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Chung M, Chen TH, Wang XS, Kim KH, Abdi S. The impact of scrambler therapy on pain and quality of life for chemotherapy-induced peripheral neuropathy: A pilot study. Pain Pract 2024. [PMID: 38418433 DOI: 10.1111/papr.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating disturbance among patients who received chemotherapy, with no effective treatment available. Scrambler therapy (ST) is a noninvasive treatment capable of improving multiple quality-of-life symptoms beyond pain. We aimed to evaluate the efficacy of ST for pain and nonpain symptoms related to CIPN. METHODS Ten patients with moderate to severe CIPN symptoms for >3 months were enrolled in a single-arm trial of ST for 10 daily sessions. CIPN-related symptoms were measured throughout the treatment period and up to 6 months thereafter. RESULTS The worst pain was reduced by 6 months (p = 0.0039). QST demonstrated the greatest improvement in pressure of 60 g (p = 0.308, Cohen's d = 0.42) and cold temperature threshold of 2.5°C (p = 0.9375, Cohen's d = 0.51) in the gastrocnemius area. Symptoms of numbness, tingling, trouble walking, and disturbed sleep had significant improvements at 6 months. Pain medication use decreased by 70% at the end of treatment and by 42% at 6 months. Patient satisfaction was high (82%) and no adverse events with ST treatment were reported. CONCLUSIONS The results of this pilot trial support the use of ST by demonstrating improvement in multiple domains of quality of life for CIPN patients during an extended follow-up of 6 months. However, further large-scale studies are needed to confirm our findings.
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Affiliation(s)
- Matthew Chung
- Department of Pain Medicine, Division of Anesthesia, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tsun Hsuan Chen
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xin Shelley Wang
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kyung-Hoon Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, South Korea, Korea
| | - Salahadin Abdi
- Department of Pain Medicine, Division of Anesthesia, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Wang AT, Wang EJ, Smith TJ, Razzak R, Christo PJ. Scrambler Therapy for Patients With Complex Regional Pain Syndrome: A Case Series. J Palliat Med 2023; 26:1302-1306. [PMID: 37477679 DOI: 10.1089/jpm.2022.0539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Complex regional pain syndrome is a chronic debilitating pain disorder that is difficult to manage, in part due to its heterogeneous clinical presentation and lack of clearly defined pathophysiology. Patients usually require a multidisciplinary approach to treatment, which can entail pharmacotherapy, physical therapy, behavioral therapy, and interventional pain procedures, such as sympathetic nerve blocks, spinal cord stimulation, and dorsal root ganglion stimulation. However, many patients continue to experience pain refractory to these multimodal strategies. Scrambler therapy (ST) is a noninvasive method of neuromodulation that is applied through cutaneous electrodes, and can alleviate chronic neuropathic pain by stimulating C-fibers and replacing endogenous pain signals with synthetic non-nociceptive signals. Although the use of ST has been reported for several types of refractory central and peripheral neuropathic pain, there is a paucity of data regarding the use of ST for complex regional pain syndrome. We present two patients with complex regional pain syndrome of the right lower extremity, who each underwent ST and experienced significant pain relief and improvement in function and quality of life.
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Affiliation(s)
- Annie T Wang
- Department of Anesthesiology and Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric J Wang
- Department of Anesthesiology and Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas J Smith
- Department of Palliative Care, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rab Razzak
- Department of Palliative Care, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Paul J Christo
- Department of Anesthesiology and Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Verma R, Shivadeva M, Bhupal DP, Veluswamy SK. Looking beyond the obvious: Role of non-invasive electroanalgesia in management of cancer pain. Indian J Cancer 2022; 59:282-287. [PMID: 35946191 DOI: 10.4103/ijc.ijc_1340_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Pain is considered as one of the most debilitating symptoms of cancer and its treatment. Owing to the limited efficacy of traditional pharmacological interventions to address cancer pain in its entirety, an avenue exists for exploration into nonpharmacological therapies. Analgesia using non-invasive electrotherapeutic modalities such as transcutaneous electrical nerve stimulation (TENS) and scrambler therapy emerges as a viable option to address cancer pain. The inability of these modalities to find a place within the recommended clinical guidelines has possibly resulted in the paucity of application of the same within the clinical setup. This perspective article aims at stimulating a discussion surrounding the inclusion of non-invasive neuromodulatory treatment techniques such as TENS and scrambler therapy to combat cancer pain and explore the benefits and pitfalls of using these techniques as an adjunct to the pre-existing treatment strategies. It is envisioned that this opinion piece will open a dialogue about a possible home for non-invasive electroanalgesia within the clinical treatment pathway for cancer pain.
