STTI, Case SK0001, Magnet Therapy for Health: A Case Study

Meet the Author

Title	Magnet Therapy for Health: A Case Study Case Study SK0001
Author	Norma Cuellar, RN, DSN
Contact Hours	1.6
Target Audience:	Health care professionals interested in alternative treatments to decrease discomfort as well as those interested in health promotion and prevention.
Purpose/Goal:	To discuss the benefits of magnetic therapy in health care promotion and prevention and present a case study on outcomes of a woman with rheumatoid arthritis who used magnetic health care technology as a health care intervention.

Objectives	Physical Exam Findings
Instructions	Laboratory/Test Data
Introduction	Course of Care
Medical/Nursing History	References
Family or Social History	TEST QUESTIONS

Sigma Theta Tau International is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center's Commission on Accreditation.

Norma Cuellar, RN, DSN
Dr. Cuellar is an assistant professor at the University of Southern Mississippi (USM) College of Nursing. Her research area is complementary and alternative medicine and family caregiving.

Dr. Cuellar received her baccalaureate degree in nursing from USM, her master's of science degree from Louisiana State University Medical Center in New Orleans, and her doctoral degree from the University of Alabama at Birmingham.

Dr. Cuellar's clinical experience includes coronary care, medical intensive care, general medicine, and home health care. She has been in education since 1988 and has been working with magnetic health care technologies for three years. She has recently been accepted for an NIH post-doctoral fellowship at the University of Virginia in Charlottesville. Dr. Cuellar has been a member of Sigma Theta Tau International since 1988.

Instructions

Medical/Nursing History:
Susan's onset of symptoms began in 1986, at 29 years of age. Prior to this, she was a highly functional young woman with two toddlers who worked three jobs for six to seven years (one full time and two part time). She presented to her physician with increased musculoskeletal discomfort, fatigue, and inability to rest. At this time, she was diagnosed and treated for fibromyalgia and depression. She was started on nonsteroidal anti-inflammatory medications (NSAIDs) and clorazepate dipotassium (Tranxene). She got some help with her symptoms but very poor relief of her discomforts.

In 1988, after two years of continued problems, Susan was sent to a rheumatologist and was diagnosed with sero-negative rheumatoid arthritis (RA) and osteoarthritis (OA) by exam and x-ray. At this time, her hands and feet showed signs of arthritis.

At the time of her diagnosis, Susan was placed on nonsteroidal anti-inflammatory medications (NSAIDs) and auranofin (Ridaura), or oral gold, which resulted in a 9-15-month period of remission after taking auranofin (Ridaura) for 2 years. Her disease progressed slowly over the next 15 years with 3-4 flare-ups per year. Susan continued to try different medications for relief. She said, "I've tried almost every NSAID that has come on the market (Motrin, Aleve, Aspirin, Disalcid, Daypro, Arava, Relafen, Toradol, Tolectin, Nalfon, Dolobid, and Clinoril)." She was treated with disease-modifying anti-rheumatic drugs (DMARDs), which included leflunomide (Arava), hydroxychloroquine (Plaquenil), auranofin (Ridaura), and methotrexate (Rheumatrex). Leflunomide (Arava) did not do anything to alleviate her symptoms. The hydroxychloroquine (Plaquenil) and auranofin (Ridaura) caused severe skin reactions/rash.

Additional history included a report of cellulitis in her right foot in 1997. Endoscopic examinations, to check for gastrointestinal ulcers, were negative. Susan had a tubal ligation in 1988. She reported no organ involvement. She has no allergies, although she cannot take acetylsalicylic acid (ASA) or sulfa while on methotrexate (Rheumatrex). She reported complaints of headache at least twice a week related to temporo-mandibular joint (TMJ) syndrome diagnosis.

Family or Social History:
Susan is married and is the mother of two teenage daughters. She is able to work part time and is a full-time student in a graduate program. Susan's mother was diagnosed with RA about the same time Susan was. Her mother was 55 years old at the time of her diagnosis. Susan has three sisters and three brothers who have no history of disease.

