Electromagnetic Field Therapies: A Bibliography from Medline

Phil Rogers MVB MRCVS
1, Esker Lawns, Lucan, Dublin, Ireland
e-mail : philrogers@tinet.ie

4. Skin, Ulcers, Wounds

4a. Skin

Aleksaniants GD (1987) [Use of an EMF and iodine-bromine baths in the complex treatment of patients with circumscribed scleroderma - Article in Russian]. Vestn Dermatol Venerol 3:56-58. PMID: 3604436, UI: 87266118

Badea MA, Vasilco R, Sandru D, Paslaru L, Jieanu V, Comorosan S (1993) The effect of pulsed EMF (Diapulse) on cellular systems. Rom J Physiol Jan;30(1-2):65-71. Interdisciplinary Research Group, Fundeni Hospital, Bucharest, Romania. This was a study of the effect of a 27.12 MHz PEMF (Diapulse) on microbial growth. A strain of K 12 E. coli grown in complete Pennassay medium was subjected to Diapulse action for 30 m, at 8 h and 12 h of growth. In this experiment, designed to be close to the physiological conditions of open wounds, the PEMF action promoted no increase of cell population, indicating the safety of this type of therapy for wound healing process. The same K 12 E. coli strain grown in Pennassay medium for 2 h was inoculated into a minimal growth medium and the lagless exponential growth thus obtained was followed spectrophotometrically. Diapulse PEMF was applied to this lagless phase of cellular cultures at 30, 60, and 90 m after inoculation. A slight increase in the number of cells occurred at 2 and 4 h after the Diapulse application, when the cultures were previously subjected to Diapulse action between the period of 60 and 90 m of their growth. A possible molecular mechanism for these PEMF effects is discussed. PMID: 7982019, UI: 95072991

Cheng K, Tarjan PP, Thio YC, Mertz PM (1996) In vivo 3-D distributions of electric fields in pig skin with rectangular pulse electrical current stimulation (RPECS). Bioelectromagnetics 17(4):253-262. Dept of Biomedical Engineering, Univ of Miami, Coral Gables, Florida, USA. We developed stimulating and detecting electrodes. We examined 3-D distributions of electric fields experimentally in living pig skin under and around the stimulating electrodes with the detecting electrodes and rectangular pulsed electrical current stimulation (RPECS). We verified our previous physical assumption, E approximately I/(A sigma dz), in the skin under the electrode, where E, I, A and sigma dz respectively represent the electric field, the externally imposed peak current, the cross sectional area of the stimulating electrode and the perpendicular conductivity of the skin. Pulses were 30 mA, 140 us and 128 Hz. These parameters were previously used in our lab to enhance cutaneous regeneration, in vivo, with RPECS. PMID: 8891184, UI: 97046263

Dovzhanskii SI, Suvorov AP (1979) [Effect of a permanent EMF on experimental allergic skin reactions - Article in Russian]. Vopr Kurortol Fizioter Lech Fiz Kult Jan;1:63-64. PMID: 425362, UI: 79140328

Ring J (1993) [The skin and the environment - Article in German]. Hautarzt Oct;44(10):625-635. Hautklinik und Allergieabteilung, Universitats-Krankenhaus Eppendorf. The skin is in such continuous and intimate interaction with environmental influences as no other organ. Environment comes in contact with the organism in the form of substances or forces (physical, chemical, biological) and via different routes: irradiation (EM irradiation, often referred to in a simplified way as "light"), air, food, direct contact with the skin, injection, or psychosocial interactions. All these influences can lead to disease under certain conditions and in certain individuals, and especially to skin disease. The critical factors are the dose, the mode and time of contact; this is evident with regard to sunlight and its acute and chronic effects. Not only for noxious chemicals are the classification and differentiation of primary toxic reactions from hypersensitivity reactions of predisposed individuals crucial. Hypersensitivity reactions can either be immunologically mediated (allergic) or non-immunological (idiosyncrasy, pseudo-allergy). The existence of a genetic disposition does not exclude the importance of environmental factors. Atopic eczema is an example of a disease that can be influenced dramatically by a variety of environmental factors. Many toxic environmental factors are known to induce skin changes long before systemic or life-threatening diseases appear. The skin can be regarded as a "signal organ" for possible noxious environmental influences. Increased research efforts in this field are mandatory. Publication Types: Review Review, tutorial PMID: 8225971, UI: 94042058

