PEMF: A survey of clinical and individual uses and perceptions

Abstract

The scope of clinical applications of PEMF has been remarkably extensive for decades.  Marketing claims of PEMF products are even more extensive.  With the emergence of affordable, highly efficient PEMF in a portable/wearable form factor, individual owners of PEMF have also started to increase sharply in number.  Though PEMF has been listed and in some cases approved (510K) for use by the FDA for a few specific applications, its adoption and clinical use in mainstream medicine remains narrow and very limited.  The primary clinical uses of PEMF have been by practitioners in alternative, integrative, functional, and complimentary medicine and related fields.  The objective of this study is to determine the primary uses, perceptions, and observations of individuals as well as clinicians who actively use PEMF in their clinical practice.

This paper summarizes an open questionnaire administrated to attendees at the meeting of the Academy of Comprehensive Integrative Medicine (ACIM) in November 2019 in Orlando Florida.  There were 421 respondents to the survey.  The survey was administered to registered attendees, was entirely voluntary and uncompensated, and the results were analyzed and presented at the ACIM conference by the author (RG Dennis).

Briefly, the main questions asked were:

#1: What do you use PEMF for? (multiple-select response)

#2: What other uses do you have for PEMF?  (open-ended response)

#3: Do you have any interesting or unusual applications for PEMF? (open-ended response)

#4: What uses of PEMF are you most interested in getting more information about? (select)

#5: Are you interested in any other uses of PEMF that have not been listed? (open)

#6: Do you use PEMF along with any other type of therapy? (ADJUNCTIVE) (select)

#7: Do you have any other adjunctive or synergistic uses for PEMF? (open)

#8: Did you observe synergistic effects? (select)

#9: Which PEMF systems do you have? (select from list)

#10: What other PEMF systems do you use? (those not listed) (open)

#11: Have you tried combining portable (personal) PEMF with whole-body PEMF? (select)

#12: Have you ever observed or experienced adverse effects from the use of PEMF? (select)

#13: Briefly explain any adverse effects you have experienced or observed. (open)

#14: Based on your observations and experience, PEMF is most effective for…? (select)

#15: What applications of PEMF do you think work LEAST WELL or NOT AT ALL? (select)

#16: Are you an individual user or clinician? (select)

#17: Clinical advice: is PEMF best used at home or in a clinic? (select)

#18: For or HEALTH CARE PROVIDERS, what modalities do you combine with PEMF? (open)

The survey was followed by informal discussions and questions, which are also summarized.  These included the perceptions related to PEMF system cost, fraudulent claims, and the use of PEMF as a “last resort” despite the apparent safety and effectiveness of PEMF.

Full detailed responses to the survey are included in the Appendix.

Citation

Dennis R. (2021). PEMF: A survey of clinical and individual uses and perceptions. Journal of Science and Medicine; 3(2):1-46. https://doi.org/10.37714/josam.v2i4.69.

Introduction

The scope of clinical applications of Pulsed Electro-Magnetic Fields (PEMF) has been remarkably extensive for decades, enough so that books have been written on the topic which cite in total ~1000 peer review publications [1-3], though the actual number of publications ranges from ~500 to ~3000, depending upon how PEMF is defined, and the scope of its applications, which can be defined as narrowly as “human clinical applications”, or broadened to include PEMF as often reported only by its more specific clinical designations such as TMS (transcranial magnetic stimulation), or by inclusion of PEMF research in veterinary medicine, agriculture (seed and plant stimulation), and industrial bioprocessing. Because electricity and magnetism are bound together as electro-magnetism, a single fundamental physical force, the boundary between purely electrical effects versus electro-magnetic effects in biology can become blurred, especially in the case of electro-magnetic induction, where it is unclear whether the primary effect on the biological system under study is due to induced electrical current, directly due to magnetism, or both. Therefore, depending on the definition of the type of electro-magnetic pulses being studied, and the scope of biological systems to which they are applied, the number of peer-reviewed papers on the topic will number from a minimum of about 500 to a maximum of many thousands.

