Tag Archives: Depression
Pulse Electromagnetic Field: PEMF electromagnetic mats, is it hocus pocus or is this a real life treatment
Virginia Thornley, M.D., Neurologist, Epileptologist
April 8, 2018
Introduction
Many patients suffer from chronic pain due to a number of medical conditions. Medications have been tried, physical therapy, ablative procedures, even nerve stimulators have been implanted without much luck. Treatment always has to start somewhere and just because a treatment modality sounds inconceivable does not mean it will not work. First, anecdotal and testimonial reports come in, followed by small case series, then large randomized clinical trials which are the gold standard studies. This is the final step before they are officially approved to be on the market with the nod from the FDA and eventually covered by insurance.
One may have seen a commercial about electromagnetic mats, or even seen someone bring one out to use. Or perhaps seen on street corners, vendors swearing by magnetic wristbands. Pregnant women have heard about electromagnetic wristbands to help with nausea but what is all the hoopla? Is it just a hocus pocus magic trick with effects due to a placebo reaction or is there really a science behind it?
Mechanism behind PEMF
One such treatment is the PEMF or the pulse magnetic field treatment. In the field of PEMF or pulsed electromagnetic field therapy, there is an extremely low electromagnetic field that depolarizes, repolarizes and hyperpolarizes the cells. The idea is that there is an inherent gravitational magnetic energy coming from the earth which exerts some effects on the human system and the way the human systems work. The idea is that cells are dependent on small amounts of energy in order to function. Physicians are well aware that sodium channels open to allow sodium to propagate causing an electric current within the nervous system. It is a similar concept, these electrical currents allow the systems to do their natural function. Cells are dependent on a certain amount of positivity or negativity for channels to open and close within the cell membrane. When this is disrupted the cell cannot efficiently perform its function. It focuses primarily on the microvessels dependent on this energy where wastes are expended because the cell is metabolizing more effectively with increased blood flow at the microcirculatory level. The microcirculation is dilated rather than constricted and able to carry away the natural products of metabolism. In addition, microvessels are important in serving the purpose of transmitting products from one organ to another. When this does not occur, the system is at an imbalance which likely contributes towards the diseased state. This energy can be directed towards the area of interest to modulate pain or exert its desired results. As far-fetched as it sounds what is more astounding are the many scientific reports showing the medical benefits of this concept.
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.
In conclusion
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.
Reference
- 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
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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
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Ryang, et al, “Effects of pulsed electromagnetic field on the knee osteoarthritis a systematic review,” Rheumatology, 2013, May, 52 (5) 815-824.
Cannabidiol and tetrahydrocannabinol: effectiveness in post-traumatic stress disorder, anxiety and depression
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.
References
- 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.)
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