | | |
Collapse
|
28
|
Low-intensity pulsed ultrasound (LIPUS) and pulsed electromagnetic field (PEMF) treatments affect degeneration of cultured articular cartilage explants. INTERNATIONAL ORTHOPAEDICS 2014; 39:549-57. [PMID: 25267432 DOI: 10.1007/s00264-014-2542-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 09/16/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE Articular cartilage has some capacity for self-repair. Clinically used low-intensity pulsed ultrasound (LIPUS) and pulsed electromagnetic field (PEMF) treatments were compared in their potency to prevent degeneration using an explant model of porcine cartilage. METHODS Explants of porcine cartilage and human osteoarthritic cartilage were cultured for four weeks and subjected to daily LIPUS or PEMF treatments. At one, two, three and four weeks follow-up explants were prepared for histological assessment or gene expression (porcine only). RESULTS Non-treated porcine explants showed signs of atrophy of the superficial zone starting at one week. Treated explants did not. In LIPUS-treated explants cell clusters were observed. In PEMF-treated explants more hypertrophic-like changes were observed at later follow up. Newly synthesized tissue was present in treated explants. Gene expression profiles did indicate differences between the two methods. Both methods reduced expression of the aggrecan and collagen type II gene compared to the control. LIPUS treatment of human cartilage samples resulted in a reduction of degeneration according to Mankin scoring. PEMF treatment did not. CONCLUSIONS LIPUS or PEMF prevented degenerative changes in pig knee cartilage explants. LIPUS reduced degeneration in human cartilage samples. LIPUS treatment seems to have more potency in the treatment of osteoarthritis than PEMF treatment.
Collapse
|
29
|
Abstract
BACKGROUND This is an update of a Cochrane review first published in 2002. Osteoarthritis is a disease that affects the synovial joints, causing degeneration and destruction of hyaline cartilage and subchondral bone. Electromagnetic field therapy is currently used by physiotherapists and may promote growth and repair of bone and cartilage. It is based on principles of physics which include Wolff's law, the piezoelectric effect and the concept of streaming potentials. OBJECTIVES To assess the benefits and harms of electromagnetic fields for the treatment of osteoarthritis as compared to placebo or sham. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9), PreMEDLINE for trials published before 1966, MEDLINE from 1966 to October 2013, CINAHL and PEDro up to and including October 2013. Electronic searches were complemented by handsearches. SELECTION CRITERIA Randomised controlled trials of electromagnetic fields in osteoarthritis, with four or more weeks treatment duration. We included papers in any language. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion in the review and resolved differences by consensus with a third review author. We extracted data using pre-developed data extraction forms. The same review authors assessed the risk of bias of the trials independently using the Cochrane 'Risk of bias' tool. We extracted outcomes for osteoarthritis from the publications according to Outcome Measures in Rheumatology Clinical Trials (OMERACT) guidelines. We expressed results for continuous outcome measures as mean difference (MD) or standardised mean difference (SMD) with 95% confidence interval (CI). We pooled dichotomous outcome measures using risk ratio (RR) and calculated the number needed to treat (NNT). MAIN RESULTS Nine studies with a total of 636 participants with osteoarthritis were included, six of which were added in this update of the review. Selective outcome reporting was unclear in all nine included studies due to inadequate reporting of study design and conduct, and there was high risk of bias for incomplete outcome data in three studies. The overall risk of bias across the nine studies was low for the other domains.Participants who were randomised to electromagnetic field treatment rated their pain relief 15.10 points more on a scale of 0 to 100 (MD 15.10, 95% CI 9.08 to 21.13; absolute improvement 15%) after 4 to 26 weeks' treatment compared with placebo. Electromagnetic field treatment had no statistically significant effect on physical function (MD 4.55, 95% CI -2.23 to 11.32; absolute improvement 4.55%) based on the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scale from 0 to 100 after 12 to 26 weeks' treatment. We also found no statistically significant difference in quality of life on a scale from 0 to 100 (SMD 0.09, 95% CI -0.36 to 0.54; absolute improvement 0.09%) after four to six weeks' treatment, based on the SF-36. No data were available for analysis of radiographic changes. Safety was evaluated in four trials including up to 288 participants: there was no difference in the experience of any adverse event after 4 to 12 weeks of treatment compared with placebo (RR 1.17, 95% CI 0.72 to 1.92). There was no difference in participants who withdrew because of adverse events (measured in one trial) after four weeks of treatment (RR 0.90, 95% CI 0.06 to 13.92). No participants experienced any serious adverse events. AUTHORS' CONCLUSIONS Current evidence suggests that electromagnetic field treatment may provide moderate benefit for osteoarthritis sufferers in terms of pain relief. Further studies are required to confirm whether this treatment confers clinically important benefits in terms of physical function and quality of life. Our conclusions are unchanged from the previous review conducted in 2002.
