Pulsed Magnetic Field Therapy in Refractory Neuropathic Pain Secondary to Peripheral Neuropathy: Electrodiagnostic Parameters—Pilot Study

Pulsed electromagnetic fields attenuate human musculocutaneous nerve damage induced by biceps eccentric contractions

Pulsed electromagnetic field (PEMF) therapy, a noninvasive treatment, has shown promise in mitigating nerve damage. However, unaccustomed exercises, such as eccentric contractions (ECCs), can damage both muscle and nerve tissue. This study investigated whether magnetic stimulation (MS) with PEMF could aid in nerve recovery after ECCs in the elbow flexors. Twenty participants were randomly assigned to either a control (CNT) or an MS group. Following ECCs, we measured the latency of the M-wave in the musculocutaneous nerve as an indicator of nerve function. Additionally, isometric torque, range of motion, and muscle pain were assessed for muscle function. Interestingly, only the CNT group exhibited a significant increase in latency on Day 2 (p < 0.05). The MS group, on the other hand, displayed an earlier recovery trend in isometric torque, range of motion, and muscle soreness. Notably, muscle soreness significantly decreased immediately after MS treatment compared to pretreatment levels. These findings suggest that MS treatment can effectively attenuate nerve damage induced by ECCs exercise.

Early Intensive Neurorehabilitation in Traumatic Peripheral Nerve Injury-State of the Art

Traumatic nerve injuries are common lesions that affect several hundred thousand humans, as well as dogs and cats. The assessment of nerve regeneration through animal models may provide information for translational research and future therapeutic options that can be applied mutually in veterinary and human medicine, from a One Health perspective. This review offers a hands-on vision of the non-invasive and conservative approaches to peripheral nerve injury, focusing on the role of neurorehabilitation in nerve repair and regeneration. The peripheral nerve injury may lead to hypersensitivity, allodynia and hyperalgesia, with the possibility of joint contractures, decreasing functionality and impairing the quality of life. The question remains regarding how to improve nerve repair with surgical possibilities, but also considering electrical stimulation modalities by modulating sensory feedback, upregulation of BDNF, GFNF, TrKB and adenosine monophosphate, maintaining muscle mass and modulating fatigue. This could be improved by the positive synergetic effect of exercises and physical activity with locomotor training, and other physical modalities (low-level laser therapy, ultrasounds, pulsed electromagnetic fields, electroacupuncture and others). In addition, the use of cell-based therapies is an innovative treatment tool in this field. These strategies may help avoid situations of permanent monoplegic limbs that could lead to amputation.

Non-pharmacological management of neuropathic pain in older adults: a systematic review

INTRODUCTION

Neuropathic pain encompasses multiple diagnoses with detrimental impacts on quality of life and overall health. In older adults, pharmacological management is limited by adverse effects and drug interactions, while surgical management involves perioperative risk. Prior reviews addressing non-pharmacological interventions for neuropathic pain have not focused on this demographic. Therefore, this systematic review synthesizes the evidence regarding the effectiveness of non-pharmacological interventions in reducing neuropathic pain severity in older adults.

METHODS

PubMed, CINAHL, Web of Science, and PsycInfo were searched using key terms, with inclusion criteria of age ≥ 65, neuropathic pain, non-pharmacological intervention, pain severity measurement, English language, peer-reviewed, and either randomized controlled trial (RCT) or quasi-experimental design. In total, 2759 records were identified, with an additional 28 records identified by review of reference lists. After removal of duplicates, 2288 records were screened by title and abstract, 404 full-text articles were assessed, and 19 articles were critically reviewed and synthesized.

RESULTS

Of the 14 RCTs and 5 quasi-experimental studies included in the review, the most common intervention was electric and/or magnetic therapy, followed by acupuncture, mindfulness meditation, exercise, and light therapy. Several studies revealed both statistical and clinical significance, but conclusions were limited by small sample sizes and methodological shortcomings. The interventions were generally safe and acceptable.

CONCLUSIONS

Results should be interpreted with consideration of clinical vs statistical significance, mediators of pain severity, and individual variations in effectiveness. Further research should address multimodal and novel interventions, newer models of care, and technology-based interventions.

Adaptive Autonomic and Neuroplastic Control in Diabetic Neuropathy: A Narrative Review

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a worldwide socioeconomic burden, and is accompanied by a variety of metabolic disorders, as well as nerve dysfunction referred to as diabetic neuropathy (DN). Despite a tremendous body of research, the pathogenesis of DN remains largely elusive. Currently, two schools of thought exist regarding the pathogenesis of diabetic neuropathy: a) mitochondrial-induced toxicity, and b) microvascular damage. Both mechanisms signify DN as an intractable disease and, as a consequence, therapeutic approaches treat symptoms with limited efficacy and risk of side effects.

