It is based on a different theoretical mechanism than the traditional gate control theory in which the electric stimulation of A-beta fibers is delivered to block pain signals and produce an analgesic effect. The active principle with scrambler therapy is that artificial strings of action potentials calibrated to synchronize C-fiber surface receptors may replace endogenous pain information with synthetic "non-pain" information 11. Scrambler therapy is a noninvasive electroanalgesia technique that utilizes transcutaneous electrical stimulation to reorganize maladaptive pain signaling pathways 10, 11. However, pharmacotherapy alone may be limited with regard to efficacy and tolerance, with less than one-third of patients experiencing 50% or greater pain relief 5, 6, 7, 8, 9. Pharmacologic treatment with analgesics such as tricyclic antidepressants, serotonin-noradrenaline reuptake inhibitors, and gabapentinoids is typically the first step in managing neuropathic pain 5, 6. Neuropathic pain can have a profound negative impact on the quality of life of affected patients, and it can also have high socioeconomic costs 3, 4. Comprising a wide range of heterogeneous conditions, it is highly prevalent, affecting up to 10% of the general population 2. Neuropathic pain is pain caused by a lesion or disease of the peripheral and/or central somatosensory nervous system 1. Further studies are warranted to confirm that capturing neuropathic pain phenotypes can optimize the use of scrambler therapy. Treatment response to scrambler therapy appears different depending on the neuropathic pain phenotypes, with more favorable outcomes in patients with preferentially paroxysmal pain rather than persistent pain. Linear mixed-effects model analyses revealed differential response to scrambler therapy across clusters (p = 0.003, pain NRS p = 0.072, BPI interference subdimension). Hierarchical clustering based on the NPSI profiles partitioned the patients into 3 clusters with distinct neuropathic pain phenotypes. 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. 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). A post-hoc analysis was performed to investigate whether cluster analysis of the Neuropathic Pain Symptom Inventory (NPSI) profiles could identify a subgroup of patients regarding neuropathic pain phenotype and treatment outcome.
#Scrambler therapy trial
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. Despite growing evidence of its efficacy in patients with neuropathic pain, little is known about the clinical factors associated with treatment outcome.
Scrambler therapy is a noninvasive electroanalgesia technique designed to remodulate the pain system.
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