High-Intensity Peripheral Magnetic Stimulation for Musculoskeletal Pain

Abstract

Background: High-intensity peripheral magnetic stimulation (PMS), delivered as repetitive peripheral magnetic stimulation (rPMS) or functional magnetic stimulation (FMS), is increasingly used in rehabilitation, but interpretation is limited by unstable terminology, heterogeneous protocols, and frequent conflation with low-intensity electromagnetic field therapies. Scope: This narrative review synthesizes peer-reviewed orthopedic, rehabilitation, pain, and translational literature on high-intensity PMS for musculoskeletal pain, including randomized trials, meta-analyses, mechanistic studies, feasibility studies, and adjacent evidence. Low-intensity exposure studies, non-musculoskeletal applications, commercial booklets, and non-indexed reports are discussed only to clarify scope, safety, or evidentiary boundaries. Findings: The evidence base comprises several meta-analyses and a set of controlled, mechanistic, pilot, and feasibility studies. In low back pain, pooled estimates suggest short-term pain reduction (SMD -1.16, 95% CI -1.56 to -0.76; very-low GRADE certainty; VAS MD -1.89, 95% CI -3.32 to -0.47; very-low-to-low GRADE certainty) and disability gains (ODI MD -6.55 to -8.39; very-low-to-low GRADE certainty), with partial primary-trial overlap between pooled syntheses. Myofascial trials show short-term analgesic signals at low certainty. Mechanistic studies using fNIRS and TMS suggest cortical reweighting beyond peripheral afferent recruitment and segmental modulation at very-low certainty. Pilot evidence in radicular pain and knee osteoarthritis is promising but not definitive, especially when PMS is tested as an adjunct rather than standalone therapy. Conclusion: High-intensity PMS is a biologically plausible, noninvasive adjunct for selected musculoskeletal pain presentations when paired with rehabilitation that converts transient analgesia into movement and function. Its clinical role depends on adequately powered sham-controlled trials with standardized dose reporting, validated outcomes, durable follow-up, and embedded mechanistic endpoints