OBJECTIVE

Here, we propose that the human body exclusively employs mechanisms of adaptation to protect itself during an adverse event. For this purpose, two control systems are defined, namely the autonomic and the neural control systems. The autonomic control system responds via inflammatory and immune responses, while the neural control system regulates neural signaling, via plastic adaptation. Both systems are proposed to regulate a network of temporal and causative connections which unravel the complex nature of diabetic complications.

RESULTS

A significant result of this approach infers that both systems make DN reversible, thus opening the door to novel therapeutic applications.

The Pharmacological Treatment of Chronic Pain: From Guidelines to Daily Clinical Practice

In agreement with the International Association for the Study of Pain, chronic pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. To date, there are several types of pain: nociceptive, neuropathic, and nociplastic. In the present narrative review, we evaluated the characteristics of the drugs used for each type of pain, according to guidelines, and their effects in people with comorbidity to reduce the development of severe adverse events.

A comparative study between transcutaneous electrical nerve stimulation and pulsed electromagnetic field therapy in the management of post-herpetic neuralgia of the sciatic nerve

OBJECTIVES

To compare the efficacy of pulsed electromagnetic field therapy (PEMFT) versus transcutaneous electrical nerve stimulation (TENS) in the treatment of post-herpetic neuralgia of the sciatic nerve.

METHODS

A double-blinded randomized clinical study has included 56 patients (18 males and 38 females). Participants were randomly and equally assigned into 2 groups. Both groups received conventional physical therapy treatment. Moreover, group (A) has an additional TENS, and group (B) had PEMFT. Both modalities were applied once daily, 3 times a week for 20 minutes for 8 successive weeks. Visual analog scale (VAS) and carbamazepine intake (CMI) dose have been assessed before and after interventions.

RESULTS

There was a significant decrease in VAS and CMI post-treatment in group A and B compared with that pretreatment (P > .001). The percent decrease in VAS and CMI in group A were 72.44% and 69.47% respectively and that for group B was 68.95% and 67.94% respectively. The findings revealed a non-significant difference in VAS and CMI (P > .05) between groups. The Means of VAS and CMI were (2.4 ± 0.78, 204.5 ± 16.76 and 2.67 ± 0.9, 210.57 ± 16.5) in group A and group B respectively. The mean difference for VAS and CMI was (-0.27 and -6.07) between groups post-treatment respectively.

CONCLUSION

Both TENS and PEMFT were effective and nearly equivalent in improving the post-herpetic neuralgia of the sciatic nerve as measured by in VAS and CMI. Clinical recommendations should be highlighted to instigate the using of TENS and PEMFT in the management of post-herpetic neuralgia of the sciatic nerve.

Do Magnetic Fields Have a Place in Treating Vascular Complications in Diabetes?

The use of electromagnetic field therapy (EMFT) is a non-invasive, potential alternative or complementary choice in the treatment of wounds, chronic pain, neuropathy, and other medical conditions, including tissue repair and cell proliferation. Static magnetic fields (SMFs) have been reported to increase microcirculatory blood flow by mediating vasodilation via nitric oxide. Studies report that SMF exposure causes homeostatic, normalizing effects on the vascular tone that may have beneficial effects in situations where tissue perfusion is limited, such as may be present in diabetes. Pulsed electromagnetic fields (PEMFs) have also shown promise in treating diabetic wounds by improving wound healing rates and other attributes. Our purpose was to critically review prior applications of EMFT for relevancy and effectiveness in treating diabetic complications. The goal was to provide information to allow for informed decisions on the possible use of these modalities in the treatment of persons with diabetic complications. The focus was on the following major areas: wound healing, neuropathy, blood glucose control, blood flow, inflammation and oxidative stress.

New insights into bioelectronic medicines: A new approach to tackle diabetic peripheral neuropathy pain in clinics

Bioelectronic medicines are a newer way to treat and diagnose the diseases associated with biological systems. All vital organs of the body are innervated, commanding brain to regulate the homeostasis functions. Bioelectronic medicines rely on implications of electrical stimulations or signals associated with the nervous system for real-time treatment. Diabetic peripheral neuropathy (DPN) is a most prevalent micro-vascular complication associated with diabetes mellitus. Complex plexus of nerves were affected in this complication with impaired function. Bioelectronic medicines are future hope for effective treatment of DPN.

Efficacy of extremely low-frequency magnetic field in fibromyalgia pain: A pilot study

The purpose of this pilot study was to determine the efficacy of an extremely low-frequency magnetic field (ELF-MF) in decreasing chronic pain in fibromyalgia (FM) patients. Thirty-seven females were recruited and randomized into two groups: one group was first exposed to systemic ELF-MF therapy (100 microtesla, 1 to 80 Hz) and then to sham therapy, and the other group received the opposite sequence of intervention. Pain, FM-related symptoms, and the ability to perform daily tasks were measured using the Visual Analog Scale, Fibromyalgia Impact Questionnaire (FIQ), Fibromyalgia Assessment Scale (FAS), and Health Assessment Questionnaire (HAQ) at baseline, end of first treatment cycle, beginning of second treatment cycle (after 1 mo washout), end of second treatment cycle, and end of 1 mo follow-up. ELF-MF treatment significantly reduced pain, which increased on cessation of therapy but remained significantly lower than baseline levels. Short-term benefits were also observed in FIQ, FAS, and HAQ scores, with less significant effects seen in the medium term. ELF-MF therapy can be recommended as part of a multimodal approach for mitigating pain in FM subjects and improving the efficacy of drug therapy or physiotherapy.

The change of HCN1/HCN2 mRNA expression in peripheral nerve after chronic constriction injury induced neuropathy followed by pulsed electromagnetic field therapy

Neuropathic pain is usually defined as a chronic pain state caused by peripheral or central nerve injury as a result of acute damage or systemic diseases. It remains a difficult disease to treat. Recent studies showed that the frequency of action potentials in nociceptive afferents is affected by the activity of hyperpolarization-activated cyclic nucleotide-gated cation channels (HCN) family. In the current study, we used a neuropathy rat model induced by chronic constriction injury (CCI) of sciatic nerve to evaluate the change of expression of HCN1/HCN2 mRNA in peripheral nerve and spinal cord. Rats were subjected to CCI with or without pulsed electromagnetic field (PEMF) therapy. It was found that CCI induced neural cell degeneration while PEMF promoted nerve regeneration as documented by Nissl staining. CCI shortened the hind paw withdrawal latency (PWL) and hind paw withdrawal threshold (PWT) and PEMF prolonged the PWL and PWT. In addition, CCI lowers the expression of HCN1 and HCN2 mRNA and PEMF cannot restore the expression of HCN1 and HCN2 mRNA. Our results indicated that PEMF can promote nerve regeneration and could be used for the treatment of neuropathic pain.

Mercury poisoning as a cause of intracranial hypertension

Mercury poisoning is a rare but fatal toxicologic emergency. Neurologic manifestations involving the central nervous system are seen usually with chronic mercury intoxication. The most commonly seen complaints are headache, tremor, impaired cognitive skills, weakness, muscle atrophy, and paresthesia. Here, we present a male patient who was chronically exposed to elemental mercury and had papilledema and intracranial hypertension without parenchymal lesion in the central nervous system. A 12-year-old male patient was referred to our emergency room because of severe fatigue, generalized muscle pain and weakness, which was present for a month. Physical examination revealed painful extremities, decreased motor strength and the lack of deep tendon reflexes in lower extremities. He had mixed type polyneuropathy in his electromyography. Whole blood and 24-hour urinary mercury concentrations were high. A chelation therapy with succimer (dimercaptosuccinic acid) was started on the fourth day of his admission. On the seventh day of his admission, he developed headache and nausea, and bilateral papilledema and intracranial hypertension were detected on physical examination. Acetazolamide was started and after 1 month of treatment, the fundi examination was normal. The patient stayed in the hospital for 35 days and was then discharged with acetazolamide, vitamin B6, gabapentin, and followed as an outpatient. His clinical findings were relieving day by day. Although headache is the most common symptom in mercury poisoning, the clinician should evaluate the fundus in terms of intracranial hypertension.

Is static magnetic field exposure a new model of metabolic alteration? Comparison with Zucker rats

PURPOSE

The aim of this study was to investigate if the metabolic alterations observed after static magnetic field (SMF) exposure participates in the development of a pre-diabetic state. A comparison study using the insulin resistant animal model, the Zucker rat and the SMF-exposed Wistar rat was carried out.

MATERIALS AND METHODS

Zucker rats were compared to Wistar rats either exposed to a 128 mT or 0 mT SMF (sham exposed) and analysed. This moderate-intensity SMF exposure of Wistar rats was performed for 1 h/day during 15 consecutive days.

RESULTS

Wistar rats exposed to the SMF showed increased levels of carbohydrate and lipid metabolites (i.e., lactate, glycerol, cholesterol and phospholipids) compared to sham-exposed rats. Zucker rats displayed a normoglycemia associated with a high insulin level as opposed to Wistar rats which presented hyperglycemia and hypoinsulinemia after exposure to the SMF. During the glucose tolerance test, unexposed Zucker rats and Wistar rats exposed to the SMF exhibited a significantly higher hyperglycemia compared to sham-exposed Wistar rats suggesting an impairment of glucose clearance. In muscle, glycogen content was lower and phospholipids content was elevated for both unexposed Zucker rats and Wistar rats exposed to the SMF compared to Wistar rats sham control.

CONCLUSIONS

This study provides evidence that the metabolic alterations following exposure to a static magnetic field of moderate intensity could trigger the development of a pre-diabetic state.

The influence of pulsed magnetic fields (PMFs) on nonsynaptic potentials recorded from the central and peripheral nervous systems in vitro

The influence of pulsed magnetic fields (PMFs) on nonsynaptic potentials recorded from the central and peripheral nervous system in vitro has been investigated. The population spikes (PSs) recorded from hippocampal slices during antidromic stimulation and compound action potentials (CAPs) recorded from the segments of the sciatic nerve were used as indicators of neuronal activity. The potentials recorded from both preparations were significantly and permanently enhanced following PMF (0.16 Hz, 15 mT) exposure. The increase in the antidromic PS occurred even in the presence of potassium channel blocker tetraethylammonium (TEA) and was accompanied by multiple spiking. Among all frequencies of PMF tested (0.5, 0.16, 0.07, 0.03, 0.0 Hz), the frequency of 0.5 Hz was the most effective in enhancement of potential amplitude. The influence of PMF on the amplitude of two CAPs evoked by the pair of electrical stimuli applied in rapid succession has also been evaluated. In control conditions the potential triggered by the second stimuli was slightly smaller expressing the phenomenon of short-term depression (STD). Although PMF exposure amplified the amplitude of both potentials, the increase in the size of the first potential was significantly greater increasing further the magnitude of STD. The blocking of potassium channels reversed STD into facilitation. One of the possible mechanisms involved in PMF action could be the modification of the axonal threshold, which was significantly reduced following exposure to PMF.

Diabetic peripheral neuropathy

Diabetes mellitus is a global lifelong health problem. By 2030, the projected worldwide prevalence of diabetes will reach 366 million (Wild et al, 2004). Diabetes can lead to a variety of complications including diabetic peripheral neuropathy. The occurrence of diabetic peripheral neuropathy (DPN) is 25% for patients with a history of 10 years or more of diabetes, and 50% for those with a 20-year history or longer (Pirart, 1977).

Repetitive 50 Hz pulsed electromagnetic field ameliorates the diabetes-induced impairments in the relaxation response of rat thoracic aorta rings

PURPOSE

To evaluate the characteristic features of mechanical responses and the membrane potential changes induced by repetitive pulsed electromagnetic field (PEMF, 50 Hz, 5 mT) in thoracic aorta rings obtained from streptozotocin-induced diabetic and healthy control rats to determine if PEMF could ameliorate problems associated with diabetes.

METHODS

Sixty male Wistar rats weighing 250-290 g were randomly divided into two experimental groups, each containing 30 animals. Streptozotocin was given via tail vein to produce diabetes mellitus (DM) in the first group rats. The second group rats were treated only with % 0.9 saline and considered as non-DM group. Both groups were also divided into two subgroups as DM + PEMF, DM + sham, PEMF and sham, each containing 15 animals. Although the DM + PEMF and PEMF groups were treated, the DM + sham and sham groups were not treated with PEMF. The PEMF treatment occurred four times daily for 30 min at 15-min intervals repeated daily for 30 days. Thoracic aorta rings from both DM and non-DM rats exposed to PEMF were evaluated for contraction and relaxation responses and membrane potential changes in the presence or absence of chemical agents that were selected to test various modes of action.

RESULTS

Relaxation response of thoracic aorta rings was significantly reduced in DM than non-DM group. PEMF treatment significantly increased the relaxation response of the diabetic rings to acetylcholine, and reduced the concentration response to phenylephrine. Resting membrane potential was significantly higher in DM than in non-DM group. Inhibitors of nitric oxide (NO), both nitro-L-arginine (L-NO-ARG) and L-NO-ARG + indometacin combination, produced a significant transient hyperpolarisation in all groups. Inhibitors of potassium channel activity, charybdotoxin or apamine, produced a membrane depolarisation. However, PEMF did not induce any significant effect on the membrane potential in DM group.

