February 14, 2018
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Cranial electrotherapy safe, may benefit anxiety, depression

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Low-strength evidence indicated that cranial electrical stimulation does not result in serious harms and may improve outcomes in patients with anxiety or depression, according to research published in Annals of Internal Medicine.

Cranial electrical stimulation (CES) is increasingly popular as a treatment, yet its clinical benefit is unclear,” Paul G. Shekelle, MD, PhD, from West Los Angeles Veterans Affairs Medical Center, and colleagues wrote.

Shekelle and colleagues performed a systematic review of data from 26 randomized trials to determine the effects of CES for the treatment of chronic painful conditions, depression, anxiety and insomnia.

The researchers found that two trials with small sample sizes comparing CES with usual care did not indicate a statistically significant benefit in pain for patients with fibromyalgia or anxiety for those with an anxiety disorder. There were conflicting results among 14 trials that used sham or placebo controls for painful conditions, including headache, neuromuscular pain and musculoskeletal pain.

A potential modest benefit was observed with CES vs. sham treatments for anxiety and depression in four older trials and one from 2014. Inconclusive or conflicting findings were seen in trials involving patients with insomnia (n = 2), insomnia and anxiety (n = 1) or depression (n = 3).

“The evidence for the effectiveness and safety of CES is sparse,” Shekelle and colleagues concluded. “Low-strength evidence suggests a beneficial association in patients with anxiety and depression. The intervention is probably safe, but strength of evidence is low because few RCTs reported adverse events.”

In an accompanying editorial, Wayne B. Jonas, MD, from Samueli Integrative Health Programs in Alexandria, Virginia, wrote that the review by Shekelle and colleagues should prompt physicians to be more cautious in using CES.

“We do not know [its] mechanism of action, so the effects may be achievable with self-care approaches that are less expensive and less passive,” he wrote. “Clearly, we need to know more on how it works, not only compared with sham CES but also with other approaches, both drug- and nondrug-based.” – by Alaina Tedesco

Disclosure: Shekelle and Jonas report no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.