Physical Examination Findings:
Susan presents as a thin, middle-aged woman with swollen and tender joints of all fingers and toes. On a scale of 0-10 for discomfort, her average is 3-4, depending on her activity and the time of day. She reports more discomfort in the early morning and late evening. She has subcutaneous nodules on the bases of her great and fifth toes (both feet), nodules on both wrists, and nodules on the base of her left fifth finger and right fourth proximal interphalangeal (PIP) joint. She has good range of motion (ROM) in all joints except in her hands and wrists. She complains of extreme fatigue. She reports that in the last 2 years, new nodules appeared with every visit to the physician.

Susan reports the tendency to get sick with infections much easier than the general public and has an upper respiratory infection (URI) with antibiotic treatments about two to three times per year. She reports a urinary tract infection (UTI) about once a year. Other symptoms include discoloration of extremities with exposure to cold (turn blue/purple). She also reports that her symptoms get worse with the onset of her menstrual cycle.

Susan reports 2-4 extreme flare-ups per year precipitated by emotional and physical stress. With these flare-ups, Susan experiences stiffness, joint swelling, and extreme fatigue. During this time she is unable to dress, get in or out of the shower, drive, or do activities of daily living. She also reports episodes of shortness of breath. "Everything takes a lot longer to accomplish." She must have frequent rest periods of 2-3 hours during these times.

Susan reports side effects of drugs she has taken. She reports that the prednisone has made her eyes and mouth dry since beginning therapy in June 1999. Her current dose is 10mg/day. She is limited in the drugs she can take because of side effects including increased gastric distress (requiring Cytotec, Tums, and Mylanta), nausea, and skin rashes.

Susan has periods of feeling depressed. She has learned to assist herself through various alternative options including prayers, helping others (She believes there is always someone worse off than she.), gentle exercise at the gym, and spending time with friends.

Laboratory/Test Data:
Susan's lab results include a positive RA titer (Her RA titer had been negative until 1998.); hemoglobin and hematocrit (H&H) 12/36; liver enzymes and urinalysis within normal limits. She has not had x-rays since her diagnosis in 1988. Lab work has been done every 2 months while she has been on methotrexate (H&H, liver enzymes, urinalysis). Susan has not had an erythrocyte sedimentation rate (ESR) in the last 2 years, although her ESR has been slightly elevated in the past. She has not been tested for the HLA-DR4 gene.

Course of Care:
Currently, Susan takes the following medications: methotrexate (Rheumatrex) 1cc (25mg) weekly, prednisone 10mg per day; celecoxib (Celebrex) 200mg daily; calcium supplement 600mg twice a day (BID); multivitamin; acetaminophin (Tylenol) when needed (prn) (500mg prn every 4 hours); and Darvocet N 100 prn, 1-2 BID. She reports a discomfort level of 8 (on a scale of 0-10; 10 being worst) almost daily.

In the past, Susan has tried alternative health remedies. These included herbal preparations, rubs (Myoflex, Theragesic), shark cartilage, feverfew, goldenseal, echinachea (This made her autoimmune disease worse!), and combination preparations of herbs for arthritis. She also has tried drinking green teas and vinegar or honey preparations. Susan had agreed to try the magnetic health care products when she realized that her disease was progressing and her condition deteriorating. She has experienced severe discomfort and has taken 10mg prednisone per day. She had reached the point where she could not work and was dependent upon her children to dress her and drive her where she needed to go. Susan had not been able to sleep and has had edema in all her joints. She had been taking large amounts of medications for her discomfort, but they had provided no relief. She had also reported an increase in gastrointestinal (GI) upset with reflux and indigestion. She has tried using magnetic wraps for her joints and insoles for her shoes and sleeping on a magnetic pad (sleep system).

After using the magnetic products for one month, Susan reports increased quality of sleep and nearly total elimination of lower extremity edema. She continues to have some edema with menses. She is able to decrease her intake of Darvocet N by 75 percent. The nodule on her right heel is gone, and she reports no new nodules.

