Virginia Thornley, M.D., Neurologist, Epileptologist
April 8, 2018
Some scientific studies corroborating its effectiveness while some could not come up with an effective conclusion nor a negative outcome
It has found its way in a myriad of conditions including pain, psychiatric disorders such as depression, neurological conditions making it a plausible alternative in treating medical conditions. In a randomized controlled clinical study evaluating pain from knee osteoarthritis in 57 patients, an electrodeless therapy delivered a sinusoidal magnetic field of about 4-12 hertz in the treated group. The treated group showed a great reduction in pain, stiffness, and disability compared to the control group with sham treatment. Using the VAS visual analog scale for pain and WOMAC (Western Ontario and McMaster University Index. Effectiveness was graded as very good and good in the PEMF treated group at 29% and 27% respectively compared to the sham-treated group at 0% and 15.5% (1).
In a pilot study of 24 patients, PEMF was applied showing a 50% reduction to neuropathic pain in a study in 2005 (2).
In one study of failed back surgery cases, PEMF was applied to 35 patients for 45 days. 67% of responders claimed meaningful improvement compared to sham-treated, 44% had less back pain 55% had less leg pain in those treated. There was a higher response 60% in those who had a discectomy compared to those without(3).
PEMF was applied to a large group of patients of 482 and compared to 448 non-PEMF patients. Those PEMF-treated had a significant reduction of pain (4).
One review of 14 randomized clinical trials could not come up with a general conclusion supporting its effectiveness due to different types of frequencies, different parameters, and different settings used.
While there have been numerous reports spanning 3 decades on not just pain but other conditions as well such as edema and healing in the post-operative state in plastic surgery, effectiveness in bony diseases, insomnia, even depression, regarding its effectiveness, the jury is still out. Large uniform clinical randomized trials are needed to officially approve of this alternative type of treatment for it to be widely accepted as is always the case. As with acupuncture which was previously considered Eastern medicine and has now gained popularity in treating medical conditions, anything novel will be met with some amount of skepticism. However, for any cutting edge open-minded physician this may be a non-risky alternative treatment in treating different medical conditions, when a patient has already failed everything. Just like Neo on the Matrix one may just need to take the red pill to keep your mind open.
- Wuschech, et al, “Effects of PEMF on patients with osteoarthritis:results of a prospective, placebo controlled double blind study,” Bioenergetics, 2015 Dec., 36(8):576-85
- Weintraub, et al, “Pulsed magnetic field therapy in refractory neuropathic pain secondary to peripheral neuropathy:electrodiagnostic parameters-pilot study,” Neurorehab. Neural Repair., 2004, Mar., 18 (1): 42-46
Harper, et al, “An open-label pilot study of pulsed electromagnetic field therapy in the treatment of failed back surgery syndrome pain,” Int. Med Case Rev. J., 2014, Dec., 8:13-22
Ryang, et al, “Effects of pulsed electromagnetic field on the knee osteoarthritis a systematic review,” Rheumatology, 2013, May, 52 (5) 815-824.
Virginia Thornley, M.D., Neurologist, Epileptologist
March 20, 2018
Post-traumatic stress disorder is the silent disorder that could be affecting the co-worker who sits one cubicle over from you. When one hears of post-traumatic stress disorder, one thinks of traumatizing incidents such as war, abuse or some other devastating event but can occur even in situations such as car accidents or a spouse of many decades suddenly leaving. It is the quiet disorder that if you do not expound on it, nobody really knows about it. Because of the stigma surrounding psychological disorders, often times, help is not sought in a timely manner.
It is often characterized by nightmares waking someone up in the middle of the night or sudden flashbacks when placed in a situation similar to the traumatic event. Management includes working with a psychiatrist using conventional medications and a psychologist using behavioral therapy. It is not uncommon for a patient to have to go through many different anti-depressants or anxiolytics before one finds the correct drug and titration. But sometimes even the best medications fail to treat someone with Post-traumatic stress disorder adequately. Psychotherapy may be helpful in some patients depending on the patient. In others, there is less benefit and some dislike the thought of reliving the experience in order to learn coping mechanisms.
Alternatives include non-pharmacologic measures including relaxation techniques such as doing yoga, Tai Chi or meditation. Exercise can often boost the mood and doing enjoyable activities may help alleviate symptoms without the addition of pharmacologic agents. Doing something one enjoys or taking joy in the simple activities in life such as writing poetry, art therapy, taking up a sport may help alleviate some of the stress. Great tips can be found on Psychiatrist, Dr. Welby’s site found here: https://drmelissawelby.com/exercise-depression-get-started-want-stay-bed/
More and more patients are turning towards alternative measures, finding that conventional medications are not always optimal. Cannabidiol works through the endocannabinoid pathway and modulates its effect through the CB1 receptor which is predominantly found in the nervous system. The CB2 receptor is found mostly in the immune system. In some studies, it was found that cannabidiol may help reduce fearful memory if taken in the conditioning phase so that rather than reacting to the stimulus with fear, the stimulus is then associated with a different reaction and may help mitigate the symptoms of post-traumatic stress disorder through this mechanism (1). In another study, it was found to influence synaptic dendrites and may contribute towards learned memory in the hippocampus (2).
Cannabidiol interacts with the 5HT-A receptor which is an important receptor in mitigating the symptoms of anxiety. Serotonin works through the 5HT1-A receptors. Some anxiolytics and anti-depressants work through an increase in serotonin which boosts the mood. Cannabidiol itself is known to have a calming effect with none of the euphoria found in THC alone. Cannabidiol is non-intoxicating and when combined with low dose tetrahydrocannabinol has great medical effects.
In summary, when medications and therapy are found to be ineffective for post-traumatic stress disorder, anxiety or depression, cannabidiol which is non-intoxicating may be an effective therapeutic option alone or in conjunction with low dose THC and should be considered.
- Uhernik, et al, “Learning and memory are modulated by cannabidiol when administered during trace fear-conditioning,” Neurobiology of Learned Memory, 2018, Feb., 9, 149:58-76. doi: 10.1016/j.nlm.2018.02.009 (Epub ahead of print)
- Lee, et al, “Cannabidiol regulation of emotion and emotional memory processing: relevance for treating anxiety-related and substance abuse disorder,” British Journal of Pharmacology, 2017, Oct., 174 (19): 3242-3256. doi: 10.1111/bph.13724. (Epub. 2017 Mar. 9.)