Scrambler therapy improves pain in neuromyelitis optica

Mealy, Maureen A.; Kozachik, Sharon; Cook, Lawrence J.; Totonis, Lauren; Salazar, Ruth Andrea; Allen, Jerilyn K.; Nolan, Marie T.; Smith, Thomas J.; Lévy, Michaël

doi:10.1212/wnl.0000000000009370

Cited by 28 publications

(23 citation statements)

References 36 publications

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“…While the e cacy of scrambler therapy in central neuropathic pain has rarely been investigated, we observed a favorable treatment outcome in the patients with spinal cord lesions of various etiologies including myelitis, ischemia, vascular malformation and subacute combined degeneration. In keeping with our results, a recent sham-controlled study involving 22 patients with neuromyelitis optica spectrum disorder showed that scrambler therapy can improve pain, depression, and anxiety 38 . The bene ts of scrambler therapy for central neuropathic pain deserve further investigations.…”

Section: Discussionsupporting

confidence: 91%

Differential Response to Scrambler Therapy by Neuropathic Pain Phenotypes

Min

Baek

Lee

et al. 2021

Preprint

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Scrambler therapy is a novel noninvasive electroanalgesia technique designed to remodulate the pain system. Despite growing evidence of its efficacy in patients with neuropathic pain, little is known about the clinical factors associated with treatment outcome. We conducted a prospective, open-label, single-arm trial to assess the efficacy and safety of scrambler therapy in patients with chronic neuropathic pain of various etiologies. A post-hoc analysis was performed to investigate whether cluster analysis of the Neuropathic Pain Symptom Inventory profiles could identify a subgroup of patients regarding neuropathic pain phenotype and treatment outcome. Scrambler therapy resulted in a significant decrease in the pain numerical rating scale (NRS) score over 2 weeks of treatment (least squares mean of percentage change from baseline, −15%; 95% CI, −28% to −2.4%; p < 0.001). The mean score of Brief Pain Inventory (BPI) interference subdimension was also significantly improved (p = 0.022), while the BPI pain composite score was not. Hierarchical clustering partitioned the patients into 3 clusters with distinct neuropathic pain phenotypes. Linear mixed-effects model analyses revealed differential response to scrambler therapy across clusters (p = 0.003, pain NRS; p = 0.072, BPI interference subdimension). Treatment response to scrambler therapy appears different depending on the pain-related sensory profile, with more favorable outcomes in patients with preferentially paroxysmal pain rather than persistent pain. Further studies are warranted to confirm that capturing neuropathic pain phenotypes can optimize the use of scrambler therapy.

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Section: Discussionsupporting

confidence: 91%

Differential Response to Scrambler Therapy by Neuropathic Pain Phenotypes

Min

Baek

Lee

et al. 2021

Preprint

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“…The studies focused on pain without diagnostic specification ( 18 , 25 , 51 ), neuropathic pain ( 26 , 28 , 49 , 50 , 53 , 55 , 56 ), one study on neuropathic pruritus ( 52 ), painful tonic spasms ( 29 – 32 ), ON-related headache ( 54 ), and a description of diverse pain types ( 2 , 27 ). One randomized single blind sham-controlled trial studied the effect of Scrambler therapy in NMOSD patients with central neuropathic pain ( 55 ). All other studies ( n = 17) were descriptive and non-interventional.…”

Section: Resultsmentioning

confidence: 99%

“…The trial showed pain reduction from a median baseline numeric rating scale (NRS) pain score of 5.0-1.5 after 10 days of treatment. The median NRS score did not significantly decrease in the sham arm (55). Currently, the lack of clear guidelines regarding the frequency and stimulation amplitude necessary to achieve sufficient pain reduction currently limits the use of TENS (57,198,199).…”

Section: Fourth-line Therapymentioning

confidence: 88%

“…Three studies on immunosuppressive treatment in AQP4-Ab-positive NMOSD have shown promising results when examining pain as a secondary outcome: two in patients treated with the humanized monoclonal IL-6 antibody tocilizumab ( 125 , 160 , 161 ) and one in patients treated with low-dose mycophenolate mofetil (MMF) ( 162 ). One study on the positive effect of Scrambler therapy for the treatment of neuropathic pain in NMOSD was identified ( 55 ). No studies were found investigating pain treatment in MOGAD.…”