4b. Ulcers

Alekseenko AV, Gusak VV, Iftodii AG, Tarabanchuk VV, Shcherban NG, Stoliar VF (1992) [The efficacy of interstitial electrophoresis in treating trophic ulcers of the lower extremities - Article in Russian]. Lik Sprava Sep;9:96-99. A clinico-lab study revealed the efficiency of intratissue electrophoresis of drugs in the complex treatment of patients with trophic ulcer of the lower extremities. This is related to the favourable effect of the EMF on the lesion focus and possibility to increase the concentration of drugs in the inflammation focus. PMID: 1481521, UI: 93127644

Comorosan S, Vasilco R, Arghiropol M, Paslaru L, Jieanu V, Stelea S (1993) The effect of diapulse therapy on the healing of decubitus ulcer. Rom J Physiol Jan;30(1-2):41-45. Interdisciplinary Research Group, Fundeni Hospital, Bucharest, Romania. The effect of high peak power PEMF (Diapulse) on treatment of pressure ulcers is under investigation. 20 elderly patients, aged from 60 to 84, hospitalized with chronic conditions and bearing long-standing pressure ulcers, are subjected to Diapulse sessions (1-2 daily), parallel to conventional treatment. 5 patients undergo conventional therapy, serving as control and 5 others follow conventional+placebo Diapulse treatment. All patients were daily monitored, concerning their clinical status and ulcers' healing. After a maximum 2-wk treatment, bulge healing rate was: 85% excellent and 15% very good healing under Diapulse therapy; in the placebo group, 80% patients show no improvement and 20% poor improvement; in the control group, 60% patients show no improvement and 40% poor improvement of ulcers. This investigation strongly advises for Diapulse treatment as a modern, uninvasive therapy of great efficiency and low social costs in resolving a serious, widespread medical problem. Publication Types: Clinical trial PMID: 7982015, UI: 95072987

Duran V, Zamurovic A, Stojanovic S, Poljacki M, Jovanovic M, Durisic S (1991) [Therapy of venous ulcers using pulsating EMFs: personal results - Article in Serbo-Croatian (Roman)]. Med Pregl 44(11-12):485-488. Klinika za infektivne i dermatoveneroloske bolesti, Medicinski fakultet, Novi Sad. The authors review the results of the treatment of venous varices by a PEMF, by the use of IVEMT-2 apparatus, treated at the Dept of Dermatovenereology in Novi Sad and the Institute of Med Rehabilitation. The treatment was carried out in 18 patients: 5 men and 13 women, mean age 56 yr, all with venous varices of post-thrombophlebitic origin. The number of sessions within the PEMF treatment was 10/patient, each session lasting 15 m. The results were followed by measuring the varix surface before and after the treatment. The number of varices before the therapy was 26 and after the treatment was 20. The total surface of the varices before the treatment was 55183.90 mm2, the mean surface being 2122.46 mm2. After the treatment 6 varices epithelialized, while the total surface was 36902.51 mm2. The mean surface of the varices after the treatment was 1845.13 mm2. The varix surface reduction rate after the treatment was 33.13%. Considering the number of patients, the obtained results are preliminary and they reflect the benefits of PEMF for epithelialization of venous varices. PMID: 1821449, UI: 92334277

Ieran M, Zaffuto S, Bagnacani M, Annovi M, Moratti A, Cadossi R (1990) Effect of low frequency pulsing EMFs on skin ulcers of venous origin in humans: a double-blind study. J Orthop Res Mar;8(2):276-282. Dept of Med Angiology, Arcispedale S. Maria Nuova, Reggio Emilia, Italy. The effect of an EMF on the healing of skin ulcers of venous origin in humans has been investigated in a double-blind study. 44 patients have been admitted to the study; one-half were exposed to active stimulators (experimental group) and the remaining to dummy stimulators (control group). The stimulation was scheduled to last a maximum of 90 d. The success rate was significantly higher in the experimental group both at d 90 (p<.02) and in the follow-up period (p<.005). The effect of the EMF may last even when the stimulation is over. No ulcers worsened in the experimental group, while 4 worsened in the control group. 25% of the patients in the experimental group and 50% in the control group experienced recurrence of the ulcer. Stimulation with an EMF is a useful adjunctive therapy in the management of these patients. Publication Types: Clinical trial Controlled clinical trial PMID: 2303961, UI: 90155636

