Benefits and Harms of Cranial Electrical Stimulation for Chronic Painful Conditions, Depression, Anxiety, and Insomnia

  title={Benefits and Harms of Cranial Electrical Stimulation for Chronic Painful Conditions, Depression, Anxiety, and Insomnia},
  author={Paul Shekelle and Ian Cook and Isomi M. Miake-Lye and Marika Suttorp Booth and Jessica M. Beroes and Selene S. Mak},
  journal={Annals of Internal Medicine},
Cranial electrical stimulation (CES) is a noninvasive method of applying low-intensity electrical current to the head. It is related to but distinct from other forms of transcranial electrical stimulation, including electroconvulsive therapy and transcranial direct current stimulation. Versions of transcranial electrical stimulation vary in the placement of electrodes and the intensity and waveform of the current (1). According to Guleyupoglu and colleagues (1), CES evolved from the concept of… 
Cranial Electrical Stimulation: What Is It, and Should We Use It in Practice?
  • W. Jonas
  • Medicine, Psychology
    Annals of Internal Medicine
  • 2018
The review by Shekelle and colleagues provides an update on current evidence from randomized controlled trials of CES devices for chronic pain, depression, anxiety, and insomnia, and found the current evidence of effectiveness for any of these conditions to be limited.
A Critical Review of Cranial Electrotherapy Stimulation for Neuromodulation in Clinical and Non-clinical Samples
A critical review of studies using CES in clinical and non-clinical populations found severe methodological concerns, including potential conflicts of interest, risk of methodological and analytic biases, issues with sham credibility, lack of blinding, and a severe heterogeneity of CES parameters selected and employed across scientists, laboratories, institutions, and studies.
Current challenges: the ups and downs of tACS
Some ways in which artefacts of tACS may be better managed using high-frequency protocols are described, and innovative methods for current interactions within the brain that offer either dynamic or more focal current distributions while also minimising transcutaneous effects are described.
Closed-Loop Transcranial Alternating Current Stimulation: Towards Personalized Non-invasive Brain Stimulation for the Treatment of Psychiatric Illnesses
It is proposed that closed-loop tACS deserves attention as a promising personalized medicine strategy in psychiatry given the urgent need of novel therapeutic interventions for psychiatric disorders.
Ameliorating Emotional Attention through Modulation of Neural Oscillations with Transcranial Alternating Current Stimulation
The results support a seminal outcome for the effect of IAF-tACS on emotional attention modulation, demonstrating a feasible and individual-specific therapy for neuropsychiatric disorders related to emotion processing, especially regarding oscillatory disturbances.
The efficacy of transcranial alternating current stimulation for treating post-stroke depression
This study will be the first randomized controlled trial to evaluate the efficacy and safety of tACS at a 77.5-Hz frequency and 15-mA current in reducing depressive severity in patients with PSD and explore its effect on gamma and beta-oscillations involving in emotional regulation.
Efficacy and Tolerability of Cranial Electrotherapy Stimulation in the Treatment of Anxiety: A Systemic Review and Meta-Analysis
CES is effective in reducing anxiety symptoms with moderate effect size in patients with both primary and secondary anxiety and was well-tolerated and acceptable.
Effects of add-on transcranial direct current stimulation on pain in Korean patients with fibromyalgia
It is suggested that tDCS can result in significant pain relief in FM patients and may be an effective add-on treatment.


Cranial Electrical Stimulation
This chapter gives an overview of CES history, of evidence for CES efficacy for diverse clinical conditions, discusses proposed mechanisms of action, safety and regulatory issues, and the future of CES.
Alternating current cranial electrotherapy stimulation (CES) for depression.
There are insufficient methodologically rigorous studies of cranial electrical stimulation in treatment of acute depression, and there is a need for double-blind randomized controlled trials of CES in the treatment of severe depression.
Effects of cranial electrotherapy stimulation on resting state brain activity
Results suggest that CES causes cortical brain deactivation, with a similar pattern for high‐ and low‐frequency stimulation, and alters connectivity in the default mode network (DMN).
A pilot study of cranial electrotherapy stimulation for generalized anxiety disorder.
It is suggested that CES may reduce symptoms of anxiety in GAD, and the use of CES in clinical settings should be explored.
Non-invasive brain stimulation techniques for chronic pain.
  • N. O’Connell
  • Psychology, Medicine
    The Cochrane database of systematic reviews
  • 2018
Evaluating the efficacy of non-invasive cortical stimulation techniques in the treatment of chronic pain found a small effect with heterogeneity, but no difference between low-frequency stimulation and rTMS applied to the prefrontal cortex compared to sham for reducing pain intensity at short-term follow-up was found.
Using cranial electrotherapy stimulation to treat pain associated with spinal cord injury.
The results suggest that CES can effectively treat chronic pain in persons with SCI.
Noninvasive Brain Stimulation with Low-Intensity Electrical Currents: Putative Mechanisms of Action for Direct and Alternating Current Stimulation
Preliminary studies show that although AC stimulation has only modest effects on cortical excitability, it has been shown to induce synchronous changes in brain activity as measured by EEG activity, and cranial AC stimulation may render its effects through rhythmic stimulation that synchronizes and enhances the efficacy of endogenous neurophysiologic activity.
The Treatment of Fibromyalgia with Cranial Electrotherapy Stimulation
It is concluded that CES is as effective as the drug therapies in several trials, with no negative side effects, and deserves further consideration as an additional agent for the treatment of fibromyalgia.
Transcutaneous electrical stimulation.
  • W. Bauer
  • Medicine
    Archives of otolaryngology--head & neck surgery
  • 1986
To the Editor .—I was pleased to read that Dr Dobie has explored electrical tinnitus suppression, as reported in the July 1986 issue of theArchives, 1 but his success rate was extremely poor and