The effect of pulsed electromagnetic fields in the treatment of cervical osteoarthritis: a randomized, double-blind, sham-controlled trial. Repetitive magnetic stimulation: a novel therapeutic approach for myofascial pain syndrome. Pulsed high frequency (27MHz) electromagnetic therapy for persistent neck pain. A double blind, placebo-controlled study of 20 patients. A randomized controlled study on the effect of two different treatments (FREMS AND TENS) in myofascial pain syndrome. A randomized clinical trial of TENS and exercise for patients with chronic neck pain. The immediate effectiveness of electrical nerve stimulation and electrical muscle stimulation on myofascial trigger points. Low energy high frequency pulsed electromagnetic therapy for acute whiplash injuries. A double blind randomized controlled study. Therapeutic effects of peripheral repetitive magnetic stimulation on myofascial pain syndrome. Randomised clinical trial of manipulative therapy and physiotherapy for persistent back and neck complaints: results of one year follow up. Transcutaneous electrical nerve stimulation vs. transcutaneous spinal electroanalgesia for chronic pain associated with breast cancer treatments. The effect of pulsed electromagnetic fields in the treatment of osteoarthritis of the knee and cervical spine. Report of randomized, double blind, placebo controlled trials. Prospective comparison of the effect of direct current electrical stimulation and pulsed electromagnetic fields on instrumented posterolateral lumbar arthrodesis. Active treatment of chronic neck pain: a prospective randomized intervention. Efficacy of electroacupuncture and TENS in the rehabilitation of chronic low back pain patients. A double-blind trial of the clinical effects of pulsed electromagnetic fields in osteoarthritis.
The purpose of this study was to evaluate the effect of electromagnetic field therapy (PEMF) on pain, range of motion (ROM) and functional status in patients with cervical osteoarthritis (COA). Thirty-four patients with COA were included in a randomized, double-blind study. PEMF was administrated to the whole body using a mat 1.8 x 0.6 m in size. During the treatment, the patients lay on the mat for 30 min per session, twice a day for 3 weeks. Pain levels in the PEMF group decreased significantly after therapy (p<0.001), but no change was observed in the placebo group. The active ROM, paravertebral muscle spasm and neck pain and disability scale (NPDS) scores improved significantly after PEMF therapy (p<0.001) but no change was observed in the sham group. The results of this study are promising, in that PEMF treatment may offer a potential therapeutic adjunct to current COA therapies in the future. The aim of this study was to evaluate the short, medium and long-term effects of peripheral repetitive magnetic stimulation (rMS) on myofascial pain compared with transcutaneous electrical nerve stimulation (TENS).Fifty-three subjects with myofascial trigger points (TPs) at the level of the superior trapezius muscle were allocated randomly to three groups. The first group (n=17) was treated with rMS, the second (n=18) with TENS and the third (n=18) received a placebo treatment. Each treatment consisted of ten daily 20-minute sessions. Patients were evaluated before and immediately following treatment, and at one and three months after the end of treatment. Outcome measures were: the "neck pain and disability visual analogue scale" (NPDVAS), an algometric evaluation of pain, an evaluation of the TP characteristics, and the range of cervical bending and rotation contralateral to the affected trapezius muscle. At the end of treatment, the rMS group showed a significant improvement in the NPDVAS, algometry, TP characteristics, and cervical contralateral rotation. This improvement also persisted at one and three months post-therapy. After treatment, the TENS group showed significant improvement in the same outcome measures except for algometry. At the one month follow-up visit, this improvement had returned to non significant levels in all outcome measures with the exception of NPDVAS. No significant effect of TENS was seen at the three-month follow-up visit. The placebo group showed no significant improvement in any measure. Our results strongly suggest that at medium and longer term intervals peripheral rMS may be more effective than TENS for the treatment of myofascial pain. In the majority of patients with neck pain, symptoms will resolve spontaneously or quite quickly in response to therapy. However, some patients' symptoms persist for a long period, irrespective of therapy. In this study, 20 patients with persistent (greater than 8 weeks) neck pain were enrolled in a double blind, placebo-controlled trial of low energy, pulsed electromagnetic therapy (PEMT)--a treatment previously shown to be effective in soft tissue injuries. For the first 3-week period, group A (10 patients) received active PEMT units while group B (10 patients) received facsimile placebo units. After 3 weeks, both pain (visual analogue scale (P less than .023) and range of movement (P less than .002) had improved in the group on active treatment compared to the controls. After the second 3 weeks, during which both groups used active units, there were significant improvements in observed scores for pain and range of movement in both groups. PEMT, in the form described, can be used at home easily in the treatment of patients with neck pain. It is frequently successful and without side effects. Myofascial pain syndrome (MPS) is a frequent cause of chronic muscoloskeletal pain. Transcutaneous electrical nerve stimulation (TENS) is one of the most frequently employed treatments in MPS. The aim of this study is to compare the short and medium-term effects of frequency modulated neural stimulation (FREMS) to those of TENS in MPS.
