MAGNETIC THERAPY FOR THE MANAGEMENT OF SOMATIC PAIN

Dan E. Briggs, RN, BSN

Submitted in Partial Fulfillment of the Requirements for

the Master of Science in Nursing Degree

Edinboro University of Pennsylvania

Magnetic therapy for the
management of somatic pain
by Dan E. Briggs.
Thesis Nurs. 2001 B854m
c. 2

Approved by:

Xidith Schilling, CRNP, PliDj/^
^Committee Chairperson
/&/

Alice Conway, CRNP,
- Committee Member

ate

Pdul Kollut, DO
Committee Member

Date

0
o

Abstract

Magnetic Therapy for the Management of Somatic Pain

Throughout history, humankind has experienced the unpleasant sensation of
pain. Pursuant to this, relief from the discomfort of pain has been sought through

whatever means conceivable including the use of magnets. This study was done to

help provide a basis for the decision as to weather or not health care providers should
advocate the use of static magnets in pain management. The theoretical framework of
this study was the Four Conservation Principals by Myra Levine (1969), specifically
the conservation of patient energy regarding the inflammatory process.

This research studied the effects of commercially available medical magnets,
of varying size, on a convenient sample of 10 patients from the northwestern
Pennsylvania area having somatic pain for more than one month. The McGill Pain

Questionnaire was used at baseline, 24 hours, and 7 days after beginning magnetic

therapy. The Student t test revealed a statistically significant improvement after 24

hours, which continued at 1 week, as measured by the three parameters of the McGill
Pain Questionnaire that were addressed. To be considered significant the t value had
to be greater than 1.833. The three parameters were: The Number of Words Chosen
which had a net improvement of t = 3.1058 (p - 0.0009), the Present Pain Index
which had a net improvement of t = 6.5000 (p < 0.0001), and the Pain Rating Index

which had a net improvement oft = 5.3930 (p < 0.0001). Magnetic therapy continues

to be vigorously studied and shows promising results (Whitaker &Adderly, 1998).

Acknowledgements

I would like to take this opportunity to express my thanks and appreciation to
those who, through their contributions and support, made this thesis possible. I would
first like to thank my wife and children for their patience and understanding. I also

wish to express my gratitude to Dr. Robert Melzack for allowing the use of his

McGill Pain Questionnaire. Thanks to Dr. Janet Geisel, Dr. Judith Schilling, Dr. Alice
Conway, and Dr. Paul Kohut for their input and guidance. My sincere appreciation to

each and every participant of the study, and to Sandy Hearn for her invaluable
assistance.

iii

Table of Contents
Content

Page

Abstract

Acknowledgements

iii

List of Tables

vii

Chapter I: Introduction

Background of the Problem

Problem Statement

Theoretical Framework

Statement of Purpose

Definition of Terms

Assumptions

Limitations

Summary

Chapter II: Review of Literature

Pain Physiology
Pharmacologic Interventions

Magnetic Theories

Magnetic Studies

Pulsed Electromagnetic Fields

Static Magnetic Fields

Summary

Content

Page

Chapter III: Methodology

,25

Hypothesis

Operational Definitions

Setting, Sample, and Procedure

Informed Consent

Instrumentation

Data Analysis

Summary

Chapter IV: Results

Demographics

Number of Words Chosen (NWC)

Present Pain Index (PPI)

Pain Rating Index (PRI)

Summary,

33
34

Chapter V: Discussion
Sample,

NWC, PPI, PRI

Conclusions

Recommendations

Summary

Content

Page

References

Appendixes

A. Informed Consent

B. McGill Pain Questionnaire

,44

C. Permission to Use McGill Pain Questionnaire

List of Tables
Table

Page

1. Demographic Information

2. Number of Words Chosen

3. Present Pain Index

4. Pain Rating Index

vii

Chapter I
Introduction
This study is intended to help shed some light on the controversy over whether or

not to suggest magnetic therapy for patients not responding well to conventional
therapies. This chapter provides an overview of pain management involving the use of

magnetic therapy. It also discusses the physiology of pain, thereby laying the groundwork
for the more in-depth analysis of pain control by means of static magnetic fields. Also

addressed in this chapter is the theoretical framework guiding the study, the assumptions
and limitations of the study, and definitions of terms used.
Background of the Problem

“There is nothing in human experience more central than our capacity to feel, and
no aspect of this so crucial as our capacity to suffer, perhaps more particularly to suffer

from extremes of physical pain” (Petrie, 1967, p. 1). Throughout human history, the
experience of physical pain, albeit in varying degrees, has been ubiquitous (Petrie). Pain
is the experiencing of an unpleasant emotional or sensory stimulus arising from actual or
potential tissue damage (Thomas, 1997). In the United States each year 155 million

people experience a minimum of at least one episode of acute pain, one-third of which is

reported as severe, causing an estimated 700 million workdays to be lost, at a cost of $60
billion annually (Thomas). The experience of pain is modified, or amplified, by a number
of dynamic and ever-changing interactions of emotional, mental, biochemical,

physiological, social, psychological, cultural, and physical factors. Thus, pain
experienced at one time may be perceived as severe, and at another time perceived as

minimal, though all outward parameters appear equal or unchanged.

Pain is one of the most common reasons patients consult a physician, yet it is

often inadequately treated” (Fingerhood, 1999, p. 284). One reason that pain is not

adequately treated is an alleged obsession by healthcare providers with the possibility of
causing drug addiction, even though studies have reported that physical dependence on

something such as an opioid requires routine therapeutic dosing, four to six times a day,

for 6 weeks (Thomas, 1997). Fingerhood wrote that treatment of pain should be based on
the clinician’s findings and evaluation of the causative agent. This treatment should
include consideration of not only pharmacologic agents, but also nonpharmacologic

therapies, and should be prescribed, as appropriate.
There are many nonpharmacologic therapies for pain such as relaxation,
meditation, and imagery. One such nonpharmacologic therapy may be the use and

manipulation of magnetic fields. Scientists are still at a loss to define and quantify

magnetism, but do agree that it is one of the primary forces in the universe (Whitaker &

Adderly, 1998). Magnetic fields exist not only in magnets, both electromagnets and
permanent magnates, but also within biologic organisms including human beings
(Whitaker & Adderly). The existence of magnetic fields generated within the cells of our

bodies is evidenced by the use of a major diagnostic tool known as magnetic resonance
imaging (MRI) (Rosenfeld, 1996). The MRI machine interprets the magnetic fields

produced by the various tissues of our bodies to help guide diagnosis and treatment of
disease. Historically, natural magnetic rocks known as lodestone where used by ancient

cultures to treat everything from gout to baldness with varying degrees of success, much

of which was later attributed to the placebo effect. However, in recent years an increasing

number of studies have shown that there may, indeed, be some truth to the supposition

that magnets do exhibit healing properties (Whitaker & Adderly).