CONCLUSIONS

Diabetes reduced the relaxation response of thoracic aorta rings. It also affected the membrane potentials of the rings. Treatment with PEMF ameliorated the diabetes-induced impairments in the relaxation response of these rings.

Magnetfeldtherapie – Ergebnisse hinsichtlich evidence based medicine

Therapy with electromagnetic fields has a very old tradition in medicine. The indications are widespread, whereas little is known about the effects. Controlled randomizied studies with positive results for pulsed electromagnetic fields (PEMF) are available for osteotomies, the healing of skin wounds, and osteoarthritis. Comparison of the studies is difficult because of the different doses applied and intervals of therapy. Therefore recommendations regarding an optimal dosis and interval are, depending on the disease, quite variable.

Complementary and Alternative Pain Therapy in the Emergency Department

One primary reason patients go to emergency departments is for pain relief. Understanding the physiologic dynamics of pain, pharmacologic methods for treatment of pain, as well CAM therapies used in treatment of pain is important to all providers in emergency care. Asking patients about self-care and treatments used outside of the emergency department is an important part of the patient history. Complementary and alternative therapies are very popular for painful conditions despite the lack of strong research supporting some of their use. Even though evidenced-based studies that are double blinded and show a high degree of interrater observer reliability do not exist, patients will likely continue to seek out CAM therapies as a means of self-treatment and a way to maintain additional life control. Regardless of absolute validity of a therapy for some patients, it is the bottom line: "it seems to help my pain." Pain management distills down to a very simple endpoint, patient relief, and comfort. Sham or science, if the patient feels better, feels comforted, feels less stressed, and more functional in life and their practices pose no health risk, then supporting their CAM therapy creates a true wholistic partnership in their health care.CAM should be relatively inexpensive and extremely safe. Such is not always the case, as some patients have discovered with the use of botanicals. It becomes an imperative that all providers be aware of CAM therapies and informed about potential interactions and side effects when helping patients manage pain and explore adding CAM strategies for pain relief. The use of regulated breathing, meditation, guided imagery, or a massage for a pain sufferer are simple but potentially beneficial inexpensive aids to care that can be easily employed in the emergency department. Some CAM therapies covered here, while not easily practiced in the emergency department, exist as possibilities for exploration of patients after they leave, and may offer an improved sense of well-being and empowerment in the face of suffering and despair. The foundations of good nutrition, exercise, stress reduction, and reengagement in life can contribute much to restoring the quality of life to a pain patient. Adding nondrug therapies of physical therapy, cognitive-behavioral therapy, TENS, hypnosis, biofeedback, psychoanalysis, and others can complete the conventional picture. Adding in simple mind/body therapies, touch therapies, acupuncture, or others may be appropriate in select cases, and depending on the circumstances, may effect and enhance a conventional pain management program. Armed with an understanding of pain dynamics and treatments, practitioners can better meet patient needs, avoid serious side effects, and improve care when addressing pain management in the emergency department.

Effectiveness of frequency-modulated electromagnetic neural stimulation in the treatment of painful diabetic neuropathy

AIMS/HYPOTHESIS

The largely unsatisfactory results reported for the pharmacological treatment of diabetic neuropathy has spurred the search for alternative therapies. The aim of this study was to evaluate the efficacy of frequency-modulated electromagnetic neural stimulation (FREMS) as a novel treatment for painful diabetic neuropathy.

METHODS

Patients (n=31) with painful neuropathy associated with decreased nerve conduction velocity (<40 m/s) and increased vibration perception threshold (>25 V) were enrolled in a randomised, double-blind, crossover study designed to compare the effects of FREMS with those of placebo. Each patient received two series of ten treatments of either FREMS or placebo in random sequence, with each series lasting no more than 3 weeks. The primary efficacy end point was the change in pain measured by a visual analogue scale (VAS).

RESULTS

FREMS induced a significant reduction in daytime and night-time VAS pain score (all p<0.02). Furthermore, FREMS induced a significant increase in sensory tactile perception, as assessed by monofilament; a decrease in foot vibration perception threshold, as measured by a biothesiometer; and an increase in motor nerve conduction velocity (all p<0.01). No significant changes were observed after placebo. Comparison of measurements at the 4-month follow-up with those at baseline revealed that a significant benefit persisted for all measures that showed an improvement at the end of treatment, with an additional improvement in quality of life evaluated by the Short Form-36 questionnaire (all p<0.05). No significant side effects were recorded during the study.

CONCLUSIONS/INTERPRETATION

FREMS is a safe and effective therapy for neuropathic pain in patients with diabetes and is able to modify some parameters of peripheral nerve function.