Joann B. Hunsberger, MD, MS,1,2 Vaishali Rathee, MD,2 and Thomas J. Smith, MD, FACP, FASCO, FAAHPM3,i
Abstract
Background: Scrambler therapy (ST) is a relatively new neuromodulation technique that is useful in treatment of medication-resistant pain syndromes, including chemotherapy-induced peripheral neuropathy and other chronic pain syndromes. Amyloidosis commonly leads to peripheral neuropathy, and although the mechanism is unclear, it is possibly related to amyloid deposits on the nerve.
Case Presentation: In this case presentation, we describe the novel use of ST for a patient with 13 years of neuropathic pain related to amyloidosis and worsened by chemotherapy. The patient reported bilateral hand pain with burning and aching and bilateral numbness on the soles of her feet. Her upper extremities were treated with 4 days of 40 minute ST treatment sessions providing reduction in her pain scores to zero.
Discussion: Current therapy for amyloid peripheral neuropathy aims at treating the underlying condition, and then medical management with gabapentinoids. This is first case presentation showing successful treatment with ST.
Keywords: amyloidosis; neuromodulation; neuropathic pain; scrambler therapy
1Pediatric Anesthesiology and Pediatric Pain Management, Division of Pediatric Anesthesiology, Department of Anesthesiology and CCM, Johns Hopkins Charlotte R. Bloomberg Children’s Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 2Hospice and Palliative Medicine, Johns Hopkins Medical Institutions, Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA.3Section of Palliative Medicine, Division of General Internal Medicine, Johns Hopkins Medical Institutions, JHUSOM, Baltimore, Maryland, USA.iORCID ID (https://orcid.org/0000-0003-3040-6434). Accepted May 25, 2021.
FIG. 1. Position of ST electrode sets to cover dermatomes C6–8. Five sets available. Amyloid neuropathy C6, 7, 8 dermatomes on R; combined C6–7 and 7–8 on L. ST, scrambler therapy.
FIG. 2. Pain scores pre- and post-ST, by days. ‘‘0’’ is represented by 0.1 to show on the graph.
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