Problem Statement
Throughout history, ill or injured patients generally have tried to find ways of

alleviating their discomfort by whatever means they deemed reasonable including not
only allopathic treatment, but also treatments involving “alternative medicine.” Magnetic

therapy is not currently a widely accepted and taught treatment for the management of
pain, resulting in the potential for the patient to loose out on this form of possible pain
relief. Nurse practitioners have a responsibility to help educate, guide, and advocate those

treatments that may prove beneficial to the patient, while protecting patients from further
harm or exacerbation of illness. To this end, the nurse practitioner needs to have a good

working knowledge and understanding not only of standard medical management of
various ailments, but also of many alternative medical practices and treatments. This kind

of information is often not part of current nurse practitioner education on a regular basis.

Gaining such knowledge will help nurse practitioners to remain open minded to their
patients’ needs and desires to attain and maintain an optimal level of health and
functioning.
Theoretical Framework
The energy field theory of Myra Levine (1969), known as the Four Conservation

Principles, was selected as the theoretical framework for this study. This framework deals
with the patient as a whole, and addresses the inflammatory response specifically as a
subgroup in the conservation of patient energy principle. Levine’s theory directs the

nurse, or in this case the nurse practitioner, to assist the patient in conservation of energy

and integrity through therapy or support (Meleis, 1997). The Four Conservation

Principles are as follows:

1. The principle of the conservation of patient energy.
2. The principle of the conservation of structural integrity.
3. The principle of the conservation of personal integrity.
4. The principle of conservation of social integrity.

One of the major concepts of the principle of conservation of patient energy is the
organismic response, which is the individual’s ability to adapt to environmental changes,
both internal and external (Marriner, 1986). Part of this organismic response is the

inflammatory response that, if unchecked, can become a serious drain on an individual’s
energy reserves. The inflammatory response is a defense mechanism to remove or keep
out unwanted irritants or pathogens, and is a way of healing (Marriner, 1986). A goal of
the nurse is to assist the patient in management of the balance between maintaining

sufficient energy and processes, such as healing and aging, that drain energy (Levine,
1969). Conservation of structural integrity is another major concept in the theory, which

states that healing is restorative to structural integrity and that the nurse should attempt to
limit the amount of tissue involved in the disease process (Marriner, 1986). Respecting

the patient’s wishes, supporting his or her defenses, and providing education fall under
the principle of conservation of personal integrity (Marriner, 1986). Conservation of
social integrity is the fourth and final principal which states that life and health in general

are given meaning through the quality and quantity of social interactions with those
around us (Levine, 1969).

W hen the patient is experiencing pain, either long-term or short-term, an impact is
exerted on the four principles: (a) energy, (b) structural integrity, (c) personal integrity,

and (d) social integrity. The nurse practitioner, treating the patient as a whole, can exert
an effect on all four principles by assisting the patient with the management and control

of the pain. This can be accomplished by several means including prescription of
pharmacological agents, teaching of relaxation techniques, manipulation therapy, and the
use of alternative medicine techniques such as magnetic therapy, which was the focus of

this study. The nurse practitioner, therefore, is to draw on a knowledge base from the
sciences to create an atmosphere within the patient’s environment favorable for healing

and restoration of energy (Meleis, 1997).

Statement of Purpose

The study examined the results of magnetic therapy for the control and alleviation

of pain. The information obtained through this study may be used to help determine if
magnetic therapy should or should not be advocated by the nurse practitioner.
Definition of Terms
Several terms used in this study are defined in order to assure a proper frame of

reference, and to avoid misconception.
1. Pain refers to the experience of unpleasant stimuli of either acute or chronic
nature (Tortora & Anagnostakos, 1984).

2. Magnet is a physical object that exerts a constant or static magnetic field
(Whitaker & Adderly, 1998).

3. Electromagnet is a device that creates a magnetic field while electricity flows

through a coil of conducting wire (Whitaker & Adderly, 1998).

4. The nurse practitioner is a primary health care provider who provides health
care and education to patients with common acute and stable chronic disease conditions
(Sheehy & McCarthy, 1998).

5. A patient is a person who is seeking aid for the treatment of a health-related

problem.

6. Alternative medicine is the approach to medical diagnosis and therapy that has

not been developed by use of generally accepted scientific methods (Thomas, 1997).
7. Gauss is a unit of measure of magnetic force (Thomas, 1997).

Assumptions
This study was based on several assumptions:
1. Pain is whatever the patient says it is, and occurs whenever the patient says it

does (McCaffery, 1968).

2. Patients experiencing pain find the experience unpleasant and wish to alleviate
the pain.
3. Nurse practitioners are motivated to help patients address their medical needs,

and help the patient to conserve energy and promote physical, emotional, and social well

being.
4. Participants in the study were able to read and understand the survey tool.
5. Participants in the study answered questions honestly.
6. Study participants used the magnets as directed.

Limitations
There were several limitations inherent in this study:

1. The McGill Pain Questionnaire, utilized in the study, is not individualized to

the type and degree of pain experienced by each patient, but incorporates most common
pain descriptors.

2. The sample group was small, which may affect the generalizability of the
results.
3. The sample group \yas from a population located in northwestern Pennsylvania,

which may also affect the generalizability of the results to the greater populous.

4. Pain was assessed via subjective data collection.
5. No scientific definition of the substance of the magnetic field is available by
current science.

6. Magnetic therapy was individualized to each patient’s needs.
7. No placebo control group was used.

8. Participants had the foreknowledge that they would receive an active magnet.

Summary
This chapter has established the framework upon which this study of the effects of
magnetic therapy on pain control was based. It addressed the subject of pain, how it is

perceived, and the cost of pain in the United States. The Four Principles of Conservation

by Myra Levine (1969) was the theoretical framework for this study. Terms used in the
study have been defined, and assumptions and limitations acknowledged.