                Forty subjects with upper trapezius MPS were randomly allocated to 1 of 2 groups, treated with either FREMS (n=19) or TENS (n=21). Each treatment consisted in 10 sessions lasting 20 min each. Patients were evaluated before treatment, at 1 week, and at 1 and 3 months after the end of treatment. Clinical evaluation included parameters for measurement of pain levels using the neck pain and disability visual analogue scale (NPDVAS) and algometry, evaluation of myofascial trigger point characteristics and measurement of the range of cervical movement (range of motion, ROM).
                The FREMS group showed a significant improvement in the NPDVAS, algometry, in myofascial trigger point characteristics, and in the ROM (homolateral rotation, controlateral rotation, bending and extension) after the end of treatment and at 1 and 3 months follow-up evaluation. The TENS group showed significant improvement in the same outcome measures except for algometry and cervical extension, but these improvements were maintained only at the 1 month follow-up evaluation. However, were not observed statistically significant differences between FREMS of TENS in many of outcome measures.
                Both FREMS and TENS have positive short-term effects on MPS. But, medium-term effects were achieved only with FREMS. To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on acupuncture points and neck exercise in chronic neck pain patients.
                A randomized clinical trial.
                Hospital-based practice.
                Two hundred and eighteen patients with chronic neck pain.
                Subjects were randomized into three groups, receiving either (1) TENS over the acupuncture points plus infrared irradiation (TENS group); (2) exercise training plus infrared irradiation (exercise group); or (3) infrared irradiation alone (control); twice a week for six weeks.
                The values of verbal numeric pain scale, Northwick Park Neck Pain Questionnaire, and isometric neck muscle strength were assessed before, at the end of the six-week treatment, and at the six-month follow-up.
                Results demonstrated that after the six-week treatment, significant improvement in the verbal numerical pain scale was found only in the TENS group (0.60+/-2.54, p = 0.027) and the exercise group (1.57+/-2.67, p < 0.001). Though significant reduction in Northwick Park Neck Pain Questionnaire score was found in all three groups, post-hoc tests showed that both the TENS and the exercise group produced better improvement (0.38+/-0.60% and 0.39+/-0.62% respectively) than the control group (0.23+/-0.63%). Significant improvement (p = < 0.001 to 0.03) in neck muscle strength was observed in all three groups, however, the improvement in the control group was not clinically significant and it could not be maintained at the six-month follow-up.
                After the six-week treatment, patients in the TENS and exercise group had a better and clinically relevant improvement in disability, isometric neck muscle strength, and pain. All the improvements in the intervention groups were maintained at the six-month follow-up. This study is designed to investigate the immediate effectiveness of electrotherapy on myofascial trigger points of upper trapezius muscle. Sixty patients (25 males and 35 females) who had myofascial trigger points in one side of the upper trapezius muscles were studied. The involved upper trapezius muscles were treated with three different methods according to a random assignment: group A muscles (n = 18) were given placebo treatment (control group); group B muscles (n = 20) were treated with electrical nerve stimulation (ENS) therapy; and group C muscles (n = 22) were given electrical muscle stimulation (EMS) therapy. The effectiveness of treatment was assessed by conducting three measurements on each muscle before and immediately after treatment: subjective pain intensity [(PI) with a visual analog scale], pressure pain threshold [(PT) with algometry], and range of motion [(ROM) with a goniometer] of upper trapezius muscle (lateral bending of cervical spine to the opposite side). When the effectiveness of treatment was compared with that of the placebo group (group A), there was significant improvement in PI and PT in group B (P < 0.01) but not in group C (P > 0.05). The improvement of ROM was significantly more in group C (P < 0.01) as compared with that in group A or group B. When each group was divided into two additional subgroups based on the initial PI, it was found that ENS could reduce PI and increase PT significantly (P < 0.05), but did not significantly (P > 0.05) improve ROM, as compared with the placebo group for both subgroups. EMS could significantly (P < 0.05) improve ROM, but not PT, better than the placebo groups, for either subgroup. It could reduce PI significantly more (P < 0.05) than placebo controls only for the subgroup with mild to moderate pain, but not with severe pain. For pain relief, ENS was significantly better (P < 0.05) than EMS; but for the improvement of ROM, EMS was significantly better (P < 0.05) than ENS. It is concluded that ENS is more effective for immediate relief of myofascial trigger point pain than EMS, and EMS has a better effect on immediate release of muscle tightness than ENS. The standard treatment of acute whiplash injuries (soft collar and analgesia) is frequently unsuccessful. Pulsed electromagnetic therapy PEMT (as pulsed 27 MHz) has been shown to have pro-healing and anti-inflammatory effects. This study examines the effect of PEMT on the acute whiplash syndrome. One half of the 40 patients entering the study received active PEMT collars: the other half facsimile (placebo). All patients were given instructions to wear the collar for eight hours a day at home and advised to mobilise their necks. At 2 and 4 weeks the actively treated group had significantly improved (p less than 0.05) in terms of pain (visual analogue scale). By chance movement scores for the PEMT group were significantly worse at entry to the study than the control group (p less than 0.05). At 12 weeks they had become significantly better (p less than 0.05). PEMT as described is safe for domiciliary use and this study suggests that PEMT has a beneficial effect in the management of the acute whiplash injury. To evaluate short- and medium-term effects of peripheral repetitive magnetic stimulation (rMS) on myofascial pain.
                Eighteen patients who presented with myofascial trigger points (TPs) at the level of the superior trapezius were separated into two groups according to a restricted randomization scheme. Group 1 (n=9) underwent treatment with rMS that consisted of a total of 10 sessions, each lasting 20min, in which 4000 magnetic stimuli were administered in 5s trains at 20Hz at the TP. Group 2 (n=9) received a placebo treatment that consisted of the application of a non-functioning ultrasound therapy device to the TP. Patients were evaluated before treatment, at the end of treatment, and again 1 week and 1 month after the conclusion of the treatment. Clinical evaluation included parameters for measuring pain levels (VAS, NPDVAS and algometry), the myofascial TP characteristics and the range of cervical movement (ROM).
                The rMS group showed a significant improvement in VAS, NPDVAS, algometry, as well as in the characteristics of the TP after conclusion of treatment. Improvements in the ROM were also present in rotation and controlateral bending. This improvement persisted after 1 month. On the other hand, the placebo group did not show any significant improvement in the tests considered.
                The results of this study show that peripheral rMS may have positive short- and medium-term therapeutic effects on myofascial pain. To compare the effectiveness of manipulative therapy, physiotherapy, treatment by the general practitioner, and placebo therapy in patients with persistent non-specific back and neck complaints.
                Randomised clinical trial.
                Primary health care in the Netherlands.
                256 patients with non-specific back and neck complaints of at least six weeks' duration who had not received physiotherapy or manipulative therapy in the past two years.
                At the discretion of the manipulative therapists, physiotherapists, and general practitioners. Physiotherapy consisted of exercises, massage, and physical therapy (heat, electrotherapy, ultrasound, shortwave diathermy). Manipulative therapy consisted of manipulation and mobilisation of the spine. Treatment by general practitioners consisted of drugs (for example, analgesics), advice about posture, home exercises, and (bed)rest. Placebo treatment consisted of detuned shortwave diathermy (10 minutes) and detuned ultrasound (10 minutes).
                Changes in severity of the main complaint and limitation of physical functioning measured on 10 point scales by a blinded research assistant and global perceived effect measured on a 6 point scale by the patients.
                Many patients in the general practitioner and placebo groups received other treatment during follow up. Improvement in the main complaint was larger with manipulative therapy (4.5) than with physiotherapy (3.8) after 12 months' follow up (difference 0.9; 95% confidence interval 0.1 to 1.7). Manipulative therapy also gave larger improvements in physical functioning (difference 0.6; -0.1 to 1.3). The global perceived effect after six and 12 months' follow up was similar for both treatments.
                Manipulative therapy and physiotherapy are better than general practitioner and placebo treatment. Furthermore, manipulative therapy is slightly better than physiotherapy after 12 months. Chronic pain associated with breast cancer treatment is becoming increasingly recognized. Patients with this condition can experience significant physical and psychological morbidity and may benefit from nonpharmacological interventions as part of a multidisciplinary team approach. We compared the effectiveness of transcutaneous electrical nerve stimulation (TENS), transcutaneous spinal electroanalgesia (TSE), and a placebo (sham TSE) in a randomized controlled trial. The study sample comprised 41 women with chronic pain following breast cancer treatment, and outcome measures included pain report, pain relief, pain interference, anxiety and depression, arm mobility, and analgesic consumption. There was little evidence to suggest that TENS or TSE were more effective than placebo. All three interventions had beneficial effects on both pain report and quality of life, a finding that may be due to either psychophysical improvements resulting from the personal interaction involved in the treatment or a placebo response. Although electrical stimulation appears to be well tolerated in this population, further research is needed to establish its effectiveness for chronic cancer treatment-related pain. We conducted a randomized, double blind clinical trial to determine the effectiveness of pulsed electromagnetic fields (PEMF) in the treatment of osteoarthritis (OA) of the knee and cervical spine.
                A controlled trial of 18 half-hour active or placebo treatments was conducted in 86 patients with OA of the knee and 81 patients with OA of the cervical spine, in which pain was evaluated using a 10 cm visual analog scale, activities of daily living using a series of questions (answered by the patient as never, sometimes, most of the time, or always), pain on passive motion (recorded as none, slight, moderate, or severe), and joint tenderness (recorded using a modified Ritchie scale). Global evaluations of improvement were made by the patient and examining physician. Evaluations were made at baseline, midway, end of treatment, and one month after completion of treatment.
                Matched pair t tests showed extremely significant changes from baseline for the treated patients in both knee and cervical spine studies at the end of treatment and the one month followup observations, whereas the changes in the placebo patients showed lesser degrees of significance at the end of treatment, and had lost significance for most variables at the one month followup. Means of the treated group of patients with OA of the knee showed greater improvement from baseline values than the placebo group by the end of treatment and at the one month followup observation. Using the 2-tailed t test, at the end of treatment the differences in the means of the 2 groups reached statistical significance for pain, pain on motion, and both the patient overall assessment and the physician global assessment. The means of the treated patients with OA of the cervical spine showed greater improvement from baseline than the placebo group for most variables at the end of treatment and one month followup observations; these differences reached statistical significance at one or more observation points for pain, pain on motion, and tenderness.
                PEMF has therapeutic benefit in painful OA of the knee or cervical spine. The purpose of this prospective study was to compare the effect of adjunctive direct current (DC) electrical stimulation and pulsed electromagnetic field therapy (PEMF) on augmentation of instrumented lumbar fusion. Sixty-one patients undergoing lumbar spine fusion were enrolled in the study and randomized to one of three treatment protocols: 1) adjunctive PEMF group (n = 22) fitted with Spinal-Stim model 8212(AME) within 30 days of surgery; 2) DC group (n = 17) had a SpF-2T stimulator(EBI) implanted at the time of surgery; or 3) control group (n = 22). The fusion mass bone mineral density (BMD) assessment was performed on 3-month and 1-year radiographs for each patient. Lateral flexion-extension and anteroposterior radiographs were evaluated at 1 year to determine the presence of fusion. Clinical outcome patient analyses were performed at 1 year. At 1-year follow-up, radiographic fusion and fusion mass bone density were not significantly different among the groups. In the nonstimulated group, there were 43% excellent, 43% good, and 14% fair results. In the PEMF group, there were 35% excellent, 50% good, 10% fair, and 5% poor results. In the DC group, there were 32% excellent, 37% good, and 31% fair results. The results of the current study suggest that electrical stimulation does not significantly enhance fusion rate in instrumented lumbar arthrodesis, although we observed a statistically insignificant trend toward increased fusion mass BMD in the electrically stimulated groups. The significance of increased BMD remains unknown. A randomized comparative study with single-blind outcome assessments.
                To compare the efficacy of a multimodal treatment emphasizing proprioceptive training (ACTIVE) with activated home exercises (HOME) and recommendation of exercise (CONTROL) in patients with nonspecific chronic neck pain.
                The efficacy of active exercises and passive physiotherapy for neck trouble has been somewhat disappointing in the previous few studies.
                Seventy-six patients (22 men, 54 women) with chronic, nonspecific neck pain participated. Sixty-two participated the 1-year follow-up. Subjective pain and disability, cervical ranges of motion, and pressure pain threshold in the shoulder region were measured at baseline, at 3 months, and at 12 months. The ACTIVE treatment consisted of 24 sessions of proprioceptive exercises, relaxation, and behavioral support. The HOME regimen included a neck lecture and two sessions of practical training for home exercises and instructions for maintaining a diary of progress. The CONTROL treatment included a lecture regarding care of the neck with a recommendation to exercise.
                The average self-experienced total benefit was highest in the ACTIVE group, and the HOME group rated over the CONTROL group (P < 0.001). Differences between the groups in favor of the ACTIVE treatment were recorded in reduction of neck symptoms and improvements in general health and self-experienced working ability (P < 0.01-0.03). Changes in measures of mobility and pressure pain threshold were minor.
                Regarding self-experienced benefit, the multimodal treatment was more efficacious than activated home exercises that were clearly more efficacious than just advising. No major differences were noted in objective measurements of cervical function between the groups, but the content validity of these assessments in chronic neck trouble can be questioned. Fifty-four patients treated in a 3-week inpatient rehabilitation program were randomly assigned to and accepted treatment with electroacupuncture (n = 17), TENS (low intensity transcutaneous nerve stimulation, n = 18), and TENS dead-battery (placebo, n = 18). Outcome measures included estimates of pain (on a Visual Analogue Scale) and disability by both physician and patient, physical measures of trunk strength and spine range of motion, as well as the patient's perceptions of the relative contribution of the education, exercise training, and the electrical stimulation. Analyses of variance were utilized to determine effects of treatment (electroacupuncture, TENS, placebo) across time (admission, discharge, and return) for the outcome measures. There were no significant differences between treatment groups with respect to their overall rehabilitation. All 3 treatment groups ranked the contribution of the education as being greater than the electrical stimulation. However, the electroacupuncture group consistently demonstrated greater improvement on the outcome measures than the other treatment groups. For the visual analogue scale measure of average pain, there was a statistical trend at the return visit suggesting that the acupuncture group was experiencing less pain. Further evaluation of pulsed electromagnetic fields (PEMF), which have been observed to produce numerous biological effects, and have been used to treat delayed union fractures for over a decade.
                In a pilot, double-blind randomized trial, 27 patients with osteoarthritis (OA), primarily of the knee, were treated with PEMF. Treatment consisted of 18 half-hour periods of exposure over about 1 month in a specially designed noncontact, air-coil device. Observations were made on 6 clinical variables at baseline, midpoint of therapy, end of treatment and one month later; 25 patients completed treatment.
                An average improvement of 23-61% occurred in the clinical variables observed with active treatment, while 2 to 18% improvement was observed in these variables in placebo treated control patients. No toxicity was observed.
                The decreased pain and improved functional performance of treated patients suggests that this configuration of PEMF has potential as an effective method of improving symptoms in patients with OA. This method warrants further clinical investigation.
We cannot make any definite statements on the efficacy and clinical usefulness of electrotherapy modalities for neck pain. Since the quality of evidence is low or very low, we are uncertain about the estimate of the effect. Further research is very likely to change both the estimate of effect and our confidence in the results. Current evidence for PEMF, rMS, and TENS shows that these modalities might be more effective than placebo but not other interventions. Funding bias should be considered, especially in PEMF studies.  Galvanic current, iontophoresis, electric muscle stimulation(EMS), and static magnetic field did not reduce pain or disability. Future trials on these interventions should have larger patient samples and include more precise standardization and description of all treatment characteristics.