Collapse
Affiliation(s)
- Shasha Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, No.37 Guo-xue-xiang Street, Chengdu, Sichuan Province, China, 610041
| | | | | | | | | | | |
Collapse
|
30
|
Hilz FM, Ahrens P, Grad S, Stoddart MJ, Dahmani C, Wilken FL, Sauerschnig M, Niemeyer P, Zwingmann J, Burgkart R, von Eisenhart-Rothe R, Südkamp NP, Weyh T, Imhoff AB, Alini M, Salzmann GM. Influence of extremely low frequency, low energy electromagnetic fields and combined mechanical stimulation on chondrocytes in 3-D constructs for cartilage tissue engineering. Bioelectromagnetics 2013; 35:116-28. [PMID: 24203577 DOI: 10.1002/bem.21822] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 09/16/2013] [Indexed: 12/21/2022]
Abstract
Articular cartilage, once damaged, has very low regenerative potential. Various experimental approaches have been conducted to enhance chondrogenesis and cartilage maturation. Among those, non-invasive electromagnetic fields have shown their beneficial influence for cartilage regeneration and are widely used for the treatment of non-unions, fractures, avascular necrosis and osteoarthritis. One very well accepted way to promote cartilage maturation is physical stimulation through bioreactors. The aim of this study was the investigation of combined mechanical and electromagnetic stress affecting cartilage cells in vitro. Primary articular chondrocytes from bovine fetlock joints were seeded into three-dimensional (3-D) polyurethane scaffolds and distributed into seven stimulated experimental groups. They either underwent mechanical or electromagnetic stimulation (sinusoidal electromagnetic field of 1 mT, 2 mT, or 3 mT; 60 Hz) or both within a joint-specific bioreactor and a coil system. The scaffold-cell constructs were analyzed for glycosaminoglycan (GAG) and DNA content, histology, and gene expression of collagen-1, collagen-2, aggrecan, cartilage oligomeric matrix protein (COMP), Sox9, proteoglycan-4 (PRG-4), and matrix metalloproteinases (MMP-3 and -13). There were statistically significant differences in GAG/DNA content between the stimulated versus the control group with highest levels in the combined stimulation group. Gene expression was significantly higher for combined stimulation groups versus static control for collagen 2/collagen 1 ratio and lower for MMP-13. Amongst other genes, a more chondrogenic phenotype was noticed in expression patterns for the stimulated groups. To conclude, there is an effect of electromagnetic and mechanical stimulation on chondrocytes seeded in a 3-D scaffold, resulting in improved extracellular matrix production.
Collapse
Affiliation(s)
- Florian M Hilz
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany; AO Research Institute, Davos, Switzerland; Clinic of Orthopaedics and Sport Orthopaedics, Technical University of Munich, Munich, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Fini M, Pagani S, Giavaresi G, De Mattei M, Ongaro A, Varani K, Vincenzi F, Massari L, Cadossi M. Functional Tissue Engineering in Articular Cartilage Repair: Is There a Role for Electromagnetic Biophysical Stimulation? TISSUE ENGINEERING PART B-REVIEWS 2013; 19:353-67. [DOI: 10.1089/ten.teb.2012.0501] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Milena Fini
- Laboratory of Preclinical and Surgical Studies, Technological Innovations, and Advanced Therapies, Rizzoli Orthopaedic Institute, Bologna, Italy
- Laboratory of Biocompatibility, Technological Innovations, and Advanced Therapies, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Stefania Pagani
- Laboratory of Preclinical and Surgical Studies, Technological Innovations, and Advanced Therapies, Rizzoli Orthopaedic Institute, Bologna, Italy
- Laboratory of Biocompatibility, Technological Innovations, and Advanced Therapies, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Gianluca Giavaresi
- Laboratory of Preclinical and Surgical Studies, Technological Innovations, and Advanced Therapies, Rizzoli Orthopaedic Institute, Bologna, Italy
- Laboratory of Biocompatibility, Technological Innovations, and Advanced Therapies, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Monica De Mattei
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Alessia Ongaro
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Katia Varani
- Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Fabrizio Vincenzi
- Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Leo Massari
- Department of Biomedical Sciences and Advanced Therapies, St. Anna Hospital, Ferrara, Italy
| | - Matteo Cadossi
- II Orthopaedics and Trauma Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy
| |
Collapse
|
32
|
Pulsed electromagnetic fields increased the anti-inflammatory effect of A₂A and A₃ adenosine receptors in human T/C-28a2 chondrocytes and hFOB 1.19 osteoblasts. PLoS One 2013; 8:e65561. [PMID: 23741498 PMCID: PMC3669296 DOI: 10.1371/journal.pone.0065561] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 04/27/2013] [Indexed: 12/30/2022] Open
Abstract
Adenosine receptors (ARs) have an important role in the regulation of inflammation and their activation is involved in the inhibition of pro-inflammatory cytokine release. The effects of pulsed electromagnetic fields (PEMFs) on inflammation have been reported and we have demonstrated that PEMFs increased A2A and A3AR density and functionality in different cell lines. Chondrocytes and osteoblasts are two key cell types in the skeletal system that play important role in cartilage and bone metabolism representing an interesting target to study the effect of PEMFs. The primary aim of the present study was to evaluate if PEMF exposure potentiated the anti-inflammatory effect of A2A and/or A3ARs in T/C-28a2 chondrocytes and hFOB 1.19 osteoblasts. Immunofluorescence, mRNA analysis and saturation binding assays revealed that PEMF exposure up-regulated A2A and A3AR expression. A2A and A3ARs were able to modulate cAMP production and cell proliferation. The activation of A2A and A3ARs resulted in the decrease of some of the most relevant pro-inflammatory cytokine release such as interleukin (IL)-6 and IL-8, following the treatment with IL-1β as an inflammatory stimuli. In human chondrocyte and osteoblast cell lines, the inhibitory effect of A2A and A3AR stimulation on the release of prostaglandin E2 (PGE2), an important lipid inflammatory mediator, was observed. In addition, in T/C-28a2 cells, the activation of A2A or A3ARs elicited an inhibition of vascular endothelial growth factor (VEGF) secretion. In hFOB 1.19 osteoblasts, PEMF exposure determined an increase of osteoprotegerin (OPG) production. The effect of the A2A or A3AR agonists in the examined cells was enhanced in the presence of PEMFs and completely blocked by using well-known selective antagonists. These results demonstrated that PEMF exposure significantly increase the anti-inflammatory effect of A2A or A3ARs suggesting their potential therapeutic use in the therapy of inflammatory bone and joint disorders.