Chapter II

Review of Literature

This chapter reviews the body of knowledge relevant to the question: should

magnetic therapy be advocated by the nurse practitioner for the treatment of somatic
pain? This review of literature provides a brief description of the physiology of pain

and current pharmacologic interventions, and theories as to how magnetic fields alter

pain perception. Also presented is an overview of information obtained from studies
done in recent years concerning both static and electromagnetic fields for the

treatment of pain.
Pain Physiology

“Pain is whatever the experiencing person says it is, existing whenever he

says it does” (McCaffery, 1968). Since each person is different, the perception and
interpretation of pain is colored by pervious experiences in life. This gives rise to a

constellation of descriptions and beliefs regarding pain as it impacts on the
psychosocial and physical functioning of each person. The American Pain Society
(APS) defines pain in this maimer: “Pain is an unpleasant sensory and emotional
experience associated with actual or potential tissue damage, or described in terms of

such damage” (APS, 1992, p. 2). Although the emotional consequences of pain

should not be ignored by the nurse practitioner, for the sake of this study only the
physiologic aspects of pain were examined. Pain can be categorized into different
forms: (a) somatic or visceral (Tortora & Anagnostakos, 1984), and (b) acute or

chronic (Thomas, 1997). Somatic pain can arise from stimulation of receptors located

in the skin, fascia, tendons, skeletal muscles, and joints. Visceral pain arises from the
internal organs, or viscera. Acute pain is considered to be pain of sudden or slow

onset, of any intensity from mild to severe, with an anticipated or predictable duration
of less than 6 months. Chronic pain is defined as pain of sudden or slow onset, of any

intensity from mild to severe, constant or recurring without an anticipated or
piedictable end and a duration greater than 6 months. Pain is the brain’s interpretation

of neural impulses received from pain receptors, also known as nociceptors, which
are the branched ends of dendrites, found in nearly every tissue of the body (Tortora

& Anagnostakos, 1984). For pain to occur, a signal must go through four stages: a)
transduction, b) transmission, c) perception, and d) modulation (McCaffery & Pasero,
1999). Noxious stimuli, be they chemical, mechanical, or thermal, cause damage to

cells which in turn release substances at the point of contact such as histamine,
bradykinin, prostaglandins, serotonin, and substance P. In sufficient quantity, these

substances alter the permiability of the nociceptor’s cellular membrane to sodium
ions. The sudden influx of sodium ions temporarily changes the polarity of the inside

of the cell to a positive charge relative to the outside of the cell. This is called

depolarization. Potassium ions are then exchanged with the sodium, returning the cell
to its normal state, called repolarization. When depolarization and repolarization

occur with sufficient regularity, an action potential is created and the stimulus is

converted to an impulse. This occurrence is known as transduction, and transpires in a
matter of milliseconds. Transmission now takes place from the point of contact to the
dorsal horn of the spinal cord via nociceptor fibers. There are two types of nociceptor

fibers responsible for this first leg of transmission: C fib<ers and A delta (AS) fibers.
The AS fibers quickly transmit well localized, sharp pain signals across large

diameter neural fibers that have very little myelinization. The C fibers are smaller in
size, have no myelinization, and conduct dull, aching, poorly localized pain signals

more slowly than the AS. Both fibers are sensitive to mechanical and thermal stimuli,
but the C fibers are also sensitive to chemical stimuli. Once at the end of the

nociceptor tract of either C or Ab fibers, the pain impulse must be carried across the
synaptic gap to the dorsal horn by neurotransmitters such as substance P, adenosine

triphosphate, and glutamate. After being carried to the dorsal horn, the pain impulse
then travels up the ascending fibers within the spinothalamic tract, which terminates

in the brain stem and thalamic regions. The thalamus then directs the impulse to
central structures of the brain where the impulse is processed and becomes a

conscious experience and perception occurs. It is believed that many areas of the
brain are involved in this perception of pain. The reticular system is thought to be

responsible for the autonomic response to pain, the limbic system for the behavioral
and emotional response, and the somatosensory cortex for the localization and

characterization of the pain. Once pain is perceived, however, the final step of

modulation takes place. Modulation involves the descending pain pathways
originating at the brain stem and terminating in the dorsal horn of the spinal cord.

These descending fibers inhibit the transmission of the pain impulse and provide
some analgesia by releasing substances such as neurotensin, norepinephrine,

serotonin, y-aminobutyric acid, and endogenous opioids also known as enkephalins

and endorphins. These endogenous opioids are very effective but only for a short
time. They degrade very quickly leaving the pain impulse unencumbered to deliver its

message (McCaffery & Pasero, 1999).
Pharmacologic Interventions

The path that a pain impulse must travel from contact with a noxious stimulus

to the point of perception provides several targets of opportunity for intervention with
medications. At the point of contact with the noxious stimuli, damaged cells release

phospholipids which are broken down by phospholipase into arachidonic acid, which
is in turn broken down by cyclooxygenase into prostaglandins (McCaffery & Pasero,
1999). Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the action of

cyclooxygenase on arachidonic acid, thus preventing the formation of prostaglandins
(Copstead, 1995). However, the use of NSAIDs can also precipitate unwanted and

dangerous side effects. The predominant untoward result of NSAID therapy is the
induction of gastric and intestinal ulcerations due to the lack of prostaglandins being

produced in the digestive tract, which serve to protect the structures from damage

from the irritants present in them. These ulcers can result in blood loss leading to
anemia. Other side effects include increased bleeding time due to inhibition of

platelet aggregation; in patients with hepatic or renal disease or congestive heart
failure the rate of glomerular filtration and renel blood flow are decreased. Inhibition

of uterine motility and hypersensitivity reactions also pose a concern (Insel, 1996).
The use of corticosteroids is another means to inhibit the synthesis of prostaglandins.

Corticosteroids block the action of phospholipase (McCaffery & Pasero, 1999).

However, they are not without side effects also: immune suppression, need for the
body to be slowly weaned off of them, and the fact that excessive amounts can impair

muscle functioning (Schimmer & Parker, 1996).

Another target for the inhibition of the pain impulse is the synaptic gap

between the end of the nociceptor fibers and the dorsal horn of the spinal cord. It is at
this juncture that blocking the release of the neurotransmitters needed to bridge the

gap can propagate interruption of pain transmission. This is accomplished to a degree

during modulation by endogenous opioids, which quickly degrade, but to a greater
and longer lasting degree by exogenous opioids: morphine, Demerol®, and codeine,

for example. These medications bind with opioid receptors on the neural cell and
block the release of the neurotransmitters (McCaffery & Pasero, 1999). Though

effective, they are not without inherent risk. Many side effects are related to the use

of these medications including respiratory depression, nausea, vomiting, dizziness,
dysphoria, hypotension, mental clouding, pruritus, constipation, urinary retention, and
increased pressure within the biliary tract. Additionally, increased pain sensitivity

may occur after the medication wears off (Reisine & Pasternak, 1996).
Pharmacologic manipulation of the sodium ion channels has also proven to be
effective in some cases for slowing or blocking the pain transmission. Some

anticonvulsant medications are used for this purpose. The influx of sodium into the
cell is mediated, thereby limiting or stopping transduction (McCaffery & Pasero,
1999). These medications can have serious and even lethal cross-reactions with other

medications the patient may be taking. Other undesired effects may include cardiac

dysrhythmias, CNS depression, behavioral changes, gastrointestinal symptoms,

megaloblastic anemia, and hirsutism. These medications may also require careful
monitoring of their blood plasma levels (McNamara, 1996),
Magnetic Theories

Whitaker and Adderly (1998) highlighted several key theories regarding the
suspected action of magnets on biological tissues resulting in a decrease of pain.
Since magnets themselves are not fully understood, research continues. Several

theories have been proposed, with varying degrees of potential substantiation.
1. Ion-specific channel mediation suggests that sodium and calcium channels
are effected by magnetic fields. When the flow of these ions is altered, distortion of
cellular conductivity results. Therefore, the transmission of pain reception may be
greatly altered or impeded.

