Background 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 patient with pain. Methods Patients received Scrambler Therapy for ten sessions (one daily) over a two- week period. The primary outcome was change in pain numeric rating scale (NRS) at 1 month; secondary outcomes were changes in the Brief Pain Inventory and European Organization for Treatment and Cancer QLC-CIPN-20 over time. Results 39 patients, mean age 56.5, 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. (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. Conclusions 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.

Neuropathic pain is commonly seen in cancer patients, either as a direct result of the malignancy or as a consequence of the treatment rendered. In recent years, methadone has been utilized in the treatment of neuropathic pain because of its additional mechanism of action as an NMDA-receptor antagonist. In this paper we discuss the etiology of neuropathic pain in cancer patients, unique properties of methadone, and prior studies on methadone in this patient population. While methadone has been established as a cheap and effective agent in treating cancer pain, specific studies are needed comparing methadone to other opioids in the management of cancer-related neuropathic pain.

Breast cancer may recur through 15 years and beyond after diagnosis; thus, breast cancer patients require long-term follow-up after adjuvant treatment to detect recurrent disease. History taking, physical examination, and regular mammography are still the foundation of appropriate breast cancer follow-up in the adjuvant setting. Clearly, breast MRI has a role in certain high-risk patients, but in moderate-risk patients, the decision to use MRI must be based on the complexity of the clinical scenario. Other routine imaging studies (CT, positron emission tomography, and bone scans) and laboratory testing--including tumor marker assessments--in asymptomatic patients have not demonstrated an improvement in survival, quality of life, toxicity, or cost-effectiveness. Survivorship issues are also an inherent part of breast cancer follow-up; physicians should make every effort to address supportive care issues unique to breast cancer survivors including hot flashes, bone health, neuropathy, and risk-reduction strategies.

Even when managed according to guidelines, approximately 14% of cancer patients have unrelieved pain or unacceptable side effects, and there is good evidence that patients still are not receiving optimal therapy. Implantable drug delivery systems (IDDS) administer small amounts of drugs directly to the spinal cord and reduce systemic narcotic exposure by a factor of 300 to one. In a large randomized trial of 202 patients with pain scores of 7.5 or higher, despite 200 mg or more of morphine or equivalent narcotics, IDDS gave better clinical success than comprehensive medical management (84.5% vs 70.8%, P=0.05). Pain scores were reduced by 52% versus 39%, drug toxicity scores were reduced by 50% versus 17%, and IDDS patients lived longer. Even the most refractory pain patients--those failed by a month of comprehensive medical management by experts--when subsequently provided with IDDS, had a 27% reduction in pain scores and a 50% reduction in drug side effects. Given multiple positive small cohort studies and a positive high-power randomized trial, IDDS should be considered as the best treatment for this population.

Patients may legally and ethically refuse life-sustaining care. These patients considered their lives to be more burdensome than beneficial near the end of their lives, both carefully planned the time and circumstance of their deaths, and both fulfilled a long-standing desire to donate their organs. This study describes a potential opportunity for patients with progressive neurologic illness.