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Original Article
Impact of electromagnetic field exposure on pain, severity, functional
status and depression in patients with primary fibromyalgia syndrome
Abeer El Zohiery
a
, Yasser El Miedany
b
, Tarek Elserry
c
, Ossama El Shazly
d
, Salwa Galal
a,
⇑
a
Rheumatology and Rehabilitation Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
b
King’s College, London, United Kingdom
c
Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
d
Orthopedic Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
article info
Article history:
Received 11 October 2020
Accepted 12 October 2020
Available online xxxx
Keywords:
Fibromyalgia syndrome
Electromagnetic field
Hypersensitivity
Functional status
Depression
abstract
Introduction: Fibromyalgia syndrome (FMS) is a chronic condition characterized by generalized body
pain, and mood disturbances of unknown etiology. Electromagnetic hypersensitivity (EHS), where
patients report ‘‘hypersensitivity” to electro-magnetic fields (EMF). They wonder whether aches and
pains, headaches, depression, sleeping disorders, could be associated with EMF exposure.
Aim of the work: Is to investigate if fibromyalgia symptoms and scores are affected by the exposure to
EMF.
Patients and methods: This study included 80 FMS patients. The numerical pain rating scale (NPRS),
Montgomery-Asberg Depression Rating Scale (MADRS) and the revised fibromyalgia impact question-
naire (FIQR) were used. A patient self-reporting questionnaire invented by the authors in Arabic for
the frequency and intensity of EMF exposure was validated and used.
Results: The mean age of the patients was 38.7 ± 11 years and mean disease duration 4.5 ± 2.4 years. The
male to female ratio was 1:2.8. A near-by cellular phone or electric tower did not significantly affect dis-
ease scores (p > 0.05), Microwave users appeared to have higher wide spread pain index (WPI) and sys-
tem severity (SS) scores than non-users, but the difference was not statistically significant (p = 0.08 and
0.06) respectively. FMS scores significantly increased with higher TV watching duration, while MADRS
score significantly decreased with higher cellular phone use indices. MADRS depression score was
increased with shorter distance from electric tower, though not statistically significant (p = 0.76)
Conclusion: This study highlights a possible pathological link between fibromyalgia and exposure to elec-
tromagnetic radiation. Excess exposure to electromagnetic devices could be one of the underlying or at
least augmenting factors of fibromyalgia symptoms.
Ó2020 Egyptian Society of Rheumatic Diseases. Publishing services provided by Elsevier B.V. This is an
open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction
Fibromyalgia syndrome (FMS) is a chronic condition character-
ized by generalized body pain, and mood disturbances of unknown
etiology. Potential contributing factors include genetic, neurologic,
psychologic, sleep and immunologic factors. Despite our increased
understanding of the condition, there are no objective diagnos-
tic tests and diagnosis is often made by exclusion. This lack of a
single unifying pathophysiology elucidates the puzzling manage-
ment approach. FMS patients usually complain of fatigue, sleep
disturbance, impaired cognition, hypersensitivity to multiple
household chemicals, hormonal and nervous system imbalances,
‘‘mind fog”, multiple allergies and anxiety [1]. On the other hand,
some people attribute those same non-specific physical symptoms
such as headache, body aches and fatigue to exposure to radiofre-
quency electromagnetic fields (RF-EMF) emitted from wireless
devices such as cellular phone, electric towers, microwave ovens,
radio and television transmitters [2].
Electromagnetic hypersensitivity (EHS) is a new syndrome,
where the exposure to electric or magnetic fields are accused to
the patients’ aches and pains, headaches, depression, lethargy,
sleeping disorders, and even convulsions and epileptic seizures [3]
Recently, a high prevalence of musculoskeletal pain/syndromes,
like juvenile FMS, benign joint hypermobility syndrome, myofas-
cial syndrome, tendinitis, bursitis, epicondylitis, and complex
https://doi.org/10.1016/j.ejr.2020.10.001
1110-1164/Ó2020 Egyptian Society of Rheumatic Diseases. Publishing services provided by Elsevier B.V.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Peer review under responsibility of Egyptian Society of Rheumatic Diseases.
⇑
Corresponding author at: Faculty of Medicine, Ain Shams University, Ramsis
Street, Abbassia Square, Cairo, Egypt.
E-mail address: salwagalal@med.asu.edu.eg (S. Galal).
The Egyptian Rheumatologist xxx (xxxx) xxx
Contents lists available at ScienceDirect
The Egyptian Rheumatologist
journal homepage: www.elsevier.com/locate/ejr
Please cite this article as: A. El Zohiery, Y. El Miedany, T. Elserry et al., Impact of electromagnetic field exposure on pain, severity, functional status and
depression in patients with primary fibromyalgia syndrome, The Egyptian Rheumatologist, https://doi.org/10.1016/j.ejr.2020.10.001
regional pain syndrome, was observed in female adolescents who
used at least two electronic devices [4]. There is little scientific evi-
dence to support the idea of EHS and no definite accepted biolog-
ical mechanism to explain the hypersensitivity theory. Research on
this issue is difficult because of the subjective element, apart from
direct effects of fields themselves. So, more studies are needed to
prove any relation [5].
Since it was recently documented that FMS patients had worst
quality of life among rheumatic diseases [6], thus the question now
arises whether the symptoms of FMS are lately aggravated by the
surrounding EMFs, or not? In either case, EMFs put a huge stress
on the immune system, which is probably already compromised.
The aim of our work is to investigate if fibromyalgia symptoms
and scores are influenced by the exposure to electromagnetic
devices.
2. Patients and methods
This study primarily included 84 patients who fulfilled the cri-
teria of FMS, diagnosed according to the American College of
Rheumatology (ACR) 2010 criteria [7]. After providing the ques-
tionnaire, 4 drop outs were encountered due to improvement
and lack of interest, so only 80 patients finally completed the study
questionnaire. The patients were recruited from the outpatient
clinics of the Rheumatology, Orthopedics and Neurosurgery
Departments. Patients were excluded if they had any chronic pain-
ful condition, neurological disorder, rheumatic or autoimmune dis-
ease, trauma or previous fractures, or malignancies. Those
receiving antidepressants, steroids or lipid lowering agents were
also excluded. Local ethical and methodological protocols for
approval of the study were followed. All patients who participated
in the study signed an informed consent in accordance to the 2008
Declaration of Helsinki.
Assessment and exclusion were based on clinical, radiologic and
laboratory findings. The pain intensity was assessed using a
numerical pain rating scale (NPRS) (0 = no pain, 10 = severe pain)
[8]. Depression was assessed using Montgomery-Asberg Depres-
sion Rating Scale (MADRS) [9] and categorized as normal (0–10),
mild (11–30), moderate (31–45) and severe (46–60). The func-
tional status was assessed using the revised Fibromyalgia impact
questionnaire (FIQR) and all questions were graded on a 0–10
numeric scale [10]. In addition to the wide spread pain index
(WPI) and system severity (SS) score included in the 2010 diagnos-
tic criteria [7]. Such scores are not applicable if a healthy control
group was included.
Electromagnetic field (EMF) exposure: All patients answered a
self-reporting questionnaire (Appendix) to assess the frequency
and intensity of EMF exposure. This questionnaire was created by
authors, closed type, translated to Arabic language for easy com-
munication with patients, and we provided help to those with
low education. It included the use or exposure to cellular phones,
lap tops, televisions, electric power towers, cellular phones power
towers and microwave usage. A pilot test on few patients was per-
formed in order to validate it after revision. The distance from the
device and duration of exposure were also well thought-out by
asking if the patients lived nearby an electric tower, and if answer
was yes, they should mention how far in kilometers
approximately.
A device use index was calculated for each device by multiply-
ing the rate of its use per day by 365 by the total number of years of
use, this index was created by the statistician according to the sim-
ple smoking index calculation that considered the number of cigar-
ettes smoked per day multiplied by the total duration of smoking
in days or years [11].
Statistical analysis: Tests were performed using the statistical
package for the social sciences (SPSS; version 22). Data were pre-
sented as number and percentages, mean and standard deviation
with 95% confidence interval or median and interquartile range.
Pearson Chi square or Student t-test were used to compare 2 groups
and ANOVA if more than 2 groups. Spearman correlation coefficient
was considered. P value was considered significant if <0.05.
3. Results
Finally, 80 patients fulfilling the criteria of FMS were enrolled
and finished this study. The mean age of the patients was 38.7 ± 1
1 years and mean disease duration 4.5 ± 2.4 years. The male to
female ratio was 1:2.8. On classifying the patients according to
the age groups, 17 were < 30 years, 53 were in the age category
30–49 years while 10 were 50 years. As for the occupation, 27
(33.8%) were housewives, 5 (6.25%) had office-based jobs, 16
(20%) were medical staff, 3 (3.75%) had high profile physical
effort-based jobs and 29 (36.25%) were manual workers. As regards
residency, 58.8% of the patients were living in urban areas and
41.2% hosted rural zones. Descriptive clinical data and scores are
shown in Table 1.
Presence of a near-by cellular phone or electric tower did not
significantly affect the assessed disease parameters (Table 2).
Scores were comparable as regards computer use while WPI and
SS tended to be higher in those using the microwave (Table 3).
The SS score significantly correlated with TV watching duration
while MADRS score was inversely related to cellular phone use
index (Table 4). The MADRS score tended to inversely correlate
with the distance from the electric tower (Table 5). Only the cellu-
lar phone use index significantly correlated with the NPRS in those
<30 years (r = 0.6, p = 0.01) and inversely with the MADRS in those
30–49 years old (r = -0.38, p = 0.005).
4. Discussion
Fibromyalgia syndrome is a diffuse, chronic pain syndrome as-
sociated with tender body areas and somatic complaints [12].
The prevalence of FMS is remarkably high; it affects 2–5% of the
general population, mainly women, the men to women ratio being
1–9; those mostly affected were in their forties, although cases
among teenagers are increasing [13]. Electromagnetic triggers for
the symptoms reported by sufferers are: cellular phones, phone
base stations, power lines, fluorescent lighting and household
Table 1
Electromagnetic field exposure, devices used and assessed scores in primary
fibromyalgia syndrome patients.
Variable n (%) or mean ± SD (95%CI) Primary FMS patients (n = 80)
Near to a cellular phone tower 30 (37.5)
Near to an electricity tower 9 (11.3)
Uses a computer 41 (51.2)
Uses a microwave 29 (36.3)
Uses a cellular phone 80 (100)
Scores
WPI 9.9 ± 2.9 (9.2–10.5)
SS 7.4 ± 2.1 (6.9–7.9)
NPRS 7.6 ± 1.5 (7.21–7.9)
FIQR 75.2 ± 13.8 (72.1–78.3)
MADRS 41.0 ± 10.8 (38.6–43.4)
mild 17 (21.3)
moderate 35 (43.8)
severe 28 (35.0)
FMS: fibromyalgia syndrome, WPI: wide spread pain index; SS: system severity;
NPRS: numerical pain rating scale, FIQR: revised fibromyalgia impact question-
naire; MADRS: Montgomery-Asberg depression rating scale.
A. El Zohiery, Y. El Miedany, T. Elserry et al. The Egyptian Rheumatologist xxx (xxxx) xxx
2
items such as televisions and microwave. Notably, not all sufferers
reported being sensitive to all potential triggers and many reported
only 1 or 2 items as being problematic. The EMFs emitted by these
devices vary considerably regarding frequencies in the radio,
microwave, kilohertz, and extremely low-frequency ranges [14].
Electrosensitivity is now recognized that individuals may suffer
nausea, headaches, and muscle pains when exposed to EMFs from
cellular phones, electricity pylons, and computer screens [15].
Worth mentioning, a concomitant significant increase in the preva-
lence of FMS has been reported world-wide from 2005 to 2017
[16–29]. Hence this work aimed to study a possible link.
To our knowledge, this is the first study to investigate the
impact of EMF exposure on FMS symptoms and scores. A weak
association between exposure to EMF and non-specific physical
symptoms scores are reported in some, but not all of the electro-
hypersensitive persons [2]. On the other hand, Hallberg and Ober-
feld stated that FMS has symptoms similar to those exhibited by
people suffering from electro-sensitivity [3]. In this work, it was
found that microwave users tended to have a have higher SS score
and WPI than non-users. The brain is the most sensitive target
organ for microwave radiation. Mitochondrial injury occurs earlier
and more severely than in other organs, subsequently disturbance
of brain energy metabolism occurs. The biological effects of micro-
wave radiation are widespread involving varieties of signaling
pathways [30]. Consequently, such impact on painsignaling path-
way that leads to abnormal perception of sensation which subse-
quently lowers the pain threshold. Furthermore, this work
revealed an association between TV watching duration and SS
score. Spending long hours in front of TV screens affect negatively
sleeping habits, which in turn is usually associated with increased
waking-time tiredness [31]. A study proved that television inter-
Table 2
Effects of cellular phones and electric towers on fibromyalgia syndrome patients’ scores.
Score
mean ± SD
Primary FMS patients (n = 80) near-by to
Cellular phone tower pElectric tower p
no
(n = 50)
yes
(n = 30)
no
(n = 71)
yes
(n = 9)
WPI 10.2 ± 3.1 9.2 ± 2.6 0.14 10 ± 3 8.8 ± 1.6 0.24
SS 7.4 ± 2.1 7.5 ± 2.1 0.81 7.3 ± 2.1 8.3 ± 2.1 0.17
NPRS 7.6 ± 1.5 7.4 ± 1.6 0.51 7.6 ± 1.5 7.1 ± 1.7 0.44
FIQR 76.8 ± 13.4 72.6 ± 14.5 0.18 75.8 ± 14.1 70.7 ± 11.7 0.3
MADRS 42.2 ± 10.6 39.1 ± 11.1 0.22 41.3 ± 10.5 38.9 ± 13.9 0.54
FMS: fibromyalgia syndrome, WPI: wide spread pain index; SS: system severity; NPRS: numerical pain rating scale, FIQR: revised fibromyalgia impact questionnaire; MADRS:
Montgomery-Asberg depression rating scale.
Table 3
Effects of computer and microwave use on fibromyalgia syndrome patients’ scores.
Score
mean ± SD
Primary FMS patients (n = 80) using
Computer pMicrowave p
no
(n = 39)
yes
(n = 41)
no
(n = 52)
yes
(n = 28)
WPI 9.9 ± 2.8 9.9 ± 3.1 0.98 9.4 ± 2.5 10.7 ± 3.4 0.06
SS 7.4 ± 1.8 7.4 ± 2.3 0.95 7.1 ± 2 7.97 ± 2 0.08
NPRS 7.5 ± 1.7 7.6 ± 1.4 0.73 7.5 ± 1.3 7.7 ± 1.9 0.49
FIQR 74.6 ± 14.7 75.8 ± 13.1 0.7 73.8 ± 13.3 77.7 ± 14.8 0.23
MADRS 42.7 ± 9.4 39.4 ± 11.9 0.17 41.8 ± 9.6 39.6 ± 12.7 0.42
FMS: fibromyalgia syndrome, WPI: wide spread pain index; SS: system severity; NPRS: numerical pain rating scale, FIQR: revised fibromyalgia impact questionnaire; MADRS:
Montgomery-Asberg depression rating scale.
Table 4
Correlation of different electronics calculated indices with the assessed scores in fibromyalgia syndrome patients.
Score
r (p)
Calculated Device Use Index by primary FMS patients (n = 80)
Total Cellular phone Computer Microwave TV watching
WPI 0.06 (0.61) 0.03 (0.77) 0.09 (0.42) 0. 17 (0.14) 0.18 (0.12)
SS 0.07 (0.54) 0.04 (0.74) 0.07 (0.55) 0.2 (0.08) 0.23 (0.04)
NPRS 0.03 (0.83) 0.01 (0.91) 0.13 (0.68) 0.13 (0.27) 0.11 (0.35)
FIQR 0.1 (0.37) 0.1 (0.39) 0.01 (0.96) 0.17 (0.14) 0.09 (0.43)
MADRS 0.2 (0.07) 0.27 (0.01)0.13 (0.25) 0.06 (0.6) 0.11 (0.34)
FMS: fibromyalgia syndrome, WPI: wide spread pain index; SS: system severity; NPRS: numerical pain rating scale, FIQR: revised fibromyalgia impact questionnaire; MADRS:
Montgomery-Asberg depression rating scale.
Bold values are significant at p < 0.05.
Table 5
Correlation between distance from cellular phone and electric towers with the
assessed scores in fibromyalgia syndrome patients.
Score
r (p)
Distance from towers in FMS patients (n = 80)
Cellular phone (n = 30) Electric (n = 9)
WPI 0.16 (0.39) 0.18 (0.65)
SS 0.01 (0.95) 0.44 (0.23)
NPRS 0.1 (0.6) 0.09 (0.82)
FIQR 0.15 (0.45) 0.47 (0.2)
MADRS 0.06 (0.76) 0.4 (0.28)
FMS: fibromyalgia syndrome, WPI: wide spread pain index; SS: system severity;
NPRS: numerical pain rating scale, FIQR: revised fibromyalgia impact question-
naire; MADRS: Montgomery-Asberg depression rating scale.
A. El Zohiery, Y. El Miedany, T. Elserry et al. The Egyptian Rheumatologist xxx (xxxx) xxx
3
feres with intellectually demanding tasks due to cognitive process-
ing capacity limitations caused by TV watching for long time [32].
The association of depressive symptoms with extensive cellular
phone use has been revealed [33]. In contrast, a negative correla-
tion between MADRS score and the cellular phone use was
detected. Others suggested that exposure to the EMF emitted by
cellular phones may have a facilitating effect on attention func-
tions and cognitive processing [34]. Lengthy phone chatting with
friends is sometimes relieving and makes people feel better, hence
such a finding may be explained. It has been reported that the EMF
emitted from electric towers with long time exposure, can influ-
ence normal brain physiology, possibly through changes in cortical
excitability [35]. This can explain the tendency to higher MADRS
depression scores with shorter distance from electric towers. The
number of patients near-by an electric tower was small and this
observation should be considered in future researches.
Cellular phone use was associated with musculoskeletal pain,
and the most frequent sites of these complaints were the back,
neck, and shoulders. This was observed in one third of adolescents
with musculoskeletal pain, especially in females using at least two
electronic devices [4]. Amazingly, this agreed with the present
results as a significant relation between cellular phone use index
and NPRS among patients less than 30 years old was spotted. Log-
ically, it could be related to the mechanical effect, caused by wrong
and long-standing postures acquired during chats especially
among teens. Moreover, it could be related to the bio-effects of
EMF, one of which is the increase in the nitric-oxide levels up to
3-folds [36]. Nitric oxide (NO) may be involved in the mechanisms
of pain generation and transmission throughout the central and
peripheral nervous systems as well as locally released pain media-
tors (including formation of inflammation and vascular edema)
[37]. Furthermore, aging is associated with marked impairment
of determinants of NO generation and effect [38]. In addition, fur-
ther adverse effects due to the emitted EMF from the cellular
phones were reported to be associated with the duration of use like
sleeplessness, fatigue and chronic headache [39]. Teens and young
adults are the most frequent users and high frequency of cellular
phone use at baseline was a risk factor for mental health outcomes
among the young adults [33]. On the other hand, it was reported
that exposure of the central nervous system to weak electromag-
netic fields may have analgesic and antinociceptive effects. The
mechanisms of that effect remain to be elucidated. There is evi-
dence that endogenous opioid systems are affected by magnetic
fields. Proposed mechanisms of how weak magnetic fields may
affect the central nervous system include induced electric currents,
magnetite, radical pair combinations and resonance interactions,
so trans-magnetic stimulation (TMS) of the brain can be used to
improve pain in some of fibromyalgia patients [40].
A limitation of this work was the subjective calculation of the
distances and mobile using timing. Moreover, electromagnetic
field devices were not entirely included in this study.
In conclusion, this study highlights a possible pathological link
between fibromyalgia and exposure to electromagnetic radiation.
Excess exposure to electromagnetic devices could possibly be one
of the underlying or at least augmenting factors of fibromyalgia
symptoms.
Conflict of interest
None.
Funding
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
Appendix A. Supplementary data
Supplementary data to this article can be found online at
https://doi.org/10.1016/j.ejr.2020.10.001.
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