To achieve even a basic understanding of PEMF requires knowledge in an astonishing range of scientific disciplines, including cell and molecular biology, biophysics, physiology, electrical engineering, advanced physics of electro-magnetism, and clinical medicine. And it touches upon many more fields, too numerous to mention. No one seems to understand PEMF fully, though several PEMF marketers of dubious integrity claim to, perhaps due to the Dunning-Kruger effect. But at the time of this writing, no coherent and comprehensive explanation of the biophysical mechanism of PEMF has been tested and independently verified. This leads to the practical conclusion that, for the time being, perhaps the best way to understand and use PEMF is through its observed clinical uses and effects without the need to understand exactly why it works. It is from that conclusion that surveys of the usage and outcomes of the use of PEMF become one of our best available tools to begin to understand PEMF; through trial, careful observation, and experience.

This seems to have been the tacit policy adopted by regulatory agencies. Without an understanding of the underlying biological mechanisms, PEMF has been FDA listed and in some cases approved (510K) for use for a few specific clinical indications including fracture non-unions and post-operative pain, and also for major depression and certain types of migraine when it is realized that TMS (transcranial magnetic stimulation) is only one form of PEMF. It has also been approved for clinical use for more than four decades:

"Pulsed electromagnetic field systems with FDA PMA include the EBI Bone Healing System from Electrobiology, Inc., which was first approved in 1979 and indicated for non-unions, failed fusions, and congenital pseudarthroses; and the Cervical-Stim from Orthofix, which was approved in 2004 as an adjunct to cervical fusion surgery in patients at high risk for non-fusion."

Nonetheless, the adoption of PEMF for widespread use in mainstream medicine remains narrow and is generally restricted to use by prescription. As a result, the primary groups employing PEMF on a regular basis for the broadest spectrum of its potential users are clinicians, caregivers, and individuals who are willing to entertain treatment modalities in what has been broadly termed the “alternative” space, though other terms such as “complimentary”, “integrative”, and “functional” medicine have become increasingly popular for reasons both professional and legal [4].

As far back as 2012, almost a third of American adults used these “alternative” healthcare approaches, and their number has been steadily growing. This may be due simply to demand: there are an estimated 7,000 to 10,000 cataloged human diseases and conditions, for which mainstream medicine offers effective treatments only for approximately 500 [5]. These estimates remain hotly debated, especially the precise scope and meaning of terms such as “disease” versus “condition” and “cure” versus “treatment”. Nonetheless, estimates in these ranges are publicly offered by reputable spokespeople for the NIH (Cindy McConnell). However, the numbers could be much larger; the upper bound for diseases and related human conditions being tabulated to be about 70,000 by the ICD-10 [6].

Why has medicine in the modern era only effectively addressed such a small fraction of known human disease? The argument from mainstream medicine has been something to the effect that “sure, there are thousands of diseases for which we have no effective treatment or cure, but these are very rare (known as orphan diseases) and they represent only a tiny fraction of the total number of people afflicted by disease.” The implication is that mainstream medicine has dealt with all of the major diseases and conditions, accounting for the great majority of those afflicted. But does this pass the sniff test?

No. Not at all. Starting at the top, the single largest human health condition in terms of number of adults afflicted on a national and global scale is chronic pain, as illustrated in Figure 1.

Figure 1.The numbers of Americans afflicted with the most prevalent serious diseases. Note that the number of sufferers of chronic pain outnumber all sufferers of diabetes, heart disease, cancer, stroke, and dementia, combined. The estimated annual cost to American society of chronic pain due to lost work and costs associated with care and treatment is approximately equal to the annual U.S. defense budget, each accounting for approximately 3% of the US GDP (FY 2016).