Collapse
|
33
|
Bhatia D, Bejarano T, Novo M. Current interventions in the management of knee osteoarthritis. J Pharm Bioallied Sci 2013; 5:30-8. [PMID: 23559821 PMCID: PMC3612336 DOI: 10.4103/0975-7406.106561] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 05/30/2012] [Accepted: 08/30/2012] [Indexed: 11/16/2022] Open
Abstract
Osteoarthritis (OA) is progressive joint disease characterized by joint inflammation and a reparative bone response and is one of the top five most disabling conditions that affects more than one-third of persons > 65 years of age, with an average estimation of about 30 million Americans currently affected by this disease. Global estimates reveal more than 100 million people are affected by OA. The financial expenditures for the care of persons with OA are estimated at a total annual national cost estimate of $15.5-$28.6 billion per year. As the number of people >65 years increases, so does the prevalence of OA and the need for cost-effective treatment and care. Developing a treatment strategy which encompasses the underlying physiology of degenerative joint disease is crucial, but it should be considerate to the different age ranges and different population needs. This paper focuses on different exercise and treatment protocols (pharmacological and non-pharmacological), the outcomes of a rehabilitation center, clinician-directed program versus an at home directed individual program to view what parameters are best at reducing pain, increasing functional independence, and reducing cost for persons diagnosed with knee OA.
Collapse
Affiliation(s)
- Dinesh Bhatia
- Department of Biomedical Engineering, Adaptive Neural Systems Laboratory, Miami, Florida, USA
| | | | | |
Collapse
|
34
|
Low Frequency Pulsed Electromagnetic Field Affects Proliferation, Tissue-Specific Gene Expression, and Cytokines Release of Human Tendon Cells. Cell Biochem Biophys 2013; 66:697-708. [DOI: 10.1007/s12013-013-9514-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
35
|
Ongaro A, Varani K, Masieri FF, Pellati A, Massari L, Cadossi R, Vincenzi F, Borea PA, Fini M, Caruso A, De Mattei M. Electromagnetic fields (EMFs) and adenosine receptors modulate prostaglandin E(2) and cytokine release in human osteoarthritic synovial fibroblasts. J Cell Physiol 2012; 227:2461-9. [PMID: 21830213 DOI: 10.1002/jcp.22981] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Synovial fibroblasts (SFs) contribute to the development of osteoarthritis (OA) by the secretion of a wide range of pro-inflammatory mediators, including cytokines and lipid mediators of inflammation. Previous studies suggest that electromagnetic fields (EMFs) may represent a potential therapeutic approach to limit cartilage degradation and control inflammation associated to OA, and that they may act through the adenosine pathway. Therefore, we investigated whether EMFs might modulate inflammatory activities of human SFs from OA patients (OASFs) treated with interleukin-1β (IL-1β), and the possible involvement of adenosine receptors (ARs) in mediating EMF effects. EMF exposure induced a selective increase in A(2A) and A(3) ARs. These increases were associated to changes in cAMP levels, indicating that ARs were functionally active also in EMF-exposed cells. Functional data obtained in the presence of selective A(2A) and A(3) adenosine agonists and antagonists showed that EMFs inhibit the release of prostaglandin E(2) (PGE(2)) and the proinflammatory cytokines interleukin-6 (IL-6) and interleukin-8 (IL-8), while stimulating the release of interleukin-10 (IL-10), an antinflammatory cytokine. These effects seem to be mediated by the EMF-induced upregulation of A(2A) and A(3) ARs. No effects of EMFs or ARs have been observed on matrix degrading enzyme production. In conclusion, this study shows that EMFs display anti-inflammatory effects in human OASFs, and that these EMF-induced effects are in part mediated by the adenosine pathway, specifically by the A(2A) and A(3) AR activation. Taken together, these results open new clinical perspectives to the control of inflammation associated to joint diseases.
