What is considered an emerging area for arthritis therapy is the use of pulsed electromagnetic field (PEMF) therapy and electrotherapeutics. Termed, "electroceuticals", PEMF are highly-refined electromagnetic fields that are now being used to non-invasively "kickstart" the body's natural anti-inflammatory response to treat pain and inflammation and help soft tissue wounds heal faster.
Numerous in vitro and clinical studies have demonstrated that electric and magnetic energy has a positive effect on connective tissue healing. This has prompted an extensive amount of research in orthopedics and rheumatology. While modern pulsed electromagnetic fields (PEMF) have been available for more than 20 years, they are only now becoming a standard of care for delayed union fracture treatment.
Electromagnetic fields can be delivered by using direct placement of an electrode non-invasively by capacitive coupling (opposing electrodes placed on skin across the target area) or inductive coupling (PEMF induce an electric current in the target area without skin contact altogether).
In a randomized trial, Zizic et al studied a pulsed electric device used to treat 78 patients with chronic knee osteoarthritis via skin surface electrodes. The active treatment was superior to placebo in symptom reduction and was proved to be effective for symptom reduction and cost effective (Zizic TM, Hoffman KC, Holt PA, Hungerford DS, O'Dell JR, Jacobs MA, Lewis CG, Deal CL, Caldwell JR, Cholewczynski JG, et al. The treatment of osteoarthritis of the knee with pulsed electrical stimulation. J Rheumatol 22(9):1757-61, 1995).
The application of PEMF stimulation for osteoarthritis has been supported by additional work by Trock et al. In their experiment 86 patients with knee osteoarthritis were exposed to 9 hours of PEMF stimulation over a 1-month period using a non-contact device. Up to 36% of the patients noticed improvement in pain and function. PEMF therapy is considered safe but should be avoided in those who are pregnant, those patients with permanent pacemakers and patients with known cancer (Trock DH, Bollet AJ, Markoll R. The effect of pulsed electromagnetic fields in the treatment of osteoarthritisof the knee and cervical spine. Report of randomized, double blind, placebo controlled trials. Trock DH, Bollet AJ, Markoll R. Rheumatol 21(10):1903-11, 1994).
Because of the non invasive nature of this mode of therapy, it has promise as an additional weapon in the arsenal of the rheumatologist in treating osteoarthritis. Where PEMF will fall exactly in the sequence of treatment is still unknown. Further experience should clarify this issue.
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