This chart is based on data from the following sources:

1. http://www.painmed.org/PatientCenter/Facts_on_Pain.aspx (archived April 2016)
2. http://www.ncbi.nlm.nih.gov/pubmed/20797916

The fact is that many of the most prevalent and most severe chronic disease conditions have no effective mainstream treatments or cures. Many of these are life-long, progressive, and debilitating. The amount of human suffering is beyond estimation, not to mention the vast cost to society. It is a troubling fact that mainstream medicine simply marginalizes any approaches contrary to those that are already widely accepted. In so doing, they fail to serve many of the greatest and most pressing unmet human needs. And there is ample evidence, in the form of thousands of peer-reviewed scientific reports, that there are forms of non-mainstream treatments that have great promise for very effectively addressing many of these currently “untreatable” major disease conditions, without observed side effects, without any risk of addiction, and at low cost.

This brings us back to the topic of PEMF. PEMF has been actively studied and reported in peer review for about the past 60 years, resulting in approximately a thousand peer-reviewed scientific papers, which have been summarized in the popular press [1-3]. These books summarize the use of PEMF, which report very positive benefits without observed side effects, for over 40 different general classes of disease and disability, many of which have no safe and effective treatment options. These 40 broad classes of disease represent hundreds to thousands of specific conditions, including more than 200 specific conditions associated with aging. Interestingly, many of the conditions that have been observed to benefit from the use of PEMF are largely different from those that are treated effectively by mainstream medicine. Based on these estimates, there is the potential that the widespread acceptance and proper use of PEMF could approximately double the number of conditions that could be safely and effectively treated.

What exactly is “PEMF”, and does it “work” for the treatment of chronic pain (or anything else)? To begin with and most importantly, PEMF is not just one thing; it represents a vast scope of ways that electro-magnetism can be applied therapeutically. This has been described in a recent paper, where it is determined by modeling that PEMF could be applied in any one of over a quadrillion different ways. This is far more than the number of known chemical species in the universe [7]. So, it is incorrect to assert simply that PEMF in general “works” or “does not work” for any particular medical condition without first defining the specific form of PEMF being employed.

However, when properly applied, many different forms of PEMF have been observed to have great benefits for the reduction of chronic pain. This suggests that the many possible forms of PEMF that are distinguished primarily by regulatory definition and misunderstanding can be grouped into a few different general classes of PEMF waveforms, some of which are generally and broadly effective, whereas others are less so [8].

A recent nursing study surveyed people with chronic pain who had been using a commercially-available portable (personal) PEMF device [9]. The average respondent for this survey had been suffering chronic pain for greater than six months, and as long as a decade or more in many cases. The responses were very positive:

1. 99% of the participants experienced some pain relief or a good therapeutic outcome
2. 86% of participants reported decreased use of pharmaceuticals (mostly “pain killers”)
3. 98% of participants experienced an improvement in their quality of life
4. 96% of participants experienced increased hope
5. 95% of participants experienced an increase in functionality

In open discussion/narrative sessions, without prompting, about half of the respondents reported that they experienced prolonged reduction of pain, long after the use of PEMF was discontinued, and about a third of respondents reported that they achieved reduced pain by using low-intensity PEMF daily. These findings are not just relevant to “rare conditions” because chronic pain afflicts about 1 in 3 of all adults, and there are no safe and effective treatments in the mainstream other than “pain blocking” drugs and devices. Such pain-blocking drugs and devices often lead to progressive damage and degeneration, and many have been shown to be neither safe nor effective following widespread use after regulatory approval. Consider opioids, for example.

In this recent nursing study, the benefits of PEMF cannot simply be attributed to the placebo effect. To begin with, the placebo effect might explain as much as 30% to 40%, but not 90% or more. And the typical respondent had reported the use of 26 other treatments and modalities prior to trying PEMF, so there had been ample opportunity for each respondent to find relief through the placebo effect long before ever resorting to the use of PEMF. Rather, it would be reasonable to assume the contrary: that the respondents to this survey were self-selected as people who had demonstrated a persistent resistance to the placebo effect. Nonetheless the vast majority of them found very good and lasting relief from chronic pain through the use of PEMF, even though it had been tried only as a last resort. And nonetheless, many mainstream practitioners consider this and similar observations to be purely “anecdotal”.

To begin to clarify the real-world perceptions and uses of PEMF, this survey was conducted to begin to understand how PEMF is actually employed by individuals and clinicians.

