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A Comparison of Cranial Electrotherapy Stimulation Alone or with Chiropractic Therapies in the Treatment of Fibromyalgia.

Dr. Steve Tyers, Dr. Ray B. Smith
 
ABSTRACT:  This study conducted at the Integrated Medical Centers of California, La Jolla, compared Alpha-Stim CES alone (N=20) to Alpha-Stim CES and chiropractic treatment (N=40). Sixty patients diagnosed with fibromyalgia between the ages of 25 and 57 (mean of 45) completed informed consent, and were then evaluated on the Profile of Mood States along with self-ratings of their pain level, quality of sleep, feeling of well being, and quality of life, all on 10-point scales. Tender points were also evaluated. Patients were treated at 0.5 Hz, one hour per day for three weeks via ear clip electrodes. They were able to adjust the current to a comfortable level between 0 and 500 microamperes, with the majority choosing between 100 and 300 microamperes. No attempt was made to adjust medications.

One of the CES patients and 3 of the CES plus chiropractic patients dropped out leaving two groups of 19 and 37 patients. The patients who received CES alone achieved an average of 26% improvement in their pain levels, while the combined therapy group achieved 34% improvement. The combined therapy group exhibited an improvement of 32% in their tender point evaluations. The combined therapy group also fared better in 5 of the psychological measures. On the overall sleep self-rating scales, 87% of the patients entering the study rated their sleep as moderate to very poor. At the end of the study, 80% rated their sleep as moderate to excellent, an almost mirror image turn around in their quality of sleep. The authors concluded that CES is a valuable adjunct to chiropractic management of fibromyalgia patients. No negative side effects were reported.

Key words: Fibromyalgia, CES, Electrotherapy, Microcurrent, Chiropractic
 

The diagnosis of fibromyalgia has been on the rise in the past 15-to-20 years.  Its incidence was rated as high as 4.8% of the population as of 1995. and is still climbing.1 Numerous drug trials with the patients have been reported, with one reviewer noting that the pain reduction found in 34 such medication studies has averaged no more than 28%. and the medications have often been accompanied by sometimes serious side effects, in up to 20% of the study patients.2
Because it is known that psychological stress tends to augment the pain message3,4, we at the integrated Medical Centers of California, La Jolla, decided to do a clinical trial of cranial electrotherapy stimulation (CES) alone, compared with a group of patients who received CES plus physical medicine.
CES is an FDA accepted, non-drug treatment for depression, anxiety and insomnia. all stress producing dysfunctions.5  In an earlier study reported at an international conference in 1999, CES had been shown to reduce the perception of pain at the tender points significantly.6
We decided to attempt a replication of earlier CES treatment findings in fibromyalgia patients, and compare them with a second group of patients who would receive indicated chiropractic care along with CES therapy. This would allow us to evaluate any effect of the combination treatment on fibromyalgia  pain.

Method

Sixty patients with a prior diagnosis of fibromyalgia signed voluntary consent forms to be in the study. Every third patient was assigned to receive CES alone, while the others were to receive both CES and chiropractic treatment. All patents were between the ages of 25

and 57 (mean 45) Five were male, and three were Latin American.
All patients were pre-tested on the Profile of Mood States (POMS), a standardized psychological test. In addition, all were asked to rate their overall pain level, their quality of sleep, their feeling of well being and their quality of life. on 10-point scale. Finally, their pain level on nine bilateral tender point sites and three bilateral sham tender point sites were evaluated by the senior author. The tender point scores were self-reported, on a 10-point scale, for each point probed, with any scores obtained on the sham points subtracted from the total.
All patients were given portable CES units and asked to treat them-selves, via ear clip electrodes, one hour each day for the three weeks of the study. The devices were preset to provide 0.5 Hz, bilaterally symmetrical pulses with no direct current bias. The current intensity could be adjusted from 0 to 500 microamperes, with the majority of the patients choosing to
treat themselves at a level between 100 and 300 microamperes.
In addition to CES. the second two thirds of the patients were given chiropractic treatment. The specific combination of therapy to be utilized in the study would he aimed at restoring balance between the muscles, the spine, and the nervous systems us a whole, with proper posture thought of as being a key element in reducing the physical forms of stress.
Each patient in the second group was asked to come to the clinic three times a week, during the three weeks or the study, to receive hands-on treatment. On their last visits, they were given the final treatment followed 20 minutes later, by the final tender point evaluations, POMS testing and final ratings on the self rating scales.
No attempt was made to adjust or change any medications the patients may have been on.
 

 Procedure

Each study participant was analyzed for postural imbalances when he/she came for the first treatment. Their primary trigger points were established and correlated with their aberrant biomechanics.  The patient then received therapy, consisting of specific chiropractic adjustments to the axial skeleton, with specific trigger point therapy to affected musculature. Repetitive Postural Reflex analysis was used to tine-tune the application of myofascial therapies. Reflex muscle work was applied, while the trigger points were worked on. Specific. stretches were performed after the manual therapy session. This consisted of cervical Posture Pump therapy and postural movement exercise. CES was performed during the same visit to relax the patient, and facilitate the homeostasis between the body and the brain.

Results

One of the CES patients (Group I) and three of the CES plus chiropractic patients (Group II) did not complete the final paper work, leaving two groups of 19 and 37 patients respectively.
Figure 1 shows how the two groups fared on percent improvement on the items measured by the self-rating scales and. also. no their render point pain scores. (See Fig- I below)

It is of interest that, while CES alone obtained an average 26% gain in pain improvement- which compared favorably with the maximum of 28% improvement found in medication studies as reported above--Group II obtained a self-rated pain gain of 34%, and a tender point improvement of 32%- -which is better than that found in medication studies in fibromyalgia patients, Not shown in the table, but perhaps of more significance in the current study, is that. while 63% of the
 

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The American Chiropractor • Volume 23, Issue 2 • 2001

 

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A Comparison of Cranial Electrotherapy Stimulation Alone or with Chiropractic Therapies in the Treatment of Fibromyalgia