Kirillov IB, Suchkova ZV, Lastushkin AV, Sigaev AA, Nekhaeva TI (1996) [Magentotherapy in the comprehensive treatment of vascular complications of diabetes mellitus - Article in Russian]. Klin Med (Mosk) 74(5):39-41. 320 diabetes mellitus (DM) patients were exposed to impulsed magnetic field, 100 control DM patients received conservative therapy alone. 270 patients had microangiopathy, macroangiopathy was diagnosed in 50 patients. Magnetotherapy in combination with conservative methods gave good and satisfactory results in 74% of patients versus 28% in control group. Metabolism stabilization resulted in some patients in reduced blood sugar. Use of magnetic field produced faster and longer response than conservative therapy. PMID: 8999182, UI: 97062022

Komissarova IV (1975) [Effect of ultra-high frequency EMF in continuous and pulse regimens on the indicators of serotonin metabolism in patients with ulcer disease - Article in Russian]. Vopr Kurortol Fizioter Lech Fiz Kult Mar;2:170-174. PMID: 1229083, UI: 76226202

Stiller MJ, Pak GH, Shupack JL, Thaler S, Kenny C, Jondreau L (1992) A portable pulsed EMF (PEMF) device to enhance healing of recalcitrant venous ulcers: a double-blind, placebo-controlled clinical trial. Br J Dermatol Aug;127(2):147-154. Ronald O. Perelman Dept of Dermatology, New York Univ Med Ctr, New York. A prospective, randomized, double-blind, placebo-controlled multicentre study assessed the clinical efficacy and safety of pulsed EM limb ulcer therapy (PELUT) in the healing of recalcitrant, predominantly venous leg ulcers. The portable device was used at home for 3 h daily during this 8-wk clinical trial as an adjunct to a wound dressing. Wound surface area, ulcer depth and pain intensity were assessed at wk 0, 4 and 8. At wk 8 the active group had a 47.7% decrease in wound surface area vs. a 42.3% increase for placebo (p<.0002). 50% of the ulcers in the active group healed or markedly improved vs. 0% in the placebo group, and 0% of the active group worsened vs. 54% of the placebo group (p<.001). Significant decreases in wound depth (p<.04) and pain intensity (p<.04) favouring the active group were seen. Patients whose ulcers improved significantly after 8 wk were permitted to continue double-blind therapy for an additional 4 wk. 11 active and 1 placebo patient continued therapy until wk 12, with the active treatment group continuing to show improvement. There were no reports of adverse events attributable to this device. The PELUT device was a safe and effective adjunct to non-surgical therapy for recalcitrant venous leg ulcers. Publication Types: Clinical trial Multicenter study Randomized controlled trial PMID: 1390143, UI: 93002349

Todd DJ, Heylings DJ, Allen GE, McMillin WP (1991) Treatment of chronic varicose ulcers with pulsed EMFs: a controlled pilot study. Ir Med J Jun;84(2):54-55. Dept of Dermatology, Belfast City Hospital. To evaluate the efficacy of PEMFs in healing of chronic varicose ulcers, 19 patients with this condition were included in a double-blind controlled clinical trial. All patients received standard ulcer therapy throughout the duration of the study and were randomly divided into two groups to receive either active or inactive PEMF therapy. Active therapy was provided by the use of a pair of helmholtz coils twice/wk for 5 wk and inactive therapy was provided on an identical regimen with identical coils wound so that no magnetic field was produced when an electric current was passed through them. The clinician and patients were unable to distinguish the active or inactive coils. No statistically relevant difference was noted between the two groups in the healing rates of the ulcer, change in the lower leg girth, pain or infection rates. However there was a trend in favour of a decrease in ulcer size and lower leg girth in the group treated with active PEMF. As PEMF is a novel treatment for chronic varicose ulcers, more work needs to be done to establish treatment parameters and its usefulness in the treatment of this condition. Publication Types: Clinical trial Randomized controlled trial PMID: 1894496, UI: 91373144

Vesovic-Potic V, Conic S (1993) [Use of pulsating high-frequency EMFs in patients with diabetic neuropathies and angiopathies - Article in Serbo-Croatian (Cyrillic)]. Srp Arh Celok Lek Aug;121(8-12):124-126. Belgrade Institute of Rehabilitation. High-frequency PEMF therapy was carried out in 22 patients with diabetic polyneuropathy and angiopathy of the lower extremities (18 M, 4 F, aged 48.2+6.3 yr; 10 insulin-dependent persons, and 12 on oral antidiabetic treatment). The aim of the study was to verify the effect of this therapy on symptoms, neurophysiological findings and peripheral circulation. The diagnose of diabetic polyneuropathy was based on the electromyographic examination of foot and calf muscles, measurement of motor nerve conduction velocity of peroneal and tibial nerve, and sensory nerve conduction velocity of sural nerve. Diagnosis of diabetic polyneuropathy was based on EMG examination of the foot and calf muscles, measurement of the motor nerve conduction velocity of peroneal and tibial nerves, and the sensory nerve conduction velocity of the sural nerve. Diabetic angiopathy was diagnosed by oscillometric examination, measurement of skin temperature and claudication distance. The same methods were used to evaluate the therapeutic effect of EMF. Therapy significantly improved the symptoms and all registered parameters of peripheral circulation, but neurophysiological parameters did not change significantly. Therefore, high-frequency PEMF is recommended for the treatment of diabetic angiopathy. It can be used as an initial therapy, or combined with physical agents which are commonly used in the treatment of patients with neuropathic changes in lesions of peripheral nerve. PMID: 7725151, UI: 95242150

4c. Wounds

Alekseenko AV, Gusak VV (1991) [Treatment of trophic ulcers of the lower extremities using a magnetic field - Article in Russian]. Klin Khir 7:60-63. The experience with treatment of 126 patients with ulcerous-necrotic lesion of the lower extremities of different genesis was summarized. A comparative evaluation of the effectiveness of treatment depending on a type of the magnetic field: the constant, alternating, or travelling impulse one was carried out. The most effective was the use of a travelling impulse magnetic field. The data give grounds to recommend the wide use of magnetotherapy in the complex treatment of trophic ulcers of the lower extremities. PMID: 1942838, UI: 92047074

Dindar H, Zeybek N, Yucesan S, Barlas M, Yurtaslani Z, Yazgan E, Konkan R, Ozguner IF, Gokcora IH (1993) Augmentation of mucosal adaptation following small-bowel resection by EMF stimulation in rats. Tokai J Exp Clin Med Jun;18(1-2):39-47. Dept of Pediatric Surgery, School of Med, Ankara Univ, Turkiye. Survival after massive resection of the small intestine is often possible due to substantial hyperplasia of the mucosal surface in the remaining small intestine. While nutrients provide the major stimulus for hyperplasia in the clinical setting, the availability of drugs to augment this process would have obvious therapeutic implications. EMF stimulation of connective tissue and skin increased the DNA and messenger RNA and protein synthesis in experimental studies. We evaluated the ability of EMF stimulation to augment mucosal hyperplasia after massive small bowel resection in the rat. 2 groups of 10 Wistar rats (250 g), were subjected to 70% jejunoileal resection. Group 1 received EMF stimulation for 10 d at a dosage of 43.2 Gauss; group 2 received no stimulation. After 14 d, segmental evaluation of mucosal mass in the remaining small intestine was determined by measuring mucosal protein, and disaccharidase levels, as well as intestinal length and circumference. EMF stimulation seemed to augment mucosal adaptation after massive small bowel resection in the proximal and distal small intestine of rats. PMID: 7940605, UI: 95026918

