5555 Glenridge Connector NE Suite 200
Atlanta, GA 30342 USA
Dr. James Fugedy has treated patients for over 30 years. He graduated from the Creighton University School of Medicine, completed his Residency in Anesthesiology at the Yale-New Haven Hospital and was certified by the American Board of Anesthesiology.
Dr. Fugedy is an ardent advocate of universal healthcare. His vocation is to provide for the treatment-refractory patient.
Dr. Fugedy: “It is disheartening when treatment provides inadequate relief for the patient. Treatment-refractory chronic pain patients are compelled to search for doctors, clinics, protocols and procedures until improvement is achieved. This is an arduous, expensive and frustrating journey. Besides not providing improvement, successive treatment failures can be depressing, demoralizing and depersonalizing. Some may find the treatment-refractory frustrating to work with. I refer to them as my “special patients.” How can you not admire and be inspired by perseverance and endurance when dealing with this degree of adversity?
“For treatment-resistant conditions, listening to the patient is especially important. The most profound insights often come from the patient's own words. Communication forms the foundation of the therapeutic relationship upon which healing occurs.
“When I read the initial studies utilizing transcranial direct current stimulation, I was very excited because here was a procedure for treatment-resistant patients which was effective, easy-to-do, inexpensive and without side effects. In 2006, I described tDCS to a fibromyalgia patient and my anticipation for its certification and availability. She agreed that tDCS demonstrated impressive results, but she needed it now, not in the future. I called the FDA that day. They verified that the “off-label” use of a direct current stimulator, certified for iontophoresis, could be used to provide tDCS. This is similar to the “off-label” use of pharmaceuticals, such as amitriptyline which is frequently prescribed for the relief of chronic pain and insomnia, for which is it is effective, although it is certified only for use as an antidepressant. With completion of the tDCS protocol, the patient experienced a 40% reduction of her fibromyalgia pain. My excitement was second only to hers.
“After tDCS studies for depression were published, I was contacted by a patient who requested tDCS before undergoing a course of electroconvulsive therapy for treatment-resistant depression. He wanted to go back to work, but was afraid that the side effects of ECT might interfere with his memory. He experienced a significant reduction of depression symptoms and was able to return to work. After 4 months he needed to be retreated. He lived a long distance from the clinic. The 3 hour round trip drive produced no therapeutic benefit. Because of the ease of use and safety of tDCS, I proposed training and supervising him to do it himself at home. His results were as good as mine. When the effects wore off again after 4 months, he purchased his own stimulator. At that point his lifetime cost for tDCS ended.
“I did not invent tDCS. I did not develop tDCS. I simply want to make tDCS accessible for patients who would benefit. Treatment in the clinic is available, but for out-of-town patients, this may become an agonizing safari, as protocols are of 1 to 2 weeks duration or longer. My experience with home-use of tDCS has been consistently favorable. Competent patients can be instructed to safely administer tDCS, just as diabetic patients are taught to give themselves insulin injections. tDCS stimulators are inexpensive. Besides the obvious cost reduction, home-use eliminates the discomfort and inconvenience of travel, facilitates longer treatment protocols and makes tDCS more available.
“New tDCS studies are literally published weekly. Improvements in technique, understanding and application continue. I expect that future protocols will be even more effective. Although today’s tDCS treatment is not the final product, it is effective, safe and even at this point of development significantly beneficial for the treatment-refractory patient.
“Currently, I provide tDCS for treatment-resistant patients suffering from the chronic, central pain syndromes (migraine, complex regional pain syndrome, temporomandibular joint disorder, neuropathy, phantom limb syndrome, multiple sclerosis pain and fibromyalgia), depression, tinnitus and for stroke rehabilitation. This year I began using tDCS to improve learning, enhance cognitive function and augment memory. In the future, I envision tDCS benefiting ADHD, autism and PTSD.”