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A Practical Protocol for Electromedical
Treatment of Pain

Chapter 61 in Pain Management: A Practical Guide for Clinicians

Daniel L. Kirsch, Ph.D., D.A.A.P.M., F.A.I.S.

results also have been reported for labor, epilepsy, hypertension, surgery, spinal cord injuries, chronic pain, arthritis, cerebral atherosclerosis, eczema, dental pain, asthma, ischemic heart disease, stroke, motion sickness, digestive disorders as well as various addictive disorders including cocaine, marijuana, heroin and alcohol abuse (Brovar, 1984; Daulouede, 1980; Feighner, Brown, & Olivier, 1973; Gomez & Mikhail, 1978; Overcash & Siebenthall, 1989; Patterson, 1983; Schmitt, Capo, Frazier, & Boren, 1984; Smith, 1975; Smith, 1982; Wharton, McCoy, & Cofer, 1982).

Reflex sympathetic dystrophy (RSD) and fibromyalgia syndrome (FS) are two significant pain diagnoses from primary central and autonomic nervous system etiologies that respond best to CES (Alpher & Kirsch, 1998; Lichtbroun, Racier, & Smith, 1999). Adding somatic treatment with MET to these two conditions does not seem to improve the outcomes.

Besides specific pathological disorders, there are a growing number of studies being conducted that show increases in cognitive functions. Michael Hutchison (1986) discussed several mind-enhancement techniques in his book Megabrain, devoting Chapter 9 to CES as a tool for attaining higher levels of consciousness. Sparked by Hutchison, Madden and Kirsch (1987) completed a study that demonstrated CES is a useful tool for improving psychomotor abilities. Smith (1999) demonstrated that CES significantly improved stress-related cognitive dysfunction, such as attention deficit disorder (ADD), after only 3 weeks of treatment, and maintained the effect through an 18-month follow-up assessment.


Cranial electrotherapy stimulation devices are generally similar in size and appearance to TENS units, but pro-duce very different waveforms. Standard mA-current TENS devices must never be applied transcranially. CES electrodes can be placed bitemporally, forehead to posterior neck, bilaterally in the hollow just anterior to the mastoid processes, or through electrodes clipped to the earlobes. The ear clip method, developed by the author, is the easiest and possibly most effective electrode placement.

The electrodes must first be wet with an appropriate conducting solution. When using ear clip electrodes, apply them to the superior aspect of the ear lobes, as close to the jaw as possible. Start with a low current and gradually increase it. If the current is too high the patient may experience a painful stinging sensation at the electrodes, dizziness, or nausea. If any of these three symptoms arise, immediately reduce the current and the symptoms will subside in a few moments. After a minute or two, try increasing the current again, but keep it at a comfortable level. It is okay for the patient to feel the current as long as it is not uncomfortable.

The ideal treatment time is 20 to 60 minutes, but some patients may achieve the full benefits of a CES treatment within 10 minutes. Many dentists use it instead of nitrous oxide gas to help relax patients during dental procedures (Winick, 1999). Sometimes these dental procedures last for hours with the patient undergoing CES treatment the entire time.
Although CES treatment is indicated for insomnia, because of the increased alertness some patients find it difficult to fall asleep immediately after a treatment. Accordingly, it is recommended that CES be used at least 3 hours before going to bed. Also, in most cases after daily treatments for the first week or two, treating every other day is usually more effective than daily treatment.


During the treatment, most patients will experience a subjective change in body weight. They may feel heavier at first and then lighter, or they may feel lighter initially. The patient may feel worse during the heavy cycle and this feeling can last for hours or even days in rare cases unless extra treatment time is given. There-fore, it is important to continue the treatment if the patient feels heavier at the end of the allotted time, even if it has already been 20 minutes or more. Continue for at least 2 to 5 minutes after the patient feels lighter. Not all patients will be aware of these weight-perception changes.

Following CES, most people feel better, less distressed, and more focused on mental tasks. They generally sleep better and report improved concentration, increased learning abilities, enhanced recall, and a heightened state of well-being.

Psychologists first described these general feelings during the 1970s as an alpha state of consciousness. Meditation, biofeedback training, relaxation instructions, chanting, hypnotherapy, and certain religious rituals also produce such states. This is not the same as the alpha brain wave frequency of 8 to 13 Hz. Often, practitioners are confused by device representatives who claim that their particular devices will output and entrain a brain to the alpha frequency. There is no evidence to support that CES devices work on an entrainment principle.


There have not been any significant lasting harmful side effects reported in any of the research literature from either MET or CES. As with all electrical devices, caution is advised during pregnancy, and with patients using an older model (pre-1998) demand-type pacemaker. In addition, it is recommended that patients do not operate complex machinery or drive automobiles during and shortly after a CES treatment.

Microcurrent electrical therapy and cranial electrotherapy stimulation are electromedical modalities that use low level currents that usually do not exceed 1 mA. Beneficial effects have been reported for a wide variety of pain, psychological distress, and addiction-related disorders.
Pain is a complex process encompassing the entire nervous system. To achieve optimal results through electromedical intervention, the peripheral and central nervous systems should both be treated. Cranial electrotherapy stimulation induces a relaxed, alert state. It is a primary modality effective for controlling anxiety, depression, insomnia, and generalized stress ubiquitous in pain patients. In addition, there is mounting evidence that CES can enhance cognitive functions. Because of its safety and effectiveness, the combination of MET and CES used with the protocols described here is highly recommended for a broad range of pain and stress-related disorders.

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Pain Management: A Practical Guide for Clinicians • Chapt. 61 • 2002

Used with permission of Electromedical Products International, Inc.

©2006 by

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A Practical Protocol for Electromedical Treatment of Pain