# Alpha-Stim ## Posts ### What Does Pain Medicine Do to Your Body? What Does Pain Medicine Do to Your Body? Pain medications are primarily designed to block pain signals in the body or they alter the way your brain perceives pain. Common categories of pain killers include opioids, NSAIDs (Nonsteroidal Anti-inflammatory Drugs), and acetaminophen. Each affects the body in different ways. But is pain relief really only possible with medication? A Breakdown of how different types of painkillers affect the body Opioids: The most common pain medication, opioids include pain relievers like morphine and oxycodone. These painkillers bind to opioid receptors in the brain and spinal cord. When they bind, they block pain signals and produce feelings of euphoria. Opioids are typically used for severe pain, often post-surgical. They are known to make you feel drowsy and lead to tolerance build-up, dependence, and addiction. Opioids can also make you feel nauseous, constipated, and cause slower breathing. NSAIDs: You’re probably familiar with these - ibuprofen and naproxen are two examples. NSAIDs work to reduce inflammation and block the production of chemicals (cyclooxygenase enzymes) in the body that create pain and swelling. NSAIDs are commonly used for arthritis, reducing fever, menstrual cramps, physical injuries, and chronic pain conditions. But while NSAIDs are often available over the counter, they still pose risks. For example, overuse of NSAIDs can lead to stomach problems, ulcers, and in some cases, can cause heart or kidney problems. Read more about using NSAIDs from the National Institutes of Health here.  Acetaminophen: You are definitely familiar with this one if you’ve ever had a sports injury or headache.  Acetaminophen works similarly to an NSAID, reducing pain signals in the brain. It’s often a go-to for reducing fever, and is generally considered safe when taken as directed. However, similar to NSAIDs, taking acetaminophen in high doses or too much, too long, can cause problems. Specifically, high doses of acetaminophen can cause severe liver damage and harm your kidneys. Anticonvulsant and Neuromodulators: Specifically, in this case, we’re talking about Gabapentin. Mistakenly thought to be an NSAID, gabapentin is an anticonvulsant and neuromodulator. It is often prescribed to help with pain, particularly nerve pain, but it does not target the enzymes that create pain and swelling like an NSAID. Gabapentin specifically affects the calcium channels in the nervous system and is thought to work by reducing the transmission of pain signals. Pain Relief Medications Pose Long-term Risks Did you notice the theme in the above? Pain killers are designed to inhibit (block) or modulate. Pain relief comes from altering the way pain signals are delivered to the body, whether this is a chemical, a channel in the body, or a signal. But the one thing they also have in common is that prolonged use can lead to dependence and addiction (among other side effects). Moreover, when used too often or inappropriately, pain medications can harm the rest of your body. So when exploring pain management therapies, pain relief medications may not be the best option if you are suffering from chronic pain, or even acute pain (and especially if you have other health issues). Alternative Pain Management Therapy for Acute Pain and Chronic Pain While some medications may offer quick pain relief, there is a safer option for both acute and chronic pain that can be used at home and long-term. One of the things we love about Alpha-Stim is that, unlike many prescription medications, Alpha-Stim doesn’t pose the risk of addiction, tolerance, or the severe side effects medications can cause. People with implanted pacemakers or implanted or wearable defibrillators, and who are pregnant, should not use Alpha-Stim. With Alpha-Stim, adverse effects are usually rare (occurring less than 1% of the time), and are mild, and self-limiting. The potential effects of using Alpha-Stim for some people include feeling dizzy, headaches, or potential skin irritations. See more about indications and risks here. Does Alpha-Stim work for relieving pain? Here is what some users say: “Not only have I experienced relief from anxiety and insomnia; additionally, Alpha-Stim treatments have reduced or eliminated accompanying physical pain.” - CH (MAJ) David J. Fair, PhD, Former President, American Association of Police Officers, Former President, Homeland Crisis Institute, USA “Alpha-Stim was the first thing that helped manage chronic moderate-to-severe pain where drugs of different kinds could not. Those I referred Alpha-Stim to over the years have had similar experiences.” - Paul Schaum, Facebook, USA “I am honestly amazed by this tiny little magical device! I suffer from a selection of health issues that cause chronic pain (Ehlers-Danlos Syndrome, Complex Regional Pain Syndrome) and have been searching for ways to manage this holistically. I have definitely noticed a cumulative reduction in pain and have also found it incredibly useful in managing anxiety. It is hard to put into words how much it helps - it truly is something you need to try to understand! Aside from the therapeutic benefits, I have been truly blown away by the amazing customer care from Alpha-Stim. I feel like a valued customer and patient and I am so grateful to have your support! Highly, highly recommend!!!” - Caitlin Dione Booth, TrustPilot, UK See how Alpha-Stim works for acute pain relief, chronic pain relief, and post-traumatic pain relief > Talk to a Doctor About Alpha-Stim > *Alpha-Stim is FDA cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. Sources: https://nida.nih.gov/publications/drugfacts/prescription-opioids https://www.ncbi.nlm.nih.gov/books/NBK361006/ ### Melatonin vs Alpha-Stim for Better Sleep Melatonin vs Alpha-Stim for Better Sleep Some over-the-counter sleep supplements and prescription medications are associated with making you feel groggy and foggy the next morning. And if you’re already taking medication for other health conditions, adding one more to the mix may not be a good idea. Below, we outline why Alpha-Stim® may be a better choice than melatonin for getting better, longer sleep. Taking Melatonin May Make You Drowsy or Dizzy Daytime drowsiness. Feeling dizzy or nauseous. Headaches. These are all common side effects of melatonin, according to the  Mayo Clinic and the Sleep Foundation. Other less common side effects include:Changes to your mood (feeling depressed or anxious)Vivid dreams or nightmaresConfusionReduced alertnessAbdominal crampsWhile a relatively common sleep aid, the adverse effects of melatonin tend to occur with higher doses or with options that are designed to provide extended release. Plus, part of the reason daytime drowsiness is cited as a common side effect is that melatonin can also remain active in the body for longer periods of time, especially in older adults.  Why is Alpha-Stim Better for Helping You Sleep? While melatonin is suggested for insomnia, as the Mayo Clinic points out, there’s no clinical evidence showing its effect on sleep quality and duration: “Research suggests that melatonin might slightly reduce the time it takes to fall asleep, but its effects on sleep quality and total sleep time aren't clear.”Meanwhile, Alpha-Stim has been thoroughly researched and is backed by clinical evidence to show that it can:Improve sleep durationImprove sleep qualityWorks better than common sleep medicationsPlus, unlike the side effects that come with melatonin and other drugs for sleeping disorders, there are no such side effects with Alpha-Stim. This means you can sleep longer and better without any regrets the next morning. Some patients find immediate sleep improvements, while others take a few weeks.And because the effects of Alpha-Stim build on the progress of the last session, many Alpha-Stim users see increased levels of relief over time. Moreover,  because Alpha-Stim uses Cranial Electrotherapy Stimulation (CES), Alpha-Stim users are free from the worry of dependence and withdrawal that you could experience with certain sleep medications. Finally, while melatonin may address sleep problems, it cannot address the underlying causes of insomnia, including (but not limited to) anxiety, depression*, or pain. Alpha-Stim can! See what people say about Alpha-Stim for sleep >  Get Alpha-Stim yourself > *Alpha-Stim is FDA cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. Sources:https://www.mayoclinic.org/drugs-supplements-melatonin/art-20363071 https://www.sleepfoundation.org/melatonin/melatonin-side-effects Lichtbroun AS, Raicer MMC, Smith RB. The treatment of fibromyalgia with Cranial Electrotherapy Stimulation. Journal of Clinical Rheumatology. 2001; 7(2):72-78.Kirsch, D.L., Price, L.R., Nichols, F., Marksberry, J.A., & Platoni, K.T. Military Service Member and Veteran Self-Reports of Efficacy of Cranial Electrotherapy Stimulation for Anxiety, PTSD, Insomnia, and Depression. (2014). The Army Medical Department Journal, 46-54.  ### What Can a Lack of Sleep Do to My Body? What Can a Lack of Sleep Do to My Body? Sleep is crucial to your health and well-being. And we mean everything. From having energy to focus and think clearly, to going on a morning run, to regulating your emotions, gut, and hormones. A lack of sleep can disrupt normal bodily functions and slow down your body and brain’s ability to function at their best. What a Lack of Sleep Can Cause  1. Emotional DysregulationFeeling frustrated, irritable, or like you can’t get control of your emotions? That’s from not getting enough sleep. And when you go longer without enough good quality sleep, your body can enter a negative feedback loop, which can worsen both sleep and mental health.In one study, the University of Pennsylvania researchers found that subjects who slept only 4.5 hours a night for one week reported feeling more stressed, angry, sad, and mentally exhausted. And when the same individuals resumed a normal sleep schedule, they also reported a dramatic improvement in their mood.Going without sleep can:Cause irritability and stressLead to the development of a mood disorder Make you feel more angry and frustratedHeighten your emotional reactions to positive and negative situationsMake it harder to regulate your emotionsMake depression worseCan blunt positive emotions, making it harder to feel excited, happy, or even contentDecrease your ability to feel pleasure or enjoyment from activities you usually loveImpair your ability to recognize and interpret emotions in yourself and othersResult in less control over emotional responses 2. Increased AnxietyEver notice how when you’re sleep deprived, you’re more easily agitated, stressed, more easily angered, and have trouble focusing? That’s because there is a strong link between sleep deprivation and increased anxiety.And data backs this up. “Sleep deprivation makes us less happy, more anxious” is the title of a study summary from the American Psychological Association after they synthesized more than 50 years of research on sleep deprivation and mood. One of the study authors, Cara Palmer, PhD, said,  “This study represents the most comprehensive synthesis of experimental sleep and emotion research to date, and provides strong evidence that periods of extended wakefulness, shortened sleep duration, and nighttime awakenings adversely influence human emotional functioning.”  The researchers found that a lack of sleep resulted in fewer positive emotions (joy, happiness, contentment) and increased anxiety symptoms (increased worrying, rapid heart rate).  The link between sleep and anxiety:Anxiety can cause restless sleepIncreased anxiety can make sleep issues worseSleep problems can increase anxiety levels and make it harder to cope with daily stressorsNot enough sleep can make existing anxiety symptoms worseInsufficient sleep over time can cause an anxiety disorder  3. Hormone IssuesNot getting enough sleep can impact hormone levels big time. And, the reverse is true as well. When hormones are deregulated, your sleep quality can also diminish. A lack of sleep can disrupt the release of critical hormones (ones that impact your metabolism, weight, ability to sleep, and more). Specifically, sleep deprivation can disrupt the release of cortisol, melatonin, leptin, ghrelin, estrogen, progesterone, and thyroid hormones. Poor sleep also interferes with your circadian rhythm, and this is your body’s internal clock it uses to regulate hormone release.  When the circadian rhythm is interfered with, this can cause further hormonal imbalances. 4. Weight GainDid you see us mention cortisol, leptin, and ghrelin above? Yep. When sleep disrupts these hormones, it causes a significant impact on weight management. Why? Those hormones are responsible for appetite, metabolism, and overall energy expenditure. When they are unbalanced, this can lead to increased hunger, decreased feelings of fullness, and slow down your metabolism. As a result of less sleep, your body may either be burning fewer calories, or you could end up eating more, and as a result, gain weight. Cortisol increases can also lead to increased fat storage, so as cortisol levels become more unbalanced (higher) due to sleep deprivation, your body is triggered to think it’s in danger or will store more fat. Sleep longer and better with Alpha-Stim® Alpha-Stim is something many are choosing to help with insomnia and improve both the amount of time they sleep and the quality of sleep they get. It’s not like melatonin, which can make you feel hungover the next morning, either. Alpha-Stim is a drug-free alternative and something that can also help relieve anxiety.See how Alpha-Stim can help you get better sleep. INCREASED SLEEP TIME After only 5 treatments, military Service Members with insomnia reported an increase of 43 minutes of sleep.1 IMPROVED SLEEP QUALITY In one study, the number of subjects rating their quality of sleep as poor dropped from 60% to 5% after using Alpha-Stim.2 Preferred Over Medication One survey showed patients feel better with Alpha-Stim insomnia treatment than with common sleep drugs.3 Also Treats Anxiety Alpha-Stim is also designed to treat anxiety, providing patients with simultaneous anxiety and insomnia relief.Sources:https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-https://www.columbiapsychiatry.org/news/how-sleep-deprivation-affects-your-mental-healthhttps://www.bannerhealth.com/healthcareblog/teach-me/how-sleep-can-affect-stresshttps://www.healthline.com/health/sleep/how-sleep-can-affect-your-hormone-levels https://www.sleepfoundation.org/mental-health/anxiety-and-sleepDinges, D. et al., Cumulative Sleepiness, Mood Disturbance, and Psychomotor Vigilance Decrements During a Week of Sleep Restricted to 4 – 5 Hours Per Night, Sleep. 1997 Apr; 20 (4): 267–277.https://pmc.ncbi.nlm.nih.gov/articles/PMC2831427/https://www.webmd.com/sleep-disorders/features/insomnia-emotional-tollhttps://www.ynhhs.org/articles/does-lack-of-sleep-cause-weight-gainhttps://www.healthline.com/nutrition/sleep-and-weight-loss Lande RG, Gragnani C. Efficacy of Cranial Electric Stimulation for the treatment of insomnia: A randomized pilot study. Complementary Therapies in Medicine. 2013; 21(1):8-13.Lichtbroun AS, Raicer MMC, Smith RB. The treatment of fibromyalgia with Cranial Electrotherapy Stimulation. Journal of Clinical Rheumatology. 2001; 7(2):72-78.Kirsch, D.L., Price, L.R., Nichols, F., Marksberry, J.A., & Platoni, K.T. Military Service Member and Veteran Self-Reports of Efficacy of Cranial Electrotherapy Stimulation for Anxiety, PTSD, Insomnia, and Depression. (2014). The Army Medical Department Journal, 46-54. ### Why is My Anxiety So Bad? Why is My Anxiety So Bad? Anxiety can be caused by a number of factors. Some people may not even experience anxiety until they’re adults, while others may deal with it throughout their lives. Life experiences, genetics, underlying medical conditions, negative thought patterns, lack of sleep, and stressful situations can all cause anxiety and make it worse. So if you’re asking yourself, “Why is my anxiety so bad?” lately, take a closer look at the potential causes, contributing factors, and our recommendations for next steps. Life Experiences and Stress Stress is well known for making anxiety work. Work pressure. Relationship problems. Financial concerns. Major life events like moving, losing a loved one, divorce, or unemployment can also trigger or worsen both stress and anxiety. This year alone, CNN reported that rising job market anxiety has coincided with relatively stable unemployment, jumping to the highest level it’s ever been. When your body is exposed to stressful situations, both in the short- and long-term, it can contribute to anxiety and exacerbate how bad it can get. Traumatic events like abuse or neglect can also make anxiety worse. And when these things build up, or combine with negative thoughts, other lifestyle factors, that’s when you really start to feel overwhelmed and anxious. Negative Thought Patterns and Behaviors You’ve heard it before - speak kindly to yourself. Practice self-love. Practice positive thoughts and manifest good things. It’s not just some Instagram-quote nonsense. It’s good advice. Constant negative self-talk, overthinking, and excessive worrying can increase anxiety and become harmful patterns that are hard to break. Part of managing high-functioning anxiety is also learning how to create healthy coping mechanisms to avoid the negative internal spiral of self-critical thoughts and ruminating over things too much. Mayo Clinic wrote a great article on managing high-functioning anxiety, and we absolutely recommend checking it out if you relate to this. Biological Factors If your mom or dad struggles with anxiety, it’s likely you will too. A family history of anxiety disorders can increase the likelihood that you may also have anxiety. [The National Institute of Mental Health specifically looks at generalized anxiety disorder and genetics here.] Beyond your genetics, your brain chemistry (which can be influenced by hormones like cortisol and involves certain areas to help regulate emotions and fear), and any underlying medical conditions like thyroid or heart issues can trigger anxiety or make symptoms worse. Imbalances in your hormones and brain chemistry can contribute to anxiety, and when you’ve crossed everything else off the list, it may be time to look inside (literally) and see if your physical health is making your anxiety worse. Lifestyle Factors What you eat. How well you sleep. If you're moving your body enough. How you live your life can have a big impact on anxiety. Not sleeping enough can make anxiety worse Eating a poor diet can impact both your physical and mental health, potentially contributing to making your anxiety worse Not moving your body enough can create more tension and worsen anxiety If you drink too much caffeine or alcohol, or use certain drugs and medications, the American Medical Association has found that your anxiety can get worse as a result What to Do When Your Anxiety is Too Much If your anxiety is severe or persistent, the very first thing to do is seek help from a mental health professional. This is especially important if your anxiety is interfering with your daily life, causing panic attacks, and you’ve tried self-help strategies and are still struggling to cope. We also recommend discussing Alpha-Stim® with your therapist or doctor, as it can be used during your therapy sessions, at home, at the office, and multiple times a day. For people struggling with anxiety, this small device has been found to significantly reduce anxiety and enable calm, relaxation, and focus. Alpha-Stim user Emma recently shared her experience on TrustPilot: “Fantastic device! I've suffered with general anxiety and panic attacks along with insomnia for years. The device is portable, easy to use and calms my mind down, allowing me to relax.” > Get more information about Alpha-Stim here! > Set up a telehealth appointment here and see if Alpha-Stim is a good option for you.  Sources: https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-managing-anxiety-disorders# https://medvidi.com/blog/signs-your-anxiety-is-getting-worse  https://www.piedmont.org/living-real-change/signs-you-have-too-much-anxiety https://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder-gad https://www.medicalnewstoday.com/articles/why-is-my-anxiety-so-bad  ### Anxiety Symptoms & Signs Anxiety Symptoms & Signs Anxiety can present in a variety of ways, and you can experience anxiety intermittently or all the time. Sometimes triggers like a stressful job, a toxic relationship, or chaotic environments can make your anxiety worse. You may sometimes wonder if it’s fear or anxiety, and be searching “how to know if you have anxiety” (or the quick text version “how to know if u have anxiety”). Below are some physical signs and symptoms that could mean you’re experiencing anxiety. Physical signs of anxiety Be on the lookout for these five common physical signs of anxiety. Rapid heartbeat: A faster, more noticeable, and possibly irregular heartbeat Breathing difficulties: Having a hard time breathing or breathing rapidly Excessive sweating: Sweating more than usual, even when it's not warm out Dizziness: Feeling lightheaded or dizzy Heaviness or smothering sensations: Chest pain or feelings of smothering and heaviness Restlessness: Feeling like you can’t sit still and are agitated can be a sign of anxiety Muscle tension: Stiff and tense muscles, especially in your upper back, shoulders, and neck area Fatigue: Even when sleeping a good 8 hours, you feel drained or tired Stomach problems: Anxiety can cause gastrointestinal issues, including nausea, diarrhea, and even irritable bowel syndrome If you notice them happening more often, it's probably time to explore some options for anxiety treatment, especially if natural remedies or soothing self-care activities aren't enough anymore. How to know whether you have anxiety Identifying the physical signs above is a good place to start if you’re trying to determine if you have anxiety or not. Anxiety is a complex condition, and often recognizing it involves identifying physical and emotional symptoms. Some emotional and cognitive symptoms of anxiety to also keep in mind: Excessive worrying Feeling overwhelmed Difficulty focusing on tasks, making decisions, or concentrating in general Feeling on edge or restless Easily frustrated, impatient, or angry Having a panic attack Avoiding activities, situations, settings, or people that trigger anxiety symptoms (even if they’re important, like a job) Feeling detached or disconnected from others, your surroundings, and even your own body If these symptoms interfere with your daily life, seeking guidance from a doctor or mental health professional is crucial for accurate diagnosis and treatment. For some people, anxiety can be persistent and severe, while others may only have mild anxiety or anxiety when specific conditions are present. This is why talking with a mental health professional about your anxiety treatment options - like Alpha-Stim® - is a good first step. Options for treating anxiety quickly There are a variety of options for treating anxiety. Therapy is common, and medication has become less popular as people become more aware of the side effects. Alpha-Stim is another option. This small, handheld device is FDA-cleared for treating anxiety (and insomnia - because let’s face it, if you’re anxious, your sleep is likely awful, and if you’re not sleeping, your anxiety is probably getting worse). Why consider Alpha-Stim® over anxiety medication? Besides the fact that it costs less than medication long-term, Alpha-Stim also doesn’t have the lasting side effects that medications for anxiety and insomnia do. Plus, if you’re sensitive to medication or already on other medications and worried about interference, Alpha-Stim is a much better option. You can also use Alpha-Stim alongside other anxiety treatments. > Get some quick information about Alpha-Stim and how to get your own here! > Schedule a telehealth appointment to get Alpha-Stim Sources: https://health.ucdavis.edu/blog/cultivating-health/symptoms-of-anxiety-and-how-to-know-when-you-need-help/2024/08 https://www.webmd.com/anxiety-panic/ss/slideshow-anxiety-physical-symptoms  https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/feelings-and-symptoms/anxiety-disorder-signs/ ### Empowering Veterans Through Alpha-Stim Blog Empowering Veterans Through Alpha-Stim The following video is episode 18 of The Unseen Journey, a podcast from Operation Red Wings Foundation that’s dedicated to supporting veterans and their families who are navigating life after the military. In Episode 18, special guest Tonja Trammell, EPI Vice President of Government Services, shares Alpha-Stim and its impact on mental health and well-being. The episode also dives into various applications of Alpha-Stim, its benefits, and how it has helped veterans to manage anxiety, insomnia, and chronic pain. Watch the podcast below! *Alpha-Stim is FDA-cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. ### 4 Tips for Managing Depression When Retired Blog 4 Tips for Managing Depression When Retired 1. Create a Sense of Structure No matter how fulfilling their career, many people look forward to the day they can retire. Without having to work, they think of all the time they can spend doing the things they enjoy, seeing the people they love, and passing their days as they please.It can be a shock to then realize that retirement isn’t always unconditionally happy. Some people dive enthusiastically into their retirement only to find that where they expected joy and ease, they are instead experiencing symptoms of depression. Many retired adults may miss the sense of identity, meaning, or purpose that a career provides. Some miss the structure it gives each day. Others miss the embedded social aspect of co-workers. Here are four tips to help handle depression when adjusting to retirement.Without the structure of a typical workday, you may feel overwhelmed by the blank slate of the day ahead of you. It may be tempting to spend the whole day doing absolutely nothing or there may be an urge to fill every moment with something productive. Neither extreme is ideal, caution experts at Harvard Medical School: “Doing either too little or too much can lead to the same symptoms, such as anxiety, depression, appetite loss, memory impairment, and insomnia.”You don’t need to map out each and every day, but it may be helpful to have some basic elements in place. For example, you can establish a weekly tennis match with friends, or make a habit of going for a stroll after dinner. Maybe you decide that Wednesday mornings are the perfect time to call a relative, or that Sunday afternoons are great for sitting down with the newspaper and a coffee. Whatever it is, establishing some type of structure will give you something to look forward to, and a sense of accomplishment. 2. Explore Your New Sense of Self Just as your employment gave structure to your days, it also contributed to your sense of self. Even if you worked to live, rather than lived to work, your employment was likely a defining part of your life. Many people take great pride in their roles, proudly introducing themselves along with their titles.According to Nancy Schimelpfening, from the non-profit Depression Sanctuary, “The person’s sense of self is tied up very strongly in what he or she does for a living; and, with retirement, a sense of loss can occur, leaving a person struggling to understand who they are and what their value is.”Take a moment to remember what invigorates you, and what your values are. Try keeping a journal and reflecting on what’s important to you now, what new goals you’d like to accomplish, and what ideas you have for the year. 3. Get Active Outside & in Your Community Yet another factor that can contribute to depression in retirement is the change in your social life. When you were working, you likely had regular social interaction with coworkers, supervisors, clients, and/or vendors. And now, all of a sudden, that network is no longer a part of your day-to-day routine.Regular social interaction is essential to our mental health: “Dozens of studies have shown that people who have satisfying relationships with family, friends and their community are happier, have fewer health problems, and live longer,” according to Harvard Women’s Health Watch.When retired, consider new ways to create connection and social interaction.Go for a hike with friendsJoin a community activity groupVolunteer at a local animal or homeless shelterJoin an organization for a cause that’s become important to you Try a new hobby 4. Consider Extra Support Perhaps you’ve taken all the right steps already – you’ve added structure to your days, logged some volunteering hours, and regularly connected with loved ones – but you’re still feeling depressed. What now? Are antidepressants the necessary next step to relief?You may be surprised to learn that there is a safer option for treating depression. Unlike antidepressant medications, Alpha-Stim is a medical device that offers a drug-free option. Alpha-Stim® M and Alpha-Stim AID devices offer a safe, effective, and easy option. While Alpha-Stim is only FDA-cleared for anxiety, insomnia, and pain, it is approved for depression outside of the United States.Learn more about how Alpha-Stim works for depression here > Decrease in Depression In clinical trials, Alpha-Stim recipients reported an 82% decrease of ≥ 50% or greater in depression scores after five weeks using the CES therapy.1 Improvement After Use In a clinical trial of Alpha-Stim patients, After 6 weeks, users experienced 42.8% improvement.2Sources:Barclay TH, Barclay RD. A clinical Trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders. 2014; 164:171-177. Presented at the American Psychological Association National Conference, Honolulu, July 2013.Bystritsky A, Kerwin  L, Feusner J. A pilot study of cranial electrotherapy stimulation for generalized anxiety disorder. Journal of Clinical Psychiatry. 2008; 69:412-417. Presented at the American Psychiatric Association meeting, San Francisco, 2009. ### How Soon Will I See Results with Alpha-Stim? Blog How Soon Will I See Results with Alpha-Stim? Alpha-Stim is a fast, safe, and effective treatment for anxiety, insomnia, depression*, and pain, bringing significant relief to 9 out of 10 users. But when you are suffering from any of these conditions, you want to know exactly how fast and how effective Alpha-Stim is.Below, we outline the expected timeline for results for each condition. It’s important to note; however, that everyone responds differently to treatment.*FDA cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. How Fast Does Alpha-Stim Work for Anxiety? Most people experience relief from anxiety with their very first treatment with Alpha-Stim. You may use your Alpha-Stim on an as-needed basis for your anxiety, or at regular intervals such as daily or every other day.Learn more > How Fast Does Alpha-Stim Work for Insomnia? While some people may experience better, longer sleep after just one treatment, it typically takes at least 2 to 3 weeks for insomnia to improve, and in some cases, it could take over a month of 2-3 treatments a week.Learn more > How Fast Does Alpha-Stim Work for Pain? Pain relief is often immediate, with users experiencing benefits during their very first treatment. Alpha-Stim treatments have a cumulative effect, so symptoms will continue to improve with repeated use. One exception is chronic, widespread pain, which is best treated with daily treatments and may take a few weeks for noticeable improvement. After an initial program of daily treatments, chronic pain management with Alpha-Stim might require weekly or more frequent treatments for life. Learn more > How Fast Does Alpha-Stim Work for Depression*? Depression symptoms take the longest to abate. It often takes 3 or more weeks for a significant change to occur, although some people feel relief within a matter of days.Learn more > How Long Should My Alpha-Stim Session Be? For all these conditions, Alpha-Stim is usually used for 20 to 60 minutes, either daily or a few times a week. The exception is that immediate direct pain management can often be achieved using the Smart Probes in about five minutes or less. Since results are cumulative with Alpha-Stim, many patients are able to decrease use over time and may find that they can maintain their relief with treatments only once a week. There is no risk of overuse with Alpha-Stim.  Get Started with Alpha-stim Schedule a telehealth visit with a health care professional today to get started with Alpha-Stim. Schedule Now ### Alpha-Stim Brings Veteran Anxiety Relief After Medications Fall Short Blog   Alpha-Stim Brings Veteran Anxiety Relief After Medications Fall Short Alpha-Stim Testimonials Alpha-Stim is unique from other anxiety treatments in that it’s drug-free and doesn’t come with the risk of addiction. Moreover, it’s safe for patients to use at home or in a clinical setting with their healthcare practitioner. But for some people, Alpha-Stim is a later treatment choice, and many often try medications or other modalities first. For United States veteran Joe Jeffrey, Alpha-Stim AID was the saving grace following insufficient results with anti-anxiety and other conventional medications. We recently got to talk with Joe about his experience with Alpha-Stim, and below is the conversation. ALPHA-STIM: What has been your overall experience with Alpha-Stim? JOE: “The Alpha-Stim AID  has become a crucial part of my weekly routine, offering a lifeline in my battle against anxiety... After several years with medications, the [Alpha-Stim] has remarkably transformed my well-being since 2016, providing relief from once-a-week to once-a-month sessions. It's not just a device; it's a life-saver!” (See below for more about why Joe chose Alpha-Stim!) ALPHA-STIM: What made you consider trying/getting Alpha-Stim? JOE: “I considered Alpha-Stim due to intense battles with [anxiety] since 2005. Conventional medications and self-medication with alcohol had negative impacts, leading to a suicide attempt, reckless behavior, and strained relationships. Deploying to Afghanistan worsened the situation, resulting in my separation from my second wife and severe emotional struggles. Traditional treatments [for anxiety] were ineffective, and I was open to alternatives.” ALPHA-STIM: How did you go about getting Alpha-Stim? JOE: “During a crisis, an Army Reserve Psychiatrist attached to my active duty Unit in Afghanistan, [and he] suggested Alpha-Stim AID after I expressed reluctance towards traditional pills. The process involved daily sessions for 10 days, gradually adjusting the device settings to find the most effective level.” ALPHA-STIM: How has your experience been using your Alpha-Stim so far? JOE: “My experience using Alpha-Stim has been transformative. Following the recommended 10-day protocol, I experienced increased energy, improved sleep, and a sense of relaxation. Over time, I transitioned to maintenance usage, now using it weekly. The device has allowed me to engage in activities and be more attentive to my family, positively impacting my overall well-being.” ALPHA-STIM: What has been the positive impact of Alpha-Stim on your life? JOE: “Alpha-Stim has had a profound positive impact on my life. It played a crucial role in saving me from a dark period marked by suicide attempts and emotional turmoil. The device has provided relief from symptoms of [anxiety], allowing me to participate in activities I previously avoided. I can now enjoy concerts with my wife and theme parks with my kids.” ALPHA-STIM: What would you say to others who are considering Alpha-Stim? JOE: “I would strongly encourage others considering Alpha-Stim to give it a try, especially if traditional medications have been ineffective or undesirable. My personal experience with the device has been life-changing, bringing relief from debilitating mental health challenges. It offers a non-pharmaceutical alternative that has significantly improved my overall well-being.” Take charge of your life with Alpha-stim Schedule a telehealth visit with a health care professional today to get started with Alpha-Stim. Schedule Now If you suffer from anxiety or insomnia and are searching for effective, lasting relief without the lasting side effects of medications, Alpha-Stim is here for you. Get started today here. * Alpha-Stim is FDA-cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. ### The True Cost of Chronic Pain: It's Not Just Financial Blog   The True Cost of Chronic Pain: It's Not Just Financial Chronic pain is more prevalent than ever before. With more than 20% of Americans dealing with long-term pain, chances are good that you or someone you know is struggling. And while physical discomfort takes a toll on its own, chronic pain also takes a toll on your mental health. Various research studies have illustrated a concrete link between chronic pain and anxiety, insomnia, and depression. (Read more about that here.) But what are the true costs of chronic pain? Below we look at some of the ways chronic pain can be detrimental to your quality of life and well-being. A Prescription for Alpha-Stim May or May Not Be Required The financial burden that pain sufferers often face can be immense. You want respite from your pain, so you spend money on treatment after treatment, seeking one that will finally bring you relief. Or perhaps you’ve consulted with multiple doctors and tried a variety of therapies, each one adding to a mounting pile of medical debt. The cost of prescription drugs today is on the rise as well, making it even harder for those with chronic pain to get the help they need while still having enough funds for other life necessities like a mortgage or rent, groceries, and gas. Looking at the country as a whole, the estimated cost of chronic pain is “$560 billion to $635 billion per year, composed of direct health care costs ($261 billion to $300 billion), days of work missed ($11.6 billion to $12.7 billion), and lower wages ($190.6 billion to $226.3 billion.) The cost of pain [is] more than that of heart disease and cancer treatments.” Clearly, pain can be devastating to your financial health as well as your physical and mental well-being. What makes treatment for chronic pain so expensive? Many people have copays for doctor appointments, physical therapy, and prescriptions, as well as hefty out-of-pocket expenses for surgeries or diagnostic scans. Even when copays and out-of-pocket payments for appointments and treatments are relatively small individually, they add up over time. Missed Opportunities at Work or with Friends In addition to the direct costs of seeking and receiving treatment, many people who suffer from chronic pain have to take time off of work, or even change their career altogether. Says one woman interviewed for an article in Marie Claire, “At one point I wanted to be a journalist, but there’s no way I could work those long hours.” The emotional cost of missing out on the life you want to lead cannot be quantified. Chronic pain can also lead to mood swings, increased irritability, confused thinking, and trouble focusing, resulting in decreased productivity and altered behavior. Social Disconnection and Isolation Alongside the changes to your mood and ability to take advantage of fun activities, the compounding effects of chronic pain often lead to psychological costs stemming from a disrupted social life. Maybe you’re watching your budget so closely, to pay for your medical expenses, that you can’t afford a night out with friends. Maybe you no longer feel the desire to be around others or do the things you used to love and are constantly fatigued. Pain often provokes emotional responses in people, and with chronic pain, both chronic anxiety and depression are extremely common. And as pain keeps you from connecting with others, the effects of depression may get worse as well. Options for Treating Chronic Pain While many options exist today for managing or treating pain, some are riskier than others. Chronic pain treatments can range from over-the-counter and prescription medications to invasive surgical procedures and implanted devices. And these options can pose serious risks including addiction or nerve damage or may not be an option due to a pre-existing health condition. A safer option for treating chronic pain is the Alpha-Stim M device, which is FDA-cleared to provide long-lasting relief from acute, chronic, and post-traumatic pain without the need for surgical implantation or medication. It’s also a safer financial option, with a one-time cost for the device that you can use FSA and HSA funds to purchase!  Veterans + Active Service Members see special pricing and how to get Alpha-Stim here.  First responders see special purchasing options here. And unlike with medications, results with Alpha-Stim are cumulative over time. The more you use it, the better you’ll feel, and the less you’ll need it. This is a stark contrast to many pain medications, which require you to increase your dosage over time to reap the same level of benefit. *FDA-cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. ### United States Army Bomb Technician Finds Relief with Alpha-Stim® Blog U.S. Army Bomb Technician Finds Relief with Alpha-Stim Selfless service. Personal courage. These are two of the core Army values that men and women in uniform vow to uphold while serving in this branch of the U.S. Military.While every day of service requires courage and selflessness, it takes a special kind of grit to persevere after a combat-related injury. What follows is a letter from a 38-year-old bomb technician – still currently serving, with 20 years of Active Duty – relating his personal experience.“In 2008, I was hit with a monster of a blast, which blew out my right ear drum and caused a noticeable traumatic brain injury and irreversible nerve damage to my right arm. I had struggled through the pain for nearly 10 years before my wife (a nurse) forced my hand at taking a sleep study.This EEG [a test that measures electrical activity in the brain using small, metal discs (electrodes) attached to the scalp] from this appointment encouraged military doctors to refer me to the Intrepid Center (TBI clinic) here at Fort Campbell where I received premium care and attention.Through the process of my therapy, I was recommended to try Alpha-Stim M for anxiety, insomnia, and pain management. Up until this evening, I had only been using the earclips for insomnia and the probes for local treatment of pain in my right arm. Tonight out of desperation (pain), I tried your electrodes on my upper arm (above the elbow) and back of the hand to treat my ulnar nerve pain in my right arm.I found a great reduction in resting pain (from a 4 to a 0) and an extension pain that I would call a 2-3 from a hard 8. I ran the electrodes at a current level of 6 for a total of 40 minutes and I am amazed at the results.Thank you for your product. Thank you for a non-medicinal option. I hope more will benefit from your product as I have.” Alpha-Stim is an Integral Part of the Intrepid Spirit Center Program for Treating Military Personnel As he mentions in his note, this Service Member was treated at an Intrepid Spirit Center, a satellite location of the National Intrepid Center of Excellence. These facilities use a multi-disciplinary approach to treat both the body and the mind of the soldier, relying on Alpha-Stim® as an integral part of their program.Alpha-Stim is an FDA-cleared, handheld medical device proven time and again to effectively treat anxiety, insomnia, acute, post-traumatic, and chronic pain. This is what makes it an ideal therapy for the inextricably linked mental and physical wounds of war.Moreover, since Alpha-Stim is not a prescription drug, there is no risk of addiction or lasting side effects. There is also no negative impact on a service member’s ability to perform his or her duties. Alpha-Stim helps service members continue to perform while getting the relief they need to live healthier, happier lives. Alpha-Stim is Trusted by Military Organizations and Personnel The United States Military has long trusted Alpha-Stim to bring the ultimate in care to our men and women in uniform. Alpha-Stim is a key part of the U.S. Navy’s Pain Management Initiative, it has excelled in research studies conducted at Walter Reed National Military Medical Center, and it is a mainstay of William Beaumont Army Medical Center’s holistic approach to treatment.Veterans and current Service Members also sing the praises of Alpha-Stim. One Navy SEAL tried everything but found no relief until he discovered Alpha-Stim. Another Veteran finally experienced a reduction in her chronic pain after struggling with other treatments. Getting Alpha-Stim as a Veteran or Current Service Member Alpha-Stim is available at more than half of the nation’s VAs. For more information and additional testimonials, Veterans and Service Members can click here or call 1-800-FOR-PAIN and ask to speak to Government Services. We’re here to help – and we thank you for your service. ### How to Treat Pain After Working Out Blog How to Treat Pain After Working Out Whether you signed up at a new gym, invested in equipment to work out at home, or simply vowed to dust off those running shoes hiding in the back of your closet, the temptation to dive into a new routine and start a transformation can sometimes make people overzealous – which can lead to some serious aches and pains.While some muscle soreness is your body’s way of adapting to new exercise, other aches and pains can be a warning sign that you’ve done too much, too soon, and are at risk for injury. How can you tell the difference, and what is the best way to feel better, fast?Your workouts should be challenging but not painful. And no matter where you are at in your fitness journey, it’s important to know when to stop pushing yourself.Below we look at muscle soreness and pain, how to know when to stop, and an easy way to relieve post-workout pain. Delayed Onset Muscle Soreness (DOMS) So you crushed your workout yesterday – congratulations! But today, you’re not feeling quite so elated. Your muscles ache in places you didn’t know you had muscles. What’s going on?Delayed onset muscle soreness is the name for muscle aches and pains that crop up one to two days after you’ve engaged in an intense or unfamiliar workout session.  It’s the result of tiny tears in your muscle fibers, which trigger an inflammatory response. According to the American College of Sports Medicine, these are the main symptoms of DOMS you may experience:Muscle painSwellingStiffness of the joint, along with reduced range of motionTenderness when touching the sore muscleTemporary weakness of the muscleUsually, DOMS will resolve on its own within a matter of days. The more you engage in physical activity, the less you will experience DOMS. This also means that your muscles are getting stronger. When is Muscle Soreness Something More? While muscle soreness is normal after a new or intense workout, it’s also important to know when your aches and pains are a sign of something more serious. You should always heed what your body is trying to tell you. What are the signs that your discomfort is more than just DOMS?Typical soreness will set in roughly 12 to 24 hours after your workout. An actual injury, however, will start to hurt immediately. DOMS will fade after one to three days. Pain from an injury will persist and potentially even worsen.Soreness feels dull and achy but shouldn’t prevent you from going about your day. With an injury, the pain is more likely to feel sharp or shooting and may amplify with specific movements that engage the injured body part.DOMS may come with some slight swelling, but an injury can cause visible inflammation and redness.Finally, an injury will also tend to be localized to the body part that is hurt, while soreness tends to be more widespread over a broader area of the body (sharp pain in your ankle, for example, as opposed to sore legs overall.)  What if you can’t tell the difference? The bottom line with pain is this: if you feel that something is amiss, it’s always better to play it safe and seek the advice of a medical professional than to keep pushing forward. You know your body best; listen to what it is telling you.It’s important to listen to your body’s cues so you can tell the difference between normal aches and pains, and a more severe injury. How to Treat Pain and Soreness Regardless of whether you’re facing run-of-the-mill soreness or the pain from an acute injury, you have options for relief. Ice and rest are great, but sometimes you need more than that. But did you know that pain medications aren’t your only option? Alpha-Stim M is a drug-free way to treat your pain after the gym (In fact it’s used by some professional athletes such as former Olympic swimmer Ragga Ragnars and pro-wrestler Emma Bruntil). Alpha-Stim M is an FDA-cleared medical device that safely and effectively relieves acute, post-traumatic, and chronic pain. You can learn more about Alpha-Stim M and how it works here. With Alpha-Stim M you can see the following benefits:Rapid pain reliefNo risk of addiction or lasting side effectsNo risk of overuse; you can treat your pain as often as you need toResults are cumulative (the more you use it, the less you’ll need to)Moreover, you can use Alpha-Stim as a standalone treatment or in conjunction with other modalities such as physical therapy and acupuncture. Setting Yourself Up For Long-term Success in the Gym Resolving to undertake an exercise regimen is an admirable goal. Don’t let pain undermine your ambition. What is important is to adopt a workout program that works for you and your lifestyle. Sustainability is key: you want to enjoy your workouts, and you need your body to support them – so caring for your pain is absolutely essential.Alpha-Stim can help you embrace your goals when it’s incorporated as part of your routine, helping you to keep pain at bay. Disclaimer: This blog is not intended to substitute medical guidance provided by a licensed healthcare professional or primary healthcare physician. Please contact your physician if you suspect that you've experienced an injury ### “A New Lease on Life”: Alpha-Stim Brings Relief to Veteran After Years of Suffering Blog “A New Lease on Life”: Alpha-Stim Brings Relief to Veteran After Years of Suffering Our nation’s Service Members put everything on the line when they step into their uniforms. These selfless men and women understand that they may face grave danger during their service, yet they commit to serve and protect their country anyway.It’s why when we receive letters from Veterans and Service Members using Alpha-Stim, we are proud to know we are providing a drug-free option that allows them to live their lives without the risk of addiction or lasting side effects.Recently, we received a heartfelt letter from veteran Katjia Bagnell recounting her struggles with pain, anxiety, insomnia, and depression* that resulted from combat-related injuries. Though it was heartbreaking to hear that she suffered for so long, we were elated to hear that she has now found relief with her Alpha-Stim M. *FDA cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. In her own words, here is her story: “My name is Katjia Bagnell and I’m an American Veteran of foreign and American wars. I was injured and I have been in pain from the top of my head to the bottom of my toes. For several years, I’ve been in and out of wheelchairs and walkers.I have severe bilateral damage to my SI joints, hips, and pelvic region. I have cervical, shoulder, and cranial damage, and traumatic brain injury. I have seizures. I have fatigue, depression, panic disorder, and anxiety disorder.I have pain constantly – 24/7.At 49 years old, I went to my doctor. It was either put a bullet in my head or go on pain medication after refusing it for a very long time. And I told her I wanted to go on pain medication.She came up with the Alpha-Stim M as a solution. Within three weeks, I was out of the wheelchair. I’m sleeping through the night. I can manage the pain. I feel like I have enough energy to walk around and not feel like I’m dying.For my panic disorder and my anxiety disorder, which I was on [medication] for, I no longer take the medication.I plan on getting off the antidepressants when I see my psychiatrist, as my depression has disappeared. Due to the Alpha-Stim, my affect has improved 100% and my pain which was over a 10 on a daily basis has gone down to zero.I cannot say enough about the Alpha-Stim. It has changed my life. It has given me a new lease on life and a new outlook.” We are honored to have been able to bring life-changing results to Katjia, and all the other Veterans and Service Members who have discovered the benefits of Alpha-Stim.  Alpha-Stim for Veterans and Service Members Many veterans are frustrated with standard treatments for their anxiety, insomnia, and pain. This is often due to unpleasant side effects, the risk of addiction from prescription medications, or the potential negative impact on their life and/or careers. Alpha-Stim is a handheld, prescription medical device that is FDA-cleared to treat pain, anxiety, and insomnia. It is FDA-cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. Learn more about Alpha-Stim for veterans and active military personnel here or call 1-800-FOR-PAIN and ask to speak to Government Services. Discover More ABout Alpha-stim Learn more about Alpha-Stim technologies below. Learn More ### I Tried Alpha-Stim: Here is my Honest Review Blog   I Tried Alpha-Stim: Here is my Honest Review By Amy Nicholson; original article at currentbody.com Did you know that with the help of innovative technologies, there’s now a completely natural way to treat anxiety, insomnia and depression* without medication? Introducing the Alpha-Stim AID Device. This wearable device stimulates the brain and normalizes the default mode network observed in psychiatric disorders, providing rapid, effective, and lasting relief without the dangerous side effects of medication. In new trials conducted by the NHS, 63% of patients saw an improvement in anxiety symptoms while 77 of 161 participants achieved total remission. Although statistics can be impressive, in our experience it’s also incredibly useful to hear about genuine experiences using the technology. We spoke to Victoria, one of our valued customers, about her Alpha-Stim journey to see what it was really like to use the device. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Tell us a little more about your background “When I was asked if I would like to trial the Alpha-Stim AID, I didn’t dare to have too much hope. The AID is hailed as a ‘drug-free treatment that works’ for anxiety, depression, and insomnia, and having lived for as long as I can remember with all three this sounded too good to be true. I went into it with a faint kind of optimism; I wanted it to work but didn’t want the disappointment if it didn’t make me feel better. I am happy to say that following a full 10-week program I feel much, much better than before. My moods have leveled, and when life starts to feel as if it may get back on top of me using the Alpha-Stim lowers my anxiety. I can think rationally about navigating through situations that arise without spiraling into a complete panic. I don’t get the shakes from the sheer thought of a meeting at work, I can do my weekly food shop without listening to loud music to drown out the noise, and I can even say that I get a good night’s sleep now.” What solutions have you tried in the past? “To give you some background on why I was asked to trial the device I’ll explain some of my background in dealing with my mental health. I’ve tried counseling sessions from the age of 11 – with very limited success. I was so worried that I would make my therapist feel bad if I told them I wasn’t feeling better. I would lie about how low my moods were which in turn meant they would stop the sessions. For years I had been on medications for anxiety and depression; Fluoxetine and Sertraline worked best for me. The tablets came with caveats, though. I experienced side effects like dissociation, dulling of emotions (the good as well as bad), and tremors to name just a few. Earlier this year I stopped taking my Sertraline almost by accident. I was busy with work, my parents were ill, and I kept forgetting to book an appointment for a review with my GP. They stopped my prescription in the end, and I found myself going cold turkey. This is where the Alpha-Stim came in. I was struggling – badly – when it was suggested that I give it a go.” How did you find the first Alpha-Stim treatment? “The manual is incredibly thorough which I was glad for, I prefer to know the rationale behind everything, so reading through all the technical points helped a great deal. There are also a whole host of clinical studies published online about the device which are an interesting read if you can stand the jargon. After reading as much as I could and going over the instructions twice, I unboxed everything. The AID comes with little pads which stick on to the earclips, making it look like you’re wearing headphones. The device itself reminds me of the original Game Boy, it isn’t too big and it isn’t difficult to use. Perhaps the strangest part was applying the solution to the pads and then clipping them to my ears – it was cold and wet, but I realized I had used too much of the solution. Alpha-Stim says that using the device for 1 hour at 200μA is a perfect starting point, so that’s what I did. Well… that’s what I did after I tried using it at 400μA. Curiosity got the best of me, but I soon learned that more is not necessarily better! Every person’s body is different, so the ideal setting for you is going to be different, too. I’ve learned that it’s a really good idea to start on 200μA and begin increasing the power until you feel slight vertigo (dizziness, like that swooping sensation you have in your tummy after being on a rollercoaster). You will absolutely know it when you feel it. At that point turn the device down by one setting and you’ve hit the perfect level. I played chilled-out music in the background and I sat for an hour, still as a statue, because I didn’t want to mess anything up. The best way to describe the way it made me feel is like being under the weight of a thick duvet; warm, weighty, and comforting. If I had ever had the nerve to get a massage, I thought, then this is probably how my body would have been afterward. The whole world had melted away, I’d managed to spend a whole hour not worrying. I could barely believe that it had gone so well so soon.” How did you feel after the treatment? “I slept like a baby. No, really. My long-standing friends call me a vampire because I’m always awake during the night. I’ve tried everything to improve my sleep but the concept of an ‘early night’ has always eluded me. Podcasts, audiobooks, meditation, sleeping tablets, herbal teas… the list goes on. After my first treatment with the Alpha-Stim (at about 6 pm), I found myself crawling into bed at 10:30 pm. I slept through the night without waking up – a miracle in itself – but more than that I didn’t even have nightmares. I could have done a dance when I woke up the next morning! From trial and error (and research) I’ve also found that the treatment time varies per person. You can’t over treat with the device, but you can under treat, and it is not a good feeling. That nice heavy feeling I mentioned will subside when you’ve used the device for long enough, if you stop treatment too soon it can stay with you for days.” So how did you find the experience overall? Was it positive? “It works. It works! My anxiety was improved from the first treatment – the effects wore off after a few hours but the more I kept up with my treatments the longer the results stayed with me. My depression took longer to work on, but I have felt a significant improvement with this. In the middle of trialing the Alpha-Stim we had a bereavement in the family, and I can’t imagine how I would have coped without the AID. The Alpha Stim AID doesn’t require checkup treatments with my doctor, I don’t have any side effects, and I’m no longer stuck setting an alarm to remember to take a tablet every day. Now that I’m used to the device, I can watch TV or potter around while using it (it comes with a lanyard to keep the device around your neck). It has become a part of my daily routine at this point and I’m so glad I was given the opportunity to try it.” Learn More About Alpha-Stim® Alpha-Stim is an FDA-cleared, handheld medical device that has been proven time and again to effectively treat anxiety, insomnia, and acute, post-traumatic, and chronic pain. Learn more about Alpha-Stim devices for each indication below. Treating Anxiety Treating Insomnia Treating Pain Treating Depression* *Alpha-Stim is FDA cleared to treat anxiety, insomnia, and pain, with approval for depression outside of the United States. Discover More ABout Alpha-stim Learn more about Alpha-Stim technologies below. Learn More ### Can Alpha-Stim Offer Aging Adults a Safer Choice for Pain Relief? Blog   Can Alpha-Stim Offer Aging Adults a Safer Choice for Pain Relief? Aging Adults are Not Immune to Addiction The opioid crisis in the United States has been making headlines over and over again for years. And it’s become a core concern for the pain medicine field in the last decade as the consequences of opioids have become clearer. According to the CDC, more than 700,000 people died from a drug overdose between 1999 and 2017, and the majority of drug overdose deaths in 2017 involved opioids. And Mayo Clinic reports that recent studies suggest that up to one-third of people who take opioids or chronic pain misuse them, with more than 10% becoming addicted over time. Although opioids have become a villain in the eyes of many people, these drugs are typically prescribed in a good-faith attempt to quell pain. And when a person is suffering from pain, they are often willing to consider any remedy that might bring them relief. And for older adults with changing brain sensitivity levels, the mixing of remedies can have dangerous consequences. This makes older adults especially vulnerable. Moreover, since many aging adults struggle with pain and mobility issues, as well as take multiple medications, the interaction of opioids with other medications and the risk for addiction is higher. Opioid Addiction Is Critical Concern Among Seniors What’s more concerning is for aging adults, substance abuse is climbing. In July 2023, The New York Times reported on the fact that aging Baby Boomers use drugs more than their parents did, and that as they age and experience the physiological changes that come with age, the risk of abuse is climbing. A quick excerpt from the article showcases the situation: “A study of opioid use disorder in people over 65 enrolled in traditional Medicare, for instance, showed a threefold increase in just five years — to 15.7 cases per 1,000 in 2018 from 4.6 cases per 1,000 in 2013… Most substance use disorders among older people involve prescribed medications, not illegal drugs. And since most Medicare beneficiaries take multiple drugs, ‘it’s easy to get confused,’ Dr. Humphreys said. ‘The more complicated the regimen, the easier to make mistakes. And then you have an overdose.’” The U.S News and World Report found as well that opioid-related overdose deaths increased 17.2% from 2016 to 2017 in adults aged 65 and older. Aging Adults Should Consider Non-Drug Alternatives According to the CDC, in 2021 an estimated 20.9% of U.S. adults  (51.6 million) experienced chronic pain. An estimated 6.9% (17.1 million) experienced high-impact chronic pain. The report also found that the prevalence of both chronic pain and high-impact chronic pain was higher among older adults. Fortunately, addictive drugs are not the only option for treating chronic pain. Alpha-Stim M offers aging adults a drug-free alternative that is proven to effectively treat chronic pain, as well as acute pain and post-traumatic pain. It’s usable across the body, as a stand-alone treatment, or adjunctively as part of a larger treatment plan. An FDA-cleared, handheld medical device, Alpha-Stim M delivers relief directly to the source of pain and can be used at home safely. For aging adults in remote settings, this makes Alpha-Stim a fantastic option. Below are other key benefits Alpha-Stim offers that make it a safer, better choice for pain relief. Benefits of Alpha-Stim M for Aging Adults with Pain No risk of overuse or addiction Easy to use at home and in remote settings Results are long lasting and often immediate Treatments take only minutes Alpha-Stim is safe and appropriate for use in aging adults with chronic conditions Can safely be used in conjunction with other medications or treatment modalities, if necessary (ideal for adults on medications for diabetes, congestive heart failure, etc.) Moreover, Alpha-Stim M also treats anxiety, insomnia, and depression* – all of which are common among aging adults and comorbidities of chronic pain. *Alpha-Stim is FDA-cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. Try Alpha-Stim for Drug-Free Pain Relief The golden years are meant to be just that: golden. With Alpha-Stim, older adults can enjoy their best lives, without worrying about the risk of addiction or lasting side effects. Backed by decades of clinical research and patient success stories, Alpha-Stim is simply a better, safer choice for pain relief among older adults.  Whether for yourself or a loved one, get started today and experience the difference. Get started today with a telehealth appointment to see if Alpha-Stim is a good option for you. Get pain relief with Alpha-stim Find a health care practitioner today to get started with Alpha-Stim M for acute, chronic, and post-traumatic pain relief. Just contact our team to find a health care practitioner near you. Find a Professional ### What is Cranial Electrotherapy Stimulation or CES? Blog What is Cranial Electrotherapy Stimulation or CES? Cranial Electrotherapy Stimulation (CES) is a type of treatment in which the brain is stimulated by a tiny current of electricity, no more than 600 millionths of an ampere. This current is so low that many users cannot even feel it and those that do feel a small tingle. While all CES devices transmit electricity to the brain, only Alpha-Stim offers a unique, patented waveform that has been rigorously tested and is backed by decades of success. Alpha-Stim® is such a CES device. However, while all CES devices transmit electricity to the brain, only Alpha-Stim offers a unique, patented waveform that has been rigorously tested and is backed by decades of success. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. How Does CES Work? Alpha-Stim applies rhythmic, low-amplitude current to the brain via earclip electrodes. Psychiatric disorders, such as anxiety and insomnia, are associated with alterations in electric activity in large-scale brain networks. Research suggests that Alpha-Stim® CES modulates large-scale brain network activity patterns in two synergistic ways: 1) by stimulating cranial nerves including the vagus nerve, 2) by directly modulating cortical oscillations in the temporal lobe, which is part of the default mode network. Ultimately, these two ways of stimulating the brain normalize the pathological signaling in the default mode network observed in psychiatric disorders, providing rapid, effective, and lasting symptom relief without the side effects of medication. Is CES the Right Choice for Me? If you suffer from anxiety and/or insomnia an Alpha-Stim CES device may be able to help. Alpha-Stim is an ideal CES option for the following reasons:It is perfectly safe to use in conjunction with other treatment modalities.You can use Alpha-Stim in conjunction with current medications if approved by your doctor. There is no risk of misuse or abuse, or addiction or withdrawal. It is a safe alternative to medications for people who are recovering from addiction, or anyone who prefers not to take drugs.)Alpha-Stim is safe for individuals who may otherwise be hard to treat including the elderly, those with chronic or complex conditions (including cancer), who are already on a number of medications, or who need a drug-free option.Treatments with Alpha-Stim are also quick and easy, and conducted in the comfort of your own home. That being said, Alpha-Stim should not be used by people who have pacemakers or other implantable devices. Does CES Work for Anxiety, Insomnia, and Pain? The short answer is yes. While CES may be getting more attention as of late, Alpha-Stim is actually not a “new” treatment at all. It has been changing lives for the better since 1981 and has continued to evolve with new devices and technical updates since then. More than 100 clinical research studies have been conducted on the effectiveness of Alpha-Stim. Across these studies, results have shown that Alpha-Stim users experience clinically significant relief from their symptoms and often get results far superior to those of medications.  “So far, I have overall had good results from the Alpha-Stim AID. In fact, one day while doing household tasks I walked in front of a mirror and noticed that I was smiling! That's new behavior and truly a result of this device. I am also experiencing a feeling of well-being and deep sleep that I haven't experienced since college days.” Alpha-Stim User “I experienced the worst depression I have ever felt. I never have had depression until now. It’s the worst feeling ever. Makes the days go by so much slower. I went to my doctor, hoping for medicine. Instead he let me try Alpha- Stim. This product ended up being a life changer! It is awesome!” Angie Lamborghini “After 3 months, I feel like a new person. I would recommend Alpha-Stim to anyone suffering from depression or anxiety.” Laine Downing Previous Next Commonly Asked Questions About Alpha-Stim and Cranial Electrotherapy Stimulation Do I need a prescription for Alpha-Stim? In the United States, a prescription is required for Alpha-Stim. You can schedule a telehealth appointment though to get Alpha-Stim faster.Outside the United States, Alpha-Stim is available over the counter. Will my insurance pay for an Alpha-Stim device? Insurance coverage varies by policy. Durable medical equipment coverage is often required to obtain some level of reimbursement for Alpha-Stim devices. We do not bill private carriers but will assist you by providing a paid invoice and a sample Statement of Medical Necessity for your practitioner to complete. This statement is typically required by the insurance carrier if the device is covered. If you have a flex spending account (FSA) or health savings account (HSA), you may often use these to purchase an Alpha-Stim. How do I get started using Alpha-Stim? It’s easy to get started with Alpha-Stim. First, if you live in the United States, you’ll need a prescription from a licensed healthcare practitioner. Once you have that, you can either order directly through our website, or we can put you in touch with your local distributor. If you’d like us to provide additional information to your doctor, we can do that, too! Simply provide his or her information on our submit a doctor form. If you’re just not sure where to begin and would like for an Alpha-Stim representative to contact you, complete the form located here and we’ll be in touch to help.Outside of the United States, Alpha-Stim is available without a prescription; you can skip straight to the ordering step. ### FAQ: Does my doctor need to prescribe Alpha-Stim? Blog Does My Doctor Need to Prescribe Alpha-Stim? Alpha-Stim FAQs A Prescription for Alpha-Stim May or May Not Be Required In the United States, federal law restricts Alpha-Stim to be for sale by, or on the order of a licensed health care practitioner. In the U.S.,  you need a healthcare practitioner’s prescription to get Alpha-Stim. (You can also do so online with a telehealth appointment.)  Alpha-Stim is FDA-cleared for anxiety, insomnia, and pain only.In most countries outside of the United States, Alpha-Stim is available without a prescription. However, consultation with a qualified healthcare professional is recommended for difficult and unresponsive problems or when you plan to use Alpha-Stim in conjunction with pharmaceuticals or other therapeutic interventions. Who qualifies as a licensed health care practitioner? Most health care practitioners who are licensed to diagnose and treat anxiety, insomnia, and/or pain can typically write an order for an Alpha-Stim; however, the ability for specific practitioners to prescribe or order Alpha-Stim varies. Practitioners should check with their state board if they are unsure of their licensing rights.[If you are a practitioner looking to get started with Alpha-Stim, please contact our team at alpha-stim@epii.com.]Ready to get started with Alpha-Stim yourself? Get more information about Alpha-Stim devices here. Get Started Discover Alpha-Stim technology today. Alpha-Stim® AID For anxiety and insomnia. Learn More Alpha-Stim® M For anxiety, insomnia and pain. Learn More ### Alpha-Stim Works Better and Costs Less than Medication Blog Alpha-Stim® Works Better and Costs Less than Medication When it comes to treating your anxiety, insomnia, depression* or pain, you want the most effective option available to you. But the cost of medications can add up, especially when you need them long-term. The good news is, that Alpha-Stim is not only more effective than drugs at treating the indications above, but it costs less too. *Alpha-Stim is FDA-cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States.https://youtu.be/96wda15JU8wThe numbers speak for themselves: not only does Alpha-Stim outperform drugs, but it does so with no lasting side effects, and no risk of addiction. On top of that, it even costs less. Comparing Costs of Alpha-Stim to Prescription Drugs Over a five-year period, Alpha-Stim users can save thousands of dollars compared with drugs and other treatments typically used to treat anxiety, insomnia, depression, and pain. When you consider the results that are possible with the Alpha-Stim M device as a pain and mental health solution, as well as the safety of the therapy, it’s clear why we believe there’s no better value available.The Alpha-Stim AID and M treat anxiety, insomnia, and depression.. The Alpha-Stim M also treats pain. Alpha-Stim AID is $840, and the Alpha-Stim M is $1,299. Both models carry a 5-year warranty.The cost comparison charts below show all Alpha-Stim costs needed for treatment, including accessories purchased over time. To make this a more accurate product-to-product comparison, the drug costs do not include ongoing physician visits to change drug prescriptions, adjust dosages, treat side effects, or the likelihood of increasing drug costs over the five-year period.Alpha-Stim® AID Accessory Costs: $90/year $60 for 3 boxes of 256 felt electrode pads for earclips $15 for 250ml conducting solution refill size bottle $15 for an 8-pack of AAA lithium batteriesAlpha-Stim® M Accessory Costs: $173/year $60 for 3 boxes of 256 felt electrode pads for earclips $15 for 250ml conducting solution refill bottle $18 for an 8-pack of AA lithium batteries $80 for 4 boxes of 100 probe electrode pads  Ready to get started with Alpha-Stim? Schedule a telehealth appointment here.*Minor and self-limiting risks: alpha-stim.com/risk.  ### 5 Simple Steps to Pain Relief with Alpha-Stim Blog   5 Simple Steps to Pain Relief with Alpha-Stim Alpha-Stim FAQs Alpha-Stim® is a handheld medical device that brings fast, safe, and effective relief from acute, post-traumatic, and chronic pain. With Alpha-Stim, microcurrent electrical therapy (MET) is delivered through a patented waveform directly to the site of the pain using two Smart Probes and a proven protocol that was developed by Dr. Daniel L. Kirsch, inventor of Alpha-Stim. How Alpha-Stim Works to Relieve Pain Physical discomfort is transmitted by electrochemical signals that go from the source of your pain to your brain. Instead of providing relief via a chemical method, like pain-relieving drugs that can have long-term side effects and risk of addiction, the Alpha-Stim device treats right at the source of pain and directly to your brain. It takes less than 5 minutes to treat the site of your pain using the Alpha-Stim Smart Probes. We also suggest afterward wearing the earclips for 20 minutes to treat the anxiety or insomnia that can often accompany the pain. Both can be done in the comfort of your home. Most Alpha-Stim users notice an immediate reduction in pain and an improved quality of life, even from their first treatment. 5 Steps for Relieving Pain with Alpha-Stim Step 1: The Big X Using the Smart Probes, make a large X over the site of your pain. In this step, you want to think big – if the pain is in your knee, the X will encompass most of your leg. Step 2: The Star Pattern Now move closer to where it hurts, making a series of smaller X’s to form a star pattern around the site of your pain. Step 3: Treat the Opposite Side In Step 3, you’ll use the Smart Probes to treat the opposite side of the body. So if your left knee hurts, you will also treat the right. Step 4: Connect the Two Sides Now it’s time to connect the two sides of the body. Step 5: Finish with Earclips A 20-minute cranial electrotherapy stimulation (CES) session via earclips is the final step and is what sets the device apart from other electrical treatments for pain. Alpha-Stim also treats accompanying anxiety, insomnia, and depression* via the earclips. *FDA cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. Need more training videos on Alpha-Stim? Access our full educational videos playlist here. Then, choose the video topic that fits your need, such as 1-Minute Pain Protocol with Smart Probes or AS-Trode Electrode Treatment Strategies & Demonstration. If you suffer from pain and are searching for effective, lasting relief without the scary side effects of medications, Alpha-Stim is here for you. Get started today here. Alpha-Stim® is a handheld medical device that brings fast, safe, and effective relief from acute, post-traumatic, and chronic pain. With Alpha-Stim, microcurrent electrical therapy (MET) is delivered through a patented waveform directly to the site of the pain using two Smart Probes and a proven protocol that was developed by Dr. Daniel L. Kirsch, inventor of Alpha-Stim. ### How has Alpha-Stim M Changed Your Professional View of Anxiety and Pain as Coexisting Conditions Blog How has Alpha-Stim M Changed Your Professional View of Anxiety and Pain as Coexisting Conditions An Interview with Dr. Devon Charlton on Alpha-Stim for Treating Pain More and more, research is showcasing the connection between pain conditions and anxiety and insomnia. Patients with chronic pain are especially susceptible to these coexisting conditions, and it’s pushed physicians to consider more comprehensive treatments that account for the body and mind collectively. To gain more insight into this, we sat down with Dr. Devon Charlton, MPH, FACR, FACP,  to discuss his views on pain and anxiety/insomnia as coexisting conditions and how Alpha-Stim M has influenced his treatment approach and view of pain management. Alpha-Stim: Thanks so much for talking with us Dr. Charlton. First off, how did you hear about Alpha-Stim? Can you tell us a bit about how you got started with Alpha-Stim?Dr. Charlton: Honestly, I don’t remember exactly where I found the information, but I think it was within one of our journals. I was looking for options for our chronic pain patients and for my own orthopedic injury-related pain. I contacted the representative and tried the Alpha-Stim M unit for a 30-day trial. From there, I worked on troubleshooting and fine-tuning techniques with the device before I offered it to patients.After working with Alpha-Stim for some time, I then would return to the local representative with additional questions on specific difficult situations and interesting observations. I also started attending webinars and live presentations primarily focused on behavioral health and pain management specialists. Interestingly, I seemed to be the only rheumatologist attending, therefore I found that I had some unique insights that others may not have experienced due to the difference in our medical domains.  Alpha-Stim: As a rheumatologist, you see a lot of different pain conditions. How do you use Alpha-Stim M with your patients?Dr. Charlton: Rheumatologists see a large variety of disease and clinical situations frequently extending beyond the straightforward rheumatological disorder including but not limited to post-surgical, acute, and chronic musculoskeletal pain; central pain disorders; poor sleep patterns; situational anxiety and depression, etc. Furthermore, even when we have control of the underlying rheumatological disorder some patients still have difficult-to-treat pain, fatigue, and sleep dysfunction requiring additional modalities and out-of-the-box thinking. The body is quite electrical and from an engineering perspective, the MET and CES that Alpha-Stim uses provides an interesting method of targeting these electrochemical pathways which we may miss with our typical approaches.  I offer Alpha-Stim during the office visit as another non-invasive and non-medication-based tool in managing pain, anxiety, and [insomnia] in the appropriate patient. I can either start a session within the office visit or I can set them up with a unit at home. And then I can help with any difficulties, questions or incorrect techniques going forward at follow-up visits. I am confident that if there are no positive results within the first 3 weeks, then it is not being used correctly. Examples of what I’ve experienced include, but are not limited to the following observations with MET and CES modalities with Alpha-Stim M:Dissipation of neuropathic pain, complex regional pain syndrome discomfort, allodynia and dysesthesia; Sudden decrease in pain with acute injuries, post-operative states including areas around wounds or chronic arthritic pain; Snapping out of a sympathetic and anxious state, so that I could simply complete an exam and/or conversation; Longer periods of sleep with less daytime fatigue or simply being able to fall asleep;Rapid improvement of acute disc herniation-related pain and muscle spasm. Every patient has been different in their responses and sometimes more than one round of treatment was needed, or I wasn’t targeting the correct source of pain and I had to make an adjustment. Ultimately, I found that I was obtaining results with Alpha-Stim that I wasn’t achieving with medications or with other conventional interventions.  Alpha-Stim: Has Alpha-Stim M changed your view on the pain care continuum? If so, how?Dr. Charlton: I have supported the idea of pain being on a continuum influenced by multiple factors and treating it as such rather than pain as being within discrete buckets.  I feel that I fail in treating the patient’s pain when simply focusing on the direct rheumatological pathway(s) rather than working on the multiple variables within the continuum. Therefore, as I treat specific organic pathways within rheumatology, I also work on the mechanical factors and the often-ignored holistic variables to tackle more spokes of the wheel. When I started adding MET and CES modalities from the Alpha-Stim M, I could see and hear the immediate and the prolonged compounding effects; and it felt like I was previously missing a much-needed tool in the daily battle. Alpha-Stim: Evidence shows anxiety and insomnia, as well as depression, co-exist with pain. Have you seen this in your patients? And how has this changed your perception of pain treatment and how do doctors approach this?Dr. Charlton: I witness these connections in a wide breadth of patients pretty much every day within the rheumatology domain. For example, I see patients with a controlled disease yet they still suffer from pain and exhaustion that doesn’t match the testing or exams. And once we dig deeper and start treating the concomitant sleep, lifestyle, and mood variables, we start to see improvement in the pain levels, energy, sleep patterns, nutrition, etc.  In another example, today’s world is always on and so our mind and body are adding to biological discord; however, the Alpha-Stim M’s MET and CES combination provides another way to tone down the disharmony whilst minimizing medications, adverse effects, and cost.Overall, I think most doctors know the intertwining of these variables, but it’s easier and faster to explain it and leave it to the patient to fix or throw medications at the problem. Instead, I aim to empower the patient to find healing and eventually not to need me in the future. I sort of practice along the lines of what Sir William Osler once said, "One of the first duties of the physician is to educate the masses not to take medicine." Alpha-Stim: Finally, Alpha-Stim M is designed for mind and body treatment. How has Alpha-Stim changed your view of pain and anxiety/insomnia as coexisting conditions? And has it changed your treatment approach for your patients as a result?Dr. Charlton: In addition to my previous observations and thoughts, I have become more aggressive in treating anxiety and insomnia in parallel to pain management. Secondly, I find myself more empathetic to the reality of their pain, sleep disorder, exhaustion, and anxiety even when the exam, imaging, and lab testing don’t necessarily support the reported condition.  Yet, I find the most difficult obstacle is communicating the connection and obtaining patient buy-in as we work to address the indirect pain factors. Alpha-Stim: Thanks so much Dr. Charlton! Anything else you feel is important to share related to treating pain either for patients or other healthcare professionals?Dr. Charlton: I have been gathering many examples of interesting clinical responses and situations in which we previously felt stuck or didn’t realize the obstacles preventing further healing until we broke through with the MET and CES modalities of the Alpha-Stim M, but we only have so much time and space for discussion.  The above responses are not the thoughts or opinions of Alpha-Stim or Electromedical Products International, Inc. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Get pain relief with Alpha-stim Find a health care practitioner today to get started with Alpha-Stim M for acute, chronic, and post-traumatic pain relief. Just contact our team to find a health care practitioner near you. Find a Professional ### Three Ways Chronic Pain May Be Impacting Your Life Blog   Three Ways Chronic Pain May Be Impacting Your Life We all know about emotional pain but what about physical pain? Emotional pain and crises can change a person’s quality of life, perspective on the world, and personality, but what about physical pain? Can chronic pain cause this too? Physical pain can indeed change a person in ways that are as life-altering as emotional pain. The biggest reason is that often chronic pain is accompanied by anxiety, depression, and even insomnia. A recent article “Chronic Pain Does Not Occur in Isolation” highlights the connection between chronic pain and stress, anxiety, depression, and insomnia. Below, let’s look more closely at how chronic pain may be impacting your life in connection to mental health and well-being. Chronic Pain Can Cause Mood Changes or Disorders There’s no doubt that pain affects mood, and vice versa. Researchers used to believe that emotional conditions like anxiety and depression caused chronic pain. But as they have learned more about the way the brain and nervous system function, they’ve discovered that pain has some of the same biological processes that anxiety and depression do.  Chronic pain can cause feelings of hopelessness and depression, and depression can magnify chronic pain. A study from the University of Arizona found that among all U.S. adults today who have unremitted anxiety or depression, 55.6% also suffer from chronic pain. The same study also found that adults with chronic pain were approximately 5x more likely to report anxiety or depression symptoms compared to individuals without chronic pain. Pain provokes an emotional response, and with chronic pain, many people are constantly stressed or tense. This can quickly translate to anxiety, depression, and other emotional issue (see below) commonly associated with depression. Chronic pain can contribute to or result in the following related to mood, emotion, and mental health: Anxiety Altered mood, irritability, or  anger Confused thinking Decreased self-esteem and social isolation It can also consequently result in issues related to quality of life including problems at work, physical deconditioning or weight loss/gain, and lack of sexual desire and sleep. Here’s an illustrated example of how pain can impact the quality of life, related to mood: Leo is a hair stylist who is on his feet all day, so when he developed persistent back pain it really affected his life. He’s tried everything from acupuncture to a chiropractor, and even the ancient form of alternative medicine called cupping therapy. Between clients at work, he uses a power massager on the pain areas. He’s also been known to lie down in the break room and have one of his co-workers help him with stretching exercises. Each of these tactics provides temporary relief, but it only lasts for as long as an hour to a day. None of them have a lasting effect. He hasn’t tried medication yet to help ease his pain because he worries about the side effects and the possibility of developing a dependency, or even worse, an addiction. He’s considering chemical pain management if things don’t improve soon. This situation brings feelings of helplessness and depression for Leo. He often feels anxiety about the future of the career he loves. Leo gets pretty angry at the world because he doesn’t see why he has to endure this chronic back pain. The anger can lead to self-pity and resentment that he has a hard time controlling. Chronic Pain Can Change Your Behavior As mentioned above, chronic pain has been connected to social isolation, a feeling of hopelessness, lack of exercise, and mood shifts. While chronic pain alone can cause issues related to mobility and social interaction due to physical limitations, the compounding effects of anxiety and/or depression can further this issue. And with this combination, a person with chronic pain may be more likely to develop chronic depression. A randomized controlled trial from 2021 showcased the role of social isolation in physical and emotional outcomes among pain patients, finding that individuals with chronic pain benefit from social interaction, including positive improvements in self-reported emotional and physical functioning. The key takeaway is that similar to how medications or alcoholic drinks can alter a person’s state of mind and behaviors, chronic pain can cause you to behave differently, become more reactive or sensitive, recluse yourself from friends, family and your favorite activities, and ultimately alter your usual lifestyle. Below is an illustrated example showing how Leo’s behavior, and consequently his life, was changed by chronic pain: Leo is naturally a gregarious, outgoing, active guy. He’s always on the go and spends much of his free time doing DIY projects for his home and garden. His energy at work can be infectious. In fact, some of his colleagues call him “Electric Leo”. That was before he developed the chronic back pain. Now, his daily activities have been severely limited by his pain. Nearly every movement can inflame his back, so he has to control how he moves. No longer is he able to work in his backyard or dance around his salon to entertain his clients. He’s had to develop specific ways to stand up or sit down that will limit the pain he encounters doing either. Chronic Pain Can Hurt Your Sleep Quality and Duration A lack of sleep, caused by chronic pain, can make it difficult to function during the day. Pain can be both a cause and a consequence of sleep deficiency, so it’s not shocking that this bidirectional relationship can negatively impact the mental and physical health of individuals. Below are key facts related to chronic pain and sleep noted from an article published in the Journal of Neuropsychopharmacology. The relationship between chronic pain and sleep issues: Deficiencies in sleep duration and quality and chronic pain are highly common comorbidities Pain can disrupt sleep Shortened sleep sessions (or disruptive sleep) can lower pain thresholds, and increase spontaneous pain or sensitivity to pain Poor sleep quality / insufficient sleep duration are risk factors for developing chronic pain (this is concerning say for those currently experiencing acute pain) Poor sleep can contribute to heightened sensitivity to painful stimulation (hyperalgesia) The below shows how Leo’s chronic pain led to insomnia, which also worsened his existing mental health and emotional challenges: Leo also developed insomnia due to his condition and changed his natural sleep position in order to get the few hours of pain-free sleep that he could manage. As a result, his behaviors toward others have further changed. The lack of sleep has put him on edge, and he can become easily provoked. Worst of all, his pain is so prevalent that it’s all he can focus on, making him less interested in the people in his life. Leo wants the never-ending cycle of physical pain and behavioral effects to stop. Now. Takeaway: Untreated, Chronic Pain Can Damage your Life How have the changes in Leo’s mood and personality affected his life situations? His clients, who always look forward to seeing him, have noticed a marked change in his energy. Some have found other stylists and others are considering the change. His demeanor hasn’t helped his personal life, either. His friends seem to be less inclined to spend time with him and his short fuse has caused problems with his beleaguered partner. His financial situation is no better either thanks to his behavior at work. All of the hours missed at work have cost him lots of money. Like many chronic pain sufferers, Leo doesn’t see an end to what has become both a financial and personal crisis. Alpha-Stim Offers a Safer Way to Take Control of Chronic Pain Alpha-Stim M is an FDA-cleared advanced pain management device that can help provide immediate and long-term pain relief.* But what’s unique about Alpha-Stim M is that it’s not only designed to treat physical pain. Alpha-Stim M is uniquely designed for users to also treat coexisting anxiety, insomnia, and depression.** Learn more about Alpha-Stim M for chronic pain relief at home >  Severe Pain Reduction In a study of patients with severe pain, Alpha-Stim M significantly reduced pain by an average of 71% after only five treatments.1 Decrease in Post-Traumatic Pain In a post-traumatic pain study, 56% of patients at 3 months and 85% at 6 months were somewhat or very satisfied with the device for reducing pain levels.2 Also Treats Anxiety Alpha-Stim AID is also designed to treat anxiety, providing patients with simultaneous anxiety and insomnia relief. *Minor and self-limiting risks: alpha-stim.com/risk.  **FDA cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. ### Can Alpha-Stim Help with Injuries from the Workplace or Car Accidents? Blog   Can Alpha-Stim Help with Injuries from the Workplace or Car Accidents? How Alpha-Stim M can treat both the body and mind If you’ve been unable to work due to a workplace injury or a car accident, you know it can turn your life upside down. Not only are you dealing with physical pain and the massive disruption to your normal routine, but you are probably also worried about your finances and the impact on your family, feeling anxious about your recovery, and experiencing changes in your mood. Workplace and Car Accident Injuries are Physical and Mental “One-third of people who have a major injury deal with major depression afterward,” according to Charles Bombardier, Ph.D., professor and head of clinical and neuropsychology at the University of Washington. “That number goes from one-third to more than half if you have a traumatic brain injury (TBI).” Sleep is key to helping your body to heal as well, but if you’re in pain or physically uncomfortable, being able to get a good night’s sleep may be difficult. Up to 2/3 of patients who report having chronic pain also experience sleep issues. Dr. Robert Bolas, a pain specialist, explains, “Pain worsens sleep patterns and sleep disturbances worsen pain. It’s a vicious cycle.” Treating the Pain, Anxiety, Insomnia, and Depression Fortunately, there is a way to treat both physical and mental symptoms of a workplace injury or car accident. Alpha-Stim M has been proven to treat anxiety, insomnia, pain, and depression safely and effectively. It is FDA-cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. Alpha-Stim is safe to use at home, in the office, or with your doctor, with no risk of addiction or lasting side effects. It is also safe to use in conjunction with other treatment modalities, such as physical therapy or counseling. Unlike drugs, which often require ever-higher dosages to maintain their efficacy, Alpha-Stim becomes more effective over time. The more often you use it, the better you’ll feel, and the less you’ll need it. Healthcare Insurance Payors Also Benefit from Choosing Alpha-Stim Alpha-Stim is the ideal solution for patients and payors alike. Over five years, Alpha-Stim users can save thousands of dollars compared with drugs and other treatments typically used to treat anxiety, insomnia, depression*, and pain. When you consider the results that are possible with Alpha-Stim as a pain and mental health solution, as well as the safety of the therapy, it’s clear why we believe there’s no better value available. Visit our healthcare payors page for more information, including a more detailed cost savings analysis and how to get started. *FDA cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. ### Will I Need to Use Alpha-Stim Every Day, Forever? Blog Will I Need to Use Alpha-Stim Every Day, Forever? Alpha-Stim FAQs If you’re new to Alpha-Stim or are considering it for anxiety, insomnia, depression*,  or pain relief, you may be wondering “How long do I need to use it for?”Once you start to feel better, will you need to use Alpha-Stim every day? Will you need to use it for the rest of your life? Will you need to increase the frequency or duration of your treatments to maintain the same results?*FDA cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. How often do I need to use Alpha-Stim to see results? One of the best things about Alpha-Stim, and what sets it apart from the competition, is that its results are cumulative. In other words, you will need your Alpha-Stim less and less over time, since each treatment builds on the effects of previous treatments.For example, if you are using your Alpha-Stim to treat anxiety, you may start with daily sessions that range from 20 minutes to an hour. As the weeks pass and your symptoms abate, you may find that you need only a 20-minute treatment every day, every other day, or even weekly.Similarly, if you suffer from pain, you can use your Alpha-Stim on an as-needed basis. Since the results accumulate with use, you will likely notice that you need fewer and fewer treatments to maintain the same level of relief.Essentially, you can determine a treatment schedule that works best for you and your lifestyle based on your results. How fast does Alpha-Stim work for anxiety? Most people experience relief from anxiety from their very first treatment with Alpha-Stim. You may use your Alpha-Stim on an as-needed basis for your anxiety, or at regular intervals such as daily or every other day. How fast does Alpha-Stim work for insomnia? While some people may experience better, longer sleep after just one treatment, it typically takes at least 2 to 3 weeks for insomnia to improve with Alpha-Stim. In some cases, it could take over a month of 2-3 treatments a week.  How fast does Alpha-Stim work for depression*? Depression symptoms can take the longest to abate. It often takes an average of three or more weeks for a significant change to occur, although some people feel relief within a matter of days.*Alpha-Stim is FDA-cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. How fast does Alpha-Stim work for pain? Pain relief is often immediate, with users experiencing benefits during their very first Alpha-Stim M treatment. Alpha-Stim treatments have a cumulative effect, so symptoms will continue to improve with repeated use. One exception is chronic, widespread pain, which is best treated with daily treatments and may take a few weeks for noticeable improvement. It’s important to talk with your pain management professional about pain relief progress and how to adapt using Alpha-Stim and/or other treatments accordingly.  Should I decrease my treatments with Alpha-Stim over time? You may find that you do not want to decrease your treatments with Alpha-Stim. That’s okay too! With Alpha-Stim AID and Alpha-Stim M, there is no risk of overuse and no harmful interactions with medications or other treatment modalities that you may be using. Do I need to use Alpha-Stim for the rest of my life? The short answer? No, you will not need to use Alpha-Stim every day for the rest of your life. But there is no reason you can’t do so if you want to.For more information on how long it may take to see results for specific indications, please click here.If you need more information about using your Alpha-Stim device check out your user guide or reach out to our Customer Support team here. **Minor and self-limiting risks: alpha-stim.com/risk.***This blog is not intended to substitute medical guidance provided by a licensed healthcare professional or primary healthcare physician. ### FAQ: What Type of Batteries Should I Use? Blog What Type of Batteries Do I Use with Alpha-Stim? Alpha-Stim FAQs Alpha-Stim® devices are battery-powered and depending on which device you choose (Alpha-Stim M or Alpha-Stim AID) the batteries you use will differ. Both devices will initially arrive with lithium batteries to get you started. What batteries does Alpha-Stim M use? Alpha-Stim M uses AA batteries. What batteries does Alpha-Stim AID use? Alpha-Stim AID uses AAA batteries. Important Things to Know About Batteries with Alpha-Stim First, try to use lithium batteries in your Alpha-Stim device. Lithium batteries will last longer (greater value over time).Second, do not use rechargeable batteries. The patented waveform produced by Alpha-Stim is very specific. Rechargeable batteries do not discharge evenly, and the unstable power supply from rechargeable batteries may hinder its effectiveness.Although you will need to replace the batteries in your Alpha-Stim as time goes by, Alpha-Stim remains more cost-effective than many medications. If you need more information about using your Alpha-Stim device check out your user guides or reach out to our Customer Support team here. ### Talking with Healthcare Practitioners About Using Alpha-Stim Blog Talking with Healthcare Practitioners About Using Alpha-Stim Alpha-Stim technology offers healthcare practitioners working with patients dealing with anxiety, insomnia, depression* and pain a safe, drug-free treatment option. In the last few years, we’ve sat down with some experts who tried Alpha-Stim and then incorporated it into their practice. We asked their thoughts on the technology, what encouraged them to choose to make it part of their routine practice, and the benefits over other treatment modalities. Below are a few excerpts of healthcare practitioner experiences with Alpha-Stim M and Alpha-Stim AID from recent webinars where these individuals presented their experiences. *Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. What Two Healthcare Professionals Say About Using Alpha-Stim with Patients Using Alpha-Stim for Improved Mental Health Whitney Erickson - Family Nurse Practitioner & Psychiatric Mental Health Nurse PractitionerCurrently provides outpatient care for adults 25 years and older and is dual certified through the American Nurses credentialing center as both a family nurse practitioner and psychiatric mental health nurse practitioner enabling her to provide well informed integrated care to individuals who often struggle with higher complex, full morbid mental and physical conditions.“Most people outside of the medical and mental health professions underestimate the intensity of anxiety that has taken over the US. According to the anxiety and depression Association of America. nearly 40 million adults in the US suffer from anxiety disorders… Most common symptoms I see in my personal practice headaches, heart rate and rhythm variability, difficulty concentrating, and gastrointestinal distress. Inherently, I'll have a couple clients few times a week sprinting back and forth from the restroom. Someone clutching their chest complaining of chest pain. Treatment for somatic symptoms typically involves addressing the underlying psychological issue. But what if we're not sure what's going on? Do we always need to reach for psychotropics during times of uncertainty? Or could we be more harmful? Hence, not all clients are created equal. Not all cases are created equal. Not all of our patients want to pursue medication management. Traditional treatment for anxiety, therapy, medication lifestyle changes. What if we can offer more right now? In the moment? What if it's easy? For both you and the patient? It's usually easy for someone but not both. Did I mention low to no side effect burden?...I can attest to it personally. With the right treatment, we can help significantly reduce and sometimes eliminate anxiety, leading those under our care to healthier, more fulfilling lives. I've applied Alpha stem during acute anxiety, panic attacks and reduce the duration as well as the unpleasantness that follow suit.”Erickson also then talks about meeting patients where they are and that instead of pushing more intense modalities before a patient is ready, that Alpha-Stim can offer these patients with poor readiness a gentler but effective option: “But what happens when we don't meet our clients where they are? What if we push in the end a modality like EMDR to quickly when their readiness is poor? Now we've sent them packing more traumatized and when they arrived, and it may take us days, weeks, months, sometimes even years to recover that. What if you could start with a more gentle, a more benign solution to facilitate those challenging conversations? I use alpha stem all the time during sessions just to more delicately facilitate progression to have those conversations without ramping up the anxious trauma response, or mine.” Alpha-Stim and Rheumatology in Internal Medicine Dr. Devon Charlton, specializes in rheumatology and is certified by the American Board of Internal Medicine, UPMC Regional Orthopedics“So as many rheumatologists will attest, we don't deal with just autoimmune cases. However we see a large variety of conditions with multiple domains and medicine covered. Sometimes these are overlapping with rheumatological conditions that retreat and sometimes are really the end of the road for a lot of these patients who are trying to make sense of their symptoms, and simply looking for outside-of-the-box thinking when it comes to pain relief… But I really want to focus on the scope of FDA indications for this device pain, anxiety and sleep disorder, poor sleep. So I thought we'd go through some scenarios within the clinic that I normally see where I've really found this device helpful. And on a side note, I did use it on myself after a label tear in my hip. And with pain from that postoperatively and with my sports and other things I like to do. So I've tested it on myself before really using it on everybody else but within the clinic.So we see a lot of centralized pain syndromes, we see a lot of amplified musculoskeletal pain syndrome, we see a lot of fibromyalgia, you know, Complex Regional Pain disorders. So a lot of this is mixed into the consults we get. And even in patients we're already seen for other things and rheumatoid arthritis, psoriatic arthritis, etc. These can overlap on top of that, too. So we see a lot of mechanical pain patients, a lot of advanced softer arthritis, general osteoarthritis, degenerative disc disease, TMJ tension, headaches, etc. We see a lot of post-surgical patients with prior trauma-related pain. We see the bread-and-butter inflammatory autoimmune diseases that rheumatology is known for. And then on top of this, we see a lot of concomitant mood disorders, a lot of patients with anxiety, insomnia, [and] then we see a lot of chronic fatigue and altered sleep patterns from a lot of the associated conditions I recently mentioned.So, a couple of patients stories that come to mind after going through all those different scenarios. So one of the patients came to me and had psoriatic arthritis. So we were treating that and kept having chronic discomfort in the right foot. And the X-rays didn't show anything there, the lab work was totally fine. She was on adequate therapy to treat her underlying issue, yet she still had foot pain, and it did not go away, and it did not match her exam. So I did. I used the Alpha stim M, which has the probes, and it also has the CES. So you're doing the microcurrent, and you're also doing the cranial electrotherapy. So I did the electric current microcurrent therapy on the foot. That following week, she had three to four hours, of a pain-free foot for the first time in a long time. So that was kind of my eyes open to the possibilities of using Alpha-stim. A lot of our fibromyalgia patients have chronic fatigue, widespread pain disorder, and more really central pain, there are a lot of neurological processes going on. And I found that using the device whether in the office at the time of the visit, or after the visit, patients have had a positive response to it. And one patient bouncing off the table with severe [pain], anxiety, frustrated by everything, everything hurts, nothing's working. I said hold on, I want to try something with you. I went in, hooked up the device, and this time I did the CES on him. While he was doing the whole visit, it was like flipping a switch it calmed him down. He was able to relax, so we could get through the visit, go through his history, and figure out what was really going on. And he really enjoyed the enjoy the experience. So it was another interesting example of patients who have used it during their CPAP and who couldn't tolerate the CPAP to treat their sleep apnea, which was also one of the drivers of their central pain syndromes.Same thing with psoriatic arthritis patients, I've had patients with a lot of chronic fatigue, despite treating their joint pain in the back pain and their skin and sleep issues. And they just could not find a solution to this barrier. And I found that using the Alpha-Stim in the office and outside the office on a routine basis has really helped manage such symptoms, in these patients.So it's again and again with patients in the office, that I'm finding interesting nuances and how to how to overcome these barriers that typically in rheumatology, we've had very difficulty doing, you know, we treat the disease, we treat the target, we got the inflammation under control, the disease seems fine, but we can't get past these, what we sometimes called type two symptoms such as lupus patients, or chronic fatigue and RA or psoriatic arthritis, you know, chronic pain despite really no measurable inflammation on exam or for lab work or even imaging. So it's been a very interesting experience thus far enough. I've been using it for at least a couple of years now. Not only myself and friends of family, but in all these patients.” How to Start Prescribing Alpha-Stim If you’re thinking about trying Alpha-Stim in your own practice, learn more here with our resources for healthcare professionals. Alpha-Stim is easy to use with patients, both in the clinical and office settings, as well as by patients themselves at home. Alpha-Stim can be prescribed both in-person in a qualified healthcare clinic or office setting, as well as via telehealth appointments.A prescription for Alpha-Stim is only required in the United States and it is available over the counter outside of the United States, making it easy for patients to access this device and easy for you to prescribe. Learn more about prescribing Alpha-Stim here. ### Alpha-Stim vs. TENS Therapy for Pain Relief Blog   Alpha-Stim® vs. TENS Therapy for Pain Relief Both Alpha-Stim and transcutaneous electrical nerve stimulation (TENS) units are used to provide drug-free pain treatment, but there is a big difference in what they do and how they perform. In fact, the only thing they have in common is electricity. They both provide pain relief via an electrical device, but that’s where the similarities end. How Does a TENS Unit and Alpha-Stim Device Work? A TENS unit applies an electrical current through electrode patches that stick onto the surface of the skin, directly where the pain is, and is often used to treat symptoms such as back pain or aching muscles. It creates a tingling sensation that temporarily blocks pain signals using the gate theory. When treating pain, Alpha-Stim uses Smart Probes or AS-Trodes™ to deliver a patented, complex waveform via microcurrent electrical therapy (MET) to modulate or change the pain signal instead of blocking it. It is FDA-cleared to provide fast, safe, and proven effective pain relief for patients battling post-traumatic (including post-surgical), acute, and chronic pain. MET is a form of TENS, however, it uses far less current. With a TENS device, the current can be several hundred times stronger than an Alpha-Stim. What Makes Alpha-Stim Different from a TENS Unit? Unlike a TENS unit, an Alpha-Stim M device can also use cranial electrotherapy stimulation (CES) via small clips on your earlobes to treat conditions that often occur alongside chronic pain, like anxiety, insomnia, and depression*. TENS units do not treat these indications. *Alpha-Stim is FDA-cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. Alpha-Stim and TENS Give Different Pain Reduction Results Moreover, Although TENS can be quick to initially reduce some pain, the results are usually short-term. Also, the body typically adjusts to it. As a result, maintaining a therapeutic effect requires an increased amount of current. Conversely, the effects of Alpha-Stim are not only fast-acting but long-lasting and cumulative, allowing patients to decrease use over time. There is also a significant amount of research supporting the safety and effectiveness of Alpha-Stim. TENS Alpha-Stim® • Blocks pain signals using the gate control theory • Modulates pain signals at the cellular level • Is applied with adhesive electrodes • Is applied with either Smart Probes or AS-Trodes™ • Provides quick, but short-term, results • Provides quick, long lasting, sustainable results • Requires increasing amounts of current to remain effective • Effects are cumulative, so the treatment frequency is decreased over time • Relieves the insomnia, depression, and anxiety that often accompanies chronic pain First-Hand Report of Alpha-Stim vs. TENS Alpha-Stim user Paul Schaum noted that he experienced “limited use” and “no lasting benefits” from TENS, but saw a significant difference and everything changed when he was introduced to Alpha-Stim. “I have multiple areas of pain and once was pretty much limited to a wheelchair except for short distances; some days I couldn’t even lift up a pen. I was introduced to Alpha-Stim without being told what it was at a VA doctor’s appointment,” Schaum said. “The amazing effect of the device still astounds me. I have seen it have a similar effect on the military, disabled vets, and civilians. I am not pain-free, but it is manageable. Drugs were of little help and the untoward side effects were certainly not helpful. My medication list was cut in more than half after being on Alpha-Stim for a brief period. NO, I am not a paid spokesman, just a thankful patient.” As Schaum referenced, in addition to providing lasting relief that is not available with TENS, Alpha-Stim stands apart from prescription pain medications by offering a treatment that comes with no risk of addiction and no lasting side effects. Read more testimonials from patients who have used Alpha-Stim for pain management here.   Get pain relief with Alpha-stim Schedule a telehealth visit with a health care professional today to get started with Alpha-Stim M for acute, chronic, and post-traumatic pain relief. Schedule Now ### For Sleep and Studying, This Veteran Finds Success with Alpha-Stim Blog For Sleep and Studying, This Veteran Finds Success with Alpha-Stim Alpha-Stim Testimonials When it comes to school, the demands of homework, studying, and sitting for long exams can add up to quite a bit of a mental struggle. For those who already struggle with anxiety or insomnia, succeeding at school may be even harder. Ashley Russell-Gray, a Veteran and a student, was prescribed an Alpha-Stim® to help with her insomnia. Not only did Alpha-Stim help her to get better quality sleep, but it proved to be a vital tool for managing her anxiety while she navigates her PA program.Read below for a quick testimonial from Ashely about using Alpha-Stim AID. “I’ve found the Alpha-Stim very helpful. I use it every night to help me fall asleep, which really beats having to take sleeping medication all the time. I’ve been using it for sleep for almost a year and it has made a huge difference.A few months ago, I started using Alpha-Stim while I study and take exams for PA school. I can’t begin to tell you how much of a difference it makes when I have to sit still for a 1-3 hour exam. Prior to using Alpha-Stim, I would have to get up, stretch, and reset at least 3 times during an exam [due to anxiety]. I just finished 10 final exams over the last week (ranging from 1.5-2.5 hours) and I sat straight through all of them while using the device.Studying with Alpha-Stim is beneficial for decreasing [my] anxiety. Before Alpha-Stim, I would never have been able to achieve this level of sleep. It has been such an improvement to my overall quality of life.” Take Charge of your life with alpha-stim Schedule a telehealth visit with a health care professional today to get started with Alpha-Stim. Schedule Now ### Can Chronic Pain Trigger Anxiety and Depression? Blog Can Chronic Pain Trigger Anxiety and Depression? If you suffer from chronic pain, you know all too well that it is incredibly disruptive – it can hinder your ability to do the things you enjoy and your capacity for handling everyday tasks. When you are in pain, what once felt easy may seem much more difficult. You learn quickly which tasks, movements, and positions you can tolerate, and which ones make things worse. Anxiety Triggered by Painful Stimulation If you know that certain movements or actions are going to hurt, it makes sense that you would try to avoid them. But this avoidance of certain movements can become a problem in its own right. According to a recent article in Psychology Today, people with chronic pain may develop “Kinesiophobia” – fear of movement – and “become psychologically paralyzed. This condition is marked by crippling anxiety due to fear of movement (and the possibility of re-injury) experienced by someone with chronic pain who is afraid to exercise or perform activities of daily life.”This represents an extreme degree of what is called pain interference – “the degree to which pain limits or interferes with an individual’s physical, mental, and social activities.” Because what makes chronic pain so devastating is that it isn’t “merely” physical: it is a truly life-altering condition.It’s important to note that your pain does not have to be overwhelming or unbearable in order for it to affect your life and your mood. In fact, pain is supposed to interfere with your mood – it’s the brain’s way of letting you know that your body has suffered in some way. If you stub your toe, for example, you know that it is not a life-threatening injury and that you will not be rushed to the hospital. Even so, the pain interferes with the task at hand (such as walking). You know that the pain will pass, but the impact of the sudden, unexpected pain still rattles your mood and disrupts your activity.And that mood disruption occurs even with fleeting pain that you know will dissipate quickly. Suffering from chronic pain, on the other hand, can become a vicious cycle: you become overwhelmed with anxiety about making your pain worse, day in and day out. That mental distress, in turn, can amplify the perception of pain; meanwhile, you develop depression from being constantly in pain and missing out on the activities you once enjoyed. It is a very human reaction – again, consider the stubbed toe – but that does not make it any less miserable when you are suffering. Fortunately, there is a way to break the cycle. What’s the Right Choice for Treating Pain Alongside Anxiety? Taking pain and anti-anxiety medications might seem like an easy solution, but the combination can be risky for many people. Taken separately, these medications come with a long list of potential side effects, not to mention the risk of addiction and withdrawal. But Alpha-Stim offers a non-drug option you can choose.Alpha-Stim® allows you to treat your pain precisely where it hurts. After treating with Smart Probes (shown) or AS Trodes, a CES session with Earclip Electrodes will relieve anxiety, insomnia, and depression.Alpha-Stim is a fast, safe, and effective treatment for anxiety, insomnia, depression*, and pain (acute, post-traumatic, and chronic). It is an FDA-cleared, handheld medical device that you use in the comfort of your own home. Relief is long-lasting and often immediate, with 9 out of 10 users experiencing clinically significant improvement.*FDA cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States.With Alpha-Stim, you can treat not only your pain, but the anxiety and the depression that may come hand-in-hand. Many people find that they can reduce or discontinue their medications when using Alpha-Stim, but it is safe to use in conjunction with other treatment modalities. And unlike with medications, the results of Alpha-Stim are cumulative – you may find that you need to use it less over time.Don’t let pain control your life. Get started today and experience freedom from pain.   ### Is it Workplace Stress or Workplace Anxiety? Blog Is it Workplace Stress or Workplace Anxiety? Stress is common in the workplace. In fact a report by the American Institute of Stress found that 80% of workers feel stressed on the job, and nearly half say they need help learning how to manage it. Furthermore, 40% of workers reported their job was very or extremely stressful, and 25% viewed their jobs as the number one stressor in their lives.1  But is it just workplace stress? Could you have workplace anxiety? Identifying Workplace Anxiety According to a medically reviewed article on WebMD, workplace anxiety isn’t uncommon. While stress is commonplace, if it’s constant and overwhelming, and prevents you from living your life, it’s possible you actually have an anxiety disorder.2 Below are a few signs (within the workplace) that a person may be struggling with an anxiety disorder. Appearing unengaged in their workDecreased or poor job productivityA drop in job performance Missing a high number of days of workComplaining of physical symptoms such as sweating, not sleeping well, or stomach upset without an additional explanation (such as a hot office, a wrong food choice at lunch, etc.) Clinical psychologist Debra Kissen, PhD, also notes that looking at how a person feels throughout the weekday can be helpful.3 “’[Evaluate your anxiety] in terms of how severe it is and how disabling,” Dr. Kissen says. ‘Maybe it’s showing up and you’re still operating pretty effectively or when you’re feeling that way, maybe you’re only 10% as effective as you would be otherwise.’” The Negative Impact of Workplace Anxiety Having anxiety at work can significantly impact both you and your career. You may struggle to connect or collaborate with coworkers. You may feel like projects are harder to handle or complete. You may even start making decisions based on your anxiety like turning down a great promotion because the thought of more responsibility, traveling or public speaking makes your anxiety ramp up.4The Anxiety Disorders Association of America (ADAA) 2006 Stress & Anxiety Disorders Survey found some key findings as well that show a  strong negative correlation between anxiety in the workplace and its impact on a person’s professional and personal lives.5On the job, employees said stress and anxiety most often impact their workplace performance, relationship with coworkers and peers, quality of work, and relationships with superiors. More than three-fourths said that workplace stress and anxiety carried over into their personal lives, especially for men. One in four reported persistent stress or excessive anxiety that impaired their ability to function73% said anxiety caused them to avoid social situations at work while 43% said it caused them to avoid participating in meetingsOnly one-fourth of those with an anxiety disorder have told their employer, while the other three-fourths feared doing so would affect promotion opportunities, result in a negative note in their employee file, and that their boss would interpret it as a lack or unwillingness to do the specific activity.    And with more than 40 million U.S. adults (19.1% of the population) having an anxiety disorder, and 301 million globally (4% of the population), this is likely impacting productivity more than employers may realize. It’s also one more reason why supporting employee’s mental health and wellness is so critical. How to Identify if You Have Anxiety Understanding the difference between workplace stress and workplace anxiety could help you manage your symptoms. The following symptoms may indicate that you may have workplace anxiety:Losing interest in workOvereating or undereatingDifficulty sleeping, concentrating, or remembering thingsFeeling like you need to be perfect all the timeWorrying constantly and cryingAvoiding friends, family, and colleaguesFeeling tense, irritable, tired, and unengaged Treating Workplace Anxiety There are a lot of options for treating anxiety today. Medications, mediation, mobile apps, and therapy. But one that you may not know about is Alpha-Stim®.  A non-invasive, non-drug cranial electrotherapy stimulation (CES) device, Alpha-Stim is FDA-cleared to safely and effectively treat anxiety. (It also is FDA-cleared for insomnia, which is a common coexisting condition with anxiety.) Why should employees consider Alpha-Stim? One of the biggest benefits for working professionals with anxiety who use Alpha-Stim is they can use it at the office. A session with Alpha-Stim can be done in about 20 minutes, so it’s easy to do during a quick screen break or even while someone works away on their computer. In fact one study found that Alpha-Stim recipients reported significantly less anxiety after one 20-minute session.7 Moreover, because the results of Alpha-Stim are cumulative, users often see increased relief over time. In clinical trials, patients reported an average of 94% less anxiety after using Alpha-Stim for 5 weeks.8 Employers also need to help employees with anxiety Another critical element to treating workplace anxiety is the way an employer decides to support its workforce’s needs. This can be anything from offering mental health resources such as virtual or in-person therapy, offering educational resources or a discounted subscription to a meditation or calming app, creating quiet spaces for desensitizing or reducing stress around the office, or even considering a program that could allow employees to check-out Alpha-Stim devices in the office for a session so long as they have a recorded prescription. See if Alpha-Stim AID is Right for You. Give Alpha-Stim AID a try for anxiety relief today. Schedule a telehealth consult below with a licensed health care provider to get started. Schedule now Sourceshttps://www.stress.org/workplace-stresshttps://www.webmd.com/anxiety-panic/features/workplace-anxietyhttps://www.webmd.com/anxiety-panic/features/workplace-anxietyhttps://adaa.org/managing-stress-anxiety-in-workplace/anxiety-disorders-in-workplace#:~:text=Having%20an%20anxiety%20disorder%20can,be%20unable%20to%20meet%20deadlines.https://adaa.org/workplace-stress-anxiety-disorders-surveyhttps://adaa.org/understanding-anxiety/facts-statisticsLee S-H, Kim W-Y, Lee C-H, et al. Effects of cranial electrotherapy stimulation on preoperative anxiety, pain and endocrine response. Journal of International Medical Research. 2013; 41(6) 1788–1795.Barclay TH, Barclay RD. A clinical Trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders. 2014;164:171-177. Presented at the American Psychological Association National Conference, Honolulu, July 2013.Source note: The information provided is not an official diagnosis and should therefore not be used for diagnosing or treating a medical condition. Those seeking medical advice should consult with a licensed physician. ### Alpha-Stim Offers Relief for Medication-Sensitive Individual Blog   Alpha-Stim Offers Relief for Medication-Sensitive Individual Alpha-Stim Testimonials Many people struggle to find the right treatment for anxiety, insomnia, depression*, or pain. It can take a bit of trial and error. Sometimes it’s a mix of your doctor’s recommendations and doing one’s own research. And for people who are sensitive to the effects of medication, finding a treatment option that’s safe and effective can be even more challenging. For Bonnie Rosenthal, the search for the right way to treat her mental health conditions evolved over several years. She first heard of Alpha-Stim in 2012 but did not begin using it until several years later. *FDA cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. Following Bonnie’s experience with Alpha-Stim, we were pleased to hear this from her: “In 2012 my holistic [health care] provider recommended Alpha-Stim. While I had helpful conversations with Alpha-Stim employees, I decided not to purchase the device at the time.  Five years later I was taking part in a women’s trauma program. I found a full-page ad about Alpha-Stim. It seemed like a message, and I then began to pursue getting a device for myself.   I had many helpful conversations with Alpha-Stim staff, all of whom were helpful and kind in answering questions and allaying my concerns given my other medical issues. Ultimately I bought the Alpha-Stim AID for treatment of my anxiety and depression.   As I attempted to get used to the device I found it difficult to work with the earclips, so I upgraded to the Alpha-Stim M. With the Alpha-Stim M I would be able to utilize different protocols that didn’t have to include the earclips. In addition, I would be able to use the device to treat my pain.   I am severely medication-sensitive. I needed this device to work for me and it did.  After some time I knew I could go down to using it a few times per week, [but] I utilize my device every day.  I put it on at a current I can tolerate, and I keep it on as long as I desire.  It has been helpful and rewarding to see its effectiveness with my depression, anxiety, and pain.   I am satisfied that I made the right decision with Alpha-Stim.  I recommend it to many people I know.  I am firsthand a very satisfied customer.”  Bonnie discovered firsthand what so many other patients over the years have learned: Alpha-Stim works, and it works well. Choosing the Right Alpha-Stim Device for You When Alpha-Stim is used for anxiety, insomnia, and depression, it employs a modality called cranial electrotherapy stimulation (CES), delivering an electrical microcurrent to the brain through two earclip electrodes. To treat pain, Alpha-Stim M delivers microcurrent electrical therapy (MET) through two handheld Smart Probes directly to the site of your pain. The Alpha-Stim M also comes with AS-Trodes™, which adhere to the skin, providing an alternative method for treating pain. Since Alpha-Stim is not a drug, there is no risk of addiction, overuse, or lasting side effects. This is why for individuals who are medication sensitive, like Bonnie, Alpha-Stim is a good choice. It can safely be used every single day, although many people are able to taper off their treatments over time. Alpha-Stim can also be used safely in conjunction with other medications and treatment modalities if a person wants to continue with a drug-based treatment as well. Finding the right treatment can take years, but why wait? Get started with Alpha-Stim today and let nothing stop you from living your best life. Take Charge of your life with alpha-stim Schedule a telehealth visit with a health care professional today to get started with Alpha-Stim. Schedule Now ### How Many Alpha-Stim Treatments Does It Take to See Results? Blog   How Many Alpha-Stim Treatments Does It Take to See Results? One of the most common questions we get is “How fast can I see results with Alpha-Stim?” It’s a great question and a fair one. Especially because Alpha-Stim devices work for anxiety, insomnia, depression*, and pain. Alpha-Stim is FDA-cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. How Fast Can I See Results with Alpha-Stim? Alpha-Stim M treats pain, anxiety, insomnia, and depression, while Alpha-Stim AID treats only anxiety, insomnia, and depression. For some conditions, results are experienced immediately and for others, a small amount of time and persistence provides needed relief and results. [Learn more about how long to use Alpha-Stim and when to decrease usage here.] Does Alpha-Stim Work the Same for Everyone? Nope. Just like any medical device, medical therapy, or medication, Alpha-Stim will work differently for each person who uses it. Every person has a unique physical and physiological makeup, and this can influence how quickly Alpha-Stim works and the level of relief a person feels in the short- and long term. That being said, as we mentioned above, Alpha-Stim provides cumulative relief. This means that each person should see improvements over time, with the benefits of compounded results adding on top of each other for greater relief. Success Story: Alpha-Stim Helps Woman Walk Away from Hip Pain and Medications After Just Two Treatments People who suffer from chronic pain know all too well how frustrating it can be to find the right treatment. Medications might work at first, but sometimes only temporarily – and they come with a whole host of nasty side effects. Alternative treatments such as physical therapy can be costly and time-consuming and can take weeks before providing any relief. Rose Lindner, shared her experience with Alpha-Stim for pain relief with us, and you can read it below. “At first I was apprehensive about using the AS Trodes for my hip. Finally, on Saturday, I did the best I could. I hooked up all 4 Trodes to my right leg,  hip and groin area for 20 minutes. [Then again on] Sunday for 20 minutes. It worked!!! I was miserable, but Alpha-Stim is taking away the pain and making it easier to move around!   I’m so blessed by this! I have spent the entire year tapering off of medicine; an opioid was one of them. Then I fell and my hip started keeping me down. I finished all my tapering on November 30th. I have absolutely NO desire to take the pain medicine road again.  Then I used the Alpha-Stim and it worked and its relief lasts much longer than a pain pill and there are no crazy, toxic side effects!”** **Minor and self-limiting risks: alpha-stim.com/risk. Could Alpha-Stim Work for Me? Many people can benefit from Alpha-Stim! You can learn more about how Alpha-Stim works here, or if you’re ready to get started, go ahead and set up a telehealth appointment below. SEe if Alpha-Stim is right for you Schedule a telehealth visit with a health care professional today to get started with Alpha-Stim. Schedule Now ### How Alpha-Stim Can Help People Struggling to Keep Their Health-Related New Year’s Resolutions Blog How Alpha-Stim Can Help People Struggling to Keep Their Health-Related New Year’s Resolutions Did you know that about 80% of people give up on their New Year’s resolutions by mid-February? It’s true! This is often due to not enough thought into planning and/or employing unrealistic timelines or methods that aren’t sustainable. Many people set goals without considering their current health status or schedule (busy job or family life) and making time for these goals becomes a big challenge.Fortunately, Alpha-Stim may be able to help with some of our health and wellness-related resolutions. See below for how Alpha-Stim could help with these 9 common health-, wellness- and fitness-focused New Year’s resolutions. New Year’s Resolutions Alpha-Stim Can Help You With 1. Exercise More If pain is preventing you from moving as much as you’d like and getting to the gym routinely, Alpha-Stim M may be a helpful option. Alpha-Stim M is an FDA-cleared prescription medical device that you can use for immediate and long-term pain relief. It can be used on your shoulder, neck, back - really anywhere else on your body - and can offer instant and ongoing relief.In one study of patients with severe pain, Alpha-Stim M significantly reduced pain by an average of 71% after only five treatments. (Source: Holubec JT. Cumulative response from Cranial Electrotherapy Stimulation (CES) for chronic pain. Practical Pain Management. 2009; 9(9):80-83.) 2. Spend More Time with Family and Friends If your anxiety is making you avoid social situations at school or with friends and family, talk with your mental health provider about Alpha-Stim to help with your anxiety. Anxiety can present or increase for some people in social settings, so talking with your mental health provider about Alpha-Stim may be a great idea. The best part? You can use Alpha-Stim at home and for as little as 20 minutes per session, so taking charge of your anxiety is a bit easier to do.Learn how Alpha-Stim works for anxiety here > 3. Learn a New Activity or Sport (CrossFit, Surfing, Yoga, etc.) Whether it’s pain in your knee or restless nights sleeping that keep you from trying CrossFit, learning to surf, or finally getting that yoga membership, next year is going to be different. See how Alpha-Stim can help you overcome pain and insomnia so you can finally check learning that new activity off your bucket list.  4. Run a Half-Marathon (or Marathon) When you’re a new runner or moving up to bigger races, it’s not unheard of to experience a bit of pain along the way. Many adults experience acute and/or chronic pain as a result of age, injury, or an underlying condition. If running a race is on your resolution list, consider how Alpha-Stim M could help.Alpha-Stim M uses hand-held probes or self-adhesive electrodes to deliver microcurrent electrical therapy (MET) directly to the pain site to provide non-invasive, sustainable pain relief. Get pain relief with Alpha-stim Schedule a telehealth visit with a health care professional today to get started with Alpha-Stim M for acute, chronic, and post-traumatic pain relief. Schedule Now 5. Live Life to the Fullest Better sleep. Less anxiety. Reduced pain. Living life to the fullest looks different for everyone, but helping your body and mind feel the best they can is key no matter your vision. Alpha-Stim is designed to help you care for your body and your mind. See what real users have to say here. 6. Practice Better Self-Care Self-care isn’t just bubble baths and meditation. Self-care means taking critical steps to manage anxiety and insomnia. Both can be detrimental to your physical and mental health, social interactions, job performance, and overall quality of life. Alpha-Stim can help you treat both anxiety and insomnia easily and at home - without medication. Proven to Help with Anxiety, Insomnia, and Depression* OVERALL DECREASE IN ANXIETY In clinical trials, patients reported an average of 61% less anxiety immediately after using the CES therapy. After 5 weeks, that average was 94%.1 IMPROVED SLEEP QUALITY The number of subjects rating their quality of sleep as poor dropped from 60% to 5%. DECREASE IN DEPRESSION In clinical trials, Alpha-Stim recipients reported an 82% decrease of ≥ 50% or greater in depression scores after five weeks using the CES therapy.Sources:1 Barclay TH, Barclay RD. A clinical Trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders. 2014;164:171-177. Presented at the American Psychological Association National Conference, Honolulu, July 2013.2 Lichtbroun AS, Raicer MMC, Smith RB. The treatment of fibromyalgia with Cranial Electrotherapy Stimulation. Journal of Clinical Rheumatology. 2001; 7(2):72-78.3 Barclay TH, Barclay RD. A clinical Trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders. 2014; 164:171-177. Presented at the American Psychological Association National Conference, Honolulu, July 2013.* FDA cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States.  7. Get More Sleep / Improve Sleep Habits /Make Sleep a Priority So much living to do, so little time. But sleep must be a priority, and it’s one a lot of people let slip. Various studies show that insomnia may be prevalent in 10-60% of the population, but fortunately, Alpha-Stim can help. In fact, one survey showed patients feel better with Alpha-Stim insomnia treatment than with common sleep drugs.Source: Kirsch, D.L., Price, L.R., Nichols, F., Marksberry, J.A., & Platoni, K.T. Military Service Member and Veteran Self-Reports of Efficacy of Cranial Electrotherapy Stimulation for Anxiety, PTSD, Insomnia, and Depression. (2014). The Army Medical Department Journal, 46-54. 8. Better Manage My Anxiety There are a lot of options today for managing and treating anxiety. And for some people, medication isn’t a comfortable option or their current modality isn’t enough. Alpha-Stim has been helping people with anxiety since 1981, and below is a great testimonial to its ability to help you take charge of your life again. “As a mom and having the unstable job of being an actress, who sometimes needs to travel all over the world to work, it can be demanding and at times quite stressful. I never thought of myself as having anxiety the way it was usually described to me but when I think back to a few months ago, and throughout the pandemic (where projects fell through and a lot of uncertainty with my job was a constant for quite some time) I can say now that I have indeed experienced bursts of anxiety.” Ragga Ragnars, Actress, Former Olympic Swimmer 9. Make Healthier Decisions Making healthier choices doesn’t just include fruit and vegetables or opting for water over soda. You can also be more conscious about the healthcare-related items that enter your body, such as the prescription medications you may be taking for pain. Understanding the risks and consequences of medications is important, and your healthcare provider can help you with this. But, something else to discuss with them is where you can opt to NOT use a prescription medication. For example, Alpha-Stim M is a drug-free device that can help relieve acute, chronic, and post-traumatic pain.In fact, when compared to pain relief responses from patients using Vicodin and OxyContin, patients self-reported greater reductions in pain with Alpha-Stim. See below.Source: Kirsch, D.L., Price, L.R., Nichols, F., Marksberry, J.A., & Platoni, K.T. Military Service Member and Veteran Self-Reports of Efficacy of Cranial Electrotherapy Stimulation for Anxiety, PTSD, Insomnia, and Depression. (2014). The Army Medical Department Journal, 46-54.Alpha-Stim M is an effective form of pain management designed to help you avoid or reduce the need for pain medicine, but it is safe to use with prescriptions or over-the-counter medications if needed. Learn more here > How to Get Alpha-Stim for the New Year One of the best things about Alpha-Stim is that in most states (not currently available for residents in Rhode Island and Vermont), you can get a device via a telehealth visit with an approved health practitioner here. You can choose the time/date and set it up to meet your schedule, then do the visit from your computer or mobile phone. Alpha-Stim requires a prescription, so get a referral and schedule your telehealth appointment here to get started today.Alternatively, contact your healthcare provider about getting a prescription for Alpha-Stim and send this link to them to help them get started.   ### Should You Consider Alpha-Stim Before Steroid Injections for Joint Pain? Blog Should You Consider Alpha-Stim Before Steroid Injections for Joint Pain? Painful joints are a chronic issue for many people, with roughly 30 million Americans affected by osteoarthritis. Joint pain can make it difficult for you to move around as well as you used to, or to go about your usual daily activities, so it makes sense to seek relief from the pain.  Can Steroid Shots for Joint Pain Cause More Harm Than Good? Doctors will sometimes offer corticosteroid shots to osteoarthritis patients who are suffering from chronic pain in their knees and hips. These injections were previously thought to pose no risk to patients.However, a 2019 study found that 8% of patients who received steroid injections suffered from complications, including the breakdown of cartilage or even bone loss or fractures. A HealthLine article further explains the risks of steroid injections: the shots “may eventually cause joints to collapse, which requires joint replacement surgery to treat. Some patients developed rapidly progressive osteoarthritis. This happens when an arthritis-affected joint deteriorates more quickly than usual. Some were diagnosed with a type of stress fracture known as a subchondral insufficiency fracture. Some were diagnosed with complications from osteonecrosis, which happens when bone tissue dies.” In short, although steroid injections may offer temporary relief from pain in the hips and knees, they ultimately may cause more damage than osteoarthritis itself. What once seemed to be a risk-free option for patients with chronic pain should now be weighed against its potential harm. Consider a Less Invasive Option Before Injections for Joint Pain Chronic joint pain can interfere with your daily life; but steroid injections may not be the best path to relief. Or at least, a person should consider a less invasive option first.Fortunately, there is a safer first-step option for treating chronic pain. Alpha-Stim M is an FDA-cleared medical device proven to treat acute, post-traumatic, and chronic pain safely and effectively. It is non-invasive and easy to use, with treatments lasting just minutes. The Science Behind Treating Pain with Alpha-Stim Alpha-Stim M delivers Microcurrent Electrical Therapy (MET) through two handheld Smart Probes, which allow you to treat your pain precisely where it hurts. Relief is long-lasting and often immediate. And since Alpha-Stim is not a drug, there is no risk of overuse, addiction, lasting side effects, or withdrawal. Results with Alpha-Stim are cumulative over time – so the more you use it, the less you’ll need to. It is safe to use in conjunction with other treatment modalities, but many people find that they can decrease or discontinue their other pain management methods (always check with your doctor first!) Alpha-Stim is backed by more than 100 clinical research studies over decades of experience. And while the science speaks for itself, patient testimonials flood in as well. https://youtu.be/uIMzGmjHdTE*FDA-cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States.  Get pain relief with Alpha-stim Schedule a telehealth visit with a health care professional today to get started with Alpha-Stim M for acute, chronic, and post-traumatic pain relief. Schedule Now ### What Makes Alpha-Stim® Better Than Other CES Devices? Blog What Makes Alpha-Stim Better Than Other CES Devices? As a healthcare consumer, you have choices when it comes to selecting your mode of treatment. It can be confusing to sift through the available options, especially when you just want to feel better fast.If you suffer from anxiety, insomnia, depression*, or pain, you may have heard about a treatment option called Cranial Electrotherapy Stimulation, or CES. CES has been cleared by the US Food and Drug Administration (FDA) and is available by prescription in the United States.