Susan reports that since wearing the insoles, her feet no longer get sore, and no edema occurs as the day progresses. The magnetic pillow helps the TMJ discomfort from the arthritis in her jaw. The wraps assist in lessening the discomfort and reduce the swelling in her wrists.

With consistent use of magnets, Susan is able to decrease her daily dose of prednisone by half. The decrease in prednisone, as well as use of the magnetic sleep system, is also minimizing her GI symptoms. She reports that the use of the sleep system and the other magnets are helping to decrease her backache and the discomfort and swelling in her joints during her menstrual cycle.

Principles of Magnetic Therapy

Recently, there has been a multitude of publicity on magnetic health care technology stating that magnet treatment is considered an alternative therapy and not considered medical treatment. Magnets are advertised as harmless, all natural, and without negative side effects. Many people are opting for magnets as a choice in prevention of disease, as well as for easing chronic discomforts. The use of magnet health care technology is a $5 billion industry worldwide (Whitaker & Adderly, 1998). Health care professionals need to understand how magnets work on the body and the implications of their use in health care situations.

Susan's choice to use magnetic therapy was an independent one. When a patient chooses alternative health care practices, it is important for nurses to include these practices in their assessment, planning, and intervention to assure optimal health care outcomes. Nurses must be nonjudgmental when taking the history of a patient who uses alternative health care options. When patients find alternative health care practices therapeutic, they will use them despite the opinion of the health practitioner . Nursing interventions include determining safety and effectiveness of the therapy, assessing for side effects and harmful interactions, identifying safe dosages for therapeutic effects, communicating with health care providers, and teaching clients the pros and cons of using alternative therapies (licensing, quality of products, standards, and costs).

How Magnets are Believed to Work

Magnets can be used at primary, secondary, or tertiary levels of care. It should be clearly stated that magnetic health care products are not intended to treat or cure any disease or illness; however, when they are used in conjunction with medical treatments, they can enhance a patient's health and well-being. Magnetic health care products are not registered medical devices in the United States; therefore, no medical claims can be made, and there is no Food and Drug Administration (FDA) approval. A patient should always seek a health care provider's opinion when using any alternative therapies.

Many people may ask, "How do these magnets really work?" . Though there is no pure, single answer for this question, many theories are being considered. People who gain relief from magnets don't care about scientific evidence as long as the magnets provide relief from chronic discomforts and aches. It can be said that magnets are natural and safe. A 40-year study of permanent magnet use commissioned by the World Health Organization in 1987 (Sandyk, 1994) demonstrated neither negative side effects nor "mutagenic process" from their use.

All magnets have two poles: a north and a south pole. The earth itself is a large magnet with north and south poles, and all life is exposed to its magnetic energy. If we did not have this energy, we would die, and everything would fall apart since we are held together by magnetic forces (Livingston, 1996).

Many studies on the effects of magnetism have been done on animals (Hannemann, 1990). Homing pigeons use the earth's magnetic field to navigate. In one study, a tiny magnet was put on each pigeon's head. The pigeons were unable to fly in one direction and scattered in all directions. In a study by the U.S. government, a cage of rats was shielded from the natural magnetic field of the earth. Within 6 weeks, some rats lost their hair, and some sickened and some died. When the natural magnetic field was restored, the rats' health and hair were restored (Whitaker & Adderly, 1998).

Human body systems (e.g., nervous, respiratory, digestive, etc.) are complex electrochemical processes that are not clearly understood. Can magnets have an effect on our electrochemical processes and thus on our health? Recently, researchers found magnetite (a strongly magnetic mineral) in human brain, heart, lung, and spleen tissue raising speculation that magnetite may have some biological function. This may support some of the theories being studied to determine the effects of magnets on the human body. These theoretical effects include: 1) increased blood flow; 2) increased energy through the body's meridian systems; 3) stimulation of electrical impulses in the nervous system; 4) direct effect on the pineal gland; 5) realignment of certain molecules in the membranes of the cells; 6) inhibition of the build-up of cholinesterase (an enzyme found in nerve endings that inactivates acetylcholine, which is essential in pain control); 7) reduction of acid build-up in the body, and 8) the Hall Effect (charged ions become more active when they pass through a magnetic field causing heat, dilatation of blood vessels, better oxygenation of tissues, and an increased ability of cells to eliminate toxins, Whitaker & Adderly, 1998). Major research is in progress to determine how magnets affect the body. In reality, no one really knows; however, many people believe in the magnet's ability to make them feel better.