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Affiliation(s)
- Ridhi Verma
- Department of Physiotherapy, M S Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Manu Shivadeva
- Department of Physiotherapy, M S Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Divya Priya Bhupal
- Department of Physiotherapy, M S Ramaiah Medical College, Bengaluru, Karnataka, India
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Abstract
Background: Scrambler therapy (ST) is a relatively new neuromodulation technique that is useful in treatment of medication-resistant pain syndromes, including chemotherapy-induced peripheral neuropathy and other chronic pain syndromes. Amyloidosis commonly leads to peripheral neuropathy, and although the mechanism is unclear, it is possibly related to amyloid deposits on the nerve. Case Presentation: In this case presentation, we describe the novel use of ST for a patient with 13 years of neuropathic pain related to amyloidosis and worsened by chemotherapy. The patient reported bilateral hand pain with burning and aching and bilateral numbness on the soles of her feet. Her upper extremities were treated with 4 days of 40 minute ST treatment sessions providing reduction in her pain scores to zero. Discussion: Current therapy for amyloid peripheral neuropathy aims at treating the underlying condition, and then medical management with gabapentinoids. This is first case presentation showing successful treatment with ST.
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Affiliation(s)
- Joann B Hunsberger
- Pediatric Anesthesiology and Pediatric Pain Management, Division of Pediatric Anesthesiology, Department of Anesthesiology and CCM, Johns Hopkins Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Hospice and Palliative Medicine, Johns Hopkins Medical Institutions, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Vaishali Rathee
- Hospice and Palliative Medicine, Johns Hopkins Medical Institutions, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA
| | - Thomas J Smith
- Section of Palliative Medicine, Division of General Internal Medicine, Johns Hopkins Medical Institutions, JHUSOM, Baltimore, Maryland, USA
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5
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Berninger LE, Smith TJ. Scrambler therapy for incident pain in bone metastases. J Osteopath Med 2021; 121:539-542. [PMID: 33794081 DOI: 10.1515/jom-2021-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/03/2021] [Indexed: 11/15/2022]
Abstract
Incident pain, described as pain induced by bone metastasis and produced by movement, can be devastating. The high doses of opioids needed to control such pain may sedate the patient and cause additional complications. Treatment of incident pain with pharmaceuticals has rarely been studied; only eight patients have been reported in the literature who did not receive additional opioids. We present the case of a 69 year old man with shoulder destruction due to bone metastases who was able to use his arm for normal activities without pain after three sessions of scrambler therapy, a noninvasive form of electrical neuromodulation that requires further study.
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Affiliation(s)
| | - Thomas J Smith
- Johns Hopkins Medical Institutions, Sidney Kimmel Comprehensive Cancer Center, 600 N. Wolfe Street, Blalock 369, Baltimore, MD21287-0005, USA
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6
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Kashyap K, Singh V, Mishra S, Dwivedi SN, Bhatnagar S. The Efficacy of Scrambler Therapy for the Management of Head, Neck and Thoracic Cancer Pain: A Randomized Controlled Trial. Pain Physician 2020; 23:495-506. [PMID: 32967392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Pain is still a common feature in all types of cancers including head and neck and thoracic cancer. Neuromodulatory techniques have gained popularity over opioids in recent times because of the risks associated with chronic opioid therapy. There are no clinical trials evaluating the efficacy of scrambler therapy (ST) for the management of pain due to head and neck and thoracic cancer. OBJECTIVE This trial was undertaken to evaluate the efficacy of scrambler therapy (ST) for pain relief and to assess the possible effect of ST on the dosage of opioids in patients suffering from cancer pain. STUDY DESIGN A randomized control trial (RCT) was performed. SETTING The trial was conducted at the Pain and Palliative Care Unit of the Dr. B.R. Ambedkar Institute Rotary Cancer Hospital of All India Institute of Medical Sciences, New Delhi, India. METHOD Forty patients were included in each of the 2 arms, control and Intervention. In both arms, patients were given pain management drugs. In the intervention group, patients additionally received 10 consecutive sessions of ST with one follow-up after 7 days. A numeric rating scale (NRS-11) was used to measure pain. Drug dosage was also recorded. RESULTS Overall, pain decreased in both arms. However, pain decreased more in the intervention arm as compared to the control arm. The total change in the mean score of the NRS-11 from baseline to follow-up was 3.1 and 6.19 in the control and ST arms, respectively. Differences between pain scores in both arms became significant from day 3 onwards. Mean morphine dose was significantly lower in the intervention arm from day 7 onwards. LIMITATIONS The study followed the patients until one week after the last treatment session and encouraged patients to return for treatment if their pain returned to previous levels within 10 days. Moreover, patients in the control arm received the standard of care in the form of pharmacological treatment but did not receive either transcutaneous electrical nerve stimulation (TENS) or a sham (placebo) procedure. CONCLUSIONS The trial showed that ST is an effective treatment for the management of pain due to head and neck and thoracic cancer. On the basis of this study, the use of ST for the management of refractory cancer pain in head and neck and thoracic cancer is recommended.
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Affiliation(s)
- Komal Kashyap
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | | | - Seema Mishra
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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7
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Abstract
Aim: Déjerine-Roussy syndrome or central thalamic pain can be devastating, and treatment with drugs and even deep brain stimulation can be unsatisfactory. Scrambler therapy is a form of neuromodulation that uses external skin electrodes to send a 'non-pain' signal to the brain, with some success in difficult-to-treat syndromes such as neuromyelitis optica spectrum disorder. We used scrambler therapy to treat a patient with 6 years of disabling Déjerine-Roussy syndrome pain. Methods: A 56-year-old man received multiple daily then monthly treatments with electrode pairs placed just above the area of distal pain. Each treatment was for 40 min. Results: His allodynia and hyperalgesia resolved within 10 min, and his pain score fell to almost zero after 30 min. Months later, he resumed normal activity and is off all his pain medications. No side effects were noted. Conclusion: Scrambler therapy appeared to reverse 6 years of disabling pain safely and economically, and continues to be effective. Further multi-institutional trials are warranted for this rare syndrome.
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Affiliation(s)
- Paul J Christo
- Anesthesiology & Critical Care Medicine-Pain Medicine (PJC), Neuro-oncology (DOK), & Palliative Care Programs Sidney Kimmel Comprehensive Cancer Center (TJS), all at Johns Hopkins University, Baltimore, MD 21287, USA
| | - David O Kamson
- Anesthesiology & Critical Care Medicine-Pain Medicine (PJC), Neuro-oncology (DOK), & Palliative Care Programs Sidney Kimmel Comprehensive Cancer Center (TJS), all at Johns Hopkins University, Baltimore, MD 21287, USA
| | - Thomas J Smith
- Anesthesiology & Critical Care Medicine-Pain Medicine (PJC), Neuro-oncology (DOK), & Palliative Care Programs Sidney Kimmel Comprehensive Cancer Center (TJS), all at Johns Hopkins University, Baltimore, MD 21287, USA
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Abstract
Scar pain from thoracotomy, hepatectomy, or similar operations is distressing and difficult to treat. Scrambler Therapy is a novel form of superficial neuromodulation that has been effective in treating different types of neuropathic pain. We report here two cases of dramatic relief from disabling scar pain with one or two sessions of Scrambler Therapy.
