Historic CES Research


Nancy E. White PhD: A Highly Effective Treatment for Anxiety, Depression, and Insomnia without Serious Side Effects

The number of people in this country exhibiting symptoms of depression and anxiety continues to grow and is projected to continue growing through the next decade at least. The symptoms of these disorders cause substantial distress for the sufferers and their families and cost society dearly each year in lost time and suboptimal job performance. Recent research has raised questions about the effectiveness of medications long considered a standard of care in the treatment of these conditions. In light of this information it seems appropriate to explore alternative therapies that demonstrate a high level of effectiveness in mediating anxiety and depression without serious side effects.

Ya. S. Katsnelson, V. A. Leosko: Evaluation Of The Effectiveness Of A New Method Of Transcranial Electroanalgesia For Clinical Anesthesiology 

A regimen for transcranial electroanalgesia which had been designed on the basis of experimental findings was included for the first time into the complex of anesthesiology aid. Transcranial electroanalgesia was used in more than 500-cases of heart surgery, including those with extracorporeal [artificial] circulation, as well as lung and gastrointestinal surgery in. patients aging from 6-months to 86-years who had a severe concomitant pathology.

Richard Schmitt, PhD, Thomas Capo, BS, and Ehrin Boyd, MD:  Cranial Electrotherapy Stimulation as a Treatment for Anxiety in Chemically Dependent Persons.  Alcolholism: Clinical and Experimental Research, 10(2) March/April 1986

Cranial electrotherapy stimulation (CES) is reported to be effective treatment for anxiety, a major presenting symptom among chemically dependent patients.  In this study, 40 inpatient alcohol and/or poly-drug users were given CES or sham CES in a double blind design.  An additional 20 patients served as norlmla hospital routine controls.  Dependent measures of anxitety were the Profile of Mood States, the Institute for Personality and Ability Testing Anxiety Scale, and the State/Trait Anxiety Index.  CES-treated patients showed significantly greater improvement on all anxiety measures than did either control group.  There were no differences in response between older and younger patients, or between the primary drug or alcohol users.  No placebo effect was found on any of our measures.  It is concluded that CES is a clinically significant addition to the treatment regimen for this patient population.

Limoge A. [Electricity in pain management]. [French] [English Abstract. Journal Article] Presse Medicale. 28(39):2197-203, 1999 Dec 11

For more than thirty years there has been a revival of electrotherapy in the treatment of pain. Analgesia by electrical current is now based on transcutaneous or percutaneous nerve stimulation, deep stimulation, posterior spinal cords stimulation, and transcutaneous cranial stimulation.EFFICACY: It is now scientifically proven that electrostimulation of certain peripheral fibers and of different structures of the central nervous system plays an undeniable role in filtration and control of painful messages. However, precise indications are a prerequisite. Transcutaneous electrical nerve stimulation is only effective if it acts on neurogenic pain, only if the nerve pathways to be stimulated are superficial, and only if the conduction pathways between the area of stimulation and the superior centers are intact. Neurosurgical electrostimulation techniques should only be proposed after failure of simple therapies. INDICATIONS: For acute pain, electrostimulation of certain intracerebral structures and transcutaneous cranial electrostimulation may be indicated. Clinicians have a multitude of electrostimulators at their disposal but generally, the parameters recommended for their use have no serious scientific basis. The selected electrical neurostimulator must provide effective nerve stimulation without causing lesions. Electrostimulation could be considered as an adjunct to medicinal treatment for pain relief.

Stanley TH. Cazalaa JA. Limoge A. Louville Y. Transcutaneous cranial electrical stimulation increases the potency of nitrous oxide in humans. [Journal Article] Anesthesiology. 57(4):293-7, 1982 Oct.

