Pulsed electromagnetic fields dosing impacts postoperative pain in breast reduction patients.
Author: Taylor EM1, Hardy KL1, Alonso A1, Pilla AA2, Rohde CH3.
Affiliation:
1Division of Plastic and Reconstructive Surgery, Columbia University Medical Center, New York, New York. 2Departments of Biomedical Engineering and Orthopedics, Columbia University, Mount Sinai School of Medicine, New York, New York. 3Division of Plastic and Reconstructive Surgery, Columbia University Medical Center, New York, New York. Electronic address: chr2111@cumc.columbia.edu.
Conference/Journal: J Surg Res.
Date published: 2014 Aug 9
Other:
Pages: S0022-4804(14)00742-2 , Special Notes: doi: 10.1016/j.jss.2014.08.007 , Word Count: 264
BACKGROUND:
Pulsed electromagnetic fields (PEMF) reduce postoperative pain and narcotic requirements in breast augmentation, reduction, and reconstruction patients. PEMF enhances both calmodulin-dependent nitric oxide and/or cyclic guanosine monophosphate signaling and phosphodiesterase activity, which blocks cyclic guanosine monophosphate. The clinical effect of these competing responses on PEMF dosing is not known.
METHODS:
Two prospective, nonrandomized, active cohorts of breast reduction patients, with 15 min PEMF per 2 h; "Q2 (active)", and 5 min PEMF per 20 min; "5/20 (active)", dosing regimens were added to a previously reported double-blind clinical study wherein 20 min PEMF per 4 h, "Q4 (active)", dosing significantly accelerated postoperative pain reduction compared with Q4 shams. Postoperative visual analog scale pain scores and narcotic use were compared with results from the previous study.
RESULTS:
Visual analog scale scores at 24 h were 43% and 35% of pain at 1 h in the Q4 (active) and Q2 (active) cohorts, respectively (P < 0.01). Pain at 24 h in the 5/20 (active) cohort was 87% of pain at 1 h, compared with 74% in the Q4 (sham) cohort (P = 0.451). Concomitantly, narcotic usage in the 5/20 (active) and Q4 (sham) cohorts was not different (P = 0.478), and 2-fold higher than the Q4 (active) and Q2 (active) cohorts (P < 0.02).
CONCLUSIONS:
This prospective study shows Q4/Q2, but not 5/20 PEMF dosing, accelerated postoperative pain reduction compared with historical shams. The 5/20 (active) regimen increases NO 4-fold faster than the Q4 (active) regimen, possibly accelerating phosphodiesterase inhibition of cyclic guanosine monophosphate sufficiently to block the PEMF effect. This study helps define the dosing limits of clinically useful PEMF signals.
Copyright © 2014 Elsevier Inc. All rights reserved.
KEYWORDS:
Breast reduction; Calmodulin; Nitric oxide; PEMF; Postoperative pain; Signaling
PMID: 25199571
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