History of Magnetic Therapy/Cultural Implications

Magnets have been used for centuries in health care. Aristotle is believed to have been the first physician to speak on the benefits of magnets. It is said that Cleopatra wore a lodestone (magnetic rock) on her forehead while she slept to prevent the signs of aging. Many case studies were documented in the 17th and 18th centuries on how magnets were used to treat pain. In a post-Civil War catalogue, Sears & Roebuck advertised a wide variety of magnetic jewelry (Livingston, 1996).

Considered an Eastern tradition, healers in India, China, and Egypt have documented the use of magnets for ages. Magnets are believed to balance the Ying Yang and the body's meridians to achieve health. Certain points on the body have been identified that can be manipulated for better health (pressure points). If the energy field is out of balance, the natural energy flow of the body is blocked and illness occurs.

The medical community in the United States has not accepted magnet therapy. As Western medicine evolved and the scientific paradigm of medicine emerged, many treatments formerly deemed mainstream have now been relegated to the category of alternative or nontraditional treatments. With the discovery of antibiotics and technological advances in surgical procedures, alternative therapies have not been considered scientific or medically sound practice; however, as patients become increasingly involved in their own health and want options in their health decisions, the use of alternative medicine is increasing.

Many countries today use magnets to treat health care problems. "Magnetic therapy has been officially accepted as a medical procedure in Germany, Japan, Israel, Russia, and 45 other countries for the treatment of arthritis, back pain, bursitis, carpal tunnel syndrome, headaches, sinus headaches, tennis elbow, sleep disorders, and many other inflammatory, orthopedic, and neurological problems" (Whitaker & Adderly, 1998, p. 37). As more research is done, the acceptance of magnet therapy may be seen in more countries.

Types of Magnetic Treatment

There are currently two types of magnetic treatments available to patients: electromagnets and permanent magnets. Both will be discussed; however, permanent magnets are those used in alternative therapies and in this case study.

Electromagnets are magnets produced through an electrical current. They can be turned on and off, are always in motion, and are stronger than permanent magnets. Electromagnets are synonymous with pulsating magnets and are considered medical devices. They can be found in clinics and hospitals for treatment of health conditions such as fractures and joint/muscle injuries, and for diagnosis of health conditions (Magnetic resonance imaging (MRI) is an electromagnet.). Electromagnetic machinery is very expensive and not easily available to patients for use. Use of this equipment requires a physician's order.

Permanent magnets are not dependent upon electrical current and are constantly giving off magnetic energy because of their molecular makeup and processing. Their magnetic fields are static or motionless. Permanent magnets are easy to use, readily available when needed, and cheaper than electromagnets. These magnets can be purchased without a physician's order.

It is important to realize that a wide variation in magnets exists. The quality of a magnet depends on its pattern and purpose for use. Since there are no Food and Drug Administration (FDA) regulations to guide magnets, patients can purchase magnets of poor quality and inadequate strength and may receive no education as to their uses and side effects.

Magnet strength is measured in units of gauss much like a light bulb's output is measured in units of watts. Gauss represents the number of "north and south poles" in one square centimeter of magnet (Washing & Hricak, 1993). A refrigerator magnet has about 100 gauss; a variety of magnets worn on the body have from 500-2,000 gauss; an electromagnetic medical device has 20,000 gauss; and an MRI has approximately 30,000 gauss. The size of a magnet does not indicate its strength. Magnetic strength depends on the coercivity of the magnet's makeup. The horseshoe magnet is an example of a magnet with high coercivity; it has increased magnetic strength because of its specific design and shape. Patients need to understand the strength of the magnets they are using. Patients may need magnets with more or less gauss to be effective in providing relief for their health care problems.