The potency, amnesic, and postanesthetic analgesic effects of transcutaneous cranial electrical stimulation (TCES) were evaluated during N2O anesthesia in 120 unpremedicated patients, prior to urologic or general surgical operations. The patients were divided into six groups of 20 each with respect to what concentration of N2O in oxygen they were allowed to breathe (75, 62.5, and 50%), and whether they were or were not stimulated with TCES. Recordings of heart and respiratory rates, systolic arterial blood pressure, and minute ventilation were made prior to and after 20 min of N2O, and one minute later following application of a Kocker clamp to the upper inner thigh for one minute. The presence or absence of movement during the painful stimulus, memory of the painful stimulus, and postanesthetic pain at the clamp site (20 min after anesthesia) were also evaluated. Patients who received TCES had significantly lower incidences of movement, memory of the painful stimulus, and postanesthetic pain at the stimulation site at each N2O concentration than patients not getting TCES. TCES did not alter circulatory and respiratory dynamics prior to painful stimulation and prevented an increase in arterial blood pressure during painful stimulation in patients receiving 50% N2O. These data indicate that TCES significantly increases the analgesic potency of N2O and probably also the depth of anesthesia.

Stanley TH. Cazalaa JA. Atinault A. Coeytaux R. Limoge A. Louville Y. Transcutaneous cranial electrical stimulation decreases narcotic requirements during neurolept anesthesia and operation in man. [Journal Article] Anesthesia & Analgesia. 61(10):863-6, 1982 Oct.

The influence of transcutaneous cranial electrical stimulation (TCES) on fentanyl requirements was evaluated in 50 patients undergoing urologic operations with pure neuroleptanesthesia (droperidol, diazepam, fentanyl, and air oxygen) with (group I) or without (group II) simultaneous TCES. All patients had silver electrodes (three) applied between the eyebrows and behind each mastoid process and attached to a 167-kHz current generator. Current was delivered only to group I. The wave form was a complex nonsinusoidal, nonsquare wave pattern which was applied intermittently in a 3-msec-on 10-msec-off sequence. All patients had anesthesia induced with droperidol (0.20 mg/kg IV), diazepam (0.2 mg/kg IV), and pancuronium (0.08 mg/kg IV), and, after tracheal intubation, had anesthesia maintained with fentanyl in 100-microgram intravenous increments every 3 minutes whenever and as long as systolic arterial blood pressure and/or heart rate were greater than 20% of control (preanesthetic induction) values. Fentanyl requirements averaged 6.1 +/- 0.5 and 7.9 +/- 0.4 microgram/kg/min for a mean total dosage of 9.0 +/- 0.9 and 12.5 +/- 0.8 microgram/kg for the entire operation in groups I and II, respectively. These differences between groups were statistically significant (p less than 0.05). The data demonstrate that TCES augments the analgesic effects of fentanyl and thus reduces fentanyl requirements during urologic operations with neuroleptanesthesia.

Klawansky S, Yeung A, Berkey C, Shah N, Phan H, Chalmers TC.  Meta-analysis of randomized controlled trials of cranial electrostimulation. Efficacy in treating selected psychological and physiological conditions.  The Journal of Nervous and Mental Disease, 183(7) 478-841995 Jul.

To clarify the diverse published results of cranial electrostimulation (CES) efficacy, we conducted an extensive literature review that identified 18 of the most carefully conducted randomized controlled trials of CES versus sham treatment. For the 14 trials that had sufficient data, we used the techniques of meta-analysis to pool the published results of treating each of four conditions: anxiety (eight trials), brain dysfunction (two trials), headache (two trials), and insomnia (two trials). Because studies utilized different outcome measures, we used an effect size method to normalize measures which we then pooled across studies within each condition. The meta-analysis of anxiety showed CES to be significantly more effective than sham treatment (p < .05). Pooling did not affect results that were individually positive (headache and pain under anesthesia) or negative (brain dysfunction and insomnia). Most studies failed to report all data necessary for meta-analysis. Moreover, in all but two trials, the therapist was not blinded and knew which patients were receiving CES or sham treatment. We strongly recommend that future trials of CES report complete data and incorporate therapist blinding to avoid possible bias.

Gabis L. Shklar B. Geva D. Immediate influence of transcranial electrostimulation on pain and beta-endorphin blood levels: an active placebo-controlled study. [Clinical Trial. Comparative Study. Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Gov't] American Journal of Physical Medicine & Rehabilitation. 82(2):81-5, 2003 Feb.

Stimulation of the antinociceptive system by noninvasive electrical current from electrodes placed on the head is a renewed method of pain relief. METHODS: We conducted a randomized, double-blind, placebo-controlled study on 20 chronic back pain patients. They were treated with either transcranial electrostimulation (TCES) or an active placebo device. Pain level and serum beta-endorphin levels were measured before and after treatment. RESULTS: beta-Endorphin level increased in seven of the ten patients from the treatment group and did not change in eight of ten patients from control group (P = 0.057 between groups). Pain level decreased in eight treated patients and seven control patients (significant decrease for each group, no significant difference between groups). CONCLUSIONS: Transcranial electrostimulation is a nonpharmacologic method of pain relief accompanied or mediated by beta-endorphin release. The comparable degree of the initial clinical response emphasizes the powerful placebo effect on reported pain not mediated by endorphin release. This preliminary study shows that noninvasive electrical stimulation is a safe treatment with a positive effect on beta-endorphin blood levels.

Markina LD. Kratinova EA. The effects of transcranial electrostimulation on the adaptive state. [Clinical Trial. Controlled Clinical Trial. Journal Article] Neuroscience & Behavioral Physiology. 34(1):101-4, 2004 Jan.

The effects of transcranial electrostimulation on medical students with different types of adaptive responses (training, activation, stress, reactivation), levels of reactivity, and psychophysiological and autonomic status were studied. These experiments showed that transcranial electrostimulation was effective for subjects with adaptive responses of the training and activation types but not in those with stress combined with marked vagal tension. Transcranial electrostimulation facilitated improvements in psychophysiological parameters of the students and increased the level of body reactivity.

Joy ML. Lebedev VP. Gati JS. Imaging of current density and current pathways in rabbit brain during transcranial electrostimulation. [Journal Article. Research Support, Non-U.S. Gov't] IEEE Transactions on Biomedical Engineering. 46(9):1139-49, 1999 Sep.

A magnetic resonance imaging (MRI) method was used for a noninvasive study of current density (CD) and current pathways (CP’s) inside the skull during transcranial Electrostimulation in rabbits. The transcranial impulse current directions studied were those previously used in transcranial electric treatment either sagittally or bilaterally. MRI data were collected from slices perpendicular to the direction of current application. In these slices, only the perpendicular component of the CD was measured. Computer methods for accurate topographic mapping of the main areas with high CD and for reconstruction of CP’s are described.

It was revealed that current applied on the head sagittally passed mostly through the cerebrospinal fluid in the basal brain cisternas connected in series, and through the anterior horns of the lateral ventricles, foramina of Monro, ventrocaudal part of the third ventricle, aqueductus, and fourth ventricle. Possible connections between these CP’s are suggested. Bilaterally applied current passed through the brain and skull core more diffusely without concentrations in cisternas and ventricles. The results of the present study suggest an explanation for the observation that sagittally applied current more effectively stimulates brain structures with antinociceptive function and elicits more pronounced analgesic effect.

Cartwright RD. Weiss MF. The effects of electrosleep on insomnia revisited. [Clinical Trial. Controlled Clinical Trial. Journal Article. Research Support, U.S. Gov't, Non-P.H.S.] Journal of Nervous & Mental Disease. 161(2):134-7, 1975 Aug.

Ten subjects who had suffered from sleep onset insomnia for a minimun of 2 years participated in a double blind study of the effects of electrosleep on this disorder. This paper reports a 2-year follow-up of these subjects. Of the five subjects who received 24 live treatments, four appeared to be able to fall asleep with little difficulty and to awake feeling moderately to very well rested. Only one appeared to have relapsed during the 2-year-no-treatment period. Of those receiving sham treatment four were having quite a bit of difficulty falling asleep but three of the five awoke feeling moderately well rested. Although the number of subjects is small, the trends appear consistent with the interpretation that sleep habits were improved for most of the real treatment subjects and for few of those receiving sham treatment.

