Okay, Ballerina, here are the full details:

We are delivering the standard 2.0 mAMP for 20 minutes, resulting in a total dose of 40 mAMP minutes. She tolerates this okay.

We are using anodal stimulation (I incorrectly wrote cathodal stimulation in prior post), with the red (positive) lead over the right motor cortex (contralateral to the area of her worst pain, on the left side of her coccyx/perineal region), and black (negative) lead at the left supra-orbital position. Everything I've read suggests anodal stimulation of the motor cortex to be most efficacious for chronic pain.

We are using the following system components to deliver the current:

1) Iomed Phoresor II Auto iontophoresis device

2) 3" x 3" Amrex rubber pad w/ sponge insert (actually 2" x 2" contact surface with skin; 25.8 cm2)

3) pin to banana pin adaptors (to insert into the rubber pad)

4) (3) snap to pin converters (to connect between the electrophoresor's wires and the pin to banana pin adaptor)

I bought these >2 years ago, and tried to list the websites I purchased them from (still valid)**edit**

Again, my question is simple: are you finding a lead position that works better than that which we are using? If so, what is it, if I may ask? I hope you have continued to experience improvement.

I had already clicked on these items while trying to find a way to send a PM, but the options simply do not appear. I assume it's because I'm still too new and am not permitted to PM. Maybe this will change after a few more posts.

I did appreciate the advice, though. Thank you!

I read this thread with a lot of excitement. My wife has RSD in her left arm and I am considering purchasing this device ourself to perhaps work as a group here to post results and positioning. Has anyone else than ballerina tried this treatment themselves with success? I'd love to hear more input

Ballerina;
Would you consider posting a youtube video on how you use the unit and where you apply the pads? This is such an inexpensive option to try I think the more info we can learn and share it could help a lot of people out. Thanks so much

iguanabill:

thanks for your post. Your questions are helping sort through the details of tdcs.

I would guess that you need to give ballerina a more specific description of of the location on the head you are placing your anodes/cathode...

from reading the research papers, I think the accepted paradigm to use is the EEG 10-20 system... most the researchers have put the For example, many researchers put the anode over the “C3” area (which correlates to the hand position for the Penfield brain map (I cannot post Web addresses yet -- I don't have enough postings)..

I'm curious about the same things you are. I am about ready to start some trials.

Thanks a lot for posting your information about the electrodes etc!! The part about the adapters to the banana plugs, etc. threw me for a loop for a while.. .. I kept on trying to figure out if I needed to order what other parts etc. etc.

So, anybody else reading this and also using the Square Amrex type rubber edged sponge electrodes---pay attention to the adapter part that iguanabill has stated. I ended up going down to a local electronic supply store and buying some banana plugs cutting the leads off the wires, and soldering banana plugs through the wire ends. I then tested the device on my multimeter to ensure the device was working correctly in putting out a steady 2ma.........but if I could have found some adapters -- I probably would've used the adapters that iguanabill used...

The adaptors are very inexpensive. I just got a PM from Ballerina, so it looks like I can communicate that way. PM me and I'll give you the exact links for purchasing them (if I am allowed to do so)...but in the meanwhile you can probably find them yourself online at the following companies:

(1) 3" x 3" Amrex rubber pad w/ sponge insert (actually 2" x 2" contact surface with skin; 25.8 cm2) - Austinmedical
(2) pin to banana pin adaptors (to insert into the rubber pad) - Austinmedical
(3) snap to pin converters (to connect between the electrophoresor's wires and the pin to banana pin adaptor) - Balegoonline

These accessories worked for the particular stimulator I purchased. They attached to the (button?) snaps on the end of the leads that came with my stimulator. Ballerina listed sources for her purchases; I don't recall how similar they were to mine.

Bingo...now that I've posted >5 posts, the option to PM now appears!

voner: for the motor cortex position, we use the "C3" position on the top of the head between the ears, but as my wife's worst pain is below the waist and near the midline of her body, I keep the electrode close to the midline of her skull rather than more lateral, closer to the ear. If you check out a homunculus image online, you'll see where the different parts of the body correspond to the motor cortex (I've taught Anatomy and Physiology for many years, so I knew the homunculus would be informative). But bear in mind that the precise position isn't real important given the wide distribution of the electrical charge.

Many people use special elastic bands to secure the electrodes, but we use self-adhering ace wrap, which you can readily find at a drug store. We first secure the cathode (black) lead in the supra-orbital position on her left forehead with about a 20" strip of ace wrap. We then secure the anode (red) lead to the motor cortex using a similar stip of ace wrap. The ace wrap works perfectly fine.

I'll throw out one more suggestion. tDCS does not penetrate deep in the brain. There is a remarkably simple, non-invasive, cost-free method to stimulate deeper brain structures: it's called (caloric) vestibular stimulation.

You simply lie down in bed with a towell beneath your head, and then put ice cold water (using an eyedropper) into the ear contralateral to (on the opposite side of) your worst pain for 30-60 seconds. The cold stimulation will provoke nystigmus (eyes rapidely darting back and forth) and vertigo; you will probably want to keep your eyes closed, and you definitely do not want to be on your feet during this procedure! Functional imaging shows that the procedure activates a number of deeper brain structures, including the insula which are involved with pain processing.

You can search for the handful of papers exploring this form of stimulation at PubMed. Ramachandran's group claims remarkable and lasting pain relief from a single treatment in several CRPS patients. Most of the papers consist of case reports (an exception being central post-stroke pain). The lack of a definitive study for CRPS invites some doubt, but the procedure is definitely worth a try. Unfortunately, it appears to work much better for upper-body pain, so it hasn't benefitted my wife's condition.

My suggestion is to consider this treatment in combination with tDCS. I see no reason why you can't do the ice-water treatment once a day over an extended period of time.

Hi Ballerina and others who have posted about this topic!

Unfortunately, I have no scientific background so reading about T.D.C.S has been a bit confusing for me.

However, I did find a doctor in Sacramento who is doing Transcranial Magnetic Stimulation for patients with depression. He seemed willing to look into TMS for chronic pain; it seemed like he inferred there might need to be a change in where the machine was placed on the head.

Anyways to my point, is T.M.S. similar to T.D.C.S.? Is it worth giving T.M.S. a try? Or is T.D.C.S. the only way to go?

I would greatly appreciate any info or advice in this matter. Thank you all for your posts about this topic. I hope this is something that helps more of us.