1. Low-strength evidence suggests that cranial electrical stimulation (CES) may be moderately beneficial for patients with depression and anxiety.
2. There was insufficient evidence that CES provides clinically important benefit for fibromyalgia, neuromusculoskeletal pain, degenerative joint pain, headache, depression, or insomnia.
Evidence Rating Level: 1 (Excellent)
Study Rundown: CES is a technique that uses the application of low-intensity electrical currents to the head for noninvasive stimulation of the brain. Although there is growing interest and availability of CES devices, clinical benefits remain unclear. This systematic review summarizes the evidence for the risks and benefits of CES for patients of adult age who have a chronic painful condition, depression, anxiety, or insomnia. Using several databases, the authors found insufficient evidence that CES provides clinically important benefit for fibromyalgia, neuromusculoskeletal pain, degenerative joint pain, headache, depression, or insomnia. There was low-strength evidence that CES may be moderately beneficial for patients with depression and anxiety. Due to insufficient reporting of adverse events and lack of data for the mechanism by which CES produces clinical effects, further research is needed to determine the safety and mechanism of action of CES.
A strength of this study is that it synthesizes the available study data for several common conditions. Limitations of the study include small sample size, short duration, high risk of bias caused by inadequate blinding, and insufficient information regarding patients’ existing treatments.
In-Depth [systematic review]: Researchers used data from PubMed, Embase, PsycINFO, and the Cochrane Library through 10 October 2017. Studies meeting eligibility criteria included 28 articles from 26 randomized controlled trials. Two small trials comparing CES to usual care did not show statistically significant evidence for pain outcomes in patients with fibromyalgia or for anxiety outcomes in patients with anxiety. In 14 trials using placebo or sham controls, patients had painful conditions such as neuromuscular pain, musculoskeletal pain, or headache. These 14 trials had conflicting outcomes. Compared to a sham control, 5 trials showed low-strength evidence of a potential modest benefit for patients with depression and anxiety. Of these 5 trials, 4 were completed over 40 years ago, and 1 was from 2014. Findings were conflicting or ambiguous for 2 trials for insomnia, 1 trial for insomnia and anxiety, and 3 trials for depression. Data suggests that there are no serious side effects from using CES. However, this evidence is of low strength due to the lack of adverse event reporting by most trials.
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