Dindar H, Renda N, Barlas M, Akinay A, Yazgan E, Tincer T, Cakmak M, Konkan R, Gokcora IH, Yucesan S (1993) The effect of EMF stimulation on corticosteroids-inhibited intestinal wound healing. Tokai J Exp Clin Med Jun;18(1-2):49-55. Dept of Pediatric Surgery, School of Med, Ankara Univ, Turkiye. EMF stimulation has been used successfully in the clinical setting to promote healing of ununited fractures. In a few studies, EMF stimulation enhanced soft tissue healing. To investigate the effect of EMF stimulation on intestinal wound healing in normal rats and in those treated with corticosteroids, 80 Wistar rats received twice-daily injections of either saline dexamethasone (0.1 mg/kg/d) for 2 wk. Animals then underwent creation of single-layer, inverting small intestine anastomoses. All injections were continued postoperatively. Animals were grouped as intestinal anastomoses; intestinal anastomoses plus EMF stimulation; intestinal anastomoses plus dexamethasone; and intestinal anastomoses plus dexamethasone plus EMF. On postoperative d 7 and 14, the anastomosed intestines were removed and the tensile strength (TS) and hydroxyproline (OH-P) contents measured. EMF stimulation significantly increased intestinal wound healing in normal animals by d 7 and 14. Corticosteroids significantly impaired the healing of the small intestine anastomoses, with decreased TS and OH-P contents after wk 1 and 2. However, EMF stimulation significantly reversed this inhibitory effect. PMID: 7940606, UI: 95026919

Kuliev RA, Babaev RF, Akhmedova LM, Ragimova AI (1992) [Treatment of suppurative wounds in patients with diabetes mellitus by magnetic field and laser irradiation - Article in Russian]. Khirurgiia (Mosk) Jul;7-8:30-33. The efficacy of including a magnetic field, low-intensity laser beam, and their combination in the complex of therapeutic measures was studied in 119 patients with suppurative wounds and diabetes mellitus. With the use of magnetic field or laser beam intoxication diminished, the organism's immunological status was stabilized within a shorter time, the wound process followed a quicker course, and treatment took less time. The magnetic-laser effect has advantages over separate use of these factors. PMID: 1469868, UI: 93108702

Nikolova L, Popov A, Klouchek E (1984) [Effect of interference current and low-frequency magnetic field on tissue regeneration - Article in Russian]. Vopr Kurortol Fizioter Lech Fiz Kult May;3:19-23. PMID: 6332416, UI: 84301978

Grechko BV, Teliushchenko DA, Kadyshev IuG, Litvinov PG, Marilova SB (1988) [Use of a UHF field to accelerate the epithelialization of donor wounds in burn patients - Article in Russian]. Klin Khir 3:75-76. PMID: 3043083, UI: 88301371

Szram S, Bielnik K, Sondej J (1987) [Morphological and morphometric studies of the healing of an experimental musculo-cutaneous wound after its exposure to a constant EMF - Article in Polish]. Chir Narzadow Ruchu Ortop Pol 52(6):463-468. PMID: 3452501, UI: 88254311

Vodovnik L, Karba R (1992) Treatment of chronic wounds by means of electric and EMFs: Part 1 - Literature review. Med Biol Eng Comput May;30(3):257-266. Faculty of Electrical & Computer Engineering, Univ of Ljubljana, Slovenia. The healing of a cutaneous wound is accompanied by endogeneous electrical phenomena. Not knowing whether they represent merely a side-effect of the physiological processes which take course during healing or whether they play a much more important role as mediators of healing, externally applied electricity was examined as a therapeutic tool for the enhancement of natural regenerative processes. In the present review a historical literature survey dealing with human applications of electric current for wound healing acceleration is given. It presents a complete palette of heterogeneous studies, differing in the parameters of applied electric current, in delivery modes as well as in the types of wounds being stimulated. Because of all these differences, comparing the efficacy of the described methods is difficult and could hardly be objective. Therefore greater stress was laid upon the discussion concerning the problems in designing clinical studies (size of the sample, control group, ethics of the procedures), rationales for the employment and possible underlying mechanisms of particular methods, and problems of evaluating their efficacy. In spite of the extensive work performed in the field of electrical wound healing we remain only part way towards explaining the mechanisms by which electricity reinforces the regenerative capabilities of injured tissue as well as only part way towards the selection of the optimal stimulation method from among the published reports. Publication Types: Review Review, academic PMID: 1453797, UI: 93086183