2. Pineal gland stimulation theory suggests that the magnetic fields may
directly effect the pineal gland. This effect would stimulate a cascade production of

melatonin, serotonin, and various other enzymes. Such changes in various chemical
levels could impact on the ability to sense pain.
3. Gate theory, widely used to explain why acupuncture is effective for pain

mediation, revolves around stimulation of the large pain fibers of the central nervous

system overriding the small pain fiber receptors. It is postulated that the magnetic
field stimulates the large pain fibers descending from the brain, effectively overriding
the transmission of pain perception carried by the small pain fibers (Melzack & Wall,

1965).

4. Vasodilatation theory suggests that blood flow is increased in the area

affected by the magnetic field via vasodilatation. The increased flow of blood then
carries away toxins, pathogens, and by-products of the inflammatory process.

Included in this theory may be one of the principles of physics called the Hall effect.
The Hall effect states that positively and negatively charged ions passing through a

magnetic field produce heat. Hence, the positively and negatively charged ions
contained in the blood produce heat within the blood vessel when passing through the
static magnetic field which causes dilation of surrounding capillaries, resulting in

increased flow of blood which brings nutrients and removes waste.

Magnetic Studies
The following studies reviewed the efficacy of magnetic fields for control of
pain. These studies have tested both pulsed electromagnetic fields, as well as the use

of static or permanent magnetic fields, with various types of somatic pain including

chronic neck pain, postpolio pain, and the pain of osteoarthritis.
Pulsed electromagnetic fields. Researchers Binder, Hazelman, Parr, and

Fitten-Jackson (1984) studied the effect of pulsed electromagnetic field therapy for

persistent rotator cuff tendinitis. The study participants consisted of 29 patients, in a
double-blinded controlled study, whose symptoms of rotator cuff tendinitis had been

refractory to steroid injection and other conventional conservative measures. During
the first 4 weeks of the study the experimental group of 15 patients received an oval
shaped coil of copper wire, attached to the shoulder with two Velcio® straps, and

supplied with electromagnetic pulsed generators. The control group of 14 pa

received similar coils but with inactive generators. Patients were instructed to use the

coils five to nine times a day for at least 1 hour at a time. At the end of 4 weeks the

experimental group had significantly (g = 0.02) less pain than the control group as
measured by physical mobility and subjective pain scoring. At this point the control
group then received active electromagnetic pulsed generators, and both groups were

studied for another 4 week period. At the end of the second 4 week period no further
improvement was seen in the initial experimental group, but the control group had

caught up to the experimental group in pain reduction. It was concluded, therefore,
that the primary impact of the magnetic fields was experienced within the first 4 week

timeframe. At 16 weeks post treatment, 66 % of the patients were symptomless.
Ultimately, more than 70 % of the patients studied improved to varying degrees with
pulsed electromagnetic field therapy as compared to their baseline. The researchers

offered no explanation as to why the patients improved, but concluded that the
improvement was a direct result of the magnetic therapy.
Research by Foley-Nolan, Barry, Coughlan, O’Connor, and Roden (1990),

studied the effects of pulsed high frequency (27MHz) electromagnetic therapy for

persistent neck pain. This was a double-blinded, placebo controlled study of 20
patients over 18 years old with neck pain for more than 8 weeks, and refractory to at
least one course of NS AID medication. The study used miniaturized diathermy
generators, incorporated into soft cervical collars, delivering short wave pulsed

magnetic fields at 450 cycles per second. Patients were randomly assigned functio

or nonfunctional units as they entered the study. The 6 week study was di

two 3 week cycles, and patients were assessed on

a weekly basis. At the end of the

first 3 week cycle the group with the active units reported a significant (p < 0.023)
decrease in pain, the median pain score dropping from 7 to 4 on the visual analogue
scale 1 to 10, with 10 being the worst pain. The inactive group reported only a median

change from 6.75 initially to 5.5 at the end of the first cycle. Range-of-motion of the

neck was also measured on a scale of 1 to 6, with 6 being full range-of-motion. The
active group median score rose from 3.6 initially to 4.1 at 3 weeks (p < 0.008), and to

4.8 at 6 weeks (p = 0.018). The inactive group median range-of-motion score changed

from the initial measure of 3.3 to 3.45 at 3 weeks (p = NS), but at 6 weeks had
increased to 4.6 (p < 0.008) after receiving active units for the second half of the

study. The pain experienced by the control group with inactive units also decreased in
the second 3 week cycle with active units, from 5.5 to 3.0 (p < 0.012). It was

speculated that the improvements in mobility and the reduction of pain were due to
anti-inflammatory and prohealing effects produced by the magnetic fields, with the

greatest benefit seen within the first 3 weeks of active unit use.
Trock, et al. (1993) presented a double-blinded trial of the clinical effects of

pulsed electromagnetic fields on the pain of osteoarthritis. The pilot study consisted

of 27 patients, 18 years of age or older, with complaints of arthritic symptoms for at
least 1 year, and refractory to anti-inflammatory medications, physical therapy, and
other analgesics. Twenty-one of the patients complained of knee pain, five patients

complained of joint pain of the hand, and one patient had ankle pain. Experimental
treatments consisted of extremely low frequency pulsed electromagnetic f

averaging 10 to 20 gauss, with a pulse phase of 67 milliseconds. Treatments were

given three to five times a week, for 30 minutes at a time, for a total of 18 treatments
extending over more than 1 month. Fifteen patients were randomized to the active

treatment group, and 12 patients were randomized to the placebo group. No
significant differences existed between the two groups at baseline. Six different

variables were addressed: overall severity of pain, difficulty score with most
troublesome activity of daily living (ADL), pain with most troublesome ADL, worst
discomfort in previous week, pain on joint motion by physician examination, and

joint tenderness by physician examination. The active treatment group improved
significantly in each variable (p = 0.0023, 0.0020, 0.0313, 0.0009, 0.0195, 0.0024,
respectively) by the end of the 1 month treatment period, as compared to the placebo

group. Assessments were done midway through the trial, at the conclusion of the
trial, and 1 month post treatment. By the midpoint of the study the actively treated
group averaged 34% improvement compared to 8% improvement in the placebo

group. At the end of the treatment period the active group had improved an average
of 36% and the placebo group only 10%. Interestingly, when both groups were

reassessed 1 month after the conclusion of the treatment phase the actively treated

group continued to improve to an average of 47%, and the placebo group only to an
average of 14%. During the study, two of the actively treated patients reported such a

degree of improvement that they no longer needed to take their pain medication.

None of the placebo group patients reported being able to stop their pain me
Furthermore, no evidence of toxicity was found secondary to the magnetic th

The researchers suggested that the possible mechanism involved was that of
mediation of ion-specific channels, but conceded that this explanation was

speculation.

With the statistically significant results of their pilot study (Track et al. 1993)
of pulsed electromagnetic therapy on osteoarthritis, researchers Track, Bollet, and

Markoll (1994) conducted a larger study of 167 patients with osteoarthritis of the
knee or cervical spine. Osteoarthritis of the knee was present in 86 of the patients and
the remaining 81 study patients had osteoarthritis of the cervical spine. Patients were

exposed to 30 minute treatments of pulsed electromagnetic fields, three to five times
per week, for a total of 18 treatments over a 1 month period. The two groups were

assessed separately, each with its own active treatment and placebo controlled groups.
For this study, patients were required to be at least 35 years old with localized

symptoms such as pain and stiffness that had persisted for a minimum of a 1 year
period. The patients were instructed not to change any part of their current
therapeutic regimen during the study. The actively treated groups averaged between

29% and 36% (p < 0.0001 to = 0.0009) improvement in all variables assessed,
whereas the placebo groups averaged only between 11% and 19% (p — 0.002 to - 0.3)

improvement. At the 1 month follow-up, the data again demonstrated a continued
improvement for both actively treated groups beyond what had been achieved at the

conclusion of the 18 treatments. The placebo groups showed little or no
improvement, and in some cases continued degeneration at their I month fol

The researchers felt that this continued improvement was very noteworthy, p

out that the effectiveness of NSAID medication stops when the patient discontinues
use of the medication, whereas improvement continued after the

use of magnetic

therapy.
Static Magnetic Fields. Like pulsed electromagnetic fields, static magnetic
fields are being used to treat somatic pain. Though much of the acclaim for static or

permanent magnetic therapy is anecdotal, there are a few studies regarding the
subject. One study involved the use of a magnetic bracelet worn about the wrist by
test subjects (Harper & Wright, 1977). This study consisted of 16 volunteers, without

physical ailment, involved in a double-blinded trial of the bracelet’s analgesic
properties. Each subject, acting as their own control, wore a bracelet for 5 minutes,
without knowing if it was active or placebo, prior to the test. Then each subject was

exposed to a radiant heat source five times, both with and without the bracelet. The
differences between pain thresholds of the groups were evaluated with a t test, and
revealed no significant alteration of pain tolerance. The researchers concluded that
there was no support for the claim of analgesic effect produced by the bracelet against

the discomfort induced by radiant heat.

Magnetic necklaces were investigated for their therapeutic effectiveness on
neck and shoulder pain (Hong et al., 1982). One hundred and one volunteers with a
mean age of 30 years, and a range from 18 to 62 years, were enrolled in the study. 46

male and 55 female. Forty-nine of the participants had no symptoms

of chronic neck

Pain, the remaining 52 participants had chronic neck and shoulder pain p

ePisodic for more than 1 year. None of the participants were receiving

of treatment for 6 months prior to, or during, the experimental study. The necklaces

used incorporated between 7 and 11 magnetic elements measuring 8mm long by

2.2mm in diameter. The magnetic field density at the surface of the elements was

1300 gauss, which rapidly decreased to 0 gauss when 9mm away from the element

surface. The nonmagnetic necklaces were visually indistinguishable from the active
units. Each participant, with or without pain, was randomly assigned an active or

placebo necklace. All participants were told that they were receiving treatment with a
magnetic necklace and were to wear the necklace in contact with the skin 24 hours a

day for a 3 week period. Excitation thresholds of the suprascapular nerve and
conduction times of the ulnar nerve were measured at baseline prior to donning the
necklace, and at weekly intervals. The analysis of variance of the excitation

thresholds showed no significant change between active and placebo treated groups.
However, ulnar nerve conduction time of the large pain fibers was significantly (no p

reported) reduced in the actively treated group without pain, but showed no change in
the groups with pain or placebo. Subjectively, 52% of the participants with pain,

treated with active magnetic necklaces reported improvement, and 44% of the pain
group with placebo necklaces also reported improvement (p < 0.001). The researchers

(Hong et al., 1982) suggested that some portion of the gate theory, as well as the Hall
effect, may have accounted for the changes in the ulnar nerve conduction to reduce
pain, but speculated that the magnetic field produced by the tiny elements were to
superficial and small. Furthermore, the subjective evaluation failed to she

on the effectivieness of magnetic necklaces.

y g

In the late 1990s, a double-blinded study on the response of pain to static
magnetic fields was conducted in postpolio patients (Vallbona, Hazlewood, & Jurida

1997). Fifty patients complaining of arthritic-like or muscular pain, with a diagnosis

of postpolio syndrome, were enlisted in the study. The patients met inclusion criteria
of being less than 140% of ideal body weight as predicted by age and height, had had
“significant” pain for the last 4 weeks, and had not ingested any form of pain

medication for 3 hours prior to the test. These patients were fitted with either static

magnetic devices, or placebo devices of exactly the same size and shape, in a double
blinded manner. The active devices ranged from 300 to 500 gauss at the surface, and
varied in size from a 90mm disc, to a credit card size, to a 175mm strip. Additionally,

the devices had concentrically arranged circles of alternating magnetic polarity. After

the appropriate sized device was attached to the area of greatest pain with adhesive

tape, the patients remained in the clinic, or its immediate location, for 45 minutes.
The McGill Pain Questionnaire (Melzack, 1975) was utilized before and after

treatment to provide a subjective evaluation of the device’s effect on the patient s

pain. The results showed a highly significant difference (p < 0.0001) between the
active group’s pre- and post- evaluations. Of the patients with active devices, 76/o

reported significantly decreased pain. In the placebo group, only 19 /o reported
improvement but to a much lesser degree than the active group. Upon review of their
results, the researchers felt that static magnetic fields were indeed an effecti

help treat postpolio pain, and that the effect may be dependent on the penetration of

the field. This penetration would be related to the intensity of the field

distance beneath the surface required to reach the fascial plane

causing the pain. They

concluded that:

The delivery of static magnetic fields through a magnetized device directly
applied to a pain trigger point or to a localized painful area results in

significant relief of pain within a short period of time ... and with no apparent
side effects. Based on the results of this study and reports in the literature of
the effect on people with arthritis, it appears that magnetic field energy may

be useful in the management of pain in individuals with other types of
impairments that are commonly treated in primary care settings (Vallbona et

al., pp. 1202 - 1203).
More recently, published in March of 2000, a pilot study by Collacott,

Zimmerman, White, and Rindone examined the use of static magnetic fields for their

effect on chronic low back pain. The study was designed as a randomized, double

blind, placebo-controlled, crossover pilot study and consisted of 19 men and one
woman with stable low back pain for a minimum of 6 months with a

years. On radiographic exam of the low back region prior to beginning th

patients were found to have spondylosis of the lumbar region. Comp

randomization was used to assign each participant to either an active magnetic unit or

a sham unit. The active magnetic unitwas in the shape of a trapez01d t0

back, with an average of 300 gauss at the surface that contacted the skin (rang ,
G to 330 G). The sham unit was of the same shape and material, b

demagnetized rendering it at 0 G. Each participant w

days per week. After 1 week with the unit, a 1 week period was maintained without

the use of any unit before changing to an opposite unit for the same time period; if the
first unit was magnetized then the second unit was sham, and visa versa. The McGill

Pain Questionnaire and a visual analog scale were utilized to measure pain before and
after treatment on the first day with each unit, and at the end of each week. Range of

motion (ROM) was also measured at these intervals. At the conclusion of the

treatment periods the overall change from baseline on the visual analog scale for the

sham portion was -0.40, and the magnetic portion changed -0.49 (p = 0.86). ROM
increased by 0.85° for the sham and 2.8° for the magnet (p = 0.66). The pain rating
index of the McGill Pain Questionnaire changed by -2.0 for the sham and -0.5 for the

magnet (p = 0.55). It was the conclusion of the researchers that the magnet provided
no statistically significant benefit over the sham unit.

Summary
Magnetic therapy for the control of somatic pain is increasingly becoming a

subject of study. This chapter reviewed the physiology of pain and summarized some

of the current medical treatments. Then a number of studies done in the last 2 decades
on magnetic therapy were discussed. These studies provided valuable insight into the

area of magnetic therapy: its positive results with pulsed electromagnetics as well as
with static magnetics. In light of increasing public interest in alternative medicine,

and the shortcomings of current allopathic treatment for many patients, magnetic
therapy presents an intriguing possibility without side effects either sho

term. In order to guide and educate patients about this mcieM rem(!<iy
knowledge is needed to indicate which methods are best

Chapter III
Methodology

The purpose of this study was to help determine if nurse practitioners should

advocate the use of magnets for the control of somatic pain. This chapter presents the

selection of the sample group, setting of the study, and the method of data collection.
Also discussed are the study’s hypothesis, operational definitions, and the means of
data analysis. Informed consent issues are also addressed.
Hypothesis

It was hypothesized that magnetic fields produced by permanent magnets
would decrease somatic pain in adults.

Operational Definitions
1. Somatic pain is that undesirable discomfort arising from stimulation of pain
receptors of the skin, fascia, tendons, skeletal muscles, and joints. Somatic pain may

also be interchangeably referred too simply as pain, and was be measured using the

McGill Pain Questionnaire (Melzack, 1975).
2. Magnet refers to a physical object that exerts a constant or static magnetic
field (Whitaker & Adderly, 1998).
3. PPI is the present pain index, which is the intensity of discomfort related to

a visual analog scale from 1/mild to 5/excruciating (Melzack, 1975).

4. PRI stands for the pain-rating index on the rank value of pain descriptors.
Words in each subgroup have a predetermined value and were summed to obtain a
total PRI score (Melzack, 1975).

5. NWC stands for the number of words chosen to describe the pain (Melzack,

1975).
Setting, Sample, and Procedure
The participants in this study were a small group of ten volunteers taken from

a population located in northwestern Pennsylvania. They were referred to a family
practice medical office, generally by word of mouth, while seeking resolution of
somatic pain that had not been otherwise sufficiently relieved by pharmacologic or
physical therapy interventions. The somatic pain had been present for longer than 1

month. A manufacturer’s representative instructed each participant on the use of a
magnet, in each participant’s home. The magnets used varied in strength from 450
gauss to 700 gauss. Each participant was individually assessed and an appropriate

magnet was selected by the manufacturer’s representative based on location and size
of the area of pain. The McGill Pain Questionnaire was administered by voluntary
completion of the survey and returned by mail at three points during the study: once

at baseline, again 24 to 48 hours after application of the magnet, and again 1 week

after initial magnet application. Each survey had a tracking code attached, but no

names were ever used. The participants were permitted to remove the magnet as

needed for such things as bathing and sleeping. Otherwise they were asked to keep
the magnet in place. Participants received a copy of the study results by mail if so

desired, by including a self-addressed stamped envelope with the submission of the
final survey.

Informed Consent

It was explained to each participant on an individual basis that they were
agreeing to be part of a prospective study on the effects of static magnets (Appendix
A). The information was not used for marketing purposes and they received no

remuneration for their voluntary contribution to the study. Furthermore, all
participants remained anonymous since no names were required on the survey.

Confidentiality was maintained. The completion and return of the surveys constituted

informed consent. Data is reported only in the aggregate.
Instrumentation

The survey instrument used in this study was the McGill Pain Questionnaire
(Appendix B). This questionnaire has been used in numerous studies regarding pain,

including at least two previous studies on magnetic therapy: Vallbona, Hazlewood, &

Jurida, (1997) and Collacott, Zimmerman, White, & Rindone (2000). The nature and

diversity of this survey lends itself to a wide variety of experimental as well as

practical uses. In constructing the questionnaire more than 300 patients, physicians,
and students were interviewed. The correlation between the measuring parameters

was very good (p < 0.05). Permission to use the McGill Pain Questionnaire (Melzack,
1975) was obtained from Dr. Ronald Melzack, of the McGill University in Montreal
Canada, first by telephone and then confirmed by faxed permission (Appendix C).
The McGill Pain Questionnaire has four sections in addition to a section

collecting biographical information. Part one gives an anatomical drawing of the
human body with anterior and posterior views for the participant to mark the location

of his or her pain. Part two asks what that particular participant’s pain feels like,
giving twenty groups of two to six descriptive words in each group. The participant is

to circle all that apply. Part three inquires as to how the pain changes over time asking
participants what relieves the pain, what exacerbates the pain, and to choose a pattern
descriptive of the pain over time. Part four introduces a visual analogue scale for

ranking intensity of pain as it relates to six different questions.
Data Analysis
Using the McGill Pain Questionnaire (Melzack, 1975), several forms of data

were retrieved and extrapolated. Each participant acted as his or her own control. The

PRI was determined by adding the rank values of the descriptors in the survey at each

measuring interval. The net change was calculated for statistical significance by
means of the t test for correlated groups with a = 0.05. The NWC was measured at
each interval, and again the net change was calculated. Any differences between PPI

scores at each interval were also assessed for significance by means of the t test.
Summary

The goal of this study was to establish whether or not nurse practitioners

should advocate the use of magnets for management of somatic pain. This chapter has

presented the McGill Pain Questionnaire as a data collecting tool. Participant

confidentiality and volunteer status were also discussed. Sample, setting, procedure,
and data analysis have also been described.

