As we begin this new millennium, we rely on various forms of technology to diagnose our patients through an ever- increasing armamentarium of new devices. New therapeu-
tic technologies for a variety of disorders also offer a remarkable and unprecedented track record in both safety and efficacy.
A fresh look at physiology is needed to better understand and intervene in the primary medical complaint of pain. Western universities are still teaching that life is based on a chemical model. Given the explosive growth in electrical technologies and our ever increasing understanding of physics, it is more realis- tic in the 21st century to view biological processes on an elec- trochemical basis rather than on a chemical basis alone.
Modern thinking on the subject far transcends the use of force in electromedical interventions. Scientific electromedicine has only evolved recently, over the past 50 years. This is due, in part, to advances in electrical technology and our understanding of biophysics as a distinct discipline from biochemistry. The most recent advancements involve only microcurrent levels of stimu- lation, often sufficiently minute as to not even be felt by the pa- tient being treated.
Integrating Biochemistry and Biophysics
Robert O. Becker, MD, an orthopedist/researcher at the State University of New York, spent more than 30 years attempting to determine how trillions of cells with hundreds of subtypes can function harmoniously in life.1 He found that a primitive direct current data transmission and control system exists in biologi- cal systems for the regulation of growth and healing. He calls this the fourth nervous system. His studies of extraneuronal ana- log electrical morphogenetic fields have established the impor- tance of bioelectricity for all life processes. Becker has laid the groundwork for the medical professions to start to evolve to- wards a more reasonable integrated view of biology incorporat- ing our understanding of both biochemistry and biophysics.
Björn Nordenström, MD, Emeritus Professor of Radiology at Karolinska Institute in Stockholm who also served as Chairman of the Nobel Assembly,  has proposed a new and distinct model  of bioelectrical control systems he calls biologically closed elec- tric circuits (BCEC).2,3 Nordenström's theory is that the mechan- ical blood circulation system is closely integrated anatomically and physiologically with a bioelectrical system. The principle is
analogous to closed circuits in electronic technology.
The earliest concept of such field effects can be traced back to ancient China. Traditional oriental medicine is based on the controlling power of ch'i or ki energy; a concept that predates electricity but may be considered analogous today.4 East Indi- ans use the term prana to represent a similar observed phenom- enon. Homeopathy is based on the energetic residual of the  chemical after it has been so diluted that chemists question its continued existence. Western allopathic medicine is limited to a mechanistic approach to physiology and accordingly stands alone in its reliance on synthetic chemical treatments and inva- sive procedures. While no system has come close to the overall contributions made by Western medicine, the reported results in electromedical pain management to date are reason enough to re-explore the underlying mechanisms of traditional thera- pies towards modernizing them and automating technologies  to function harmoniously in concert with clinical protocols.
In Western civilization, the first documented use of electrici- ty to manage pain was by the physician Scribonius Largus in 46AD. He claimed that just about everything from headaches to gout (head to toe) could be controlled by standing on a wet beach near an electric eel. Not surprisingly, attempts at produc- ing pharmaceutical preparations from dead eels proved ineffec- tive. In 1791, Luigi Galvani discovered that electrical impulses could cause muscle contraction. By 1800, Carlo Matteucci showed that injured tissue generates an electric current. The discovery of alternating current by Faraday in 1830 opened the door to the development of man-made devices as sources of electricity. Over 10,000 medical practitioners in the United States alone made use of electrotherapeutic modalities until publication of the 1910 Flexner report which stated that there was no scientific basis for electromedicine at that time. Dr. Flexn- er's report was originally prepared by the American Medical As- sociation and sponsored by the Carnegie Endowment for the Advancement of Teaching.5
Since then, arguably the greatest development in the field of electromedicine was when Becker electrically induced limb re- generation in frogs and rats as a model to study bioelectrical forces as a controlling morphogenetic field.6 Regeneration rep- resents a return to embryonic control systems and cellular ac- tivities within a localized area. It can therefore be considered a

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more accessible and more observable form of morphogenesis. The complexity of instructions required to designate all of the details to recreate a finished extremity is impossible to transmit by biochemical processes alone.7
Evolution of Electromedicine
Transcutaneous electrical nerve stimulation (TENS) came on the scene in the 1970s following Melzack and Wall’s introduction of the Gate Control Theory of pain in 1965 in which counter stim- ulation could effectively close the gate to peripheral pain mes- sages attempting to ascend spinal pathways to the brain.8 TENS stimulation is typically applied at a level of 60 or more mil- liamperes of current. Nearly 40 years later, microcurrent elec- trical therapy (MET) now attempts to alter or eliminate the pain message by inducing normalization of neural function, as well as healing at the pain site, as opposed to serving as a counter- irritation analgesic.9
Following closely behind TENS was the introduction, in the 1980s, of electromagnetic bone healing devices that are utilized to heal non-union fractures. For the first time this allows physi- cians to heal non-union fractures that previously necessitated amputation.
One of the most promising advances in electromedicine today is cranial electrotherapy stimulation (CES).10 This therapy usu- ally uses less than one milliampere of current directed through the brain for the treatment of anxiety, insomnia and depression; all of which are ubiquitous in pain patients. Researchers at sev- eral major universities in America and elsewhere along with the Veterans Medical Centers are establishing the analgesic effects of CES for chronic intractable pain such as in spinal cord in- juries.11 Dr. Ronald Melzack’s group has now centered their thinking on a pain neuromatrix in the brain that develop pain messages autonomously, even in the absence of incoming nox- ious input from the body.12 This can account for phantom limb pain and many other types of chronic pain.13 The latest cranial

electrotherapy stimulation research is showing dramatic im- provement in pain throughout the body from such difficult man- agement problems as fibromyalgia, spinal cord injuries, and chronic regional pain syndrome from current applied across the brain.11,14-16
So from slow beginnings in the latter half of the 20th centu- ry, we now have hundreds of FDA approved electrical devices. Some stimulate muscle contraction so that people with para- lyzed muscles can maintain muscle tone in unused limbs thus preventing atrophy. Other disabled people use them in learn- ing to walk again, or in developing new skills in using their arms or hands, for example.
Other electrical stimulators are now widely implanted in the body, such as the cardiac pacemaker, electrical stimulators in various parts of the brain to prevent such things as fine tremor of the hands or whole body seizures, and now for depression.17,18 Dorsal column stimulators implanted along the spinal cord in- terdict pain from various etiologies.
We have had electroacupuncture since the early 1970s when it was introduced from China via Hong Kong. Most contempo- rary acupuncturists use some form of electromedical treatment delivered to the acupuncture points because it is safer, faster, more effective, and provides longer lasting results. Many acupuncturists prefer electrical modalities to needles for these reasons and that it avoids the fear of needles some people ex- perience.19
Discussion
One might ask: “Why do we not try the most inexpensive and conservative treatments first, instead of last?” When such treat- ment is based on sound electromagnetic principles, most physi- cians are surprised to discover that the results are often more immediate and spectacular than they can imagine. In fact, elec- tromedicine is fast becoming recognized as one of the primary safe, efficacious, and certainly most cost effective treatments of

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choice in the 21st century. Its greatest benefit is in maintaining functional homeostasis.
Yet, a lack of updated education in health care professionals is the main stumbling block to widespread acceptance of the modern theories and practice of electromedicine.
Ironically, the other problem is the wide variety of technolo- gies available. At present, there are hundreds of different mod- els of transcutaneous electrical nerve stimulation (TENS) de- vices in the marketplace and an increasing number of other elec- trical devices applied through the skin or implanted. Most health care practitioners who desire to utilize such technology have received little or no training in electrobiology or electrical technology. Hence, when it comes to making an educated deci- sion on what type of instrument to choose for a practice or a particular patient, practitioners are often overwhelmed when meeting an electromedical sales representative. Purchase deci- sions are frequently made based on lack of knowledge, misin- formation, unsubstantiated claims such as testimonials not backed by solid research, or price. If a device is effective in only 2% of the population, treatment of 1,000 patients can result in 20 testimonials. The plural of anecdote is not data. According- ly, healthcare professionals should rely only on evidence-based technologies supported by double-blind research.
Looking Forward
This Electromedical Department of Practical Pain Management will help unravel the confusion surrounding this rapidly expand- ing field. We will bring only the best, most qualified authors and

proven technologies to these pages. We hope it helps your pa- tients and your practice as well. The first article that will appear in the next issue will be about the research (there have been two university-based double-blind studies conducted to date ) and practical protocols for treating fibromyalgia syndrome. ■

Daniel L. Kirsch, PhD, DAAPM, FAIS, is Chairman of Electromed- ical Products International, Inc. of Mineral Wells, Texas and an in- ternationally renowned authority on electromedicine with 33 years ex- perience in the electromedical field. He is a board-certified Diplomate of the American Academy of Pain Management, Fellow of the Ameri- can Institute of Stress, Member of the International Society of Neuronal Regulation, and a Member of Inter-Pain (German/Swiss Pain Special- ty Organization). He is also a research consultant to the VAMC and US Army. He served as Clinical Director of The Center for Pain and Stress- Related Disorders at Columbia-Presbyterian Medical Center, New York City, and of The Sports Medicine Group, Santa Monica, California. He is the author of The Science Behind Cranial Electrotherapy Stimu- lation, other books and textbook chapters on electromedicine, as well as numerous scientific and review articles.

References
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Nordenström BEW. Biologically closed electric circuits: Clinical, experimental and theoretical evidence for an additional circulatory system. Nordic Medical Pub- lications. Stockholm, Sweden. 1983.
Nordenström BEW. Exploring biologically closed electric circuits. Nordic Med- ical Publications. Stockholm, Sweden. 1998.
Kirsch D. The Complete Clinical Guide to Electro-Acutherapy (2nd ed.). Nation- al Electro-Acutherapy Foundation. Glendale, California. 1978.
Walker MJ. Dirty Medicine: Science, Big Business, and the Assault on Natural Health Care. Slingshot Publications. London. 1993.
Becker RO. Mechanisms of Growth Control. Charles C. Thomas Co. Springfield, Missouri. 1981.
Becker RO. Electrical control systems and regenerative growth. Journal of Bio- electricity. 1982. 1(2):239-264.
Melzack R. Prolonged pain relief by brief, intense transcutaneous somatic stim- ulation. Pain. 1975. 1:373-375.
Mercola JM and Kirsch DL. The basis for microcurrent electrical therapy (MET) in conventional medical practice. Journal of Advancement in Medicine. 1995. 8(2):107-120.
Kirsch DL. The Science Behind Cranial Electrotherapy Stimulation 2nd Ed. Medical Scope Publishing. Edmonton, Alberta. 2002.
Tan G, Rintala DH, Thornby J, Yang J, Wade W, and Vasilev C. Using cranial electrotherapy stimulation to treat pain associated with spinal cord injury. Journal of Rehabilitation Research and Development, In Press, 2006. 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.
Melzack R. Pain and the neuromatrix in the brain. J of Dental Education. 2001. 65(12):1378-1382.
Melzack R. From the gate to the neuromatrix. Pain. August 1999. Suppl 6:S121-126.
Cork RC, Wood P, Ming N, Clifton S, James E, and Price L. The effect of cra- nial electrotherapy stimulation (CES) on pain associated with fibromyalgia. The In- ternet Journal of Anesthesiology. 2004. 8(2).
Lichtbroun AS, Raicer MC, and Smith R. The treatment of fibromyalgia with cranial electrotherapy stimulation. Journal of Clinical Rheumatology. 2001. 7(2):72-78.
Alpher EJ and Kirsch DL. Traumatic brain injury and full body reflex sympa- thetic dystrophy patient treated with cranial electrotherapy stimulation. American Journal of Pain Management. 1998. 8(4):124-128.
Lüders HO. Deep Brain Stimulation and Epilepsy. Martin Dunitz. London. 2004.
Donovan, CE. Out of the Black Hole. Wellness Publishers. St Louis. 2005.
Story RT. Comprehensive Meridian Therapy. NY Chiro College. 1995.
Kirsch DL. Electromedicine: the other side of physiology. Chapter 60 in Pain Management: A Practical Guide for Clinicians (the textbook of the American Acad- emy of Pain Management) edited by Richard S. Weiner. CRC Press. Boca Raton, Florida. 2002. Pp 749-758.

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