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 done at least three hours before going to bed. Also, in most cases after the first week or so of CES, treating every other day is usually more effective than every day. Results
The end result of a successful CES session is that the patient will feel more relaxed and more alert; as if they have a type A mind in a type B body. Immediately after a CES treatment, patients usually report feeling relaxed and somewhat inebriated for the first few minutes. This is a pleasant and very comfortable sensation. After several minutes to hours, the light-headed feelings usually disappear, the relaxed state remains and a profound sense of alertness is achieved. This relaxed/alert state will usually remain for an average of 12 to 72 hours after the first few treatments. With regular use it is possible for the patient to habituate to this preferred state of consciousness. Following CES, many patients relate feeling better, less distressed, and more focused on mental tasks. They generally sleep better and report improved concentration, increased learning abilities, enhanced recall and heightened states of well-being. These general feelings were first described by psychologists during the 1970's as an alpha state of consciousness. Such states are also produced by meditation, biofeedback training, relaxation instructions, chanting, hypnotherapy and certain religious rituals. This is not the same as the alpha brain wave frequency of three to eight Hz. Often, practitioners are confused by device representatives who claim that their particular device will output and entrain a brain to the alpha frequency. There is no evidence to support that any devices work on an entrainment principle.
Contraindications
As mentioned earlier, there have been no harmful side effects reported in any of the research literature since CES was begun in the 1950's. As with all electrical devices, caution is advised during pregnancy and on patients with a demand-type pacemaker. In addition, we recommend that patients not operate complex machinery or drive automobiles during and shortly after a CES treatment.
Summary
CES is an electrical transcranial therapy that employs devices which do not exceed 1.5 milliamperes and usually work in the microampere current range. Beneficial effects have been reported for a wide variety of pain, distress and addiction disorders.
Pain is a central nervous system event. To achieve optimal results through electromedical intervention, the brain should also be treated. Cranial electrotherapy stimulation produces a relaxed, alert state. It is effective in controlling the anxiety, depression, insomnia and generalized stress associated with pain patients and as a primary modality for these disorders. In addition, there is mounting evidence that CES can enhance various cognitive functions. Because of its safety and effectiveness, CES is highly recommended for a broad range of pain-related disorders.
AURICULAR MEDICINE
Auricular medicine is an interesting and highly effective system of treating the entire body from the external ear. It originated in China but has been redeveloped in Europe, primarily France and Germany, over the past 40 years. Prior to that, Egyptians used earrings to treat eye and fertility problems. Through Mediterranean trading routes, the Romans learned this technique and would use it to cauterize specific points on ears for sciatica.
In 1957, Paul Nogier, M.D., a French neurologist noticed several of his patients had scars on the same spot on their ears (Nogier, 1972). They each related their scars to a prior treatment for sciatic pain by a local unconventional practitioner. Nogier confirmed that treatment of specific points on the external ear alleviated specific problems of the body. He proposed and proved a somatotopic relationship exists between different anatomical areas of the body and specific points on the ear. He then began mapping auricular points based on an embryological model and found somatic correlations with mesoderm, ectoderm and endodermal auricular structures. Under Chairman Mao's direction, The Nanking army ear acupuncture team studied over 2,000 patients confirming Nogier's findings (Huang, 1974). In the U.S., Oleson, Kroening and Bresler (1980) completed a conclusive study to determine the validity of auricular points. Using a double-blind model they examined 40 patient's ears to diagnose "problem present" or "problem absent" at specific somatic sites. They achieved a 75.2% correlation between auricular diagnostic measurements and problem areas. In 1983, Ercolani, Zucchini and Poli (1983) had encouraging results with functional amblyopia in children. Zanini (1983) studied 724 various pain conditions with auricular medicine and Electro-Acutherapy compared to traditional acupuncture. He obtained superior results with auricular medicine. This technique was discredited by the American Medical Association when Melzack and Katz (1984) published a placebo study on 36 pain patients. They did not see a significant difference between the treated and placebo groups. It is interesting how this study did not use a device made for auricular medicine, nor was it done by practitioners trained and experienced in this modality.
Very brief, six to ten second stimulation at about 100 microamperes on auricular points can often produce profound, and immediate results. The key is to treat the exact point on the front and directly behind it on the back of the ear associated with the regional area of pathology. These areas are called corresponding points. They will measure highly conductive and be sensitive to pressure, sometimes long after the pathology is considered healed. The points Shen-men (literally, "heaven's gate"), Adrenal and Subcortex (thalamus) must also be treated on the front of the ear for neuromusculoskeletal pain disorders. Auricular medicine charts are available from most acupuncture supply companies.
CASE HISTORIES
Three case histories are given to illustrate the effectiveness of electromedical procedures. Although they may seem rather amazing to those inexperienced with MET, they actually somewhat representative of the results seem with the better instrumentation available today.
Case one: This was published by William Bauer, M.D. (1983). At the time of publication, Dr. Bauer was from the Division of Otolaryngology, Case Western Reserve University School of Medicine and Chief, Department of Otolaryngology at the Veterans Administration Medical Center in Cleveland.
"A 58-year-old man had squamous cell carcinoma of the laryngopharynx diagnosed in 1980. It was staged at T4N2MO. The patient received full-course radiation therapy to the primary tumor in the piriform sinus and to the ipsilateral neck mode. He had recurrence in the larynx after one year and underwent a laryngectomy and radical neck dissection. Four months later, a metastatic mass was discovered in the area of the neck that had been operated on. Further radiation treatment was given and provided temporary palliation of growth and pain. Pain became the most notable problem, requiring at least 7 mg of morphine every four hours along with various sedatives. This failed to give complete relief. At this point, electrical stimulation to the neck was given. Treatment was given directly across the area of the tumor with a current of 500 microamperes at 0.5 Hz for ten minutes. The pain disappeared. The treatment was repeated the following two consecutive days, and the patient remained pain free for one week without further treatment. At the end of one week, pain returned and he was again treated. The patient again remained pain free, but began having symptoms of withdrawal from the morphine. He was then placed on a regimen of methadone hydrochloride. He is presently pain free with electrical treatments every three days for one minute."
Case two: This is a letter written by a retired dentist to an electromedical manufacturing company (Chudzinski, 1990). In this case, the patient purchased a small unit for home care.
"I am a retired 69 year old dentist trained in oral surgery. I purchased the Alpha-Stim CS to treat a recurring pain and spasticity in both sternocleidomastoid muscles which did not respond very well to the traditional treatment. By placing one electro pad on the muscle origin and its mate toward the muscle insertion and the other set of pads in the contra-position, I gave the most painful left muscle two twenty minute 0.5 Hz treatments. There was a very noticeable relief of pain. I treated the less painful right muscle in the same manner and the pain was almost fully relieved. It took four days of treatment to relieve all of the pain and stiffness. In addition to the above results and a bonus which I cannot explain, a left sub-deltoid bursitis which had been bothering me for about four months completely disappeared the morning after the first muscle treatment. I have been bothered with an intermittent tinnitus since about 1950. It became continuous in about 1965. I was unaware that there was any successful treatment of this annoying complaint. The noise in my left ear was a constant loud whistling and the right ear a less noisy ringing. By placing the ear clip electrodes on my earlobes and the pads at the level of my upper posterior teeth and using 0.5 Hz for two 20 minute treatments for about a week, the ringing noise disappeared completely and the whistling noise was reduced about 85%. Thank you for developing this new instrument. It certainly has made my life more enjoyable."
Case Three: This patient was seen by Dr. Fred Lerner in his private practice in Santa Monica, California. A twenty-six year old female was involved in a rear-end type automobile accident. She was not wearing a seat belt and on impact struck her chin against the steering wheel rendering her unconscious for several minutes. She sustained injuries to her temporomandibular joint, neck, low back and was also diagnosed with post-concussion syndrome. After almost two years of multiple therapies which included drugs, heat, ultrasound, massage, manipulation, electric muscle stimulation, a temporomandibular joint splint and various stretching exercises, as well as consulting several different practitioners in the process, she still complained of constant headaches that began suboccipitally and wrapped around to both temples. She graded the headaches as beginning at a level of three out of ten, ten being the worst, upon arising in the morning and proceeding to a level of eight out of ten by mid-afternoon, thus incapacitating her. Her low back pain had resolved although her neck pain radiated into the trapezius areas bilaterally and was fairly constant at a level of three to four out of ten. All of her symptoms were aggravated by "stress." Furthermore, she complained of difficulty concentrating, had trouble falling asleep and when she did, slept fitfully. She complained of occasional short-term memory lapses and various other mild dysfunctions of mental capacity consistent with the post-concussion syndrome. Extensive diagnostics procedures were done, including plain films, computerized tomography (CT) scan of the neck, a magnetic resonance image (MRI) of the brain and a complete neurological evaluation. The patient even had an overnight sleep laboratory electroencephalograph (EEG). None of these provided a structural finding that would account for her symptoms.
Although her case had been litigated, a settlement compromise had occurred six months before. Therapeutic trial was begun using CES with bioconductive therapy administered in the trapezius areas bilaterally. Treatment was provided three times per week for two weeks, at which time a re-evaluation was made. Her headache levels had decreased to a mid-afternoon peak of four out of ten, with no pain on arising. Her neck pain had subsided to a level of one to two out of ten and she had experienced two nights of uninterrupted sleep. She reported an increased ability to concentrate and stated that she was beginning to feel like her old self again.
The patient was instructed on the use of a prescribed home Alpha-Stim CES/bioconductive therapy device, including electrode placement, frequency of use and length of treatment. On six month's follow-up she presented with occasional minimal pain in her neck region, had one headache in the last two months that she graded at an intensity level of three and had fully resumed a normal lifestyle.
SUMMARY
The proposed theories do not yet fully account for the observable results. Accordingly, several questions remain: 1) what is the exact nature of the relationship between the specific harmonics of various tissues and these methods? 2) what is the mechanism responsible for electrogenesis when induced by various forms of electricity? 3) why doesn't a given tissue respond in the same way at different times? 4) why don't nonunion fractures with gaps larger than one-half the diameter of the bone, and synovial pseudoarthroses, respond to any form of electromedical intervention? 5) what are the exact parameters of stimulation that should be used in what type of clinical situation to give the best response? 6) Finally, if it is true that people who have been over-exposed to electricity fail to benefit from electromedical therapy, what has occurred physiologically and what can we do to reverse it? One must stray from the routine procedures of the day in order to create the advances of tomorrow. There is still a lot to learn about bioelectricity and electromedicine. In order to do so, we must first acknowledge that there is another side of physiology. We must take the time and spend the money to fight oppressive government bureaucracies such as the FDA who clearly support the drug industry monopoly. Everyone concerned about health should demand widespread access to conservative, non-damaging alternative care. To lessen human suffering is a notable goal. That we have not been able to achieve enough of this to date is a good indication that the answers must lay elsewhere. Biophysics must be better understood to realize the actual basis for the control of the regulatory processes of life. Even at its current state of evolution, electromedicine is an unprecedented conservative, cost-effective, safe and powerful tool in the management of the pain patient. As such, it should be the first priority on the list of treatment options.
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