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Fibromyalgia Basics

Cranial Electrical Stimulation (CES)

Preliminary studies looking at CES’ potential to treat fibromyalgia and related symptoms are promising. However, there are two downsides to CES: (1) the up-front cost of the device and (2) the lack of sufficient research to confirm the benefits. Before any therapy can be recommended, you need to know the odds that it will work and which symptoms it might relieve. Besides, doctors won’t prescribe a therapy unless they can provide this type of information to their patients with confidence.

What is CES?

In concept, a tiny electrical current is thought to stimulate the cerebral cortex through electrodes attached to the earlobes. The CES device is as small as a cell phone, battery-powered, and has two wires with a clip on each end (one for each earlobe). The intensity of the current is so small that most people just feel a tingling sensation on the earlobes.

CES is FDA-approved for treating insomnia, anxiety, depression, and pain. There are even several studies to suggest the device works for these indications. But how does a tiny current transmitted through the earlobe work to relieve these symptoms? No one knows, but here are some likely mechanisms of CES:

  • Increases the brain’s alpha-waves to promote relaxation
  • Improves blood flow to brains areas that need it
  • Balances the communications between brain networks
  • Increases various neurotransmitters such as GABA and serotonin (they help relieve many symptoms)
  • Balances communication between the brain and the peripheral nervous system
  • Reduces brain inflammation (based on the findings of more potent brain stimulation devices)

Symptoms Treated

Ten years ago, a small study in fibromyalgia patients showed this treatment approach reduced pain and sleep disturbance over a two-month period.1,2 Brain imaging of a few patients showed reduced activity in several pain processing areas. Less activity implies the brain is not spinning its wheels to fight incoming pain signals. In addition, fibromyalgia patients were less sensitive to painful stimuli at the end of the study.

Aside from looking at its role in reducing fibromyalgia pain, many studies show CES alleviates anxiety, improves sleep, and reduces depression.3 Unfortunately, not all treatment trials generate the same favorable results and it is still unclear how the device works. In addition, the data is less compelling for the treatment of depression. On the upside, though, CES doesn’t appear to produce any serious side effects.

Although manufacturers of CES devices claim it helps with a variety of symptoms, it’s most likely to relieve anxiety.4 This also includes anxiety-related insomnia. But can the effects of CES measure up to commonly prescribed medications or counseling for anxiety? According to a study done in college students, the answer is yes.5

Richard Morriss, M.D., a psychiatrist at the University of Nottingham in the UK, has treated around 400 patients using CES. “About 40 to 50 percent show some benefit in anxiety,” says Morriss, adding that eight percent get side effects. “The most common are headache, dizziness, nausea, and skin irritation at the site of the ear clip. These are short-lived and mild.”

Morriss uses the Alpha-Stim brand of CES, which sells for $840 (same as 600 English pounds). While this is a lot of money, the financial barriers are greatly reduced in the United Kingdom, compared to the United States. For starters, people can rent the device for three months for only $52. If the device works, patients can continue to rent it or elect to outright purchase it. In the United States, people have to purchase the device without knowing whether it will help.

Prescription barriers are lower in the UK as well. Nurses and other non-medical staff often prescribe the device. A physician’s prescription is not required. Based on studies conducted by Morriss and others, CES is the more cost-effective option for treating anxiety and insomnia. This is why the UK’s health delivery system makes CES affordable to patients.

CES for Fibro?
… a work in progress

CES shows tremendous promise for treating fibromyalgia because it can be safely used in a home setting. Treatments generally last one hour, but the therapy can be done while watching TV, reading a book, or getting ready for bed at night. It’s convenient and the primary side effects are tingling of the earlobes and dizziness, which are generally mild.

CES sounds like an ideal therapy, so why is it that your doctor has not prescribed it for you? More studies are needed to show it effectively treats a significant portion of people with fibromyalgia. After all, physicians can’t prescribe a therapy unless they have data on its efficacy. Plus, there is another hurdle for patients living in the United States: insurance doesn’t cover the cost of CES devices. Insurers require more proof as well.

Fortunately, Anna Woodbury, M.D., fibromyalgia researcher at Emory University in Atlanta, GA, is working to provide the much-needed answers. She is the lead investigator of a trial to evaluate CES for treating fibromyalgia. In addition to determining the effectiveness of the therapy, Woodbury is using elaborate brain imaging to determine how the device works. Part of the study is funded by AFSA and you can read more about it in the Projects Funded section.

Before shelling out money for any therapy, you deserve to know:

    • Is it effective for treating fibromyalgia?
    • What are the key symptoms that it treats?
    • What are the odds that CES will help fibromyalgia patients? Is it one out of ten or one out of three?

Woodbury’s research on CES is laying the groundwork for answering these questions. In the meantime, keep in mind that the FDA approval of CES means it is safe; it doesn’t guarantee it will work for you.

Attention Active Military Members and Veterans: Roughly 50 percent of VA and DOD facilities cover the Alpha-Stim CES device. Contact the Government Services department (option 2) at Alpha-Stim for guidance. The number is (800) 367-7246.

    1. Taylor AG, et al. Pain Manag Nurs 14(4):327-335, 2013.
    2. Taylor AG, et al. EXPLORE 9(1):32-40, 2013.
    3. Brunye TT, et al. Front Hum Neurosci 15:625321, 2021. Free Article
    4. Chung FC, et al. Front Psychiatry 14:1157473, 2023. Free Article
    5. Royal S, Morriss R, at al. BMC Primary Care 23:97, 2022. Free Article