Permanent magnets come in a variety of forms: insoles, wraps, bracelets, necklaces, metallic pieces to put on the body, seats, mattresses, pillows, and sleep masks. Magnets are applied directly on the body over an area of discomfort. Each individual responds differently to the use of magnets. For those who get results, some people get immediate relief; others get results within 7-10 days. Permanent magnets must be worn consistently. If a person does not get positive results, it may be because the magnets are not 1) worn correctly, 2) strong enough (need a product with higher gauss), and/or 3) worn long enough. Health outcomes improve with use of the product over an extended period of time (Tierra, 1997). Some people report an increase in discomfort upon initial application of the magnets. This is a normal response, much like first starting an exercise program. These symptoms usually resolve after wearing the products for 7-10 days, and the usual result is that the patient eventually feels better than before.

Research

A vast amount of research has been done on magnets worldwide; however, research in the United States has been limited. Much of the research on magnets done in the United States has been on the electromagnets that are considered medical devices. The reasons for doing research on electromagnets are many, including: 1) a more controlled environment is possible (These devices are located in hospitals and health care agencies.); 2) the treatment is controlled (These devices give off an exact amount of energy for an exact amount of time.); 3) the experimental studies technique (It's easy to have a control group since the patient cannot feel the magnetic energy source, so there is no placebo effect.); and 4) the ease of measuring the patient benefit.

Recently, more research has been initiated to determine if permanent magnets are as beneficial as electromagnets. Research on electromagnetic therapy includes the positive effects of electromagnetic energy on neck pain, Parkinson's disease, multiple sclerosis, depression, Tourette's syndrome, diabetic angiopathies, urinary problems, vascular problems, pain, respiratory problems, sinusitis, placental insufficiency, and trophic ulcers, to name a few. Research in permanent magnet therapy includes the effects on the destruction of cancer cells, immediate pain, chronic pain, head injuries, whiplash, menstrual pain, urethral stenosis, inflammatory diseases, polio, wound healing, and fibromyalgia (Almond, 1997; Lawlis & Freeman, 2001; Sandyk, 1997; Skoromets & Nikitina, 1999; Szor & Topp, 1998; Varcaccio, Carriero, Loizzo, Amoruse & Loizzi, 1995; Whitaker & Adderly, 1998).

Future of Magnetic Therapy

The future of magnetic therapy is very exciting. Currently, research is being done at medical centers all over the United States using magnets for a variety of health care conditions. More physicians and health care agencies are accepting alternative forms of therapy and recommending magnetic health care as a possibility for their patients. According to a recent report from the Journal of the American Medical Association (JAMA), from 1990 to 1997, the use of alternative treatments increased from 33.8 percent to 42.1 percent of the population (Eisenberg, Davis, Ettner, Appel, Wilkey, Van Rompay, & Kessler, 1998). In the same time period, 46.3 percent of patients were using an alternative medicine practitioner, an increase of 10 percent. Estimated costs for alternative treatment services increased 45.2 percent and were estimated at $21.2 billion, which exceeded the out-of-pocket expenditures for all U.S. hospitalizations. It is estimated that $27 billion is spent annually on alternative medicine/treatments. This is a substantial increase, which indicates that an increasing portion of the population is seeking this form of treatment. Magnetic health care products were chosen as one of the top ten alternative therapies by patients with arthritis (Horstman, 1999). Few people are NOT skeptical when first introduced to magnetic health care products. Most people who try them do find some relief with the products. Many doubt their own belief systems because of how much better they do feel.

