A Review of Scrambler Therapy for Chronic Neuropathic Pain

Abstract

Objectives • Review current clinical evidence, correlational scientific findings, and ongoing randomized clinical trials for Scrambler Therapy in the management of refractory neuropathic pain. • Describe how the therapy is done, including common mistakes and expert pointers. Pain remains one of the most common clinical problems and causes of debility, disability, and lost productivity. (Simon L, 2012; Institute of Medicine 2011) Neuropathic pain is particularly vexing as relief is often incomplete and associated with significant medication side effects. Spinal cord stimulation is effective, with pain reductions of 50%-90% reported in well-designed randomized trials (Deer TR, 2014) but is invasive, permanent, and expensive (over $75,000/ implant.) Scrambler Therapy (ST) is a new way of relieving pain by giving artificial nerve impulses to simulate “non-pain” information along the damaged pathways to repair damaged nerve pathways, capturing the nerve pathways much like spinal cord stimulation. Clinical efficacy has been demonstrated with 14 published studies showing relief of pain from a minimum of 25% up to 95% at one month, with no side effects (Majithia, Smith, Loprinzi, in press). Specific examples include over 50% reduction in chemotherapy induced neuropathic pain, numbness, and tingling (Smith TJ, 2010; Pachman D, 2014); 50%-95% reduction in post-herpetic pain (Smith 2013; Ko YK, 2013); over 50% reduction in low back pain in a randomized sham controlled trial (Starkweather A, 2015); and 91% reduction in pain in PHN, failed back syndrome, and spinal cord stenosis (Marineo G, 2012). There is good evidence for a “learning curve” that explains why experienced treaters have the best results. (Pachman D, 2014) Some correlational science includes dramatic reduction in mRNAs for pain-involved NGF, GDNF, and others (Starkweather A, 2015); observations that antidepressant (eg, gabapentin) (Moon YJ, 2014) use is associated with less effect postulated by less neuronal repair and sustained changes in fMRIs of the brain. (Ko, in press.) Several governments, including Korea and the Eurozone, now fully reimburse for therapy but ST is relatively unknown in the U.S. We will review the evidence, ongoing sham controlled trials, and illustrate how it works in real time.