Immediately before each treatment determine the patient's current pain level and the positions that exacerbate the pain. Ask the patient to rate their present pain on a scale of 0 (no pain) to 10, with 10 being excruciating, debilitating pain. Tell the patient to consider 10 as "the worst this condition has been". Also note any immediate limitations-of-motion, positive orthopedic and neurologic test findings, and psychological distress. This therapy usually produces instantaneous results so these indicators are necessary reference parameters to determine effectiveness throughout a single treatment session.

As mentioned above, do not place the electrodes on each side of the spine for back pain as is done with TENS. With this placement the current will travel just under the skin and never reach the problem. A better way is to place one electrode next to the spine and the other on the contralateral side, anteriolaterally (front and opposite side). A line drawn between those will go right through the spinal nerves.

Treat head, neck, and back (axial skeleton) problems bilaterally. If the other side is ignored, there is a good chance the problem will have been missed because pain often exhibits on the tense side which may just be compensating for muscular weakness on the other side. So after a few 10 second approaches with small diameter probes, or about 10 minutes with self-adhesive electrode pads, reverse sides.

Often the pain will migrate as a response to therapy. Follow it. Use the same treatment strategy described above for the pain's new location.

Although most people will achieve immediate results, some will have a delayed effect and others will have a combined effect, continuing to improve over a day or two after the treatment.

Microcurrent electrical therapy will not work for everybody. However, as originally reported in an earlier version of this text, in nearly all cases of failure the common denominator is that the patient has had a significant exposure to a strong electrical current. This means that they have either been held by electrical current at some time in their life, or that they have been treated with milliampere TENS or similar modalities for a prolonged period of time (e.g., years). As yet, there is still no known effective method for treating people so afflicted.

The most commonly seen reversible reason patients fail to respond to treatment is that they have surgical or traumatic scars. Identify all scars by taking a very thorough, persistent history, and examining the patient completely. All scars are important no matter how old or how far they are from the chief complaint. Scar tissue impedes the systemic flow of endogenous bioelectricity because it is a poor conductor of electricity. Accordingly, scar tissue may interfere with the patient's entire bioelectrical system. If scars are present they should be treated with silver/silver-chloride (Ag/AgCl) electrodes for ten minutes per scar, at least four times. Simply cover the scars with the electrodes or, for large scars, place the electrodes on the ends of the scars. This may be done four days in a row or there can be a short interval of up to a few days between the scar treatments.

When treating scars the person may experience a significant surge of energy. It can be viewed as if an electrical bioresistor is broken down. Patients will often report feeling half their age, or 20 years younger after scar therapy. Since people have nothing to compare their life experience with, they usually attribute the subtle effects of scars on their electrical system as normal aging. Be aware that this treatment will more often than not also increase the pain because the whole body and mind "wakes up", including the painful part. However, when this happens in nearly all cases, the painful area can then be successfully treated. Always schedule enough time to treat the pain after the scar treatment so the patient will not need to endure even a temporary increase in pain.

If all the scars are treated and there is still no or poor results there are a few other options. Question the patient about old injuries that may not have healed properly. These could also be electrical blocks and should be approached in the same way as scars. To relieve pain in some patients a lower current setting of no more than 100 A with the Ag/AgCl electrodes for one or more hours at a time is necessary. Higher pulse repetition rates may produce results in some people when the 0.5 Hz fails, but this is rare.

Cranial electrotherapy stimulation (CES) is the application of low-level pulsed electrical currents (usually less than one milliampere) applied to the head for medical and/or psychological purposes.

Cranial electrotherapy stimulation has also been known by many other names. Transcranial electrotherapy (TCET), neuroelectric therapy (NET), alphasleep, electroanalgesia, electronarcosis and the original electrosleep are just a few of the more common terms that have referred to the same therapy.

Cranial electrotherapy stimulation was first called electrosleep because it was thought to induce sleep. Rabinovich, a Russian, is given credit for making the first claim for electrical treatment of insomnia in 1914 (Achte, Kauko, & Seppala, 1968). In 1957, in the U.S.S.R., Anan'ev et al. published the first work on CES and the first book, simply titled Electrosleep, was published a year later by Gilyarovski. This generated a high degree of interest in the then-known Eastern Block countries and CES was soon adopted as a treatment modality. Obrosow (1959) reviewed the CES literature and published the first American paper on CES. By 1966 the first International Symposium on Electrotherapeutic Sleep and Electroanesthesia was held in Austria. Cranial electrotherapy stimulation use had spread worldwide by the late 1960's when animal studies of CES began in the U.S. at the University of Tennessee, and at what is now the University of Wisconsin Medical School. These were soon followed by human clinical trials at the University of Texas Medical School in San Antonio, the University of Mississippi Student Counseling Center and the University of Wisconsin Medical School. There are well over 100 published reports on CES in the U.S. and several times that amount in the European literature.

The most comprehensive research review published to date on CES is a chapter in a textbook by Ray B. Smith, Ph.D. (1985). Dr. Smith has been researching CES since 1972. He concluded, "There are 40 studies of CES readily available in the U.S., in which the dependent variable is reliable. When these are examined alone it becomes apparent that CES is effective in alleviating symptoms of anxiety, depression, and insomnia...CES appears effective as a treatment for withdrawal in the chemically dependent person...Other promising areas of treatment are in hypergastric acidity and migraine headaches." Dr. Smith adds, "CES appears to be safe, with no harm or negative side effects having been reported to date in controlled studies...Finally, while one usually assumes some placebo effect from a treatment as dramatic as this, none has been reported in studies controlled for this effect." Sidney Klawansky, M.D., Ph.D. (1993) has recently concluded a meta-analysis of CES at Harvard and has also found it to be efficacious.

Open marketing of CES devices began in the 1970's in the U.S. for the treatment of anxiety, depression and insomnia. To date, several thousand Americans are treated with CES annually, and more than 50,000 people own CES devices which have been prescribed for home use. From a broad reading of the published literature, no negative effects or contraindications have been found from the use of CES, either in the U.S. or in other parts of the world. Regardless of these facts, CES is in jeapordy of being removed from the market in the United States due to a recent FDA action.

In addition to the accepted claims for anxiety, depression and insomnia, CES has been researched with significant results for many other conditions. Smith and Shiromoto (1992) showed it to be effective in blocking fear perception in phobic patients. Favorable results have also been reported for labor, epilepsy, glossalgia, hypertension, surgery, spinal cord injuries, chronic pain, arthritis, cerebral atherosclerosis, eczema, dental pain, asthma, ischemic heart disease, stroke, motion sickness, digestive disorders as well as