A. Limoge, C. Robert, T.H. Stanley.  Transcutaneous cranial electrical stimulation (TCES): A review 1998.  Neuroscience and Biobehavioral Reviews 23 (1999) 529–538

The Transcutaneous Cranial Electrical Stimulation (TCES) technique appeared at the beginning of the 1960s and is aimed to act at the level of the central nervous system. The current, composed of high frequency pulses interrupted with a repetitive low frequency, is delivered through three electrodes (a negative electrode placed between the eyebrows while two positive electrodes are located in the retro-mastoid region). Due to the characteristics of the current delivered, shortcomings encountered with previous electrical stimulation techniques are avoided. The main property of TCES is to potentiate some drug effects, especially opiates and neuroleptics, during anesthetic clinical procedures. This potentiation effect permits drastic reduction of pharmacological anesthetic agent and reduces post-operative complications.  Animal studies performed with TCES demonstrated that this stimulation releases 5-hydroxy-indol-acetic acid and enkephalins. Despite numerous clinical and animal studies performed with this technique for several decades, TCES mechanisms are not completely elucidated but results obtained without undesirable effect are encouraging signs to continue investigations of this particular technique.

  • (Note:This study is repeated 3 articles down)

Louis Stinus, Marc Auriacombe, Jean Tignol, Aimt Limoge and Michel Le Moal.   Transcranial electrical stimulation with high frequency intermittent current (Limoge’s) potentiates opiate-induced analgesia: blind studies.  Pain, 42 (1990) 351-363

Transcutaneous cranial electrical stimulation (TCES) with high frequency (166 kHz) intermittent current (100 Hz; Limoge current) has been used for several years in cardiac, thoracic, abdominal, urological and micro-surgery. The main benefits are a reduced requirement for analgesic drugs, especially opiates, and a long-lasting postoperative analgesia. We have confirmed these clinical observations in rats using the tail-flick latency (TFL) test to measure pain threshold. TCES was not found to modify the pain threshold in drug-free rats, but it potentiated morphine-induced analgesia (systemic injection). To obtain a maximal effect, the stimulation must be initiated 3 h before the drug injection and be maintained throughout the duration of its pharmacological action.  TCES potentiation was found to depend on the dose of the drug, the intensity of the current and the polarity of electrodes. These findings were confirmed by blind tests of the efficiency of TCES on several opiate analgesic drugs currently used in human surgery (morphine, fentanyl, alfentanil and dextromoramide). The analgesic effect of these 4 opiates (TFL as % of baseline without or with TCES) were respectively: 174%, 306%; 176%, 336%; 160% 215%; and 267%, 392%. The results were obtained not only after systemic opiate treatment, but also after intracerebroventricular injection of morphine (10 ng; analgesic effect 152%, 207% with TCES) suggesting that TCES potentiation of opiate-induced analgesia is centrally mediated.

Rosalind Dymond Cartwright, PhD and Marc F Weiss, MA.  Brief Communication: The Effects of Electrosleep on Insomnia Revisited.  The Journal of Nervous and Mental Disease, 161(2) 134-137, 1975

Ten subjects who had suffered from sleep onset insomnia for a minimum of 2 years participated in a double blind study of the effects of electrosleep on this disorder.  This paper reports a 2-year follow-up of these subjects.  Of the five subjects who received 24 live treatments, four appeared to be able to fall asleep with little difficulty and to awake feeling moderately to very well rested.  Only one appeared to have relapsed during the 2-year no-treatment period.  Of those receiving sham treatment four were having quite a bit of difficulty falling asleep but three of the five awoke feeling moderately well rested.  Although the number of subjects is small, the trends appear consistent with the interpretation that sleep habits were improved for most of the real treatment subjects and for few of those receiving sham treatment.

Daniel L. Kirscha, and Ray B. Smith.  The use of cranial electrotherapy stimulation in the management of chronic pain: A review.  NeuroRehabilitation 14 (2000) 85–94.

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.

Paul F. White, PhD, MD, FANZCA, Shitong Li, MD, and Jen W. Chiu, MB, MMed, DEAA.  Electroanalgesia: Its Role in Acute and Chronic Pain Management.  Anesthesia and Analgesia 2001;92:505–13.

The practice of using electrical stimulation for pain control began centuries ago. However, renewed interest in electroanalgesia is related in part to a better understanding of the physiologic basis of pain perception and transmission, as well as to the efforts of researchers interested in finding alternatives to the traditional opioid and nonopioid analgesic drugs.  Electrical stimulation has been applied directly to the spinal cord, deep brain centers, peripheral nerves, and to the traditional Chinese acupoints, in an effort to improve the management of acute and chronic pain.  This report examines the current scientific evidence supporting the use of electroanalgesia in pain management.

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