Among the largest unanswered questions relating to therapeutic uses of PEMF are:

1. who is using it?
2. what are they using it for?
3. what type of PEMF are they using? and
4. how are they using it?

Answering these questions is particularly difficult because the use of PEMF has been largely relegated to the alternative, non-mainstream community, with no standardization, virtually no regulatory oversight, and a Wild-West attitude of price gouging and flagrantly irresponsible and fraudulent claims dominating the PEMF marketplace. Nonetheless, the biological benefit and therapeutic potential of PEMF has been widely observed and published in the peer-reviewed scientific and clinical literature, an increasing number of PEMF devices are gaining regulatory approval in the USA, virtually zero adverse effects of PEMF have been reported, and the use of PEMF as both a primary and adjunctive modality has rapidly been gaining momentum. The intelligent and effective use of PEMF in a clinical and health setting requires a certain level of education and direct experience, but at this point such information remains largely disseminated by word-of-mouth. This survey was developed to help begin to answer some of the key questions about who is using PEMF, and basic questions about how they are using it.

The group surveyed were all attendees at the ACIM 2019 conference in Orlando, Florida. This group was highly self-selected for alternative clinicians, patients, and those applying self-treatment using alternative and integrative modalities. Groups not well represented included veterinarians of all types, mainstream medical practitioners and caregivers, scientists, the general public, and skeptical segments of society.

The individual survey questions and responses largely speak for themselves. The results are summarized graphically in the Results section, with complete survey response data and written comment responses included in the Appendix.

Methods

Prior to and on the first day of the ACIM Conference in Orlando, Florida on November 16, 2019, registered attendees were asked to complete a survey detailing their use of PEMF and their clinical observations. The survey was conducted on-line using surveymonkey.com. Participation was entirely voluntary. No personal identifying information, other than their positive status as registered conference attendees, was collected from any respondent. Any potentially individually identifiable information was removed from all open-ended responses or any other locations where it might have been inadvertently captured. Respondents were not rewarded or compensated for participation. The results of the survey were presented in summary form at the end of the conference, which generated considerable interest.

The survey was made up of 18 questions, some with open-ended responses, others with a “select one or multiple answers” response format.

The results are presented in graphical summary form in the Results section as well as in their complete and raw form in the Appendix. No statistical analysis was performed other than to determine the relative frequency of answers. In most cases, respondents were allowed to check more than one answer if multiple answers were applicable.

Results

The survey was completed by 421 conference attendees. Some respondents skipped some questions. Each question, and the corresponding answers, are summarized below and are provided as raw tabulated data in the Appendix.

Question #1: What do you use PEMF for?

Number of respondents: 421

Response format: 75 possible uses for PEMF, select as many as apply

Average number of uses for PEMF reported per respondent: 6.7

This can be interpreted to mean that the typical respondent uses PEMF for about 6 or 7 different health-related conditions, of the total 75 possible options on the survey that could have been selected.

Figure 2.Top eight responses to the question: “What do you use PEMF for?”

For all responses, see the full list in the Appendix for Question #1

Question #2: What other uses do you have for PEMF? (if NONE type "none")

Response format: Respondents were given empty text response boxes on the survey in which they could submit written, free-form text responses. Identifying information and duplicates were removed and spelling was corrected.

See Appendix for list of answers to this open-ended question

Question #3: Do you have any interesting or unusual applications for PEMF? (if NONE type "none")

Response format: Respondents were given empty text response boxes on the survey in which they could submit written, free-form text responses. Identifying information and duplicates were removed and spelling was corrected.

See Appendix for list of answers to this open-ended question

Question #4: What uses of PEMF are you most interested in getting more information about?

Number of respondents: 413

The typical respondent indicated an interest to learn an average of 14 additional possible uses for PEMF, of the 75 possible uses listed in the survey.

Figure 3.Top seven responses to the question: “What uses of PEMF are you most interested in getting more information about?”, showing only those responses for which at least 35% of respondents answered affirmatively.

For all responses, see the full list in the Appendix for Question #4.

Question #5: Are you INTERESTED in any other uses of PEMF that have not been listed in Question #4?

Number of respondents: 392

See Appendix for list of answers to this open-ended question.

Question #6: Do you use PEMF along with any other type of therapy? (ADJUNCTIVE)

Number of respondents: 365

The typical respondent uses PEMF adjunctively with an average of 4.3 other modalities.

Figure 4.Responses to the question: “Do you use PEMF along with any other type of therapy? (ADJUNCTIVE)”

See Appendix for the complete list of tabulated answers.

Question #7: Do you have any other adjunctive or synergistic uses for PEMF?

Number of respondents: 365

See Appendix for list of answers to this open-ended question.

Question #8: Synergistic effects: Did the use of PEMF change the effectiveness of the other treatments?

Alternatively: Do you observe any synergistic effects?

Number of respondents: 365

Figure 5.Responses to the question: “Do you observe any synergistic effects?”

For all responses, see the full list in the Appendix for Question #8

Question #9: Which PEMF systems do you have?

Number of respondents: 409

Figure 6.Responses to the question: “Which PEMF system(s) do you have?”

For the full table of responses, see the Appendix for Question #9.

Question #10: What other PEMF systems do you use? (those not listed in the previous question)

Number of respondents: 396

See Appendix for list of answers to this open-ended question.

Question #11: Have you tried combining portable (personal) PEMF with whole-body PEMF?

Number of respondents: 407

Figure 7.Responses to the question: “Have you tried combining portable (personal) PEMF with whole-body PEMF?”

For the tabulated list of responses, see the Appendix for Question #11.

Question #12: Have you ever observed or experienced adverse effects from the use of PEMF?

Number of respondents: 407

Figure 8.Responses to the question: “Have you ever observed or experienced adverse effects from the use of PEMF?”

For the tabulated of responses, see the Appendix for Question #12.

Question #13: Briefly explain any adverse effects you have experienced or observed.

Number of respondents: 392

See Appendix for a complete list of answers to this open-ended question.

Question #14: Based on your observations and experience, PEMF is most effective for which conditions?

Number of respondents: 362

Figure 9.Responses to the question: “Based on your observations and experience, PEMF is most effective for which conditions?”

For the full list of tabulated responses, see the Appendix for Question #14

Question #15: What applications of PEMF do you think work LEAST WELL or NOT AT ALL?

Number of respondents: 319

Figure 10.Top six responses to the question: “What applications of PEMF do you think work LEAST WELL or NOT AT ALL”

For the full table of responses, see the Appendix for Question #15.

Question #16: Are you an individual user or clinician?

Number of respondents: 413

Figure 11.Responses to the question: “Are you an individual or clinician?”

For the tabulated responses, see the Appendix for Question #16.

Question #17: Clinical advice: is PEMF best used at home or in a clinic?

Number of respondents: 369

Figure 12.Responses to the question: “If you are a clinician, do you advise that PEMF is best used at home or in a clinic?”, excluding the majority of respondents who answered “I am not a clinician”.

For the complete list of tabulated responses, see the Appendix for Question #17.

Question #18: If you are a CLINICIAN or HEALTH CARE PROVIDER, what modalities do you combine with PEMF?

List as many as apply to your practice.

Number of respondents: 369

See Appendix for a complete list of answers to this open-ended question.

This completes the formal survey responses. Following the formal survey, additional information was gathered informally and analyzed. These questions focused on perceptions of the use of PEMF, the PEMF market in general, and barriers to entry. These will be briefly discussed in the next section.

Discussion

Turning first to the informal discussions elicited by the survey during the final days of the ACIM meeting, when the survey was complete, several patterns emerged. During follow-up discussions, people offered many opinions and insights into their use, or reluctance to use, PEMF in their practice or for their own health. While not included in the formal survey, their answers and comments were collected, and several additional patterns became apparent.