Chapter IV
Results

This chapter presents the results of a three survey series administered to
voluntary participants in the northwestern Pennsylvania area. Data is presented in the

form of tables as well as didactic. Statistical analysis is also presented to establish any
statistical significance in pain score changes between baseline and the experimental
conditions.

Demographics

A total of twelve individuals responded to the survey series. Two participants

were excluded from the study due to incomplete surveys. All participants had been
dealing with their individual pain for longer than 1 month and in many cases for

years. They also continued to use any medication regimen that may have been
prescribed for them by their healthcare provider. The majority of participants were
female. The ages of the participants ranged from 31 to 78 years and they had a variety

of somatic complaints (Table 1). The mean age was 48.9 years old with a standard

deviation of 17.2 years. None of the participants reported any untoward effects of the
magnetic therapy.

Number of Words Chosen (NWC)
The raw scores were compiled and the student t test was applied for the

statistical analysis. With a = 0.05, to be considered a statistically significant score,
the t obtained had to be greater than 1.833. The t score was computed for the changes
reflected at 24 hours, 1 week, and for any change between those two time frames.

A statistically significant improvement was reflected in the NWC at the 24 hour

mark, t = 2.5180 (p = 0.0059). The NWC at one week indicated continued
improvement t

3.1058 (p = 0.0009), which is an even more significant improvement

from baseline but not a significant change from the 24 hour mark t = 0.6446 (p =
0.2611). The scores are shown in Table 2, and it can be seen that not every participant
had the same level of improvement.

Table 1
Demographic Information (N

Gender

10)

Age

Somatic Complaint

Male

Osteoarthritis

Female

TMJ

Female

Sciatic pain

Female

TMJ

Female

Sciatic pain

Female

Low back pain

Female

Low leg pain

Female

Shoulder bursitis

Female

Arthritis

Female

Low back pain

Note. TMJ refers to the medical condition temporomandibular joint dysfunction.

Table 2

Number of Words Chosen (N = 10)

Base line

24 hours

10.6

mean-

6.4

One week

■mean

5.3

Present Pain Index (PPI)
The PPI is a measure of the participants' pain as it is at the time they are filling

out the each of the surveys. The index is an analogue scale from one to five with the
number one indicating mild pain, increasing to the number five, indicating

excruciating pain. Table 3 shows the compilation of the survey results. The results

indicated a very significant improvement at 24 hours, t

6.000 (p < 0.0001) with

continued improvement to one week, t = 6.500 (p < 0.0001). Like the NWC, the

greatest change in scores appeared at the 24 hour mark. The change from the 24 hour

mark to the one week mark was not statistically significant with t = 1.500 (p =
0.0668).

Table 3

Present Pain Index (N = 10)

Raw Scores

Mean

Baseline:

2.5

24 hours:

1.5

One week: 1

1.2

Pain Rating; Index (PRI)
The PRI contains the greatest number of variables with scores potentially ranging

from 0 to 78. In this study the scores ranged from 55 at baseline to 0 at one week of
treatment. At 24 hours, a significant improvement was indicated with t = j.7109 (p

0-0001). At one week the t

5.3930 (p < 0.0001) indicating continued improvement

and still a significant change over baseline. The change from the 24 hour mark to 1
week was t = 1.1605 (p = 0.1230), not indicating a statistically significant change.
Table 4 shows the raw scores gathered.

Table 4
Pain Rating Index (N = 10)

Raw Scores

Mean

Baseline:

49 20

26.3

24 hours:

13.9

One week:

10.5

Summary

This chapter has presented the results of a magnetic therapy regimen, compiled
from a three survey series completed by 10 participants in northwestern Pennsylvania.
The results were then subjected to statistical analysis via the Student t test to
determine if any statistically significant benefits occurred. The results of each subset

of data reflected similar levels of improvement which met criteria to be considered
statistically significant.

Chapter V

Discussion

This chapter provides a summary of the results of the three survey series

investigating the effectiveness of magnetic therapy for the management of somatic
pain. A sample of 10 participants with somatic pain volunteered to complete the three

survey series. The conclusions of this study are discussed in this chapter as well as
recommendations for individual healthcare providers and future researchers.

Sample
The sample size for this study was comparatively small. In statistical analysis,

a sample size of at least 30 participants is recommended to be able to apply the results
to the population at large. Also, with nine females and only one male responding, the

results cannot be assumed to reflect the potential outcomes for both genders.

NWC, PPL PRI
All three sections of the McGill Pain Questionnaire showed similar results.

The critical level for statistical significance was greatly exceeded in each section, and
continued to progress through the 1 week treatment period. Again, each section

showed the greatest benefit gains within the first 24 hours.
Conclusions
This researcher feels that the data obtained support several conclusions. The
first conclusion being that static magnetic therapy does, indeed, provide relief of
somatic discomfort. However, to what degree this is true was not fully revealed in the

data of this study. All participants knew that the magnets were being used in an

attempt to mitigate the pain they were experiencing. Therefore, the amount of

improvement due to psychological expectation on the part of the participant cannot be
separated from the physiologic response of the body’s pain mechanisms.
Secondly, placement of the magnet on the skin over the area of the greatest
pain appeared effective. All participants were able to successfully place the magnet

where it was needed most, as determined by the participants. Since this means of
placement was the only one used in this study, an effective comparison to other

methods, such as over acupuncture points, cannot be made.

Thirdly, magnetic therapy posed no harm to the participants of this study.
None of the participants reported any untoward effects from the magnetic therapy.
None of the individuals in this study were using any form of pacemaker, internal or

external. The potential benefits of magnetic therapy for individuals who do have
pacemakers has not been explored to the knowledge of this researcher, probably due

to the fact that magnets are used to turn off most pacemakers and could lead to some
unhealthy results.

