title: Efficacy of cranial electrotherapy stimulation for neuropathic pain following spinal cord injury: a multi-site randomized controlled trial with a secondary 6-month open-label phase.
abstract: BACKGROUND
  Chronic pain is a significant problem for many individuals following spinal cord injury (SCI). Unfortunately, SCI-related neuropathic pain has proven to be largely refractory to analgesic medications and other available treatments. Cranial electrotherapy stimulation (CES) has been effective in managing some types of pain. It involves the application of a small amount of current through the head via ear clip electrodes.
  
  
  OBJECTIVE
  Explore the effectiveness of CES for neuropathic pain in persons with SCI and chronic pain.
  
  
  METHODS
  Multi-site, double-blind, sham-controlled study.
  
  
  METHODS
  Adults with SCI and chronic neuropathic pain at or below the level of injury were randomized to receive active or sham CES.
  
  
  METHODS
  Application of active CES or sham CES 1 hour daily for 21 days. Six-month open-label phase to assess 'as-needed' CES use.
  
  
  METHODS
  Change in pre- to post-session pain ratings as well as change in pain intensity, pain interference, pain quality, pain beliefs and coping strategies, general physical and mental health status, depressive symptomatology, perceived stress, and anxiety pre- to post-treatment.
  
  
  RESULTS
  The active group reported a significantly greater average decrease in pain during daily treatments than the sham group (Kruskal-Wallis chi-square = 4.70, P < 0.05). During the 21-day trial, there was a significant group × time interaction for only one outcome variable; the active group showed larger pre- to post-treatment decreases in pain interference than the sham group did (F = 8.50, P < 0.01, d = 0.59).
  
  
  CONCLUSIONS
  On average, CES appears to have provided a small but statistically significant improvement in pain intensity and pain interference with few troublesome side effects. Individual results varied from no pain relief to a great deal of relief.
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. tan.gabriel@va.gov
authors.forename: Gabriel
authors.initials: G
authors.lastname: Tan
authors.forename: Diana H
authors.initials: DH
authors.lastname: Rintala
authors.forename: Mark P
authors.initials: MP
authors.lastname: Jensen
authors.forename: J Scott
authors.initials: JS
authors.lastname: Richards
authors.forename: Sally Ann
authors.initials: SA
authors.lastname: Holmes
authors.forename: Rama
authors.initials: R
authors.lastname: Parachuri
authors.forename: Shamsi
authors.initials: S
authors.lastname: Lashgari-Saegh
authors.forename: Larry R
authors.initials: LR
authors.lastname: Price
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000209:etiology* / Q000628:therapy*; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D013119:Spinal Cord Injuries / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome