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Renew Your Subscription and List Your Practice for Free!Chronic pain sufferers are using our pain specialist directory to find pain specialists in your area. The opioid and NSAID pathways serve as models for understanding the analgesic effect of new and alternative therapeutics such as pulsed radio frequency energy (PRFE).By John Moffett, PhD, Nicole Kubat, PhD and Richard A.
PRFE refers to non-thermal, non-ionizing, non-contact electromagnetic energy with a carrier frequency of 27.12 MHz, delivered with pulse bursts of 10 Aµsec to 1 msec at a frequency of 1 to 1000 Hz. PRFE is to be distinguished from pulsed radio frequency electrical current,7 a modality with similar nomenclature that has been used broadly in medicine, specifically in nerve ablation and electrosurgery. The induction of pain by noxious stimuli is received by the AI? nerve fibers, a series of nerve fibers distinct from tactile and proprioceptive receptors. In contrast to nociceptive sensation of pain, neuropathic pain is the result of damage or insult to the nerve structure itself.11 This type of pain can cause neural supersensitivity and may be associated with inflammation and diabetes.
The standard for the treatment of pain is the use of opioids and non-steroidal anti-inflammatory drugs (NSAIDs). Three classical endogenous opioid peptide families have been identifieda€”the endorphins, enkephalins, and dynorphinsa€”all of which share the common amino terminal amino acid motif (opioid motif) Tyr-Gly-Gly-Phe-(Met or Leu).16 The opioid motif is followed by various carboxy-terminal amino acids ranging in length from 0 to 26 residues. Considering the large number of opioid peptide ligands, it is not surprising that numerous corresponding opioid receptors have been isolated. Vertical Health Media, LLC does not, by publication of the advertisements contained herein, express endorsement or verify the accuracy and effectiveness of the products and claims contained therein. Practical Pain Management is sent without charge 10 times per year to pain management clinicians in the US. Magnetic and electromagnetic fields are now recognized by the XXI century medicine as real physical entities that promise healing of various health problems, even when conventional medicine has failed. This paper was triggered by information found on Internet that a new, computerized system for pulsed electromagnetic field (PEMF) therapy has been introduced on the market. This paper discusses only the modalities that utilize time varying low frequency EMF, known as pulsed electromagnetic fields. It should be noted, that, thus far, the medical communities’ approach to magnetotherapy is as to an adjuvant therapy, especially for treatment of a variety of musculoskeletal injuries. The fundamental questions related to the biophysical conditions under which EMF signals could be recognized by cells in order to modulate cell and tissue functioning remain to be elucidated.
The medical part of the equation should identify the exact target and the “dose” of EMF that the target needs to receive.
The largest populations of patients that have received, or could benefit frommagnetic field therapy are victims of musculoskeletal disorders, wounds and pain.
Diabetic foot ulcers are probably the most common chronic wounds inwestern industrialized countries.
The National Institutes of Health estimate that more than 48 million Americans suffer chronic pain that results in a 65 billion loss of productivity and over $100 billion spent on pain care (Markov, 2004c).
Recent advances in magnetotherapy suggest that carefully selected magnetic fields might be helpful in treatment of diseases as Parkinson’s, Alzheimer, as well as Reflex Sympathetic Disorders which have relatively small number of potential users. However, regulatory and reimbursement issues have prevented more widespread use of PEMF modalities, especially in the USA. Today magnetic-field-dependent modalities could be categorized in six groups,but this paper is discussing only the PEMF signals (for details see Markov,2004c). The PEMF signals in clinical use have variety of designs, which in most cases is selected without any motivation for the choice of the particular waveform, field amplitude or other physical parameters.
From the symmetrical sinewaves engineers moved to an asymmetrical waveform by means of rectification. The other type of sinewave-like signals might be seen when a sinewave signal is modulated by another signal. Figure 4 Example of amplitude modulation of a high frequency sinusoidal signal Usually, the sinewave signal is at high frequency (in KHz and MHz range), while the modulating signal is a low frequency signal.
In addition to sinewave type signals, a set of devices which utilize unipolar or bipolar rectangular signals is available at the market.
The first clinical signal approved by FDA for treatment of nonunion or delayed fractures (Bassett, 1974, 1977) exploited the pulse burst approach.
Figure 6 The original signal for treatment of non-union fractures proposed by Bassett et al.
Biological effects of electromagnetic fields., Crete 16-20 October 2006, ISBN# 960-233-172-0, p.
The aim of this lecture is to outline the main physiological processes involved in the healing of wounds and to suggest a mechanism by which pulsed radiofrequency (RF) energy, or the currents induced in tissues by the application of that energy, may influence its course. Emphasis is given to the part played by edema in inhibiting the processes of wound healing.


Pulsed radiofrequency electromagnetic field therapy is available in various forms.  Extensive clinical research has been conducted with a large number of clinical publications for hard to heal and chronic wounds. RecoveryRx® technology is the miniaturization of the traditional large equipment used in hospitals and clinics.  Advances in microelectronics have made it possible to deliver the clinically proven and superior extended duration therapy in small, convenient and cost-effective applications. RecoveryRx® is applied to the wound, incorporating into the dressing or on top of the dressing for 24 hours per day. In a case series of four patients who were treated with RecoveryRx® at Temple Foot and Ankle Clinic, Philadelphia, all the patients had long standing ulcers that had failed previous therapies. Diabetic patient with Venous Stasis Ulcer had undergone compression therapy and no appreciable healing was seen. Diabetic patient with ulcer on right foot, previous failed therapy debridement, use of Promogran dressing. All four patients healed after the introduction of RecoveryRx® therapy, two in 3 weeks and two patients healed in 8 weeks. In this review, pulsed radio frequency energy fields will be discussed in relation to use in pain management, with an emphasis on the cellular and molecular mechanisms of action related to the pharmaceutical analgesics. These devices are considered by the FDA to be non-thermal shortwave diathermy devices (category ILX) and have been cleared to market for adjunctive use in the palliative treatment of postoperative pain and edema in superficial soft tissue (Figure 1). Pulsed radiofrequency electrosurgical devices use an electrode to directly apply alternating current in the radiofrequency range to tissue in order to cut, vaporize, or ablate. The commercially available Provant Pulsed Radio Frequency Energy device for the treatment of postoperative pain. These specialized fibers (unmyelinated C fibers and thinly myelinated AI? fibers) sense the physiochemical properties of pain stimuli. Peptides in the 3 opioid families are encoded from 3 corresponding genes that are transcribed and translated into prepropeptides and later cleaved into the final opioid peptide ligands. Vertical Health Media, LLC disclaims any liability for damages resulting from the use of any product advertised herein and suggests that readers fully investigate the products and claims prior to purchasing. Today magnetotherapy provides a noninvasive, safe and easy method to directly treat the site of injury, the source of pain and inflammation, and other types of diseases and pathologies. Physicians from ancient Greece, China, Japan and Europe successfully applied natural magnetic materials in their daily practice.
Therefore, a large body of research, including many clinical studies that report the successful application of static magnetic fields and high frequency EMF as well as electroporation and electrical stimulation will remain outside this paper. There is a large body of basic science and clinical evidence that time-varying magnetic fields can modulate molecular, cellular and tissue function in a physiologically and clinically significant manner. The scientific and medical communities still lack the understanding that different magnetic fields applied to different tissues could cause different effects. Then, physicists and engineers should design the exposure system in such way that the target tissue received the required magnetic flux density. More than 2 million people suffer from pressure ulcers and as many as 600,000 to 2.5 million more have chronic leg and foot wounds (Wysocki,1996). Of the millions who have diabetes mellitus, 15 per cent will suffer foot ulceration which often leads to amputation (100,000 per annum in the US alone).
Thus, the clinical effects of PEMF on musculoskeletal system repair are physiologically significant and often constitute the method of choice when the conventional standard of care has failed to produce adequate clinical results. PEMF modalities are usually applied directly on the targeted area of the body. These types of signals basically flip-flop the negative part of the sinewave into positive, thereby creating a pulsating sinewave. However, the most successful implementation of this signal is shown in animal experiments as causing anti-angiogenic effects (Williams et al., 2001).
There are also devices that apply two high frequency signals and the interference of both signal results in an interference magnetic field (Todorov, 1982). Probably for those signals the most important is to know that due to the electrical characteristics (mostly the impedance) of the unit, these signals could never be rectangular.
Reference is made to the growing evidence that pulsed RF energy affects the time course of wound healing and the hypothesis is proposed that one possible mechanism by which pulsed RF energy accelerates wound healing is by reducing edema.
Failed therapy included offloading, debridement and application of triple antibiotic ointment.
These devices are different in design and operating principle from PRFE, which involves delivery of RF electromagnetic fields by means of a non-contact radiating antenna. The result of the cleavages and post-translational modifications is a large number of opioid peptides with multiple activities.
Opioid (endogenous or natural occurring) binding to cognate receptors produces a number of intracellular effects linked to analgesia.
Immediate early genes after pulsed radiofrequency treatment: neurobiology in need of clinical trials.


Understanding inflammatory pain: ion channels contributing to acute and chronic nociception. Activity-dependent potentiation of calcium signals in spinal sensory networks in inflammatory pain states.
A better understanding of anti-inflammatory drugs based on isoforms of cyclooxygenase (COX-1 and COX-2). Effects of pulsed electromagnetic fields on postoperative pain: a double-blind randomized pilot study in breast augmentation patients. Effects of pulsed electromagnetic fields on interleukin-1 beta and postoperative pain: a double-blind, placebo-controlled, pilot study in breast reduction patients. Pulsed radio frequency energy field treatment of cells in culture results in increased expression of genes involved in the inflammation phase of lower extremity diabetic wound healing. Millions of people worldwide have received help in treatment of musculoskeletal system, as well as pain relief. The contemporary magnetotherapy has begun immediately after the World War II by introducing both magnetic and electromagnetic fields, generated by various waveshapes of the supplying currents. One should not expect, for example, that the magnetic field which is beneficial for superficial wounds, might be as good for fracture healing. Compared to regular pharmaceuticals, PEMF offers an alternative with fewer, if any, side effects.
In concert with this policy, the Center for Medicare Services (CMS) for a period of time refused to allow reimbursement even for modalities cleared by FDA. The textbooks usually show the rectified signal as a set of ideal semisinewaves. However, due to the impedance of the particular design such ideal waveshape is impossible to be achieved. Investigating a range of amplitudes for 120 pulses per second signal, the authors demonstrated that the 15 mT prevents formation of the blood vessels in growing tumors, thereby depriving the tumor from expanding the blood vessel network and causing tumor starvation and death. These therapies have been shown to be effective, but due to the frequency of the applications (up to twice daily for 30 min) it has limited potential for widespread use.
This makes for a simple application of this powerful technology, which not only promotes wound healing but also reduces chronic wound pain. These sensory inputs to the dorsal horn are then carried by different pathways to the specific processing centers of the brain, such as the lateral thalamus, medial thymus, and limbic structures, each being implicated in different aspects of pain perception. These effects include inhibition of adenyl cyclase activity, activation of K+-linked currents, and suppression of Ca2+ currents.
Pulsed electromagnetic fields are one important modality in magnetotherapy and recent technological innovations, such as Curatron PEMF devices, offer excellent, state of the art computer controlled therapy system. Starting in Japan, this modality quickly moved to Europe, first in Romania and the former Soviet Union. Particular attention must be paid to the biophysical dosimetry which should predict which EMF signals could be bioeffective and monitor this efficiency. This is a tremendous advantage versus pharmaceutical treatment at which the administered medication spreads over the entire body, thereby causing adverse effects in different organs, which sometimes might be significant.
As a result, the ideal form is distorted and in many cases a short DC-type component appears between two consecutive semi sine-waves.
The alternating 40 ?T sinusoidal magnetic field is at 76.6 Hz (a combination of Ca2+ and Mg2+ resonance frequencies). In this paper the development, state of the art and future of pulsed electromagnetic field therapy are discussed.
During the period 1960-1985 nearly all European countries designed and manufactured own magnetotherapeutic systems.
This raises the question of using theoretical models and biophysical dosimetry in selection of the appropriate signals and in engineering and clinical application of new PEMF therapeutic devices. This signal, shown in has oscillating character, but due to the DC magnetic field it oscillates only as a positive signal. With the large number of opioid ligand and receptor combinations possible, determining which result in analgesia has been problematic.
In fact, the CMS has now recognized that PEMF is a plausible therapeutic modality which produces sufficient clinical outcome to permit, and reimburse for, use in the off-label application of healing chronic wounds, such as pressure sores and diabetic leg and foot ulcers (Pilla, 2006).
There are recent suggestions that the rectangular signals should be replaced by more realistic trapezoid signals. This proven benefit could be obtained by using both static and time-varying magnetic fields.



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