Section: Treatment Of Pain In Nmosd and Mogadmentioning

confidence: 99%

“…Neuromodulation, including intracranial stimulation, spinal cord stimulation, high-frequency and burst spinal cord stimulation, and dorsal root ganglion stimulation, is considered to be fourth-line treatment before starting medication with long-term opioids ( 55 , 182 ). As mentioned above, one phase II study has shown a positive effect of Scrambler therapy for the treatment of neuropathic pain in 22 AQP4-positive NMOSD patients ( 55 ). Scrambler therapy is non-invasive technology with Food and Drug Administration (FDA) 510(k) approval for acute, chronic, and postoperative pain.…”

Section: Treatment Of Pain In Nmosd and Mogadmentioning

confidence: 99%

See 2 more Smart Citations

Pain in NMOSD and MOGAD: A Systematic Literature Review of Pathophysiology, Symptoms, and Current Treatment Strategies

2020

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Neuromyelitis optica spectrum disorders (NMOSDs) and myelin oligodendrocyte glycoprotein-antibody-associated disease (MOGAD) are autoimmune inflammatory disorders of the central nervous system (CNS). Pain is highly prevalent and debilitating in NMOSD and MOGAD with a severe impact on quality of life, and there is a critical need for further studies to successfully treat and manage pain in these rare disorders. In NMOSD, pain has a prevalence of over 80%, and pain syndromes include neuropathic, nociceptive, and mixed pain, which can emerge in acute relapse or become chronic during the disease course. The impact of pain in MOGAD has only recently received increased attention, with an estimated prevalence of over 70%. These patients typically experience not only severe headache, retrobulbar pain, and/or pain on eye movement in optic neuritis but also neuropathic and nociceptive pain. Given the high relevance of pain in MOGAD and NMOSD, this article provides a systematic review of the current literature pertaining to pain in both disorders, focusing on the etiology of their respective pain syndromes and their pathophysiological background. Acknowledging the challenge and complexity of diagnosing pain, we also provide a mechanism-based classification of NMOSD- and MOGAD-related pain syndromes and summarize current treatment strategies.

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Scrambler therapy for treatment of poststroke pain

Stowell‐Campos,

Lawrence,

Marsh

et al. 2024

Ann Clin Transl Neurol

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ObjectiveStrokes involving sensory pathways can result in contralesional pain syndromes often refractory to pharmacologic interventions. Scrambler therapy (ST) is a noninvasive electroanalgesia device used to treat pain caused by peripheral neuropathy; however, data are scarce regarding its use in conditions secondary to central nervous system pathology. We evaluate the efficacy of ST to treat poststroke pain.MethodsTwenty patients with a history of prior stroke resulting in contralesional pain were randomized to receive ST or Sham as an adjunct to their stable medication regimen. Participants underwent 5 consecutive daily 40‐min sessions. The study was blinded to patient and assessor. Pain scores (0–10) were recorded at baseline, pre‐ and postsession, and 4 weeks after final treatment. Student's t‐tests compared differences in the mean change in pain score between groups immediately post‐treatment #5, and at 4‐weeks. The chi‐squared analysis compared the proportion of patients in each group with >50% pain reduction.ResultsParticipants randomized to ST had a mean change in pain score of −3.73 (SD 2.85) postintervention and −2.57 (SD 2.07) at 4 weeks, while the Sham group had a mean change in score of −0.94 (SD 1.36) and −0.25 (SD 0.84) (p between groups = 0.012, 0.004, respectively). Significantly more participants treated with ST reported a >50% reduction in pain immediately postintervention compared to Sham (70% vs. 10%, p = 0.006), but not at follow‐up (30% vs. 10%, p = ns).InterpretationST may effectively decrease poststroke pain compared to Sham. Larger studies are needed to evaluate confounders such as stroke location, time from stroke, and concomitant treatment with medications.

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Scrambler therapy improves pain in neuromyelitis optica

Cited by 28 publications

References 36 publications

Differential Response to Scrambler Therapy by Neuropathic Pain Phenotypes

Differential Response to Scrambler Therapy by Neuropathic Pain Phenotypes

Pain in NMOSD and MOGAD: A Systematic Literature Review of Pathophysiology, Symptoms, and Current Treatment Strategies

Scrambler therapy for treatment of poststroke pain

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