The effect of pulsed electromagnetic field therapy on pain, quality of life, sleep quality, depression, disability and inflammatory markers in patients with lumbar disc disorder

Objective: It is aimed to investigate the effect of pulsed electromagnetic field therapy (PEMT) on pain, quality of life, sleep quality, depression, disability and inflammatory markers in patients with lumbar disc disorder. Materials and Methods: A total of 50 patients aged between 18-55 who had mechanical type low back pain for at least 3 months and who met the inclusion criteria were included in the study. The patients were randomly divided into two different treatment groups (1st group; exercise program + PEMT and 2nd group; exercise program + Sham PEMT). A total of 20 sessions of treatment were given to both groups in the presence of a physiotherapist for four weeks, five days a week. In the exercise + PEMT group, an exercise program and magnetic field therapy was applied to the lumbar region at 50 hz, 85 Gauss (0.0085 Tesla) and 20 min / day with an electromagnetic field device. For the exercise + sham PEMT group, an exercise program and magnetic field device was applied for 20 minutes to the lumbar region as it was turned off. Patients did not know whether the device was on or off. The patients were evaluated by the same physician three times, at the beginning of the treatment, at the end (4th week) and at the 12th week. Demographic data (age, gender, BMI) of the patients, duration of illness and drug use were recorded. Pain levels were evaluated with VAS and McGill-Melzack Pain Questionnaire (MPQ), depression with BDI, disability with ODI, quality of life with SF-36, and sleep quality with PSQI. As a biomarker; IL-1, IL-6, IL-17, IL-23, TNF-a, RANTES, NPY levels were measured and the results were recorded as ng / dl. In the healthy adult group, blood samples were taken only once and demographic and clinical parameters were questioned. Statistical analysis was done with Statistical Package for the Social Sciences (SPSS) 26 developed for Windows. p <0.05 was considered statistically significant. Results: It was found that pain, disability and depression increased, sleep quality and joint mobility significantly decreased in patients with chronic low back pain compared to healthy individuals. Significant improvements were detected in VAS, SF-36, BDI, ODI, and PSQI scores within the group in both the PEMT group and the sham PEMT group after treatment and at the 12th week controls. Significant advancement was achieved in the VAS-motion, ODI and vitality sub-parameters of SF-36 in the PEMT group compared to the sham PEMT group after treatment (p <0.05). The levels of IL-6, IL-23 and RANTES were found to be higher in the pre-treatment PEMT and sham PEMT groups, although it was not statistically significant compared to the healthy group. There was no significant difference in other markers. Since the pre-treatment IL-1 levels of the PEMT group and the sham PEMT groups were different, the percentage change was calculated. There was a significant increase in the sham-PEMT group compared to the PEMT group between pre-treatment and 12th week measurements. PEMT prevented the rise in IL-1, IL-6 and IL-17 levels throughout treatment. However, it was observed that there was no significant effect on inflammatory markers in the 12th week controls after the treatment was discontinued and these markers increased again. PEMT did not cause a decrease in TNF-alpha, IL-23, NPY, and RANTES levels during and after treatment. In the PEMT group, it was observed that the intragroup increase in lumbar flexion, extension, rotation and Fingertips to Floor Distance (FTF) values continued significantly in the 12th week after treatment.In the intra-group evaluation after the treatment in the PEMT group, it was observed that the increase in lumbar flexion, extension and rotation and the decrease in Fingertips to Floor Distance (FTF) continued significantly in the 12th week. Among the groups, FTF decrease was found significantly in favor of the PEMT group. All biomarkers were positively correlated with each other, except IL-17. There was no correlation between biomarkers and age, BMI, BDI, ODI, and PSQI. Conclusion: In our study, it was found that PEMT in addition to exercise program in chronic low back pain was more effective and reliable in the early period in clinical and functional recovery. This suggests that it cannot maintain its effectiveness in the long term. On the other hand, although its effect on biomarkers is not clear due to different pathways in the inflammatory process, it suggests that it has an anti-inflammatory effect in the short term. In order to evaluate these effects clearly, it is necessary to carry out studies specific to inflammatory processes with more patients. Keywords: chronic low back pain, lumbar discopathy, pulsed electromagnetic field therapy, inflammatory biomarker