*Alpha-Stim is FDA-cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States.As with most products, however, there is a wide range of pricing among CES devices – and this is one situation where you do not want to skimp on quality in favor of a bargain. Alpha-Stim is a CES device that is trusted worldwide by medical professionals for its fast, safe, and effective treatment of anxiety, insomnia, depression, and pain. Alpha-Stim was invented in 1981 and has been changing lives ever since. But what makes Alpha-Stim special? Unique Benefits of Alpha-Stim What makes Alpha-Stim superior to other CES devices on the market is its patented waveform. Alpha-Stim generates a unique configuration of microcurrent unavailable in any other CES device. For anxiety, depression, and insomnia, this waveform is transmitted to the brain via patented Earclip Electrodes. With the Alpha-Stim M, two handheld probes also deliver the microcurrent directly to the site of pain.Because of these patents, Alpha-Stim is in a class of its own. The Alpha-Stim waveform is delivered via earclips and modulates large-scale brain network activity patterns in two synergistic ways: 1) by stimulating cranial nerves, and 2) by directly modulating cortical oscillations in the temporal lobe. Ultimately, these two ways of stimulating the brain normalize the pathological signaling in the default mode network observed in psychiatric disorders, providing rapid, effective, and lasting symptom relief without the side effects of medication. Unique Benefits of Alpha-Stim Patents and design are important, but that is not the only advantage to Alpha-Stim. Over 100 independent clinical research studies and published reports support the effectiveness of Alpha-Stim. Nine out of ten users experience significant relief when treating their anxiety, insomnia, depression, and pain.Further, Alpha-Stim is honored to be trusted and relied upon by the United States military. It is available at more than half of the nation’s VA hospitals and has become a first line of treatment for the men and women who serve our country.READ: United States Army Bomb Technician Finds Relief with Alpha-StimREAD: Alpha-Stim is Key Part of U.S. Navy Pain Management InitiativeAdditionally, an MD Anderson Cancer Center study published in the Journal of Pain and Symptom Management provided even more solid evidence supporting the value and effectiveness of Alpha-Stim. These studies have been conducted on Alpha-Stim specifically.Other CES companies may cite research in their favor – but these studies are outdated and typically decades old while studies that support the effectiveness of Alpha-Stim continue to be released regularly, and award-winning publications are touting the benefits as well. What Real Alpha-Stim Users Say For when research is simply too academic, patient testimonials also support the excellence of Alpha-Stim.“My wife has always struggled with anxiety and the first time she used the Alpha-Stim I saw something I’d never seen before. A complete calm. Love how it helps in just 20 minutes.” – Mike Mansueto, a loving husband“I want to thank all of you for making the Alpha-Stim available. Within a week of using it, I experienced relief from clinical depression, which has stubbornly resisted treatment for over two years. Until I started using the Alpha-Stim, I had only partial relief with a SSRI antidepressant. Within three days, I noticed my sleep was much improved. Then, I noticed feeling more emotionally resilient. Today, I am almost back to the outgoing, spontaneous person I know myself to be!” – Sue Clark Lindh“I recently discovered Alpha-Stim and the results have been nothing short of amazing. Not only have I experienced relief from anxiety and insomnia, but, additionally, I have reduced accompanying physical pain.” – CH (MAJ) David J. Fair, PhD, former President, American Association of Police Officers; former President, Homeland Crisis Institute, TexasRead more Alpha-Stim testimonials from both patients and providers here > ### FDA Regulatory Info for Alpha-Stim Device Classification Name: Stimulator, Nerve, Transcutaneous, for Pain Relief 510(k) Number: K896948 Regulation Number: 882.5890 Device Name: ALPHA-STIM CS Applicant: ELECTROMEDICAL PRODUCTS, INC. Contact:  L Kirsch Classification Product Code: GZJ Date Received: 12/13/1989 Decision Date: 02/23/1990 Decision: Substantially equivalent (SE) Classification Advisory Committee: Neurology Review Advisory Committee: Neurology Statements/Summary/Purged Status: Purged, no summary or statement Type: Traditional Reviewed by Third Party: No Product Classification Device Stimulator, Nerve, Transcutaneous, For Pain Relief Regulation Description Transcutaneous Electrical Nerve Stimulator for Pain Relief. Regulation Medical Specialty Neurology Review Panel Neurology Product Code GZJ Submission Type 510(k) Regulation Number 882.5890 Device Class 2 GMP Exempt? No Establishment Registration Database Establishment: ELECTROMEDICAL PRODUCTS INTL., INC. 2201 Garrett Morris Pkwy. Mineral Wells, TX 76067-9034 Registration Number: 2020648 Operations: Initial Distributor, Specification Developer Status: Active Date of Registration Status: 2006Owner/Operator: ELECTROMEDICAL PRODUCTS INTL., INC. 2201 Garrett Morris Pkwy. Mineral Wells, TX 76067-9034 Owner/Operator Number: 9027065 Official Correspondent: Ms. Tracey Kirsch ELECTROMEDICAL PRODUCTS INTL., INC. 2201 Garrett Morris Pkwy. Mineral Wells, TX 76067-9034 Phone: 940-328-0788 104 Code of Federal Regulations 5890 [Code of Federal Regulations] [Title 21, Volume 8] [Revised as of April 1, 2005] [CITE: 21CFR882.5890] TITLE 21–FOOD AND DRUGS CHAPTER I–FOOD AND DRUG ADMINISTRATION DEPARTMENT OF HEALTH AND HUMAN SERVICES SUBCHAPTER H–MEDICAL DEVICES PART 882 — NEUROLOGICAL DEVICES Subpart F–Neurological Therapeutic Devices Sec. 882.5890 Transcutaneous electrical nerve stimulator for pain relief. (a) Identification. A transcutaneous electrical nerve stimulator for pain relief is a device used to apply an electrical current to electrodes on a patient’s skin to treat pain. (b) Classification. Class II (performance standard ### M Quick Start Guide Alpha-Stim® M Quick Start Guide The Alpha-Stim M device is a battery-powered electrical device that produces low-level electrical currents to treat anxiety, insomnia, and pain. Device accessories connect to the Alpha-Stim® M to facilitate treatment. Click the image below to view and download the PDF.  ### AID Quick Start Guide The Alpha-Stim® M device is a battery powered electrical device that produces low level electrical current to treat anxiety, insomnia and pain. Device accessories connect to the Alpha-Stim® M to facilitate treatment. ### Alpha-Stim M® Owner's Manual The Alpha-Stim® M device is a battery powered electrical device that produces low level electrical current to treat anxiety, insomnia and pain. Device accessories connect to the Alpha-Stim® M to facilitate treatment. ### Alpha-Stim AID® Owner's Manual The Alpha-Stim® AID device is a battery powered electrical device that produces low level electrical current to treat anxiety and insomnia. Device accessories connect to the Alpha-Stim® AID to facilitate treatment ### Alpha-Stim vs Prescription Drugs: Let’s Talk Side Effects Blog Alpha-Stim vs Prescription Drugs: Let’s Talk Side Effects Alpha-Stim offers a safer option for treating pain and mental health conditions One of the most notable factors about Alpha-Stim is its ability to treat anxiety, insomnia, depression* and pain, without the negative side effects attached to most prescription medications.In fact, out of over 100 clinical research studies, less than 1% of patients reported mild and self-limiting side effects, including dizziness (6 cases or 0.07%), skin irritation/electrode burns (6 cases or 0.07%), and headaches (9 cases or 0.10%).Below we look at the side effects of medications vs the safer option of using Alpha-Stim.*FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Alpha-Stim vs Prescription Drugs for Anxiety When anxiety hits, it fills normal, everyday activities with panic and fear of the unknown, a possible emergency or a worst-case scenario becoming reality. Anxiety can be one of the most frustrating hindrances because individuals who have it often don’t know why they are battling it, or how to stop it. Seeking help can often result in a prescription that only continues to hinder the ability to participate in daily activities.When looking specifically at anxiety, the NIMH noted that many patients are also prescribed Benzodiazepines or anti-anxiety medications such as Clonazepam, Alprazolam, and Lorazepam.Side effects of these anti-anxiety medications can include:DrowsinessDizzinessNauseaBlurred visionHeadacheConfusionTirednessNightmaresProblems with coordinationDifficulty thinking or rememberingIncreased salivaMuscle or joint painFrequent urinationBlurred visionChanges in sex drive or abilityRashHivesSwelling of the eyes, face, lips, tongue, or throatDifficulty breathing or swallowingHoarsenessSeizuresYellowing of the skin or eyesDepressionDifficulty speakingYellowing of the skin or eyesThoughts of suicide or harming yourselfDifficulty breathingAnxiety can be impairing enough, without having to deal with side effects that slow you down even further.Why Alpha-Stim is better: Alpha-Stim offers almost immediate relief for acute anxiety. Reduction is usually experienced during a single treatment. Moreover because it’s not a drug, it can be used more safely and in conjunction with other treatment modalities. Alpha-Stim is also a safer choice for those with preexisting chronic conditions (excluding those with implanted devices such as cardiac defibrillators), or who may already be taking other medications that could negatively interact with anxiety medications. “It was like it just melted the anxiety away. I could not believe the relief. How many times have I dealt with the anxiety because I didn’t want to take the drugs? Alpha-Stim allows me to fix my problem without stopping life. Life still goes on. To have a solution to the problem that allows me to go on about my life without any adverse effects is incredible.” – Dakota Meyer, US Marine and Medal of Honor recipient Alpha-Stim vs Prescription Drugs for Insomnia Insomnia leaves its victims lying awake at night, wondering why they cannot participate in one of the most basic human functions: sleep. Desperate individuals reach out to their doctors looking for relief from exhaustion, and they are often met with prescription medications that may provide temporary relief, but that often hinder their ability to function the next day.In addition to being prescribed for anxiety, benzodiazepines are also often prescribed for insomnia because of their ability to act as a “hypnotic sedative,” according to WebMD. Common sedatives prescribed for insomnia include Xanax, Valium, Ativan, Librium, Lunesta, Sonata, Ambien, Rozerem, and Halcion.Side effects from these medications prescribed for insomnia include:Burning or tingling in the hands, arms, feet, or legsChanges in appetiteConstipationDiarrheaDifficulty keeping balanceDizzinessDaytime drowsinessDry mouth or throatGasHeadacheHeartburnImpairment the next dayMental slowing or problems with attention or memoryStomach pain or tendernessUncontrollable shaking of a part of the bodyUnusual dreams weaknessInsomnia medication is often associated with a “hangover” type effect. Why Alpha-Stim is better: There are no such side effects with Alpha-Stim, allowing you to get more and better sleep, without any regrets the next morning. Patients usually see improvement after the initial treatment, but results may take up to three weeks.“My doctor prescribed the Alpha-Stim for my chronic insomnia. The first night I tried it, I went to sleep without any medication for the first time in years. It’s a small miracle! As I continue to use it, I find my mind is clearer, my moods more even and my stress level is at an all-time low. I’m extremely grateful to have discovered this wonderful device.” — Linda Segall Alpha-Stim vs Prescription Drugs for Pain Then there is pain. The term may be broad, but it affects us all at one time or another. When pain reaches a certain level, it calls for a trip to the doctor. However, a patient with temporary pain—maybe sore limbs following a car accident, or recovery from a minor surgery— is often issued a permanent diagnosis when a doctor prescribes small doses of highly addictive medications.The United States is currently facing an opioid epidemic, which is taking the lives of around 91 Americans each day. This is due in part to the increasing rate at which doctors prescribe the highly addictive medication, which is found in fentanyl, hydrocodone, meperidine, methadone, morphine, and oxycodone, to patients suffering from varying degrees of pain.As WebMD noted, while basic symptoms from opioid pain medication include constipation, drowsiness, nausea, and vomiting.  One of the most alarming symptoms stems from the fact that after taking the medication, “you might find that you need more and more of the drug to achieve the same effect in reducing pain.”Symptoms of withdrawal from opioid pain medications include:DiarrheaNauseaVomitingMuscle painAnxietyIrritabilityWhen it comes to traditional prescription medications for pain, not only is the list of side effects long, but it also includes conditions that can severely impact the patient’s daily activities. A prescription for temporary pain can come packed with side effects such as “mental slowing or problems with attention or memory” or “impairment the next day.”Why Alpha-Stim is better: Alpha-Stim is safe and proven effective for treating acute, post-traumatic, and chronic pain. It offers immediate relief before medication would even have time to start taking effect. When you’re in pain and need relief, the last thing you need is impairment from drugs. Moreover, unlike many pain medications, there is no risk of overuse or addiction.“I wish this would get into more Veterans’ hands versus a multitude of prescriptions. I have taken numerous NSAIDs and narcotic pain relievers and there is no comparison. This device is amazing. Keep getting the word out so fewer Veterans have to suffer! A grateful disabled Veteran!” – Carl Warner, US Military Veteran, Florida Alpha-Stim vs Prescription Drugs for Depression When depression sets in, it can affect you mentally, physically and emotionally. Whether it comes as a result of the loss of a loved one or a divorce, a trip to the doctor in search of something that will return you to feeling like your normal self can often result in a prescription that only makes the depression worse.According to the National Institute of Mental Health (NIMH), one of the most common medications doctors prescribe to treat depression is antidepressants. Antidepressants are also used for other health conditions, such as anxiety, insomnia, and pain. The most popular types of antidepressants are called selective serotonin reuptake inhibitors such as Fluoxetine, Citalopram, Sertraline, Paroxetine and Escitalopram.The list of side effects for these medications is long and includes a variety of symptoms. The side effects listed by the FDA are:Nausea and vomitingWeight gainDiarrheaSleepinessSexual problemsThoughts about suicide or dyingAttempts to commit suicideNew or worsening depressionNew or worsening anxietyFeeling very agitated or restlessPanic attacksTrouble sleeping (insomnia)New or worsening irritabilityActing aggressively, being angry, or violentActing on dangerous impulsesAn extreme increase in activity and talking (mania)Other unusual changes in behavior or mood A prescription for a patient who is battling a bout of depression can actually worsen and prolong the condition with side effects such as “thoughts about suicide or dying,” “attempts to commit suicide,” and “new or worsening depression.”Why Alpha-Stim is better: When treating depression with Alpha-Stim, significant improvement typically takes three weeks or more of daily treatment. After the depression is under control, two to three treatments per week or less are usually sufficient to maintain good results.“I want to thank all of you for making the Alpha-Stim available. Within a week of using it, I experienced relief from clinical depression, which has stubbornly resisted treatment for over two years. Until I started using the Alpha-Stim, I had only partial relief with a SSRI antidepressant. Within three days, I noticed my sleep was much improved. Then, I noticed feeling more emotionally resilient. Today, I am almost back to the outgoing, spontaneous person I know myself to be!” – Sue Clark Lindh*FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### Alpha-Stim Smart Probes vs. AS-Trodes: Which Should You Use to Treat Your Pain? Blog Alpha-Stim Smart Probes vs AS-Trodes: Which Should You Use to Treat Your Pain? When you purchase an Alpha-Stim M, you receive both Smart Probes and AS-Trode™ brand electrodes. Both can be used to treat acute, post-traumatic (including postoperative) and chronic pain, but how do you know which to use to treat your specific pain? Let’s first go over how Alpha-Stim treats pain, and then we’ll dive into when to use the probes versus the electrodes. Using MET to Treat Pain The term Microcurrent Electrical Therapy (MET), is used to describe a low current form of transcutaneous electrical nerve stimulation (TENS) used for pain control. With Alpha-Stim, MET is applied in a specific pattern around the pain site for approximately 2 to 5 minutes through Smart Probes, or AS-Trode self-adhesive electrodes for longer applications. What is the difference between MET and TENS? While MET technology may sound similar to previous forms of TENS, the difference is found in the fact that MET uses far less current, but delivers the current in much longer pulses. In a traditional TENS device, the current is often several hundred times stronger than with Alpha-Stim. While the simple waveform used by TENS can initially reduce pain somewhat, the body accommodates to it, and therefore maintaining a therapeutic effect requires an increased amount of current.In contrast, Alpha-Stim MET uses a more complex, patented waveform to modulate the pain signal rather than blocking it. The effects from Alpha-Stim are long-lasting and cumulative, and patients tend to see better results with continued use. There is also a significant amount of research supporting the safety and effectiveness of Alpha-Stim. Using Alpha-Stim M Smart Probes vs AS-Trodes Dr. Daniel L. Kirsch, inventor of Alpha-Stim, said that when it comes to Alpha-Stim’s Smart Probes versus AS-Trodes, the probes are almost always more effective. He is fond of saying, “It’s better to treat in the right place for 10 seconds than in the wrong place for 10 hours.”Kirsch suggested that patients should start out by using probe treatments and look for one place that relieves the pain the most. If the pain remains after the probe treatment, they should place the AS-Trodes on that spot at 600 µA, or the highest comfortable current level, until the pain subsides.“If the pain is not diminishing rapidly (after a few minutes) with the AS-Trodes, move them around every 10 minutes or so until you find a placement that works best,” Kirsch said.AS-Trodes are necessary for treating post-traumatic or post-surgical pain with the Alpha-Stim (0.5 Hz and 100 µA for a minimum of one hour at a time),” Kirsch said. “Leave the AS-Trodes on at 100 µA for as long as possible (24/7) turning the current up to 600 µA to manage pain. Once the pain subsides, turn it back to 100 µA. This may be used indefinitely as necessary.” The AS-Trodes can also be used in place of the earclips for CES if patients experience dizziness. Kirsch said that in this case, patients should place the AS-Trodes on their shoulders and treat at a low current. “Our general protocol follows sound electrophysiological properties, culled from several health care systems I studied over four decades. It is proven to work beyond most other therapies, including drugs,” Kirsch said.Learn more about Alpha-Stim for pain management here, or if you’re ready to try Alpha-Stim as part of your path to fast, safe, and effective pain relief, get started here. If you already own an Alpha-Stim and would like help on how to use your Alpha-Stim M device, we offer free clinical support Monday – Friday from 8 am – 5 pm CST at 1-800-FOR-PAIN. You can also email clinical support questions to info@epii.com. ### FDA “Cleared” Versus “Approved”: What’s the Difference? Blog   FDA “Cleared” Versus “Approved”: What’s the Difference? The question is sometimes asked: Why is Alpha-Stim “cleared” by the Food and Drug Administration (FDA), as opposed to “approved?” Of course, all the medical devices in the U.S. market are examined by the FDA to determine if they are safe and effective. Alpha-Stim is FDA-cleared for anxiety, insomnia, and pain, with approval for depression outside of the United States. Why is FDA Review Important? All manufacturers who seek to market medical devices in the United States must first pass a very thorough process with the FDA through one of two pathways—the section 510(k) process, where a device is “cleared” for distribution, or the Premarket Approval (PMA) process, where a device is “approved” by the FDA. Today’s process stems from the Medical Device Amendments added to the Food, Drug and Cosmetic Act in 1976, establishing three regulatory classes for medical devices. Because there were devices already on the market prior to 1976, all devices were considered either pre-amendment medical devices, or new concept medical devices that had never been in commercial distribution (e.g., MRI, and lasers). The new devices had to undergo a PMA, a process that is significantly more expensive and difficult for the manufacturer, more like a new drug application ending in FDA “approval” due to the fact that there is no existing history of the medical device. To accommodate the pre-amendment devices, the FD&C included a clause in section 510(k), which states that if a medical device manufacturer can prove their technology is “substantially equivalent” to a type of medical device that was on the market before 1976, then the FDA can clear the device for commercial distribution using the slightly easier requirements of the section 510(k) process. What is Alpha-Stim’s FDA Status? Alpha-Stim has gone through the section 510(k) process, and as a result, is FDA-cleared for interstate marketing and export for the treatment of anxiety, insomnia, and acute, post-traumatic, and chronic pain. Alpha-Stim has endured more FDA regulatory requirements than most medical devices in U.S. history, including more than a half dozen extensive reviews of the safety and effectiveness of the technology along with post-marketing surveillance, and biannual quality system reviews. So does “FDA Clearance “ vs “FDA Approval” matter? In the end, the FDA does not endorse any medical product, be it a drug or device, and regardless of how a product enters the market, both FDA approval and FDA clearance are legally equal authorizations to market and export a device. Ready to learn more or get started with Alpha-Stim? We’re here to help! Learn more about Alpha-Stim here or contact us today with questions. *Minor and self-limiting risks: alpha-stim.com/risk.  ### How to Handle Anxiety and Depression Post-Pandemic Blog   How to Handle the Long-term Impact of COVID-19 on Anxiety and Depression While some people are now going about their normal lives, others, who struggled with anxiety prior to the COVID-19 global pandemic, or who developed anxiety or depression during the months of isolation, are living in a new normal. According to the World Health Organization (WHO), the new normal includes anxiety and depression being increased 25% worldwide.  WHO also noted that “It also indicates that women have been more severely impacted than men and that people with pre-existing physical health conditions, such as asthma, cancer, and heart disease, were more likely to develop symptoms of mental disorders.” So if more people are suffering from anxiety and depression, and both can be compounded by existing health conditions, how can individuals take back control of their mental health? Reducing Anxiety Without Medications While there are a lot of treatment options for anxiety, and various severity levels of anxiety a person can experience, many people today are looking for drug-free options. The increased awareness of the side effects of medications for anxiety, depression, and especially pain, has resulted in increased demand by patients for something else. Moreover, the pandemic showed the need to be able to enable self-managed care at home. Alpha-Stim solves both these challenges by offering a safe, drug-free option for relieving anxiety and depression* at home. Patients can even obtain a prescription (U.S required only) for a device via telehealth appointment, making it an easy and accessible option. See how Alpha-Stim works for anxiety > See how Alpha-Stim works for depression* > * Alpha-Stim is only FDA-cleared for treating anxiety, insomnia, and pain, with approval for depression outside the United States. Real-World Examples of Alpha-Stim for Anxiety and Depression See below for what one Alpha-Stim user said about their experience using Alpha-Stim for anxiety developed as a result of the pandemic, and the positive impact it has had on their lives below. (See what some providers have said too here.) “I am a critical care nurse who had COVID twice in 2020 while providing bedside care to inpatient veterans at Salem VAMC. I am now disabled due to long-COVID with physical and mental health issues. I am on 3 medications for anxiety (panic attacks) & depression with limited effect. In my first 20-minute session, the Alpha-Stim device relieved my long-COVID anxiety. As a nurse, I hope for the best and prepare for the worst. Alpha-Stim has me believing in miracles. Thank you! While I still have other long-COVID issues to deal with, my quality of life has been greatly improved due to Alpha-Stim. All the best and be curious!” - Michael Huemmer, RN ### Electromedical Products International, Inc., Awards First Annual Innovative Young Investigator in Brain Stimulation Award Electromedical Products International, Inc. (EPI), manufacturer of Alpha-Stim® technology, announced today that it has awarded its first annual Innovative Young Investigator in Brain Stimulation Award to Tobias Schwippel, M.D. EPI established this award to recognize and nurture excellence in the field of non-invasive brain stimulation. Recipients are early-career researchers making notable, innovative contributions in the field who demonstrate the potential to be leaders in clinical research and practice. The award provides recipients a travel stipend to attend a prestigious conference in the field of their choice to present their work. Dr. Tobias Schwippel, Director of Clinical Research at the Carolina Center for Neurostimulation, focuses on non-invasive brain stimulation research in psychiatry. His current research, investigating the neural signatures thought to underlie multiple psychiatric disorders, may build a foundation for future, more efficacious therapeutic approaches. “Dr. Schwippel is a rising star pursuing new, and potentially meaningful, research approaches in neurostimulation in psychiatry,” said Flavio Frohlich, Ph.D., chair of EPI’s Scientific Advisory Board. “With this award, EPI is proud to invest in future generations of talented clinicians exploring non-invasive brain stimulation approaches that may change and improve treatment paradigms to benefit patients.” Dr. Schwippel will attend the International Brain Stimulation Conference, being held February 19 - 22 in Lisbon, Portugal, where he will host a Q&A session on the future of brain stimulation in psychiatry. He will be joined by Leah Townsend, Ph.D., chief scientific officer of EPI. About Electromedical Products International, Inc. (EPI) EPI is a leading medical device company in non-invasive brain stimulation for psychiatric disorders and microcurrent therapy for pain management. The company is the manufacturer of Alpha-Stim, a prescription medical device available in more than 50 countries worldwide (prescription not required outside the U.S.). Alpha-Stim is FDA cleared to provide fast, safe, and effective treatment of anxiety, insomnia, and depression via cranial electrotherapy stimulation (CES) and pain via microcurrent electrical therapy (MET). ### Tracey B. Kirsch Announces Retirement From Electromedical Products International, Inc. It is with emotion and excitement that I write this memo to inform you that effective September 1st I retired from my daily operational duties as EPI’s Chief Executive Officer. I am now in a consultative role to support Brian Burke in his position as our President. Additionally, as a shareholder, I will remain active on our Board of Directors. Some of you have been utilizing Alpha-Stim® technology through much of my 31-year tenure leading this 40-year-old company. It has been an interesting and challenging experience to bring disruptive technology into the allopathic medical world. Dan and I have always believed in our mission and the fact that the people deserve our non-invasive, inexpensive, and oftentimes miraculous technology regardless of the obstacles placed before us. Dan was quite the pioneer and well before his time, when he introduced the first Alpha-Stim device to the world in 1981. The hurdles have been immense, but worth it when we repeatedly hear the life changing reports of our customers’ successes with Alpha-Stim technology. These reports are what kept us fighting the good fight each day to keep EPI moving forward toward more widespread acceptance of our treatment approach. Our successes to date could not have been achieved without the hard work of the entire EPI team and the increasing utilization by our dedicated customers. EPI is currently working on its 9th and 10th generation Alpha-Stim models. This has been no easy feat in the very political medical and regulatory environments of today. Our integrity, expertise and perseverance have been instrumental in our success and the development of the firm foundation that Alpha-Stim has achieved. There is still much work to be done and there are many very exciting opportunities on the horizon that will move Alpha-Stim toward even greater acceptance as a first line treatment for pain and mood disorders worldwide. Thank you all for the support and dedication to the mission. It has been an honor and a pleasure to lead this company. I am proud of the work done by our team every day and I appreciate the confidence you have placed in us to provide effective cutting-edge technology to your patients. I look forward to witnessing the ongoing success of EPI and Alpha-Stim from the beach! Sincerely and gratefully yours, Tracey B. Kirsch ### This is how stimulating the brain can improve our well-being (Good Things Utah) - Life can seem to stop when we’re not feeling our best. Overall wellness is the key to a fruitful life but is diminished when our minds and bodies experience forms of stress. And while prescription medications can show some results, they’re also followed by an entire gamut of side effects hurting our day-to-day life. So what options are there to improve our well-being? To tackle these disruptions, one of the latest tech innovations called Alpha-Stim is showing promising results for patients around the world. Alpha-Stim CES (Cranial Electrotherapy Stimulation) is an FDA-cleared medical device targeting the brain and providing relief from things like anxiety, insomnia, and depression. Extensive studies have been done showing this device is both effective and safe — meaning no side effects, medications, or addiction risk. How does it accomplish all this? According to expert Leah Harter with Christian Center of Park City: “It sends just the smallest electrical impulse — it feels just like a tingle. What it does is its calming down your brain waves. It brings your alpha waves up and your delta waves down… Even within the hour, we’ll see a huge difference in our clients. They can relax, finally.” The device is compact, and easy to travel with for results on the go. Even better, the ear clips are virtually unnoticeable — very much resembling your average headphones. Many patients have also reported improvements in their pain levels, with treatments taking only 20 minutes to complete. The devices can be purchased online and are prescribed by a doctor or licensed healthcare practitioner. “There are two units,” says Tim Augustine with Alpha-Stim. “One treats anxiety, insomnia, and depression. The other treats all of those, plus pain.” Take your health back without the use of pills, surgery, or injections by using the Alpha-Stim CES devices. They even offer a 30-day money-back guarantee — if the device doesn’t work for you, send it back for a full refund. For more information about them and to purchase one of your own, go to Alpha-Stim.com or call 1-800-FOR-PAIN. ### Brian Burke Joins Electromedical Products International, Inc. as President Electromedical Products International, Inc. (EPI), manufacturer of Alpha-Stim technology, has announced Brian Burke as President. Mr. Burke comes to EPI with extensive experience in the medical technology industry, including over 15 years in startup, private equity and public company environments, in the orthopedic, spine, and maxillofacial-dental sectors. “Brian is a proven leader across all areas of management in a medical technology company with considerable experience. We are confident that he will do a fantastic job leading EPI into the future,” says Tracey B. Kirsch, EPI Chief Executive Officer. Prior to joining EPI, Mr. Burke served as chief operating officer of Titan Spine, Inc. a designer, producer and distributor of innovative titanium interbody fusion devices. During that time, he was the principal strategist overseeing all global operations including business plan development, organizational infrastructure, continuous improvement process, revenue generation and YOY profitability culminating in the acquisition of Titan by Medtronic plc where he established diligence processes and integration strategies post-acquisition for all operational functions. Before that, Mr. Burke served as general manager of North America for Zimmer Biomet Dental, where he led integration activities and presided over all sales and marketing functions after Zimmer purchased Biomet. Prior he worked at Biomet 3i, an innovator and global leader in oral and reconstructive surgery, in a variety of commercial and operational leadership roles in North America, Latin America and Asia. About Alpha-Stim® Alpha-Stim is a non-invasive prescription medical device (prescription not required outside the U.S.) that is FDA cleared to provide fast, safe, and effective treatment of anxiety, insomnia, depression, and pain. The brain functions electrochemically and can be readily modified by electrical intervention. The Alpha-Stim AID utilizes cranial electrotherapy stimulation (CES) to deliver the only patented waveform which is clinically proven to significantly decrease anxiety and comorbid depression. The Alpha-Stim M uses CES to treat anxiety, insomnia, and depression, plus microcurrent electrical therapy (MET) to treat pain. Alpha-Stim can be used alone, along with other therapies, or as an adjunct to medication (without the risk of drug-drug interactions). There are no serious adverse effects, no risk of addiction, and more than 100 research studies over 40 years that prove the effectiveness of this low-level electrical prescriptive brain therapy. About Electromedical Products International, Inc. (EPI) Electromedical Products International, Inc. (EPI) was formed in 1981 to develop, manufacture and market Alpha-Stim technology worldwide. The original device weighed over 40 pounds; today, because of advancements in electronics and computer technology, the Alpha-Stim is portable and accessible to patients. EPI is fully committed to supporting its products and customers through ongoing research, education and clinical support. To date, EPI has received regulatory approvals in numerous countries. Alpha-Stim products and accessories are FDA cleared in the United States, have obtained the CE mark for regulatory approval in Europe (through the European Medical Device Regulation), been awarded the UL (Underwriter's Laboratory) safety listing, are licensed by TGA (Australia), and are approved throughout most of the world. ### ABC News - Restoring sleep quality with this non-invasive medical device (Good Things Utah) Of the many things affected by the pandemic, sleep is certainly one of the most important deficits to arise. Insomnia is running rampant today, with studies showing over 25% deal with it at some point every year. While today’s insomnia cases are most commonly reported to be caused by stress, they can also be caused by factors like: Pain Travel Poor Sleep Habits Shift work (police officer or graveyards) Late meals Some of the symptoms of insomnia include: Difficulty falling or staying asleep Waking up during the night Feeling fatigued after a full night’s sleep Increased number of errors or mistakes while performing daily activities Irritability or anxiety Daytime sleepiness Inability to focus or remember things Alpha-Stim Alpha-Stim is a non-invasive, FDA-cleared medical device used as a safe, effective treatment for those facing mental and emotional trauma. The device has also demonstrated that it can effectively combat chronic insomnia. In one sleep study, the number of subjects who reported poor quality of sleep dropped from 60% to 5% while using the device. After only 5 treatments with the Alpha-Stim device, military service members suffering from insomnia reported a sleep increase of 43 minutes. Surveys also show patients feel better with Alpha-Stim than they do with medications when it comes to treating insomnia.   ### Could a Brain Zapper End My Years of Insomnia? Blog Could a Brain Zapper End My Years of Insomnia? Desperate to kick sleep medication, India Sturgis tried a radical new treatment to stimulate her brain’s alpha waves…and the results were life-changing The following is a guest post by India Sturgis, originally written for the Daily Mail.I am in a small basement room in a London clinic with five electrodes attached to my head.Three [of them] run to a small black box about the size of a hard drive, the other two are clipped to my ears and join a grey device.The neuro-psycho-physiologist Lesley Parkinson looks on with interest.‘Well done brain, yes!’ she says. ‘Look, absolutely lovely bursts of alpha waves.’I’m having an electroencephalogram (EEG), which measures brain electrical activity before, during and after using an Alpha-Stim device.I’m here because of a diagnosis of generalized anxiety disorder three years ago, a history of insomnia, and the hope this unorthodox approach might prove one of the final bricks in the wall of my recovery.Alpha-Stim has been around for a while, but it’s starting to make waves in some areas of mental health care, thanks to a small but growing body of evidence from clinical studies and patient testimonials — and a need to find alternatives to medication and waiting times involved in therapy.Marketed as a treatment for anxiety, insomnia, depression* and pain, Alpha-Stim is a form of cranial electrotherapy stimulation — the device I’m attached to generates a microcurrent of electricity (less than half a milliampere, compared with, say, the 540 milliamperes drawn from a 60-watt lightbulb) — which helps to normalize the activity of a certain type of brainwave called alpha waves.*FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. These are associated with states of calmness, relaxation, and meditation in an awake brain and have a measurable frequency (between 7.5 Hz and 13 Hz on an EEG).Other brainwaves also read by an EEG include beta waves (associated with a busy, active, anxious mind), delta waves (linked to sleep), and gamma waves (associated with concentration).I notice little during the treatment, except a fuzzy rhythmic buzzing every couple of seconds at my earlobes.To my surprise, my EEG shows there’s a significant change in the frequency and size of my alpha waves — I wasn’t expecting such an immediate effect.This is not my first time using the device. For five weeks I’ve been ‘plugging myself in’ for an hour every evening in front of the television, and for the first time in years, I’m able to fall asleep without medication.For me, three years after being admitted to the Priory Hospital in Roehampton, South-West London, this is no small miracle.My battle with insomnia, which I had experienced on and off for seven years, had dropped off a cliff.I was spending whole nights awake, at turns frustrated, hysterical, and back to sanguine. I had amassed generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), a specific phobia of going to bed (clinophobia), and situational depression as a result of all these conditions.In the worst moments, I’d avoid going into my bedroom during the day because it had taken on such negative connotations. The panic attacks I’d started experiencing I had alone, screaming into a pillow in our attic bedroom so as not to wake my husband or our young daughter. Although I could function during the day, for example keeping up with work and friends on the surface, my husband took the brunt of my short fuse behind closed doors. I didn’t deal well with him changing plans or sneezing at night.Anxiety — not something I had previously identified with — increased week on week. I was malfunctioning on a grand scale.After a month as an in-patient and several more as a day-patient, I was discharged from the hospital with prescriptions and an altered outlook.During the months and years since, I’ve spent time and energy turning this mess around with a combination of time away from work and a social life, psychoeducation, cognitive behavioral therapy, medication, and various other coping mechanisms, such as yoga, deep breathing, and keeping a diary. I reorganized myself at a fundamental level.Last year, I felt comfortable enough to begin the slow process of dropping my sleep medication.It took ten months to reduce the amitriptyline from 40mg to 5mg, but stopping that final, measly half-pill was proving difficult.Old feelings of anxiety, linked to sleep, re-emerged along with a night-time agitation I hadn’t felt for years.I heard about Alpha-Stim while researching a book I’m writing about anxiety, and wondered if it could help me. In truth, it sounded far-fetched — bathing your brain in electricity on the sofa to quell anxiety — so I checked it was safe with my psychiatrist.Last year, the National Institute for Health and Care Excellence (NICE) concluded that Alpha-Stim showed promise for managing anxiety disorders and it’s currently being trialed by the NHS in Northamptonshire.An earlier study, published in 2019 by Nottingham University in the Journal of Affective Disorders, found that around half of 161 volunteers with generalised anxiety disorder were in remission after 24 weeks, having used the device for an hour every day over a 12-week period — although the study participants were not compared to a control group.Side effects were fleeting and rare: mild headache, short spells of dizziness or nausea (if levels were too high), or skin irritation from the electrodes.Alpha-Stim is safe, my psychiatrist agreed and could be worth a try, as any reduction in my anxiety might give me more confidence in my ability to sleep at night.The first evening I’m wired up to the device, I feel relaxed enough to hold off taking my sleep medication.The device is easy to use, you simply moisten the disposable electrode felt pads with a conduction solution containing mineral salts to help the current flow better, attach the clips to each ear and turn the device on. Nothing much seems to happen apart from the rhythmic tingle at my earlobes — but that night I drift into sleep without trouble. I wake up tentatively happy and more confident.Users are advised to aim for 20, 40 or 60 minutes every day for around four to eight weeks, then scale back use to roughly three times a week — or when required. Alpha-Stim can be used before or alongside medication and therapy.The kit costs from £480, or you can rent it from £25 a week plus VAT for a minimum of four weeks, which is expensive (I borrowed mine from a supplier, themicrocurrentsite.co.uk).Dr James Kustow, a psychiatrist and medical director of The Grove Practice, a mental health training provider and therapy service, has used the device with about 200 patients.He says that, while there’s enough good data for people to feel ‘reasonably confident’ in its efficacy and safety, there are unanswered questions, and the NHS would need to see more research before it could consider rolling it out.One concern is that no one has yet proven how its anti-anxiety effect works. As well as boosting alpha waves, some research suggests the device activates groups of nerve cells located in the base of the brain which produce the chemicals serotonin and acetylcholine, which relate to positive mood, according to James Giordano, a professor of neurology at Georgetown University, in the U.S., who works with Alpha-Stim.Dr Kustow and others believe it probably works by directly stimulating the vagus nerve, part of the autonomic nervous system that controls unconscious actions such as breathing and digestion.The vagus nerve stretches from the brain to our major organs, and stimulating it is thought to put us into a ‘rest-and-digest’ (rather than fight-or-flight) state, says Dr Kustow.Since using the device for the first time 12 weeks ago, I’ve not felt the need to take the amitriptyline once, and my anxiety surrounding bedtime has dropped to almost zero.The only downsides have been a slightly itchy, irritated patch of skin behind my ears and — once — a short spell of nausea and dizziness when I turned the current up too high to see what would happen.This, according to Dr Kustow, is because the device can stimulate the vestibulocochlear nerve which passes near the ear and is involved in balance.Turning down the device stopped the sensation in seconds — but clinicians argue this underlines why Alpha-Stim should be introduced to patients by trained professionals, rather than it being purchased online as it currently is in the UK.After one week, I was sleeping more deeply and waking less often. A few times I have even awoken having slept soundly the entire night — something I haven’t done for many years. After ten weeks I stopped using it; I kept forgetting, which shows how relaxed I have become.It’s hard to know exactly how much is actually down to the placebo effect but, frankly, I don’t care. Getting a good night’s sleep without relying on medication has been a long time coming. See if Alpha-Stim is Right for You. Give Alpha-Stim a try for insomnia relief. Learn more about how Alpha-Stim can help you improve the quality of your sleep below. Learn More ### Electromedical Products International, Inc. Announces Acquisition of Pulvinar Neuro Electromedical Products International, Inc. (EPI), the leading medical device engineering and manufacturing company using cranial electrotherapy stimulation (CES) to treat mental health and pain disorders, is pleased to announce its acquisition of Pulvinar Neuro (Pulvinar), a leading research-oriented medical device firm focused on the development of closed-loop and other novel neuromodulating brain stimulation solutions for the clinical treatment of various mental health disorders. EPI is the market leader in low-current, non-invasive CES and microcurrent electrical therapy (MET) technology for the safe, fast, effective and drug-free treatment of anxiety, insomnia, depression, and pain. The company was founded in 1981 by Dr. Daniel Kirsch and has a long-standing track record of marketing its patented, FDA-cleared Alpha-Stim® technology with devices being sold in more than 50 countries worldwide. The acquisition will provide Pulvinar resources to accelerate the development and commercialization of its patented and proprietary technologies, including transcranial alternating current stimulation (tACS), individualized feedback stimulation, and cloud-enabled digital therapeutics for the treatment of psychiatric and neurological illnesses. This transaction supports Pulvinar’s mission as a company founded by researchers for researchers and will facilitate its ability to advance and expand collaborations with the research community to develop this technology for clinical applications. “We are very excited about adding Pulvinar and its team of brain stimulation and data science experts to our team. Pulvinar expands our scientific and research capabilities addressing non-invasive, drug free treatment solutions for anxiety, insomnia, depression and pain as well as other indications we plan to pursue for FDA clearance,” said EPI’s CEO Tracey B. Kirsch. Pulvinar Neuro was founded by Dr. Flavio Frohlich, Associate Professor of Psychiatry and Director of the Carolina Center for Neurostimulation at the University of North Carolina School of Medicine. “Our transaction with EPI, the leader in non-invasive electric brain stimulation, is a unique opportunity to dramatically accelerate the translation of the next generation brain stimulation technology from the research to the clinical arena,” said Dr. Frohlich. Pulvinar Neuro CEO Dr. Leah Townsend said, “I am looking forward to working with EPI to bring the next generation of personalized non-invasive brain stimulation to market, complementary with EPI’s suite of devices, which we are confident will benefit millions of patients who are looking for effective and safe treatment options. I could not imagine a better partner than EPI with its decades of experience in developing and commercializing its technology.” About EPI EPI is a medical device company that designs, manufactures and markets cranial electrotherapy stimulation and microcurrent electrical therapy prescription medical devices. Their products have utility patents in the U.S., China and Europe and are cleared by the FDA for use in medical facilities, physician offices and at home in the U.S. It has been on the Federal Supply Schedule in the US since 2005. It requires medical prescription in US but is sold over the counter worldwide.   ### NBC4 Washington - Electrotherapy Device Treats Anxiety, Insomnia, Depression Nov 22, 2021 - It can affect anyone at any time. It doesn’t discriminate by age, race, gender or income. Yet many of us find that mental health and mental illness are tough topics to talk about. That’s why NBC4 is shining a light on the subject by providing education, information and hope. Dr. Josh Weiner, a psychiatrist in Louisiana, recently shared his experience with Alpha-Stim in an interview on NBC4 Washington. About Alpha-Stim® Alpha-Stim is an FDA cleared, handheld medical device that has been proven time and again to effectively treat acute, post-traumatic, and chronic pain, as well as anxiety, insomnia, and depression. Alpha-Stim uses cranial electrotherapy stimulation (CES), delivered through a patented waveform via two earclip electrodes, to treat anxiety, insomnia, and depression. Microcurrent electrical therapy (MET) delivers pain relief directly to the source of discomfort via two handheld Smart Probes. The safety and effectiveness of Alpha-Stim is backed by over 140 independent clinical research studies. Unlike with medications, there is no risk of addiction or lasting side effects. Alpha-Stim is available by prescription in the United States and over-the-counter in other countries. Get started today! Minor and self-limiting risks > ### ABC4 Good Things Utah Feature on Alpha-Stim ABC4 Good Things Utah featured Alpha-Stim on a segment titled "Drug-free solution for anxiety, insomnia, depression*, and pain has proven effective in 9 out of 10 people". About Alpha-Stim® Alpha-Stim is an FDA cleared, handheld medical device that has been proven time and again to effectively treat acute, post-traumatic, and chronic pain, as well as anxiety, insomnia, and depression. Alpha-Stim uses cranial electrotherapy stimulation (CES), delivered through a patented waveform via two earclip electrodes, to treat anxiety, insomnia, and depression. Microcurrent electrical therapy (MET) delivers pain relief directly to the source of discomfort via two handheld Smart Probes. The safety and effectiveness of Alpha-Stim is backed by over 140 independent clinical research studies. Unlike with medications, there is no risk of addiction or lasting side effects. Alpha-Stim is available by prescription in the United States and over-the-counter in other countries. Get started today! See minor and self-limiting risks > *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  ### “A New Lease on Life”: Alpha-Stim Brings Relief to Veteran After Years of Suffering *Alpha-Stim is FDA-cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States.   Our nation’s Service Members put everything on the line when they step into their uniforms. These selfless men and women understand that they may face grave danger during their service, yet they commit to serve and protect their country anyway. We at EPI recently received a heartfelt letter from a Veteran, recounting her struggles with pain, anxiety, insomnia, and depression that resulted from a combat-related injury. Though it is heartbreaking to know that she suffered for so long, we are elated to hear that she has found relief with Alpha-Stim®. In her own words, here is her story. My name is Katjia Bagnell and I'm an American Veteran of foreign and American wars. I was injured and I have been in pain from the top of my head to the bottom of my toes. For several years, I've been in and out of wheelchairs and walkers. I have severe bilateral damage to my SI joints, hips, and pelvic region. I have cervical, shoulder, and cranial damage, and traumatic brain injury. I have seizures. I have fatigue, depression, panic disorder, and anxiety disorder. I have pain constantly - 24/7. At 49 years old, I went to my doctor. It was either put a bullet in my head or go on pain medication after refusing it for a very long time. And I told her I wanted to go on pain medication. She came up with the Alpha-Stim M as a solution. Within three weeks, I was out of the wheelchair. I'm sleeping through the night. I can manage the pain. I feel like I have enough energy to walk around and not feel like I'm dying. For my panic disorder and my anxiety disorder, which I was on [medication] for, I no longer take the medication. I plan on getting off the antidepressants when I see my psychiatrist, as my depression has disappeared. Due to the Alpha-Stim, my affect has improved 100% and my pain that was over a 10 on a daily basis has gone down to zero. I cannot say enough about the Alpha-Stim. It has changed my life. It has given me a new lease on life and a new outlook. We are honored to have been able to bring life-changing results to Katjia, and all the other Veterans and Service Members who have discovered the benefits of Alpha-Stim. But what is Alpha-Stim? It’s an FDA cleared medical device that is clinically proven to safely and effectively treat anxiety, insomnia, depression, and pain. A tiny current of electricity is transmitted through electrodes that clip onto your earlobes – a modality called cranial electrotherapy stimulation (CES.) The patented waveform of electricity restores balance to your brainwaves, relieving your anxiety, insomnia, and depression. Two handheld Smart Probes deliver relief directly to the site of your pain. Relief is long lasting and often immediate. For pain, Alpha-Stim uses microcurrent electrical therapy (MET). Two handheld Smart Probes deliver relief directly to the site of your pain. Relief is long lasting and often immediate. Since Alpha-Stim is not a drug, there is no risk of addiction or lasting side effects. Results are cumulative over time – the more you treat with Alpha-Stim, the better you’ll feel, and the less you’ll need it! Many people, like Katjia, find that they feel so good with Alpha-Stim, they can taper off of their medications (always check with your prescribing physician before making any changes to your medications.) Alpha-Stim is backed by decades of experience and 140 clinical research studies. It is available at more than half of the nation’s VAs. Visit our Veterans and Service Members page, or call 1-800-FOR-PAIN and ask to speak to Government Services. Why struggle another day? Get started today and see how Alpha-Stim can change your life for the better. About Alpha-Stim® Alpha-Stim is an FDA cleared, handheld medical device that has been proven time and again to effectively treat acute, post-traumatic, and chronic pain, as well as anxiety, insomnia, and depression. Alpha-Stim uses cranial electrotherapy stimulation (CES), delivered through a patented waveform via two earclip electrodes, to treat anxiety, insomnia, and depression. Microcurrent electrical therapy (MET) delivers pain relief directly to the source of discomfort via two handheld Smart Probes. The safety and effectiveness of Alpha-Stim is backed by over 140 independent clinical research studies. Unlike with medications, there is no risk of addiction or lasting side effects. Alpha-Stim is available by prescription in the United States and over-the-counter in other countries. Get started today! See minor and self-limiting risks >       ### Crisis intervention with Trembling Hands: My Reactions as a Helper in the Western Germany Floods Blog Crisis Intervention with Trembling Hands: My Reactions as a Helper in the Western Germany Floods The following blog is a guest post written by Dr. Axenia Schäfer about using Alpha-Stim in Western Germany following devastating flooding. On the night of July 14, flash flooding decimated parts of Western Germany. The physical damage was immense, as was the psychological trauma of the people affected by the disaster. What follows is the narrative of Dr. Axenia Schäfer, who assisted with the crisis response by gathering Alpha-Stim devices and guiding distraught residents through treatments to ease their [anxiety]. Using Alpha-Stim Following a Catastrophic Event Western Germany faced terrible flash flooding in the night of July 14th to 15th. More than 180 people died, and more than 70 are still missing. There are villages where the infrastructure is flooded away (water supply, waste water, electricity, railroads, streets, bridges). Many people lost family members, friends, neighbors, homes, and all their belongings.Dr. Axenia Schäfer assisted with crisis response by gathering Alpha-Stim® devices and guiding distraught residents through treatments to ease their stress and anxiety.My brother lives in the region and our relief campaign started in the classic way: pumping water and shoveling mud. But it soon became clear that not only muscle power, rubber boots, and buckets were needed, but also support to help people with the psychological stress. That is why my brother began to collect Alpha-Stim devices available in his area, so that they could be used by doctors and trained teams for crisis intervention and relief.Companies and private individuals alike donated their Alpha-Stim devices. The manufacturer of Alpha-Stim, Electromedical Products International, Inc. (EPI), donated 25 devices, sent from Texas to Germany.One woman affected by the disaster had to smile in the middle of the nightmare while I prepared an Alpha-Stim for her. It was an understanding smile: my hands were trembling – a classic symptom of anxiety.So it came about that I not only prepared the Alpha-Stim devices for flood victims to ease their tension and help them sleep; I also had to use my Alpha-Stim to calm myself down. The Alpha-Stim waveform often works within a few minutes to relieve anxiety. The symptoms are “zapped” away.Inner restlessness and tension, trembling hands, pain, a knot in the stomach, an inability to sleep properly despite exhaustion, thoughts revolving around a possible failure of one's own – the reactions of body and mind caused by the fear and horror of a crisis are many. And this applies not only to people who are directly affected by the disasters, but also to their helpers.Western Germany faced terrible flash flooding in the night of July 14th to 15th. More than 180 people died, and more than 70 are still missing.In disaster situations in Germany, acute care for severely stressed people is usually provided by doctors, trained laymen, first responders, emergency chaplains, or psychologists. Our resource for this disaster is Alpha-Stim, the small device that emits a special microcurrent via the earlobes. It sounds unusual, but has been proven effective for more than 40 years, and has been examined in clinical research studies. Even with first responders, it is safe and extremely easy to use.When Tracey Kirsch, the CEO of EPI, became aware of the catastrophe, she did everything to provide fast and exceptional help with this exceptional device. The crisis intervention team that is using Alpha-Stim here in the flooded villages, their helpers and of course the people affected by the flood – and last but not least me, having my steady hands back – are very grateful to have Alpha-Stim for treatment. Electromedical Products International, Inc. (EPI), manufacturer of Alpha-Stim, is proud to have been able to contribute to the efforts of Dr. Schäfer’s team. Our thoughts are with everyone who has been affected by this disaster.  ### New UK Study Confirms: Alpha-Stim Improves Quality of Life By Relieving Anxiety Researchers from the United Kingdom’s Northamptonshire Healthcare NHS Foundation Trust (NHFT) and General Practice Alliance (GPA) recently conducted a study to examine whether Alpha-Stim® can be a useful tool to improve quality of life for those with anxiety and depression. Alpha-Stim is a CES device that delivers a microcurrent of electricity to balance the user’s brainwaves Currently in the UK, psychological intervention is a recommended treatment for GAD, but patients face long wait times for appointments, individual therapy can be expensive, and has non-response rates of 60-66%.¹ Medications are another standard option, but these come with the risk of unpleasant side effects, are not always effective, and can be costly. With these downfalls to psychotherapy and medications as first-line treatments, the NHFT and GPA researchers sought to analyze the effectiveness of Alpha-Stim as an alternative treatment option. Alpha-Stim is a cranial electrotherapy stimulation (CES) device that delivers a microcurrent of electricity, through earclip electrodes, to balance the user’s brainwaves. The patented waveform of electricity is painless, and the device is compact and easy to use in a patient’s own home. Treatments take just 20 minutes per day and a physician’s supervision is not required. While more than 140 clinical research studies have already proven the safety and effectiveness of Alpha-Stim at treating anxiety and depression – including one by the NHS itself that proved the clinical- and cost-effectiveness of the device at treating GAD – this new study went one step further, in an attempt to determine the device’s impact on quality of life itself. After 6 weeks of treatment with Alpha-Stim, improvements in anxiety and depression were on par with previous studies, which was no surprise to researchers. What was unique to this study, however, was the concrete evidence of an improved quality of life: “Of these improvements the dimensions of self-care, ability to perform usual activities and anxiety/depression were statistically significant. The largest effect sizes were observed in ability to perform usual activities and the anxiety/depression dimension. This indicates the positive impact of Alpha-Stim on the real-world functioning and wellbeing of patients.”² Alpha-Stim lifts the burden of anxiety and depression so effectively that people can live their lives the way they want to. In other words, Alpha-Stim lifts the burden of anxiety and depression so effectively that people can genuinely live their lives the way they want to. With medications, you may find relief from anxiety and depression but with the cost of unpleasant side effects that drag you down. Therapy may provide some benefit to some people, but you may have to wait weeks or even months for a session. With Alpha-Stim, you can conduct a treatment whenever it is convenient for you, in the comfort of your own home – without investing the time in traveling to and from a therapy session, and without the risk of lasting side effects from medications. Why settle for a treatment option that is anything less than ideal? When you struggle with anxiety and depression, you want relief from your symptoms without accepting some other detriment such as lost time, a large financial burden, or unpleasant side effects. Alpha-Stim lets you have the best of all worlds. With Alpha-Stim, you get relief from your anxiety and depression, as well as an overall improved quality of life. Patients have said so for decades, and now the research does, too. The abstract of this study is available; the full text of the study is here.   ¹Griffiths, C., Leathlean, C., Smart, D., Zafar, A., Hall, C.-L. and Deeks, S. (2021) Alpha-Stim Cranial Electrotherapy Stimulation (CES) for Anxiety Treatment: Outcomes in a United Kingdom (UK) Primary Care Practice. Open Journal of Psychiatry, 11, 187 ²Griffiths, C., et al., 196 ### I Tried Alpha-Stim: Here is my Honest Review Current Body Article By Amy Nicholson; original article at currentbody.com Did you know that with the help of innovative technologies, there's now a completely natural way to treat anxiety, insomnia and depression without medication? Introducing the Alpha-Stim AID Device. This wearable device calms and relaxes the body by sending tiny electric currents through earclips, increasing the frequency of the soothing Alpha waves in the brain. In new trials conducted by the NHS, 63% of patients saw an improvement in anxiety symptoms while 77 of 161 participants achieved total remission. Although statistics can be impressive, in our experience it's also incredibly useful to hear about genuine experiences using the technology. We spoke to Victoria, one of our valued customers, about her Alpha-Stim journey to see what it was really like to use the device. Tell us a little more about your background When I was asked if I would like to trial the Alpha-Stim AID Device I didn't dare to have too much hope. The AID is hailed as a 'drug-free treatment that works' for anxiety, depression, and insomnia, and having lived for as long as I can remember with all three this sounded too good to be true. I went into it with a faint kind of optimism; I wanted it to work but didn't want the disappointment if it didn't make me feel better. I am happy to say that following a full 10-week programme I feel much, much better than before. My moods have levelled, and when life starts to feel as if it may get back on top of me using the Alpha-Stim lowers my anxiety. I can think rationally about navigating through situations that arise without spiraling into a complete panic. I don’t get the shakes from the sheer thought of a meeting at work, I can do my weekly food shop without listening to loud music to drown out the noise, and I can even say that I get a good night’s sleep now. What solutions had you tried in the past? To give you some background on why I was asked to trial the device I’ll explain some of my background in dealing with my mental health. I’ve tried counselling sessions from the age of 11 - with very limited success. I was so worried that I would make my therapist feel bad if I told them I wasn't feeling better. I would lie about how low my moods were which in turn meant they would stop the sessions. For years I had been on medications for anxiety and depression; Fluoxetine and Sertraline worked best for me. The tablets came with caveats, though. I experienced side effects like dissociation, dulling of emotions (the good as well as bad), and tremors to name just a few. Earlier this year I stopped taking my Sertraline almost by accident. I was busy with work, my parents were ill, and I kept forgetting to book an appointment for a review with my GP. They stopped my prescription in the end, and I found myself going cold turkey. This is where the Alpha-Stim came in. I was struggling - badly - when it was suggested that I give it a go. How did you find the first Alpha-Stim treatment? The manual is incredibly thorough which I was glad for, I prefer to know the rationale behind everything, so reading through all the technical points helped a great deal. There are also a whole host of clinical studies published online about the device which are an interesting read if you can stand the jargon. After reading as much as I could and going over the instructions twice, I unboxed everything. The AID comes with little pads which stick on to the ear clips, making it look like you’re wearing headphones. The device itself reminds me of the original Game Boy, it isn’t too big and it isn’t difficult to use. Perhaps the strangest part was applying the solution to the pads and then clipping them to my ears - it was cold and wet, but I realised I had used too much of the solution. Alpha-Stim say that using the device for 1 hour at 200μA is a perfect starting point, so that’s what I did. Well… that’s what I did after I tried using it at 400μA. Curiosity got the best of me, but I soon learned that more is not necessarily better! Every person’s body is different, so the ideal setting for you is going to be different, too. I’ve learned that it’s a really good idea to start on 200μA and begin increasing the power until you feel slight vertigo (dizziness, like that swooping sensation you have in your tummy after being on a rollercoaster). You will absolutely know it when you feel it. At that point turn the device down by one setting and you’ve hit the perfect level. I played chilled out music in the background and I sat for an hour, still as a statue, because I didn’t want to mess anything up. The best way to describe the way it made me feel is like being under the weight of a thick duvet; warm, weighty, and comforting. If I had ever had the nerve to get a massage, I thought, then this is probably how my body would have been afterwards. The whole world had melted away, I’d managed to spend a whole hour not worrying. I could barely believe that it had gone so well so soon. How did you feel after the treatment? I slept like a baby. No, really. My long-standing friends call me a vampire because I’m always awake during the night. I’ve tried everything to improve my sleep but the concept of an ‘early night’ has always eluded me. Podcasts, audiobooks, meditation, sleeping tablets, herbal teas… the list goes on. After my first treatment with the Alpha-Stim (at about 6 pm) I found myself crawling into bed at 10:30 pm. I slept through the night without waking up - a miracle in itself - but more than that I didn’t even have nightmares. I could have done a dance when I woke up the next morning! From trial and error (and research) I’ve also found that the treatment time varies per person. You can’t over treat with the device, but you can under treat, and it is not a good feeling. That nice heavy feeling I mentioned will subside when you’ve used the device for long enough, if you stop treatment too soon it can stay with you for days. So how did you find the experience overall? Was it positive? It works. It works! My anxiety was improved from the first treatment - the effects wore off after a few hours but the more I kept up with my treatments the longer the results stayed with me. My depression took longer to work on, but I have felt a significant improvement with this. In the middle of trialing the Alpha-Stim we had a bereavement in the family, and I can’t imagine how I would have coped without the AID. The Alpha Stim AID doesn’t require checkup treatments with my doctor, I don’t have any side effects, and I’m no longer stuck setting an alarm to remember to take a tablet every day. Now that I’m used to the device, I can watch TV or potter around while using it (it comes with a lanyard to keep the device around your neck). It has become a part of my daily routine at this point and I’m so glad I was given the opportunity to try it. About Alpha-Stim® Alpha-Stim is an FDA cleared, handheld medical device that has been proven time and again to effectively treat acute, post-traumatic, and chronic pain, as well as anxiety, insomnia, and depression. Alpha-Stim uses cranial electrotherapy stimulation (CES), delivered through a patented waveform via two earclip electrodes, to treat anxiety, insomnia, and depression. Microcurrent electrical therapy (MET) delivers pain relief directly to the source of discomfort via two handheld Smart Probes. The safety and effectiveness of Alpha-Stim is backed by over 100 independent clinical research studies. Unlike with medications, there is no risk of addiction or lasting side effects. Alpha-Stim is available by prescription in the United States and over-the-counter in other countries. Get started today! See minor and self-limiting risks >   ### Alpha-Stim® is the Latest Cool Science on NPR’s “Cool Science Radio” On KPCW’s Cool Science Radio, hosts John Wells and Lynn Ware Peek discuss the latest in fascinating technology. Their goal is to help listeners understand complex topics by making them entertaining and accessible. [fusion_button link="https://www.kpcw.org/post/new-technology-helps-treat-insomnia-anxiety-and-depression#stream/0" text_transform="" title="" target="_blank" link_attributes="" alignment_medium="" alignment_small="" alignment="center" modal="" hide_on_mobile="small-visibility,medium-visibility,large-visibility" sticky_display="normal,sticky" class="" id="" color="default" button_gradient_top_color="" button_gradient_bottom_color="" button_gradient_top_color_hover="" button_gradient_bottom_color_hover="" accent_color="" accent_hover_color="" type="" bevel_color="" border_width="" border_radius="" border_color="" border_hover_color="" size="" stretch="default" margin_top="" margin_right="" margin_bottom="" margin_left="" icon="" icon_position="left" icon_divider="no" animation_type="" animation_direction="left" animation_speed="0.3" animation_offset=""]Listen Now[/fusion_button]   Leah Harter, Director of Counseling at the Christian Center of Park City, recently joined John and Lynn to talk about the technology she employs at her practice to help her patients. Leah, like many other therapists and practitioners worldwide, relies on Alpha-Stim® to help her clients with their anxiety, insomnia, and depression: "Cool Science Radio" hosts John Wells and Lynn Ware Peek. “There is this little device called Alpha-Stim. You wear these clips on your earlobes and it sends the smallest electrical impulse, really tiny. It brings up the alpha waves, it helps your brain relax, and it brings down the delta waves, which will help with better sleep. It’s something clients can wear while they’re in session. Some clients have liked it so much that they have purchased their own units. It’s a great support for people.” Leah practices what she preaches; she has personally used Alpha-Stim, saying “I’ve seen it and experienced it myself for just calming down and for sleeping better at night.” John brings up the point that many people aren’t helped by, or choose not to take, traditional medications to treat their anxiety, insomnia, or depression. Leah confirms that Alpha-Stim is completely different from pharmaceuticals, and works by balancing the brain rather than altering the body’s chemistry the way medications do. Where drugs affect the body chemically, Alpha-Stim works with the body and brain electrically. Leah Harter, like many other therapists and practitioners worldwide, relies on Alpha-Stim® to help her clients with their anxiety, insomnia, and depression The hosts also discuss the misconception that Alpha-Stim is similar to ECT (electroconvulsive therapy.) The two modalities are completely different, as Leah explains. Alpha-Stim provides only “the tiniest microcurrent. As you’re wearing the unit you hardly know it’s there.” The beauty of Alpha-Stim’s patented waveform is that a little truly goes a long way. “The research on the smallest intensity shows its effectiveness.” Better still, results with Alpha-Stim are cumulative over time. The more you use it, the better you feel, and the less you’ll need it. The group also touched upon the COVID-19 pandemic and its effect on peoples’ mental health. According to Leah, most people have been in “survival mode” for the past year – as the pandemic begins to fade, the emotions will begin to sink in. John points out that the isolation of the past year means many people may be suffering at home. With Alpha-Stim, however, you don’t need to leave the comfort of your own home to reap the benefits. Although a prescription is required, you do not need to visit a doctor’s office for treatments. Even though Cool Science focuses on “new” technology, Alpha-Stim has been changing lives for decades. It is FDA cleared and its effectiveness has been proven by more than 100 clinical research studies. Since Alpha-Stim is not a drug, there is no risk of addiction or lasting side effects. It is safe to use in conjunction with other treatment modalities, but is effective as a standalone treatment as well. If you’re struggling with anxiety, insomnia, or depression, why wait? Get started today and see what Alpha-Stim can do for you! About Alpha-Stim® Alpha-Stim is an FDA cleared, handheld medical device that has been proven time and again to effectively treat acute, post-traumatic, and chronic pain, as well as anxiety, insomnia, and depression. Alpha-Stim uses cranial electrotherapy stimulation (CES), delivered through a patented waveform via two earclip electrodes, to treat anxiety, insomnia, and depression. Microcurrent electrical therapy (MET) delivers pain relief directly to the source of discomfort via two handheld Smart Probes. The safety and effectiveness of Alpha-Stim is backed by over 100 independent clinical research studies. Unlike with medications, there is no risk of addiction or lasting side effects. Alpha-Stim is available by prescription in the United States and over-the-counter in other countries. Get started today! See minor and self-limiting risks > ### BBC One’s “The Truth About Improving Mental Health” Features Alpha-Stim® as a Treatment for Insomnia The latest edition of BBC One’s science documentary series The Truth About centers on offering a critical guide to health and wellbeing. In this episode, host Alex Scott and Clinical Psychologist Professor Tanya Byron took a look at the trending science behind optimizing mental health. Alex Scott and Clinical Psychologist Professor Tanya Byron took a look at the trending science behind optimizing mental health. Over the past year, researchers from Imperial College London in collaboration with the BBC surveyed and studied the mental health of more than 350,000 people living in the UK following the coronavirus shelter-in-place restrictions. Their findings, relayed in this episode, offer a glimpse into the impact of the global pandemic on the mental wellbeing of the British public. Early findings indicate many people are feeling isolated and experiencing greater levels of stress and anxiety. One mental health issue covered in this episode is insomnia. With so many people suffering from stress and anxiety, it is no surprise that sleep problems have become more prevalent over the past year. To that end, Alex Scott decided to try Alpha-Stim® to see if it could help with her recent sleeplessness. Alpha-Stim is an FDA cleared cranial electrotherapy stimulation (CES) device available by prescription in the US, and over the counter outside of the US. Two electrodes clip onto your earlobes and deliver a tiny, painless current of electricity to your brain. Treatments take just 20 minutes and are done in the comfort of your own home. To see whether Alpha-Stim could bring relief for her sleep issues, Alex visited Leslie Parkinson, a clinical psychologist who treats patients for a variety of issues, including insomnia. Dr. Parkinson first attached electrodes to Alex’s scalp using an EEG cap in order to measure her brainwaves pre-and post-treatment with Alpha-Stim. She sought to determine Alex’s baseline, followed by brain activity after a cup of coffee, before demonstrating the calming effect of an Alpha-Stim treatment. After just 15 minutes of Alex using the Alpha-Stim, Dr. Parkinson reported that the treatment “had quite a significant impact,” showing a drastic increase in alpha waves in Alex’s brain activity. After just 15 minutes of Alex using the Alpha-Stim, Dr. Parkinson reported that the treatment “had quite a significant impact,” showing a drastic increase in alpha waves in Alex’s brain activity. “I use it with all my insomnia patients,” Dr. Parkinson says. “They use it every night for 20 minutes before they go to sleep and sometimes it’s within a few days, but usually within two to four weeks they’re sleeping very well.” Dr. Parkinson’s comments fit well with what many patients have known for decades: Alpha-Stim works, and it works well. In one study, the number of subjects who reported poor quality of sleep dropped from 60% to 5% while using the device. And after only 5 Alpha-Stim treatments, military Service Members with insomnia reported an increase of 43 minutes of sleep. Surveys also show that patients feel better with Alpha-Stim® than with medications when it comes to treating insomnia. Alex was similarly impressed with the results of her Alpha-Stim® treatment. She points out that while the NHS needs to conduct more independent studies before issuing Alpha-Stim for patients with insomnia, it has already trialed and approved the device for the treatment of anxiety, with great success. One person has already reached out to express their gratitude after watching this very episode. "I bought this after seeing it on a BBC programme. I suffer from Generalized Anxiety Disorder and severe insomnia. Two days after starting to use the Alpha-Stim I slept without taking any sleeping tablets and it has also really helped with my anxiety. I can’t recommend this enough. It’s really life changing." - GA Pons Although Alpha-Stim is presented in this episode as a new technology, the truth is that it has been changing lives for decades. More than 100 clinical research studies have proven that it is safe and effective, and patient testimonials never cease to pour in. So if you, like so many others right now, are seeking to optimize your mental health, know that you can trust in Alpha-Stim. You’ll be glad you did. *Alpha-Stim is FDA cleared to treat anxiety, insomnia, and pain, with approval for depression outside of the United States. ### Alpha-Stim Featured in Men's Journal Men's Journal Magazine just published its list of the 11 best products for improving mood, treating anxiety, and reducing stress. We're proud to announce that Alpha-Stim was featured as one of their top picks! Alpha-Stim AID Josh Briley, Ph.D., clinical psychologist licensed in the state of Texas and science and education director for Electromedical Products International, Inc., has used this FDA-cleared cranial electrotherapy stimulation (CES) device both personally and with his patients with much success. “Within a few minutes of placing the ear clips on your earlobes and setting the current to a comfortable level, you feel very relaxed and calm, as if your anxiety and stress have just melted away,” Briley says. The product is backed by 100+ clinical studies, demonstrating its effectiveness in treating anxiety, insomnia, depression*, and pain. “I’ve used Alpha-Stim with veterans who have suffered with anxiety for decades. In my 17 years as a practicing psychologist, I’ve never seen anything work more quickly, effectively, or safely than Alpha-Stim.” The safety and effectiveness of Alpha-Stim is backed by over 100 independent clinical research studies. Unlike with medications, there is no risk of addiction or lasting side effects. Alpha-Stim is available by prescription in the United States and over-the-counter in other countries. Get started today! *Alpha-Stim is FDA cleared to treat anxiety, insomnia, and pain, with approval for depression outside of the United States. ### Electromedical Products International, Inc. Announces Retirement of Dr. Daniel L. Kirsch, the Inventor of Alpha-Stim The inventor of Alpha-Stim, Dr. Daniel L. Kirsch, has announced his retirement after a 40-year career in electromedicine. Dr. Kirsch, a neurobiologist, introduced Alpha-Stim to the market in 1981 and since then has made it his mission to raise awareness and acceptance of the technology in a medical world that relies almost exclusively on prescription drugs. He did that by focusing on building credibility through medical research, rather than marketing hype. Dr. Kirsch began his career studying and teaching acupuncture which, in the 1950s, evolved to electroacupuncture, inspiring him to develop his own system he called electro-acutherapy, which then evolved into his unique system of microcurrent electrical therapy. At first, he modified acupuncture, and electroacupunture devices to work with the new techniques he developed to avoid penetrating the skin with needles, eventually designing the waveform that is the basis of Alpha-Stim technology. He refers to his early career as modernizing acupuncture but eventually he developed much easier techniques still in use today. Throughout his career, he did the missionary work for psychologists and psychiatrists to slowly accept brain stimulation as a safer and more effective innovative form of intervention in mental health. Dr. Kirsch has been an instrumental figure in overcoming skeptics and opening the door to electromedicine. As brain technologies evolved, more open-minded, holistic, and integrative practitioners embraced electromedicine implementing this technology into their practices. This opened the door to the mainstream medical market, where Alpha-Stim is being accepted by doctors today who previously relied solely on drugs. Alpha-Stim is supported by over 100 completed independent research studies and published reports that utilize some of the most rigorous, randomized controlled clinical research methods. These studies were mostly done at American and British universities, the Department of Defense and Veteran Affairs Medical Centers. “I am proud to have helped millions of people through Alpha-Stim technology,” said Dr. Kirsch, “especially after drugs failed. I chose to teach doctors how to integrate Alpha-Stim into their practices rather than market to consumers in order to achieve mainstream credibility and reach more patients at a time.” The American Academy of Pain Management recognized Dr. Kirsch’s accomplishments and lifetime dedication to teaching pain management and awarded him the Richard Weiner education award in 2008. As a pioneer in electromedicine, Dr. Kirsch believes that in the next decade, physics will overtake chemistry as the master science in therapeutic healthcare as it already has in diagnostic medicine. “Technology will replace many, if not most prescription drugs due to the safety and effectiveness, not to mention that Alpha-Stim is not addictive and does not develop tolerance where the dosage has to be constantly raised until it is not safe. The brain works through electrical connections, so it makes sense to treat it electrically rather than just chemically,” said Kirsch. Although retiring from Electromedical Products International, Inc, the company he founded in 1981, Dr. Kirsch is not going gently into that good night. He presently is applying his lifetime of learning and experience as the President of The American Institute of Stress: www.stress.org. AIS is a nonprofit organization which helps people understand and control their stress to prevent or reverse disease, including producing two free magazines, certifying a stress assessment test and online courses, credentialing professionals practicing stress management, providing a clearinghouse of evidence-based stress science and management techniques, and producing a series of six documentaries scheduled for release in early 2021.   ### Alpha-Stim Leads to Hope and Joy After More Than Half a Century of Trauma Blog   Alpha-Stim Leads to Hope and Joy After More Than Half a Century of Trauma Alpha-Stim Testimonials We care deeply about our customers and never tire of hearing firsthand accounts from people whose lives have been transformed by Alpha-Stim. This is especially true for Alpha-Stim users who tell us Alpha-Stim has helped them finally find relief from anxiety, insomnia, depression* or pain after losing hope that they would ever feel happy and whole again. Dan Jacobs was one such Alpha-Stim user. At 57, Dan started incorporating Alpha-Stim into his daily routine, marking a turning point in his life. Below he shares his experience with Alpha-Stim AID and how he was able to improve his mental health, and thought process and return to a more robust, joyful life. “My whole life has been filled with an overwhelming level of stress and trauma. I grew up in a dysfunctional home that lacked any semblance to love. I’ve experienced just about every form of trauma you can imagine. I have witnessed people being shot, stabbed, and beaten up. I have witnessed riots, family violence, and major disasters of both man and nature. My whole life has been nothing but trauma-filled. My road to restoration began when my wife announced that she had cancer. I believe that was the proverbial “straw that broke the camel’s back.” I sought out help from many people and places. I opened up my spiritual self, sought treatment through a mental health provider, and began taking a low dose of Trazodone before bedtime to help with the unbelievable night terrors that I was having every night. I made major life changes and even sought treatment through the use of a hyperbaric chamber to help with the traumatic brain injuries that I have sustained. In June of 2017, my therapist introduced me to Alpha-Stim, as she believed I could benefit from its use. After a short while, I made the spontaneous statement, “I haven’t felt that way since the age of 17.” She remarked that this was what she was hoping for: to find an alternative treatment without drugs, alcohol, and medications. I agreed that it was a very good alternative. I noticed that when I was using Alpha-Stim, my thought process changed. Instead of the ruminating and building of anxiety, I would give thought to something then it would quickly be released. I was no longer perpetuating the negative thought patterns that I had learned over my 57 years of life. That was a freedom that I had not known until then. Before Alpha-Stim, the negative thoughts would simply go on and on until replaced by something of greater concern, and the frustrations and fear would simply continue. This would lead to anger, and that also would go unresolved. I found Alpha-Stim helpful in ways I had not thought possible. I began using it almost daily at first. I find great relief in my level of anxiety to this day. I continue to use Alpha-Stim, but I have reduced my use as I feel I do not need it as much. I believe the Alpha-Stim has a cumulative effect and that it “rewires” the brain’s functions. I no longer respond to stress in the same way that I had in the past. I still don’t like loud and sudden sounds, but I’m not running for the safety of my quiet bedroom to avoid them, either. Thank you for this treatment and the very positive experience that I’ve encountered.” We are proud to say that the benefits Dan experienced from using Alpha-Stim have been echoed by many. One woman saw tremendous relief from chronic pain following injuries from her time as a Service Member. Another, a student and veteran, found Alpha-Stim helpful for treating anxiety and insomnia. Want to learn more about Alpha-Stim yourself? Discover how Alpha-Stim AID and Alpha-Stim M can work to help you take control of your life again here. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### Struggling First Responder Finds “Stupendous” Relief Blog Struggling First Responder Finds “Stupendous” Relief Alpha-Stim Testimonials First responders are the unsung heroes of our community. Paramedics, police officers, and firefighters are the first trained professionals to respond to an emergency. We seldom think of the risks they take every time they put on their uniform. Accidents, trauma, pain, loss, grief – possibly the worst day in our lives is the daily life of first responders. The cumulative toll on their mental health is enormous. If you are a first responder, you know how the stress of the job continues and accumulates over time. Even after the shift ends, you may find you’re struggling with anxiety, depression*, and getting a good night’s sleep.What follows is one former first responder’s life-changing experience with Alpha-Stim to help relieve insomnia and anxiety. Read Dr. J.D. Rogers’ story and that of his physician Dr. Corrine Cherek below. “Alpha-Stim Has Changed My Life” “About five months ago, a colleague introduced me to Dr. Cherek, [who] was seeking volunteers to determine if Alpha-Stim is beneficial to first responders struggling with trauma and other mental and behavioral health issues. Dr. Cherek’s professional services focus on active and former first responders and their family members who are struggling with the effects of personal and vicarious anxiety, insomnia, pain, and other stressors.After conducting an assessment, Dr. Cherek determined that I met the criteria for Alpha-Stim therapy.My first session with Dr. Cherek commenced in April 2020. Approximately two weeks into our sessions, I began experiencing a cessation in the restlessness, irritability, and negative thinking that I would intermittently experience.The benefit of including Alpha-Stim in our counseling sessions can be described in one word: Stupendous! At the beginning of week three, friends and professional colleagues began noticing an improvement in my disposition, evidenced by the unconscious whistling of a tune, singing, and initiating humorous exchanges.What was most appreciated was the dramatic decrease in melancholia and stress. Even episodes of insomnia began to decrease. I had also begun experiencing an increase in energy levels as well as a clearer mind. There was also a quelling of negative fixations and ruminations. Alpha-Stim helped me to manage intrusive thoughts.Alpha-Stim is a therapeutic intervention that I would recommend not only for first responders and their families but to any individuals struggling with trauma and other stressors…Alpha-Stim has changed my life!” The testimonial of Dr. Rogers is bolstered by the enthusiastic feedback from his prescribing physician, Dr. Corinne Cherek:“As a grief and spiritual counselor, I work primarily with abuse, addiction, grief, loss, suicide, & trauma. I have witnessed a plethora of clients suffer immensely, many discouraged, and not wanting any more prescription medications.When I was introduced to Alpha-Stim, the COVID-19 pandemic was affecting all of us. In 20 minutes [with Alpha-Stim], I felt as if I had meditated for several hours. I realized that I could use Alpha-Stim to cope with compassion fatigue[.].I shared my experience with a colleague who was a former first responder. He had just experienced the deaths of several loved ones and was struggling. He agreed to be a test subject for me. Witnessing his transformation before my eyes was nothing less than a miracle…Between the two of us, he was receiving Alpha-Stim an average of 5-6 times per week. In a matter of weeks, he was whistling and making great progress.As I shared the test subject’s results, especially with my first responder clients, they were willing to have a session that included Alpha-Stim. I have several firefighters and police officers who have highly benefited from Alpha-Stim, most in just one session. It is my hope and dream to find a way so that each first responder has an Alpha-Stim.” Alpha-Stim has been proven time and again to relieve anxiety, insomnia, depression*, and pain safely and effectively. It is an FDA-cleared medical device, not a drug, there is no risk of addiction or lingering side effects that could interfere with your ability to perform your duties.*FDA cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States.Click here to learn more about Alpha-Stim for first responders > https://www.youtube.com/watch?v=QR-E0Pld8XM  ### Veteran Finally Finds Drug-Free Pain Relief with Alpha-Stim Blog Veteran Finally Finds Drug-Free Pain Relief with Alpha-Stim Alpha-Stim Testimonials Chris Bechard, a Veteran in Boulder, Colorado, recently shared his frustrating experience as he tried to find an effective treatment for his pain, and the immense relief he felt, body and mind when he finally got Alpha-Stim.Below Chris shares his story about Alpha-Stim for pain relief:“I’m a service-connected Veteran with a chronic pain disability. For the last 20 years, I have been treated at the VA. Unsuccessfully. I have tried a range of narcotics, off-label meds, injections, patches, physical therapy, TENS, psychology, biofeedback, and holistic healing (acupuncture and herbals.) None of it worked and over time, my pain became worse and more widespread, almost getting to the point that I contemplated suicide.In my quest to find something that may give me some relief, I read about Alpha-Stim for the first time almost a year ago. Since then, I have tried my darndest to canvas the ‘VA neighborhood’ for someone who would be able to help me procure this device, as I was also suffering from depression, anxiety, and insomnia due to my intractable pain. No one had heard of the device, and they basically dismissed the idea that this would be a worthwhile avenue to pursue.Out of desperation, I emailed Alpha-Stim and was quickly put in touch with [sales rep] Joseph. From the beginning, not only did Joseph reach out to me to see how he could help, but he genuinely took an interest in me, my suffering, and my failed efforts to convince my primary care physicians, pain management team, and patient advocates that this device was worth a shot.Joseph emailed me instructions to pass along to my PCP on how to order the Alpha-Stim M, detailed information about it, and offered his contact information in case she had any questions. Several days later, Joseph sent me an email, stating he had good news and that the Alpha-Stim M had shipped. I couldn’t believe it! A couple days later, I received it and began using it immediately.I have been using the Alpha-Stim M for a few weeks now, every day – sometimes twice a day. All in all, it has reduced my overall pain by 50-60%, my anxiety is down to negligible levels, and I am able to get quality sleep after years of not being able to do so without the help of some very sedating medication. To say I am pleased would be the understatement of the century.Why the Veterans Administration doesn’t use the Alpha-Stim in all their facilities for ALL patients with the same symptoms as mine, I cannot fathom. They must have spent tens of thousands of dollars on me in-office visits, medication, physical therapy and other modalities, all without much success. Here is a single device that is easy to operate, portable, and cost-effective, that in a very short time has given me a tremendous amount of relief.I am so very grateful for my Alpha-Stim. But I am even more grateful to Joseph for going above and beyond and taking a personal interest in my case to get this device into my hands, when all other attempts by others have failed or fallen by the wayside. I owe Joseph a huge debt of gratitude.” Alpha-Stim: A Drug-Free Option Veterans Can Use for Pain Relief If you struggle with pain, anxiety, or insomnia, Alpha-Stim may be able to help. You may feel like you’re waging an uphill battle to find the right treatment, especially if your doctor has never heard of Alpha-Stim, although Alpha-Stim is currently available at more than half of the nation’s VAs. If you have questions about how to get Alpha-Stim, our team of highly dedicated, highly trained representatives can make the process painless for you.Veterans and Service Members, call 1-800-FOR-PAIN and ask for Government Services. You can also visit www.alpha-stim.com/military.For civilians, please click here to get started with Alpha-Stim. ### AHA Business Podcast Features Alpha-Stim & Tracey Kirsch On this week's AHA Business Podcast, host Allan speaks with Tracey B. Kirsch, president of Electromedical Products International, Inc. Tracey talks about Alpha-Stim, a cranial electrotherapy stimulation technology that is used to treat anxiety, stress, insomnia, depression, and physical pain. She explains how the technology came to be and how she hopes to make it a more common medical treatment in place of addictive prescription drugs.   [fusion_button link="https://podcasts.google.com/feed/aHR0cHM6Ly9hbmNob3IuZm0vcy8xZTU3MWJiMC9wb2RjYXN0L3Jzcw/episode/ZTFjZDY5YmEtM2Q2NC00YzlmLWE0YjQtZDAwNzJmNDAzZTc5" text_transform="" title="" target="_blank" link_attributes="" alignment="center" modal="" hide_on_mobile="small-visibility,medium-visibility,large-visibility" class="" id="" color="default" button_gradient_top_color="" button_gradient_bottom_color="" button_gradient_top_color_hover="" button_gradient_bottom_color_hover="" accent_color="" accent_hover_color="" type="" bevel_color="" border_width="" size="" stretch="default" shape="" icon="" icon_position="left" icon_divider="no" animation_type="" animation_direction="left" animation_speed="0.3" animation_offset=""]Listen Now[/fusion_button] ### How to Safely Clean and Care for Your Alpha-Stim Blog How to Safely Clean and Care for Your Alpha-Stim Alpha-Stim FAQs Personal hygiene is obviously important, but so too is cleaning and caring for the technologies that interact with your body. Alpha-Stim® devices are no different.If you’re using Alpha-Stim, you may be wondering how best to keep your device clean and sanitary. Here are our tips for how to safely clean and care for your Alpha-Stim M or Alpha-Stim AID. Use Your Owners’ Manual for Alpha-Stim Care Guidance We recommend that you follow CDC guidelines and always refer to a device’s user manual to ensure that you are cleaning and maintaining it according to the manufacturer’s recommended guidelines.  Your Alpha-Stim Owner’s Manual has detailed instructions on how to care for your device and keep it in optimal condition. Lost your owner’s manual? Your Alpha-Stim Owner’s Manual is available online, too!Download the Alpha-Stim M Manual >Download the Alpha-Stim AID Manual > Quick Guide to Cleaning Your Alpha-Stim If you want a quick reminder on how to care for your Alpha-Stim, we have a quick and easy guide for you.  What you need: Mild soapA lint-free clothIsopropyl alcohol  Steps to quickly and safely clean your Alpha-Stim device Be sure to place your Alpha-Stim in an area where it will not be exposed to water and where it is not likely to be dropped or have another object fall on it. (We recommend laying a small towel on a table.)Use a mild soap (other cleaning solutions could damage the screen and case).  Dampen the lint-free cloth with water and mild soap, and gently wipe the surface of the case and screen. Do not spray any cleaners directly onto your device. Steps to quickly and safely clean your Alpha-Stim Earclip Electrodes or Probe Electrode Pads Remove the Earclip Electrode Pads (EEPs)/ Probe Electrode Pads (PEPs) after each use.Apply a solution of 70% isopropyl alcohol on the electrodes. Remove and discard the conducting solution-soaked pads after each treatment. Next, new EEPs/PEPs should be placed on the Earclip Electrodes/Probe Electrodes prior to storing your device.  Do you have other questions about your Alpha-Stim? We’re here to help! Email us any time at info@epii.com or give us a call at 1-800-FOR-PAIN. Our dedicated Clinical Support Team is here to answer all your questions. ### When “Normal” Is Scary – How to Cope with Anxiety After Staying at Home We can all start to breathe a sight of relief. Our efforts to follow the shelter-in-place order, to contain the spread of the coronavirus (COVID-19) pandemic is starting to pay off.  Many states are starting to ease restrictions and lifting stay-at-home advisories. Concerns for our safety and that of our loved ones, meant many of us didn’t find it too stressful to start working from home, and only venture out for groceries or other essentials. COVID-19 has changed work for many people, with some working from home and others not able to work while their employer's business is closed. Shelter in place Isolating ourselves at home to protect ourselves and our loved ones, at a time when the world outside is unsafe, feels right. For many, the first few weeks of shelter-in-place provided a unique opportunity to reconnect with our families and those  physically close to us.  However, the mandate has been in force for close to 12 weeks, and for many being homebound without a break from our immediate family, transitioning kids to virtual schooling, loss of income, perhaps becoming sick or having to care for others is increasingly stressful. For those living alone, the shelter-in-place order may have resulted in feelings of isolation, loneliness and depression. The stay-at-home period was uniquely stressful for all of us and returning to normal will be too. Transitioning to normality The idea of transitioning back to society after all we’ve experienced in the last few months is causing a great deal of worry and stress. Few of us would describe ourselves as anxious people, but returning to ‘normality’ amidst reports that infection rates remain high, is an understandably frightening and anxiety provoking prospect. If you are in an ‘at risk category’ your concerns may be even more amplified. If you have been told by your employer that you can return to work, you may be understandably concerned about the risk of becoming infected or infecting loved ones when you return home. Perhaps you are unsure that your employer has taken sufficient precautions to prevent the spread of COVID-19. It may be that public transport is the only means for you to get to work, or you work in a customer facing role; if your fears of contagion, virus or bacteria feel like they have multiplied, you are not alone. You are not alone Feelings of anxiety are common, now more so than ever.  A recent poll by the American Psychiatric Association found that 40% of Americans are experiencing anxiety about themselves or a loved one contracting COVID-19. The number of Americans expressing worry and concern about their lives and contacting the Disaster Distress Helpline has increased by 300%. As the executive director of the Texas chapter of the National Alliance on Mental Illness (NAMI) Greg Hansch said, “As a result of COVID-19, many more people are much lonelier than they’ve ever been before”. If you have concerns about how you or a loved one will manage the transition, we have some researched backed suggestions. Prescription medications A report by America’s State of Mind published in April of 2020, states that the rate of prescriptions for benzodiazepines (e.g., Xanax, Ativan, Valium, Klonopin) a class of drugs typically prescribed to treat anxiety has increased by 34% from February to March of this year, coinciding with the start significant media coverage of COVID-19. If anxiety is something you are struggling with, there are a multitude of ways to get help managing your symptoms. Prescription medications such as anxiolytics, can be an effective short-term solution for anxiety, but do carry significant risks, including dependence and abuse, and potentially dangerous drug-drug interactions, and medication is not a viable solution for all anxiety sufferers. Alternative treatments If you’ve tried medications in the past to manage your anxiety and did not get the relief you hoped for, you just want to consider non-pharmacological interventions, or you’re not a suitable candidate for medication, Alpha-Stim® might be a good fit for you. Alpha-Stim can be taken on the go and is easily used at work or home. Alpha-Stim is an FDA cleared medical device that is clinically proven to safely and effectively treat anxiety. Clinical trials have shown that 90% of Alpha-Stim® users experience clinically significant relief from symptoms of anxiety. Results are long lasting and often immediate, and treatments take just 20 minutes in the comfort of your own home. Alpha-Stim sends a tiny current of electricity to your brain through electrodes that clip onto your earlobes; this is a modality known as cranial electrotherapy stimulation (CES.) There are in excess of 100 clinical trials conducted over several decades supporting the efficacy of Alpha-Stim, and the device has been used in people for whom medication treatments may be contraindicated. If you’re not completely impressed with your results, our 30 day money-back satisfaction guarantee lets you send the device back! Alpha-Stim uses a patented waveform of electricity that restores balance to your brainwaves, reducing your feelings of anxiety. The benefits are cumulative, the more often you use Alpha-Stim, over time the less you’ll need to. There is no risk of addiction or lasting side effects from continual use of the Alpha-Stim. Some anxiety sufferers have reported that they find it helpful to use the device prior to engaging in activities they are anxious about. Conversely, others choose to use the Alpha-Stim at the end of the day to unwind and de-stress. There is no ‘one way’ to use the device, it can be used to suit your lifestyle and schedule. Tips to thrive The expression “unprecedented times” may seem like it has been overused, yet the reality is that none of us have ever experienced such a radical change to our way of living and working, paired with such an extended period of isolation and confinement.  The feelings of worry and anxiety you or a loved one may be experiencing are adaptive and consistent with a period of extreme stress - it is not a sign of weakness. We are all still processing the impact of the events of the last few months. Indeed, "unprecedented times" call for "unprecedented solutions". If you are looking to thrive as you return to the "new normal", consider Alpha-Stim  as a possible option.   ### Dr. Kirsch Welcomed as New #SameHere Practitioner Dr. Daniel L. Kirsch was recently invited to the #SameHere Practitioner Alliance and featured in the #SameHere newsletter. Dr. Kirsch is the President of the nonprofit American Institute of Stress, and the Chairman of Electromedical Products International, Inc. He has over four decades of experience in the medical field, including extensive clinical practice experience. Throughout his career Dr. Kirsch has designed medical devices and their applications and developed clinical systems for implementing pain and mental health normalization technologies. Dr. Kirsch is also the inventor of Alpha-Stim®, an electrotherapy device prescribed around the world by physicians and other healthcare professionals to effectively treat chronic, acute, and post-traumatic pain, and anxiety, insomnia, and depression*. According to Dr. Kirsch, "the brain is actually far more electrical than chemical. Mood disorders like anxiety and depression are controlled through electrochemical signals in your brain. When these signals aren’t functioning properly, the hormones and neurotransmitters that regulate your emotions can become unbalanced causing changes in your mood and other symptoms. By modulating the brain’s electrochemical signals, Alpha-Stim brain tech can safely and effectively improve your mood. And it does so at the speed of electricity, faster than you can metabolize a pill." #SameHere founder Eric Kussin has experienced Alpha-Stim firsthand and says, "I am now back to a point where I feel 'myself' again, much healthier and ready to attack the world; and once again at the happiest place I’ve been personally and professionally". Read more about why Alpha-Stim works to improve mental health >  *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  About #SameHere #SameHere is a global movement to normalize the conversation around mental health. They state, "Until we acknowledge we all face varying degrees of challenges that affect our mental health, we can’t come together to change the paradigm." ### Denise Richards Uses Alpha-Stim After Surgery on Episode of Real Housewives of Beverly Hills On last night’s episode of The Real Housewives of Beverly Hills, Denise Richards underwent surgery to repair a rare double hernia called femoral hernia that was caused by heavy lifting that adds a lot of stress on the body. The doctor told Richards that it is extremely dangerous, and she had to have surgery right away. Richards, when speaking to her husband, said that she is in a lot of pain even with her high pain tolerance. After her surgery, once they made it back to their hotel room, Aaron Phypers asked Richards if she packed her Alpha-Stim in order to help relieve her post-op pain after the surgery. There are several things you can do to help ease your anxiety, insomnia, and depression during difficult times. Alpha-Stim® is an FDA cleared cranial electrotherapy stimulation (CES) device that is clinically proven to safely and effectively treat anxiety and insomnia. A tiny current of electricity is passed through two electrodes that clip onto your earlobes, making you feel better fast. Nine out of ten users experience clinically significant relief from their anxiety, with results that are long lasting and often immediate. Treatments with Alpha-Stim are painless and take just 20 minutes to conduct in the comfort of your own home. Alpha-Stim is also a fast, safe, and effective way to treat acute, post-traumatic, and chronic pain. It is an FDA cleared, handheld medical device – not a drug – that delivers long-lasting and often immediate relief from all types of pain. Two handheld Smart Probes transmit a tiny current of electricity directly to the site of your pain, in a pain-free modality known as microcurrent electrical therapy (MET.) A full treatment takes just minutes to conduct. Backed by more than 100 clinical studies, Alpha-Stim is safe to use in conjunction with other treatment modalities. Unlike with medications, there is no potential risk from starting or stopping treatments suddenly. You can use Alpha-Stim as often as you need to, without risk of overuse – and you can stop treatments whenever you want, with no risk of withdrawal. Denise Richards is just one of thousands that find this drug-free, non-invasive treatment beneficial to their overall wellness. You can see the episode here. ### What Is Cranial Electrostimulation? A tiny current can pack a powerful lift for the brain. Blog What Is Cranial Electrostimulation? A tiny current can pack a powerful lift for the brain. Article originally written for Psychology Today by Emily Deans, MD | Posted Dec 22, 2017 Source: Flickr Creative Commons EEGEvery once in a while I read the twitter feed or see a youtube video from one of those “biohacking’ Silicon Valley dudebros…you know, the aging men on the West Coast with too much money who want to extend a happy and healthy life by whatever means possible, whether it’s MCT oil in coffee, the blood of youngsters, or expensive supplements. One of these biohackers, Dave Asprey, walks around with electric leads stuck to his forehead, getting constant low-level stimulation to “improve” his brain. So of course when I saw ads geared toward psychiatrists for similar stimulation machines (you might even be seeing some of those ads right now!), my skepticism cannon locked on target. Tiny electric currents through the brain having some effect other than a fancy and expensive placebo? It reminded me of the old electric treatments used at the turn of the 20th century for every little thing, from cancer to anemia. We do have a couple electricity-based, gadget treatments in psychiatry, but they involve inducing seizures or a very powerful magnet placed over the prefrontal cortex. I thought cranial electrostimulation (CES), the application of a tiny electric current to the brain, must be overhyped nonsense, but I hadn’t really looked into it.Then I picked up a year-old copy of my favorite practical evidence-based psychiatry newsletter, The Carlat Report. A college asked me, “Why don’t we try one of those machines they talk about in this article?” The machines discussed were the Alpha-Stim, one of several CES devices on the market. The psychiatrist interviewed in The Carlat Report said they could be quite useful, and in her opinion, worked well for folks with anxiety and insomnia, often enabling patients who relied heavily on addictive benzodiazepines or sleeping medications to reduce or eliminate those medicines. The machines are FDA cleared for the treatment of anxiety, insomnia, depression, and some pain syndromes.Well, that sounded quite promising. In a psychiatry clinic like ours, we have a host of patients with anxiety and/or insomnia who have not been fully helped by non-addictive meds and therapy, who thus rely on benzodiazepines and sleeping meds every day. Often patients come in for the first time already on these meds, and we work for months to years to reduce or eliminate them if possible. It would be great to have an easier and effective way to decrease the use of addictive and sleeping medications. Other patients who don’t want to use those meds struggle with constant anxiety they’ve lived with for years. But could a machine that looks a bit like an old mp3 player with electrodes you clamp to your earlobes really help?So I decided, finally, to look into the available literature. We also bit the bullet and purchased one of the machines for about $800.I promptly discovered we are quite late to the party. CES was invented in the Soviet Union in 1954 (I am picturing some Jason Bourne-type superhuman-creating experiments to improve Soviet athletes or chess players), spread rapidly through the Eastern Bloc, Europe, and Japan and arrived in the US in the 60s. University research started with treating insomnia and pain syndromes. In 1979, Dr. Daniel Kirsch invented the particular waveform used in the Alpha-Stim, which is based on a waveform put out by healthy nerve tissue. This device has since been used in over 100 independent and many peer-reviewed studies* for anxiety, depression, insomnia, and pain. It is widely used and studied in the army, particularly in PTSD, and the VA will pay for the devices for veterans. Dentists use CES machines for acute anxiety regulation for their patients, and psychiatrists, psychologists, and physical therapists in Texas and the South apparently know all about the machine and have a lot of experience with it.But what does the machine do, and how does it work? An fMRI study shows it decreases cortical activity, and cerebral spinal fluid studies show it increases serotonin and beta endorphins in the central nervous system. Quantitative EEG reports show it decreases (deep sleep) delta waves and increases alpha waves, associated with meditation and first stage sleep…thus, acutely, the application of the micro current can lead to a sense of alert but calm energy, clearheadedness, and wellbeing. Sessions last from 20-60 minutes depending on the amount of current you can tolerate. Side effects can include vertigo or dizziness (if the stimulation is set too high or you can’t tolerate the machine), headache (approx 1 in 1000) or skin irritation (approx 1 in 1500). No cases of mania or serotonin syndrome have been reported.Long term, daily or near daily use of the machine for 3-6 weeks can be quite effective in improving sleep, anxiety, and depression symptoms, according to several randomized controlled trials. This effect can be maintained with 2-3X a week treatments. It doesn't work for everyone, and a pilot trial in Alzheimer's patients was negative. Anecdotal experience from colleagues who use the device supports the anxiety and insomnia research.My own n=1 experience showed an immediate decrease in feelings of stress for 6-7 hours (that feels a little too good to be quite legal…a bit like the “high” after a good workout) with early morning treatment, followed by a solid and restorative night’s sleep. You can see the improvement in my sleep tracking software: the first image is from a typical night in the week before using the machine. The second is the first night after morning use.Source: Emily DeansI did have the machine set too high the first time (my own fault), resulting in a couple hours of residual dizziness, and I did experience a very mild “crash” of sorts after about 7 hours, though that went away after the 10th daily use and hasn’t come back. My response and the feedback from the patients we had try it in clinic was positive enough that we bought two more machines. All my clinic colleagues have used it, with one other immediately buying a machine of her own, and another unable to tolerate even the lowest setting.What are the down sides, besides cost (though repeated therapy visits and copays for meds can add up quickly)? What does even a tiny electric current applied to your brain nearly every day do to you, long term? The Facebook site has anecdotes of people using the device for 10 years or more, but there’s not really any solid long term data. However, insomnia and anxiety long term is definitely not good for the body and brain, and long term use of sleep medications is linked to dementia, so if a device can improve deep, restorative sleep and reduce anxiety without addiction, the risks and benefits discussion can tilt pretty quickly. The data for conditions such as bipolar depression or psychosis are very limited, though the machine is used in inpatient psych unites, head injury and stroke recovery units, so quite sick folks, without problems or side effects other than those mentioned above. The only contraindications are pregnancy and powered implanted medical devices such as pacemakers.For my patients with anxiety and depression, I use a simple metaphor…usually they’ve struggled for years with symptoms we now know is related to the sympathetic “fight or flight” nervous system engaged in high gear. Meditation, therapy, sleep management, lifestyle advice…all of this is geared to powering up the parasympathetic “rest and digest” nervous system that has become atrophied under the burden of constant stress, depression, insomnia, and anxiety. These folks are like the guys at the gym who only do chest presses and biceps curls…they get jacked but walk around like bent-over gorillas. What they need are lat pulls and posterior chain exercises to equalize their bodies, and lifestyle interventions, relaxation, and restorative sleep can strengthen that weak “rest and digest” nervous system. I postulate the CES machines force the brain to work on those lat pulls, to chill out and get to a meditative state, but passively, without the hard work and practice of very effective meditation. In any event, another useful weapon in the armamentarium against chronic anxiety and insomnia is always welcome.I’m going to continue to use the machine for now, though I doubt I’ll ever walk around all day with electrodes stuck to my forehead or inject the blood of my younger peers... *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### F5 Live: Refreshing Technology TV features Alpha-Stim at CES 2020 Alpha-Stim wants to treat your pain without addictive drugs Interview by Todd Cochrane of Geek News Central. Managing chronic pain can be difficult, especially with the possibility of addiction to drugs. Alpha-Stim uses electrotherapy to treat pain and more. While our medical industry tends to try and solve problems with drugs, there can be many other ways to solve the same problem. For example, many people are incapable of taking medication for insomnia because of work obligations. There is also the possibility of side effects, like more serious health conditions or even addiction. To help overcome these issues is Alpha-Stim. How does Alpha-Stim work? Rather than medication, the Alpha-Stim device works by using electrical impulses. The reasoning behind the method is that 98 percent of the human nervous system is electrical, not chemical. By using the cranial electrotherapy stimulation (CES) device, people have the potential to treat anxiety, depression, insomnia, and physical pain. The device is in two pieces: the control pack and the ear clips. Together, they look like an MP3 player and earbuds. While the most common usage will be in the privacy of your home, if you were to use it in public, you'll look like you're just listening to music. A session takes 20 minutes and involves incredibly low power - so small that most people never consciously feel it. Why choose Alpha-Stim? While there are other entrants in the personal electrotherapy market, most are not backed by empirical evidence. Alpha-Stim, on the other hand, is. The company provides various studies of the technology showing how it can be effective for various pain management scenarios, as well as insomnia and depression. It is important to note that our staff have not tested the device and cannot speak to personal experiences with it. However, published scientific and clinical studies certainly help alleviate some of the concerns generated by late-night infomercial products making unbelievable claims. Alpha-Stim has two models available ranging from $795 to $1195.   ### New Year, New You, New…Pain? Here’s How to Get Relief When You Hit the Gym Too Hard There’s nothing quite like the start of a new year to motivate us to set new goals. One of the most common resolutions people make at the start of a new year is to get healthier – and for a lot of us, that means getting more exercise. Whether you signed up at a new gym, invested in equipment to work out at home, or simply vowed to dust off those running shoes hiding in the back of your closet, the temptation to dive into a new routine and start a transformation can sometimes make people overzealous – which can lead to some serious aches and pains. Your workouts should be challenging, but not painful. It's important to know when to stop pushing yourself. While some muscle soreness is your body’s way of adapting to new exercise, other aches and pains can be a warning sign that you’ve done too much, too soon, and are at risk for injury. How can you tell the difference, and what is the best way to feel better, fast? Delayed Onset Muscle Soreness (DOMS) So you crushed your workout yesterday – congratulations! But today, you’re not feeling quite so elated. Your muscles ache in places you didn’t know you had muscles. What’s going on? Delayed onset muscle soreness is the name for muscle aches and pains that crop up one to two days after you’ve engaged in an intense or unfamiliar workout session.  It’s the result of tiny tears in your muscle fibers, which trigger an inflammatory response. According to the American College of Sports Medicine, these are the main symptoms of DOMS you may experience: Muscle pain Swelling Stiffness of the joint, along with reduced range of motion Tenderness when touching the sore muscle Temporary weakness of the muscle The good news is, DOMS will resolve on its own within a matter of days. The more you engage in physical activity, the less you will experience DOMS – it means that your muscles are getting stronger! Some people believe that a workout isn’t effective unless you are sore afterwards, but that is simply not the case. Know Your Body; Know Your Pain While muscle soreness is normal after a new or intense workout, it’s also important to know when your aches and pains are the sign of something more serious. You should always heed what your body is trying to tell you. What are the signs that your discomfort is more than just DOMS? It's important to listen to your body's cues so you can tell the difference between normal aches and pains, and a more severe injury. Typical soreness will set in roughly 12 to 24 hours after your workout. An actual injury, however, will start to hurt immediately. Additionally, DOMS will fade after one to three days. Pain from an injury will persist and potentially even worsen. Soreness feels dull and achey, but shouldn’t prevent you from going about your day. With an injury, the pain is more likely to feel sharp or shooting, and may amplify with specific movements that engage the injured body part. An injury will also tend to be localized to the body part that is hurt; soreness tends to be more widespread over a broad area of the body (sharp pain in your ankle, for example, as opposed to sore legs overall.) DOMS may come with some slight swelling, but an injury can cause visible inflammation and redness. The bottom line with pain is this: if you feel that something is amiss, it’s always better to play it safe and seek the advice of a medical professional than to keep pushing forward. You know your body best; listen to what it is telling you. Treating Pain and Soreness Regardless of whether you’re facing run-of-the-mill soreness or the pain from an acute injury, you have options for relief. Ice and rest are great, but sometimes you need more help than that. But did you know that pain medications aren’t your only option? You don’t have to take drugs, and accept all of their potential side effects, to feel better. Alpha-Stim delivers relief directly to the site of your pain using noninvasive Smart Probes or AS Trodes Alpha-Stim® is a better way to treat your pain. It is an FDA cleared medical device – not a drug – that safely and effectively relieves acute, post-traumatic, and chronic pain. Alpha-Stim uses two handheld Smart Probes to deliver a tiny current of electricity directly to the site of your pain. This modality is called microcurrent electrical therapy (MET) – and not only is it painless, but it’s easy to use in the comfort of your own home. Treatments take mere minutes to complete, yet relief is long lasting and often immediate. Not only will you experience rapid pain relief, but the range of motion of restricted joints improves within just minutes of using Alpha-Stim. In fact, change in mobility is one of the clinical criteria used to measure success in a treatment session. For example, if you had pain in your lower back, you would bend over to see how close you can get your fingers to the floor before you experience pain that hinders your movement. When re-testing your mobility just 2 to 5 minutes after using Alpha-Stim to treat the lower back, the distance between your fingers and the floor becomes reduced or even eliminated entirely. Since Alpha-Stim is not a drug, there is no risk of addiction or lasting side effects. There is also no risk of overuse; you can treat your pain as often as you need to. But one of the best things about Alpha-Stim is that its results are cumulative. In other words, the more you use it, the less you’ll need to.  You can use Alpha-Stim as a standalone treatment or in conjunction with other modalities such as physical therapy and acupuncture. Setting Yourself Up For Long-term Success Resolving to undertake an exercise regimen is an admirable goal; don’t let pain undermine your ambition. What is important is to adopt a workout program that works for you and your lifestyle. Sustainability is key: you want to enjoy your workouts, and you need your body to support them - so caring for your pain is absolutely essential. Alpha-Stim can help you embrace your goals for 2020 and every year beyond. Don’t let pain sideline you for another moment. Get started today, and crush every goal you set for yourself! https://www.youtube.com/watch?v=PqkYrvfc6vI About Alpha-Stim Alpha-Stim® is an FDA cleared, handheld medical device that has been proven time and again to effectively treat acute, post traumatic, and chronic pain, as well as anxiety, insomnia, and depression.  Alpha-Stim uses cranial electrotherapy stimulation (CES), delivered through a patented waveform via two earclip electrodes, to treat anxiety, insomnia, and depression. Microcurrent electrical therapy (MET) delivers pain relief directly to the source of discomfort via two handheld Smart Probes. The safety and effectiveness of Alpha-Stim is backed by over 100 independent clinical research studies. Unlike with medications, there is no risk of addiction or lasting side effects. Alpha-Stim is available by prescription in the United States and over-the-counter in other countries. Get started today!   ### EPI President Tracey Kirsch Honored with UNO 25 Award Tracey B. Kirsch accepting her UNO 25 award from University of New Orleans president John Nicklow.Tracey B. Kirsch, president of Electromedical Products International, Inc., was selected as a 2020 honoree of UNO 25, an initiative that identifies, recognizes and celebrates 25 high-impact businesses or organizations that are owned or led by University of New Orleans alumni. “The 2020 class of UNO 25 highlights the varied and widespread influence of graduates of the University of New Orleans,” said President John Nicklow. “Our alumni lead iconic New Orleans brands and respected organizations throughout the region in areas including engineering, health care, education, transportation, hospitality, accounting, banking, construction, technology, human resources, marketing and public relations. In many different ways, they help stimulate economic growth and contribute to an enhanced quality of life for those in their communities.” EPI is worldwide innovator in mental healthcare and pain management devices. Tracey has been president of EPI since 1992 and after 9/11 she negotiated a Federal Supply contract with the Department of Defense and Veteran’s Affairs Medical Centers. As a result, the US Army and Navy, as well as over 100 Veteran hospitals, became the biggest Alpha-Stim users to date. In addition to the Department of Defense, Alpha-Stim is being used and researched by leading American medical centers, such as MD Anderson Cancer Center where it improved the quality of life of advanced cancer patients. Business really took off in 2019, when the National Health Service of the United Kingdom published its research findings resulting in its bringing Alpha-Stim into the intervention process early; because it was proven to be highly effective, far safer and much less expensive than psychological counseling or medications. Under the leadership of UNO’s alumni Tracey B. Kirsch, Alpha-Stim’s advanced medical technology, is changing the lives of Service Members, veterans, and civilians worldwide; by providing fast, safe and effective non-drug relief of anxiety, insomnia, depression*, and pain, without side effects or risk of addiction. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.    ### Kurt ‘The CyberGuy’ from FOX & Friends features Alpha-Stim in his CES Roundup The Consumer Electronics Show (CES) in Las Vegas, NV brings tech together from both major and emerging industries and highlights the latest tech with over 4,400 companies exhibiting their products, with more than 170,000 attendees from 160 countries. Kurt "The CyberGuy" Knutsson from FOX & Friends featured Alpha-Stim in his CES 2020 roundup and stopped by the booth to interview its inventor, Dr. Daniel L. Kirsch. "It puts a specific waveform through the brain and causes changes in the EEG. In 20 minutes, your anxiety will melt away. You'll feel very relaxed," says Dr. Kirsch. “It’s a real alternative,” says Fox and Friends.   *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  ### Chicago Psychology Podcast on Alpha-Stim Stress & Pain Relief with Alpha-Stim: Col. Kathy Platoni & Robert Kallus Jan 6, 2020 - Dr. Hoye with Chicago Psychology Podcast interviews Col. Kathy Platoni, a military psychologist, and Indiana Licensed Counselor Robert Kallus. They discuss the use and research of the Alpha-Stim device. The Alpha-Stim is a handheld, prescription medical device that is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. This little device has a long history of research and development. The Alpha-Stim was developed in the 1980s by Dr. Daniel Kirsch. With over 100 clinical trials, including a recent ground-breaking study for anxiety in the UK, it is one of the most studied medical devices. You may have heard about it in interviews with people like decorated combat veteran Dakota Meyer. Dr. Platoni discusses her use of the device in her civilian practice as well as her use of the Alpha-Stim in war zones with US combat troops to reduce stress and insomnia. She also discusses her research with the use of the Alpha-Stim device with first responders to reduce anxiety. Dr. Kallus likewise reports about his experience of client success with patients in his private practice. ### Alpha Brain Waves: What Are They, And Why Are They So Important? Blog Alpha Brain Waves: What Are They, And Why Are They So Important? You may be aware that the human brain is electric. But did you know that the brain operates with five types of brainwaves? In the brain, there are five distinct types of brainwaves, each with their own electric frequency. Each category has a different electrical frequency and plays a distinct role in how we think, behave, and feel. All of them exist at the same time in your brain, but each takes a turn being dominant at certain times. The Five Types of Brainwaves There are 5 distinct types of brainwaves, each with their own electric frequencyGamma waves are the fastest of the types of brainwaves; they “relate to simultaneous processing of information from different brain areas and have been associated with higher states of conscious perception.”¹Beta waves are the next fastest; they are low amplitude and have a frequency between 15 and 40 cycles per second. This type of brainwave is related to mentally engaged tasks, such as talking or teaching or taking part in a debate.²Alpha waves are slower than beta waves, but higher in amplitude. Their frequency is between 3 and 13 cycles per second. Where beta waves represent arousal, “alpha represents non-arousal. A person who has completed a task and sits down to rest…who takes time out to reflect or meditate is usually in an alpha state.”Theta waves are even slower, between 5 and 8 cycles per second. A person who is daydreaming or lost in thought may be in a theta state – this state is characteristic of tasks that are automatic and do not require mental effort. People who are in a theta state may say that they’re in the “flow.”Delta waves are the slowest of all, with only 1.5 to 4 cycles per second. Dreaming while sleeping, when accompanied by REM, would be an example of a delta state. The Role of Alpha Waves While each type of brainwave serves its own essential purpose, neuroscientists have found that an increase in alpha waves reduces symptoms of anxiety and depression. As explained in an article in Psychology Today, “when alpha oscillations are prominent, your sensory inputs tend to be minimized and your mind is generally clear of unwanted thoughts.”Each type of brainwave is important; each has its essential role in our functioning properly as human beings. But when one type begins to dominate the others and the brain becomes out of balance – when our alpha waves take a backseat – we start to experience anxiety, insomnia, and depression.Think of it this way: when you are in a state of high alertness, your brain quickly adapts to help you function at your best in the moment. Gamma waves are likely dominant in this situation, and you’re firing on all cylinders. The other types of brainwaves, including alpha, fade into the background. But this is not sustainable – at some point, you need to calm down again. If your alpha waves, the ones associated with calmness and relaxation, are out of balance and never have a chance to become dominant, your mood will likely deteriorate. Without relaxation and a sense of wellbeing, anxiety will spike, your sleep will suffer, and depression will settle in.EEG results: there is an increase in alpha activity (relaxation brain waves) with a simultaneous decrease in delta activity (sleep brain waves) after using Alpha-Stim® for 20 minutes. How and Why Alpha-Stim Works Alpha-Stim M and Alpha-Stim AID devices utilize Cranial Electrotherapy Stimulation (CES) and Microcurrent Electrical Therapy (MET) that directly influence the brainwaves to relieve anxiety, insomnia, depression*, and pain.CES is a form of non-invasive brain stimulation that applies rhythmic, low-amplitude current to the brain via earclip electrodes. Psychiatric disorders, such as anxiety and insomnia, are associated with alterations in electric activity in large-scale brain networks. Research suggests that Alpha-Stim CES technology modulates large-scale brain network activity patterns in two synergistic ways. (Learn more here).MET is the process of directing microcurrent through the body via Smart Probes or self-adhesive AS-Trodes to treat pain. When applied peripherally, the rhythmic, low-amplitude current of Alpha-Stim MET modulates the peripheral signaling in pain circuits that emanate from the spinal cord, providing rapid, effective, and lasting pain relief with no risk of addiction or tolerance.Alpha-Stim AID: Microcurrent is transmitted to the brain via earclip electrodes to treat anxiety, insomnia, and depression*.Alpha-Stim M: Microcurrent is delivered via electrodes placed on the body at the pain site for the treatment of acute, chronic, and post-traumatic pain. Also includes earclips to treat anxiety, insomnia, and depression*. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Sources:https://www.psychologytoday.com/us/blog/the-athletes-way/201504/alpha-brain-waves-boost-creativity-and-reduce-depression?fbclid=IwAR37sOvM6UfTPqyY56YKTaz-SRHkH3gY4Qw_ZX8UWRfxy3qpKqXFt_n5Gqkhttps://www.scientificamerican.com/article/what-is-the-function-of-t-1997-12-22/ ### Business Insider: hedge-fund performance coach is recommending device to calm nerves during market stress Business Insider recently published an article about traders using Alpha-Stim to decrease workplace stress and anxiety, allowing them to "stay in the eye of the storm." One hedge fund manager talks about how he uses the device regularly, both in the office during the trading day and in the evening when he wants to relax. Read Article >  *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  ### Alpha-Stim Is a Relaxing Alternative Treatment for Anxiety Blog Alpha-Stim Is a Relaxing Alternative Treatment for Anxiety Alpha-Stim Testimonials The following article is a guest post by Kelly Grinsteinner, originally written for and published in hometownfocus.us.  An alternative treatment: Alpha-Stim treatment can feel like a Bahamas vacation It fits in the palm of your hand or easily hangs from your neck and is no larger than a cell phone. The wires coming from the small device look like a set of earbuds, but the ends are clips bearing tiny cotton rings inside of each. Once the cotton rings are dampened with a conducting solution, the clips are placed on the earlobes.When attached and in use, the device delivers a natural level of microcurrent through the brain to stimulate and modulate specific groups of nerve cells. The microcurrent is tiny—just millionths of an ampere—and so gentle that most people don’t even feel it. This electrical waveform modulates the cells’ signals to return to baseline, normal functioning. In other words, this electrotherapy works its powers.The device is called an Alpha-Stim. “It’s an alternative to medication for anxiety and depression* because it has the same effect,” said Janis Allen, MSW, LICSW and CEO of Range Mental Health Center (RMHC). “By using electrodes that are put on your ears, it stimulates your brain to increase serotonin levels.”Allen specializes in crisis and trauma processing, specifically eye movement desensitization and reprocessing (EMDR). She first came across the Alpha-Stim while attending the National Eye Movement Desensitization and Reprocessing International Association (EMDRIA) conference in Minneapolis in 2016.“I had to try this device. I wanted to see if what they claimed was true,” she said about her piqued curiosity. “I went early one morning before meetings and sat for 30 minutes to experience the Alpha-Stim machine.”Allen said her sense of well-being was immediately increased. “I felt great. It increased my focus,” she confirmed. “I also talked to a veteran at a booth next to them and he highly endorsed the option.”Having such a good experience, Allen returned to RMHC excited to share her experience. “I was working at the Wellstone Center at the time and thought we could use this device for short-term stabilization of our folks experiencing mental health crisis,” she explained. “It could help them self-regulate and increase their sense of calm and well-being.” Wellstone Center is a crisis residential program for individuals experiencing a mental health/emotional crisis. It is located at 214 Chandler Avenue Eveleth.Allen’s request for RMHC to purchase the device was met with approval by a regional mental health initiative which bought them for the agency. Today, RMHC has about a dozen Alpha-Stim devices at its various locations.“It’s a great replacement for medications, because so many people have adverse reactions to medication, side effects and so forth,” opined Becca Leaders, MS, LMFT, current clinical director of mobile crisis services and Wellstone Crisis Center. “What this does is [it] goes through the central nervous system in the ear lobes to the back of the brain and addresses the issue the same way medications would but without the side effects.”The Alpha-Stim is an individual unit that each person uses or wears for a 20-, 40- or 60-minute session, depending how often one uses it and his/her comfort level. “They can use this and do whatever they want to do—have it on during a therapy session, during group, while watching TV or making dinner,” Leaders noted. “It’s super simple.”The device works well for people in crisis or experiencing increased anxiety or depression. It can also help ease insomnia. “Research has been done with veterans on using the Alpha-Stim to address anxiety and depression with great results,” said Allen. “It can decrease the need for medication and increase an overall sense of well-being.”Results can include significantly reduced pain, anxiety, depression, or insomnia—all without medication. Results are often immediate and long lasting. Other bonuses include no lasting side effects, no risk of addiction and no danger of interaction with medications. Most people experience significant relief after a single treatment, according to Leaders.“We hear people talk about DBT (dialectical behavior therapy) or mindfulness, and how mindfulness is supposed to be living in the present moment, enjoying it, being very calm, not letting things in or out of your brain as far as racing thoughts and just really slowing everything down,” she explained. “My description of this is that it forces mindfulness. Slow down, chill out. It gives you that mindfulness of hanging out on the back deck or being at the cabin and just tuning into that moment.”The calm that comes over one is akin to a nice warm 20-second hug that releases the chemical oxytocin and lowers blood pressure and heart rate, noted Allen. This calms the emotion center in the brain down to increase self-regulation and increase a sense of wellbeing.“It’s not supposed to hurt in any way, shape or form. It’s meant to be very relaxing,” added Leaders. “You feel nothing at first, then suddenly you start to feel a bit floaty. It’s supposed to be very ‘ahhh.’” The individual sets the level of microcurrent. A sense of dizziness or bed spins is too high and should be reduced for effectiveness.“The goal is to find that calming number and going higher does not mean you get better results. You have to decide what’s comfortable for you,” explained Leaders. “There is no right or wrong way, but if you experience a headache or nausea, put it back on for 20 minutes at a lower setting. It means your brain needs more time adjusting.”Pain, insomnia and mood conditions—like anxiety and depression—are all controlled by the body’s central nervous system. The nervous system is comprised of billions of individual cells that communicate every sensation by conducting electrochemical signals between the cells in the body and brain.Only two percent of the nervous system is chemical, yet we tend to try to alleviate pain with prescription medications which attempt to target an issue or imbalance in the body with the use of chemicals. Most of the nervous system—an enormous 98 percent—is electrical. Alpha-Stim’s electrotherapy is an alternative and effective way to treat the body rather than by using chemicals in the form of pills or injections. With continued use, the effects of the device can be even greater, increasing cumulatively over time as cell function becomes more readily modulated.“Everyone is different. Some choose to wear a device all day,” acknowledged Leaders. “…For someone who struggles with anxiety or depression every single minute of every single day, using this might be a Bahamas vacation.”Allen said results and feedback from RMHC clients who’ve used the device has been positive. “They wanted to use it again because it helped them feel better,” she said. “I’ve had people come in in crisis and have asked if it’s something they want to try as a means of de-escalating the crisis. It’s been helpful. Plus, people can end up not having to take as much medication to treat their mental health symptoms. … It’s a good treatment option.”Alpha-Stim can be used on its own or in conjunction with physical therapy, medication and other forms of pain management. It is also known for helping fight sleepless nights and the constant burden of stress.“People have slept better after using one,” confirmed Allen. “I had one person come in with migraines and wasn’t sleeping. She started using one consistently at our appointments and her migraines went from once a week to once a month. She was sleeping better at night, which reduced her migraines and having to go the ER to get shots.”According to Electromedical Products International, Inc. (EPII), the maker of Alpha-Stim, research has proven the device’s safety, impact and long-term effectiveness. Physician and patient surveys show that 90 percent of those who use the device experience significant relief when using it as a form of pain, anxiety, depression or insomnia treatment. This is supported by more than 100 completed, independent research studies and published reports, many of which were randomly controlled trials to ensure rigorous testing and clinically validated results.Successful results have landed the Alpha-Stim in the hands of key healthcare providers. More than 200 Department of Defense (DoD) practitioners and over 92 Veterans Administration (VA) hospitals use the device with military personnel for acute, chronic and post-traumatic pain, anxiety, depression and insomnia treatment, according to EPII.The device is ideal for those not wanting to take medications, Leaders stressed. “It really works best for those who are frustrated with medications and willing to try other things,” she expounded. “They find this is effective and has the nice benefit of not having to worry about any side effects.” Some are hesitant to try this form of treatment, which Leaders emphasized is simply an option—not a mandate.“We ask if they want to try it and have a conversation on its use,” she said. “I’d say three out of four are typically willing to try it. If someone is treatment resistant, we could put it on, but they are likely too adverse for it to work. Those individuals are used to Benzos or narcotics for the quick, automatic control, which will work every time. However, it doesn’t require any use of coping skills, so no matter what, they will always return to that place.”Medications are a temporary fix, whereas an Alpha-Stim could bring down the overall anxiety or depression levels so one is better throughout the day.“If someone’s anxiety is always at an eight or nine, this brings it down to a six or seven overall—that’s the hope,” said Leaders. “It can help panic attacks, but the goal is more like a morning meditation use. This is the Zen you attempt to find when you have all those thoughts racing through your head. It takes things down a notch—makes one more functional, more stable, feeling more relaxed, slows down impulsivity to make better decisions. At least that’s the potential.”Wellstone is a 24-hour residential center where RMHC offers crisis reduction as well as anxiety and depression reduction. Leaders said the Alpha-Stim serves the individuals there well and repeats that it all comes down to choice.“It’s all about preferences—how high (of level), how long one uses it, how effective it is for you, what you use it in place of or in addition to,” she added. “Truly there is no right or wrong answer. It’s just something unique, different that’s out there as a treatment option.”*FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  ### Woman Finds Freedom from Paralyzing Anxiety with Alpha-Stim Blog Woman Finds Freedom from Paralyzing Anxiety with Alpha-Stim Alpha-Stim Testimonials For people who suffer from anxiety, symptoms can be positively life-altering. What once felt normal and easy can become fraught and overwhelming. Activities that once filled you with joy may start to fill you with dread.The onset of anxiety might be gradual, over months or years or even a lifetime. Or it can strike suddenly and without warning. Jazlyn Canter experienced the latter. Below Jazlyn shares her story, and her resulting experience with Alpha-Stim for relieving anxiety. “Back in November, I had my very first panic attack. It came out of nowhere and I literally thought I was dying. I couldn’t stand up; I couldn’t see straight; I began praying to God, begging him not to take me away. I even had my aunt on the phone begging her to not let me die, and that if I did to tell my whole family I loved them. I was not being dramatic – they say a panic attack can mimic heart attacks, strokes, and it’s one of the closest ways to experiencing death. I believed I was dying so strongly that an ambulance was called, and I proceeded to go to the hospital where they clarified for me that I, in fact, had a panic attack.My life completely changed after that day. I stopped eating for a whole week. I lost my faith in God. I stopped going in public. I stopped having fun and going on dates. I stopped seeing friends, and even family. I didn’t go anywhere or do anything. I quit doing everything I enjoyed and more. I slept on my dad’s couch for 6 months because I was too scared to be at home. I could hardly ride in the car. I couldn’t even stay home alone because I feared I would just die…alone.”Jazlyn’s story likely strikes a chord with many others who have endured a panic attack. And as she mentions, she was not being dramatic: anxiety is powerful and can quickly overwhelm sufferers both mentally and physically.Fortunately, there is a fast, safe, and effective treatment for anxiety: there is Alpha-Stim®
. It employs a modality called cranial electrotherapy stimulation (CES), in which a tiny current of electricity is delivered through two earclip electrodes to normalize signals in the brain. Jazlyn experienced the results firsthand:“I began therapy, which led me to this amazing device called Alpha-Stim, and my life began to change. Don’t believe me? Well, some examples: I went on vacation. I can go in public. I hang out with my friends. I’ve been seeing family very frequently. Riding in the car no longer bothers me. I am sleeping at home and no longer on my dad’s couch. I can stay home alone with no issues. I gained my faith back in God and now it’s stronger than ever. I look at my life totally differently.I can’t tell you the last time I had an attack. Actually, I can’t tell you the last time I was full-on anxious. I can officially say, that because of Alpha-Stim, my anxiety is almost in remission, and that is something I feared I would never be able to say. Thank you so much to the people at Alpha-Stim!”Jazlyn’s story of success with Alpha-Stim is amazing,  but it is certainly not the only one. Alpha-Stim is an excellent alternative for people who wish to avoid the dangerous side effects of or dependence on medications. Moreover, many have told us Alpha-Stim is more effective at treating anxiety than some medications, and that users like that Alpha-Stim doesn’t have the side effects or risk of addiction that many prescription medications do. Try Alpha-Stim for Anxiety Relief If anxiety is interfering with your ability to enjoy life the way you want to, Alpha-Stim can help. Treatments are fast, easy, and done in the comfort of your own home. Better still, the results are cumulative. You’ll feel better and better over time, and you’ll likely be able to reduce the frequency of your treatments. Alpha-Stim can also safely be used in conjunction with other modalities or medications.Anxiety can wreak havoc on your life and finding the right treatment can be a harrowing experience in itself. That’s why we have a 30-day return policy, so you can see if Alpha-Stim is a good fit for you. Get started today to see if Alpha-Stim is a good option for you with a quick telehealth appointment here. See minor and self-limiting risks > ### Veteran Breaks the Vicious Cycle of Chronic Pain with Alpha-Stim Chronic pain, depression, and anxiety can all exacerbate each other, contributing to a vicious cycle. Chronic pain can have a massive impact on your quality of life. The burden of dealing with long-term pain can affect not just your physical wellbeing but your mental health as well, leading to depression, anxiety, and trouble sleeping. Pain puts us in a bad mood, and the tension from being in a bad mood causes more pain, or what pain specialists call the vicious cycle. Trying to break free from it may seem like an impossible task at times. Alpha-Stim® is an FDA cleared medical device proven to treat acute, post-traumatic, and chronic pain, as well as the anxiety, insomnia and depression that often accompany it. Alpha-Stim is not a drug, so there is no risk of addiction or lasting side effects. But best of all, it works. Time and again, patients reach out to share their success stories. Here is one such story, from a Veteran named Terry Garrett: The VA issued me the Alpha-Stim for Generalized Anxiety Disorder and depression. The unit worked quite well for my anxiety and insomnia and fairly well for my depression. However, my issues have developed mainly from my chronic daily migraines, which I have experienced for the last 7 years. I have been unsuccessfully treated for migraines with medication. Using the Alpha-Stim with the earclips did not help the migraines. After reading some positive reports of Veterans with TBI’s having success treating headaches with the Alpha-Stim, I decided to try using the sticky electrodes placed just forward of my ears, centrally located on the trigeminal nerve area. I use Alpha-Stim on the maximum setting for 40 minutes at least once per day. The migraines have been reduced from 15 or more long term, high level migraines per month to 3 or 4 low level, very short migraines per month. I am truly thrilled with the results. I’ve been very cautious about these results but I have almost two months of very reduced migraine pain now, which makes me very hopeful. Terry’s results are amazing, but not uncommon with Alpha-Stim. It has been proven safe and effective over decades of experience and in more than 100 clinical research studies. You can read additional patient testimonials here. The bottom line is that Alpha-Stim works, and it works well. Alpha-Stim brings relief directly to the site of your pain using either Smart Probes or adhesive AS Trodes To treat pain with Alpha-Stim, it is always best to use the two handheld Smart Probes that deliver Microcurrent Electrical Therapy (MET) directly to the site of your pain. Treatments are noninvasive and take only a matter of minutes. You can also use the AS Trodes, as Terry opted to do - these are adhesive electrodes than can be worn on the body over a longer period of time. The choice is yours; our clinical support team is here to help you figure out the treatment method that works best for you and your lifestyle, at no additional charge. Treatments with Alpha-Stim are quick and painless, yet relief is long lasting and often immediate. Additionally, results with Alpha-Stim are cumulative over time. In other words, the more you use it, the better you will feel. And since Alpha-Stim is not a drug, it is safe to use in conjunction with other treatment modalities. With Alpha-Stim, you can treat your body and your brain; you can stop the vicious cycle of pain, depression, and anxiety. You don’t have to choose between pain relief and your mental wellbeing, and you don’t have to settle for medications. Get started today, and let nothing stop you. Veterans and Service Members, visit alpha-stim.com/military, or call 1-800-FOR-PAIN and ask to speak to Government Services. Alpha-Stim is available at more than half of the nation’s VAs.   https://www.youtube.com/watch?v=BqgHQLcu5Hg About Alpha-Stim Alpha-Stim® is an FDA cleared, handheld medical device that has been proven time and again to effectively treat acute, post traumatic, and chronic pain, as well as anxiety, insomnia, and depression. Alpha-Stim uses cranial electrotherapy stimulation (CES), delivered through a patented waveform via two earclip electrodes, to treat anxiety, insomnia, and depression. Microcurrent electrical therapy (MET) delivers pain relief directly to the source of discomfort via two handheld Smart Probes. The safety and effectiveness of Alpha-Stim is backed by over 100 independent clinical research studies. Unlike with medications, there is no risk of addiction or lasting side effects. Alpha-Stim is available by prescription in the United States and over-the-counter in other countries. Get started today! ### Documentary Gives Thrilling Glimpse into Electromedical Treatment and Its Impact on Modern Medicine “Electroceuticals are the next wave of new treatments we will have to treat disease,” states a November 4, 2019 Time magazine article titled “Why It’s Time to Take Electrified Medicine Seriously”. The American Institute of Stress’ new documentary, The Brain Electric: Healing Wave of the Future, gives a thrilling glimpse into the world of the brain’s electric circuitry, and offers hope for anyone who suffers from anxiety, insomnia, depression*, and pain. In a world that has come to rely on medication to treat every ailment, this film reveals the science behind a safer and more effective alternative. The documentary explores Alpha-Stim® technology and the ways in which it is being used worldwide by leading research organizations, the United Kingdom’s NHS, the U.S. Military, and others as a revolutionary alternative to pharmaceuticals. Alpha-Stim is a cranial electrotherapy stimulation (CES) device FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Its clinical and cost effectiveness, as well as its safety, surpasses that of medications, and it is backed by decades of research and results. As Alpha-Stim inventor and neurobiologist Dr. Daniel L. Kirsch says, “the future of medicine is in biophysics, not in biochemistry.” Justin Smith, producer of the documentary, interviews healthcare professionals who have incorporated Alpha-Stim into their treatment protocol, including Kathy Platoni, Clinical Psychologist, Col, US Army (Ret) Professor Sriram Yennu, University of Texas MD Anderson Cancer Center Jean-Ronel Corbier, Pediatric Neurologist Ava Frick, Integrative Veterinarian Steve Haltiwanger, Psychiatrist Also appearing in the documentary is Medal of Honor Recipient Dakota Meyer, who credits Alpha-Stim with helping him be a better, more present father for his young children, and avoid self-medicating with alcohol. The Brain Electric explores not only Alpha-Stim’s impact on humans, but animals as well. “Alpha-Stim has helped save the lives of countless animals who may otherwise have been put to sleep due to their pain,” says Dr. Frick. For a limited time only, you can view the full documentary for free on The American Institute of Stress’ website at www.stress.org/thebrainelectric. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  ### Twin Cities Live: Alpha-Stim is a Powerful Tool to Treat Dental Anxiety Blog Twin Cities Live: Alpha-Stim is a Powerful Tool to Treat Dental Anxiety Many people – nearly 50%, in fact – experience anxiety around visits to the dentist; far from being uncommon, dental anxiety is a very real issue that can be daunting enough to prevent people from getting the care they need.  But did you know that there is a fast, safe, and drug-free way to quell your dental anxiety?In a recent news segment on Twin Cities Live, anchor Elizabeth Reis described her experience using Alpha-Stim to alleviate her anxiety about getting a root canal. Her fear of the procedure was so intense that she started crying immediately upon hearing she would need to have the work done. Fortunately, her dentist – Dr. Scott Shamblott of St. Paul, MN- trusts in Alpha-Stim to bring comfort and relief to his patients during and before procedures.Watch the news segment here > Using Alpha-Stim for Relieving Dental Anxiety Alpha-Stim is an FDA-cleared medical device that uses a modality called cranial electrotherapy stimulation (CES) to modulate brain activity - providing rapid, effective, and lasting relief without the side effects of medication. A tiny current of electricity is transmitted painlessly through electrodes that clip onto your earlobes. The earclips are so small that you can use headphones or earbuds simultaneously if you want a distraction from your procedure, and they won’t interfere with your dentist’s work.  1 Winick, Reid L. Cranial electrotherapy stimulation (CES): a safe and effective low cost means of anxiety control in a dental practice. General Dentistry. 1999; 47(1):50-55. How Alpha-Stim works in dental settings Alpha-Stim can be used as a stand-alone treatment for dental anxietyIt also makes nitrous oxide (“laughing gas”) more effective, allowing dentists to use less of it in their patients. This is beneficial for both patients and dentists because it reduces side effects and adverse reactions and allows practitioners to “bridge the gap” of nitrous; sometimes, even the maximum dose does not bring adequate relief.Moreover, as Reis experienced during her appointment, Alpha-Stim is effective within minutes, bringing an immediate sense of calm and relaxation. “I was almost napping,” she explained; “I totally didn’t think that was going to be the case. And it’s a long time that you’re sitting there for a root canal.”Alpha-Stim is not a drug, so there is no risk of lasting side effects or interactions with other medications. And since there is no risk of overuse, Alpha-Stim can be used for the entire duration of a dental appointment, as well as beforehand. Try Alpha-Stim for Dental Anxiety Don’t live in fear of dental procedures for one more day. With Alpha-Stim, you can get the dental care you need without the stress and anxiety. You can live your best life and have your best smile, too. Learn more about getting Alpha-Stim here.If you’re a dental professional looking for non-medication alternatives to offer patients, learn more here about getting started with Alpha-Stim> (Important Clarifications from the Twin Cities segment) Dr. Shamblott states that you must be a healthcare practitioner to get an Alpha-Stim. This is not the case; while you do need a prescription from a healthcare professional, one of the best parts of Alpha-Stim is that you can get one via a telehealth appointment in most states if you don’t have a doctor readily available.While Alpha-Stim can be used while wearing some types of earrings, those made with conductive metals should be removed prior to treatment.  ### Healing Hoof Steps Equine Therapy Brings Relief with Horses and Alpha-Stim Northwest Florida is home to one of the most concentrated veteran populations in the United States: over 106,000 veterans reside there. Nearby, there are several active duty military bases, including Pensacola Naval Air Station, Tyndall AFB, Egling AFB, Duke Field, and Hurlburt Field. At the same time, 20% of residents in Okaloosa County experience major depressive disorders - a rate higher than the national average. Healing Hoof Steps utilizes both equine therapy and Alpha-Stim to bring relief to Service Members This setting makes Crestview, Florida the prime location for Healing Hoof Steps, an equine assisted therapy and learning service dedicated to “improving lives one foot and one hoof step at a time.” Founded in 2014 by Narissa Jenkins, the daughter of a Vietnam veteran, the organization connects patients with horses to provide mental, emotional, and behavioral health services. Veterans in particular can find amazing success with equine therapy – and Healing Hoof Steps is one of only 17 programs in the Unites States to hold the venerable EAGALA (Equine Assisted Growth and Learning) Military Services Provider certification. Equine therapy is especially effective at treating the invisible wounds of war and helping to build resilience among a population that is sometimes resistant to traditional therapy. Alpha-Stim® is honored to be a part of the treatment program at Healing Hoof Steps. This FDA-cleared, handheld medical device is proven by hundreds of clinical research studies to safely and effectively treat anxiety, insomnia, and pain It is the perfect complement to the other therapies offered at Healing Hoof Steps; together, they address the most pressing needs of veterans and civilians alike. According to Connie Baldwin, Clinical Director of Healing Hoof Steps, several veterans report having better sleep with just one Alpha-Stim session per week. Other clients have found relief from their chronic pain, with many of them ultimately getting their own Alpha-Stim devices to use at home. Healing Hoof Step’s very first client to use Alpha-Stim was a combat veteran with such severe anxiety, he could neither work nor sleep. After two months of Alpha-Stim treatments, at a frequency of three sessions per week, that veteran is now back to driving his tractor-trailer across the country. Thanks to Healing Hoof Steps and Alpha-Stim, he has his life back. Alpha-Stim Smart Probes provide long-lasting, cumulative pain relief in under 5 minutes Alpha-Stim has been behind success stories like these for decades. Many Service Members avoid medications, no matter how much they are suffering, for fear they will not be able to perform their duties at full capacity. What makes Alpha-Stim especially beneficial for this population is that it is not a drug: there is no risk of addiction, withdrawal, or lasting side effects. There is no risk of misuse or overuse, and no impairment – just relief. Alpha-Stim is available at more than 100 of the nation’s VAs and has long been trusted and relied upon by the U.S. Military. Both Veterans and those still currently serving experience drastic improvement with Alpha-Stim, from both the physical and invisible wounds of war. Veterans and current Service Members can learn more at alpha-stim.com/military or by calling 1-800-FOR-PAIN and asking for Government Services. We are grateful for your service and would be honored to help you find relief. https://www.youtube.com/watch?v=R2zsDs-6wMc About Healing Hoof Steps Healing Hoof Steps is located in Crestview, Florida. The organization utilizes equine therapy to treat mental, emotional, and behavioral health issues in both civilians and Veterans. It is an EAGALA Military Services Provider and a Certified Community Partner with the United Way of Okaloosa and Walton Counties for 2019. Learn more at healinghoofsteps.org     ### Alpha-Stim Proven to Relieve Anxiety, Insomnia, and Depression Among First Responders Firefighters, EMTs, police officers, and other crisis response professionals are inevitably and repeatedly exposed to traumatic events. Over time, the cumulative effects of these stressors, combined with a schedule disruptive to normal sleep patterns, leads to adverse effects on both the physical and mental wellbeing of first responders. A new study published in Jacobs Journal of Psychiatry and Behavioral Science has found that Alpha-Stim®, a non-invasive, non-drug medical device, is highly successful at relieving anxiety, depression*, sleep, and pain among first responders. Gregory Moyer, a detective with Dayton Police, participated in the study. (WKEF/WRGT) These professionals are often hesitant to seek treatment. Some do not want the risk of side effects that come with medications; others fear retribution, stigmatization, and being negatively labeled by their peers.¹ Cranial electrotherapy stimulation (CES) treatments offer a safe and discreet method for these professionals to effectively improve their quality of life by reducing anxiety and stress, improving mood and quality of sleep, and relieving pain. In 2018, 86 law enforcement professionals participated in a study to determine the effectiveness of Alpha-Stim. Participants used the CES device for 20 to 60 minutes daily over the course of six weeks; they utilized a smartphone application to measure baseline levels and changes in mood, sleep, and pain. Participants reported their perceived levels of discomfort for each indication on a scale from 0 to 10. Upon completion of the study, statistical analysis revealed statistically highly significant (p < .001) for anxiety, insomnia, depression, and pain. The effect size values were greater than two standard deviations for all outcome measures, demonstrating a high level of improvement from baseline to posttest measures. Stress and burnout are legitimate concerns among today’s first responders and law enforcement professionals, forcing many to suffer in silence from anxiety, insomnia, depression, and pain. Alpha-Stim is an effective treatment method for these essential professionals, bringing significant relief in as little as 20 minutes a few times per week and allowing them to perform optimally and enjoy a higher quality of life at the same time. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  Alpha-Stim is a handheld medical device - not a drug - so there is no risk of addiction or lasting side effects. ¹University of Phoenix Study Finds 93 Percent of First Responders Say Mental Health is as Important as Physical Health. UOPX News 2018. About Alpha-Stim Alpha-Stim® is a handheld medical device that is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Alpha-Stim uses cranial electrotherapy stimulation (CES), delivered through a patented waveform via two earclip electrodes, to treat anxiety, insomnia, and depression. Microcurrent electrical therapy (MET) delivers pain relief directly to the source of discomfort via two handheld Smart Probes. The safety and effectiveness of Alpha-Stim is backed by over 100 independent clinical research studies. Unlike with medications, there is no risk of addiction or lasting side effects. Alpha-Stim is available by prescription in the United States and over-the-counter in other countries. Get started today! https://www.youtube.com/watch?v=QR-E0Pld8XM ### A Unique Solution to Educator Burnout: Study Proves Alpha-Stim Improves Anxiety, Insomnia, Depression, and Pain In Teachers Ninety-three percent of teachers feel some degree of burnout.¹ When burnout becomes severe, teachers may become ineffective, emotionally exhausted, dissatisfied, negative, and pessimistic.² When the discontent becomes too much to bear, many teachers leave the profession. According to Ingersol, Merrill, and Stuckey, more than 41 percent of new teachers leave teaching within five years of entry.³ A new study published in the Journal of Depression and Anxiety has found that Alpha-Stim®, a handheld, non-drug medical device, is highly successful at improving anxiety, depression, sleep, and pain among teachers. For many teachers, the stress of a workday lasts long after the final bell rings. With burnout a prevalent and growing issue among educators, cranial electrotherapy stimulation (CES) treatments offer a potential method for teachers to safely and effectively improve their quality of life by reducing anxiety, improving mood and quality of sleep, and relieving pain. Following a successful pilot study in the UK, the study sought to examine the effectiveness of Alpha-Stim CES treatments on teachers. Over the course of 6 weeks, participants used Alpha-Stim for 20-60 minutes each day. Participants utilized a smartphone application to measure baseline levels and changes in mood, sleep, and pain. Teachers reported their perceived levels of discomfort for each indication on a scale from 0 to 10. Upon completion of the study, statistical analyses revealed statistically highly significant (p values of <0.001) for anxiety, insomnia, depression*, and pain. Over a total of 237 treatments, the effect size values were greater than two standard deviations for all outcome measures, demonstrating a high level of improvement from baseline to posttest measures of perceived symptoms. Teacher burnout is a legitimate concern among today’s educators, forcing many to either suffer from anxiety, insomnia, depression, and pain, or leave the profession altogether. Alpha-Stim is an effective treatment method for teachers, bringing significant relief in as little as 20 minutes two or three times a week, allowing educators to perform optimally and enjoy a higher quality of life at the same time. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  Alpha-Stim is an FDA cleared, handheld medical device proven to improve anxiety, insomnia, depression, and stress in teachers. ¹Herman KC, Hickmon-Rosa J, Reinke WM (2018) Empirically derived problems of teacher stress, burnout, self-efficacy, and coping and associated student outcomes. Journal of Positive Behavior Interventions 20: 90-100. ²Alkhateeb O, Kraishan OM, Salah RO (2015) Level of psychological burnout of a sample of secondary phase teachers in Ma’an Governorate and its relationship with some other variables. International Education Studies 8: 56-68; De la Sablonnière R, Tougas F, De la Sablonnière É, Debrosse R (2012) Profound organizational change, psychological distress and burnout symptoms: e mediator role of collective relative deprivation. Group Processes & Intergroup Relations 15: 776-790. ³Ingersoll R, Merrill L, Stuckey D (2014) Seven trends: the transformation of the teaching force, updated April 2014. CPRE Report (#RR-80). Philadelphia: Consortium for Policy Research in Education, University of Pennsylvania. About Alpha-Stim Alpha-Stim® is a handheld medical device that is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Alpha-Stim uses cranial electrotherapy stimulation (CES), delivered through a patented waveform via two earclip electrodes, to treat anxiety, insomnia, and depression. Microcurrent electrical therapy (MET) delivers pain relief directly to the source of discomfort via two handheld Smart Probes. The safety and effectiveness of Alpha-Stim is backed by over 100 independent clinical research studies. Unlike with medications, there is no risk of addiction or lasting side effects. Alpha-Stim is available by prescription in the United States and over-the-counter in other countries. Get started today! https://www.youtube.com/watch?v=BqgHQLcu5Hg ### Tools to help law enforcement deal with stress and PTSD - ABC News [fusion_builder_container hundred_percent="no" equal_height_columns="no" menu_anchor="" hide_on_mobile="small-visibility,medium-visibility,large-visibility" class="" id="" background_color="" background_image="" background_position="center center" background_repeat="no-repeat" fade="no" background_parallax="none" parallax_speed="0.3" video_mp4="" video_webm="" video_ogv="" video_url="" video_aspect_ratio="16:9" video_loop="yes" video_mute="yes" overlay_color="" video_preview_image="" border_color="" border_style="solid" padding_top="" padding_bottom="" padding_left="" padding_right="" type="legacy"][fusion_builder_row][fusion_builder_column type="1_1" layout="1_1" background_position="left top" background_color="" border_color="" border_style="solid" border_position="all" spacing="yes" background_image="" background_repeat="no-repeat" padding_top="" padding_right="" padding_bottom="" padding_left="" margin_top="0px" margin_bottom="0px" class="" id="" animation_type="" animation_speed="0.3" animation_direction="left" hide_on_mobile="small-visibility,medium-visibility,large-visibility" center_content="no" last="true" min_height="" hover_type="none" link="" border_sizes_top="" border_sizes_bottom="" border_sizes_left="" border_sizes_right="" first="true"][fusion_text] PERRYSBURG TOWNSHIP, Ohio (WTVG) - Police officers deal with traumatic crime scenes everyday. Police advocates say they have noticed an alarming number of officers who have died by suicide and who are suffering from post traumatic stress disorder. Perrysburg Township officers are testing out a device to help them deal with anxiety, depression and insomnia. The device is called the Alpha-Stim electrotherapy. It's a drug free treatment. It connects to your ear lobes and sends a small amount of electricity into your body. [/fusion_text][fusion_button link="https://www.13abc.com/content/news/Tools-to-help-law-enforecement-deal-with-stress-and-insomnia-547591261.html" text_transform="" title="" target="_blank" link_attributes="" alignment="center" modal="" hide_on_mobile="small-visibility,medium-visibility,large-visibility" class="" id="" color="default" button_gradient_top_color="" button_gradient_bottom_color="" button_gradient_top_color_hover="" button_gradient_bottom_color_hover="" accent_color="" accent_hover_color="" type="" bevel_color="" border_width="" size="" stretch="default" icon="" icon_position="left" icon_divider="no" animation_type="" animation_direction="left" animation_speed="0.3" animation_offset="" border_radius=""]Watch Video[/fusion_button][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container] ### Can Alpha-Stim Offer Aging Adults a Safer Choice for Pain Relief? The opioid crisis in the United States has been making headlines over and over again lately – and for good reason. According to the CDC, more than 700,000 people died from a drug overdose between 1999 and 2017, and the majority of drug overdose deaths in 2017 involved opioids. Although opioids have become a villain in the eyes of many people, these drugs are typically prescribed in a good faith attempt to quell pain. And when a person is suffering from pain, they are often willing to consider any remedy that might bring them relief. This makes older adults especially vulnerable: since aging adults often struggle with pain and mobility issues, as well as social isolation, it can be especially difficult to identify drug abuse and addiction in this population. Having mental health issues or a disability, being hospitalized, living in a long-term care facility or experiencing chronic pain can all increase the risk of opioid addiction in the elderly. U.S. News and World Report cites projections that 5.7 million adults over the age of 50 will suffer from a substance abuse disorder by the year 2020. “While a family or personal history of addiction heightens the risk that an older person will develop a substance use problem, there are many other risk factors, including having mental health issues or a disability, being hospitalized, living in a long-term care facility or experiencing chronic pain,” says Kate Lufkin, a cognitive behavioral specialist who recently spoke at the Aging in America Conference in New Orleans. According to Lufkin, older adults can be prone to a line of thinking such as, “My doctor gave this to me and I feel better. Why would I stop?” This mindset is dangerous with opioids, which may need to be taken in ever-increasing dosages to maintain their effectiveness. When the primary goal is to stop the pain, following doctor’s orders may fall to the wayside – and thus begins the first step towards abuse and addiction. With 20% of older adults suffering from chronic pain, and opioid-related overdose deaths increasing 17.2% from 2016 to 2017 in adults aged 65 and older, it is critical to address this issue head-on – especially since the over-65 group was the only age bracket to see an increase in opioid-related deaths in the past year. Furthermore, most addiction treatment programs are tailored for younger people, and can be difficult for older adults to attend if they need transportation or other assistance. Fortunately, addictive drugs are not the only option for treating pain. Alpha-Stim® is an FDA cleared, handheld medical device proven to effectively treat acute, post-traumatic, and chronic pain. It delivers relief directly to the source of pain with two handheld Smart Probes; results are long lasting and often immediate, and treatments take only minutes. Alpha-Stim is a drug-free treatment that delivers relief directly to the site of pain. Alpha-Stim is safe and appropriate for use in aging adults: it is easy to use in the comfort of home, and there is no risk of overuse or addiction. Alpha-Stim can safely be used in conjunction with other medications or treatment modalities, if necessary. On top of that, Alpha-Stim also treats anxiety, insomnia, and depression – all of which are common among aging adults. With Alpha-Stim, there is no risk of overuse or withdrawal – there is no harm if it is used “incorrectly.” Furthermore, the results are cumulative – in other words, the more you use Alpha-Stim, the more effective it becomes. Many people find that they can reduce the frequency of their treatments and maintain the same benefit. The golden years are meant to be just that: golden. With Alpha-Stim, older adults can enjoy their best lives, without worrying about the risk of addiction or scary side effects. Backed by decades of clinical research and patient success stories, Alpha-Stim is simply a better, safer choice for pain relief among older adults.  Whether for yourself or a loved one, get started today and experience the difference. About Alpha-Stim Alpha-Stim® is an FDA cleared, handheld medical device that has been proven time and again to effectively treat acute, post traumatic, and chronic pain, as well as anxiety, insomnia, and depression.  Alpha-Stim uses cranial electrotherapy stimulation (CES), delivered through a patented waveform via two earclip electrodes, to treat anxiety, insomnia, and depression. Microcurrent electrical therapy (MET) delivers pain relief directly to the source of discomfort via two handheld Smart Probes. The safety and effectiveness of Alpha-Stim is backed by over 100 independent clinical research studies. Unlike with medications, there is no risk of addiction or lasting side effects. Alpha-Stim is available by prescription in the United States and over-the-counter in other countries. Get started today! https://www.youtube.com/watch?v=EV_cR7GC1uo ### The Dayton, Ohio Police Answered That Age Old Question, “Where is a Cop When You Need One?” Article by The American Institute of Stress In just 24 seconds, the alert and capable heroes of the Dayton, Ohio Police Department saved countless lives from an Antifa affiliated mass murder. These first responders protect and serve us well, and American Institute of Stress Fellow and Editor of the Institute’s free Combat Stress magazine, COL (Ret) Kathy Platoni, PsyD, protects and serves these brave men and woman in return. At a dinner in Dayton with Dr. Platoni and AIS President Dr. Daniel Kirsch, Chief of Police Richard Biehl described some of the horrific things that police officers see in the course of their workday. Things that can’t be unseen and have a tendency to creep back into the minds of good people. “Police officers swim in a sea of suffering,” Biehl said. “Anxiety, depression, Post-Traumatic Stress Disorder and sleep deprivation are a real concern. If we really want police officers to have a full career and be healthy when they retire, we have to invest more in wellness including mental health.” Dr. Daniel L Kirsch, along with EPI president Tracey B. Kirsch, and Dayton Police Department and Dayton SWAT psychologist Col Kathy Platoni PsyD meet with the Dayton Fraternal Order of Police president, Detective Rick Oakley, and Dayton Police Department Chief Richard Biehl. Dr. Platoni pointed out that while she saw the absolute worst human being are capable of in Iraq and Afghanistan, police officers are on the job every day for 20 years and more often, much longer. As a result of that meeting, AIS recently expanded the scope of Combat Stress and changed the byline of it from Bringing You All the Way Home, to Harnessing Post Traumatic Stress for Service Members, Veterans and First Responders. And AIS is partnering with the All Clear Foundation, another nonprofit who are just coming online as “A Resource for First Responders.” Together we will work with first responders to further our mutual goals of improving the quality of life for those who serve us. Towards this end, Dr. Platoni and Dayton Police Detective and Fraternal Order of Police President, Rick Oakley conducted a study published in Jacobs Journal of Psychiatry and Behavioral Science last month on 86 police officers, sheriff’s officers, and firefighters using the Alpha-Stim® medical device, a prescription brain stimulator invented by AIS president, Dr. Daniel Kirsch. The participants experienced a very significant decrease in anxiety, insomnia, depression, and pain by using Alpha-Stim CES. As a result, the manufacturer, Electromedical Products International, Inc. in Mineral Wells, Texas, donated Alpha-Stims devices to the study participants, and now more of the $800 devices to be shared by the reminder of the Dayton Police Department, after the recent shooting. Robert P. Hogeland, Retired Captain, Dayton Fire Dept., who is currently a co-team member with Dr. Platoni on the Southwest Ohio Critical Incident Stress Management Team (SWOCISM) had this to say, “COL Kathy Platoni, PsyD is receiving many, many accolades, yet she asks for none of them. She is a quiet warrior who guards the divide between Heaven and Hell in the hearts and minds of soldiers, law enforcement officers, and firefighters. Her only desire appears to be to continue to serve with effectiveness. Bravo!” Assigned to the 467th MED DET (Combat Stress Control), COL Platoni was deploying to Afghanistan with the mental health team that was massacred in Fort Hood, on September 5, 2009. The names of those fallen heroes are tattooed on her arm. In fact, the Journal News focused on that in their August 5, 2019 headline about COL Platoni, “Dayton shooting: Ft. Hood survivor helps officers deal with stress of ‘carnage.’” For 9 years and counting, she has been urging politicians to overturn President Obama’s ridiculous assertion that it was due to “workplace stress” rather than an act of war. The difference means everything to the survivors and families of those killed by the terrorist, Nidal Hasan. The families deserve the benefits afforded those killed in action. And the survivors shouldn’t have to struggle to pay their medical costs. Coincidental to the current shooting, COL Platoni had just written a multiple signature letter to President Trump, dated August 2, 2019, about the Fort Hood massacre. Little did she know she would get to deliver it in person when the command staff of the Dayton Police Department invited her to meet in private with the President. President Trump visits the hospital in Dayton, Ohio COL Platoni stated, “I am honored beyond words to have been included by the heroes of THE Dayton Police Department and to have been asked to stand by their sides during today’s meeting with the President, First Lady, Governor Mike DeWine, Senator Sherrod Brown, Senator Rob Portman and his wife, and Congressman Mike Turner. There was no press allowed, other than White House photographers, because the President wanted this to be a quiet celebration for the injured patients in a Miami Valley Hospital conference room, the entire ER staff, trauma surgeons, Dayton FD and Dayton PD. I was hoping at least Fox News was going to splatter this event across the world to celebrate these everyday heroes. One of the Dayton officers, after much ado with the Secret Service, presented commemorative police badges to President Trump. No one is allowed to present anything directly to the President, but Mr. Trump sure grabbed those up in hurry. He could not possibly have been more engaging, warm, or filled with gratitude for the extraordinarily heroic deeds of both police and fire in the face of a madman, gunning down as many innocents as they could under a hail of bullets.” President Trump receiving commemorative police badges from Dayton Police Department She went on to say, “I was able to give our letter [regarding Fort Hood] to two staffers and have the address of another. They promised to deliver these directly to the President. In fact, the President invited us all to the White House and said he would see us in the Oval Office. HOLY CRAP! I PRAY that after NINE years of treasonous cover up by the previous administration, that this ship may have begun to right itself. Hopefully we will know where we stand very soon.” Ever gracious, COL Platoni added, “Thank you all so very much for such undying support, guidance, input and belief in this mission on behalf of all the victims of the Fort Hood Massacre. Thank you, officers and command staff of the Dayton Police Department, for allowing me to walk this walk with you and to provide for the welfare of the phenomenal men and women in blue.” The American Institute of Stress sends our thanks as well, and our commitment to making all of America’s heroes feel safe again, in their own minds, as they keep us safe in ours. COL Platoni pictured on far left. COL Platoni pictured on far right. ### Alpha-Stim Can Help Veterans and Service Members Better Treat Pain and Mental Health Blog Alpha-Stim Can Help Veterans and Service Members Better Treat Pain and Mental Health Military men and women often face physical and mental health struggles as a direct result of their service. They may sustain physical injuries during training or combat that can lead to acute or chronic pain. According to the VA, “Chronic pain is more prevalent and of greater intensity in veterans than in the general population.” Various studies support this, with one finding that between 2008 and 2016, veterans were about 40% more likely to experience severe pain than non-veterans.”Anxiety, insomnia, and depression are also common among current and veteran military members. Between 2000 and 2012 alone the VA reported a 327% increase in reported anxiety disorders. A study in 2018 evaluating insomnia in veterans revealed that “Sleep problems are particularly common among United States military veterans, with one-half to two-thirds of the 2.5 million U.S. military troops who served in Afghanistan (Operation Enduring Freedom, OEF) and Iraq (Operation Iraqi Freedom, OIF) complain of insomnia problems on returning home.” The same study noted prevalent complaints from Vietnam and Korea conflicts, suggesting insomnia problems are chronic within veteran populations.A recent study published in early 2023 highlighted depression as one of the leading mental health conditions in the military, with studies showing up to 9% of all appointments in the ambulatory military health network are related to depression. Even without being stationed in a war zone, a Service Member faces a stressful lifestyle day in and day out. Although being in the military can be a great source of pride and honor, it can also take a toll on the physical and mental health of those who serve.With such prevalence of the above conditions among Service Members, the United States military healthcare system has embraced Alpha-Stim® for its effectiveness as a drug-free treatment option. Alpha-Stim is a handheld medical device that works without medications to restore balance to the brain and deliver fast, safe, and lasting relief. It is FDA-cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. Alpha-Stim Helps Veteran Drastically Reduce Reliance on Opioids Below is an excerpt from one Veteran’s experience. He was able to reduce his opioid use by 75% with the help of Alpha-Stim.“I’ve used Alpha-Stim for pain, anxiety, depression*, and insomnia with fantastic results since October of 2014. I have 967 hours of use logged on it.I first used it for polyarthritis and bursitis. I found the results to be fast and cumulative. Since my pain points are throughout my body, I’d spend around two hours everyday with the probes, and then 40 minutes with CES treatment.After a few months, I’d reduced my narcotic/opioid use by 75%. Yes. 75%...I now use MET for breakthrough pain. I’ve continued using CES daily for 40 minutes.The Alpha-Stim has been an incredibly important part of my healthcare the past five years. I cannot imagine living without this device. I am unable to express in words my gratitude to those who have made this device possible for me to use.I am 70 years old now. I wish I could have used this after my discharge in 1969. Without a doubt, my life would be different now.”*FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  Learn More About Alpha-Stim for Service Members and Veterans Want to learn more about Alpha-Stim? You can learn more about Alpha-Stim M and Alpha-Stim AID here. Ready to try Alpha-Stim? If you are a Service Member or Veteran, please call 1-800-FOR-PAIN to speak to Government Services to get started.  ### Cranial electrostimulation and anxiety There are more options to treat anxiety than you realize Repost from Pscyhology Today, by Emily Deans M.D. You might be surprised that one of the most difficult psychiatric conditions to treat is clinical anxiety. For most folks, pathological anxiety begins in childhood, and by the time someone gets to see a medication specialist in my area, a person has often been struggling for decades, and has already seen a therapist and tried medication offered by the primary care physician. By pathological anxiety, I don’t necessarily mean the nervousness that comes before public speaking or watching your kid perform at a recital…anxiety can be a good thing, to help us prepare and get things done. If we didn’t have anxiety about the possibility of being evicted, we might not be on top of paying the rent every month. When anxiety becomes crippling, when it prevents you from going out, from enjoying social interactions, or becomes so pervasive that you are worried all the time with chronic physical symptoms like headaches or irritable bowel…then it crosses the line into the pathologic. Anxiety is also a driving force and complication for many other psychiatric issues, such as clinical depression. Many folks with ADHD use anxiety to help them focus and get work done (the classic example is waiting until the last minute to get a project done, then anxiety drives you to stay up all night and hyper focus on making a great paper.) While there’s nothing necessarily wrong with that in the short term, over the long term, chronic stress and anxiety will affect sleep, cardiovascular health, and enjoyment of life in general. I’ve met plenty of people who not only cannot relax, they actively resist doing so, as they’ve been relying on anxiety to keep them going for so many years. The same sorts of folks tend to hate interventions like mindfulness, yoga, or meditation, as it feels extremely uncomfortable and a waste of time. After all, they are super busy and stressed out, and now we want to add more things like…sitting still and clearing the mind to the schedule? For a psychiatrist, this presents a clinical conundrum. The early interventions like therapy and an SSRI or buspirone have failed, but you have someone sitting in your office whose life is devoured by stress. Maybe they are smoking a lot of pot or drinking to get to sleep at night, so they wake up more anxious with rebound anxiety in the middle of the night. At this point we don’t have too many options left…more meds, now with more risk and side effects than the ones already tried (and someone with a bad experience with prior meds *and* anxiety may reasonably balk at trying another). Now you’re in the position of trying to help a strung out and overwhelmed person not only give up the nightly three glasses of wine that is the only thing that settles them down and asking them to take on a part time job of self-care (exercise, plenty of sleep, down time) before everything gets worse. As I discovered a year or so ago, there is another non-medication option for treating anxiety with several positive randomized controlled trials and decades of clinical use, especially in the military and in dentists’ offices. Various Cranial Electrostimulation (CES) devices are FDA cleared for this purpose. I have most experience with the Alpha-Stim. It uses a small current that has the result of increasing alpha waves, decreasing deep sleep delta waves, and decreasing feelings of stress and improving sleep. While some folks can’t tolerate it (due to headaches or a seasick feeling), most people do well, and many notice anxiety melting away in the moment, leaving you with a feeling of calm alertness that can last for a day or more. It’s not addictive, and if used properly has few if any self-limited side effects. The main down side of the treatment is cost…the retail price is $800 in the US. While that is less than a single day’s hospitalization, since it is often not covered by insurance, it can be out of reach for many people (especially as financial worries are often a cause of chronic stress and anxiety). The NHS did an open label study published in May in the Journal of Affective Disorders offering Alpha-stim to patients who had generalized anxiety disorder, had failed minor therapeutic interventions, and were on the waiting list for more intensive Cognitive Behavioral Therapy (CBT) for anxiety. Half the patients out of 161 recruited had their anxiety symptoms remit with 6 weeks of Alpha-stim and so they did not have to go into the more intensive therapy. The researchers estimated that they saved 540 pounds ($685) per patient by using the CES device rather than CBT.  Without a control group or blinding, the study has limitations, but other blinded, randomized controlled trials have also shown CES to be beneficial for anxiety. The paradoxical thing about chronic anxiety is that someone who is feeling better has more time and energy to take on better self-care. They have the confidence to say no to bosses and family members asking for more and more. They are sleeping better so they feel more like exercising…which will help them sleep better. They don’t desperately need that drink or three or the dose of clonazepam when they get home from work to wind down and get to sleep in the first place. We need more interventions to break the cycle of anxiety and help folks take control of their lives. About the Author Emily Deans, M.D., is a psychiatrist with a practice in Massachusetts. Online: Dr. Emily Deans' Website ### NHS Study of Alpha-Stim for Anxiety Can Revolutionize Mental Health Care in the UK Study Proves Alpha-Stim Treatment is As Effective and More Cost Efficient Than Current First-Line Therapy The National Health Services (NHS) of the United Kingdom has released a new study on the clinical and cost effectiveness of Alpha-Stim®, a non-drug medical device designed for easy, at-home use. The study, which was published in the Journal of Affective Disorders, included 161 volunteers suffering from Generalized Anxiety Disorder (GAD), who had experienced unsatisfactory relief with other therapies. The Sunday Times reports that “half of patients went into remission after treating themselves with the battery-operated device. Researchers say it has the potential to revolutionize mental healthcare and could save the health service millions of pounds.” While the effectiveness of Alpha-Stim has been proven by over 100 research studies in the United States, the NHS sought to examine not only the clinical effectiveness of the device, but the cost effectiveness of using it in the British single payor healthcare system. Alpha-Stim proved to be a cost-effective choice with a savings of £540 ($680) per patient, compared to other available treatments. According to Dr. Richard Morriss, principal investigator of the study and Professor of Psychiatry at the University of Nottingham, this could take a huge burden off the workload for Improving Access to Psychological Treatment (IAPT) services in England which sees GAD as 1 of 2 common problems with 4.4% of the British population affected. https://youtu.be/OuOAg7Ji1t4 “Alpha-Stim CES was more effective at achieving remission than we expected. As well as improvements in anxiety, there were improvements in depression and insomnia,” said Dr. Morriss in The Sunday Times. Given that 25% of the European population suffers from depression or anxiety, and universal services such as mental health are largely funded by taxes in the European healthcare systems, savings of over £540 per patient is a tremendous win. Results achieved with Alpha-Stim in the NHS study prove that this neuromodulation treatment is a valuable alternative or a complement to the psychological treatment. An article in Woman and Home highlighted that the Alpha-Stim “could well be a useful alternative to treatment, for people looking for a different option – or those unhappy with the long NHS wait times that often come with anxiety treatments. Patients waiting for CBT can often wait upwards of eight weeks. A speedier, at-home option would likely be welcomed.” In the wake of this groundbreaking research, Sky News profiled Steve Hutchinson, a father of four, who suffered from anxiety, insomnia, and depression until he discovered Alpha-Stim. “The change has been unbelievable in terms of my quality of life. It’s allowed me to do stuff that perhaps I would have struggled to do otherwise.” While Hutchinson was not a participant in the study, his results are in line with those discovered through the research. https://youtu.be/_mn7IdrWKlM In a companion article in The Sunday Times, a victim of violent sexual assault says, “After using the Alpha-Stim device, I am no longer jumping at every shadow and sound.” She reveals how after being traumatized for 16 years, she is at last finding some relief. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### Alpha-Stim Team Urges Lawmakers to Revise Mental Health Protocol for Service Members and Veterans Pictured in above image: Medal of Honor Recipient Dakota Meyer, EPI President Tracey B. Kirsch, Representative Mike Conaway, and EPI Board Member Chris Weidenhammer.  As a nation, we rely on our military men and women to protect us; we admire their bravery and owe a debt of gratitude to their selfless service. Service Members risk so much by serving. They should, in turn, be offered only the absolute best in care for their physical and mental wellbeing, both while they serve and long after. Practitioners in the Department of Defense and the Veterans Affairs Administration must adhere to certain guidelines when treating Servicemen and Servicewomen, to ensure a standard of care across the nation. Alpha-Stim® is recognized by and included in these joint guidelines as an effective treatment for pain. It is a handheld medical device that delivers drug-free relief directly to the site of pain through two Smart Probes. Alpha-Stim is a key part of the U.S. Navy Pain Management Program and the alternative medicine center at William Beaumont Army Medical Center. Its pain relief is so powerful that it even helped one veteran avoid amputation of both of his legs. EPI Board Member Chris Weidenhammer, President Tracey B. Kirsch, Senator Ted Cruz, and Medal of Honor Recipient Dakota Meyer Alpha-Stim is also proven to treat anxiety, insomnia, and depression – all of which can plague current Service Members and Veterans. It is incorporated in the healing program at Intrepid Spirit Centers and has been proven effective by Walter Reed National Military Medical Center’s Psychiatry Continuity Service. Frustratingly, however, Alpha-Stim is not included in the VA and DoD guidelines for mental health protocol, despite the evidence of its effectiveness. For this reason, EPI President Tracey B. Kirsch, Board Member Chris Weidenhammer, and Medal of Honor Recipient Dakota Meyer traveled to Washington, DC, to meet with lawmakers. The intention of the team was to bring to the lawmakers’ attention the need to include Alpha-Stim in the joint guidelines for mental health treatment for Service Members and Veterans. In addition to the numerous studies proving the effectiveness of Alpha-Stim, the team also presented the finding that the National Health Service saves roughly $700 per patient by using Alpha-Stim instead of the current treatment standard of cognitive behavioral therapy. In other words, not only is Alpha-Stim the more effective mental health treatment, but the more affordable one as well. Because Alpha-Stim is not a drug, there is no risk of addiction, lasting side effects, or withdrawal. Results are cumulative over time; patients often find that they need fewer and fewer treatments as their symptoms improve. This is in stark contrast to medications, which often need increased dosages over time to maintain their effectiveness. Even so, there is also no risk of overuse, and Alpha-Stim can be used in conjunction with other treatment modalities as well. Alpha-Stim is a powerful tool that has been proven time and again to improve the mental health – and therefore, the lives – of our nation’s men and women in uniform. That there are bureaucratic barriers preventing the use of this technology in those who stand to benefit from it is unacceptable. By bringing the issue to the attention of lawmakers, EPI hopes to make relief more accessible to those who have given so much – it’s what they deserve. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### City Mission Offers Drug-free Pain Relief to Residents City Mission Offers Drug-free Pain Relief to Residents The waiting room was full, almost overflowing with City Mission residents waiting to get relief from their pain. Every Wednesday, the City Mission Medical Center becomes a Drug-free Pain Management Clinic, where residents receive drug-free pain treatments from licensed medical professionals.“Our goal is to help people manage their pain,” said Cyndi Urbanowicz, a retired flight nurse and one of the medical volunteers at the clinic. “Unfortunately, most of the residents we see have chronic pain. We’re helping to decrease their pain and other symptoms.”Sadly, the need for a drug-free pain management clinic like the one at City Mission is overwhelming. More than 30% of all Americans have some form of acute or chronic pain, and pain-relieving opioids are now the most commonly prescribed class of medications in the United States.Dave, a current City Mission resident, comes to the clinic every week for relief from his chronic neck pain.“It’s just such a blessing,” Dave said. “When I think of what City Mission is providing for me here, it brings tears to my eyes.”When Dave was in high school, he was a star athlete, earning a baseball scholarship to college. In his Senior year, he blew out his knee, which required extensive surgery. “My knee has never been the same,” he said. “It still gives me trouble to this day.”Unfortunately, a few years later, his health deteriorated even further. He started experiencing pain, stiffness, and loss of motion in his neck. “It was very painful just doing basic things,” he said. “That’s really what got my addiction rolling.” To combat the pain of the degenerative spine disorder that was slowly fusing together the vertebrae in Dave’s neck, his doctor prescribed pain-relieving opioids. As his condition declined, he needed more and more drugs to keep up with the pain. Eventually, the prescribed medication stopped working altogether, and he turned to street drugs.His addiction caused him to lose his job, his home, and what was left of his family.Sadly, Dave’s story is all too common. In 2016, American healthcare providers wrote 214 million prescriptions for opioid pain medications, which is a rate of over 66 opioid prescriptions for every 100 Americans. In that same year, more than 40% of all opioid overdose deaths involved prescription opioids.This is a serious and a growing problem in our country and our community. The drug-free pain management clinic is one of City Mission’s newest ways to fight back.Thankfully, for Dave, he came to City Mission a little over a year ago. He has been clean for sixteen months and, as a Resident Assistant, has become a trusted and responsible part of the City Mission team.When the Drug-free Pain Management Clinic opened several months ago, Dave finally began to get the pain relief he desperately needed.“I struggle,” he said. “It can be miserable some days. And I have trouble sleeping nearly every night. I’ll be exhausted, but I just can’t get comfortable enough to sleep.”“But,” he continued. “the best nights of sleep I get are after my sessions at the clinic. It relaxes me so much, I’ll go to sleep almost immediately and sleep for hours. It makes a world of difference.”Dave receives several different types of treatment at the Clinic including physical therapy, positional release therapy, Alpha-Stim, and prayer.First, he goes to physical therapy, administered by Dr. Nathan Romesburg, who owns Romesburg Physical Therapy and Sports Fitness in Washington. For Dave, Dr. Romesburg, who volunteers his services at the Mission, focuses on stretching and exercising his neck, working to relieve pain and restore range of motion.Next, Dave moves to Positional Release Therapy with Dr. Paula Turocy, who is the Director of Pre-Medical and Health Professions Programs at Duquesne University. She volunteers her time every Wednesday to provide a drug-free alternative therapy. The treatment works, she explains, by “moving the body into positions of comfort” which naturally “‘turns down’ the intensity of activity in the pain receptors in the body.”After that, Dave undergoes Alpha-Stim therapy administered by Cyndi Urbanowicz, who was one of the creators of the City Mission Drug-free Pain Management Clinic’s treatment program. Alpha-Stim therapy applies a very low-level current of electricity to the site of the pain, which can regulate the signals within nerve cells to create lasting and significant pain relief. “Dave is our spokesman for the Alpha-Stim,” said Urbanowicz. “He tells everybody about it. The biggest difference I see the treatment making for him is his range of motion, but in addition to relieving pain, the Alpha-Stim reduces anxiety and helps with better sleep. Lack of sleep can make everything worse.”Urbanowicz is working to submit a formal request to get a personal Alpha-Stim device donated for Dave, so he can use it whenever he needs relief, which will be a great thing for him, because the more he uses the device, the more effective it will be to treat his pain. She explained, “If Dave had access to his own personal device, he would be able to reduce his pain throughout the entire week and he’d be able to have consistent good sleep.” A personal Alpha-Stim device could be a revelation for Dave in his struggle against the chronic pain he has suffered with for years.Finally, Dave receives spiritual facilitation from Cathy Orient, who prays over each resident between their treatments. Orient records Dave’s requests in a notebook and promises to pray for him throughout the week. She takes a moment during Dave’s treatment to pray for him to get the rest he needs.All of these treatments are effective for a wide range of ages and conditions. They have no significant side effects and offer zero threat of addiction. They are also cumulative. “At first, the relief only lasted a day or so,” Dave explained. “Now that I’ve been going a few months, it’s lasting into the weekend. Hopefully, at some point, it will last from week to week.”Dave is rebuilding his life physically and spiritually at City Mission. “I was in tip top shape my whole life,” he said. “Things just slowly got worse and worse for me, but I believe it all happened for a reason. I’m grateful to be here at the Mission. I hope that someday I’ll be able to work a full-time job and contribute to society again.”*FDA cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. ### Alpha-Stim® Relieves More than Just Anxiety at the Dentist: It Treats Dental Pain, Too Many people suffer from dentist-related anxiety. In fact, as many as 20% of Americans avoid the dentist altogether, as a result of their anxiety or fear. But just because it’s common doesn’t mean that you have to accept it. Having dental anxiety can make a toothache even worse. Alpha-Stim treats both the anxiety and the pain. Alpha-Stim® is an FDA cleared, handheld medical device that is proven to bring fast, safe, and effective relief from anxiety – including dental anxiety. Dentists embrace the use of Alpha-Stim in their practices because not only is the patient able to enjoy a state of calm and relaxation, but the device is so compact that it does not interfere with cleanings or procedures. Alpha-Stim is also safer than nitrous (or “laughing gas”) and has no lingering side effects. But anxiety relief is not the only benefit of using Alpha-Stim; it can also alleviate dental pain. One patient, Paul Schaum, relates his personal experience: I have seen people bring Alpha-Stim to the dentist over the years and not just for anxiety, but [also] for pain. My Alpha-Stim Rep insisted that he deliver the device to my home. I had a dental abscess at the time. I was on an antibiotic before they could do a root canal. It was a bit painful and the pain medication did nothing to abate the pain. When the Rep heard about that, he asked if he could do an external treatment in the area of the tooth in question. I let him do it, as it was better than doing nothing. I knew what the device had done to ameliorate my chronic moderate to severe pain. I was still shocked as by the time the treatment ended, I had no further dental pain - none. Mr. Schaum is certainly not the first person to experience such relief from his dental pain. A study in the American Journal of Orthodontics found that a single 20-minute treatment with Alpha-Stim significantly outperformed the placebo at reducing pain in dental patients. The pain intensity in the Alpha-Stim group remained markedly lower than that of the placebo and control groups over a period of four days. Alpha-Stim is compact enough to use during dental cleanings or procedures. If you’ve been avoiding the dentist because of your anxiety or fear, or if you are suffering from dental pain, Alpha-Stim can help. Unlike with medications, there is no risk of scary side effects or impairment after your appointment ends. You can use Alpha-Stim both before and during your cleaning or procedure – there is no risk of overuse, so you can continue your treatment for the duration of your appointment, no matter how long it lasts. Alpha-Stim is a standout in the dental world for its effective anxiety and acute pain relief, but it’s important to know that Alpha-Stim also treats depression*, insomnia, and all types of pain: acute, post-traumatic, and chronic. In other words, Alpha-Stim is not only a valuable tool in the dentist’s office, but it can also improve your everyday life. If your dentist does not yet offer Alpha-Stim, click here to submit his or her information, and we’ll help get them started. If you are interested in getting an Alpha-Stim of your own, get started here! *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  About Alpha-Stim Alpha-Stim uses cranial electrotherapy stimulation (CES) delivered through a patented waveform via two earclip electrodes to treat anxiety, insomnia, and depression*. Microcurrent electrical therapy (MET) delivers pain relief directly to the source of discomfort via two handheld Smart Probes. The safety and effectiveness of Alpha-Stim is backed by over 100 independent clinical research studies. Alpha-Stim is available by prescription in the United States and over-the-counter in other countries. Get started today! https://www.youtube.com/watch?v=fZrYcs4VNyQ ### Alpha-Stim® is an Integral Part of the Healing Program for Invisible Wounds of War In 2010, the Intrepid Fallen Heroes Fund undertook the initiative to build multiple facilities at which military personnel can heal from the traumas of combat. Called Intrepid Spirit Centers, these satellite locations of the National Intrepid Center of Excellence employ a multidisciplinary approach to care, which, according to the Fund, “has enabled more than 90% of patients to continue on Active Duty with many of their symptoms reduced or controlled.” The Intrepid Spirit Center in Fort Belvoir, VA, opened on September 11, 2013. Alpha-Stim® is one of the most critically important components of treatment at the Intrepid Spirit Centers. Many Service Members who are treated at the Centers suffer from anxiety and insomnia. Alpha-Stim is therefore a vital part of the treatment program, bringing significant and proven relief to men and women in uniform across the country for those very conditions. Alpha-Stim uses Cranial Electrotherapy Stimulation (CES), delivered through two Earclip Electrodes, to restore balance to brainwaves. As the Fallen Heroes Fund explains on their website: That’s the purpose of Alpha-Stim therapy: to return the mind to a state of normalcy and calm. In eliciting these positive feelings, stress and agitation decrease, moods stabilize, and certain types of pain may even decrease. Common symptoms of both TBIs and PTS may include anxiety, memory loss, sleeplessness or insomnia, and depression. TBIs can also cause increased agitation and memory issues. Alpha-Stim therapy can help reduce and even sometimes eliminate these effects. Service Members have reported excellent success with Alpha-Stim. Learn more here! Since Alpha-Stim is not a drug, there is no risk of addiction or lasting side effects; there is also no risk of impairment, so Service Members do not need to worry about interference with their ability to perform their duties. Relief is long lasting and often immediate. Additionally, results are cumulative – Alpha-Stim becomes more and more effective over time, so treatments are needed less frequently. This is in stark contrast to many medications, which not only bear scary side effects and a risk of addiction, but also often require dosage increases to maintain their efficacy. Alpha-Stim has long been trusted by the U.S. Military, and is honored each time they are able to bring relief to a Service Member or Veteran. The mission of the Intrepid Fallen Heroes Fund is an honorable one; one that drastically improves the lives of people who are willing to sacrifice for their country. Seven Intrepid Spirit Centers have been opened so far from coast to coast, with three more sites planned. Learn more about the Fallen Heroes Fund here. Veterans and current Service Members who are interested in getting an Alpha-Stim of their own can call 1-800-FOR-PAIN and ask to speak to Government Services or visit alpha-stim.com/military. Alpha-Stim is currently available at more than half of the nation’s VAs. Get started today! About Alpha-Stim Alpha-Stim uses cranial electrotherapy stimulation (CES) delivered through a patented waveform via two earclip electrodes to treat anxiety, insomnia, and depression*. Microcurrent electrical therapy (MET) delivers pain relief directly to the source of discomfort via two handheld Smart Probes. The safety and effectiveness of Alpha-Stim is backed by over 100 independent clinical research studies. Alpha-Stim is available by prescription in the United States and over-the-counter in other countries. Get started today! FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### How to Treat Insomnia and Pain Together Blog How to Treat Insomnia and Pain Together The relationship between chronic pain and sleep disorders, such as insomnia, is more complex than it may seem. And if they exist at the same time, it’s important to treat them both. Pain and Insomnia Have a Bidirectional Relationship Research in the last few years has established a bidirectional relationship between chronic pain and sleep issues/disorders. Specifically:Pain can be a cause and consequence of sleep deficiency.Sleep can contribute to and exacerbate pain.   Moreover, the same study that outlined the above, also notes the following findings: Chronic pain is highly comorbid with deficiencies in sleep duration or quality Pain can disrupt sleepShort/disturbed sleep can lower pain thresholdsPoor sleep can result in increases in the development or exacerbation of spontaneous pain symptoms This relationship can be especially problematic for individuals with chronic pain, and it’s a cycle that can be amplified over time if both issues are not treated effectively. Treating Pain and Sleep Together While there are a lot of options for treating acute and chronic pain, and insomnia, individually, not many exist that can approach both conditions. Alpha-Stim M is unique in that it can actually treat both pain and insomnia.  How does Alpha-Stim M do this?  The Alpha-Stim M includes handheld Smart Probes or AS-Trode self-adhesive electrodes for site-specific MET pain therapy, as well as earclips that provide cranial electrotherapy stimulation (CES)—to relieve common comorbidities associated with pain, including anxiety, insomnia, and depression*.Learn more about how Alpha-Stim M treats pain here > Why is Treating Both Sleep and Pain Important? According to an article in U.S. News & World Report, research from the journal BMC Musculoskeletal Disorders “suggests that an array of sleep problems – including difficulty initiating and maintaining sleep, early awakening, non-restorative sleep and fatigue – are important predictors for the future development of (chronic widespread pain) both over a five-year and an 18-year span.”Poor sleep quality is linked to increased risks for mood disorders such as anxiety and depression, as well as cardiovascular disease, diabetes, and more. This new research suggests that fatigue and pain may actually be caused by abnormalities in pain systems in the body, rather than merely sleep issues as was once thought.In short, the relationship between sleep and chronic pain is one that researchers are still trying to understand; but what is absolutely clear is that quality sleep is essential to your physical and mental wellbeing in countless ways.If you suffer from chronic pain and insomnia, you know that it can be a vicious cycle: the lack of sleep can exacerbate your pain, which then keeps you awake, which can lead to depression and anxiety about being tired and in pain. And since it can be dangerous to take both pain medications and anti-anxiety medications at the same time, it may feel like you are stuck in this pattern forever. Learn more about how Alpha-Stim can help you treat both sleep and pain conditions so you can take charge of your life again. Take Charge of Your Life with Alpha-stim Schedule a telehealth visit with a health care professional today to get started with Alpha-Stim M to treat insomnia and pain. Schedule Now *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  ### Radio Interview: Dayton Police Using Brain Stimulation To Reduce Stress Nov 2018 - Ann Thompson with Cincinnati WVXU radio did an interview with Dayton Police Department Chief Richard Biehl and Dayton Police Psychologist Kathy Platoni.  A third of Dayton's police force is part of a pilot study to reduce stress using brain stimulation. One hundred  officers are now in the fourth week of a six-week study for the therapy, already proven effective in both civilians and military. Chief Richard Biehl knows his department is under a lot of stress and he says if that stress is not managed properly, potential outcomes can include burnout and poor performance and decision making in the wake of difficult circumstances. "I can't think of a more trying time to be in policing than in more of these recent years," he says. "With all the complex roles for police officers dealing with arrest to domestic terrorism to active shooters." Biehl learned about the technology from Centerville Clinical Psychologist Kathy Platoni. She's been prescribing it for years, both to civilians and to military in Iraq and Afghanistan when she was a colonel in the Army. The Alpha-Stim device, as it's called, has wires that clip to the user's ear lobes. According to Platoni, the Alpha-Stim device "is called cranial electrotherapy stimulation at a sub-sensational level, which means you're not supposed to feel the effects of the device." She adds, "It passes a microcurrent through the brain and causes internal quiet." She says Alpha-Stim benefits users the more they use it. Dayton officers usually use it at home for up to 40 minutes a day. From left: Dayton FOP President and Detective Rick Oakley, Dayton Police Chief Richard Biehl, Alpha-Stim inventor Daniel Kirsch, EPI President Tracey Kirsch and Dayton police psychologist Col Kathy Platoni. "I applaud the F.O.P. leadership and membership for deciding to take advantage of this opportunity to allow officers to try this device," says Biehl. Alpha-Stim was developed by Texas-based Electromedical Products International, Inc. Dr. Platoni says she is not a paid spokesperson. Dayton police are in the process of reporting their results. Based on that, the department will decide if it will continue using the devices and how much it would cost. About Alpha-Stim® Alpha-Stim® is an FDA cleared, handheld medical device that is proven to be fast, safe, and effective. Alpha-Stim is not a drug, so there is no risk of addiction or lasting side effects. It brings clinically significant relief to 9 out of 10 users. Alpha-Stim delivers cranial electrotherapy stimulation (CES) through earclip electrodes. Treatments last 20 to 60 minutes and are easy and pain-free. Relief is long lasting and often immediate, and the results are cumulative - unlike with medications, users may need fewer and fewer treatments over time. Alpha-Stim is available by prescription in the United States and over the counter in other countries. Click here to get started today! ### Letter to the Editor on 'Evidence Insufficient to Support Cranial Stimulation for Chronic Pain' The following is a letter to the editor of Pain Medicine News, submitted by Dr Jeff Marksberry, Chief Science and Clinical Officer of Electromedical Products International Inc.The letter is in response to an article written by Pain Medicine News, based on a review article done by the VA Evidence-based Synthesis Program (ESP). To the Editor: The recent article titled “Evidence Insufficient to Support Cranial Stimulation for Chronic Pain” (Pain Medicine News 2018;16[7]:1) was a summary of the review article published in the Annals of Internal Medicine, titled “Benefits and Harms of Cranial Electrotherapy Stimulation for Chronic Painful Conditions, Depression, Anxiety and Insomnia” (2018;168[6]:414-421). The report focused on studies that used devices no longer on the market, while omitting most of the research relevant to the Alpha-Stim (Electromedical Products International) brand of cranial electrotherapy stimulation (CES) devices, which are primarily used in the Department of Veterans Affairs (VA), Department of Defense (DOD) and civilian markets. Alpha-Stim is the only CES device on the Federal Supply Schedule for the DOD and VA. The authors set arbitrary exclusion criteria in finding studies for their review—far more restrictive than the government’s definition of valid scientific evidence—which allowed the reviewers to eliminate much of the best evidence supporting CES. The reviewers completely omitted animal and mechanistic studies including EEG and functional MRI research, and they chose not to speak to any VA practitioners who have clinical expertise with CES. More than half of the VA medical centers have used Alpha-Stim technology, and in 2017 more than 100 VA medical centers purchased Alpha-Stim devices for veterans. This review article is completely at odds with the judgment and experience of licensed health care professionals who actually practice medicine in the VA. It reviewed a legal medical treatment used in the VA for decades independent of the people who actually use it in the VA who know exactly how well it works for the apparent purpose of denying them the right to prescribe it. The report was successful at stopping all VA medical centers from purchasing CES devices for two weeks. Within that time frame, so many VA practitioners complained about the inadequate review of science that 75% of the VA medical centers were promptly provided waivers. Soon after, 100% of the business was reinstated. The review was also extremely biased. For example, Lande and Gragnani’s short five-day insomnia study of service members at Walter Reed National Military Medical Center was reviewed as having no difference between groups. There were actually significant effects on days 1 and 4, and a trend toward significance on day 5 (P<0.079). More importantly, service members slept an average of 43 minutes more a night.1 It is revealing that the Annals report reviewed many studies from 40 years ago that used devices long off the market while omitting current and relevant research. CES devices are unique to one another based on the waveform produced as well as the device parameters. These devices are not like generic drugs, but rather a category of analgesics, for example, that range from aspirin to morphine. Alpha-Stim has over 100 published reports (www.alpha-stim.com/ wp-content/ uploads/ 2016/ 12/ CE-June-2018.pdf) over its 37 years of distribution, most by independent researchers at American universities, the VA and the DOD who have attained institutional review board approval without industry funding. Because Alpha-Stim is subsensory, an effective double-blind, randomized controlled trial protocol is used in much of the research. The results are consistently robust with medium to high effect sizes. If the VA is actively seeking nonaddictive, safe and effective treatments for anxiety, insomnia, depression and pain, then a review regarding the benefits and harms of a treatment should consider all valid scientific evidence without bias, especially when no safety issues exist. That would be a true review of CES in 2018. Jeff Marksberry, MD, CCRP, FAIS Chief Science and Clinical Officer Electromedical Products International Inc. Reference Lande RG, Gragnani C. Efficacy of cranial electric stimulation for the treatment of insomnia: a randomized pilot study. Complement Ther Med. 2013;21(1):8-13. ### Dayton, OH Police Participate in Alpha-Stim® Research Study Work related burnout, “compassion fatigue,” and mood and sleep disorders are all issues endured by law enforcement professionals. Given the challenges faced everyday on the job, it’s no wonder that police officers bear indisputably high levels of stress. Alpha-Stim inventor, Dr. Daniel L Kirsch, along with EPI president Tracey B. Kirsch, and Dayton Police Department and Dayton SWAT psychologist Col Kathy Platoni PsyD meet with the Dayton Fraternal Order of Police president, Detective Rick Oakley, and Dayton Police Department Chief Richard Biehl. The National Institute of Justice reports that inadequate or outdated equipment, rotating shifts, and ever-changing duties and responsibilities contribute to officer stress and fatigue. Additionally, sleep deprivation - a direct result of irregular working hours - leads to increased sickness, higher risk of involvement in automobile accidents, and a greater incidence of dying in the line of duty. In fact, a study found that "four out of eight officers involved in on-the-job accidents and injuries were impaired because of fatigue.” Electromedical Products International, Inc. (EPI), a medical device manufacturer based in Texas, aims to lessen these issues in first responders and is conducting a study with volunteers from the Dayton, Ohio Fraternal Order of Police. In the study, police officers will use an Alpha-Stim device for 6 weeks, and will track their progress over that time period. Volunteers will report on the quality of their mood and sleep over the course of the study. Alpha-Stim is a non-invasive, FDA cleared prescription medical device that delivers safe and effective non-drug relief of anxiety and insomnia. Officers participating in the study will get to keep the $800 device at no cost. Backed by more than 100 independent clinical research studies, Alpha-Stim has been proven time and time again to work quickly, safely and effectively. It is trusted and relied upon by the United States Military, and it is offered at more than half of the nation’s VA medical centers. EPI recently donated devices to first responders in its hometown of Mineral Wells, Texas. The recipients of the devices provided feedback for the new Alpha-Stim iPhone progress-tracking app. A newly developed Android app will be tested by the participants in the Dayton, OH study. To learn more about Alpha-Stim, call 1-800-FOR-PAIN or visit www.alpha-stim.com About Alpha-Stim® Alpha-Stim® is a non-invasive prescription medical device that is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Although it is so safe that it is approved for sale outside of the United States without a prescription. The brain functions electrochemically and can be readily modified by electrical intervention. The Alpha-Stim utilizes cranial electrotherapy stimulation (CES) and microcurrent electrical therapy (MET) to deliver the only patented waveform on the market which is clinically proven to work in 9 out of 10 people who use it, even when other therapies failed. Alpha-Stim can be used alone, along with other therapies, without the risk of drug interactions. There are no serious adverse effects, no risk of addiction, and more than 100 clinical and mechanistic research studies that prove the effectiveness of this low level brain therapy. To learn more, call 1-800-FOR-PAIN or visit www.alpha-stim.com. Full disclosure of the minor and self-limiting risks at www.alpha-stim.com/risk. ### Alpha-Stim® is Key Part of U.S. Navy Pain Management Initiative Blog Alpha-Stim is a Key Part of the U.S. Navy Pain Management Initiative The following is a guest post written by Petty Officer 1st Class Laura Myers for the DVIDS (Defense Visual Information Distribution Service) from 2018. September is Pain Awareness Month. Various organizations use this time to raise awareness of issues of pain and pain management. Naval Medical Center Portsmouth’s (NMCP) Pain Management Clinic and Interdisciplinary Pain Medicine Clinic provide in-depth treatment methods that support the Bureau of Medicine and Surgery (BUMED) Navy Comprehensive Pain Management Program (NCPMP).NCPMP is an initiative to aid in the restoration of function and relief of pain by broadening access to evidence-based, standardized, multimodal, and interdisciplinary pain across Navy Medicine, ensuring treatment efficacy through practice guidelines, education, and analysis of treatment outcomes.“The Navy Comprehensive Pain Management Program is not just a matter of seeing us (physicians) and having procedures and medications, it’s a more holistic approach to the individual that examines everything about their life, like what they eat, how stressed they are, how they are sleeping and their activities throughout the day, because all of those things are contributors to wellness, well-being, how the patient perceives pain and how they will react to our treatments,” said Lt. Cmdr. Benjay Kempner, a Pain Medicine Fellow in NMCP’s Pain Management Clinic. “Much of the recovery we found out is dependent on these factors, individual effort and other things they do to rehabilitate and fix the things that cause the pain to begin with.”This program focuses on pain management therapies and education, and alternative ways to combat pharmacologic approaches, including opioid therapy.“All of this is to combat the opioid epidemic and for opioid safety,” said Lt. Cmdr. Victor Rivera, an NMCP pain management attending physician in the Pain Management Clinic. “Everything we do is to get our patients off opioids or to significantly reduce the use.”Some of the pain management procedures are injections such as epidural steroid injections, facet injections, facet blocks and nerve blocks. Alternative therapies for pain management include acupuncture, physical therapy, pain psychology, Alpha-Stim®, and pain education.“Once your pain gets to about the three-month mark, it becomes chronic pain,” said Michele Guse, NMCP’s Interdisciplinary Pain Medicine Clinic manager. “It is something that we have to learn to live with and deal with and learn to get through our daily activities with, it’s probably not going away.”Acupuncture, a traditional Chinese medicine, is used to manage pain because needles are inserted into certain points of the body that have more nerve endings and blood vessels and it is believed that there is a cascade of chemicals and hormones that are created because of how the nervous system reacts.“This creates what we call happy hormones, serotonin and dopamine, to help reduce pain and make you feel relaxed, happier and helps improve mood and sleep,” said Neida Fedison, the acupuncturist for NMCP’s Interdisciplinary Pain Medicine Clinic. “The more complex part of the Chinese medicine is the belief that the whole body contains energy, and that energy gets blocked and it disrupts the natural balance when we suffer any physical, mental or emotional trauma. Acupuncture helps to regain that balance.”Physical therapy treatments are not the traditional physical therapy sessions. The physical therapist focuses on stretching, movement, yoga classes and pool therapy.“For people with pain, traditional physical therapy has not been 100% successful, so the therapists focus on movement with pain and what is safe to do,” Guse said.NMCP has two pain psychologists and they do a myriad of different therapies, including cognitive behavior therapy, independent and group sessions, acupuncture relaxation therapy and pain education.“Pain education teaches people how to learn to live with their pain, mostly from a psychology perspective,” said Darren Love, a pain psychologist for NMCP’s Interdisciplinary Pain Medicine Clinic. “Teaching patients what is chronic pain and ways to learn to live with it. We teach them how to communicate more effectively with others and they learn how to manage stress, all of those things, and more, are built into the program to, again, teach them to learn how to live with their pain.”The newest pain management therapy offered at NMCP is Alpha-Stim. It is a clinically proven medical device that relieves anxiety, insomnia, and pain using electromedical technology. Alpha-Stim begins at the electron level, allowing the body’s cells to return to their natural functioning state.“Our goal is to help our patients learn how to manage their pain so they can live the life they want without it causing so much distress,” Love said. “If we can improve their mood and their sleeping, we are more likely to improve their overall pain and their perception of pain, allowing them to stay on active duty.”As the U. S. Navy’s oldest, continuously operating hospital since 1830, Naval Medical Center Portsmouth proudly serves past and present military members and their families. The nationally acclaimed, state-of-the-art medical center, including its ten branches and TRICARE Prime clinics, serves the Hampton Roads area and additionally offers premier research and teaching programs designed to prepare new doctors, nurses, and hospital corpsmen for future roles in healing and wellness. ### Alpha-Stim®: A Safe Alternative for Aging Adults Our nation is in the thick of an opioid crisis. In October 2017, the U.S. Department of Health and Human Services declared the situation a Public Health Emergency, citing the fact that more than 140 Americans die each day from overdoses. Opioids come in multiple forms, from the insidious heroin to painkillers prescribed in good faith by a doctor. It is the latter type that is increasingly being used by aging adults in the United States. This seems to fall in line with the fact that “81 percent of adults over 65 endure multiple chronic conditions such as arthritis, hypertension, heart disease, and diabetes. There also can be emotional pain from the loss of relatives and close friends, and concerns about the continued ability to live independently.” It is typically not the over-65 set that is abusing opioids; however, “the population of older adults who misuse opioids is projected to double from 2004 to 2020.” There are a few important reasons for this expected rise among the elderly: Multiple surgeries may result in long term use of pain medication, which increases the odds of misuse Some adults take more painkillers than they are supposed to, if the drugs aren’t reducing the pain effectively Older adults often face more barriers to getting the medications they need, for a variety of reasons. As a result, they may resort to obtaining prescriptions from friends or family without proper instructions Over the course of a person’s lifetime, even small injuries can add up over time, leading to a severe pain syndrome later in life A new poll conducted by the University of Michigan, which surveyed 2,000 Americans between the ages of 50 and 80, reveals that there may be an even bigger contributor to the problem: a lack of explanation by doctors to their elderly patients about the risks associated with prescription pain medications. Of the survey respondents, “the majority didn’t recall their doctors or pharmacists talking about the risk of addiction, the risk of overdose, or what to do with leftover pills. About 40 percent said their doctors didn’t talk to them about the side effects of opioid use or guide them on when to cut back on pain medications.” It is important to note that lack of information shouldn’t necessarily bear the brunt of the blame: “Growing older often also means it’s harder to absorb information, interpret numbers, and do calculations, according to the Centers for Disease Control and Prevention.” The survey results do not tell us whether the risks weren’t communicated or whether the patients forgot. Regardless of the source of miscommunication, aging adults are at risk of misusing opioids – and the results can be dire. Alpha-Stim® is a fast, safe, and effective treatment for acute, post-traumatic and chronic pain. It is not a drug – it is an FDA cleared, handheld medical device that is easy to use for patients of all ages. Alpha-Stim works better and costs less than commonly prescribed pain medications. Because Alpha-Stim is not a drug, there is no risk of addiction or the lasting side effects of prescription drugs. Additionally, the effects of Alpha-Stim are cumulative. Whereas many medications require increased dosages to remain effective, patients may find that they need less frequent Alpha-Stim treatments over time. Alpha-Stim delivers Microcurrent Electrical Therapy (MET) directly to the site of pain using two handheld Smart Probes. It also uses Cranial Electrotherapy Stimulation (CES), through Earclip Electrodes, to treat depression, anxiety, and insomnia. Pain relief is long lasting and often immediate, with 9 out of 10 users experiencing significant relief. Don’t let age slow you down. You don’t have to live with pain – or the side effects associated with medications - just because you are getting older. Get started today, and let Alpha-Stim help you enjoy your golden years to their fullest. https://www.youtube.com/watch?v=BqgHQLcu5Hg ### Inspiring New Book Features Alpha-Stim® as Key to a Dog’s Recovery Nobody Told Me My Legs Don’t Work: Journey of a Down Dog is the remarkable true story about a golden retriever named Keegan and her two devoted humans, Travis and Renea Yates. After suffering a spinal stroke, Keegan was left paralyzed from the shoulders down – but Travis and Renea refused to give up hope that their beloved dog might walk again someday. The two embarked on a life-changing journey that tested their marriage, their patience, and their finances. Travis and Renea were committed to doing whatever it took to help Keegan leave behind her “down dog” status and learn to walk again. After an unsatisfactory and dismal prognosis from a veterinary neurologist, Travis hunted high and low for a veterinarian who could actually help – and he was lucky to discover Dr. Ava Frick, “one of the pioneers in the field of animal rehabilitation,” and “the doctor [Travis and Renea] would put every ounce of faith and trust in to find a way to get Keegan walking again.” At the first session, Dr. Frick evaluated Keegan’s condition and taught Travis and Renea some exercises to perform with Keegan at home to try to reestablish the connection between her legs and her brain. Dr. Frick’s team also introduced Alpha-Stim® at the first visit, showing the couple “how to use the probes along Keegan’s neck, spine, and paws, spending 30 seconds in each location.” In all, Travis and Renea had about three hours of rehabilitation work to perform at home with Keegan each day. Alpha-Stim treatments, along with rehabilitation exercises and chiropractic care, were instrumental in getting Keegan back on her feet. Some chapters of Nobody Told Me My Legs Don’t Work are written from the perspective of Keegan herself, expressing her dismay over losing control of her body or excitement over her progress. In one such passage, she refers to her Alpha-Stim treatment, saying “That’s where my nerve endings from my brain to the parts of my body that don’t work so well are remapped using tiny electrical impulses. I don’t feel any pain when they do my therapy. I really like the ear clip part. I feel really relaxed after that is done and normally take a nap.” Keegan in her wheelchair “Alpha-Stim was key to [Keegan’s] recovery and as the story rolls out, this fact is brought to light,” says Dr. Ava Frick. A pioneer in treating animals with microcurrent therapy, she was an apt expert to have composed the foreword to this inspiring story. Her implementation of Alpha-Stim therapy from day one is a testament to her trust in its effectiveness. While the 167-page book is an easy and enjoyable read, Dr. Daniel L. Kirsch, inventor of the Alpha-Stim, says “It’s hard to read this without emotion.” He was impressed by the tale of Keegan and her owners, and deemed it “a giant step for dogkind.” If you or your furry friend suffers from pain, anxiety, insomnia, or depression, Alpha-Stim can help. Proven by more than 100 independent clinical studies, it surpasses the efficacy of medications – without the risk of addiction or lasting side effects. Alpha-Stim is an FDA cleared medical device that provides fast, safe, and effective treatment for acute, chronic, and post-traumatic pain, as well as anxiety, insomnia, and depression. Using cranial electrotherapy stimulation (CES), transmitted through Earclip Electrodes, the device delivers an electrical microcurrent to the brain. The patented Alpha-Stim waveform is what makes it so effective, and what sets it apart from any other CES device on the market. It is clinically effective for 9 out of 10 users, and regularly changes the lives of humans and animals as drastically as it has improved Keegan’s. Nobody Told Me My Legs Don’t Work is available at Amazon and Barnes & Noble. For more information about using Alpha-Stim for veterinary medical care and treatment, visit alphastimforanimals.com. ### EEG Study at Walter Reed Medical Proves Alpha-Stim Significantly Effective A new study from Walter Reed National Military Medical Center’s Psychiatry Continuity Service has proven that a 20 minute session with the Alpha-Stim AID® brings clinically significant results. The subjects in the study were active duty military members who suffered from depression* and sleep problems, as well as other trauma-related symptoms. The fifty subjects received 20-minute sessions with Alpha-Stim; brain wave activity was recorded immediately before the treatment, immediately after the treatment, and 10 minutes after the conclusion of the treatment. The participants also reported their levels of distress both before and after the Cranial Electrotherapy Stimulation (CES) session. After treating with Alpha-Stim for 20 minutes, participants reported a significant decrease in their subjective levels of distress. Additionally, there was a significant increase in beta brain wave frequencies, with an even greater change manifesting 10 minutes after the end of the treatment, “suggesting an increase in mental alertness, focus, and concentration.” Read the study on PubMed > The Alpha-Stim AID delivers CES through earlobe-attached electrodes to treat anxiety, insomnia, and depression. It is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States, and has been proven effective in study after study to bring relief to users in as little as 20 minutes. Alpha-Stim is not a drug; it bears no risk of addiction and no lasting side effects, and the results are cumulative – rather than needing an ever-higher dosage (as with drugs). Patients often find they can reduce the frequency of their Alpha-Stim treatments as their symptoms abate. The Alpha-Stim AID, as well as the Alpha-Stim M (which treats anxiety, insomnia, and depression, along with chronic, acute, and post-traumatic pain) are available by prescription in the United States, and through more than half of the nation’s VAs.  It is available over the counter in other countries. This study from Walter Reed proves – yet again – what so many patients have already experienced firsthand: Alpha-Stim works, and it works well. To take the first step towards relief from your own depression, anxiety, insomnia, or pain, get started today.   https://www.youtube.com/watch?v=BqgHQLcu5Hg ### Dakota Meyer Featured in PTSD Journal Dakota Meyer Featured in PTSD Journal Dakota Meyer, Marine and Medal of Honor recipient, is featured in the cover story of the Summer 2018 issue of PTSD Journal. The article, titled Dakota Meyer: Hero Soldier and Citizen, talks about Meyer's goal to "do all he can to give back to his fellow soldiers".Meyer states in the article, "It took the military three months to turn me into a soldier. But they gave me one week to become a civilian. I think the battle after the battle is the hard one."He talks about his own person battle and how he discovered immediate anxiety relief with Alpha-Stim®."For me, it melted my anxiety away. I'm telling you, it was like someone lifted a pack off my back," Meyer said. "I couldn't believe the results. Everyone needs to know about Alpha-Stim."Read the article now >https://youtu.be/h0g6di_i9z0 ### A Letter from a Grateful Veteran Successes are frequent among people who use Alpha-Stim® to treat their anxiety, insomnia, depression, and pain: the FDA cleared CES device brings clinically significant relief to 9 out of 10 users. Even so, some success stories are so exceptional that patients reach out to Alpha-Stim directly to share their life-changing results. What follows is an excerpt from one such letter. “My name is Loretta Diana Vinson, I’m a veteran, United States Army, and I am extremely pleased with your product! Your product is a miracle wonder! . On July 8th, I was stricken with a sharp pain in my head. The sharp pain subsided, however, I was stricken with a headache. I took two Tylenol, got in bed, hoping that would be what I needed to get rid of the headache. Unfortunately, the Tylenol did not work, the headache became so severe I had to go to the emergency room on July 9th. During the 7 hours that I was in the emergency room, I had a CT scan, blood draw, and a spinal tap performed to narrow down the cause of the headache. After the results came back, I was told, ‘You have a textbook migraine headache. I will be prescribing you some medicine that should help.’ [The medication] seemed to, not decrease, but enhance the pain that I was having. I suffered with the headache on Tuesday, because I didn’t want to go back to the emergency room. Wednesday, I knew I had to go back to the doctor. The doctor prescribed a Toradol shot that was given in the clinic, along with Naproxen for the headache and Zofran for nausea to take home with me. The Zofran worked, the Naproxen only took the sharpness of the headache away, the dull throbbing pain remained. . Fast-forward to July 17, 2018, I had an appointment at the Veteran’s Administration (VA) treatment facility with one of the nurse practitioners. At this appointment I was being seen to follow-up on medicines that I’d been prescribed to help with my anxiety and sleep disorder. I shared with the provider about the migraine headache that I was having and how it had been since July 8th and I was still suffering with this headache. What I was sharing with her, she listened, and she actually HEARD me! She asked me if I’d ever heard of Alpha-Stim. She went on to tell me about your product and she even shared some of testimonials about your product. . July 18, 2018, I checked in for my appointment with the Sleep Health Integrative Physician. [The doctor] asked, ‘How are you feeling right now?’ My response, ‘I have a migraine headache for, today makes, 11 days now, emergency visit, with a follow-up primary care appointment, didn’t help to remove the headache. I also have chronic pain in my back, and to top it all off, I’m not getting quantity or quality sleep. So, to answer your question, I’m not feeling the best.’” Reporting her pain as an 8 out of 10, Ms. Vinson listened as the doctor told her about Alpha-Stim and asked if she would like to try it. Ms. Vinson agreed to try the Alpha-Stim offered to her. Her letter continues: “Seven minutes using the Alpha-Stim device, the headache I had, had moved from my temporal area and localized itself to the back of my head. Twelve minutes in, the throbbing was completely gone and what I felt was like something that I could peel off of the back of my head. Twenty minutes later, headache gone and I felt hungry. After I left the doctor’s office, I got something to eat, came home, got in bed and slept the most peaceful sleep that I’d only wished for before. . God bless the doctor, medical team, wise enough to take the time to develop a product that does what it is designed to do without any side effects for patients like me. Take it from a patient who has suffered with chronic pain for 20 years and I have to tell you, to know that my quality of life shall improve, I’ll say it again, I’m am very pleased with your product!” Survey Shows Patients Feel Better with Alpha-Stim Than with Drugs As Ms. Vinson has experienced, Alpha-Stim is a fast, safe, and effective treatment for acute, chronic, and post-traumatic pain, as well as anxiety, insomnia, and depression. Its patented waveform delivers cranial electrotherapy stimulation (CES) to the brain through two small Earclip Electrodes. Since Alpha-Stim is not a drug, there is no risk of addiction or last side effects. And just as Ms. Vinson explains, it even works better than medications. Proven effective by decades of independent clinical research, Alpha-Stim is available by prescription in the United States (and over the counter in other countries.) It is trusted and relied upon by the United States Military, and is available at more than half of the nation’s VAs. Veterans and Service Members can call 1-800-FOR-PAIN and speak to the dedicated Government Services department at Alpha-Stim for assistance. If you suffer from anxiety, insomnia, depression, or pain, and would like to experience the improved quality of life that Ms. Vinson describes in her letter, get started today. Why wait another moment for relief? https://www.youtube.com/watch?v=BqgHQLcu5Hg ### Author’s Bias Evident in Political Review to Deny Benefits to Veterans Rebuttal to: Evidence Insufficient to Support Cranial Stimulation for Chronic Pain. PMN, July 26, 1018 The recent article titled, Evidence Insufficient to Support Cranial Stimulation (sic) for Chronic Pain, Pain Medicine News, July 26, 1018 was a summary of the review article published in the Annals of Internal Medicine titled, Benefits and Harms of Cranial Electrotherapy Stimulation for Chronic Painful Conditions, Depression, Anxiety and Insomnia (2018;168(6):414-421). The review was funded by the Veterans Administration’s Evidence Based Synthesis Program. The search strategy employed by the authors to locate studies appeared to be designed to provide an extremely biased sampling omitting the majority of the available published data. The report focused on studies which used devices that are no longer on the market while omitting most of the research relevant to the Alpha-Stim brand of cranial electrotherapy stimulation devices primarily used in the VA, DOD and civilian markets. Alpha-Stim is the only CES device on the Federal Supply Schedule for the DOD and VA. The authors set arbitrary and capricious exclusion criteria in finding studies for their review, outside of the government’s definition of science, presumably to arrive at a preconceived position. The government’s actual definition of valid scientific evidence is “… when taken as a whole, is adequate to support a determination that there is reasonable assurance that the device is safe and effective for its conditions of use... (2) Valid scientific evidence is evidence from well-controlled investigations, partially controlled studies, studies and objective trials without matched controls, well-documented case histories conducted by qualified experts, and reports of significant human experience with a marketed device.” CFR Title 21, found here. Many of the included 1970s studies on CES devices that have not been on the market in decades were held up to the much more rigorous 21st Century scientific standards to advise against the use of modern devices. Following this logic, the National Highway Traffic Safety Administration would not allow Cadillacs on the road today because the Model T Ford (circa 1908-1927) didn’t have seat belts or air bags. Why should the manufacturer of Alpha-Stim, Electromedical Products International, Inc., be held accountable in 2018 for 40 year old research on defunct products? What does that have to do with helping today’s Veterans recover from the trauma of war? More than half of the VA Medical Centers have used Alpha-Stims and in 2017 more than 100 VA medical centers purchased Alpha-Stim devices for its patients. This article is completely at odds with the judgment and experience of licensed healthcare professionals who actually practice medicine in the VA. It reviewed a legal medical treatment used in the VA for decades independent of the people who actually use it in the VA who know exactly how well it works for the apparent purpose of denying them the right to prescribe it. It was an obvious attempt to cut off these purchases. Not one person who uses Alpha-Stim within the VA was contacted by the authors. The report was successful at stopping all VA’s from purchasing Alpha-Stims for two weeks. Within that time frame so many VA practitioners complained about this junk review of science that 75% of the VA’s were promptly provided waivers. Soon after 100% of the business was reinstated. One clear cut example of the bias in this review is seen where they dismiss COL Lande’s study at Walter Reed National Military Medical Center by falsely stating that “There was no significantly significant differences between groups…” thus completely misrepresenting the study as proof that CES does not help Service Members. That is clearly not what the author published and if they bothered to check with him they would have found that Alpha-Stim CES is the most used CAM modality at Walter Reed. Are the authors claiming they are more knowledgeable about this treatment than psychiatrists who use it at America’s foremost military hospital? The study actually reported that there were significant findings on days 1 and 4 of the five days and a clear trend towards significance on the fifth day in men. Are pharmaceuticals found to increase sleep on the very first day of use and every day thereafter? Even if that were true, the risk/rewards ratio for sleep drugs is awful and impedes Service Members ability to carry out missions, while CES is very safe and never disables Service Members like drugs. Most importantly the spread between the treatment group and sham treated group in this Service Member study was over an hour of sleep time in this population that only sleeps a few hours a night if that. So how can a one-half to one-third increase in sleep time be described as no difference? And the study was conducted over just five days although we urged them to do it for 3-6 weeks because it was in a partial hospitalization program. That means that the Service Members had serious comorbidities that could impair CES results in such a short study (and even then only 44 of the 57 completed the 5 days). Nevertheless, if the authors did an honest review of this study they would have said there were most certainly significant differences between the groups. Except in females, although this is the first time any CES research reported a gender bias. Females Service Members might need to undergo this treatment longer to get results. Besides five days being inadequate, there were only 11 females in the 57 subject study. Here is an honest review, in part: The total time slept approached significance (p=0.079) on day 5 in favor of the active CES group. The active CES group average about 43 extra minutes’ total sleep time while the sham CES group subjects reported an average of 19 minutes less sleep time.  A gender difference also emerged. Men in the active CES group who completed 5 sessions of CES reported a significant improvement in total time slept at two points in the study, after the initial (p=0.04, d=0.41) and after the fourth (p=0.03, d=0.49) treatments as compared to men in the sham group. There were no significant changes among the females. If the authors merely followed the FDA’s definition of valid scientific evidence in CFR Title 21 and limited their review to devices currently on the market, or preferably the Alpha-Stim alone as it is the one used at VA’s nationwide they would have come to a completely different conclusion. The manufacturer, Electromedical Products International, Inc., loans Alpha-Stim devices to interested researchers who have attained IRB approval but has yet to fund a single study. All Alpha-Stim studies, including many RCT’s done by the US Army and VA’s and American Universities are online here. An honest, comprehensive review titled, Scientific and Clinical Literature Examination is also available by request. This document, prepared for and scrutinized by the European Device Directives and used for the FDA and other regulatory agencies, contains a brief history of cranial electrotherapy stimulation, a section on mechanisms specific to the patented Alpha-Stim therapy that includes 3 fMRI studies, A LORETA study and several EEG studies, a graphical summary of all the research followed by annotated abstracts of all the studies which report on the indicated uses of anxiety, insomnia, depression and pain. The document also contains results from published peer reviewed Alpha-Stim Service Member and Veteran Surveys which polled active duty and veteran Service Members on if they found the Alpha-Stim effective for their treatment of anxiety (90%), PTSD (63%), insomnia (81%), depression (78%), pain (65%) and headaches (78%). These surveys also contained questions about safety and side effects with the responds overwhelmingly (99%) reporting that they felt the device was safe and effective. In obtaining a complete picture of the safety and efficacy for CES devices, it is important to note that the current 8th generation Alpha-Stim uses a patented waveform. Drugs with different chemical makeups produce different effects and side-effects and the same is true for CES devices. This distinction was repeatedly validated in court when EPI won five lawsuits against companies who copied the technology. The distinction in waveforms between device brands means that a CES device can only claim efficacy and safety from studies which used that particular device and that particular waveform. The Scientific and Clinical Literature Examination contains 24 randomized placebo controlled trials and 12 open-label and case studies that all used Alpha-Stim as the treatment devices. The latest study published in February 2018 conducted at the University of Texas MD Anderson Cancer Center reported significant improvement in BPI pain (p=0.13), PSQI daytime dysfunction (p=0.002), HADS anxiety (p<0.001), ESAS anxiety (p=0.001), HADS depression (p=0.024), ESAS depression (p=0.025), PSQI daytime dysfunction (p=0.002), and medication use (p=0.006) among advanced cancer patients after 4 weeks of use.  (Yennurajalingam S, Kang D-H, Hwu W-J, et al. Cranial electrotherapy stimulation for the management of depression, anxiety, sleep disturbance, and pain in patients with advanced cancer: a preliminary study. Journal of Pain and Symptom Management.  2018; 55(20):198–206.) Many VA patients are actively seeking non-addictive, safe and effective treatment options for anxiety, insomnia, depression and pain. In the literature review performed by the Evidence-based Synthesis Program no significant adverse events or serious side effects were found. These findings are consistent with EPI’s safety report to the FDA on February 10, 2012 which found no serious adverse events and the most common adverse events (<1%) were both mild and self-limiting: skin irritation at the site of the electrodes in very light skinned individuals, dizziness and headache. Both dizziness and headache occur when the current is set too high for the individual and these symptoms generally subside when the current is decreased. The Scientific and Clinical Literature Examination also contains a more in-depth safety summary. It is unfortunate and certainly of no benefit to Veterans that the authors have published a junk science review to support a predetermined political conclusion to deny benefits to Veterans for the benefit of the pharmaceutical industry. If the VA is actually seeking non-addictive, safe and effective treatments for anxiety, insomnia, depression and pain, and a solution to the opioid epidemic, then a review regarding the benefits and harms of a treatment should consider all valid scientific evidence without bias, especially when no safety issues exist.  That would be a true review of the benefits and harms of CES in 2018. ### Army Medical Center Uses Alpha-Stim® As Key Part of Holistic Approach William Beaumont Army Medical Center has been a leader in pain management innovations since the early 2000’s, when the global war on terror began. WBAMC pioneered “the first alternative medicine center in the Department of Defense,” according to special project officer COL Richard Petri, MD. Chronic pain and subsequent opioid use are common among troops returning home from deployment; in fact, the National Institute of Health has found that nearly two thirds of veterans are in pain. The high incidence of chronic pain among troops led to the WBAMC’s formation of the Interdisciplinary Pain Management Center at Fort Bliss in 2012. The center specializes in the treatment of both physical and psychiatric pain, with the understanding that “treatment needs to be interdisciplinary and multimodal in its approach.” William Beaumont Medical Center WBAMC is at the forefront of treatment for Service Members, utilizing a wide range of modalities including meditation, biofeedback, animal-assisted therapy, and Alpha-Stim. In a time when 15% of troops use opioids to treat their pain, and with the knowledge that “prescriptions are a quick fix,” these far safer alternative interventions are essential to the return to normalcy for the troops. The results of this holistic approach are undeniable; the successes at William Beaumont spurred NATO to undertake a five-year study on the effectiveness of integrative medicine, focused on the role of holistic treatments for service members. The results of the study support a whole-person approach to recovery that incorporates alternative modalities. In short, NATO confirmed that William Beaumont is pursuing the most effective path to recovery for Service Members who are suffering. Alpha-Stim is a key component to the physical and mental wellbeing of many troops returning from combat. Not only does Alpha-Stim quickly and effective treat chronic, acute, and post-traumatic pain, but it also treats depression*, anxiety, and insomnia – all with or without drugs as it can be used in conjunction with other therapies or can be used on its own. Just as integrative healing is nothing new for William Beaumont Army Medical Center, the effectiveness of Alpha-Stim is not news for the Department of Defense. Walter Reed National Military Medical Center Psychiatric Continuity Services has conducted studies showing that Alpha-Stim improved sleep and concentration in Service Members, as measured by EEG. Alpha-Stim is offered at more than half of the nation’s VAs, providing drug-free relief for Veterans across the United States. There is no risk of addiction and no lasting side effects, allowing Service Members to strive toward that ultimate goal – feeling like themselves again. Alpha-Stim uses a patented waveform to treat pain directly where it hurts, delivering Microcurrent Electrical Therapy (MET) through two handheld probes. It treats depression, anxiety, and insomnia using Cranial Electrotherapy Stimulation (CES), which passes through electrodes that clip onto the earlobes. Relief is long-lasting and often immediate; and unlike with drugs that build up tolerance, improvement with Alpha-Stim is cumulative, allowing you to taper off instead of continually increasing your dosage. It is FDA cleared and the rare side effects are minor and self limiting, such as headaches and skin irritation at the electrode site. Alpha-Stim is available by prescription in the United States (and over-the-counter in other countries); Service Members and Veterans can ask for it at their VA or DOD medical center or call Alpha-Stim’s Government Services department at 1-800-FOR-PAIN. Service members and their families – even NATO – trust William Beaumont Army Medical Center for the most innovative and effective treatment options. The experts at William Beaumont trust Alpha-Stim. Why wait? Get started today. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  https://www.youtube.com/watch?v=BqgHQLcu5Hg ### How to Know if Alpha-Stim is Working for You Blog How to Know if Alpha-Stim is Working for You Alpha-Stim FAQs If you use Alpha-Stim to treat pain or anxiety, you might notice relief immediately. But if you’re using your device to treat insomnia or depression*, the results may not be as instant. And everyone measures changes in mental health differently.Our 30-day return policy allows you time to see if Alpha-Stim is right for you because everyone is different.*FDA cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. Getting Relief with Alpha-Stim Some people notice an improvement right away: “It worked from the first time I used it. It just relaxes my brain completely, reported user Genee Schock. Paul Schaum also experienced a sudden shift after Alpha-Stim treatment, saying “Without realizing it, my pain level went from ‘extreme’ to tolerable. My anger also went with the pain.”In some cases, a loved one or significant other will notice a change before the patient does. “My partner was the one who noticed the sudden difference in my mental health and I was starting to sleep much better,” said Sarah Viengpraprok-Amin.Mike Mansueto also observed a positive shift in his wife: “My wife has always struggled with anxiety and the first time she used the Alpha-Stim I saw something I’d never seen before. A complete calm. Love how it helps in just 20 minutes.”One patient, who was using Alpha-Stim to treat his insomnia, was surprised to see his results reflected by his FitBit: the fitness tracker recorded improvements in sleep data before the patient himself had become aware of the change. Here are some things that you may notice as your Alpha-Stim begins to work: Longer sleep durationLess irritabilityFewer anxiety attacksImproved and/or balanced moodMore frequent laughter Adverse effects are usually rare (occurring less than 1% of the time), mild, and self-limiting, including dizziness, skin irritation/electrode burns, and headaches. Need Help With Your Alpha-Stim? If you’ve been treating with Alpha-Stim but are uncertain whether it’s bringing results, don’t give up. Give us a call at 1-800-FOR-PAIN, and our Clinical Support team can help you troubleshoot and optimize your treatments to obtain maximum effectiveness. Your results are our priority.How did you know when your Alpha-Stim was working? We’d love to hear from you if you want to share your story. Just contact us here to share! ### Alpha-Stim® Praised in USA Today Expert Panel on Opioid Crisis USA Today recently sponsored a panel of experts in the field of substance abuse to share their insights on the nation’s ongoing opioid crisis. Part of the USA Today Opioid campaign, the purpose of the panel was to shed light on the scope of the stigma attached to addiction, and to discuss innovative solutions. Dr. Javier Francisco Vilasuso Expert panelist Dr. Javier Francisco Vilasuso, of Florida’s Anesthesia Pain Care Consultants, spoke about technological innovations that can be utilized for pain management and to combat the overuse of and reliance on dangerous medications. Dr. Vilasuso discussed the use of electrical signals in the body as a nonmedicinal way to aid in relieving pain, anxiety and insomnia - and this is precisely where Alpha-Stim is leading the charge. Dr. Vilasuso’s trust in Alpha-Stim when treating patients at Anesthesia Pain Care Consultants is a testament to its effectiveness: “We have utilized this device on many of our most challenging opiate dependent patients and have seen promising results. Most patients are finding that they need less opiate medication to control their pain. They also mention that their stress levels are much improved.” Reduced dependence on medication is a clear asset in the midst of our country’s opioid crisis. Alpha-Stim is non-addictive and bears no risk of lasting side effects. What sets Alpha-Stim even farther apart from drugs is its cumulative effect. With most medications, patients must take ever higher doses to attain the same results, due to the body adapting to the drugs. Alpha-Stim, on the other hand, becomes more effective over time – patients who at first need daily treatments may find that they are able to taper down to a few treatments per week, or only as symptoms dictate. Alpha-Stim is a noninvasive, prescription medical device that uses Cranial Electrotherapy Stimulation (CES) to send signals to the brain to alleviate depression, anxiety, and insomnia. The microcurrent is delivered through ear clips and is mild – most people do not even feel it. To treat pain, the Alpha-Stim M delivers Microcurrent Electrical Therapy (MET) directly to the site of a patient’s pain with two handheld probes or electrode pads. Pain relief is long-lasting and often occurs immediately. Alpha-Stim is FDA cleared and has been proven effective in over 100 clinical studies. In a study of severe pain patients, Alpha-Stim significantly reduced pain by an average of 71% after only 5 treatments. (1) Breaking away from a paradigm in which opioids are prescribed without pause is no small feat; the innovative practices embraced by Dr. Vilasuso and the rest of the USA Today panel – as well as many others who share their pursuit – are making enormous strides in a safer, more sustainable direction. Patients who are in pain may fear that there is no alternative to opiates, that their suffering is unending, that the reduction in prescription drugs means nothing but continued discomfort and stress. But Alpha-Stim is a safe, effective, and easy to use treatment that brings lasting results. Get started today! *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  https://www.youtube.com/watch?v=BqgHQLcu5Hg About Dr. Vilasuso Javier Francisco Vilasuso, MD, a fellowship-trained interventional pain medicine physician, earned his medical degree from the University of Miami’s Miller School of Medicine. He attended the University of South Florida where he completed his fellowship training in pain management and residency in anesthesiology. He currently practices at Anesthesia Pain Care Consultants in Tamarac, Florida. Dr. Vilasuso is a member of the American Board of Anesthesiology, the American Society of Regional Anesthesiology and Pain Medicine and the American Society of Anesthesiologists. He has contributed to numerous conferences and case studies with regard to techniques used in the treatment of chronic pain patients. In 2013, he was honored by the International Association of Anesthesiologists and recognized in its renowned publication called The Leading Physicians of the World.   ### MTV Teen Mom Star Relies on Alpha-Stim® Although rumors have been circulating that MTV Teen Mom OG star Tyler Baltierra is heading to rehab for mental health issues, Baltierra has responded that he is using other therapeutic methods instead: “I am not going to a rehab. I had a therapy appointment yesterday, I do Alpha-Stim sessions & looking into EMDR therapy as well,” he tweeted. Tyler Baltierra and his daughter The star recently spoke openly about his depression on social media, telling his fans that he felt “so empty…so alone,” despite having his wife, daughter, and dog sleeping nearby. The topic of rehab had been addressed earlier in this season of Teen Mom as well, but Baltierra opted instead to focus on his health and his family by quitting smoking and losing weight. As Baltierra has discovered, Alpha-Stim treats safely and effectively, and without drugs – so there is no risk of addiction and no lasting side effects and Alpha-Stim can be used on its own or in conjunction with other modalities, the way Baltierra is using his device along with therapy and potentially EMDR. The Alpha-Stim AID is an FDA cleared, handheld medical device that uses a patented waveform, delivered through ear clips, to treat  anxiety and insomnia, with clearance for depression outside of the United States. Treatments are fast and easy, allowing you to focus on the things that matter to you the most. To treat pain, the Alpha-Stim M uses two handheld probes to deliver Microcurrent Electrical Therapy (MET) directly to the site of pain. Both models are available by prescription in the United States and over the counter in other countries.   https://www.youtube.com/watch?v=Z-EZgTAw7KI ### The Evolution of Alpha-Stim®: From a 40-lb Box to a Sleek Handheld Device Blog The Evolution of Alpha-Stim: From a 40-lb Box to a Sleek Handheld Device Over the years, the design of Alpha-Stim has evolved, but the underlying technology has been proven effective time and again at treating anxiety, insomnia, pain and depression*.  Alpha-Stim uses a patented waveform that sets it apart from all other treatments. Alpha-Stim uses Cranial Electrotherapy Stimulation (CES) for anxiety, insomnia, and depression*, and Microcurrent Electrical Therapy (MET) for pain.  *Alpha-Stim is FDA-cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. Learn more about how Alpha-Stim works here. Below is a timeline showcasing the evolution of Alpha-Stim technology over time. Get Started with Alpha-Stim No matter what it looks like on the outside, Alpha-Stim remains a safe and effective treatment for anxiety, insomnia, depression*, and pain. Get started today and see why Alpha-Stim has been trusted by practitioners and patients since leg warmers and acid-wash jeans were cool.Healthcare Professionals: Learn more about prescribing Alpha-Stim here >Patients: Learn more about getting Alpha-stim here >   ### FAQ: Do I Need to Adjust my Other Treatments If I Use Alpha-Stim? Blog Do I Need to Adjust My Other Treatments If I Use Alpha-Stim? Alpha-Stim FAQs Many people who are considering using Alpha-Stim® to treat their anxiety, insomnia, depression* or pain are often already treating their conditions with some other method. These other treatments often include medications, occupational or physical therapy, chiropractic care, or counseling. If you’re currently treating anxiety, insomnia, depression or pain and are considering Alpha-Stim, you may be wondering how Alpha-Stim fits into your current regimen. Here are some answers to common questions and concerns about using Alpha-Stim with other treatments.*FDA cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States.  Can I reduce or stop taking my medication when I start Alpha-Stim? You may find that Alpha-Stim provides so much relief that you want to lower the current dose of your medications. It is essential that you do not make any changes to your dosage without first consulting with your prescribing physician. He or she can work with you to devise an appropriate and safe plan for adjusting your current medication. How does Alpha-Stim affect my therapy/hypnosis/EMDR sessions? Using Alpha-Stim before therapy, hypnosis, or EMDR may actually improve the efficacy of your session. Alpha-Stim lowers anxiety and promotes a sense of calm and relaxation, which will allow for maximal benefit from your other therapies. You may also use your Alpha-Stim during a therapy session to ease your anxiety. Is it safe to use Alpha-Stim with my medications? You do not have to stop taking your medications if you do not want to. Alpha-Stim is a drug-free medical device and is safe to use with your current prescription meds without risk of adverse reactions. That being said, it’s always a good idea to talk with your prescribing physician first. How does Alpha-Stim affect my therapy sessions? Using Alpha-Stim before therapy could improve the efficacy of your session. This applies for physical therapy, occupational therapy, as well as psychological therapy. Alpha-Stim helps treat anxiety and promotes a sense of calm and relaxation, which can help allow for increased benefits driven by your other therapies. You may also use your Alpha-Stim during a therapy session! If Alpha-Stim isn’t a drug, what is it and how does it work? Alpha-Stim is an FDA-cleared, non-invasive medical device. It is FDA-cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States. Alpha-Stim uses Cranial Electrotherapy Stimulation (CES) with a patented waveform technology to treat anxiety and insomnia through electrodes that clip onto your earlobes. For the treatment of acute, chronic, or post-traumatic pain, Microcurrent Electrical Therapy (MET) is delivered directly to the site of your pain for non-invasive and immediate relief. Unlike drugs, Alpha-Stim devices have no risk of addiction or lasting side effects. You can get Alpha-Stim with a prescription in the United States and over the counter in other countries.See how to get Alpha-Stim here! My practitioner isn’t familiar with Alpha-Stim, and I have more questions. What do I do? Our clinical support team is here to help you get the most out of your Alpha-Stim. We are dedicated to helping you integrate Alpha-Stim into your life in a way that works for your unique lifestyle and needs. From protocols to troubleshooting, we are here to answer all of your questions. You can even return your device within 30 days of purchase if you are not satisfied, and get a full refund, minus a 10% restocking fee. You can learn more about return and refund policies here. It can be intimidating to make a change in the way you are treating your depression, anxiety, insomnia, or pain. But if you are ready for more relief than you are getting from your current treatment plan, or are interested in a non-drug solution, Alpha-Stim is a safe and effective addition that brings real results. Get started today with Alpha-Stim here.Contact our support team here > Using Alpha-Stim with Other Treatments It can be intimidating to make a change in the way you are treating your depression, anxiety, insomnia, or pain. But if you are ready for more relief than you are getting from your current treatment plan, or are interested in a non-drug solution, Alpha-Stim is a safe and effective addition that brings real results. READ NEXT: Will I Need to Use Alpha-Stim for the Rest of My Life? If you need more information about using your Alpha-Stim device check out your user guide or reach out to our Customer Support team here. ### MD ANDERSON: Alpha-Stim® Treatment Effective on Common Cancer Symptoms Pain, anxiety, depression* and insomnia relieved with drug-free solution People battling cancer know that today’s treatments are light-years ahead of where they were even a few years ago. But what about the symptoms of the disease, like pain and depression? According to a recent MD Anderson Cancer Center study released this month by the Journal of Pain and Symptom Management, drug-free Alpha-Stim has been found to be an effective treatment for the debilitating pain and overwhelming anxiety and depression that cancer patients often suffer. There have been scores of studies proving the effectiveness of Alpha-Stim, but this is the most recent one focused on advanced cancer patients – a segment of the population that is routinely prescribed medications for pain, anxiety, insomnia and depression. The study found that advanced cancer patients who were treated with cranial electrotherapy stimulation (CES) via a handheld, noninvasive medical device called Alpha-Stim for just four weeks saw significant improvement of pain, anxiety, and depression, with insomnia relief trending toward significant. Daniel L. Kirsch, PhD, inventor of the Alpha-Stim, noted that one of the most powerful conclusions of the current study is that it asserts the power of Alpha-Stim to go beyond typical prescription medications. “I am very happy, but not surprised to see that Alpha-Stim technology has been able to help advanced cancer patients on multiple issues during the most difficult period in their lives,” Kirsch said. “It has already been recognized as the preferred drug-free choice for a wide variety of people, from veterans fighting pain and depression to dental patients with high anxiety and many others.” While Alpha-Stim is FDA cleared as a fast, safe and proven effective treatment, and has more clinical research than any other device in its class, there have yet to be published studies in patients with advanced cancer. This study examined the safety and efficacy of this non-drug treatment option, affirming years of research that Alpha-Stim is extremely effective, with no serious adverse effects and no risk of addiction, unlike opioids. Jeffrey Marksberry, MD, former chief science and clinical officer at EPI, noted that this study is especially important as Americans struggle with an ongoing opioid epidemic that is fueled by current prescription medications. “We are very proud and excited about this independent study from MD Anderson. It further corroborates the previous independent studies that found that Alpha-Stim is a viable treatment option for pain, anxiety, insomnia and depression, even in one of the most difficult-to-treat patient populations,” Marksberry said. “Not only is it viable, but it is also faster, safer and more effective than pharmaceuticals, without the addictive qualities, and in the long run less expensive.” Click here to read the study from MD Anderson Cancer Center on “Cranial Electrotherapy Stimulation for the Management of Depression, Anxiety, Sleep Disturbance, and Pain in Patients with Advanced Cancer: A preliminary study,” published by the Journal of Pain and Symptom Management. Click here to learn more or get started on your journey with Alpha-Stim! *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  ### Alpha-Stim Treats Dental Anxiety So You Can Keep Your Dentist Appointment and Your Healthy Smile If going to the dentist gives you anxiety, you are certainly not alone – as many as 40 million Americans avoid going to the dentist as a result of their anxiety or fear, according to Columbia University College of Dental Medicine. There are many aspects of a dental visit that can bring on feelings of panic – the anticipation of discomfort; fear of the unknown; worry about needing painful procedures; or any number of other factors. But there is no need to let your anxiety prevent you from having a sparklingly clean smile. Alpha-Stim® is here to help. Alpha-Stim is a handheld, non-invasive medical device that provides immediate relief from anxiety without medication. There is no risk of addiction with Alpha-Stim, and there are no lasting side effects. Relief from anxiety is attainable in just 20 to 60 minutes of treatment, which can take place before or during visits to the dentist – whenever your anxiety is at its worst. On top of that, the effectiveness of Alpha-Stim on dentist-specific anxiety has been studied – and patients reported an average of 61% less anxiety during procedures. Alpha-Stim fits in the palm of your hand, and its ear clips are as small as earbuds, allowing you to easily treat your anxiety while in the dentist’s chair without interference. Brenda Pokorny of Charlotte, NC has done exactly that, with success: I have regularly been using my Alpha Stim device for all my dental appointments and procedures.  I start using it 5-15 minutes before my appointment as I am then in full alpha wave mode for the procedure.  Last week I had a 3 and a half hour extraction done.  The tooth was abscessed with bone loss.  Alpha Stim kept me feeling calm and at peace and out of fight or flight mode with no other sedation.  All the yanking, pulling, scraping etc did not phase me or cause me any fear or anxiety.  I will never go to the dentist without my Alpha Stim device.   It makes a very emotionally hard situation more than bearable." Dental practitioners are also aware of the tremendous benefit Alpha-Stim can provide to patients during cleanings and treatments. Dr. Lisa Lucey of Meridian Point, Ireland, “introduced the Alpha-Stim to her practice and for some patients it has been life changing. It’s an alternative to oral medication with zero down time. You can still pop in for a visit on your lunch.” See Dr. Lucey’s full Facebook post here. If your anxiety has been keeping you away from the dentist’s office – or has left you dreading routine visits – Alpha-Stim can help. FDA cleared and available by prescription (in the U.S.), it can relieve your anxiety both before and during your appointments. Alpha-Stim is available over the counter outside of the U.S. Get started today and let Alpha-Stim make the dentist’s office a more bearable place for you. ### 5 Popular Alpha-Stim Tech Tips Blog 5 Popular Alpha-Stim Tech Tips Alpha-Stim FAQs If you’re having problems with your Alpha-Stim not working, try these popular tech support tips to help you troubleshoot your device.  