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11/25/2012 12:17 PM

Transcranial direct current stimulation

jpcrps
jpcrps  
Posts: 1661
Senior Member
I'm an Advocate

I had never heard of this before, but it has been studied by the NIH, and is approved by FDA for pain. It looks a bit like an electrically generated lobotomy technique to me, but is apparently comparable to a TENS unit for the brain. I have heard of deep brain stimulation, but i think that is a different 'in patient' technique done at hospital.

I found out about this device while cruising another CRPS support forum and hunted down this abstract from the NIH which specifically deals with pain and references the CRPS population. NIH has other studies relating to Fibromyalgia, drug and alcohol treatment (detox). It also refers to TMS - transcranial magnetic stimulation, of which I also know nothing!

Has anyone else heard of this or tried it? I did find an old post from 2010 on TMS, but at that point there was no FDA approval.

Please find below the abstract. The forum I was searching had a 4 page discussion of the device, with positive comments. I also searched for makers of the device who stated that ordering the device required a letter from a doctor and that most insurance will cover it for pain.

Has anyone else has heard of this or tried it? I will be asking my PM about it!

http://www.ncbi.nlm.nih.gov/pubmed/20336445

NIH ABSTRACT:

In the last decade, radiological neuroimaging techniques have enhanced the study of mechanisms involved in the development and maintenance of neuropathic pain. Recent findings suggest that neuropathic pain in certain pain syndromes (e.g., complex regional pain syndrome/reflex sympathic dystrophy, phantom-limb pain) is associated with a functional reorganization and hyperexitability of the somatosensory and motor cortex. Studies showing that the reversal of cortical reorganization in patients with spontaneous or provoked pain is accompanied by pain relief stimulated the search for novel alternatives how to modulate the cortical excitability as a strategy to relieve pain. Recently, non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) were proposed as suitable methods for modulation of cortical excitability. Both techniques (TMS and tDCS) have been clinically investigated in healthy volunteers as well as in patients with various clinical pathologies and variety of pain syndromes. Although there is less evidence on tDCS as compared with TMS, the findings on tDCS in patients with pain are promising, showing an analgesic effect of tDCS, and observations up to date justify the use of tDCS for the treatment of pain in selected patient populations. tDCS has been shown to be very safe if utilized within the current protocols. In addition, tDCS has been proven to be easy to apply, portable and not expensive, which further enhances great clinical potential of this technique.

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The FDA approval which I found did not include pain...although depression, anxiety and insomnia were approved... The FDA refers to it as Cranial Electrical Stimulation.

SEE: http://www.fda.gov/downloads/AdvisoryCommittees/ CommitteesMeetingMaterials/MedicalDevices/ MedicalDevicesAdvisoryCommittee/NeurologicalDevicesPanel/ UCM290787.pdf

dated Feb, 10,2012

"4.3

CES has been investigated for a variety of uses over the years, including, but not limited to conditions such as pain, asthma, and attention deficit disorder. As noted above, the public comments also describe a number of different uses. However, the discussion will be limited to the currently cleared indications and those for which petitions have been received. All other uses are beyond the scope of these proceedings."

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Hoping some of you have responses or experience with this device. It has been pretty quiet around here over the holidays.

Love,

Jenny

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11/25/2012 12:28 PM
revvanbus
revvanbus  
Posts: 2032
VIP Member

Sounds promising for at least some of us. The main problem until the FDA releases it as a treatment for chronic pain is that many insurances will pay only part if any for the treatments. Please check with your insurance company(s) to see that you would not end up deep in debt. I hope it helps and gives us another option to try.

Jenny, thanks for reporting on it.

Rev.

Rev.


11/25/2012 12:50 PM
jpcrps
jpcrps  
Posts: 1661
Senior Member
I'm an Advocate

IDK if I missed an FDA approval. The suppliers web site provides a ICD-10 code for using it for pain and names 3 insurance companies that will cover it for pain.

11/26/2012 03:40 PM
footinmouth
Posts: 282
Member

I've not heard of "Transcranial Direct Current Stimulationalso heart it referred to as TCMS). In the UK there is some research being done with regards to TCMS. I'm currently waiting to get approved for a research study.

I believe the basic theory is that electromagnetic pulses are used on the brain to temporarily interrupt the firing sequences. This allows them to reset themselves. It's used in conjunction with a fMRI to target a specifically affected part of the brain. TCMS has been used since the 60's I believe but more for depression. The research that is being completed with regards to pain is all new.

That's about all I know. If I get into the research study here I'll post the results. Don't expect anything soon though as I've been trying to get into the study for about 9 months now and I've only just got is passed my pain specialist.


11/27/2012 12:53 AM
jpcrps
jpcrps  
Posts: 1661
Senior Member
I'm an Advocate

I am a little skeptical of this one. People don't know enough about the brain yet. Clearly there are elecromagnetic waves that surround and infuse the body. not sure i want to tinker with them yet.

Best of luck to you in this study, and I hope you will find that this is an important step forward. i know that they have discovered 5 different brain areas that are changed due to crps. Not sure that this device, or the TCMS can target the necessary areas cleanly enough... but much is yet to be learned, and i will be hopeful for you and for all of us.

Love,

jenny


11/28/2012 05:48 PM
footinmouth
Posts: 282
Member

The first step for me (after getting in if they are still even doing the study) is to find out what it's all about. I have horrible sensitivities to pharmaceuticals so I have no idea how I might respond.

I agree that there's probably not enough known about the brain but there's also so little information about TCMS that I want to get that information before I make a decision. The last thing I want is to have some additional issue like constant drooling or wetting myself.

As I understand, the fMRI gives a good idea as to the area affected and the design of the devices allows the pulses to target very specific areas. Beyond that it does seem a bit crude. Just a bit flashier version of electroshock.

fim


11/28/2012 09:39 PM
jpcrps
jpcrps  
Posts: 1661
Senior Member
I'm an Advocate

FIM,

Very interested to hear your updates. There are places on line selling these things for home use.... no controls.... Wishing you MUCH success with this.

Love,

Jenny


11/29/2012 02:16 PM
footinmouth
Posts: 282
Member

Home use???? NOOOOOOOOOO!! Why not just do a little open heart surgery on the dining room table while we're at it?

11/29/2012 02:21 PM
revvanbus
revvanbus  
Posts: 2032
VIP Member

Too new, too experimental, too much potential for permanent injury to brain and nervous system. I think I'll pass, thank you.

Rev.


11/30/2012 05:22 PM
footinmouth
Posts: 282
Member

I watched a show a while back about lobotomy's (lobotomies?)...

I was interesting to see how essentially brutal and crass they were with little regard for what you might call scientific procedure and understanding. Funny thing is that much of the work done with some of the older crude brain surgery and treatments has lead us to the understanding of the brain that we have today, which is apparently pretty immense compared to 60 or so years ago.

I've never been 100% keen on TCMS but when you can't do the meds and the only thing you have to keep the pain at bay is your own will... you start to think the extreme things are actually pretty reasonable. Maybe todays TCMS is yesterdays lobotomy.

Frankly, I'm not to sure that the long term effects are known, but you never do until someone gives it a go. I guess it's a matter of who wants to volunteer. I'm still not sure. What I do know is that I don't want to end up pissing myself and forgetting who I am every time someone turn on a microwave.

By the way, Thanks Jenny.

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