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 generally last 30 effective minutes. After finishing the first cycle, including 10 to 12 consecutive ST, booster cycles can be given when they are needed. The protocol for patients who use anticonvulsants for analgesic purposes typically includes 10 treatments + those required 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 are insufficient, and relapse is quicker.
The electrical stimulus conveys different combinations of strings of “no pain” signals, very similar to the endogenous 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 creating sensory information variables in time, always compatible with specific recognition characteristics of polymodal surface C receptors. Throughout these processes, the patient feels his or her pain disappearing immediately.
Electrode placement demands scrupulous compliance with 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 on 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 the 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 in phantom limb cases. The advanced strategies should be recommended only after having acquired an in-depth understanding of the 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.
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 for analgesic purposes. 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 supports 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 treatments/cycles when necessary. Scrambler Therapy® cannot prevent beforehand expressions of acute pain linked to possible mechanical damage associated with 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 is prescribed for palliative care, including treatments when necessary.
Scrambler Therapy® is a methodology specifically studied for neuropathic and oncologic pain. The usage of anticonvulsants for analgesic purposes generally calls for more treatments, needed for the weaning. The first five treatments with anticonvulsants can provide unstable results that return to normal with the continuation of the treatment cycle. The protocol for patients who use anticonvulsants typically includes 10 treatments plus those required 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 are 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 also exist 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® 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 free dedicated software to be used together with the Scrambler Therapy®. This software includes many functionalities and an automatic analysis of each treatment that provides 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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