Tip 1. Check Your Batteries If your device won’t turn on, try replacing your batteries. Be sure to replace them with new batteries that are fresh out of the package. Batteries that have been sitting in a drawer could be unintentionally mixed in with older batteries.We suggest using lithium batteries as they last roughly 20-30 hours. The Alpha-Stim M uses two AA batteries, while the AID uses two AAA batteries.Make sure your batteries are facing the right way. If they are inserted incorrectly, the device will not power on. Tip 2. Change the Alpha-Stim Electrode Pads If you aren’t feeling a connection or your device starts counting down but stops after three seconds, change your Earclip Electrode Pads or Smart Probe Electrode Pads. We suggest changing after each use. Tip 3. Use More Conducting Solution If you aren’t using enough conducting solution, you may not be able to get a good connection. We suggest using at least 3 to 4 drops per electrode pad and adding additional solution during treatment as needed. The pads should be completely soaked with the solution. If you need to purchase more, we offer large 250mL bottles that you can use to refill the 15mL dropper bottle that comes with your device. Tip 4. Be Sure Your Skin is Clean and Dry Before using your Alpha-Stim, make sure that your skin is clean where the electrodes will be placed. Lotion or other topical substances can create a barrier and disrupt the connection. You can keep alcohol wipes handy and use them to quickly clean your earlobes. Tip 5. Check Your Earclip or Leadwire Plug If your leadwire plug has become damaged, it will not complete the circuit on the device.Troubleshooting Alpha-Stim M for connection issuesCheck wires for any breaks or build up.Clean earclips with isopropyl alcohol.Test using the leadwire by itself. Plug one lead wire into channel one, (left side). Touch the metal ends together making a X. Hold to complete the circuit. The device should double beep and timer will count. It will continue to count while connection is made. If you release, the timer should stop.Repeat steps for channel two (right side).Troubleshooting Alpha-Stim AID for connection issuesPlease reach out to technical support.Replacement leadwires and earclips can be purchased on our webshop. Contact Our Customer Support Team if You Still Need Help If you’re still having issues with your device not working properly, please contact our Customer Support team here. ### FAQ: How Long Should I Use Alpha-Stim, and When Should I Decrease Use? Alpha-Stim treatments are cumulative, allowing you to taper off frequency of use while still maintaining results. And because there’s no way to overdose on Alpha-Stim, this leaves room for you to manage your routine in a way that gets the best results for you. Unlike most prescription medications, Alpha-Stim also has no risk of addiction or tolerance so each treatment is as effective as the last. Everyone responds differently to Alpha-Stim treatments, so there’s no one answer to when to decrease use. Initially, you should treat at least once a day for about 3 weeks or until you start to feel balanced. Then you use it every other day to maintain results. Twice a week may be enough but if symptoms return, then add more treatments. Ultimately, you can also use it on an as-needed basis. Treatment can be done at any time of day. However, we do not recommend treating within 3 hours before going to bed as some people may be more alert after treatment. Other people can fall asleep with Alpha-Stim on. Alpha-Stim for Pain Management When using Alpha-Stim for pain management, acute and post-traumatic pain (including post-surgical pain) should be treated with AS-Trodes for at least an hour at a time but 24 hours is okay too. For longer lasting results try treating at 100 microamperes (1 on the display) if that is enough current to manage the pain. If not, raise the current as high as necessary. The highest current on the Alpha-Stim is still far less than any other brain stimulator on the market. Don’t forget: more is not necessarily better when using Alpha-Stim! In some cases of chronic pain treating with the probes every other day is actually better than treating every day. If at first the pain gets worse, that’s a good sign that the neuromuscular system is readjusting and balancing out. If it gets worse it will get better. Remember you are working towards a long-term management solution, not just 4-6 hours of relief. The best treatment strategy is the one that provides the most relief. Some experimentation is expected. What is the best level for me? Finding the right treatment level. Each person’s comfort level during treatment can be different. To find your own personal level of comfort when using the ear clips for cranial electrotherapy stimulation, slowly increase the current until you feel a tingle/pulse, dizzy feeling, or floating motion, like you’re rocking on a boat. Then quickly press the decrease button once, wait a moment, then decrease it again until you don’t feel dizzy anymore. If treating at a level of 2.5 or above, you should treat for 20 minutes. Below this level, you should treat for 40 minutes, or 1 hour. Treat as often as necessary to get the best effects, but not more than that. Click here to view Alpha-Stim owner’s manuals and how-to videos, or read more FAQs. For additional clinical support, please call 1-800-FOR-PAIN. ### US Declares Opioid Crisis a Health Emergency The Solution is Available Now Using Modern American Technology As the United States government declares the ongoing opioid crisis a national public health emergency, all hope is not lost for patients who can not tolerate or do not want to go down the rabbit hole of using opioids. In fact, this technology promises to do everything on the President’s wish list, except it’s not a drug. During a speech from the White House, President Trump referred to the opioid epidemic as the "worst drug crisis in American history," as statistics show that more than 100 Americans die each day from both prescription opioid medications and heroin. “Addressing it will require all of our effort, and it will require us to confront the crisis in all of its very real complexity,” Trump said. “As Americans, we cannot allow this to continue. It is time to liberate our communities from the scourge of drug addiction. We can be the generation that ends the opioid epidemic. We can do it.” The answer already exists, and it’s not spending billions of more taxpayer dollars to find a hypothetical safer drug. https://youtu.be/biE_f0edOZw Alpha-Stim is clinically proven to provide fast, safe and effective pain relief, even in the worst pain disorders imaginable, without any of the dangerous side effects or risk of addiction that come from opioids. Because the solution uses modern American technology and not patented chemical compounds, there are no lasting significant side effects at all. In fact, this solution is already being used and researched in over 100 VA Medical Centers and military hospitals for some of the worst combat-related injuries from the Middle East wars. FDA cleared, Alpha-Stim is a prescription medical device that simultaneously treats acute, post-traumatic or chronic pain, along with anxiety, insomnia and depression*, using ear clip electrodes to deliver a very low level of electricity in a patented waveform. It is one of the most researched medical devices on the market having been proven safe and effective by more than 100 clinical research studies in over 35 years of use. While the body develops a tolerance for opioids, meaning the dosage must be increased to maintain the effect, the effects from Alpha-Stim treatments are quite the opposite. A sort of reverse tolerance to the therapy develops, so over time, fewer and/or shorter Alpha-Stim treatments will be needed to achieve the same level of relief. Yet the effects of Alpha-Stim technology are similar to drugs. It is believed that the Alpha-Stim waveform effectively targets the body’s receptors and activates them through frequency matching in a manner that is similar to chemical ligands (drugs). After all, drugs are chemical compounds that can be broken down into atoms and their electrons. Physicians are prescribing more therapeutic devices now than ever before, especially in the fields of pain management and mental health. The most recent clinical research study on Alpha-Stim was conducted at The University of Texas MD Anderson Cancer Center, one of the largest and most prestigious cancer research centers in the world. The researchers studied advanced cancer patients, a segment of the population that is routinely prescribed opioid medications for pain. The study found that advanced cancer patients who were treated with cranial electrotherapy stimulation (CES) using Alpha-Stim technology daily for four weeks saw significant improvement in their pain, anxiety, depression and sleep. The authors made it clear that the patients were already on drugs, and even though addiction and tolerance were not so much of an issue in these patients, they conducted the study because the drugs alone did not provide adequate relief. Because we live in a drug culture, it’s not uncommon for people to only try Alpha-Stim after drugs fail. It is time to consider this equally effective, but completely safe solution to pain, mood and sleep problems as a first line treatment. The only real side effects from Alpha-Stim is the possibility of a temporary headache due to relaxing neck muscles or skin irritation at the electrode sites in light-skinned people. It will cause a very brief dizzy feeling, like rocking in a boat, when it is first applied. Then the current is reduced until that feeling goes away. It uses extremely small amounts of electricity so most people don’t even feel it at all. Sometimes covered by insurance, and with a price ranging from $1,195 to $795 depending on the Alpha-Stim model, it becomes cheaper than drugs over time and is warrantied to work for 5 years. Click here to learn more or get started on your journey with Alpha-Stim! *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  https://youtu.be/Z-EZgTAw7KI ### Own The Dash: Dakota Meyer’s Campaign to Inspire Others Dakota Meyer, U.S. Marine Corps Veteran, Medal of Honor recipient and Alpha-Stim advocate, has started a new campaign called Own the Dash, inspiring others to take ownership of their lives. “Own the Dash is about owning your life, leaving a legacy and giving back more than you take. It's about making the most of each day and giving your life a true meaning, one without doubt or insecurity. The last legacy you leave this world is a tombstone, and that tombstone reduces your life to two dates: the day you're born and the day you die, two days that are insignificant in the grand scheme of what you can control. What actually matters is the dash in between.” Meyer has been vocal about his mission to improve his life, which has included using Alpha-Stim to treat his battle with anxiety. “So I don’t talk about it much because it’s definitely something I’m not proud of, but I have a rough time with anxiety. I just started this new Alpha-Stim treatment. It’s the only thing that I have found so far that’s not medication that helps a ton. I just wanted to share in case you all are looking for something,” Meyer wrote on Instagram in February. https://youtu.be/h0g6di_i9z0 The Own the Dash website invites you to “Share Your Story” and tell how you have taken ownership of your life, and how you are working to leave your legacy. “Your actions will inspire others to also honor the life they’ve been given. In a time when the world seems hopeless, our mission begins with each person showing the world that hope is alive and well.” One man wrote that his decision to own the dash occurred when he and his family decided that instead of just going on annual missions trips, they would make a difference by becoming involved in the foster system and adopting children from both Guatemala and the United States. Another wrote that his version of owning the dash occurs on daily basis as a firefighter, a CrossFit coach/gym owner and a parent of an autistic son, when he makes the conscious choice to ask the question, “Why not you?” Meyer says his vision for Own the Dash is to create a community of selflessness and accountability that empowers individuals to accept nothing less than being the best that they can be. “I appreciate everyone’s support in this vision to change the world,” Meyer said. ### Why Alpha-Stim is An Excellent Option for Integrative Medicine When you are battling pain, your primary goal is to just make it go away. If the pain persists or is reoccurring, you may begin to wonder if there is a deeper reason why it won’t go away—and that search for overall healing is just the start of integrative medicine. The American Association for Integrative Medicine defines integrative medicine as healthcare that views the patient as the most important member of the medical team and applies all safe and effective therapies without subservience to any one school of medical thought, while the National Institute of Health’s National Center for Complementary and Alternative Medicine defines integrative medicine as a process that “combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.” How can Alpha-Stim be used in integrative medicine? The main goal of integrative medicine is to achieve overall healing, and that aligns with the goal of Alpha-Stim. When you are feeling pain in your leg, you don’t just use the AS Smart Probes to treat that one area on your leg—you treat the surrounding area and other leg as well. Electromedical Products International, Inc., manufacturer of Alpha-Stim, noted that many integrative clinics have set up protocols or Alpha-Stim programs that allow patients to try the device in the clinic between 1 to 5 times, before deciding if they’d benefit from purchasing one for home use. “It fits nicely into integrative care as it can be used as a standalone therapy, but can also be added as an adjunct to current therapy to further results,” an EPI employee said. “Since cranial electrotherapy stimulation (CES) has a potentiation effect on medications, making them more effective, patients require less of them, which allows the practitioner to decrease the patients’ medications and even eliminate them in some cases. This is very important if the patient has a history of addiction, or is currently on multiple medications.” One unique feature of Alpha-Stim is that the handheld medical device has the ability to treat multiple conditions that often go hand-in-hand. In addition to treating pain, Alpha-Stim is also FDA cleared to treat anxiety and insomnia, with clearance for depression outside of the United States. “If you ask any pain doctor, he or she will say the biggest issue their patients have is they can’t sleep. We have one device that can treat their pain AND help them sleep. This is monumental for most of their patients, not to mention almost all of them have some form of anxiety and/or depression.” Can you imagine a life where instead of searching for another prescription to add to the ones you’re already on, you have one solution that helps treat all of the above?! Learn more about Alpha-Stim for pain management or Get Started on your path to fast, safe and effective pain relief. ### Alpha-Stim Featured in Documentary on Electroceuticals and Future of Medicine Alpha-Stim, a prescription medical device manufactured by Electromedical Products International, Inc., was recently featured in Body Electric: Electroceuticals and the Future of Medicine, a documentary that seeks to revolutionize the way we think about health and the human body. The film was produced, directed and written by British filmmaker Justin Smith, whose previous works include Statin Nation: The Great Cholesterol Cover-Up, and Statin Nation II: What Really Causes Heart Disease. "In the future, medical treatments will be based on electroceuticals rather than pharmaceuticals,” Smith said. “Instead of prescriptions for chemical molecules, doctors will prescribe specific frequencies. This is not science fiction—it's happening right now. Although it is not widely known about because of the near monopoly the pharmaceutical industry has on medicine.” The film highlights how the technology behind the Alpha-Stim provides a superior alternative to current pharmaceutical medications, in that it provides treatment from pain, anxiety, insomnia and depression* without a host of negative side effects. Dr. Jeff Marksberry, former Vice President for Science and Education at EPI and a fellow at The American Institute of Stress, said that in addition to acting as a non-drug, non-invasive option, Alpha-Stim stands out because after over 100 studies, the reported side effects have all been minor and self-limiting. “What we see in our safety profile is that there is a less than 1 percent chance of a side effect,” Marksberry said. “The most common side effect is that you get a headache. And that’s about 1 in 1,000 patients who are reporting a headache.” Not only does Alpha-Stim provide treatment without the side effects that come with most prescription medications—it actually works! Dr. Daniel Kirsch, President of AIS, noted that Alpha-Stim has a history of providing fast, safe and effective relief. “We put a pretty high bar there—we said 50 percent,” Kirsch said, recalling the expectations that were put in place for a 2014 study in which at least 83 percent of the patients saw a 50 percent improvement in anxiety or depression. “Saying 50 percent is quite ambitious, and yet we achieved it. There’s no drug study in anxiety that even comes close to that.” Tracey Kirsch, President of EPI and a board member for AIS, noted that one of the most powerful facts about Alpha-Stim is that while the body of the device has changed over the years, its technology has remained the same. “The interesting thing about Alpha-Stim is that the waveform, the mechanism of action if you will, that makes the device work hasn’t changed in 35 years. We’ve changed the buzzers, we’ve changed the whistles, we’ve gotten better at applying it in the protocols.” Despite a wealth of clinical studies that support the power of Alpha-Stim to treat pain, anxiety, insomnia and depression, EPI has spent years trying to work with the Food & Drug Administration, in order to obtain an accurate classification. The documentary gives an in-depth look at Alpha-Stim’s journey over the years, as well as what lies ahead for the future of electromedicine. You can view the documentary online or purchase the DVD through The American Institute of Stress at www.stress.org/bodyelectric. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  ### Alpha-Stim Featured in New American Psychiatric Association Book on Complementary and Integrative Treatments July 2017 - The American Psychiatric Association recently released Complementary and Integrative Treatments in Psychiatric Practice, a book with unrivaled scope, easy readability, and outstanding clinical relevance. The APA says it is an indispensable resource for psychiatric and other health care professionals, also well suited for individuals with mental disorders and their family members who are seeking updated, practical information on complementary, alternative, and integrative medicine (CAIM). The technology behind the Alpha-Stim is featured in a chapter titled Cranial Electrotherapy Stimulation in the Psychiatric Setting. It explores topics such as the advent of CES technology, the mechanisms of action that are used, and physiological and psychological effects of cranial electrotherapy stimulation on anxiety, insomnia, and depression*. The feature on the impact on CES technology in the psychiatric setting was a collaboration between executive team members from Electromedical Products International Inc. and fellows from the American Institute of Stress. Daniel L. Kirsch, Ph.D. is the inventor of Alpha-Stim and the President of the American Institute of Stress. He has over four decades of experience in the medical field, including extensive clinical practice experience, and has been working extensively with the United States military since 2005. Kirsch held board certification in pain management with the American Academy of Pain Management since 1990. Throughout his career, Dr. Kirsch has designed medical devices and their applications and developed clinical systems for implementing pain and stress control technologies. Dr. Jeff Marksberry served as the Vice President for Science and Education at Electromedical Products International Inc. He has more has more than ten years of experience in medical education as a special consultant for two international medical schools. He also has expertise in medical licensure regulations for all 50 states and sovereign Native American governments as well as Canada, Australia, New Zealand and The Netherlands. His focus areas included writing curriculum for continuing medical education programs for medical schools and universities. Dr. Michel Woodbury-Farina is an American Institute of Stress fellow from Puerto Rico, and Chair of the Daily Life Stress Board. In addition to running his own private practice in Puerto Rico, Dr. Woodbury-Farina is an Associate Professor at the University of Puerto Rico School of Medicine. His areas of research include psychiatric epidemiology, Phase III Pharmaceutical trials in adult and adolescent schizophrenia, and adult depression and nutritional studies on adult schizophrenics. Timothy Barclay, Ph.D. is an American Institute of Stress fellow from Virginia. He is a Licensed Clinical Psychologist, and an Associate Professor of Psychology at Liberty University. He specializes in the treatment of PTSD, depression, anxiety, obesity and the use of non-invasive brain stimulation techniques. Barclay’s background includes time served as both a police officer and a U.S. Army Ranger. He is also the creator of the High Capacity Model of Well-being, and the President of Psychotherapy Solutions, L.L.C.   *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  ### Alpha-Stim® Provides Excellent Alternative and Solution to Opioid Epidemic Non-Invasive Medical Device Offers Fast, Safe & Effective Relief from Pain Without Drugs No matter the source, people in pain need relief. When a person is experiencing pain, they are frequently prescribed opioids such as oxycodone, hydrocodone, and methadone. According to the CDC, deaths from prescription opioids have more than quadrupled since 1999, and 91 Americans die every day from an opioid overdose (that includes prescription opioids and heroin). Over time, there is a reduction in the effectiveness of pharmaceutical drugs as the body develops drug resistance. This leads to increased dosages and decreased pain relief. The National Institute on Drug Abuse says that nearly 80 percent of Americans using heroin (including those in treatment) reported misusing prescription opioids prior to using heroin. With opioid addiction on the rise, more and more people are looking toward non-drug treatment options. The Alpha-Stim® M, a handheld, non-invasive prescription medical device, is FDA cleared to treat acute, post-traumatic and chronic pain through microcurrent electrical therapy (MET). Unlike drugs, Alpha-Stim treatments are cumulative and the body will not accommodate to this therapy, however, Alpha-Stim effectively targets receptors, activating them through frequency matching in a manner that is similar to chemical ligands. Over time, fewer and/or shorter treatments will be needed to achieve the same level of pain relief. Featuring a patented waveform that is proven by more than 100 clinical research studies, Alpha-Stim also uses cranial electrotherapy stimulation (CES) to treat the anxiety, insomnia, and depression* that often accompany pain. This low-level electrical therapy treats everything at once, without the negative side effects that accompany pharmaceuticals and with zero risk of addiction. As a non-addictive pain management option, Alpha-Stim is an excellent treatment solution for patients who: Are addicted to, or at risk of, addiction to opiates Have drug interaction risk factors Have vocational restrictions on narcotic use Are elderly Are at risk due to compromised organ systems Are medication resistant Learn more about Alpha-Stim for pain management or Get Started on your path to fast, safe and effective pain relief. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  ### Dakota Meyer Talks About His Experience with Alpha-Stim for Anxiety https://www.youtube.com/watch?v=h0g6di_i9z0&t=15s "I truly believe that being in Iraq and Afghanistan, and even some of my worst days in Afghanistan, is a lot of times easier than some of my general days here at home," said Dakota Meyer, US Marine and Medal of Honor recipient. "I feel like I’ve tried almost everything. I’ve tried medication. A lot of it just self-medication, drinking. Trying to do something to be able to get that relief long enough to be able to get just a little rest somewhere. It was like it just melted the anxiety away. I could not believe the relief. How many times have I dealt with the anxiety because I didn’t want to take the drugs? Alpha-Stim allows me to fix my problem without stopping life. Life still goes on. To have a solution to the problem that allows me to go on about my life without any adverse effects is incredible. I never talked about anxiety, especially publicly. I felt so intrigued by this and I felt so much relief by it. If it can help me this much, then it can help anybody." Dakota shared with his battle with anxiety in February, when he posted about a new device that he'd been using. Learn more about Alpha-Stim for anxiety > ### How two small electric ear clips helped me cure my fear of the dentist SOME 70% of those visiting the dentist in Ireland will feel anxiety or nervousness to some degree. And Colette Brennan, 42, is one of those unlucky ones, suffering with an extreme form of dental anxiety that makes her physically sick. Then her dentist introduced her to a pioneering new microcurrent treatment called the Alpha-Stim, she tells her story... VIEW ARTICLE PDF ### Electromedical Products International Inc. awarded a Federal Supply Schedule contract for Alpha-Stim® Mineral Wells, July 19, 2016: Electromedical Products International Inc., the manufacturer of the Alpha-Stim®, a medical device used to treat anxiety, insomnia, depression and pain, announced today, it has been awarded a Federal Supply Schedule (FSS) contract. The five-year FSS contract supports the delivery of Alpha-Stim devices into the federal medical facilities of the Department of Defense and the VA, one of the largest integrated health care delivery systems in the country with over 170 hospitals. “We have been supplying Alpha-Stim devices to the VA and Department of Defense hospitals for many years. We welcome this renewed contract, which makes accessing our devices easier and allows us to continue growing our list of customers who are successfully using Alpha-Stim technology to address the burden of mental health and pain complaints, thereby ensuring improved patient outcomes,” said Tracey Kirsch, President of EPI. The Alpha-Stim AID, which is the size of a smartphone, sends microcurrents of electricity to the brain. These painless pulses of electrical current which measure less than one milliampere, increase a patient’s naturally occurring alpha waves to create a less anxious state of mind. The treatment takes around 20 minutes a day. Small electrodes, similar to clip-on earrings, are placed on the earlobes with wires running to the device. Patients undergoing Alpha-Stim treatments appear as though they are listening to music on their smartphone. Alpha-Stim CES and MET devices are FDA cleared and CE marked as safe and effective treatment for anxiety, insomnia, depression* and pain. The patented Alpha-Stim waveform is proven safe and effective as a stand-alone and adjunct non-pharmaceutical therapy. Alpha- Stim is supported by more scientific research than any therapeutic medical device in its class. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  ## Pages ### Privacy Policy Privacy Policy This is the Electromedical Products International (EPI) Privacy Policy. This Privacy Policy explains how we handle the personal information that you provide to us on websites controlled by EPI. Please read this privacy policy before using the EPI website or submitting personal information to us. By using this site, you agree to the terms of this Privacy Policy. Whenever you submit information via this site, you consent to the collection, use, and disclosure of that information in accordance with this Privacy Policy. This privacy policy does not apply to personal information collected from you offline, to the EPI website that do not link to this privacy policy, to residents of countries other than the United States, or to third-party websites to which the EPI website may link. Your use of this site, which link to this privacy policy is subject to this privacy policy and the Terms of Use. Information Collection EPI collects information in two ways: Personal information. EPI collects personal information that you enter into data fields on the EPI website. 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This privacy policy was last updated on September 16, 2014 and is effective as of that date. ### Translated Owner's Manuals Instructions for Use for Customers Outside of the US How to use Alpha-Stim AID and Alpha-Stim M for the treatment of anxiety, insomnia, depression, and pain. To request a translated owner's manual for countries outside of the United States, please fill out the form below and our customer support team will email you the appropriate owner's manual.If you have questions about how to use your device, free clinical support is available at alpha-stim@epii.com. Name First Last Email(Required) Device Type(Required) Alpha-Stim M Alpha-Stim AID Country(Required)LanguageArabicDanishDutchEnglishFinnishFrenchGermanGreekHebrewHungarianItalianLatvianLithuanianNorwegianPolishPortugueseRussianSloveneSpanishSwedishComments Δ ### Alpha-Stim for Payors A Unique Solution for Payors and Patients Alike Alpha-Stim M and Alpha-Stim AID for the treatment of anxiety, insomnia, depression, and pain. Alpha-Stim Offers Safe Solution for Health Plan Members Alpha-Stim is a prescription medical device cleared by the FDA to treat anxiety, insomnia and pain only, with approval for depression outside of the United States.The Alpha-Stim CES device utilizes a unique, patented, microcurrent waveform that interacts with an individual’s bioelectricity, allowing the body to return towards homeostasis, a balance that causes normal functioning of both the brain and peripheral nervous system.Alpha-Stim is so easy to use as a pain or mental health solution that patients can administer it themselves at home while relaxing, reading, using a computer or watching TV. Many people treat their brain while doing light chores at home such as cooking using the included belt clip or lanyard, or simply putting the cell phone-sized device in their pocket.The precise specifications of a therapeutic medical device waveform is analogous to the chemical composition of a pharmaceutical. The Alpha-Stim CES device generates a unique patented waveform that no other device can emulate. The highly refined and rigorously tested waveform transmits microcurrents via patented earclip electrodes for the AID device (which treats anxiety, depression, and insomnia), and via either handheld or self-adhesive electrodes placed on the body at the pain site for the M device.Well-constructed scientific surveys, by both doctors and patients, consistently find that 9 out of 10 people who use Alpha-Stim as a solution for their mental health or pain get significant relief. More often than not, results are experienced from the very first treatment. These large effect sizes are supported by over 100 completed, independent research studies and published reports, many of which were double-blind, randomized, placebo-controlled trials (RCTs) to ensure clinically validated results.That’s why over 200 US Department of Defense (DOD) practitioners and over 92 Veterans Administration (VA) hospitals use Alpha-Stim with military personnel. In fact, both the US military and VA have published RCTs on Alpha-Stim and are continuing to use and research it. Side effects are mild and self-limiting, primarily consisting of headaches (0.20%) and skin irritation (0.11%) at the electrode site. In over 39 years of use, there has never been a significant lasting side effect.https://www.youtube.com/watch?v=q-KELGjnY_EWatch how the National Health Service found Alpha-Stim to be so safe, efficacious and cost effective it is becoming the first line treatment in the UK.The NHS study revealed a savings of £541 in the UK, with a projected cost saving of $1,965 – $3,930 in the US. This is based on the purchase of a $795 Alpha-Stim AID and the typical American standard of care for anxiety patients (see chart below in cost containment section). What is CES? Cranial electrotherapy stimulation (CES) is a generic term denoting low level electrical stimulation to the brain. CES refers to devices that deliver electrical currents transcranially through electrodes. The brain functions electrochemically and can readily be modulated by an electrical waveform. Pain, mood conditions (like anxiety and depression), and insomnia are all controlled by the body’s central nervous system. The billions of individual cells that comprise the nervous system communicate every sensation by conducting electrochemical signals between the cells in your body and brain.Alpha-Stim’s waveform is delivered using our unique, patented earclips. The ears are an efficient and easy way to apply electrodes to direct the current across the brain. LORETA (computerized EEG) studies prove that Alpha-Stim CES device technology benefits the whole brain with the ear clip application. What is MET? Microcurrent electrical therapy (MET) is a generic term used to describe a low level current form of transcutaneous electrical nerve stimulation (TENS) used for pain control typically applied for 2 – 5 minutes through probes, or self-adhesive electrodes for longer applications.MET differs from traditional TENS in that MET uses lower current levels and longer pulse widths. The Alpha-Stim MET technology produces residual and cumulative results not generally seen with higher current TENS devices. In a traditional TENS device based on 1970s technology, the current is more than one thousand times stronger than with Alpha-Stim, so the mechanisms and effects differ.MET is used for acute, chronic and post-traumatic pain using a current so small, it is a subsensory experience for most patients. You need a cost-effective option. Alpha-Stim delivers. Over a five-year period, Alpha-Stim users can save thousands of dollars compared with drugs and other treatments typically used to treat anxiety, insomnia, depression, and pain. When you consider the results that are possible with the Alpha-Stim CES device as a pain and mental health solution, as well as the safety of the therapy, it’s clear why we believe there’s no better value available.Alpha-Stim MAlpha-Stim M Cost: $1,299Accessory Costs: $173/year• $60 for 3 boxes of 256 felt electrode pads for earclips• $15 for 250ml Alpha-Stim Conducting Solution refill bottle• $18 for an 8-pack of AA lithium batteries• $80 for 4 boxes of 100 probe electrode padsAlpha-Stim AIDAlpha-Stim AID Cost: $840Accessory Costs: $90/year• $60 for 3 boxes of 256 felt electrode pads for earclips• $15 for 250ml Alpha-Stim Conducting Solution refill size bottle• $15 for an 8-pack of AAA lithium batteries Alpha-Stim® M For pain, anxiety, insomnia, and depression. Learn More Alpha-Stim®AID For anxiety, insomnia, and depression. Learn More Cost Containment The cost comparison charts below show all Alpha-Stim costs needed for treatment, including accessories purchased over time. To make this a more accurate product-to-product comparison, the drug costs do not include ongoing physician visits to change drug prescriptions, adjust dosages, treat side effects, or the likelihood of increasing drug costs over the period of the device’s 5-year limited warranty. The graph on the right compares Alpha-Stim AID costs to Cognitive Behavioral Therapy (CBT), Transcranial Magnetic Stimulation (TMS), and Electroconvulsive Therapy (ECT). One year of Alpha-Stim treatment includes the initial device purchase, a 250mL conducting solution refill bottle and an 8-pack of AAA lithium batteries, for a total cost of $834.CBT costs include 15 sessions at $150 per session, for a total treatment cost of $2,250. TMS sessions cost between $400-500 for a total cost of about $15,000. Ten ECT sessions at $2,500 per session costs a total of $25,000. Treatment prices are from www.pyschologytoday.com and the American Psychological Association.The National Health Services (NHS) of the United Kingdom has released a new study on the clinical and cost effectiveness of Alpha-Stim. Alpha-Stim proved to be a cost-effective choice with a savings of £541 ($687 in U.S. dollar) per patient, compared to standard treatments. The cost savings in the United States healthcare system are projected to be even greater, in the range of $1,965 to $3,930, compared to 8 sessions of CBT and other typical treatment approaches “Alpha-Stim CES was more effective at achieving remission than we expected. As well as improvements in anxiety, there were improvements in depression and insomnia,” said Dr. Morriss, principal investigator of the study and Professor of Psychiatry at the University of Nottingham. Not only is the Alpha-Stim CES device uniquely effective, but also EPI is the only CES company that has the staff and resources to partner with the DOD to help our Service Members cope with the trauma of war. The United States Department of Defense uses Alpha-Stim because of the restrictions and costs of psychotherapy and drugs. Offer the best care to retain and attract new members Customer satisfaction bears more weight than ever before; if your members aren’t happy with their benefits and service, your quality rating takes a direct hit. With the demand for effective mental healthcare growing, it is of vital important to offer the services your members want and need.With Alpha-Stim, patients do not have to discontinue their other medications or therapy; but many people find that Alpha-Stim is effective enough that they no longer need other treatment modalities in order to maintain the improvements to their physical and mental health.The bottom line with customer satisfaction is this: your members want optimal health with minimal hassle and expense. Alpha-Stim is a fast, safe, and effective treatment for multiple diagnoses and indications. And since its effects are cumulative over time, patients will feel better the more they use it. Unlike with medications, the dosage does not need to be increased over time; prescription renewals, refills, and reauthorizations are not required; and there is no risk of addiction, overuse and abuse, or withdrawal.Patients use Alpha-Stim in the comfort of their own home, making it an appealing option for those with hectic schedules. It is a portable, safe, and easy way for people to attain the results they desire. Offering Alpha-Stim as a covered service gives your members what they want – as well as a powerful incentive to renew their policy with you, year after year. Policies are changing. Keep in step with Alpha-Stim. Policies are constantly being updated, and it’s up to you to stay in compliance. With more stringent controls over pain management, and increased pressure to screen for depression, it may seem like an uphill battle to keep pace with ever-changing requirements. The financial incentive for receiving high scores on hospital consumer assessments has been correlated with the over-prescribing of opioids. Pain medications have historically been the first line method of treatment for pain – despite the toll they take on patients after leaving the hospital or doctor’s office. But Alpha-Stim offers pain relief so effective that there is no need to worry about lowered scores on patient satisfaction of pain management. In fact, you will find quite the opposite, as new Alpha-Stim devotees become satisfied with their symptom management, often for the first time ever. If therapy and drugs offered adequate management of symptoms for everyone, there would be no demand for Alpha-Stim. But the reality is that few people are satisfied with their current treatments for mood- and pain-related disorders. The call for widespread mental health screenings of adolescents aged 12 and older will lead to increased diagnoses of depression, anxiety disorders, and other mental illness in this demographic. Alpha-Stim has been proven to be a safe and effective treatment for anxiety and depression not only in adults, but in children and teenagers. Treating mental illnesses at an early stage vastly improves the outlook for these patients, granting them better quality of life both immediately and long-term. The good news is, it’s easier than ever before to offer your members coverage for Alpha-Stim. Not only did the FDA downclassify CES from Class III into Class II for anxiety and insomnia, but the Centers for Medicare and Medicaid Services approved the HCPCS code for CES as E0732: Cranial electrotherapy stimulator with accessories. The time is right to set a higher standard for patient care. By offering coverage of Alpha-Stim, patients will feel better faster – leading to more satisfied customers and more cost-effective coverage policies for all. Moving to value-based care: Alpha-Stim is the gold standard for mental and physical health. The demands on you as an insurer are steep, and may feel impossible at times. Patients insist on better care while new policies pressure you to push costs ever lower – is this even sustainable for a payor? With Alpha-Stim, the answer is a resounding yes.The portability and ease of use of Alpha-Stim allows it to be seamlessly integrated into an individual’s daily activities. Whether used for mental health, pain management, or both, Alpha-Stim rapidly improves the quality of life of patients. This, in turn, reduces costs for all parties: Patients spend less time and money by reducing reliance on medication and behavioral and physical therapies; providers can more effectively address their patients’ diagnoses, improving productivity; and payors reap the benefits of one of the most cost-effective treatment modalities in existence.The integration of behavioral and primary care is one of the most pressing challenges that today’s payors and providers face. Alpha-Stim bridges the gap between physical and mental/behavioral healthcare, providing the perfect solution for ACOs that may otherwise struggle to provide quality versions of both.If you are reading about Alpha-Stim for the first time you are probably trying to compare it with a treatment you are already familiar with. Don’t: Alpha-Stim is completely different from everything else on the market. In fact, we urge you to try it yourself. You will be amazed at how good you feel after just one treatment. After trying just a single treatment with Alpha-Stim, the device’s biggest skeptics become its strongest proponents. ### Regulatory Information Regulatory Information US Food & Drug AdministrationNOTE: The products indicated in the FDA’s files are older versions of Alpha-Stim® products. The Alpha-Stim M and Alpha-Stim AID are registered as updates to the original 510(k) applications, and do not appear in the online FDA database.VIEW DOCUMENTATION FOR PAIN INDICATIONS & OTHER FDA INFORMATION >European RegulatoryCE Certification ### A Meta-Analyses of Cranial Electrotherapy Stimulation in the Treatment of Insomnia A Meta-Analyses of Cranial Electrotherapy Stimulation in the Treatment of Insomnia Price LR, Briley J, Hitching R. A Meta-Analyses of Cranial Electrotherapy Stimulation in the Treatment of Insomnia. Ann Psychiatry Mental Health. 2020; 8(3): 1157. Download ArticleFunding Source, Location of Study or Author’s AffiliationElectromedical Products International, Mineral Wells, TexasDeviceAlpha-Stim®Key VariableInsomniaObjectiveSummarize the scientific data on Alpha-Stim Cranial Electrical Stimulation (CES) as a treatment of insomnia by performing a systematic review of the literature. Determine the efficacy of Alpha-Stim CES by conducting meta-analyses of the available studies using Alpha-Stim as a treatment for insomnia.DesignA systematic literature review including Randomized Controlled Trials (RCTs) and Non-Randomized Studies on Interventions (NRSIs) for the use, effectiveness, and the risk/benefit of Alpha-Stim CES in the treatment of insomnia disorders. Following Cooper’s Taxonomy of Literature Reviews, appropriate for the behavioral and physical sciences and the PRISMA reporting guidelines. As CES devices differ significantly in their electrical outputs and usage, individual assessment is warranted. Accordingly, the meta-analysis was limited to one CES device for the treatment of insomnia.Primary Outcome MeasureTreatment of insomnia using Alpha-Stim CES, includingLevel of useEffectivenessRisk/benefitSecondary Outcome MeasureNone reported.Key Inclusion CriteriaTo be included in this meta-analysis, studies were:RCTs – inclusive of subjects blinding (with a description of how blinding was implemented), a sham versus active conditionUse of valid and reliable measurement instrumentsNRSIs with patients exhibiting symptoms of insomnia.A pretest-posttest design (additional repeated measures were acceptable)Rated as “good” or “fair.”Key Exclusion CriteriaNone reportedProtocol SummaryA computer-based search of MEDLINE and EMBASE databases since their beginning.A search of the Cochrane Central Register of Controlled Trials (CENTRAL) included in the Cochrane Library.The search proceeded within abstract, subject terms, and titles of studies and reports published in peer-reviewed journals between January 1, 1981, and August 26, 2020. Keywords: Insomnia and Alpha-Stim and cranial electrotherapy stimulation and randomized control trial or nonrandomized or open-label or case study.Screening references are given in relevant systematic reviews and identified RCTs.Citation tracking of identified RCTs using the Science Citation Index through the Web of Science.A scoring rubric for each study was applied using the guidelines from Zaza et al., (2000) with scoring categories of 0-1 limitations (rating = good); 2-4 limitations (rating = fair); 5-9 limitations (rating = limited) in the selection of the research studies to be included in the meta-analysis. The Revised Cochrane Risk-of-Bias Tool was used to inform the decision to include a study within an RCT design.Device Application ProtocolThe evaluation of strengths and limitations of the research studies included in the meta-analyses adhered to guidelines published by Zaza et al., (2000), the Cochrane Handbook for Systematic Reviews of Interventions, and in the Handbook of Research Synthesis and Meta-Analysis.Statistical Analysis PlanA complementary approach to synthesize the meta-analytic results from the NRSIs with RCTs was used. Cohen’s d effect size summary metric was used in all analyses. Fixed and random effects models, inclusive of homogeneity of Cohen’s d effect sizes are reported on 8 studies found in the CENTRAL registry using Cooper’s Taxonomy of Literature Reviews. The meta-analyses were performed using the Comprehensive Meta-Analysis, version 3 program.ResultsSubjectsThe inclusion criteria yielding 3 RCTs and 5 NRSIs. The RCTs had a total sample of N=163, and the 5 NRSIs had a total of 376 participants.Data AnalysisThe studies used in the meta-analyses all had significant outcomes of p<0.05 through p<0.001 for insomnia and many also revealed equally good effects for the treatment of anxiety and depression.The meta-analytic results of the three (N=3) RCT studies on insomnia and the accompanying statistical summary show a large effect in favor of the active treatment group. The average (population) effect for the 3 studies was observed as d = -0.83 (i.e., the mean insomnia level at posttest for the active group was -0.83 standard deviations lower than the mean insomnia level of quality sleep for the sham group).An effect size of -0.83 is classified as large. Given the congruency (i.e., closeness), between the summary statistics of Fixed- and Random-effects models. It is reasonable to also state that CES shows a large effect in favor of the active treatment group relative to reductions in insomnia.The five (N=5) NRSI studies included in this meta-analysis on insomnia and the accompanying statistical summary of the studies show a small effect in favor of the active treatment group. The average (population) effect for the Fixed-effects model was -0.38 (small), and for the Random-effects model, the average effect was -0.41 (medium).Meta-Analyses Summary Statistics – Insomnia RCTs. Point estimate = average standard effect, d, over 3 studies. Q-value = test of study heterogeneity (i.e., are the set of effect sizes homogeneous). I-squared = magnitude of study heterogeneity (~25% = small; ~50% = medium; ~75% = large).Meta-Analysis Summary Statistics – Insomnia NRSI. Point estimate = average standard effect, d, over 5 studies. Q-value = test of study heterogeneity (i.e., are the set of effect sizes homogeneous). I-squared = magnitude of study heterogeneity (~25% = small; ~50% = medium; ~75% = large).The forest plots show for the RCTs and NRSIs show (a) the effect size d, (b) the variability of each study’s effect via the 95% confidence interval, and (c) the average (i.e., population estimate) effect size for all the studies (blue diamond). The symbols in the forest plot depict the relative weight for each of the studies (e.g., the larger the symbol the greater the relative contribution each study makes to the final result). Also informative is the width of the confidence interval. For example, the larger the sample size of an individual study, the smaller the width of the interval and the greater the precision of the effect size.Forest Plot: Summary Statistics of Effect Sizes from Alpha-Stim CES RCTs of Insomnia (N=3).Forest Plot: Summary Statistics of Effect Sizes from Alpha-Stim CES NRSIs of Insomnia (N=5).The studies included in the meta-analyses report that patients receiving CES treatment have shown improvements in negative domains that typically cooccur with insomnia such as somatization, interpersonal sensitivity, obsessive or compulsive thoughts, excessive worry, hostility, fearfulness, alcohol and substance use, and paranoia. Concurrently patients report improvement in symptoms associated with CES treatment as measured by the Global Assessment of Function (GAF), a measure incorporated in some of the studies in the meta-analyses and by clinicians using the Clinical Global Impression (CGI), scale to report on patient improvement.ConclusionThese meta-analyses of CES as a treatment for insomnia showing demonstrate a large (d = -0.83), average effect size for the 3 RCTs, in addition to a small (d = -0.38), average effect size for 5 NRSI studies in favor of the active CES treatment group. The effect sizes and Cohen’s d values were medium for the RCTs and small for the NRSIs. In comparison, the effect sizes typically associated with antidepressant medication for published studies is 0.37 (95% CI, 0.33 to 0.41), and for unpublished studies, it’s less than 0.15 (95% CI, 0.08 to 0.22), both qualifying as small. When the side effect profile of medications vs CES is considered, the supremacy of CES over medications is even more notable.The risk profile for CES was virtually negligible, with mild and self-limiting vertigo or cervicogenic headaches when the current is too high, and skin irritation at the electrode site reported in less than 1% of patients.The authors concluded that CES has a significant effect in the treatment of moderate to severe insomnia across a variety of patient populations and was significantly more effective than wait-list controls. In addition, CES is an effective treatment for insomnia in a range of populations with a spectrum of insomnia severity, as evidenced by pre-and post-scores of the appropriate insomnia measures based on the sample population – civilian, military, and first responders. Moreover, it is a useful adjunctive to other ongoing treatments including pharmacotherapy and psychotherapy for insomnia.LimitationsParticipants were self-selected resulting in possible selection bias. The RCTs had a limited number of patients with a significant diagnosis of disordered sleep. The NRSIs lacked randomization and a control group and many of the patients were continuing to receive other treatments (e.g., pharmacotherapy).Study Quality: Good ### A Meta-Analysis of Cranial Electrotherapy Stimulation in the Treatment of Depression A Meta-Analysis of Cranial Electrotherapy Stimulation in the Treatment of Depression Price, L., Briley, J., Haltiwanger, S. and Hitching, R., 2021. A Meta-Analysis of Cranial Electrotherapy Stimulation in the Treatment of Depression. Journal of Psychiatric Research. (135), 119-134. Funding Source, Location of Study or Author’s Affiliation Electromedical Products International, Mineral Wells, Texas. Device Alpha-Stim® Key Variable Depression Objective Summarize the scientific data on Alpha-Stim® Cranial Electrical Stimulation (CES) as a treatment of depression by performing a systematic review of the literature. Determine the efficacy of Alpha-Stim® CES by conducting meta-analyses of the available studies using Alpha-Stim® as a treatment for depression. Design A systematic literature review including Randomized Controlled Trials (RCTs) and Non-Randomized Studies on Interventions (NRSIs) for the use, effectiveness, and the risk/benefit of Alpha-Stim® CES in the treatment of depression. Following Cooper’s Taxonomy of Literature Reviews, appropriate for the behavioral and physical sciences and the PRISMA reporting guidelines. As CES devices differ significantly in their electrical outputs and usage, individual assessment is warranted. Accordingly, the meta-analysis was limited to one CES device for the treatment of depression. Primary Outcome Measure Treatment of depression using Alpha-Stim® CES, including Level of use Effectiveness Risk/benefit Secondary Outcome Measure None reported. Key Inclusion Criteria To be included in this meta-analysis, studies were: RCTs inclusive of subjects blinding and a sham versus active condition. NRSIs with patients exhibiting symptoms of depression. Use of valid and reliable measurement instruments. A pretest-posttest design (additional repeated measures were acceptable). Rated as “good” or “fair.” Key Exclusion Criteria None reported. Protocol Summary A computer-based search of MEDLINE and EMBASE databases since their beginning. A search of the Cochrane Central Register of Controlled Trials (CENTRAL) included in the Cochrane Library. The search proceeded within abstract, subject terms, and titles of studies and reports published in peer-reviewed journals between January 1, 1981, and August 26, 2020. Keywords: Depression and Alpha-Stim and cranial electrotherapy stimulation and randomized control trial or nonrandomized or open-label or case study. Screening references are given in relevant systematic reviews and identified RCTs. Citation tracking of identified RCTs using the Science Citation Index through the Web of Science. A scoring rubric for each study was applied using the guidelines from Zaza et al., (2000) with scoring categories of 0-1 limitations (rating = good); 2-4 limitations (rating = fair); 5-9 limitations (rating = limited) in the selection of the research studies to be included in the meta-analysis. The Revised Cochrane Risk-of-Bias Tool was used to inform the decision to include a study within an RCT design. Device Application Protocol The evaluation of strengths and limitations of the research studies included in the meta-analyses adhered to guidelines published by Zaza et al., (2000), the Cochrane Handbook for Systematic Reviews of Interventions, and in the Handbook of Research Synthesis and Meta-Analysis. Statistical Analysis Plan A complementary approach to synthesize the meta-analytic results from the NRSIs with RCTs was used. Cohen’s d effect size summary metric was used in all analyses. Fixed and random effects models, inclusive of homogeneity of Cohen’s d effect sizes are reported on 17 studies found in the CENTRAL registry using Cooper’s Taxonomy of Literature Reviews. The meta-analyses were performed using the Comprehensive Meta-Analysis, version 3 program. Results Subjects The inclusion criteria yielded 5 RCTs (N=242) and the 12 NRSIs (N=1,173) represent 16 data sets with a combined for total of 1,415. Male and female subjects from adolescents to 60 years old. Data Analysis The studies used in the meta-analyses all had significant outcomes of p<0.05 through p<0.001 for depression and many also revealed equally good effects for the treatment of anxiety and insomnia. The meta-analytic results of the five (N=5) RCT studies on depression and the accompanying statistical summary show a medium effect in favor of the active treatment group. The average (population) effect for the 5 studies was observed as d = -0.69 (i.e., the mean depression level at posttest for the active group was -0.69 standard deviations lower than the mean depression level of the sham group). An effect size of -0.69 is classified as medium. Given the congruency (i.e., closeness), between the summary statistics of Fixed- and Random-effects models, it is reasonable to also state that CES shows a medium effect in favor of the active treatment group relative to reductions in depression. Meta-Analyses Summary Statistics – Depression RCTs. Point estimate = average standard effect, d, over 5 studies. Q-value = test of study heterogeneity (i.e., are the set of effect sizes homogeneous). I-squared = magnitude of study heterogeneity (~25% = small; ~50% = medium; ~75% = large). Meta-Analysis Summary Statistics – Depression NRSI. Point estimate = average standard effect, d, over 12 studies. Q-value = test of study heterogeneity (i.e., are the set of effect sizes homogeneous). I-squared = magnitude of study heterogeneity (~25% = small; ~50% = medium; ~75% = large). The forest plots for the RCTs and NRSIs show (a) the effect size d, (b) the variability of each study’s effect via the 95% confidence interval, and (c) the average (i.e., population estimate) effect size for all the studies (blue diamond). The symbols in the forest plot depict the relative weight for each of the studies (e.g., the larger the symbol the greater the relative contribution each study makes to the final result). Also informative is the width of the confidence interval. For example, the larger the sample size of an individual study, the smaller the width of the interval and the greater the precision of the effect size. Forest Plot: Summary Statistics of Effect Sizes from Alpha-Stim CES RCTs of Depression (N=5). Forest Plot: Summary Statistics of Effect Sizes from Alpha-Stim CES NRSIs of Depression (N=12). The studies included in the meta-analyses report that patients receiving CES treatment have shown improvements in negative domains that typically cooccur with depression such as somatization, interpersonal sensitivity, obsessive or compulsive thoughts, excessive worry, hostility, fearfulness, alcohol and substance use, and paranoia. Concurrently patients report improvement in symptoms associated with CES treatment as measured by the Global Assessment of Function (GAF), a measure incorporated in some of the studies in the meta-analyses and by clinicians using the Clinical Global Impression (CGI), scale to report on patient improvement. Conclusion These meta-analyses of CES as a treatment for depression demonstrate a medium (d = -0.69), average effect size for the 5 RCTs, in addition to a small (d = -0.43), average effect size for 12 NRSI studies in favor of the active CES treatment group. In comparison, the effect sizes typically associated with antidepressant medication for published studies is 0.37 (95% CI, 0.33 to 0.41), and for unpublished studies, it is less than 0.15 (95% CI, 0.08 to 0.22), both qualifying as small. When the side effect profile of medications vs CES is considered, the supremacy of CES over medications is even more notable. CES Medication RCTs -0.69 0.37 NRSIs -0.43 Effect size treatment of depression CES vs. medication. The risk profile for CES was virtually negligible, with mild and self-limiting vertigo or cervicogenic headaches when the current is too high, and skin irritation at the electrode site reported in less than 1% of patients. The authors concluded that CES has a significant effect in the treatment of moderate to severe depression across a variety of patient populations and was significantly more effective than wait-list controls. In addition, CES is an effective treatment for depression in a range of populations with a spectrum of depression severity, as evidenced by pre-and post-scores of the appropriate depression measures based on the sample population – civilian, military, and first responders. Moreover, it is a useful adjunctive to other ongoing treatments including pharmacotherapy and psychotherapy for depression. Limitations Participants were self-selected resulting in possible selection bias. The RCTs had a limited number of patients with a significant diagnosis of depression. The NRSIs lacked randomization and a control group and many of the patients were continuing to receive other treatments (e.g., pharmacotherapy). Study Quality: Good ### Quantitative Analysis of Electroencephalogram During Cranial Electrotherapy Stimulation Quantitative Analysis of Electroencephalogram During Cranial Electrotherapy Stimulation Schroeder, M.J., and Barr, R.E. Quantitative analysis of electroencephalogram during cranial electrotherapy stimulation. Clinical Neurophysiology. 2001; 112:2075-2083. Doctoral dissertation, The Graduate School of the University of Texas at Austin, 191 pages, 1999. This Institutional Review Board-approved study describes the quantitative changes of the electroencephalogram (EEG) due to 30 – 80 mA of Alpha-Stim cranial electrotherapy stimulation (CES) and the concurrent use of CES in 3 neurofeedback (NFB) sessions. 12 normal male subjects between the ages of 20 – 50 were tested. Subjects were right handed and right eye dominant. They had no previous head injury requiring medical attention, no history of epileptic seizures or convulsions, were never treated for insomnia or depression, and were not taking psychoactive prescription drugs.Instrumentation methods to acquire artifact-free EEG during CES were developed and compared. A noise-cancellation technique was used to eliminate CES noise from the EEG. Each subject underwent a double-blind, crossover design under five treatment conditions: 1) Sham/Control (no treatment), 2) 0.5 Hz CES, 3) 100 Hz CES, 4) 0.5 Hz CES/NFB, 5) NFB. All treatments were administered to each subject for 20 minutes on different days. Occipital EEG data was acquired before, during, and after the treatment. From the processed EEG data, 22 different parameters were analyzed for changes due to the various treatment conditions. Among these parameters was a newly developed alpha modulation index. The alpha modulation index delineates the characteristic waxing and waning of the alpha rhythm from the more general case of alpha activity using a method based on complex demodulation. The index performed well when applied to simulated and physiological data. Thorough statistical analyses were applied to each experimental EEG parameter and treatment relative to the sham control. Each of the four types of treatment was compared with the controls on a paired t-test. A 22 ANOVA factorial design compared each of the four treatment conditions against each other. A time analysis of variance was also computed for each treatment against the controls to partial out any effects from the position in the study at which subjects received each treatment.The principal experimental results indicate that both the 0.5 Hz and 100 Hz CES significantly shift the alpha band power distribution downward in frequency relative to control as shown by the alpha mean frequency variable in the EEG. 100 Hz CES also significantly reduces the relative amount of beta band power over time relative to control. NFB alone shifts the beta band power frequency significantly upward relative to control. There is a significant inverse interaction in the alpha index parameter during the combined CES/NFB treatment nullifying the increase in the parameter from each treatment alone, however the combined CES/NFB treatment may cause an increase in the physiological DC potential of the EEG. These findings suggest that Alpha-Stim CES elicits changes in the EEG that are quantifiable and beneficial to people with stress related disorders. The author concluded that the fact that both 0.5 Hz and 100 Hz CES, two completely different treatment parameters, showed significant changes from pre to post treatment for the same variable lends strong support to the claim that the effects seen are real.No negative side effects were found during or following the study. No subject left the study early, nor did any complain about any study parameter during or following the study.The graph shows that Alpha-Stim CES significantly reduced the alpha frequency of the EEGs from pre to post treatment when compared with the controls.The graph shows four different EEG parameters that are related to reduced stress and a more relaxed state. The F-Score value comparisons with the control group are shown. It can be seen that while the Alpha-Stim CES was very effective in reducing stress in this patient group, neurofeedback was insignificantly helpful, and the beta power fraction actually increased in that group. ### Normalization of intrinsic neural circuits governing Tourette’s Syndrome using cranial electrotherapy stimulation Normalization of intrinsic neural circuits governing Tourette’s Syndrome using cranial electrotherapy stimulation Qiao J, Weng S, Wang P, Long J, Wang Z. Normalization of intrinsic neural circuits governing Tourette’s Syndrome using cranial electrotherapy stimulation. IEEE Trans Biomed Eng. 2015;62(5):1272-80.DeviceAlpha-Stim®Key VariablesNormalization of functional activity in intrinsic cortical neural circuitsTicsObjectiveThe purpose of this study was to investigate if cranial electrotherapy stimulation (CES) can normalize the functional activity and intrinsic neural circuits of adolescents with Tourette’s Syndrome (TS) adolescents.DesignThis 24 weeks prospective study was done on the naturalistic use of CES by adolescents with TS. This article includes a subset of a larger study examining 8 adolescents with TS who had functional magnetic resonance imaging (fMRI) and completed the Yale Global Tic Severity Scale (YGTSS) before their first CES treatment and after their final CES treatment. The larger study included a total of 42 adolescents with TS (34 subjects completed the YGTSS only and the 8 adolescents who had baseline and post treatment fMRIs, and completed the Y-GTSS.Effectiveness EndpointsThere were two effectiveness endpoints (1) Data from fMRI (N=8) pre and post CES treatments, and (2) Scores on the YGTSS (N=42) pre and post CES treatments.Key Inclusion CriteriaMale or female right-handed patients (less than 12 years old) with a diagnosis of TS (according to DSM-IV) were included in the study. All the patients were physical healthy and had an IQ of no less than 100. The patients were drug free for at least one month before enrollment in the study.Key Exclusion CriteriaIndividuals with the following conditions were excluded from the study; co-occurring anxiety and attention deficit hyperactivity disorder, current depression, and, current or previous history of psychosis.Protocol SummaryData from fMRI and the YGTSS were collected for baseline measures. Baseline measures were done at enrollment, prior to the first CES treatment. Endpoint measures were done at the end of 24 weeks after the last CES treatment.Device Application ProtocolThe CES treatment procedures used in this study were consistent with current established standards for clinical practice. Each patient was instructed to set the Alpha-Stim SCS current between 10 and 500 µA using ear clip electrodes. The frequency was 0.5 Hz with a pulse duration of 2 milliseconds. Patients titrated the duration and current strength of CES to their perceived optimal level. They did one or two daily CES sessions, ranging from 20 to 60 minutes each.Outcome MeasuresFunctional magnetic resonance imaging (fMRI).Resting-state fMRI was performed on a 3T magnetic resonance unit (GE Signa Medical Systems, Twinspeed, Milwaukee) in the Renmin Hospital of Wuhan University. A birdcage head coil and restraining foam pads were used to minimize head motion. Functional data were acquired using a gradient-echo, T2∗-weighted echo-planar imaging with BOLD contrast pulse sequence. Thirty two contiguous axial slices that covered the entire hemisphere and brainstem were acquired along the AC–PC plane, with a 64 × 64 matrix (repetition time = 2000 msec, echo time = 30 msec, field of view = 24cm × 24 cm, and slice thickness = 4 mm without a gap).Yale Global Tic Severity Scale (YGTSS).The YGTSS is a clinician administered scale that is used to evaluate the severity of motor and phonic tics. The clinician describes a list of possible tics, first motor and then vocal tics, that may have occurred during the previous week. Once the tics that occurred over the previous week are identified, the clinician asks about the frequency, intensity, complexity, and the effect that the tics had in the person’s daily life. These dimensions are rated and the combined total can be used as a measure for overall tic severity. The YGTSS also includes a section that evaluates the overall impairment caused by the tics that is rated from 0 to 50. A score of 0 indicates that TS has no negative impact on a person’s life, while a score of 50 indicates a marked negative impact on the person’s life.SubjectsForty-three subjects were enrolled in the larger study. Subjects received daily CES treatments for 24 weeks and completed the YGSST at baseline and post CES treatments. One subject dropped out after one week of CES treatments for “lack of efficacy.” Eight subjects had fMRIs at baseline and after completing CES treatments, in addition to completing the YGSST at baseline and post CES treatments.Data AnalysisDescriptive statistics were used for YGSST scores. Differences were examined using paired t-tests. For fMRI analysis, Independent component analysis (ICA) with hierarchical partner matching method was used to examine the functional connectivity between regions within cortico-striato-thalamo-cortical (CSTC) circuit. Granger causality was used to investigate effective connectivity among these regions detected by ICA. The authors then performed pattern classification on independent components with significant group differences that served as endophenotype markers to distinguish the adolescents between TS and the normalized ones after CES.ResultsThe decrease in YGTSS scores indicating a decrease in motor and vocal tics from baseline to the end of 24 weeks of CES treatment was highly significant, p = < 0.01 (Figure 1).Figure 1. Decrease in motor and verbal tics of TS from baseline to after CES treatments.The effect size, d = 3.913, was ≥ 0.8 and therefore considered large (Cohen, 1988).Functional magnetic resonance imaging (fMRI).After CES, subjects exhibited altered spontaneous functional connectivity in brain areas within the CSTC circuit involved in motor generation or control, including SMA, caudate, PFC, ACC, and default mode network (DMN), primary in PCC. The functional activity and connectivity in motor pathways were suppressed, while activations in the control portions of CSTC loop were increased in subjects after CES compared with before CES.Authors’ conclusionsThe normalization of the balance between motor and control portions of the CSTC circuit may result in the recovery of TS adolescents.Quality of the researchThis was a non-experimental, naturalistic study that was done to determine if CES may be beneficial for individuals with TS. A strength of the study is the investigators used baseline and post-treatment fMRI scans in a subset of the subjects to identify changes in brain function. The design was appropriate for this study as a critical review of the literature revealed no previous research could be found on using CES to treat TS. This initial, exploratory study provides a solid foundation for a larger, randomized controlled trial that examines the efficacy of decreasing the motor and vocal tics of TS.Comments on the findings of the studyThe distinction between functional and effective connectivity is essential to understand when interpreting the results of studies like the present one. Functional connectivity describes the statistical dependencies between two or more variables (e.g., regions of neural activation within the brain). These dependencies can be undirected (as in correlation analysis) or directed (as in Granger Causality and “transfer entropy”; Granger 1969). Importantly, functional connectivity analyses make minimal assumptions about the physical underlying mechanisms of action. In contrast, effective connectivity aims at finding the simplest possible circuit diagram explaining observed responses (Friston, 2013). For example, models of effective connectivity allow researchers to compare how well distinct mechanistic models perform given an observed set of data. The effective connectivity approach is exemplified in Dynamic Causal Modeling (DCM) within a Bayesian statistical modeling framework. However, DCM is suited for (a) models where only a few regions of activation have been identified (or will be) and (b) models to be theoretically posited aprior (i.e., it is a theoretically driven, model testing approach to understand neural mechanisms of action propagating upward to the network level). When little is known apriori about the mechanistic nature of the neural system as in the present study, an attempt is made to bridge functional and effective connectivity approaches to provide a foundation for understanding the mechanism(s) of action that can then lead to models of effective and functional network connectivity. To this end, the authors use a state-of-the-art approach, independent components analysis (ICA) to identify regions of activation (from BOLD signal data acquired using fMRI) that are involved in resting state fMRI data with TS patients. This step is followed by hierarchical partner matching (HPM) to identify functional brain networks. Next, Granger Causality was used to test for significant causal relations between identified regions of interest (e.g., see Table II, p. 1277). Granger Causality captures temporal properties of fMRI data while also controlling for the simultaneous regression of all variables in the model (these models are also known as multivariate autoregressive time series models (Price, 2012). Finally, the authors also used pattern recognition methods based on resting state fMRI data to verify the normalization in intrinsic brain functional activity and activation connectivity between TS patients before and after CES treatment.One challenge when studying a condition such as TS is that the disease involves the motor and control systems from a biophysical and neural perspective. Importantly, the authors found that the “motor” and “control” parts of the CTSC system lack normalization in TS patients. Specifically, the authors here found that an increase in functional activity and connectivity in PCC suggesting normalization (i.e., return to a state similar to that of non-TS) of functional deficits associated with impaired motor inhibition.Statistical analysisIn this study the researchers examined blood oxygenation level dependent (BOLD) fluctuations and intrinsic brain functional connectivity based on resting-state functional MRI data. The researchers used an independent cluster analysis (ICA) at the individual level followed by hierarchical partner matching (HPM) to identify functional brain networks in resting state condition. The use of the ICA algorithm with HPM provided a solid analytic strategy for identifying ICs that were reproducible across individuals. The number of ICs to generate for each subject was determined by using minimum description length (MDL) for the lower bound and Akaike’s Information Criterion (AIC) for the upper bound. The interval for their study was between 20 to 130 clusters (with an interval or increment of 10). To the authors’ credit, they employ cross-validation approaches to investigate the tenability of their regional activation identification strategy based on the before and after CES subject data. Cross-validation is an important step when exploratory search strategies are used in high density data structures. Granger causality was also used to measure causal interactions among components of the cortico-straito-thalamo-cortical (CTSC) circuit that generates or controls motor behavior.The present study provides many strengths methodologically and analytically. Overall, the methodology and analyses used are well-suited and represent the current state-of-the-art considering the goals of the investigation. Certainly, replication with a more rigorous design is recommended given the sample size and the fact that no sham group was employed. A recommended future study is to include randomized controlled trial (RCT) using a control (sham condition) and treatment (CES) condition. Additionally, given the findings of the present study, it is possible to posit a theoretically mechanistic model that can be formally evaluated using DCM analysis. Finally, as the authors correctly note, fMRI scanner noise may affect subjects in different ways (i.e., may affect subject-specific fMRI BOLD signals). Therefore, silent techniques such as EEG should be used to compare the results with those obtained using fMRI data.Annotated abstract references for above comments on the findings of the studyFriston, K., Moran, R., Seth, A.K. Analyzing connectivity with Granger Causality and dynamic causal modeling. Neuroimage. 2013; 19:1273-1302.Price, L. R., (2012). Small sample properties of Bayesian multivariate autoregressive time series models. Structural Equation Modeling. 2012; 19(1):51-64.Granger, C.W.J. (1969). Investigating causal relations by econometric models and cross-spectral methods. Econometrica, 1969; 37:424-438.Author AffiliationsJianping Qiao is a Lecturer at College of Physics and Electronics, Shandong Normal University, Jinan, China.Shenhong Weng is an Associate Chief Physician and an Associate Professor at Renmin Hospital of Wuhan University, Wuhan, China.Pengwei Wang is a Lecturer at the School of Information Science and Engineering, Shandong University, Jinan, China.Jun Long is a Professor and Vice Dean at the School of Information Science and Engineering,Central South University, Changsha, China.Zhishun Wang is an Associate Professor in Brain Imaging with the Department of Psychiatry at Columbia University, New York, NY, USA, and New York State Psychiatric Institute, New York. ### Prospective Study of Brain Wave Changes Associated with Cranial Electrotherapy Stimulation The Use of Microcurrent Electrical Therapy and Cranial Electrotherapy Stimulation in Pain Control Kulkarni, A.D. The use of microcurrent electrical therapy and cranial electrotherapy stimulation in pain control. Clinical Practice of Alternative Medicine. 2001; 2(2):99-102. Funding Source, Location of Study or Author’s Affiliation Nav-Durga Hospital, Bombay, India. Device Alpha-Stim® 100 Key Variables Pain, depression, and anxiety. Objective Assess the effectiveness of Alpha-Stim microcurrent electrical therapy (MET), cranial electrotherapy stimulation (CES) or a combination of both therapies for patients who had been refractory to previous treatments. Design Daily treatment with MET or CES over three weeks for one hour. CES was given to all patients in which clinical depression or anxiety states appeared to accompany their pain complaint. Primary Outcome Measures Pain was scored on an 11-point self-rating VAS scale, with 0 being no pain and 10 being the most intense pain they had experienced to date. Secondary Outcome Measures Depression Anxiety Key Inclusion Criteria Refractory response to pain. No medications for pain relief Key Exclusion Criteria None reported. Protocol Summary Daily treatments for one hour daily, Monday through Friday, for three weeks. No pain medications were taken during the study period. MET was given via probes or self-adhesive electrodes at 600 uA. CES current was regulated by each patient from 100 to 300 uA. Device Application Protocol The treatment strategies were either CES, MET via probe electrodes, MET via self-adhesive electrodes, or a combination of CES and one or the other type of MET electrode. MET, when given, was given by either probes or self-adhesive electrodes at 600 uA. Treatment with CES for one hour daily over three weeks, regulated by each patient, ranging from 100 to 300 uA. Participants were instructed to turn the current up until they felt a bit lightheaded and then turn it down to their comfort level. Statistical Analysis Plan Comparison of mean self-report measures of pain, depression, and anxiety pre- and post-treatment. Results Subjects A total of 20 patients who had been refractory to previous treatments completed informed consent and joined the study in the order that they presented at the first author’s hospital pain clinic. Ages ranged from 30 to 75 years (mean=44) and 15 were females. No study blinding is reported. Data Analysis Statistical analysis revealed the following: Nine patients (45%) left the study early following reduction of their pain to a level between 0 and 1.5 on the 11-point scale. One had complete remission of her pain after only two treatments. Of three patients who received no relief, none returned for the final week of treatment. Seven patients (35%) who were treated with CES plus self-adhesive electrodes began at an average pain level of 7.7 (range 5-10) and ended with an average of 3.7 (range 0-10), or a 52% reduction in pain from an average of 12 days of treatment. Seven patients who were treated with CES plus probes fared even better beginning with a pain level of 7.1 (range 4-8) and ending at an average of 1.1 (range 1-6), or an 85% reduction of pain from an average of 8.1 days of treatment. Five patients (25%) were treated with CES only. They experienced an average of 50% drop in their pain level from 4.4 (range 3-7) to 2.2 (range 0.5-5) with an average of 10.6 days of treatment. No negative side effects were reported. Conclusions Treatment response was associated with length of time since pain onset. Patients who had been in pain for two months and four months improved 94% and 100 %, respectively. Patients with I00% pain reduction had pain lasting four years, five years, and six years. The overall correlation between duration of pain and improvement following treatment was – 0.19, not significant with this number of subjects. When this was broken down into those whose pain had lasted less than a year and compared with those whose pain had lasted five years or more, the correlation was -0.05 and -0.42, neither of which was statistically significant. The authors concluded that MET and CES are effective treatments for chronic pain patients. Limitations This study had a small sample size consisting primarily of females, which could limit generalizability of the results. The author states the original intent was to conduct a double-blind randomized controlled trial, but “found out that our patient group could not be depended on for that kind of cooperation.” Instead, the therapist determined the appropriate treatment regimen based on symptoms. While this is consistent with clinical practice, it can potentially introduce bias into the reported results, according to the Cochrane Risk of Bias tool. Study Quality: FAIR ### Electrical Treatment of Severe Head and Neck Cancer Pain The Use of Microcurrent Electrical Therapy and Cranial Electrotherapy Stimulation in Pain Control Kulkarni, A.D. The use of microcurrent electrical therapy and cranial electrotherapy stimulation in pain control. Clinical Practice of Alternative Medicine. 2001; 2(2):99-102. Funding Source, Location of Study or Author’s Affiliation Nav-Durga Hospital, Bombay, India. Device Alpha-Stim® 100 Key Variables Pain, depression, and anxiety. Objective Assess the effectiveness of Alpha-Stim microcurrent electrical therapy (MET), cranial electrotherapy stimulation (CES) or a combination of both therapies for patients who had been refractory to previous treatments. Design Daily treatment with MET or CES over three weeks for one hour. CES was given to all patients in which clinical depression or anxiety states appeared to accompany their pain complaint. Primary Outcome Measures Pain was scored on an 11-point self-rating VAS scale, with 0 being no pain and 10 being the most intense pain they had experienced to date. Secondary Outcome Measures Depression Anxiety Key Inclusion Criteria Refractory response to pain. No medications for pain relief Key Exclusion Criteria None reported. Protocol Summary Daily treatments for one hour daily, Monday through Friday, for three weeks. No pain medications were taken during the study period. MET was given via probes or self-adhesive electrodes at 600 uA. CES current was regulated by each patient from 100 to 300 uA. Device Application Protocol The treatment strategies were either CES, MET via probe electrodes, MET via self-adhesive electrodes, or a combination of CES and one or the other type of MET electrode. MET, when given, was given by either probes or self-adhesive electrodes at 600 uA. Treatment with CES for one hour daily over three weeks, regulated by each patient, ranging from 100 to 300 uA. Participants were instructed to turn the current up until they felt a bit lightheaded and then turn it down to their comfort level. Statistical Analysis Plan Comparison of mean self-report measures of pain, depression, and anxiety pre- and post-treatment. Results Subjects A total of 20 patients who had been refractory to previous treatments completed informed consent and joined the study in the order that they presented at the first author’s hospital pain clinic. Ages ranged from 30 to 75 years (mean=44) and 15 were females. No study blinding is reported. Data Analysis Statistical analysis revealed the following: Nine patients (45%) left the study early following reduction of their pain to a level between 0 and 1.5 on the 11-point scale. One had complete remission of her pain after only two treatments. Of three patients who received no relief, none returned for the final week of treatment. Seven patients (35%) who were treated with CES plus self-adhesive electrodes began at an average pain level of 7.7 (range 5-10) and ended with an average of 3.7 (range 0-10), or a 52% reduction in pain from an average of 12 days of treatment. Seven patients who were treated with CES plus probes fared even better beginning with a pain level of 7.1 (range 4-8) and ending at an average of 1.1 (range 1-6), or an 85% reduction of pain from an average of 8.1 days of treatment. Five patients (25%) were treated with CES only. They experienced an average of 50% drop in their pain level from 4.4 (range 3-7) to 2.2 (range 0.5-5) with an average of 10.6 days of treatment. No negative side effects were reported. Conclusions Treatment response was associated with length of time since pain onset. Patients who had been in pain for two months and four months improved 94% and 100 %, respectively. Patients with I00% pain reduction had pain lasting four years, five years, and six years. The overall correlation between duration of pain and improvement following treatment was – 0.19, not significant with this number of subjects. When this was broken down into those whose pain had lasted less than a year and compared with those whose pain had lasted five years or more, the correlation was -0.05 and -0.42, neither of which was statistically significant. The authors concluded that MET and CES are effective treatments for chronic pain patients. Limitations This study had a small sample size consisting primarily of females, which could limit generalizability of the results. The author states the original intent was to conduct a double-blind randomized controlled trial, but “found out that our patient group could not be depended on for that kind of cooperation.” Instead, the therapist determined the appropriate treatment regimen based on symptoms. While this is consistent with clinical practice, it can potentially introduce bias into the reported results, according to the Cochrane Risk of Bias tool. Study Quality: FAIR ### Is microcurrent stimulation effective in pain management? An additional perspective. The Use of Microcurrent Electrical Therapy and Cranial Electrotherapy Stimulation in Pain Control Kulkarni, A.D. The use of microcurrent electrical therapy and cranial electrotherapy stimulation in pain control. Clinical Practice of Alternative Medicine. 2001; 2(2):99-102. Funding Source, Location of Study or Author’s Affiliation Nav-Durga Hospital, Bombay, India. Device Alpha-Stim® 100 Key Variables Pain, depression, and anxiety. Objective Assess the effectiveness of Alpha-Stim microcurrent electrical therapy (MET), cranial electrotherapy stimulation (CES) or a combination of both therapies for patients who had been refractory to previous treatments. Design Daily treatment with MET or CES over three weeks for one hour. CES was given to all patients in which clinical depression or anxiety states appeared to accompany their pain complaint. Primary Outcome Measures Pain was scored on an 11-point self-rating VAS scale, with 0 being no pain and 10 being the most intense pain they had experienced to date. Secondary Outcome Measures Depression Anxiety Key Inclusion Criteria Refractory response to pain. No medications for pain relief Key Exclusion Criteria None reported. Protocol Summary Daily treatments for one hour daily, Monday through Friday, for three weeks. No pain medications were taken during the study period. MET was given via probes or self-adhesive electrodes at 600 uA. CES current was regulated by each patient from 100 to 300 uA. Device Application Protocol The treatment strategies were either CES, MET via probe electrodes, MET via self-adhesive electrodes, or a combination of CES and one or the other type of MET electrode. MET, when given, was given by either probes or self-adhesive electrodes at 600 uA. Treatment with CES for one hour daily over three weeks, regulated by each patient, ranging from 100 to 300 uA. Participants were instructed to turn the current up until they felt a bit lightheaded and then turn it down to their comfort level. Statistical Analysis Plan Comparison of mean self-report measures of pain, depression, and anxiety pre- and post-treatment. Results Subjects A total of 20 patients who had been refractory to previous treatments completed informed consent and joined the study in the order that they presented at the first author’s hospital pain clinic. Ages ranged from 30 to 75 years (mean=44) and 15 were females. No study blinding is reported. Data Analysis Statistical analysis revealed the following: Nine patients (45%) left the study early following reduction of their pain to a level between 0 and 1.5 on the 11-point scale. One had complete remission of her pain after only two treatments. Of three patients who received no relief, none returned for the final week of treatment. Seven patients (35%) who were treated with CES plus self-adhesive electrodes began at an average pain level of 7.7 (range 5-10) and ended with an average of 3.7 (range 0-10), or a 52% reduction in pain from an average of 12 days of treatment. Seven patients who were treated with CES plus probes fared even better beginning with a pain level of 7.1 (range 4-8) and ending at an average of 1.1 (range 1-6), or an 85% reduction of pain from an average of 8.1 days of treatment. Five patients (25%) were treated with CES only. They experienced an average of 50% drop in their pain level from 4.4 (range 3-7) to 2.2 (range 0.5-5) with an average of 10.6 days of treatment. No negative side effects were reported. Conclusions Treatment response was associated with length of time since pain onset. Patients who had been in pain for two months and four months improved 94% and 100 %, respectively. Patients with I00% pain reduction had pain lasting four years, five years, and six years. The overall correlation between duration of pain and improvement following treatment was – 0.19, not significant with this number of subjects. When this was broken down into those whose pain had lasted less than a year and compared with those whose pain had lasted five years or more, the correlation was -0.05 and -0.42, neither of which was statistically significant. The authors concluded that MET and CES are effective treatments for chronic pain patients. Limitations This study had a small sample size consisting primarily of females, which could limit generalizability of the results. The author states the original intent was to conduct a double-blind randomized controlled trial, but “found out that our patient group could not be depended on for that kind of cooperation.” Instead, the therapist determined the appropriate treatment regimen based on symptoms. While this is consistent with clinical practice, it can potentially introduce bias into the reported results, according to the Cochrane Risk of Bias tool. Study Quality: FAIR ### The Use of Microcurrent Electrical Therapy and Cranial Electrotherapy Stimulation in Pain Control The Use of Microcurrent Electrical Therapy and Cranial Electrotherapy Stimulation in Pain Control Kulkarni, A.D. The use of microcurrent electrical therapy and cranial electrotherapy stimulation in pain control. Clinical Practice of Alternative Medicine. 2001; 2(2):99-102.Funding Source, Location of Study or Author’s AffiliationNav-Durga Hospital, Bombay, India.DeviceAlpha-Stim® 100Key VariablesPain, depression, and anxiety.ObjectiveAssess the effectiveness of Alpha-Stim microcurrent electrical therapy (MET), cranial electrotherapy stimulation (CES) or a combination of both therapies for patients who had been refractory to previous treatments.DesignDaily treatment with MET or CES over three weeks for one hour. CES was given to all patients in which clinical depression or anxiety states appeared to accompany their pain complaint.Primary Outcome MeasuresPain was scored on an 11-point self-rating VAS scale, with 0 being no pain and 10 being the most intense pain they had experienced to date.Secondary Outcome MeasuresDepressionAnxietyKey Inclusion CriteriaRefractory response to pain.No medications for pain reliefKey Exclusion CriteriaNone reported.Protocol SummaryDaily treatments for one hour daily, Monday through Friday, for three weeks. No pain medications were taken during the study period. MET was given via probes or self-adhesive electrodes at 600 uA. CES current was regulated by each patient from 100 to 300 uA.Device Application ProtocolThe treatment strategies were either CES, MET via probe electrodes, MET via self-adhesive electrodes, or a combination of CES and one or the other type of MET electrode. MET, when given, was given by either probes or self-adhesive electrodes at 600 uA. Treatment with CES for one hour daily over three weeks, regulated by each patient, ranging from 100 to 300 uA. Participants were instructed to turn the current up until they felt a bit lightheaded and then turn it down to their comfort level.Statistical Analysis PlanComparison of mean self-report measures of pain, depression, and anxiety pre- and post-treatment.ResultsSubjectsA total of 20 patients who had been refractory to previous treatments completed informed consent and joined the study in the order that they presented at the first author’s hospital pain clinic. Ages ranged from 30 to 75 years (mean=44) and 15 were females. No study blinding is reported.Data AnalysisStatistical analysis revealed the following:Nine patients (45%) left the study early following reduction of their pain to a level between 0 and 1.5 on the 11-point scale.One had complete remission of her pain after only two treatments.Of three patients who received no relief, none returned for the final week of treatment. Seven patients (35%) who were treated with CES plus self-adhesive electrodes began at an average pain level of 7.7 (range 5-10) and ended with an average of 3.7 (range 0-10), or a 52% reduction in pain from an average of 12 days of treatment.Seven patients who were treated with CES plus probes fared even better beginning with a pain level of 7.1 (range 4-8) and ending at an average of 1.1 (range 1-6), or an 85% reduction of pain from an average of 8.1 days of treatment. Five patients (25%) were treated with CES only. They experienced an average of 50% drop in their pain level from 4.4 (range 3-7) to 2.2 (range 0.5-5) with an average of 10.6 days of treatment.No negative side effects were reported.ConclusionsTreatment response was associated with length of time since pain onset. Patients who had been in pain for two months and four months improved 94% and 100 %, respectively. Patients with I00% pain reduction had pain lasting four years, five years, and six years. The overall correlation between duration of pain and improvement following treatment was – 0.19, not significant with this number of subjects. When this was broken down into those whose pain had lasted less than a year and compared with those whose pain had lasted five years or more, the correlation was -0.05 and -0.42, neither of which was statistically significant. The authors concluded that MET and CES are effective treatments for chronic pain patients.LimitationsThis study had a small sample size consisting primarily of females, which could limit generalizability of the results. The author states the original intent was to conduct a double-blind randomized controlled trial, but “found out that our patient group could not be depended on for that kind of cooperation.” Instead, the therapist determined the appropriate treatment regimen based on symptoms. While this is consistent with clinical practice, it can potentially introduce bias into the reported results, according to the Cochrane Risk of Bias tool.Study Quality: FAIR ### Cumulative Response from Cranial Electrotherapy Stimulation (CES) for Chronic Pain Cumulative Response from Cranial Electrotherapy Stimulation (CES) for Chronic Pain Holubec, JT. Cumulative response from cranial electrotherapy stimulation (CES) for chronic pain. Practical Pain Management. 2009; 9(9):80-83.Funding Source, Location of Study or Author’s AffiliationTexas College of Osteopathic Medicine, Texas.DeviceAlpha-Stim® SCSKey VariablesPainObjectiveInvestigate the effect of a specified treatment course with CES with pain. Consecutive treatments were performed to determine cumulative results.DesignThis study was an open label trial involving patients entering a pain clinic who were offered a complementary CES treatment. Patients that accepted the treatment were given a pain questionnaire and rated intensity on a 1–10 scale. The patients were asked to repeat this once the treatment was over. The patients also had the chance to come back for consecutive treatments for up to five days. This study was an open clinical trial.Primary Outcome MeasureThe primary effectiveness endpoint was the change from baseline in the last post-treatment scores in pain.Change in pain level from baseline to post treatment.Secondary Outcome MeasureNone reported.Key Inclusion CriteriaAll patients who entered the pain clinic who did not meet the exclusion criteria.Key Exclusion CriteriaPregnantPresence of implanted pacemaker, pump, or stimulator device.Protocol SummaryPatients entering the Regional Pain Care Center of North Texas were offered the chance to receive a complementary CES treatment for their pain. Less than 1% of patients refused the treatment. Patients that participated filled out a pain questionnaire and rated their pain from 1–10 both before and after the CES treatment.Device Application ProtocolPatients were able to adjust the current to a comfortable level and treated for 20 minutes. Most patients chose between 200 and 300 uA. Patients were also given the chance to come back for consecutive treatments for up to five days to test for cumulative improvement.Statistical Analysis PlanThis was an open label study in which standard statistical methods were not used.ResultsSubjectsA sample of 525 consecutive patients who entered the Regional Pain Care Center of North Texas.Data AnalysisThe percentage improvement in pain was calculated after each round of treatments. Fewer patients participated on the following day as more patients became pain free.Cumulative improvement in pain after 1-5 CES treatmentsConclusionOne to five 20-minute CES treatment sessions produced a reduction in pain ranging from 42% to 71% in the approximately 80% of patients who responded. No negative side effects were observed by any member of the clinic staff or reported by the patients. Accordingly, this study gives credence to the claim that CES has a positive cumulative effect in refractory patients with a wide range of pain-related disorders.LimitationsThis study is not equivalent to a randomized controlled, double blind trial but it does provide important information regarding the role of CES in pain management. This study also illustrates the cumulative effect seen with continued use.Study Quality: FAIR ### Incorporating Complementary and Alternative Medicine (CAM) Therapies to expand Psychological Services to Veterans Suffering from Chronic Pain Incorporating Complementary and Alternative Medicine (CAM) Therapies to expand Psychological Services to Veterans Suffering from Chronic Pain Tan, Gabriel, Dao, Tam K., Smith, Donna L., Robinson, Andrew and Jensen, Mark P. Incorporating complementary and alternative medicine (CAM) therapies to expand psychological services to veterans suffering from chronic pain. Psychological Services. 2010; 7(3):148–161. This article describes the results of expanding psychological services for veterans being seen in an interdisciplinary pain management program to include 5 choices of complementary and alternative medicine (CAM) approaches at the Michael E. DeBakey Veterans Affairs Medical Center Pain Management Program. Clinics are made available 3 times a week for an hour each on a drop-in-as-needed basis (without the need to make appointment) making it more convenient and accessible to the veterans. The CAM choices were cranial electrotherapy stimulation (CES) using the Alpha-Stim (AS) medical device, 3 biofeedback devices: Stress Eraser (SE), EmWave (EM), Respirate (RR) or an audio-visual entrainment device called the David Pal. 32 veterans participated during the review period. Each veteran could choose from among the 5 CAM modalities and switch to another at any time, however, a large majority (73%) of veterans chose to use AS, followed by SE (11%) down to 4% for the David PAL. Approximately 3 months of pretreatment data was compared with 3 months post treatment data. The vets were asked to complete a self-monitoring form indicating self reported pain ratings and other benefits including sleep, anxiety, depression, and sense of well being before and after the session as well as similar benefits since the last session. Other outcome measures were from 4 assessments: PHQ-2, OASIS, MOS SPI-I, MHI-5.The benefits observed following the introduction of CAM therapies included: improved attendance and veterans’ involvement in group-based therapies, reductions in reported pain and anxiety, improved sleep, and an increased sense of emotional well being in the participants.Attendance32 Veterans participated during the review period, resulting in a total of 197 visits to one or more of the 32 CAM groups offered from 03–01-2009 to 05–22-2009. Among the 5 CAM portable devices made available to the Veterans (the option of switching devices between sessions was permitted), a majority opted for the AS (73%), followed by 11% for the SE, 6% for the EW, 6% for the RR, and 4% for the AVS. The average number of Veterans who attended each CAM group session was significantly higher than the average number attending Pre-CAM groups: CAM average 6.16 (SD = 1.99; range, 2 to 9); Pre-CAM average 2.97 (SD = 1.49; range, 1 to 7); [two-sample t test, t(63) = -7.303, p <.001].Pain ReductionA paired t test indicated an average decrease of 1.02 units (SD =1.10) on the 0–10 Numerical Rating Scale of pain intensity during the study period, which was statistically significant t(196) = -12.99, p <.001, and represented a large effect size of .93.Benefits Reported From Session MonitoringVeterans reported substantial “improvements since last session” especially in pain and sense of well-being (73% and 74%, respectively). “Yes” responses to progress (improvement) were also quite substantial (83% for relaxation, 77% for mood, and 80% for well-being postsession).Changes in Standardized Measures of Patient FunctioningMonthly administration of a set of 4 brief, standardized assessment tools was used as a supplement to the session rating forms to assess and monitor progress on 4 outcome domains in addition to pain intensity: anxiety, depression, sleep quality, and sense of well being. Statistical analysis was performed using SPSS version 17.0. T-tests examined changes in these additional outcome measures. Although the change scores were not statistically significant, perhaps because of the low sample size, the effect sizes for improvements in well-being, sleep, anxiety, and depression were promising (1.54, 0.73, 0.44, and 0.37, respectively).Outcome With Respect to the 3 Hypotheses TestedHypothesis 1 stated that CAM therapies would be acceptable to Veterans and feasible for clinicians to implement in a pain management program. This hypothesis was supported by results of informal retrospective review by clinicians of the ease of recruiting and enrollment (acceptability to Veterans), and ease of incorporating CAM therapies into the existing pain management program (feasibility). There was little or no obstacle in implementing such a program. The cost for acquiring the CAM devices used currently ranges from $145 for SE to $450 for AS, which is affordable for many programs, especially when considered in light of the costs of other medical equipment and devices. For example, a single nerve block injection for low back pain typically costs around $600.00, including facility and professional charges. Hypothesis 2 stated that adding CAM therapies to the program would improve attendance rates. This hypothesis was also supported. The average CAM group attendance per session was shown to be significantly higher than the average group attendance per session during the 3 months Pre-CAM period (6.20 vs. 2.97 participants per group, respectively). Hypothesis 3, which states that adding CAM therapies reduces pain intensity ratings and improves quality of life among participants, also received preliminary support by the findings. Along with acceptability, results indicate that the CAM therapies used in the MEDVAMC program show promising levels of efficacy as an alternative or additional treatment modality in a group setting. For example, the reduction in reported pain intensity among the CAM participants as a group was modest but statistically significant, with a Cohen’s d of .93. In addition to pain reduction, Veterans who participated in the CAM therapies also reported improvements in a number of quality of life measures. Specifically, the Veterans reported an average improvement (at the end of each session) as follows: 83% for “relaxation,” 77% for “mood,” and 80% for “well being.” When asked to rate “improvement since last session” of treatment across a variety of symptoms, a sizable portion of the participants answered “yes,” especially with respect to pain and sense of well being (73 and 74%, respectively). When standardized assessment tools were used as a supplement to the session rating forms to examine differences in scores between assessment periods 1 and 3 (roughly 2 months apart), the results indicated that, although the change scores were not statistically significant, perhaps due to the small sample size, the effect sizes for improvements in well-being, sleep, anxiety, and depression were promising (1.54, 0.73, 0.44, and 0.37, respectively). Clearly, the Veterans who received the CAM treatments felt that these treatments were beneficial and helpful.These findings indicate that the CAM therapies could be easily incorporated into a traditional pain management program. Perhaps the greatest potential benefits of the CAM therapies presented in this paper lies in the observation that the CES and the SE could potentially be used as a form of self management which could be combined with other psychological interventions such as CBT. Furthermore, these devices are relatively inexpensive, require minimal training to use and could be self-administered at home by the veterans without having had to come into the VA. Given the observation that veterans require very minimal instruction to use the devices, the CAM modalities could probably be used to provide self treatment at home; thus increasing the accessibility of effective treatment to those residing in rural settings or where the cost of frequent traveling to the VA is an obstacle. Finally, unlike other psychological treatments, the CAM modalities appear to have minimal stigma and have more face validity to the veterans. This is a particularly notable for the OEF/OIF vets who have shown very high no-show rates and avoidance of mental health type of treatment for which psychological services are identified as indicated. ### Effect of transcutaneous electrical nerve stimulation for controlling pain associated with orthodontic tooth movement Effect of transcutaneous electrical nerve stimulation for controlling pain associated with orthodontic tooth movement. Roth, Peter M, & Thrash, William J. Effect of transcutaneous electrical nerve stimulation for controlling pain associated with orthodontic tooth movement. American Journal of Orthodontics. 1986; 90(2):132-138. 45 adult subjects, 27 men and 18 women, between 22 and 41 years old (mean of 28 years) were randomly assigned to an Alpha-Stim (TENS) group, a placebo group, and a control group following the signing of an institutionally approved consent form at Baylor College of Dentistry in Dallas, Texas. They were further subdivided into 18 seconds intraoral stimulation of 50 µA at 0.5 Hz, and 20 minutes of extraoral stimulation of 500 µA at 0.5 Hz, and 1, 2, and 3 day treatment duration groups. In each subject Unitek S-1 elastic orthodontic separators were placed mesial and distal to the upper first molars, bilaterally. Subjects were asked to rate their discomfort every 12 hours for 4 days with a 10 cm visual analogue scale (VAS) ranging from no pain to severe pain.In the control group postseparation tooth pain began between 0 and 12 hours, and lasted between 60 and 72 hours, confirming previous published reports. There was a significant interaction between treatment modality and measurement period. Those subjects receiving Alpha-Stim treatment reported significantly (P<.001) lower VAS scores than those receiving placebo at the 24, 36, and 48 hour assessment periods. The total Alpha-Stim group VAS means dropped from 14.6 at 12 hours to 6.72 at 60 hours, while the placebo means changed from 13.33 to 12.89, and the control group from 17.88 to 18.00. The effects of treatment location and applications were not significant, there was no significant effect of treatment schedule on reported pain levels as a single application of AlphaStim was shown to be effective in reducing pain for more than 48 hours and was as effective as 2 or 3 treatments. Nor was there any significant difference between the placebo and control groups at any time.The authors noted that the clinical application of their findings is significant. They describe possible mechanisms of action, many potential benefits to dental patients, and suggest that perhaps a reduction in the pain experienced during orthodontics would lead to better patient compliance.The graph shows that the one, 20 minute Alpha-Stim treatment reduced pain to the level that would be achieved in all three groups at the end of the four day rating period when all mouths were essentially healed. Though the 24 hour period ratings seemed to indicate a placebo effect from the sham treated patients when compared with the placebo controls, their was no significant difference found on testing of the means. In fact, there were no statistically significant differences in the sham treated and placebo control patients at any rating period, showing that while the actual treatment was significantly effective in eliminating peridontal pain in these patients, there was no placebo effect from the treatment condition. ### Biofeedback and Electromedicine Reduce the Cycle of Pain-Spasm-Pain in Low Back Patients Biofeedback and Electromedicine Reduce the Cycle of Pain-Spasm-Pain in Low Back Patients Zimmerman, Stephen I, & Lerner, Fred N. Biofeedback and electromedicine reduce the cycle of pain spasm pain in low back patients. Medical Electronics. June 1989; 117:108-120. Doctoral dissertation (SZ), City University Los Angeles, 284 pages, 1987. Download Article45 subjects were selected from those who responded to public notices. All were required to obtain a physician’s referral for erector spinae spasms at a level between the third and fifth lumbar vertebrae, with associated low back pain. Subjects were excluded if they were pregnant, had a history of heart disease, psychosis, diabetes, epilepsy, drug or alcohol abuse, or were on pain medications or other rehabilitative therapy during the time of the study. They were then randomly divided into 3 treatment groups of Alpha-Stim electrical stimulation and EMG biofeedback (Group I), biofeedback alone (Group II), or Alpha-Stim electrical stimulation alone (Group III). 1 subject in Group II, and 2 in Group III failed to complete the study. 20 treatments were given, twice a week for 30 minute sessions, to the remaining 42 subjects of which 26 (61.9%) were female and 16 (38.1%) were male, ranging in age from 23 to 62 years old (mean of 41.1 years). Each Group started the study with an essentially equal relevant history of approximately 16.4 months. There were no significant differences in any of the 3 groups in sex, education level, occupational level, injury site and duration of pain, or socioeconomic class. The only significant group difference was in age between Group I with a mean of 35.7 years, and Group II with a mean of 44.6 years. Measures used to assess treatment outcome were trunk mobility evaluation, Subjective Units of Disturbance (SUDS), daily pain record cards for home recording, electromyogram (EMG) microvoltage readings and pre and post-treatment Minnesota Multiphasic Personality Inventory (MMPI).All Groups improved significantly in their trunk mobility. Daily pain cards also improved across all groups, however, it was evident by the conclusion of the study that Groups I and III who received electrical stimulation noted a greater reduction in perceived pain than the biofeedback subjects in Group II. SUDS, a measure of how their physical symptoms resulted in psychological distress was measured on a 0 (no disturbance) to 100 (extreme disturbance) scale. Group I subjects demonstrated the best improvement in SUDS which were reduced from an initial mean of 89 to a final of 8.3, and Group III reported a greater improvement in SUDS than Group II. All Groups exhibited significant and equivalent reductions in their EMG after the first treatment session. All Groups also exhibited a decrease in their level of psychological distress as evidenced by changes in the MMPI. Clinically significant decrements of impairment were found to exist on 13 of 17 MMPI subscales: Lie, Faking Bad, Sophisticated Liar, Hypochondriasis, Depression, Hysteria, Psychopathic Deviant, Paranoid, Psychasthenia, Schizophrenia, Caudality, Low Back Pain, and Somatic Complaints. The findings denote a shift from individuals who present themselves, in the aggregate, as displaying clinically significant effects which connote persons who are overly sensitive towards others, with an increased emphasis upon their own symptomatology and decreased expectancy that others will be supportive and empathetic, while at the same time use physical complaints to focus attention upon themselves so as to manipulate others, towards more open and accepting individuals who experience less stressful and more adaptive patterns of functioning.The authors concluded that the results suggest that the effects of each treatment modality were cumulative, or additive to the other mode of treatment, and more effective than each procedure used alone, with the exception of EMG findings. No side negative effects were reported.The graph shows the percent improvement in pain for the biofeedback group alone, for the Alpha-Stim group alone, and for the biofeedback plus Alpha-Stim microcurrent stimulation group. It can be seen that the greatest improvement for the biofeedback group was 37%, for the Alpha-Stim group was 71% while the improvement of the combined treatment group was 89%.The graph shows the mobility gain from biofeedback alone and shows the potentiating effect of Alpha-Stim when used with biofeedback therapy. It can be seen that with 20 sessions of biofeedback, there was a 22% gain in back mobility, the group that had Alpha-Stim microcurrent stimulation gained 33%, whereas for the group that had 10 biofeedback sessions, alternated with 10 Alpha-Stim treatments, the gain in mobility was 64%.The graph shows that while biofeedback therapy reduced the patients’ perception of personal psychological distress by 39% by the end of the study the group receiving both biofeedback and Alpha-Stim microcurrent stimulation perceived an 85% drop in their level of psychological distress. ### The Effect of Variable Microcurrents on EEG Spectrum and Pain Control The Effect of Variable Microcurrents on EEG Spectrum and Pain Control Heffernan, Michael. The effect of variable microcurrents on EEG spectrum and pain control. Canadian Journal of Clinical Medicine. 1997; 4(10):4-11. 50 subjects were evaluated in this 2 part double-blind study in which the researcher proposed a model of spectral smoothing using EEG (API Neurodata system) as a measure of regeneration and pain reduction. In phase 1, 2 minute spectral averages of root mean square EEG amplitude versus frequency were compared between 2 groups: a normal group of pain free persons (N=10), and an age (40 – 65 years old, mean of 60), sex matched group of pain patients with degenerative joint disease (N=10). The pain patients had at least 8 hours of pain per day for at least 2 years, and the pain-free subjects had no pain for 2 years. Pain-free subjects produced smooth declining spectral curves (mean deviation in RMS = 0.2, P>0.1), whereas the pain group showed many irregularities, and significant “unevenness” in EEG spectral arrays (mean deviation in RMS = 2.4, P>.01). On the basis of these findings and prior research the researcher proposed using spectral smoothness as a model to evaluate the effectiveness of differing microcurrent stimulators in safely treating pain patients.In phase 2, 30 pain patients half males, half females, 30-65 years old, with at least 2 years of DJD of hip, shoulder, knee, or back, confirmed by X-ray, and unresponsive to medication, completed informed consent and were randomly assigned to 1 of 3 groups. Double blinding was achieved by placing the stimulators out of sight of both the investigator and subjects. They were each given a 5 minute test dose of stimulation from 3 differing stimulators, a 15 Hz, 500 Hz, and 15,000 Hz device (Liss Stimulator), a 0.5 Hz, random, biphasic device (Alpha-Stim), and a continuous 0.5 Hz device for control (BK Instruments). Using current limited, 500 µA stimulation bilaterally to the wrists, post stimulation spectral smoothing and pain control was found to be superior with the Alpha-Stim (deviation from normal FFT 3.1 pre to 0.4 post, P<.01). Although all 3 stimulators produced approximately a tenfold increase in RMS amplitude, the control 0.5 Hz device (deviation from normal FFT 2.7 pre to 2.6 post, P>0.1) and the Liss Stimulator (deviation from normal FFT 2.8 pre to 3.0 post, P>0.1) both produced considerable distortion from the EEG spectrum of normal, pain free subjects. Ordinal 5-point pain scales before and after stimulation showed that only the Alpha-Stim produced significant pain control with a five minute test dose 4.5 to 2.1, (P<.01), versus 4.3 to 4.5 (P>0.1) with the Liss Stimulator, and 4.6 to 4.8 (P>0.1) with the control device.The researcher discusses these findings by proposing a theory of rapid pain control from regenerative restoration of normal cellular electrical fields. This theory of rapid pain reduction by electric field restoration is then contrasted with pain control by stress induction and increased production of endorphins. Finally the researcher discusses implications of using the spectral smoothing of both EEG and body fields as a model of reversing the negative, carcinogenic effects of externally applied extremely low frequency (ELF) when used therapeutically or delivered inadvertently from human electrical power usage. No side effects were reported.NOT ALL WAVEFORMS ARE ALIKE!The following charts are modified from Heffernan, 1997. FIGURE 1: Two minute spectrum of EEG, frequency versus RMS amplitude, for a pain free normal subject. FIGURE 2: Two minute spectrum of EEG, frequency versus RMS amplitude, for a pain subject with DJD.  FIGURE 5: Two minute spectrum of EEG, frequency versus amplitude, of a subject while being treated with a 0.5 Hz, functiongenerator. Correlation Function ExplanationThe correlation function is obtained by multiplying each X(t) by X(t-tau) and summing the result over all the data points. The sum is then plotted as a function of tau. This gives a measure of how dependent data points are on their neighbors. The value of tau at which the correlation function remains small is the correlation time. ### The Effect of Microcurrent Stimulation on Postoperative Pain After Patellar Tendon Bone Anterior Cruciate Ligament Reconstruction The Effect of Microcurrent Stimulation on Postoperative Pain After Patellar Tendon Bone Anterior Cruciate Ligament Reconstruction Sizer P, Sawyer S, Brismee J, Jones K, Bruce J, Slauterbeck J. The effect of microcurrent stimulation on postoperative pain after patellar tendon-bone anterior cruciate ligament reconstruction. Presented at the American Physical Therapy Association Annual Conference and Exposition, Indianapolis, Indiana; June, 2000.PurposeThe purpose of this study was to determine the effectiveness of microcurrent electrical therapy in providing pain relief to a selected post-operative patient population.SubjectsSubjects were 19 females and 22 males (mean age of 21.1) who received arthroscopic bone-patellar tendon-bone anterior cruciate ligament (ACL) reconstruction.Methods and MaterialsSubjects were randomly assigned to one of two treatment groups (“Microcurrent” or “Placebo” Groups) in a double blind experimental design. Using a portable microcurrent device (Alpha-Stim 100 by Electromedical Products International, Inc, Mineral Wells, Texas), the Microcurrent Group received 100 microamperes of microcurrent at 0.5 Hz with a 50% duty cycle, which was below the subject’s perception threshold. The Placebo Group followed the same protocol with a placebo stimulator. All subjects were instructed to use the microcurrent unit as needed for pain relief in one-hour sessions, with at least 30 minutes between sessions. The 10 days postoperative microcurrent protocol accompanied a standardized physical therapy rehabilitation program. The subjects made daily entries into a logbook, recording frequency of microcurrent use, pain medication intake, and constant pain levels on a visual analog scale (0 to 10).Analysis and ResultsThe subjects’ pain levels (dependent variable), which decreased over time, were lower for all 10 post-operative days in the Microcurrent Group (n=25) compared to the Placebo Group (n=16). A 2 (“Treatment Group”) x 10 (“Post-Operative Time”) ANOVA (with repeated measures on “Post-Operative Time”) demonstrated a significant between-subjects main effect for the “Treatment Group” factor [F(1,39)=9.29, p=0.004], indicating that a statistically lower degree of post-operative pain was experienced by the subjects receiving microcurrent. In addition, a significant within-subjects main effect for the “Post-Operative Time” factor ([F(9,9)=18.672, p<0.0001]) was obtained.ConclusionThese results indicate that Alpha-Stim microcurrent electrical therapy is beneficial for post-operative pain control after ACL reconstruction. ### Treating Spinal Cord Injury Pain with Cranial Electrotherapy Stimulation Treating Spinal Cord Injury Pain with Cranial Electrotherapy Stimulation Tan, G., Rintala, D., Herrington, R., Yang, J., Wade, W., Vasilev, C. and Shanti, B.F. Treating spinal cord injury pain with cranial electrotherapy stimulation. Journal of Spinal Cord Medicine. 2003; 26(3). Poster presented at the Annual Meeting of the American Paraplegia Society, Las Vegas, Nevada, September 2-4, 2003. A double–blind, sham-controlled, pilot study was undertaken in which 38 veterans at the VA Medical Center in Houston, Texas with spinal cord injuries (SCI) with neuropathic or musculoskeletal pain were randomly assigned to either a treatment (n = 18) or a control group (n = 20). They were trained to self-administer Alpha-Stim CES treatment in the comfort of their home. The treatment group received one hour per day of 100 microampere sub-sensation CES for a total of three consecutive weeks (21 days).  The control group received sham CES for the same amount of time.  After completion of the treatment, participants in the control group were offered an open label use of the device for 21 days. They again completed pain ratings before and after each daily session. The average change in pain on a scale from 0 to 10 from before to after each session across the 21 days was .73 for the active CES treatment group and .08 for the sham treatment group (Figures 1 and 2). This was a significant difference (t separate = 2.27, p < .034, effect size = .135). In separate t-tests, there was a significant difference between the before-session and after-session pain ratings for the active treatment group (mean before = 6.46, mean after = 5.73, t = 2.69, p< .016), but the difference between the before and after ratings for the sham treatment group was not significant (mean before = 6.08, mean after = 6.00, t = 0.98, p< .337).Furthermore, when 17 participants from the group that originally had the sham treatment, participated in the subsequent open-label phase (3 people declined the open-label phase), there was a significant difference between the before and after ratings (Figure 3, mean before = 5.97, mean after = 5.51, t = 3.47, p< .003).The participants in both groups also completed the Brief Pain Inventory before and after the 21-day treatment phase. The group who received the active CES treatment reported significantly less interference in activities due to pain after completing the intervention compared with prior to the intervention (Figure 4, t = 3.31, p < .004). There was no significant change in pain interference for the group who received sham CES (t = 1.22, p < .238).Based on both reported pain reductions pre and post each session as well as pre and post the full series of treatments, Alpha-Stim CES treatment was found to be significantly more efficacious than the sham treatment with a moderate to large effect size. The findings also indicate significant reduction in pain interference and catastrophizing after CES treatment.Figures 1, 2, and 3: Daily Pain Rating for Active CES and Sham CES Groups  ### The effect of cranial electrotherapy stimulation (CES) on pain associated with fibromyalgia The Effect of Cranial Electrotherapy Stimulation (CES) on Pain Associated with Fibromyalgia Cork, Randall C., Wood, Patrick, Ming, Norbert, Shepherd, Clifton, Eddy, James, Price, Larry. The effect of cranial electrotherapy stimulation (CES) on pain associated with fibromyalgia. The Internet Journal of Anesthesiology.  2004; 8(2).DeviceAlpha-Stim®Key VariableAnxietyObjectiveTo evaluate the effect of a specified treatment course with CES on fibromyalgia patients’ anxiety, pain, tender point scores, and functional impairment when compared to sham treatment under the same experimental conditions in subjects meeting the inclusion and exclusion criteria. The findings for the variable of anxiety are discussed in this abstract.DesignAn IRB approved 6 week study that included a 3 week randomized, sham treatment controlled clinical trial arm followed by a 3-week open label arm in which subjects in the sham group participated in a treatment course of CES. The investigators used the Alpha-Stim double-blind, sham-controlled RCT protocol for this study.Primary Effectiveness Endpoint: AnxietyThe primary effectiveness endpoint for anxiety in the Phase I RCT was the change from baseline in the last post-treatment scores on the Profile of Mood States (POMS) compared to the sham treatment group at the end of week 3 of the study. The primary effectiveness endpoint for anxiety in the Phase II open label arm was the change from baseline in the last post-treatment scores on the POMS to post-test at the end of week 6 of the study.Other effectiveness outcome measures were measured at the end of week 3 of the study and included both clinician rated and patient rated outcome measures. The following clinician rated measures was included: Tender point score evaluation. The following patient rated measures were included: McGill Pain Questionnaire (SF-MPQ), and Oswestry Score for functional impairment from pain.Key Inclusion Criteria• Male and female subjects with fibromyalgia ranging from 22 – 75 years of age.• Diagnosis of fibromyalgia was verified by a physician pain specialist using the criteria of the American College of Rheumatology Criteria for the Classification of Fibromyalgia (Wolfe et al., 1990).Key Exclusion Criteria• Pregnancy.• Presence of implanted pacemakers, pumps or stimulators.• Superficial or internal ear infections.Protocol SummaryRandomization assignment was established prior to the start of the study by the manufacturer of Alpha-Stim® CES devices. Evaluations of primary effectiveness endpoint and secondary outcome measures were taken at baseline prior to the start of the treatment period. No change was made in the medical management of the patients during the study. The protocol consisted of 2 phases:• Phase I: 3 weeks of treatment with either the active CES device or the sham device.Following the baseline tests, subjects were taught to use the CES device, and were instructed to use it every day for 1 hour over the 3 week period. At the end of 3 weeks, the subjects returned to the clinic, and primary and secondary outcome measures were repeated.• Phase II: After the blinding was broken subjects in the sham group were given the option to receive active CES for 3 weeks. Those that elected to do so returned to the clinic after the 3 week period and were retested.Device Application SummaryThe active CES device was pre-set and locked by the manufacturer at 100 µA which is a subsensory level. The sham CES device was pre-set and locked by the manufacturer so that it did not emit electricity. The length of treatment, 60 minutes, was also pre-set and locked by the manufacturer for both active and sham devices. The sham device was identical in appearance to the active CES unit, but did not conduct an electrical current. The devices were randomized by the manufacturer and then packed in a device box in the order they should be given to subjects.Study BlindingThe subjects, investigators, physicians and staff were all masked to the identity of the devicesOutcome MeasuresThe Profile of Mood States (POMS) was used to measure anxiety. The POMS has established reliability and validity (McNair et al., 2014).ResultsSubjectsA total of 74 subjects were enrolled, 70 females and 4 men ranging in age from 22 – 75 (M = 53) years of age. The average duration of symptoms was 7.3 years (range 1 -21 years). Subjects were randomized to the active CES group (N=39) or sham group (N=35).Baseline MeasurementsThere were no statistically significant differences at baseline between active CES and sham treatment groups for any of the outcome measures.Data AnalysisData were analyzed with repeated measures analysis of variance, with least significant difference a posteriori testing in both Phase I and Phase II of the study.Phase I RCT Effectiveness Results: Week 3Seventy-four (74) subjects, 39 active CES and 35 Sham, completed the testing at the completion of week 3 visit. The active CES group had significantly decreased anxiety scores, tender points and pain compared to sham group. There was no significant difference between groups on pain as measured by the McGill Pain Questionnaire, or functional impairment. Table 1 shows results of statistical analyses of all outcome measures.Outcome VariablesScaleP ValuesAnxietyPOMSP < 0.01Pain Intensity (NRS)NRSP < 0.01Tender Point ScoreTender Point ScoreP < 0.01Pain SF-MPQSF-MPQn.s.Functional ImpairmentOswestry Scoren.s.Table 1. P-Values for Comparison Between Active and Sham Treatment Means Changesfrom Baseline to Week 3Phase II Open Label Effectiveness Results: 6 WeeksData were analyzed with repeated measures analysis of variance, with least significant difference a posteriori testing. Table 2 shows results of statistical analyses of outcome measures at week 6. Figure 1 shows patient mood as measured by the POMS where higher scores represent more anxiety. Outcome VariablesScaleP ValuesAnxietyPOMSP < 0.001Pain IntensityNRSP < 0.001PainSF-MPQP < 0.001Tender Point ScoreTender Point ScoreP < 0.001Functional ImpairmentOswestry Scoren.s.Table 2. P-Values for Changes from Baseline within CES Open Label Group at week 6 Figure 1. Patient mood as measured by the Profile of Mood States (POMS). A higher score represents more anxiety. The anxiety reported by the CES group after 3 weeks of CES was significantly less than the anxiety reported by the sham group after 3 weeks of sham treatment (p<0.01). After crossover and 3 weeks of subsequent CES treatment, the sham group reported a significant decrease in anxiety levels from their baseline scores (p<0.001).Quality of the ResearchStrength of this study are; use of a double-blind, sham controlled RCT design; the active and sham devices were preset for time and current level, and the sham CES device was identical to the active CES device except they did not emit electricity; the study was adequately powered with an N of 74, based on the research on the effect sizes for CES for treatment of anxiety. This 2004 study measured general anxiety using the POMS scale which was commonly used at that time and has established clinical and research utility in the literature. Today, a more likely choice by investigators would be the Hamilton Anxiety Rating Scale or other similar anxiety scale. The significant finding for anxiety in this study is consistent with findings from other CES RCTs that showed CES significantly decreases anxiety.Author AffiliationRCC, Professor and Chair Director, Pain Management, Department of AnesthesiologyLouisiana State University School of Medicine in Shreveport, LSUHSC, LA.ReferencesMcNair DM, Lorr M, Droppleman LF. Profile of Mood States 2nd Editon (POMS 2™). JvR Psychometrics, Accessed on 4/18/2014, http://www.psychologyafrica.com/wp-content/uploads/2013/07/Profile_of_Mood_States_2nd_Edition.pdfWolfe, et al. American College of Rheumatology Criteria for the Classification of Fibromyalgia: Report of the Multicenter Criteria Committee. Arthritis Rheum, 33:160-172, 1990.  ### Feasibility of using cranial electrotherapy stimulation for pain in persons with Parkinson’s disease Feasibility of Using Cranial Electrotherapy Stimulation for Pain in Persons with Parkinson’s Disease Rintala, Diana H., Tan, Gabriel, Willson, Pamela , Bryant, Mon S., and Lai, Eugene C. H. Feasibility of using cranial electrotherapy stimulation for pain in persons with parkinson’s disease. Parkinson’s Disease. 2010. 8 pages. Objectives To assess the feasibility of treating musculoskeletal pain in the lower back and/or lower extremities in persons with Parkinson’s disease (PD) with cranial electrotherapy stimulation (CES). Design Randomized, controlled, double-blind trial. Setting. Veterans Affairs Medical Center, Community. Participants Nineteen persons with PD and pain in the lower back and/or lower extremities. Thirteen provided daily pain rating data. Intervention Of the thirteen participants who provided daily pain data, 6 were randomly provided with active CES devices and 7 with sham devices to use at home 40 minutes per day for six weeks. They recorded their pain ratings on a 0-to-10 scale immediately before and after each session. Main Outcome Measure Average daily change in pain intensity. Results Persons receiving active CES had, on average, a 1.14-point decrease in pain compared with a 0.23-point decrease for those receiving sham CES (Wilcoxon Z=-2.20, P=.028). Conclusion Use of CES at home by persons with PD is feasible and may be somewhat helpful in decreasing pain. A larger study is needed to determine the characteristics of persons who may experience meaningful pain reduction with CES. Guidelines for future studies are provided. ### 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 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 Tan, Gabriel, Rintala, Diana, Jensen, Mark P., Richards, J. Scott, Holmes, Sally Ann, Parachuri, Rama, Lashgari-Saegh, Shamsi and Price, Larry R. 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. The Journal of Spinal Cord Medicine. 2011; 34(3):285-296. 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. Alpha-Stim 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. The objective of this study was to explore the effectiveness of CES for neuropathic pain in persons with SCI and chronic pain in a multi-site, double-blind, sham-controlled format conducted at 4 Veterans and one civilian hospital. Adults with SCI and chronic neuropathic pain at orbelow the level of injury were randomized to receive active or sham CES 1 hour daily for 21 days. A six-month open-label phase was added to assess ‘as-needed’ CES use.Assessments were made of changes 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. ### A randomized, controlled, double-blind pilot study of the effects of cranial electrical stimulation on activity in brain pain processing regions in individuals with fibromyalgia A randomized, controlled, double-blind pilot study of the effects of cranial electrical stimulation on activity in brain pain processing regions in individuals with fibromyalgia Taylor, Ann Gill, Anderson, Joel G., Riedel, Shannon L., Lewis, Janet E. and Bourguignon, Cheryl. A randomized, controlled, double-blind pilot study of the effects of cranial electrical stimulation on activity in brain pain processing regions in individuals with fibromyalgia. Explore. 2013; 9(1):32-40. ObjectiveTo investigate the effects of microcurrent cranial electrical stimulation (CES) therapy on activity in pain processing brain regions.DesignA randomized, controlled, three-group, double-blind pilot study.ParticipantsPersons with physician-diagnosed fibromyalgia.InterventionActive CES device, sham device, and usual care alone.ResultsThose individuals using the active device had a greater decrease in average pain (P = .023) than individuals using the sham device or receiving usual care alone over time. Preliminary analyses of the functional magnetic resonance imaging data on a subset of six participants from each of the two device groups show that individuals using an active CES device had a decrease in activation in the pain processing regions of the brain compared to those using a sham device.ConclusionsThe observed decrease in activation in the pain processing regions may indicate a decrease in neural activity in these regions that may be related to decreased pain. This is the first randomized, controlled trial of CES in patients diagnosed with fibromyalgia to report functional magnetic resonance imaging data.  ### Reducing sheriff’s officers’ symptoms of depression using cranial electrotherapy stimulation (CES): a control experimental study. Reducing Sheriff’s Officers’ Symptoms of Depression Using Cranial Electrotherapy Stimulation (CES): A control experimental study Mellen, Ronald R. and Mackey, Wade. Reducing sheriff’s officers’ symptoms of depression using cranial electrotherapy stimulation (CES): a control experimental study. The Correctional Psychologist. 2009; 41(1):9-15. DeviceAlpha-Stim®Key VariablesDepression, AnxietyObjectiveTo evaluate the effect of a specified treatment course with CES on sheriff officers’ depression and anxiety when compared to sham treatment under the same experimental conditions in subjects meeting the inclusion and exclusion criteria.DesignAn IRB approved 3 week randomized, sham treatment controlled, double-blind clinical trial. The sham device was identical in appearance to the active CES device, but did not conduct an electrical current. The active CES device was set to 100 µA, a subsensory level. The subjects and investigators were masked to the identity of the device.Primary Effectiveness EndpointsThe primary effectiveness endpoint was the change from baseline in the last post-treatment scores on the outcome depression measures (BDI and BSI-D) and anxiety measures (BAI and BSI-A) compared to the sham treatment group at the endpoint of the study.Key Inclusion Criteria• Officers from the Sheriff’s staff ≥ 21 years of age.Key Exclusion Criteria• Pregnancy.• Presence of implanted pacemakers, pumps or stimulators.Protocol SummaryRandomization assignment was established prior to the start of the study. Evaluations of primary effectiveness endpoint measures were taken at baseline 2 days before treatment began. Post-assessment were taken the week following each subject’s final treatment. Following the baseline tests, subjects were taught to use the CES devices and were instructed to do a CES treatment for 20 minutes daily for 20 days. While doing a CES treatment, subjects went about their daily tasks.Device Application ProtocolThe active CES device was pre-set and locked by the manufacturer at 100 µA which is a subsensory level. The sham CES device was pre-set and locked by the manufacturer so that it did not emit electricity. The length of CES treatments was also pre-set and locked by the manufacturer for both the active and sham devices.Study BlindingThe subjects, investigators and staff were masked to the identity of the devices.Outcome MeasuresThe Beck Anxiety Inventory was used to measure anxiety (Beck et al, 1988a) and the Beck Depression Inventory was used to measure depression (Beck et al., 1988b). Both scales have established reliability and validity. The Brief Symptom Inventory Anxiety Subscale and the Brief Symptom Inventory Depression Subscale were also used to measure anxiety and depression. The Brief Symptom Inventory has established reliability and validity (Meachen et al., 2008).ResultsSubjectsA total of 21 subjects completed the study, 10 females and 11 males.Data AnalysisData were analyzed using the independent-samples t-test to compare the difference between the active CES and sham groups on depression and anxiety scores.DepressionThe active CES group had significantly lower depression scores on the BDI (p<0.05) and the BSI-D (p< 0.01) than the sham group.AnxietyThere was no significant difference on anxiety scores between the active CES and sham group. The unexpected non-significant result for anxiety is most likely due to a protocol deviation. Because of a heavy workload for subjects who were parole officers, outcome measurement of state (situational) anxiety and depression were rescheduled and done one week after the final CES treatment. While the findings for depression were stable and remained significant, post-test evaluations for state anxiety should have been done immediately after the completion of the last CES treatment as state anxiety varies depending on the immediate situation. This is the most likely reason for the non-significant anxiety findings taken one week after the final CES treatment. Table 1 shows the results of statistical analyses of the outcome measures. Outcome VariablesScaleP ValuesDepressionBeck Depression InventoryP < 0.01DepressionBrief Symptom Inventory- Depression SubscaleP < 0.05AnxietyBeck Anxiety Inventoryn.s.AnxietyBrief Symptom Inventory- Anxiety Subscalen.s.Table 1. P-Values for Comparison of Active CES and Sham groups on depression and anxiety outcome measures.Quality of the ResearchStrength of this study are: the Alpha-Stim double-blind, sham controlled RCT protocol was used; and active CES devices were set at the subsensory level of 100 µA and sham CES devices set so they did not emit electricity. The CES devices were pre-set to these specifications by the manufacturer. Limitations of the study are: the small N; and endpoint measures were not taken as scheduled in the protocol but rather one week after the final CES treatment because of an unexpected heavy workload that interfered with the clinical trial. Change in depression was stable and significant, but change in state anxiety was non-significant. Since state anxiety changes from moment to moment with the situation, the deviation from the Alpha-Stim CES protocol in the measurement of anxiety one week later as opposed to right after the last CES treatment most likely accounts for the non-significant findings for anxiety.Author AffiliationsRRM, Associate Professor, Department of Criminal Justice, Jackson State University, Jackson, AL. WM, Visiting Professor, Department of Criminal Justice, Jackson State University, Jackson, AL.ReferencesBeck, Aaron T.; Epstein, Norman; Brown, Gary; Steer, Robert A. An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 1988a, 56(6), 893-897.Beck AT, Steer RA, Garbin MG. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 1988b, 8(1), 77-100.Meachen SJ, Hanks RA, Millis SR, Rapport LJ. The reliability and validity of the brief symptom inventory-18 in persons with traumatic brain injury. Archives of Physical Medicine and Rehabilitation. 2008 May;89(5):958-65. ### The effects of cranial electrotherapy stimulation therapy combined with psychological intervention in treating post-stroke depression The Effects of Cranial Electrotherapy Stimulation Therapy Combined with Psychological Intervention in Treating Post-stroke Depression Wang, X., Xia, P., Lin, Q., Cheng, K., Chen, A., Yang, T., & Xueping, L. I. The effects of cranial electrotherapy stimulation therapy combined with psychological intervention in treating post-stroke depression. Chinese Journal of Physical Medicine and Rehabilitation. 2015; 37(9):680-682.Funding Source, Location of Study, or Author’s AffiliationDepartment of Rehabilitation, Nanjing Hospital Affiliated with Nanjing Medical University, Nanjing, ChinaDevice Alpha-Stim®Key VariablesDepressionObjectiveTo evaluate the effects of cranial electrotherapy stimulation therapy combined with psychological intervention for treating depression alter cerebral infarction.DesignEighty (80) patients diagnosed with depression following a cerebral infarction, referred to as Post-Stroke Depression (PSD) were randomly allocated into two groups. Both groups were given routine rehabilitation training and psychological intervention [Treatment As Usual (TAU)], and the experimental group received TAU and Cranial Electrotherapy Stimulation (CES). All patients were evaluated with Hamilton’s depression scale (HAM-D), the mini-mental state examination (MMSE), and the Barthel index (BI) scores before and after four weeks of treatment.Primary Outcome MeasureDepression as measured by the Hamilton Depression Rating Scale (HAM-D) which has a maximum score of 52, with 0-7 (no depression); 8-16 (mild depression); 17-23 (moderate depression); and ≥24 (severe depression).Secondary Outcome MeasureCognitive impairment as measured by the Mini-Mental State Examination (MMSE) which has a total score of 30, with 27-30 indicative of normal cognition and a score of <27 indicative of cognitive impairment.Activities of daily living (ADLs) as measured by the Barthel index (BI) which has a total score was 100, with >60 indicative of independence (Good with basic self-help ability), 40-60 mildly dependent (Moderate dysfunction needing some help with ADLs, 20-40 suggestive of severe dependency (Clear and obvious dependence on others), and <20 representing total disability (Complete and total dependence on others).Key Inclusion CriteriaClinical diagnosis criteria specified in Classification and Diagnostic Criteria of Mental Disorders in China Edition 3 issued by Chinese Medical Association Psychiatric SocietyFirst attack of Post-Stroke Depression (PSD)Hamilton Depression Scale (HAM-D) ≥18Cerebral infarction confirmed by Computed Tomography (CT) or Magnetic Resonance Imagery (MRI)Able to cooperate with physical examination and provide informed consentKey Exclusion CriteriaOther pre-existing psychiatric disorders, including depressionPsychoactive drug substancesSevere systematic illnessEpilepsySignificant cognitive impairment, inclusive of dementia, aphasia, or deliriumProtocol SummaryEighty patients diagnosed with depression following a cerebral infarction, referred to as Post-Stroke Depression (PSD) were randomly allocated into two groups. Both groups were given routine rehabilitation training and psychological intervention [Treatment As Usual (TAU)], and the experimental group received TAU and Cranial Electrotherapy Stimulation (CES). All patients were evaluated with Hamilton’s depression scale (HAMD), the mini-mental state examination (MMSE), and the Barthel index (BI) scores before and after four weeks of treatment.Control group: The TAU group received psychosocial skills training tailored to the patients’ socioeconomic background and educational level focused on improving face-to-face communication. The medical care team were encouraged to provide a supportive and caring environment to patients. Nursing staff provided easily accessible information regarding the etiology, risk factors, main symptoms, general course of the disease, therapeutic methods and prognosis-related factors, etc. of cerebral infarction. Patients were given opportunities one-on-one aimed at relieving the psychological distress associated with a cerebral infarction, and any confusion, pessimism, or disappointment they may be feeling. With the care team reminding patients of the progress they were making in their recovery and providing words of encouragement. Patients were given the opportunity to have family members join them in the psychosocial skills training they received.Experimental group: The active condition received the same psychosocial skills training and supportive environment as the TAU group. In addition, patients received CES using Alpha-Stim for 60 minutes twice daily during the first two weeks, and for 60 minutes daily every two days for the remaining two weeks.Device Application ProtocolAlpha-Stim CES was administered in a supine position at 0.5 Hz and 10-500 μA for 60 minutes. A standard course of treatment was four weeks. In the first two weeks, CES was given twice a day for 60 minutes; and in the second two weeks once every two days for 60 minutes.Statistical Analysis PlanSPSS 17.0 statistical software package was used for data processing. The measurement data were compared through t-test, and the enumeration data were compared through χ2 test, with p<0.05 indicating a statistically significant difference.MoodThe comparison of the therapeutic effect of TAU in comparison to TAU+CES on depression symptoms was analyzed by comparing pre and post HAM-D scores.The reduction rate of HAM-D scores before and after treatment was taken as the evaluation criteria.A reduction rate of HAM-D score = [(HAM-D score before treatment -HAM-D score after treatment)/HAM-D score before treatment] x 100%, in which ≥75% indicated Cured, ≥50% Markedly Effective, ≥25% Effective, and <25% Ineffective.CognitionVariations in the MMSE score pre and post-treatment across the two groups were used to evaluate any changes to cognitive impairment.IndependenceThe BI score was used to evaluate changes to the number of ADLs that patients were able to do before and after treatment.ResultsSubjectsA total of 80 patients were randomly assigned to the control group (TAU) and the experimental group (TAU+CES), with 40 patients in each group. There was no statistically significant difference between the two groups in terms of gender, average age, level of education, average course of the disease, and other general data, etc. (p>0.05) were comparable.In the treatment group (TAU+CES), there were 19 males and 21 females aged between 40-82 years old, with mean (SD) age of 56.63±9.71 years and mean (SD) of 10.44±2.72 years of education, and a mean (SD) course of disease of 2.93±1.69 months. In the experimental group, 18 cases were diagnosed with left hemiplegia and 22 cases with right hemiplegia.In the control group (TAU), 17 males and 23 females were enrolled, aged between 39-82 years, with a mean (SD) age of 57.15±9.75 years, mean (SD) education 10.26±2.41 years, and mean (SD) course of disease of 2.94±1.37 months. In the control condition, 24 cases of left hemiplegia and 16 cases of right hemiplegia were enrolled.Data AnalysisBefore treatment, the differences in HAM-D, MMSE, and BI scores between the two groups were not statistically significant (p>0.05). After 4 weeks of treatment, HAM-D, MMSE, and BI scores of both groups were improved in comparison to those before treatment. The reduction in depression, improved cognition, and greater independence as evidenced by HAM-D, MMSE, and BI scores in the TAU+CES group showed were superior to those in the control group, with statistically significant difference (p<0.05).During treatment, no adverse reactions were found in the two groups. After four weeks of treatment, the total marked effective rate of treatment was higher in the CES+TAU group than the TAU group (p<0.05).Change in mean HAM-D Score pre and post-treatment for the control (TAU) and experimental (TAU+CES) conditionChange in mean MMSE Score pre and post-treatment for the control (TAU) and experimental (TAU+CES) condition.Change in mean BI Score pre and post-treatment.ConclusionThere was no significant difference between the two groups in terms of any of the measures before treatment. After four weeks of treatment, both groups had improved significantly, but the improvements on all measures were significantly better in the treatment group. CES combined with psychosocial skills training significantly reduced symptoms of depression and increased cognitive function in patients with PSD, resulting in significant improvements to the patients’ independence and ADL. The authors conclude that CES stimulates the release of endorphins, in addition to stimulation the release and reabsorption of dopamine, concurrently addressing any imbalance between the adrenergic and cholinergic.LimitationsWhile this study was a randomized controlled trial, it was not double-blind. Therefore, both participants and investigators were aware of assigned intervention category. Additionally, the authors do not mention their procedures for missing data. According to the Cochrane risk-of-bias tool, each of these conditions can introduce unintended bias into a study.Study Quality: FAIR ### Comparative Observation between Single Use of Fluoxetine and Its Combination with CES Comparative Observation between Single Use of Fluoxetine & Its Combination with CES Luo, H-D, Luo, H-L., Hong, L-F Comparative Observation between Single Use of Fluoxetine and Its Combination with CES. Chin J Mod Drug Appl. 2015; 9(7). Funding Source, Location of Study, or Author’s Affiliation Meizhou City People’s Hospital, Meizhou, China Device Alpha-Stim® Key Variables Depression Objective Compare the clinical effect of fluoxetine combined with Cranial Electrotherapy Stimulation (CES) in the treatment of depression. Design A total of 90 patients diagnosed with depression were randomly divided into two treatment groups (1) experimental (fluoxetine combined with CES), and (2) control group (fluoxetine only). Each group contained 45 cases. After four weeks of treatment and using the Hamilton Depression Rating Scale (HAM-D) and Treatment Emergent Symptom Scale (TESS) the impact of the treatment conditions were evaluated for efficacy, speed of response, any adverse reactions. Primary Outcome Measure Measures were taken at baseline, two weeks, and four weeks post-treatment Change is depression scores as measured by HAM-D Assessment of side effect profile and treatment response as measured by TESS Secondary Outcome Measure Routine assessment at baseline, end of weeks: 1, 2, 3, 4, and post-treatment of Blood Urine Stool Liver function Electrocardiogram (ECG) Electroencephalogram (EEG) Key Inclusion Criteria Depression diagnosis as specified in Chinese Classification and Diagnostic Criteria of Mental Disorders, Edition 3 (CCMD-3) A total score of 17 items on the HAMD ≥18 Discontinuation of all medications Willingness to be treated with 20mg of fluoxetine daily, increasing to 30mg daily No additional psychiatric disorders Absence of significant Cognitive or intellectual impairment Communication or comprehension difficulties inclusive of aphasia Key Exclusion Criteria Severe heart, liver, or kidney disease Epilepsy Glaucoma Protocol Summary Discontinuation of all medications with a wash-out period of 1 week, and random allocation into two groups of 45. Control group received Treatment As Usual (TAU) which consisted of fluoxetine 20mg daily after breakfast, increased to 30mg/d within two weeks until the end of four weeks. Experimental group received fluoxetine (TAU) in addition to CES, twice daily for 30 minutes for three weeks, and then once daily every two days until the end of week 4. During the treatment, patients could also take Inderal, Vitamin B6, or a small dose of benzodiazepines based on their conditions. Routine blood, urine, stool, and liver function tests were performed, in addition to ECG and EEG before treatment and at the end of weeks 1, 2, 3, and 4 of treatment. Device Application Protocol Treatment time for CES using Alpha-Stim was 30 minutes two times per day for the first three weeks and one treatment every two days for the final week. The course of treatment was four weeks. Statistical Analysis Plan Statistical analysis using SPSS18.0 statistical software, with measurement data expressed with mean ± standard deviation (SD) and tested by t-test. Data were expressed with rate (%) and were tested by χ2 test. A significance level of p<0.05 indicated a statistically significant difference. Change in HAM-D was used to evaluate the degree of depression and TESS to calculate any side effects at baseline, end of two and four weeks. The clinical effect of fluoxetine and fluoxetine + CES was categorized into four levels from highly effective to not effective. The treatment response as measured by the TESS scale was arranged as (1) ≥75% indicating clinical recovery, (20) ≥50% indicating significant improvement, (3) ≥25% indicating improvement, and (4) <25% indicating no effect. A reduction of HAM-D scores from baseline was indicative of efficacy and the final HAM-D score was categorized as (1) ≤7 indicating no depression, (2) 8-17 indicating mild depression, (3) 18-23 indicating moderate depression, and (4)  ≥24 indicating severe depression. Results Subjects Total of 90 patients in two groups of 45 patients. The TAU+CES group included 23 males and 22 females with a mean (SD) age of 31.3±5.6 years and a mean (SD) course of disease of 3.56±3.3 months. In comparison, the TAU group included 21 males and 24 females with a mean (SD) age of 32.2±4.4 years and a mean (SD) course of disease of 3.21±4.2 months. The two groups were comparable as no significant differences at baseline were reported (p>0.05). Data Analysis After two weeks of treatment, the TAU+CES condition showed mean (SD) HAM-D scores of 15.4±3.56 and 19.5±3.14 for the TAU. The reduction in scores was a statistically significant difference between the two groups at the end of two weeks of treatment (p<0.05) in favor of TAU+CES. At week 4 post-treatment the mean (SD) HAM-D score in the TAU+CES group was 10.3±3.23 and 10.2±3.15 in the TAU condition. No statistically significant difference between the two conditions were observed at the end of four weeks of treatment. The TAU+CES mean (SD) HAM-D score at baseline was 25.3±4.10 and 26.4±3.52 in the TAU group were not significantly different.  Both conditions showed significant reductions in HAM-D scores from baseline to end of treatment (p<0.05). No significant differences were reported in the speed of response as measured by TESS scores between the two groups from baseline to end of treatment. Mean Change in HAM-D score at baseline and 4 weeks post-treatment. Conclusion  The authors reported that fluoxetine combined with CES for the treatment of depression resulted in a faster treatment response and yielded a superior therapeutic effect. The authors also concluded and recommended using CES as an augmentation strategy in the pharmacological treatment of depression. Summarizing that CES + fluoxetine reduces the duration of depression symptoms, improves treatment compliance, and limits the adverse effects of depression to patients and their families. No adverse effects were reported by combining fluoxetine with CES that were not expected by single-use fluoxetine. Limitations While this study was a randomized controlled trial, it was not double-blind. Therefore, both participants and investigators were aware of assigned intervention category. Additionally, the authors do not mention their procedures for missing data. According to the Cochrane risk-of-bias tool, each of these conditions can introduce unintended bias into a study. Study Quality: FAIR ### Effect of CES combined with escitalopram on quality of life and activities of daily living of patients with depression after cerebral infarction Effect of CES Combined with Escitalopram on Quality of Life and Activities of Daily Living of Patients with Depression After Cerebral Infarction Lyu, X. Effect of CES combined with escitalopram on quality of life and activities of daily living of patients with depression after cerebral infarction. Chinese Journal of Practical Nervous Diseases, 21(22), 2018.Funding Source, Location of Study or Author’s AffiliationThe Tenth Ward, Luoyang Rongkang Hospital, Luoyang, ChinaDeviceAlpha-Stim®Key VariablesPost-Stroke DepressionObjectiveTo observe the effect of Cranial Electrotherapy Stimulation (CES) combined with escitalopram on quality of life and activities of daily living of patients with Depression after Cerebral Infarction or Post-Stroke Depression (PSD).DesignPatients with a diagnosis of Acute Cerebral Infarction (ACI) and Post-Stroke Depression (PSD) were enrolled in a randomized sham controlled study of CES in addition to Treatment as Usual (TAU) inclusive of the antidepressant Escitalopram compared to a control group of TAU and Escitalopram only. Pre- and post-treatment scores were statistically analyzed to assess the efficacy of CES as an alternative or augmentation strategy for PSD, quality of life, and activities of daily living.Primary Outcome MeasureDepression as assessed using the Hamilton Depression Rating Scale (HAM-D)Neurological impairment as measured by the Modified Edinburgh-Scandinavia Stroke Scale (MESSS)Secondary Outcome MeasureQuality of life as measured by the World Health Organization Quality of Life Questionnaire abbreviated version (WHOQOL-BREF)Activities of daily living and independence as measured by the modified Barthel Index (BI)Key Inclusion CriteriaAcute Cerebral Infarction (ACI) confirmed via MRI examination and a Modified Edinburgh-Scandinavia Stroke Scale (MESSS) score of >16 pointsPost-Stroke Depression (PSD) as evidenced by a minimum HAM-D score of >18 pointsKey Exclusion CriteriaPrior history of depression or family depressionLoss of consciousness (LOC)Limb dysfunctionCongenital mental retardationDysfunction of heart, liver, kidney, or other important organs, or otherwise unfit for CESPotential for poor compliance or unlikely to be able to adhere to study protocolProtocol SummaryThe Control group was given Treatment as Usual (TAU) consistent with an ACI including medical observation and treatment (1. blood glucose and blood lipids management, 2. blood pressure monitoring and treatment as needed, 3. adequate water-salt balance, and 4. appropriate cerebral circulation). In addition, all patients received psychological counseling and pharmacological management with escitalopram. The initial dose was 5mg/day, then increased to 10mg/day after taking for five days, and the dosage was increased to 20mg/day as appropriate for four weeks continuously.The CES group received all of the same TAU management as the control group, inclusive of psychological and pharmacological treatment.Device Application ProtocolThe Alpha-Stim was used to administer CES. Patients were asked to lay supine and the electrodes were attached to the earlobes and stimulation frequency set to 0.5 Hz and current intensity to 10-500 μA. Each treatment session of CES was 60 minutes twice daily for the first two weeks, and once daily for the final two weeks.Statistical Analysis PlanSPSS 19.0 software was used for data analysis, and the change in WHOQOL-BREF, HAM-D, MESSS, and BI scores pre- and post-treatment were expressed by mean ± standard deviation and the comparison among groups was tested by t-test. A significance level of p<0.05 was used to infer a statistical significance.ResultsSubjectsA total of 160 patients were enrolled in the study, with 80 in each group.  There were 46 males and 34 females in the control group aged between 45-70 years and with a mean age of 59.3±8.8 years. The CES group included 48 males and 32 females, aged between 46-70 years and with a mean age of 59.3±8.8 years.Data AnalysisThere were no significant differences at baseline in age or gender between the two groups (p>0.05).At baseline quality of life scores between the two groups were not significantly different (p>0.05). At post-treatment, the CES group had significantly higher scores in quality of life over the control group (p<0.05).Groupn PhysicalPsychologicalSocialFunctionalTotal average score of quality of lifeCES80Baseline20.2±3.416.1±4.714.4±2.122.3±4.817.9±4.2Post-treatment25.4±2.3*#20.9±3.2*#18.8±3.1*#25.8±3.3*#22.9±3.4*#Control80Baseline19.7±3.615.8±4.814.2±3.122.1±4.417.6±4.1Post-treatment22.1±2.8*18.3±2.4*16.1±2.8*24.2±3.1*20.2±3.2Note: Compared with that before treatment, *p<0.05; compared with control group, *p<0.05WHOQOL-BREF scores between the 2 groups before and after treatmentBefore treatment, there was no significant difference in scores of HAM-D, MESS, or MBI between the two groups (p>0.05). After treatment, the scores of HAM-D and MESS of both groups decreased significantly (p<0.05), but the scores of the CES group were significantly lower than those of the control group (p<0.05). A reduction in scores is commensurate in a reduction in depression severity.Groupn HAM-DMESSSBICES80Baseline22.8±3.122.9±5.121.7±8.3Post-treatment11.7±4.8*#12.5±4.8*#68.3±8.5*#Control80Baseline22.7±3.223.1±5.421.6±8.5Post-treatment16.4±5.7*17.1±5.4*57.2±3.9*Note: Compared with that before treatment, *p<0.05; compared with control group, #p<0.05HAMD, MESS, and MBI scores between the 2 groups before and after treatmentChanges in Depression scores at baseline and post-treatmentConclusionA common complication of patients with cerebral infarction is depression. Referred to as Post-Stroke-Depression the commensurate behavioral and psychological changes negatively impact the rehabilitation process of patients. In addition, PSD is an important factor for recovery of neurological and motor deficits, and gradual improvement of activities of daily living. The authors explain that CES combined with escitalopram improves the quality of life of patients and enhances the treatment effect of escitalopram resulting in more effective and faster relief from depression symptoms. The authors conclude that improvements to patients’ depression promotes the recovery of neurological function resulting in improvements to activities of daily living and the quality of life of patients. CES is a safe and effective non-drug treatment for PSD and in conjunction with escitalopram improves the quality of life of patients and activities of daily living, and its effect is superior to the pure treatment of escitalopram.LimitationsWhile this study was a randomized controlled trial, it was not double-blind. Therefore, both participants and investigators were aware of assigned intervention category. Additionally, the authors do not mention their procedures for missing data. According to the Cochrane risk-of-bias tool, each of these conditions can introduce unintended bias into a study.Study Quality: FAIR ### Effect of CES Combined with Flupentixol-melitracen for Depression After Stroke Effect of CES Combined with Flupentixol-melitracen for Depression After Stroke Liu, Y., Xie, L., Wang, L., Zhao, R-J., Xu F., & WANG, W-S. Effect of CES combined with flupentixol-melitracen for depression after stroke. Chinese Journal of Misdiagnosis. 16(2):106-109, 2021.Funding Source, Location of Study or Author’s AffiliationDepartment of Neurology, Xingtai People’s Hospital, Xingtai 054000, ChinaDeviceAlpha-Stim®Key VariablesDepressionObjectiveTo study the effect of cranial electrotherapy stimulation (CES) combined with flupentixol-melitracen for depression after stroke.DesignA randomized controlled trial. Patients were randomly divided into two groups, a medication only control group (MED) and a medication combined with CES group (MED+CES).Primary Outcome MeasureDepression, as measured on the Hamilton Depression Rating scale (HAM-D), a 17-item item self-report measure. Items are scored 0-2 or 0-4. Score totalized are categorized as: normal (<7), possible depression (7-17), depression (17-24), and severe depression (>24).Secondary Outcome MeasureTreatment effect based on HAM-D score after treatment compared with before treatment. Reduction rate is divided into: Ineffective (<25%), Improved (25-49%), Effective (50-75), and Excellent (≥75%).Adverse reactionsKey Inclusion CriteriaStroke, confirmed by MRI and brain CT, conforming to the diagnostic criteria proposed at the Fourth National Cerebrovascular Disease Conference.Diagnosis of depression according to the Classification and Diagnostic Criteria of Mental Disorders in China.HAM-D score >17.No disturbance of consciousness and normal cognitive functioning.Key Exclusion CriteriaGlaucomaHepatic and renal dysfunctionPregnant or lactating womenAnaphylactic reaction to drugs used in the studyPrevious history of depressionProtocol SummaryA randomized cohort of two groups with a total of 45 patients each. The control group (MED) was treated with flupentixol-melitracen, including 10 mg melitracen and -.5 mg flupentixol in each tablet, once in the morning and once in the evening for 28 days. The experimental group (CES+MED) received the same medication dosage, plus CES treatment, for 28 days.Device Application ProtocolThe Alpha-Stim device was set to 1.5Hz and the current intensity was adjusted to 10-500 μA. The patient’s earlobe was cleaned before treatment, and the earclips were attached to the earlobe after applying a conducting solution. The current was increased until the patient felt a weak pinpricking sensation in the earlobes. The patient was advised to stay relaxed throughout the CES treatment process. The authors do not provide information regarding the length of each CES treatment.Statistical Analysis PlanThe data was analyzed using SPSS 23.0 statistical software. The measurement data was expressed by () and tested by t. The enumeration data is expressed by (%) and tested by χ2. If p<0.05, the difference is statistically significant.HAM-D measurements were taken before treatment, after two weeks of treatment, and after four weeks of treatment. HAM-D scores after treatment were compared to the before treatment scores. The deduction rate was divided into the following categories: Ineffective (<25%), Improved (25-49%), Effective (50-75), and Excellent (≥75%). Frequency of adverse reactions were recorded for each group.ResultsSubjectsA total of 90 patients with post-stroke depression admitted by the hospital from February 2018 to February 2020 were selected, randomly divided into two groups, 45 cases each. There were 25 males and 20 females in the study group, at the age of 43-76 years old, (56.6±6.9) years old on average, among which 22 patients suffered from right hemisphere lesion and 23 patients suffered from left hemisphere lesion. There were 24 males and 21 females in the control group, at the age of 44-78 years old, (57.1±6.8) years old on average, among which 20 patients suffered from right hemisphere lesion and 25 patients suffered from left hemisphere lesion. The comparative difference in general data of two groups had no statistical significance (p<0.05), but had comparability.Data AnalysisHAM-D scores for the MED and MED+CES groups were not significantly different. The MED+CES had significantly lower scores on the HAM-D than the MED group after two weeks and four weeks (p<0.05), as indicated in the graph below.Mean depression changes in the MED and MED+CES groupsTreatment effectiveness rates were significantly higher (p<0.05) for the MED+CES group (95.6%) at the end of four weeks than for the MED group (82.2%). The MED+CES group had only two participants report treatment was ineffective, compared to eight participants in the MED group. Additionally, 18 participants in the MED+CES group, compared to only 10 in the MED group, demonstrated excellent effectiveness based on HAM-D scores, as indicated in the chart below.Treatment effectiveness after four weeks for MED+CES and MED groupsAdverse reactions were not significantly different between the two groups. The reported adverse reactions were mild and consistent with the side effects of flupentixol-melitracen.GroupCasesDizzinessThirstyDrowsinessConstipationNauseaAdverse reaction rate (%)CES+MED452432314 (31.1%)MED453433316 (35.6%)χ2 value      0.562p value      >0.05Types and rates of adverse reactionsConclusionCombining CES with a medication commonly prescribed for post-stroke depression significantly improved the treatment effectiveness over using the medication alone, without increasing the incidence or severity of adverse reactions.LimitationsThe authors did not follow the recommended treatment protocol for Alpha-Stim CES, using a frequency of 1.5 Hz rather than the recommended 0.5 Hz. Also, duration of treatment for each CES session was not specified, and the correct dosage for Alpha-Stim CES involves an interaction of current and time, with lower current intensities requiring longer treatment durations. The authors do not discuss an a priori plan for missing data, nor do they describe the randomization method used in the study.Study Quality: FAIR ### Effects of Cranial Electrotherapy Stimulation on Suicidal Ideation and Event-related Potentials in Patients with Treatment-resistant Depression Effects of Cranial Electrotherapy Stimulation on Suicidal Ideation and Event-related Potentials in Patients with Treatment-resistant Depression Gao, C., Kong, S., Duan, H., Yang, Z., Li, D. Effects of cranial electrotherapy stimulation on suicidal ideation and event-related potentials in patients with treatment-resistant depression. China Journal of Health Psychology. 2021; 29(2):183-188.Funding Source, Location of Study, or Author’s AffiliationJiading District Mental Health Center, Shanghai, ChinaMental Disease Prevention and Treatment Institute of Chinese People’s Liberation Army.DeviceAlpha-Stim® SCSKey VariablesSuicide, Depression, and Physiological Markers.ObjectiveTo investigate the effect of Cranial Electrotherapy Stimulation (CES) on suicidal ideation and its electrophysiological mechanism in patients with depression.DesignA total of 67 patients with Treatment-Resistant Depression (TRD) were randomly divided into two groups. The CES group received active CES treatment for eight weeks and the Control condition used an identical non-powered device. Before and after treatment suicidal ideation, depression, and physiological measures of patients in both groups were assessed.Primary Outcome MeasureSuicidal ideationas measured by the Beck Scale for Suicide (BSS) ideation – Chinese Version, (BSS-CV)including suicidal ideation and intent on 19 items and a severity level of 0-2 three-level on a maximum score of 38higher scores equating greater suicidal riskDepression severityas measured by the Hamilton Depression Rating Scale (HAM-D)a total of 17 items to evaluate the severity and a severity level of 0-4Score ranges: “Normal or no depression” ≤7, “Mild depression” 8-17; “Moderate depression” 18-24; “Severe depression” >24Secondary Outcome MeasureElectrophysiological changes as measured by the Contingent Negative Variation (CNV).Key Inclusion CriteriaDiagnosis of Major Depressive Disorder as indicated by the International Classification for Disease (ICD-10)Meet criteria for Treatment-Resistant Depression (TRD) or prior history of 2 or more failed anti-depressant treatment trials at full-dosage and durationHamilton Depression Rating (HAM-D) scale ≥18Aged 18-60 yearsNo ECT or other physical therapy in the preceding four weeks.Key Exclusion CriteriaHistory of hypertension, diabetes or endocrine disease, other chronic diseases, or other serious physical diseasesPrior history of other psychiatric disorderHistory of alcohol or substance abuse/dependencyProtocol SummarySubjects were randomly divided into two groups using a random number table. The active CES and sham devices were identical, with the exception of the sham being a non-powered device. Treatment sessions were identical in duration and frequency. Pre and post assessment measures of suicide, depression, and electrophysiological measures were taken before and after treatment.Device Application ProtocolCES treatment was given using the Alpha-Stim® SCS three times a week, 20 minutes every time for eight weeks. The earclips were attached to both earlobes with the clamp electrode, and a stimulation intensity between 10~500μA and frequency was set to 0.5Hz. Patients were able to gradually increase the intensity until they reported tingling or lightheadedness. The same connection method was also used in the control group, but the power of the device was off.The CNV completed using an International Electroencephalogram Society approved brain electrophysiological instrument and in accordance with their recommendations. Effective electrode on head was put in Cz, the reference electrode was put in the right mastoid process and was connected with the ground electrode at 2cm above the midpoint of both eyebrows. The inductive stimulation mode consisted of S1 and S2, of which S1 was a short tone stimulation, and belonged to the prompt signal; S2 is Goggle flash stimulation and belonged to the command signal. Once the subject received S2, the key reaction was immediately done to interrupt S2. Analysis index: Incubation period and amplitude of M1 (early component) and M2 (late component), and occurrence rate of Post-Imperative Negative Variation (PINV).Statistical Analysis PlanComparisons between the Active CES condition and the Sham Control on the BSS-CV, HAM-D, and CNV from baseline to post-treatment. SPSS 17.0 statistical package was used for data analysis, data were expressed as mean and standard deviation, and the independent sample and paired-sample were tested by t-test respectively; the enumeration data were tested by χ2 and a significance level set at p<.05.ResultsSubjectsA total of 67, with 33 in the CES group, including 18 males and 15 females with a mean age of 32.1±8.9 years, and mean years of education of 12.9±3.9 years. The control group included 34 subjects, including 18 males and 16 females, with mean age of 31.7±9.3 years, mean years of education of 12.6±3.7 years. The difference in gender, age, and years of education was not statistically significant.Data AnalysisBaseline suicidal ideation, suicidal risk, and depression scores between the two groups were not statistically different, but after CES treatment, the scores of HAM-D (t=-2.0865, -2.1518; p<.05), and the scores of suicide ideation on the BSS (t= 2.0315, p<.05) in the CES group were significantly lower than that in the control group.ItemsCES group (n=33)Control group (n=34)Before treatmentAfter treatmentBefore treatmentAfter treatmentSuicidal ideation5.87±3.214.39±2.51*△5.75±3.115.69±2.72Suicidal risk11.98±6.859.53±5.3611.67±6.5411.78±6.97HAM-D22.31±3.2220.45±3.78*22.84±3.6221.30±3.14Note: Through comparison with that before treatment, *p<.05; Through comparison with control group, △p<.05Change of clinical symptoms before and after treatmentMean change in suicidal ideation pre-and post- CES treatment.Mean change in depression pre-and post- CES treatment.Baseline CNV incubation period and amplitude, PINV occurrence rate, and other indexes between the two groups were not significantly different, but after treatment M2 amplitude increased and the incidence of PINV decreased in the CES group (t= 2.3513, p<.05; χ2= 5.0708, p<.05), representing a statistically significant difference compared to the control group (t =-2.0252. p<.05; χ2=4.7308, p<.05).Items CES group (n=33)Control group (n=34)Before treatmentAfter treatmentBefore treatmentAfter treatmentIncubation period (ms)M1452.3±143.5424.8±138.9443.7±151.9451.8±142.6M21215.2±327.41168.8±309.71243.7±336.51195.4±317.5Amplitude (μV)M111.8±5.212.1±4.912.3±5.111.9±4.2M210.5±5.613.8±5.8*△10.8±5.511.1±5.1PINV occurrence rate% (n) 39.4(13)12.1(4)*△41.2(14)38.2(12)Note: Through comparison with that before treatment, *p<.05; Through comparison with control group, △p<.05Change of key indexes of CNV before and after treatmentConclusionThe authors conclude that CES treatment can relieve the suicidal ideation of patients with major depressive disorder and treatment-resistant depression. The authors note CES treatment stimulates the production of certain neurotransmitters, such as 5-hydroxytryptamine, which also affects the chemical activity of a neuron’s peripheral region, further regulating activation. These electrophysiological changes may represent the mechanisms of action of CES at relieving suicidal ideation. The observable change in Event-Related Protocols (ERP) before and after CES treatment suggests that ERP may have clinical application as a potential warning or indicator of suicidal ideation that may encourage early diagnosis and appropriate treatment.LimitationsWhile the design and results of this study are good, the recommended treatment frequency for Alpha-Stim CES is daily for the first three to six weeks, rather than three times a week, as was utilized in this study. Having participants treat daily for eight weeks may have resulted in more significant decreases in suicidal ideation and depression.Study Quality: GOOD ### Effects of Cranial Electrotherapy Stimulation on the Levels of HPA, BDNF and Clinical Symptoms in Patients with Mild Depression Effects of Cranial Electrotherapy Stimulation on the Levels of HPA, BDNF and Clinical Symptoms in Patients with Mild Depression Kong, S., Gao, C., & Yang, Z. Effects of Cranial Electrotherapy Stimulation on the Levels of HPA, BDNF and Clinical Symptoms in Patients with Mild Depression. Journal of International Psychiatry. 48(1), 2021.Funding Source, Location of Study or Author’s AffiliationJiading District Mental Health Center, ShanghaiDeviceAlpha-Stim® SCSKey VariablesAnxiety, Insomnia, and Depression.ObjectiveTo investigate the effects of cranial electrotherapy stimulation (CES) on the hypothalamic-pituitary-adrenal (HPA) axis, levels of brain-derived neurotrophic factor (BDNF), and clinical symptoms in patients with mild depression.DesignA randomized sham-controlled study of eighty-six patients with mild depression divided into two groups. Blood samples were collected before and after 8 weeks of treatment to measure cortisol (COR), adrenocorticotropic hormone (ACTH), and brain-derived neurotrophic factor (BDNF). Accompanying depression, anxiety, and sleep measures were taken pre and post-treatment. Depression was measured using the Hamilton Depression (HAM-D) and anxiety using the Hamilton Anxiety (HAM-A) rating scales. Insomnia was assessed using the Insomnia Severity Index (ISI). Patients received either active or sham CES for 20 minutes per session, 3 times per week, over 8 weeks.Primary Outcome MeasureBlood serum levels ofCORACTHBDNFSecondary Outcome MeasureDepression, as evaluated using the 17 items HAM-D rating scale. A total HAM-D total score of (i) 0–7 is considered “Normal”, (ii) 8–16 “Mild depression”, (iii) 17–23 “Moderate depression”, (iv) > 24 indicative of “Severe depression.”Anxiety, as evaluated using the 14 item HAM-A rating scale. A HAM-A total score of (i) < 7 indicates “No anxiety”, (ii) 7-13 “Possible anxiety”, (iii) 14-20 “Definite anxiety”, (iv) 21-28 “Definitive and obvious anxiety”, and (v) ≥ 29 “Possibly severe anxiety”.Sleep as measured by the ISI and indicative of the quality of sleep in the previous two weeks. The ISI includes 7 items scored over 5 levels (0-4) with severity from mild to severe. A total score (i) <7 indicates “Absent of insomnia”, (ii) 8-14, “Mild insomnia”, (iii) 15-21 “Moderate insomnia”, and (iv) 22-28, “Severe insomnia”.Key Inclusion CriteriaDepression – meet diagnostic criteria as per the International Classification of Diseases (ICD-10) for mild depression or a HAM-D score of 17-24.Anxiety – a HAM-A score of 7-20.Age – between 18-60 years.Body Mass Index (BMI) lower than 30kg/m2.No antidepressant medication, electric convulsive treatment (ECT), or other psychiatric treatments in the past four weeks.Key Exclusion CriteriaPsychiatric HistoryHistory of other psychiatric disorders.Active or prior history of suicidal ideation or intent or the emerge of during treatment.History of alcohol or substance abuse/dependenceChronic Conditions – diagnosis of hypertension, diabetes, endocrine disease, other chronic diseases, or serious physical diseases.Protocol SummaryA total of 86 patients with mild depression were enrolled in the study. Subjects were randomly assigned to the study group and control group using a random number table. All subjects were diagnosed with mild depression and underwent a weekly psychological evaluation and were withdrawn from the study if their symptoms worsened or they developed suicidal ideation or intent.WeightSubjects’ height and weight were measured using a DST-500 ultrasonic wave height and weight measuring apparatus and calculated as BMI=Weight/height 2 (kg/cm2).Blood SamplingA sample of 8ml of venous blood was taken at the elbow following a period of fasting into anticoagulant-free tubes for serum preparation and 1.5ml of blood was collected in tubes for plasma and supernatant preparation and placed in a thermostatic water bath for 1h. Blood samples were centrifuged at 3,000r/min for 5min, then centrifuged plasma was stored at -80℃ in a refrigerator until levels of COR, ACTH and BDNF were assayed. Samples were taken before and after 8 weeks of treatment and used to assess change in COR, ACTH, and BDNF levels.Hormone AssessmentCOR was tested using the Roche E170 kit and was analyzed by electrochemiluminescence.ACTH was tested using the France CIS Bio International kit and was determined by enzyme-linked immunosorbent assay (ELISA).BDNF determination:BDNF level was centrally determined by ELISA, the coefficient of inter-batch variation was less than 5%, and the coefficient of intra-batch variation was less than 4%. The kit was provided by Wuhan Boster Biological Technology Co., Ltd., sensitivity: <2pg/mL, scope: 31.2-2,000pg/mL.Device Application ProtocolPatients in the active and sham conditions received CES treatment using the Alpha-Stim® SCS device. The treatment protocol was 3 times every week, for 20 minutes, over 8 weeks. The clamp electrodes in the CES device were attached bilaterally to the earlobes and the electrodes connected to the device. The intensity was set to 10-500 μA and the frequency to 0.5Hz. Patients were able to gradually increase the intensity until they felt a mild tingling sensation. The device used in the sham condition was applied in the same way, but the power of the device was turned off.Statistical Analysis PlanThe data were analyzed using SPSS 17.0 statistical package. The measurement data showed the mean and standard deviation, and the independent sample and paired-sample were tested by t-test; The enumeration data were tested by χ2 and a significance level set to p<.05.ResultsSubjectsA total of 86 patients with mild depression were enrolled in the study. No significant differences between the active and sham groups in terms of gender (X2=0.074, p=.8276), age (t=0.2181, p=.8278), education level (t=-0.5362, p=.5932), and BMI (t=-0.4880，p=.6268) were reported.In the active CES group, 43 patients – 25 males and 18 females, aged between 18-52 years old, mean age of 31.5±8.3years were enrolled. The mean education level of the active CES group was 12.8±3.7 with a range of 9-16 years, and a mean BMI of 23.8±2.8kg/m2.In the sham CES condition, a total of 43 patients were enrolled, 24 males and 19 females aged between 18-54 years, with a mean age of 31.9±8.7 years. The education level for the sham CES group ranged between 9-16 years, with a mean of 12.4±3.2 years, and a mean BMI of 24.1±2.9kg/m2.Data AnalysisAnxiety, Depression, and InsomniaThe difference between HAM-D, HAM-A, and ISI of the active and sham CES condition before treatment was not statistically significant (t=-1.801, -0.8956, 0.6223; p=.2413, 0.3730, 0.5354).After treatment, the HAM-A and ISI scores in the active CES group decreased significantly (t=-2.5512, -2.7228; p=.0125, 0.0079) and were significantly lower than the sham CES group (t=2.1188, 3.2795; p=.0371, 0.0015).The change in HAM-D from baseline to post-treatment was significant (t=-1.7267; p=.0879). However, the difference between the active and sham conditions was not statistically significant (t=-1.6207; p=.1088).The change in HAM-D, HAM-A, and ISI before and after treatment in the sham group was not statistically significant (t=-1.0497, 0.4402, 0.2418; p=.2969, 0.6609, 0.8095).Change in clinical symptoms of anxiety, depression, and sleep in the active and sham CES group before and after treatmentItemsActive CES (n=43)Sham CES (n=43)Before treatmentAfter treatmentBefore treatmentAfter treatmentHAM-D20.5±2.819.4±3.119.8±2.720.4±2.6HAM-A15.8±3.313.9±3.6*△15.2±2.915.5±3.4ISI16.5±4.813.5±5.4**△△17.2±5.617.5±5.9Note: HAM-D (Hamilton Depression Scale); HAM-A (Hamilton Anxiety Scale); ISI (Insomnia Severity Index).Compared with baseline, **p<.01, *p<.05; Compared with the sham CES condition, △△p<.01, △p<.05.Change in mean depression (HAM-D) scores from pre- to post-treatment.Change in mean anxiety (HAM-A) scores from pre- to post-treatment.Change in mean insomnia (ISI) scores from pre- to post-treatmentHPA and BDNF levelsThe were no significant differences in baseline levels of COR, ACTH, and BDNF between the active and sham CES groups (t=0.3088, -0.4415, 0.4717; p=.7582, 0.6600, 0.6383).After treatment, the concentration of COR in the active CES group decreased (t=-2.0538; p=.0431) and was significantly lower than that of the sham condition (t=2.3613; p=.0205).The change in ACTH and BDNF levels from baseline to post-treatment was not significant (t=0.2788, 0.9442; p=.7811, 0.3478), and the difference between the active and sham conditions was also not statistically significant (t=-1.0609，-0.7806; p=.2918, 0.4372).The change in ACTH and BDNF before and after treatment in the sham CES condition was not statistically significant (t=-0.2102, -0.2425, -0.3333; p=.8340, 0.8090, 0.7398).Change in HPA axis regulating hormone and BDNF in the active and sham CES group before and after treatmentItemsActive CES (n=43)Sham CES (n=43)Before treatmentAfter treatmentBefore treatmentAfter treatment COR (nmol/d)435.3±147.7372.5±135.6*△446.1±175.4454.2±181.9 ACTH (pg/m)45.6±28.947.2±24.142.9±27.841.5±25.7 BDNF (pg/m)28.1±11.531.2±18.229.5±15.728.4±14.9 Note: COR (cortisol); ACTH (adrenocorticotropic hormone); BDNF (brain-derived neurotrophic factor).Compared to baseline, *p<.05; Compared with the sham CES condition, △p<.05.After CES treatment, the level of COR, and HAM- A and ISI scores in the active CES group decreased significantly (t=-2.0538, – 2.5512, – 2.7228; p=.0431, 0.0125, 0.0079), and was significantly lower than the sham CES group (t= 2.3613, 2.1188, 3.2795; p=.0205, 0.0371, 0.0015).HAM-D and ACTH did not show a significant change from baseline to post-treatment (p>0.05) in either the active or the sham CES conditions.ConclusionThe results from the study demonstrated CES treatment resulted in changes to COR plasma concentrations in patients with mild depression but did not cause significant changes to levels of ACTH and BDNF. The authors concluded that CES treatment plays a positive role in improving anxiety and insomnia symptoms in patients with mild depression, but its effect on depression was poor. Stating that the observable changes in hormone levels of patients with mild depression following CES treatment are likely associated with stimulation of the HPA axis, and the reason for the accompanying reduction in symptoms of anxiety and insomnia, but not depression. The authors proposed that stimulation of the HPA axis is likely one of the possible mechanisms of action CES.LimitationsThe choice of treatment protocol used in this study is inconsistent with the Instructions For Use in treating depression with Alpha-Stim CES. The Owner’s Manual indicates daily treatment for a minimum of three weeks is necessary to treat depression. The protocol of treating three times a week may not have been sufficient to allow participants to receive the full benefit of Alpha-Stim treatment for depression. This study also did not follow the EPI protocol for a double-blind randomized controlled trial, which is to set the active devices to 100 uA for 60 minutes and for the sham devices to be set identically to the active devices, but not emit a current.Study Quality: FAIR ### Evaluation of the potential efficacy of the Alpha-Stim SCS in the horse Evaluation of the Potential Efficacy of the Alpha-Stim SCS in the Horse Clark, Nancy, Mills, Daniel & Marchant, Jeremy. Evaluation of the potential efficacy of the Alpha-Stim SCS in the Horse. DeMontfort University Equestrian Centre and Field Station, Caythorpe, Lincolnshire, United Kingdom. January, 2000. Download ArticleDeviceAlpha-Stim®Key VariableSleep time (“dozing”)ObjectiveThe purpose of this study was to examine the efficacy of CES on anxiety in horses across 4 trials. The investigators were interested in the effect of CES on anxiety. The time spent dozing is a variable in the horse that reflects decreased anxiety. This abstract will focus on the outcome variable of dozing rather than anxiety because strict observational measures were taken for dozing behavior.DesignThis was a 2 phase open-label animal clinical trial. The pilot study was done to establish that CES would not pose any threat to the welfare of the horses and to determine the appropriate CES treatment setting. Results from the pilot study were: (1) the horses accepted CES therapy without incidence, and (2) The current setting of 200 µA was found as to be the most appropriate for the larger Phase II study based on the horses’ behaviors.Phase II StudyPrimary Effectiveness EndpointsThe primary effectiveness endpoints for this open label were the change from baseline in the last post-treatment observational scores on 27 horse behaviors. In this abstract, only the amount of time spent dozing across trials 1 – 4 will be discussed.Protocol SummaryThe Alpha-Stim CES device was attached to bridle of the horse and the electrodes were placed using a standard position above the point of articulation of the lower jar, just below the ear after the area was soaked with saline so there was proper conduction (See Figure 1). Each trial began with the investigator waiting for signs of acceptance of the CES from the horse before proceeding. There was one baseline measurement (trial 1) followed by two 10 minute CES treatments with the current set to 200 µA (trials 2 and 3) followed by a final endpoint measurement (trial 4) at 2 days later in an 8 testing day period. There were 4 testing periods during each day; 10-11 AM, 2-3 PM, 4-6 PM and 6-8 PM. Each horse was tested once during each time slot over the 8 days of testing. Baseline measures were taken at trial 1, 20 minute CES treatments were done during trials 2 and 3 and endpoint measures were done during trial 4 using a detailed and specific ethogram used for behavior studies and behavior states in the horse and a rating sheet for specific behaviors.Figure 1. The CES device was attached to the bridle of the horse and the electrodes were placed using a standard position above the point of articulation of the lower jar, just below the ear after the area was soaked with saline.Device Application ProtocolTrial 1 lasted 10 minutes (CES device was on bridle, but current was off). In trials 2 and 3, the current on the CES device was set to 200 microamperes after the horse had habituated to the device and CES treatment lasted for 20 minutes. Endpoint measures were taken during trial 4 (no CES treatment).Outcome MeasuresThis was an observational study of selected horse behaviors including dozing using a detailed strict protocol that included an ethogram and behavior recording sheet.ResultsSubjectsEight horses (2 fillies, 3 mares and 3 geldings with varied backgrounds based at the De Monfort University Equestrian Center and Field Station at Caythorpe, Lincolnshire, UK were selected as subjects for this study. Protection of the horses from stress related to the CES treatment was a primary concern of the investigators. The decision was made apriori that if a horse did not habituate to the CES treatment and seemed stressed the treatment would be immediately stopped and that horse would be excluded from further trials. All equine subjects in this study accepted CES treatments without difficulty.Data AnalysisPaired t-tests, correlation and descriptive statistics were used for data analysis in this study.Dozing Endpoint OutcomeFigure 2 shows the amount of time the 8 individual horses spent dozing during observations across different trial phases.Figure 2. Amount of time spent dozing for each individual horse.A comparison of the means for the amount of time the horses spent dozing across trials 1-4 was significant (p<0.05). There was a significant correlation (p=0.013) between the time spent dozing and at trial phases 2 through 4 as seen in Figure 3. Interestingly, the outcome measure for dozing was held 2 days later after the final CES treatment, yet the time spent dozing increased after the last CES treatment with the final outcome measurement indicating a longitudinal effect.Figure 3. Mean Time Spent Dozing. The time spent dozing increased significantly (p<0.05) from trial 1 to trial 4.The proportion of time spent standing dozing across phases was found to have a positive correlation with the trial phase (r=0.220, p=0.013) the time spent dozing increasing in each successive trial phase. The time spent dozing across trial phases had a negative correlation with the time spent standing alert (r=-0.945, p<0.001), time spent eating bedding (r=-0.205, p=0.05) and time spent eating forage (r=-0.331, p.001).Quality of the ResearchStrengths of this study are; it uses an animal model to examine the effect of CES on increased sleep, and it used a well-thought out, detailed strict protocol for the administration of the CES treatments and the observations that were made during the testing period using an ethogram and behavior recording sheet. This study also provides a foundation for a larger RCT on the effect of CES on horses. Limitations of the study are; the small N, the absence of a control group, and the use of t-tests for analysis (paired t-test was commonly used in the 1990’s and early 2000s where today a repeated measures ancova or similar statistical test would most likely be used). The significant results of this horse study are consistent with the significant findings of Alpha-Stim® RCT human studies on the effect of CES related to sleeping behavior.Author AffiliationsNC, DM, JM, DeMontford University Lincoln, Caythorpe Campus, Grantham, Lincs., United Kingdom. ### Efficacy of Cranial Electric Stimulation for the Treatment of Insomnia: A randomized pilot study Efficacy of Cranial Electric Stimulation for the Treatment of Insomnia: A randomized pilot study Lande, R. Gregory and Gragnani, Cynthia. Efficacy of cranial electric stimulation for the treatment of insomnia: A randomized pilot study. Complementary Therapies in Medicine, 21(1):8-13, 2013. DeviceAlpha-Stim®Key VariableInsomniaObjectiveThe purpose of this pilot study was to examine the potential efficacy of CES for the treatment of insomnia.DesignThis was an IRB approved 5 day pilot study that used a randomized, sham controlled, double-blind design.Primary Effectiveness EndpointThe primary effectiveness endpoint was the change from baseline in the total sleep time (from sleep log) for the active group compared to the sham treatment group at the endpoint of study.Secondary Outcome MeasuresThe secondary outcome measure was the change from baseline in the last post-treatment scores on the time to sleep onset and number of awakenings from sleep logs for active CES subjects compared to the sham treatment at the endpoint of study.Key Inclusion Criteria• Male and female active duty Service Members receiving mental health careat the Psychiatry Continuity Service at Walter Reed National Military Medical Center, Bethesda, Maryland.• Must have score ≥ 21 on the psychiatric impairment rating scale (PIRS).Key Exclusion Criteria• Pregnancy, planning to become pregnant or nursing.• Presence of implanted cardiac pacemakers, pumps or electrical stimulators.• Subjects determined by clinical evaluation and self-administered psychometric tests as actively suicidal, having a seizure disorder history or active vertigo.Protocol SummaryThe device manufacturer pre-set and locked the active and sham devices at the specified settings. The active CES device was set and locked at 100 µA. The sham CES device was set and locked at “0” so that it did not emit electricity. Subjects were randomly assigned to a sham or active CES group by the investigator who randomly selected a device from the box containing 10 active CES devices and 10 sham CES devices. Each subject received a 60 minute active or sham CES treatment daily for 5 days. Subjects completed a sleep log daily for the 5 days. After the 5 days, subjects completed a sleep log at 2 follow-up points, 3 days and 10 days.Device Application ProtocolThe active CES device was pre-set and locked by the manufacturer at 100 µA which is a subsensory level. The sham CES device was pre-set and locked by the manufacturer so that it did not emit electricity. The sham device was identical to the active CES device, except it did not emit electricity. The 60 minutes length of treatment was also pre-set and locked by the manufacturer for both active and sham devices.Study BlindingThe subjects, investigators and staff were all masked as to the identity of the device, active or sham.Outcome MeasuresThe total sleep time was measured from subjects’ reports in their daily sleep log.ResultsSubjectsFifty-seven (57) subjects enrolled and completed the study; 46 males and 11 females. There were 28 in the active CES group and 29 in the sham CES group. Over three-quarters of the subjects completed the full 5 CES treatments (N=44, 77%).Data AnalysisData were analyzed using descriptive statistics, chi-square, 2 way analysis of variance and independent sample t-tests.Total Sleep TimeThe total time slept approached significance (p=0.079) on day 5 in favor of the active CES group. The active CES group average about 43 extra minutes total sleep time when compared to the sham CES group subjects who reported an average of 19 minutes less sleep time. A gender difference also emerged. Men in the active CES group who completed 5 sessions of CES reported a significant improvement in total time slept at 2 points in the study, after the initial (p=0.04, d=0.41) and after the fourth (p=0.03, d=0.49) treatments as compared to men in the sham group. There were no significant changes among the females.Figure 1. Change in total sleep time in minutes between the active group, which had plus 43 more minutes of sleep and the sham group which had 19 fewer minutes of sleep a night after only 5 treatment sessions (p=0.079).Quality of the ResearchThis pilot study was done in preparation for a grant proposal submission. Strengths of the study are: the use of a randomized, double-blind, sham controlled design; and the detailed CES device protocol and the structured protocol for the CES treatments. The major limitation of this study is the number of CES treatments. For the treatment of insomnia the recommended protocol is a minimum of daily CES treatments for at least 4 weeks and 6 to 8 weeks is sometimes required. The investigators state that the small N of the study was a limitation of the study. However, based on the effect size for insomnia, the N of 57 is adequate to detect the effect of CES if subjects in the active CES group have the recommended amount of daily treatments, 4 to 8 weeks.Author AffiliationsR. Gregory Lande. Psychiatric Continuity Service, Walter Reed National Military Medical Center, Bethesda, MD. Cynthia Gragnani, Psychiatric Continuity Service, Walter Reed National Military Medical Center, Bethesda, MD ### The treatment of fibromyalgia with cranial electrotherapy stimulation The Treatment of Fibromyalgia with Cranial Electrotherapy Stimulation Lichtbroun, Alan S., Raicer, Mei-Ming C., and Smith, Ray B. The treatment of fibromyalgia with cranial electrotherapy stimulation. Journal of Clinical Rheumatology. 2001; 7(2):72-78. Presented at the Fifteenth Annual International Symposium on Acupuncture and Electro-Therapeutics, Columbia University, New York, October 1999. DeviceAlpha-Stim®Key VariablesAnxiety, Sleep Quality (Insomnia) and DepressionObjectiveTo evaluate the effect of a specified treatment course with CES on fibromyalgia patients’ sleep quality, anxiety, depression, anger, tender point scores, self-rated pain, vigor, fatigue, confusion, feelings of well-being, and quality of life when compared to sham treatment under the same experimental conditions in subjects meeting the inclusion and exclusion criteria.DesignAn IRB approved 6 week study that included a 3 week randomized, sham treatment controlled, double-blind clinical trial arm followed by a 3 week open label crossover arm in which subjects in the sham and control groups could elect to participate in a treatment course of CES.Primary Effectiveness EndpointThe primary effectiveness endpoint in the RCT was the change from baseline in the last post-treatment self-rated scores on the 10 point Numerical Rating Scale (NRS) for overall pain, quality of sleep, feelings of well-being and quality of life, and Profile of Mood States (POMS) subscales compared to the sham treatment group at the end of week 3 of the study.The primary effectiveness endpoint in the open label crossover arm was the change from baseline in the last post-treatment scores on the 10 point Numerical Rating Scale (NRS) to post-test for overall pain, quality of sleep feelings of well-being and quality of life, and POMS subscales at the end of week 6 of the study. Effectiveness outcome measures were completed at the end of week 3 of the RCT study and at the end of the open label crossover arm 3 weeks later.Key Inclusion Criteria• Male and female subjects with fibromyalgia ≥ 21 years of age.• Diagnosis of fibromyalgia was verified by a board certified rheumatologist using the criteria established by the American College of Rheumatology.Key Exclusion Criteria• Pregnancy.• Presence of implanted pacemakers, pumps or stimulators.Protocol Summary Randomization assignment was established prior to the start of the study. The measurements of primary effectiveness endpoint were taken at baseline, prior to start of treatment period. No change was made in the medical management of the patient during the study. The protocol consisted of two arms:• RCT arm: 3 weeks of treatment with either the active CES device or the sham device. Following the baseline tests, subjects were taught to use the CES device, and were instructed to use it every day for one hour over the 3 week period. At the end of 3 weeks, the subjects returned to the clinic, and outcome measures were repeated.• Open label crossover arm: At this time blinding was broken and subjects in the sham and control groups were given the option to receive active CES for 3 weeks. 23 of the 40 subjects in the sham group elected to participate in the open label crossover arm. Subjects used the CES device daily for 1 hour for 3 weeks. At the completion of the 3 week open label crossover arm, subjects were retested on study outcome measures.Device Application ProtocolSubjects were randomly assigned into 3 separate groups, ether active CES at a subsenate level, sham group or control by drawing subjects names out of a container. The active CES device was set to 100 µA, a subsensory level. The sham device was identical in appearance to the active CES unit, but used ear clips made for this study that did not conduct an electrical current.Study BlindingThe subjects, investigators, physicians and staff were all masked as to the identity of the device.Outcome MeasuresThe Profile of Moods (POMS) subscale A was used to measure anxiety and the POMS subscale D was used to measure depression. Sleep quality was measures by a 10 point numerical rating scale. All scales used have established reliability and validity (McNair et al., 2014, 1971; Farrar et al., 2008).ResultsSubjectsA total of 60 subjects were enrolled, 58 females and 2 men ranging in age from 23 – 82 (M = 50) years of age. All 60 subjects completed the post-testing at the completion of the last treatment at the end of their week 3 visit. The average duration of symptoms was 11 years (range 1 – 40 years). Subjects were randomized to the active CES group (N=20), sham group (N=20) or a wait-in-line placebo control group (N=20).Baseline Measurements: Group EquivalenceThere was no statistically significant difference at baseline between active CES and sham treatment groups on any of the 12 outcome measures.Data AnalysisIn December 2011, the data from this 2001 Lichtbroun study were reanalyzed to by Dr. Larry Price, statistical consultant to Electromedical Products International, Inc. to verify the findings previously reported and to conduct additional more powerful analyses that could provide a more comprehensive description of the findings. The raw data was analyzed using analysis of covariance (ANCOVA) and Mann-Whitney U. The investigators originally used a one-way analysis of variance (ANOVA) to comparing baseline and endpoint study outcomesPrimary Effectiveness Results: Week 3The active CES group had significant findings on 8 of the 11 variables compared to the sham group: significantly lower anxiety scores (p=0.04, d = -.60), higher quality of sleep scores (p = 0.02,d = .45), lower pain scores (p = .004, d = .65), higher feelings of well-being scores (p = .007, d = .73), higher quality of life scores (p =.000, d = .97), lower fatigue scores (p = 0.03, d = -.72 and lower anger scores (p = 0.04, d = .60) compared to sham group (See Table 1). The treatment effect sizes between active CES and sham group ranged from -.36 to .97 on 8 significant variables, with a pooled effect size of .64. Table 1shows results of statistical analyses of outcome measures and Figures 1 and 2 show the results between groups in anxiety scores and sleep quality. Outcome Variables Scale AnalysisP Values,Cohen’s dTender point ScoreTender point scaleANCOVAp = .02,  d = -.36PainSelf-report NRSANCOVAp = .004, d = .65Quality of SleepSelf-report NRSANCOVAp = 0.02, d = .45Well-beingSelf-report NRSANCOVAp = .007, d = .73Quality of LifeSelf-report NRSANCOVAp  =.000, d = .97FatiguePOMS-F SubscaleANCOVAp = 0.03, d = .72AnxietyPOMS-Anxiety SubscaleMann-Whitney Up = 0.04, d = .60AngerPOMS-Anger SubscaleMann-Whitney Up = 0.04, d = .60DepressionPOMS-D SubscaleANCOVAn.s.VigorPOMS-V SubscaleANCOVAn.s.ConfusionPOMS-C SubscaleANCOVAn.s.Table 1. P-values for comparison between active CES and sham groups at week 3.Figure 1. Mean anxiety scores by groupFigure 2. Sleep quality results by groupOpen Label Crossover Results: Week 6After completion of the RCT arm, 23 of the 40 sham or control patients opted for actual CES in an open label crossover arm where they could increase the current in accordance with the standard clinical protocols for Alpha-Stim CES. Data were analyzed with repeated measures analysis of covariance variance, with least significant difference a posteriori testing. Table 7 shows results of statistical analyses of outcome measures at week 6. Outcome VariablesScaleP ValuesTender Point ScaleTender Point Scalep <0.001Self-Rated PainNRSp <0.05Quality of SleepNRSp <0.001Well-BeingNRSp <0.001VigorPOMS-Vp <0.01FatiguePOMS-Fp <0.03Table 2. P-Values for changes from baseline to post-test within open label crossover group at week 6.Quality of the ResearchStrengths of this study are: use of a randomized, sham controlled, double-blind design (the investigators chose to use the Alpha-Stim RCT research protocol for the study); active and sham Alpha-Stim devices were pre-set and locked at the designated levels for each specific group for current level and time by the manufacturer at the factory and sham units were the same as active units, except they did not emit electricity; randomization of devices was done by the manufacturer and followed according to the protocol by the investigators; use of 3 groups, active sham and the control group; and the structured and detailed protocol for the CES treatments for both active and sham groups. A limitation of the original data analysis is that it used analysis of variance (ANOVA) and no within or between group effect sizes were included. In the 2011 reanalysis of the data, analysis of covariance (ANCOVA) was used to provide a more comprehensive description of the findings. The Profile of Mood States (POMS) subscales were used to measure anxiety and depression. This was a common approach in the late 1990s and early 2000s. Today, the Hamilton Anxiety Rating Scale or similar rating scale that focuses entirely on the anxiety would most likely be used. The same is true for measuring the variable of depression. The effect of CES on depression was not significant in this study in contrast to the findings of other Alpha-Stim studies on depression. One possible explanation for this finding is the use of the POMS subscale on depression, whereas other studies used scales that focused specifically on depression, such as the Hamilton Depression Rating Scale. The findings for anxiety and sleep quality in this study are consistent with the findings of other Alpha-Stim studies that found CES significantly decreases anxiety and improves sleep quality.Author AffiliationsASL, Robert wood Johnson Medical School, East Brunswick, NJ. MMC, Real Word Health, Wall, NJ. RBS, Electromedical Products International, Mineral Wells, TX,ReferencesFarrar JT, Troxel AB, Stott C, Duncombe P, Jensen MP. Validity, reliability, and clinical importance of change in a 0-10 numeric rating scale measure of spasticity: a post hoc analysis of a randomized, double-blind, placebo-controlled trial. Clinical Therapeutics. 2008 May;30(5):974-85McNair DM, Lorr M, Droppleman LF. Profile of Mood States 2nd Editon (POMS 2™). JvR Psychometrics, Accessed on 4/18/2014, http://www.psychologyafrica.com/wp-content/uploads/2013/07/Profile_of_Mood_States_2nd_Edition.pdf,McNair DM, Lorr M, Droppleman LF. Manual for the Profile of Mood States. San Diego, CA: Educational and Industrial Testing Service, 1971.  ### Cranial electrical stimulation improves symptoms and functional status in individuals with fibromyalgia Cranial Electrical Stimulation Improves Symptoms and Functional Status in Individuals with Fibromyalgia Taylor, Ann Gill, Anderson, Joel G., Riedel, Shannon L., Lewis, Jante E., Kinser, Patricia A., and Bourguignon, Cheryl. Cranial electrical stimulation improves symptoms and functional status in individuals with fibromyalgia. Pain Management Nursing. 2013 Dec;14(4):327-335. Download article Device Alpha-Stim® Key Variable Insomnia (Sleep Disturbance) Objective To investigate the effect of a specified treatment course with CES on fibromyalgia (FM) patients’ sleep disturbance, pain, fatigue, and the impact of fibromyalgia on functional status when compared to sham treatment under the same experimental conditions in subjects meeting the inclusion and exclusion criteria. Design This was an IRB approved 8 week, randomized, sham controlled, double blind clinical trial. Subjects in the active CES and sham groups did a 60 minute treatment every day for 8 weeks. A third control group received usual care. Sleep disturbance is the variable of interest for this report. Primary Effectiveness Endpoint The primary effectiveness endpoint was the change from baseline in the last post-treatment scores on the outcomes measures for sleep disturbance, pain, fatigue and functional status compared to the sham treatment group at the endpoint of the 8 week study. Key Inclusion Criteria • Male and female subjects with fibromyalgia ranging ≥ 21 years of age. • Diagnosis of fibromyalgia was verified using the criteria established by the American College of Rheumatology. • Reported an initial pain level equal to or greater than 3 on a 0 – 10 numeric rating scale (NRS). • Had stable medication use related to FM for at least 4 weeks. • Ability to read, write, and understand the English language. Key Exclusion Criteria • Pregnant or breast-feeding. • Presence of implanted pacemaker, pump or stimulator device. • History of seizures. Protocol Summary Randomization assignment was established prior to the start of the study by the manufacturer of the Alpha-Stim device through the assignment of unique numbers (active or sham) to devices, Devices were assigned to subjects in the order listed on the device log.. Baseline measures were taken prior to start of treatment period and again at the endpoint of the study. No change was made in the medical management of the patient during the study. Participants in the active CES and sham groups were instructed to use the Alpha-Stim CES device for 60 continuous minutes each day for 8 weeks. Participants in the CES device group received devices that were active and preset at the factory to provide maximum of 60 minutes of modified square-wave biphasic stimulation at 0.5 Hz and 100 μA, the lowest setting that has been used in previous studies with patients with FM and below the level of perception. Participants in the sham device group received sham devices that were identical to the active device, but did not deliver any electrical stimulation. Device use was monitored by asking participants to document at what time and for how long the device was used each day. Device Application Protocol The active CES device was pre-set and locked by the manufacturer at 100 µA which is a subsensory level. The sham CES device was pre-set and locked by the manufacturer so that it did not emit electricity. The length of treatment, 60 minutes, was also pre-set and locked by the manufacturer for both active and sham devices. Study Blinding The subjects, investigators, physicians and staff were all masked as to the identity of the device. Outcome Measures The General Sleep Disturbance scale was used to evaluate the incidence and nature of subjects’ sleep disturbances. The scale has established reliability and validity (Achterberg et al., 1981). Results Subjects The sample consisted “primarily of Caucasian females” who on average had a high school education or slightly above. Forty-six (46) subjects, 17 active CES, 14 Sham and 15 controls, completed the testing after the last treatment at the week 8 visit. Baseline Measurements: Group Equivalence There were no statistically significant differences at baseline between active, sham and control groups for any of the demographic or outcome variables. Data Analysis. Data were analyzed using separate multilevel models to estimate mean differences among the 3 groups for each of the pain measures (NRS and SF-MPQ). Model parameters were estimated by restricted maximum likelihood, and the within-subject variance-covariance matrix modeled in the form determined by Akaike’s AIC criterion. Random coefficients regression models (for each outcome) were used to fit the data collected each week using weekly data points to estimate intercepts and slopes for each group. At Level 1 (within-subject analysis), the models essentially averaged each participant’s intercept and slope while accounting for serial correlation among measurements taken on the same participant. Sleep Disturbance (Insomnia) While all 3 groups reported scores that were in the insomnia range at baseline, the active CES group was the only group that reported decreased scores over the course of the study and completed the study with scores below the range of insomnia (p=0.001). Figure 1 shows the mean change over time in sleep disturbance symptoms among the active group, sham group and control group. Figure 1. Mean change over time in symptoms and functional status over time among the active group, sham group and control group for (sleep disturbance (p=0.001). Quality of the Research Strengths of this study are: use of a randomized, sham controlled, double-blind design (The investigators chose to use the Alpha-Stim RCT research protocol for the study); active and sham Alpha-Stim devices were pre-set and locked at the designated levels for each specific group for current level and time by the manufacturer at the factory and sham devices were the same as active, except they did not emit electricity; randomization of devices was done by the manufacturer according to the protocol by the investigators; diagnosis of fibromyalgia was verified using the criteria established by the American College of Rheumatology before subjects could be in the study; and the structured and detailed protocol for the CES treatments for both active and sham groups.. The finding that CES significantly decreases sleep disturbances (insomnia) is consistent with other Alpha-Stim studies that found that CES significantly decreases insomnia. Author Affiliations AGT, JGA, SLR, PAK, and CB, Center for the Study of Complementary and Alternative Therapies, University of Virginia, Charlottesville. JEL, Division of Clinical Rheumatology, Department of Medicine, University of Virginia, School of Medicine, Charlottesville, VA. References Achterberg J, McGraw P, Lawlis GF. Rheumatoid arthritis: a study of relaxation and temperature biofeedback training as an adjunctive therapy. Biofeedback and Self Regulation. 1981 Jun;6(2):207-23 ### Treatment of Sleep Disorder with Cranial Electrotherapy Stimulation Combined with Psychological Counseling in Postmenopausal Women: A Randomized Study Treatment of Sleep Disorder with Cranial Electrotherapy Stimulation Combined with Psychological Counseling in Postmenopausal Women: A Randomized Study Kong, J., Wu, J., Jiang, X., et al. Treatment of Sleep Disorder with Cranial Electrotherapy Stimulation Combined with Psychological Counseling in Postmenopausal Women: A Randomized Study. Chinese Journal of Medicinal Guide. 2014; 921, 16(6):(Serial No.128). Funding Source, Location of Study, or Author’s Affiliation Women Health Care, Nanjing Maternity and Child Health Care Hospital, Nanjing, China Device Alpha-Stim® Key Variables Menopausal symptoms, sleep, depression, and anxiety. Objective To compare the effects of Cranial Electrotherapy Stimulation (CES) combined with psychological counseling for the treatment of disordered sleep in post-menopausal women. Design Investigate the occurrence of insomnia and its frequently secondary impact on depression, anxiety, and quality of life in peri- and post-menopausal women. Assess the efficacy of CES, a non-pharmacological FDA cleared treatment for insomnia in conjunction with psychological counseling and compare it to psychological counselling alone. Measure changes in symptom profile at baseline, 4, and 8 weeks after treatment. Primary Outcome Measure Menopausal symptoms as measured by the Kupperman Index (KI) based on the grade of 0-3. The KI items include Vasomotor symptoms (hectic fever and sweating) Sensory disturbance Insomnia Depression Dizziness Fatigue Joint and muscle pain Headache Palpitation Skin formication Hyposexuality Urinary tract infection Sleep as measured by the Pittsburg Sleep Quality Index (PSQI) based on the grading score of 0-3 on the 18 scoring items divided into the 7 components of sleep: Quality Latency Duration Efficiency Disturbance Daytime dysfunction Medication use Secondary Outcome Measure Anxiety indicated by the Self-Rating Anxiety Scale (SAS) based on the grade scoring of 1-4 Depression assessed by the Self-Rating Depression Scale (SDS) based on the scoring grade of 1-4 Key Inclusion Criteria Pittsburgh Sleep Quality Index (PSQI) score ≥7 Women aged ≥40 and ≤60 years old amenorrhea for ≥3 and ≤12 months Perimenopausal symptoms as indicated by a score of ≥15 in the modified KI Aged ≥40 years old with inconsistent menstrual cycles not attributed to pregnancy Follicle Stimulating Hormone (FSH) levels ≥10U/L Women who have undergone artificial menopause or ovarian ablation ≥ 6 weeks with FSH ≥10U/L Intact uterus and bilateral ovaries Key Exclusion Criteria Non-perimenopausal women Sex hormone treatment in preceding three months Diagnosis of Hyperthyroidism Coronary atherosclerotic heart disease Hypertension or pheochromocytoma Neurasthenia Psychosis Other diseases closely associated with primary symptoms Taking medication for insomnia, anxiety, or depression Men Protocol Summary A randomized Intent-to-Treat (ITT) study of women aged 35-40 years presenting with disordered sleep and meeting full eligibility criteria were enrolled in the study. A total of 139 women were randomly allocated into two groups. Group A received psychological counseling and CES (CES+PSY). Group B received weekly psychological counseling (PSY). Peri- and post-menopausal symptoms were assessed following the Technical Guidelines for Clinical Research on Treatment of Menopausal Syndrome with Traditional Chinese Medicine (TCM) and Natural Medicines issued by the China Food and Drug Administration. FSH levels were taken on the 3rd day of menstruation for peri-menopausal women. Women in the PSY + CES condition received treatment using the Alpha-Stim daily for 60 minutes over eight weeks and psychological counseling once a week. Patients receive supervision for the first three treatment sessions and then self-administered CES at home for the remainder of the study. The comparator group received psychological counseling once a week for eight weeks. Device Application Protocol Alpha-Stim was used to administer CES to Group A (CES+PSY). Patients were instructed to turn on the power, coat the bilateral earclips with conductive fluid and attach them to each earlobe. During self-administration, patients were instructed to gradually increase the current intensity from 10-500 μA, and to calibrate the maximum dosage at a level that was comfortable for them or when they felt a tingling sensation. The duration of each treatment cycle was 60 minutes and occurred daily over eight weeks. Statistical Analysis Plan Using prevalence rates for insomnia among peri- and post-menopausal women, a power calculation estimated a sample size of 60 cases, with the margin for a withdrawal rate of 20%, the total cases were determined as 72. The ratio of the experimental group to the control group was 1:1, and the random coding table followed the order in which the cases were selected. Software was used to obtain random numbers and to generate random grouping. Data analysis was conducted using SPSS 17.0 and Excel 2010. Statistical analysis included t-test, chi-square test, and analysis of variance (ANOVA). Higher scores are indicative of greater impairment (e.g., high KI indicative of multiple menopausal symptoms or high PSQI score suggestive of poorer sleep quality) and taken at baseline, followed by 4- and 8-weeks post-treatment. Results Subjects A total of 139 peri- and post-menopausal women aged 35-40 years were recruited to the study as they attended the Nanjing Maternity and Child Health Care Hospital, in China. The rate of subject attrition was 12.2% (N=17), with eight patients lost to follow up or withdrawn from the study before or at baseline, resulting in 131 patients considered in the ITT analysis. A further nine patients withdrew from during treatment, resulting in 122 patients completing the 8-week study, with 63 cases in Group A and 59 cases in Group B. The mean (SD) age of Group A was 47±4 years and 46±4 years in Group B. The difference in age distribution between conditions was not statistically significant (p=0.52). The difference in marital status, education level, etc. was also not statistically significant (p=0.38, p=0.20). Data Analysis Menopausal Symptoms: The KI scores at baseline between the two groups were not significantly different (p=0.67) with a mean (SD) of 22.5±7.1 for the CES+PSY group and 23.3±6.2 for the PSY group. The reduction in KI scores in the CES+PSY group after four weeks was more than 7, suggesting an improvement in peri-menopausal symptoms, and after 8 weeks, the reduction was 12.4, suggesting a greater reduction in symptoms with prolonged CES treatment. In comparison, for the PSY group, at 4 weeks the reduction in KI scores was 4 and 5.6 at 8 weeks (p=0.00). Further details are shown in the following table. Comparison of mean and standard deviation of peri-menopausal symptoms and sleep quality before and after treatment in both groups. Anxiety & Depression Symptoms: Patients in both groups showed symptoms of moderate to severe depression and anxiety at baseline, but no significant difference between the groups was reported (p>0.05). After eight weeks of psychological counseling and the addition of CES in Group A, depression and anxiety symptoms of both groups were significantly lower, with a symptom reduction rate of over 50%. The mean improvement rate of depression and anxiety symptoms in CES+PSY was 7%-10% higher than that of PSY the group, a statistically significant difference (p=0.00). Percent improvement in anxiety and depression Sleep Disruption: The PQSI scores at baseline were not significantly different (p=0.09), Group A’s mean (SD) score was 15.1±2.5 and 14.5±3.0 for Group B. After 4 weeks after treatment, the reduction of Group A was more than 7, suggesting an improvement in insomnia, with greater CES treatment resulting in greater symptom relief as evidence by a further reduction of more than 9 points at 8 weeks post-treatment. The table above shows the comparison to Group B, with a score reduction of 3.7 at four weeks and 6 at eight weeks, which were significantly less than the score reductions seen in Group A (p=0.00). Mean Change in Total PSQI score Safety Analysis: Group A reported six cases of mild and controllable adverse reactions. The common side-effects included dizziness, nausea, and skin-tingling sensation, and ceased immediately after reducing the intensity or stopping CES treatment. These reported reactions are expected sensations when current is turned too high and are addressed in the published instructions for using Alpha-Stim. Group B reported no adverse reactions. Conclusion The main treatment approach for menopausal symptoms is Hormone Replacement Therapy (HRT). Although effective, HRT has a relatively small therapeutic dose range, so adverse reactions may easily occur. HRT is not suitable for all patients, including those with malignant tumors associated with sex hormones, such as ovarian and uterine cancer. In some situations, HRT may increase the risk of ovarian cancer or endometrial cancer. CES treatment offers a non-drug approach for the management of perimenopausal syndrome that is effective in reducing menopausal symptoms, sleep disturbance, and emotional distress. Furthermore, it is safe, with extremely low risks for any patient. This study demonstrated CES combined with psychological counseling resulted in faster treatment response and significant improvements to menopausal symptoms (p<0.05) and reduction in the occurrence of disordered sleep (p<0.01). In addition, compliance rates as evidence by lost-to-follow-up were lower in the CES condition. The authors conclude that CES avoids the possible adverse reactions common in medication for the management of insomnia and warrants further clinical investigation. The authors proposed a mechanism of action where CES promotes the secretion and balance of 5-hydroxytryptamine, dopamine, norepinephrine, and other neurotransmitters in the brain and improves the imbalance of neurotransmitters caused by the decline of estrogen level. Limitations The authors point out the following limitations in the study. The observation period was only eight weeks, the longer-term therapeutic efficacy needs to be studied. Sleep was evaluated only by a self-report measure, a more in-depth study assessing sleep structure (such as polysomnography) should be conducted. Study Quality: FAIR ### A control study of a hypnotic drug plus cranial electrotherapy stimulation in the treatment of insomnia A Control Study of a Hypnotic Drug Plus Cranial Electrotherapy Stimulation in the Treatment of Insomnia Bie, H., Ren, L., & Li, X. A control study of a hypnotic drug plus cranial electrotherapy stimulation in the treatment of insomnia. Journal Clinical Psychosomatic Disorders. 2016; Vol 22, No. 3:17-20. Funding Source, Location of Study or Author’s Affiliation Tianjin Occupational Diseases Precaution and Therapeutic Hospital, Tianjin, China Device Alpha-Stim® Key Variables Insomnia Objective To explore the efficacy of a hypnotic drug plus cranial electrotherapy stimulation (CES) in the treatment of insomnia. Design Using a random number table, 152 insomnia patients were assigned to three groups: CES group (n=50), drug (n=51), and combination (n=51). The CES group was treated with CES, the drug group with zopiclone, and the combination group with CES plus zopiclone; for 4 weeks. The degree of disordered sleep was assessed using the Athens Insomnia Scale (AIS) before and after treatment. Primary Outcome Measure Insomnia Disordered sleep was assessed using the Athens Insomnia Scale (AIS) before treatment, at the end of the 2nd, and 4th The AIS is an internationally recognized self-report sleep quality assessment scale. Self-reported perceptions, feelings, and opinions about individual changes to sleep quality are used as the assessment of the treatment’s efficacy. The AIS scale is a total of 8 questions, scored on 4 levels, reflective of the level of sleep quality. The total score for all items in the AIS scale is classified as (i) <4 “No sleep disorder”; (ii) ≥4 as “Probable insomnia”, (iii) >6 “Insomnia”. The higher the AIS total score is, the worse the sleep quality is Secondary Outcome Measure None reported. Key Inclusion Criteria Meet diagnostic criteria for non-organic insomnia as per the Diagnostic and Statistical Manual of Mental Disorders in the US Edition 5 (DSM-5). Agreement to not use any other drugs that act on the central nervous system during the study or use any measure which has a hypnotic effect or may cause disordered sleep.  Key Exclusion Criteria Organic brain disease. Serious physical disease. Substance abuse or dependence. History of psychiatric disorder. Pregnant or breastfeeding. Protocol Summary The CES only group received only CES treatment as described below. The medication only group was prescribed a once nightly dose of 7.5mg of zopiclone. The combination group received the same CES treatment protocol as the CES only group and the same medication regiment as the MED only group. Device Application Protocol The Alpha-Stim device was used to administer CES treatment. Patients were instructed to remain seated during CES treatment, check that the CES device and leads were connected, apply conducting solution to both electrode pads, and then clamp them bilaterally to each earlobe, and turn the device on. The current intensity was self-adjusted ranged between 10-500 μA, and the frequency was 1.5 Hz. Patients were then instructed to adjust the intensity from the lowest setting until they felt a mild tingling but comfortable sensation. The mild tingling or mild dizziness of patients is considered a normal phenomenon during treatment. The treatment time was once a day, for 60 minutes each time. Statistical Analysis Plan Change in insomnia symptoms from baseline to posttreatment in the AIS scale was used as a measure of treatment efficacy. All data were processed by SPSS15.0 statistical package, the measurement data tested by t-test, and the enumeration data tested by χ2. Results Subjects A total of 152 patients were enrolled in the study, (i) fifty (n=50) in the CES group, (ii) fifty-one (n=51) in the MED group, and (iii) fifty-one (n=51) in the MED+CES group. There were 23 males and 27 females in CES group, aged 27-66 years, mean age of 51.5±3.0 years, and a disease course of 3-40 months, and a mean of 12.3±2.5 months on average. The MED group included 24 males and 27 females, aged 28-69 years, mean age of 47.5±6.2 years and disease course of 3-37 months, 13.1±2.7 months on average. There were 24 males and 27 females in the MED+CES group aged 29-67 years, and 48.5±5.2 years on average, with disease course of between 3-36 months, on average 13.3±2.3 months. There were no significant differences in gender, age, and course of disease of the three groups (p>.05). Data Analysis The effective rate of the CES group was 76.0%, MED group was 76.5%, and MED+CES group was 84.3% at the end of the 4th week. The results confirmed an effective rate of the combination group (MED+CES) as being higher than that of the CES only group (CES), and the drug group (MED). The effective rate between the three groups is different but not significantly so (χ2=0.23, p>.05). The AIS total scores of the three groups after treatment were significantly lower than pretreatment (p<.01). The AIS total scores of the MED+CES group at the end of the 2nd and 4th week were significantly lower than those of the CES group and MED group (p<.01 and p<.05 respectively). The AIS total score of the MED group at the end of the 2nd week was significantly lower compared with that of the CES group (p<.01) and was not significantly (p>.05) different from the CES group at the end of the 4th week. Comparison of AIS scores of three groups before and after treatment  Group Before treatment After treatment At the end of the 2nd week At the end of the 4th week CES group (n=50) 17.8±2.1 14.8±2.1**△△▲▲ 6.3±2.1**△△ Drug group (n=51) 17.6±1.7 12.8±2.2**△ 5.8±2.1**△ Combination group (n=51) 17.8±0.7 11.8±2.1** 4.8±1.7** Note: by comparison with that before treatment, **p<0.01; by comparison with combination group, △p<0.05, △△p<0.01; by comparison with drug group, ▲▲p<0.01 Mean changes in AIS total scores for MED, CES, and MED+CES groups Conclusion The study shows that AIS total scores of the three groups after treatment were significantly reduced compared with pretreatment (p<.01), but AIS total scores for the drug group and combination group at the end of the 2nd week were significantly lower than those of the CES only group. This finding is consistent with clinical use of Alpha-Stim to treat insomnia, as it can take four weeks for patients to achieve the full benefit in treating insomnia with CES. The results from this study suggest that the drug (MED) and the drug plus CES (MED+CES) treatment take effect more quickly than CES alone (CES). At the end of the 4th week, the AIS total score of the combination group (MED+CES) was significantly lower than the CES only (CES) group and the drug only (MED) group. These results suggest CES and Zoplicone have equivalent efficacy in the treatment of insomnia, and have a cumulative effect over time, but the combination of the two has a synergistic or augmentative quality and can reinforce treatment effectiveness and improve sleep quality. In conclusion, CES and hypnotic medication have equivalent efficacy in the treatment of insomnia, and CES provides an effective means for a non-drug treatment of insomnia, but the combination of the two has a superior effect and can reinforce treatment effectiveness and improve sleep quality. Limitations This is a well-designed randomized controlled trial, but no blinding occurred. Therefore, according to the Cochrane Risk of Bias guidelines, it is possible for bias to be unintentionally introduced into the results of the study. The authors indicate a disadvantage of this study is that the AIS is a self-report sleep quality scale, that measures subjective feelings about sleep. The study did not have an objective indicator or assessment of sleep quality. Another disadvantage is the reported frequency (1.5 Hz) used for CES in this study. The patented Alpha-Stim waveform is designed for a frequency of 0.5 Hz, therefore higher frequencies are not as effective for CES treatment. Study Quality: FAIR ### Impact of Cranial Electrotherapy Stimulation Based Analysis of Heart Rate Variability in Insomnia Impact of Cranial Electrotherapy Stimulation Based Analysis of Heart Rate Variability in Insomnia Khyatee, S., Sarker,A., & Aggarwal R. Impact of Cranial Electrotherapy Stimulation Based Analysis of Heart Rate Variability in Insomnia. In: Prateek M., Sharma D., Tiwari R., Sharma R., Kumar K., Kumar N. (eds) Next Generation Computing Technologies on Computational Intelligence. NGCT 2018. Communications in Computer and Information Science, Vol 922. Springer, Singapore, 2019. Funding Source, Location of Study, or Author’s Affiliation Amity Institute of Physiotherapy, Amity University, Noida, U.P., India Device  Alpha-Stim® AID Key Variables Sleep Objective Investigate the cross-sectional association between cranial electrotherapy stimulation (CES), sleep duration along with its quality and autonomic activity function in healthy individual utilizing two factors, the Global Pittsburgh Sleep Quality Index (PSQI) for evaluation of subjective sleep duration and quality and measuring beat to beat variation of the heart through heart rate variability. Design A randomized controlled trial on the impact of CES on HRV and insomnia. Patients that reported sleeping less than six hours were categorized as “Insomniac.” Patients were randomly allocated to the control and CES condition. Primary Outcome Measure HRV measured by Physio Pack (Kubios 2.1). Sleep quality as measured by Global Pittsburg Sleep Quality Index (PSQI) score. Secondary Outcome Measure None reported. Key Inclusion Criteria Diagnosis of Insomnia (Sleep <6 hours) Male or females >18 having: Regular night sleep. Normal basal metabolic index. Key Exclusion Criteria Diagnosed with systemic or sleep disorders. Shift work. Pregnante. Regular daytime sleep/prolonged deviated sleep. Protocol Summary A pre and post-experimental study of patients diagnosed with insomnia were randomly allocated into two conditions, Control and Experimental (CES). Short-term HRV was measured by recording a five-minute ECG of each subject. HRV was assessed as per protocol. Sleep quality was measured by the global PSQI. Device Application Protocol After PSQI screening a set of instructions (i.e., to remain nil orally two hours before the test) was conveyed to the selected subjects. HRV was assessed with certain requisites such as removing any metal objects (including jewelry), being silent and relaxed with closed eyes lying Supine with palms facing upwards, without any physical movements. HRV examination room had an ambient temperature of 22 °C without direct light exposure to the subject. Alpha-Stim CES was given to participants in the Experimental group for five days per week for 20 minutes per day, over 21 days. The author does not discuss the current intensity used in this study. Statistical Analysis Plan Statistical analysis was done using SPSS software. Shapiro Wilk test was done to check normal distribution. Further, an independent t-test was used to check the differences between the two Clusters. A significance level of p<0.05 was adopted as a threshold for statistical significance. Results Subjects A total of forty (40) males and females aged 18 to 44 years were screened and enrolled. Participants were randomly allocated into the Control and Experimental groups and categorized based on their sleep quality and duration and quality, the autonomic activity of 40 subjects was assessed with HRV for further analysis. No significant differences were reported at baseline between the groups. Data Analysis Geometric indices of Time Domain were significantly better in the Experimental group as compared to the Control, including STDHR, (p<.025), SDNN (p<.047), RMSSD (p<.048), RR Tri (p<.037), and TINN (p<.047). In the Frequency Domain Factors statistically, significant differences were found in VLF (p<.032), HF (p<.044), and Total Power (p<.045). Significant differences in favor of CES were reported on sleep quality and quantity as measured by PSQI and HRV as indicated by Physio Pack (p<.05). The mean (SD) sleep quality and duration of the subjects before treatment in the Control and Experimental group were not significantly different. Baseline measures in the PSQI scores for quality for the Control group were 5.83±0.83 and 5.74±0.64 in the Experimental group. The mean (SD) sleep duration in the Control condition was 5±1.02 and 5±0.40 in the Experimental condition. Post-treatment sleep quality and duration were significantly better in the CES condition (p<.05). The mean (SD) Global PSQI score in the Experimental condition was 5.76±0.56 and 2.05±1.19 in the control. With the mean (SD) for sleep duration of 5±0.90 for the CES condition and 7±0.40 for the Control. Baseline Post-Treatment Factors Sham  Control Active  CES p Value Sham  Control Active  CES p   Value Mean RR (ms) 849±186.75 841.30±68.15 n.s. 851.04±78.11 870.8±149.6 0.833 STD RR (ms) 73.95±5.87 71.99±5.80 n.s. 72.99±5.60 71.10±11.66 0.825 Mean HR (1/min) 3.58±2.02 4.19±1.26 n.s. 4.54±1.12 4.86±1.02 0.025* STDHR (1/min) 41.12±27.16 48.25±11.14 n.s. 44.14±16.40 59.45±18.8 0.047* RMSSD (ms) 38.2±31.24 37.25±14.44 n.s. 39.72±19.4 51.92±27.29 0.048* NN50 55.88±32.44 61.41±52.46 n.s. 68.42±54.62 92.6±61.44 0.156 pNN50 (%) 18.4±20.24 17.20±15.21 n.s. 18.20±14.24 28.22±21.28 0.195 SBP (mm/Hg) 9.59±5.88 10.69±2.61 n.s. 10.63±1.51 13.75±4.09 0.037* DBP (mm/Hg) 157.22±104.79 175.62±125.7 n.s. 165.6±68.7 228.25±78.40 0.047* Values expressed in Mean±S.D.; n.s. (Not significant); * (Significant Difference p<.05); RR (mean of the RR intervals); HR (Heart Rate); STDHR (Standard Deviation of Heart Rate); SDNN (Standard Deviation of NN Intervals); RMSSD (Root Mean Square of Successive Differences); NN50 (Number of Pairs of Successive NN Intervals that differ by more than 50 ms); pNN50 (Proportion of NN50 divided by total number of NN intervals); RRTri (Triangular Index of RR intervals); TIN (Triangular Interpolation of RR intervals); ms (milliseconds). HRV pre and post-CES for control and experimental groups Mean of RR Interval Pre and Post for Control and CES Groups. Mean Global Pittsburg Sleep Quality Score Pre and Post for Control and CES Groups. Mean Triangular Interpolation of RR Interval Pre and Post for Control and CES Groups. Mean Successive NN intervals Pre and Post for Control and CES Groups. Mean Triangular Index of RR Interval Pre and Post for Control and CES Groups. Conclusion Poor quality and short duration sleep have an impact on HRV as associated with the nomic nervous function. HRV indexes (time, geometric, and frequency domain) from the first five minutes resting (supine) ECG data was increased in the CES condition, including RMSSD, TINN, and RRTri which defines the dominance of parasympathetic control with an increase of overall HRV, there was improved sympathovagal balance. An increase in HRV indexes is an indicator of improved sympathovagal balance and an increase of parasympathetic tone. CES stimulates cortical areas, subcortical areas, and cranial nerves in the brain. The authors propose a mechanism of action of CES supporting sympathovagal balance and parasympathetic dominance through regulation of the autonomic nervous system. Limitations The small sample size of this study limits generalizability of the findings. Replication of the study with a larger sample is warranted to better understand the mechanism of action of CES on HRV. While this was a good quality randomized control trial, the lack of double-blinding can potentially introduce bias into the interpretation of the results. The authors do not discuss a power analysis to determine appropriate sample size, nor do they discuss an apriori method of handling missing data. Study Quality: GOOD ### Military Service Member and Veteran Self-Reports of Efficacy of Cranial Electrotherapy Stimulation for Anxiety, PTSD, Insomnia, and Depression Military Service Member and Veteran Self-Reports of Efficacy of Cranial Electrotherapy Stimulation for Anxiety, PTSD, Insomnia, and Depression Kirsch, D.L., Price, L.R., Nichols, F., Marksberry, J.A., & Platoni, K.T. Military Service Member and Veteran Self-Reports of Efficacy of Cranial Electrotherapy Stimulation for Anxiety, PTSD, Insomnia, and Depression. The Army Medical Department Journal. 2014; 46-54.Funding Source, Location of Study or Author’s AffiliationScience and Education at Electromedical Products International, Mineral Wells, TexasDeviceAlpha-Stim®Key VariablePerceptions of efficacy of Alpha-Stim for treatment of anxiety, insomnia, depression, and pain.ObjectiveUnderstand Service Members’ and veterans’ perceptions of the effectiveness and safety of cranial electrotherapy stimulation (CES) for anxiety, PTSD, insomnia, depression, pain, and headache.DesignEmail addresses for potential participants were obtained from prescriptions for Alpha-Stim CES devices written by DOD or VA practitioners that were on file at Electromedical Products International, Inc., Mineral Wells, Texas, the manufacturer of the device. Service members and veterans (N=1,514) who had obtained an Alpha-Stim CES device through the Department of Defense or Veterans Affairs Medical Center from 2006-2011 were invited to participate in the web-based survey via email. No study blinding was reported.Primary Outcome MeasuresPerceptions of the effectiveness and safety of CES using an online survey for:AnxietyDepressionInsomniaPainHeadachePTSDSecondary Outcome MeasuresPerceived effectiveness of survey respondents who were taking prescription medications for their condition and those that used CES only using an online survey.Key Inclusion CriteriaUsing an Alpha-Stim CES devices written by DOD or VA practitioners that were on file at Electromedical Products International, Inc., Mineral Wells, Texas, the manufacturer of the device.Key Exclusion CriteriaNone reported.Protocol SummaryService members and veterans who had obtained an Alpha-Stim CES device through the Department of Defense or Veterans Affairs Medical Center from 2006-2011 were invited to participate in the web-based survey.Device Application ProtocolThe survey responders were expected to have used the Alpha-Stim device as per the recommendations of their medical provider when reporting their perceptions of the effectiveness and safety of CES for anxiety, PTSD, insomnia, depression, pain, and headacheStatistical Analysis PlanNo apriori hypothesis were formally reported as this was a non-probability, purposive sampling survey study was to examine Service Members’ and veterans’ perceptions of the effectiveness and safety of CES for anxiety, PTSD, insomnia, depression, pain, and headache. A seven-point Likert scale, which has established validity in the literature, was used to measure respondents’ perceived effectiveness of CES for anxiety, PTSD, insomnia, and depression. The choices on the Likert scale were:Worse (negative change)No change (0%)Slight improvement (1% to 24%)Fair improvement (25% to 49%)Moderate improvement (50% to 74%)Marked improvement (75% to 99%)Complete recovery (100%)ResultsSubjectsService members and veterans (N=1,514) were invited to participate in the web-based survey via email. One hundred fifty-two participants (152) returned questionnaires. Seven (7) questionnaires did not include any effectiveness and safety data. Thus, the valid sample size was N=145 for the analysis of the effectiveness and safety questions. All participants used CES at home following a DOD or VA CES protocol.Perceived improvement of anxiety from CES by group.Seventy-two percent (72%) of respondents were active-duty service members and 28% were veterans. The sample was 75% male. Subjects ranged in age from 19-67 years with a mean of 38 years. Eighty-two percent (82%) were still using Alpha-Stim CES. Seventy-three percent (73%) were currently taking at least one prescription drug for their condition. The length of time respondents reported using Alpha-Stim ranged from three months to three years. The median length of time respondents used Alpha-Stim CES was nine months.Service members’ and veterans’ perceived effectiveness of Alpha-Stim for anxiety, insomnia, and depression.Effectiveness of Alpha-Stim CESAnxiety (N=114). Of the total group, 46.5% reported less anxiety and clinical improvement of ≥ 50% while 20.2% reported clinical improvement of anxiety between 25-49%. In the total group, 66.7% respondents reported ≥ 25% improvement in anxiety. In the CES only group (no medications), 57.7% reported decreased anxiety and clinical improvement of ≥ 50% while 15.4% reported clinical improvement of anxiety between 25-49% for a total of 73.1% of respondents who reported less anxiety and clinical improvement ≥ 25%. In the CES and medications group, 43.2% of respondents reported decreased anxiety and clinical improvement ≥ 50% while 21.6% reported decreased anxiety 25-49% improvement for a total of 64.8% of respondents who reported decreased anxiety and clinical improvement ≥ 25%.PTSD (N=88). Of the total group, 38.6% reported less anxiety and clinical improvement of ≥ 50% while 23.9% reported clinical improvement of anxiety between 25-49%. In the total group, 62.5% respondents reported ≥ 25% improvement in anxiety. In the CES only group (no medications), 50.0% reported decreased anxiety and clinical improvement of ≥ 50% while 22.2% reported clinical improvement of anxiety between 25-49% for a total of 72.2% of respondents who reported less anxiety and clinical improvement ≥ 25%. In the CES and medications group, 35.7% of respondents reported decreased anxiety and clinical improvement ≥ 50% while 24.3% reported decreased anxiety 25-49% improvement for a total of 60.0% of respondents who reported decreased anxiety and clinical improvement ≥ 25%.Insomnia (N=98). Between 25-49% for a total of 85.8% of respondents who reported less insomnia and clinical improvement ≥25%. In the CES and medications group, 40.3% of respondents reported decreased insomnia and clinical improvement ≥50% while 19.5% reported decreased insomnia of 25-49% improvement for a total of 59.8% of respondents who reported decreased insomnia and clinical improvement ≥25%.Headache. The most striking finding was that 100% of those respondents who were using Alpha-Stim for headache reported improvement of ≥25% and 64.7% of these respondents reported improvement of ≥50%.Safety of Alpha-Stim CESNinety-nine percent (99%) of subjects in this survey considered CES technology to be safe. Ninety-nine percent (99%) of participants did not report any problems related to using CES self-directed at home following a DOD or VA CES Protocol. One respondent reported not being shown how to use the CES device properly.ConclusionsService members and veterans perceived CES as a safe and effective treatment for anxiety, PTSD, insomnia, depression, pain, and headache when used either as an adjunct to pharmaceutical therapy or as a stand-alone therapy. In addition, the findings support that service members and veterans can successfully use self-directed CES at home following a DOD or VA CES protocol.LimitationsThe survey was a non-probability, purposive sampling survey asking participants to retrospectively report their perceptions of the effectiveness and safety of CES for anxiety, PTSD, insomnia, depression, pain and headache.Study Quality: FAIR ### Cranial Electrotherapy Stimulation in Patients Suffering from Acute Anxiety Disorders Cranial Electrotherapy Stimulation in Patients Suffering from Acute Anxiety Disorders Overcash, Stephen J. Cranial electrotherapy stimulation in patients suffering from acute anxiety disorders. American Journal of Electromedicine. 1999; 16(1):49-51. DeviceAlpha-Stim®Key VariableAnxietyObjectiveTo evaluate the effectiveness of cranial electrotherapy stimulation (CES) on patients’ anxiety levels.DesignAn open label retrospective analysis of 197 patients who were seen at a mental health clinic between January 1989 and January 1995.Primary Effectiveness EndpointThe primary effectiveness endpoint was the change from baseline in the last post-treatment scores on the Numerical Rating Scale (NRS) for anxiety, along with physiological measurements of electromyogram (EMG), electrodermal response (EDR), and finger temperature (FT) taken at the last therapy session.Key Inclusion Criteria• Subjects who had CES treatments for anxiety from January 1989 to January 1995 and had completed the baseline and final evaluation post-test measures.• Diagnosis of anxiety was verified by a doctoral level clinical psychologist and scores on the Numerical Rating Scale for anxiety, EMG, EDR, and finger temperature assessments.Key Exclusion Criteria• Pregnancy.• Presence of implanted pacemakers, pumps or stimulators.Protocol SummaryAn Alpha-Stim CES treatment was done for 25 minutes at a comfortable current setting up to 500 µA at the beginning of a therapy session. Measurements of outcome variables were taken before and after treatment. The final post-treatment measurements were taken at the last treatment session.Device Application ProtocolThe CES treatments were 25 minutes long and the current was set at a comfortable level for the subjects, between 100-500 µA in the clinic. Over 80% of the time, patients were also loaned an Alpha-Stim CES device to take home and they used the device once or twice a day in a manner consistent with how they were using it during therapy sessionsPre-specified Criteria for SuccessThe level of significance was set at p<0.05.Outcome MeasuresA numerical rating scale (NRS), 0-100, with 100 being the “highest amount of anxiety they can imagine” and 0 being no anxiety. The NRS has established reliability and validity for measuring anxiety (Davey, 2007) The following physiological indices of anxiety were also measured; electromylegram (EMG), Electrodermal response (EDR), and peripheral temperature.ResultsSubjectsThere were 197 patients who began treatment. Of those, 182 completed treatment: 55 males and 127 females. The average age was 35.6 years.Baseline MeasurementsBaseline measures on the anxiety Numerical Rating Scale. EMG. EDR and finger temperature were taken prior to the first CES treatment at the first therapy session.Data AnalysisData were analyzed using paired t-tests scores.AnxietySubjects had significantly lower scores on the 0-10 numerical rating scale for anxiety (p<.05), significantly lower EMG scores (p<.05), significantly lower EDR scores (p<.05) and significantly higher finger temperature scores (p<.05) at post-test from baseline, with all factors indicating and cross confirming less anxiety (See Figure 1, 2, 3 and 4).Figure 1. Mean anxiety scores over time on the 0-100 numerical rating scale (NRS).Figure 2. Mean scores over time on EMG as an objective physiological measure of anxiety.Figure 3. Mean scores over time on EDR as an objective physiological measure of anxiety.Figure 4. Mean scores over time on peripheral temperature as an objective physiological measure of anxiety.Quality of the ResearchStrengths of this study are; it was adequately powered with a large N of 197 subjects, both subjective and objective physiological measures of anxiety were used, and an analysis of the data was done comparing outcomes by the therapist’s level and type of training in order to determine if the effect was from CES or from the therapist (there were no significant differences in outcomes by level of training of therapist). This was a retrospective study and it has the following limitations; lack of controls; lack of a standard protocol for CES treatments that includes number of treatments, the current level and length of treatment, and for where treatments were done – clinic, home or both places. However, the findings of this study that CES significantly decreases anxiety is consistent with other Alpha-Stim CES studies that found CES significantly decreases anxiety.Author AffiliationSJO, Clinical Psychologist and Certified Biofeedback Clinician, Chambersburg, PAReferenceDavey HM, Barratt AL, Butow PN, Deeks JJ. A one-item question with a Likert or Visual Analog Scale adequately measured current anxiety. Journal of Clinical Epidemiology. 2007 Apr;60(4):356-60.  ### A Pilot Study of Cranial Electrotherapy Stimulation for Generalized Anxiety Disorder A Pilot Study of Cranial Electrotherapy Stimulation for Generalized Anxiety Disorder Bystritsky, A., Kerwin, L., Feusner, J. A pilot study of cranial electrotherapy stimulation for generalized anxiety disorder. Journal of Clinical Psychiatry. 2008; 69:412-417. Funding Source, Location of Study or Author’s AffiliationFunding was provided by a grant from the Saban Family Foundation to Dr. Bystritsky. This study was conducted at the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California.DeviceAlpha-Stim® SCSKey VariablesAnxiety and depression.ObjectiveTo evaluate the effect of a specified treatment course with cranial electrotherapy stimulation (CES) on the anxiety and depression levels in general anxiety disorder (GAD) patients.DesignAn IRB approved 6-week open label study. Baseline measurements were done just prior to the first CES treatment and outcome variables measurements were done at endpoint of study right after the final CES treatment. The Mini-International Neuropsychiatric Interview was conducted at screening to confirm GAD diagnosis using DSM-IV criteria. Patients were eligible for the study if they met a cut-off score of >16 on the HAM-A and a score 16 on the HAM-A and <17 on the HAM-D-17.Key Exclusion CriteriaPrimary diagnosis meeting DSM-IV criteria for any Axis I disorder other than GAD.DSM-IV diagnosis of mental retardation, pervasive developmental disorder, or neurologic impairment.Current diagnosis or recent (6-month) history of drug or alcohol dependence or abuse.Current suicidal ideation and/or history of suicide attempt.Any personality disorder of sufficient severity to interfere with participation in the study.Presence or history of a medical disease that might put the patient at risk or compromise the study.Pregnant or breastfeeding women and those of childbearing potential who were not practicing a reliable form of contraception.Protocol SummaryBaseline measures were done prior to start of treatment and outcomes measures were done at end point of study, six weeks. No change was made in the medical management of the patients during the study. After instruction on how to use the CES device, participants subsequently self-administered CES at home Those treated with benzodiazepines (alprazolam and lorazepam) took them on an as-needed basis no more than twice per week.Device Application ProtocolSubjects self-administered CES for 60 consecutive minutes each day between the hours of 3:00 PM and 7:00 PM for a total of six weeks. Subjects recorded each treatment session in daily treatment logs, which were reviewed at three weeks and six weeks study visits. All subjects chose 300 µA as their preferred level of current.Statistical Analysis PlanApriori hypothesis was that application of an Alpha-Stim would reduce anxiety. Response to treatment was defined as a reduction of 50% or more on the HAM-A and a CGI-I score of 1 or 2 (very much improved or much improved, respectively).ResultsSubjectsA total of 15 subjects expressed interest in the study and engaged in an initial telephone screen. 20% of participants (N=3) were deemed ineligible to participate because of age (N=1) and psychiatric comorbidity (N=2). Twelve (12) subjects enrolled and received CES treatment. The mean and SD age of the sample was 42.83±10.27 years. Of the 12 individuals enrolled in the study, 9 females and 3 males, 5 participants had been taking psychotropic medications (venlafaxine, N=2; alprazolam, N=2; lorazepam, N=1) for at least 3 months prior to enrollment and continued throughout the study. Two of these had failed 2 previous adequate trials of SSRIs. There were no statistically significant differences at baseline on any of the outcome measures. Nine (9) subjects completed the testing at the endpoint of the study, week 6.Data AnalysisData were analyzed using a one sample paired t-test to compare baseline to endpoint means on outcome variables with significance levels set at p=.05, 2-tailed. After treatment, participants exhibited a significant change from baseline (30.58±11.24) to endpoint (23.83±7.57) on the FDADS-Anxiety subscale scores (t=2.35, p=0.039, d=-.75) as well as on the HAM-A (baseline 21.25±5.82; endpoint 12.67±5.47; t=3.083, p=0.01, d=-1.52). In addition, a significant difference was exhibited in HAM-D-17 scores from 10.50±15.01 at baseline to 6.00±3.64 at endpoint (t=3.01, p=0.01, d=-.41). Mean anxiety scores on HAM-A and FDADS-A Mean depression scores pre- and post-treatment Safety Outcome MeasuresThree subjects withdrew from the study after baseline measures because of the side-effects of headache (N=2) or dizziness (N=1). These side-effects are suggestive of a central nervous system effect by CES.ConclusionThis study indicates CES may improve anxiety and depression symptoms associated with GAD. The value of this study is that it forms a basis for a large randomized controlled trial on the effect of CES on GAD. This study is also valuable because the findings are consistent with the findings of RCT studies that showed CES significantly decreases anxiety.LimitationsThis study has the limitations of an open-label small pilot study, such as the small number of subjects. The authors also state because of the small N of the study, the placebo effect associated with GAD could be a confounding variable.Study Quality: FAIR ### Cranial Electrotherapy Stimulation (CES) As a Treatment for Reducing Stress and Improving Prefrontal Cortex Functioning in Victims of Domestic Violence. Cranial Electrotherapy Stimulation (CES) As a Treatment for Reducing Stress and Improving Prefrontal Cortex Functioning in Victims of Domestic Violence Mellen, Ronald R., Case, Jan and Ruiz, Deanna J. Cranial electrotherapy stimulation (CES) as a treatment for reducing stress and improving prefrontal cortex functioning in victims of domestic violence. International Association for Correctional and Forensic Psychology Newsletter. 48(3):12-15, 2016.DeviceAlpha-Stim®Key VariableAnxietyObjectiveThe objective of this study was to determine if Cranial Electrotherapy Stimulation (CES) was effective for reducing post traumatic stress and improving prefrontal cortex functioning in victims of domestic violence.DesignThis was an open label study design.Primary Effectiveness EndpointBrief Symptom Inventory (BSI)Secondary Outcome MeasuresBehavioral Rating Inventory of Executive Function (BRIEF-A) including the Behavioral Regulation Index and the Metacognition Index.Key Inclusion CriteriaThe study sample included females who were victims of domestic violence and living in a shelter.Protocol SummaryDue to the high resident turnover rate in domestic violence shelters, the protocol only required daily 20 minutes CES treatments for 5 consecutive days.Outcome MeasuresOutcome measures included the Brief Symptom Inventory (BSI), the Behavioral Rating Inventory of Executive Function (BRIEF-A) including the Behavioral Regulation Index and the Metacognition Index.SubjectsThis study included 10 females who were victims of domestic violence and living in a shelter. The average age was 45 years old and most reported either being married to or living with the abuser.ResultsTable 1 below shows the changes in the primary and secondary measurements after 5 CES treatments.Table 1. This table contains results from the primary and secondary study measures.ConclusionAll three BSI global scales and 2 of 3 scales in the BRIEF-A found significant reductions in stress levels for the 10 sheltered residents. The 9 clinical measures of the BSI did not achieve statistical significance; however, the trend lines indicated positive changes in all nine of the clinical variables suggesting movement toward more normalized functioning in each category. Specifically, there were reductions seen in somatization, obsessive-compulsive thinking, reduced levels of depression, anxiety, hostility and improved ability to relate interpersonally. There are also reductions in phobic anxiety, paranoid ideation and psychoticism.The study shows that CES may contribute to reductions in psychological stress experienced by victims of domestic abuse. The results from the BRIEF-A suggest improvements in global functioning within the cortical and subcortical areas of the brain that may improve victims’ abilities to think more clearly and make better decisions. ### Cranial Electrotherapy Stimulation for the Management of Depression, Anxiety, Sleep Disturbance, and Pain in Patients with Advanced Cancer: A preliminary study. Cranial Electrotherapy Stimulation for the Management of Depression, Anxiety, Sleep Disturbance, and Pain in Patients with Advanced Cancer: A preliminary study. * Study conducted at MD Anderson Cancer CenterYennurajalingam S, Kang D-H, Hwu W-J, Padhye NS, Masino C, Dibaj SS, Liu DD, Williams JL, Lu Z, Bruera E. Cranial electrotherapy stimulation for the management of depression, anxiety, sleep disturbance, and pain in patients with advanced cancer: a preliminary study. Journal of Pain and Symptom Management. E-published ahead of print, September, 2017.ContextCranial Electrotherapy Stimulation (CES) is a safe modulation of brain activity for treating depression, anxiety, insomnia, and pain. However, there are no published studies in patients with advanced cancer (ACP).ObjectivesThe aim of the study was to determine the feasibility and preliminary efficacy of a 4-week CES intervention on depression, anxiety, sleep disturbance, and pain scores. Concurrent salivary biomarker studies were conducted.MethodsIn this one group open label pre- and post-intervention study with a 4-week CES intervention, ACP’s with one or more of four moderate intensity (≥3/10) ESAS symptoms (depression, anxiety, sleep disturbance, and pain) were eligible. Adherence (0-100%), satisfaction rates (0-10), and safety were assessed. ESAS, HADS, PSQI, BPI, and salivary levels (cortisol, alpha amylase, CRP, and IL-1 beta and IL-6) were assessed from baseline to week 4.Results33/36(92%) completed the CES. Median (IQR) adherence CES use and satisfaction scores were 93% (89-100) and 10(9-10) respectively and the adherence criteria was met in the study. CES use was safe (no grade 3 or higher adverse events). HADS anxiety (p<0.001), HADS depression (p=0.024), ESAS anxiety (p= 0.001), depression (p=0.025), BPI pain (p=0.013), PSQI daytime dysfunction (p=0.002), and Medication use (p=0.006) scores improved after 4 week CES treatment.ConclusionsIn this preliminary study we found that the use of CES was safe and feasible in ACP. The use of CES was associated with significant improvement of depression, anxiety, pain, and sleep scores. These findings support further studies of CES in ACP for symptom control. ### Nonopioid Alternatives to Addressing Pain Intensity: A Retrospective Look at Two Noninvasive Pain Treatment Devices Nonopioid Alternatives to Addressing Pain Intensity: A Retrospective Look at Two Noninvasive Pain Treatment Devices Morrow DJ, Fischer EP, Walder AM, Jubran NI. Nonopioid alternatives to addressing pain intensity: a retrospective look at two noninvasive pain treatment devices. Federal Practitioner, 2019;36(4): 181-187.DevicesAlpha-Stim®, Cold laserKey VariablePain, anxiety and depressionObjectiveResearch the response in veterans with chronic pain to nonopioid treatments with Alpha-Stim CES and cold laser therapy.DesignVeterans were referred to the pain multi-modality clinic for a face-to-face assessment and recommendations in developing a comprehensive pain treatment plan. The staff was trained to manufacturers guidelines and then the veterans were trained on how to use the devices at home. Veterans who had chronic or persistent pain (≥ 3 months) that interfered with function or quality of life were considered good candidates for a device trial if they are actively involved in pain self-care, logistically able to participate, able to use a device long-term, and had no contraindications. For Alpha-Stim M (AS-M), veterans came to the clinic 5 days a week for 2 weeks. For cold laser therapy, veterans attend the clinic 5 days a week for 1 week.Primary Effectiveness EndpointAssess response of pain by comparing Alpha-Stim and a cold laser device (LTO).Secondary Outcome MeasuresDetermine if the treatment devices had any effect in reducing comorbid anxiety and depression,Key Inclusion CriteriaGives informed written and oral consent to the study.Key Exclusion CriteriaPregnancyImplantation with a pacemaker or an implantable cardioverter device (ICD).Protocol SummaryData for veterans who completed valid treatments of AS-M or LTO from May 9, 2014 to August 20, 2016, were included in the analyses. For an AS-M treatment to be considered valid, the veteran must have attended at least 8 sessions and completed assessment instruments at baseline (preintervention) and following completion (postintervention). For an LTO treatment to be considered valid, the veteran must have attended at least 4 sessions and completed assessment measures at baseline and after completion. Participants completed a daily pain log and recorded self-ratings (0-to-10 scale) of pain and relaxation levels before and after using the device. These scores were primarily used to assist in determining whether goals, set collaboratively by the clinician and the veteran at the first session, had been met. Veterans completed the following measures at baseline and after trial completion:The Beck Depression Inventory (BDI)The Beck Anxiety Inventory (BAI)The Pain Catastrophizing Scale (PCS)The Subjective Units of Distress Scale (SUD)The Brief Pain Inventory (BPI) ResultsSubjectsDevice trials were initiated for 161 veterans (LTO, 70; AS-M, 91). Distribution of devices was unequal because veterans are assigned to one device or the other based on clinical presentation. Failure to complete a trial (n = 46; 28.6%) typically was because of travel barriers, lack of interest in continuing, and for 3 veterans, reports of headaches that they attributed to the AS-M treatment. Of the 115 participants who completed valid trials, 88 (76.5%) also completed assessment measures at pre- and postintervention (LTO = 38; AS-M = 50). None of the participants in this study completed trials with both the AS-M and LTO devices. Most participants were male (84.1%) and rural residents (85.5%). The average age of participants was 56.6 years, and < 20% were Operation Enduring Freedom/Operation Iraqi Freedom/Operation NewDawn-era veterans.Data AnalysisDescriptive statistics were used to characterize the sample overall and by modality.Paired t tests were used to assess changes on each assessment measure over time and foreach device separately. The significance of change was assessed for 8 outcomes for each device. In this context, using a conservative Bonferroni correction, significance was set at p<.006. Because AS-M is designed to address depression, anxiety, and sleep as well as pain, whereas LTO is not, device assignments were based on clinical considerations rather than randomization. Therefore, no comparisons were made between devices, and outcomes were assessed independently for the 2 devices.ConclusionTreatment with AS-M and LTO were both associated with statistically significant reductions in pain severity (BPI), pain interference (BPI), daily pain intensity scores (daily pain log), and pain catastrophizing (PCS). Use of AS-M was associated with statistically significant improvements in depression (BDI), anxiety (BAI), and distress (SUD) scores. In addition, veterans completing AS-M treatment showed a statistically significant improvement in self-reported relaxation scores. Nonpharmacologic, noninvasive devices pose fewer risks and seem to be more effective in reducing pain intensity than traditional treatments, including medications or surgical intervention. In light of the current emphasis on evidence-based health care and as the evidence for the effectiveness of noninvasive pain devices modalities grows, it is likely that treatments incorporating modalities such as microcurrent electrical therapy (MET), CES, and LTO will become common options for managing chronic pain.LimitationsThe findings were limited because they were derived from a retrospective, quality improvement evaluation of outcomes from a single VA clinic. Findings must be considered in the context of the relatively small samples of veterans. Because analyses were conducted as part of a quality improvement effort, veterans were offered a specific device based on clinical indications, there were no comparisons between devices, and there was no comparison group. Although most participants were using medication and other treatments as part of their pain treatment plan, all reported continued pain intensity before use of a device so the results achieved from the devices were above the results achieved from medications. ### A novel medical device that relieves anxiety, depression and pain while improving sleep in a population of teachers A novel medical device that relieves anxiety, depression and pain while improving sleep in a population of teachers Kirsch TB, Kuhn J, Price LR, Marksberry J, Haltiwanger SG. A novel medical device that relieves anxiety, depression and pain while improving sleep in a population of teachers. Journal of Depression and Anxiety, 2019; 8:334.Funding Source, Location of Study or Author’s AffiliationThis study was supported by a research grant from The Brazos Foundation, an independent charity in Mineral Wells, Texas, which paid for the health screenings. The Alpha-Stim® devices used in this study were provided free of charge by Electromedical Products International, Inc.DeviceAlpha-Stim® AIDKey VariablesAnxiety, insomnia, depression, and painObjectiveThis study was conducted to confirm the benefits of Alpha-Stim cranial electrotherapy stimulation (CES) technology as an effective non-drug treatment for anxiety, mood, depression, sleep, and pain in teachers following a successful pilot study at the Leigh Academy, Dartford, United Kingdom. The second objective was to determine whether a new Alpha-Stim smartphone app was a reliable method of evaluating the effectiveness of using the device to treat anxiety, insomnia, depression, and pain.DesignThirty-five (35) teachers (29 females and 6 males) in the Mineral Wells, Texas Independent School District, volunteered to participate in a study to reduce anxiety, depression, insomnia, and pain. It was a six-week open-label design where participants tracked their progress using a new smartphone app to record their symptoms at least five days per week. The subjects were encouraged to use the device for 20-60 minutes any time of day and for any indication. Baseline measurements were taken prior to starting the six-week study.Primary Outcome MeasuresAnxiety (primary outcome 1) subjects reported their perceived level of anxiety five days per week (twice per day – pretest-posttest) over a six-week period using an 11-point Numerical Rating Scale representing a continuous level of measurement. A value of 0 signifies the absence of symptoms and a value of 10 signifies a high level of discomfort perceived by subjects. Ratings data were recorded daily (pretest and posttest) using a smartphone application.Depression (primary outcome 2) subjects reported their perceived level of depression five days per week (twice per day – pretest-posttest) over a six-week period using an 11-point Numerical Rating Scale representing a continuous level of measurement. A value of 0 signifies the absence of symptoms and a value of 10 signifies a high level of discomfort perceived by subjects. Rating data were recorded daily (pretest and posttest) using a smartphone application.Insomnia (primary outcome 3) subjects reported their perceived level of insomnia five days per week (twice per day – pretest-posttest) over a six-week period using an 11-point Numerical Rating Scale representing a continuous level of measurement. A value of 0 signifies the absence of symptoms and a value of 10 signifies a high level of discomfort perceived by subjects. Rating data were recorded daily (pretest and posttest) using a smartphone application.Pain (primary outcome 4) subjects reported their perceived level of pain five days per week (twice per day – pretest-posttest) over a six-week period using an 11-point Numerical Rating Scale representing a continuous level of measurement. A value of 0 signifies the absence of symptoms and a value of 10 signifies a high level of discomfort perceived by subjects. Rating data were recorded daily (pretest and posttest) using a smartphone application.Secondary Outcome MeasuresThe second purpose of this study was to examine the effectiveness of monitoring Alpha-Stim CES treatment using a smartphone application. Outcome measures were pre-post scores used in monitoring anxiety, depression, insomnia, pain, and stress in a sample of teachers.Key Inclusion CriteriaSubjects needed to be in good medical health or have stable chronic medical conditions.Key Exclusion CriteriaExcluded was a diagnosis of any other mental disorder g., substance use disorder, eating disorder, bipolar disorder, non-affective psychosis.PregnancyImplanted medical device (e.g., a pacemaker, defibrillator, cochlear implant, spinal cord stimulator, or deep brain stimulator).Protocol SummaryParticipants were instructed to turn the current on the Alpha-Stim to the point of feeling dizziness or vertigo, then turning the current down slightly until the feeling dissipates, for 20-60 minutes daily. The frequency of the waveform was constant at 0.5 Hz, and the current was adjustable from 100–500 uA.At pretest (baseline) and posttest, data on outcome measures were recorded as perceived levels of discomfort specific to the teachers’ anxiety, depression, insomnia, and pain.The study was conducted for six weeks with a smartphone app, during which time they monitored themselves at least five days per week.Participants were permitted to use the device any time of day and for any indication. At the end of six weeks, they were asked to complete a survey of perceived effectiveness.The smartphone application used by subjects for reporting their perceived level of insomnia, pain, anxiety, depression, and stress includes an 11-point scale representing a continuous level of measurement expressed as values of 0–10. A value of zero (0) signified the absence of any symptoms and a value of ten (10) signified a high level of discomfort as perceived by the participants.Statistical Analysis PlanA priori sample size calculations were not performed, a total convenience sample of 35 subjects volunteered and were screened for inclusion in the study. No formal study hypotheses were articulated. The goal of the study was to conduct a field trial to determine the efficacy of a newly developed smartphone app. No missing data were present.An analysis to determine missing data (e.g., MCAR, MAR or MNAR) was not conducted or missing data replacement algorithm was used. Consequently, no Intent-to-Treat analysis was conducted. Instead, a Complete Case approach was used in all statistical analyses. The primary analysis was mixed-model nested within-subjects analysis to determine any consistent differences on the primary outcome measures within subjects over time.ResultsSubjectsA total of 29 female and 6 male teachers between the ages of 22 and 60 years participated in the study over the full six weeks.Data AnalysisData were analyzed using the student t-test comparing pre and posttest measurements. The statistical analyses revealed highly significant improvement (p<0.001) in anxiety, depression, insomnia, and pain. The effect size Cohen’s d values from a total of 237 treatments were greater than 2 standard deviations for all outcome measures indicating a high level of practical change from baseline to posttest supporting the capability of Alpha-Stim CES technology in reducing self-perceived symptoms and the ability to monitor progress on the Alpha-Stim app.Decrease in mean anxiety, depression, insomnia, pain, and stress scores over 6 weeks. ConclusionThe treatment effect with Alpha-Stim CES on anxiety, insomnia, depression, and pain was consistent with prior surveys and confirmed the precision of the new app in determining progress from a single treatment and a series of treatments. Anxiety was the most selected condition treated. Insomnia showed the greatest improvement in this study, followed closely by depression. During the study, each participant was instructed to report any discomfort or perceived safety issues. No participant reported any safety-related problems verbally or during treatment. This study established that Alpha-Stim is a successful non-drug treatment of anxiety, insomnia, and depression. The authors state Alpha-Stim is a good treatment option for individuals concerned about the side effects of medications to treat these conditions.LimitationsThe small sample size of this study consisted mostly of females, which may impact the generalizability of the findings. There were no formal a priori hypotheses and or a priori power calculations to determine minimum sample size.Study Quality: FAIR ### First responder research shows that electrical brain stimulation helps control anxiety, insomnia, and depression First responder research shows that electrical brain stimulation helps control anxiety, insomnia, and depression Platoni K, Oakley R, Haltiwanger SG, et al. First responder research shows that electrical brain stimulation helps control anxiety, insomnia, and depression. Journal of Depression and Anxiety, 2019; 2(1): 006.DeviceAlpha-Stim®Key VariablesAnxiety, insomnia, depression, and painObjectiveThis study was designed to investigate the effectiveness of Alpha-Stim® cranial electrotherapy stimulation (CES) in a group of 86 first responders for the treatment of anxiety, insomnia, depression, and pain.DesignThe study included a nonrandomized pretest-posttest design with participants choosing to participate or not (i.e., self-selecting into participation). The independent (treatment) variable in this study was exposure to active CES. Participants were instructed to use the Alpha-Stim at a comfortable current intensity level adjustable from 100-600 microamperes for 20-60 minutes daily. At pretest (baseline) and posttest, data on outcome measures included perceived level of discomfort specific to the following indications anxiety, insomnia, depression, and pain.Primary Effectiveness EndpointTo demonstrate that Alpha-Stim CES is effective in decreasing anxiety, insomnia, depression, and painSecondary Outcome MeasuresThe second purpose of this study was to examine the effectiveness of monitoring Alpha-Stim CES treatment using a smartphone app. Outcome measures were anxiety, depression,insomnia, pain and stress in a sample of first responders.Key Inclusion CriteriaParticipants were required to give informed written and oral consent to the study.Free of any major medical or mental illnessKey Exclusion CriteriaExcluded was a diagnosis of any other mental disorder g., substance use disorder, eating disorder, bipolar disorder, non-affective psychosis.PregnancyImplantation with a pacemaker or an implantable cardioverter device (ICD).ResultsBaseline MeasurementsBaseline measurements were taken prior to starting the six-week study.Data AnalysisAnalysis of the results was done by measuring the differences between the pretest and posttest mean of the participants. For anxiety the pretest mean was 4.18 and the posttest was 1.93 producing a reduction in anxiety of 54% with p <.001, and Cohen effect size d=1.21 (large). Similar results were seen in insomnia with a pretest mean of 5.70 and posttest mean of 3.80 for a reduction of 33% with p<.001 (two-tailed), and effect size d=1.18 (large), depression measures were a pretest mean of 3.95 and posttest mean of 2.83 for a reduction of 28% with p <.001 (two-tailed), and effect size d=.81 (large) and the pain pretest mean was 4.62 and posttest mean of 2.58 for a reduction of 44% with p<.001, and effect size d=.72 (large).ConclusionThese 86 police officers, sheriff’s officers, and firefighters experienced a very significant decrease in anxiety, insomnia, depression, and pain by using Alpha-Stim CES. The statistical analyses revealed highly significant values of p<.001 for anxiety, depression, insomnia, and pain. The effect size Cohen’s d values were large for all outcome measures indicating a high level of practical change from baseline to posttest, which supports the capability of Alpha-Stim CES technology in reducing anxiety, insomnia, depression and pain symptoms and the ability to monitor progress on the Alpha-Stim app. No complaints were made by participants except mild dizziness that resolved during a session when the current was adjusted down to a lower level. This study supported the hypothesis that the use of a smartphone application could be useful in helping individuals track their response to Alpha-Stim CES and in monitoring their progress over time.LimitationsThere was no control group and the study was not a randomized controlled trial. ### Clinical effectiveness and cost minimisation model of Alpha-Stim cranial electrotherapy stimulation in treatment seeking patients with moderate to severe generalised anxiety disorder Clinical effectiveness and cost minimisation model of Alpha-Stim cranial electrotherapy stimulation in treatment seeking patients with moderate to severe generalised anxiety disorder Morriss R, Xydopoulos G, Craven M, Price L and Fordham R. Clinical effectiveness and cost minimisation model of Alpha-Stim cranial electrotherapy stimulation in treatment seeking patients with moderate to severe generalised anxiety disorder. J Affect Disord, 2019 Apr 15;253: 426-437.DeviceAlpha-Stim®Key VariableAnxietyObjectiveThere were four aims in this current study to determine:The proportion of anxiety patients treated with CES in IAPT services who reach the clinical threshold for remission (GAD-7 score of 7 or less, reliable improvement and recovery after treatment at 12 weeks.)The proportion of anxiety patients treated with CES in IAPT services who maintain the clinical threshold for remission (GAD-7 score of 7 or less), reliable improvement and recovery at 24 weeks.If there are significant changes over 24 weeks in generalized anxiety, depression, insomnia, social adjustment and quality of life.If the cost of CES offsets the cost of psychological treatment and other treatment over 24 weeks.DesignAn open (ethical approved) consecutive patient cohort design with a 24 week follow up in National Health Service (NHS) mental health treatment settings in England was employed where all participants were offered Alpha-Stim cranial electrotherapy stimulation (CES) for 6–12 weeks if they had not reached remission with therapist or full guided self-help and were waiting to receive individual cognitive behavior therapy (iCBT).Primary Effectiveness EndpointThe primary outcome is the proportion of participants who reach remission (7 points or less) at 12 and 24 weeks on the GAD-7 since IAPT services are paid according to the proportion of patients who reach this threshold after treatment in their service.Secondary Outcome MeasuresPersonal Health Questionnaire is a 9-item self-rated measure of the severity of depression symptoms. Remission is a total score of 9 or less at 12 or 24 weeks in those who had scored 10 or more at baseline.Athens Insomnia Scale has 8 items with a maximum score of 24. A score of 6 indicates a possible sleep problem and 4 indicates recovery.Work and Social Adjustment Scale is an 8-item self-rated measure of work and social function. A total score of 20 or more indicates considerable impairment in function.EQ5D-5L is a 6-item self-rated measure of health utility and quality of life.Key Inclusion CriteriaA score of 8 or more on GAD-7 scale, a 7-item self-rated measure of symptoms of generalized anxiety disorder.A clinical diagnosis of generalized anxiety disorder alone or in combination with a comorbid depression or other anxiety disorder e.g. obsessive-compulsive disorder or physical health morbidity.On waiting list for individual CBT (high intensity psychological intervention).Does not require urgent clinical care.Gives informed written and oral consent to the study.Agrees to return Alpha-Stim equipment at the end of the study.Key Exclusion CriteriaExcluded was a diagnosis of any other mental disorder g., substance use disorder, eating disorder, bipolar disorder, non-affective psychosis.PregnancyImplantation with a pacemaker or an implantable cardioverter device (ICD).Protocol SummaryConsecutive treatment seeking patients who received low intensity IAPT interventions (therapist guided self-management on a computerized CBT program or bibliotherapy for GAD) but had not reached a total score of 8 or more, were unlikely to meet any exclusion criteria. All participants were offered 60 min per day of Alpha-Stim CES treatment at a current of one hundred microamperes per day 7 days per week for 6 consecutive weeks. The 60 min session starts when the ear clips are attached and stops automatically when the hour is finished. Participants could choose to continue with the same CES treatment for a further 6 weeks, thereby completing 12 weeks CES treatment in total. At the end of 12 weeks the participants could not receive any further CES treatment.ResultsOf 161 patients recruited, 72 (44.7%) and 77 (47.8%) achieved remission on the GAD-7 at 12 and 24 weeks respectively with 122 (75.8%) receiving at least 6 weeks CES. Mean (SD) GAD-7 score at baseline significantly improved from 15.77 (3.21) to 8.92 (5.42) and 8.99 (6.18) at 12 and 24 weeks respectively (p<0.001). 80 (49.7%) participants required further individual CBT. CES provided a saving of £540.88 ($684.68) per patient.The proportions of participants achieving reliable improvement on the GAD-7 were 102 (63.4%) and 105 (65.2%) at 12 and 24 weeks respectively. No patient showed reliable deterioration at 12 or 24 weeks. The vast majority of the drop in GAD-7 is experienced in the first 6 weeks and there is no statistically significant difference between week 6 and any subsequent time point up to week 24.Subjects161 patients were recruited. All 161 participants started CES treatment and112 (69.6%) completed at least 6 weeks treatment. ConclusionThis study shows that in moderate to severe treatment seeking patients with GAD, nearly 45% of patients achieved remission and 63% reliable improvement in their self-rated anxiety symptoms with Alpha-Stim CES treatment. These improvements were maintained for a further 12 weeks after CES was completed whether or not patients received iCBT in addition. Most of the improvement with CES was seen in the first 4 weeks. The study showed a moderate effect size. Remission rates are lower than reported for iCBT in routine IAPT services in the UK. The mean severity of GAD-7 symptoms decreased from severe to mild and below case threshold over 12 weeks and remained at that level for 24 weeks. There were similar drops in depression symptoms and insomnia symptoms as well as improvements in function and quality of life although all of these effects were smaller with some slippage between 12 and 24 weeks. There was a high degree of attrition of the study to follow up with the loss of 55.2% by 24 weeks despite financial incentive to provide data as opposed to 40% that we had anticipated. The study was adequately powered because CES was highly effective. As well as improvements in anxiety, there were improvements in depression and insomnia, which are also indications for CES. In conclusion, This study provides evidence that CES is clinically effective while reducing cost during administration and for three months afterwards in routine treatment settings offering psychological treatments for moderate to severe GAD. Alpha-Stim CES improves the efficiency of these services, a critical issue due to the shortage and high turnover of psychological treatment staff, allowing them to reach their targets for remission with fewer highly skilled staff.Side EffectsAlpha-Stim CES was well tolerated with only six (4%) patients stopping it because of minor side effects and four (3%) because they were not making any progress.Quality of the ResearchThe strengths of the study were that clinical and cost effectiveness was examined in a consecutive large sample of treatment seeking patients in universally available publicly funded services provided by the state irrespective of the ability to pay or health insurance. Inclusion criteria were set to reflect the criteria used by IAPT services to offer individual CBT. This criterion was set at 8 or more on the GAD-7 reflecting the upper end of mild severity compared to the usual clinical thresholds for mild, moderate and severe anxiety of 5,10 and 15 on the GAD-7. However, 95% of the sample had moderate or severe symptoms of GAD at baseline, well above the minimum threshold for entry to the study and the national NHSIAPT criteria for remission. They had already failed to improve with facilitated bibliotherapy or computerized psychological treatment for GAD, so spontaneous improvement was unlikely. Placebo responses are less frequent in research participants with less severe anxiety or depression and in those who have not responded to previous active treatment for their condition. Therefore, the study shows the effectiveness of CES in a clinical treatment seeking sample of patients with moderate to severe treatment resistant generalized anxiety disorder.LimitationsThere are important limitations of the study. There was no control group and the study was not a randomized controlled trial. However, metanalysis of previous RCTs of active CES versus sham CES already provides evidence that CES is effective in treating anxiety and depression symptoms. ### Alpha-Stim Cranial Electrotherapy Stimulation (CES) for Anxiety Treatment: Outcomes in a United Kingdom (UK) Primary Care Practice Feasibility, acceptability and costs of nurse-led Alpha-Stim cranial electrostimulation to treat anxiety and depression in university students Royal, S., Keeling, S., Kelsall, N., Price, L., Fordham, R., Xydopoulos, G., et al. Feasibility, acceptability and costs of nurse-led Alpha-Stim cranial electrostimulation to treat anxiety and depression in university students. BMC Primary Care. 2022; 23:97. Funding Source, Location of Study or Author’s Affiliation University of Nottingham Health Service, Cripps Health Centre, United Kingdom. Funded by National Institute of Health Research (NIHR), with the devices being loaned to the clinic by the manufacturer. Device Alpha-Stim® AID Key Variables Anxiety and Depression. Objective To evaluate the effectiveness and the cost effectiveness of a new medical device for the treatment of mild to moderate depression and anxiety in Primary Care when delivered through an innovative nurse-led clinic. Assess a group of participants attending the mental health clinic who used Alpha-Stim AID either alone or in combination with other treatments. Ispero was used to gather a baseline PHQ-9 and GAD-7 scores and then compared this with a score taken after 8 (6-10) weeks of use. Design The study evaluated the effectiveness of a new treatment without increasing the cost burden. It was conducted at a GP surgery in the City of Nottingham and ran for six months. The first study procedure was registration with the Ispero system (CE-marked but not currently part of standard management) and completion of the baseline assessments it contains. The results of this will be available immediately and will assist the clinician in identifying the most appropriate management option. Management options include: Self help Support agencies including NHS, University, and voluntary sector. Psychological therapy with one of the three NHS provider organizations in Nottingham. Alpha-Stim treatment for those with generalized anxiety (CE-marked but not currently standard management). Referral to a GP to discuss medication. The participants responses were monitored by Ispero and used at future contacts to guide further management. After eight weeks an investigator contacted the participant to ask permission to inspect their Ispero data and collect outcome measures. They were then offered an opportunity to withdraw consent for participation. In addition, participants were offered a personal appointment with a study clinician so that data can be reviewed in a consultation environment. Participants completed a short user satisfaction survey. A control group of patients attending their GP practice with mental health problems that would have been eligible for inclusion in the study were identified at the end of the study and a retrospective notes review will be performed by the PI. Study design has been chosen as it aligns with current NHS priorities and causes minimal disruption to participants and local services. A non-randomized controlled trial was chosen as it seemed more ethical than a randomized control trial. In addition, it would create logistical problems that would not outweigh the benefits in outcome data quality and comparability. Primary Outcome Measures To compare PHQ-9, GAD-7 and satisfaction survey responses in the experimental group with a selection of patients receiving usual care in an ad-hoc control group. Secondary Outcome Measures To determine the effectiveness of the new National Health Service (NHS) pathway (Alpha-Stim CES) in managing the conditions when compared with a group of patients receiving standard care and establish its acceptability to patients and providers. To compare the cost-effectiveness of the new NHS pathway with usual care. Explore levels of service use and use of prescription medication. Key Inclusion Criteria Adults with mild to moderate anxiety and/or depression symptoms presenting to primary care. Be registered with the practice. Aged 18 or over. Adult patients attending the participating practice requesting an appointment to discuss a mental health problem. Not requiring immediate referral to secondary care because of symptom severity. Capacity to understand the patient information sheet and give consent to participation. Key Exclusion Criteria Patients not suitable for the nurse-led mental health clinic would include those who appear distressed or at acute risk of harm to themselves or others or who appear to be intoxicated. Patients with mental health problems related to a terminal or acute physical illness. Unable to communicate effectively in English. Protocol Summary Entry into the study were offered to attendees at a walk-in clinic for people who have mental health problems. The clinic is located at the student health center on the University of Nottingham main campus. All attendees were assessed by a trained mental health nurse on presentation to the service. Non eligible patients were offered usual care according to the standard operating procedures of the service. Patients who were eligible to join the study were given an information sheet and time to consider participation. Patients who did not give consent were offered usual care according to the standard operating procedures of the service. Patients who consented were entered into the trial. Device Application Protocol Alpha-stim® AID is small battery powered device that passes microcurrents through the brain of the user to stimulate alpha waves. The treatment is delivered by two small clips attached to each ear and lasts for between twenty minutes and one hour each day. This technology has been used as a treatment for anxiety and depression for over forty years and has a large supporting scientific literature including a recent systematic review. Electrical stimulation was applied via ear clip electrodes at the lowest setting (0.5 Hz, 100 μA) based on previous positive studies of the device for depression and anxiety. Study Duration: Over 6-10 weeks, with measurements taken at 8 weeks. No adverse events were reported during the trial and nine patients expressed a high degree of satisfaction with their Alpha-Stim treatment in solicited feedback collected at the end of the study. No negative feedback was received. Statistical Analysis Plan Any data extracted for comparison was fully anonymized and no patient identifiable data was seen by any person who is not an employee of the study practice. The null hypothesis was that the new pathway is no more effective than standard treatment. Compare the scores with those from an equal number of young people who did not enter the treatment pathway and were seen by a doctor in the first instance (usual care). As part of routine service evaluation, PHQ-9 and GAD7 scores were collected between six and ten weeks of treatment following first presentation and the data was used as an ad-hoc comparator. Scores were collected over the same period (January to May 2020) and came from patients with new presentations of minor mental health problems which would have been suitable for the pathway had space on it been available. Results Subjects Active Cohort An initial sample of 48 participants consented to the study and were initially loaned units. 47 young people (mean age 21.4 years, 77% female) contributed data to active part of the study. One patient returned their Alpha-Stim® as they had not disclosed the use of illegal stimulants and decided to seek alternative treatment. One patient person broke their device accidently after four weeks but did contribute scores to the study. Comparator Control A sample of 47 control group scores were identified by an investigator who was not part of the trial (NK). The mean age of this group was 22.7 years and 79% were female. Follow Up There were 187 contacts during a total of 2,667 days of supervised management in the intervention group which is equivalent to contact every 14.3 days. In the control group there were 156 contacts in 2,392 days which is equivalent to a contact every 15.3 days. Data Analysis Intention to treat and completed group analyses was performed for the behavioral measures. The mean baseline in anxiety was a GAD7 score of 13.6 and the mean score after treatment was 8.5. This improvement was significant at p<0.05. In the control group, the mean baseline GAD7 score was 12.9 and the mean post-treatment score was 8.7, a significant (p<.05) decrease. These results show that Alpha-Stim CES is as effective as the NHS usual treatment pathways for GAD. The mean baseline in depression was a PHQ-9 score of 15.35 and the mean score after treatment was 11.24 – representing an improvement that was significant at p<0.001. No PHQ-9 scores are reported for the control group. Change in average PHQ depression score from pre to post treatment. Conclusions The results of this study suggest that a care pathway incorporating Alpha-Stim was non-inferior to usual care and may indeed be slightly better in terms of mean reduction of PHQ-9 and GAD-7 scores. The researchers estimated that a 20-minute appointment in the nurse-led clinic costs £23.67 ($30.41) and that a 20-minute appointment with a doctor as part of usual care calculated by the same formula is £42.61 ($54.75). Given the similar rate of consultation the authors believe the Alpha-Stim pathway represents a significant cost saving likely to be in the region of 10-20% allowing for fewer and shorter consultations in the usual care group. No adverse events were reported during the trial and nine patients expressed a high degree of satisfaction with their Alpha-Stim treatment in solicited feedback at the end of the study. No negative feedback was received. Limitations Given this study included a sample of patients presenting to primary care, participants were not able to be randomly assigned to CES or usual care groups. Study Quality: GOOD ### Feasibility, acceptability and costs of nurse-led Alpha-Stim cranial electrostimulation to treat anxiety and depression in university students Feasibility, acceptability and costs of nurse-led Alpha-Stim cranial electrostimulation to treat anxiety and depression in university students Royal, S., Keeling, S., Kelsall, N., Price, L., Fordham, R., Xydopoulos, G., et al. Feasibility, acceptability and costs of nurse-led Alpha-Stim cranial electrostimulation to treat anxiety and depression in university students. BMC Primary Care. 2022; 23:97.Funding Source, Location of Study or Author’s AffiliationUniversity of Nottingham Health Service, Cripps Health Centre, United Kingdom. Funded by National Institute of Health Research (NIHR), with the devices being loaned to the clinic by the manufacturer.DeviceAlpha-Stim® AIDKey VariablesAnxiety and Depression.ObjectiveTo evaluate the effectiveness and the cost effectiveness of a new medical device for the treatment of mild to moderate depression and anxiety in Primary Care when delivered through an innovative nurse-led clinic. Assess a group of participants attending the mental health clinic who used Alpha-Stim AID either alone or in combination with other treatments. Ispero was used to gather a baseline PHQ-9 and GAD-7 scores and then compared this with a score taken after 8 (6-10) weeks of use.DesignThe study evaluated the effectiveness of a new treatment without increasing the cost burden. It was conducted at a GP surgery in the City of Nottingham and ran for six months.The first study procedure was registration with the Ispero system (CE-marked but not currently part of standard management) and completion of the baseline assessments it contains. The results of this will be available immediately and will assist the clinician in identifying the most appropriate management option.Management options include:Self helpSupport agencies including NHS, University, and voluntary sector.Psychological therapy with one of the three NHS provider organizations in Nottingham.Alpha-Stim treatment for those with generalized anxiety (CE-marked but not currently standard management).Referral to a GP to discuss medication.The participants responses were monitored by Ispero and used at future contacts to guide further management.After eight weeks an investigator contacted the participant to ask permission to inspect their Ispero data and collect outcome measures. They were then offered an opportunity to withdraw consent for participation. In addition, participants were offered a personal appointment with a study clinician so that data can be reviewed in a consultation environment.Participants completed a short user satisfaction survey.A control group of patients attending their GP practice with mental health problems that would have been eligible for inclusion in the study were identified at the end of the study and a retrospective notes review will be performed by the PI.Study design has been chosen as it aligns with current NHS priorities and causes minimal disruption to participants and local services.A non-randomized controlled trial was chosen as it seemed more ethical than a randomized control trial. In addition, it would create logistical problems that would not outweigh the benefits in outcome data quality and comparability.Primary Outcome MeasuresTo compare PHQ-9, GAD-7 and satisfaction survey responses in the experimental group with a selection of patients receiving usual care in an ad-hoc control group.Secondary Outcome MeasuresTo determine the effectiveness of the new National Health Service (NHS) pathway (Alpha-Stim CES) in managing the conditions when compared with a group of patients receiving standard care and establish its acceptability to patients and providers.To compare the cost-effectiveness of the new NHS pathway with usual care.Explore levels of service use and use of prescription medication.Key Inclusion CriteriaAdults with mild to moderate anxiety and/or depression symptoms presenting to primary care.Be registered with the practice.Aged 18 or over.Adult patients attending the participating practice requesting an appointment to discuss a mental health problem.Not requiring immediate referral to secondary care because of symptom severity.Capacity to understand the patient information sheet and give consent to participation.Key Exclusion CriteriaPatients not suitable for the nurse-led mental health clinic would include those who appear distressed or at acute risk of harm to themselves or others or who appear to be intoxicated.Patients with mental health problems related to a terminal or acute physical illness.Unable to communicate effectively in English.Protocol SummaryEntry into the study were offered to attendees at a walk-in clinic for people who have mental health problems.The clinic is located at the student health center on the University of Nottingham main campus.All attendees were assessed by a trained mental health nurse on presentation to the service.Non eligible patients were offered usual care according to the standard operating procedures of the service.Patients who were eligible to join the study were given an information sheet and time to consider participation.Patients who did not give consent were offered usual care according to the standard operating procedures of the service.Patients who consented were entered into the trial.Device Application ProtocolAlpha-stim® AID is small battery powered device that passes microcurrents through the brain of the user to stimulate alpha waves. The treatment is delivered by two small clips attached to each ear and lasts for between twenty minutes and one hour each day. This technology has been used as a treatment for anxiety and depression for over forty years and has a large supporting scientific literature including a recent systematic review. Electrical stimulation was applied via ear clip electrodes at the lowest setting (0.5 Hz, 100 μA) based on previous positive studies of the device for depression and anxiety. Study Duration: Over 6-10 weeks, with measurements taken at 8 weeks. No adverse events were reported during the trial and nine patients expressed a high degree of satisfaction with their Alpha-Stim treatment in solicited feedback collected at the end of the study. No negative feedback was received.Statistical Analysis PlanAny data extracted for comparison was fully anonymized and no patient identifiable data was seen by any person who is not an employee of the study practice. The null hypothesis was that the new pathway is no more effective than standard treatment.Compare the scores with those from an equal number of young people who did not enter the treatment pathway and were seen by a doctor in the first instance (usual care).As part of routine service evaluation, PHQ-9 and GAD7 scores were collected between six and ten weeks of treatment following first presentation and the data was used as an ad-hoc comparator.Scores were collected over the same period (January to May 2020) and came from patients with new presentations of minor mental health problems which would have been suitable for the pathway had space on it been available.ResultsSubjectsActive CohortAn initial sample of 48 participants consented to the study and were initially loaned units.47 young people (mean age 21.4 years, 77% female) contributed data to active part of the study.One patient returned their Alpha-Stim® as they had not disclosed the use of illegal stimulants and decided to seek alternative treatment.One patient person broke their device accidently after four weeks but did contribute scores to the study.Comparator ControlA sample of 47 control group scores were identified by an investigator who was not part of the trial (NK).The mean age of this group was 22.7 years and 79% were female.Follow UpThere were 187 contacts during a total of 2,667 days of supervised management in the intervention group which is equivalent to contact every 14.3 days.In the control group there were 156 contacts in 2,392 days which is equivalent to a contact every 15.3 days.Data AnalysisIntention to treat and completed group analyses was performed for the behavioral measures. The mean baseline in anxiety was a GAD7 score of 13.6 and the mean score after treatment was 8.5. This improvement was significant at p<0.05. In the control group, the mean baseline GAD7 score was 12.9 and the mean post-treatment score was 8.7, a significant (p<.05) decrease. These results show that Alpha-Stim CES is as effective as the NHS usual treatment pathways for GAD.The mean baseline in depression was a PHQ-9 score of 15.35 and the mean score after treatment was 11.24 – representing an improvement that was significant at p<0.001. No PHQ-9 scores are reported for the control group.Change in average PHQ depression score from pre to post treatment.ConclusionsThe results of this study suggest that a care pathway incorporating Alpha-Stim was non-inferior to usual care and may indeed be slightly better in terms of mean reduction of PHQ-9 and GAD-7 scores.The researchers estimated that a 20-minute appointment in the nurse-led clinic costs £23.67 ($30.41) and that a 20-minute appointment with a doctor as part of usual care calculated by the same formula is £42.61 ($54.75).Given the similar rate of consultation the authors believe the Alpha-Stim pathway represents a significant cost saving likely to be in the region of 10-20% allowing for fewer and shorter consultations in the usual care group.No adverse events were reported during the trial and nine patients expressed a high degree of satisfaction with their Alpha-Stim treatment in solicited feedback at the end of the study. No negative feedback was received.LimitationsGiven this study included a sample of patients presenting to primary care, participants were not able to be randomly assigned to CES or usual care groups.Study Quality: GOOD ### Cranial application of low level transcranial electrotherapy vs. relaxation instruction in anxious patients Cranial Application of Low Level Transcranial Electrotherapy vs. Relaxation Instruction in Anxious Patients Gibson, Thomas H. and O’Hair, Donald E. Cranial application of low level transcranial electrotherapy vs. relaxation instruction in anxious patients. American Journal of Electromedicine, 4(1):18-21, 1987. Doctoral dissertation (TG), California School of Professional Psychology. 1983. 152 pages. In this single blind study, 64 volunteer subjects responded to newspaper advertisements, 32 males and 32 females, ranging in age from 22 to 55 years old (mean = 36.64), who scored 50 or above on the State Trait Anxiety Inventory (STAI), completed informed consent and were randomly assigned to 20 minutes relaxation training (RT) on audio tape only, Alpha-Stim CES only, RT plus CES, or to a control group which listened to a neutral audio tape and received sham CES. There were 8 males plus 8 females in each group. 9 of the original 73 subjects were dropped from the study due to failure to meet the study criteria or failure to show up. Treatment time was 1, 20 minute session, and relaxation was measured by frontalis muscle electromyogram (EMG) and a post treatment STAI. Subjects responded on the STAI significantly (P<.001) better than controls and equally to either RT alone with a means of 52.88 pretest to 32.19 post, CES alone: 52.31 pre to 30.06 post, or both RT and CES together: 53.69 pre to 30.44 post. The control group only dropped from 53.25 to 51.94. The EMG trend paralleled the STAI with means of 15.64 µV to 11.10 post test in the RT alone, 17.12 to 11.17 µV in the CES alone, 17.41 to 9.77 µV in the combined group, and 14.14 to 14.47 µV in the control group. Analysis of variance for EMG scores showed highly significant F-ratios for the time variance term and the group X time interaction term. Results were further verified by Tuckey’s tests for pair-wise comparisons.The authors concluded that the results of this study indicates that the Alpha-Stim may be a useful adjunctive therapy for short term treatment of symptoms of anxiety. The treatment appears to have about the same efficacy as the same amount of time of relaxation instructions, but is easier to administer. No side effects were reported.The graph shows how the three treatment groups fared on anxiety and EMG testing, with each of the three groups significantly improved, while the controls did not change significantly. ### An investigation of the effectiveness of cranial electrotherapy stimulation in the treatment of anxiety disorders among outpatient psychiatric patients, impulse control parolees and pedophiles. An Investigation of the Effectiveness of Cranial Electrotherapy Stimulation in the Treatment of Anxiety Disorders Among Outpatient Psychiatric Patients, Impulse Control Parolees and Pedophiles Voris, Marshall D. An investigation of the effectiveness of cranial electrotherapy stimulation in the treatment of anxiety disorders among outpatient psychiatric patients, impulse control parolees and pedophiles. Delos Mind/Body Institute Newsletter. 1995. Dallas and Corpus Cristi, Texas. DeviceAlpha-Stim®Key VariableAnxietyObjectiveTo evaluate the effect of a specified treatment course with CES on anxiety in outpatient psychiatric patients when compared to sham treatment under the same experimental conditions in subjects meeting the inclusion and exclusion criteria.DesignThis was an IRB approved randomized, sham controlled, double-blind study in which subjects received either active CES or sham cranial electrotherapy stimulation for one 20 minute treatment during their regular group therapy session. There was also a usual care control group. The subjects, investigators, statistician and staff were all masked as to the identity of the device.Primary Effectiveness EndpointThe primary effectiveness endpoint was the change from baseline to the post-treatment measurement scores for anxiety of the active group compared to the sham treatment group and control group at the completion of the treatment period.Secondary Outcome MeasuresThe secondary effectiveness endpoints were the change from baseline in the post-treatment scores for the physiological parameters of muscle tension and vasodilation as measured by electromyogram (EMG) and finger temperature (FT) for all 3 groups.Key Inclusion Criteria• Male and female subjects with anxiety attending group therapy session dealing with anxiety issues.• Diagnosis of anxiety was verified by a psychiatrist and confirmed using the State Anxiety Inventory (SAI).Key Exclusion Criteria• Pregnancy.• Presence of implanted pacemakers, pumps or stimulators.Protocol SummaryThe subjects were randomized based on which seats they took in the group therapy room. Prior to the individuals entering the room each seat had been assigned a treatment. This method of randomization was selected so subjects had the freedom to choose where they sat for group therapy, as usual. Using a “blinding box” the investigators and subjects were unaware as to which subject was receiving active or sham treatment. There were 3 experimental populations: 1) group A: individuals receiving active CES treatment; 2) group B: individuals receiving sham CES; and 3) group C: individuals receiving usual care only (control). The control subjects were known because they were not wearing ear clip electrodes hooked up to a device. Over a period of 10 days, all the clinic therapy groups that worked with anxiety were tested. All subjects were tested using the dependent variables of the State Trait Anxiety Inventory (STAI), EMG, and FT, before and again immediately following the treatment condition. The STAI was done first, followed by EMG on the frontalis muscle and then skin temperature measured by a hand held temperature probe. All 3 dependent variables were administered again immediately post treatment. Baseline measures were taken prior to the one 20 minute CES treatment and at the completion of group therapy for both the active and sham groups. No change was made in the medical management of the patients during the single session study.Device Application SummaryThe sham device was identical in appearance to the active CES unit, but did not conduct an electrical current. The active CES device was set to 300 µA. A “double-blinding” box was used to conceal the CES device from view of the subjects and research team.Study BlindingInvestigators, subjects, research staff and statistician were all masked to the identity of the devices.Outcome MeasuresSpielberger’s State Anxiety Inventory was used to measure anxiety. The scale has established reliability and validity (American Psychological Association, 2014; Spielberger 2010).Physiological measures, EMG, EDR and finger temperature, that are indications of decreased anxiety were also measured to validate level of anxiety (Bond et al., 1971).ResultsSubjectsA total of 105 subjects completed the study consisting of an active CES group (N= 38), sham group (N=35) and control group (N=32).Baseline Measurements: Group EquivalenceThere were no statistically significant differences at baseline between the active CES and sham treatment groups for any of the outcome measures.Data AnalysisData were analyzed using the independent-samples t-test to compare the difference between the active CES and sham groups on depression and anxiety outcome scores. The median was used rather than the mean to eliminate scores that fell widely out of range and would have skewed the data interpretation. Scores on the STAI between 40 and 70 were accepted at pre-test. Scores between 75 and 95 were accepted on skin temperature and scores higher than 4.0 was accepted for EMG at pretest. No restrictions were placed on posttest scores.AnxietyThe active CES group had significantly lower anxiety scores on the State Anxiety Inventory (SAI) compared to sham group (p=.0001, d = -1.60) and control groups. The active CES group had significantly lower scores on EMG (p=.0001, d = -1.08) and increased scores on finger temperature (p=.0141. d = .50) than sham and control groups, indicating less anxiety. Figures 1, 2 and 3 show results of statistical analyses of outcome measures for the active group compared to the sham and control groups.Figure 1. Median state anxiety scores by group.Figure 2. Median EMG scores by group.Figure 3. Median Finger Temperature Scores by group.Quality of the ResearchThis was the first Alpha-Stim CES study that used the Alpha-Stim masked, sham controlled, randomized clinical trial research protocol. The study has served as a foundation for the development of RCTs on the effectiveness of CES for the treatment of anxiety. Strengths of the study are (1) the rigor of the research design and the use of 3 groups- active, sham and control, (2) the study was adequately powered with an N of 105, (3) diagnosis of an anxiety disorder was confirmed by a psychiatrist, (4) the research team, subjects and statistician were masked to the identity of the devices, and (5) the use of a valid subjective state anxiety scale (SAI) confirmed by objective physiological measures of anxiety. The investigator noted a limitation of the study was the method of randomization based on seating. The general outpatient psychiatric subjects tended to arrive early and select a chair resulting in more of these subjects in the active CES group than in the sham and control groups. There were fewer parolees, who usually arrived later, in the active group and more in the sham and control groups. While the chair method was used to be consistent with the usual routine in group therapy, for future studies the investigator recommended that subjects be randomly assigned by group.Author AffiliationClinical Director, Delos Mind/Body Institute, Corpus Christi, Texas.ReferencesAmerican Psychological Association. The State-Trait Anxiety Inventory (STAI). Accessed 4/19/2014, http://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/trait-state.aspx.Bond AJ, James DC, Lader MH. Physiological and psychological measures in anxious patients. Psychological Medicine. 1974 Nov;4(4):364-73.Spielberger CD. State-Trait Anxiety Inventory. Corsini Encyclopedia of Psychology. Published Online: January 2010, http://onlinelibrary.wiley.com/book/10.1002/9780470479216. ### Cranial electrotherapy stimulation (CES): a safe and effective low cost means of anxiety control in a dental practice Cranial Electrotherapy Stimulation (CES): A safe and effective low cost means of anxiety control in a dental practice Winick, Reid L. Cranial electrotherapy stimulation (CES): a safe and effective low cost means of anxiety control in a dental practice. General Dentistry. 1999; 47(1):50-55. DeviceAlpha-StimKey VariableAnxietyObjectiveTo evaluate the effect of CES on dental patients’ anxiety when compared to sham treatment under the same experimental conditions in subjects meeting the inclusion and exclusion criteria.DesignThis was an IRB approved, randomized, sham controlled, double-blind, clinical trial. The subjects, investigator and staff were all masked as to the identity of the device.Primary Effectiveness EndpointThe primary effectiveness endpoint was the change from baseline measures of anxiety scores compared to the sham group at the completion of the dental procedures.Key Inclusion Criteria1. Dental patients having common dental surgical procedures.2. Male and female subjects ≥ 20 years of age.3. Must report having anxiety about the dental procedure.Key Exclusion Criteria• Pregnancy• Presence of implanted pacemakers, pumps or stimulators• Persons who reported no anxiety about the dental procedure were excluded from this study.Protocol SummaryPatients were randomly assigned to the active CES group (N = 16), or sham CES (N = 17) group in the order they arrived for various dental procedures. A “double-blinding box” provided by the manufacturer of the Alpha-Stim CES device was used so neither the patient nor the dentist was aware of who was receiving actual stimulation. The 100 mm Visual Analogue Scale (VAS) of “not anxious” on the left to “very anxious” on the right was used at baseline, midpoint of the procedure and at the endpoint of the dental procedures by both the patient and dentist, and an inverse 7 point Likert scale with 1 “more anxious” to 7 “less anxious” was used at the conclusion of each treatment as a method to corroborate the findings from the VAS scale. On the VAS a higher score indicated more anxiety while on the inverse Likert scale a lower scale indicated more anxiety.Device Application ProtocolSubjects were randomized to either the active or sham groups in the order that they arrived at the dental office. Baselines measures were done just prior to the active or sham CES treatment. Outcome measures were done at mid-point in the procedure and endpoint measures were done right after the completion of the procedure. The active CES device was pre-set at 200 µA and the sham CES device was set to “0” so the ear-clip electrodes did not emit electricity. The time on both the active and sham devices was set to “continuous,” so the CES treatment continued until the procedure was done.Study BlindingThe subjects, investigator and staff were all masked as to the identity of the device.ResultsSubjectsA total of 33 subjects, 9 males and 24 females, 20 to 59 years old, completed the study.Baseline MeasurementsBaseline measurements were taken prior to the start of the procedure and before the active CES or sham treatment. There was no significant difference in anxiety levels at baseline between the active and sham groups.Data AnalysisData were analyzed using the student t-test (unpaired) comparing the active and sham groups at baseline, mid-point and endpoint of study.AnxietyThe mean value for the dentist’s and patient’s baseline evaluations tended to be higher in the treatment group at the start probably due to the more severe procedures in that group compared to the sham group, but was not significant. The active CES group had lower anxiety scores (VAS) from baseline to endpoint of the study than the sham group as measured by the investigator (p<.02) and subjects (p<.02), see Figure 1. Findings using an inverse Likert scale corroborated these findings for both the investigator evaluation (p < .01) and subjects’ evaluation (p <.01).Figure 1. Comparison of group means on VAS anxiety scale by group over time.Quality of the ResearchStrengths of this study include: (1) use of a randomized, sham controlled, double-blind design; (2) active and sham Alpha-Stim devices were pre-set at the designated levels for each specific group for current and time; (3) sham devices were the same as active devices except they did not emit electricity; (4) all subjects had common dental procedures such as fillings, crowns or bridge, or dental exams and cleaning; (5) all subjects reported dental anxiety at baseline in order to be in the study; (6) an inverse Likert scale was used post-test as a method to corroborate the findings from the VAS scale; and (7) the subjects, investigator and staff were all masked as to the condition of the device. The small N (33) in this study could be considered a limitation of the study. However, based on the moderate to large effects sizes for anxiety in the literature, the N of 33 for this study was large enough to detect a significant difference between the active CES and sham CES groups in favor of the active CES group. This study was done in 1999 and the investigator used student t-tests to analysis the data which was common in that time period. Today, an investigator would most likely use repeated measures ANCOVA for data analysis. However, this study showed that CES decreases anxiety and this is consistent with the findings of other Alpha-Stim research that found CES decreases anxiety. ### Results of cranial electrotherapy stimulation to children with mixed anxiety and depressive disorder Results of cranial electrotherapy stimulation to children with mixed anxiety and depressive disorder Chen Yixin, Yu Lin, Zhang Jiuping, Li Lejia, Chen Tunong, Chen Yi. Results of cranial electrotherapy stimulation to children with mixed anxiety and depressive disorder. Shanghai Archives of Psychiatry. 2007; 19(4):203-205. DeviceAlpha-Stim®Key VariablesAnxiety, DepressionObjectiveThe purpose of this study was to examine the efficacy of CES for the treatment of mixed anxiety and depressive disorder (MAD) in children.DesignThis study used a randomized, sham controlled clinical trial design in which subjects in the active CES and sham groups had CES treatments for 15 days.Primary Effectiveness EndpointThe primary effectiveness endpoint was the change from baseline in the last post-treatment scores on the Zung Self-Rating Depression Scale (SDS) and the Zung Self-Rating Anxiety Scale (SAS) compared to the sham CES group at the endpoint of study.Key Inclusion Criteria• Male or female children between 8 to 16 years of age.• Diagnosis of mixed anxiety and depression disorder (MAD) by a “specialist physician” prior to acceptance into the study (Experimental group only).• Must score > 40 on the combined scores of the SAS and SDS.Key Exclusion Criteria• Pregnancy, planning to become pregnant or nursing.• Presence of implanted pacemakers, pumps or electrical stimulators.• Subjects have taken drug therapy for MAD or emotional disorders.Protocol SummarySubjects for the experimental group were randomly selected from children with MAD who met the criteria for entry into the study and who were patients at the Children’s Psychological Health Clinic at Nanjing Brain Hospital. Subjects for the control group were randomly selected from a group of children with emotional problems who were recommended by their teacher at elementary or middle schools in the city and met the > 40 score criteria on combined SAS and SDS scores but did not meet the diagnostic criteria for anxiety disorder or depressive disorder. Baselines measures were done prior to the first active or sham CES treatment and endpoint measures were done after the completion of the final CES treatment.Device Application ProtocolThe current of the active CES device was set at a comfortable level for the active group subjects, between 100 – 500 µA. The current of the sham CES device was increased until the sham subject felt a “skin sensation,” then decreased and shut off, so that the device did not emit electricity. Neither group felt any sensation from the device for the remainder of the treatment. The length of each treatment was 10-15 minutes. The treatment schedule was 5 daily CES treatments followed by 2 days off and then this schedule was repeated 2 more times.Outcome MeasuresThe Zung Self-Rating Anxiety Scale (SAS) and the Zung Self-Rating Depression Scale (SDS) were used to measure anxiety and depression. Both scales have established reliability and validity (Zung et al., 1971; 1965).ResultsSubjectsThere were 60 subjects in the study, 30 in each group. In the active CES group there were 25 males and 5 females. In the sham group there were 19 males and 11 females. All subjects were between 8 to 16 years of age. There were no significant differences in gender and age between the two groups.Data AnalysisChi-Square and ANOVA were used to analyze the data.AnxietyThere was a significant difference between the active and sham groups for anxiety at endpoint of study (p<0.01), Figure 1. Figure 1. Mean Anxiety Scores by Group.DepressionThere was a significant difference between the active and sham groups for depression at endpoint of study (p<0.01), Figure 2.Figure 2. Mean depression scores by group.Quality of the ResearchStrengths of this clinical study are: the investigators used a randomized, sham controlled design; the diagnosis of MAD was verified by a physician prior to acceptance into the study for the experimental group; sham CES devices were the same as active CES devices except they did not emit electricity; and Based on the effect sizes for anxiety and depression in other Alpha-Stim® CES studies, this was an adequately powered study with an N of 60. A limitation of this study is that the sham group did not meet the criteria for MAD. One possible explanation for this is that recruitment of enough children with MAD was a problem. Other limitations are: the current for the active group (100 – 500 µA) and length of CES treatment (10 – 15 minutes) for all subjects were not the same. The findings from this study on the significant effect of CES on anxiety and depression are similar to those found by Lu in children (Lu et al., 2005) and in other Alpha-Stim® CES studies with adult subjects.Author AffiliationsAll authors: Child mental health research center, Nanjing Bran Hospital, Nanjing Medical University, Nanjing, ChinaReferencesZung WWK. A rating instrument for anxiety disorders. Psychosomatics. 1971; 12: 371-379Zung WWK, Richards CB, Short MJ. Self-rating depression scale in an outpatient clinic Further validation of the SDS. Arch Gen Psychiatry. 1965 Dec;13(6):508-15. ### The effect of cranial electrotherapy stimulation on preoperative anxiety and hemodynamic responses Cranial Electrotherapy Stimulation (CES) and the Reduction of Stress Symptoms in a Sheriff’s Jail Security and Patrol Officer Population: A Pilot Study Mellen, Ronald R. and Mackey, Wade. Cranial electrotherapy stimulation (CES) and the reduction of stress symptoms in a sheriff’s jail security and patrol officer population: a pilot study. American Jails. 2008; 22(5): 32-38. Device: Alpha-Stim, 0.5 Hz, 50% duty cycle, 100 µA, biphasic asymmetrical rectangular waves, ear clip electrodes This double blind study examined the ability of CES to reduce stress related symptoms in the security and patrol officer’s staff of a rural sheriff’s jail. All 22 subjects completed 20, 20 minute sessions of the Treatment Group (N=11) and Control Group (N=11) on the pre-treatment Brief Symptom Inventory (BSI) or sub-scales. This was true for the clinical scales and the global scales suggesting both groups were similar, as measured by the BSI. No changes were found between pre- and post-assessment means for the control group. However significant changes were found in the treatment group’s BSI results, suggesting a positive influence from using CES. In addition, the treatment group findings support the argument that Alpha-Stim CES provides a global brain modulation. Differences in pre/post-treatment means for the treatment group were: 1. Somatization: measures bodily complaints (P<.008), 2. Obsessive/Compulsive: repetitive thoughts and actions (P<.020), 3. Interpersonal Sensitivity: difficulties with interpersonal relationships (P<.077), 4. Depression: sad mood, loss of energy, difficulty sleeping or sleeping too much (P<.015), 5. Anxiety: excessive worry, (P<.015). Hostility: feelings of anger toward others and the world (P<.077), 7. Phobia: excessive fearful reactions toward objects, insects and such (P<.177), 8. Paranoia: excessive fears that are not supported by evidence (P<.066), 9. Psychoticism: these individuals can appear unusual and emotionally distant (P<.050). The BPI also has 3 global scales for measuring stress: 1. Global Index: the most sensitive measure of stress (P<.007), 2. Positive Symptom Distress: degree of stress being reported (P<.042), and 3. Positive Symptom Total: total number of symptoms endorsed by a subject (P<.004). 20 of the participants also completed a 19-item Alcohol/Drug Use Questionnaire developed by the authors to provide demographic information on their addictions. Attendance by the treatment group was higher than the control group: 71% for the treatment group compared to 41% for the control group. The attrition rate for the experimental group was 29% and for the control group 59%. The most common reason for not completing the program was non-compliance, e.g., failure to attend, a failed drug test or other program rule violations. One of the 4 experimental group dropouts was due to injuries related to a car accident. A second stated the treatment was helping and she wanted to continue but reported physical discomfort from the treatment. The authors concluded that Alpha-Stim seems to provide a global modulation effect in substance abusers. The effect could be calming the subjects and allowing them to access the cortical and sub-cortical areas of the brain that they need for making better decisions. Results supported the use of CES for reducing clinical and stress symptoms in the treatment group and maintaining attendance in treatment. ### Cranial electrotherapy stimulation (CES) and the reduction of stress symptoms in a sheriff’s jail security and patrol officer population: a pilot study Cranial Electrotherapy Stimulation (CES) and the Reduction of Stress Symptoms in a Sheriff’s Jail Security and Patrol Officer Population: A Pilot Study Mellen, Ronald R. and Mackey, Wade. Cranial electrotherapy stimulation (CES) and the reduction of stress symptoms in a sheriff’s jail security and patrol officer population: a pilot study. American Jails. 2008; 22(5): 32-38. Device: Alpha-Stim, 0.5 Hz, 50% duty cycle, 100 µA, biphasic asymmetrical rectangular waves, ear clip electrodesThis double blind study examined the ability of CES to reduce stress related symptoms in the security and patrol officer’s staff of a rural sheriff’s jail. All 22 subjects completed 20, 20 minute sessions of the Treatment Group (N=11) and Control Group (N=11) on the pre-treatment Brief Symptom Inventory (BSI) or sub-scales. This was true for the clinical scales and the global scales suggesting both groups were similar, as measured by the BSI. No changes were found between pre- and post-assessment means for the control group. However significant changes were found in the treatment group’s BSI results, suggesting a positive influence from using CES. In addition, the treatment group findings support the argument that Alpha-Stim CES provides a global brain modulation. Differences in pre/post-treatment means for the treatment group were: 1. Somatization: measures bodily complaints (P<.008), 2. Obsessive/Compulsive: repetitive thoughts and actions (P<.020), 3. Interpersonal Sensitivity: difficulties with interpersonal relationships (P<.077), 4. Depression: sad mood, loss of energy, difficulty sleeping or sleeping too much (P<.015), 5. Anxiety: excessive worry, (P<.015). Hostility: feelings of anger toward others and the world (P<.077), 7. Phobia: excessive fearful reactions toward objects, insects and such (P<.177), 8. Paranoia: excessive fears that are not supported by evidence (P<.066), 9. Psychoticism: these individuals can appear unusual and emotionally distant (P<.050). The BPI also has 3 global scales for measuring stress: 1. Global Index: the most sensitive measure of stress (P<.007), 2. Positive Symptom Distress: degree of stress being reported (P<.042), and 3. Positive Symptom Total: total number of symptoms endorsed by a subject (P<.004). 20 of the participants also completed a 19-item Alcohol/Drug Use Questionnaire developed by the authors to provide demographic information on their addictions.Attendance by the treatment group was higher than the control group: 71% for the treatment group compared to 41% for the control group. The attrition rate for the experimental group was 29% and for the control group 59%. The most common reason for not completing the program was non-compliance, e.g., failure to attend, a failed drug test or other program rule violations. One of the 4 experimental group dropouts was due to injuries related to a car accident. A second stated the treatment was helping and she wanted to continue but reported physical discomfort from the treatment.The authors concluded that Alpha-Stim seems to provide a global modulation effect in substance abusers. The effect could be calming the subjects and allowing them to access the cortical and sub-cortical areas of the brain that they need for making better decisions. Results supported the use of CES for reducing clinical and stress symptoms in the treatment group and maintaining attendance in treatment. ### An examination of cranial electrotherapy stimulation (CES) on alpha-amylase levels, cortisol levels and state-trait anxiety scores in the chronically mentally ill. An Examination of Cranial Electrotherapy Stimulation (CES) on Alpha-amylase Levels, Cortisol Levels and State-trait Anxiety Scores in the Chronically Mentally Ill Strentzsch, Julie A. An examination of cranial electrotherapy stimulation (CES) on alpha-amylase levels, cortisol levels and state-trait anxiety scores in the chronically mentally ill. Doctoral Dissertation, Saint Mary’s University, San Antonio, Texas, 2008.DeviceAlpha-Stim®Key VariableState AnxietyObjectiveTo evaluate the effect of a specified treatment course with CES on chronically mentally ill patients’ anxiety when compared to sham treatment under the same experimental conditions in subjects meeting the inclusion and exclusion criteria.DesignThis was an IRB approved 3 week randomized, sham controlled, double-blind, clinical trial.Primary Effectiveness EndpointThe primary effectiveness endpoint was the change from baseline in the last post-treatment scores on the State Anxiety Inventory (SAI) compared to the sham group at the end point of the study.Secondary Outcome MeasuresSecondary outcome measures of trait anxiety, cortisol and alpha-amylase levels were measured at the end of the 3 week study.Key Inclusion Criteria• Chronically mentally ill outpatients attending a partial hospitalization program.• Diagnosis of anxiety by subject’s physician.Key Exclusion Criteria• Pregnancy.• Presence of implanted pacemakers, pumps or stimulators.Protocol SummaryBaseline measures were taken on the day the subjects were accepted into the study. The active and sham groups had CES treatments every day at 11 am during a therapy session. The control group attended the therapy session but was not connected to a CES device. At the end of 3 weeks, primary and secondary outcome measures were repeated.Device Application ProtocolThe active CES device was pre-set and locked by the manufacturer at 100 µA which is a subsensory level. The sham CES device was pre-set and locked by the manufacturer so that it did not emit electricity. The length of treatment, 60 minutes, was also pre-set and locked by the manufacturer for both active and sham devices. There were an equal number of active and sham devices. Randomization of the devices were done at the factory and the devices were packed in the order that they would be assigned to subjects.Study BlindingThe subjects, investigators and staff were all masked as to the identity of the device.Outcome MeasuresThe Spielberger State/Trait Anxiety Inventory was used to measure anxiety. It has established reliability and validity (American Psychological Association, 2014; Spielberger 2010).ResultsSubjectsA total of 45 subjects were enrolled and 38 subjects completed all post-test requirements; active CES group (N=15), sham group (N=15), and usual care control group (N=8). Diagnoses included bipolar disorder (N=13, 31%), generalized anxiety disorder (N=5, 12%), major depressive disorder (N=4, 10%), schizoaffective disorder (N=9, 21%) and schizophrenia (N=11, 26%).Baseline Measurements: Group EquivalenceThere were no statistically significant differences at baseline among the groups for any of the outcome measures.Data AnalysisData were analyzed using paired samples t-tests.AnxietyThe active CES group had significantly lower scores on the State Anxiety Index (SAI), indicating less state anxiety, than the sham group (P=.02, d = -.41) or control group. As expected, since trait (chronic) anxiety is usually a stable personality trait it is less responsive to change than state anxiety (Spielberger, 2010) there was no significant difference between the active and sham groups on trait anxiety. There was no significant difference among groups on the variables of cortisol and alpha-amylase levels. Figure 1 shows results of statistical analyses of outcome measures for state anxiety for the 3 groups.Figure 1. Mean state anxiety scores by group.Quality of the ResearchStrengths of this study are: use of a randomized, sham controlled, double-blind design (The investigator chose to use the Alpha-Stim RCT research protocol for the study); active and sham Alpha-Stim devices were pre-set and locked at the designated levels for each specific group for current level and time of treatment by the manufacturer at the factory; sham units were the same as active units, except they did not emit electricity; randomization of devices was done by the manufacturer and followed according to the protocol by the investigator; diagnosis of anxiety was verified using the criteria from the DSM-IV before subjects could be in the study; and the use of a structured and detailed protocol for the CES treatments for both active and sham groups. Previous effect sizes from other CES studies for anxiety indicate the N of the study had sufficient power to detect differences. A limitation of this 2008 study is the use of paired samples t-tests which was a common practice at that time. Today, an analysis of covariance would most likely be used and it would provide a more comprehensive description of the data. The effect size in this study for anxiety approached moderate (d=0.41) in contrast to the moderate to very large effect sizes for anxiety in other Alpha-Stim CES RCT studies. This is probably due to the limited treatment time of 3 weeks in this chronically mentally ill patient population. The significant finding of this study that CES decreases anxiety is consistent with other Alpha-Stim studies that had similar findings.ReferencesAmerican Psychological Association. The State-Trait Anxiety Inventory (STAI). Accessed 4/19/2014, http://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/trait-state.aspx.Spielberger, C. D. State-Trait Anxiety Inventory. Corsini Encyclopedia of Psychology. Published Online: January 2010, http://onlinelibrary.wiley.com/book/10.1002/9780470479216. ### Curative effect of CES as adjuvant therapy on elderly patients with chronic insomnia Curative Effect of CES as Adjuvant Therapy on Elderly Patients with Chronic Insomnia Qin, S., Sheng, J., Guo, W., Zhang, X. Curative effect of CES as adjuvant therapy on elderly patients with chronic insomnia. Practical Geriatrics. 2013; Vol. 27, No. 5:399-402. Funding Source, Location of Study or Author’s AffiliationDepartment of Psychology, Jingzhou Mental Health Center, Jing-zhou, China DeviceAlpha-Stim® Key VariablesSleep, Depression, and Anxiety. ObjectiveTo observe the clinical effect of cranial electrotherapy stimulation (CES) combined with alprazolam on elderly patients with chronic insomnia. DesignA group of 108 elderly patients with chronic insomnia were randomized into three groups as part of an 8-week treatment study. The groups include a (1) medication group (MED) that received only alprazolam, (2) a CES group (CES) that received only CES treatment, and (3) a combined treatment group (MED+CES) that receiving both alprazolam and CES. Treatment efficacy was measured by comparing baseline and post-treatment sleep latency, total sleep time, and sleep efficiency using the Pittsburgh Sleep Quality Index (PSQI). Anxiety and depression typically accompany chronic insomnia, and any change in levels of anxiety and depression pre- and post-treatment were measured using the Hamilton Anxiety (HAM-A) and Hamilton Depression (HAM-D) rating scales. Changes to patients’ symptoms were evaluated by two research physicians trained to a consistency kappa value of 0.87. Primary Outcome MeasureSleep quality latency duration measured using the PSQI a 19-item scale that measures sleep quality and disturbance over two weeks. translated into Chinese by Liu Xianchen et al. (1996) the reliability and validity of which has been recognized by Chinese university students and patients with insomnia, depression, and neuroses. the PSQI includes7 factors and 19 self-evaluation items, the range of scores for each factor are from 0-3. higher PSQI scores indicate poorer sleep quality. Secondary Outcome MeasureAnxiety As measured by the 14-item HAM-A scale each item has a score range of 1-5 score. The reliability and validity of the HAM-A has been widely recognized in China since Bai, Ji & Chen’s (2018) translation to Chinese. HAM-A total score (i) < 7 indicates “No anxiety”, (ii) 7-13 “Possible anxiety”, (iii) 14-20 “Definite anxiety”, (iv) 21-28 “Definite and obvious anxiety”, and (v) ≥ 29 “Possibly severe anxiety”. Depression as measured by the 17-item Hamilton Depression Rating (HAM-D) scale which has a maximum score is 52 and each item is scored between 0 and 4. a total HAM-D total score of (i) 0–7 is considered as being “Normal”, (ii) 8–16 suggesting “Mild depression”, (iii) 17–23 “Moderate depression”, (iv) scores over 24 indicative of “Severe depression.” Key Inclusion CriteriaInsomnia meet diagnostic criteria for insomnia as specified in the Chinese Classification of Mental Disorders (CCMD-3). insomnia with > 6 months since the onset of symptoms. with sleep latency >30 minutes nightly. reduced actual sleep time of <6 hours every night. PSQI ≥8. Age ≥ 60 years. Key Exclusion Criteria Insomnia caused by another mental or psychiatric disorder. Severe heart, lung, brain, liver, kidney, or other organic diseases. Diagnosis of sleep apnea. Drug and alcohol dependence or abuse. Protocol SummaryA mandated washout period of two weeks prior to the start of treatment and discontinuation of all medications including antipsychotic, antidepressant, antianxiety, and mood stabilizers during the 8-weeks of treatment. Patients were randomly allocated into one of three groups: (1) CES, (2) MED, and (3) MED+CES. All patients were asked to keep a sleep diary and to record changes in sleep, including latency and total sleep time, and to estimate their sleep efficiency. CES therapy was administered using Alpha-Stim and the device was used in accordance with the manufacturer’s instructions. Patients in the CES only group received daily treatment for 20 minutes each time for eight weeks. The MED group were prescribed daily oral alprazolam 0.2~0.8mg to be taken 30 minutes before sleep. The MED+CES group received the same CES treatment protocol and dosage of alprazolam as the CES only and MED only groups. Device Application ProtocolCES therapy was administered using Alpha-Stim and in accordance with the manufacturer’s instructions. The current intensity was set to 10-500 μA and the frequency to 1.5 Hz. During treatment, patients were asked to sit and given the opportunity to self-calibrate the magnitude of the current until they felt a slight tingling sensation. The treatment was given once a day, for 20 minutes each time over a period of eight weeks. Statistical Analysis PlanTreatment efficacy was evaluated by comparing total PSQI score, sleep latency, sleep efficiency, total sleep time, total HAM-A and HAM-D scores before and after eight weeks of treatment. A reduction in the total PSQI score and sleep latency, and an increase in total sleep time and sleep efficiency was interpreted as an improvement in sleep quality. At the end of eight weeks of treatment, a reduction in total HAM-A and HAM-D scores from baseline was indicative of a reduction in anxiety and depression. All data were analyzed using SPSS 11.0 statistical software and a significance level of p<.05 set for interpretation of results. Analysis of Variance (ANOVA) was used for significance testing of between group comparisons. The Student–Newman–Keuls (SNK) post-hoc test was used for pairwise comparison. Paired sample t-test was used for the measurement data within a group. All cases completed 8 weeks of treatment, and no cases withdrew from the study. Results SubjectsA total of 108 patients aged >60 years were allocated into three groups of 36. The CES only group had an average course of the disease of 4.78±3.14 years and included 18 males and 18 females aged between 60 to 75 years equating to a mean age of 67.88±4.38 years. Patients in the medication only group were aged between 60 to 78 years, with an average age of 66.21±7.36, and included 18 males and 18 females, with and an average course of disease of 4.83±2.62 years. In the combination treatment group 19 males and 17 females aged from 60 to 76 years with an average age of 67.65±4.81 years, and an average course of disease of 4.92±2.53 years were enrolled. No statistically significant differences at baseline were found between the subjects in the three groups in terms of age, gender, sleep efficiency, PSQI, HAM-A, and HAM-D (p>.05). Data AnalysisScore across all three groups and measures were significantly reduced from baseline to the end of the eighth week of treatment (p<.05). SleepComparison of total PSQI scores from baseline to the end of the eighth week of treatment in all three groups was significantly reduced (p<.05). The reduction in total PSQI scores was greatest in the MED+CES group than in the CES only or MED groups (p<.05). The reduction in total PSQI score was higher in the MED group than in the CES only group (p<.05). Change in sleep (PSQI) scores before and after treatment among the 3 groups. Sleep latency, total sleep time, and sleep efficiencyAfter eight weeks of treatment, all three groups showed significant (p<.05) improvements in total sleep time and sleep efficiency, and significant reductions in sleep latency (p<.05). The increase in total sleep time and sleep efficiency was highest in the MED+CES group than the CES only or MED only groups (p<.05). Sleep latency was reduced more significantly in the MED+CES group than in the CES only and MED only groups (p<.05). Total sleep time and sleep efficiency increased more significantly in the CES only group than in the MED only group (p<.05). There was no significant difference between the CES only group or the MED only group (p>.05). Comparison of clinical efficiency before and after treatment among the 3 groups Item   CES Only MED Only MED+CES Sleep latency (min) Before treatment 81.33±34.83 80.73±35.33 83.33±28.74 After treatment 33.16±11.31* 33.65±11.38* 24.06±8.23*# Total sleep time (min) Before treatment 216.71±43.41 222.50±58.98 229.38±46.51 After treatment 373.47±40.65* 281.88±38.02*△ 413.75±42.41*△# Sleep efficiency (%) Before treatment 45.04±17.24 45.12±18.22 43.34±17.48 After treatment 79.06±10.70* 68.85±12.34* 82.52±8.93* Note: Compared with before treatment, *p<.05; compared with the CES only group, △p<.05; compared with the medication only group, #p<.05 Anxiety and DepressionCompared with before treatment, the total HAM-A and HAM-D scores of the three groups were significantly reduced after eight weeks of treatment (p<.05). Reduction in HAM-A and HAM-D scores were greatest in the MED+CES group than those in the CES only and MED only groups (p<.05). The reduction in total HAM-A and HAM-D scores in the MED group were higher than those in the CES only group (p<.05). Change in anxiety (HAM-A) scores before and after treatment among the 3 groups. Change in depression (HAM-D) scores before and after treatment among the 3 groups. ConclusionThe mainstay treatment for geriatric insomnia includes the use of benzodiazepines, which although effective are associated with greater adverse effects, risk of drug-drug interactions, and toxicity due to physiological changes associated with aging. Consequently, the need for non-medication treatments is urgently needed. In this study, CES or alprazolam – a common medication for sleep, were equally effective in treating geriatric patients with chronic insomnia. However, the results indicated that a combination treatment approach of CES and medication was significantly better at improving patients’ quality of sleep, reducing sleep latency, and increasing sleep duration, and perceived satisfaction with the level of reported sleep. In addition, combination treatment reduced the accompanying anxiety and depression symptoms more substantially. The authors concluded that CES combined with alprazolam is the best treatment for elderly patients with chronic insomnia. Furthermore, the authors stated that they anticipate that once sleep improvements stabilized beyond the initial 8-week treatment cycle, that they would consider gradually reducing or discontinuing alprazolam, and developing a treatment plan focused on maintenance or consolidation using CES only. LimitationsThe study did not adhere to the recommended treatment guidelines for the use of Alpha-Stim CES as they set the frequency to 1.5 Hz rather than the recommended of 0.5 Hz. In addition, 20 minutes of daily CES treatment may not have been sufficient for patients whose comfortable current level was 200 uA or less. These deviations from recommended treatment guidelines may have impacted the results for the CES only group and the CES+MED group. Study Quality: FAIR ### The role of relaxation therapy and cranial electrotherapy stimulation in the management of dental anxiety in Nigeria The Role of Relaxation Therapy and Cranial Electrotherapy Stimulation in the Management of Dental Anxiety in Nigeria Koleoso ON, Osionwo HO, Akkhigbe. The role of relaxation therapy and cranial electrotherapy stimulation in the management of dental anxiety in Nigeria. ISOR Journal of Dental and Medical Sciences. 2013; 10(4): 51-57. DeviceAlpha-Stim®Key VariableDental AnxietyObjectiveThe purpose of this study was to assess the therapeutic efficacy of 3 treatment modalities for the treatment of dental anxiety: relaxation therapy (REL), cranial electrotherapy stimulation (CES), and a combination treatment of relaxation therapy and CES.DesignThis was an IRB approved study that used a randomized, quasi-experimental research design that had pre-post measures.Primary Effectiveness EndpointThe primary effectiveness endpoint was the change from baseline in the post-treatment scores on the Modified Dental Anxiety Scale (MDAS) among the 4 groups (the 3 treatment groups and the control group) at the endpoint of the study.Key Inclusion Criteria• Male or female subjects ≥ 18 years old.• Subjects who were experiencing oral pain conditions for at least 3 months.• Pain was due to identifiable physical oral pathology and verified by a dentist.• Subjects had high anxiety scores of ≥ 14.25 on MDAS.Key Exclusion Criteria• Pregnancy, planning to become pregnant or nursing.• Presence of implanted pacemakers, pumps or electrical stimulators.• Facial pain.• Acute oral pain less than three months.• Psychogenic oral pain.• Pain due to oral cancer.• Traumatic injures associated with oral pain.• Individuals with gross mental abnormality or other diagnosable neurological disorders.Protocol SummaryRespondents who reported high dental anxiety (≥ 14.25) and who agreed to come for the therapeutic interventions for the next 3 days were randomly assigned to 1 of 4 groups based on the order in which they arrived back at the psychological assessment room after they had been treated by the dentist; relaxation therapy group, CES treatment group, both treatments simultaneously group and the no treatment control group. During the relaxation therapy session, subjects listened to 30 minutes of relaxation training that was played on an MP-3 audio recorder via head phones. Subjects in the combined relaxation and CES treatment group did a 45 minute CES treatment while listening to the relaxation instructions. Subjects in the CES treatment group completed a 45 minute CES treatment. Treatment sessions for all subjects took place in the same room between 9 AM to 12 noon each day. After the three days of treatment, subjects returned to the Dental Centre the following Monday to complete the MDAS.Device Application ProtocolThe Alpha-Stim CES unit was used for CES treatments. The device was set at 0.5 Hz and the current was increased until the subject felt “light-headed” and then decreased “to their comfort level.” The length of treatment was 45 minutes. Each subject had one individual meeting with the lead investigator during the 3 daysOutcome MeasuresThe Modified Dental Anxiety Scale (MDAS) was used to measure dental anxiety symptoms. A study by Humphris et al. (2009) confirmed the “high” reliability and validity of the MDAS.ResultsSubjectsOne hundred thirty-eight (138) potential subjects reported high anxiety on the MDAS. Of these 40 respondents agreed to participate and completed the study. The primary reasons given for not participating in the study was inadequate time, cancelled appointments or did not live in the city where the study was conducted.Baseline Measurements Potential subjects had to score ≥ 14.25 on the MDAS indicating high dental anxiety in order to be accepted into the study. Their screening score was used as the baseline measure.Data AnalysisOne-way ANOVA was used to compare mean dental anxiety scores across the 4 groups. The t-test for independent samples was used to compare the mean scores of dental anxiety at pre-test and post-test. Descriptive statistics and reliability assessment (Cronbach alpha and split-half method), and post hoc Scheffe’s test were also used.Dental AnxietyThe CES group means (M=10.20), the relaxation group (M=10.70) and the combined treatment group (M=9.40) had significantly lower dental anxiety (p<0.01) than the control group (M=18.30) at the endpoint of the study as seen in Figure 1. Each of the 3 treatments significantly decreased dental anxiety (p <0.05) from pre-test to post-test. There was no statistically significant difference among the treatment groups on dental anxiety. Based on the findings of this study, CES was as effective at decreasing dental anxiety as relaxation therapy and the combined treatment group. However CES is easier to use compared to learning relaxation techniques.Figure 1. Mean dental anxiety scores by group at the end of the study.CES=active group, RELAXATION=relaxation instruction group, CES+REL=combined group.Quality of the ResearchStrengths of this clinical study are: the use of a randomized quasi-experimental research design that had pre-post measures; the use of a valid and reliable scale (MDAS); and the cut-off score for dental anxiety on the MDAS in this study was established in a previous pilot study. Limitations are: the small N, there were 10 subjects in each of the 4 groups; and a lack of standardization of CES treatments as they were individualized for each subject. The finding of this study that CES significantly decreases dental anxiety, is as effective in decreasing anxiety as relaxation, and is easier to use than learning relaxation techniques is consistent with previous findings by Gibson et al, in 1987. The finding that CES significantly decreases anxiety is also consistent with the other Alpha-Stim CES anxiety studies in the literature that found CES significantly decreases anxiety.Author AffiliationsKoleoso, ON. Department of Mental Health, University of Benin Teaching Hospital, Benin City, Nigeria; Osinowo, HO. Department of Psychology, University of Ibadan, Ibadan, Nigeria; Akhigbe, KO. Department of Mental Health, University of Benin Teaching Hospital, Benin City, Nigeria.ReferencesGibson, Thomas H. and O’Hair, Donald E. Cranial application of low level transcranial electrotherapy vs. relaxation instruction in anxious patients. American Journal of Electromedicine, 4(1):18-21, 1987Humphris GM, Dyer TA, Robinson PG. The modified dental anxiety scale: UK general public population norms in 2008 with further psychometrics and effects of age. BMC Oral Health. 2009 Aug 26; 9:20. ### Effects of cranial electrotherapy stimulation on preoperative anxiety, pain and endocrine response Effects of Cranial Electrotherapy Stimulation on Preoperative Anxiety, Pain and Endocrine Response Lee, S-H, Kim, W-Y, Lee C-H, Min, T-J, Lee Y-S, Kim J-H. Effects of cranial electrotherapy stimulation on preoperative anxiety, pain and endocrine response. Journal of International Medical Research. 2013; 41(6) 1788–1795. DeviceAlpha-Stim®Key VariablesPreoperative anxietyObjectiveThe purpose of this study was to investigate the efficacy of CES for the treatment of preoperative anxiety, withdrawal response during injection of rocuronium, postoperative pain, and stress hormone levels.DesignThis was an IRB approved study that used a randomized, sham controlled, double-blind design in which subjects in the treatment group received one 20 minute CES treatment the day before surgery and one 20 minute treatment just prior to surgery. The sham group received the same number and length of CES treatments with a sham CES device.Primary Effectiveness EndpointThe primary effectiveness endpoint was the last post-treatment scores on a 5 point Likert scale, where “1” indicated no anxiety to “5” indicated extremely anxious as compared to the sham treatment group at the endpoint of the study.Key Inclusion Criteria• Female participants between 20-65 years of age.• Diagnosis of suspected thyroid cancer and scheduled for surgery.• American Society of Anesthesiologists (ASA) physical status classification I or II.Key Exclusion Criteria• Pregnancy, planning to become pregnant or nursing.• Presence of implanted pacemakers, pumps or electrical stimulators.• Age > 65 years.• Body mass index ≥ 25.• Diagnosed with renal disease, endocrine or neuromuscular disease.• Current use of psychiatric drugs.Protocol SummarySubjects were randomized to either an active CES or control group using computer generated random numbers. All subjects in the active and sham groups had a CES treatment between 20:00 – 22:00 PM on the day before surgery and between 7:00 – 9:00 AM on the day of surgery.Device Application ProtocolThe active CES device was pre-set at 100 µA which is a subsensory level. The sham device was identical to the active CES device, but did not emit electricity. The length of treatment, 20 minutes, was also pre-set for both active and sham devices. Anxiety was assessed in the pre-operative holding area after the CES treatment.Study BlindingThe subjects, investigators, physicians and staff were masked as to the identity of the device, active or sham.Pre-Specified Criteria for SuccessPre-specified criteria for success was p=0.05.Outcome MeasuresA five point Likert self-report scale was used to measure anxiety; ‘1’ indicated no anxiety, ‘2’ indicated slightly anxious, ‘3’ indicated moderate anxiety, ‘4’ indicated a lot of anxiety and ‘5’ indicated extremely anxious. A Likert scale to measure anxiety has established reliability and validity (Davey, 2007).ResultsSubjectsThere were 50 subjects in this study, 25 in the active CES group and 25 in the sham CES group. All 50 subjects completed the study.Baseline Measurements: Group EquivalenceThere was no statistically significant difference at baseline between active CES and sham treatment groups on age, height or body weight.Data AnalysisData were analyzed using the exact V2 test, the Mann Whitney U-test and descriptive statistics.AnxietyThere was a significant difference between the active and sham groups for anxiety in favor of the active CES group at endpoint of study (p<0.016). The active CES group had significantly lower anxiety scores at the endpoint of the study on the Likert anxiety scale (Figure 1). Figure 1. The CES group had significant lower anxiety scores than the sham group after CES treatment (active or sham) after CES in the preoperative holding area (p=0.016).Quality of the ResearchStrengths of the study are : a randomized, sham controlled, double-blind design was used; active and sham devices were pre-set for each group for current level and time; sham devices were the same as active devices, except they did not emit electricity. A limitation of the study is that baseline measures were not taken for anxiety prior to CES treatment. Including a baseline measure of anxiety would have strengthened this study. A limitation cited by the investigators was the inability to control for any possible placebo effect experienced by the control group due to sham treatment. They recommended that in future research, 3 groups be included; active, sham and a placebo control group. The findings of this study are consistent with the findings of other CES studies on anxiety; CES decreases anxiety.Author AffiliationsWoon Young Kim. Professor, Department of Anesthesiology and Pain Medicine, Korea University, Ansan Hospital, Gojan-Dong, Ansan-City, Kyrungki-Do, Republic of Korea.ReferenceDavey HM, Barratt AL, Butow PN, Deeks JJ. A one-item question with a Likert or Visual Analog Scale adequately measured current anxiety. Journal of Clinical Epidemiology. 2007 Apr;60(4):356-60. ### CES Clinical Trial for Anixety & Comorbid Depression A Clinical Trial of Cranial Electrotherapy Stimulation for Anxiety and Comorbid Depression Barclay TH, Barclay RD. A clinical trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders. 2014; 164:171-177. Presented at the American Psychological Association National Conference, Honolulu, HI, July 2013. DeviceAlpha-Stim®Key VariablesAnxiety, DepressionObjectiveThe purpose of this study was to examine the efficacy of CES for the treatment of anxiety and depression.DesignThis was an IRB approved 5 week study that used a randomized, sham controlled, double-blind design in which subjects in the treatment and sham groups participated in a daily one hour treatment of CES using active or sham Alpha-Stim CES devices. The sham device was identical to the active CES device, except it did not conduct an electrical current. The active CES device was set to 100 µA, a subsensory level. The subjects, investigators, physicians and staff were all masked as to the identity of the device.Primary Effectiveness EndpointThe primary effectiveness endpoint was the change from baseline in the last post-treatment scores on the Hamilton Anxiety Rating Scale (HAM-A) compared to the sham treatment at the endpoint of the 5 week study.Secondary Outcome MeasuresThe secondary outcome measure was the change from baseline in the last post-treatment scores on the Hamilton Depression Rating Scale (HAM-D17) compared to the sham treatment at the endpoint of the 5 week study.Key Inclusion Criteria• Male and female participants between 18-65 years of age.• Diagnosis of an anxiety disorder was verified by a licensed clinical psychologist in an interview using the DSM-IV criteria.• Must score > 15 on the HAM-A.• Score on HAM-A must be higher than score on the HAM-D17.• If on antidepressant medication, the medication and dose must be stable for at least 3 months before entering study.• Must be in good health; chronic medical conditions must be stable.Key Exclusion Criteria• Pregnancy, planning to become pregnant or nursing.• Presence of implanted pacemakers, pumps or electrical stimulators.• Use of Benzodiazepines more than twice per week.• Met DSM-IV criteria for an Axis I diagnosis, other than an anxiety disorder.• Participant judged by investigator to be a risk for suicide or has attempted suicide one or more times within the past 12 months.• Current alcohol or substance abuse.• Participants exhibiting a psychiatric condition that would require inpatient or partial psychiatric hospitalization.Protocol SummaryThe Alpha-Stim CES active and sham devices were randomized by the manufacturer and the devices were packed in the device box in the order which they were to be assigned. Subjects were assigned a device based on the order the devices came out of the box. Baseline measures were done prior to the first CES treatment. Subjects had 5 weeks of daily CES treatment for 60 minutes with either an active or sham device. Outcome measures were done at the end of 1, 3 and 5 weeks.Device Application ProtocolThe active CES device was pre-set and locked by the manufacturer at 100 µA which is a subsensory level. The sham CES device was pre-set and locked by the manufacturer so that it did not emit electricity. The length of treatment, 60 minutes, was also pre-set and locked by the manufacturer for both active and sham devices.Study BlindingThe subjects, investigators, physicians and staff were masked as to the identity of the device, active or sham.Outcome MeasuresThe Hamilton Anxiety Rating Scale was used to quantify the severity of anxiety symptoms and to identify the response to CES. It has established reliability and validity in the literature (Maier et al., 1988). The Hamilton Depression Rating Scale17 (HAM-D17) was used to quantify the severity of depression symptoms and identify the response to CES. It is has established reliability and validity in the literature (Cusin et al., 2009).Pre-Specified Criteria for SuccessPre-specified criteria for success was set at ≥50% improvement for anxiety and ≥50% improvement for depression.Power Analysis and Sample SizeA power analysis was done and indicated that for two groups and at least one covariate that 107 subjects were needed for an ANCOVA analysis, an effect size of d=0.50 and p=0.05.ResultsSubjectsOf the 115 subjects who enrolled in the study, 108 subjects completed the study. There were 57 subjects in the active CES group and 51 subjects in the sham CES group.Baseline Measurements: Group EquivalenceThere was no statistically significant difference at baseline between active CES and sham treatment groups on anxiety, depression and subject characteristics of age, gender, use of prescribed medication and type of anxiety or depression disorder.Data AnalysisSubjects completed mid-point testing at the end of 3 weeks and endpoint testing at the completion of the last treatment at the end of their week 5 visit. Data were analyzed using ANCOVA and descriptive statistics. Cohen’s d was used to determine effect sizes (Cohen, 1998)AnxietyThere was a significant difference between the active and sham groups for anxiety from baseline to endpoint of study (p<0.001, d=0.94). The HAM-A scores decrease in the active group of 16.14 (29.51 to13.37; 54.6%) was more than 2 times the mean decrease of 7.58 (27.56 to 19.98; 27%) on the HAM-A for the sham group (See Figure 1). Eighty-three percent (83%) of the active CES group had a decrease of ≥ 50% decrease in anxiety scores on the HAM-A from baseline to endpoint of study. Note: All subjects must have met DSM-IV criteria for anxiety and scored > 15 on the HAM-A to be included in the study.Figure 1. Mean anxiety scores by group.DepressionThere was a significant difference between the active and sham groups for depression from baseline to endpoint of study (p<0.001, d=0.78). The HAM-D17 scores decrease in the active group of 8.04 (14.5 to 6.47; 55.4%) was more than 2.3 times the mean decrease of 3.26 (13.22 to 9.96; 24%) on the HAM-D17 for the sham group (See Figure 2). Eighty-two percent (82%) of the active CES group had a decrease of ≥ 50% decrease in depression scores on the HAM-D17 from the baseline to the endpoint of study.Figure 2. Mean depression scores by group.Quality of the ResearchThis is a strong study that used a randomized, sham controlled, double-blind design and was adequately powered. Active and sham Alpha-Stim devices were pre-set and locked at the designated levels for each specific group (active or sham) to maintain the current level and treatment time by the manufacturer. Sham devices were the same as active, except they did not emit electricity. Randomization of devices was done by the manufacturer and followed according to the protocol by the investigators. Individuals had to meet the DSM-IV criteria for an anxiety disorder to be in the study. Pre-specified criteria for success were established for the study. CES treatments were done daily for 60 minutes for both active and sham groups. ANCOVA was the appropriate analysis for the data on anxiety and depression. All subjects (N-108 at end of study) completed the HAM-D17 at baseline and endpoint of study. A limitation of the study is that the number of individuals within the total groups who met the DSM-IV criteria for depression was small (12 in the active CES group and 11 in the sham group), however the total active CES group had significantly lower scores on the HAM-D17 from baseline to endpoint of study than the total sham CES group (p<0.001, d=0.78). The range for no depression is 0 to 7 on the HAM-D17, so there was ample room for subjects who did not have depression to have lower scores on the HAM-D17 at endpoint of study from CES treatments. This is most likely what happened. Subjects in the active CES group who had depression scored significantly lower on depression scores at endpoint of the study indicating less depression. Subjects in the active group who were in the “no depression” range on the HAM-D17 had lower scores at endpoint representing an improved mood status.Author AffiliationsBarclay, TH. Associate Professor, Department of Psychology, Liberty University, Lynchburg, VA; Barclay, RD. Associate Vice President for Analytics and Decision Support at Stetson University, Daytona Beach, FL.ReferencesCusin C, Yang H, Yeung A, Fava M. Rating scales for depression. In L. Baer, MA Blais (eds,) Handbook of Clinical Rating Scales and Assessment in Psychiatry and Mental Health, Current Clinical Psychiatry. New York, NY: Humana Press, 2009.Maier W, Buller R, Philipp M, Heuser I. The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. Journal of Affective Disorders. 1988 Jan-Feb;14(1):61-8. ### Clinical Efficacy of Assisted CES Treatment on Depression Clinical Efficacy of Assisted Cranial Electrotherapy Stimulation Treatment on Depression Wei Y., Yang Z., Pan H., Zhao S-J., Fang J-Z. Clinical Efficacy of Assisted Cranial Electrotherapy Stimulation Treatment on Depression. Neural Injury and Functional Reconstruction. July 2014, 9(4):317. Funding Source, Location of Study, or Author’s Affiliation Department of Psychiatry, The Third People’s Hospital of Changshu City, Jiangsu 215500, China Device Alpha-Stim® Key Variables Depression and anxiety. Objective To observe the curative effect and safety of antidepressants combined with cranial electrotherapy stimulation (CES) in treatment for depression patients Design A group of patients diagnosed with depression and anxiety were randomly allocated into two groups. The control group received antidepressant medication, and the experimental group CES. The treatment cycle for both groups was 6 weeks. Pre- and post-treatment depression scores were measured using the Hamilton Depression Rating Scale (HAM-D) and anxiety using the Hamilton Anxiety Rating Scale (HAM-A). The level of cognitive impairment was assessed using the Wisconsin Card Sorting Test (WCST). With the safety of the treatment modalities assed using the Treatment Emergent Symptom Scale (TESS). Primary Outcome Measure Pre and post scores for: Depression measured by Hamilton Depression Rating Scale (HAM-D) Anxiety assessed by the Hamilton Anxiety Rating Scale (HAM-A) Secondary Outcome Measure Cognition as measured by the Wisconsin Card Sorting Test (WCST) Safety as assessed by Treatment Emergent Symptom Scale (TESS) Key Inclusion Criteria Diagnosis of depression following the Classification and Diagnostic Criteria of Mental Disorders in China Edition 3 (CCMD-3) HAM-D ≥17 Male or female aged 16-68 years old Key Exclusion Criteria Prior diagnosis of a neurodegenerative disease History of or current substance use or dependence Pregnant, lactating, or planning to become pregnant Diagnosis of epilepsy Implanted medical devices, including pacemakers, insulin pumps Protocol Summary A total of 80 patients were randomly allocated into two groups of 40. Both groups received Treatment as Usual (TAU) consisting of antidepressant medication, with the experimental group receiving CES using Alpha-Stim in addition to medication (TAU+CES). The drug classes for the antidepressant medication included Noradrenergic and Specific Serotonergic Antidepressants (NaSSA), Selective Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), Selective Serotonin Reuptake Inhibitor (SSRIs), Serotonin Antagonist and Reuptake Inhibitors (SARIs), and Tricyclic Antidepressants (TCAs). Drug Class Condition & Frequency TAU+CES TAU Noradrenergic and Specific Serotonergic Antidepressants (NaSSA) 14 14 Selective Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) 12 13 Selective Serotonin Reuptake Inhibitor (SSRIs) 9 7 Serotonin Antagonist and Reuptake Inhibitors (SARIs) 3 3 Tricyclic Antidepressants (TCAs) 2 3 Total 40 40 The number of patients in each drug class. During the CES treatment cycles, combination with other medications or treatments was not permitted (i.e., antipsychotics, antidepressants, mood stabilizers, electric convulsive therapy, or systematic psychotherapy). CES therapy was administered using Alpha-Stim as per the manufacturer’s instructions. Subjects received four courses of treatment, each treatment cycle lasting 20 minutes, over five days, with a two-day rest period between treatment cycles, resulting in 20 days of treatment over six weeks. The symptom severity and adverse drug reactions were evaluated respectively at the time of admission and the end of 1, 2, 4, and 6 weeks of treatment, and patients’ cognitive functions were evaluated at the time of admission and the end of the 6th week. Treatment response was assessed by two attending psychiatrists who had been rigorously trained, respectively evaluated the individuals in the two groups and tested their consistency on their scale evaluations (Kappa=0.86). Device Application Protocol Patients were instructed to (1) clean their earlobes with a wet cotton pad, (2) apply the conductive solution, and (3) gently clamp the electrodes around the base of their earlobes. Patients were advised to relax and lay down in a location where they would not be disturbed. Instructions to set the Alpha-Stim CES device to a frequency of 0.5 Hz and intensity between 10-500 μA were given to patients. Each patient had the ability to self-calibrated the minimum threshold of intensity by gradually increasing it until they experienced a mild tingling sensation. The course of treatment was 20-minutes over a five-day period.  Each course was started two days after completion of the former one, and each patient received four courses of treatment, 20 treatments in total. Statistical Analysis Plan The reduction of HAM-D scores was used as the evaluation indicator of efficacy (i.e., HAM-D score ≤7 indicating clinical recovery, and HAM-D reduction ≥50% indicating effectiveness). Significance testing using t-tests, chi-square, and repeated measures Analysis of Variance (ANOVA) at a statistically significant level of p<0.05. SPSS 17.0 statistical software was used to analyze the data. Results Subjects The TAU+CES condition included 40 patients, 15 males, and 25 females, with a mean (SD) age of 36.36±13.53 years, and a depression diagnosis with a mean (SD) of 18.74±16.25 weeks; with six patients having a family history of depression. The mean (SD) total HAM-D score at baseline was 25.32±5.24. The TAU group included 12 males and 28 females, a total of 40 subjects with a mean (SD) age of 34.72±12.48 years, and a diagnosis of depression of with a mean (SD) of 71±15.52 weeks; of which seven subjects reported a family history of depression. The mean (SD) total HAM-D score at baseline was 25.89±4.67. The dose of each antidepressant drug was adjusted to the therapeutic dose within 1-2 weeks according to individual tolerance. The difference in type, composition and mean dose of antidepressant drugs between the two groups was not significant (p>0.05). No significant differences between groups in cognitive impairment as measured by WCST scores were reported at baseline. No significant changes in hemogram, ECG, liver, and kidney functions were found between the two groups. A total of five patients across the two groups did not complete or were withdrawn from the study. The difference in withdrawal rate between the two groups was not statistically significant (x2=0.213, p>0.05). Data Analysis After the treatment the HAM-D and HAM-A scores in the two groups were significantly lower than before treatment (p<0.01). In the sixth week, the assisted efficiency and curative rates between the two groups showed no significant difference (p>0.05). In the 4th week, the efficiency in the TAU+CES group was significantly higher than in TAU group (p< 0.05). Mean HAM-D Score Baseline Through Week 6 of Treatment Mean HAM-A Score at Baseline Through Week 6 of Treatment. Efficacy: The efficacy of treatment was assessed at Weeks 2, 4, and 6, and shown in the table below.  The efficacy and curability rate of the TAU+CES condition was significantly higher (p<0.05) at the 4th week of treatment than the TAU condition. No significant difference in efficacy or curability between the two conditions was observed at the 2nd or 6th week post-treatment. Group N Week 2 Week 4 Week 6 Effective Cured Effective Cured Effective Cured TAU 37 6(16.22%) 1(2.70%) 11(29.73%) 6(16.22%) 26(70.27%) 18(48.65%) TAU+CES 38 11(28.95%) 2(5.26%) 20(52.63%) 10(26.32%) 30(78.95%) 21(55.26%) x2 1.73 0.32 4.06 1.14 0.75 0.33 P 0.188 0.572 0.044 0.286 0.388 0.566 Comparison of efficacy and curability Response: At baseline, there was so significant difference in HAM-D (p>0.05) between the two groups. The TAU comparator and the TAU+CES condition both resulted in a reduction in depression and anxiety symptoms as evidenced by the lower HAM-D and HAM-A scores (p<0.01). Symptoms of disordered sleep and depression (total HAM-D) were significantly lower at the end of the 2nd week of treatment in the TAU+CES condition compared to the TAU group. Significant reductions in symptoms of depression, anxiety, and occurrence of disordered sleep were reported in the TAU+CES group at the end of the 4th week of treatment. These improvements in symptoms are evidenced by the lower total HAM-D (p<0.05); HAM-A, retardation, and frequency of disrupted sleep (p<0.01). In addition, faster treatment response times were shown in the TAU+CES condition. Cognition: After six weeks of treatment, the TAU and the TAU+CES groups showed significant improvement in cognitive impairment (p<0.05 and p<0.01). With a greater number of correct responses and a lower number of incorrect responses from baseline to post-treatment in the TAU+CES group than that in the TAU group (p<0.05). The occurrence of random incorrect and classified responses increased from baseline to six weeks post-treatment in both groups, but there were no significant differences between the groups. Risk: In the TAU+CES group a total of 38 patients completed the study and two were withdrawn (one self-discontinued medication and one switched from depression to mania). While in the TAU condition 37 patients completed the study and three were withdrawn (one switching from depression to mania, one requiring mild electroconvulsive therapy (mECT), and one self-discontinuing medication). The difference in withdrawal rate between the two groups was not statistically significant (x2=0.213, p>0.05). The majority of minor adverse reactions or side effects occurred within the first two weeks of treatment. As treatment progressed, side-effects diminished and were well tolerated. There was no significant difference in the TSSS score between the TAU and TAU+CES groups, with details shown in the table below. The comparison of the adverse events between the two groups revealed no difference (p >0.05). The reported adverse events are known side-effects of antidepressant medication and unrelated to Alpha-Stim use. Conclusion In this study, TAU and TAU+CES effectively reduced symptoms of depression, anxiety, and disordered sleep, with higher treatment response rates in the TAU+CES condition at 4 weeks post-treatment (p<0.05). Cognitive decline associated with depression showed a greater improvement in the TAU+CES group. The authors concluded that CES was an effective augmentation strategy to pharmacological treatment. The TAU+CES condition increased the speed of treatment response and efficacy. Additionally, CES is a safe treatment approach with minimal and self-limiting side effects. The authors describe a mechanism of action for CES where the electrical stimulation reaches the thalamus, hypothalamus, brainstem, and limbic and reticular system resulting in greater brain electrical activity mapping (BEAM) and the release of 5-hydroxytryptamine (5-HT), endorphin, and melatonin. With a commensurate increase in the concentration of γ-aminobutyric acid (GABA), which collectively quickly and effectively relieves depression, anxiety, and disordered sleep, in addition to cognitive impairment associated with depression. Limitations This was a well-designed, randomized controlled study, but it was not a double-blind study. Therefore, limitations include both participants and investigators being aware of assigned interventions. The researchers do not discuss their procedures for missing data. According to the Cochrane risk-of-bias tool, each of these conditions may introduce unintended bias into a study. Study Quality: FAIR ### A comparative study of anxiety disorders treatment with Paroxetine in combination with cranial electrotherapy stimulation therapy. A comparative study of anxiety disorders treatment with Paroxetine in combination with cranial electrotherapy stimulation therapy LU Ling, HU Jun. A comparative study of anxiety disorders treatment with Paroxetine in combination with cranial electrotherapy stimulation therapy. Medical Innovation of China, 11(08):080-082, 2014.DeviceAlpha-Stim®Key VariableAnxietyObjectiveThe objective was to explore the add-on effect of cranial electrotherapy stimulation therapy in the treatment of anxiety disorders.DesignRandomized controlled trial, (N=120)Primary Effectiveness EndpointHamilton Anxiety Scale (HAM-A)Secondary Outcome MeasuresClinical Global Impression Scale (CGI-SI)WHO Quality of Life questionnaire (WHOQOL-BREF)Protocol SummaryPatients enrolled in the study (N=120) entered the 6 week treatment phase after a one-week washout period. The control group was given 10 – 20 mg of paroxetine (Paxil) daily while the treatment group received the same daily dose of paroxetine (10 – 20 mg) in combination with daily cranial electrotherapy stimulation (CES) treatments. The treatment course was 6 weeks in duration. The primary measurement of efficacy was reductive ratio in the HAM-A and CGI-SI with ≥75% being clinically cured, 50 – 74% obviously improved, 25 – 49% improved and <25% as ineffective. The WHO quality of life measurement was used to measure quality of life factors at baseline and week 6.Device Application ProtocolSubjects were treated with Alpha-Stim CES at 0.5 Hz, between 50 – 500 μA for 60 minutes daily for a total of 42 days. In the first treatment investigators increased the current until the subjects reported a tingling or dizziness. At that point the current was reduced to a subsensory level. The subjects were then treated at this level for the duration of the study.Data AnalysisA database was created and SPSS 15.0 software was used for statistical analysis of the data obtained. The measurement data was expressed as ( ), t-tests were used for comparison. The enumeration data was tested with χ2, where PResultsSubjectsThe control group (N=60) received 10 – 20 mg of paroxetine while the treatment group (N=60) received 10 – 20 mg of paroxetine combined with daily CES treatments.Baseline Measurements: Group EquivalenceThere was no statistical difference between the control and treatment groups at baseline.HAM-ABoth the control and the treatment groups showed improvement in HAM-A scores with each consecutive measurement. The comparison of HAM-A scores showed no significant changes between control and treatment groups at baseline, week 2 or week 4 but there was a significant difference in the two groups at week six (p<0.01). The treatment group which consisted of daily paroxetine and CES improved significantly more than the control group which received paroxetine alone.Figure 1. This graph compares the improvement in anxiety scores between the CES treatment and control groups which was significant (p<0.05) at 6 weeks.CGI-SIThe control group and the treatment group yielded significant improvement from baseline to the six week endpoint. While both groups reported significant improvement, there was more improvement in the treatment group and the difference between the control and treatment groups was also statistically significant (p<0.05).WHOQOL-BREFThe quality of life scores reduced significantly (p<0.05) over the 6 week treatment course in both groups but of the 4 domains there was only a significant difference between the control and treatment groups in the physical domain (p<.05).ConclusionThe results of this study showed that six weeks of combining paroxetine with daily CES treatments, yielded significant improvement over paroxetine alone on the HAM-A scale from baseline to 6 weeks out. This was confirmed with the HAM-A (p<0.01) and the CGI-SI (p<0.05). There was also a significant reduction in quality of life however there was no significant difference between the control and treatment groups except in the physical domain (p<0.05). ### Sertraline combined Alpha-Stim clinical observations on the treatment of 30 cases of generalized anxiety disorder. Sertraline combined Alpha-Stim clinical observations on the treatment of 30 cases of generalized anxiety disorder Ou, Y. & Li, C. Sertraline combined Alpha-Stim clinical observations on the treatment of 30 cases of generalized anxiety disorder. Chinese Journal of Ethnomedicine and Ethnopharmacy. 2015; 24(17):73-75.Funding Source, Location of Study or Author’s AffiliationThe Second People’s Hospital of Pingxiang City Jiangxi Province, Pingxiang, ChinaDevice Alpha-Stim®Key VariablesAnxietyObjectiveEvaluation of sertraline combined with Alpha-Stim on clinical efficacy and safety in the treatment of generalized anxiety disorder (GAD).DesignA group of sixty patients diagnosed with GAD were randomly allocated into a control group (MED) that received treatment-as-usual (TAU) consisting of Sertraline. The experimental group received 6 weeks of cranial electrotherapy stimulation (CES) in addition to medication (MED+CES). Baseline and post-treatment scores in the Hamilton Anxiety Rating Scale (HAM-A) were used to assess clinical response. The side effect profile of each treatment was measured using the Treatment Emergent Symptom Scale (TESS).Primary Outcome MeasureChange in GAD symptoms as measured by the HAM-A before and after treatment. A HAM-A total severity score of (i) < 7 indicates “No anxiety”; (ii) 7-13 “Possible anxiety”; (iii) 14-20 “Definite anxiety”; (iv) 21-28 “Definite and obvious anxiety”; and (v) ≥ 29 “Possibly severe anxiety”.Secondary Outcome MeasurePrevalence of side effects as measured by the TESS. The TESS is used to assess adverse events that first occurred or worsened in severity after the initiation of therapy. The scale includes measures of behavioral toxicity, laboratory abnormalities, cardiovascular, autonomic, and nervous system reactions, body weight, headache, and appetite changes. Scores range from 0 to 4, with a higher score indicative of more serious adverse reactions.Key Inclusion CriteriaMeet ICD-10 diagnostic criteria for GAD.Normal blood and urine analysis, liver and renal function assessment, and electrocardiogram (ECG).Key Exclusion CriteriaOrganic brain disease.Alcohol, drug, or substance abuse or dependence.Severe physical disease.Pregnant or lactating.Medical history contraindicating the use of Alpha-Stim CESHistory of epilepsy.An implanted electronic device such as a cardiac pacemaker or insulin pump.History of symptoms associated with a hemorrhagic stroke.Monoamine oxidase (MAOIs) use within two weeks prior to study start.Protocol SummaryA group of 60 patients diagnosed with GAD were randomly allocated into one of two groups. Treatment efficacy involved comparing pre and post-anxiety severity using the HAM-A. In addition, any side effects of treatment were measured using the TESS.The control condition received treatment-as-usual (TAU) medication. Patients in the MED group were prescribed an initial dose of 50mg/d of Sertraline and up to a maximum dose of 200mg/d depending on anxiety severity and the patients’ tolerance. The mean Sertraline dosage of the MED group was 73.5±23.7mg/d. The MED+CES group received six weeks of CES in addition to TAU with Sertraline. The Sertraline dosage in the MED+CES group was identical to the MED group with a mean of 65.5±15.6mg/d.Device Application ProtocolAlpha-Stim was used in the MED+CES group to administer daily CES treatment for six weeks, each treatment session was 20 minutes. Earclip electrodes were clamped to the patient’s earlobes and the stimulation intensity was set to between 10-500 μA, the frequency was set to 0.5 Hz, with an output pulse width of 0.5s.Statistical Analysis PlanClinical efficacy was observed by comparing the change in HAM-A score. A patient whose HAM-A score from baseline to post-treatment was reduced by ≥75% was labeled as healed; 50%-74% as making significant progress; 25%-49% as having improved; and <24% as remaining unchanged.SPSS 16.0 software was used for data processing, the enumeration data were tested by χ2, and the measurement data by t test. A p<.05 level was set as indicative of a statistically significant difference.ResultsSubjectsA total of 60 subjects were enrolled in the study, 36 females and 24 males, aged between 20 to 61 years. The MED+CES group included 30 patients, 13 males, and 17 females, mean age of 47.1±9.6 years. The MED group included 30 patients, 11 males, and 19 females, mean age of 46.3±9.3 years. Statistical analysis at baseline showed no significant differences between the groups in terms of gender and age, and the groups were considered comparable (p>.05).Data AnalysisFrom the first week of treatment, the reduction in total HAM-A score from baseline in the MED+CES group compared to the MED group was significantly lower (p<.05). In addition, the Sertraline dosage of patients in the MED+CES group reporting a reduction in anxiety levels is lower than the patients in the MED group. The lower dosage of medication in the MED+CES group equated to a total lower incidence of adverse reactions (p<.05).AnxietyThe baseline HAM-A scores were 24.12±7.58 and after the first week of treatment, they were reduced to 17.36±5.76, a statistically significant difference (p<.05). The significant reduction in HAM-A scores in the MED+CES group shows that Sertraline combined with CES for the treatment of GAD results in rapid treatment response. The differences in HAM-A scores were also significantly lower (p<.01) at the end of weeks two and four. However, at the end of the sixth week, the comparative difference in HAM-A scores between the two groups wasn’t statistically significant (p>.05), as shown in the table and graph below.Measurement timeMED + CES (n=30)MED (n=30)Baseline24.12±7.5823.85±7.82The 1st week of treatment17.36±5.76*20.95±7.61The 2nd week of treatment10.72±5.82**17.58±6.22The 4th week of treatment6.23±4.56**10.58±4.36The 6th week of treatment5.26±3.646.98±4.52Note: Through comparison with the control (MED) group, *p<.05, **p<.01Comparison of HAM-A scores at different times of treatmentMean anxiety (HAM-A) score from baseline to end of treatment for the control (MED) and experimental (MED+CES) group.EfficacyThe comparative difference in clinical efficacy between the two treatment groups was not statistically significant (p>.05). However, as the table below indicates, the total effective rate percentage for the MED+CES group is greater than the MED group.GroupCaseHealedSignificant ProgressImprovedUnchangedTotal effective rate %MED+CES3015103293.5MED30985873.3Comparison of clinical efficacySafetyThe comparative difference in the occurrence of adverse reactions as measured by the TESS during the six weeks of treatment in the two groups wasn’t statistically significant (p<0.05). However, the total occurrence of adverse events was significantly higher in the MED than the MED+CES group, as shown below.Adverse reactionsMED+CESMEDNausea13Loss of appetite03Headache10Dizziness01Loss of appetite20Thirst03Transaminase rise02Palpitation01Total occurrence rate/%13.3*43.3Note: Compared with the control (MED) group, *p<.05Frequency of adverse events (TESS)ConclusionSertraline combined with Alpha-Stim for the treatment of GAD is fast, safe, and effective. The results from this study show that medication plus CES leads to rapid treatment response, reduced medication dose, low side effect profile, and greater patient treatment compliance. Consequently, the authors concluded that CES deserves to be clinically promoted and applied, particularly as an augmentation strategy to traditional medication treatment for GAD.LimitationsWhile the results of this study are good, the CES protocol utilized is not consistent with other studies or with clinical instructions for use. For participants who were able to tolerate currents higher than 250 uA, the 20-minute treatment duration is sufficient, but for patients requiring lower than 200 uA, 60 minutes of treatment is recommended. Consequently, the efficacy of CES compared to medication only or as the role of CES as an augmentation strategy is likely to be even higher than reported in the current study. Additionally, while the randomization technique in this study is effective, neither the investigators nor the participants were blinded to the treatment condition, which could introduce unintentional bias into the results, according to the Cochrane Risk of Bias Tool.Study Quality: FAIR ### Cranial electrotherapy stimulation affects mood state but not levels of peripheral neurotrophic factors or hypothalamic-pituitary-adrenal axis regulation Cranial electrotherapy stimulation affects mood state but not levels of peripheral neurotrophic factors or hypothalamic-pituitary-adrenal axis regulation Roh, HT. & So, W-Y. Cranial electrotherapy stimulation affects mood state but not levels of peripheral neurotrophic factors or hypothalamic-pituitary-adrenal axis regulation. Technology and health care: Official Journal of the European Society for Engineering and Medicine. 2017; 25(3):403–412.Funding Source, Location of Study, or Author’s AffiliationSports and Health Care Major, College of Humanities and Arts, Korea National University of Transportation, Chungbuk, Korea.DeviceAlpha-Stim® 100Key VariablesChanges in neurotrophic factors and mood.ObjectiveThe present study aimed to evaluate changes in the hypothalamic-pituitary-adrenal (HPA) axis response and levels of neurotrophic factors, blood cortisol, adrenocorticotropic hormone (ACTH), neurogenesis, and neuroplasticity; as well as changes in mood state, in patients undergoing Cranial Electrotherapy Stimulation (CES) therapy.DesignA randomized controlled trial (RCT) designed to assess changes in the HPA axis response and levels of neurotrophic factors, and changes in mood states following a period of eight weeks of treatment in a Sham comparator and Active CES group. Blood samples were collected before and following treatment and changes in mood state in both groups.Primary Outcome MeasureBaseline and eight-week post-treatment levels ofCortisolAdrenocorticotropic Hormone (ACTH)Brain-Derived Neurotrophic Factor (BDNF)Nerve Growth Factor (NGF)Secondary Outcome MeasureChanges in mood state were also examined at the time of blood collection using the Korean version of Profile of Mood States (KPOMS).Key Inclusion CriteriaBody mass index (BMI) under 30kg/m2Key Exclusion CriteriaSignificant history of medical problems, drug use, or mental illnessChronic diseases such as hypertension or diabetesHistory of smokingParticipation in a regular exercise program in the last six monthsProtocol SummaryParticipants were randomly assigned to either a Sham CES group (n=25) or an Active CES group (n=25). Randomization of each group was conducted using a simple online randomization algorithm (Random.org). Anthropometric measure, blood, hormone, and neurotrophic factors were measured at baseline and eight weeks post-treatment.Anthropometric measurements: Height, weight, and body composition were measured. Height was measured using a stadiometer, while weight and body composition were measured using an Inbody720 device that utilizes an eight-polar bio-impedance analysis method.Blood sampling & analyses: 8 ml blood samples were collected from cardinal veins in the forehand of each participant using a 22-gauge needle, serum separator tube, and ethylenediamine tetra-acetic acid tube. Collected blood was centrifuged at 3000 rpm for 15 minutes to analyze blood levels of cortisol, ACTH, BDNF, and nerve growth factor NGF. Samples were refrigerated at −80◦C until further analysis.Levels of HPA axis regulation-related hormones: Plasma cortisol and ACTH levels were analyzed via radioimmunoassay (RIA) and immunoradiometric assay (IRMA) using a Cortisol Coat-A-Count® Kit and an ACTH IRMA (CT) Kit respectively.Peripheral neurotrophic factor levels: Serum BDNF and NGF levels were analyzed via sandwich enzyme-linked immunosorbent assay. A Human BDNF ELISA Kit was used to analyze levels of BDNF, while an NGF sandwich ELISA Kit was used to analyze NGF levels. Levels were quantified at 450 nm absorbance using a microplate reader.Mood state: Changes in mood state were assessed using the Korean version of the Profile of Mood States (KPOMS), adapted from the original version developed by McNair et al. (1992). The questionnaire consists of 65 items scored along a five-point Likert scale and is divided into six sub-domains: Tension-Anxiety, Depression-Dejection, Anger-Hostility, Vigor-Activity, Fatigue-Inertia, and Confusion-Bewilderment.Device Application ProtocolCES treatment using Alpha-Stim® 100 was conducted in 20-minute sessions, three times per week for eight weeks. Clip electrodes were attached to both earlobes of patients in the Active CES group, who received treatment with a current of 100 μA at a frequency of 0.5 Hz, according to manufacturer instructions and following the methods utilized in advanced studies by Kirsch and Nichols (2013), and Anderson et al. (2014). The same procedure was followed for the Sham CES group, though the power of device remained off.Statistical Analysis PlanData are expressed as means and standard deviations (SD), and were analyzed using SPSS version 21.0. Two-way repeated-measures analyses of variance (ANOVA) were conducted to assess time and group differences in each variable. Both independent and dependent t-tests were conducted to examine significant interactions. The level of significance was set at a value of 0.05.ResultsSubjectsFifty (50) healthy postmenopausal women were randomly assigned to either a Sham CES group (n=25) or an Active CES group (n=25).Data AnalysisChanges in hormones associated with HPA axis regulation and neurotrophic factors following CES treatment revealed no significant differences to levels of plasma cortisol, plasma ACTH, serum BDNF, and serum NGF, or interaction between time and group following CES treatment (p>0.05).CES (Cranial Electrotherapy Stimulation); CV (Coefficient of Variation); ACTH (Adrenocorticotropic Hormone); BDNF (Brain-Derived Neurotrophic Factor); NGF (Nerve Growth Factor).Changes in HPA axis regulation hormones and neurotrophic factors before and after treatment.Two-way repeated-measures ANOVA for Tension-Anxiety, Depression-Dejection, Anger-Hostility, Vigor-Activity, Fatigue-Inertia, and Confusion-Bewilderment, and interaction between time and group revealed significant differences in Tension-Anxiety (F=14.339, p<0.001) and Depression-Dejection scores (F=9.796, p<0.003) following CES treatment.CES (Cranial Electrotherapy Stimulation); CV (Coefficient of Variation); T-A (Tension-Anxiety); D-D (Depression-Dejection); A-H (Anger-Hostility); V-A (Vigor-Activity); F-I (Fatigue-Inertia); C-B (Confusion-Bewilderment) ∫ p<0.05 vs Before; #p<0.05 vs Sham CES group; ∗p<0.05 vs Before; #p<0.05 vs Sham CES group.Changes in mood state before and after treatment.Post-hoc analysis revealed no significant differences before and after treatment in the Sham CES group, while significant decreases in Tension-Anxiety and Depression-Dejection scores (p<0.05) were observed in the Active CES group. Furthermore, Depression-Dejection scores were significantly lower in the Active CES group than in the Sham CES group (p<0.05) following treatment. However, there were no significant differences in Anger-Hostility, Vigor-Activity, Fatigue-Inertia, and Confusion-Bewilderment scores (p>0.05).Mean Change in Depression-Dejection Baseline to Post-Treatment.Mean Change in Tension-Anxiety Baseline to Post-TreatmentConclusionNo significant differences in cortisol, ACTH, BDNF, or NGF were observed between the two participant groups (p>0.05) following the treatment period. However, those in the Active CES group exhibited significantly decreased Tension-Anxiety and Depression-Dejection scores on the POMS relative to pre-treatment scores (p<0.05). Furthermore, Depression-Dejection scores following treatment were significantly lower in the Active CES group than in the Sham CES group (p<0.05). No significant differences were observed in any other POMS scores such as Anger-Hostility, Vigor-Activity, Fatigue-Inertia, and Confusion-Bewilderment (p>0.05).The authors concluded that their results suggest that eight weeks of CES treatment does not induce changes in blood levels of neurotrophic factors or HPA-axis-related hormones, though such treatment may be effective in treating symptoms of anxiety and depression.The absence of significant changes in plasma cortisol or ACTH levels are at odds with patients reports of significant improvement in mood states related to anxiety and depression. Further studies should utilize neuroimaging methods such as functional magnetic resonance imaging (fMRI), single-photon emission computed tomography (SPECT), and positron emission tomography (PET) should be conducted in order to examine the effect of CES treatment on brain activity.LimitationsThe CES protocol utilized in this study is not consistent with other studies or with clinical instructions for use regarding current intensity and duration of treatment. At 100 uA, 60 minutes of treatment is recommended. Additionally, it is likely that a longer-term study is needed to demonstrate chemical changes from Alpha-Stim CES treatment. Additionally, the authors do not discuss a plan for missing data in their statistical analysis.Study Quality: FAIR ### Efficacy of Cranial Electrotherapy Stimulation on Anxiety and Sleep Qualities Among Elderly Patients with Chronic Sleep Disorders. Efficacy of Cranial Electrotherapy Stimulation on Anxiety and Sleep Qualities Among Elderly Patients with Chronic Sleep Disorders. Ren, Y., Zhu, Y., Yang, J., & Ding, F. Efficacy of Cranial Electrotherapy Stimulation on Anxiety and Sleep Qualities Among Elderly Patients with Chronic Sleep Disorders. Chinese Journal Modern Nursing. 2019; 25(24).Funding Source, Location of Study or Author’s AffiliationGeriatric Department and Nursing Department, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.Device Alpha-Stim® SCSKey VariablesAnxiety & Sleep.ObjectiveTo explore the effects of cranial electrotherapy stimulation (CES) on anxiety and sleep quality among elderly patients with chronic sleep disorders.DesignA randomized controlled trial of 120 elderly patients with chronic sleep disorders was randomly divided into a control and treatment group, with 60 cases in each group. The control group MED received treatment-as-usual (TAU) that involved medication, either clonazepam or ramelteon. The treatment group CES received a course of CES treatment constituting once daily, 20 minutes session, over 12 weeks. The sleep quality and anxiety of patients in the two groups were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and the Hamilton Anxiety Rating (HAM-A) scale before treatment and after a course of treatment.Primary Outcome MeasureSleep quality and quantity as measured by the PSQI, a 19-item scale to measure sleep quality and disturbance over two weeks. The PSQI includes 7 factors and 19 self-evaluation items, the scores range for each factor from 0-3. Higher PSQI scores indicate poorer sleep quality.Anxiety as measured by the HAM-A scale before treatment and after a course of treatment. The HAM-A total score (i) < 7 indicates “No anxiety”, (ii) 7-13 “Possible anxiety”, (iii) 14-20 “Definite anxiety”, (iv) 21-28 “Definite and obvious anxiety”, and (v) ≥ 29 “Possibly severe anxiety”.Secondary Outcome MeasureNone reported.Key Inclusion CriteriaSleep disturbancemeet the diagnostic criteria insomnia specified in the Chinese Classification of Mental Disorders (CCMD-3).latency to persistent sleep (LPS) is prolonged (>30 minutes).actual sleep time is reduced (<6 hours every night).a disease course of more than 6 months.Aged ≥ 60 years.Key Exclusion CriteriaSignificant or severe organ dysfunction, malignant tumors, other end-stage diseases.Severe cognitive disorders.Sleep apnea syndrome.Sleep disorders caused by severe mental disorders.Receiving long-term drug or other treatments.Not taking an antidepressant, anxiolytics, sleep medication, or other psychotropic drugs within the 2 weeks before the start of the study.Protocol SummaryA group of 120 elderly patients with chronic sleep disorders was randomly divided into a control group (n=60 MED) receiving standard medical care that involved medication and an experimental treatment group (n=60 CES) that received a course of CES treatment constituting a once-daily, 20 minutes session, over 12 weeks. The sleep quality and anxiety of patients in two groups were evaluated at baseline and post-treatment using the PSQI and HAM-A scale.Patients in both groups received routine nursing care and regular telephone follow-up with information aimed at promoting general health, instructions on drug use, medication reminders, Q&A opportunities, psychological support, and reminders to return to outpatient visits.In the MED group, patients took sleep medication as prescribed by their doctor – typically 2mg qd hs of Clonazepam (specification: 0.5mg per tablet) or of 4mg qd hs Ramelteon (specification 8mg per tablet) every day.  Patients in the experimental CES group received CES treatment for 20 minutes before falling asleep every day for 12 weeks.Before the intervention, informed consent was obtained from the patient; inclusion criteria were reviewed; patient’s clinical data, including medical history, was collected, a physical assessment was conducted, and vital signs were collected. The medical team also provided an auxiliary examination and reviewed past or concomitant medications.Device Application ProtocolThe CES group received CES treatment using the Alpha-Stim® SCS. The patient’s earlobes were thoroughly cleaned with mild soapy water, dried, and the electrodes were attached to the earlobes near the jawbone. The current intensity was adjusted from the minimum value and gradually increased until the patient felt a comfortable mild tingling sensation.All patients received CES treatment for 20 minutes before falling asleep every day for 12 weeks. During treatment, patients were advised to relax, and engage in activities associated with minimal movements, such as reading a book or newspaper, but were asked to not talk with others during treatment.Statistical Analysis PlanSPSS 23.0 statistical software was used for data analysis. The measurement data were expressed as mean ± standard deviation (SD), and the enumeration data were expressed with frequency and percentage (%). Significance testing using t-test and χ2 test were carried out for independent samples, and p<.05 level equated to a statistically significant difference.ResultsSubjectsIn total 120 patients were enrolled in the study, with 60 randomly allocated into the MED and CES. Subjects were withdrawn from the study if they showed (1) adverse reaction(s) during the intervention, (2) failure to complete the study for any reason. Consequently, a total of 52 patients in the MED group and 55 in the CES group completed the study. Baseline comparison measures showed no statistically significant differences between the patients in each group (p>.05) shown in the table below.GROUPCasesMalesFemaleAge Years (mean/SD)Disease Course Months (mean/SD)MED52282465.2 + 4.224.5 + 10.2CES55302566.8 + 5.926.1 + 13.0X2/t value  0.005-1.623– 0.71p-value  0.9420.1080.479Comparison of general data in elderly patients with chronic sleep disorders between both groups.Data AnalysisThe results showed that the therapeutic effect of CES was better than that of traditional drug therapy (p<.001).After the intervention, the total PSQI scores of the treatment group (CES) were lower (7.08±0.98) than those of the control group (MED) (8.97±1.38), indicating greater improvement in sleep quality, and the difference was statistically significant (t=8.127, p<.001).Comparison of posttreatment differences in sleep disturbanceMoreover, according to HAM-A scores, CES treatment was better than the MED group at improving sensory system symptoms, gastrointestinal tract symptoms, genitourinary system symptoms, and autonomic nervous system symptoms, etc. (p<.001). The change in HAM-A scores suggested that CES improves sleep and anxiety; in addition to improving the sensory system, gastrointestinal tract, genitourinary system, and autonomic nervous system symptoms (p<.001).GROUPCasesTotal ScoreAnxietyNervousnessFearInsomniaCognitive DisorderDepressionSomatic AnxietyCES528.12+3.111.02+0.240.89+0.070.42+0.091.08+0.171.42+0.210.87+0.110.71+0.07MED5513.12+5.121.56+0.191.01+0.170.58+0.071.98+0.411.58+0.191.11+0.090.78+0.09t value -6.063-12.940-4.726-10.296-14.681-4.125-12.3814.504p value <0.001<0.001<0.001<0.001<0.001<0.001<0.001<0.001 GROUPCasesSensory SystemCardiovascular SystemRespiratory SystemGastrointestinal SystemGenitourinary SystemAutonomic Nervous SystemPerformance When Talking With Others CES520.58±0.471.37±0.110.34±0.110.82±0.180.47±0.130.47±0.180.21±0.07MED551.74±0.181.38±0.070.58±0.212.37±0.290.85±0.071.57±0.170.44±0.15t value -17.030-0.5647.462-32.998-18.964-32.510-10.069p value <0.0010.574<0.001<0.001<0.001<0.001<0.001             Comparison of anxiety (HAM-A) scores after treatment between the control (MED) and experimental group (CES). Comparison of posttreatment differences in anxietyConclusionThe authors conclude that, compared with traditional medication treatments, CES more effectively improves sleep quality and reduces anxiety in elderly patients with chronic sleep issues, without adverse reactions. The results of the HAM-A demonstrate CES also improved the physiological symptoms of anxiety more effectively than medication.LimitationsOnly the post treatment scores on the PSQI and HAM-A are provided, so the progress throughout the 12-week treatment period cannot be determined. Additionally, participants in the CES condition treated before going to bed, despite the Instructions for Use (IFU) for Alpha-Stim advising against treating within 3-4 hours of going to sleep.Study Quality: FAIR ### Acupuncture combined with cranial electrotherapy stimulation on generalized anxiety disorder: A randomized controlled trial Acupuncture combined with cranial electrotherapy stimulation on generalized anxiety disorder: A randomized controlled trial Liu, E., Zhang, W., Wang, J., Zhao, F., & Bai, Y. Acupuncture combined with cranial electrotherapy stimulation on generalized anxiety disorder: A randomized controlled trial. Chinese Acupuncture & Moxibustion. 2020; 40(11).Funding Source, Location of Study or Author’s AffiliationDepartment of TCM, First Hospital of Hebei Medical University, Shijiazhuang, ChinaDeviceAlpha-Stim® SCSKey VariablesAnxiety and Quality of Life.ObjectiveTo observe the therapeutic effect of acupuncture combined with cranial electrotherapy stimulation (CES) on generalized anxiety disorder (GAD).DesignA randomized controlled study comparing the effectiveness of four (K=4) different treatment groups (1) medication only (MED), (2) acupuncture only (ACU), (3) cranial electrotherapy stimulation only (CES), and (4) acupuncture plus CES (ACU + CES) for the treatment of generalized anxiety disorder (GAD). The medication only (MED) group was considered the control group as it received treatment-as-usual (TAU), and the acupuncture only (ACU) and CES only (CES) and acupuncture plus CES (ACU+CES) are the experimental groups.Baseline and post-treatment anxiety scores were measured using the Hamilton Anxiety Rating (HAM-A) scale. Similarly, baseline and end of treatment quality of life were assessed using the World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF). Adverse events were measured using the Treatment Emergent Symptom Scale (TESS). Patients were assessed at the end of the study and relapse rates reassessed 12 months after the end of treatment. Primary Outcome MeasureAnxietyAssessed using the Hamilton Anxiety Rating Scale (HAM-A).The HAM-A includes a severity scale for each item from 0 “Not present” to 4 “Severe”Scores range from 0–56 with <17 indicating “Mild severity”; 18–24 “Mild to moderate severity”, and 25–30 “Moderate to severe”.Quality of LifeMeasured by the World Health Organization’s Quality of Life Questionnaire Brief Version (WHOQOL-BREF)The WHOQOL-BREF is a 26-item instrument consisting of four domains: physical health (7 items), psychological health (6 items), social relationships (3 items), and environmental health (8 items), and other general health items.Each item in the WHOQOL-BREF is scored from 1 to 5 on a response scale. Secondary Outcome MeasureSide EffectsMeasured by the Treatment Emergent Symptom Scale (TESS).The TESS scale is used to assess adverse events that first occurred or worsened in severity after initiation of treatment or therapy.The scale includes measures of behavioral toxicity, laboratory abnormalities, cardiovascular, autonomic, and nervous system reactions, body weight, headache, and appetite changes.Scores range from 0 to 4, with a higher score indicative of more serious adverse reactions. Key Inclusion CriteriaMet criteria for Generalized Anxiety Disorder (GAD) according to the Chinese Classification of Mental Disorder, 3rd edition (CCMD-3). The clinical manifestations of GAD include restlessness, insomnia, a sense of dread, feeling constantly “on edge”, dizziness, irritability, difficulty concentrating, and muscular tension or pain.Diagnosis of GAD ≥6 monthsHamilton Anxiety Rating (HAM-A) scale ≥14Age <80 yearsProvide informed consentBe willing to be randomized into one of the treatment groupsFollow the study protocol Key Exclusion CriteriaChronic medical conditions such as severe heart, brain, liver, kidney, hematopoietic system, etc.Not a good candidate or unfit for CES or acupuncture treatment.Use of anxiolytic medication in the last two weeks or discontinued medication within the last two weeks.Other psychiatric disorders. Protocol SummaryPatients in all four groups (K=4) received treatment for sixty (60) days irrespective of group assignment.Medication only (MED): in the medication (MED) only TAU group patients were treated with oral tandospirone citrate (brand name Sediel) an anxiolytic and antidepressant drug used in China and Japan. The dosage was 10mg after breakfast, lunch, and dinner.CES only (CES): the CES only (CES) group received treatment using the Alpha-Stim® SCS device daily for 60 minutes each time.Acupuncture only (ACU): the acupuncture only (ACU) group received traditional acupuncture applied daily for 30 minutes to (1) Baihui (GV 20), (2) Sishencong (EX-HN 1), (3) Yintang (GV 29),(4) Shenting (GV 24), etc.Acupuncture plus CES (ACU+CES): the acupuncture plus CES (ACU+CES) group received CES treatment before acupuncture. The treatment protocol for the acupuncture and CES were the same as the acupuncture only (ACU) and CES only (CES) group. Device Application ProtocolCES was administered using the Alpha-Stim® SCS, and patients were instructed to lay supine or sit comfortably, saturate the electrode pad with conducting liquid, then clamp the electrode at the base of both earlobes. Once the device was attached patients were instructed to turn the power switch on and adjust the intensity from level 0-5 until a slight feeling of dizziness or a sensation of tingling on the earlobes occurred. Treatment was daily, for 60 minutes each time, for 60 continuous days of the treatment trial. Statistical Analysis PlanChanges in HAM-A and WHOQOL were observed, the clinical effect was evaluated, and the anxiety relapse rate was measured in all four groups at follow-up one year after treatment ended. The relapse rate was set at a HAM-A score ≥14.The therapeutic effect was evaluated by comparing the change in HAM-A scores. HAMA score indicator = [(HAM-A score before treatment – HAM-A score after treatment)/HAM-A score before treatment] ×100%. The results were interpreted as HAM-A score (1) ≥75% “Cured”, (2) 50%≤ HAM-A score indicator <75% “Excellent”, (3) 25%≤ HAM-A score indicator <50% “Effective”, (4) <25% HAM-A score indicator “Ineffective”.SPSS 18.0 software was used for statistical analysis, and the measurement data were described by mean ± standard deviation (SD). The comparison among groups is used with single-factor analysis of variance (ANOVA), and the comparison between two groups is checked by Least Significant Difference (LSD); the enumeration data is checked by χ2. A significance level of p<.05 is used to determine a statistically significant difference. ResultsSubjectsA total of 200 patients with GAD were randomly allocated into four groups (K=4) using a random number table, with 50 cases per group (n=50). Comparison of subjects’ general characteristics at baseline across all groups, including gender, age, and course of the disease were not statistically significant (p>.05). The groups can be considered comparable.The MED only (MED) group included 22 males and 28 females, aged 27-70 years, representing a mean age 38±3 years, and a course of disease between 6-40 months, equating to a mean course of 13.6±2.6 months.In the CES only (CES) group  22 males and 28 females aged 25-69 years were enrolled, with a mean age of 37±3 years, and a course of disease between 7-39 months, reflecting a mean of 13.0±3.1 months since disease onset.The acupuncture only (ACU) group enrolled 20 males and 30 females, aged 25-71 years, reflecting a mean age of 38±3 years, and a course of disease ranging from 6-41 months, with a mean onset of 14.0±2.4 months.The acupuncture plus CES group (ACU+CES) enrolled 21 males and 29 females aged from 27-72 years old and having a mean age of 38±2 years, and a disease course of 7-42 months, and a mean of 13.5±2.7 months since onset. Data AnalysisAcross all four groups, patients reported benefitting from the treatment they received. The level of anxiety was significantly reduced as evidenced by the lower HAM-A scores (p<.05). Furthermore, quality of life as measured by the WHOQOL- BREF significantly improved following treatment as indicated by the higher scores post-treatment (p<.05).Anxiety:No statistically significant difference in the level of anxiety between the four groups was reported before treatment (p>.05). Following treatment, the HAM-A score of all four groups decreased significantly (p<.05). The acupuncture plus CES (ACU+CES) group reported the largest decrease in anxiety from baseline to post-treatment (p<.05). Comparison of anxiety (HAM-A) score before and after treatment in each group.GroupCasesBefore treatmentAfter treatmentBefore treatment – after treatmentACU+CES5021.68±2.138.45±1.21113.12±1.782,3,4ACU only5021.24±2.1712.78±1.6718.73±1.21CES only5021.45±2.0513.19±1.4317.89±1.13MED only5021.65±2.1313.76±1.6816.56±0.76Note: Through comparison with that before treatment of this group 1p<.05; through comparison of difference before and after therapy of acupuncture only group (ACC) 2p<.05; through comparison of difference before and after therapy of CES only group (CES) 3p<.05; through comparison of difference before and after therapy of medication only group (MED) 4p<.05.Comparison of anxiety (HAM-A) score before and after treatment in each group. Note: acupuncture plus CES (ACU+CES); acupuncture only (ACU); CES only (CES); medication only (MED).Quality of Life:At baseline, no statistically significant difference in the quality of life as measured by the WHOQOL-BREF was reported between the four groups (p>.05). After therapy, the WHOQOL-BREF score of all four groups of patients increased significantly (p<.05). The patients in the acupuncture plus CES (ACU+CES) group reported a larger increase in WHOQOL-BREF scores than the other three groups (p<.05). The increase in scores reflects greater quality of life post-treatment. Comparison of WHOQOL-BREF score before and after therapy in each groupGroupCasesBefore therapyAfter therapyAfter therapy – before therapyACU+CES5065.12±4.2180.32±3.67115.37±2.022,3,4ACU only5065.28±3.8974.76±3.8919.12±1.23CES only5065.02±4.1774.13±4.2318.96±1.18MED only5064.76±4.2473.98±4.1418.72±1.10Note: Through comparison with that before therapy of acupuncture plus CES (ACC+CES) group 1p<.05; through comparison of difference before and after treatment of acupuncture only group (ACU) 2p<.05; through comparison of difference before and after treatment of CES only (CES) group 3p<.05; through comparison of difference before and after treatment of medication only (MED) group 4p<.05.Adverse Events:A comparison of adverse events across the four groups as measured by the TESS scores indicates that patients in the medication only (MED) group reported significantly higher side effects than the other treatment conditions (p<.05). In addition, the relapse rate at follow-up, 1-year post-treatment was significantly higher in the medication only (MED) group than those of the other three groups (p<.05).Comparison of TESS score and follow-up relapse rate after treatment in each groupGroupCasesTESS scoreRelapseCasesRelapse rate/%ACU+CES500.17±0.28124.01ACU500.13±0.311612.01CES only500.15±0.241510.01MED only501.04±0.681734.0Note: acupuncture plus CES (ACC+CES); acupuncture only (ACU); CES only (CES); medication only (MED);through comparison with medication group 1p<.05.Effectiveness:The total effective rate of the medication only (MED) group was 80%, for the CES only group (CES) 80%, and for the acupuncture only (ACU) group 84%. Although the improvements to patients’ life following treatment are substantial, all the treatment conditions were significantly lower than the 96% effective rate reported by the acupuncture plus CES group (ACU+CES) (p<.05).Comparison of clinical effect of each treatment groupGroupCaseCuredExcellentEffectiveIneffectiveTotal effective rate/%ACU+CES50112512296.0ACU only5061917884.01CES only50615191080.01MED only50413231080.01Note: acupuncture only (ACU); CES only (CES); medication only (MED); acupuncture plus CES (ACU+CES);through comparison with acupuncture plus CES group (ACU+CES) 1p<.05. ConclusionOverall, the total effective rate in the acupuncture plus CES group was significantly better than the other three groups (p<.05). Noticeably, the reduction in anxiety and improvements to the quality of life reported by patients in the acupuncture plus CES (ACU+CES) group was significantly greater than the other three groups (p<.05).The authors conclude acupuncture combined with CES can effectively relieve symptoms in patients with GAD, improve their quality of life, reduce the occurrence of adverse reactions, and the relapse rate. The authors support the mechanism of action proposed in the literature that CES therapy stimulates the secretion and release of a range of neurotransmitters including 5-hydroxytryptamine and endogenous morphine peptides by the cerebral cortex and hypothalamus, that subsequently support the reduction of anxiety symptoms. In this study, the CES group and the MED group had similar reductions in anxiety symptoms and improvements in quality of life. However, the CES group experienced significantly fewer and less severe side effects than the medication group. Additionally, the rates of relapse were over three times more in the medication group than in the CES at one-year follow-up. Thus, the clinical effectiveness of CES is superior to that of medication. Limitations: This was a strong RCT with one-year follow up that measured both anxiety and quality of life. However, the randomization was not blinded and both participants and investigators were aware of group assignments. Additionally, the authors did not discuss an a priori plan for missing data in this article. Study Quality: GOOD ### Comparison of the effects of cranial electrotherapy stimulation and midazolam as preoperative treatment in geriatric patients: A CONSORT-compliant randomized controlled trial Comparison of the effects of cranial electrotherapy stimulation and midazolam as preoperative treatment in geriatric patients: A CONSORT-compliant randomized controlled trial Park BS, Jin S, Kim WY, Kang DS, Choi YJ, Lee YS. Comparison of the effects of cranial electrotherapy stimulation and midazolam as preoperative treatment in geriatric patients: A CONSORT-compliant randomized controlled trial. Medicine (Baltimore). 2022 Sep 2; 101(35). Download ArticleFunding Source, Location of Study or Author’s AffiliationThis study was conducted at the Department of Anesthesiology and Pain Medicine, Ansan Hospital of Korea University College of Medicine. The protocol was approved by the hospital’s institutional review board (2020AS0142) and registered at the Clinical Research Information Service (KCT0006110). Written informed consent was obtained from all patients participating in this study.DeviceAlpha-Stim 100®Key VariablesAnxietyObjectiveTo observe and compare the clinical effect of cranial electrotherapy stimulation (CES) and midazolam as preoperative treatments in geriatric patients.DesignInitially, 90 patients were recruited, but 10 patients were withdrawn either spontaneously or in accordance with the exclusion criteria. In this study, 80 patients were included and randomly divided into 2 groups using a computer-generated randomization method: midazolam premedication group (M group, n = 40) and CES pretreatment group (CES group, n = 40). Preoperative anxiety was measured using the 5-point Likert scale, with anxiety levels rated from “Not at all” to “Severe”. The sedation score was assessed using the Ramsay sedation scale, which is a 6-point scale with sedation scores rated from “Anxious and agitated” to “Patients exhibit no response”. Vital signs that were measured include: Systolic and diastolic blood pressure (SBP & DBP), mean arterial pressure (MAP), heart rate (HR), and peripheral capillary oxygen saturation (SpO2). Different investigators performed pre-anesthesia visits, assessment of preoperative anxiety scores and sedation levels, midazolam premedication, CES pretreatment, and anesthesia induction.Primary Outcome MeasureAll measures were assessed three times: (1) on the day before surgery; (2) in the pre-operative holding area on the day of surgery; and (3) after entering the operating room.Anxiety was evaluated via 5-point Likert scale:5-point Likert scale (1) indicates “not at all”, (2) “mild”, (3) “intermediate”, (4) “moderate”, and (5) “severe”.Sedation score was assessed using the Ramsay sedation scale.On a 6-point scale (1) indicates “Anxious and agitated, or restless, or both”, (2) “cooperative, oriented, and tranquil”, (3) “responds to commands only”, (4) “brisk response to light glabellar tap or loud auditory stimulus”, (5) “sluggish response to light glabellar tap or loud auditory stimulus”, and (6) “patients exhibit no response”.Secondary Outcome MeasureAll measures were assessed three times: (1) on the day before surgery; (2) in the pre-operative holding area on the day of surgery; and (3) after entering the operating room.Vital signs were measured:Systolic and diastolic blood pressure (SBP & DBP), mean arterial pressure (MAP), heart rate (HR), and peripheral capillary oxygen saturation (SpO2).Key Inclusion CriteriaEligible patients wereAged 65 to 79 years oldAmerican Society of Anesthesiologists Physical Status Classification II or IIIScheduled for elective surgery under general anesthesia.Key Exclusion CriteriaThe exclusion criteria includedPsychiatric medications,Obesity (body mass index >30 kg/m2)Chronic alcoholism, liver cirrhosisSerious renal diseaseEndocrine or neuromuscular diseaseArrhythmiaPacemaker or pulmonary disease.Protocol SummaryIn this study, 80 patients were included and randomly divided into 2 groups using a computer-generated randomization method: midazolam premedication group (M group, n = 40) and CES pretreatment group (CES group, n = 40). Pre-anesthesia visits, assessment of preoperative anxiety scores and sedation levels, midazolam premedication, CES pretreatment, and anesthesia induction were performed by different investigators.The anxiety score, sedation score, and vital signs (systolic and diastolic blood pressure, mean blood pressure, HR, and oxygen saturation) were assessed three times: on the night before (baseline) and on the day of the surgery in the preoperative holding area (PHA) and in the operating room (OR) before anesthesia induction.The patients in the M group were intramuscularly injected with midazolam (0.07 mg/kg) 30 minutes before receiving general anesthesia, whereas the patients in the CES group received 20 minutes of CES pretreatment on the day before and on the morning of the surgery. A microcurrent stimulator (Alpha-Stim 100®; Electromedical Products International, Inc., Mineral Wells, TX) was used.Anesthesia was induced with intravenous injection of propofol (2.0mg/kg) and rocuronium (0.9mg/kg). Three minutes of mask ventilation with sevoflurane administration (3 vol%) at an oxygenated air flow of 8 L/min and a fraction of inspired oxygen of 1.0 was performed before intubation.Device Application ProtocolThe electrode clips of the microcurrent stimulator were attached to the patient’s earlobe, and the microcurrent was adjusted to the power of which the patient experienced light dizziness and a tingling sensation. The power of the microcurrent was limited between 200 μA and 0.5 Hz. All patients were premedicated via intramuscular injection of glycopyrrolate (0.005 mg/kg) 30 minutes before receiving general anesthesia.Statistical Analysis PlanThe SPSS software version 25.0 for Windows (SPSS Inc., Chicago, IL) was used for statistical analysis. All data except sex were presented as the mean ± standard deviation. Demographic data were analyzed using either the Mann–Whitney U test, the independent t test, or the chi-square test. A p-value of <.01 was considered statistically significant after Bonferroni correction. The preoperative anxiety score and sedation score were analyzed via the chi-square test. A p-value of <.05 was considered statistically significant. Vital signs of each group on the night before surgery, on the day of the surgery in the PHA, and in the OR before anesthesia induction were analyzed via the Mann–Whitney U test or the independent t test. A p-value of <.0033 was considered statistically significant after Bonferroni correction.The preoperative anxiety score and sedation score were analyzed via the chi-square test. A p-value <.05 was considered statistically significant. ResultsSubjectsA total of 80 patients, with 40 in the CES group, including 21 males and 19 females with a mean age of 69.3± 3.6 years. The M group included 40 subjects, including 22 males and 18 females, with a mean age of 70.3± years. No significant difference in age, sex, weight, height, history of previous surgery, operation time, or anesthesia time were observed between the M group and the CES group.Demographic characteristics of patients in the M and CES groups. Data AnalysisAnxietyThe anxiety scores in the PHA were significantly lower in the CES group compared with the M group (p = .02). No significant difference was observed in the anxiety scores in the general ward on the night before the surgery and in the OR between the 2 groups.Changes in anxiety scores for the M and CES groups. Sedation scoreThe sedation scores in the PHA were significantly lower in the CES group than those in the M group (p < .001). However, no significant difference in the sedation scores was observed in the general ward and OR between the 2 groups.Changes in sedation scores for the M and CES groups.Vital signsThe M group and the CES group showed no significant differences in systolic, diastolic, and mean blood pressures in the general ward on the night before surgery, in the PHA, and in the OR. No significant difference in HR was observed in the general ward on the night before surgery and in the PHA. However, HRs in the OR were significantly slower in the M group than those in the CES group (M premedication group, 69.2±10.5 beats/min; CES group, 79.6 ±15.3 beats/min) (p < .001).Changes in vital signs for M and CES groups Finally, the M group and the CES group showed no significant difference in the baseline oxygen saturation in the general ward on the night before. Oxygen saturations in the PHA (M group, 94.3% ± 2.4%; CES group, 97.4% ±1.8%) and the OR (M group, 95.9% ±1.8%; CES group, 97.5% ± 1.6%) were significantly higher in the CES group than those in the M group (p <.001).Changes in Oxygen Saturation for M and CES groupsConclusionIn 65- to 79-year-old patients with American Society of Anesthesiologists Physical Status Classification II or III, CES pretreatment, in comparison with the midazolam premedication, resulted in lower anxiety levels in PHA with less risk of over-sedation and respiratory depression before surgery. Their results showed that pretreatment with CES reduces preoperative anxiety levels and withdrawal responses to rocuronium-induced pain. The study concluded that the noninvasive nature of CES and the absence of serious side effects, indicate it can safely be used on the day before and the day of surgery.LimitationsThe study utilized less than 200 uA of CES for only 20 minutes each. Recommended treatment durations for currents at 200 uA or lower is 60 minutes.Study Quality: GOOD ### Educational Opportunities Educational Opportunities CES and MET education webinarIf you are a licensed healthcare practitioner and would like to attend a CES and MET education webinar, please fill out the form below. If you would prefer to watch a pre-recorded webinar, please note that below.  