Collapse
Affiliation(s)
- A Ongaro
- Department of Morphology and Embryology, University of Ferrara, Ferrara, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Rodríguez-De la Fuente AO, Alcocer-González JM, Heredia-Rojas JA, Rodríguez-Padilla C, Rodríguez-Flores LE, Santoyo-Stephano MA, Castañeda-Garza E, Taméz-Guerra RS. Effect of 60 Hz electromagnetic fields on the activity of hsp70 promoter: an in vivo study. CELL BIOLOGY INTERNATIONAL REPORTS 2012; 19:e00014. [PMID: 23124775 PMCID: PMC3476825 DOI: 10.1042/cbr20110010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 01/10/2012] [Indexed: 11/17/2022]
Abstract
Exposure to EMFs (electromagnetic fields) results in a number of important biological changes, including modification of genetic expression. We have investigated the effect of 60 Hz sinusoidal EMFs at a magnetic flux density of 80 μT on the expression of the luciferase gene contained in a plasmid labelled as pEMF (EMF plasmid). This gene construct contains the specific sequences for the induction of hsp70 (heat-shock protein 70) expression by EMFs, as well as the reporter for the luciferase gene. The pEMF vector was electrotransferred into quadriceps muscles of BALB/c mice that were later exposed to EMFs. Increased luciferase expression was observed in mice exposed to EMFs 2 h daily for 7 days compared with controls (P<0.05). These data along with other reports in the literature suggest that EMFs can have far-reaching effects on the genome.
Collapse
Affiliation(s)
- Abraham O. Rodríguez-De la Fuente
- *Universidad Autnoma de Nuevo Len, UANL, Facultad de Ciencias
Biolgicas, Av. Universidad sn Ciudad Universitaria San Nicols de los
Garza Nuevo Len, C.P. 66451, Mexico
| | - Juan M. Alcocer-González
- *Universidad Autnoma de Nuevo Len, UANL, Facultad de Ciencias
Biolgicas, Av. Universidad sn Ciudad Universitaria San Nicols de los
Garza Nuevo Len, C.P. 66451, Mexico
| | - J. Antonio Heredia-Rojas
- *Universidad Autnoma de Nuevo Len, UANL, Facultad de Ciencias
Biolgicas, Av. Universidad sn Ciudad Universitaria San Nicols de los
Garza Nuevo Len, C.P. 66451, Mexico
| | - Cristina Rodríguez-Padilla
- *Universidad Autnoma de Nuevo Len, UANL, Facultad de Ciencias
Biolgicas, Av. Universidad sn Ciudad Universitaria San Nicols de los
Garza Nuevo Len, C.P. 66451, Mexico
| | - Laura E. Rodríguez-Flores
- †Universidad Autnoma de Nuevo Len, UANL, Facultad de
Medicina, Av. Universidad sn Ciudad Universitaria San Nicols de los
Garza Nuevo Len, C.P. 66451, Mexico
| | - Martha A. Santoyo-Stephano
- *Universidad Autnoma de Nuevo Len, UANL, Facultad de Ciencias
Biolgicas, Av. Universidad sn Ciudad Universitaria San Nicols de los
Garza Nuevo Len, C.P. 66451, Mexico
| | - Esperanza Castañeda-Garza
- *Universidad Autnoma de Nuevo Len, UANL, Facultad de Ciencias
Biolgicas, Av. Universidad sn Ciudad Universitaria San Nicols de los
Garza Nuevo Len, C.P. 66451, Mexico
| | - Reyes S. Taméz-Guerra
- *Universidad Autnoma de Nuevo Len, UANL, Facultad de Ciencias
Biolgicas, Av. Universidad sn Ciudad Universitaria San Nicols de los
Garza Nuevo Len, C.P. 66451, Mexico
| |
Collapse
|
37
|
Whiplash Patients with Cervicogenic Headache After Lateral Atlanto- Axial Joint Pulsed Radiofrequency Treatment. Anesth Pain Med 2012. [DOI: 10.5812/aapm.3590] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
38
|
Chua NHL, Halim W, Evers AWM, Vissers KCP. Whiplash patients with cervicogenic headache after lateral atlanto-axial joint pulsed radiofrequency treatment. Anesth Pain Med 2012; 1:162-7. [PMID: 24904786 PMCID: PMC4018693 DOI: 10.5812/kowsar.22287523.3590] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 12/06/2011] [Accepted: 12/12/2011] [Indexed: 11/23/2022] Open
Abstract
Background: Whiplash patients regard cervicogenic headache (CEH) as the most burdensome symptom of their condition. Sufferers experience a significant degree of disability from headache, associated neck pain and disability, and sleep disturbance. Lateral C1/2 joint pulsed radiofrequency (PRF) treatment has been shown to produce significant relief from headache in patients with CEH. Objectives: The objective of this retrospective questionnaire study of 45 consecutive whiplash patients with CEH who had undergone antero-lateral atlantoaxial joint pulsed radiofrequency treatment (AA PRF) was to evaluate the treatment’s long-term effects on pain-related disability and health-related quality of life. Patients and Methods: Four questionnaires were sent to all 45 patients who had undergone AA PRF: 1) The short form-36 (SF-36); 2) The neck disability index (NDI); 3) The medical outcome scale-sleep scale (MOS-SS); 4) The headache impact test-6 (HIT-6). All 45 patients received AA PRF under fluoroscopic guidance. PRF treatment was conducted at 45 V with a pulsed frequency of 4 Hz and a pulsed width of 10 ms for 4 minutes . Results: Patients who responded to the procedure reported lower pain scores at 2, 6, and 12 months of follow-up compared to nonresponders. More important, patients reported marked improvements in headache impact (P < 0.01), neck-disability scores (P < 0.01), awakening due to headache (P < 0.01), and sleep problems (9-item; P < 0.05) on the MOS-SS. Responders to the procedure also reported a significantly higher health-related quality of life in terms of bodily pain (P < 0.05) and health change (P < 0.01) on the SF-36. Conclusions: In light of the inherent limitations of our retrospective study, AA PRF treatment can only be tentatively viewed as a promising treatment modality for whiplash patients with CEH and is subject to validation in future studies.
Collapse
Affiliation(s)
- Nicholas HL Chua
- Department of Anesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore
- Corresponding author: Nicholas HL Chua, Department of Anesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, P O. Box: 308433, Singapore. Tel : +65-63577771, Fax: +65-63577772,
| | - Willy Halim
- Department of Anesthesiology and Pain Management, St Anna Hospital, Geldrop, The Netherlands
| | - Andrea WM Evers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Kris CP Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
39
|
Ciofani G, Danti S, Ricotti L, D’Alessandro D, Moscato S, Mattoli V. Applications of Piezoelectricity in Nanomedicine. NANOMEDICINE AND NANOTOXICOLOGY 2012. [DOI: 10.1007/978-3-642-28044-3_8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
40
|
Hug K, Röösli M. Therapeutic effects of whole-body devices applying pulsed electromagnetic fields (PEMF): a systematic literature review. Bioelectromagnetics 2011; 33:95-105. [PMID: 21938735 DOI: 10.1002/bem.20703] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 08/12/2011] [Indexed: 11/08/2022]
Abstract
Pulsed electromagnetic fields (PEMF) delivered by whole-body mats are promoted in many countries for a wide range of therapeutic applications and for enhanced well-being. However, neither the therapeutic efficacy nor the potential health hazards caused by these mats have been systematically evaluated. We conducted a systematic review of trials investigating the therapeutic effects of low-frequency PEMF devices. We were interested in all health outcomes addressed so far in randomized, sham-controlled, double-blind trials. In total, 11 trials were identified. They were focused on osteoarthritis of the knee (3 trials) or the cervical spine (1), fibromyalgia (1), pain perception (2), skin ulcer healing (1), multiple sclerosis-related fatigue (2), or heart rate variability and well-being (1). The sample sizes of the trials ranged from 12 to 71 individuals. The observation period lasted 12 weeks at maximum, and the applied magnetic flux densities ranged from 3.4 to 200 µT. In some trials sporadic positive effects on health were observed. However, independent confirmation of such singular findings was lacking. We conclude that the scientific evidence for therapeutic effects of whole-body PEMF devices is insufficient. Acute adverse effects have not been reported. However, adverse effects occurring after long-term application have not been studied so far. In summary, the therapeutic use of low-frequency whole-body PEMF devices cannot be recommended without more scientific evidence from high-quality, double-blind trials.
Collapse
Affiliation(s)
- Kerstin Hug
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | | |
Collapse
|
41
|
Effects of low-energy NMR on posttraumatic osteoarthritis: observations in a rabbit model. Arch Orthop Trauma Surg 2011; 131:863-8. [PMID: 21063883 DOI: 10.1007/s00402-010-1205-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To evaluate a possible beneficial effect of low-energy nuclear magnetic resonance (NMR) on cartilage in moderate and severe posttraumatic osteoarthrosis in the rabbit using a macroscopic and a histological grading system. DESIGN Following transection of the anterior cruciate ligament of both knees in 24 skeletally mature New Zealand White rabbits, we observed different stages of osteoarthrosis (OA) 6 and 12 weeks postoperatively. Animals were randomized into four groups: Group 1 (eight animals) was treated after 6 weeks by NMR (magnetic field: 20-40 G, interference field: 2.35 mT, 100 kHz; MBST Device, MedTec, Germany), with 1 h of treatment for seven consecutive days. Group 2 was treated in the same pattern after 12 weeks. The sham-operated groups 3 and 4 received no treatment. Seven days after the last treatment, OA was macroscopically graded and hyaline cartilage of the load bearing area was evaluated histologically according to the Mankin scale. RESULTS Macroscopically, there was less OA in group 1 (p < 0.01), but did not reveal significance in group 2 (p = 0.11) compared to the sham groups. There was no significant difference in the Mankin score in both of the treated groups compared to the control groups (group 1: p = 0.36; group 2: p = 0.81). CONCLUSIONS The results showed some beneficial macroscopic effect in mild OA with less macroscopic OA signs in the treated animals but without a histological effect in the Mankin scale. There was no effect found in the pattern later OA. On behalf of these results, NMR for the treatment of posttraumatic OA cannot be recommended at this point of time.
