Effectiveness Not Established

Scrambler Therapy

for Peripheral Neuropathy

Scrambler therapy is a noninvasive approach that uses surface electrostimulation on dermatomes to "scramble" the transmission of pain messages to the brain. Scrambler therapy has been examined in patients with cancer for its effect on neuropathic pain and neuropathy symptoms.

Systematic Review/Meta-Analysis

Majithia, N., Smith, T.J., Coyne, P.J., Abdi, S., Pachman, D.R., Lachance, D., . . . O’Neill, C. (2016). Scrambler therapy for the management of chronic pain. Supportive Care in Cancer, 24, 2807–2814.

Purpose

STUDY PURPOSE: To evaluate what is known about mechanisms of scramble therapy and investigate preliminary evidence regarding efficacy

TYPE OF STUDY: General review/semi-systematic review

Search Strategy

DATABASES USED: PubMed, SCOPUS, EMBASE, Google Scholar
 
INCLUSION CRITERIA: Studies and reports involving scrambler therapy or Calmare
 
EXCLUSION CRITERIA: Not specified

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 20
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Three studies were randomized, controlled trials, one of which was open-label

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 20
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,200
  • SAMPLE RANGE ACROSS STUDIES: 3–226 patients
  • KEY SAMPLE CHARACTERISTICS: Four reports involved patients with chemotherapy-induced peripheral neuropathy; seven studies included patients with cancer

Phase of Care and Clinical Applications

PHASE OF CARE: Not specified or not applicable

Results

Most reports showed positive results for pain reduction for various pain syndromes. One double-blind, randomized trial showed no difference between controls and those receiving scrambler therapy for chemotherapy-related peripheral neuropathy.

Conclusions

Scramble therapy may have benefit for management of chronic pain and symptoms of peripheral neuropathy; however, current evidence is limited and weak.

Limitations

  • Limited number of studies included
  • No quality evaluation
  • Mostly low quality/high risk of bias studies
  • Low sample sizes

Nursing Implications

Scrambler therapy, a neuromodulator approach to pain relief, may have some benefit in the management of chronic pain and peripheral neuropathy; however, current evidence is limited, and study designs have high risk of bias. Given the promising findings with scrambler therapy, additional well-designed research is warranted.

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Research Evidence Summaries

Pachman, D.R., Weisbrod, B.L., Seisler, D.K., Barton, D.L., Fee-Schroeder, K.C., Smith, T.J., . . . Loprinzi, C.L. (2015). Pilot evaluation of Scrambler therapy for the treatment of chemotherapy-induced peripheral neuropathy. Supportive Care in Cancer, 23, 943–951. 

Study Purpose

To determine the effectiveness of Scrambler therapy in patients with chemotherapy-induced peripheral neuropathy (CIPN)

Intervention Characteristics/Basic Study Process

Scrambler therapy involves the use of low-dose electrical stimulation delivered through electrodes placed around patient-reported painful areas. Five sets of electrodes can be placed around a painful area at one time. The goal of this study was to replace pain with no pain and/or lessening of symptoms. Patients were treated daily for up to 10 days.

Sample Characteristics

  • N = 37  
  • AGE = 33–79 years
  • MALES: 32%, FEMALES: 67%
  • KEY DISEASE CHARACTERISTICS: Breast, ovarian, colon/rectal, lymphoma, and nine other primary cancers
  • OTHER KEY SAMPLE CHARACTERISTICS: Thirteen patients were treated with taxol, eight received carboplatin/ taxol, nine received oxaliplatin, four received cisplatin therapies, and three received vincristine.

Setting

  • SITE: Not stated/unknown    
  • SETTING TYPE: Outpatient  
  • LOCATION: USA

Phase of Care and Clinical Applications

PHASE OF CARE: Mutliple phases of care

Study Design

Prospective, open-label trial

Measurement Instruments/Methods

Measurements included numerical analog scales from 0–10 that were part of a neuropathy questionnaire, a global impression of change questionnaire, and the Rydel-Seiffer Tuning Fork to evaluate patient vibratory sense.

Results

Pain scores decreased 53% from baseline to day 10. Numbness decreased 37%, and tingling decreased 44%. Increased quality of life was reported during treatment as well as during the 10-week follow-up period. All of these changes were significant (p < 0.0002). The vibration perception scores measured with the Rydel-Seiffer Tuning Fork also improved.

Conclusions

Although Scrambler therapy demonstrated positive effects in this trial, a large randomized, controlled trial is needed to confirm its efficacy in CIPN. Special training and experienced personnel need to be in place for someone to deliver this therapy. Practicality and cost need to be factored in for this type of intervention.

Limitations

  • Small sample (< 100)
  • Risk of bias (no control group)
  • Risk of bias (no random assignment)
  • Findings not generalizable
  • Only 10 weeks of follow-up
  • Thirty-two patients completed the study.
  • Findings in solid tumors only and in a small number, making it hard to generalize findings

Nursing Implications

A large, randomized study is needed for future research. Scrambler therapy is not a very practical treatment, and cost of the treatment was not discussed. Also, specific training is needed to administer it. Currently, insufficient evidence recommends its use.

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