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 The therapy, known as cranial electrical stimulation, delivers a
current similar to that of a 9-volt battery through electrodes on
skin to the brain. Researchers examined data from 26 clinical trials
that randomly assigned some patients with a variety of chronic
painful conditions to receive this therapy and others to get a
placebo or dummy treatment or stick with usual care.
Most of these trials were too small or brief to offer conclusive
evidence that cranial electrical stimulation works for headache,
joint pain, musculoskeletal pain, headache, fibromyalgia, insomnia,
or depression alone, the analysis found.
For people with both depression and anxiety, however, researchers
found “low-strength” evidence of a modest benefit.
“If there is a benefit, it is probably not on average a large
benefit, because when a treatment has an average benefit that is
large this is usually pretty obvious even from a small number of
studies or even studies of a small number of patients,” said lead
study author Dr. Paul Shekelle, of the West Los Angeles Veterans
Affairs Medical Center.
“But the benefit of cranial electrical stimulation does not have to
be large for it to still be a useful additional option for treatment
of these conditions, because for most of them we don’t have large
benefit treatment options,” Shekelle said by email.
With depression and anxiety in particular, four of the five studies
in the analysis were conducted more than 40 years ago using shock
therapy devices that are no longer available, researchers note in
the Annals of Internal Medicine.
In the largest and most current study, patients did report bigger
reductions in depression and anxiety symptoms with shock therapy
than with usual care that included antidepressants. But the study
only enrolled 115 patients and lasted just five weeks.
If this study had found similar benefits after six months or a year,
that might have offered “moderate” quality evidence of
effectiveness, Shekelle said. And if a few additional studies of
this size and duration got consistent results, then there might be
“high quality” proof.
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Cranial electrical stimulation appeared safe, or at least the review
didn’t find evidence of serious side effects.
Amid a worsening opioid crisis, doctors and patients are
increasingly considering this type of therapy as an alternative to
prescription painkillers, many of which can be addictive. But based
on the research to date, the evidence in support of cranial
electrical stimulation is sparse, researchers concluded.
“This information is disappointing,” Dr. Wayne Jonas, executive
director of Samueli Integrative Health Programs in Alexandria,
Virginia, writes in an accompanying editorial.
Insufficient proof of effectiveness from this collection of mostly
small, brief studies doesn’t necessarily mean cranial electrical
therapy is ineffective, Jonas writes.
It might still not be the best use of money, though. At the military
hospital where Jonas works, an electrical stimulation device costs
the hospital $1,500. Active duty patients can get one for free,
while others pay $300 out of pocket.
“It should be used only after physician evaluation and under proper
supervision,” Jonas said by email.
“In our clinic we determine if a person may benefit and then try it
under supervision in the clinic at least three times,” Jonas added.
“If there is a benefit, we will provide a machine to take home after
proper instruction and with ongoing follow-up and monitoring.”
SOURCE: http://bit.ly/2wYH0qu Annals of Internal Medicine, online
February 12, 2018.
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