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Only machine of its kind in SC appears to get results for patients in pain

Helen Adams | adamshel@musc.edu | May 18, 2017

patient Douglas Foxworth, Dr. Gibson, nurse Watson
Photos by Sarah Pack
Douglas Foxworth talks with Dr. John Gibson and nurse Julie Watson before she attaches electrodes to try to ease his foot pain.

Retired teacher Douglas Foxworth was suffering from pain so severe that it felt like his feet were on fire. The cause was unknown — it’s called idiopathic peripheral neuropathy. When the Sumter man heard about a new pain treatment at MUSC Health called scrambler therapy, he jumped at the chance to try it.

“That morning when I went in, I was practically in tears. When they asked how my pain was, I said a nine, pushing a ‘ten’ out of ten,” Foxworth said.

He became one of the first patients in South Carolina to try scrambler therapy. The scrambler device, by Calmare, has been cleared by the Food and Drug Administration. Nurse Julie Watson described how it works. “The scrambler therapy device uses transcutaneous electrical stimulation to replace maladaptive pain information with ‘non-painful’ or ‘normal’ messages. It does this by traveling along the same pathways to the brain.” 

Julie Watson putting electrodes on Douglas Foxworth 
Watson places electrodes on Foxworth's feet. 

In other words, as its name suggests, scrambler uses electrical stimulation on the skin to scramble what nerves are trying to tell the brain. Each treatment lasts between a half-hour and 45 minutes. Foxworth had 12 sessions over a 2 1/2-week period. “The first day when they put those electrodes on, about 10 or 15 minutes after, the pain level went down,” he said. “It didn’t last, but the pain level went down to where it was tolerable.”

By the end of the 12th session, the difference was dramatic. “I still have some pain, but I’m no longer on pain medication. The pain is very mild,” Foxworth said. “I consider that this was effective to eliminate probably 90 percent of my pain.”

Palliative care specialist Pat Coyne, who introduced scrambler therapy at MUSC Health, said about 80 percent of the patients who try it feel a substantial difference. He first heard about scrambler therapy while he was working at Virginia Commonwealth University. “We did three research studies,” he says. “We went into the research trying to prove it didn’t work, and everyone kept saying they felt better.”

Pat Coyne 
Pat Coyne 

The skepticism Coyne initially felt resonates with MUSC Health palliative care doctor John Gibson. “Our team has been very happy with the results we have seen,” Gibson said. “I think the biggest point of skepticism for everyone who sees scrambler is that no one really understands how it works. There are theories that make sense, but no one has proven how it works.”

Scrambler therapy was invented by an Italian professor, Coyne said. It has been around for almost two decades, but wasn’t introduced in the U.S. until around 2010. The device requires careful monitoring. “With the electrodes, it senses the nerve firing. The electricity comes in wave forms and pulses. You adjust those based on when the patient tells you the pain is going away,” Coyne said. 

His research team wasn’t alone in finding scrambler therapy was effective. An article in the journal Supportive Care in Cancer said 19 out of 20 reports on scrambler therapy came up with positive results.

Dr. John  Gibson 
Dr. John Gibson 

It’s a nuanced treatment, Coyne said. “A nurse is going to be sitting at the bedside and adjusting the dials. It will be different each time, and the leads will change because the pain typically gets smaller with each treatment. Really, what it’s trying to do is, when the nerves fire, it’s firing against them. So the pulsation never makes it to the brain and you don’t feel pain. And in doing so, we know it changes the way calcium is absorbed. Nerves that fire a lot actually are sometimes calcium deprived. You’re trying to reset the nerves to normal.”

Coyne said research shows patients who had scrambler therapy showed improvements in their natural pain-fighting reserves. “They get depleted when they’re fighting pain all the time. We found their endorphins changed.”

During a training period at MUSC Health, patients could volunteer to try scrambler therapy. It’s now in use in MUSC Hollings Cancer Center, covered by Medicare, Medicaid, and some insurance providers. “Starting off, we’re going to focus on the cancer population, but it’s going to be open to anyone who has this nerve pain,” Coyne said.

Watson, who has treated patients with the scrambler, said cancer treatments can cause neuropathic pain and sensation problems. “They may be able to stay on their treatments longer or at doses they may not have been able to previously tolerate. This treatment can be life-changing for some by enhancing quality of life and allowing them to do activities they may not have previously been able to do,” Watson said. 

“We treated a patient with chemo-induced neuropathy, and he wanted to work out and jump rope as he once did. Before he completed his treatments, his numbness had improved so much in his feet that he began jumping rope, which he had not been able to do for several years. Having a non-invasive, non-pharmacological alternative such as scrambler therapy that has shown proven benefit for neuropathic pain is a tremendous stride here at MUSC Health.”

Gibson, the palliative care physician, said it’s important to look for new ways of treating pain. “Unfortunately, and despite years of effort, the health system does not do a great job of treating pain, particularly neuropathic pain, which is really what scrambler is targeted toward,” he said.

“The mainstay of treatment currently is drugs, all of which come with a number of side effects. In many instances, these medicines do not adequately control the pain or cannot be tolerated by the patient. Among these medications are the opioids, which pose possible risks to the patient, and as everyone now has seen commonly on the news, opioids come with a heavy burden on our public health," Gibson said.

Neuropathic pain, particularly chemotherapy-induced neuropathy, is typically a chronic form of pain. "There is very little evidence that opioids are effective in chronic pain, and there are significant issues with tolerance to these medicines which often leads patients to higher and higher doses of the medicine, usually with more side effects," Gibson said. "Scrambler offers the potential to significantly reduce the patient’s pain with basically no side effects and no ongoing need to take pills. Without the pills, many of the societal burdens of pain medicines will be reduced as well.”

Coyne envisions having several scrambler devices at MUSC Health in the future. With scrambler therapy, he said, “The numbness goes away, which no one’s ever found a way to fix. Some meds take away the pain, but the numbness stays.”

To be treated with scrambler therapy at MUSC Health, patients must have a referral from a doctor. Watson said common conditions treated include chemo-induced neuropathy, diabetic neuropathy, phantom limb pain, failed back syndrome, trigeminal neuralgia, postherpetic neuralgia and chronic regional pain syndrome.

Before scrambler therapy, Foxworth, the teacher from Sumter, was taking the pain reliever gabapentin. He’s not anymore, but knows his pain may flare up again. “More than likely it will reoccur. When that happens, I’ll go back for what they call a booster treatment. I’m very pleased with what scrambler therapy has done for me."