Webinar Form If you are a licensed healthcare practitioner and would like to attend a CES and MET education webinar, please fill out the form below and we will contact you with upcoming live webinar dates. If you would prefer to watch a pre-recorded webinar, please check the appropriate box below and we will email a personal invitation. 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Typically, an in-office/clinic trial can help identify which of your patients will readily respond to Alpha-Stim treatment. For more questions or details about the trial, including special practitioner pricing, please fill out the form below to have an Alpha-Stim representative contact you.Name(Required) First Last Email(Required) Phone(Required)Practice Name(Required)Zip Code(Required) Δ Learn more about Alpha-Stim® Clinical Research StudiesInvolving Alpha-Stim Learn More Alpha-Stim Brings Relief to Veteran After Years of Suffering Read More Alpha-Stim Improves Quality of Life By Relieving Anxiety Learn More ### App Terms & Conditions Electromedical Products International, Inc. END-USER LICENSE AGREEMENT (UNITED STATES) Effective Date: January 2022 IMPORTANT – PLEASE READ THE TERMS OF THIS END-USER LICENSE AGREEMENT (THE “EULA”) CAREFULLY.  THIS EULA IS A BINDING, CONTRACTUAL AGREEMENT BETWEEN YOU AND ELECTROMEDICAL PRODUCTS INTERNATIONAL, INCORPORATED (“EPI”) AND APPLIES TO YOUR USE, AS APPLICABLE, OF EPI’S ALPHA-STIM® MOBILE APPLICATION, AND/OR ANY OTHER EPI SOFTWARE OR APPLICATION, INCLUDING ALL ENHANCEMENTS, VERSIONS, AND MODIFICATIONS TO THE FOREGOING (EACH AND COLLECTIVELY, THE “SOFTWARE”). THIS EULA APPLIES TO YOUR USE OF THIS SOFTWARE UNDER APPLICABLE UNITED STATES LAWS AND REGULATIONS. THIS EULA DOES NOT APPLY TO YOUR USE OF ANY OTHER EPI PRODUCTS AND SERVICES. SEPARATE FROM THIS EULA, OTHER TERMS AND CONDITIONS SHALL APPLY WITH RESPECT TO YOUR PERSONAL AND/OR HEALTH DATA SUBMITTED AND COLLECTED THROUGH THE SOFTWARE. THESE ADDITIONAL TERMS AND CONDITIONS ARE CONTAINED IN EPI’S “PRIVACY POLICY & TERMS OF USE”, WHICH IS HEREBY INCORPORATED INTO THIS EULA. BY INSTALLING AND USING THIS SOFTWARE, YOU ARE ACCEPTING AND AGREEING TO ALL TERMS AND CONDITIONS CONTAINED IN THIS EULA (AND THE PRIVACY POLICY & TERMS OF USE), AND MUST INDICATE YOUR AGREEMENT BY TAPPING THE CHECKBOX “I ACCEPT AND AGREE TO THE TERMS & CONDITIONS”.  IF YOU DO NOT WISH TO AGREE TO ALL OF THE TERMS AND CONDITIONS IN THIS EULA, DO NOT TAP THE “I ACCEPT AND AGREE TO THE TERMS & CONDITIONS” CHECKBOX, IN WHICH CASE YOU WILL NOT BE PERMITTED TO USE THE SOFTWARE.  YOUR TAP ON THE CHECKBOX CONSTITUTES YOUR ELECTRONIC SIGNATURE ON THIS EULA AND YOUR CONSENT TO EXECUTE THIS EULA ELECTRONICALLY. BY ACCEPTING THE EULA AS DESCRIBED ABOVE, YOU (1) ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTAND, AND AGREE TO BE BOUND BY THIS EULA (AND THE PRIVACY POLICY & TERMS OF USE); (2) REPRESENT THAT YOU ARE OF LEGAL AGE TO FORM A BINDING CONTRACT; AND (3) REPRESENT THAT YOU HAVE THE AUTHORITY TO ENTER INTO THIS EULA PERSONALLY. ONLY INDIVIDUALS MAY ENTER INTO THIS EULA. IF YOU DO NOT AGREE TO ALL THE TERMS AND CONDITIONS OF THIS EULA, OR IF YOU DO NOT HAVE SUCH AUTHORITY, YOU MUST NOT ACCEPT THIS EULA OR ACCESS, INSTALL, OR USE THIS SOFTWARE. PLEASE NOTE THAT THIS EULA MAY APPLY TO EITHER (1) PATIENTS OF “EPI PRODUCTS AND SERVICES” (DEFINED IN THE PRIVACY POLICY & TERMS OF USE) WHO WILL USE THE SOFTWARE FOR THEIR OWN INFORMATION AND MENTAL HEALTH MANAGEMENT, OR (2) NON-PATIENT USERS (SUCH AS HEALTHCARE PROVIDERS, FAMILY MEMBERS, OR CAREGIVERS OF PATIENTS) OF EPI PRODUCTS AND SERVICES, WHO HAVE BEEN GIVEN AUTHORIZATION BY THE PATIENT TO ACCESS THE PATIENT’S DATA THROUGH THE USE OF THIS SOFTWARE.  WHERE ANY TERMS AND CONDITIONS OF THIS EULA APPLY TO ONE TYPE OF USER BUT NOT THE OTHER, THIS EULA WILL INDICATE SO THROUGH LABELS, TITLES, OR PREFACES. Please note that this EULA is subject to change by EPI in its sole discretion at any time. When changes are made, EPI will provide an updated version of the EULA available in the Software. We will also update the “Last Updated” date at the top of this EULA. Depending on the nature of the update and the applicable data privacy and security laws, EPI may require you to provide an additional consent to the updated EULA in a specified manner before further use of the Software is permitted. Patients of EPI Products and Services.  If you are a patient utilizing EPI Products and Services, please note that you must obtain certain EPI cranial electrotherapy stimulation (CES) and microcurrent electrical therapy (MET) equipment (“Equipment”) from a healthcare provider or supplier.  In some countries, such as the United States of America, obtaining Equipment requires a prescription.  Contact EPI, or your healthcare provider or supplier, for details on obtaining the Equipment.  The Software you are using (for example, the Alpha-Stim Mobile App) may not be fully functional without such Equipment.  The Software enables health information collected by the Equipment to be displayed and transmitted through the Software, and conveniently shared with your healthcare provider, family member, and/or caregiver. If the Software is installed on your mobile device, your device may need to be physically near the Equipment to enable full functionality. In addition, the maintenance and security of this Equipment may influence the performance of the Software. Under this EULA, it is your responsibility to ensure the Equipment’s maintenance and functionality. Non-Patients of EPI Products and Services.  As an individual given authorization to access the personal and health information of a patient, your use of the Software will not require obtaining or purchasing the Equipment.  You understand and agree that your access to a patient’s data through this Software shall be permitted and determined only by the patient’s express authorization (which the patient may arrange for through the Software).  By utilizing this Software, you agree that your access and use of the patient data shall solely be for purposes defined by the patient, and consistent with monitoring and/or analyzing mental health symptoms and trends experienced by the patient.  You agree not to share the patient data with any third parties without the appropriate consent of the patient.  The patient, in his/her sole discretion, may choose to limit or terminate your access to their data through the Software at any time. Our goal is to provide helpful and accurate information through the Software, but we make no endorsement, representation or warranty of any kind about any information displayed therein. We are not responsible for the correct use of information you receive through the Software. If you rely on any such information, you do so solely at your own risk. The Software is not intended to diagnose, treat, cure, or prevent any disease. If you are a patient, you must consult with a healthcare professional regarding your use of the Equipment. We are not responsible for any health problems that may result from information obtained through the Software. 1. SOFTWARE 1.1     License. Subject to your compliance with this EULA, EPI grants you a limited non-exclusive, non-transferable, non-sublicensable, revocable license to download, install and use a copy of the Software on a mobile device, tablet, and/or computer that you own or control, and to run such copy of the Software solely for your personal, non-commercial use. 1.2     Apple® and Android® App Stores. You acknowledge and agree that the availability of the Software is dependent on the third party from whom you received / downloaded the Software, i.e., the Apple App Store or Google® Play Store (“App Store”). With respect to any Software accessed through or downloaded from the Apple App Store (an “Apple-Sourced Application”), you will only use the Apple-Sourced Application (i) on an Apple-branded product that runs iOS® (Apple’s proprietary operating system) and (ii) as permitted by the “Usage Rules” set forth in the Apple App Store Terms of Service. (See also Section 1.3 below regarding additional terms for Software obtained through Apple iTunes.)  Similarly, with respect to any Software accessed through or downloaded from a Google Play Store, you will only use the Software (i) on a compatible Android device and (ii) as permitted by the applicable terms and conditions of the Google Play Store. You acknowledge that this EULA is between you and EPI, and not with the App Store. EPI, not the App Store, is solely responsible for the Software, the content thereof, maintenance, support services, warranty, and addressing any claims relating thereto (e.g., product liability, legal compliance, or intellectual property infringement).  In order to use the Software with full functionality, you must have access to a wireless network or internet access, and you agree to pay all fees associated with such access. You also agree to pay all fees (if any) charged by an App Store in connection with the Software. You agree to comply with, and your license to use the Software is conditioned upon your compliance with, all applicable third-party terms of agreement (e.g., the App Store’s terms and policies) when using the Software.  You acknowledge that the App Store (and its subsidiaries) are third-party beneficiaries of this EULA and will have the right to enforce it. 1.3     Additional Terms for Software from Apple App Store (or iTunes). The following applies to any Software accessed through or downloaded from the Apple App Store: (a)          You acknowledge and agree that (i) this EULA is between you and EPI only, and not Apple, and (ii) EPI, not Apple, is solely responsible for the Apple-Sourced Application and content thereof. Notwithstanding this, your use of the Apple-Sourced Application must comply with the applicable Apple App Store Terms of Service. (b)          You acknowledge that Apple has no obligation whatsoever to furnish any maintenance and support services with respect to the Apple-Sourced Application. (c)           In the event of any failure of the Apple-Sourced Application to conform to any applicable warranty, you may notify Apple, and Apple will refund the purchase price for the Apple-Sourced Application to you and to the maximum extent permitted by applicable law, but Apple will have no other warranty obligation whatsoever with respect to the Apple-Sourced Application. As between EPI and Apple, any other claims, losses, liabilities, damages, costs or expenses attributable to any failure to conform to any warranty will be the sole responsibility of EPI. (d)          You and EPI acknowledge that, as between EPI and Apple, Apple is not responsible for addressing any claims you have or any claims of any third party relating to the Apple-Sourced Application or your possession and use of the Apple-Sourced Application, including, but not limited to: (i) product liability claims; (ii) any claim that the Apple-Sourced Application fails to conform to any applicable legal or regulatory requirement; and (iii) claims arising under consumer protection or similar legislation. (e)           You and EPI acknowledge that, in the event of any third party claim that the Apple-Sourced Application, or your possession and use of that Apple-Sourced Application, infringes that third party’s intellectual property rights, as between EPI and Apple, EPI, not Apple, will be solely responsible for the investigation, defense, settlement, and discharge of any such intellectual property infringement claim to the extent required by this EULA. (f)             You and EPI acknowledge and agree that Apple, and Apple’s subsidiaries, are third-party beneficiaries of this EULA as related to your license of the Apple-Sourced Application, and that, upon your acceptance of this EULA and conditions of this EULA, Apple will have the right (and will be deemed to have accepted the right) to enforce this EULA as related to your license of the Apple-Sourced Application against you as a third party beneficiary thereof. (g)          Without limiting any other terms of this EULA, you must comply with all applicable third-party terms of agreement when using the Apple-Sourced Application. 1.4     Open-Source Software.  Certain software code incorporated into or distributed with the Software may be licensed by third parties under various “open-source” or “public-source” software licenses (such as the GNU General Public License, the GNU Lesser General Public License, the Apache License, the Berkeley Software Distribution License, and the Sun Public License) (collectively, the “Open Source Software”).  Notwithstanding anything to the contrary in this EULA, the Open Source Software is not licensed under Section 1.1 and instead is separately licensed pursuant to the terms and conditions of their respective open-source software licenses.  You agree to comply with the terms and conditions of such open-source software license agreements. 1.5     Data and Privacy In all cases, all patient and non-patient data that is collected, transmitted, and stored through the Software, is governed by and subject to EPI’s Privacy Policy & Terms of Use (incorporated into this EULA, as mentioned above).  As stated in the introduction above, by agreeing to this EULA and using this Software, you acknowledge that you have read and agree to the Privacy Policy & Terms of Use.  This includes EPI’s use of your Personal Information (information that can be used to identify you personally, as defined in more detail in the Privacy Policy & Terms of Use), non-personal information, device/computer technical data, and other information as described herein. While EPI is not a “Covered Entity” under the Health Information Portability and Accountability Act of 1996, as amended and as implemented by the associated regulations (“HIPAA”) and therefore not subject to HIPAA Standards, EPI takes data privacy and security very seriously and follows industry standards for data protection and safeguards when it comes to the collection, storage, handling, and transmission of patient data. By using the Software, you agree to allow the Software to store relevant personal and (if you are a patient) health data on your mobile device, computer, tablet, or other similar device, including your email address, login information, and certain health information.  This information shall be transmitted to EPI’s database/server through your smartphone’s mobile data service, Wi-Fi, or internet access.  Your data stored in and collected through the Software will be saved for an indefinite period of time, with appropriate, industry-standard levels of data security and protection, on an EPI server on the Google Cloud Platform. Usage Data.  In addition to the data displayed through the Software, the Software may, from time to time, automatically report back information to EPI’s servers related to usage of the Software without notice to you (“Usage Data”).  Usage Data by itself does not include Personal Information (defined below) and may be used by EPI as it deems appropriate in compliance with all applicable laws, including helping diagnose and resolve technical and performance issues in relation to the Software.  By using the Software, you hereby consent and agree to such collection, transmission, and use of Usage Data and agree to get all necessary consent(s) from any authorized user and/or patient for such contemplated usage. Personal Information.  Any Personal Information collected through your use of this Software may be utilized to contact you for various appropriate reasons (as outlined in the Privacy Policy & Terms of Use).  As an example, EPI may contact you to ensure that you are properly using the Equipment and Software (if you are a patient), to offer assistance and guidance as appropriate, to provide technical or important updates, and/or to offer promotions, programs, and educational information.  To accomplish these efforts and services, EPI may share or transmit your Personal Information to third parties, in accordance with the EPI Privacy Policy & Terms of Use.  Except in cases where EPI may be required to disclose Personal Information (for example, to the FDA or other government agencies), any data transfer to third parties in most situations shall be accomplished through an appropriate written agreement, with clear requirements for data protection and confidentiality. Technical Data.  In addition, the Software will save and transmit to EPI certain information regarding your mobile device, tablet, and/or computer, such as the specific model, operating system, issues with installation and operation, and other technical information that will be used to maintain and improve the Software for all users as well as your own experience. De-identified Information.  Also in accordance with the Privacy Policy & Terms of Use, EPI may utilize any of your de-identified data (which cannot be used to identify you personally) for any legitimate purpose, including towards improving EPI Products and Services, customer service enhancement, new product development, research, training and education, and/or data analytics.  By agreeing to this EULA, you are giving EPI consent to use your de-identified data as described herein and in the EPI’s Privacy Policy & Terms of Use. 1.6     Ownership. You agree that EPI and its suppliers own all rights, title and interest in the Software. You will not remove, alter or obscure any copyright, trademark, service mark or other proprietary rights notices incorporated in or accompanying the Software. 1.7      No Medical Services.  You understand and agree that EPI does not provide any licensed health care services, nor does EPI provide medical, health, or other professional advice or decision-making, through this Software or otherwise.  In addition, EPI does not monitor or verify the accuracy of your data within the Software.  Notwithstanding this, if you are a patient, you may authorize your physician or other healthcare provider to access your data through the Software for consultation, analysis, therapy decisions, and/or adjustments to your care. 2. USE OF THE SOFTWARE 2.1     Updates. EPI may require you to accept updates to the Software that you have installed on your mobile device, tablet, and/or computer. You acknowledge and agree that EPI may update the Software with or without notifying you. You may need to update third-party software from time to time in order to use the Software. 2.2     Certain Restrictions. As a condition of use, you agree not to use the Software for any purpose that is prohibited by the EULA or by applicable law. You shall not (and shall not permit any third party to): (a) license, sell, rent, lease, transfer, assign, reproduce, distribute, host or otherwise commercially exploit the Software, (b) modify, translate, adapt, merge, make derivative works of, disassemble, decompile, reverse compile or reverse engineer any part of the Software except to the extent the foregoing restrictions are expressly prohibited by applicable law; (c) interfere with or attempt to interfere with the proper functioning of the Software; (d) attempt to engage in or engage in, any potentially harmful acts that are directed against the Software or EPI, including but not limited to violating or attempting to violate any security features of the Software; or (e) access the Software in order to build a similar or competitive website, application or service. Any future release, update or other addition to the Software shall be subject to this EULA. EPI, its suppliers and service providers reserve all rights not granted in this EULA.  Any unauthorized use of the Software terminates the licenses granted by EPI pursuant to this EULA. 2.3     User Content. The Software may contain features or methods that allow users to submit and share texts, feedback, suggestions, ideas, commentary, messages, information, documents, images, questions, links, and other material through the Software or directly to EPI (all together, “User Content”). You take sole responsibility for all User Content you submit, and all User Content you submit must be your own. You grant EPI and its affiliates a non-exclusive, worldwide, royalty-free license (with the right to sublicense) to reproduce, distribute, publicly display and perform, transmit, adapt, and translate any User Content you submit, in whole or in part and in any medium now known or later developed, for any purpose (with the exception of any User Content that consists of Personal Information). You represent and warrant that the User Content you submit does not (i) defame any party; (ii) violate any party’s copyright, trademark, patent, trade secret, right to privacy or publicity, or any other proprietary or personal right; (iii) contain any material or information furnished to you in confidence or with the understanding that it would not be disclosed or published (including, but not limited to, any confidential information related to the business of your employer, colleagues, or clients); or (iv) otherwise violate any applicable law or regulation. You additionally represent, warrant and covenant that you are under no obligation that would in any way interfere with the disclosure or use of any User Content you submit. ACCOUNT REGISTRATION. You may be required to register and create an account in order to use the Software. The EPI Privacy Policy & Terms of Use describe the registration process and the Personal Information collected. INDEMNIFICATION. You agree to indemnify and hold EPI and its parents, subsidiaries, affiliates, officers, employees, agents, partners and licensors (collectively, the “EPI Parties”) harmless from any losses, costs, liabilities and expenses (including reasonable attorneys’ fees) relating to or arising out of: (a) any data or Personal Information (as such term is defined in the EPI Privacy Policy & Terms of Use) you submit to or through the Software; (b) your use of, or inability to use, the Software; (c) your violation of this EULA; (d) your violation of any rights of another party, or (e) your violation of any applicable laws, rules or regulations. EPI reserves the right, at its own cost, to assume the exclusive defense and control of any matter otherwise subject to indemnification by you, in which event you will fully cooperate with EPI in asserting any available defenses. You agree that the provisions in this section will survive any termination of this EULA. DISCLAIMER OF WARRANTIES. YOU EXPRESSLY UNDERSTAND AND AGREE THAT TO THE EXTENT PERMITTED BY APPLICABLE LAW, YOUR USE OF THE SOFTWARE IS AT YOUR SOLE RISK, AND THE SOFTWARE IS PROVIDED ON AN “AS IS” AND “AS AVAILABLE” BASIS, WITH ALL FAULTS. THE EPI PARTIES EXPRESSLY DISCLAIM ALL WARRANTIES, REPRESENTATIONS, AND CONDITIONS OF ANY KIND, WHETHER EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OR CONDITIONS OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NON-INFRINGEMENT. THE EPI PARTIES MAKE NO WARRANTY, REPRESENTATION OR CONDITION THAT: (1) THE SOFTWARE WILL MEET YOUR REQUIREMENTS; (2) THE SOFTWARE WILL BE UNINTERRUPTED, TIMELY, SECURE OR ERROR-FREE; (3) THE RESULTS THAT MAY BE OBTAINED FROM USE OF THE SOFTWARE WILL BE ACCURATE OR RELIABLE; OR (4) ANY ERRORS IN THE SOFTWARE WILL BE CORRECTED. THE SOFTWARE MAY BE SUBJECT TO DELAYS, CANCELLATIONS AND OTHER DISRUPTIONS. THE EPI PARTIES ASSUME NO RESPONSIBILITY FOR THE TIMELINESS, DELETION, MIS-DELIVERY OR FAILURE TO STORE ANY DATA THROUGH THE SOFTWARE. THE EPI PARTIES HAVE NO CONTROL OVER AND ASSUME NO RESPONSIBILITY FOR ANY PERSONAL INFORMATION THAT IS SHARED BY YOU WITH ANY THIRD PARTIES. 6. LIMITATION OF LIABILITY 6.1     DISCLAIMER OF CERTAIN DAMAGES. YOU UNDERSTAND AND AGREE THAT IN NO EVENT SHALL EPI PARTIES BE LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES ARISING OUT OF OR IN CONNECTION WITH THE SOFTWARE, INCLUDING, WITHOUT LIMITATION, ANY DAMAGES RESULTING FROM LOSS OF USE, DATA, OR PROFITS, WHETHER OR NOT EPI HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, OR FOR ANY DAMAGES FOR PERSONAL OR BODILY INJURY OR EMOTIONAL DISTRESS ARISING OUT OF OR IN CONNECTION WITH THIS EULA, ON ANY THEORY OF LIABILITY, RESULTING FROM: (1) THE USE OR INABILITY TO USE THE SOFTWARE; (2) UNAUTHORIZED ACCESS TO OR ALTERATION OF YOUR TRANSMISSIONS OR DATA; OR (3) ANY OTHER MATTER RELATED TO THE SOFTWARE. 6.2     CAP ON LIABILITY. UNDER NO CIRCUMSTANCES WILL THE EPI PARTIES BE LIABLE TO YOU IN THE AGGREGATE FOR MORE THAN TEN DOLLARS ($10.00). 6.3     BASIS OF THE BARGAIN. THE LIMITATIONS OF DAMAGES SET FORTH ABOVE ARE FUNDAMENTAL ELEMENTS OF THE BASIS OF THE BARGAIN BETWEEN EPI AND YOU. 7. TERM AND TERMINATION 7.1     Term. This EULA will commence on the date when you accept it (as described in the preamble above) and remain in full force and effect until terminated in accordance with this Section 7. 7.2     Termination by EPI. If you have breached any provision of this EULA, or if the EPI is required to do so by law (e.g., where the provision of the Software is, or becomes, unlawful), EPI has the right to suspend or terminate any services provided to you. You agree that all terminations for cause shall be made in EPI’s sole discretion and that EPI shall not be liable to you or any third party for any termination of your Account. In addition, the provision of certain functionality provided by EPI through the Software will automatically terminate if you no longer use or have access to the Equipment. 7.3     Termination by You. If you want to terminate any services provided by EPI through the Software, you may do so by deleting the Software. 7.4     Effect of Termination. Termination includes deletion of all data on the Software (with the understanding that data may remain on any Equipment being used and/or the applicable EPI server). EPI will not have any liability whatsoever to you for any suspension or termination. All provisions of this EULA which by their nature should survive, shall survive termination of this EULA, including without limitation, ownership provisions, warranty disclaimers, and limitation of liability. 8. GENERAL PROVISIONS 8.1     Electronic Communications. The communications between you and EPI use electronic means. For contractual purposes, you (1) consent to receive communications from EPI in an electronic form; and (2) agree that all terms and conditions, agreements, notices, disclosures, and other communications that EPI provides to you electronically satisfy any legal requirement that such communications would satisfy if it were to be in writing. The foregoing does not affect your statutory rights. 8.2     Release. You hereby release the EPI Parties and their successors from claims, demands, any and all losses, damages, rights, and actions of any kind, including personal injuries, death, and property damage that is either directly or indirectly related to or arises out of the Software or your use thereof. If you are a California resident, you hereby waive California Civil Code Section 1542, which states, “A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which, if known by him must have materially affected his settlement with the debtor.” 8.3     Assignment. This EULA, and your rights and obligations hereunder, may not be assigned, subcontracted, delegated, or otherwise transferred by you without EPI’s prior written consent, and any attempted assignment, subcontract, delegation, or transfer in violation of the foregoing will be null and void. 8.4     Force Majeure. EPI shall not be liable for any delay or failure to perform resulting from causes outside its reasonable control, including, but not limited to, acts of God, war, terrorism, riots, embargos, acts of civil or military authorities, fire, floods, accidents, strikes or shortages of transportation facilities, fuel, energy, labor or materials. 8.5     Dispute Resolution. If you believe that EPI has not adhered to this EULA, please contact EPI by emailing us at appsupport@epii.com. We will do our best to address your concerns. If you feel that your complaint has been addressed incompletely, we invite you to let us know for further investigation. 8.6     Choice of Law and Venue. This EULA and any action related thereto will be governed and interpreted by and under the laws of the State of Texas, without giving effect to any conflict of laws principles that require the application of the law of a different state.  You hereby expressly consent to the personal jurisdiction and venue in the state and federal courts for the county in which EPI’s principal place of business is located for any lawsuit filed against you by EPI arising from or related to this EULA. The United Nations Convention on Contracts for the International Sale of Good does not apply to this EULA. 8.7     Limitations Period. YOU AND EPI AGREE THAT ANY CAUSE OF ACTION ARISING OUT OF OR RELATED TO THIS EULA MUST COMMENCE WITHIN ONE (1) YEAR AFTER THE CAUSE OF ACTION ACCRUES. OTHERWISE, SUCH CAUSE OF ACTION IS PERMANENTLY BARRED. 8.8     Notice. Where EPI requires that you provide an e-mail address, you are responsible for providing EPI with your most current e-mail address. In the event that the last e-mail address you provided to EPI is not valid, or for any reason is not capable of delivering to you any notices required/ permitted by this EULA, EPI’s dispatch of the e-mail containing such notice will nonetheless constitute effective notice. You may give notice to EPI at appsupport@epii.com. 8.9     Waiver. Any waiver or failure to enforce any provision of this EULA on one occasion will not be deemed a waiver of any other provision or of such provision on any other occasion. 8.10     Severability. If any provision of this EULA is, for any reason, held to be invalid or unenforceable, the other provisions of this EULA will remain enforceable, and the invalid or unenforceable provision will be deemed modified so that it is valid and enforceable to the maximum extent permitted by law. 8.11    Export Control. You may not use, export, import, or transfer the Software except as authorized by U.S. law, the laws of the jurisdiction in which you obtained the Software, and any other applicable laws. In particular, but without limitation, the Software may not be exported or re-exported (a) into any United States embargoed countries; or (b) to anyone on the U.S. Treasury Department’s list of Specially Designated Nationals or the U.S. Department of Commerce’s Denied Persons List or Entity List. By using the Software, you represent and warrant that (i) you are not located in a country that is subject to a U.S. Government embargo, or that has been designated by the U.S. Government as a “terrorist supporting” country and (ii) you are not listed on any U.S. Government list of prohibited or restricted parties. You also will not use the Software for any purpose prohibited by U.S. law, including the development, design, manufacture or production of missiles, nuclear, chemical or biological weapons. You acknowledge and agree that products, services or technology provided by EPI are subject to the export control laws and regulations of the United States. You shall comply with these laws and regulations and shall not, without prior U.S. government authorization, export, re-export, or transfer EPI products, services or technology, either directly or indirectly, to any country in violation of such laws and regulations. 8.12     Entire Agreement. This EULA is the final, complete and exclusive agreement of the parties with respect to the subject matter hereof, and supersedes and merges all prior discussions between the parties with respect to such subject matter. ### HIPAA Compliance/Patient Request for Health Info Patient Request for Health Info EPI is governed by the Health Insurance Portability and Accountability Act (HIPAA) (42 U.S.C. §1301 et seq.). Such use of your personal medical information and history shall be protected in compliance with HIPAA.If you would like to request a copy of your personal data, please complete the web form below. Patient Request for Health Info Name* First Middle Last Date of Birth* MM slash DD slash YYYY Phone*Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country How would you like to receive your records?* Mail Email Fax EPI should provide records to:* Myself Personal Representation (indicated below) Recipient NameRecipient PhoneRecipient FaxRecipient Mailing AddressRecipient Email (if applicable)AUTHORIZATION By typing your name below, you as a patient or patient representative authorize this request. 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Δ ### Med Ed Request Form Medical Education Request Form Sales Representative(Required)Regional Sales Manager(Required)Email(Required) Phone(Required)Date of Requested Program(Required)Please give 6 weeks lead time before a requested event, if possibleTime of Requested Program(Required)Type of Activity(Required) Doctor Dinner Webinar with KOL Lunch - In Person Lunch - Virtual Podcast Conference Other Education Focus(Required) Mental Health Pain All Indications If "Other", Please DescribeNumber of Expected Attendees(Required)Requested Presenter(Required)Greg Redmond, DPT - Physical Therapist - LAKaren Shuler, DPT - Physical Therapist - SCJill Fichtel, MD - Dermatologist - TNHaramandeep Singh, MD - Telemedicine, Sleep Specialist - CAShawn Spooner, MD, FAFP, CAQSM - Primary Care, Sports Med, Military - IAT. 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International Order Inquiry Request Name(Required) First Last Phone(Required)Email(Required) Location(Required) AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Δ ### CES Certification CES Certification Please fill out the form below for your certificate information, then complete the test by answering each question below.  Welcome to your CES Certification Full Name (as you would like it to appear on your certificate) Facility/Organization Address City State Country Zip Code Phone Email The recommended frequency for use in both Alpha-Stim® Cranial Electrotherapy Stimulation (CES): 0.5 Hz 200 Hz 500 Hz 100 Hz None Neuroimaging studies, such as qEEG and fMRI, have shown Alpha-Stim CES to: Increase activity of hyperactive nerve cells in the anxiety and pain processing centers of the brain Balance nerve cell activity to restore homeostasis to the nervous system Have no effect on nerve cell activity Decrease the activity of hypoactive nerve cells None It is never recommended to perform a CES session while: Working on a computer Using a microwave Operating a vehicle Within 20 minutes of walking None In the United States, cranial electrotherapy stimulation (CES) is cleared for: Anxiety & Insomnia ADHD Schizophrenia Substance Use Disorders None How do patients most commonly report feeling after a session of Alpha-Stim CES? Relaxed Alert Calm All of the above None After speaking with Mrs. Jay, you prescribe Cranial Electrotherapy Stimulation (CES). During the last 5 minutes of a 20-minute treatment session, she reports feeling “heavy”, “groggy”, and “disoriented”. Based on these symptoms, what next steps should you take? Discontinue the treatment immediately Advise the patient to go home and sleep Continue CES until at least 2 minutes after the patient no longer reports these symptoms Reduce the current for about 2 minutes then discontinue the treatment None Mr. Kay initially sought treatment for insomnia and you prescribed Cranial Electrotherapy Stimulation (CES) daily. During his two-week follow up appointment, Mr. Kay complains that his insomnia is not improving. How will you advise the patient? The insomnia is treatment resistant and therefore will never go away Educate the patient that insomnia may take 3 weeks for CES to provide relief. Discontinue CES treatment immediately Recommend doubling the current and time of treatments None Contraindication(s) for use of Alpha-Stim CES is/are: Pacemakers, defibrillators, and other implanted electric devices that cannot be turned off. Headaches Seizures Cancer None During a follow up appointment with a patient for which you prescribed Cranial Electrotherapy Stimulation (CES), the patient complains of having headaches, vertigo, and nausea when they use their CES. The symptoms appear after they start the session and remain for several hours following treatment. How do you advise the patient? You tell them they are "imagining things" You recommend using a lower current and treating longer if necessary You recommend continuing treatment as is until the symptoms go away You add a 24 mg Ondansetron None Which of the following is true regarding Alpha-Stim CES treatment? Higher currents will provide better results The patient needs to feel the current for treatment to be effective The proper dosage is an inverse relationship between current level and time of treatment None of the above None What is the protocol for determining the current level for an Alpha-Stim CES treatment session? The current and duration of treatment depends on the indication being treated Turn the current up until a slight vertigo is experienced, then decrease immediately until the dizziness stops Use the same current for every treatment session Leave the current on the default setting when the device is powered on None Which of the following are possible side effects to Alpha-Stim CES treatment? Headaches Transient vertigo Skin irritation at the site of electrodes All of the above None Time's upCancel ### CES & MET Certification CES & MET Certification Please fill out the form below for your certificate information, then complete the test by answering each question below. Welcome to your CES and MET Certification. Full Name (as you would like it to appear on your certificate) Facility/Organization Address City State Country Zip Code Phone Email In treating a patient with pain utilizing Microcurrent Electrical Therapy (MET), the first step in the standard 5-step protocol is: Placing probes in a star pattern around the area Crossing the spine with the probes Placing the probes beyond the treatment area in at least 2 places, directing the current between the Probes through the treatment area (“big X”) The 1-minute protocol None The standard recommended frequency for use in both Alpha-Stim® Cranial Electrotherapy Stimulation (CES) and Microcurrent Electrical Therapy (MET) is: 0.5 Hz 200 Hz 500 Hz 100 Hz None Which of the following are included in the safety warnings listed in the Alpha-Stim user manual: While working on a computer, using a microwave, or going for a walk Using Alpha-Stim in adjunct with other pharmacotherapy options While operating a vehicle, stimulating over the eyes, or while pregnant Using Alpha-Stim before undergoing surgery or other invasive medical procedures None In the United States, cranial electrotherapy stimulation (CES) is FDA cleared for: Anxiety & Insomnia ADHD Schizophrenia Substance Use Disorders None In the United States, microcurrent electrical therapy (MET) is FDA cleared to treat which of the following indications: Infections Pain Dry skin Hypertension None The individual experience of using Alpha-Stim can vary from patient to patient. What are some commonly reported feelings after a session of Alpha-Stim CES? Relaxed Alert Calm All of the above None What is the One Minute Protocol, when using the Smart Probes with Microcurrent Electrical Therapy? Placing the probes ipsilateral on the body Placing the probes on each of the digits of either the hands or the feet Placing the probes contralateral on the body Placing the probes in a star pattern None After speaking with Mrs. Jay, you prescribe Cranial Electrotherapy Stimulation (CES). During the last 5 minutes of a 20-minute treatment session, she reports feeling “heavy”, “groggy”, and “disoriented”. Based on these symptoms, what next steps should you take? Discontinue treatment immediately Advise the patient to go home and sleep Continue CES until at least 2 minutes after the patient no longer reports these symptoms Reduce the current for 2 minutes and discontinue treatment None Mr. Kay initially sought treatment for insomnia and you prescribed Cranial Electrotherapy Stimulation (CES) daily. During his two-week follow up appointment, Mr. Kay complains that his insomnia is not improving. How will you advise the patient? The insomnia is treatment resistant and therefore will never go away Refer to published clinical resources (Khyatee et al., 2019) and educate the patient that insomnia may take 3 weeks or more for CES to provide relief Discontinue CES treatment immediately Recommend doubling the current and time of treatments None Contraindications for use of Cranial Electrotherapy Stimulation (CES) and Microcurrent Electrical Therapy (MET) are: Use of Alpha-Stim® is contraindicated with implanted pacemakers or implanted or wearable defibrillators Headaches Seizures Cancer None During a follow up appointment with a patient for which you prescribed Cranial Electrotherapy Stimulation (CES), the patient complains of having uncomfortable side effect that persist even after a CES treatment has ended. Which department at EPI should you contact to report these to? Customer Service (info@epii.com) Medical Affairs (medicalaffairs@epii.com) The local Alpha-Stim sales representative in your area None of the above None Before treating a patient for pain with Microcurrent Electrical Therapy (MET), a best practice is to: Have the patient estimate their pain on a scale of 0 to 10 Have the patient lay supine on a table Wash the area with iodine solution Have the patient lay prostrate on a table None During a CES treatment session, what describes the process for determining the optimal current level for an individual patient? Patients increase the current level until a noticeable tingling sensation can be felt on the earlobe, signifying that the appropriate level has been achieved. The mild tingling sensation serves as a tool demonstrating that the appropriate amount of current is being applied Patients start at the highest current level and decrease the current until they can no longer notice a tingling sensation on their earlobes Patients begin at the lowest current setting (1) and slowly increase the current until a slight rocking or dizzy sensation occurs, signifying that vestibular activation has been achieved. At this point patients decrease the current just below vestibular threshold ensuring a comfortable and effective treatment session Patients begin at the lowest current setting (1) and increase the current until a slight rocking or dizzy sensation occurs, signifying that vestibular activation has been achieved. At this point patients increase the current level several settings higher and wait several minutes for the rocking sensation to subside None Which of the following are possible side effects to Cranial Electrotherapy Stimulation (CES) treatment as listed in the owner’s manual? Headaches Transient vertigo Skin irritation at site of electrodes All of the above None Alpha-Stim is FDA cleared and CE certified. True False None Which of the following is true of Alpha-Stim treatments: They are complicated and require a trained, licensed provider to conduct treatments in office. They are ineffective and have no supporting research, the benefits can be attributed to placebo effect. Treatments are easy to complete and can be done by the patient at home at their convenience. Alpha-Stim treatments are stand-alone treatment only. No other treatment approaches, such as medications or therapy, should be attempted while a patient is undergoing a course of Alpha-Stim treatment. None Which of the following treatment options can Alpha-Stim safely be used in adjunct with: Psychiatric drugs (SSRIs, Benzodiazapines, ASDs, etc.) Psychotherapy Neurofeedback therapy All of the above None While many traditional TENS devices use stimulation in the milliamp range, Alpha-Stim uses electrical current in the ______ range, often leading to more subtle and comfortable treatment sessions: Picoamp Microamp Milliamp None The outlined protocols using the Alpha-Stim smart probes are carefully designed to target which of the following: The endocrine system Multiple levels of the pain pathway Blood vessels Muscle tissue None While treating pain using Alpha-Stim M, what would be the goal of advising a patient to follow up with a CES treatment session? CES can be used to target comorbid anxiety and insomnia that chronic pain patients may also report experiencing CES delivered through the earclips can be used to treat pain in the ear and the back of the head CES treatment is used to achieve acute pain relief that the smart probes or adhesive trodes alone cannot provide None of the above None Time's upCancel ### Get Started - Patient Get Started With Alpha-Stim® Alpha-Stim is the only non-invasive therapy proven to safely provide significant and sustainable relief for people with anxiety, insomnia, depression*, and acute and chronic pain.FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.If you are a patient or a healthcare provider but are unsure how to get started with Alpha-Stim, simply click below. Based on your answer, we’ll help you identify the best next step and provide informative resources to help you move forward.Please choose which you best identify with: Please check the box for one or more of the following conditions you're experiencing:(Required) Anxiety Insomnia Depression (not FDA cleared in the US) Pain (acute, post-traumatic, chronic) Based on your answers, it sounds like Alpha-Stim® AID is the best option for you! Let us help you learn more about Alpha-Stim AID, how to get it, and financing. We’ll send you a quick email with everything you need to know.Based on your answers, it sounds like Alpha-Stim® M is the best option for you! Let us help you learn more about Alpha-Stim M, how to get it, and financing. We’ll send you a quick email with everything you need to know.Name First Last Email Δ Learn more about Alpha-Stim® Clinical Research StudiesInvolving Alpha-Stim Learn More Alpha-Stim Brings Relief to Veteran After Years of Suffering Read More Alpha-Stim Improves Quality of Life By Relieving Anxiety Learn More ### First Responder Alpha-Stim for First Responders Supporting your mental health and well-being the way you support your communities Every day, first responders like yourself are exposed to strenuous situations and phenomena that most people don’t have to handle. As a result, your job can take a toll on your physical and mental well-being. Recent research has found that 69% of EMS providers report insufficient time between traumatic incidents, with many expected to be on duty up to and beyond 24 hours. And a 2022 study analysis of first responders found a high prevalence of depression, anxiety, and stress, as well as value in early assessment and management of mild anxiety, depression, and stress to prevent progression.High levels of stress, physical demands, and inadequate or erratic sleep push your body and mind to the limit on a regular basis. It’s no surprise then that first responders struggle with anxiety, insomnia, depression, and pain. In fact, in 2021 Kaiser found that 85% of first responders had experienced mental health issues.But because of the demands of your job, it might not make sense for you to take medications that could impair your ability to perform at your best. Or you may feel uncomfortable with the risk of medication side effects. Alpha-Stim Offers First Responders a Safe, Drug-Free Solution Thankfully for first responders, there is a safe, fast and effective way to treat your anxiety or relieve pain, without the worries of lasting side effects or risk of addiction.Alpha-Stim is an FDA cleared, non-invasive handheld medical device that safely and effectively helps first responders with anxiety, insomnia, depression*, and acute, chronic, and post-traumatic pain. Alpha-Stim It fits in the palm of your hand, and its earclips are as small as earbuds, making treatment easy, discreet, and portable. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Drug-Free Treatment That Works Alpha-Stim electrotherapy devices offer a cost-effective, drug-free option for treating anxiety, insomnia, and pain quickly and safely. Take charge of your life again today with Alpha-Stim. Anxiety Manage anxiety without medication anywhere, anytime. Learn More insomnia Take back your nights with Alpha-Stim for treating insomnia. Learn More depression A safe and effective way to treat depression without the side effects of drugs. Learn More pain Alpha-Stim M is approved to treat acute, chronic, and post-traumatic pain. Learn More *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. What First Responders Say About Alpha-Stim “I haven’t slept more than 4 hours in a night in years. The VA used this on me last week, 30 minutes a day for three days. I slept 6 hours two nights and almost 7 the third night. More sleep, better the mood, much less anxiety.” – Paul Reinhardt, US veteran “Alpha-Stim has proven, over time, to be my reliable source for relief. It eliminates my severe and chronic pain and restores a welcomed and peaceful sense of well-being.” Jack McCalister, U.S. Military Veteran,Oklahoma “I haven’t slept more than 4 hours in a night in years. The VA used this on me last week, 30 minutes a day for three days. I slept 6 hours two nights and almost 7 the third night. More sleep, better the mood, much less anxiety.” Paul Reinhardt, U.S. Veteran “I am a critical care nurse that had Covid twice in 2020 while providing bedside care to inpatient veterans at Salem VAMC. I am now disabled due to long-Covid with physical and mental health issues. I am on 3 medications for anxiety (panic attacks) & depression with limited effect. In my first 20-minute session, the Alpha-Stim device relieved my [anxiety]. As a nurse, I hope for the best and prepare for the worst. Alpha-Stim has me believing in miracles. Thank you! While I still have other long-Covid issues to deal with, my quality of life has been greatly improved due to Alpha-Stim. All the best and be curious!” Michael Huemmer, RN "The benefit can be described in one word: Stupendous! At the beginning of week three, friends and professional colleagues began noticing an improvement in my disposition, evidenced by the unconscious whistling of a tune, singing, and initiating humorous exchanges. What was most appreciated was the dramatic decrease in melancholia and stress. Even episodes of insomnia began to decrease. I had also begun experiencing an increase in energy levels as well as a clearer mind.” Dr. J.D. Rogers, Former First Responder Previous Next https://youtu.be/vmulGIJ6nw4 Alpha-Stim First Responder Research & News Platoni K, Oakley R, Haltiwanger SG, Kirsch TB, Marksberry J and Price LR. First responder research shows that electrical brain stimulation helps control anxiety, insomnia, and depression. JJ Psych Behav Sci. 2019; 6(1): 25-31.  Mellen, Ronald R. and Mackey, Wade. Reducing sheriff’s officers’ symptoms of depression using cranial electrotherapy stimulation (CES): a control experimental study. The Correctional Psychologist. 2009; 41(1):9-15.  Mellen, Ronald R. and Mackey, Wade. Cranial electrotherapy stimulation (CES) and the reduction of stress symptoms in a sheriff’s jail security and patrol officer population: a pilot study. American Jails. 2008; 22(5): 32-38.   View more research articles and insights > telehealth Visit Get Alpha-Stim via a telehealth visit with a licensed healthcare provider Schedule Now shop online Purchase Alpha-Stim devices and accessories in our online store Shop Now talk with our team Speak with a representative on the phone to learn more Call Now Sources:https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-may2018.pdfHuang G, Chu H, Chen R, Liu D, Banda KJ, O'Brien AP, Jen HJ, Chiang KJ, Chiou JF, Chou KR. Prevalence of depression, anxiety, and stress among first responders for medical emergencies during COVID-19 pandemic: A meta-analysis. J Glob Health. 2022 Jul 25;12:05028. doi: 10.7189/jogh.12.05028. PMID: 35871411; PMCID: PMC9309001. First Responder Mental Health and Wellness. (2021, November 15). Kaiser Permanente. https://business.kaiserpermanente.org/insights/mental-health-workplace/first-responder-support ### Dental Alpha-Stimfor Dental Anxiety Don’t let anxiety stand between your patients and their dental health As many as 20% of Americans avoid going to the dentist as a result of anxiety or fear. Whether it’s a routine cleaning or a more complicated procedure, it is normal for patients to experience anxiety in the dental chair. While you can prescribe medication to help sedate your patients before a cleaning or dental procedure, there is a non-drug option that is both safe and proven effective. In fact, the effectiveness of Alpha-Stim on dentist-specific anxiety has been studied – and patients reported an average of 61% less anxiety during procedures. IMMEDIATE RESULTS Patients reported an average of 61% less anxiety after using the CES therapy.4 Alpha-Stim Offers Dental Patients a Drug-Free Option Alpha-Stim is an FDA cleared, non-invasive medical device that brings lasting and immediate relief from anxiety – without medication. It fits in the palm of your hand, and its ear clips are as small as earbuds, allowing patients quick and discreet relief during their appointment without interfering with the work of you and your team.Your patients already know that their dental health is important. With Alpha-Stim in your armamentarium, you can offer a relaxing experience in your practice that will encourage them to stay on top of their appointments.  What Dentists and Patients are Saying https://youtu.be/QPgigEWRHiwhttps://youtu.be/M8JC2c-a2tU “We understand that with dental visits can come a feeling of anxiety or intense fear. Sometimes it can lead to cancelling the appointment itself or sudden panic attacks. Dr Lisa Lucey spends dedicated time with each patient building trust, confidence and caring relationships. However, she also understands that for some of her patients they may still feel anxious before treatment. Dr Lisa introduced the Alpha-Stim to her practice and for some patients it has been life changing. It’s an alternative to oral medication with zero down time. You can still pop in for a visit on your lunch.” Lucey Dental “I have regularly been using my Alpha Stim device for all my dental appointments and procedures. I start using it 5-15 minutes before my appointment as I am then in full alpha wave mode for the procedure. Last week I had a 3-and-a-half-hour extraction done. The tooth was abscessed with bone loss. Alpha Stim kept me feeling calm and at peace and out of fight or flight mode with no other sedation. All the yanking, pulling, scraping etc. did not phase me or cause me any fear or anxiety. I will never go to the dentist without my Alpha Stim device. It makes a very emotionally hard situation more than bearable.” Brenda PokornyCharlotte, NC Dental Anxiety Significantly Reduced with Breakthrough Microcurrent Treatment Read More How two small electric ear clips helped me cure my fear of the dentist Read More Alpha-Stim versus Nitrous You and your patients may not have heard of Alpha-Stim before, but once you see how it compares to nitrous oxide, you’ll be amazed!Backed by decades of experience and over 100 clinical research studies, Alpha-Stim has stood the test of time – simply because it works. Bring Alpha-Stim into your practice today and witness firsthand how much of an improvement it can make. Your patients – and their smiles – will thank you. With Alpha-StimWith NitrousPossible Side Effects of NitrousEarclip electrodes are small and comfortable for the patient, and will not interfere with your workThe patient has full control of their treatment settingsThere is no impairment and no lasting side effects, so patients don’t need to worry about finding a ride home from proceduresThere is no risk of overuse or overdose. Patients can use Alpha-Stim as often and for as long as needed, even for the most routine of cleaningsPatients may experience lingering side effectsStaff may experience adverse effects with long-term, repeated exposurePatients may have objections to or fears about using drugsIt may be unsafe to use on patients with certain health conditions, such as respiratory illness or vitamin B-12 deficiency2NauseaVomitingHeadacheSleepinessSweatingShiveringDiminished motor skillsAdditionally, in 2008, nitrous oxide was added to California’s Proposition 65 list of chemicals known to cause cancer, birth defects, or reproductive harm3. Nitrous oxide is considered a risk for both developmental toxicity and female reproductive toxicity. telehealth Visit Get Alpha-Stim via a telehealth visit with a licensed healthcare provider Schedule Now shop online Purchase Alpha-Stim devices and accessories in our online store Shop Now talk with our team Speak with a representative on the phone to learn more Call Now Sources:https://www.webmd.com/oral-health/easing-dental-fear-adults#1https://www.healthline.com/health/nitrous-oxide-side-effects#longterm-effectshttps://www.cda.org/portals/0/pdfs/fact_sheets/nitrous_oxide_english.pdfWinick, Reid L. Cranial electrotherapy stimulation (CES): a safe and effective low cost means of anxiety control in a dental practice. General Dentistry. 1999; 47(1):50-55. ### Telehealth Alpha-Stim Telehealth Referral Get Alpha-Stim® with a quick telehealth appointment. We understand that going to a doctor may not be possible at this time. If you are suffering from anxiety, insomnia, or pain and don’t have a doctor, are unable to visit your doctor, or would like to use telehealth for just $99, we can refer you to a group that might be able to help. If you live outside the qualifying states, please know that we are working on providing a telehealth referral in your area. If you are outside of the United States, you do not need a prescription to purchase Alpha-Stim. Click below to schedule an appointment (referral not currently available for residents in Rhode Island and Vermont).  Schedule Appointment ### Alpha-Stim for Veterans & Active Military | Alpha-Stim Alpha-Stim® for Veterans & Active Military Service Members, feel better without taking prescription drugs.As a Service Member or Veteran, you know that military duty can change your life in a positive way – but it can also take a steep toll on you physically, mentally and emotionally. Whether or not you have deployed or seen combat, transitioning to civilian life comes with unique difficulties, especially if you’re battling with symptoms of PTSD, such as insomnia, anxiety, and depression.Many veterans are frustrated with standard treatments for their anxiety, insomnia, depression, and pain. Often, side effects are unpleasant and negatively impact quality of life on their own. Medications either are not effective or need increasing dosages to maintain the benefits. And multiple medications are often prescribed to treat the different symptoms, leading to an increased risk of interaction.*FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Marine and Medal of Honor Recipient Dakota Meyers Shares Battle with Anxiety & Non-Drug Treatment Providing Him Relief Alpha-Stim Offers Service Members & Veterans a Drug-Free Option Alpha-Stim is a handheld, prescription medical device that is FDA cleared to treat pain, anxiety, insomnia, and depression*. It can help you feel like you again, with no nasty side effects and no risk of addiction. Just imagine being able to do your daily activities without anything slowing you down or getting in your way. Getting Alpha-Stim through a VA or DOD Medical Center Alpha-Stim is in over half of the VA and DoD centers nationwide, but facilities vary in their use and utilization of the device.Our Government Services team can guide you in the best way to get an Alpha-Stim, depending on the facility that you receive treatment at.Please give us a call at 800-367-7246 and select option 2 for Government Services. What Service Members & Veterans are Saying About Alpha-Stim “The Alpha-Stim has been an incredibly important part of my healthcare the past five years. I cannot imagine living without this device. I am unable to express in words my gratitude to those who have made this device possible for me to use. I am 70 years old now. I wish I could have used this after my discharge in 1969. Without a doubt, my life would be different now..” LLJW “It has reduced my overall pain by 50-60%, my anxiety is down to negligible levels, and I am able to get quality sleep after years of not being able to do so without the help of some very sedating medication. To say I am pleased would be the understatement of the century. I am so very grateful for my Alpha-Stim.” Chris Bechard, VeteranBoulder, CO Previous Next Special Consideration for Veterans, Service Members, and First Responders For those individuals on the front lines of caring for today’s communities, we offer special pricing and discounts. If you are a service member, veteran or first responder, or have a patient who is, please ask about available discounts. Call Now Ask Us About Alpha-Stim® telehealth Visit See if Alpha-Stim is right for you via a telehealth visit with a licensed healthcare provider Schedule Now shop online Purchase Alpha-Stim devices and accessories in our online store Shop Now talk with our team Speak with a representative on the phone to learn more Call Now ### Indications and Risks Indication and Risk Information Electromedical Products International, Inc. is an International Standards Organization (ISO) certified organization. ISO is an International organization working with some 140 countries and the United Nations to maintain standards for all applications of technology for global industry. Requirements for the medical device industry relate to design controls, risk management, environmental controls, special processes (e.g. software validation), traceability, record retention, and regulatory actions such as vigilance. Please see below for information related to indication and risk for Alpha-Stim® technologies. Electromagnetic interference This equipment has been independently tested by outside agencies and found to comply with the limits of Comité International Spécial des Perturbations Radioélectriques (CISPR). These limits are designed to provide reasonable protection against harmful interferences in a residential or clinical environment. However, it is still possible that interference could occur in a particular environment. In case interference does occur, increase the distance between this device and the equipment it interferes with. Consult Electromedical Products International, Inc. if the problem persists. United States European Union United Kingdom Indications The Alpha-Stim AID is a precision medical device used for cranial electrotherapy stimulation for the treatment of anxiety and insomnia.The Alpha-Stim M is a precision medical device and is an effective treatment with broad applications for a variety of syndromes involving pain, and for the management of anxiety and insomnia, or for the short term relief of symptoms associated with these indications.  In many cases, it is the sole therapeutic method required. Effective results in pain management have been achieved during and/or subsequent to stimulation over affected body parts, adjacent areas, and areas distant from those in pain. As with any therapeutic intervention, not all people will respond to the Alpha-Stim M. The degree of efficacy will vary with the nature of the problem being treated, the overall health of the person, and with the method of treatment. As much as a one-month initial trial may be required to see significant reductions in symptoms. CES for Insomnia and Anxiety The historical indications for CES devices have mentioned “anxiety” and “insomnia,” which are umbrella terms that encompass a variety of specific diagnoses, severities, etc. CES devices have been found to collectively demonstrate a class effect for treating “anxiety” and/or “insomnia.” Evidence specific to the Alpha-Stim® technology can be found in the “Clinical Literature Summary on Alpha-Stim® for Anxiety and Insomnia” section of the Owner’s Manual, which details the populations for which EPI has evidence. Individuals using this device should work with the prescribing healthcare practitioner to determine the best treatment settings to use. Warnings and Precautions Safety of stimulation has not been established during pregnancy.Do not stimulate directly on the eyes or press the probes over the carotid sinus (on the neck near the larynx). Application of the electrodes near the thorax may increase the risk of cardiac fibrillation.Potential hazard from simultaneous connection of a patient to a high frequency surgical medical equipment and stimulator may result in burns and possible damage to the stimulator.Operation in close proximity (e.g. 1m) to a shortwave or microwave therapy medical equipment may produce instability in the stimulator output.Modification of your Alpha-Stim® device or accessories is not allowed, it could result in injury.Do not place Alpha-Stim® in direct contact with lint, dust, light (including sunlight).For external use only. Small parts, keep out of reach of children, avoid inhalation or swallowing. Do not allow children to use or handle this device.This device is intended to be used in individuals who are 18 years of age or older.Brain development continues beyond 18 years of age. The long-term effects of electrical stimulation from this device on the brain has not been studied.Do not operate potentially dangerous machinery or vehicles during treatment, and in some cases for several hours after treatment.Do not plug leadwires into wall sockets or line cord receptacles under any circumstances. Doing so could result in severe shock or burns whether the leadwires are attached to the stimulator or not.Patients should be monitored by their physician for signs of worsening.If a patient experiences headaches while using the device, they should consult their physician prior to continued use of the device.Caution Statement for United States: Federal law (USA only) restricts this device to sale by, or on the order of a licensed healthcare practitioner. Outside the USA it is available worldwide without a prescription but consultation with a qualified healthcare professional is recommended for difficult and unresponsive problems or when used with pharmaceuticals or other therapeutic intervention. Contraindications Use of an Alpha-Stim device is contraindicated with implanted pacemakers or implanted or wearable defibrillators. Adverse effects Adverse effects are usually rare (occurring less than 1% of the time), mild, and self-limiting.DizzinessSkin irritation/electrode burnsHeadaches Reporting Device Issues Please contact EPI if you have any concerns with the device: Call EPI at 1-800-367-7246 or email alpha-stim@epii.com. If you are located outside of the US, please call +1-940-328-0788.You may also report any adverse events to the FDA using the following information:MedWatch is the Food and Drug Administration’s (FDA) program for reporting serious reactions, product quality problems, therapeutic inequivalence/failure, and product use errors with human medical products, including drugs, biologic products, medical devices, dietary supplements, infant formula, and cosmetics.If you think you or someone in your family has experienced a serious reaction to a medical product, you are encouraged to take the reporting form to your doctor. Your healthcare provider can provide clinical information based on your medical record that can help FDA evaluate your report.However, we understand that for a variety of reasons, you may not wish to have the form filled out by your healthcare provider, or your healthcare provider may choose not to complete the form. Your healthcare provider is not required to report the information. In these situations, you may complete the Online Reporting Form yourself.You will receive an acknowledgement from FDA when your report is received. Reports are reviewed by FDA staff. You will be personally contacted only if we need additional information.Submitting adverse event reports to FDA Use one of the methods below to submit voluntary adverse event reports to the FDA:Report Online at: www.accessdata.fda.gov/scripts/medwatch/ index.cfm?action=reporting.homeConsumer Reporting Form FDA 3500B. Follow the instructions on the form to either fax or mail it in for submission. For help filling out the form, see MedWatchLearn. The form is available at:  www.fda.gov/safety/medical-product-safety-information/medwatch-forms-fda-safety-reportingCall FDA at 1-800-FDA-1088 to report by telephone.Reporting Form FDA 3500 is commonly used by health professionals. The form is available at: www.fda.gov/safety/medical-product-safety-information/medwatch-forms-fda-safety-reporting CE Conformity Statement for Europe The Alpha-Stim AID, and Alpha-Stim M are Class IIa, Type BF medical devices. Both of which have been independently tested by outside agencies to provide assurance of conformity to applicable standards for medical equipment safety and electromagnetic compliance. Indications The Alpha-Stim AID is a precision medical device used for cranial electrotherapy stimulation in adults 22 years and above for the treatment of anxiety, insomnia, depression and pain.The Alpha-Stim M is a precision medical device used for cranial electrotherapy stimulation in adults 22 years and above for the treatment of anxiety, insomnia, depression and pain, AND transcutaneous electric nerve stimulation for management of acute, chronic and post-traumatic pain. It is an effective treatment for anxiety, insomnia, depression and pain using Earclip Electrodes, Smart Probes and AS-Trodes. In many cases, it is the sole therapeutic method required. Effective results in pain management have been achieved during and/or subsequent to stimulation over affected body parts, adjacent areas, and areas distant from those in pain. As with any therapeutic intervention, not all people will respond to the Alpha-Stim M. The degree of efficacy will vary with the nature of the problem being treated, the overall health of the person, and with the method of treatment. As much as a one month initial trial may be required to see significant reductions in symptoms. Warnings and Precautions Safety of stimulation has not been established during pregnancy.Do not stimulate directly on the eyes or press the Smart Probes over the carotid sinus (on the neck near the larynx). Application of the electrodes near the thorax may increase the risk of cardiac fibrillation.Potential hazard from simultaneous connection of a patient to a high frequency surgical medical equipment and stimulator may result in burns and possible damage to the stimulator.Operation in close proximity (e.g. 1m) to a shortwave or microwave therapy medical equipment may produce instability in the stimulator output.Modification of your Alpha-Stim device or accessories is not allowed, it could result in injury.Do not place Alpha-Stim in direct contact with lint, dust, light (including sunlight).For external use only. Small parts, keep out of reach of children, avoid inhalation or swallowing. Do not allow children to use or handle this device without adult supervision.Do not operate potentially dangerous machinery or vehicles during treatment, and in some cases for several hours after treatment.Do not plug leadwires into wall sockets or line cord receptacles under any circumstances. Doing so could result in severe shock or burns whether the leadwires are attached to the stimulator or not.Caution Statement for United States: Federal law (USA only) restricts this device to sale by, or on the order of a licensed healthcare practitioner. Outside the USA it is available worldwide without a prescription but consultation with a qualified healthcare professional is recommended for difficult and unresponsive problem  Contraindications Use of an Alpha-Stim device is contraindicated with implanted pacemakers or implanted or wearable defibrillators. Adverse effects Adverse effects are usually rare (occurring less than 1% of the time), mild, and self-limiting.DizzinessSkin irritation/electrode burnsHeadaches Indications The Alpha-Stim AID is a precision medical device used for cranial electrotherapy stimulation in adults 22 years and above for the treatment of anxiety, insomnia, depression, and pain.The Alpha-Stim M is a precision medical device used for cranial electrotherapy stimulation in adults 22 years and above for the treatment of anxiety, insomnia, depression and pain, and transcutaneous electric nerve stimulation for management of acute, chronic and post-traumatic pain. It is an effective treatment for anxiety, insomnia, depression and pain using Earclip Electrodes, Smart Probes and AS-Trodes. In many cases, it is the sole therapeutic method required. Effective results in pain management have been achieved during and/or subsequent to stimulation over affected body parts, adjacent areas, and areas distant from those in pain. As with any therapeutic intervention, not all people will respond to the Alpha-Stim ® M. The degree of efficacy will vary with the nature of the problem being treated, the overall health of the person, and with the method of treatment. As much as a one-month initial trial may be required to see significant reductions in symptoms. Warnings and Precautions Safety of stimulation has not been established during pregnancy.Do not stimulate directly on the eyes or press the Smart Probes over the carotid sinus (on the neck near the larynx). Application of the electrodes near the thorax may increase the risk of cardiac fibrillation.Potential hazard from simultaneous connection of a patient to a high frequency surgical medical equipment and stimulator may result in burns and possible damage to the stimulator.Operation in close proximity (e.g. 1m) to a shortwave or microwave therapy medical equipment may produce instability in the stimulator output.Modification of your Alpha-Stim device or accessories is not allowed, it could result in injury.Do not place Alpha-Stim in direct contact with lint, dust, light (including sunlight).For external use only. Small parts, keep out of reach of children, avoid inhalation or swallowing. Do not allow children to use or handle this device without adult supervision.Do not operate potentially dangerous machinery or vehicles during treatment, and in some cases for several hours after treatment.Do not plug leadwires into wall sockets or line cord receptacles under any circumstances. Doing so could result in severe shock or burns whether the leadwires are attached to the stimulator or not.Caution Statement for United States: Federal law (USA only) restricts this device to sale by, or on the order of a licensed healthcare practitioner. Outside the USA it is available worldwide without a prescription but consultation with a qualified healthcare professional is recommended for difficult and unresponsive problem  Contraindications Use of an Alpha-Stim device is contraindicated with implanted pacemakers or implanted or wearable defibrillators. Adverse effects Adverse effects are usually rare (occurring less than 1% of the time), mild, and self-limiting.DizzinessSkin irritation/electrode burnsHeadaches Indications The Alpha-Stim AID is a precision medical device used for cranial electrotherapy stimulation for the treatment of anxiety and insomnia.The Alpha-Stim M is a precision medical device and is an effective treatment with broad applications for a variety of syndromes involving pain, and for the management of anxiety and insomnia, or for the short term relief of symptoms associated with these indications.  In many cases, it is the sole therapeutic method required. Effective results in pain management have been achieved during and/or subsequent to stimulation over affected body parts, adjacent areas, and areas distant from those in pain. As with any therapeutic intervention, not all people will respond to the Alpha-Stim M. The degree of efficacy will vary with the nature of the problem being treated, the overall health of the person, and with the method of treatment. As much as a one-month initial trial may be required to see significant reductions in symptoms. CES for Insomnia and Anxiety The historical indications for CES devices have mentioned “anxiety” and “insomnia,” which are umbrella terms that encompass a variety of specific diagnoses, severities, etc. CES devices have been found to collectively demonstrate a class effect for treating “anxiety” and/or “insomnia.” Evidence specific to the Alpha-Stim® technology can be found in the “Clinical Literature Summary on Alpha-Stim® for Anxiety and Insomnia” section of the Owner’s Manual, which details the populations for which EPI has evidence. Individuals using this device should work with the prescribing healthcare practitioner to determine the best treatment settings to use. Warnings and Precautions Safety of stimulation has not been established during pregnancy.Do not stimulate directly on the eyes or press the probes over the carotid sinus (on the neck near the larynx). Application of the electrodes near the thorax may increase the risk of cardiac fibrillation.Potential hazard from simultaneous connection of a patient to a high frequency surgical medical equipment and stimulator may result in burns and possible damage to the stimulator.Operation in close proximity (e.g. 1m) to a shortwave or microwave therapy medical equipment may produce instability in the stimulator output.Modification of your Alpha-Stim® device or accessories is not allowed, it could result in injury.Do not place Alpha-Stim® in direct contact with lint, dust, light (including sunlight).For external use only. Small parts, keep out of reach of children, avoid inhalation or swallowing. Do not allow children to use or handle this device.This device is intended to be used in individuals who are 18 years of age or older.Brain development continues beyond 18 years of age. The long-term effects of electrical stimulation from this device on the brain has not been studied.Do not operate potentially dangerous machinery or vehicles during treatment, and in some cases for several hours after treatment.Do not plug leadwires into wall sockets or line cord receptacles under any circumstances. Doing so could result in severe shock or burns whether the leadwires are attached to the stimulator or not.Patients should be monitored by their physician for signs of worsening.If a patient experiences headaches while using the device, they should consult their physician prior to continued use of the device.Caution Statement for United States: Federal law (USA only) restricts this device to sale by, or on the order of a licensed healthcare practitioner. Outside the USA it is available worldwide without a prescription but consultation with a qualified healthcare professional is recommended for difficult and unresponsive problems or when used with pharmaceuticals or other therapeutic intervention. Contraindications Use of an Alpha-Stim device is contraindicated with implanted pacemakers or implanted or wearable defibrillators. Adverse effects Adverse effects are usually rare (occurring less than 1% of the time), mild, and self-limiting.DizzinessSkin irritation/electrode burnsHeadaches Reporting Device Issues Please contact EPI if you have any concerns with the device: Call EPI at 1-800-367-7246 or email alpha-stim@epii.com. If you are located outside of the US, please call +1-940-328-0788.You may also report any adverse events to the FDA using the following information:MedWatch is the Food and Drug Administration's (FDA) program for reporting serious reactions, product quality problems, therapeutic inequivalence/failure, and product use errors with human medical products, including drugs, biologic products, medical devices, dietary supplements, infant formula, and cosmetics.If you think you or someone in your family has experienced a serious reaction to a medical product, you are encouraged to take the reporting form to your doctor. Your healthcare provider can provide clinical information based on your medical record that can help FDA evaluate your report.However, we understand that for a variety of reasons, you may not wish to have the form filled out by your healthcare provider, or your healthcare provider may choose not to complete the form. Your healthcare provider is not required to report the information. In these situations, you may complete the Online Reporting Form yourself.You will receive an acknowledgement from FDA when your report is received. Reports are reviewed by FDA staff. You will be personally contacted only if we need additional information.Submitting adverse event reports to FDA Use one of the methods below to submit voluntary adverse event reports to the FDA:Report Online at: www.accessdata.fda.gov/scripts/medwatch/ index.cfm?action=reporting.homeConsumer Reporting Form FDA 3500B. Follow the instructions on the form to either fax or mail it in for submission. For help filling out the form, see MedWatchLearn. The form is available at:  www.fda.gov/safety/medical-product-safety-information/medwatch-forms-fda-safety-reportingCall FDA at 1-800-FDA-1088 to report by telephone.Reporting Form FDA 3500 is commonly used by health professionals. The form is available at: www.fda.gov/safety/medical-product-safety-information/medwatch-forms-fda-safety-reporting CE Conformity Statement for Europe The Alpha-Stim AID, and Alpha-Stim M are Class IIa, Type BF medical devices. Both of which have been independently tested by outside agencies to provide assurance of conformity to applicable standards for medical equipment safety and electromagnetic compliance. Indications The Alpha-Stim AID is a precision medical device used for cranial electrotherapy stimulation in adults 22 years and above for the treatment of anxiety, insomnia, depression and pain.The Alpha-Stim M is a precision medical device used for cranial electrotherapy stimulation in adults 22 years and above for the treatment of anxiety, insomnia, depression and pain, AND transcutaneous electric nerve stimulation for management of acute, chronic and post-traumatic pain. It is an effective treatment for anxiety, insomnia, depression and pain using Earclip Electrodes, Smart Probes and AS-Trodes. In many cases, it is the sole therapeutic method required. Effective results in pain management have been achieved during and/or subsequent to stimulation over affected body parts, adjacent areas, and areas distant from those in pain. As with any therapeutic intervention, not all people will respond to the Alpha-Stim M. The degree of efficacy will vary with the nature of the problem being treated, the overall health of the person, and with the method of treatment. As much as a one month initial trial may be required to see significant reductions in symptoms. Warnings and Precautions Safety of stimulation has not been established during pregnancy.Do not stimulate directly on the eyes or press the Smart Probes over the carotid sinus (on the neck near the larynx). Application of the electrodes near the thorax may increase the risk of cardiac fibrillation.Potential hazard from simultaneous connection of a patient to a high frequency surgical medical equipment and stimulator may result in burns and possible damage to the stimulator.Operation in close proximity (e.g. 1m) to a shortwave or microwave therapy medical equipment may produce instability in the stimulator output.Modification of your Alpha-Stim device or accessories is not allowed, it could result in injury.Do not place Alpha-Stim in direct contact with lint, dust, light (including sunlight).For external use only. Small parts, keep out of reach of children, avoid inhalation or swallowing. Do not allow children to use or handle this device without adult supervision.Do not operate potentially dangerous machinery or vehicles during treatment, and in some cases for several hours after treatment.Do not plug leadwires into wall sockets or line cord receptacles under any circumstances. Doing so could result in severe shock or burns whether the leadwires are attached to the stimulator or not.Caution Statement for United States: Federal law (USA only) restricts this device to sale by, or on the order of a licensed healthcare practitioner. Outside the USA it is available worldwide without a prescription but consultation with a qualified healthcare professional is recommended for difficult and unresponsive problem  Contraindications Use of an Alpha-Stim device is contraindicated with implanted pacemakers or implanted or wearable defibrillators. Adverse effects Adverse effects are usually rare (occurring less than 1% of the time), mild, and self-limiting.DizzinessSkin irritation/electrode burnsHeadaches Indications The Alpha-Stim AID is a precision medical device used for cranial electrotherapy stimulation in adults 22 years and above for the treatment of anxiety, insomnia, depression, and pain.The Alpha-Stim M is a precision medical device used for cranial electrotherapy stimulation in adults 22 years and above for the treatment of anxiety, insomnia, depression and pain, and transcutaneous electric nerve stimulation for management of acute, chronic and post-traumatic pain. It is an effective treatment for anxiety, insomnia, depression and pain using Earclip Electrodes, Smart Probes and AS-Trodes. In many cases, it is the sole therapeutic method required. Effective results in pain management have been achieved during and/or subsequent to stimulation over affected body parts, adjacent areas, and areas distant from those in pain. As with any therapeutic intervention, not all people will respond to the Alpha-Stim ® M. The degree of efficacy will vary with the nature of the problem being treated, the overall health of the person, and with the method of treatment. As much as a one-month initial trial may be required to see significant reductions in symptoms. Warnings and Precautions Safety of stimulation has not been established during pregnancy.Do not stimulate directly on the eyes or press the Smart Probes over the carotid sinus (on the neck near the larynx). Application of the electrodes near the thorax may increase the risk of cardiac fibrillation.Potential hazard from simultaneous connection of a patient to a high frequency surgical medical equipment and stimulator may result in burns and possible damage to the stimulator.Operation in close proximity (e.g. 1m) to a shortwave or microwave therapy medical equipment may produce instability in the stimulator output.Modification of your Alpha-Stim device or accessories is not allowed, it could result in injury.Do not place Alpha-Stim in direct contact with lint, dust, light (including sunlight).For external use only. Small parts, keep out of reach of children, avoid inhalation or swallowing. Do not allow children to use or handle this device without adult supervision.Do not operate potentially dangerous machinery or vehicles during treatment, and in some cases for several hours after treatment.Do not plug leadwires into wall sockets or line cord receptacles under any circumstances. Doing so could result in severe shock or burns whether the leadwires are attached to the stimulator or not.Caution Statement for United States: Federal law (USA only) restricts this device to sale by, or on the order of a licensed healthcare practitioner. Outside the USA it is available worldwide without a prescription but consultation with a qualified healthcare professional is recommended for difficult and unresponsive problem  Contraindications Use of an Alpha-Stim device is contraindicated with implanted pacemakers or implanted or wearable defibrillators. Adverse effects Adverse effects are usually rare (occurring less than 1% of the time), mild, and self-limiting.DizzinessSkin irritation/electrode burnsHeadaches We’re here to help If Alpha-Stim does not begin to control your pain, anxiety, insomnia, or depression within one month, consult your healthcare practitioner, authorized Alpha-Stim distributor, or EPI for advice. ### Get Started Get Started With Alpha-Stim® Alpha-Stim® is the only non-invasive therapy proven to safely provide significant and sustainable relief for people with anxiety, insomnia, depression*, and acute and chronic pain.*FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.If you are a patient or a healthcare provider but are unsure how to get started with Alpha-Stim, simply click below. Based on your answer, we’ll help you identify the best next step and provide informative resources to help you move forward.Please choose which you best identify with: Learn More About Alpha-Stim® Now Clinical Research StudiesInvolving Alpha-Stim Learn More Alpha-Stim Brings Relief to Veteran After Years of Suffering Read More Alpha-Stim Improves Quality of Life By Relieving Anxiety Learn More ### Using Alpha-Stim Adjunctively with EMDR and Complex Trauma Cases Webinar Using Alpha-Stim Adjunctively with EMDR and Complex Trauma Cases https://www.youtube.com/watch?v=oyPX08YbYxg&t=1*Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### Treating Post-Traumatic Pain & Comorbid Anxiety, Insomnia, and Depression with Alpha-Stim Clinical Treatment of Post-Traumatic Pain and Comorbid Anxiety, Insomnia, and Depression with Alpha-Stim https://www.youtube.com/watch?v=Iv5Cji6rLsg*Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### Alpha-Stim: A First-line Therapy for First Responders Webinar Alpha-Stim: A First-Line Therapy for First Responders https://www.youtube.com/watch?v=ot9twFdRpgQ*Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### Alpha-Stim Utilization in Telehealth Webinar Alpha-Stim Utilization in Telehealth Webinar https://www.youtube.com/watch?v=AdzjJi7B054&t=2s*Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### Using Alpha-Stim for Anxiety, Insomnia, and Depression in an Addiction Setting Alpha-Stim Utilization for Anxiety, Insomnia, and Depression in an Addiction Setting Webinar https://www.youtube.com/watch?v=eR8qYEEn3Uk&t=1s*Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### Alpha-Stim use with CBT Alpha-Stim Use with CBT https://www.youtube.com/watch?v=iCaIQSrFkiI*Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### Alpha-Stim in Psychiatry Webinar Alpha-Stim in Psychiatry https://youtu.be/FcwQo0Yro5*Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### Alpha-Stim in Integrative Medicine Alpha-Stim in Integrative Medicine https://www.youtube.com/watch?v=2hN1dgCoRQ0*Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### Alpha-Stim in Child, Adolescent & Adult Psychiatry Webinar Alpha-Stim in Child, Adolescent and Adult Psychiatry https://www.youtube.com/watch?v=HVYZYsE03pY*Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### Alpha-Stim for Treating Anxiety and Insomnia in Cancer and Surgery Patients Alpha-Stim for Treating Anxiety and Insomnia in Cancer and Surgery Patients   https://www.youtube.com/watch?v=fI4wDOxnzBs *Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### Alpha-Stim for Treating Trauma, Grief and Loss Alpha-Stim for Treating Trauma, Grief and Loss https://www.youtube.com/watch?v=zbVuhnrBjB4*Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### Alpha-Stim as a Treatment for Anxiety and Depression in County Sheriffs Officers Inmates Webinar Alpha-Stim as a Treatment for Anxiety & Depression in County Sheriff’s Officers and Inmates https://www.youtube.com/watch?v=GEBLvcbpy5Q*Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### Alpha-Stim and Physical Therapy Webinar Alpha-Stim and Physical Therapy Webinar https://www.youtube.com/watch?v=mpn1InfLv_Y*Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### Webinar ### U.S. Products Alpha-Stim AID & Accessories Treating anxiety and insomnia Shop Now Alpha-Stim M & Accessories Treating pain, anxiety, and insomnia Shop Now ### Store Shop Alpha-Stim United States Shop Now International Shop Now ### Insomnia ### Pain ### Contact Us Contact Us Get in touch with our team about Alpha-Stim Use the form below to get more information about Alpha-Stim®, talk with our sales team, or connect with our support teams. Name First Last Email PhoneWhat can we help you with? Find an Alpha-Stim Provider More information about Alpha-Stim Connect with a sales representative Schedule a healthcare provider demo Help using Alpha-Stim at home Product Registration Returns/Service + Warranty Other If you selected "Other" please explain here: Δ Need to Connect with Our Support Team Now? If you do not wish to use our Customer Support Team contact form above, or need more immediate assistance, please feel free to use one of the below options to get in touch. Call Give us a call at 1-800-367-7246. If you are located outside of the US, please call + 940-328-0788. Email  Email us at alpha-stim@epii.com. Chat Use our live chat feature on the site. Live chat sessions are only available during the open customer service hours noted above. ### Customer Support Customer Support Contact our customer support team for help with Alpha-Stim Electromedical Products International, Inc. (EPI) and our well-trained team are dedicated to helping you integrate Alpha-Stim into your life. Live customer service and technical support are available Monday through Friday from 8am - 5pm CST Please fill out the form below to get in touch with our Customer Support Team or use one of the other contact options below. Name First Last Are you a patient or provider?PatientProviderEmail PhoneWhat can we help you with? Product Registration Returns + Warranty Help using Alpha-Stim Certification webinars Procedures and protocols Technical Support Talk with Customer Service What is the issue? Explain the issue please. Δ Need to Connect with Our Support Team Now? If you do not wish to use our Customer Support Team contact form above, or need more immediate assistance, please feel free to use one of the below options to get in touch. Call Give us a call at 1-800-367-7246. If you are located outside of the US, please call + 940-328-0788. Email  Email us at alpha-stim@epii.com. Chat Use our live chat feature on the site. Live chat sessions are only available during the open customer service hours noted above. ### Support ### Distributor Portal ### Product Registration Register Your Alpha-Stim® Device Product Registration Thank you for registering your product to ensure warranty coverage under EPI’s 5 Year Limited Warranty. Previously Owned Quality Assured Alpha-Stim® products receive a 1 Year Limited Warranty. If you have any questions or there’s anything we can help you with, please don’t hesitate to call us at 800-367-7246. Type of unitAlpha-Stim AIDAlpha-Stim MAlpha-Stim 100Alpha-Stim SCSSerial Number*Contact InformationName* First Last Customer TypePractitioner purchasing for practicePatient purchasing for selfIf practitioner, degree and specialtyAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Name of clinic or hospital where Alpha-Stim is usedPurchased FromPurchased in CityPurchased Date* MM slash DD slash YYYY How did you learn about the Alpha-Stim?*PractitionerConferenceResearch StudyPrint AdvertisingGoogleFacebookEPI EmployeeOther Would you recommend Alpha-Stim to friends and family? Definitely Probably Not Sure Probably Not Definitely Not QuestionnaireThe following optional, voluntary information would be appreciated and will help in our ongoing research. Please fill in after 30 days of use.What is your diagnosis?How long have you been using your Alpha-Stim?What is your age?What is your gender? Male Female What is your occupation?How would you rate the results so far?Anxiety: Worse (negative change) No change (0%) Slight improvement (1 to 24%) Fair improvement (25 to 49%) Moderate improvement (50 to 74%) Marked improvement (75 to 99%) Complete recovery (100%) Insomnia: Worse (negative change) No change (0%) Slight improvement (1 to 24%) Fair improvement (25 to 49%) Moderate improvement (50 to 74%) Marked improvement (75 to 99%) Complete recovery (100%) Depression: Worse (negative change) No change (0%) Slight improvement (1 to 24%) Fair improvement (25 to 49%) Moderate improvement (50 to 74%) Marked improvement (75 to 99%) Complete recovery (100%) Pain: Worse (negative change) No change (0%) Slight improvement (1 to 24%) Fair improvement (25 to 49%) Moderate improvement (50 to 74%) Marked improvement (75 to 99%) Complete recovery (100%) Other (Please specify): Worse (negative change) No change (0%) Slight improvement (1 to 24%) Fair improvement (25 to 49%) Moderate improvement (50 to 74%) Marked improvement (75 to 99%) Complete recovery (100%) Did you have any side-effects from using Alpha-Stim? No Yes If yes, please specify.Provide any additional comments here. Δ   ### Products Alpha-Stim® Technologies​ *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Clinically proven treatment for anxiety, insomnia, depression*, and pain Alpha-Stim electrotherapy devices are proven to be safe and effective for treating anxiety, insomnia, depression, and acute, chronic, and post-traumatic pain. Alpha-Stim AID and Alpha-Stim M offer non-narcotic and non-surgical treatment alternatives that can be safely used in the clinical or home setting. Alpha-StimTEchnologies Alpha-Stim M Alpha-Stim AID Explore Alpha-Stim for Treating Anxiety, Insomnia, Depression & Pain Alpha-Stim® M Pain, anxiety,  insomnia, & depression. Learn More Alpha-Stim® AID Anxiety, insomnia & depression. Learn More Proven Results Overall Decrease in Anxiety In clinical trials, patients reported an average of 61% less anxiety immediately after using the CES therapy. After 5 weeks, that average was 94%.1 Improved Sleep Quality The number of subjects rating their quality of sleep as poor dropped from 60% to 5%.2 Severe Pain Reduction In a study of patients with severe pain, Alpha-Stim M significantly reduced pain by an average of 71% after only five treatments.3 Decrease in Depression In clinical trials, Alpha-Stim recipients reported an 82% decrease of ≥ 50% or greater in depression scores after five weeks using the CES therapy.4 What Patients & Providers Say About Alpha-Stim “Not only have I experienced relief from anxiety and insomnia; additionally, Alpha-Stim treatments have reduced or eliminated accompanying physical pain.” CH (MAJ) David J. Fair PhD,Former President, American Association of Police Officers; Former President, Homeland Crisis InstituteTexas “The Alpha-Stim has so much good science behind it, with many highly controlled clinical studies—this really proves its unique effectiveness for so many types of patients. And you can’t ignore the incredible safety record with no serious side effects. That’s why I recommend it to many of my patients.” Anita D. Spitz, MD, Chief Family Medicine Department Parrish Medical CenterTitusville, Florida “So far, I have overall had good results from the Alpha-Stim AID. In fact, one day while doing household tasks I walked in front of a mirror and noticed that I was smiling! That's new behavior and truly a result of this device. I am also experiencing a feeling of well-being and deep sleep that I haven't experienced since college days.” Alpha-Stim User “I am so pleased to advise you that I was able to use the Alpha-Stim device during my surgery. The staff at the surgery center were interested and of course I had brochures to provide to them. Alpha-Stim allowed me to minimize the need for pain Rx, and I believe I was off meds completely by the end of day 3. After two weeks, the surgeon was pleased with the surgical site, removed the stitches, and I was back in my office!” Dr. Corinne Cherek, health care practitioner Las Vegas, NV Previous Next Alpha-Stim Health Tracker App Keep track of progress with Alpha-Stim AID or Alpha-Stim M with the Alpha-Stim Health Tracker App. Track your treatment sessions, log daily check-ins, view progress analytics, take assessments and more.Our mobile app gives users the tools they need to get the most out of their Alpha-Stim device. Take Charge of Your Life with Alpha-Stim telehealth Visit See if Alpha-Stim is right for you via a telehealth visit with a licensed healthcare provider Schedule Now shop online Purchase Alpha-Stim devices and accessories in our online store Shop Now talk with our team Speak with a representative on the phone to learn more Call Now Sources: 1 Lichtbroun AS, Raicer MMC, Smith RB. The treatment of fibromyalgia with Cranial Electrotherapy Stimulation. Journal of Clinical Rheumatology. 2001; 7(2):72-78. 2 Lichtbroun AS, Raicer MMC, Smith RB. The treatment of fibromyalgia with Cranial Electrotherapy Stimulation. Journal of Clinical Rheumatology. 2001; 7(2):72-78. 3Holubec JT. Cumulative response from Cranial Electrotherapy Stimulation (CES) for chronic pain. Practical Pain Management. 2009; 9(9):80-83. 4Barclay TH, Barclay RD. A clinical Trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders. 2014; 164:171-177. Presented at the American Psychological Association National Conference, Honolulu, July 2013. ### Indication and Risks ### News NEWS Alpha-Stim News and Announcements Learn More About Alpha-Stim Learn more about Alpha-Stim AID and Alpha-Stim M today to discover a new way to treat anxiety and insomnia and relieve pain. Get the Facts ### Executive Team ### About About Electromedical Products International, Inc. EPI is a leading neuromodulation therapeutic company specializing in non-invasive brain stimulation for psychiatric disorders and insomnia, along with microcurrent therapy for pain management, with devices for both clinical use and research.  A company is more than its product offerings. Our people are our most important resource.  When you invest in Alpha-Stim CES device technology—whether you’re a patient, a doctor seeking a safe, effective, approach to pain relief and mood and sleep treatment, or a distributor wishing to offer an advanced medical technology to the marketplace—you’re investing in a lot more than a medical device. Alpha-Stim technology is proven and is backed by decades of research; EPI fully supports its products and customers through ongoing research, education, and clinical support. EPI is a global enterprise and has received regulatory approvals in numerous countries. Alpha-Stim products and accessories are FDA cleared in the United States for anxiety, insomnia, and pain, have obtained the CE mark for regulatory approval in Europe (through the European Medical Device Regulation), been awarded the UL (Underwriter’s Laboratory) safety listing, and are approved throughout most of the world. News from EPI Breakthrough Technology Proves Rapid Relief of Depression with Non-Invasive Brain Stimulation Depression, a debilitating disorder affecting millions worldwide, may soon be treatable with an alarmingly effective, non-invasive brain stimulation technology. Researchers from the Department of Psychiatry at the University of North Carolina – Chapel Hill, in collaboration with Electromedical Products International, Inc. (EPI), have made a significant breakthrough in effectively treating depression in just five daily sessions. An initial clinical trial, recently published in the American Journal of Psychiatry, demonstrated a pronounced reduction in symptom severity in people with major depressive disorder. Remarkably, 80% of patients were found to be free of clinical depression symptoms when assessed by a psychiatrist two weeks after completing treatment. The technology works by delivering personalized brain stimulation in response to real-time measurements of brain activity, targeting a specific rhythmic electric activity pattern known to be disrupted in major depressive disorder. Researchers identified a strong correlation between successful modulation of the targeted electric brain activity and symptom reduction. Dr. Flavio Frohlich, Professor of Psychiatry at UNC – Chapel Hill and Director of the Carolina Center for Neurostimulation, described the results as "stunning" and a potential "game changer" for millions of patients seeking better treatment options for their depression symptoms. During each session, EPI's device adjusts the mild electric waveform delivered to the patient based on the brain's response to the stimulation. “You can imagine this technology as engaging in a dialogue with the brain,” says Dr. Frohlich, who also chairs EPI’s Scientific Advisory Board. The study also highlighted how successful modulation of the targeted electric brain activity predicted symptom reduction, offering a promising new approach to treating this complex disorder. “We are thrilled about these highly promising results and are eager to rapidly move forward with a double-blind, placebo-controlled study of this technology,” says Dr. Leah Townsend, Chief Science Officer of EPI. Brian Burke, President of EPI, adds, “We knew we had a winning technology when we first saw the results of this initial clinical trial. This breakthrough highlights the potential market impact of our closed-loop brain stimulation technology and reinforces our dedication to innovation.” Contact Us If you are interested in joining our team and would like to learn about possible employment opportunities, fill out the form below or contact us at alpha-stim@epii.com. Name First Last Email PhoneWhat can we help you with? Find an Alpha-Stim Provider More information about Alpha-Stim Connect with a sales representative Schedule a healthcare provider demo Help using Alpha-Stim at home Product Registration Returns/Service + Warranty Other If you selected "Other" please explain here: Δ ### Guides Alpha-Stim® Quick Start Guides & Owners Manuals See below for Alpha-Stim AID and Alpha-Stim M product information, including quick start guides and owner manuals for use by both patients and practitioners.If you are outside of the United States, click here for instructions for use and translated Owner's Manuals. Alpha-Stim AID Quick Start Guide DOWNLOAD NOW Alpha-Stim M Quick Start Guide DOWNLOAD NOW Alpha-Stim AID Owner's Manual DOWNLOAD NOW Alpha-Stim M Owner's Manual DOWNLOAD NOW ### Videos How-to Videos & Tutorials If you have questions about how to use your Alpha-Stim device, free clinical support is available Monday through Friday from 8 a.m. to 5 p.m. CST at 1-800-367-7246. Treating Anxiety, Insomnia and Depression with Alpha-Stim Earclips *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.https://youtu.be/ImDQ2HWAS6U?si=sJYJKOHEV2keyXcv Using Earclips with Your Alpha-Stim AID https://www.youtube.com/watch?v=uKkPgM_Sigw Using Earclips with Your Alpha-Stim M Treating Pain with Alpha-Stim Smart Probes & AS-Trode Self-Adhesive Electrodes https://www.youtube.com/watch?v=wNpyMLiFLas&embeds_referring_euri=https%3A%2F%2Falpha-stim.com%2F&source_ve_path=Mjg2NjY&feature=emb_logo One Minute Protocol​ https://www.youtube.com/watch?time_continue=3&v=QyiDh_5SI48&embeds_referring_euri=https%3A%2F%2Falpha-stim.com%2F&source_ve_path=Mjg2NjQsMjg2NjY&feature=emb_logo Treating Pain with AS-Trode Self-Adhesive Electrodes https://www.youtube.com/watch?v=KjMJYwkXtcI&embeds_referring_euri=https%3A%2F%2Falpha-stim.com%2F&source_ve_path=Mjg2NjY&feature=emb_logo Treating the Knee with Smart Probes https://www.youtube.com/watch?time_continue=4&v=0fsZfMmjzww&embeds_referring_euri=https%3A%2F%2Falpha-stim.com%2F&source_ve_path=Mjg2NjY&feature=emb_logo Treating the Back with Smart Probes https://www.youtube.com/watch?v=m7JCG69UTh4 Treating the Neck with Smart Probes https://www.youtube.com/watch?v=1ZsRMdINMiQ&embeds_referring_euri=https%3A%2F%2Falpha-stim.com%2F&source_ve_path=Mjg2NjY&feature=emb_logo Treating the Ankle with Smart Probes https://www.youtube.com/watch?v=fSh7HLZNJG4 Treating the Shoulder with Smart Probes https://www.youtube.com/watch?v=ZwJTL6FVAk4&embeds_referring_euri=https%3A%2F%2Falpha-stim.com%2F&source_ve_path=Mjg2NjY&feature=emb_logo Treating the Elbow with Smart Probes https://www.youtube.com/watch?v=xDETFYwwJ_4&embeds_referring_euri=https%3A%2F%2Falpha-stim.com%2F&source_ve_path=Mjg2NjY&feature=emb_logo Treating the Wrist with Smart Probes ### Blog Blog View Blogs from Alpha-Stim ### Forms Alpha-Stim Forms Access important forms and documents related to Alpha-Stim®, certifications, orders, refunds and more below. If you don't see the form you need, support is available via email at alpha-stim@epii.com. Alpha-Stim Retail Order Form Statement of Medical Necessity Form Product Registration Sales Refund Request/Loan Return HIPAA Compliance/Patient Request for Health Info International Product Order Inquiry Form Get Started with Alpha-Stim Talk with our team today about getting Alpha-Stim M and Alpha-Stim AID to use with your patients.  Learn about special pricing, medical education opportunities, and more.Get more information at alpha-stim@epii.com.     ### Webinars Webinars Alpha-Stim Utilization in Telehealth Can Alpha-Stim be utilized in a telehealth setting? Watch this quick webinar with  Dr. Haramandeep Singh, D.ABPN, to learn more about how to prescribe and utilize Alpha-Stim with patients via telehealth or telemedicine. WATCH NOW Alpha-Stim® Practitioner Webinars Explore webinars from Alpha-Stim below.If you have a question that was not answered during the webinar, want additional information and research, or would like to be contacted by a local Alpha-Stim representative, please email alpha-stim@epii.com. Using Alpha-Stim Adjunctively with EMDR & Complex Trauma Cases Using Alpha-Stim in Integrative Medicine Alpha-Stim Use with Cognitive Behavioral Therapy (CBT) Alpha-Stim Utilization for Anxiety, Insomnia, and Depression in an Addiction Setting​ Alpha-Stim and Physical Therapy: PT Perspectives – NOT E-stim Like You Know It Alpha-Stim for Treating Anxiety and Insomnia in Cancer and Surgery Patients Incorporating Alpha-Stim Treatment for Clients Experiencing Trauma, Grief, and Loss During a Global Pandemic Clinical Treatment of Post-Traumatic Pain and Comorbid Anxiety, Insomnia, and Depression Alpha-Stim as a Treatment for Anxiety & Depression in County Sheriff’s Officers & Inmates Alpha-Stim in Child, Adolescent & Adult Psychiatry Alpha-Stim: A First-Line Therapy for First Responders Alpha-Stim in Psychiatry Ready to Try Alpha-Stim? If you’re new to Alpha-Stim, talk with one of our representatives today to learn about trying Alpha-Stim AID and Alpha-Stim M with patients in your clinic or office. You can also learn about our CES and MET webinars that offer an in-depth look at Alpha-Stim science, mechanism of action, research and protocols. Get Started CES & MET Webinar Info ### Prescribing Alpha-Stim Prescribing alpha-stim® For patients with anxiety, insomnia, depression*, or pain Alpha-Stim M and Alpha-Stim AID devices give practitioners drug-free options to offer patients struggling with anxiety, insomnia, depression* and/or pain. When used appropriately, the Alpha-Stim M MET and CES device and AID CES device may provide significant symptom improvements for many of your patients. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. prescribingAlpha-Stim for patients withanxiety, insomnia,depression, or pain How to Prescribe Alpha-Stim Alpha-Stim technologies are easy to use with patients. Alpha-Stim can be prescribed both in-person in a qualified healthcare clinic or office setting, as well as via telehealth appointments.A prescription for Alpha-Stim is only required in the United States and it is available over-the-counter outside of the US.Hundreds of thousands of people around the world have achieved remarkable results with Alpha-Stim technologies, with many practitioners often using the devices right alongside their patients.Learn more about working with Alpha-Stim and how to get started below. Getting Started with Alpha-Stim We know you want what’s best for the people you treat, whether they have anxiety, insomnia, or pain. To help new health practitioners see if Alpha-Stim is a good fit for their patients, connect with us today to talk about trying Alpha-Stim M and Alpha-Stim AID.Use the form below to get more information. Name(Required) First Name* Last Email(Required) Phone(Required)UntitledCompany (Clinic) Name(Required)Zip Code(Required) Δ Alpha-Stim® M Works for Acute & Chronic Pain Approved for treating pain conditions throughout the exterior of the body including the head, neck, back, hip, knee, and shoulder. Relief for Post-Traumatic Pain Especially key for first responders, Alpha-Stim M is approved and validated for treating post-traumatic pain. Also Treats Anxiety, Insomnia & Depression Alpha-Stim M can also be used to treat patients’ anxiety, insomnia and depression. Alpha-Stim® AID Treat Mood Conditions Safely Uses low-level electrical current to treat anxiety, insomnia and depression safely and effectively. Dynamic Therapy Use Can be used as a first-line therapy, or as an adjunct to pharmacotherapy without polypharmacy effects. Improve Health & Well-Being Alpha-Stim AID can be used in-clinic/in-office or by patients at home for continuous anxiety and insomnia treatment. Discover Alpha-Stim Discover Alpha-Stim technology today. Alpha-Stim® M For pain, anxiety, insomnia, and depression. Learn More Alpha-Stim® AID For anxiety, insomnia, and depression. Learn More “The Alpha-Stim has so much good science behind it, with many highly controlled clinical studies—this really proves its unique effectiveness for so many types of patients. And you can’t ignore the incredible safety record with no serious side effects. That’s why I recommend it to many of my patients.” Anita D. Spitz, MD, Chief Family Medicine Department Parrish Medical CenterTitusville, Florida “Not only have I experienced relief from anxiety and insomnia; additionally, Alpha-Stim treatments have reduced or eliminated accompanying physical pain.” CH (MAJ) David J. Fair PhD,President, American Association of Police Officers; President, Homeland Crisis InstituteTexas “So far, I have overall had good results from the Alpha-Stim AID. In fact, one day while doing household tasks I walked in front of a mirror and noticed that I was smiling! That's new behavior and truly a result of this device. I am also experiencing a feeling of well-being and deep sleep that I haven't experienced since college days.” Alpha-Stim User “I experienced the worst depression I have ever felt. I never have had depression until now. It’s the worst feeling ever. Makes the days go by so much slower. I went to my doctor, hoping for medicine. Instead he let me try Alpha- Stim. This product ended up being a life changer! It is awesome!” Angie Lamborghini “After 3 months, I feel like a new person. I would recommend Alpha-Stim to anyone suffering from depression or anxiety.” Laine Downing Commonly Asked Questions How can I get Alpha-Stim M or Alpha-Stim AID for patients? Typically trying Alpha-Stim in the office can identify those individuals who readily respond to Alpha-Stim treatment. You or your patients can fulfill your order 3 easy ways:Shop our online storeCall 1-800-367-7246Fax a retail order form Is there special pricing for practitioners? Special pricing options for practitioners may be available. For practitioner volume discount pricing, call us at 1-800-367-7246 (in USA), + (940) 328-0788 (outside USA), or email us at info@epii.com. Will health insurance cover Alpha-Stim for patients? Insurance coverage varies by policy. Durable medical equipment coverage is often required to obtain some level of reimbursement for Alpha-Stim devices. EPI does not bill private carriers but will assist customers by providing a paid invoice and a sample Statement of Medical Necessity for your practitioner to complete. This statement is typically required by the insurance carrier if the device is covered.The HCPCS code for the Alpha-Stim AID is E0732 and the Alpha-Stim M is E1399.Patients can also use a flex spending account (FSA) or health savings account (HSA) and may be able to qualify for financing and flexible payments. Typically trying Alpha-Stim in the office can identify those individuals who readily respond to Alpha-Stim treatment. You or your patients can fulfill your order 3 easy ways:Shop our online storeCall 1-800-367-7246Fax a retail order formSpecial pricing options for practitioners may be available. For practitioner volume discount pricing, call us at 1-800-367-7246 (in USA), + (940) 328-0788 (outside USA), or email us at info@epii.com.Insurance coverage varies by policy. Durable medical equipment coverage is often required to obtain some level of reimbursement for Alpha-Stim devices. EPI does not bill private carriers but will assist customers by providing a paid invoice and a sample Statement of Medical Necessity for your practitioner to complete. This statement is typically required by the insurance carrier if the device is covered.The HCPCS code for the Alpha-Stim AID is E0732 and the Alpha-Stim M is E1399.Patients can also use a flex spending account (FSA) or health savings account (HSA) and may be able to qualify for financing and flexible payments. ### Mobile App Alpha-Stim Health Tracker App™ A mobile app to help you track progress and get the most out of your Alpha-Stim device. Get the Alpha-Stim Health Tracker App Log your sessions, journal your day, take assessments, explore Alpha-Stim FAQs and see your progress all from your phone.The Alpha-Stim Health Tracker App gives you the tools you need to get the most out of your Alpha-Stim M or Alpha-Stim AID device. What You Can Do in the App Log Sessions Quickly log the details of your Alpha-Stim sessions, such as date, time, and current level, and rate how you felt before and after your session. Then see which settings gave you the best results, letting you personalize your treatment.Take AssessmentsEvery 2 weeks, answer a few questions about how you are doing. These clinically validated surveys are the gold standard used by clinicians to gather powerful information about your mental health and well-being.Journal Daily Check-insBeyond using your Alpha-Stim, there are other activities that have an impact on mental health. With daily check-ins, you can keep a journal of your activities and mood without having to type a single line.View Progress AnalyticsSee your progress as you track your sessions, activities, and moods. Which Alpha-Stim settings give you the best improvement?  How long before you started feeling better?  What daily activities boost your mood, and which ones make things worse?  Everyone’s Alpha-Stim and mental health journey is different – and now you can see yours in real-time.Access Alpha-Stim InformationExplore the Alpha-Stim FAQs and device guides for more details on how to use your Alpha-Stim.Get Accessories & SupportEasily access the Alpha-Stim store from the app to replenish accessories and find customer and technical support contact information for convenient support. View App Terms & Conditions here > Mobile App screenshots ### Accessories Alpha-Stim® Accessories Everything you need to get the most of your Alpha-Stim device. Whether using Alpha-Stim AID or Alpha-Stim M, below are accessories, cleaning tools, and more to help you get the best results and keep your device at the highest level of functionality. Accessories for Alpha-Stim AID Shop Now Accessories for Alpha-Stim M Shop Now Alpha-Stim Health Tracker App Keep track of progress with Alpha-Stim AID or Alpha-Stim M with the Alpha-Stim Health Tracker App. Track your treatment sessions, log daily check-ins, view progress analytics, take assessments and more. Our mobile app gives users the tools they need to get the most out of their Alpha-Stim device. ### Alpha-Stim M alpha-stim® M Take Charge of Your Life with Alpha-Stim M Alpha-Stim M is an FDA cleared, non-drug, non-surgical medical device for acute, chronic and post-traumatic pain relief, along with being able to treat the anxiety, insomnia, and depression* that can sometimes accompany pain. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Alpha-Stim M Take Chargeof your life Alpha-Stim M Features Treats acute and chronic pain conditions throughout the body Treats post-traumatic pain Can be used as a first-line therapy for pain management, anxiety, insomnia, and depression Can be used as an adjunct to pharmacotherapy without polypharmacy effects Can be used at home by patients safely and easily Includes handheld probes or self-adhesive electrodes for MET pain therapy Includes earclips for CES therapy for treating anxiety, insomnia, and depression, which are common comorbidities associated with pain Shop Now Proven to provide pain relief Severe Pain Reduction In a study of patients with severe pain, Alpha-Stim M significantly reduced pain by an average of 71% after only five treatments.1 Decrease in Post-Traumatic Pain In a post-traumatic pain study, 56% of patients at 3 months and 85% at 6 months were somewhat or very satisfied with the device for reducing pain levels. 2 ImprovedFunction One study found that chronic pain patients using Alpha-Stim reported significantly improved functionality over those receiving the usual care. 3 Better than drug-treatments When compared to pain relief responses from patients using Vicodin and OxyContin, patients self-reported greater reductions in pain with Alpha-Stim.4 Two Separate Modalities The Alpha-Stim M includes handheld Smart Probes or AS-Trode self-adhesive electrodes for site-specific MET pain therapy, as well as earclips that provide cranial electrotherapy stimulation (CES)—to relieve common comorbidities associated with pain, including anxiety, insomnia, and depression. Overall Decrease in Anxiety In clinical trials, patients reported an average of 61% less anxiety immediately after using the CES therapy. After 5 weeks, that average was 94%.5 Increased Sleep Time After only 5 Alpha-Stim insomnia treatments, military service members with insomnia reported an increase of 43 minutes of sleep. 6 Decrease in Depression In clinical trials, Alpha-Stim recipients reported an 82% decrease of ≥ 50% or greater in depression scores after five weeks using the CES therapy. 7 Take charge of Your life Alpha-Stim M is an FDA cleared non-drug, non-surgical device designed to relieve acute, chronic, and post-traumatic pain, along with anxiety, insomnia, and depression. Shop Now Alpha-Stim vs. TENS Therapy for Pain Relief Both Alpha-Stim and transcutaneous electrical nerve stimulation (TENS) units are used to provide drug-free pain treatment, but there is a big difference in what they do and how they perform.And while they both provide pain relief via an electrical device, that’s where the similarities end.Many choose a TENS unit at first because it can be quick to initially reduce some pain; however, the results are usually short-term. Conversely, the effects of Alpha-Stim are not only fast-acting but long-lasting and cumulative, for more sustainable pain relief over time. Learn more about the differences between Alpha-Stim and TENS here > Alpha-Stim vs. TENS Therapy for Pain Relief Both Alpha-Stim and transcutaneous electrical nerve stimulation (TENS) units are used to provide drug-free pain treatment, but there is a big difference in what they do and how they perform.And while they both provide pain relief via an electrical device, that’s where the similarities end.Many choose a TENS unit at first because it can be quick to initially reduce some pain; however, the results are usually short-term. Conversely, the effects of Alpha-Stim are not only fast-acting but long-lasting and cumulative, for more sustainable pain relief over time. Learn more about the differences between Alpha-Stim and TENS here > “With the help of Alpha-Stim, I can now go up and down stairs like a normal person—without the pain and discomfort that I have had since 1942.” Bud Rome, US Military Veteran New Jersey “Alpha-Stim has proven, over time, to be my reliable source for relief. It eliminates my severe and chronic pain and restores a welcomed and peaceful sense of well-being.” Jack McCallister, US Military VeteranOklahoma “Alpha-Stim got me over ‘the hump’ and made pain manageable…with continued signs of improvement. Thank you for helping me take my life back.” Mitchell LeffertTennessee Previous Next A Technology Patients & Providers Trust Alpha-Stim has been helping hundreds of thousands of people take charge of their anxiety, insomnia and pain. Alpha-Stim technology has led the way with innovative non-drug medical devices. Alpha-Stim AID and Alpha-Stim M devices are highly praised by both patients and providers. See more about why many choose Alpha-Stim » Alpha-Stim Mobile App & Accessories To help you get the most out of your Alpha-Stim M, explore our Alpha-Stim accessories. Our unique mobile app also offers Alpha-Stim users a personalized way to keep track of sessions and progress over time.  Everything you need to keep up with your Alpha-Stim M treatments. Explore our collection of Alpha-Stim M accessories including a carrying case, earclip electrodes, AS-Trodes™, and more.  View Accessories Keep track of your progress with Alpha-Stim AID or Alpha-Stim M with the Alpha-Stim Health Tracker App. Track your treatment sessions, log daily check-ins, view progress analytics, take assessments and more.  Download Now TAKE CHARGE OF YOUR LIFE WITH ALPH-STIM telehealth Visit See if Alpha-Stim is right for you via a telehealth visit with a licensed healthcare provider Schedule Now shop online Purchase Alpha-Stim devices and accessories in our online store Shop Now talk with our team Speak with a representative on the phone to learn more Call Now Sources:1 Holubec, Jerry T. Cumulative response from cranial electrotherapy stimulation (CES) for chronic pain. Practical Pain Management. 2009; 9(9):80-83..2 Tan, Gabriel, Rintala, Diana, Jensen, Mark P., Richards, J. Scott, Holmes, Sally Ann, Parachuri, Rama, Lashgari-Saegh, Shamsi and Price, Larry R. 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. The Journal of Spinal Cord Medicine. 2011; 34(3):285-296.3 Taylor AG, Anderson JG, Riedel SL, et al. Cranial Electrotherapy Stimulation improves symptoms and functional status in individuals with fibromyalgia. Pain Management Nursing. 2013 Dec; 14(4):327-335.4 Kirsch, D.L., Price, L.R., Nichols, F., Marksberry, J.A., & Platoni, K.T. Military Service Member and Veteran Self-Reports of Efficacy of Cranial Electrotherapy Stimulation for Anxiety, PTSD, Insomnia, and Depression. (2014). The Army Medical Department Journal, 46-54.5 Barclay TH, Barclay RD. A clinical Trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders. 2014;164:171-177. Presented at the American Psychological Association National Conference, Honolulu, July 2013.6 Lande RG, Gragnani C. Efficacy of Cranial Electric Stimulation for the treatment of insomnia: A randomized pilot study. Complementary Therapies in Medicine. 2013; 21(1):8-13.7 Barclay TH, Barclay RD. A clinical Trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders. 2014; 164:171-177. Presented at the American Psychological Association National Conference, Honolulu, July 2013. ### Alpha-Stim AID alpha-stim® AID Take Charge of Anxiety, Insomnia and Depression* with Alpha-Stim AID Alpha-Stim AID is an FDA-cleared, non-drug medical device designed to provide sustainable, long-term relief *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Alpha-Stim Aid Take Charge ofanxiety, insomniaand depression* Alpha-Stim® AID Features Treats anxiety, insomnia, and depression* Can be used as an adjunct to pharmacotherapy without polypharmacy effects Can be used at home safely and easily Treatments are cumulative and show improved sustainable results over time Includes earclips for CES therapy for treating anxiety and insomnia Shop Now Proven to Help with Anxiety, Insomnia & Depression Overall Decrease in Anxiety In clinical trials, patients reported an average of 61% less anxiety immediately after using the CES therapy. After 5 weeks, that average was 94%.1 Results in 1 Application In a study of preoperative anxiety, Alpha-Stim recipients reported significantly less anxiety after one 20-minute treatment.2 Increased Sleep Time After only 5 treatments, military Service Members with insomnia reported an increase of 43 minutes of sleep.3 Improved Sleep Quality The number of subjects rating their quality of sleep as poor dropped from 60% to 5%. 4 Decrease in Depression In clinical trials, Alpha-Stim recipients reported an 82% decrease of ≥ 50% or greater in depression scores after five weeks using the CES therapy. Hear What People Are Saying About Alpha-Stim® “As a mom and having the unstable job of being an actress, who sometimes needs to travel all over the world to work, it can be demanding and at times quite stressful. I never thought of myself as having anxiety the way it was usually described to me but when I think back to a few months ago, and throughout the pandemic (where projects fell through and a lot of uncertainty with my job was a constant for quite some time) I can say now that I have indeed experienced bursts of anxiety.After getting Alpha-Stim and using it for 20 minutes every day (I have had it for over 6 months now) it is safe to say that my stress and anxiety have decreased so much. I am more calm and focused when dealing with the day to day mom life, I am at ease when I travel and need help from my family with my son (my friends and my parents have been amazing at bringing my son to me when I am away working, or taking care of him at home while I am away) and before, that would stress me out a lot. Now, I go through my days with minimum stress and anxiety and absolutely love my Alpha-Stim for it.”— Ragga Ragnars, Actress, Former Olympic SwimmerView More Testimonials from Patients and Providers » Take Charge of Your Life Manage anxiety, insomnia, and depression without medication and anywhere, anytime with Alpha-Stim AID. Shop Now “Not only have I experienced relief from anxiety and insomnia; additionally, Alpha-Stim treatments have reduced or eliminated accompanying physical pain.” CH (MAJ) David J. Fair PhD,Former President, American Association of Police Officers; Former President, Homeland Crisis InstituteTexas “The Alpha-Stim has so much good science behind it, with many highly controlled clinical studies—this really proves its unique effectiveness for so many types of patients. And you can’t ignore the incredible safety record with no serious side effects. That’s why I recommend it to many of my patients.” Anita D. Spitz, MD, Chief Family Medicine Department Parrish Medical CenterTitusville, Florida “So far, I have overall had good results from the Alpha-Stim AID. In fact, one day while doing household tasks I walked in front of a mirror and noticed that I was smiling! That's new behavior and truly a result of this device. I am also experiencing a feeling of well-being and deep sleep that I haven't experienced since college days.” Alpha-Stim User “I experienced the worst depression I have ever felt. I never have had depression until now. It’s the worst feeling ever. Makes the days go by so much slower. I went to my doctor, hoping for medicine. Instead he let me try Alpha- Stim. This product ended up being a life changer! It is awesome!” Angie Lamborghini “After 3 months, I feel like a new person. I would recommend Alpha-Stim to anyone suffering from depression or anxiety.” Laine Downing Previous Next A Technology Patients & Providers Trust Alpha-Stim has been helping hundreds of thousands of people take charge of their anxiety, insomnia and pain. Alpha-Stim technology has led the way with innovative non-drug medical devices. Alpha-Stim AID and Alpha-Stim M devices are highly praised by both patients and providers. See more about why many choose Alpha-Stim » Alpha-Stim Mobile App & Accessories To help you get the most out of your Alpha-Stim AID, explore our Alpha-Stim accessories. Our unique mobile app also offers Alpha-Stim users a personalized way to keep track of sessions and progress over time.  Everything you need to keep up with your Alpha-Stim AID treatments. Explore our collection of Alpha-Stim AID accessories including a carrying case and earclips.  View Accessories Keep track of your progress with the Alpha-Stim Health Tracker App. Track your treatment sessions, log daily check-ins, view progress analytics, take assessments and more.  Download Now Take charge of your life with alpha-stim telehealth Visit See if Alpha-Stim is right for you via a telehealth visit with a licensed healthcare provider Schedule Now shop online Purchase Alpha-Stim devices and accessories in our online store Shop Now talk with our team Speak with a representative on the phone to learn more Call Now Sources:1 Barclay TH, Barclay RD. A clinical Trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders. 2014;164:171-177. Presented at the American Psychological Association National Conference, Honolulu, July 2013.2 Lee S-H, Kim W-Y, Lee C-H, et al. Effects of cranial electrotherapy stimulation on preoperative anxiety, pain and endocrine response. Journal of International Medical Research. 2013; 41(6) 1788–1795.3 Lande RG, Gragnani C. Efficacy of Cranial Electric Stimulation for the treatment of insomnia: A randomized pilot study. Complementary Therapies in Medicine. 2013; 21(1):8-13.4 Lichtbroun AS, Raicer MMC, Smith RB. The treatment of fibromyalgia with Cranial Electrotherapy Stimulation. Journal of Clinical Rheumatology. 2001; 7(2):72-78.5 Barclay TH, Barclay RD. A clinical Trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders. 2014; 164:171-177. Presented at the American Psychological Association National Conference, Honolulu, July 2013. ### Treating Pain Take Charge of your pain A drug-free option for relief from acute,chronic and post-traumatic pain. A Safer Pain Treatment Option Many adults experience acute and/or chronic pain as a result of age, injury or an underlying condition. Alpha-Stim® M is an FDA-cleared advanced pain management device that can help provide immediate and long-term pain relief. Whether you need shoulder, neck or back pain relief – or pain management anywhere else in your body – used regularly, Alpha-Stim M can offer instant and ongoing pain relief. It’s a fast, safe and effective option for treating acute and chronic pain without the adverse side effects of opioids, making it effective for a wide variety of people including veterans, fitness enthusiasts, and aging adults. Proven to Relieve Acute & Chronic Pain Alpha-Stim M has been shown to provide significant, sustainable pain relief from acute, chronic and post-traumatic pain. Severe Pain Reduction In a study of patients with severe pain, Alpha-Stim M significantly reduced pain by an average of 71% after only five treatments.1 Decrease in Post-Traumatic Pain In a post-traumatic pain study, 56% of patients at 3 months and 85% at 6 months were somewhat or very satisfied with the device for reducing pain levels.2 Also Treats Anxiety Alpha-Stim AID is also designed to treat anxiety, providing patients with simultaneous anxiety and insomnia relief. Better Than Drug-Treatments When compared to pain relief responses from patients using Vicodin and OxyContin, patients self-reported greater reductions in pain with Alpha-Stim.3 How Does Alpha-Stim M Treat Pain? Pain transmits through your body as a sensation along billions of nerve cells designed to transmit pain messages through electrochemical signals. The Alpha-Stim M uses an exclusive, patented microcurrent waveform that modulates these signals within the cells. Using hand-held probes or attachable electrodes, Alpha-Stim M delivers advanced Microcurrent Electrical Therapy (MET) directly to the pain site to provide non-invasive, sustainable pain relief.Alpha-Stim M is an effective form of pain management designed to help you avoid or reduce the need for pain medicine, but it is safe to use with prescriptions or over-the-counter medications, if needed. LEARN MORE Alpha-Stim M Also Helps to Treat Anxiety, Insomnia, and Depression In addition to treating acute, chronic and post-traumatic pain, Alpha-Stim M can also be used to deliver Cranial Electrotherapy Stimulation (CES) to relieve anxiety, insomnia, and depression*.All three often accompany pain, so Alpha-Stim M offers a holistic treatment option for patients with pain conditions. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Get pain relief with Alpha-stim Schedule a telehealth visit with a health care professional today to get started with Alpha-Stim M for acute, chronic, and post-traumatic pain relief. Schedule Now What People Say About Alpha-Stim M See what people are saying about using Alpha-Stim M for pain management and relief. “Alpha-Stim has proven, over time, to be my reliable source for relief. It eliminates my severe and chronic pain and restores a welcomed and peaceful sense of well-being.” Jack McCalister, US VeteranOklahoma "With the help of Alpha-Stim, I can now go up and down stairs like a normal person—without the pain and discomfort that I have had since 1942." Bud Rome, US VeteranNew Jersey “Alpha-Stim got me over ‘the hump’ and made pain manageable…with continued signs of improvement. Thank you for helping me take my life back.” Mitchell LeffertTennessee Previous Next Commonly Asked Questions about Alpha-Stim for Pain Relief We’ve gotten a few questions over the years about how Alpha-Stim works for pain management. See below for some of our most common questions and answers.  What kinds of pain does Alpha-Stim relieve? Alpha-Stim M can treat all types of acute pain, chronic pain, and post-traumatic pain. Is Alpha-Stim more expensive than other treatments for pain? Over 5 years, someone who takes medication – such as pain pills – or does other treatments typically used to treat acute and chronic pain can pay thousands of dollars more than someone using Alpha-Stim. How long will I have to use Alpha-Stim? Alpha-Stim effectively controls pain, anxiety, and insomnia. For some conditions, results are experienced immediately and for others, a small amount of time and persistence provides needed relief and results. Learn more about how long to use Alpha-Stim and when to decrease usage here. Alpha-Stim M can treat all types of acute pain, chronic pain, and post-traumatic pain.Over 5 years, someone who takes medication – such as pain pills - or does other treatments typically used to treat acute and chronic pain can pay thousands of dollars more than someone using Alpha-Stim.Alpha-Stim effectively controls pain, anxiety, and insomnia. For some conditions, results are experienced immediately and for others, a small amount of time and persistence provides needed relief and results. Learn more about how long to use Alpha-Stim and when to decrease usage here. Ask Us About Alpha-Stim® telehealth Visit See if Alpha-Stim is right for you via a telehealth visit with a licensed healthcare provider Schedule Now shop online Purchase Alpha-Stim devices and accessories in our online store Shop Now talk with our team Speak with a representative on the phone to learn more Call Now Featured Content Dakota Meyers shares his experience with Alpha-Stim AID for battling his anxiety.Watch Dakota’s Story » Get a quick overview of Alpha-Stim devices for use with patients.View the Alpha-StimOverview PDF Now » A new way to treat acute and chronic pain is here, with no surgery and no medications.View the Alpha-Stim Brochure Now »Sources:1 Holubec, Jerry T. Cumulative response from cranial electrotherapy stimulation (CES) for chronic pain. Practical Pain Management. 2009; 9(9):80-83..2 Tan, Gabriel, Rintala, Diana, Jensen, Mark P., Richards, J. Scott, Holmes, Sally Ann, Parachuri, Rama, Lashgari-Saegh, Shamsi and Price, Larry R. 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. The Journal of Spinal Cord Medicine. 2011; 34(3):285-296.3 Taylor AG, Anderson JG, Riedel SL, et al. Cranial Electrotherapy Stimulation improves symptoms and functional status in individuals with fibromyalgia. Pain Management Nursing. 2013 Dec; 14(4):327-335.3 Kirsch, D.L., Price, L.R., Nichols, F., Marksberry, J.A., & Platoni, K.T. Military Service Member and Veteran Self-Reports of Efficacy of Cranial Electrotherapy Stimulation for Anxiety, PTSD, Insomnia, and Depression. (2014). The Army Medical Department Journal, 46-54. ### Treating Depression Take Charge of your mental health A drug-free approach to managing depressionFDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States Take Charge of your mental health FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States A New Way to Manage Depression About 280 million people worldwide suffer from depression, the World Health Organization reports. Studies have also found that depression is more common in women than in men, and that older adults are more likely to report depression.Depression can impact everything from your relationships, your job, your overall health, and how you interact with the world around you. And because depression can appear across a range from mild to severe, how to manage it varies by person. And thankfully, medications and other more aggressive therapies are not the only option anymore.For those seeking help with their depression, Alpha-Stim® M and Alpha-Stim AID devices offer a safe, effective, and easy option. While Alpha-Stim is only FDA cleared for anxiety, insomnia, and pain, it is approved for depression outside of the United States. Significant Depression Reduction without Medication Managing depression without medication is possible. Alpha-Stim is cranial electrotherapy stimulation (CES) device that can be used at home or in clinical settings by licensed health providers to help individuals with depression. Decrease in Depression In clinical trials, Alpha-Stim recipients reported an 82% decrease of ≥ 50% or greater in depression scores after five weeks using the CES therapy.1 Improvement After Use In a clinical trial of Alpha-Stim patients, After 6 weeks, users experienced 42.8% improvement.2 How Does Alpha-Stim Treat Depression? Alpha-Stim is a non-invasive, non-drug cranial electrotherapy stimulation (CES) device that can be used to help individuals with depression, along with anxiety and insomnia. The device uses a patented microcurrent waveform to balance the electrochemical function of the brain to improve users’ emotional and physiological states.Patients wear earclip electrodes that deliver a small electrical current to the brain to help regulate brain cells’ electrochemical signals and return them to a balanced, normal functioning state.And because the effects of Alpha-Stim build on the progress of the last session, Alpha-Stim users can decrease sessions over time. Moreover,  because CES does not involve any chemicals, Alpha-Stim users are free from the worry of dependence and withdrawal.  LEARN MORE See if Alpha-Stim is Right for You. Give Alpha-Stim M or Alpha-Stim AID a try for treating and managing your depression. Schedule a telehealth consult today with a licensed health care provider to get started. Schedule now What People Say About Alpha-Stim See what people are saying about using Alpha-Stim for depression, anxiety, and improved mental well-being. “I experienced the worst depression I have ever felt. I never have had depression until now. It’s the worst feeling ever. Makes the days go by so much slower. I went to my doctor, hoping for medicine. Instead he let me try Alpha- Stim. This product ended up being a life changer! It is awesome!” Angie Lamborghini “As a mom and having the unstable job of being an actress, who sometimes needs to travel all over the world to work, it can be demanding and at times quite stressful. I never thought of myself as having anxiety the way it was usually described to me but when I think back to a few months ago, and throughout the pandemic (where projects fell through and a lot of uncertainty with my job was a constant for quite some time) I can say now that I have indeed experienced bursts of anxiety.” Ragga Ragnars, Actress, Former Olympic Swimmer “Words fall short in expressing the depth of gratitude I feel toward such an effective treatment available for people, like me, who have suffered from depression and anxiety.” Lee Jones "After getting Alpha-Stim and using it for 20 minutes every day (I have had it for over 6 months now) it is safe to say that my stress and anxiety has decreased so much. I am more calm and focused when dealing with the day to day mom life, I am at ease when I travel and need help from my family with my son (my friends and my parents have been amazing at bringing my son to me when I am away working, or taking care of him at home while I am away) and before, that would stress me out a lot. Now, I go through my days with minimum stress and anxiety and absolutely love my Alpha-Stim for it." Ragga Ragnars, Actress, Former Olympic Swimmer “After 3 months, I feel like a new person. I would recommend Alpha-Stim to anyone suffering from depression or anxiety.” Laine Downing “I am a critical care nurse that had Covid twice in 2020 while providing bedside care to inpatient veterans at Salem VAMC. I am now disabled due to long-Covid with physical and mental health issues. I am on 3 medications for anxiety (panic attacks) & depression with limited effect. In my first 20-minute session, the Alpha-Stim device relieved my long-COVID anxiety. As a nurse, I hope for the best and prepare for the worst. Alpha-Stim has me believing in miracles. Thank you! While I still have other long-Covid issues to deal with, my quality of life has been greatly improved due to alpha-stim. All the best and be curious!” Michael Huemmer, RN “I am a full time mom to an almost 7-month-old boy. Sleep deprivation worsens my anxiety and usually leads to me being down and depressed. I’ve had my Alpha-Stim for over a year now but was not religiously using it. But now I really need it for my heightened anxiety. I’ve been using it for the last 3 days and it’s been calming me down. I find that 20 mins while I meditate helps a lot. I am 100% committed to using my Alpha-Stim daily. I’m so happy I found this. Much better than taking medication. Thank you!” Precilla Morse Previous Next Take charge of your life with Alpha-Stim telehealth Visit See if Alpha-Stim is right for you via a telehealth visit with a licensed healthcare provider Schedule Now shop online Purchase Alpha-Stim devices and accessories in our online store Shop Now talk with our team Speak with a representative on the phone to learn more Call Now Sources:1 Barclay TH, Barclay RD. A clinical Trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders. 2014; 164:171-177. Presented at the American Psychological Association National Conference, Honolulu, July 2013.2 Platoni K, Oakley R, Haltiwanger SG, Kirsch TB, Marksberry J and Price LR. First responder research shows that electrical brain stimulation helps control anxiety, insomnia, and depression. JJ Psych Behav Sci. 2019; 6(1): 25-31. ### Treating Insomnia Take charge of your sleep An FDA-cleared, drug-free optionfor treating insomnia A New Way to Fight Insomnia Insomnia is the most common sleep disorder among adults worldwide. Various studies show that insomnia may be prevalent in 10-60% of the population. Insomnia is often the result of underlying causes such as high stress or anxiety, depression, certain medications, or other health conditions.And because insomnia can negatively impact mental and physical well-being, we developed Alpha-Stim® to provide a drug-free treatment option that’s safe and easy to use at home. Shop NOw Clinically Proven to Relieve Insomnia Alpha-Stim is an FDA cleared CES medical device that is clinically proven to treat insomnia and safe to use at home. INCREASED SLEEP TIME After only 5 treatments, military Service Members with insomnia reported an increase of 43 minutes of sleep.1 IMPROVED SLEEP QUALITY In one study, the number of subjects rating their quality of sleep as poor dropped from 60% to 5% after using Alpha-Stim.2 Preferred Over Medication One survey showed patients feel better with Alpha-Stim insomnia treatment than with common sleep drugs.3 Also Treats Anxiety Alpha-Stim is also designed to treat anxiety, providing patients with simultaneous anxiety and insomnia relief. How Does Alpha-Stim Work for Insomnia? Alpha-Stim is an FDA cleared CES medical device used to treat insomnia and improve overall sleep quality using an exclusive, patented waveform technology. This revolutionary waveform passes between two electrodes clipped to your earlobes to help restore balance in your brain and thereby reduce disrupted sleep.Alpha-Stim can be used between 20 minutes and 1 hour, daily, and over time, treatments can be decreased to 2-3 times per week as results improve. And because the effects of Alpha-Stim build on the progress of the last session, many Alpha-Stim users see increased levels of relief over time. Moreover,  because CES does not involve any chemicals, Alpha-Stim users are free from the worry of dependence and withdrawal. LEARN MORE What People Say About Alpha-Stim for Insomnia See what people are saying about using Alpha-Stim for treating insomnia and improving sleep quality. “The Alpha-Stim is great for our whole family! It has helped me sleep better, have a better mood, and get rid of pain! It has helped my daughter be calmer and not so hyper.” Jennifer King Guido "Not only have I experienced relief from anxiety and insomnia; additionally, Alpha-Stim treatments have reduced or eliminated accompanying physical pain." CH (MAJ) David J. Fair, PhD, Former President, American Association of Police Officers; Former President, Homeland Crisis Institute Texas “I haven’t slept more than 4 hours in a night in years. The VA used this on me last week, 30 minutes a day for three days. I slept 6 hours two nights and almost 7 the third night. More sleep, better the mood, much less anxiety.” Paul Reinhardt, US Veteran Previous Next Get a better night’s sleep. Schedule a telehealth consult today with a licensed health care provider to give Alpha-Stim a try. Schedule now Commonly Asked Questions about Insomnia We’ve gotten a few questions over the years about sleep disorders, and especially insomnia. Below are a few with answers from professionals.