Individual (non-clinical) respondents stated that the largest barriers to their personal use of PEMF was the excessive price of the large, “whole-body” clinical PEMF systems. Though most report excellent results after having been treated with a large or high-power clinical PEMF system, the cost associated with the treatments (typically $100 or more for each treatment) as well as the cost to own the system were prohibitive, and many people were actively seeking alternatives to PEMF for this reason. A second barrier has been the questionable claims that are very prevalent throughout the PEMF market. Fraudulent claims of both clinical effects as well as the underlying mechanisms of PEMF are common, and among educated potential users of PEMF, these have the effect of sharply reducing the perceived credibility of PEMF technology overall.

In addition, for both individual as well as clinical users of PEMF, many reported that they were put off by the high-pressure, almost cult-like sales practices of some of the more prominent PEMF manufacturers.

Perceived product quality has also been a problem. For individual users in particular, there is the widespread perception that portable, personal PEMF is much less effective than larger high-power clinical PEMF systems. This is the case because many of the portable PEMF systems were not built to generate PEMF waveforms that are biologically effective, and are based on the simplistic and crude prototype systems from the early to mid-1960’s, so their clinical effectiveness would be expected to be less than the larger clinical systems. These attitudes are likely to change with the increasing availability of modern, highly-effective, low-cost portable (personal) PEMF systems with demonstrated benefit for the reduction of inflammation [10], tissue regeneration [8] and pain [9].

In general, there was not a great deal of clinical interest expressed for the use of portable PEMF as an integral component of their PEMF treatment toolkit, apparently because it is thought that the availability of portable PEMF systems would undermine the demand for (and therefore the profitability of) larger, much more expensive clinical PEMF systems that many clinics have already invested in. Nonetheless, the convenience and effectiveness of portable (personal) PEMF systems is clear on the basis of the fact that most clinicians surveyed in this study own and regularly use portable PEMF, even though they have free personal access to their larger clinical systems, while at the same time not incorporating these modern, effective, convenient, and affordable PEMF systems into their clinical practice.

Clinical users had the primary barriers that it was unclear which PEMF system would give the best clinical benefit, and that the investment in the larger systems was too high to simply buy several systems to test them clinically just to select the most effective one. A lack of reliable information on the optimal clinical applications for PEMF was also a barrier.

Perhaps the most important finding during the post-survey discussions was that as a general rule, the use of PEMF has often been reserved as a “treatment of last resort”, typically for people with the most advanced and difficult cases and those that are least responsive or most refractory to other treatment modalities. This has been a persistent problem, and is somewhat difficult to understand, because PEMF has been reported to be very beneficial for a wide array of conditions, many of which are very serious and have no effective treatment options, and PEMF appears to have virtually zero reports of adverse effects [1,2]. Nonetheless, PEMF does not even register among the top 10 most common complimentary health approaches among adults [4].

In light of the repeated observation that, when properly designed and used, PEMF can be applied to great effect on many refractory conditions, it is entirely non-invasive, can be inexpensive, and appears to be entirely safe with no evidence of long-term adverse effects, it is reasonable to suggest that PEMF should be considered an early intervention, not an effort of last resort. All too often, the use of PEMF is reserved for the final stages of progressive disease and advanced disability, and often only after permanent damage has been done by a series of irreversible and ineffective procedures, such as the surgeries leading to failed back syndrome. Even under these most unfavorable and advanced conditions, PEMF is widely observed to benefit those in greatest distress. Often marginalized as “only the placebo effect”, it seems reasonable to conclude that if the sufferer were subject to placebo, they would have done so prior to the eventual use of PEMF. With this in mind, one final post-survey question that was posed informally during the ACIM meeting was “How many interventions were attempted prior to the use of PEMF?”

The question itself was sobering to those who were asked. Most offered an initial response similar to “I had never thought of it that way…”. Upon reflection, most respondents said they had tried between two and five mainstream treatments, followed by a larger number of alternative approaches, before finally employing PEMF. Most often, the delayed adoption of PEMF was attributed to (1) a lack knowledge, (2) lack of availability, (3) high cost, and (4) a general fear of electromagnetism.

Turning now to the formal survey results, several patterns become clear. When surveying the various health and clinical applications of PEMF (Question #1), the typical respondent identified 6 or 7 conditions to which they regularly applied PEMF. The eight most frequently cited uses are shown in Figure 2. These include, in rank order, injury recovery (58%), chronic pain (47%), general health (37%), joint injury and arthritis (31%), acute pain (30%), inflammation (29%), self-hacking (24%), and tissue healing and regeneration (24%). While these categories have a fair amount of overlap, they nonetheless represent a very large number of specific clinical conditions with the afflicted numbering in the billions globally that are directly suffering with some of the most pressing health issues we face, such as chronic pain and a broad range of diseases of aging.

Though about 75 different conditions were listed for Question #1, the open-ended follow-on question (#2) allowed respondents to write in the conditions they also applied PEMF to, if those conditions were not listed in Question #1. While some responses were simply repeated from Question #1, many were not listed. This clearly indicates the very wide range of health conditions to which PEMF is regularly applied.

Question #3 follows on from the first two questions, asking for interesting or unusual applications for PEMF. While there were again some repeats, there were many that were interesting and unexpected, many involving brain health and related degenerative conditions, many veterinary applications, many that were purely experimental, and a few that were simply practical health challenges that are often just overlooked (such as jet lag).

Question #4 asked whether the respondent had an interest in learning about the use of PEMF for any other applications for which they had not tried PEMF. The most frequent responses are shown in Figure 3, and generally map well with the responses in Figure 2, so it is clear that people have an interest in learning about the potential for the use of PEMF in many of the same most pressing health concerns of society, whether or not they had yet had the opportunity to try PEMF with any of these applications.

Following on this same line of questioning, #5 allowed open-ended answers for the respondents to express their interest in literally any possible use for PEMF. Once again, the scope of interests spanned a very wide range of potential applications as listed in the Appendix.

The use of PEMF as an adjunctive modality was clear from the answers to Question #6, the typical respondent indicating that they regularly use PEMF adjunctively with an average of 4.3 different modalities, the most popular being nutritional supplements, infra-red light therapy, chiropractic, massage, and grounding, as shown in Figure 4. Additional adjunctive and synergistic uses for PEMF were submitted for Question #7, and are listed in the appropriate section of the Appendix.

When asked about the synergistic effects of PEMF with other modalities (Question #8, Figure 5), only 31% of respondents indicated no synergy, whereas 62% of respondents rated the synergy as yielding “much better” or at least “somewhat better” results. Only 1% reported reduced effectiveness when PEMF was used adjunctively with other modalities.

When asked about the types of PEMF systems that respondents have (Questions 9 and 10, Figure 6), there was a clear bias toward Micro-Pulse ICES systems (the product offered by the author), but this bias does not reflect the actual percentage of use of Micro-Pulse ICES-PEMF systems in the overall PEMF market. Therefore, to avoid this bias, excluding the top three systems (Micro-Pulse models A9, M1, and C5), a predictable rank-order of the most common and popular PEMF systems emerges. The actual percentage of users for each of these systems is tabulated in detail in the Appendix (see questions 9 and 10).

Most people have not tried combining the effects of large, whole-body PEMF systems with concurrent use of portable (personal) PEMF. Figure 7 shows that 83% of respondents had never done so. However, about 16% of the 407 respondents to this question had done so, and of those, more than 2/3 found that the combined use of large clinical PEMF concurrently with portable (personal) PEMF resulted in outcomes that were “somewhat better” to “much better” than the use of only large clinical PEMF or portable PEMF systems alone.

In answer to the question: “Have you ever observed or experienced adverse effects from the use of PEMF?”, 79% of respondents said they had never observed adverse effects of PEMF (Figure 8). The remaining 21 % had observed adverse effects, but only temporary adverse effects, and of those, only 2% were considered major temporary adverse effects. There were no reported permanent adverse effects. This corroborates the observation in the Introduction section that the scientific and clinical literature, taken as a whole, is essentially devoid of reports of any serious or permanent adverse effects of PEMF treatment. Brief descriptions of the adverse effects observed by respondents to this survey are given in the Appendix, in the tabulated answers to Question #13.

