Effectiveness of pulsed electromagnetic field therapy in the management of complex regional pain syndrome type 1: A randomized-controlled trial

İsmail Cömertoğlu, Seçilay Güneş, Atilla Halil Elhan, Evren Üstüner, Şehim Kutlay, Ayşe Adile Küçükdeveci, İsmail Cömertoğlu, Seçilay Güneş, Atilla Halil Elhan, Evren Üstüner, Şehim Kutlay, Ayşe Adile Küçükdeveci

Abstract

Objectives: This study aims to investigate whether pulsed electromagnetic field (PEMF) therapy in addition to a conventional rehabilitation program is effective on pain and functioning in patients with type 1 complex regional pain syndrome (CRPS-1) of the hand.

Patients and methods: Between March 2013 and January 2015, a total of 32 patients (16 males, 16 females; mean age: 50.1±13.1 years; range, 25 to 75 years) were included. The patients were randomly allocated into two groups. The control group (n=16) received a conventional rehabilitation program consisting of physical modalities, exercises, and occupational therapy, whereas the PEMF group (n=16) received additional PEMF (8 Hz, 3.2 mT) to the affected hand. The primary outcome measure was pain intensity using the Numeric Rating Scale (NRS). Secondary outcome measures were grip and pinch strength, hand edema, hand dexterity, and hand activities. All patients received 20 therapy sessions (five sessions/week, four weeks in total) and were evaluated before and after the therapy and at the first-month follow-up.

Results: Both groups showed significant improvements in primary and secondary outcomes (p<0.05) after the therapy and at follow-up. When the groups were compared in terms of improvements in assessment parameters, no statistically significant difference was found between the two groups in any of the outcomes (p>0.05).

Conclusion: The PEMF in addition to conventional rehabilitation program did not provide additional benefit for pain and hand functions in CRPS-1. Future studies using different application parameters such as frequency, intensity, duration, and route may provide a better understanding of the role of PEMF in CRPS-1 treatment.

Keywords: Complex regional pain syndrome; physical therapy; pulsed electromagnetic field; rehabilitation; ultrasonography.

Conflict of interest statement

Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Copyright © 2022, Turkish Society of Physical Medicine and Rehabilitation.

Figures

Figure 1. Study flow chart.
Figure 1. Study flow chart.

References

    1. Harden RN, Oaklander AL, Burton AW, Perez RS, Richardson K, Swan M, et al. Complex regional pain syndrome: Practical diagnostic and treatment guidelines, 4th edition. Pain Med. 2013;14:180–229.
    1. Dutton K, Littlejohn G. Terminology, criteria, and definitions in complex regional pain syndrome: Challenges and solutions. J Pain Res. 2015;8:871–877.
    1. Shi X, Wang L, Li X, Sahbaie P, Kingery WS, Clark JD. Neuropeptides contribute to peripheral nociceptive sensitization by regulating interleukin-1β production in keratinocytes. Anesth Analg. 2011;113:175–183.
    1. Castillo-Guzmána S, Nava-Obregóna TA, Palacios-Ríosa D, Estrada-Cortinasa JÁ, González-Garcíaa MC, Mendez- Guerraa JF, et al. Complex regional pain syndrome (CRPS), a review. Medicina Universitaria. 2015;17:114–121.
    1. Urits I, Shen AH, Jones MR, Viswanath O, Kaye AD. Complex regional pain syndrome, current concepts and treatment options. Curr Pain Headache Rep. 2018;22:10–10.
    1. Kubat NJ, Moffett J, Fray LM. Effect of pulsed electromagnetic field treatment on programmed resolution of inflammation pathway markers in human cells in culture. J Inflamm Res. 2015;8:59–69.
    1. Ross CL, Zhou Y, McCall CE, Soker S, Criswell TL. The use of pulsed electromagnetic field to modulate inflammation and improve tissue regeneration: A review. Bioelectricity. 2019;1:247–259.
    1. Strauch B, Herman C, Dabb R, Ignarro LJ, Pilla AA. Evidence-based use of pulsed electromagnetic field therapy in clinical plastic surgery. Aesthet Surg J. 2009;29:135–143.
    1. Faldini C, Cadossi M, Luciani D, Betti E, Chiarello E, Giannini S. Electromagnetic bone growth stimulation in patients with femoral neck fractures treated with screws: Prospective randomized double-blind study. Current Orthopaedic Practice. 2010;21:282–287.
    1. Hei WH, Byun SH, Kim JS, Kim S, Seo YK, Park JC, et al. Effects of electromagnetic field (PEMF) exposure at different frequency and duration on the peripheral nerve regeneration: In vitro and in vivo study. Int J Neurosci. 2016;126:739–748.
    1. Durmus A, Cakmak A, Disci R, Muslumanoglu L. The efficiency of electromagnetic field treatment in complex regional pain syndrome type I. Disabil Rehabil. 2004;26:537–545.
    1. Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med. 2007;8:326–331.
    1. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials. e1-37J Clin Epidemiol. 2010;63
    1. Basford JR, Baxter GD. In: De Lisa’s Physical Medicine & Rehabilitation. Principles and Practice. Gans BM, Walsh NE, Robinson LR, editors. Philadelphia: Lippincott Williams & Wilkins; 2010. Therapeutic physical agents; pp. 1694–1712.
    1. Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am. 1984;9:222–226.
    1. Moberg E. Objective methods for determining the functional value of sensibility in the hand. J Bone Joint Surg [Br] 1958;40-B:454–476.
    1. Duruöz MT, Poiraudeau S, Fermanian J, Menkes CJ, Amor B, Dougados M, et al. Development and validation of a rheumatoid hand functional disability scale that assesses functional handicap. J Rheumatol. 1996;23:1167–1172.
    1. Olsen MF, Bjerre E, Hansen MD, Hilden J, Landler NE, Tendal B, et al. Pain relief that matters to patients: Systematic review of empirical studies assessing the minimum clinically important difference in acute pain. BMC Med. 2017;15:35–35.
    1. Chalidis B, Sachinis N, Assiotis A, Maccauro G. Stimulation of bone formation and fracture healing with pulsed electromagnetic fields: Biologic responses and clinical implications. Int J Immunopathol Pharmacol. 2011;24(1 Suppl 2):17–20.
    1. Pilla AA. Nonthermal electromagnetic fields: From first messenger to therapeutic applications. Electromagn Biol Med. 2013;32:123–136.
    1. Lednev VV. Possible mechanism for the influence of weak magnetic fields on biological systems. Bioelectromagnetics. 1991;12:71–75.
    1. Johnson MT, Ramanathan M, Owegi R, Pilla AA. Modulation of carrageenan-induced paw edema and hyperalgesia in the rat with pulsed magnetic field therapy. Proceedings of the BEMS 30th Annual Meeting, Bioelectromagnetics Society, Frederick, MD, June. 2008:156–156.
    1. Hedén P, Pilla AA. Effects of pulsed electromagnetic fields on postoperative pain: A double-blind randomized pilot study in breast augmentation patients. Aesthetic Plast Surg. 2008;32:660–666.
    1. Paolucci T, Pezzi L, Centra AM, Giannandrea N, Bellomo RG, Saggini R. Electromagnetic field therapy: A rehabilitative perspective in the management of musculoskeletal pain - A systematic review. J Pain Res. 2020;13:1385–1400.
    1. Bagnato GL, Miceli G, Marino N, Sciortino D, Bagnato GF. Pulsed electromagnetic fields in knee osteoarthritis: A double blind, placebo-controlled, randomized clinical trial. Rheumatology (Oxford) 2016;55:755–762.
    1. Nelson FR, Zvirbulis R, Pilla AA. Non-invasive electromagnetic field therapy produces rapid and substantial pain reduction in early knee osteoarthritis: A randomized double-blind pilot study. Rheumatol Int. 2013;33:2169–2173.
    1. Chen L, Duan X, Xing F, Liu G, Gong M, Li L, et al. Effects of pulsed electromagnetic field therapy on pain, stiffness and physical function in patients with knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. J Rehabil Med. 2019;51:821–827.
    1. Ay S, Evcik D. The effects of pulsed electromagnetic fields in the treatment of knee osteoarthritis: A randomized, placebo-controlled trial. Rheumatol Int. 2009;29:663–666.
    1. Dündar Ü, Aşık G, Ulaşlı AM, Sınıcı Ş, Yaman F, Solak Ö, et al. Assessment of pulsed electromagnetic field therapy with Serum YKL-40 and ultrasonography in patients with knee osteoarthritis. Int J Rheum Dis. 2016;19:287–293.
    1. Kanat E, Alp A, Yurtkuran M. Magnetotherapy in hand osteoarthritis: A pilot trial. Complement Ther Med. 2013;21:603–608.
    1. Krzyżańska L, Straburzyńska-Lupa A, Rąglewska P, Romanowski L. Beneficial effects of pulsed electromagnetic field during cast immobilization in patients with distal radius fracture. Biomed Res Int. 2020;2020:6849352–6849352.
    1. Pagani S, Veronesi F, Aldini NN, Fini M. Complex regional pain syndrome type I, a debilitating and poorly understood syndrome. Possible role for pulsed electromagnetic fields: A narrative review. E807-E822Pain Physician. 2017;20
    1. Shim H, Rose J, Halle S, Shekane P. Complex regional pain syndrome: A narrative review for the practising clinician. e424-e433Br J Anaesth. 2019;123
    1. Honda Y, Sakamoto J, Hamaue Y, Kataoka H, Kondo Y, Sasabe R, et al. Effects of physical-agent pain relief modalities for fibromyalgia patients: A systematic review and meta-analysis of randomized controlled trials. Pain Res Manag. 2018;2018:2930632–2930632.
    1. Sutbeyaz ST, Sezer N, Koseoglu F, Kibar S. Low-frequency pulsed electromagnetic field therapy in fibromyalgia: A randomized, double-blind, sham-controlled clinical study. Clin J Pain. 2009;25:722–728.
    1. Miller LK, Jerosch-Herold C, Shepstone L. Clinical assessment of hand oedema: A systematic review. Hand Therapy. 2017;22:153–164.
    1. Miller LK, Jerosch-Herold C, Shepstone L. Effectiveness of edema management techniques for subacute hand edema: A systematic review. J Hand Ther. 2017;30:432–446.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe