Chronic Pain Relief Now

Call 1-888-E-STIMULATE
Chronic Pain Relief

Mind and Body
Migraine Pain
Back Pain
Carpal Tunnel
Arthritis Pain
M.D. Surveys
Our Site Map
Prescribing Info
Contact Us

Pg. 1

Next Page>

Chronic Pain Cranial Electrotherapy StimulationThe Use of Cranial Electrotherapy Stimulation in the Management of Chronic Pain: A Review

Daniel L. Kirsch  and Ray B. Smith

NeuroRehabilitation, 14(2):85-94, 2000

Cranial Electrotherapy Stimulation (CES) has a growing history of applications in rehabilitation medicine in the United States dating back to early 1970. As a recognized non-drug treatment of anxiety, depression and insomnia, CES gained its first major application in the field of addiction treatment and rehabilitation. By the mid 1980s research was showing additional important uses of CES in the treatment of closed head injured patients, and in paraplegic and quadriplegic patients. The most recent research is showing CES to be highly effective in the management of chronic pain patients. It may be elevating the pain threshold due to its stress reducing effects when anxiety and depression are reduced below clinical levels. Modern theorists of a pain neuromatrix in the cerebral cortex may provide an additional basis for understanding CES mechanisms in the control of pain related disorders.

1. Introduction

Cranial Electrotherapy Stimulation (CES) is the application of a small amount of current, usually less than one milliampere, through the head via car clip electrodes. It came to the United States in the late 1960s under the rubric "electrosleep". It had been developed in the U.S.S.R. in 1954, and quickly spread throughout the former Eastern Bloc, then into Europe and most of the West. It was already in use in Japan when it finally arrived in the US in the 1960s. By the late 1960s, it was being researched in both animal and human subjects at several US university medical schools, including the University of Texas at San Antonio, the University of Wisconsin, and the University of Tennessee [1-3]. Major research reviews in 1980 [4], and again in 1999 [5] summarized the progress of CES in American medicine.

2. Research in rehabilitation medicine
2.1. Rehabilitation of addicted persons

The first research and subsequent use of CES in re-habilitation medicine began in the early 1970s, when research reports began coming out of the District of Columbia's 600 bed inpatient Rehabilitation Center for Alcoholics [61, and Veterans Administration Hospitals [7,8]. Following the publication of its two double-blind, placebo-controlled studies [9,10], the CompCare Corporation, then the largest rehabilitation facility in the US, if not in the world, with approximately 120 inpatient rehabilitation facilities for addiction patients, plus those with eating disorders, made the decision to put CES into their core treatment program throughout the nation. Unfortunately, there was no manufacturer of CES devices available at the time that could supply that heavy a demand for product so the plans had to be abandoned. It continued to be used in addiction treatment, however, with many facilities in both CompCare and other major addiction treatment chains making wide use of CES in their clinical treatment protocols.

2.2. The use of CES in paraplegic and quadriplegic patients

Wharton and his coworkers presented their paper "Effects of CES therapy on spinal cord injured patients" at the annual meeting of the American Spinal Injury Association in New York in 1982. They had completed a double-blind study of the use of CES with paraplegics and quadriplegics who were in an inpatient rehabilitation program in Dallas. Patients were given either suhsensation level CES or sham CES one-hour daily for three weeks, Monday through Friday. They were pre and post tested on standardized psychological measures of depression, anxiety, and cognitive function. It was found that patients receiving actual stimulation had significant improvement in all areas measured, while no placebo effect was found from sham treatment [11] . The presenters reported that CES was

subsequently employed in the hospital treatment protocol, with the physical therapists, especially, commenting that patients had much better morale during muscle exercise training when they used a CES device during the mandatory passive exercise sessions. They completed the sessions with little or no complaining, crying or other emotional negativity and acting out.

2.3. The use of CES in closed head injured patients

One of the first reports of the use of CES in closed head injured (CHI) patients appeared in 1988. It was a clinical case presentation of two CHI patients, the major focus being on their post-traumatic amnesia and subsequent cognitive deficits. It was found that following 40 minutes of CES treatment daily for three weeks, the first patient had a 55% improvement in immediate recall and a 56% increase in delayed recall. The second patient had improved 28% on immediate recall and 39% on delayed recall [12].
A subsequent double-blind, placebo-controlled study of CHI patients was published in 1994 [13]. While the major focus of the study was anxiety and depression in these patients, a side issue was the seizure disorders suffered by the patients, all of whom were on anti-seizure medication. It was not known at the time what effect CES might have on seizures. While earlier studies of addiction patients in one rehabilitation center had selectively eliminated patients known to have had withdrawal seizures, another large rehabilitation center had deliberately and successfully treated similar patients with CES to prevent withdrawal seizures [14].
During the study, one patient was observed to have a seizure and was immediately removed from further participation in the study. Following the study it was discovered that the seizure patient had been a sham-treated control and had received no stimulation. The researchers reported that when that subject's parents saw the results in the CES treated group they insisted that their son receive CES treatment. This was done, with no further seizure activity reported in this or any of the other patients who had undergone CES treatment during the study.

2.4. The use of CES in physical therapy

In an early CES study in the US, 23 patients who had been diagnosed with hemiplegia, paraplegia and muscle spasm following traumatic injuries, were given CES treatments of one hour each day for four days in an open clinical trial. Muscle spasticity was tested with an EMG

Next Page>

NeuroRehabilitation 14(2):85-94 2000

Used with permission of Electromedical Products International, Inc.

©2006 by

Disclaimers-  Alpha-Stim® is manufactured by Electromedical Products International, Inc. (EPI).  Chronic Pain Relief Now.Com and Moeller Medical, LLC are  not associated with EPI except to the extent of acting distributors of the Alpha-Stim® device.  The Alpha-Stim® name and the Alpha-Stim® logo are trademarks of EPI.
United States readers note:
Material on this site is being provided only for educational information and as background material for potential researchers, not for promotional purposes.
Chronic Pain Relief Now.Com and Moeller Medical, LLC express no opinion with regard to representations made herein.  Chronic Pain Relief Now.Com and Moeller Medical, LLC support only those representations contained within the labeling of the Alpha-Stim® products.

The Use of Cranial Electrotherapy Stimulation in the Management of Chronic Pain