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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.

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.

Electrode placement demands scrupulous compliance to the indicated methodology to identify the areas and immediate associated efficacy results. If the treatment is executed correctly, pain is usually zeroed out in real time regardless of intensity and pathology that generated it.

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.

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.

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.


Self-assessment in the ability to correctly use the Scrambler Therapy®

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.

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