Scrambler (TENS) Therapy and Spinal Cord Stimulator (SCS Implant) : Does Neuromodulation and/or Neuroaugmentation have a role?

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Post has been updated to incorporate SCS implants

Hi Guys,

Couple of members have reminded the mod team about the often forgotten use of electro stimulation in the treatment of neuropathic pain(Thank you ;)).

(1)Scrambler or TENS therapy(Neuromodulation),

Interferes with pain signal transmission, by ''mixing'' a ''non-pain'' information into the nerve fibres.It’s simple, easy, relatively inexpensive, non-invasive, and easily testable on the individual patient. You put the electrodes on, move them around and you should be able to tell in three to five days whether it’s going to work at all or not for the patient. Some have equated it to getting the same ultimate end result as spinal cord stimulator, but without having to unroof the spinal cord, sew an electrode on and then have it permanently connect to an implantable pump. A typical session on a Scrambler lasts 30 to 45 minutes, with the device sending low doses of electricity through electrodes placed on the skin of painful areas. The device “scrambles” or re-boots nerves left frayed and over-sensitized by chronic pain.So - basically working on the GATE CONTROL THEORY you feed in artificial nerve impulses designed to confuse the nerves, scramble the pain information that they’re sending, and allow them to re-set.

Although the studies are promising, they’ve been small and haven’t made much of splash in the medical community or with all types of neuropathy. Personally, scrambler has never worked for me. I have tried it on/off over the years for my CRPS - a legacy from cancer.- to no effect. In terms of its use in EM.? With systemic EM, the chronicity of my allodynia , hyperalgesia, and erythema means i can not tolerate clothes , let alone electrodes.Whilst it may confuse the hyper excited nerves and scramble info ,it actually induces local inflammatory response- vasodilation and erythema.

(2) Spinal Cord Stimulation (Neuroaugmentation) ,

Has been utilized for over 30 years for the treatment of refractory chronic pain. In comparison to most other procedures for pain management where a specific receptor is known to be the target for a particular drug or the site of action of a certain injection is the accepted premise, how SCS is able to function is shrouded in speculation. The idea that stimulation to large fibers “closes the gate” in a part of the spinal cord which in turn prevents the small fibers (pain fibers) from accomplishing their intention to communicate pain is surmised by the “gate theory” and predominates the school of thought for those looking to explain how it works. While electrical stimulation therapies inspired by the Gate Control Theory (Melzack/Wall ,1965), have succeeded, it is still a source of debate and controversy as it predicts that all types of pain should be inhibited when they are not. It would stand to reason that both acute and chronic pain, as well as nocioceptive and neuropathic pain, could be effectively treated as long as large fibers were stimulated – that has not proven to be the case.

The classic goal of SCS is to produce a field of paresthesias (a tingling sensation) directly over the patient’s pain complaints by stimulating the relevant cord structures without stimulating the nearby nerve root. By producing these paresthesias OVER the area of pain, we can interfere with the transmission of pain to the brain.

Whilst neither are for me ,I do believe in neuroplasticity. Does neuromodulation or neuroaugmentation have a role in the management of EM pain? .

Interested to hear your experiences and views.

Wishing all EM'ers a 'comfortable' night

mads

Dual System Spinal Cord Stimulation for Control of Intractable Pain in Primary Erythromelalgia: A Technical Case Report

http://www.painmed.org/2012posters/abstract-110/

Control of intractable pain in erythromelalgia by using spinal cord stimulation.

http://www.ncbi.nlm.nih.gov/pubmed/7963776

212-Scrambler52patientRCT_July2011_JPSM.pdf (358 KB)
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Thank you for the discussion Mads.

I haven't tried the scrambler as a other person here had mentioned she had once but I did buy a TENS machine for in home use but on reading the instructions it raised some concerns so I brought it and asked my doctor what he thought. My concerns were that it said do not use on red or swollen skin. It said do not use if you have heart problems such as rapid or irregular heart rate. I have started Mexilitine and I don't have those heart rate issues now but I could develop them because of my meds.

My doctor told me to take it back and get my money back. He tought it would be of no help to me and said it was more effective with muscle issues. That being said it isn't the scrambler that is only available in house in certain locations but a basic at home stimulation machine. I can't speak to the actual scrambler. He has recommended the spinal cord stimulator and that is on our list as a last result because it scares the crap out of me!'

I would be interested if anyone has had the spinal stimulator or have tried the at home TENS and if it helped.

