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
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.
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.
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.
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.
KeywordsLow back pain Lumbar disc herniation Lumbar radicular syndrome Nuclear magnetic resonance therapy VAS and sick leave SF-36 and Roland Morris disability questionnaire
Lumbar radicular syndrome
Non-steroidal anti-inflammatory drug
Roland Morris disability questionnaire
36-item short form health survey
(Therapeutic) nuclear magnetic resonance
Magnetic resonance imaging
Visual analogue scale
Minimal clinically important difference
Industry funds were received for this work from MBST® Osteo Dolor Med, AD Elektronik GmbH, Wetzlar, Germany. No additional benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. The authors thank Margot Fischer for her substantial contribution.
Conflict of interest
The Center of Excellence for Orthopaedic Pain Management Speising, Vienna, Austria received industry funds for this work from MBST® Osteo Dolor Med, AD Elektronik GmbH, Wetzlar, Germany.
- 12.Jacobson JI, Gorman R, Yamanashi WS, Saxena BB, Clayton L (2001) Low amplitude, extremely low frequency magnetic fields for the treatment of osteoarthritic knees: a double-blind clinical study. Altern Ther Health Med 7(5):54–64, 66–69Google Scholar
- 18.Akitt JW, Mann BE (2000) NMR and chemistry: an introduction to modern NMR spectroscopy, 4th edn. Stanley Thornes, CheltenhamGoogle Scholar
- 19.Froböse I, Eckey U, Reiser M et al (2000) Evaluation of the effectiveness of three-dimensional pulsating electromagnetic fields in respect to the regeneration of cartilage structures. Orthoped Pract 36:510–515Google Scholar
- 21.Steinecker-Frohnwieser B, Weigl LG, Höller C, Sipos E, Kullich W, Kress HG (2010) Modulation of VEGF and cytokines by the therapeutical nuclear magnetic resonance. In: Scientific presentation at the annual congress of the Austrian society of rheumatology and rehabilitation, Vienna 25–27 Nov 2010Google Scholar
- 22.Steinecker-Frohnwieser B, Weigl LG, Höller C, Sipos E, Kullich W, Kress HG (2009) Influence of NMR therapy on metabolism of osteosarcoma- and chondrosarcoma cell lines. In: Scientific presentation at the 36th European symposium on calcified tissues, ECTS Congress, Vienna, May 23rd–27th 2009Google Scholar
- 23.Steinecker-Frohnwieser B, Weigl L, Weberhofer G, Kress G (2014) The influence of nuclear magnetic resonance therapy (NMRT) and interleukin IL1-ß stimulation on Cal 78 chondrosarcoma cells and C28/I2 chondrocytes. J Orthoped Rheumatol 1(3):9–17Google Scholar
- 24.Handschuh T, Melzer C (2008) Treatment of osteoporosis with MBST® Magnetic ResonanceTherapy. Orthodoc 5:14–17Google Scholar
- 25.Fagerer N, Kullich W (2007) Use of magnetic resonance as new therapy options for Gonarthrosis. Arzt Praxis 927:180–182Google Scholar
- 26.van Laack W, Levers A, Staat M (2013) Gonarthrosetherapie auf Kernspinresonanzbasis mit MBST-Vierjahresbeobachtungen. Orthop Nachr 07 (08)Google Scholar
- 27.Kullich W, Ausserwinkler M (2008) Functional improvement in finger joint arthrosis by therapeutical use of magnetic resonance. Orthopädische Praxis 44(6):287–290Google Scholar
- 28.Kullich W, Schwann H, Machreich K, Ausserwinkler M (2006) Additional outcome improvement in the rehabilitation of chronic low back pain after nuclear resonance therapy. J Rheumatologia 20:7–12Google Scholar
- 30.Funke F (2010) Internet-based measurement with visual analogue scales. An experimental investigation. Dissertation, Eberhard Karls Universität TübingenGoogle Scholar
- 32.Bullinger M, Kirchberger I (1998) Der SF-36 Fragebogen zum Gesundheitszustand (SF-36): Handbuch für die deutsch-sprachige Fragebogenversion. Hogrefe, GöttingenGoogle Scholar
- 50.Truchon M, Côté D, Schmouth ME et al (2010) Validation of an adaptation of the stress process model for predicting low back pain related long-term disability outcomes: a cohort study. Spine (Phila Pa 1976) 35(13):1307–1315Google Scholar