How are magnets used in attempts to treat pain?

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How are static magnets used in attempts to treat pain?

Static magnets are usually made from iron, steel, rare-earth elements, or alloys. Typically, the magnets are placed directly on the skin or placed inside clothing or other materials that come into close contact with the body. Static magnets can be unipolar (one pole of the magnet faces or touches the skin) or bipolar (both poles face or touch the skin, sometimes in repeating patterns).⁸ Some magnet manufacturers make claims about the poles of magnets-for example, that a unipolar design is better than a bipolar design, or that the north pole gives a different effect from the south pole. These claims have not been scientifically proven.

A small number of rigorous scientific studies have examined the efficacy of static magnets in treating pain.

How are electromagnets used in attempts to treat pain?

Electromagnets were approved by the FDA in 1979 to treat bone fractures that have not healed well.^2,3 Researchers have been studying electromagnets for painful conditions, such as knee pain from osteoarthritis, chronic pelvic pain, problems in bones and muscles, and migraine headaches. However, these uses of electromagnets are still considered experimental by the FDA and have not been approved. Currently, electromagnets to treat pain are being used mainly under the supervision of a health care provider and/or in clinical trials.

An electromagnetic therapy called TMS (transcranial magnetic stimulation) is also being studied by researchers. In TMS, an insulated coil is placed against the head, near the area of the brain to be examined or treated, and an electrical current generates a magnetic field into the brain. Currently, TMS is most often used as a diagnostic tool, but research is also under way to see whether it is effective in relieving pain.^13,14 A type of TMS called rTMS (repetitive TMS) is believed by some to produce longer lasting effects and is being explored for its usefulness in treating chronic pain, facial pain, headache, and fibromyalgia pain.^15,16 A related form of electromagnetic therapy is rMS (repetitive magnetic stimulation). It is similar to rTMS except that the magnetic coil is placed on or near a painful area of the body other than the head. This therapy is being studied as a treatment for musculoskeletal pain.

What is known from the scientific evidence about the effectiveness of magnets in treating pain?

Overall, the research findings so far do not firmly support claims that magnets are effective for treatment of pain.

Findings from Reviews of Scientific Studies

Reviews take a broad look at the findings from a group of individual research studies. Such reviews are usually either a general review, a systematic review, or a meta-analysis. There are not many reviews available on CAM uses of magnets to treat pain.

• Often, these reviews compared what is known from the clinical trials of magnets for painful conditions to what is known from conventional treatments or from other CAM treatments for the same condition(s).

• One review found that static magnetic therapy may work for certain conditions but that there is not adequate scientific support to justify its use.¹

• Three reviews found that electromagnetic therapy showed promise for the treatment of some, but not all, painful conditions, and that more research is needed. One of these reviews also looked at two randomized clinical trials (RCTs) of static magnets. One reported significant pain relief in subjects using magnets, but the other did not.

• Another review concluded that TMS has an effect on the central nervous system that might relieve chronic pain and, therefore, should be studied further.¹⁴

• The remaining review found no studies on magnets for neck pain and stated that rigorous studies are much needed.

• It is important to note that the reviews pointed out problems with the rigor of most research on magnets for pain. For example, many of the clinical trials involved a very small number of participants, were conducted for very short durations (e.g., one study applied a magnet a total of one time for 45 minutes), and/or lacked a placebo or sham group for comparison to the magnet group. Thus, the results of many trials may not be truly meaningful. Most reviews stated that more and better quality research is needed before magnets' effectiveness can be adequately judged.

Findings from Clinical Trials

The studies give an overview of scientific research from 15 RCTs published in English from January 1997 through March 2004 and cataloged in the National Library of Medicine's MEDLINE database. These trials studied CAM uses of static magnets or electromagnets for various kinds of pain.

• The results of trials of static magnets have been conflicting. Four of the nine static magnet trials analyzed found no significant difference in pain relief from using a magnet compared with sham treatment or usual medical care. Four trials did find a significant difference, with greater benefit seen from magnets. The remaining trial compared only a weaker strength magnet to a stronger magnet, and found benefit from both (there was no difference between groups in how much benefit).

• Trials of electromagnets yielded more consistent results. Five out of six trials found that these magnets significantly reduced pain. The sixth found a significant benefit to physical function from using electromagnets, but not to pain or stiffness.

• Some study authors suggested that a placebo effect could have been responsible for the pain relief that occurred from magnets.

• While criticizing many of these studies, it is fair to say that testing magnets in clinical trials has presented challenges. For example, it can be difficult to design a sham magnet that appears exactly like an active magnet. Also, there has been concern about how many participants have tried to determine whether they have been assigned an active magnet (for example, by seeing whether a paperclip would be attracted to it); this knowledge could affect how meaningful a trial's results are.

Are there scientific controversies associated with using magnets for pain?

Yes, there are many controversies. Examples include:

• The mechanism(s) by which magnets might relieve pain have not been conclusively identified or proven.

• Pain relief while using a magnet may be due to reasons other than the magnet. For example, there could be a placebo effect or the relief could come from whatever holds the magnet in place, such as a warm bandage or a cushioned insole.^22,24

• Opinions differ among manufacturers, health care providers who use magnetic therapy, and others about which types of magnets (strength, polarity, length of use, and other factors) should be used and how they should be used in studies to give the most definitive answers.

• Actual magnet strengths can vary (sometimes widely) from the strengths claimed by manufacturers. This can affect scientists' ability to reproduce the findings of other scientists and consumers' ability to know what strength magnet they are actually using.

Have any side effects or complications occurred from using magnets for pain?

The kinds of magnets marketed to consumers are generally considered to be safe when applied to the skin.⁷ Reports of side effects or complications have been rare. One study reported that a small percentage of participants had bruising or redness on their skin where a magnet was worn.

Manufacturers often recommend that static magnets not be used by the following people¹:

• Pregnant women, because the possible effects of magnets on the fetus are not known.

• People who use a medical device such as a pacemaker, defibrillator, or insulin pump, because magnets may affect the magnetically controlled features of such devices.

• People who use a patch that delivers medication through the skin, in case magnets cause dilation of blood vessels, which could affect the delivery of the medicine. This caution also applies to people with an acute sprain, inflammation, infection, or wound.

There have been rare cases of problems reported from the use of electromagnets. Because at present these are being used mainly under the supervision of a health care provider and/or in clinical trials, readers are advised to consult their provider about any questions.

What should consumers know if they are considering using magnets to treat pain?

• It is important that people inform all their health care providers about any therapy they are using or considering, including magnetic therapy. This is to help ensure a safe and coordinated plan of care.

• In the studies that did find benefits from magnetic therapy, many have shown those benefits very quickly. This suggests that if a magnet does work, it should not take very long for the user to start noticing the effect. Therefore, people may wish to purchase magnets with a 30-day return policy and return the product if they do not get satisfactory results within 1 to 2 weeks.

• If people decide to use magnets and they experience side effects that concern them, they should stop using the magnets and contact their health care providers.

• Consumers who are considering magnets, whether for pain or other conditions, can consult the free publications prepared by Federal Government agencies. See "For More Information."

Is the National Center for Complementary and Alternative Medicine (NCCAM) funding research on magnets for pain and other diseases and conditions?

Yes. For example, recent projects supported by NCCAM include:

• Static magnets, for fibromyalgia pain and quality of life
• Pulsed electromagnets, for migraine headache pain
• Static magnets, for their effects on networks of blood vessels involved in healing
• TMS, for Parkinson's disease
• Electromagnets, for their effects on injured nerve and muscle cells

In addition, the papers by Alfano et al.,²⁶ Swenson,²¹ and Wolsko et al. report on research funded by NCCAM.

For More Information

• NCCAM Clearinghouse

  Toll-free in the U.S.: 1-888-644-6226 International: 301-519-3153 TTY (for deaf or hard-of-hearing callers): 1-866-464-3615

  E-mail: info@nccam.nih.gov Web site: nccam.nih.gov Address: NCCAM Clearinghouse, P.O. Box 7923, Gaithersburg, MD 20898-7923

  Fax: 1-866-464-3616 Fax-on-Demand service: 1-888-644-6226

• CAM on PubMed Web site: www.nlm.nih.gov/nccam/camonpubmed.html

  CAM on PubMed, a database developed jointly by NCCAM and the National Library of Medicine, offers citations to (and in most cases, brief summaries of) articles on CAM in scientifically based, peer-reviewed journals. CAM on PubMed also links to many publisher Web sites, which may offer the full text of articles.

• U.S. Food and Drug Administration (FDA) Web site: www.fda.gov Toll-free in the U.S.: 1-888-INFO-FDA (1-888-463-6332)

  The FDA is a Federal agency responsible for protecting the public health by assuring the safety, efficacy, and security of medicines, biological products, medical devices, foods, cosmetics, and consumer products that produce radiation.

  Center for Devices and Radiological Health (CDRH) Web site: www.fda.gov/cdrh Toll-free: 1-888-463-6332

  The CDRH has consumer information on magnets and magnetic devices and on buying medical devices online.

• Federal Trade Commission (FTC) Web site: www.ftc.gov Toll-free in the U.S.: 1-888-382-4357

  The FTC is a Federal agency that works to maintain a competitive marketplace for both consumers and businesses. It regulates all advertising, except prescription drugs and medical devices, ensuring that advertisements are truthful and not misleading for consumers. Brochures include " 'Miracle' Health Claims: Add a Dose of Skepticism."

Definitions

Alloy: A metallic substance consisting of either a mixture of two or more metals, or a metal that has been mixed with a nonmetal.

Anecdotal evidence: Evidence made up of one or more anecdotes. In science, an anecdote is a story about a person's experience, told by that person.

Chiropractic: An alternative medical system that focuses on the relationship between bodily structure (primarily that of the spine) and function, and how that relationship affects the preservation and restoration of health. Chiropractors use a type of hands-on therapy called manipulation (or adjustment) as an integral treatment tool.

Clinical trial: A research study in which a treatment or therapy is tested in people to see whether it is safe and effective. Clinical trials are a key part of the process in finding out which treatments work, which do not, and why. Clinical trial results also contribute new knowledge about diseases and medical conditions.

Diabetic peripheral neuropathy: A nerve disorder caused by diabetes. This disorder leads to a partial or complete loss of feeling in the feet and, in some cases, the hands, and pain and weakness in the feet.

Efficacy: In scientific research, a treatment's efficacy is its power to obtain a desired effect, such as reducing pain.

ET: Electromagnetic therapy.

Fibromyalgia: A chronic disorder involving musculoskeletal pain, multiple tender points on the body, and fatigue.

General review: An analysis in which information from various studies is summarized and evaluated. Conclusions are then made based on this evidence.

Magnetic resonance imaging (MRI): A test that uses powerful magnets and radio waves to create detailed pictures of structures and organs inside the body.

Meta-analysis: A type of research review that uses statistical techniques to analyze results from a collection of individual studies.

Myofascial pain syndrome: A chronic musculoskeletal pain disorder. Pain may occur when "trigger points," or especially tender areas on the body, are touched, or in other points in the body.

Peer reviewed: Reviewed before publication by a group of experts in the same field.

Placebo: A placebo is designed to resemble as much as possible the treatment being studied in a clinical trial, except that the placebo is inactive. An example of a placebo is a pill containing sugar instead of the drug or other substance being studied. By giving one group of participants a placebo and the other group the active treatment, the researchers can compare how the two groups respond and get a truer picture of the active treatment's effects. In recent years, the definition of placebo has been expanded to include other things that could have an effect on the results of health care, such as how a patient and a health care provider interact and what the patient expects to happen from the care.

Plastic change: The ability of the brain's connections to change, which affects many functions such as learning and recovery from damage.

Prospective study: A type of research study in which participants are followed over time for the effect(s) of a health care treatment.

Pulsed ET: Pulsed electromagnetic therapy, in which the magnetic field created by an electric current is turned on and off very rapidly.

Randomized clinical trial (RCT): In a randomized clinical trial, each participant is assigned by chance (through a computer or a table of random numbers) to one of two groups. The investigational group receives the therapy, also called the active treatment. The control group receives either the standard treatment, if there is one, for their disease or condition, or a placebo.

Rare-earth element: One of a group of relatively scarce, metallic elements or minerals. Examples include lanthanum, neodymium, and ytterbium.

Rheumatologist: A physician (M.D. or D.O.) who specializes in inflammatory disorders of the joints, muscles, and fibrous tissues.

rMS: Repetitive magnetic stimulation. In rMS, an insulated coil is placed against a part of the body other than the head, and an electrical current generates a magnetic field into that area.

rTMS: Repetitive transcranial magnetic stimulation. This type of transcranial magnetic stimulation, or TMS (see definition below), is believed by some to produce longer lasting effects.

Sham: A sham device or procedure is one type of placebo (defined above). When the treatment under study is a procedure or device (not a drug or other substance), a sham procedure or device may be designed that resembles the active treatment but does not have any active treatment qualities.

Systematic review: A type of research review in which data from a set of studies on a particular question or topic are collected, analyzed, and critically reviewed.

TMS: Transcranial magnetic stimulation. In this type of electromagnetic therapy, an insulated coil is placed against the head, and an electrical current generates a magnetic field into the brain.

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