When asked which conditions PEMF was most effective for (Figure 9), most (40%) responded “injury recovery”, followed by chronic and acute pain. Some respondents (16%) indicated that they had formulated the opinion based upon their experience that PEMF was “helpful for just about everything”.

Turning this question around, when asked “What applications of PEMF do you think work LEAST WELL or NOT AT ALL” (Figure 10), the most common response (46%) was to contradict the question itself by asserting “NONE; PEMF seems to work pretty well for everything”. However, 13% maintained that PEMF worked poorly or not at all for anything. This large percentage was unexpected for this option, and may have been due to the question being poorly worded and misunderstood. However, following this, there were a fairly long list of conditions where some people had observed PEMF to be ineffective, all of these occurring only 5% of the time or less. This could be due to individual variability, improper use of PEMF, or the inadvertent use of an ineffective PEMF system.

Figure 11 indicates that 86% of respondents to this survey were individual users of PEMF, while the remaining 14% were clinicians who used PEMF on their clients, themselves, or both.

In response to the question: “If you are a clinician, do you advise that PEMF is best used at home or in a clinic?”, the most common answer was “I am not a clinician”. Excluding these, the remaining answers are shown in Figure 12. About half of clinicians would recommend the use of PEMF at home, with or without the concurrent use of in-clinic PEMF, and only a very small number would recommend the use of PEMF with no other treatment modalities.

The final question on the survey was to ask what other treatment modalities they use concurrently with PEMF, and these open-ended answers are tabulated in the Appendix.

Summary and Conclusions

Considering the answers to the formal survey as well as the informally gathered information following the survey, the general trends are that PEMF has benefits that have been observed for a very broad range of applications, most common among these being injury recovery and pain, while having no observed serious and permanent adverse effects. PEMF is used widely both by clinicians and individuals for an average of 6 or 7 different health-related conditions, and as an adjunctive modality for many other alternative and mainstream approaches. About 2/3 of the time, people report that PEMF has synergistic effects when combined with other modalities, including the combined occasional use of large clinical with daily use of portable (personal) PEMF.

Statement of Potential Conflict of Interest

The author of this report (R.G. Dennis) declares both a scientific and a commercial interest in ICES®-PEMF technology: He is owner of Micro-Pulse LLC (manufacturer of the technology), holds several patents for ICES®-PEMF technology and receives royalty payments from NASA-Johnson Space Center for the commercial licensing of this technology, which he developed in its initial form (TVEMF) as a consultant for NASA in the mid-1990’s.

Appendix: Detailed survey response data

Question #1

What do you use PEMF for? (select as many as you want)

Question #2

What other uses do you have for PEMF?  (if NONE type "none")

Question # 3

Do you have any interesting or unusual applications?  (if NONE type "none")

Question #4

What uses of PEMF are you most interested in getting more information about?

Question #5

Are you INTERESTED in any other uses of PEMF that have not been listed in Question #4?

Question #6

Do you use PEMF along with any other type of therapy? (ADJUNCTIVE)

Question #7

Do you have any other adjunctive or synergistic uses for PEMF?

Question #8

Synergistic effects: Did the use of PEMF change the effectiveness of the other treatments?

Question # 9

Which PEMF system(s) do you have?

Question #10

What other PEMF systems do you use? (those not listed in the previous question)

Question #1 1

Have you tried combining portable (personal) PEMF with whole-body PEMF?

Question #1 2

Have you ever observed or experienced adverse effects from the use of PEMF?

Question #13

Briefly explain any adverse effects you have experienced or observed

Question #1 4

What applications of PEMF do you think work BEST?

Question #15

What applications of PEMF do you think work LEAST WELL or NOT AT ALL?

Question #16

Are you an individual user or clinician?

Question #17

Clinical advice: PEMF is best used at home or in a clinic?

Question #18

If you are a CLINICIAN or HEALTH CARE PROVIDER, what modalities do you combine with PEMF?

List as many as apply to your practice.

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