Collapse
|
42
|
Chua NHL, Vissers KC, Sluijter ME. Pulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications-a review. Acta Neurochir (Wien) 2011; 153:763-71. [PMID: 21116663 PMCID: PMC3059755 DOI: 10.1007/s00701-010-0881-5] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 11/12/2010] [Indexed: 12/27/2022]
Abstract
Background The objective of this review is to evaluate the efficacy of Pulsed Radiofrequency (PRF) treatment in chronic pain management in randomized clinical trials (RCTs) and well-designed observational studies. The physics, mechanisms of action, and biological effects are discussed to provide the scientific basis for this promising modality. Methods We systematically searched for clinical studies on PRF. We searched the MEDLINE (PubMed) and EMBASE database, using the free text terms: pulsed radiofrequency, radio frequency, radiation, isothermal radiofrequency, and combination of these. We classified the information in two tables, one focusing only on RCTs, and another, containing prospective studies. Date of last electronic search was 30 May 2010. The methodological quality of the presented reports was scored using the original criteria proposed by Jadad et al. Findings We found six RCTs that evaluated the efficacy of PRF, one against corticosteroid injection, one against sham intervention, and the rest against conventional RF thermocoagulation. Two trials were conducted in patients with lower back pain due to lumbar zygapophyseal joint pain, one in cervical radicular pain, one in lumbosacral radicular pain, one in trigeminal neuralgia, and another in chronic shoulder pain. Conclusion From the available evidence, the use of PRF to the dorsal root ganglion in cervical radicular pain is compelling. With regards to its lumbosacral counterpart, the use of PRF cannot be similarly advocated in view of the methodological quality of the included study. PRF application to the supracapular nerve was found to be as efficacious as intra-articular corticosteroid in patients with chronic shoulder pain. The use of PRF in lumbar facet arthropathy and trigeminal neuralgia was found to be less effective than conventional RF thermocoagulation techniques.
Collapse
Affiliation(s)
- Nicholas H L Chua
- Department of Anaesthesiology, Tan Tock Seng Hospital, Singapore, Singapore.
| | | | | |
Collapse
|
43
|
Ongaro A, Pellati A, Masieri FF, Caruso A, Setti S, Cadossi R, Biscione R, Massari L, Fini M, De Mattei M. Chondroprotective effects of pulsed electromagnetic fields on human cartilage explants. Bioelectromagnetics 2011; 32:543-51. [PMID: 21412809 DOI: 10.1002/bem.20663] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2010] [Accepted: 02/14/2011] [Indexed: 11/11/2022]
Abstract
This study investigated the effects of pulsed electromagnetic fields (PEMFs) on proteoglycan (PG) metabolism of human articular cartilage explants from patients with osteoarthritis (OA). Human cartilage explants, recovered from lateral and medial femoral condyles, were classified according to the International Cartilage Repair Society (ICRS) and graded based on Outerbridge scores. Explants cultured in the absence and presence of IL-1β were treated with PEMF (1.5 mT, 75 Hz) or IGF-I alone or in combination for 1 and 7 days. PG synthesis and release were determined. Results showed that explants derived from lateral and medial condyles scored OA grades I and III, respectively. In OA grade I explants, after 7 days exposure, PEMF and IGF-I significantly increased (35) S-sulfate incorporation 49% and 53%, respectively, compared to control, and counteracted the inhibitory effect of IL 1β (0.01 ng/ml). The combined exposure to PEMF and IGF-I was additive in all conditions. Similar results were obtained in OA grade III cartilage explants. In conclusion, PEMF and IGF-I augment cartilage explant anabolic activities, increase PG synthesis, and counteract the catabolic activity of IL-1β in OA grades I and III. We hypothesize that both IGF-I and PEMF have chondroprotective effects on human articular cartilage, particularly in early stages of OA.
Collapse
Affiliation(s)
- Alessia Ongaro
- Department of Morphology and Embryology, University of Ferrara, Ferrara, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Gurkan I, Ranganathan A, Yang X, Horton WE, Todman M, Huckle J, Pleshko N, Spencer RG. Modification of osteoarthritis in the guinea pig with pulsed low-intensity ultrasound treatment. Osteoarthritis Cartilage 2010; 18:724-33. [PMID: 20175971 PMCID: PMC2873836 DOI: 10.1016/j.joca.2010.01.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 12/21/2009] [Accepted: 01/18/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The Hartley guinea pig develops articular cartilage degeneration similar to that seen in idiopathic human osteoarthritis (OA). We investigated whether the application of pulsed low-intensity ultrasound (PLIUS) to the Hartley guinea pig joint would prevent or attenuate the progression of this degenerative process. METHODS Treatment of male Hartley guinea pigs was initiated at the onset of degeneration (8 weeks of age) to assess the ability of PLIUS to prevent OA, or at a later age (12 months) to assess the degree to which PLIUS acted to attenuate the progression of established disease. PLIUS (30 mW/cm(2)) was applied to stifle joints for 20 min/day over periods ranging from 3 to 10 months, with contralateral limbs serving as controls. Joint cartilage histology was graded according to a modified Mankin scale to evaluate treatment effect. Immunohistochemical staining for interleukin-1 receptor antagonist (IL-1ra), matrix metalloproteinase (MMP)-3, MMP-13, and transforming growth factor (TGF)-beta1 was performed on the cartilage to evaluate patterns of expression of these proteins. RESULTS PLIUS did not fully prevent cartilage degeneration in the prevention groups, but diminished the severity of the disease, with the treated joints showing markedly decreased surface irregularities and a much smaller degree of loss of matrix staining as compared to controls. PLIUS also attenuated disease progression in the groups with established disease, although to a somewhat lesser extent as compared to the prevention groups. Immunohistochemical staining demonstrated a markedly decreased degree of TGF-beta1 production in the PLIUS-treated joints. This indicates less active endogenous repair, consistent with the marked reduction in cartilage degradation. CONCLUSIONS PLIUS exhibits the ability to attenuate the progression of cartilage degeneration in an animal model of idiopathic human OA. The effect was greater in the treatment of early, rather than established, degeneration.
