Pulsed Electro-magnetic Field Therapy for Musculoskeletal Pain

Marovino T, Tassone E. Pulsed Electro-magnetic Field Therapy for Musculoskeletal Pain. Pract Pain Manag. 2023 July/August;23(4).

Pulsed electro-magnetic field (PEMF) science has evolved over the years, and dedicated research on this topic, specifically as it applies to pain management, has been growing. Independent research on PEMF has consistently demonstrated meaningful physiological treatment effects in three areas: pain, inflammation, and perfusion.

A systematic review conducted by Paolucci et al sought to identify the relationship between PEMF exposures and symptom mitigation in a heterogenous MSK chronic pain population; 21 RCTs fit the inclusion criteria for their review.¹ The results of their systematic review supported the contention that PEMF is significantly beneficial for MSK disorders (injury/disease) with the only question being that any one specific protocol could not be identified as being superior to another given the array of protocols used.

Similar results have been replicated over many years and many studies with a precise mechanism of action being more elusive to identify.^2-5

Possible Pathways

Basic science studies have identified several biochemical pathways activated by PEMF, some of which are critical in pain and inflammation and could be associated with meaningful epigenetic influences. Pathways activated by PEMF include those activated by calcium ions (Ca2+) and subsequently by nitric oxide (NO) and CGMP at the cellular level.⁶

Another hypothesis that has been posited is that of induction, whereby PEMF energy can create eddy currents leading to downstream physiochemical effects including nerve stimulation consistent with the gate control theory.⁷ Both these hypotheses provide some life science evidence to explain how PEMF exposures might lead to reduction of both pain and inflammation.

Bone Stimulation for Osteoarthritis

The use of pulsed EMF is most prevalent in knee osteoarthritis (OA), with research supporting several key therapeutic benefits on knee joint tissue including increasing PEMF signaling that modulates calmodulin-dependent nitric oxide (NO) signaling cascades in particular chondrocytes.^8,9

PEMF is well known to stimulate bone growth and is used in many of today’s bone stimulation devices. PEMF has been shown to accelerate the removal of inflammatory substances as well as the proliferation of chondrocytes. The chondroprotective effects of PEMF treatments in knee OA have been shown consistently in studies over the years.¹⁰

Perfusion and Oxygenation Effects for Ulcerations

Another intriguing physiological effect of PEMF treatment is the increase in perfusion associated with acute PEMF exposure. It is understood that PEMF induces vascularization, which leads to better perfusion and increased oxygenation of tissue which is especially important in the diabetic foot with non-healing ulcerations^11,12

However, diabetes-related ulcerations are not the only lesions that improve and resolve with improved perfusion/oxygenation. There is an entire category of ischemic type lesions that could potentially benefit from these effects including neuropathic problems. The key to improved tissue perfusion seems to be the effects PEMF has on circulating levels of NO, which is a known vasodilator substance and, when increased can lead to improved tissue oxygenation and a lowering of blood pressure.¹³