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Affiliation(s)
- Mark Yarchoan
- Oncology, Gastrointestinal Cancer, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, USA
| | - Jarushka Naidoo
- Oncology, Upper Aerodigestive Cancer Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, USA
| | - Thomas J Smith
- Oncology, Hospice and Palliative Medicine, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, USA
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Abstract
RATIONALE Neuropathy secondary to diabetes mellitus often does not respond well to conventional therapy. Scrambler therapy may be an alternative treatment for otherwise intractable neuropathy. PATIENT CONCERNS A 45-year-old female complained of bilateral plantar foot pain. She had been treated for diabetes mellitus for 5 years. Oral analgesics did not resolve her pain. Even nerve block therapy did not adequately relieve her pain. DIAGNOSES Diabetic peripheral neuropathy. INTERVENTION Scrambler therapy. OUTCOME Pain reduction; the treatment effect was based around the location of the scrambler patch. LESSONS Scrambler therapy is effective for the treatment of diabetic peripheral neuropathy. Moreover, effective pain management can be achieved for patients who complain of general pain of the sole, including the toe, by attaching scrambler patches around the ankle.
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Smith TJ, Razzak AR, Blackford AL, Ensminger J, Saiki C, Longo-Schoberlein D, Loprinzi CL. A Pilot Randomized Sham-Controlled Trial of MC5-A Scrambler Therapy in the Treatment of Chronic Chemotherapy-Induced Peripheral Neuropathy (CIPN). J Palliat Care 2019; 35:53-58. [PMID: 30714486 DOI: 10.1177/0825859719827589] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) affects 30% to 40% of patients with cancer with long-lasting disability. Scrambler therapy (ST) appeared to benefit patients in uncontrolled trials, so we performed a randomized sham-controlled Phase II trial of ST. METHODS The primary end point was "average pain" after 28 days on the Numeric Rating Scale. Each received ten 30-minute sessions of ST on the dermatomes above the painful areas, or sham treatment on the back, typically at L3-5 where the nerve roots would enter the spinal cord. Outcomes included the Brief Pain Inventory (BPI)-CIPN and the EORTC CIPN-20 scale. Patients were evaluated before treatment (day 0), day 10, and days 28, 60, and 90. RESULTS Data regarding pain as a primary outcome were collected for 33 of the 35 patients. There were no significant differences between the sham and the "real" ST group at day 10, 28, 60, or 90, for average pain, the BPI, or EORTC CIPN-20. Individual responses were noted during the ST treatment on the real arm, but most dissipated by day 30. There was improvement in the sensory subscale of the CIPN-20 at 2 months in the "real" group (P = .14). All "real" patients wanted to continue treatment if available. DISCUSSION We observed no difference between sham and real ST CIPN treatment. Potential reasons include at least the following: ST does not work; the sham treatment had some effect; small sample size with heterogeneous patients; misplaced electrodes on an area of nonpainful but damaged nerves; or a combination of these factors.
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Affiliation(s)
- Thomas J Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - A Rab Razzak
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Amanda L Blackford
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Jennifer Ensminger
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Catherine Saiki
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
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11
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Abstract
Chronic pain is often difficult to treat, requiring a comprehensive multidisciplinary therapeutic intervention and a high level of management expertise.This is particularly true for patients who are unresponsive to standard treatments for chronic pain, for which Scrambler Therapy (ST) is indicated. The aim of the present study was to evaluate the impact of ST on patient-reported moderate to severe chronic pain.This was a prospective trial on 219 patients affected by chronic pain from April 2010 to March 2016. The study consisted of 2 consecutive weeks of treatment with ST (one 30-min daily session, 5 days a week) (T0, T1, T2) and a 2-week follow-up (T3, T4). Patients were asked to describe the pain using the Numeric Rating Scale (NRS) immediately prior to and after the treatment.Two hundred nineteen patients were treated for chronic pain of different nature with mean values of 6.44 (± 2.11) at T0, 3.22 (± 2.20) at T2, and 3.19 (± 2.34) at T4. A reduction in the symptomatology from T0 to T2 was maintained throughout T4 (P value < .0001). Of the 219 patients treated with ST, 83 (37.9%) had cancer pain and 136 (62.1%) had non-cancer pain. No adverse events were reported.Future research should focus on individual response, retreatment, and maintenance therapy. The data showed a statistically significant impact of ST, which was maintained during follow-up, on patients suffering from chronic pain of different nature.
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Affiliation(s)
- Marianna Ricci
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Laura Fabbri
- Palliative Care Unit, Valerio Grassi Hospice, Forlimpopoli
| | - Sara Pirotti
- Palliative Care Unit, Valerio Grassi Hospice, Forlimpopoli
| | | | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
- Palliative Care Unit, Valerio Grassi Hospice, Forlimpopoli
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Tomasello C, Pinto RM, Mennini C, Conicella E, Stoppa F, Raucci U. Scrambler therapy efficacy and safety for neuropathic pain correlated with chemotherapy-induced peripheral neuropathy in adolescents: A preliminary study. Pediatr Blood Cancer 2018; 65:e27064. [PMID: 29630779 DOI: 10.1002/pbc.27064] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 02/28/2018] [Accepted: 02/28/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of chemotherapy, in need of effective treatment. Preliminary data support the efficacy of scrambler therapy (ST), a noninvasive cutaneous electrostimulation device, in adults with CIPN. We test the efficacy, safety, and durability of ST for neuropathic pain in adolescents with CIPN. PATIENTS AND METHODS We studied nine pediatric patients with cancer and CIPN who received ST for pain control. Each patient received 45-min daily sessions for 10 consecutive days as a first step, but some of them required additional treatment. RESULTS Pain significantly improved comparing Numeric Rate Scale after 10 days of ST (9.22 ± 0.83 vs. 2.33 ± 2.34; P < 0.001) and at the end of the optimized cycle (EOC) (9.22 ± 0.83 vs. 0.11 ± 0.33, P < 0.001). The improvement in quality of life was significantly reached on pain interference with general activity (8.67 ± 1.66 vs. 3.33 ± 2.12, P < 0.0001), mood (8.33 ± 3.32 vs. 2.78 ± 2.82, P < 0.0005), walking ability (10.00 vs. 2.78 ± 1.22, P < 0.0001), sleep (7.56 ± 2.24 vs. 2.67 ± 1.41, P < 0.001), and relations with people (7.89 ± 2.03 vs. 2.11 ± 2.03, P < 0.0002; Lansky score 26.7 ± 13.2 vs. 10 days of ST 57.8 ± 13.9, P < 0.001; 26.7 ± 13.2 vs. EOC 71.1 ± 16.2, P < 0.001). CONCLUSION Based on these preliminary data, ST could be a good choice for adolescents with CIPN for whom pain control is difficult. ST caused total relief or dramatic reduction in CIPN pain and an improvement in quality of life, durable in follow-up. It caused no detected side effects, and can be retrained successfully. Further larger studies should be performed to confirm our promising preliminary data in pediatric patients with cancer.
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Affiliation(s)
- Caterina Tomasello
- Anaesthesia and Intensive Care Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rita Maria Pinto
- Haematology Oncology Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Mennini
- Scientific Direction, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elena Conicella
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Stoppa
- Anaesthesia and Intensive Care Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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13
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Abstract
Chronic post-mastectomy pain (cPMP), including post-lumpectomy pain, is common with no established ways of treatment. We treated three consecutive patients referred with cPMP with scrambler therapy (ST), a non-invasive electrical neurocutaneous stimulation. Treatment was given across the area of pain following the dermatomes for 45 minutes daily, for several consecutive days until relief, and then was repeated as needed. The ST MC5A device synthesizes 16 different waveforms that resemble action potentials, delivered to the surface receptors of the c-fibers, to send “non-pain” information along the damaged pathways to reduce central sensitization. All three had marked (over 75%) and sustained (months) reduction of allodynia, hyperalgesia, and pain. All reported marked improvements in their quality of life and normal function. One woman was able to stop chronic opioid use. No side effects were observed. Scrambler therapy is a promising way to relieve cancer and other types of neuropathic pain, and may be helpful in cPMP. Further prospective trials are warranted.
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Affiliation(s)
- Thomas Smith
- Palliative Medicine Program, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | - Andrea L Cheville
- Physical Medicine and Rehabilitation, Mayo Clinic and Foundation, Rochester, MN, USA
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Abstract
Cancer pain remains a significant clinical problem worldwide. Causes of cancer pain are multifactorial and complex and are likely to vary with an array of tumor-related and host-related factors and processes. Pathophysiology is poorly understood; however, new laboratory research points to cross-talk between cancer cells and host’s immune and neural systems as an important potential mechanism that may be broadly relevant to many cancer pain syndromes. Opioids remain the most effective pharmaceuticals used in the treatment of cancer pain. However, their role has been evolving due to emerging awareness of risks of chronic opioid therapy. Despite extensive research efforts, no new class of analgesics has been developed. However, many potential therapeutic targets that may lead to the establishment of new pharmaceuticals have been identified in recent years. It is also expected that the role of non-pharmacological modalities of treatment will grow in prominence. Specifically, neuromodulation, a rapidly expanding field, may play a major role in the treatment of neuropathic cancer pain provided that further technological progress permits the development of non-invasive and inexpensive neuromodulation techniques.
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Affiliation(s)
- Marcin Chwistek
- Department of Hematology and Medical Oncology, Fox Chase Cancer Center/Temple Health, Philadelphia, PA, USA
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15
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Kashyap K, Joshi S, Vig S, Singh V, Bhatnagar S. Impact of Scrambler Therapy on Pain Management and Quality of Life in Cancer Patients: A Study of Twenty Cases. Indian J Palliat Care 2017; 23:18-23. [PMID: 28216858 PMCID: PMC5294432 DOI: 10.4103/0973-1075.197948] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim of the Study: To study the effect of scrambler therapy on patients with chronic cancer pain. Materials and Methods: This is a prospective, observational study conducted on patients with chronic pain due to malignancy which is not responding to oral analgesics. A total of twenty patients were included in the study (ten males, ten females) with a visual analog scale score of >4 on oral analgesics. Patients aged 18–70 years with a life expectancy of >3 months having bony, neuropathic, or mixed type of pain were included in the study. A total of 12 sessions of scrambler therapy were planned, ten sessions on consecutive days and one session each on two follow-up visits after 1 week each. Each session lasted for 40 min. Pain relief and quality of life according to the World Health Organization Quality of Life were recorded as primary outcome variables. Results: All patients had good pain relief and improvement in all four domains of quality of life. Pain scores decreased significantly (P < 0.01) after each session and at each follow-up. Patients showed significant improvement in physical, psychological, social, and environmental health (P < 0.01) after the therapy. Conclusion: Scrambler therapy offers a promising role in the pain physician's armamentarium as an adjunct to pharmacological therapy for the treatment of chronic drug-resistant cancer pain; it may bring down analgesic drug requirements significantly and improve quality of life in cancer patients. Larger prospective, randomized multicenter studies are needed to validate the findings of the small pilot studies published in literature so far.
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Affiliation(s)
- Komal Kashyap
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All Institute of Medical Sciences, New Delhi, India
| | - Saurabh Joshi
- Department of Anesthesiology, BLK Super Speciality Hospital, New Delhi, India
| | - Saurabh Vig
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All Institute of Medical Sciences, New Delhi, India
| | - Vishwajeet Singh
- Department of Biostatistics, All Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All Institute of Medical Sciences, New Delhi, India
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Smith TJ, Auwaerter P, Knowlton A, Saylor D, McArthur J. Treatment of human immunodeficiency virus-related peripheral neuropathy with Scrambler Therapy: a case report. Int J STD AIDS 2016; 28:202-204. [PMID: 27330020 DOI: 10.1177/0956462416656688] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Peripheral neuropathy is one of the most common neurological complications of HIV infection with a 30-60% lifetime prevalence. Newer HIV drugs cause less peripheral neuropathy, but patients are now living long enough to develop concomitant diabetes-related, vascular-related, and chemotherapy-related neuropathy so it continues as a major debilitating issue. Recent national CDC guidelines have stressed the importance of non-opioid therapies, especially in this population that may have had drug abuse problems. We treated a 52-year-old man who had severe disabling classic peripheral neuropathy since 1998 with Scrambler Therapy (Calmare), an FDA-cleared peripheral non-invasive neuromodulation device. His pain rapidly improved, as did his motor and sensory function, with just four 45-min treatments, and he was able to come off opioids for the first time in years. When his pain returned six months later, only two treatments were needed to resolve it. This represents the first published use of this novel, inexpensive, and non-invasive pain modality in HIV peripheral neuropathy, and should engender further trials.
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Affiliation(s)
- Thomas J Smith
- 1 From the Harry J. Duffey Family Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Paul Auwaerter
- 2 Division of Infectious Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Amy Knowlton
- 3 Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deanna Saylor
- 4 Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Justin McArthur
- 4 Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Coyne PJ, Wan W, Dodson P, Swainey C, Smith TJ. A trial of Scrambler therapy in the treatment of cancer pain syndromes and chronic chemotherapy-induced peripheral neuropathy. J Pain Palliat Care Pharmacother 2013; 27:359-64. [PMID: 24143893 PMCID: PMC4378693 DOI: 10.3109/15360288.2013.847519] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neuropathic pain is common among cancer patients and often difficult to treat. This study used Scrambler therapy, a patient-specific electrocutaneous nerve stimulation device, to treat cancer patients with pain. Patients received Scrambler therapy for 10 sessions (one daily) over a two-week period. The primary outcome was changed in pain numerical rating scale (NRS) at one month; secondary outcomes were changes in the Brief Pain Inventory and European Organization for Treatment and Cancer QLC-CIPN-20(EORTC CIPN-20), over time. Thirty-nine patients, mean age 56.5 yr, 16 men and 23 women, were treated over an 18-month period for an average of 9.3 days each. The "now" pain scores reduced from 6.6 before treatment to 4.5 at 14 days, 4.6, 4.8, and 4.6 at 1, 2, and 3 months, respectively (p < 0.001). Clinically important and statistically significant improvements were seen in average, least, and worst pain; BPI interference with life scores, and motor and sensory scales on the EORTC CIPN-20. No adverse effects were observed. In this single arm trial, Scrambler therapy appeared to relieve cancer-associated chronic neuropathic pain both acutely and chronically, and provided sustained improvements in many indicators of quality of life.
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18
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Park HS, Sin WK, Kim HY, Moon JY, Park SY, Kim YC, Lee SC. Scrambler therapy for patients with cancer pain - case series -. Korean J Pain 2013; 26:65-71. [PMID: 23342211 PMCID: PMC3546214 DOI: 10.3344/kjp.2013.26.1.65] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 11/14/2012] [Accepted: 11/15/2012] [Indexed: 12/13/2022] Open
Abstract
More than 80% of cancer patients experience cancer pain. Among them, more than 50% experience moderate to severe pain. To control cancer pain, a variety of methods have been used, including medications and nerve blocks. In some patients, however, it is impossible to perform nerve blocks due to caner metastasis into the epidural space, while in other patients, opioid dose escalation is impossible due to opioid side effects; thus, cancer pain management is difficult. Scrambler therapy is a novel approach for pain control that uses EKG-like pads, which are applied above and below the site of pain. Scrambler therapy synthesizes 16 different types of nerve action potentials that provide "non-pain" information via cutaneous nerves. The advantages of this treatment are that it is non-invasive and safe and has no significant side effects. In this case series, we report the treatment results of using scrambler therapy in three cancer patients with intractable pain.
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Affiliation(s)
- Hong Sik Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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