Scrambler Therapy Best Clinical Practice

 Basic Strategies of Scrambler Therapy

According to the ST protocol (Chronic benign pain), the patient visits the practice for 10 to 12 consecutive treatments and one treatment per day is performed over a period of two weeks. Treatment sessions may last from 30 to 60 minutes. After finishing the first cycle including 10 to 12 consecutive ST, booster cycles can be given when it is needed.
The protocol for patients who use anticonvulsant typically includes 10 treatments + those needed for  weaning. The frequency of treatment remains unchanged. It is also possible to continue the anticonvulsants analgesic therapy, however in this case results are not as good or insufficient, and relapse is quicker.

In detail, procedures for the ST start from first clearly defining the pain area. Next, electrodes are attached to the areas proximal and distal to the pain area, which is recommended that the electrodes are attached along the dermatome of the pain area, and they should be positioned in areas where there is no pain. Subsequently, electrical stimulus is applied and the intensity is increased gradually; the intensity of the electrodes set to the maximum value at which the patient does not feel discomfort. The electrical stimulus conveys different combination of strings of "no pain" signals, very similar to the strings of action potential conveyed through the nervous system. These strings are dynamically variable in many parameters that characterize the contents of  "no pain information". The concept of  "no pain information" used in ST means create sensory information variable in the time, always  compatible with specific recognition characteristics of polymodal surface C receptors, such as the feel of pressure. Throughout these processes, the patient feels his or her pain disappearing immediately. If there is no zero pain (or at least VAS VAS<1), the procedures should be started again after moving the electrodes to a different area. In addition, if there would be areas where pain remains, more electrodes would be attached to alleviate the remaining pain.

The exact electrode positioning depends only on the delimitation of the surface pain area, and immediate patient’s analgesic response while checking the efficacy of each electrode pair positioning. The basic strategy of ST is independent of pain types. Electrode positioning reference check is only dependent in the pain area and its immediate and complete disappearance when the positioning is correct. In checking analgesic progressive efficacy during positioning, every condition that can trigger pain must be verified and eliminated. During the ST, the patient should assume the most comfortable position.

•  If anticonvulsants are being used in patient, the longer treatment cycle could be needed.   

Advanced  strategies to standard positioning of electrodes must be used if there are no pain-free and normal sensitivity areas near the pain area, or phantom limb. The advanced strategies should be recommended only after having acquired a deep understanding of standard method of ST use, and only in cases of need, because they are more difficult to use and less reproducible. Advanced strategies require a specific training course, currently available only in Italy.

Notes on drug interactions

Scrambler Therapy is a methodology specifically studied for neuropathic and oncologic pain. The usage of anticonvulsants for analgesic purposes generally calls for a higher number of treatments, needed for the weaning. The first five treatment with anticonvulsant can provide unstable result , that return to normal with continue the treatment cycle.

The protocol for patients who use anticonvulsant typically includes 10 treatments + those needed for  weaning. The frequency of treatment remains unchanged. It is also possible to continue the anticonvulsants analgesic therapy, however in this case results are not as good or insufficient, and relapse is quicker.
From study-phase data the combination with Ketamine is incompatible since it seems to block the analgesic efficacy of the treatment.  The normal analgesic effect of the treatment after the patient stops taking Ketamine is still unknown. Similar suspicions exist also for muscle relaxants, which in combination with this therapy could also cause minor side effects.

Essential information about the different treatment protocols
Chronic benign pain
The treatment requires cycles (that can be repeated) of at least 10 treatments, 5 days a week (two weeks in a row). A special case is that of patients who are using anticonvulsants. In this situation, as a norm, the response is slower and less stable in time, and a cycle of 10 treatments might not be enough. The analytical explanation is that anticonvulsants diminish pain information, but also synthetic information of non-pain generated by Scrambler Therapy. Comparison of Experimental data in different ways of treatment and follow -up strongly support this hypothesis. Anticonvulsant usage is therefore not a specific contraindication, or indication of lack of efficacy on pain   due to anticonvulsants, but simply an expression of therapy combination that experimentally and in theory is unfavorable. This problem can be partially overcome by increasing the number of treatment/cycles  when necessary.
Scrambler Therapy cannot prevent beforehand expressions of acute pain linked to possible mechanical damage associated to movement (incident pain). In this case, one must consider the concurrent use of other therapies (physical and/or surgical) aimed at containing evocation of incident pain.

Oncologic pain due to anticancer treatments
If the tumor has been successfully removed, this type of pain follows the course of chronic benign pain.

Oncologic pain (palliative treatments)
Usage is in line with the patient's needs and oncologic pain guidelines.Treatment protocols are in line with what prescribed for palliative care, including treatments when necessary.

What happens during the treatment
Scrambler Therapy is a non-invasive treatment, totally automated and does not require parameter setting by the operator. The operator must identify the correct surface application areas via dermatomes. If the treatment is carried out correctly, the patient will immediately feel pain-free, regardless of initial pain intensity. It is unnecessary or required for the patient to feel stimulation in the pain area, since the active principle is not to block nerve conduction by extended electric involvement of the nerve.
If during treatment the patient still perceives pain, even if mitigated, the result will probably not suffice  to maintain analgesic effect as time goes by, and one must check for possible application flaws (see: 10 Basic Rules and Frequent Errors).

Self-assessment in the ability to correctly use the Scrambler Therapy
Key to the pain system remodulation process achieved by Scrambler Therapy is the ability to zero out pain during each treatment session, without the patient feeling any discomfort due to stimulation. In the  standard treatments envisaged and other specific indications included in the “Quick support for research and best clinical practice”, this is always possible. Therefore one can easily and automatically assess the ability to correctly use the methodology based on being able to zero out pain during the treatment session in the indicated conditions.

Scrambler Therapy Data Manager (STDM)
STDM is a free dedicated software program that received CE mark certification as a medical device to be used together with the Scrambler Therapy. This software includes many functionalities, including an automatic analysis of each treatment, that provides an immediate feedback on possible mistakes and adequate recommendations to correct them.  DIS&L strongly recommends that STDM should routinely be used with Scrambler Therapy, to teach operators how to best use this tool and decrease operator dependent variability.


U.S. DIS&L Division