Finally, the theoretical framework of the Four Conservation Principles by

Myra Levine (1969) chosen for this study, functioned well. Because the magnetic
therapy helped decrease the level of pain for the participants, the energy that was
being used by the body to deal with the pain could be focussed elsewhere. Many of
the participants expressed emotional relief with the reduction or abolition of their

pain, and were subsequently able to perform their activities of daily living at an

improved level. In so doing, their overall sense of wellbeing and productivity
improved in direct proportion.

Recommendations

Based upon the lesults of this study, this researcher does recommend the use
of magnetic therapy by practitioners for their patients in pain of somatic origin. This

does not exclude, however, the use of currently accepted pharmacologic and physical
therapies but may serve as an adjunct to these. In the case of individual patients

seeking alternatives to pharmacologic interventions, magnetic therapy may be a

viable option, and should be strongly considered.
This researcher whole-heartedly supports continued research in the field of

magnetic therapy. Until a definitive means to clinically measure pain of a physiologic
level is devised, the ‘human’ factor still weighs heavily on the interpretation of

current results. Some individuals will continue to minimize the degree of their pain,

while others will continue to amplify their perception of pain (Petrie, 1967). For now,
studies of the double blind design on much larger groups need to continue. Also to be

considered should be studies comparing magnetic therapy to conventional mild
pharmacologic interventions such as how ibuprofen, acetaminophen, and static

magnets compare for the pain relief of an ankle strain.
Summary
This chapter presented the summary of the study results. The conclusion that

magnetic therapy does have beneficial effects was based on the results obtained.
Continued investigation into this phenomena is strongly encouraged. These data

not lend support to any one theory concerning the mechanism behind the efficacious

results.

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Appendixes

Appendix A

Informed Consent

Dear Participant:

The information gathered by this study will help fulfill a requirement for my
master degree in nursing from Edinboro University of Pennsylvania, and is intended

to increase knowledge for those participating in the healing arts. This study will not
be used for marketing purposes and will in no way change your current medical

treatment. I would like to extend my sincere thanks for your willing participation in

this small prospective study on magnetic therapy, as well as my condolences for your

pain and suffering. Unfortunately, we are not able to provide remuneration for your
voluntary contribution to the study. All participants will remain strictly anonymous

and no names are required on the survey: please do not place your name anywhere on
the survey. Your information will be correlated by use of a tracking code with a

master copy of participants kept under lock and key by the manufacturer’s
representative and myself only. The completion of the surveys and return to the

researcher constitutes your consent to be a part of this study. You can receive a copy
of the study results, if so desired, by including a self-addressed stamped envelope
with the submission of the final survey. Again, thank you very much for your
participation. If you have any questions or comments you may contact me at 398-

4270, or Dr. J. Schilling at Edinboro University of Pennsylvania, Department of

Nursing 732-2900.
Sincerely,

Dan E. Briggs, RN, BSN, SFNP

Appendix B
McGill Pain Questionnaire
Tracking Code:
Age:

Date:
Gender: male / female

Medical Diagnosis:

Analgesic Medications ( such as anti-inflammatories or narcotics:

This questionnaire has been designed to tell us more about your pain. Four major
questions we ask are:
1. Where is your pain?

2. What does it feel like?
3. How does it change with time?

4. How strong is it?
It is important that you tell us how your pain feels now. Please follow the
instructions at the beginning of each part.

Part 1.

Where is your pain?

Please mark on the drawings below, the areas where you feel pain. Put E if external,
or I if internal, near the areas which you mark. Put El if both external and internal.

Part 2.

What does your pain feel like?

Some of the words below describe your present pain. Circle ONLY those

words that best describe it. Leave out any category that is not suitable. Use only a
single word in each appropriate category - the one that applies best.

1
Flickering
Quivering
Pulsing
Throbbing
Beating
Pounding

2
Jumping
Flashing
Shooting

3
Pricking
Boring
Drilling
Stabbing
Lancinating

4
Sharp
Cutting
Lacerating

5
Pinching
Pressing
Gnawing
Cramping
Crushing

6
Tugging
Pulling
Wrenching

7
Hot
Burning
Scalding
Searing

8
Tingling
Itchy
Smarting
Stinging

9
Dull
Sore
Hurting
Aching
Heavy

10
Tender
Taut
Rasping
Splitting

11
Tiring
Exhausting

12
Sickening
Suffocating

13
Fearful
Frightful
Terrifying

14
Punishing
Grueling
Cruel
Vicious
Killing

15
Wretched
Blinding

16
Annoying
Troublesome
Miserable
Intense
Unbearable

17
Spreading
Radiating
Penetrating
Piercing

18
Tight
Numb
Drawing
Squeezing
Tearing

19
Cool
Cold
Freezing

20
Nagging
Nauseating
Agonizing
Dreadful
Torturing

Part 3.

How does your pain change with time?

1. Which word or words would you use to describe the pattern of your pain?

Continuous

Rhythmic

Brief

Steady

Periodic

Momentary

Constant

Intermittent

Transient

2. What kind of things relieve your pain?

3. What kind of things increase your pain?

Part 4.

How strong is your pain?

People agree that the following 5 words represent pain of increasing intensity.

They are:
1
Mild

2
Discomforting

Distressing

4
Horrible

5
Excruciating

To answer each question below, write the number of the most appropriate
word in the space beside the question.

1. Which word describes your pain right now?

2. Which word describes it at its worst?
3. Which word describes it when it is least?

4. Which word describes the worst toothache you ever had?
5. Which word describes the worst headache you ever had?

6. Which word describes the worst stomach ache you ever had?

Appendix C
Permission to Use McGill Pain Questionnaire

Ha/.;- . fecsimile transmittal
To:

Dr. Ronald Melzack

Fax;

1 (514)398-4896

From:

Dan E. Brisks

Date:

1IZ30/99

Re:

McGill Pain Qucstionaire

Pages:

CC:
□ Urgant

□ FerRgvrew

□ Please Comment

'—Vr’feaso R*pry

□ Please Recycle

Dear Dr. Melzack:

Hello. Pursuant to our telephone conversation. I am faxing you the request for
permission to use your McGill Pain Questionnaire to interview patients involved in

my thesis study. I am doing my masters thesis for Nurse Practitioner on the

subject of magnetic therapy for the control of somatic pain and learned of your
questionnaire white doing my literature search. I am very impressed with the

questionnaire, and would very much like to use it If you have any questions or

reservations ptease contact me at the above address or phone. Thank you for
your time and consideration, and I wish you a joyful holiday season.

Please return fax your permission to me at (814) 868^396. Th;

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you.