*Please consult with a physician for medical advice. The information below does not replace medical advice received by physician. Why do I feel tired and low on energy all day, but when I go to bed I can’t sleep? If you’re feeling tired all day, you’ve likely been tempted to either double down on your caffeine intake or take a nap. Though it may seem counterintuitive, a recent article from Harvard recommends avoiding napping, as it can ruin your body’s “appetite” for sleep later at night. Caffeine consumption can likewise prevent your body from entering a restful state, even hours later.Try to stick to a schedule – even if it’s different from your “normal” routine.  Waking and going to bed at the same time each day can help your body get into a groove. It doesn’t matter if your new schedule looks completely different from what it used to; what matters is consistency. I can fall asleep, but it’s not restful, and I keep waking up. What can I do? Our bodies are wired to stay awake when we feel threatened, according to Janet Kennedy, PhD, founder of NYC Sleep Doctor. “Our bodies are misfiring,” she says, making it impossible for us to stay asleep. Dr. Kennedy recommends getting out of bed when this happens – watch a TV show, work on a puzzle, do some dishes. Waiting to go back to sleep will only make you frustrated.If insomnia is an ongoing issue for you, treatments with Alpha-Stim can bring you better quality, longer sleep. Treatments take just 20 minutes to an hour and are done in the comfort of your own home. Getting better sleep will help you be better prepared for the next day. Does insomnia trigger sleep apnea or vice versa? The American Sleep Foundation says sleep apnea and drugs prescribed to remedy other medical conditions are among the causes of insomnia.Alpha-Stim for insomnia treatment is ideal in these situations because it offers insomnia relief and better sleep habits without medication. If you’re feeling tired all day, you’ve likely been tempted to either double down on your caffeine intake or take a nap. Though it may seem counterintuitive, a recent article from Harvard recommends avoiding napping, as it can ruin your body’s “appetite” for sleep later at night. Caffeine consumption can likewise prevent your body from entering a restful state, even hours later.Try to stick to a schedule – even if it’s different from your “normal” routine.  Waking and going to bed at the same time each day can help your body get into a groove. It doesn’t matter if your new schedule looks completely different from what it used to; what matters is consistency.Our bodies are wired to stay awake when we feel threatened, according to Janet Kennedy, PhD, founder of NYC Sleep Doctor. “Our bodies are misfiring,” she says, making it impossible for us to stay asleep. Dr. Kennedy recommends getting out of bed when this happens – watch a TV show, work on a puzzle, do some dishes. Waiting to go back to sleep will only make you frustrated.If insomnia is an ongoing issue for you, treatments with Alpha-Stim can bring you better quality, longer sleep. Treatments take just 20 minutes to an hour and are done in the comfort of your own home. Getting better sleep will help you be better prepared for the next day.The American Sleep Foundation says sleep apnea and drugs prescribed to remedy other medical conditions are among the causes of insomnia.Alpha-Stim for insomnia treatment is ideal in these situations because it offers insomnia relief and better sleep habits without medication. TAKE CHARGE OF YOUR LIFE WITH ALPHA-STIM telehealth Visit See if Alpha-Stim is right for you via a telehealth visit with a licensed healthcare provider Schedule Now shop online Purchase Alpha-Stim devices and accessories in our online store Shop Now talk with our team Speak with a representative on the phone to learn more Call Now Featured Content Dakota Meyers shares his experience with Alpha-Stim AID for battling his anxiety.Watch Dakota’s Story » Get a quick overview of Alpha-Stim devices for use with patients.View the Alpha-StimOverview PDF Now » A new way to treat insomnia is here, with no medications or lasting side effects.View the Alpha-Stim Brochure Now »Sources:1Lande RG, Gragnani C. Efficacy of Cranial Electric Stimulation for the treatment of insomnia: A randomized pilot study. Complementary Therapies in Medicine. 2013; 21(1):8-13.2Lichtbroun AS, Raicer MMC, Smith RB. The treatment of fibromyalgia with Cranial Electrotherapy Stimulation. Journal of Clinical Rheumatology. 2001; 7(2):72-78.3Kirsch, D.L., Price, L.R., Nichols, F., Marksberry, J.A., & Platoni, K.T. Military Service Member and Veteran Self-Reports of Efficacy of Cranial Electrotherapy Stimulation for Anxiety, PTSD, Insomnia, and Depression. (2014). The Army Medical Department Journal, 46-54. ### Treating Anxiety Take Charge of your anxiety An FDA cleared, drug-free option for treating anxiety Take Charge of your anxiety A New Way to Manage Anxiety If you’ve ever experienced anxiety, you’re not alone. Nearly 264 million people worldwide have an anxiety disorder, the World Health Organization reports. And an estimated 30% of adults will suffer from anxiety at some point in their lifetime.Anxiety can be crippling for many people, but thankfully, medications and other more aggressive therapies are not the only option.For those seeking more control of their anxiety treatment, Alpha-Stim®  offers a safe, effective, and easy option. Significant Anxiety Relief without Medication Overall Decrease in Anxiety In clinical trials, patients reported an average of 61% less anxiety immediately after using the CES therapy. After 5 weeks, that average was 94%.1 Results in 1 Application In a study of preoperative anxiety, Alpha-Stim recipients reported significantly less anxiety after one 20-minute treatment.2 GreaterRelief In clinical studies, patients using Alpha-Stim reported greater relief from anxiety than patients taking drugs, all without side effects. How Does Alpha-Stim Treat Anxiety? Alpha-Stim is a non-invasive, non-drug cranial electrotherapy stimulation (CES) device that is FDA cleared to safely and effectively treat anxiety and insomnia. The device uses a unique, patented waveform of electrical current to balance the electrochemical function of the brain in order to improve users’ emotional and physiological states.Patients apply earclip electrodes that deliver a low-amplitude, rhythmic current to the brain, which helps regulate brain cells’ electrochemical signals and return them to a balanced, normal functioning state.Many users see results after their first treatment. And because the effects of Alpha-Stim build on the progress of the last session, many Alpha-Stim users see increased levels of relief over time. Moreover,  because CES does not involve any chemicals, Alpha-Stim users are free from the worry of dependence and withdrawal. LEARN MORE See if Alpha-Stim is Right for You. Give Alpha-Stim AID or Alpha-Stim M a try for anxiety relief today. Schedule a telehealth consult below with a licensed health care provider to get started. Schedule now What People Say About Alpha-Stim for Anxiety See what people are saying about using Alpha-Stim for anxiety relief and improved mental well-being. “As a mom and having the unstable job of being an actress, who sometimes needs to travel all over the world to work, it can be demanding and at times quite stressful. I never thought of myself as having anxiety the way it was usually described to me but when I think back to a few months ago, and throughout the pandemic (where projects fell through and a lot of uncertainty with my job was a constant for quite some time) I can say now that I have indeed experienced bursts of anxiety.” Ragga Ragnars, Actress, Former Olympic Swimmer "After getting Alpha-Stim and using it for 20 minutes every day (I have had it for over 6 months now) it is safe to say that my stress and anxiety has decreased so much. I am more calm and focused when dealing with the day to day mom life, I am at ease when I travel and need help from my family with my son (my friends and my parents have been amazing at bringing my son to me when I am away working, or taking care of him at home while I am away) and before, that would stress me out a lot. Now, I go through my days with minimum stress and anxiety and absolutely love my Alpha-Stim for it." Ragga Ragnars, Actress, Former Olympic Swimmer “I am a critical care nurse that had Covid twice in 2020 while providing bedside care to inpatient veterans at Salem VAMC. I am now disabled due to long-Covid with physical and mental health issues. I am on 3 medications for anxiety (panic attacks) & depression with limited effect. In my first 20-minute session, the Alpha-Stim device relieved my long-COVID anxiety. As a nurse, I hope for the best and prepare for the worst. Alpha-Stim has me believing in miracles. Thank you! While I still have other long-Covid issues to deal with, my quality of life has been greatly improved due to alpha-stim. All the best and be curious!” Michael Huemmer, RN “I am a full time mom to an almost 7-month-old boy. Sleep deprivation worsens my anxiety and usually leads to me being down and depressed. I’ve had my Alpha-Stim for over a year now but was not religiously using it. But now I really need it for my heightened anxiety. I’ve been using it for the last 3 days and it’s been calming me down. I find that 20 mins while I meditate helps a lot. I am 100% committed to using my Alpha-Stim daily. I’m so happy I found this. Much better than taking medication. Thank you!” Precilla Morse Commonly Asked Questions about Alpha-Stim for Anxiety We’ve gotten a few questions over the years about how Alpha-Stim works for anxiety. See below for some of our most common questions and answers.  How effective is Alpha-Stim AID for treating anxiety and insomnia? Nine out of 10 patients reported significant improvements in these conditions. Alpha-Stim AID has been proven effective by numerous clinical research studies. You can view clinical research and data here. Is Alpha-Stim more expensive than other treatments for anxiety or insomnia? Over 5 years, someone who takes medication – such as pain pills, antidepressants and sleep aids – or does other treatments typically used to treat anxiety or insomnia can pay thousands of dollars more than someone using Alpha-Stim. How long will I have to use Alpha-Stim? Alpha-Stim effectively controls pain, anxiety, and insomnia. For some conditions, results are experienced immediately and for others a small amount of time and persistence provides needed relief and results. Learn more about how long to use Alpha-Stim and when to decrease usage here. Nine out of 10 patients reported significant improvements in these conditions. Alpha-Stim AID has been proven effective by numerous clinical research studies. You can view clinical research and data here.Over 5 years, someone who takes medication – such as pain pills, antidepressants and sleep aids – or does other treatments typically used to treat anxiety or insomnia can pay thousands of dollars more than someone using Alpha-Stim.Alpha-Stim effectively controls pain, anxiety, and insomnia. For some conditions, results are experienced immediately and for others a small amount of time and persistence provides needed relief and results. Learn more about how long to use Alpha-Stim and when to decrease usage here. TAKE CHARGE OF YOUR LIFE WITH ALPHA-STIM telehealth Visit See if Alpha-Stim is right for you via a telehealth visit with a licensed healthcare provider Schedule Now shop online Purchase Alpha-Stim devices and accessories in our online store Shop Now talk with our team Speak with a representative on the phone to learn more Call Now Featured Content Dakota Meyers shares his experience with Alpha-Stim AID for battling his anxiety.Watch Dakota’s Story » Get a quick overview of Alpha-Stim devices for use with patients.View the Alpha-StimOverview PDF Now » A new way to treat anxiety is here, with no medications or lasting side effects.View the Alpha-Stim Brochure Now »Sources:1 Barclay TH, Barclay RD. A clinical Trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders. 2014;164:171-177. Presented at the American Psychological Association National Conference, Honolulu, July 2013.2 Lee S-H, Kim W-Y, Lee C-H, et al. Effects of cranial electrotherapy stimulation on preoperative anxiety, pain and endocrine response. Journal of International Medical Research. 2013; 41(6) 1788–1795. ### FAQs Alpha-Stim FAQs See below for some FAQs and commonly asked questions and answers by patients and healthcare practitioners about Alpha-Stim® technologies for treating anxiety, insomnia, depression*, and relieving pain.*FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Facts About Using Alpha-Stim for Anxiety, Insomnia, Depression, and Pain What does Alpha-Stim treat? Alpha-Stim is a prescription medical device that is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. While prescription is required in the US, it is available over-the-counter in other countries.Alpha-Stim AID is a cranial electrical therapy device for treating anxiety, insomnia, and depression.Alpha-Stim M is specifically designed as a drug-free pain relief treatment option for acute pain, post-traumatic pain, and chronic pain, along with treating anxiety, insomnia, and depression. What kinds of pain does Alpha-Stim relieve? Alpha-Stim M can help relieve all types of acute pain, chronic pain, and post-traumatic pain. Get more information here. How long will I have to use Alpha-Stim? Alpha-Stim effectively treats your anxiety, insomnia, depression, and pain. For some conditions, results are experienced immediately and for others a small amount of time and persistence provides needed relief and results. Learn more about how long to use Alpha-Stim and when to decrease usage here. Is Alpha-Stim safe to use? Yes. In over 40 years of clinical studies involving over 8,800 people, only minor side effects such as headaches and skin irritation at electrode sites have been reported by a tiny fraction of users. You can view all risk information here. Can Alpha-Stim treat pain and anxiety at the same time? We recommend treating your pain first, followed by cranial electrical stimulation treatment for anxiety, and/or insomnia. Alpha-Stim is uniquely designed to be used for anxiety, insomnia, depression, and pain. Learn more here. How effective is Alpha-Stim for treating anxiety and  insomnia? Nine out of 10 patients report significant improvements in these conditions. You can view clinical research and data here. Will I have to stop taking my medications when using Alpha-Stim? There has been no evidence of drug interaction in 40 years of research and use of Alpha-Stim. Medication change is a decision that should be discussed with your healthcare practitioner. Is Alpha-Stim approved to treat all mental health conditions? Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Alpha-Stim is a prescription medical device that is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. While prescription is required in the US, it is available over-the-counter in other countries.Alpha-Stim AID is a cranial electrical therapy device for treating anxiety, insomnia, and depression.Alpha-Stim M is specifically designed as a drug-free pain relief treatment option for acute pain, post-traumatic pain, and chronic pain, along with treating anxiety, insomnia, and depression.Alpha-Stim M can help relieve all types of acute pain, chronic pain, and post-traumatic pain. Get more information here.Alpha-Stim effectively treats your anxiety, insomnia, depression, and pain. For some conditions, results are experienced immediately and for others a small amount of time and persistence provides needed relief and results. Learn more about how long to use Alpha-Stim and when to decrease usage here.Yes. In over 40 years of clinical studies involving over 8,800 people, only minor side effects such as headaches and skin irritation at electrode sites have been reported by a tiny fraction of users. You can view all risk information here.We recommend treating your pain first, followed by cranial electrical stimulation treatment for anxiety, and/or insomnia. Alpha-Stim is uniquely designed to be used for anxiety, insomnia, depression, and pain. Learn more here.Nine out of 10 patients report significant improvements in these conditions. You can view clinical research and data here.There has been no evidence of drug interaction in 40 years of research and use of Alpha-Stim. Medication change is a decision that should be discussed with your healthcare practitioner.Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Getting Alpha-Stim Does my doctor need to prescribe Alpha-Stim? [Is a prescription required for Alpha-Stim? In the United States, a licensed healthcare practitioner needs to write a prescription for the device to be purchased. If you do not have a doctor or would like to consult with a telehealth group, click here. Learn more about getting Alpha-Stim in the United States here.For the rest of the world (outside of the USA), Alpha-Stim is available over the counter. How can I get Alpha-Stim M or Alpha-Stim AID for patients? Typically trying Alpha-Stim in the office or clinic can identify those individuals who readily respond to Alpha-Stim treatment. You or your patients can fulfill your order in 3 easy ways:Shop our online storeCall 1-800-367-7246Fax a retail order form Is there special pricing for practitioners? Special pricing options for practitioners may be available. For practitioner volume discount pricing, call us at 1-800-367-7246 (in USA), + (940) 328-0788 (outside USA), or email us at info@epii.com. How much do Alpha-Stim M and Alpha-Stim AID cost? The Alpha-Stim M device, which treats pain, anxiety, insomnia, and depression, costs $1,299.The Alpha-Stim AID device,  which treats anxiety, insomnia, and depression, costs $840.Alpha-Stim comes with a 30-day money back satisfaction guarantee, a 5-year limited warranty, and accessory costs are minimal. Is Alpha-Stim more expensive than other treatments for anxiety, insomnia, depression or pain? Over 5 years, someone who takes medication – such as pain pills, antidepressants and sleep aids – or does other treatments typically used to treat pain, anxiety and insomnia can pay thousands of dollars more than someone using Alpha-Stim. Will my health insurance cover Alpha-Stim? Insurance coverage varies by policy. Durable medical equipment coverage is often required to obtain some level of reimbursement for Alpha-Stim devices. EPI does not bill private carriers but will assist customers by providing a paid invoice and a sample Statement of Medical Necessity for your practitioner to complete. This statement is typically required by the insurance carrier if the device is covered.The HCPCS code for the Alpha-Stim AID is E0732 and the Alpha-Stim M is E1399.If you have a flex spending account (FSA) or health savings account (HSA), you may use these to purchase an Alpha-Stim. In the United States, a licensed healthcare practitioner needs to write a prescription for the device to be purchased. If you do not have a doctor or would like to consult with a telehealth group, click here. Learn more about getting Alpha-Stim in the United States here.For the rest of the world (outside of the USA), Alpha-Stim is available over the counter.Typically trying Alpha-Stim in the office or clinic can identify those individuals who readily respond to Alpha-Stim treatment. You or your patients can fulfill your order in 3 easy ways:Shop our online storeCall 1-800-367-7246Fax a retail order formSpecial pricing options for practitioners may be available. For practitioner volume discount pricing, call us at 1-800-367-7246 (in USA), + (940) 328-0788 (outside USA), or email us at info@epii.com.The Alpha-Stim M device, which treats pain, anxiety, insomnia, and depression, costs $1,299.The Alpha-Stim AID device,  which treats anxiety, insomnia, and depression, costs $840.Alpha-Stim comes with a 30-day money back satisfaction guarantee, a 5-year limited warranty, and accessory costs are minimal.Over 5 years, someone who takes medication – such as pain pills, antidepressants and sleep aids – or does other treatments typically used to treat pain, anxiety and insomnia can pay thousands of dollars more than someone using Alpha-Stim.Insurance coverage varies by policy. Durable medical equipment coverage is often required to obtain some level of reimbursement for Alpha-Stim devices. EPI does not bill private carriers but will assist customers by providing a paid invoice and a sample Statement of Medical Necessity for your practitioner to complete. This statement is typically required by the insurance carrier if the device is covered.The HCPCS code for the Alpha-Stim AID is E0732 and the Alpha-Stim M is E1399.If you have a flex spending account (FSA) or health savings account (HSA), you may use these to purchase an Alpha-Stim. Other Alpha-Stim FAQs How soon after I order Alpha-Stim will it arrive? Please allow 1-2 business days for processing before the order ships. Alpha-Stim M or AID orders require a prescription before processing. A refund of shipping charges will not be provided due to carrier delays. What does Alpha-Stim look like? The Alpha-Stim M and AID devices are both about the size of a small rectangular cell phone, (but a little thicker). What do I need to help me get started with Alpha-Stim? Each Alpha-Stim device comes with everything you need to get started: earclip electrodes and earclip electrode pads (for the Alpha-Stim AID  and Alpha-Stim M), AS-Trodes and Smart Probes with probe electrode pads (only included for the the Alpha-Stim M), Alpha-Stim Conducting Solution (to ensure a good electrical connection), two 1.5 volt batteries per device (AA for the M, and AAA for the AID), and a convenient lanyard for you to wear the Alpha-Stim device around your neck.Each Alpha-Stim also comes with an owner’s manual that explains how to use the device and what kind of relief you can expect from it.Visit our Resource Center to find online copies of the Alpha-Stim owner’s manuals and watch helpful how-to videos for using Alpha-Stim AID and Alpha-Stim M. Why is Alpha-Stim “cleared” by the FDA, not “approved”? All medical device manufacturers who seek to market devices in the United States must register with the FDA through one of two ways—the section 510(k) process, where a device is “cleared” for distribution, or the Pre-Market Approval process, where a device is “approved” by the FDA.Alpha-Stim has undergone the 510(k) process and is FDA-approved for the treatment of anxiety and insomnia as well as acute, post-traumatic, and chronic pain.Read a more in-depth explanation here. Please allow 1-2 business days for processing before the order ships. Alpha-Stim M or AID orders require a prescription before processing. A refund of shipping charges will not be provided due to carrier delays.The Alpha-Stim M and AID devices are both about the size of a small rectangular cell phone, (but a little thicker).Each Alpha-Stim device comes with everything you need to get started: earclip electrodes and earclip electrode pads (for the Alpha-Stim AID  and Alpha-Stim M), AS-Trodes and Smart Probes with probe electrode pads (only included for the the Alpha-Stim M), Alpha-Stim Conducting Solution (to ensure a good electrical connection), two 1.5 volt batteries per device (AA for the M, and AAA for the AID), and a convenient lanyard for you to wear the Alpha-Stim device around your neck.Each Alpha-Stim also comes with an owner’s manual that explains how to use the device and what kind of relief you can expect from it.Visit our Resource Center to find online copies of the Alpha-Stim owner’s manuals and watch helpful how-to videos for using Alpha-Stim AID and Alpha-Stim M.All medical device manufacturers who seek to market devices in the United States must register with the FDA through one of two ways—the section 510(k) process, where a device is “cleared” for distribution, or the Pre-Market Approval process, where a device is “approved” by the FDA.Alpha-Stim has undergone the 510(k) process and is FDA-approved for the treatment of anxiety and insomnia as well as acute, post-traumatic, and chronic pain.Read a more in-depth explanation here. ### Research Alpha-Stim Research, Studies and Reports Alpha-Stim® has been on the market as a pain and mental health solution for over 40 years and has more research than any other therapeutic MET or CES device. There are over 100  clinical studies and trials on Alpha-Stim’s microcurrent electrical therapy and cranial electrotherapy stimulation, with additional studies currently underway.All this research has been compiled and made available here, in order to help you in your research of proven effective treatments for anxiety, insomnia, depression, and pain. Alpha-Stim is FDA cleared for anxiety, insomnia, and pain only, with approval for depression outside of the United States.You can download and read most of the research below, as well as find comprehensive annotated abstracts for most by clicking on the title of the article. Graphic summaries of each indication are also provided for a quick snapshot of the results of the related studies.Anxiety     Insomnia     Depression     Pain Anxiety Research, Studies, Trials and Reports Randomized Controlled Trials Park BS, Jin S, Kim WY, Kang DS, Choi YJ, Lee YS. Comparison of the effects of cranial electrotherapy stimulation and midazolam as preoperative treatment in geriatric patients: A CONSORT-compliant randomized controlled trial. Medicine (Baltimore). 2022 Sep 2; 101(35). Download ArticleLiu, E., Zhang, W., Wang, J., Zhao, F., & Bai, Y. Acupuncture combined with cranial electrotherapy stimulation on generalized anxiety disorder: A randomized controlled trial. Chinese Acupuncture & Moxibustion. 2020; 40(11).Ren, Y., Zhu, Y., Yang, J., & Ding, F. Efficacy of Cranial Electrotherapy Stimulation on Anxiety and Sleep Qualities Among Elderly Patients with Chronic Sleep Disorders. Chinese Journal Modern Nursing. 2019; 25(24).Roh, HT. & So, W-Y. Cranial electrotherapy stimulation affects mood state but not levels of peripheral neurotrophic factors or hypothalamic-pituitary-adrenal axis regulation. Technology and health care: Official Journal of the European Society for Engineering and Medicine. 2017; 25(3):403–412.Ou, Y. & Li, C. Sertraline combined Alpha-Stim clinical observations on the treatment of 30 cases of generalized anxiety disorder. Chinese Journal of Ethnomedicine and Ethnopharmacy. 2015; 24(17):73-75.Hill, Nolan. The effects of alpha stimulation on induced anxiety. 2015. Digital Commons @ ACU, Electronic Theses and Dissertations. Paper 6. http://digitalcommons.acu.edu/etd/6. Download ArticleLU Ling, HU Jun. A comparative study of anxiety disorders treatment with Paroxetine in combination with cranial electrotherapy stimulation therapy. Medical Innovation of China, 11(08):080-082, 2014. Download Article in English or Download Article in ChineseKong, J., Wu, J., Jiang, X., et al. Treatment of Sleep Disorder with Cranial Electrotherapy Stimulation Combined with Psychological Counseling in Postmenopausal Women: A Randomized Study. Chinese Journal of Medicinal Guide. 2014; 921, 16(6):(Serial No.128).Wei Y., Yang Z., Pan H., Zhao S-J., Fang J-Z. Clinical Efficacy of Assisted Cranial Electrotherapy Stimulation Treatment on Depression. Neural Injury and Functional Reconstruction. July 2014, 9(4):317.Barclay TH, Barclay RD. A clinical trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders. 2014; 164:171-177. Presented at the American Psychological Association National Conference, Honolulu, HI, July 2013. Download ArticleLee, S-H, Kim, W-Y, Lee C-H, Min, T-J, Lee Y-S, Kim J-H. Effects of cranial electrotherapy stimulation on preoperative anxiety, pain and endocrine response. Journal of International Medical Research. 2013; 41(6) 1788–1795. Download ArticleKoleoso ON, Osionwo HO, Akkhigbe. The role of relaxation therapy and cranial electrotherapy stimulation in the management of dental anxiety in Nigeria. ISOR Journal of Dental and Medical Sciences. 2013; 10(4): 51-57. Download ArticleQin, S., Sheng, J., Guo, W., Zhang, X. Curative effect of CES as adjuvant therapy on elderly patients with chronic insomnia. Practical Geriatrics. 2013; Vol. 27, No. 5:399-402.Strentzsch, Julie A. An examination of cranial electrotherapy stimulation (CES) on alpha-amylase levels, cortisol levels and state-trait anxiety scores in the chronically mentally ill. Doctoral Dissertation. 2008. Saint Mary’s University, San Antonio, Texas.Mellen, Ronald R. and Mackey, Wade. Cranial electrotherapy stimulation (CES) and the reduction of stress symptoms in a sheriff’s jail security and patrol officer population: a pilot study. American Jails. 2008; 22(5): 32-38. Download ArticleKim, Hyun Jung, Kim, Woon Young, Lee, Yoon Sook, Chang, Moon Seok, Kim, Jae Hwan, and Park, Young Cheol The effect of cranial electrotherapy stimulation on preoperative anxiety and hemodynamic responses. Korean Journal of Anesthesiology. 2008; 55(6): 657- 661. Download Article (English) Download Article (Korean)Chen Yixin, Yu Lin, Zhang Jiuping, Li Lejia, Chen Tunong, Chen Yi. Results of cranial electrotherapy stimulation to children with mixed anxiety and depressive disorder. Shanghai Archives of Psychiatry. 2007; 19(4):203-205. Download Article in English or Download Article in ChineseWinick, Reid L. Cranial electrotherapy stimulation (CES): a safe and effective low cost means of anxiety control in a dental practice. General Dentistry. 1999; 47(1):50-55. Download ArticleVoris, Marshall D. An investigation of the effectiveness of cranial electrotherapy stimulation in the treatment of anxiety disorders among outpatient psychiatric patients, impulse control parolees and pedophiles. Delos Mind/Body Institute Newsletter. 1995. Dallas and Corpus Cristi, Texas. Download ArticleGibson, Thomas H. and O’Hair, Donald E. Cranial application of low level transcranial electrotherapy vs. relaxation instruction in anxious patients. American Journal of Electromedicine, 4(1):18-21, 1987. Doctoral dissertation (TG), California School of Professional Psychology. 1983. 152 pages. Download ArticleOpen-Label Clinical TrialsRoyal, S., Keeling, S., Kelsall, N., Price, L., Fordham, R., Xydopoulos, G., et al. Feasibility, acceptability and costs of nurse-led Alpha-Stim cranial electrostimulation to treat anxiety and depression in university students. BMC Primary Care. 2022; 23:97. Download ArticleGriffiths, C., Leathlean, C., Smart, D., Zafar, A., Hall, C-L., & Deeks, S. Alpha-Stim Cranial Electrotherapy Stimulation (CES) for Anxiety Treatment: Outcomes in a United Kingdom (UK) Primary Care Practice. Open Journal of Psychiatry. 2021, 11: 186-201. Download ArticleMorriss R, Price L. Differential effects of cranial electrotherapy stimulation on changes in anxiety and depression symptoms over time in patients with generalized anxiety disorder. Journal of Affective Disorders. 2020, 277: 785-788. Download ArticleMorriss R, Xydopoulos G, Craven M, Price L, Fordham R. Clinical effectiveness and cost minimisation model of Alpha-Stim cranial electrotherapy stimulation in treatment seeking patients with moderate to severe generalized anxiety disorder. Journal of Affective Disorders. 2019, June; 253:426-437. Download ArticlePlatoni K, Oakley R, Haltiwanger SG, Kirsch TB, Marksberry J and Price LR. First responder research shows that electrical brain stimulation helps control anxiety, insomnia, and depression. JJ Psych Behav Sci. 2019; 6(1): 25-31. Download ArticleKirsch TB, Kuhn J, Price LR, Marksberry J, Haltiwanger SG. A novel medical device that relieves anxiety, depression and pain while improving sleep in a population of teachers. Journal of Depression and Anxiety. 2019; 8:334. Download ArticleMorrow DJ, Fischer EP, Walder AM, Jubran NI. Nonopioid Alternatives to Addressing Pain Intensity: A Retrospective Look at Two Noninvasive Pain Treatment Devices. Federal Practitioner. 2019, 36(4):181-187. Download ArticleYennurajalingam S, Kang D-H, Hwu W-J, Padhye NS, Masino C, Dibaj SS, Liu DD, Williams JL, Lu Z, Bruera E. Cranial electrotherapy stimulation for the management of depression, anxiety, sleep disturbance, and pain in patients with advanced cancer: a preliminary study. Journal of Pain and Symptom Management. 2018, 55(2): 198–206. Download AbstractMellen, Ronald R., Case, Jan and Ruiz, Deanna J. Cranial electrotherapy stimulation (CES) As a treatment for reducing stress and improving prefrontal cortex functioning in victims of domestic violence. International Association for Correctional and Forensic Psychology Newsletter. 48(3):12-15, 2016. Download ArticleBystritsky, A., Kerwin, L., Feusner, J. A pilot study of cranial electrotherapy stimulation for generalized anxiety disorder. Journal of Clinical Psychiatry. 2008; 69:412-417. Download ArticleLu XY, Wang AH, Li Y, Zhang JS, Liu BX. Safety and effectiveness of cranial electrotherapy stimulation in treating children with emotional disorders. Chinese Journal of Clinical Rehabilitation. 2005; 9(8):96-7. Download article in English or Download article in ChineseOvercash, Stephen J. Cranial electrotherapy stimulation in patients suffering from acute anxiety disorders. American Journal of Electromedicine. 1999; 16(1):49-51. Download ArticleCase Series and ReportsHare, Jean P., Misialek, Leah H., Palis, Katy and Wong, Charmin. Using cranial electrotherapy stimulation therapy to treat behavioral health symptoms in a combat operational setting. Military Medicine. 2016; 181(11):1410-1412. Download ArticleKirsch, D.L., Price, L.R., Nichols, F., Marksberry, J.A., & Platoni, K.T. Military Service Member and Veteran Self-Reports of Efficacy of Cranial Electrotherapy Stimulation for Anxiety, PTSD, Insomnia, and Depression. The Army Medical Department Journal. 2014; 46-54. Download Article Insomnia Research, Studies, Trials and Reports Randomized Controlled TrialsKhyatee, S., Sarker,A., & Aggarwal R. Impact of Cranial Electrotherapy Stimulation Based Analysis of Heart Rate Variability in Insomnia. In: Prateek M., Sharma D., Tiwari R., Sharma R., Kumar K., Kumar N. (eds) Next Generation Computing Technologies on Computational Intelligence. NGCT 2018. Communications in Computer and Information Science, Vol 922. Springer, Singapore, 2019.Ren, Y., Zhu, Y., Yang, J., & Ding, F. Efficacy of Cranial Electrotherapy Stimulation on Anxiety and Sleep Qualities Among Elderly Patients with Chronic Sleep Disorders. Chinese Journal Modern Nursing. 2019; 25(24).Bie, H., Ren, L., & Li, X. A control study of a hypnotic drug plus cranial electrotherapy stimulation in the treatment of insomnia. Journal Clinical Psychosomatic Disorders. 2016; Vol 22, No. 3:17-20.Kong, J., Wu, J., Jiang, X., et al. Treatment of Sleep Disorder with Cranial Electrotherapy Stimulation Combined with Psychological Counseling in Postmenopausal Women: A Randomized Study. Chinese Journal of Medicinal Guide. 2014; 921, 16(6):(Serial No.128).Taylor, Ann Gill, Anderson, Joel G., Riedel, Shannon L., Lewis, Jante E., Kinser, Patricia A., and Bourguignon, Cheryl. Cranial electrical stimulation improves symptoms and functional status in individuals with fibromyalgia. Pain Management Nursing. 2013 Dec;14(4):327-335. Download articleQin, S., Sheng, J., Guo, W., Zhang, X. Curative effect of CES as adjuvant therapy on elderly patients with chronic insomnia. Practical Geriatrics. 2013; Vol. 27, No. 5:399-402.Lichtbroun, Alan S., Raicer, Mei-Ming C., and Smith, Ray B. The treatment of fibromyalgia with cranial electrotherapy stimulation. Journal of Clinical Rheumatology. 2001; 7(2):72-78. Presented at the Fifteenth Annual International Symposium on Acupuncture and Electro-Therapeutics, Columbia University, New York, October 1999. Download ArticleLande, R. Gregory and Gragnani, Cynthia. Efficacy of cranial electric stimulation for the treatment of insomnia: A randomized pilot study. Complementary Therapies in Medicine, 21(1):8-13, 2013. Download ArticleOpen-Label Clinical TrialsPlatoni K, Oakley R, Haltiwanger SG, Kirsch TB, Marksberry J and Price LR. First responder research shows that electrical brain stimulation helps control anxiety, insomnia, and depression. JJ Psych Behav Sci. 2019; 6(1): 25-31. Download ArticleKirsch TB, Kuhn J, Price LR, Marksberry J, Haltiwanger SG. A novel medical device that relieves anxiety, depression and pain while improving sleep in a population of teachers. Journal of Depression and Anxiety. 2019; 8:334. Download ArticleYennurajalingam S, Kang D-H, Hwu W-J, Padhye NS, Masino C, Dibaj SS, Liu DD, Williams JL, Lu Z, Bruera E. Cranial electrotherapy stimulation for the management of depression, anxiety, sleep disturbance, and pain in patients with advanced cancer: a preliminary study. Journal of Pain and Symptom Management. 2018, 55(2): 198–206. Download AbstractRickabaugh K, Johnson T, Martin S, Jones C and Onifer D. A retrospective review of patient perception of Alpha-Stimulation treatment. Poster presented at The Military Health System Symposium in Kissimmee, Florida. 2016; August 15-18. Download PosterCase Series and ReportsHare, Jean P., Misialek, Leah H., Palis, Katy and Wong, Charmin. Using cranial electrotherapy stimulation therapy to treat behavioral health symptoms in a combat operational setting. Military Medicine. 2016; 181(11):1410-1412. Download ArticleKirsch, D.L., Price, L.R., Nichols, F., Marksberry, J.A., & Platoni, K.T. Military Service Member and Veteran Self-Reports of Efficacy of Cranial Electrotherapy Stimulation for Anxiety, PTSD, Insomnia, and Depression. The Army Medical Department Journal. 2014; 46-54. Download ArticleClark, Nancy, Mills, Daniel & Marchant, Jeremy. Evaluation of the potential efficacy of the Alpha-Stim SCS in the horse. DeMontfort University Equestrian Centre and Field Station, Caythorpe, Lincolnshire, United Kingdom. January, 2000. Download Article Depression Research, Studies, Trials and Reports Randomized Controlled TrialsKong, S., Gao, C., & Yang, Z. Effects of Cranial Electrotherapy Stimulation on the Levels of HPA, BDNF and Clinical Symptoms in Patients with Mild Depression. Journal of International Psychiatry. 2021; 48(1).Gao, C., Kong, S., Duan, H., Yang, Z., Li, D. Effects of cranial electrotherapy stimulation on suicidal ideation and event-related potentials in patients with treatment-resistant depression. China Journal of Health Psychology. 2021; 29(2):183-188.Liu, Y., Xie, L., Wang, L., Zhao, R-J., Xu F., & WANG, W-S. Effect of CES combined with flupentixol-melitracen for depression after stroke. Chinese Journal of Misdiagnosis. 2021; 16(2):106-109.Lyu, X. Effect of CES combined with escitalopram on quality of life and activities of daily living of patients with depression after cerebral infarction. Chinese Journal of Practical Nervous Diseases. 2018; 21(22).Roh, HT. & So, W-Y. Cranial electrotherapy stimulation affects mood state but not levels of peripheral neurotrophic factors or hypothalamic-pituitary-adrenal axis regulation. Technology and health care: Official Journal of the European Society for Engineering and Medicine. 2017; 25(3):403–412.Luo, H-D, Luo, H-L., Hong, L-F. Comparative Observation between Single Use of Fluoxetine and Its Combination with CES. Chin J Mod Drug Appl. 2015; 9(7).Wang, X., Xia, P., Lin, Q., Cheng, K., Chen, A., Yang, T., & Xueping, L. I. The effects of cranial electrotherapy stimulation therapy combined with psychological intervention in treating post-stroke depression. Chinese Journal of Physical Medicine and Rehabilitation. 2015; 37(9):680-682.Kong, J., Wu, J., Jiang, X., et al. Treatment of Sleep Disorder with Cranial Electrotherapy Stimulation Combined with Psychological Counseling in Postmenopausal Women: A Randomized Study. Chinese Journal of Medicinal Guide. 2014; 921, 16(6):(Serial No.128).Wei Y., Yang Z., Pan H., Zhao S-J., Fang J-Z. Clinical Efficacy of Assisted Cranial Electrotherapy Stimulation Treatment on Depression. Neural Injury and Functional Reconstruction. July 2014, 9(4):317.Barclay TH, Barclay RD. A clinical trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders. 2014; 164:171-177. Presented at the American Psychological Association National Conference, Honolulu, HI, July 2013. Download ArticleAmr, Mostafa, El-Wasify, Mahmoud, Elmaadawi, Ahmed, Roberts, Jeannie, and El-Mallakn, Rif. Cranial electrotherapy stimulation for the treatment of chronically symptomatic bipolar patients. Journal of ECT. 2013; 29(2): 31-32. Download ArticleQin, S., Sheng, J., Guo, W., Zhang, X. Curative effect of CES as adjuvant therapy on elderly patients with chronic insomnia. Practical Geriatrics. 2013; Vol. 27, No. 5:399-402.Mellen, Ronald R. and Mackey, Wade. Reducing sheriff’s officers’ symptoms of depression using cranial electrotherapy stimulation (CES): a control experimental study. The Correctional Psychologist. 2009; 41(1):9-15. Download ArticleChen Yixin, Yu Lin, Zhang Jiuping, Li Lejia, Chen Tunong, Chen Yi. Results of cranial electrotherapy stimulation to children with mixed anxiety and depressive disorder. Shanghai Archives of Psychiatry. 2007; 19(4):203-205.Open-Label Clinical TrialsRoyal, S., Keeling, S., Kelsall, N., Price, L., Fordham, R., Xydopoulos, G., et al. Feasibility, acceptability and costs of nurse-led Alpha-Stim cranial electrostimulation to treat anxiety and depression in university students. BMC Primary Care. 2022; 23:97.Morriss R, Price L. Differential effects of cranial electrotherapy stimulation on changes in anxiety and depression symptoms over time in patients with generalized anxiety disorder. Journal of Affective Disorders. 2020, 277: 785-788. Download ArticlePlatoni K, Oakley R, Haltiwanger SG, Kirsch TB, Marksberry J and Price LR. First responder research shows that electrical brain stimulation helps control anxiety, insomnia, and depression. JJ Psych Behav Sci. 2019; 6(1): 25-31.Kirsch TB, Kuhn J, Price LR, Marksberry J, Haltiwanger SG. A novel medical device that relieves anxiety, depression and pain while improving sleep in a population of teachers. Journal of Depression and Anxiety. 2019; 8:334.Morrow DJ, Fischer EP, Walder AM, Jubran NI. Nonopioid Alternatives to Addressing Pain Intensity: A Retrospective Look at Two Noninvasive Pain Treatment Devices. Federal Practitioner. 2019, 36(4):181-187. Download ArticleYennurajalingam S, Kang D-H, Hwu W-J, Padhye NS, Masino C, Dibaj SS, Liu DD, Williams JL, Lu Z, Bruera E. Cranial electrotherapy stimulation for the management of depression, anxiety, sleep disturbance, and pain in patients with advanced cancer: a preliminary study. Journal of Pain and Symptom Management. 2018, 55(2): 198–206.Rickabaugh K, Johnson T, Martin S, Jones C and Onifer D. A retrospective review of patient perception of Alpha-Stimulation treatment. Poster presented at The Military Health System Symposium in Kissimmee, Florida. 2016; August 15-18. Download PosterCase Series and ReportsHare, Jean P., Misialek, Leah H., Palis, Katy and Wong, Charmin. Using cranial electrotherapy stimulation therapy to treat behavioral health Symptoms in a combat operational setting. Military Medicine. 2016; 181(11):1410-1412. Download ArticleKirsch, D.L., Price, L.R., Nichols, F., Marksberry, J.A., & Platoni, K.T. Military Service Member and Veteran Self-Reports of Efficacy of Cranial Electrotherapy Stimulation for Anxiety, PTSD, Insomnia, and Depression. The Army Medical Department Journal. 2014; 46-54. Pain Research, Studies, Trials and Reports Randomized Controlled Trials Taylor, Ann Gill, Anderson, Joel G., Riedel, Shannon L., Lewis, Jante E., Kinser, Patricia A., and Bourguignon, Cheryl. Cranial electrical stimulation improves symptoms and functional status in individuals with fibromyalgia. Pain Management Nursing. 2013 Dec;14(4):327-335. Download article Taylor, Ann Gill, Anderson, Joel G., Riedel, Shannon L., Lewis, Janet E. and Bourguignon, Cheryl. A randomized, controlled, double-blind pilot study of the effects of cranial electrical stimulation on activity in brain pain processing regions in individuals with fibromyalgia. Explore. 2013; 9(1):32-40. Download article Tan, Gabriel, Rintala, Diana, Jensen, Mark P., Richards, J. Scott, Holmes, Sally Ann, Parachuri, Rama, Lashgari-Saegh, Shamsi and Price, Larry R. 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. The Journal of Spinal Cord Medicine. 2011; 34(3):285-296. Download article Rintala, Diana H., Tan, Gabriel, Willson, Pamela , Bryant, Mon S., and Lai, Eugene C. H. Feasibility of using cranial electrotherapy stimulation for pain in persons with Parkinson’s disease. Parkinson’s Disease. 2010. 8 pages. Download Article Tan, Gabriel, Rintala, Diana H., Thornby, John, Yang, June, Wade, Walter, and Vasilev, Christine. Using cranial electrotherapy stimulation to treat pain associated with spinal cord Injury.Journal of Rehabilitation Research and Development. 2006; 43(4):461-474. Presented at the South Central VA Health Care Network’s Pain Management Initiative 2nd Annual Pain Management Symposium: Campaign Against Pain. Jackson, Mississippi, April 7, 2006. Download Article Cork, Randall C., Wood, Patrick, Ming, Norbert, Shepherd, Clifton, Eddy, James, Price, Larry The effect of cranial electrotherapy stimulation (CES) on pain associated with fibromyalgia. The Internet Journal of Anesthesiology. 2004; 8(2). Download Article Tan, G., Rintala, D., Herrington, R., Yang, J., Wade, W., Vasilev, C. and Shanti, B.F. Treating spinal cord injury pain with cranial electrotherapy stimulation. Journal of Spinal Cord Medicine. 2003; 26(3). Poster presented at the Annual Meeting of the American Paraplegia Society, Las Vegas, Nevada, September 2-4, 2003. Download Poster Lichtbroun, Alan S., Raicer, Mei-Ming C., and Smith, Ray B. The treatment of fibromyalgia with cranial electrotherapy stimulation. Journal of Clinical Rheumatology. 2001; 7(2):72-78. Presented at the Fifteenth Annual International Symposium on Acupuncture and Electro-Therapeutics, Columbia University, New York, October 1999. Sizer P, Sawyer S, Brismee J, Jones K, Bruce J, Slauterbeck J. The effect of microcurrent stimulation on postoperative pain after patellar tendon-bone anterior cruciate ligament reconstruction. Presented at the American Physical Therapy Association Annual Conference and Exposition, Indianapolis, Indiana; June, 2000. Heffernan, Michael. The effect of variable microcurrents on EEG spectrum and pain control. Canadian Journal of Clinical Medicine. 1997; 4(10):4-11. Download Article Zimmerman, Stephen I, & Lerner, Fred N. Biofeedback and electromedicine reduce the cycle of pain spasm pain in low back patients. Medical Electronics. June 1989; 117:108-120. Doctoral dissertation (SZ), City University Los Angeles, 284 pages, 1987. Download Article Roth, Peter M, & Thrash, William J. Effect of transcutaneous electrical nerve stimulation for controlling pain associated with orthodontic tooth movement. American Journal of Orthodontics. 1986; 90(2):132-138. Download Article   Open-Label Clinical Trials Platoni K, Oakley R, Haltiwanger SG, Kirsch TB, Marksberry J and Price LR. First responder research shows that electrical brain stimulation helps control anxiety, insomnia, and depression. JJ Psych Behav Sci. 2019; 6(1): 25-31. Kirsch TB, Kuhn J, Price LR, Marksberry J, Haltiwanger SG. A novel medical device that relieves anxiety, depression and pain while improving sleep in a population of teachers. Journal of Depression and Anxiety. 2019; 8:334. Morrow DJ, Fischer EP, Walder AM, Jubran NI. Nonopioid Alternatives to Addressing Pain Intensity: A Retrospective Look at Two Noninvasive Pain Treatment Devices. Federal Practitioner. 2019, 36(4):181-187. Yennurajalingam S, Kang D-H, Hwu W-J, Padhye NS, Masino C, Dibaj SS, Liu DD, Williams JL, Lu Z, Bruera E. Cranial electrotherapy stimulation for the management of depression, anxiety, sleep disturbance, and pain in patients with advanced cancer: a preliminary study. Journal of Pain and Symptom Management. 2018, 55(2): 198–206. Tan, Gabriel, Dao, Tam K., Smith, Donna L., Robinson, Andrew and Jensen, Mark P. Incorporating complementary and alternative medicine (CAM) therapies to expand psychological services to veterans suffering from chronic pain. Psychological Services. 2010; 7(3):148–161. Download Article Holubec, Jerry T. Cumulative response from cranial electrotherapy stimulation (CES) for chronic pain. Practical Pain Management. 2009; 9(9):80-83. Download Article Kulkarni, Arun D. The use of microcurrent electrical therapy and cranial electrotherapy stimulation in pain control. Clinical Practice of Alternative Medicine. 2001; 2(2):99-102. Download Article   Case Series and Reports Keizer B, Sposato L, and Yancosek K. A progressive treatment for a chronic progressive disease: the war against complex regional pain syndrome. The Pain Practitioner. 2016; 6(1):26-31. Download Article Smith, Ray B. Is microcurrent stimulation effective in pain management? An additional Perspective. American Journal of Pain Management. 2001; 11(2):62-66. Download Article Alpher, Elliott J. and Kirsch, Daniel L. Traumatic brain injury and full body reflex sympathetic dystrophy patient treated with cranial electrotherapy stimulation. American Journal of Pain Management, 8(4):124-128, 1998. Download Article Bauer, William. Electrical treatment of severe head and neck cancer pain. Archives of Otolaryngology. 1983; 109(6):382-383. Download Article Mechanistic Studies Lande GR and Gragnani CT. Prospective study of brain wave changes associated with cranial electrotherapy stimulation. Primary Care Companion for CNS Disorders. 2018; 20(1). View on PubMed | Download AbstractQiao Jainping, Weng Shenhong, Wang Pengwei, Long Jun, and Wang Zhishun. Normalization of intrinsic neural circuits governing Tourette’s Syndrome using cranial electrotherapy stimulation. Transactions on Biomedical Engineering. 2015 May;62(5): 1272-80. Download ArticleFeusner, J. D., Madsen, S., Moody, T. D., Bohon, C., Hembacher, E., Bookheimer, S. Y. and Bystritsky. Effects of cranial electrotherapy stimulation on resting state brain activity. Brain and Behavior. 2012. Pp 1-10. Download ArticleKennerly, Richard. Changes in quantitative EEG and low-resolution tomography following cranial electrotherapy stimulation. Ph.D. Dissertation, the University of North Texas. 2006. 529 pp., 81 tables, 233 figures, 171 references. Download ArticleKennerly, Richard. QEEG analysis of cranial electrotherapy: a pilot study. Journal of Neurotherapy. 2004; (8)2. Presented at the International Society for Neuronal Regulation annual conference, September 18-21, 2003 in Houston, Texas.Schroeder, M.J., and Barr, R.E. Quantitative analysis of electroencephalogram during cranial electrotherapy stimulation. Clinical Neurophysiology. 2001; 112:2075-2083. Doctoral dissertation, The Graduate School of the University of Texas at Austin, 191 pages, 1999. Download ArticleHeffernan, Michael. Comparative effects of microcurrent stimulation on EEG spectrum and correlation dimension. Integrative Physiological and Behavioral Science. 1996; 31(3):202-209. Download Article Alpha-Stim Review Articles Price, L., Briley, J., Haltiwanger, S. and Hitching, R. A Meta-Analysis of Cranial Electrotherapy Stimulation in the Treatment of Depression. Journal of Psychiatric Research. 2021; (135), 119-134. Download ArticlePrice LR, Briley J, Hitching R. A Meta-Analyses of Cranial Electrotherapy Stimulation in the Treatment of Insomnia. Annals of Psychiatry and Mental Health. 2020; 8(3): 1157. Download ArticleAseem A., Hussain M.E. Impact of Cranial Electrostimulation on Sleep: A Systematic Review. Sleep Vigilance. 2019; 3: 101–112.Ryall, Jo-Ellyn. FDA moving toward CES neuromodulation approval for home use: are we ready? Missouri Psychiatry. First Quarter- 2017: 3. Download ArticleO’Hara, Christiane and Putnam, Helen (Netta). Sleep: the missing link. Sleep assessment and interventions for combat veterans with disrupted sleep. Combat Stress; 6(1): 3-18. Download ArticleScarff, Jonathan R. When to consider cranial electrotherapy stimulation for patients with PTSD. Current Psychiatry. 2017; 16(2): 27-28. Download ArticleMassoumi L. Benefits of Alpha-Stim. The Carlat Report: Psychiatry. 2016; 14(11 &12): 1,4-5.Moehringer J and Knabe MB. Transdermal electrical neurostimulation therapies in psychiatry: A review of the evidence. Psychiatric Annals, 46(10):589-593. Posted October 11, 2016.Libretto S, Hilton L, Gordon S, and Zhang W. Effects of integrative PTSD treatment in a military health setting. Energy Psychology. 2015; 7(2):33-44. Download articleDaniel L. Kirsch, PhD, DAAPM, FAIS and Jeffrey A. Marksberry, MD, FAIS. The Evolution of Cranial Electrotherapy Stimulation for Anxiety, Insomnia, Depression, and Pain and its Potential for Other Indications. Bioelectromagnetic and Subtle Energy Medicine. pp 189-212. Boca Raton, FL: CRC Press. Download chapterAnderson, Joel G., Kebaish, Samy A., Lewis, Janet E., and Taylor, Ann G. (2015). Effects of cranial electrical stimulation on activity in regions of the basal ganglia in individuals with fibromyalgia. The Journal of Alternative and Complementary Medicine. 2014; 20(3): 206-207. Download ArticleHorowitz, Sala. Transcranial magnetic stimulation and cranial electrotherapy stimulation. Alternative and Complementary Therapies. 2013; 19(4):188-193. Download ArticleKirsch, Daniel L. and Nichols, Francine. Cranial electrotherapy stimulation for treatment of anxiety, depression and insomnia. Psychiatric Clinics of North America. 2013; 36(1):169-176. http://www.psych.theclinics.com. Download ArticleFarina Woodbury, Michael A. Efecto de la microcorriente sobre síntomas, de ansiedad, depresión, insomnio y dolor. Galenus. 2008; 1(5):15-18. Download ArticleKirsch, Daniel L. and Gilula, Marshall. CES in the treatment of insomnia: a review and meta-analysis Practical Pain Management. 2007; 7(7):28-39. Download ArticleTan Gabriel and Jensen Mark P. Integrating complementary and alternative medicine (CAM) into multidisciplinary chronic pain treatment. In Multidisciplinary Chronic Pain Management: a Guidebook for Program Development and Excellence of Treatment. Schatman and Campbell (editors). Taylor & Francis. 2007. Pp. 75-99. Download ArticleKirsch, Daniel L. and Gilula, Marshall. Cranial electrotherapy stimulation in the treatment of depression – part 1. Practical Pain Management. 2007; 7(4):33-41. Download ArticleKirsch, Daniel L. and Gilula, Marshall.Cranial electrotherapy stimulation in the treatment of depression – part 2. Practical Pain Management. 2007; 7(5):32-40. Download ArticleKirsch, Daniel L. and Gilula, Marshall. A review and meta-analysis of cranial electrotherapy Stimulation in the treatment of anxiety disorders – part 1. Practical Pain Management. 2007; 7(2):40-47. Download ArticleKirsch, Daniel L. and Gilula, Marshall. Cranial electrotherapy stimulation in the treatment of anxiety disorders: statistical considerations – part 2. Practical Pain Management. 2007; 7(3):22-39. Download ArticleKirsch, Daniel L. Cranial electrotherapy stimulation for the treatment of anxiety, depression, insomnia and other conditions. Insert: Giordano, James. Illustrating how CES works. Natural Medicine. 2006; 23:118-120. Download ArticleGilula, Marshall and Kirsch, Daniel L. Cranial Electrotherapy Stimulation Review: A Safer Alternative to Psychopharmaceuticals in the Treatment of Depression. Journal of Neurotherapy. 2005; 9(2): 7-26. Download ArticleGilula, Marshall F. and Barach, Paul R. Cranial electrotherapy stimulation: a safe neuromedical treatment for anxiety, depression or insomnia. Southern Medical Journal. 2004; 97(12):1269-1270. Download ArticleKirsch, Daniel L. and Smith, Ray B. The use of cranial electrotherapy stimulation in the management of chronic pain: a review. NeuroRehabilitation. 2000; 14(2):85-94. Download Article *This page includes research done exclusively on patented Alpha-Stim technology only. It should not be applied to other devices, even in the same category, because the waveform parameters are very different. After all, morphine and aspirin are both in the analgesics category but have very different effects and adverse events. ### Testimonials Alpha-Stim® Testimonials​ Since 1981, Alpha-Stim has helped hundreds of thousands of people achieve remarkable results. See below for testimonials from real patients and healthcare practitioners using Alpha-Stim M and Alpha-Stim AID. Alpha-StimTestimonials Ragga Ragnars Shares Alpha-Stim Experience “This is my Alpha-Stim. Safe, effective and proven relief from pain and anxiety.I absolutely love my @alphastim and recommend it to anyone who wants to try a non-drug, quick and reliable relief from pain, anxiety, insomnia and depression.”Watch the full video from Ragga Ragnars about her experience with Alpha-Stim below.FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Testimonial Videos https://youtu.be/GTmKVRYu9Xohttps://www.youtube.com/watch?v=h0g6di_i9z0https://youtu.be/TjMpATdKd6k?si=ydjRyh73e6dULHyghttps://youtu.be/uIMzGmjHdTE What People are Saying About Alpha-Stim “I haven’t slept more than 4 hours in a night in years. The VA used this on me last week, 30 minutes a day for three days. I slept 6 hours two nights and almost 7 the third night. More sleep, better the mood, much less anxiety.” Paul Reinhardt, US veteran “It has become the most used microcurrent device among our hockey players. With traveling on a bus for many hours at a time, the Alpha-Stim’s portability makes it possible for treatment at any time and any place. Best results for our players occur with treatment of the back, shoulder and hip flexor regions.” Curt Kamp, former Athletic Trainer, Seattle Thunderbirds “Not only have I experienced relief from anxiety and insomnia; additionally, Alpha-Stim treatments have reduced or eliminated accompanying physical pain.” CH (MAJ) David J. Fair PhD, Former President, American Association of Police Officers; Former President, Homeland Crisis InstituteTexas “The Alpha-Stim is great for our whole family! It has helped me sleep better, have a better mood, and get rid of pain!” Jennifer King Guido “I am a full time mom to an almost 7-month-old boy. Sleep deprivation worsens my anxiety and usually leads to me being down and depressed. I’ve had my Alpha-Stim for over a year now but was not religiously using it. But now I really need it for my heightened anxiety. I’ve been using it for the last 3 days and it’s been calming me down. I find that 20 minutes while I meditate helps a lot. I am 100% committing to using my Alpha-Stim daily. I’m so happy I found this. Much better than taking medication. Thank you!” Precilla Morse “I would recommend Alpha-Stim, especially for fellow veterans... it has helped make anxiety tolerable and sleep comes easier.” Thomas Nicholson “I am a critical care nurse that had COVID twice in 2020 while providing bedside care to inpatient veterans at Salem VAMC. I am now disabled due to long-COVID with physical and mental health issues. I am on 3 medications for anxiety (panic attacks) & depression with limited effect. In my first 20-minute session, the Alpha-Stim device relieved my long-COVID anxiety. As a nurse, I hope for the best and prepare for the worst. Alpha-Stim has me believing in miracles. Thank you! While I still have other long-Covid issues to deal with, my quality of life has been greatly improved due to Alpha-Stim. All the best and be curious!” Michael Huemmer, RN “It saved me during shoulder surgery.  It was a godsend..” Gail Moore “Have seen fantastic results for chronic pain.” Adella Mollina Perales “As a mom and having the unstable job of being an actress, who sometimes needs to travel all over the world to work, it can be demanding and at times quite stressful. I never thought of myself as having anxiety the way it was usually described to me but when I think back to a few months ago, and throughout the pandemic (where projects fell through and a lot of uncertainty with my job was a constant for quite some time) I can say now that I have indeed experienced bursts of anxiety. After getting Alpha-Stim and using it for 20 minutes every day (I have had it for over 6 months now) it is safe to say that my stress and anxiety have decreased so much. I am more calm and focused when dealing with the day to day mom life, I am at ease when I travel and need help from my family with my son, and before, that would stress me out a lot. Now, I go through my days with minimum stress and anxiety and absolutely love my Alpha-Stim for it.” Ragga Ragnars, Actress, Former Olympic Swimmer Previous Next What Providers Say About Alpha-Stim https://youtu.be/vmulGIJ6nw4https://youtu.be/QPgigEWRHiwhttps://youtu.be/M8JC2c-a2tU “The Alpha-Stim has so much good science behind it, with many highly controlled clinical studies—this really proves its unique effectiveness for so many types of patients. And you can’t ignore the incredible safety record with no serious side effects. That’s why I recommend it to many of my patients.” Anita D. Spitz, MD, Chief Family Medicine Department Parrish Medical CenterTitusville, Florida “ I am so pleased to advise you that I was able to use the Alpha-Stim device during my surgery. The staff at the surgery center were interested and of course I had brochures to provide to them. Alpha-Stim allowed me to minimize the need for pain Rx, and I believe I was off meds completely by the end of day 3. After two weeks, the surgeon was pleased with the surgical site, removed the stitches, and I was back in my office!” Dr. Corinne Cherek, health care practitionerLas Vegas Previous Next TAKE CHARGE OF YOUR LIFE WITH Alpha-Stim telehealth Visit See if Alpha-Stim is right for you via a telehealth visit with a licensed healthcare provider Schedule Now shop online Purchase Alpha-Stim devices and accessories in our online store Shop Now talk with our team Speak with a representative on the phone to learn more Call Now ### How Alpha-Stim® Works Understanding the mechanism of action & science Alpha-Stim® M and Alpha-Stim AID devices utilize cranial electrotherapy stimulation (CES) and microcurrent electrical therapy (MET). Learn more about the mechanism of action and science behind both technologies below. How Alpha-Stim Works for Anxiety, Insomnia, Depression* & Pain Cranial Electrotherapy Stimulation (CES) for anxiety, insomnia, and depression, and Microcurrent Electrical Therapy (MET) for pain.https://alpha-stim.com/wp-content/uploads/2023/12/emi101_alpha_stim_moa_animation_hd_animation_231215a-720p.mp4Alpha-Stim CES is a form of non-invasive brain stimulation that applies a patented, low amplitude waveform to the brain via earclip electrodes. Psychiatric disorders, such as anxiety and insomnia, are associated with alterations in electric activity in large-scale brain networks. Research suggests that Alpha-Stim CES modulates large-scale brain network activity patterns in two synergistic ways: Ultimately, these two ways of stimulating the brain normalize the pathological signaling in the default mode network observed in psychiatric disorders, providing rapid, effective, and lasting symptom relief without the side effects of medication.MET is the process of directing microcurrent through the body via Smart Probes or self-adhesive AS-Trodes to treat pain. When applied peripherally, the rhythmic, low-amplitude current of Alpha-Stim MET modulates the peripheral signaling in pain circuits that emanate from the spinal cord, providing rapid, effective, and lasting pain relief with no risk of addiction or tolerance.Alpha-Stim M: Microcurrent is delivered via electrodes placed on the body at the pain site for the treatment of acute, chronic, and post-traumatic pain using MET. Also includes earclip electrodes for CES to treat anxiety, insomnia, and depression.Alpha-Stim AID: Microcurrent is transmitted to the brain via earclip electrodes using CES to treat anxiety, insomnia, and depression.*Learn more about Alpha-Stim science and research here >*FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.  Get Started Discover Alpha-Stim technology today. Alpha-Stim® M For anxiety, insomnia, depression and pain. Learn More Alpha-Stim® AID For anxiety, insomnia and depression. Learn More The Alpha-Stim Difference Alpha-Stim can be safely delivered at home and is better tolerated than more expensive and burdensome alternatives. It also increases treatment motivation and thereby augments treatment response as it offers the patient agency over their recovery process by adjusting stimulation parameters.Alpha-Stim can be performed at any time during a wide range of daily activities, allowing a patient to live an active and uninterrupted lifestyle. Getting Started with Alpha-Stim Want to try Alpha-Stim AID or M devices with your patients? To help new health practitioners see if Alpha-Stim is a good fit for their patients we offer options with both devices for trying them out. Use the form below to get more information about Alpha-Stim.  Name(Required) First Name* Last Email(Required) Phone(Required)UntitledCompany (Clinic) Name(Required)Zip Code(Required) Δ Proven Results for Patients Everywhere “I am a critical care nurse that had Covid twice in 2020 while providing bedside care to inpatient veterans at Salem VAMC. I am now disabled due to long-Covid with physical and mental health issues. I am on 3 medications for anxiety (panic attacks) & depression with limited effect. In my first 20-minute session, the alpha-stim device relieved my long-COVID anxiety. As a nurse, I hope for the best and prepare for the worst. Alpha-stim has me believing in miracles. Thank you! While I still have other long-Covid issues to deal with, my quality of life has been greatly improved due to alpha-stim. All the best and be curious!” Michael Huemmer, RN “I haven’t slept more than four hours in a night in years. The VA used this on me last week, 30 minutes a day for three days. I slept 6 hours two nights and almost 7 the third night. More sleep, better the mood, much less anxiety.” Paul Reinhardt, US Veteran “It has become the most used microcurrent device among our hockey players. With traveling on a bus for many hours at a time, the Alpha-Stim’s portability makes it possible for treatment at any time and any place. Best results for our players occur with treatment of the back, shoulder and hip flexor regions.” Curt Kamp, former Athletic Trainer, Seattle Thunderbirds “I experienced the worst depression I have ever felt. I never have had depression until now. It’s the worst feeling ever. Makes the days go by so much slower. I went to my doctor, hoping for medicine. Instead he let me try Alpha- Stim. This product ended up being a life changer! It is awesome!” Angie Lamborghini "I am a full-time mom to an almost 7-month-old boy. Sleep deprivation worsens my anxiety and usually leads to me being down and depressed. I’ve had my Alpha-Stim for over a year now but was not religiously using it. But now I really need it for my heightened anxiety. I’ve been using it for the last 3 days and it’s been calming me down. I find that 20 mins while I meditate helps a lot. I am 100% committed to using my Alpha-Stim daily. I’m so happy I found this. Much better than taking medication. Thank you!" Precilia Morse Previous Next How can I get Alpha-Stim for patients? Alpha-Stim technologies are easy to use with patients. Alpha-Stim can be prescribed both in-person in a qualified healthcare clinic or office setting, as well as via telehealth appointments.Learn about prescribing Alpha-Stim below. Learn More ### Resources Resources Ragga Ragnar & Dr. Josh Briley Talk About Alpha-Stim Sit down with former Olympic Swimmer and Vikings actress Ragga Ragnars and Clinical Education Director Dr. Josh Briley as they discuss Alpha-Stim and host an exclusive Q/A session with questions from Ragga’s followers. Watch Now Explore our library of informative blogs, videos, access guides and tutorials from Alpha-Stim about anxiety, insomnia, pain, depression, and Alpha-Stim devices.FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Blogs View More Practitioner Webinars Alpha-Stim Utilization in Telehealth Using Alpha-Stim Adjunctively with EMDR & Complex Trauma Cases Using Alpha-Stim in Integrative Medicine Alpha-Stim Use with Cognitive Behavioral Therapy (CBT) Alpha-Stim Utilization for Anxiety, Insomnia, and Depression in an Addiction Setting​ Alpha-Stim and Physical Therapy: PT Perspectives – NOT E-stim Like You Know It View More Videos & Tutorials https://www.youtube.com/watch?v=uKkPgM_SigwUsing Earclips with Your Alpha-Stim AIDhttps://www.youtube.com/watch?v=uKkPgM_SigwUsing Earclips with Your Alpha-Stim M​https://www.youtube.com/watch?v=wNpyMLiFLas&embeds_referring_euri=https%3A%2F%2Falpha-stim.com%2F&source_ve_path=Mjg2NjY&feature=emb_logoOne Minute Protocol​​https://www.youtube.com/watch?time_continue=3&v=QyiDh_5SI48&embeds_referring_euri=https%3A%2F%2Falpha-stim.com%2F&source_ve_path=Mjg2NjQsMjg2NjY&feature=emb_logoTreating Pain with AS-Trode Self-Adhesive Electrodeshttps://www.youtube.com/watch?v=KjMJYwkXtcI&embeds_referring_euri=https%3A%2F%2Falpha-stim.com%2F&source_ve_path=Mjg2NjY&feature=emb_logoTreating the Knee with Smart Probes​https://www.youtube.com/watch?time_continue=4&v=0fsZfMmjzww&embeds_referring_euri=https%3A%2F%2Falpha-stim.com%2F&source_ve_path=Mjg2NjY&feature=emb_logoTreating the Back with Smart Probes​ View More Other Resources Click below to view our resources including quick start guides and practitioner forms exclusively for health care providers wanting to use Alpha-Stim with patients. Instructional Guides Practitioner Forms Ready to try Alpha-Stim? If you’re new to Alpha-Stim and not sure where to start, take this quick assessment that both health care practitioners and patients can use. Get Started “Not only have I experienced relief from anxiety and insomnia; additionally, Alpha-Stim treatments have reduced or eliminated accompanying physical pain.” CH (MAJ) David J. Fair PhD,Former President, American Association of Police Officers; Former President, Homeland Crisis InstituteTexas “The Alpha-Stim has so much good science behind it, with many highly controlled clinical studies—this really proves its unique effectiveness for so many types of patients. And you can’t ignore the incredible safety record with no serious side effects. That’s why I recommend it to many of my patients.” Anita D. Spitz, MD, Chief Family Medicine Department Parrish Medical CenterTitusville, Florida “So far, I have overall had good results from the Alpha-Stim AID. In fact, one day while doing household tasks I walked in front of a mirror and noticed that I was smiling! That's new behavior and truly a result of this device. I am also experiencing a feeling of well-being and deep sleep that I haven't experienced since college days.” Alpha-Stim User “I experienced the worst depression I have ever felt. I never have had depression until now. It’s the worst feeling ever. Makes the days go by so much slower. I went to my doctor, hoping for medicine. Instead he let me try Alpha- Stim. This product ended up being a life changer! It is awesome!” Angie Lamborghini “After 3 months, I feel like a new person. I would recommend Alpha-Stim to anyone suffering from depression or anxiety.” Laine Downing Previous Next ### Healthcare Professionals Alpha-Stim® for Healthcare Professionals *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. A patient-friendly solution for anxiety, insomnia, depression* and pain Alpha-Stim forhealthcareprofessionals Alpha-Stim M Alpha-Stim AID We know you want what’s best for the patients you treat. You want options that provide the best outcomes with the fewest side effects and require the least amount of time and discomfort to your patient. And of course, you are looking out for their pocketbooks as well.Alpha-Stim electrotherapy devices are proven to be safe and effective for treating anxiety, insomnia, depression, and acute, chronic, and post-traumatic pain. A Simpler Way to Relieve Anxiety, Insomnia, Depression & Pain Alpha-Stim devices are non-invasive, non-drug cranial electrotherapy stimulation (CES) and Microcurrent Electrical Therapy (MET) devices that help with anxiety, insomnia, depression, and pain, safely and effectively.Alpha-Stim AID is ideal for patients with anxiety, insomnia, and depression, while Alpha-Stim M is uniquely designed to provide both CES and MET modalities and able to treat anxiety, insomnia, depression, and pain. Prescribed by a healthcare provider, Alpha-Stim safely provides rapid, effective and lasting symptom relief without the risks of dangerous side effects or addiction. The device is designed to be used anywhere – at home, in a provider’s office, or any location. Learn More Proven Results Improved Sleep Quality The number of subjects rating their quality of sleep as poor dropped from 60% to 5%.1 Overall Decrease in Anxiety In clinical trials, patients reported an average of 61% less anxiety immediately after using the CES therapy. After 5 weeks, that average was 94%.2 Significant Pain Reduction In a study of patients with severe pain, Alpha-Stim M significantly reduced pain by an average of 71% after only five treatments.3 Decrease in Depression In clinical trials, Alpha-Stim recipients reported an 82% decrease of ≥ 50% or greater in depression scores after five weeks using the CES therapy.4 Healthcare Practitioners Try Alpha-Stim today. Talk to one of our reps to get started. For practitioners new to Alpha-Stim, we have options for trying both Alpha-Stim AID and Alpha-Stim M. Typically, an in-office or clinic trial can help you identify those individuals who readily respond to Alpha-Stim treatment, and if Alpha-Stim is a good fit for your practice.Use the form below to get more information about Alpha-Stim and connect with a local Alpha-Stim representative. Name(Required) First Name* Last Email(Required) Phone(Required)Job Title(Required)Company (Clinic) Name(Required)Zip Code(Required) Δ The Science Behind How Alpha-Stim Works Alpha-Stim uses two types of stimulation Cranial Electrotherapy Stimulation (CES) for anxiety, insomnia, and depression, and Microcurrent Electrical Therapy (MET) for pain.https://alpha-stim.com/wp-content/uploads/2023/12/emi101_alpha_stim_moa_animation_hd_animation_231215a-720p.mp4Cranial electrotherapy stimulation (CES) is a form of non-invasive brain stimulation that treats psychiatric disorders such as anxiety and insomnia. Alpha-Stim CES applies a patented waveform using rhythmic, low-amplitude current to the head via earclip electrodes.Psychiatric disorders, such as anxiety, are associated with alterations in electric activity in large-scale brain networks. Research suggests that Alpha-Stim CES modulates large-scale brain network activity patterns, like those seen in anxiety, in two synergistic ways:Ultimately, these two ways of stimulating the brain normalize the pathological signaling in the default mode network observed in many psychiatric disorders, providing rapid, effective, and lasting symptom relief without the side effects of medication.Patients using Alpha-Stim for pain use Smart Probes or apply self-adhesive electrodes around the part of the body where the pain originates from to deliver MET.Learn more about Alpha-Stim science and research here > Explore Alpha-Stim for Anxiety, Insomnia, Depression & Pain Alpha-Stim® M Acute, chronic and post-traumatic pain, and anxiety, insomnia, and depression. Learn More Alpha-Stim® AID Designed to to help patients suffering from  anxiety, insomnia, and depression. Learn More What Patients & Providers Say About Alpha-Stim “Not only have I experienced relief from anxiety and insomnia; additionally, Alpha-Stim treatments have reduced or eliminated accompanying physical pain.” CH (MAJ) David J. Fair PhD, Former President, American Association of Police Officers; Former President, Homeland Crisis InstituteTexas “The Alpha-Stim has so much good science behind it, with many highly controlled clinical studies—this really proves its unique effectiveness for so many types of patients. And you can’t ignore the incredible safety record with no serious side effects. That’s why I recommend it to many of my patients.” Anita D. Spitz, MD, Chief Family Medicine Department Parrish Medical CenterTitusville, Florida “So far, I have overall had good results from the Alpha-Stim AID. In fact, one day while doing household tasks I walked in front of a mirror and noticed that I was smiling! That's new behavior and truly a result of this device. I am also experiencing a feeling of well-being and deep sleep that I haven't experienced since college days.” Alpha-Stim User “I am so pleased to advise you that I was able to use the Alpha-Stim device during my surgery. The staff at the surgery center were interested and of course I had brochures to provide to them. Alpha-Stim allowed me to minimize the need for pain Rx, and I believe I was off meds completely by the end of day 3. After two weeks, the surgeon was pleased with the surgical site, removed the stitches, and I was back in my office!” Dr. Corinne Cherek, health care practitioner Las Vegas, NV Sources: 1 Lichtbroun AS, Raicer MMC, Smith RB. The treatment of fibromyalgia with Cranial Electrotherapy Stimulation. Journal of Clinical Rheumatology. 2001; 7(2):72-78. 2,4 Barclay TH, Barclay RD. A clinical Trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders. 2014;164:171-177. Presented at the American Psychological Association National Conference, Honolulu, July 2013. 3 Holubec JT. Cumulative response from Cranial Electrotherapy Stimulation (CES) for chronic pain. Practical Pain Management. 2009; 9(9):80-83. ### Alpha-Stim Device ### How Its Used ### Why Alpha-Stim? why alpha-stim technology A clinically proven, safe, effective choice for treating anxiety, insomnia, depression*, and pain *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Anxiety, insomnia, depression, and pain are common yet often devastating conditions that negatively impact overall health and well-being. Alpha-Stim® M and AID are non-drug, FDA-cleared medical devices that patients can take with them anywhere, and use long-term for fast-acting, sustainable relief, without the fear of addiction or other serious lasting side effects. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Why Alpha-StimTechnology Proven Effective for Managing Anxiety, Insomnia Depression & Relieving Pain Surveys of Alpha-Stim electrotherapy device users show overwhelming evidence of the effectiveness of the Alpha-Stim M and Alpha-Stim AID devices for improving mental and physical health. % of Patients Reporting Significant Improvements (>25%)* *Patient self-reports after using Alpha-Stim technology for at least 3 weeks. A Cost-Effective Option for Patients Today, the cost of healthcare can prevent many patients from seeking or continuing the treatments they need. It’s why we’ve made Alpha-Stim an affordable and cost-effective option. Over a five-year period, Alpha-Stim users can save thousands of dollars compared with drugs and other treatments typically used to treat anxiety, insomnia, depression, and pain. Alpha-Stim also comes with a 30-day money-back satisfaction guarantee.If you have a FSA or HSA, you can typically use it to pay for Alpha-Stim. For those who still need help, to ensure equitable access to better health, we have financing options available during the checkout process in our web shop. Learn More Explore Alpha-Stim for Anxiety, Insomnia, Depression & Pain Alpha-Stim® M For pain, anxiety, insomnia, & depression. Learn More Alpha-Stim® AID For anxiety, insomnia & depression. Learn More What Patients & Providers Say About Alpha-Stim “Not only have I experienced relief from anxiety and insomnia; additionally, Alpha-Stim treatments have reduced or eliminated accompanying physical pain.” CH (MAJ) David J. Fair PhD,Former President, American Association of Police Officers; Former President, Homeland Crisis InstituteTexas “The Alpha-Stim has so much good science behind it, with many highly controlled clinical studies—this really proves its unique effectiveness for so many types of patients. And you can’t ignore the incredible safety record with no serious side effects. That’s why I recommend it to many of my patients.” Anita D. Spitz, MD, Chief Family Medicine Department Parrish Medical CenterTitusville, Florida “So far, I have overall had good results from the Alpha-Stim AID. In fact, one day while doing household tasks I walked in front of a mirror and noticed that I was smiling! That's new behavior and truly a result of this device. I am also experiencing a feeling of well-being and deep sleep that I haven't experienced since college days.” Alpha-Stim User “I am so pleased to advise you that I was able to use the Alpha-Stim device during my surgery. The staff at the surgery center were interested and of course I had brochures to provide to them. Alpha-Stim allowed me to minimize the need for pain Rx, and I believe I was off meds completely by the end of day 3. After two weeks, the surgeon was pleased with the surgical site, removed the stitches, and I was back in my office!” Dr. Corinne Cherek, health care practitioner Las Vegas, NV TAKE CHARGE OF YOUR LIFE WITH ALPHA-STIM telehealth Visit See if Alpha-Stim is right for you via a telehealth visit with a licensed healthcare provider Schedule Now shop online Purchase Alpha-Stim devices and accessories in our online store Shop Now talk with our team Speak with a representative on the phone to learn more Call Now ### Return Policies, Service, Warranty Coverage Alpha-Stim Terms and Conditions Please see below for Alpha-Stim® technologies terms and conditions of sale, as well as information on return policies, service, and warranty coverage. Terms and Conditions of Sale In the United States, a prescription or order from a licensed healthcare professional is required for the device to ship. Please fax the prescription to 940-328-0888 or email to info@epii.com. If you do not have a doctor and would like to use telehealth to obtain a prescription, click here. Processing and Shipping Please allow 1-2 business days for processing before order ships. Alpha-Stim M or AID orders require a prescription before processing. Refund of shipping charges will not be provided due to carrier delays. Return Policy While the Alpha-Stim is significantly effective when it is used correctly for 9 out of 10 people who use it, it will not work for everyone. If the Alpha-Stim is not working well for you, please first contact your healthcare practitioner, your local authorized Alpha-Stim distributor, or EPI for technical and/or clinical support.If for any reason you wish to return your Alpha-Stim, you may return it within 30 days of purchase and get a full refund, less a 10% restocking fee. Product must be in good, working, resalable condition and returned with all accessories, packed in the original case. Valid only for your first product purchase. 30-day money-back guarantee excludes devices not purchased directly through EPI.Click here to complete a sales refund request form. Service Information The Alpha-Stim is not user serviceable (self-serviceable).To obtain service help, please first contact your authorized distributor or EPI for advice or a Return Material Authorization number (RMA). If necessary, send the entire device, with all accessories, packed in the original case, if available.Send it insured, freight prepaid, and include a copy of your invoice and a note describing the problem. Please do not forget to include your return address, including country, and your phone number, along with fax and email if you have them. Warranty Coverage Electromedical Products International, Inc. (EPI) warrants to the original purchaser (and no one else) that each new Alpha-Stim is free of defects in workmanship and materials under normal use for a period of 5 years from the original purchase date, except for accessories. Warranty/product registration must be completed online to validate the warranty. ### My account ### Checkout Checkout Free standard shipping for orders over $99. For orders outside of the United States, please email alpha-stim@epii.com.IMPORTANT: You must email or fax a Statement of Medical Necessity form or valid prescription before we can ship an Alpha-Stim device. Billing Details First Name *Last Name *Company Name (optional)Country / Region *United States (US)Street address *Apartment, suite, unit, etc. (optional)Town / City *State * Select an option…AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)ZIP Code *Phone *Email Address * Ship to a different address? First Name *Last Name *Company Name (optional)Country / Region *United States (US)Street address *Apartment, suite, unit, etc. (optional)Town / City *State * Select an option…AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)ZIP Code * Order Notes (optional) Your Order Product Subtotal Earclip Electrodes for the Alpha-Stim AID  × 1 $42.00 Alpha-Stim AID Kit (US) - For Anxiety & Insomnia  × 2 $1,764.00 AS-Trode Self-Adhesive Silver Electrode Pads for Alpha-Stim M  × 10 $156.25 (Incl. 37.5% discount) Subtotal $1,962.25 Shipping FedEx 2Day: $30.82 Priority Mail® (USPS): $40.51 Free Ground Shipping Over $99 Upgrade to FedEx 2Day: $10.00 Tax $0.00 Total $1,993.07 Have a coupon? Click here to enter your coupon code If you have a coupon code, please apply it below. Apply Affirm Pay over time You will be redirected to Affirm to securely complete your purchase. It’s quick and easy—get a real-time decision! Credit Card Pay securely using your credit card. Must be a United States issued credit card to complete the checkout process.Payment InfoCard Number *Expiration (MM/YY) *Card Security Code *Securely Save to Account PayPal Pay via PayPal. Since your browser does not support JavaScript, or it is disabled, please ensure you click the Update Totals button before placing your order. You may be charged more than the amount stated above if you fail to do so. Update totals Your personal data will be used to process your order, support your experience throughout this website, and for other purposes described in our privacy policy. Captcha * Refresh Captcha Place order Please allow 1-2 business days for processing before order ships. Refund of shipping charges will not be provided due to carrier delays. ### Cart Your Cart Free standard shipping for orders over $99. For orders outside of the United States, please email alpha-stim@epii.com.IMPORTANT: You must email or fax a Statement of Medical Necessity form or valid prescription before we can ship an Alpha-Stim device. Remove item Thumbnail image Product Price Quantity Subtotal × Earclip Electrodes for the Alpha-Stim AID $42.00 Earclip Electrodes for the Alpha-Stim AID quantity $42.00 × Alpha-Stim AID Kit (US) - For Anxiety & Insomnia $882.00 Alpha-Stim AID Kit (US) - For Anxiety & Insomnia quantity $1,764.00 × AS-Trode Self-Adhesive Silver Electrode Pads for Alpha-Stim M $25.00$15.63 AS-Trode Self-Adhesive Silver Electrode Pads for Alpha-Stim M quantity $156.25 (Incl. 37.5% discount) Update Cart Apply coupon Cart Totals Subtotal $1,962.25 Shipping FedEx 2Day: $30.82 Priority Mail® (USPS): $40.51 Free Ground Shipping Over $99 Upgrade to FedEx 2Day: $10.00 Shipping to 3948 FM 920, Weatherford, TX 76088. Change address Country / region Select a country / region… United States (US) State / County Select an option… AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP) City: Postcode / ZIP: Update Tax $0.00 Total $1,993.07 - Captcha * Refresh Captcha Proceed to Checkout Please allow 1-2 business days for processing before order ships. Refund of shipping charges will not be provided due to carrier delays. ### Shop ### Home Take charge of your life with Alpha-stim Don’t let anxiety, insomnia, depression*, or pain hold you back. Take charge with Alpha-Stim. *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Alpha-Stim AID Alpha-Stim M Take Chargeof Your Life with Alpha-Stim Alpha-Stim M Alpha-Stim AID FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Get Started Discover Alpha-Stim technology today. Alpha-Stim® M For anxiety, insomnia, depression, and pain. Learn More Alpha-Stim® AID For anxiety, insomnia, and depression. Learn More Drug-Free Treatment That Works Alpha-Stim electrotherapy devices offer a cost-effective, drug-free option for treating anxiety, insomnia, and pain quickly and safely. Take charge of your life again today with Alpha-Stim. Anxiety Manage anxiety without medication anywhere, anytime. Learn More insomnia Take back your nights with Alpha-Stim for treating insomnia. Learn More depression* A safe and effective way to treat depression without the side effects of drugs. Learn More pain Alpha-Stim M is approved to treat acute, chronic, and post-traumatic pain.*FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Learn More Hear What People Are Saying About Alpha-Stim® “As a mom and having the unstable job of being an actress, who sometimes needs to travel all over the world to work, it can be demanding and at times quite stressful. I never thought of myself as having anxiety the way it was usually described to me but when I think back to a few months ago, and throughout the pandemic (where projects fell through and a lot of uncertainty with my job was a constant for quite some time) I can say now that I have indeed experienced bursts of anxiety.After getting Alpha-Stim and using it for 20 minutes every day (I have had it for over 6 months now) it is safe to say that my stress and anxiety have decreased so much. I am more calm and focused when dealing with the day to day mom life, I am at ease when I travel and need help from my family with my son (my friends and my parents have been amazing at bringing my son to me when I am away working, or taking care of him at home while I am away) and before, that would stress me out a lot. Now, I go through my days with minimum stress and anxiety and absolutely love my Alpha-Stim for it.”— Ragga Ragnars, Actress, Former Olympic SwimmerView More Testimonials from Patients and Providers » Why Choose Alpha-Stim® ? Alpha-Stim devices have helped hundreds of thousands of people achieve remarkable results. Prescribed around the world by healthcare professionals, Alpha-Stim devices are FDA-cleared, easy to use, portable, and clinically proven to provide fast, safe relief from anxiety, insomnia, depression, and pain. Learn More Featured Content Dakota Meyers shares his experience with Alpha-Stim AID for battling his anxiety.Watch Dakota’s Story » Get a quick overview of Alpha-Stim devices for use with patients.View the Alpha-StimOverview PDF Now » A new way to treat anxiety, insomnia, and pain, with no surgery and no medications.View the Alpha-Stim Brochure Now » Take Charge of your life with alpha-stim telehealth Visit See if Alpha-Stim is right for you via a telehealth visit with a licensed healthcare provider Schedule Now shop online Purchase Alpha-Stim devices and accessories in our online store Shop Now talk with our team Speak with a representative on the phone to learn more Call Now ## My Templates ### Header HCP Alpha-Stim® for Healthcare Professionals *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. A patient-friendly solution for anxiety, insomnia, depression* and pain ### Sleep Fact Bar INCREASED SLEEP TIME After only 5 treatments, military Service Members with insomnia reported an increase of 43 minutes of sleep.1 IMPROVED SLEEP QUALITY In one study, the number of subjects rating their quality of sleep as poor dropped from 60% to 5% after using Alpha-Stim.2 Preferred Over Medication One survey showed patients feel better with Alpha-Stim insomnia treatment than with common sleep drugs.3 Also Treats Anxiety Alpha-Stim is also designed to treat anxiety, providing patients with simultaneous anxiety and insomnia relief. ### Charts costs 2024 ### pain facts Severe Pain Reduction In a study of patients with severe pain, Alpha-Stim M significantly reduced pain by an average of 71% after only five treatments.1 Decrease in Post-Traumatic Pain In a post-traumatic pain study, 56% of patients at 3 months and 85% at 6 months were somewhat or very satisfied with the device for reducing pain levels.2 Also Treats Anxiety Alpha-Stim AID is also designed to treat anxiety, providing patients with simultaneous anxiety and insomnia relief. Better Than Drug-Treatments When compared to pain relief responses from patients using Vicodin and OxyContin, patients self-reported greater reductions in pain with Alpha-Stim.3 ### Depression facts Decrease in Depression In clinical trials, Alpha-Stim recipients reported an 82% decrease of ≥ 50% or greater in depression scores after five weeks using the CES therapy.1 Improvement After Use In a clinical trial of Alpha-Stim patients, After 6 weeks, users experienced 42.8% improvement.2 ### Featured PDF Content Block Trio Featured Content Dakota Meyers shares his experience with Alpha-Stim AID for battling his anxiety.Watch Dakota’s Story » Get a quick overview of Alpha-Stim devices for use with patients.View the Alpha-StimOverview PDF Now » A new way to treat acute and chronic pain is here, with no surgery and no medications.View the Alpha-Stim Brochure Now » ### sources Sources: 1 Barclay TH, Barclay RD. A clinical Trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders. 2014;164:171-177. Presented at the American Psychological Association National Conference, Honolulu, July 2013. 2 Lee S-H, Kim W-Y, Lee C-H, et al. Effects of cranial electrotherapy stimulation on preoperative anxiety, pain and endocrine response. Journal of International Medical Research. 2013; 41(6) 1788–1795. ### AID facts 2 Improved Sleep Quality The number of subjects rating their quality of sleep as poor dropped from 60% to 5%. Decrease in Depression In clinical trials, Alpha-Stim recipients reported an 82% decrease of ≥ 50% or greater in depression scores after five weeks using the CES therapy. ### AID facts 1 Overall Decrease in Anxiety In clinical trials, patients reported an average of 61% less anxiety immediately after using the CES therapy. After 5 weeks, that average was 94%. Results in 1 Application In a study of preoperative anxiety, Alpha-Stim recipients reported significantly less anxiety after one application. Increased Sleep Time After only 5 Alpha-Stim insomnia treatments, military service members with insomnia reported an increase of 43 minutes of sleep. ### social share blogs ### blog top container Blog ### Get Pain Relief Banner Get pain relief with Alpha-stim Schedule a telehealth visit with a health care professional today to get started with Alpha-Stim M for acute, chronic, and post-traumatic pain relief. Schedule Now ### Mobile Banner Take Chargeof Your Life with Alpha-Stim Alpha-Stim AID Alpha-Stim M ### Research Template Padded Comparison of the effects of cranial electrotherapy stimulation and midazolam as preoperative treatment in geriatric patients: A CONSORT-compliant randomized controlled trial Park BS, Jin S, Kim WY, Kang DS, Choi YJ, Lee YS. Comparison of the effects of cranial electrotherapy stimulation and midazolam as preoperative treatment in geriatric patients: A CONSORT-compliant randomized controlled trial. Medicine (Baltimore). 2022 Sep 2; 101(35). Download ArticleFunding Source, Location of Study or Author’s AffiliationThis study was conducted at the Department of Anesthesiology and Pain Medicine, Ansan Hospital of Korea University College of Medicine. The protocol was approved by the hospital’s institutional review board (2020AS0142) and registered at the Clinical Research Information Service (KCT0006110). Written informed consent was obtained from all patients participating in this study.DeviceAlpha-Stim 100®Key VariablesAnxietyObjectiveTo observe and compare the clinical effect of cranial electrotherapy stimulation (CES) and midazolam as preoperative treatments in geriatric patients.DesignInitially, 90 patients were recruited, but 10 patients were withdrawn either spontaneously or in accordance with the exclusion criteria. In this study, 80 patients were included and randomly divided into 2 groups using a computer-generated randomization method: midazolam premedication group (M group, n = 40) and CES pretreatment group (CES group, n = 40). Preoperative anxiety was measured using the 5-point Likert scale, with anxiety levels rated from “Not at all” to “Severe”. The sedation score was assessed using the Ramsay sedation scale, which is a 6-point scale with sedation scores rated from “Anxious and agitated” to “Patients exhibit no response”. Vital signs that were measured include: Systolic and diastolic blood pressure (SBP & DBP), mean arterial pressure (MAP), heart rate (HR), and peripheral capillary oxygen saturation (SpO2). Different investigators performed pre-anesthesia visits, assessment of preoperative anxiety scores and sedation levels, midazolam premedication, CES pretreatment, and anesthesia induction. Primary Outcome MeasureAll measures were assessed three times: (1) on the day before surgery; (2) in the pre-operative holding area on the day of surgery; and (3) after entering the operating room.Anxiety was evaluated via 5-point Likert scale:5-point Likert scale (1) indicates “not at all”, (2) “mild”, (3) “intermediate”, (4) “moderate”, and (5) “severe”.Sedation score was assessed using the Ramsay sedation scale.On a 6-point scale (1) indicates “Anxious and agitated, or restless, or both”, (2) “cooperative, oriented, and tranquil”, (3) “responds to commands only”, (4) “brisk response to light glabellar tap or loud auditory stimulus”, (5) “sluggish response to light glabellar tap or loud auditory stimulus”, and (6) “patients exhibit no response”. Secondary Outcome MeasureAll measures were assessed three times: (1) on the day before surgery; (2) in the pre-operative holding area on the day of surgery; and (3) after entering the operating room.Vital signs were measured:Systolic and diastolic blood pressure (SBP & DBP), mean arterial pressure (MAP), heart rate (HR), and peripheral capillary oxygen saturation (SpO2). Key Inclusion CriteriaEligible patients wereAged 65 to 79 years oldAmerican Society of Anesthesiologists Physical Status Classification II or IIIScheduled for elective surgery under general anesthesia. Key Exclusion CriteriaThe exclusion criteria includedPsychiatric medications,Obesity (body mass index >30 kg/m2)Chronic alcoholism, liver cirrhosisSerious renal diseaseEndocrine or neuromuscular diseaseArrhythmiaPacemaker or pulmonary disease. Protocol SummaryIn this study, 80 patients were included and randomly divided into 2 groups using a computer-generated randomization method: midazolam premedication group (M group, n = 40) and CES pretreatment group (CES group, n = 40). Pre-anesthesia visits, assessment of preoperative anxiety scores and sedation levels, midazolam premedication, CES pretreatment, and anesthesia induction were performed by different investigators.The anxiety score, sedation score, and vital signs (systolic and diastolic blood pressure, mean blood pressure, HR, and oxygen saturation) were assessed three times: on the night before (baseline) and on the day of the surgery in the preoperative holding area (PHA) and in the operating room (OR) before anesthesia induction.The patients in the M group were intramuscularly injected with midazolam (0.07 mg/kg) 30 minutes before receiving general anesthesia, whereas the patients in the CES group received 20 minutes of CES pretreatment on the day before and on the morning of the surgery. A microcurrent stimulator (Alpha-Stim 100®; Electromedical Products International, Inc., Mineral Wells, TX) was used.Anesthesia was induced with intravenous injection of propofol (2.0mg/kg) and rocuronium (0.9mg/kg). Three minutes of mask ventilation with sevoflurane administration (3 vol%) at an oxygenated air flow of 8 L/min and a fraction of inspired oxygen of 1.0 was performed before intubation. Device Application ProtocolThe electrode clips of the microcurrent stimulator were attached to the patient’s earlobe, and the microcurrent was adjusted to the power of which the patient experienced light dizziness and a tingling sensation. The power of the microcurrent was limited between 200 μA and 0.5 Hz. All patients were premedicated via intramuscular injection of glycopyrrolate (0.005 mg/kg) 30 minutes before receiving general anesthesia. Statistical Analysis PlanThe SPSS software version 25.0 for Windows (SPSS Inc., Chicago, IL) was used for statistical analysis. All data except sex were presented as the mean ± standard deviation. Demographic data were analyzed using either the Mann–Whitney U test, the independent t test, or the chi-square test. A p-value of <.01 was considered statistically significant after Bonferroni correction. The preoperative anxiety score and sedation score were analyzed via the chi-square test. A p-value of <.05 was considered statistically significant. Vital signs of each group on the night before surgery, on the day of the surgery in the PHA, and in the OR before anesthesia induction were analyzed via the Mann–Whitney U test or the independent t test. A p-value of <.0033 was considered statistically significant after Bonferroni correction.The preoperative anxiety score and sedation score were analyzed via the chi-square test. A p-value <.05 was considered statistically significant. ResultsSubjectsA total of 80 patients, with 40 in the CES group, including 21 males and 19 females with a mean age of 69.3± 3.6 years. The M group included 40 subjects, including 22 males and 18 females, with a mean age of 70.3± years. No significant difference in age, sex, weight, height, history of previous surgery, operation time, or anesthesia time were observed between the M group and the CES group.Demographic characteristics of patients in the M and CES groups. Data AnalysisAnxietyThe anxiety scores in the PHA were significantly lower in the CES group compared with the M group (p = .02). No significant difference was observed in the anxiety scores in the general ward on the night before the surgery and in the OR between the 2 groups.Changes in anxiety scores for the M and CES groups. Sedation scoreThe sedation scores in the PHA were significantly lower in the CES group than those in the M group (p < .001). However, no significant difference in the sedation scores was observed in the general ward and OR between the 2 groups.Changes in sedation scores for the M and CES groups. Vital signsThe M group and the CES group showed no significant differences in systolic, diastolic, and mean blood pressures in the general ward on the night before surgery, in the PHA, and in the OR. No significant difference in HR was observed in the general ward on the night before surgery and in the PHA. However, HRs in the OR were significantly slower in the M group than those in the CES group (M premedication group, 69.2±10.5 beats/min; CES group, 79.6 ±15.3 beats/min) (p < .001).Changes in vital signs for M and CES groups Finally, the M group and the CES group showed no significant difference in the baseline oxygen saturation in the general ward on the night before. Oxygen saturations in the PHA (M group, 94.3% ± 2.4%; CES group, 97.4% ±1.8%) and the OR (M group, 95.9% ±1.8%; CES group, 97.5% ± 1.6%) were significantly higher in the CES group than those in the M group (p <.001).Changes in Oxygen Saturation for M and CES groups ConclusionIn 65- to 79-year-old patients with American Society of Anesthesiologists Physical Status Classification II or III, CES pretreatment, in comparison with the midazolam premedication, resulted in lower anxiety levels in PHA with less risk of over-sedation and respiratory depression before surgery. Their results showed that pretreatment with CES reduces preoperative anxiety levels and withdrawal responses to rocuronium-induced pain. The study concluded that the noninvasive nature of CES and the absence of serious side effects, indicate it can safely be used on the day before and the day of surgery. LimitationsThe study utilized less than 200 uA of CES for only 20 minutes each. Recommended treatment durations for currents at 200 uA or lower is 60 minutes. Study Quality: GOOD ### Research Summary Article Comparison of the effects of cranial electrotherapy stimulation and midazolam as preoperative treatment in geriatric patients: A CONSORT-compliant randomized controlled trial Park BS, Jin S, Kim WY, Kang DS, Choi YJ, Lee YS. Comparison of the effects of cranial electrotherapy stimulation and midazolam as preoperative treatment in geriatric patients: A CONSORT-compliant randomized controlled trial. Medicine (Baltimore). 2022 Sep 2; 101(35). Download ArticleFunding Source, Location of Study or Author’s AffiliationThis study was conducted at the Department of Anesthesiology and Pain Medicine, Ansan Hospital of Korea University College of Medicine. The protocol was approved by the hospital’s institutional review board (2020AS0142) and registered at the Clinical Research Information Service (KCT0006110). Written informed consent was obtained from all patients participating in this study.DeviceAlpha-Stim 100®Key VariablesAnxietyObjectiveTo observe and compare the clinical effect of cranial electrotherapy stimulation (CES) and midazolam as preoperative treatments in geriatric patients.DesignInitially, 90 patients were recruited, but 10 patients were withdrawn either spontaneously or in accordance with the exclusion criteria. In this study, 80 patients were included and randomly divided into 2 groups using a computer-generated randomization method: midazolam premedication group (M group, n = 40) and CES pretreatment group (CES group, n = 40). Preoperative anxiety was measured using the 5-point Likert scale, with anxiety levels rated from “Not at all” to “Severe”. The sedation score was assessed using the Ramsay sedation scale, which is a 6-point scale with sedation scores rated from “Anxious and agitated” to “Patients exhibit no response”. Vital signs that were measured include: Systolic and diastolic blood pressure (SBP & DBP), mean arterial pressure (MAP), heart rate (HR), and peripheral capillary oxygen saturation (SpO2). Different investigators performed pre-anesthesia visits, assessment of preoperative anxiety scores and sedation levels, midazolam premedication, CES pretreatment, and anesthesia induction. Primary Outcome MeasureAll measures were assessed three times: (1) on the day before surgery; (2) in the pre-operative holding area on the day of surgery; and (3) after entering the operating room.Anxiety was evaluated via 5-point Likert scale:5-point Likert scale (1) indicates “not at all”, (2) “mild”, (3) “intermediate”, (4) “moderate”, and (5) “severe”.Sedation score was assessed using the Ramsay sedation scale.On a 6-point scale (1) indicates “Anxious and agitated, or restless, or both”, (2) “cooperative, oriented, and tranquil”, (3) “responds to commands only”, (4) “brisk response to light glabellar tap or loud auditory stimulus”, (5) “sluggish response to light glabellar tap or loud auditory stimulus”, and (6) “patients exhibit no response”. Secondary Outcome MeasureAll measures were assessed three times: (1) on the day before surgery; (2) in the pre-operative holding area on the day of surgery; and (3) after entering the operating room.Vital signs were measured:Systolic and diastolic blood pressure (SBP & DBP), mean arterial pressure (MAP), heart rate (HR), and peripheral capillary oxygen saturation (SpO2). Key Inclusion CriteriaEligible patients wereAged 65 to 79 years oldAmerican Society of Anesthesiologists Physical Status Classification II or IIIScheduled for elective surgery under general anesthesia. Key Exclusion CriteriaThe exclusion criteria includedPsychiatric medications,Obesity (body mass index >30 kg/m2)Chronic alcoholism, liver cirrhosisSerious renal diseaseEndocrine or neuromuscular diseaseArrhythmiaPacemaker or pulmonary disease. Protocol SummaryIn this study, 80 patients were included and randomly divided into 2 groups using a computer-generated randomization method: midazolam premedication group (M group, n = 40) and CES pretreatment group (CES group, n = 40). Pre-anesthesia visits, assessment of preoperative anxiety scores and sedation levels, midazolam premedication, CES pretreatment, and anesthesia induction were performed by different investigators.The anxiety score, sedation score, and vital signs (systolic and diastolic blood pressure, mean blood pressure, HR, and oxygen saturation) were assessed three times: on the night before (baseline) and on the day of the surgery in the preoperative holding area (PHA) and in the operating room (OR) before anesthesia induction.The patients in the M group were intramuscularly injected with midazolam (0.07 mg/kg) 30 minutes before receiving general anesthesia, whereas the patients in the CES group received 20 minutes of CES pretreatment on the day before and on the morning of the surgery. A microcurrent stimulator (Alpha-Stim 100®; Electromedical Products International, Inc., Mineral Wells, TX) was used.Anesthesia was induced with intravenous injection of propofol (2.0mg/kg) and rocuronium (0.9mg/kg). Three minutes of mask ventilation with sevoflurane administration (3 vol%) at an oxygenated air flow of 8 L/min and a fraction of inspired oxygen of 1.0 was performed before intubation. Device Application ProtocolThe electrode clips of the microcurrent stimulator were attached to the patient’s earlobe, and the microcurrent was adjusted to the power of which the patient experienced light dizziness and a tingling sensation. The power of the microcurrent was limited between 200 μA and 0.5 Hz. All patients were premedicated via intramuscular injection of glycopyrrolate (0.005 mg/kg) 30 minutes before receiving general anesthesia. Statistical Analysis PlanThe SPSS software version 25.0 for Windows (SPSS Inc., Chicago, IL) was used for statistical analysis. All data except sex were presented as the mean ± standard deviation. Demographic data were analyzed using either the Mann–Whitney U test, the independent t test, or the chi-square test. A p-value of <.01 was considered statistically significant after Bonferroni correction. The preoperative anxiety score and sedation score were analyzed via the chi-square test. A p-value of <.05 was considered statistically significant. Vital signs of each group on the night before surgery, on the day of the surgery in the PHA, and in the OR before anesthesia induction were analyzed via the Mann–Whitney U test or the independent t test. A p-value of <.0033 was considered statistically significant after Bonferroni correction.The preoperative anxiety score and sedation score were analyzed via the chi-square test. A p-value <.05 was considered statistically significant. ResultsSubjectsA total of 80 patients, with 40 in the CES group, including 21 males and 19 females with a mean age of 69.3± 3.6 years. The M group included 40 subjects, including 22 males and 18 females, with a mean age of 70.3± years. No significant difference in age, sex, weight, height, history of previous surgery, operation time, or anesthesia time were observed between the M group and the CES group.Demographic characteristics of patients in the M and CES groups. Data AnalysisAnxietyThe anxiety scores in the PHA were significantly lower in the CES group compared with the M group (p = .02). No significant difference was observed in the anxiety scores in the general ward on the night before the surgery and in the OR between the 2 groups.Changes in anxiety scores for the M and CES groups. Sedation scoreThe sedation scores in the PHA were significantly lower in the CES group than those in the M group (p < .001). However, no significant difference in the sedation scores was observed in the general ward and OR between the 2 groups.Changes in sedation scores for the M and CES groups. Vital signsThe M group and the CES group showed no significant differences in systolic, diastolic, and mean blood pressures in the general ward on the night before surgery, in the PHA, and in the OR. No significant difference in HR was observed in the general ward on the night before surgery and in the PHA. However, HRs in the OR were significantly slower in the M group than those in the CES group (M premedication group, 69.2±10.5 beats/min; CES group, 79.6 ±15.3 beats/min) (p < .001).Changes in vital signs for M and CES groups Finally, the M group and the CES group showed no significant difference in the baseline oxygen saturation in the general ward on the night before. Oxygen saturations in the PHA (M group, 94.3% ± 2.4%; CES group, 97.4% ±1.8%) and the OR (M group, 95.9% ±1.8%; CES group, 97.5% ± 1.6%) were significantly higher in the CES group than those in the M group (p <.001).Changes in Oxygen Saturation for M and CES groups ConclusionIn 65- to 79-year-old patients with American Society of Anesthesiologists Physical Status Classification II or III, CES pretreatment, in comparison with the midazolam premedication, resulted in lower anxiety levels in PHA with less risk of over-sedation and respiratory depression before surgery. Their results showed that pretreatment with CES reduces preoperative anxiety levels and withdrawal responses to rocuronium-induced pain. The study concluded that the noninvasive nature of CES and the absence of serious side effects, indicate it can safely be used on the day before and the day of surgery. LimitationsThe study utilized less than 200 uA of CES for only 20 minutes each. Recommended treatment durations for currents at 200 uA or lower is 60 minutes. Study Quality: GOOD ### Basic Inside Page Template ### Sources Box Sources:Barclay TH, Barclay RD. A clinical Trial of cranial electrotherapy stimulation for anxiety and comorbid depression. Journal of Affective Disorders. 2014; 164:171-177. Presented at the American Psychological Association National Conference, Honolulu, July 2013.Bystritsky A, Kerwin  L, Feusner J. A pilot study of cranial electrotherapy stimulation for generalized anxiety disorder. Journal of Clinical Psychiatry. 2008; 69:412-417. Presented at the American Psychiatric Association meeting, San Francisco, 2009. ### Webinar Page Template Webinars Get Started Discover Alpha-Stim technology today. Alpha-Stim® M For anxiety, insomnia, depression, and pain. Learn More Alpha-Stim® AID For anxiety, insomnia and depression. Learn More ### Webinar REquest disclaimer Alpha-Stim Utilization for Anxiety, Insomnia, and Depression in an Addiction Setting Throughout his career psychiatrist Brian S. Earthman has treated numerous patients undergoing inpatient and outpatient psychiatric and substance abuse treatment.In his practice, he’s seen excellent results integrating Alpha-Stim® into clinical care of this patient population to treat symptoms of anxiety, insomnia and depression.Simply fill out the form below to access the webinar now.Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States.
Headline on form: Access the Webinar NowFill out the form below to access the webinar Alpha-Stim Utilization for Anxiety, Insomnia, and Depression in an Addiction Setting. all fields mandatoryFirst Name*Last Name*Email*Submit* Submit [Access Webinar] ### webinar request Alpha-Stim and Physical Therapy Webinar While Alpha-Stim® may sound like e-stim techniques used in physical therapy, the two modalities are quite different.In this webinar, hear from Greg Redmond, DPT, about how about the science behind Alpha-Stim and use cases in physical therapy.Simply fill out the form below to access the webinar now.Headline on form: Access the Webinar NowFill out the form below to access the webinar Alpha-Stim and Physical Therapy.   all fields mandatoryFirst Name*Last Name*Email*Submit* Submit [Access Webinar] ### Updated Get Started with D Alpha-Stim and Physical Therapy Webinar Thank you for requesting our webinar about the role Alpha-Stim can play in physical therapy. Below you can access the webinar.https://www.youtube.com/watch?v=mpn1InfLv_Y*Alpha-Stim is FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Get Started Discover Alpha-Stim technology today. Alpha-Stim AID For anxiety, insomnia, and depression Learn More Alpha-Stim M For pain, anxiety, insomnia, and depression. Learn More ### Manuals Loop ### Accordion FAQs Commonly Asked Questions about Alpha-Stim for Pain Relief We’ve gotten a few questions over the years about how Alpha-Stim works for pain management. See below for some of our most common questions and answers.  What kinds of pain does Alpha-Stim relieve? Alpha-Stim M can treat all types of acute pain, chronic pain, and post-traumatic pain. Is Alpha-Stim more expensive than other treatments for pain? Over 5 years, someone who takes medication – such as pain pills – or does other treatments typically used to treat acute and chronic pain can pay thousands of dollars more than someone using Alpha-Stim. How long will I have to use Alpha-Stim? Alpha-Stim effectively controls pain, anxiety, and insomnia. For some conditions, results are experienced immediately and for others, a small amount of time and persistence provides needed relief and results. Learn more about how long to use Alpha-Stim and when to decrease usage here. Alpha-Stim M can treat all types of acute pain, chronic pain, and post-traumatic pain.Over 5 years, someone who takes medication – such as pain pills - or does other treatments typically used to treat acute and chronic pain can pay thousands of dollars more than someone using Alpha-Stim.Alpha-Stim effectively controls pain, anxiety, and insomnia. For some conditions, results are experienced immediately and for others, a small amount of time and persistence provides needed relief and results. Learn more about how long to use Alpha-Stim and when to decrease usage here. ### Medium Inner Banner Take Charge of your mental health A new approach to managing depression ### Shop Page Container ### Products Archive ### Single Product Related Products ### Smaller Inner Banner Blog ### Single Post Blog ### News Loop ### Why AS timeline A History of Advancing Electrotherapy Solutions Since 1981, Alpha-Stim has helped hundreds of thousands of people achieve remarkable results, but our history in innovation and care begins a decade before. In the 1970’s, a visionary named Dr. Daniel L. Kirsch began developing the technology that ultimately became Alpha-Stim.  In 1981, Dr. Kirsch’s perfected waveform technology was revealed, and we introduced the Alpha-Stim 2000. Kirsch followed with the Alpha-Stim 350, the world’s first home care microstimulator, and our technology has continued to evolve since. ### Getting started with AS Getting Started with Alpha-Stim We know you want what’s best for the patients you treat, whether they have anxiety, insomnia, depression or pain. To help new health practitioners learn if Alpha-Stim is a good fit for their patients, we offer free 60-day trials for in-office use of both Alpha-Stim® AID and Alpha-Stim M.Use the form below to get more information about Alpha-Stim and our health practitioner trial. ### How to prescribe How to Prescribe & Use Alpha-Stim SAlpha-Stim technologies are easy to use with patients. Alpha-Stim can be prescribed both in-person in a qualified healthcare clinic or office setting, as well as via telehealth appointments. Alpha-Stim can be used as a first-line therapy, or as an adjunct to pharmacotherapy without polypharmacy effects. Alpha-Stim treatments are cumulative; however, most patients show at least some improvement after the first treatment Hundreds of thousands of people around the world have achieved remarkable results with Alpha-Stim technologies, with many practitioners often using the devices right alongside their patients. ### Proven to provide with anxiety, insomnia & depression Proven to Help with Anxiety, Insomnia & Depression Overall Decrease in Anxiety In clinical trials, patients reported an average of 61% less anxiety immediately after using the CES therapy. After 5 weeks, that average was 94%. Results in 1 Application In a study of preoperative anxiety, Alpha-Stim recipients reported significantly less anxiety after one application. Increased Sleep Time After only 5 Alpha-Stim insomnia treatments, military service members with insomnia reported an increase of 43 minutes of sleep. Improved Sleep Quality The number of subjects rating their quality of sleep as poor dropped from 60% to 5%. Decrease in Depression In clinical trials, Alpha-Stim recipients reported an 82% decrease of ≥ 50% or greater in depression scores after five weeks using the CES therapy. ### Alpha-Stim AID Features Alpha-Stim® Aid Features Treats anxiety, insomnia, and depression* Can be used as an adjunct to pharmacotherapy without polypharmacy effects Can be used at home safely and easily Treatments are cumulative and show improved sustainable results over time Includes earclips for CES therapy for treating anxiety and insomnia Shop Now ### Other Products and Accessories Alpha-Stim Mobile App & Accessories To help you get the most out of your Alpha-Stim M, explore our Alpha-Stim accessories. Our unique mobile app also offers Alpha-Stim users a personalized way to keep track of sessions and progress over time.  Everything you need to keep up with your Alpha-Stim M treatments. Explore our collection of Alpha-Stim M accessories including a carrying case, earclip electrodes, AS-Trodes™, and more.  View Accessories Keep track of your progress with Alpha-Stim AID or Alpha-Stim M with the Alpha-Stim Health Tracker App. Track your treatment sessions, log daily check-ins, view progress analytics, take assessments and more.  Download Now ### Why choose Alpha Stim Call out A Technology Patients & Providers Trust Alpha-Stim has been helping hundreds of thousands of people take charge of their anxiety, insomnia and pain. Alpha-Stim technology has led the way with innovative non-drug medical devices. Alpha-Stim AID and Alpha-Stim M devices are highly praised by both patients and providers. See more about why many choose Alpha-Stim » ### Testimonials “Not only have I experienced relief from anxiety and insomnia; additionally, Alpha-Stim treatments have reduced or eliminated accompanying physical pain.” CH (MAJ) David J. Fair PhD,President, American Association of Police Officers; President, Homeland Crisis InstituteTexas “The Alpha-Stim has so much good science behind it, with many highly controlled clinical studies—this really proves its unique effectiveness for so many types of patients. And you can’t ignore the incredible safety record with no serious side effects. That’s why I recommend it to many of my patients.” Anita D. Spitz, MD, Chief Family Medicine Department Parrish Medical CenterTitusville, Florida “So far, I have overall had good results from the Alpha-Stim AID. In fact, one day while doing household tasks I walked in front of a mirror and noticed that I was smiling! That's new behavior and truly a result of this device. I am also experiencing a feeling of well-being and deep sleep that I haven't experienced since college days.” Alpha-Stim User “I experienced the worst depression I have ever felt. I never have had depression until now. It’s the worst feeling ever. Makes the days go by so much slower. I went to my doctor, hoping for medicine. Instead he let me try Alpha- Stim. This product ended up being a life changer! It is awesome!” Angie Lamborghini “After 3 months, I feel like a new person. I would recommend Alpha-Stim to anyone suffering from depression or anxiety.” Laine Downing Previous Next ### Take Charge Call Out Box See if Alpha-Stim AID is Right for You. Give Alpha-Stim AID a try for anxiety relief today. Schedule a telehealth consult below with a licensed health care provider to get started. Schedule now ### Two Modalities Two Separate Modalities The Alpha-Stim M includes handheld Smart Probes or AS-Trode self-adhesive electrodes for site-specific MET pain therapy, as well as earclips that provide cranial electrotherapy stimulation (CES)—to relieve common comorbidities associated with pain. ### Proven to provide Pain Relief Proven to provide pain relief Severe Pain Reduction In a study of patients with severe pain, Alpha-Stim M significantly reduced pain by an average of 71% after only five treatments. Decrease in Post-Traumatic Pain In a post-traumatic pain study, 56% of patients at 3 months and 85% at 6 months were somewhat or very satisfied with the device for reducing pain levels. ImprovedFunction Chronic pain patients using Alpha-Stim reported significantly improved functionality than the usual care and sham groups one study found. Better than drug-treatments When compared to pain relief responses from patients using Vicodin and OxyContin, patients self-reported greater reductions in pain with Alpha-Stim. ### Alpha-Stim M Features Alpha-Stim® M Features Treats acute and chronic pain conditions throughout the body Treats post-traumatic pain Can be used as a first-line therapy for pain management Can be used as an adjunct to pharmacotherapy without polypharmacy effects Can be used at home by patients safely and easily Includes handheld probes or self-adhesive electrodes for MET pain therapy Includes earclips for CES therapy for treating anxiety, insomnia, and depression, which are common comorbidities associated with pain Shop Now ### Ask Us About Alpha-Stim Ask Us About Alpha-Stim® telehealth Visit See if Alpha-Stim is right for you via a telehealth visit with a licensed healthcare provider Schedule Now shop online Purchase Alpha-Stim devices and accessories in our online store Shop Now talk with our team Speak with a representative on the phone to learn more Call Now ### Featured Content Featured Content Patients & Providers Dakota Meyers shares his experience with Alpha-Stim AID for battling his anxiety.Watch Dakota’s Story » Get a quick overview of Alpha-Stim AID and Alpha-Stim M for use with patients.View the Alpha-StimOverview PDF Now » A new way to treat acute and chronic pain is here, with no surgery and no medications.Get the Alpha-Stim M Information PDF » ### Why Choose AS A New Way to Manage Anxiety If you’ve ever experienced anxiety, you’re not alone. Nearly 264 million people worldwide have an anxiety disorder, the World Health Organization reports. And an estimated 30% of adults will suffer from anxiety at some point in their lifetime.Anxiety can be crippling for many people, but thankfully, medications and other more aggressive therapies are not the only option. For those seeking more control of their anxiety treatment, Alpha-Stim AID offers a safe, effective, and easy option. ### Ragga Ragnars Hear What People Are Saying About Alpha-Stim® “As a mom and having the unstable job of being an actress, who sometimes needs to travel all over the world to work, it can be demanding and at times quite stressful. I never thought of myself as having anxiety the way it was usually described to me but when I think back to a few months ago, and throughout the pandemic (where projects fell through and a lot of uncertainty with my job was a constant for quite some time) I can say now that I have indeed experienced bursts of anxiety.After getting Alpha-Stim and using it for 20 minutes every day (I have had it for over 6 months now) it is safe to say that my stress and anxiety have decreased so much. I am more calm and focused when dealing with the day to day mom life, I am at ease when I travel and need help from my family with my son (my friends and my parents have been amazing at bringing my son to me when I am away working, or taking care of him at home while I am away) and before, that would stress me out a lot. Now, I go through my days with minimum stress and anxiety and absolutely love my Alpha-Stim for it.”— Ragga Ragnars, Actress, Former Olympic SwimmerView More Testimonials from Patients and Providers » ### Drug-Free Treatments That Works Drug-Free Treatment That Works Alpha-Stim electrotherapy devices offer a cost-effective, drug-free option for treating anxiety, insomnia, and pain quickly and safely. Take charge of your life again today with Alpha-Stim. Anxiety Manage anxiety without medication anywhere, anytime with Alpha-Stim AID. Learn More insomnia Take back your nights with Alpha-Stim AID for treating insomnia. Learn More depression Alpha-Stim AID is a safe and effective way to treat depression without the side effects of drugs. Learn More pain Alpha-Stim M is approved to treat acute, chronic, and post-traumatic pain. Learn More *FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. ### Get Started Get Started Discover Alpha-Stim technology today. Alpha-Stim® AID For anxiety and insomnia. Learn More Alpha-Stim® M For anxiety, insomnia and pain. Learn More ### Footer Electromedical Products International, Inc.2201 Garrett Morris ParkwayMineral Wells, TX 76067-9034, USAUS: 1–800–367–7246OUS: +1 940–328–0788Email: info@epii.comUK customers visitwww.alpha-stim.co.ukFDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. Regulatory and Patent Information Facebook-f Youtube Linkedin-in Instagram Alpha-Stim and the Alpha-Stim logo are registered trademarks, and LET NOTHING STOP YOU and LET NOTHING STOP THEM are trademarks of Electromedical Products International, Inc. ### Header Shop Now ### Default Kit ## Products ### Alpha-Stim AID Kit (US) - For Anxiety & Insomnia Alpha-Stim® AID is an FDA-cleared, handheld medical device designed to treat anxiety and insomnia using cranial electrotherapy stimulation (CES). It delivers a patented microcurrent waveform through comfortable earclip electrodes. Treatments are easy—just 20-60 minutes at home while reading, watching TV, or relaxing. Relief is often immediate and cumulative with regular use. Unlike medications, Alpha-Stim has no lasting side effects or risk of addiction, with 100+ clinical studies proving its safety and effectiveness. Includes everything you need to begin treatment, including: one set of Earclip Electrodes, 256 Earclip Electrodes, conducting solution, two AAA batteries, storage case, neck lanyard, and an illustrated Owner's Manual. Satisfaction Guaranteed! Includes a 30-day money-back guarantee (10% restocking fee applies). Prescription Requirement  A valid prescription or Statement of Medical Necessity from a licensed healthcare provider is required. Please submit via: Fax: 940-328-0888 Email: alpha-stim@epii.com Don't have a doctor? Click here to schedule a telehealth consultation with a licensed provider. Healthcare Providers Want to offer Alpha-Stim to your patients? Call us at 940-328-0788 to learn how to prescribe or purchase. ### Alpha-Stim M Kit (US) - For Pain, Anxiety & Insomnia Alpha-Stim® M is an FDA-cleared, handheld medical device designed to treat anxiety and insomnia, along with acute, post-traumatic, and chronic pain. It uses both cranial electrotherapy stimulation (CES) via comfortable earclip electrodes and microcurrent electrical therapy (MET) delivered through hand-held probes or self-adhesive electrodes. Treatments are simple—just 5–60 minutes in the comfort of your home, while relaxing or going about your day. Relief is often immediate and cumulative with regular use. Unlike medications, Alpha-Stim M has no lasting side effects and no risk of addiction, with over 100 independent clinical studies supporting its safety and effectiveness. Includes everything you need to get started, including a set of Earclip Electrodes, a 50 ml bottle of Alpha-Stim® Conducting Solution, empty bottle for use with Alpha-Stim® Conducting Solution, 2 sets of leadwires, 100 Probe Electrode Pads (PEPS™), 4 silver AS-Trode™ single person multiple use self-adhesive electrodes, 2 Smart Probes, 256 Earclip Electrode Pads (EEPS™), Owner’s Manual, Lanyard, Storage case, and 2 AA 1.5 volt lithium batteries. Satisfaction Guaranteed! Includes a 30-day money-back guarantee (10% restocking fee applies). Prescription Requirement  A valid prescription or Statement of Medical Necessity from a licensed healthcare provider is required. Please submit via: Fax: 940-328-0888 Email: alpha-stim@epii.com Don’t have a doctor? Click here to schedule a telehealth consultation with a licensed provider. Healthcare Providers Want to offer Alpha-Stim to your patients? Call us at 940-328-0788 to learn how to prescribe or purchase. ### AS-Trode Self-Adhesive Silver Electrode Pads for Alpha-Stim M AS-Trode self-adhesive silver electrodes are for use with the Alpha-Stim M to treat acute, chronic, and post-traumatic pain. Each pack includes 4 AS-Trodes. Buy 10+ packs and save 37.5% OFF, plus get free shipping! AS-Trode self-adhesive silver electrodes have been extensively researched by Electromedical Products International to determine that they provide optimal transfer of the Alpha-Stim patented waveform, assuring the best clinical results. ### Alpha-Stim M Smart Probe Treatment probe for use with the Alpha-Stim M microcurrent and cranial electrotherapy stimulator. ### Replacement Lead Wire for Alpha-Stim M Replacement lead wire for use with Alpha-Stim treatment probes and self-adhesive electrodes for the Alpha-Stim M microcurrent and cranial electrotherapy stimulator. ### Earclip Electrodes for the Alpha-Stim AID Earclip Electrodes for use with the Alpha-Stim AID microcurrent and cranial electrotherapy stimulator. Your earclip plug should be grey. If you have an Alpha-Stim M and your earclip plug is green, click here to view that product. ### Alpha-Stim Conducting Solution Refill 250ml refill size of Alpha-Stim Conducting Solution for use with Alpha-Stim Smart Probes and Alpha-Stim Earclip Electrodes for the Alpha-Stim M and Alpha-Stim AID. ### Earclip Electrodes for the Alpha-Stim M Earclip Electrodes for use with the Alpha-Stim M microcurrent and cranial electrotherapy stimulator. Your earclip plug should be green. If you have an Alpha-Stim AID and your earclip plug is grey, click here to view that product. ### Box of 256 Felt Earclip Electrode Pads 256 self-adhesive felt electrode pads for use with Alpha-Stim Earclip Electrodes used with the Alpha-Stim M and Alpha-Stim AID stimulators. Must apply conducting solution to insure optimal conductivity. ### Alpha-Stim AID Carry Case This soft sided, portable carry case is a convenient way to store the Alpha-Stim AID and accessories. The zippered case unfolds to reveal 2 compartments designed to hold the Alpha-Stim AID, a bottle of conducting solution, and 4 AAA batteries. Additional accessories can be stored in the see-through mesh pocket. ### Alpha-Stim AID Kit - For Anxiety, Insomnia & Depression Alpha-Stim® AID is a handheld medical device that is proven safe and effective for the treatment of anxiety, insomnia, and depression. Alpha-Stim uses cranial electrotherapy stimulation (CES) to deliver a patented waveform via two earclip electrodes. Treatments typically take 20 minutes and can be done in the comfort of your own home while doing normal, everyday activities.  Relief is often immediate and treatments are cumulative. While we suggest daily treatments until you have a noticeable decrease in symptoms, they can be done 2-3 times a week for maintenance or as needed. The safety and effectiveness of Alpha-Stim is backed by over 100 independent clinical research studies. Unlike with medications, there is no risk of addiction or lasting side effects. Alpha-Stim is supported by over 100 completed independent research studies and published reports that utilize the most rigorous, controlled clinical study methods. Again and again, the Alpha-Stim electrotherapy device has proved to quickly and safely provide relief from anxiety, insomnia, and depression. A prescription or order from a licensed healthcare professional is not required to purchase this device outside of the USA. FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. To inquire about availability and pricing outside of the United States, please contact us at 940-328-0788 or email to alpha-stim@epii.com. This product has a 30 day money back satisfaction guarantee with 10% restocking fee. ### Box of 100 Probe Electrode Pads 100 non-adhesive single-use probe electrode pads (PEPs) that fit on the Alpha-Stim Smart Probes. PEPs are used in conjunction with conducting solution. US and worldwide patents pending. ### Alpha-Stim M Carry Case This soft sided, portable carry case is a convenient way to store the Alpha-Stim M and accessories. The case unzips to reveal compartments designed to hold the Alpha-Stim M, 2 probes, bottle of conducting solution, 1 set of Earclip Electrodes and 2 AA batteries. There is also a see-through mesh pocket for holding additional accessories. Alpha-Stim and accessories not included. ### Alpha-Stim M Kit - For Pain, Anxiety, Insomnia & Depression The Alpha-Stim® M provides fast, safe and proven effective treatment of acute, post-traumatic, and chronic pain, along with the anxiety, insomnia, and depression that often accompany it. The handheld, prescription medical device uses dual modalities: microcurrent electrical therapy (MET) to treat pain at its source and cranial electrotherapy stimulation (CES) to treat mood and sleep. Many people see immediate improvement, and results are cumulative with no lasting side effects and no risk of addiction. Alpha-Stim is supported by over 100 completed independent research studies and published reports that utilize some of the most rigorous, controlled clinical study methods. Again and again, the Alpha-Stim electrotherapy device has proven to quickly and safely provide relief from pain, anxiety, insomnia, and depression. A prescription or order from a licensed healthcare professional is not required to purchase this device outside of the USA. FDA cleared for anxiety, insomnia and pain only, with approval for depression outside of the United States. To inquire about availability and pricing outside of the United States, please contact us at 940-328-0788 or email to alpha-stim@epii.com. This product has a 30 day money back satisfaction guarantee with 10% restocking fee. ## Quizzes & Surveys ### CES and MET Certification Welcome to your CES and MET Certification. Full Name (as you would like it to appear on your certificate) Facility/Organization Address City State Country Zip Code Phone Email In treating a patient with pain utilizing Microcurrent Electrical Therapy (MET), the first step in the standard 5-step protocol is: Placing probes in a star pattern around the area Crossing the spine with the probes Placing the probes beyond the treatment area in at least 2 places, directing the current between the Probes through the treatment area (“big X”) The 1-minute protocol None The standard recommended frequency for use in both Alpha-Stim® Cranial Electrotherapy Stimulation (CES) and Microcurrent Electrical Therapy (MET) is: 0.5 Hz 200 Hz 500 Hz 100 Hz None Which of the following are included in the safety warnings listed in the Alpha-Stim user manual: While working on a computer, using a microwave, or going for a walk Using Alpha-Stim in adjunct with other pharmacotherapy options While operating a vehicle, stimulating over the eyes, or while pregnant Using Alpha-Stim before undergoing surgery or other invasive medical procedures None In the United States, cranial electrotherapy stimulation (CES) is FDA cleared for: Anxiety & Insomnia ADHD Schizophrenia Substance Use Disorders None In the United States, microcurrent electrical therapy (MET) is FDA cleared to treat which of the following indications: Infections Pain Dry skin Hypertension None The individual experience of using Alpha-Stim can vary from patient to patient. What are some commonly reported feelings after a session of Alpha-Stim CES? Relaxed Alert Calm All of the above None What is the One Minute Protocol, when using the Smart Probes with Microcurrent Electrical Therapy? Placing the probes ipsilateral on the body Placing the probes on each of the digits of either the hands or the feet Placing the probes contralateral on the body Placing the probes in a star pattern None After speaking with Mrs. Jay, you prescribe Cranial Electrotherapy Stimulation (CES). During the last 5 minutes of a 20-minute treatment session, she reports feeling “heavy”, “groggy”, and “disoriented”. Based on these symptoms, what next steps should you take? Discontinue treatment immediately Advise the patient to go home and sleep Continue CES until at least 2 minutes after the patient no longer reports these symptoms Reduce the current for 2 minutes and discontinue treatment None Mr. Kay initially sought treatment for insomnia and you prescribed Cranial Electrotherapy Stimulation (CES) daily. During his two-week follow up appointment, Mr. Kay complains that his insomnia is not improving. How will you advise the patient? The insomnia is treatment resistant and therefore will never go away Refer to published clinical resources (Khyatee et al., 2019) and educate the patient that insomnia may take 3 weeks or more for CES to provide relief Discontinue CES treatment immediately Recommend doubling the current and time of treatments None Contraindications for use of Cranial Electrotherapy Stimulation (CES) and Microcurrent Electrical Therapy (MET) are: Use of Alpha-Stim® is contraindicated with implanted pacemakers or implanted or wearable defibrillators Headaches Seizures Cancer None During a follow up appointment with a patient for which you prescribed Cranial Electrotherapy Stimulation (CES), the patient complains of having uncomfortable side effect that persist even after a CES treatment has ended. Which department at EPI should you contact to report these to? Customer Service (info@epii.com) Medical Affairs (medicalaffairs@epii.com) The local Alpha-Stim sales representative in your area None of the above None Before treating a patient for pain with Microcurrent Electrical Therapy (MET), a best practice is to: Have the patient estimate their pain on a scale of 0 to 10 Have the patient lay supine on a table Wash the area with iodine solution Have the patient lay prostrate on a table None During a CES treatment session, what describes the process for determining the optimal current level for an individual patient? Patients increase the current level until a noticeable tingling sensation can be felt on the earlobe, signifying that the appropriate level has been achieved. The mild tingling sensation serves as a tool demonstrating that the appropriate amount of current is being applied Patients start at the highest current level and decrease the current until they can no longer notice a tingling sensation on their earlobes Patients begin at the lowest current setting (1) and slowly increase the current until a slight rocking or dizzy sensation occurs, signifying that vestibular activation has been achieved. At this point patients decrease the current just below vestibular threshold ensuring a comfortable and effective treatment session Patients begin at the lowest current setting (1) and increase the current until a slight rocking or dizzy sensation occurs, signifying that vestibular activation has been achieved. At this point patients increase the current level several settings higher and wait several minutes for the rocking sensation to subside None Which of the following are possible side effects to Cranial Electrotherapy Stimulation (CES) treatment as listed in the owner’s manual? Headaches Transient vertigo Skin irritation at site of electrodes All of the above None Alpha-Stim is FDA cleared and CE certified. True False None Which of the following is true of Alpha-Stim treatments: They are complicated and require a trained, licensed provider to conduct treatments in office. They are ineffective and have no supporting research, the benefits can be attributed to placebo effect. Treatments are easy to complete and can be done by the patient at home at their convenience. Alpha-Stim treatments are stand-alone treatment only. No other treatment approaches, such as medications or therapy, should be attempted while a patient is undergoing a course of Alpha-Stim treatment. None Which of the following treatment options can Alpha-Stim safely be used in adjunct with: Psychiatric drugs (SSRIs, Benzodiazapines, ASDs, etc.) Psychotherapy Neurofeedback therapy All of the above None While many traditional TENS devices use stimulation in the milliamp range, Alpha-Stim uses electrical current in the ______ range, often leading to more subtle and comfortable treatment sessions: Picoamp Microamp Milliamp None The outlined protocols using the Alpha-Stim smart probes are carefully designed to target which of the following: The endocrine system Multiple levels of the pain pathway Blood vessels Muscle tissue None While treating pain using Alpha-Stim M, what would be the goal of advising a patient to follow up with a CES treatment session? CES can be used to target comorbid anxiety and insomnia that chronic pain patients may also report experiencing CES delivered through the earclips can be used to treat pain in the ear and the back of the head CES treatment is used to achieve acute pain relief that the smart probes or adhesive trodes alone cannot provide None of the above None Time's upCancel ### CES Certification Welcome to your CES Certification Full Name (as you would like it to appear on your certificate) Facility/Organization Address City State Country Zip Code Phone Email The recommended frequency for use in both Alpha-Stim® Cranial Electrotherapy Stimulation (CES): 0.5 Hz 200 Hz 500 Hz 100 Hz None Neuroimaging studies, such as qEEG and fMRI, have shown Alpha-Stim CES to: Increase activity of hyperactive nerve cells in the anxiety and pain processing centers of the brain Balance nerve cell activity to restore homeostasis to the nervous system Have no effect on nerve cell activity Decrease the activity of hypoactive nerve cells None It is never recommended to perform a CES session while: Working on a computer Using a microwave Operating a vehicle Within 20 minutes of walking None In the United States, cranial electrotherapy stimulation (CES) is cleared for: Anxiety & Insomnia ADHD Schizophrenia Substance Use Disorders None How do patients most commonly report feeling after a session of Alpha-Stim CES? Relaxed Alert Calm All of the above None After speaking with Mrs. Jay, you prescribe Cranial Electrotherapy Stimulation (CES). During the last 5 minutes of a 20-minute treatment session, she reports feeling “heavy”, “groggy”, and “disoriented”. Based on these symptoms, what next steps should you take? Discontinue the treatment immediately Advise the patient to go home and sleep Continue CES until at least 2 minutes after the patient no longer reports these symptoms Reduce the current for about 2 minutes then discontinue the treatment None Mr. Kay initially sought treatment for insomnia and you prescribed Cranial Electrotherapy Stimulation (CES) daily. During his two-week follow up appointment, Mr. Kay complains that his insomnia is not improving. How will you advise the patient? The insomnia is treatment resistant and therefore will never go away Educate the patient that insomnia may take 3 weeks for CES to provide relief. Discontinue CES treatment immediately Recommend doubling the current and time of treatments None Contraindication(s) for use of Alpha-Stim CES is/are: Pacemakers, defibrillators, and other implanted electric devices that cannot be turned off. Headaches Seizures Cancer None During a follow up appointment with a patient for which you prescribed Cranial Electrotherapy Stimulation (CES), the patient complains of having headaches, vertigo, and nausea when they use their CES. The symptoms appear after they start the session and remain for several hours following treatment. How do you advise the patient? You tell them they are "imagining things" You recommend using a lower current and treating longer if necessary You recommend continuing treatment as is until the symptoms go away You add a 24 mg Ondansetron None Which of the following is true regarding Alpha-Stim CES treatment? Higher currents will provide better results The patient needs to feel the current for treatment to be effective The proper dosage is an inverse relationship between current level and time of treatment None of the above None What is the protocol for determining the current level for an Alpha-Stim CES treatment session? The current and duration of treatment depends on the indication being treated Turn the current up until a slight vertigo is experienced, then decrease immediately until the dizziness stops Use the same current for every treatment session Leave the current on the default setting when the device is powered on None Which of the following are possible side effects to Alpha-Stim CES treatment? Headaches Transient vertigo Skin irritation at the site of electrodes All of the above None Time's upCancel ### Test Quiz Welcome to your Test Quiz Name Pick one? 1 2 3 4 None Time's upCancel