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Magnetic Field Therapy: Purpose, Procedure, Risks, Effectiveness
Distribution of studies in three meta-analyses: Pittler [ 6 ] blue , Salomonowitz [ 18 ] red and Eccles [ 17 ] yellow. Higher quality studies described by Eccles are depicted by the inner yellow oval, bordered in black. The circled individual-studies represent those included in the meta-analysis by Pittler. The review of Salomonowitz et al. The remaining articles were reviewed and six of the seven reported non-statistically significant results.
Nine of the studies included in both reviews were the higher quality studies considered by Eccles. Only three of the studies that overlapped reported results suggesting no change with magnet therapy, either alone or compared to control.
Medical Definition of Magnet therapy
The differing conclusions appear to be related to the method of categorisation of the studies that showed similar benefit in both the treatment and control groups see Figure 4. Pittler's review contains twoadditional studies that were not referenced in either of the two previously mentioned reviews. It does not include four studies present in one or the other of those reviews. In addition, Pittler's review contains a meta-analysis of nine studies see Figure 4.
How It Works
This quantitative addition to the literature reported a trend minimally favouring magnet therapy, which did not reach statistical significance. Only one of the nine studies was reported to have statistical significance in the meta-analysis.
This was a study in patients with osteoarthritis leading the authors to suggest there may be possible benefits for this condition. For all other conditions, the question was raised as to whether further study is warranted given the convincing lack of evidence for benefit [ 6 ]. Several main themes exist in the design development of magnet therapy studies. There is a lack of standardisation in magnetic field strength and polarity.
Does Magnetic Therapy Work?
Location of the magnets is also varied. Most studies place the magnet over the site of pain. The proximity to the target tissue varies, however, when placement of a magnet is over a joint compared to deeper tissues when treating pelvic pain. Other studies attempt to demonstrate a more general enrichment in the body by testing magnets remote to the painful site. Mattresses, bracelets and necklaces are the predominate locations see Figure 3.
In the nine randomised controlled trials [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ] published since Pittler's review, only one reported statistically significant results.
The authors suggest that anecdotal observations have demonstrated less reliable results when infection or fever is involved [ 26 ]. However, this does not seem to explain the apparent benefit of the sham treatment of aphta. In two studies, though the results were not statistically significant, the control group reported slightly more benefit when compared to the magnet treatment group [ 19 , 25 ]. Blinding is frequently described as problematic in static magnet studies.
Several recent studies have attempted to address this creatively. End-of-study surveys give some insight into the patient's views on blinding. Some raise concerns regarding the adequacy of blinding. Good study design regarding blinding was suggested in other studies.
This included an inability to detect a difference in texture [ 27 ]. This design was intended to confound the definition of the placebo. By narrowing their study to participants with osteoarthritis, Richmond et al. The negative study results led the authors to recommend that patients should be informed that magnetic bracelets may not be helpful [ 23 ]. This study design tested the principle of remote placement of the magnets from the site of pain, leaving open the question for further studies testing local placement of magnets in osteoarthritis patients.
Of interest, Richmond's group did a similar study in RA patients [ 28 ] , and results are anticipated soon. It has been suggested that there seems to be an active effect of placebo or expectation that may confound the final conclusions surrounding magnet therapy [ 29 ].
Recent surveys have shown that physicians have some acceptance of the use of placebo [ 30 ] and a recent study demonstrated that a placebo may be effective even when it is fully disclosed as a placebo [ 31 ]. Future study should be designed to help in appreciating the poorly understood placebo effect. Without evidence that there is a benefit to static magnets for pain, it should be considered whether future resources should be devoted to the topic. Which side of this debate one is on will likely be grounded in how one views uncertainty. On one hand, the certainty of benefit is not supported by the many studies failing to prove the hypothesis of pain being reduced.
At some level of certainty, scientists will accept the evidence available and determine that further study is not warranted. Contrary to this, others keep the window open if there is any level uncertainty; keeping open the possibility that there is something not yet understood about the anecdotal benefits patients describe, part of which may be a beneficial placebo or expectation effect.