Thanks Ballerina for the link!
Btw I contacted one of the Doctors **

And wanted to share his response:

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Dear Steve,

60-70% of patients respond to tDCS. This has been my experience which is similiar to to that of the published studies. The problem with quoting this statistic is that studies utilizing tDCS for CRPS have small patient populations. In addition, studies using tDCS for chronic pain include patients with CRPS, but you really can't extrapolate the results for CRPS, because results may be skewed by the different conditions treated. The duration of relief provided by 5-10 treatments is about 3 months, when tDCS needs to be repeated.

Finally, non-responders to the protocol used for treatment may respond to a different protocol or to a longer period of treatment. Currently, there are 3 locations which can be stimulated to provide pain relief. These can inhibit pain, reduce sensitivity to pain and decrease the emotional component to pain.

I have used tDCS for patients having spinal cord stimulators. There is additional pain relief when tDCS is added.

Individual case reports of patients with severe pain treated with tDCS for longer periods document greater pain relief -up to 60% reduction. Most tDCS protocols still use 5-10 treatments.

I hope this information is helpful.
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Iguanabill :

thanks for your posts. Pretty darn informative and educational.
I'd love to see you, ballerina & whoever else feels confident enough, discuss your best guesses as to what's going on in tDCS…

I'm actually reasonably well-educated on the theories of electromagnetic wave propagation, etc. but what's going on with the brain and tDCS still baffles me. I'm a practical person – so I don't need to know what's going on -- but I'm a curious person, so I'd like to hear some ideas from people who don't have to consider all the ins and outs of a research publication to express their ideas.

On another note -- I'm curious if anybody has any simple and inexpensive techniques for vagal nerve stimulation? One of my other symptoms is that my autonomic system is messed up – ramped towards the sympathetic side…

Thanks!

This quote sounds like Jim Fugedy. Am I right?

As regards the length of time pain relief is provided I offer my experiences. When I first had tDCS at Beth Israel one year ago my relief began to slowly wear off and was gone by about three months. When I began in November the positive effects came to an abrupt halt when I got a minor infection. I am currently treating twice a day for twenty minutes and will do so for at least another week. Since I don't want the slow wear off thing or the abrupt halt I will be treating once a day every three days for a week and then once a day every five days to see how far that takes me.

I will share how well this works for me.

In a nutshell, tDCS modulates spontaneous neuron activity by increasing or decreasing the thresholds that determine whether the neurons send a signal. The relatively local effects of tDCS can spread throughout the brain by networks of interconnecting neuron circuits.

There are some forms of vagal stimulation you could try: gagging, holding your breath while bearing down (Valsalva maneuver), immersing your face in ice-cold water (stimulating the diving reflex), and coughing. I'm not sure whether these would have a lasting effect. Sympathetic blocks (injecting lidocaine or bupivicaine) can help reduce sympathetic activity; though they are most effective regionally (placed near the sympathetic ganglion chain), some patients respond to i.v. (total body) infusions. My wife's sympathetic issues always improved with ECT. There are also more permanent but invasive approaches (implanting a stimulator).

Please see below for an overview of neuromodulation procedures.
http://www.ncbi.nlm.nih.gov/pmc/arti...3/?tool=pubmed

In the long term picture, tDCS is really in its infancy. Having posed this question to the top three tDCS folks in the country the bottom line is no one really understands exactly how and why tDCS or why it works for some and not for others.

Steve, I'd be curious to learn the 3 locations the physician was referring to. I'm assuming they are the motor cortex used in most studies to date, the motor cortex/secondary somatosensory cortex that ballerina benefits more from, and the prefontal cortex for the emotional components to pain (which does not appear to be as efficacious as motor cortex). But...maybe he knows of something else. Would love it if you could get this information to us.

As many of you probably recognize, the brain changes dramatically with chronic pain, and brain stimulation ultimately works because it helps to restore normal brain function.

There are some authorities who argue that one can improve their pain condition behaviorally by focusing effort on using the parts of their brain that have become compromised and avoiding the parts used to excess. Memory and executive decision-making, for example, suffer dramatically from chronic pain, whereas fear, anxiety, and catastrophizing become excessive. Brain imaging studies reveal the parts of the brain in chronic pain that are hyperactive and hypoactive. With many or most chronic pain conditions, and certainly all CRPS, the perception of pain ridiculously exceeds the pain signal generated at the painful area. In essence, the pain is mostly if not entirely manufactured by the brain (this is not to say it is made up; it's very real). Extinguishing the pain becomes virtually impossible, and medications and conventional treatments will fail most patients.

I'm personally acquainted with the guy who runs the new pain program at the Betty Ford Clinic in Palm Springs, CA, and he claims that with intensive therapy all of his pain patients can gain pain reductions of 90% or so during the 6-week program. It's very expensive (roughly $1,000/day, which insurance may not cover), focused heavily on addiction recovery (they will take you off all opioids and benzos and engage you with the 12-step recovery program), and takes advantage of group therapy, which he insists is very helpful. I've been trying to convince my wife to give this a try, but she is not ready for it yet. I personally am convinced that many pain patients will benefit from a program like this and regain their normal lives.

Did you happen to ask him what experience he has with treating CRPS patients who have failed spinal cord stimulators?

How do I say this gently? We used the ice water injection into the ear to test for brain activity ' as in brain death, about 30 years ago in ER, checking the pupils reactions, before we stopped CPR, we stopped if there was no reaction. I am not sure how this would relate to pain suppression...

Here is a smattering of publications (there are others) that answer your questions:

Miller SM, Ngo TT. 2007. Studies of caloric vestibular stimulation: implications for the cognitive neurosciences, the clinical neurosciences and neurophilosophy. Acta Neuropsychiatrica 2007: 19: 183–203

full review article available here: http://www.pcng.org.au/IMG/pdf/CVSreview2007.pdf

McGeoch PD, Williams LE, Lee RR, Ramachandran VS. 2007. Behavioural evidence for vestibular stimulation as a treatment for central post-stroke pain. J Neurol Neurosurg Psychiatry 2008;79:1298–1301.

abstract here: http://jnnp.bmj.com/content/79/11/1298.abstract

Williams LE, Ramachandran VS. 2006. Novel experimental approaches to reflex sympathetic dystrophy/complex regional pain syndrome type 1 (RSD/CRPS -1) and obsessive-compulsive disorder (OCD). ABSTRACT. Neuroscience Meeting Planner. Atlanta, GA: Society for Neuroscience, 2006.

excerpt from the abstract (only the abstract was published): "...we irrigated the ear of a patient with RSD with cold water to produce vestibular caloric stimulation accompanied by nystagmus. The procedure produced a striking reduction of pain from a 7 to 4 on a visual analog scale. No such reduction occurred in two placebo controls, lukewarm water in the ear or ice cube placed on the forehead. This patient reported no reduction in pain from previous treatments with a spinal cord stimulator, a pain pump, ganglion blocks, or a transcutaneous electrical nerve stimulation (TENS) unit. We postulate the caloric stimulation activates the vestibular cortex and other areas which then “mask” the sympathetic pain in the adjacent insular cortex."

Ramachandran VS, McGeoch PD, Williams L, Arcilla G. 2007. Rapid Relief of Thalamic Pain Syndrome Induced by Vestibular Caloric Stimulation. Neurocase (2007) 13, 185–188.

full article available here: http://cbc.ucsd.edu/pdf/rapid%20relief%20caloric.pdf