Collapse
Affiliation(s)
- Ilksen Gurkan
- National Institute on Aging, National Institutes of Health, Baltimore, MD
| | | | - Xu Yang
- Hospital for Special Surgery, New York, NY
| | - Walter E. Horton
- Northeastern Ohio Universities College of Medicine, Rootstown, Ohio
| | - Martin Todman
- Smith and Nephew Group Research Centre, York Science Park, Heslington, York, UK
| | - James Huckle
- Smith and Nephew Group Research Centre, York Science Park, Heslington, York, UK
| | | | - Richard G. Spencer
- National Institute on Aging, National Institutes of Health, Baltimore, MD
| |
Collapse
|
45
|
Chang CH, Loo ST, Liu HL, Fang HW, Lin HY. Can low frequency electromagnetic field help cartilage tissue engineering? J Biomed Mater Res A 2010; 92:843-51. [PMID: 19280637 DOI: 10.1002/jbm.a.32405] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
To understand whether a low-frequency pulsed electromagnetic field (EMF) could help cartilage tissue repair in the scope of tissue engineering, we tested how EMF affected collagen gel properties and the behaviors of chondrocyte cells embedded in collagen constructs. Collagen gel and primary chondrocytes embedded in collagen were exposed to EMF for 24 h. Gel and cells that were not exposed to EMF served as controls. Collagen gel exposed to EMF was more hydrophobic and less susceptible to enzymatic degradation (both p < 0.05) than control. Three weeks after EMF exposure, chondrocytes showed higher proliferation and lower glycosaminoglycan (GAG) production (both p < 0.05) than control. By the end of the third week, aggrecan, type I, II, and X collagen mRNA expressions in the EMF group were 1.8 times higher (p < 0.05), except for type II collagen) than control. The increase in gene expression did not show up in aggrecan histological staining and type II and type X collagen immunohistochemical staining. Cells from both groups kept a normal polygonal shape through out the test period. Our results suggested that one-time EMF exposure could promote collagen-embedded chondrocytes proliferation and their gene expressions. It also promoted short-term (week 1) GAG production and lacuna formation. No apparent GAG and type II collagen production was seen in histological staining three weeks after the EMF exposure.
Collapse
Affiliation(s)
- Chih-Hung Chang
- Division of Orthopedics, Department of Surgery, Far Eastern Memorial Hospital, Pan-Chiao, Taiwan
| | | | | | | | | |
Collapse
|
46
|
|
47
|
McKay JC, Corbacio M, Tyml K, Prato FS, Thomas AW. Extremely low frequency pulsed electromagnetic field designed for antinociception does not affect microvascular responsiveness to the vasodilator acetylcholine. Bioelectromagnetics 2009; 31:64-76. [PMID: 19644977 DOI: 10.1002/bem.20533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 225 microT, extremely low frequency, pulsed electromagnetic field (PEMF) that was designed for the induction of antinociception, was tested for its effectiveness to influence blood flow within the skeletal microvasculature of a male Sprague-Dawley rat model (n = 103). Acetylcholine (0.1, 1.0, or 10 mM) was used to perturb normal blood flow and to delineate differential effects of the PEMF, based on degree of vessel dilation. After both 30 and 60 min of PEMF exposure, we report no effects on peak perfusion response to acetylcholine (with only 0.2% of the group difference attributed to exposure). Spectral analysis of blood flow data was generated to obtain information related to myogenic activity (0.15-0.40 Hz), respiratory rate (0.4-2.0 Hz), and heart rate (2.0-7.0 Hz), including the peak frequency within each of the three frequency regions identified above, peak power, full width at half maximum (FWHM), and mean within band. No significant effects due to exposure were observed on myogenic activity of examined blood vessels, or on heart rate parameters. Anesthesia-induced respiratory depression was, however, significantly reduced following PEMF exposure compared to shams (although exposure only accounted for 9.4% of the group difference). This set of data suggest that there are no significant acute physiological effects of 225 microT PEMF after 30 and 60 min of exposure on peak blood flow, heart rate, and myogenic activity, but perhaps a small attenuation effect on anesthetic-induced respiratory depression.
Collapse
Affiliation(s)
- Julia C McKay
- Bioelectromagnetics, Imaging Program, Lawson Health Research Institute, London, Ontario, Canada
| | | | | | | | | |
Collapse
|
48
|
van Bergen CJA, Blankevoort L, de Haan RJ, Sierevelt IN, Meuffels DE, d'Hooghe PRN, Krips R, van Damme G, van Dijk CN. Pulsed electromagnetic fields after arthroscopic treatment for osteochondral defects of the talus: double-blind randomized controlled multicenter trial. BMC Musculoskelet Disord 2009; 10:83. [PMID: 19591674 PMCID: PMC2714496 DOI: 10.1186/1471-2474-10-83] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 07/10/2009] [Indexed: 01/12/2023] Open
Abstract
Background Osteochondral talar defects usually affect athletic patients. The primary surgical treatment consists of arthroscopic debridement and microfracturing. Although this is mostly successful, early sport resumption is difficult to achieve, and it can take up to one year to obtain clinical improvement. Pulsed electromagnetic fields (PEMFs) may be effective for talar defects after arthroscopic treatment by promoting tissue healing, suppressing inflammation, and relieving pain. We hypothesize that PEMF-treatment compared to sham-treatment after arthroscopy will lead to earlier resumption of sports, and aim at 25% increase in patients that resume sports. Methods/Design A prospective, double-blind, randomized, placebo-controlled trial (RCT) will be conducted in five centers throughout the Netherlands and Belgium. 68 patients will be randomized to either active PEMF-treatment or sham-treatment for 60 days, four hours daily. They will be followed-up for one year. The combined primary outcome measures are (a) the percentage of patients that resume and maintain sports, and (b) the time to resumption of sports, defined by the Ankle Activity Score. Secondary outcome measures include resumption of work, subjective and objective scoring systems (American Orthopaedic Foot and Ankle Society – Ankle-Hindfoot Scale, Foot Ankle Outcome Score, Numeric Rating Scales of pain and satisfaction, EuroQol-5D), and computed tomography. Time to resumption of sports will be analyzed using Kaplan-Meier curves and log-rank tests. Discussion This trial will provide level-1 evidence on the effectiveness of PEMFs in the management of osteochondral ankle lesions after arthroscopy. Trial registration Netherlands Trial Register (NTR1636)
Collapse
Affiliation(s)
- Christiaan J A van Bergen
- Orthopaedic Research Center Amsterdam, Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
De Mattei M, Varani K, Masieri FF, Pellati A, Ongaro A, Fini M, Cadossi R, Vincenzi F, Borea PA, Caruso A. Adenosine analogs and electromagnetic fields inhibit prostaglandin E2 release in bovine synovial fibroblasts. Osteoarthritis Cartilage 2009; 17:252-62. [PMID: 18640059 DOI: 10.1016/j.joca.2008.06.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 06/07/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the role of adenosine analogs and electromagnetic field (EMF) stimulation on prostaglandin E(2) (PGE(2)) release and cyclooxygenase-2 (COX-2) expression in bovine synovial fibroblasts (SFs). METHODS SFs isolated from synovia were cultured in monolayer. Saturation and binding experiments were performed by using typical adenosine agonists: N6-cyclohexyladenosine (CHA, A(1)), 2-[p-(2-carboxyethyl)-phenetyl-amino]-5'-N-ethylcarboxamidoadenosine (CGS 21680, A(2A)), 5'-N-ethylcarboxamidoadenosine (NECA, non-selective), N6-(3-iodobenzyl)2-chloroadenosine-5'-N-methyluronamide (Cl-IB-MECA, A(3)). SFs were treated with TNF-alpha (10 ng/ml) and lipopolysaccharide (LPS) (1 microg/ml) to activate inflammatory response. Adenosine analogs were added to control and TNF-alpha- or LPS-treated cultures both in the absence and in the presence of adenosine deaminase (ADA) which is used to deplete endogenous adenosine. Parallel cultures were exposed to EMFs (75 Hz, 1.5 mT) during the period in culture (24h). PGE(2) release was measured by immunoassay. COX-2 expression was evaluated by RT-PCR. RESULTS TNF-alpha and LPS stimulated PGE(2) release. All adenosine agonists, except for Cl-IB-MECA, significantly inhibited PGE(2) production. EMFs inhibited PGE(2) production in the absence of adenosine agonists and increased the effects of CHA, CGS 21680 and NECA. In ADA, the inhibition on PGE(2) release induced by CHA, CGS and NECA was stronger than in the absence of ADA and the EMF-inhibitory effect was lost. Changes in PGE(2) levels were associated to modification of COX-2 expression. CONCLUSIONS This study supports anti-inflammatory activities of A(1) and A(2A) adenosine receptors and EMFs in bovine SFs. EMF activity appears mediated by an EMF-induced up-regulation of A(2A) receptors. Biophysical and/or pharmacological modulation of adenosine pathways may play an important role to control joint inflammation.
Collapse
Affiliation(s)
- M De Mattei
- Department of Morphology and Embryology, University of Ferrara, Ferrara, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Bloom T, Renard R, Yalamanchili P, Wapner K, Chao W, Lin SS. Stimulation of ankle cartilage: other emerging technologies (cellular, electricomagnetic, etc.). Foot Ankle Clin 2008; 13:363-79, viii. [PMID: 18692005 DOI: 10.1016/j.fcl.2008.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Advances in understanding age-related changes in articular cartilage, joint homeostasis, the natural healing process after cartilage injury, and improved standards for evaluation of a joint surface made the ultimate goal of cartilage repair a possibility. New strategies for enhancement of articular cartilages' limited healing potential and biologic regeneration include advances in tissue engineering and the use of electromagnetic fields. This article reviews developments in basic science and clinical research made with these emerging technologies concerning treatment of articular cartilage defects and treatment of osteoarthritis of the ankle.
Collapse
Affiliation(s)
- Tamir Bloom
- Division of Pediatric Othopaedics, Department of Orthopaedic Surgery, New Jersey Medical School-University of Medicine and Dentistry of New Jersey, 90 Bergen Street, Newark, NJ 07103, USA.
| | | | | | | | | | | |
Collapse
|