UNIMAG device in the complex balneological treatment of the lower back pains
Belohrad study

Introduction
Pulsed magnetic fields have been used in Czechoslovakia for therapy of various diseases since 1980. The original device constructed by J. Jerabek was provided with one applicator only (type JLM-1). In 1980 Jerabek published the first experience with his device in various diseases of locomotor apparatus. The paper dealt with arthroses of load bearing joints and vertebral algic syndromes based on degenerative changes in spinal column. Analgesic action of the pulsed magnetic field (PMF) therapy was reached in about 80% of the cases. These results were confirmed by J. Kocian (1985) in his double blind study where marked analgesic action was proved in coxarthroses. Objective evaluation of mobility in affected joints was on the margin of statistical significance.
D. Valentova (1985) and E. Thurzova et al. (1984) showed good results of magnetotherapy in treatment of vertebral algic syndromes. It seems that better results can be expected in disorders of L-spine where by objective measurement of motility marked improvement has been found simultaneously with ceasing of paravertebral spasms. No intolerance with other therapeutical processes was observed and simplicity, safety and effectivity of PMF therapy was stressed out. J. Kovarovicova (1990) described a good effect of combination of peloid packs with PMF therapy in vertebral algic syndromes where marked improvements were reached in spinal movability, Lasegue manoeuvre and Thomayer distance. Marked subjective improvements were pointed out again. A. Gavlas (1989) and J. Jezek et al. (1990) proved substantial improvement if magnetotherapy was incorporated into the complex balneotherapy in patients suffering from arthroses of load-bearing joints. Not only subjective improvement compared with commonly used procedures but also substantial reduction of analgesic drugs and NSAID administration was reported as well as reduction of joint swelling, acceleration of walking for tested distance, etc. The most important is the fact, that duration of pain relief was twice as long when compared with common balneotherapy without simultaneous application of PMF therapy.
J. Jerabek (1985) and V. Hlavaty (1990) published works about PMF efficacy in patient with ankylosing spondylitis. Except of spinal movability improvement (v.s. based on analgesic action) it was possible to cease administration or to reduce doses of analgesic drugs and NSAIDs. According to J. Jerabek in some cases duration of pain relief was surprisingly long - several years.

Exposure conditions:
UNIMAG device was used for the treatment of vertebral algic syndromes localized in lumbar part of spine as a part of complex balneological care. The term "complex balneological care" means three weeks lasted intensive rehabilitation care using water procedures (baths, underwater massages, peloid applications), special individual and group exercising, massages.
Patients were divided into two groups - placebo and exposed. For the treatment of the placebo group the patients were treated by the non-active applicator of the device. The exposed group was treated by the PMF generated from the active applicator. The applicator used was the so called "blanket", i.e. the applicator with several coils in a textile cover. The blanket was applied along the spine. Program Nr.2 was used in four cases, for treatment of the rest of the patients program Nr.1 was used. Each exposure lasted 30 minutes. Patients absolved 10 exposures in 10 days. No other electrotherapeutical procedures were applied.
As exclusion criteria known and accepted counter - indications were taken, i.e.
a) Absolute - pregnancy, pace-maker, hyperthyreoidism, suprarenal glands dysfunction, myasthenia gravis, conditions connected with bleeding (mainly bleeding into the GIT), hypothalamic and hypophyseal dysfunctions, active tuberculosis, acute viral diseases, malignancies (even in anamnesis), psychoses.
b) Relative - neurological diseases with seizures (with regard to applicator localization), severe mycotic diseases, severe atherosclerosis, menstruation if small pelvis is exposed.
c) Special attention was paid to patients with hypotension or inclination to it as well as to patients with hypertension.

Patients
Placebo group: 17 women and 8 men at the age range from 36 to 77 years, mean age 54.04 + 10.51 years, spondylosis and/or osteochondritis, troubles duration 36.58 + 32.47 months.
Exposed group: 15 women and 4 men at the age range 36 to 72 years, mean age 52.47 + 10.76 years, spondylosis and/or osteochondritis, troubles duration 37.23 + 34.56.
Statistical evaluation shows no difference between the groups with regard to both age and sex.
Duration of troubles was in all the cases several years, without significant difference between the groups again.
All the patients suffered from spinal degenerative processes localized chiefly in lumbar region.

Evaluation
A special questionnaire was used for both the subjective and objective evaluation. It is obvious that in subjective criteria 4 questions were put. The first 3 ones for description of troubles, the last one for general evaluation. In other words, the first question was "WHEN DO YOU HAVE PAINS?", the second question was "WHERE?", the third question "HOW?" and finally "HOW DO YOU LIKE IT?" The objective criteria include analgesic drugs consumption and describe spinal motility. Statistical analysis was performed using Epi-Info program, version 5.0 (WHO). As data were never distributed parametrically, p values from the non-parametrical tests were taken into account only. As a probability value p=0.05 was chosen. If calculated p was less then 0.05 then results were accepted as statistically significant.

Results
In the table 1 you can clearly see that magnetotherapy has had better score in improvement than the placebo group.
In the table 2 you can see more markedly pronounced improvement regarding differences in subjective criteria, i.e differences in score before - after the treatment.
In the table 3 criterion any improvement is evaluated. Here again, you can see that magnetotherapy has better result than the placebo group.

Analyzing objective criteria, no significant differences were found between placebo and the control group. However, strong tendency in favour of magnetotherapy was obvious. Data not shown.

Conclusion
From the results obtained it may be concluded:

1. Magnetotherapy performed with the UNIMAG device is a suitable additional therapeutic procedure in the complex spa treatment, mainly for its pain - killing effect.
   
2. No adverse effects were observed during the followed period.
   
3. As a small number of patients was treated, it is impossible to decide if program Nr. 1 or Nr. 2 is better.