磁力手鐲可能可降低下肢骨關節炎的疼痛


  Dec. 17, 2004 - 一項刊載於12月份英國醫學期刊上的多中心、隨機性對照研究顯示,因骨關節炎所引起的臀部及膝部疼痛,可以藉由磁力手鐲加以舒緩。
  
  英國Cullompton醫學院外科醫學的Tim Harlow醫師表示,永久性靜態磁力裝置的製造廠商表示,他們的產品可以降低許多狀況下引起的疼痛,這包含了骨關節炎;研究人員指出,療效試驗所獲的結果和廠商的聲明互相衝突,這些可能導因於所用的磁鐵型態及磁力不同,治療條件不同及治療次數不同等。
  
  來自Peninsula醫學院的研究人員對194位患者作了磁力手鐲的療效評估,這些患者的年齡都在45到80歲之間,並患有臀部及膝部骨關節炎;根據WOMACA(Western Ontario and McMaster Universities)對下肢骨關節炎所定義的疼痛指數,患者們的初期指數為8到20分。
  
  患者們以隨機分配的方式,分別配戴標準磁力的靜態磁力手鐲(170~200 mTesla),低磁力手鐲(21~30mTesla),或無磁力手鐲(對照組);經過12週後,試驗結果以WOMAC A、B及C(疼痛度、腳部僵硬度及腳部功能度評分)作評估,疼痛程度則以目視類比式測量器進行測量(0~100分,趨嚴重)。
  
  12週的試驗結果顯示,標準磁力組的WOMAC A分數優於對照組,兩組的平均差異為1.3分,也就是,標準磁力組的疼痛降低幅度較高;WOMAC C的評估也有類似的狀況,兩組的平均差異為4.4分。
  
  目視類比疼痛指數測量後也獲得類似的結果,即標準磁力組的疼痛降低程度遠大於對照組,兩組的平均差異為11.4分。
  
  Harlow醫師指出,WOMAC B分數並沒有改變,但這可能歸因於此測量項目的低敏感度。
  
  標準磁力組及低磁力組之間,在疼痛的降低程度上並沒有顯著差異(WOMAC A 平均差異僅為0.81分);Harlow醫師解釋,這項結果可能導因於製造的誤差,有34個低磁力手鐲,磁力超過規定的21~30 mTesla(平均128 mTesla)。
  
  因為低磁力手鐲受到高磁力磁鐵的影響,因此無法對對照組作出更客觀的效果評估,真正的對照組應該無法偵測到任何磁力。
  
  雖然本研究無法針對磁力手鐲,或無磁力手鐲的效果作解答,但是不論作用的機轉為何,磁力手鐲似乎有臨床上的正面效益。
  
  Harlow醫師強調,這些效益可以補充特殊治療的不足之處,此次的研究結果還需要更進一步的試驗來驗證,並確認治療效果是否能超過12週。
  
  本項研究由荷蘭心臟基金會(Netherlands Heart Foundation) 及荷蘭科學研究組織(Netherlands Organization for Scientific Research)兩個機構所資助。

Magnetic Bracelets May Reduce<

By Yael Waknine
Medscape Medical News

Dec. 17, 2004 — Magnetic bracelets may reduce the pain associated with osteoarthritis of the hip and knee, suggest the results of a multicenter, randomized, placebo-controlled study published in the December issue of the British Medical Journal.

"Manufacturers of permanent static magnet devices claim that they reduce pain in various conditions, including osteoarthritis," write Tim Harlow, MD, of the College Surgery in Cullompton, U.K., and colleagues. Investigators noted that the contradictory results yielded by efficacy studies may be related to differences in the type and strength of magnets used, the conditions treated, and treatment times.

Investigators from the Peninsula Medical School evaluated the effects of bracelet therapy in 194 patients aged 45 to 80 years with osteoarthritis of the hip and knee. All patients had baseline scores between 8 and 20 points on the Western Ontario and McMaster Universities osteoarthritis index (WOMAC A) for lower limb pain.

Patients were randomized to wear a standard strength static bipolar magnetic bracelet (170 ??200 mTesla), weak magnetic bracelet (21 ??30 mTesla), or non-magnetic bracelet (placebo), for a period of 12 weeks. Outcomes were evaluated using WOMAC A, B and C (pain, leg stiffness and functioning scores), and a visual analog scale for pain (0 to 100 for increasing pain).

Comparative analysis of WOMAC A scores at 12 weeks showed a significantly greater reduction of pain in the standard magnet group as compared with placebo (mean difference, 1.3; 95% Confidence Interval [CI], 0.09 – 2.60; P = .03). A similar pattern was observed for WOMAC C scores (mean difference, 4.4; 95% CI, 1.0 – 7.9; P = .01).

Analysis of visual analog pain scores likewise showed significantly greater reduction of pain in the standard magnet group as compared with placebo (mean difference, 11.4; 95% CI, 3.0 – 19.8).

"No change was seen in WOMAC B score, but this measure has been found to lack sensitivity," the authors note.

No significant differences in pain reduction were observed between the standard and weak bracelet groups (WOMAC A scores: mean difference, 0.81; CI, -0.44 – 2.07; P = .26). According to the authors, this result was due to a manufacturing error; 34 of the weak magnets exceeded the specified range of 21- to 30-mTesla (mean, 128 mTesla).

"The contamination of [the weak magnet group] with stronger magnets prevented a more objective estimation of any placebo effect," they write, noting that use of a true placebo is easily detected due to lack of magnetism.

Although the study does not entirely resolve the extent to which the effect of magnetic bracelets is specific or due to placebo, the authors point out that magnetic bracelets appear to have clinically useful benefits regardless of their mechanism of action.

"These benefits are supplementary to those from usual treatments," the authors emphasize. "Further work is needed to replicate our findings and determine whether the effect extends beyond 12 weeks."

The study was supported by grants from the Netherlands Heart Foundation and the Netherlands Organization for Scientific Research. One investigator reports receiving a VicHealth fellowship grant.

BMJ. 2004; 329:1450-1454

Reviewed by Gary D. Vogin, MD

    
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