Vol. 1 No.

3 Summer 1986 Journal of Pain and Symptom Management 151

On'ginal Article

Electrosleep and Chronic Pain

L m v r e n c e S. Schoenfeld, Nicolas E. Walsh a n d Somayaji R a m a m u r t h y
Departments of Psychiatry and Anesthesiology, Department of Physical Medicine and
Rehabilitation, and Department of AT~sthesiology, University of Texas Health Science Center

Abstract
Electrosleep has been used in the treatment of imomnia, anxiety, and depression. Many treat.
ments that are helpful in treating anxiety and depression also reduce chronic pain. Therefore,
seven patients with chronic pain were treated with electrosleep, pro patient reported signifi-
cant improvement. Electrosleep does not appear to offer a useful treatment for chronic pain.
J Pain Symptom Manag 1986;1:151-155.

Key Words
Electrosleep, chronic pain

Introduction Since 1964 the use o f cerebral electrical stim-

ulation has increased in the western European
Electrosleep (cerebral electric stimulation or countries, particularly Austria and West Ger-
CES) consists of transcerebral stimulation with many. Investigators have undertaken research
low intensity direct current which has been and have produced evidence which may indi-
used primarily in the treatment o f three target cate that this is an effective therapy. Double
symptoms--insomnia 1-4 anxiety, 5,6 and depres-
blind crossover studies in migraine headache
sion. 7,8 It has also been reported to be helpful
patients demonstrated a reduction in headache
in n u m e r o u s psychosomatic (hypertension, intensity after three weeks o f treatment while
asthma, neurodermatitis, arthritis) and somatic sham t r e a t e d p a t i e n t s did not improve. 14
(cerebral artherosclerosis, epilepsy, trigeminal Increase in 24-hour urine free catecholamines
neuralgia, spastic hemiplegia) symptoms. ~ and urinary 17-ketosteroids indicated that the
This therapy has been employed extensively brain begins creating significantly more cate-
in the Soviet Union and other eastern Euro- cholamines following five days of 30-minute-
pean countries for over 40 year~,l~ T h e Rus- per-day CES treatments. 15 This suggested that,
si.ans have allocated a substantial a m o u n t o f following tile application o f CES, individuals
time and effort to its research. T h e r e are over were at a significantly better position to handle
1000 references on electrosleep 1~ describing psychological stress.
the treatment of many thousands o f patients. Many treatment modalities that have been
Review o f the Russian reports suggests that the f o u n d effective with anxiety (biofeedback,
"statistical, experimental, and experimental relaxation training, hypnosis), depression (anti-
clinical data" were lacking, as was information depressant medication, behavior modification,
on the use o f the controls or efforts to rule out p s y c h o t h e r a p y ) , a n d i n s o m n i a (relaxation
the possibility of a placebo effect o f electrical training, hypnosis, anti-depressant medication,
sleep) 3 9behavior modification) have also been found
useful in alleviating chronic pain. As the pain
experience has a relationship with both depres-
Address reprint requests to: Dr. Lawrence S. Schoen-
feld, Deparnnent of Psychiatry, University of Texas sion and anxiet); it was felt that transcerebral
Health Science Center, 7703 Floyd Curl, San Anto- stimulation with low-amperage electrical cur-
nio, TX 78284. rent (electrosleep) should be studied with
Acceptedfor publication: March 31, 1986 chronic pain patients.
152 Schoenfeld et aL Journal of Pain and Symptom Management

Methods H e r average Visual Analog Pain Scale was 90,

which she described as fairly severe and dis-
Patie~zts. Seven patients, five male and two
tressing. H e r MMPI revealed elevations on
female, with chronic pain were studied (after
scales 1 (Hypochondriasis, T = 87), 2 (Depres-
approval of the Institutional Review Board) in
sion, T = 8 3 ) , and 3 (Hysteria, T = 7 7 ) . She
the Anesthesiology Chronic Pain Management
received CES therapy without response. Later
Program. The age range was from 28 to 73 with
treatment with acupuncture failed to provide
a mean o f 46 )'ears. T h e patients' pain had
relief. Finally a combination o f exercise and
ranged in duration from nine months to six
medication (amitriptyline and fluphenazine)
years with an average time duration o f three
brought m i n o r relief o f pain.
years.
Patient Two was a 48-year-old married m a l e
Protocol. Each.patient was administered a pain with some college and technical school train-
program questionnaire, the Minnesota ing. H e complained o f pain in the u p p e r back,
Multiphasic Personality Inventory (MMPI), and shoulder and elbow with radiation to his left
seen for physical evaluation. Patients who were hand. He reported being tense, ner~'ous and
not pregnant or planning to b e c o m e pregnant depressed. The MMPI was consistent with mod-
d u r i n g this study or who did not have a history erate depression and hypocondriasis, and ele-
o f brain tumors, stroke, epilepsy, or heart dis- vations on Scales 1 (Hypochondriasis, T = 85), 2
ease were enrolled after obtaining informed (Depression, T = 77), and 3 (Hysteria, T = 75).
consent. Prior to the first treatment the patient H e received CES and reported sleeping better,
used a standard 10 cm Visual Analog Scale to but no change was noted in his Visual Analog
assess the degree o f disability. At the conclu- Pain Scale. T h e r e had b e e n no improvement
sion o f every third treatment and at one-month with anti-depressants, c h i r o p r a c t i c adjust-
and six-month follow-up visits the patients were ments, acupuncture, and transcutaneous nerve
again asked to respond to the Visual Analog stimulator.
Pain Scale. Physician disability ratings were Patient T h r e e was a 32-year-old male who was
made at one-month and six-month follow-up involved in an on-the:job injury to his right
visits. elbow. After two surgical procedures and injec-
Patients were given a treatment orientation tion o f local anesthetics a n d steroids, he contin-
which consisted only o f an assurance that the ued to have pain. The MMPI revealed eleva-
treatment would not be harmful and a state- tions on Scales 2 (Depression, T = 75), and 3
ment indicating that the technique was being (Hysteria, T = 71). T h e r e had been no improve-
evaluated for its effect on pain. Patients were ment o f pain with antidepressant medication,
seen for 30-minute sessions three times a week transcutaneous nerve stimulator, and self-hyp-
for four weeks and received CES provided by a nosis. The patient received one CES treatment
N e u r o t o n e 101. Negative electrodes were placed and complained o f a severe headache. He with-
on the patient's closed eyelids with positive drew from the study.
electrodes located over the mastoid processes. Patient F o u r was a 54-year-old m a r r i e d
T h e electrodes were stimulated at 100 pulses woman with less than a high school education..
per second and a constant pulse width o f 0.5 She complained o f chronic back, left leg, neck,
msec. T h e amplitude was raised to secure a shoulder, and spine pain. After multiple surgi-
mild tactile sensation in the eyeballs at an ini- cal procedures she continued to have chronic
tial current o f 0.5 mamps to a maximum o f 1.0 pain. She noted her average pain level at 75 and
mamps o f alternating current. This was d o n e described the pain as fairly severe to very
during the first two minutes o f each treatment. severe. MMPI revealed elevations on Scales 1
( H y p o c h o n d r i a s i s , T = 7 5 ) , 2 (Depression,
T = 77), and 3 (Hysteria, T = 79). She completed
six CES treatments before developing severe
Case Reports headaches. Minimal improvement was noted by
P a t i e n t O n e was a 73-year-old m a r r i e d the patient at the time she was removed from
w o m a n with graduate e d u c a t i o n . She had the research protocol. She was then treated
severe rheumatoid arthritis as well as severe with antidepressants, exercise, operant pain
osteoporosis with compression fractures. She control strategies, and self-hypnosis with good
reported being tense, nervous, and depressed. pain relief.
Vol. I No. 3 Summer 1986 Electrosleep and Chronic Pain 153

Patient Five was a 28-year-old married male electrical stimulation has been used primarily
with a college education. H e complained o f in the treatment o f insomnia, anxiety, and
tightness and cramping in the lower back, depression are much less encouraging. O f the
thigh, and calf consistent with myofascial pain. nine double.blind studies conducted thus far,
H e considered himself tense, nervous, but not one yielded equivocal results, four yielded posi-
depressed, T h e MMPI revealed elevations on tive results, a n d f o u r y i e l d e d n e g a t i v e
Scales 1 (Hypochondriasis, T = 78), 0 (Social results.2,3,5,7.16-20
Introversion, T=74), and 2 (Depression, Ryan and Souheaver 5 r e p o r t e d in a double-
T = 7 2 ) . H e was treated with CES without blind study that the decrease in the State Anxi-
improvement. ety Inventory occurred with CES in a heteroge-
Patient Six was a 37-year-old married male neous psychiatric p o p u l a t i o n using 24 subjects.
with a high school and technical school educa- These findings held true regardless o f the sug-
tion. H e complained o f an on-the:job injury gestability level o f the patient. Moore 19 found
while lifting a heavy object resulting in low that CES was ineffective for reducing anxiety as
back pain. His average pain level was 75 and measured by the Taylor Manifest Anxiety Scale
described as distressing and fairly severe. T h e (TAS). These conflicting findings may have
MMPI revealed elevations on Scales 1 (Hypo- been the result o f the differential sensitivity o f
chondriasis, T = 72) and 3 (Hysteria, T = 71). H e the two instruments, ie, the State Anxiety
had been treated with TENS, biofeedback, anti- Inventory is a more sensitive barometer o f
depressants, and an in-patient pain program anxiety.
without improvement. T h e patient received Cartwright and Weiss 2 r e p o r t e d in a double-
nine treatments of CES without improvement. blind study that CES improved the sleep habits
Patient Seven was a 55-year-old married male for most o f the active treatment subjects and
with a high school education. H e complained for a few o f those receiving sham treatment.
o f low back pain. His average Visual Analog McKenzie 21 has reported a marked and consis-
Pain Scale was 60 which he described as fairly tent increase in the production o f alpha waves
severe and distressing. T h e MMPI revealed ele- in the EEGs o f subjects receiving CES~
vations on Scales 1 (Hypochondriasis, T = 90), 2 Strauss, 2~ in a double-blind evaluation o f
(Depression, T -- 95), 3 (Hysteria, T = 73), and 0 CES for patients with insomnia, noted no dif-
(Social Introversion, T = 7 3 ) . A laminectomy ference between CES when compared with
with nerve root decompression, radical discec- phenobarbitol. Statistically, there appeared to
tom),, TENS, acupuncture, and trigger point be no difference between CES and sham t r e a t -
injections had given him no significant pain ment, though tiffs comparison was based o n
relief. H e was felt to have myofascial pain and patient and nurse observer experience rather
to be pain medication dependent. H e was than EEG quantification.
treated with CES without improvement. Rosenthal 3 demonstrated the efficacy of CES
in a double-blind crossover clinical study using
23 out-patients with neurotic anxiety and
Discussion depression. T h e active treatment group showed "
Electrosleep has been r e p o r t e d to be very marked improvement in total clinical ratings
effective in the treatment o f a massive array o f on anxiety, sleep disturbance, and depression,
heterogenous psychiatric, psychosomatic, and while the patients receiving inactive treatment
somatic disorders. 1~ These non-double blind showed m i n o r improvement in average total
reports were ahnost in complete agreement clinical ratings.
that cerebral electrical stimulation is effica- Gomez 16 evaluated the use o f CES treating 28
cious in the treatment o f multiple disorders. patients u n d e r g o i n g m e t h a d o n e detoxifica-
Review o f many o f the reports would indicate tion. He found the patients treated with CES
that cerebral electrical stimulation is beneficial showed a significant reduction in m e t h a d o n e
at least in part because o f a placebo effect. It is intake, while the placebo group and control
generally recognized that most forms o f ther- group were taking m e t h a d o n e at prior levels.
apy have the potential for a short-term sugges- H e also noted that anxiety scales came down
tive effect in improving patient complaints. significantly in the CES group but not in the
T h e double-blind studies in which cerebral others.
154 Schoenfeld et al. Journal of Pain and Symptom Management

H e a r s t t7 p e r f o r m e d a double-blind study not a controlled study, the lack o f therapeutic

with 28 heterogeneous psychiatric patients in a efficacy o f cerebral electrical stimuation can
m e t h o d which eliminated the peripheral tin- only be viewed as suggested, not established.
gling sensation o f the transcerebral current. Given the positive findings in some controlled
They found the degree o f improvement in studies, further trials in pain patients are war-
depression, anxiety, insomnia, and hypocho- ranted, specifically double-blinded, placebo-
driasis with active treatment and sham treat- controlled trials. T h e complications (severe
m e n t groups did not differ. Marshall and headaches) which occurred with two o f the
Izard 18 p e r f o r m e d a double-blind study in seven treated patients further support the view
which the group treated with sham therapy that cerebral electrical stimulation does not
received peripheral cranial but not transcere- offer a useful treatment modality in these
bral electrical stimulation. The two groups did patients; further controlled trials would be
not differ in reported measure o f depression. needed to r e c o m m e n d its use.
Feighner 7 carried out a double-blind cross-
over study with 23 neurotic subjects. T h e
patients demonstrated significant improve-
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