Take care,

Alina

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Mine was both 'at home 'stimulation and 'in house 'with my palliative care team. Hey..........I am ' shit scared' of implant too ;). I also only know of one person who affirms it has helped. Again , different courses for different horses.! Its finding what helps you - isnt it?. Having driven myself crazy researching and discussing with the London and Canadian teams, I am convinced that sodium channel blockers are the way forward. Voltage gate hypothesis just does it for me. Lidocaine/mexil combo has bad press due to cardiotoxicity but the new Xenon drug will be a blocker, exactly the same but without the toxicity effects.I am becoming more and more convinced that EM is essentially genetic . Mutation NAV 1.7 is getting publicity but they are finding other genetic variants and commonalities.We ARE going to learn how to switch this damn thing off! We just all got to hang on in there and get each other through it.

Big hug

x

1 Like
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I have a spinal cord stimulator (scs) implant but do not use it as much as I'd hoped. In fact, version #2 was implanted last year but I'm not compelled to have the buzzing crowd my already full to capacity pain receptors. The intent of the scs is sound, but the worse my pain is, the less “relief” I get from the scs. There are variable controls to increase the severity of the stimulators to match an increase in pain. The extra stimulation was difficult for me to tolerate along with the severe EM pain – nonstop burning, throbbing and stabbing pain from my knees through my toes.

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Mike, Im so sorry to hear the implant isnt proving as beneficial as hoped. Would you be ok talking about your experience with an EM sufferer who is contemplating having an implant for EM?

I can forward you her email if you are happy with that.

God bless

mads

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mads,

Yes, I would be very willing to share my experiences with others.

Mike


mads said:

Mike, Im so sorry to hear the implant isnt proving as beneficial as hoped. Would you be ok talking about your experience with an EM sufferer who is contemplating having an implant for EM?

I can forward you her email if you are happy with that.

God bless

mads

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I think I speak on behalf of everyone in thanking you so much Mike. I am going to add SCS into this discussion post This is such an important topic that has not ever been fully discussed . I think you are the only member with an implant. We are going to really pick your brains ;). Get ready !!!!!!!!!!!!!!!!

Biggest hug

mads

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SCS added to discussion post

213-SpinalcordstimulationSCSinpainmanagement.pdf (302 KB) 214-TherapeuticInjectionsforPainManagement.docx (1.46 MB)
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To my understanding correct me if I’m wrong Mike…you can have a trial implant where they connect the wires but the battery and computer are left outside your body during trial. If successful they implant the computer. I think you need to have surgery every 5 to 10 years to replace the battery depending on how often it’s used. I have a few complications on having this done. First I am on blood thinners so any surgery is extra complicated and I have a pituitary tumor that requires a MR I of my brain every year. My Doctor says with the typical implant you can no longer have head MR I done but there is a special one made to allow you to continue to get them problem is you now need two computers inside instead of one and the leads are finer making them easier to move around and become less effective. I am about desperate enough to try any way but it really is a last resort.
Can I Ask YOU Mike To Post More About Your Experience Through The Surgery And What Of How It Helped And What It didnt. Do you have EM all over your body? Does it just help with burning or stabbing , pressure, needles , cramping too? Please any info you can offer would be much appreciated thank you :slight_smile:

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New research on SCS in chronic pain .

High-Frequency SCS Raises Bar on Chronic Pain Relief Melville (2015)

'Patients with severe chronic pain who undergo implantation with an investigational high-frequency spinal cord stimulation (SCS) device show twice the magnitude of pain relief and remission compared with those receiving a conventional, lower-frequency SCS device, according to results from the first randomized clinical study of the technology'.

http://www.medscape.com/viewarticle/841879?src=wnl_edit_tpal&uac=222157BT

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I just went through the spinal cord stimulator trial in December. I had the temporary unit for 5 days. I did not get enough relief with it to continue to the permanent phase. I was very disappointed in it. It was not for me. It made things worse at times. The buzzing/vibration made the flares worst and I also got electrical shocks several times. I was really hoping that the spinal cord stimulator would help but it did not. Also, my back hurt for several weeks after the trial. While you are going through the trial you can't shower or bathe and you have to carry the spinal cord stimulator with you every time you move. I ended up getting a little purse from my grandbaby and putting it in there so I could carry it with me at all times. You have your back all taped up for the entire time and that gets so red and itchy. That kind of drives you crazy!! I was happy to get it out after the 5 days since it did not help.

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They atlimited.a hero stem implant in mid January. Minecwas a total failure. It was one of the most painful procedures I have ever undergone. The team trying multiple site placements and several frequency adjustments over a 3 hour procedure. If any one out there has had success details as to location and frequency would be appreciated. Please encourage your physcians to publish outcomes. We are such a small number of patients, as you know details on treatment are limited.