Cranial Electrotherapy Stimulation (CES) for Pain Control and Other Issues

Used around the world for over 50 years, Cranial Electrical Stimulation (CES) is used for neurotransmitter balancing, mood control, IQ gains, sleep, exploration of altered states, peak performance, pain, anxiety, stress, depression and much more.

First, lets have some technical information: 

Most CES units (of which there are many) are considered: Class IIa. Type BF medical device generating microcurrent pulses which are thought to reach the brain via the auditory meatus. 

By placing either ‘electrical clip/electrodes’ on the earlobes, or small, sticky electrodes behind each ear, cranial stimulation sends a micro-current which helps to ‘balance’ the chemicals and reestablish optimal neurotransmitter levels in the brain.  CES differs from TENS stimulation; which is low-frequency and tends to just block nerve pain. Also known as ‘The Sleep Machine,’ cranial electrotherapy stimulation has been proven to help reduce stress and anxiety in patients, while allowing them to become drowsy. In addition, it has been proven useful (although, not yet FDA approved) in treating ADD, ADHD, PTSD, stage 1 hypertension, headache, tics from Tourette syndrome, Alzheimer symptoms and dementia, autism, and painful conditions of traumatic brain injury, cancer, dental pain or surgery, Parkinson’s disease and MS. CES is not electro-convulsive therapy, and has few side effects –  such as causing more lucid dreaming. Some contraindications, however, are:

  • Do not use this device if you are pregnant or lactating without first seeking advice from your doctor.
  • Do not use if you have a pacemaker (particularly demand type pacemakers) or other implanted bio-electric equipment without, again, first consulting your doctor.
  • There have been isolated reports of CES treatment lowering blood pressure so care should be taken while using CES in conjunction with high blood pressure medication. The same is true with other medications; who’s effectiveness may be ‘sped up.’ This has the advantage of being able to ‘reduce’ the dosage of some medications.

How often should one use a CES device? That is something that the patient should ask their doctor or neuropathist. If having dental work, we recommend taking the device into the dentist office with you to use during treatment. If treating at home for depression, it depends upon your symptoms; some patients use CES on an ‘as needed’ basis, where others may use it once, twice or three times per day. In our office, we will have patients use it while having other treatments; which can help them to relax or sleep through treatment. Or, for insomnia, most patients use CES an hour before going to bed. While treatment keeps most patients asleep, some people may wake up in the middle of the night and use the device again.

Depending upon the CES device, some MS or Parkinson’s patients may use it on a continuous basis to reduce tremors, drooling or to help bring back the power of speech. With the proper frequency, even facial atrophy and tongue numbness can be helped.

A ‘prescription only,’ device, CES can be purchased through an authorized distributor. Chico Holistic Healthcare can, either, use a device on you during treatment, monitor your use through our office, or help you obtain a prescription to own and use your device at home.

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Examination and Testing

The first thing I do when I look at most new patients feet is observe the condition of the skin.  Is the skin firm?  Is it filled with fluid (edema), is it discolored, is it covered with fungus… etc., do the toenails have fungus, etc.?

However, if it is a man’s foot and legs which I am looking at, the first thing I might look for is ‘hair;’ hair on the foot, hair on the ankles, hair on the knuckles of the toes and lower legs. As 70% of the people whom enter my office are diabetic, it makes sense right from the beginning to look for signs of type II diabetes.  Of course, their Intake should tell me that; however, often we find that many patients are ‘pre-diabetic.’ Many, including myself, are diagnosed with peripheral neuropathy 5 years BEFORE the diagnosis of diabetes, in fact! Next, we, usually, examine and measure the calf muscles; noting, if they are equal in size. This is compared to other testing factors to tell ‘which’ leg might be more adversely affected. Actually, it IS possible to have a better score on one leg/foot than the other; but, have that ‘better’ leg, be more adversely affected with muscle atrophy or other issues. And, through treatment, or the patients diet, ‘good or bad sides,’ may even switch, from time to time.

Next, observation is made as to if the skin on the legs or feet are cracked and dry or not.  Diabetic ulcers or sores are looked for, measured and recorded/photographed as well; even on those patients who are not diabetic (as, this could be in indication that they are pre-diabetic or fully diabetic and not know it). By photographing the sores, we can accurately gauge how well or fast the sore might be healing.

We can learn a lot just from looking at the feet.  If the tissue is blue or purple, it will lead to the next question: “Do you smoke?”  Or, as stated in previous Blogs, “were you ever a skier or a pilot, etc.”  We need to attempt to find the cause of the lack of circulation to the feet.  If the feet are purple, that is certainly an indication that the blood is just ‘pooling’ down in the feet and there is little circulation.

At this point, we turn to what is known as Toronto Clinical Scoring.  If the patient is diabetic, we use a standard test; however, if the person is not, we use a modified version of it. So, what exactly is a Toronto Clinical Scoring Test; and even more important, what is a MODIFIED Toronto Clinical Scoring Test?

Toronto Clinical Scoring Tests were originally devised to check on the ability to sense ‘sensation’ in the foot or leg; mostly, to determine if someone was suffering from Sensorimotor Neuropathy.  The physician or clinician tests for cold, cool, heat, pin prick and other issues and records their findings.  A totally healthy foot/leg scores 74 points; and points are judged by sensation on a scale of 0 to 10; with minus 5 given for any ‘hyper’ sensitivity.  This test is very effective.  However, during our years of service performing this test, we have found it to be just as accurate and effective for ‘non-diabetics’ as well; we have just ‘modified’ this test to include hands and fingers, arms, toes. Even the face is checked to see if sensitivity is just as keen on one side as the other; as often it has been found that a stroke or small TIA could affect the results of the test. If one has had a stroke or TIA, then sensitivity is going to be lower on the side with the stroke; i.e; testing scores will be lower on the side with the stroke.

Generally speaking, if one scores the same up and down a leg and foot, but still has symptoms of pain or numbness (not to mention burning or tingling) or even restless leg syndrome, the results tend to dictate symptoms of  ‘long nerve’ neuropathy – meaning, the ‘long or longest’ nerve in the body. But, when the nerves test differently from one spot to the other on the leg and/or foot/toes (or with the hands/fingers and arms), one is more likely to have short nerve neuropathy. Some of the same symptoms, such as hypersensitivity may be present in either form; as can a few other symptoms.

Is it possible to have BOTH long and short nerve issues?  Most certainly.  In testing, we start looking for issues like hypersensitivity.  In a regular diabetic test, we might take off 5 points if the foot is a bit ‘overly sensitive’ to cold or merely running the tip of a pen or Wartenberg Wheel up the bottom of the foot.  However, we might take of an additional 5 points, for a total of 10, if the foot is also unusually sensitive to cold or other touch. Pain can come from both issues as well; this is one reason, we tend to ‘double check’ ourselves and treat at least once for each short and long nerves. Whichever treatment seems to work better, tends to indicate which neuropathy tends to be the most prominent.

Through the use of this test, we can generally determine what course of action is required for treatment; to RESTORE, MANAGE and MAINTAIN ones reduced symptoms.

Of course, there is much more to determining what is needed besides just a single test; balance issues and testing may be required as well… such as Berg Balance Testing or even examination of the back. We might even check sensitivity to pressure and trigger points; or muscles which have not only ‘shortened’ and are pulling on the spine, but are adding ‘unnoticed edema’ to the back as well. 

But, the ‘Modified Toronto Clinical Scoring Test’ is instrumental in determining the ‘type’ of nerve neuropathy.  The ’cause’ of the neuropathy is quite a different matter; and, depending upon our findings, ‘assorted modalities’ might be in order in addition to a change of diet or lifestyle.

 

Next Blog: Berg Balance Testing.

Ask the Neuropathist!

Welcome to Ask the Neuropathist.

Neuropathists treat pain, burning, numbness, tingling and other issues; generally, associated with Peripheral, Autonomic, Proximal, Focal or Sensorimotor neuropathy; however, there are many more forms of neuropathy with other symptoms as well.

This page offers two ways to ask questions: either, questions in general for us to put into our Blog, or “Quick/Short Questions;” for “Ask the Grumpy Neuropathist!”

This site is not intended to diagnose or give medical advice in any way, shape or form. It is strictly to be used as an informative site to help explain some of the ‘myths’ regarding neuropathy, and actual treatments/modalities which are available through some doctors, neuropathists or physical therapists.