In the USA, the annual prevalence of low back pain in the adult population is 10–30%, and the lifetime prevalence of this condition is 65–80%. Treating chronic low back pain may include multidisciplinary and multimodal medical, psychological, physical, and interventional approaches. Treatment options include pharmacological, psychological, physical, and rehabilitation treatments, complementary and alternative medicine approaches, and minimally invasive percutaneous approaches [20]. In the current study, we aimed to compare the efficacy of PEMFT added to conventional physical therapy by forming intervention and control groups.

In this study, the control and PEMFT groups were similar in age, sex, body mass index, and comorbidities. The pretreatment VAS and QBPDS scores of the two groups were also similar. There are many studies in which physical therapy agents have been used in low back pain. Kim et al. [21] applied six sessions of ultrasound, TENS, interference flow, and hot pack therapy to patients with low back pain. They observed a significant decrease in the VAS, Functional Rating Index, and McGill Pain Questionnaire scores at the end of treatment compared to the pretreatment evaluation. In another study, patients with chronic low back pain underwent conventional physical therapy consisting of 20-minute TENS and hot pack therapy, followed by five-minute therapeutic ultrasound therapy, and their pretreatment Oswestry Disability Index (ODI) and VAS scores ​​were reported to significantly decrease one week and 12 weeks after treatment [22]. Similarly, in this study, the post-treatment VAS and QBPDS scores of the control group receiving conventional physical therapy were found to be statistically significantly lower than the pretreatment scores, but there was no significant difference between the third-week and twelfth-week scores. These results suggest that a conventional physical therapy regimen consisting of TENS, infrared, and ultrasound can be an effective option in the management of chronic low back pain.

In a prospective randomized controlled study comparing the effects of conventional non-invasive treatment modalities, Elshiwi et al. [23] included 50 patients with chronic nonspecific low back pain to investigate the efficacy of 50 Hz, 20 Gauss low-intensity PEMFT. The authors applied 15 min of TENS, five minutes of pulse ultrasound, and an exercise program in each session as conventional physical therapy. The first group (n = 25) received conventional physical therapy and PEMFT (20 min per session), and the second group (n = 25) received conventional physical therapy and a placebo PEMFT for a total of 12 sessions. The addition of PEMFT to conventional physical therapy resulted in superior clinical improvement in pain, functional disability, and lumbar joint range of motion in patients with nonspecific low back pain. Another randomized, double-blinded, placebo-controlled pilot study presented the results of 25 patients who were divided into the groups of usual care, PEMFT and usual care, and sham PEMFT. Significant improvements were reported in the ODI scores of the PEMFT group compared to the sham group from the baseline to the sixth week, which continued through the 12th -week follow-up [24]. In a study by Teresa et al. [25], low-energy PEMFT was found to improve neuropathic pain and functional status in chronic low back pain with a neuropathic component, compared to the control group. In a systematic review and meta-analysis of 14 studies, PEMFT significantly reduced low back pain compared to a placebo and other treatments. However, despite a significant reduction in chronic low back pain, this treatment was found to be ineffective in relieving acute pain [26]. In another study evaluating 51 patients with chronic low back pain in three groups, namely pulsed high-intensity laser (HILT), PEMFT, and control, Abdelbasset et al. [27] found significant differences in the PEMFT group in terms of the VAS, modified ODI, and pain disability index scores, as well as the range of motion at flexion. However, according to the inter-group comparison, the results of the HILT group were significantly better than those of the PEMFT group. Another study evaluated the PEMFT + therapeutic exercise and sham PEMFT + therapeutic exercise groups in chronic low back pain patients. The intervention group showed faster improvement in both pain and disability than the control group. There was a significant reduction in pain and disability scores at the end of the third week in the intervention group and at the end of the sixth week in the control group. In both groups, the improvements continued to be observed at the sixth, ninth, and thirteenth weeks, and the results of the two groups were similar at these weeks. The authors concluded that PEMFT reduced pain and disability in chronic low back pain, but it was not superior to other treatments [28].

In the current study, the post-treatment VAS and QBPDS scores of the PEMFT group were statistically significantly lower than the pretreatment measurements. However, there was no significant change in either score from the 3rd to the 12th week. When compared between the groups in the 3rd and the 12th week, the VAS and QBPDS scores were statistically significantly lower in the PEMFT group. Both groups benefited from the treatments, but the PEMFT group showed more significant improvements. The current results suggest that adding PEMFT treatment to the conventional physical therapy regimen yields favorable outcomes regarding pain and disability scores. Therefore, PEMFT can be regarded as an effective option for managing chronic low back pain in appropriate individuals.

This article has some limitations. First, the sample size is limited. Follow-up time is restricted, and long-term outcomes cannot be addressed. There is a risk of bias due to retrospective design. The data are based on self-reported scales; no performance measurements or range of motion assessments were undertaken. The article lacks scales measuring the quality of life, depression, or anxiety. The study was not planned with a randomized and prospective design. Subgroups of chronic low back pain were not evaluated. All patients were analyzed in the same pool. The neuropathic pain component was not assessed.