Nuclear magnetic resonance therapy in lumbar disc herniation with lumbar radicular syndrome: effects of the intervention on pain intensity, health-related quality of life, disease-related disability, consumption of pain medication, duration of sick leave and MRI analysis.

PURPOSE: The objective was to assess the effects of therapeutic nuclear magnetic resonance (tNMR) as a conservative treatment for lumbar radicular syndrome (LRS) in patients with lumbar disc herniation. METHODS: The prospective, randomised, double-blind, placebo-controlled trial included 94 patients, aged 20-60 years (44.79 ± 8.83), with LRS caused by lumbar disc herniation confirmed by MRI scans and with clinical signs of a radicular lesion without indication for surgical intervention. Treatment group (TG) and control group (CG) received standard non-surgical therapy. Additionally, the TG had seven sessions with the tNMR device with a magnetic flux density of 2.3 mT and a frequency of 85 kHz; the CG received 7 sham treatments. Outcome parameters were the treatment effect on pain intensity (Visual Analogue Scale-VAS), health-related quality of life (36-item Short Form Health Survey-SF-36), disease-related disability (Roland Morris Disability Questionnaire-RMDQ), pain medication intake, duration of sick leave and morphological changes assessed by MRI scan analysis. RESULTS: VAS scores improved significantly in both groups (p < 0.000). Only in week 4, improvement in the TG significantly surpassed that of the CG (morning pain p = 0.011, evening pain = 0.001). In both groups, SF-36 scores reflected a significant amendment in the physical component score (p < 0.000) and a significant deterioration in the mental component score (p < 0.000). SF-36 scores did not differ significantly between groups. RMDQ showed a significant amelioration in both groups (TG and CG p < 0.000), with a tendency to a superior benefit in the TG (p = 0.083). Patients in the TG recorded significantly fewer days of sick leave in month 3 after treatment (p = 0.026). MRI scan summary scores improved significantly in both groups (L4/5 p < 0.000, L5/S1 p < 0.001) and did not differ significantly between the groups. CONCLUSIONS: This trial was the first to investigate the effects of tNMR as an additional treatment of lumbar disc herniation with LRS. The application of tNMR did not meet MCID criteria. It rendered few statistically significant differences between patient groups. The overall results of this trial make a clinical implementation of tNMR in the treatment of lumbar disc herniation with LRS appear premature. Further research is needed to better understand the mode of action of tNMR on compressed neural tissue and to elucidate the issue of the cost/benefit ratio.

[Impact of magnetic resonance therapy on sickness absence of patients with nerve root irritation following a lumbar disc problem]. / Effekte der Kernspinresonanztherapie auf Krankenstand bei Patienten mit Nervenwurzelirritation infolge eines lumbalen Bandscheibenvorfalls.

BACKGROUND: The prevalence of spinal symptoms in Western industrialised countries ranges up to 80 %. Back pain ranks second among the most common reasons to seek medical advice. The resulting financial burden on the health-care system is proportional to the subjectively experienced pain. The aim of the present study was to determine whether the use of magnetic resonance therapy alters the duration of sickness absence in patients with discogenic radiculopathy. PATIENTS AND METHOD: In a double-blind prospective randomised study, the use of magnetic resonance therapy for back pain in patients with discogenic radiculopathy was evaluated in the context of health economics. Patients aged 20 to 55 years with lumboischialgia and no indication for surgery were included in the study. The primary variable was the number of days of sickness absence in a study group before and after magnetic field therapy, and in a control group. The number of days of sickness absence was determined on the basis of a pain diary and by telephone inquiry. RESULTS: Patients who were treated with an activated magnetic resonance therapy device had significantly fewer days of sickness absence (p = 0.009) when evaluated by personal telephone calls. The duration of sickness absence before therapy was 14.7 days and that after therapy 5.8 days. In contrast, the days of sickness absence in the control group were 7.6 days before therapy and 13.8 days after therapy. The duration of symptoms was negatively correlated with the days of sickness absence. Patients who reported a burden at work had more days of sickness absence (8.3 days) than those with no burden at work (3.2 days). This correlation does not apply to familial burden. The cost-effectiveness analysis showed different degrees of compensation of the cost of magnetic resonance therapy, depending on the occupational group. Direct and indirect costs of magnetic resonance therapy were compensated by 16.9 fewer days of sickness absence among workers, 11.4 fewer days of sickness absence among employees, and 9.1 fewer days of sickness absence among civil servants. CONCLUSION: Based on the number of days of sickness absence, the study confirmed that a relatively economical alternative technique is able to provide pain relief as well as benefit the health economy. Unemployed patients or patients who have submitted an application for a pension may be problematic because they may not wish to be pronounced healthy by their doctors.

[Medical relevance of magnetic fields in pain therapy]. / Medizinische Relevanz von Magnetfeldern zur Schmerztherapie.

BACKGROUND: Magnetic and electromagnetic fields have been accepted as real physical entities in medicine and are believed to achieve pain relief. Magnetic field therapy has been acknowledged as a non-invasive, safe and simple method for treatment of the site of injury, source of pain or inflammation, or other types of illnesses and pathologies. However, a consensus regarding the statistical relevance of the effects has not been established. MATERIALS AND METHODS: A detailed literature research was performed and the results were evaluated. Inclusion criteria were that the studies had to be randomized, double-blind and placebo-controlled, and no additional forms of treatment other than magnetic effects were allowed to be used. RESULTS: The evaluation of 17 studies with static magnetic fields showed on average no significant difference in pain relief between the group treated with magnetic fields and the placebo group. All studies using magnetic fields showed that forms of treatment conducted over a period of 30 min and at intervals of 1 week have no effects. In 10 studies with dynamic magnetic fields different effects were registered, which ranged from no effect to significant differences regarding pain relief between the treated and the control groups. CONCLUSIONS: Static magnetic fields are ineffective with respect to pain therapy. Dynamic magnetic fields show diverse effects. Hence, this therapy should be researched in depth.