Cranial Electrotherapy Stimulation in the Treatment of Fibromyalgia
Fibromyalgia (FM) has been reported to affect up to 10% of the population.1 In most cases patients are living with the constant, unrelenting symptoms of the condition, including widespread pain in muscles and joints, stiffness, fatigue, sleep disturbances, irritable bowel syndrome, anxiety, depression, and cognitive disorders, to name a few of the more common symptoms in this largely idiopathic syndrome.
Central Pain Mechanism
The central nervous system is implicated in FM based on the various systemic pain, mood, sleep and cognitive disorders ubiquitous to the diagnosis. This type of widespread centrally mediated pain has been called Central Sensitivity Syndrome (CSS) by University of Illinois researcher Muhammad Yunnus, MD.2 CSS diagnoses include FM, chronic fatigue syndrome, irritable bowel syndrome, tension and migraine headaches, primary dysmenorrhea, periodic limb movement disorder, restless leg syndrome, temporomandibular joint disorder, and myofacial pain syndrome. These share the common traits of pain, fatigue, poor sleep, absence of structural tissue pathology, and are all predominantly found in females. Gulf war syndrome and multiple chemical sensitivity has also been thought to be similar, if not the same condition.
Ronald Melzack became interested in central pain mechanisms from his studies of phantom limb pain in which, for example, a left leg amputee could experience intense pain in his missing left foot.3 He theorized the existence of an homunculus in the cortex which represents every part of the body. It was thought that neuromodules residing in a larger neuromatrix which comprises the homunculus, normally sends pain messages to the forebrain when sufficiently stimulated by afferent pain fibers ascending to the neuromatrix by way of the spinothalamic tract. Afferent fibers were thought to ascend from each given part of the body to its representative site on the homunculus.
When the afferent input from a specific body site is cut off, the neuromodule involved then puts out dendrites to other neuromodules in an apparent attempt to make up for the sudden lack of stimulation. Referred pain can result from these new connections.4
It has long been known that other kinds of input can increase the tendency of a pain message to fire, thus lowering the pain threshold. Chief among these are stress,5 especially stress in which the person senses a lack of personal control.6 Emotional disturbance such as anger or fear can be a real source of stress, as can unwanted noises, or lack of sleep, among many others.
Cranial Electrotherapy Stimulation (CES)
The above findings combine to focus attention upon CES as a possible way to effectively alter pain pathophysiology in the brain. Earlier studies, one on primates and one on a human seizure subject in which receptor electrodes were placed at different sites in the brain, showed that CES current applied across the head sent electrical impulses through every area of the brain, canalizing especially along the limbic system.7,8 That meant that CES stimulates the brain’s pain neuromatrix directly and it also stimulates the limbic, or emotion center of the brain, either one or both of which could be important in altering or raising the threshold of the pain message.
Accordingly, the optimum treatment for FM might well be a general treatment of the brain rather than managing the myriad complex of individual symptoms. Cranial electrotherapy stimulation (CES) uses between 100 microamperes and 4 milliamperes typically applied for 20 minutes to an hour daily or every other day. The prescription transcutaneous brain stimulator is authorized for interstate marketing and export by the Food and Drug Administration for the treatment of anxiety, depression and insomnia, but physicians are also prescribing it to treat severe forms of chronic pain, since pain is processed and felt in the nervous system, which is controlled by the brain. CES should not be confused with transcutaneous electrical nerve stimulation (TENS) which is a much stronger current delivered in a very different waveform.
Positive results from recent studies suggest that CES may provide the relief from symptoms of fibromyalgia that nothing else has. Patients use CES by clipping electrodes to their earlobes, which transmit electricity directly through the brain.
Howard Rosen, MD, an anesthesiologist/pain specialist in Monterey, California gave a lecture on fibromyalgia at the 2003 annual meeting of the American Academy of Pain Management. He said that he never uses narcotics because they don’t work well enough for his patients and once they start they never come off them. His prescription — a daily dose of mild electrical stimulation with CES.
Marilyn Lins, MD, of Utica Neurological Surgery, Inc. in Tulsa, Oklahoma said that the results she has been obtaining have been miraculous. A pain specialist, Dr. Lins reported on several fibromyalgia patients who have had sufficient pain relief to resume normal activities with as little as two 20 minute treatments per week. One of her patients stopped limping after only one treatment. Dr. Lins said, “[CES] has forever changed my treatment approach. I have never experienced results like I have had in the past two months.”
Case Study #1
ML of Tennessee had suffered from fibromyalgia, arthritis, and a sleep disorder for over six years. His physical condition worsened in spite of nutritional supplements, diets, acupuncture and hypnosis. None of which provided relief from his daily pain. He could not endure the prescribed exercise program. Medications would provide relief but clouded his mind and eventually they started to strain his liver function. Within two months of daily 20 minute treatment from a pocket-sized CES device, ML’s pain levels had decreased, his sleep improved, and he was able to gradually increase his exercise while limiting his analgesics and anti-inflammatory medications. After six months, ML was sleeping and exercising enough to reduce his medications further. By ten months he only resorted to an occasional analgesic, usually after a particularly intense exercise session or a long drive. ML said that CES technology helped him to reclaim his life. He is more alert and more active, with continuing signs of improvement.
“…CES stimulates the brain’s pain neuromatrix directly and it also stimulates the limbic, or emotion center of the brain, either one or both of which could be important in altering or raising the threshold of the pain message.”
Case Study #2
CL of California uses CES twice a day for her pain from lupus and fibromyalgia. It only took a few treatments for her to realize less frequent awakenings and a more rested feeling when she awoke. The fogginess gave way to a clear head and she felt calm. When her pain increased she was able to relieve it in minutes. She said, “If I had not experienced this myself I would have difficulty believing it! I ended up having a pleasant evening instead of being in bed with narcotic pain relievers and still feeling the pain.”