If magnets do work, what are the benefits to our health care system? If magnets prevent us from getting sick, what amount of money can this save us? Can we ever determine the cost of the things we prevent? If pain relief is the question, how much money can be saved on prescription drugs, doctor visits, or chiropractor visits? Can this alternative therapy decrease the amount of drug dependence in our country? Can it help decrease the number of drug interactions incurred by patients who take numerous medications because of their illnesses (which could possibly be prevented using this therapy)? Can magnets prevent injuries on the job that cost millions of dollars in occupational health care? Can automobile accidents related to falling asleep (inadequate sleep patterns) be decreased if people slept better using magnets? More experimental research is needed specific to health care conditions.

Currently, most insurance companies will not pay for magnet therapy. Many people are laughed at when they tell their health care providers about the benefits they get from magnets. We, as health care providers, must educate ourselves and be more accepting of this growing form of treatment our patients are using. Patients must be educated to purchase products of high quality. Companies who do research to improve the quality of magnet products should be supported. Patients must understand that magnets do not take the place of good, sensible health practices, like sound nutrition and proper exercise. Standard, conventional, medical treatment should not be ignored. A list of books available on magnetic therapy is included. Web pages related to rheumatoid arthritis can be viewed. Web pages related to complementary/alternative medicine can be viewed.

As the trend in the use of alternative therapies continues (Eisenberg et al., 1998), it is obvious that more research is needed in the use of magnetic health care technologies, including double-blind studies to determine significance of the treatment on a variety of health care conditions. Other research areas should include why these products work for some people and not for others; cultural implications of the use of magnets; effective treatment for which illnesses; who can benefit the most from these products; and how these products can be used for prevention as well as illness.

Whatever your beliefs are, patients have a right to choose the treatment that suits them. As nurses, we must respect patients' decisions and also be well informed regarding their choices.

As for Susan, she continues to improve using the magnets. When she stops using them, her symptoms return. Susan is one of thousands using magnetic products and getting benefits. As nurses, we must be aware of this form of alternative therapy and understand the implications.

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Please select the correct answer for each of the following questions. If you answer 80% or more correctly, you will be given the opportunity to register for continuing education credit. After receipt of the registration information and fee, a continuing education certificate will be mailed to you.

Your patient wants to start using magnets for pain relief and asks you what the FDA's position on magnets for health care is. You correctly state:

The FDA believes they are harmless, so we can assume that they approve of magnet use for health care.
The FDA believes they are harmless, but does not give approval of magnet use for health care.
The FDA has reviewed the research and has given approval of magnet use for healthcare.
The FDA has reviewed the research and provides guidelines and recommendations about using magnets for health care.

Your patient shares with you that he is using magnets for health care but states that he has not told his doctor. You are not surprised because studies show that some patients often do not tell their doctors because

They believe the doctor may not be familiar enough with magnet treatment to give advice and are afraid that he/she might not approve.
They believe the doctor would not approve and that he/she would insist they stop using magnets/alternative medicine.
They believe there's no reason to tell the doctor and they feel embarrassed about using magnets/alternative medicine.

All of the following are theories that may explain the effect of magnetic energy on the body except:

Hall Effect that causes increased oxygenation.
Stimulation of electrical impulses in the nervous system.
Increased circulation to the body.
Direct effect on the adrenal gland.

Many cultures widely accept magnetic technologies in their health care practices. As health care providers, how do we provide culturally competent care to those whose health care practices differ from ours?

Tell them magnets are not scientific and are an archaic practice.
Accept their beliefs and values in their health care practices.
Report that the patient uses magnets and is noncompliant.
Laugh at them in disbelief.

A normal, effective, safe amount of gauss that can be used therapeutically in a permanent magnet is:

A patient who uses magnets has come to you asking for advice. You are told the magnet didn't work, and you are asked why. All the options listed below could be a reason except:

Duration of the ailment.
Severity of the condition.
Magnets are a fad and do not work.
Patient's sensitivity.

Your patient tells you that his/her doctor is prescribing a new treatment for his/her joint pain. The treatment is electromagnetic therapy. He/she asks you what the difference is between the magnets you buy and wear and the treatment he/she will be getting at the hospital. Based on your knowledge of magnetic therapy, you know that: