Dr. Rosenblum reviews the benefits of Scrambler Therapy for CRPS and Neuropathic Pain State. 

• What is Scrambler Therapy?
• Efficacy of Scrambler Therapy for Neuropathic Pain 
• Mechanism of action of Scrambler Therapy
• Regenerative Pain Management Course
• PainExam Board Prep
• NRAP Academy Private Tutorials for Ultrasound Guidance and Regenerative Medicine

ST was introduced as a chronic pain relief method in 2003. That same year, Giuseppe Marineo published findings from a small clinical trial involving 11 terminal cancer patients suffering from drug-resistant chronic visceral pain, with all participants showing positive responses and significant reductions in pain scores. In a subsequent trial involving 226 patients with neuropathic pain, 80% reported a 50% reduction in pain. Since then, numerous case reports and studies have documented the use of ST for various pain types.

Evidence from these reports suggests that ST is effective for managing both acute and chronic pain from different causes. For instance, a child with acute mixed pain, resistant to pharmacological treatment, experienced significant relief after four ST sessions, with pain levels dropping from 5/10 to 0/10. Additionally, a 52-year-old woman with burning pain from her foot to knee, stemming from a right medullary acute hemorrhage and suffering for 12 years, reported immediate relief after ST. Her pain score decreased from 9/10 to 3/10 on the first day, and to 0/10 by the second day, remaining below 1 on the Visual Analog Scale (VAS) throughout the 10-day treatment period.

In terms of chronic pain, literature includes a case where a patient with shoulder joint pain and limited range of motion saw significant pain reduction and increased mobility after 10 sessions of ST. ST has shown considerable promise in treating severe pain conditions that are typically difficult to manage, such as complex regional pain syndrome and pain related to HIV.

Despite the encouraging results from these case studies, higher-quality evidence is necessary to establish the efficacy of ST, which could be obtained through extensive clinical trials, particularly focusing on chronic pain. Besides the aforementioned studies by Marineo and Sabato et al, additional trials have indicated that ST is an effective treatment for various chronic pain conditions, including low back pain, postherpetic pain, and neuropathic pain. For instance, a prospective study on chronic low back pain patients showed a significant decrease in VAS scores from 8.12 to 3.63 after six treatment days. Another trial involving 10 patients with postherpetic pain reported a drop in the average Numeric Rating Scale (NRS-11) score from 7.64 to 1.46 at baseline and 0.42 to 0.89 after one month, with benefits persisting at two and three months.

ST has also demonstrated significant potential in treating neuropathic pain. In a prospective study of 45 patients with neuropathic pain lasting over three months, 28 experienced a decrease in Douleur Neuropathique en 4 questions (DN4) pain scores, with four patients stopping treatment early due to complete pain resolution. The mean baseline DN4 score dropped from 5.67 to 2.82 by the end of treatment. A pilot randomized trial involving 52 patients found that 21 out of 26 in the intervention group achieved complete pain relief.

While the findings from these studies, along with others that have been systematically analyzed, suggest strong evidence for the efficacy of ST, a definitive conclusion regarding its effectiveness has not yet been reached. A systematic review by Majithia et al concluded that while studies generally indicate ST results in pain reduction with lasting benefits, there are still gaps in the evidence.

This article aims to evaluate the research needs surrounding ST for cancer pain management. While Majithia et al focused on chronic pain across various conditions and noted specific evidence limitations, this study will concentrate on the effectiveness of ST for cancer-related pain. The objective is to identify gaps in the existing literature and provide recommendations for future research through a systematic review. We will specifically analyze the types and levels of evidence supporting the use of ST in managing cancer pain and determine what studies are necessary to enhance the evidence base.

References 

Majithia, N., Smith, T.J., Coyne, P.J. et al. Scrambler Therapy for the management of chronic pain. Support Care Cancer 24, 2807–2814 (2016). https://doi.org/10.1007/s00520-016-3177-3

Mohamed, Mohamed S. I.1; Alkahlout, Lama1; Elgamal, Salma1; Mohiuddin, Amna1; Al-sayed, Talal1; Al-Marri, Hamad1; Zahid, Fatima1; Martínez-Magallanes, Daniela2; Fregni, Felipe2; Doi, Suhail A. R.1; Abdallah, Abdallah M.3; Musa, Omran A.H.1,4; Khan, Muhammad Naseem1; Babu, Giridhara R.1,*. Efficacy of scrambler therapy in chronic neuropathic pain: pairwise and dose-response meta-analysis. Brain Network and Modulation 3(3):p 63-70, Jul–Sep 2024. | DOI: 10.4103/BNM.BNM_20_24

Kashyap, Komal, and Sushma Bhatnagar. "Evidence for the efficacy of scrambler therapy for cancer pain: a systematic review." Pain Physician 23.4 (2020): 349.

PainExam Podcast Episode: An In-Depth Look at Hydrogen-Rich Water for Chronic Inflammatory Pain

In a recent episode of the PainExam podcast, Dr. David Rosenblum delves into an intriguing study published in the journal Antioxidants, exploring the therapeutic potential of hydrogen-rich water (HRW) in alleviating chronic inflammatory pain and associated mood disorders in mice. The study, conducted by Santiago Coral-Pérez and colleagues from the Institut d’Investigació Biomèdica Sant Pau and Universitat Autònoma de Barcelona, presents compelling evidence supporting the analgesic, antidepressant, and anxiolytic effects of HRW.

Study Overview

The study investigates the efficacy of HRW in treating nociceptive responses and affective disorders associated with chronic inflammatory pain. Using a mouse model induced by the subplantar injection of complete Freund's adjuvant (CFA), the researchers evaluated the impact of HRW on several parameters:

1. Nociceptive Responses: Mechanical allodynia and thermal hyperalgesia.
2. Affective Disorders: Depressive-like behaviors (measured by Tail Suspension Test and Forced Swimming Test) and anxiety-like behaviors (assessed using Elevated Plus Maze and Open Field tests).
3. Biomarker Analysis: Levels of oxidative stress, inflammatory, and apoptotic markers in the paws and amygdala.

Key Findings

1. Analgesic Effects:

• Mechanical Allodynia and Thermal Hyperalgesia: The study found that both intraperitoneal and subplantar administration of HRW significantly reduced mechanical allodynia and thermal hyperalgesia in CFA-injected mice. Remarkably, the local (subplantar) administration showed greater effectiveness, achieving complete inhibition of nociceptive responses with just one day of treatment.

2. Antidepressant and Anxiolytic Effects:

• Depressive-like Behaviors: HRW treatment normalized the increased immobility times in both the Tail Suspension Test and Forced Swimming Test, indicating potent antidepressant properties.
• Anxiety-like Behaviors: HRW also reversed the anxiety-like behaviors in the Elevated Plus Maze and Open Field tests, showcasing its anxiolytic effects without impairing motor function.

3. Biochemical Pathways:

• The study highlighted the significant role of the Nrf2/HO-1-NQO1 pathway in mediating the analgesic effects of HRW. Inhibitors targeting this pathway reversed the pain-relieving actions of HRW, underscoring its pivotal role.
• Oxidative Stress and Inflammation: HRW treatment reduced the expression of oxidative (4-HNE), inflammatory (p-IKBα), and apoptotic (BAX) markers in both the paw and amygdala tissues, demonstrating its broad-spectrum protective effects.

Implications for Clinical Practice

Dr. Rosenblum emphasizes the potential of HRW as a novel therapeutic strategy for chronic inflammatory pain and its associated comorbidities. The study's findings suggest that HRW could offer a multifaceted approach, addressing both pain and mood disorders through its antioxidant, anti-inflammatory, and anti-apoptotic properties.

Conclusion

The episode concludes with a discussion on the broader implications of these findings for pain management, particularly in conditions where chronic inflammatory pain is prevalent. Dr. Rosenblum highlights the need for further clinical trials to validate these promising preclinical results and explore the potential of HRW in human subjects.

For more detailed insights into this study, including potential applications and future research directions, tune into the PainExam podcast with Dr. David Rosenblum.

For more information go to:

https://molecularhydrogeninstitute.org/links-mhi/

References

Coral-Pérez, S., Martínez-Martel, I., Martínez-Serrat, M., Batallé, G., Bai, X., Leite-Panissi, C. R., & Pol, O. (2022). Treatment with hydrogen-rich water improves the nociceptive and anxio-depressive-like behaviors associated with chronic inflammatory pain in mice. Antioxidants, 11(11), 2153.

Dr. Rosenblum serves at AMETD's 2024 Conference as faculty and discusses the safe and accurate usage of Ultrasound to Guide PRP injecitons

Discussed in this lecure:

Knee, Hip, Shoudler, Ligament and Tendon Targets, the ultrasound technique, the evidence for PRP and controversy.  Controversy with respect to the Achilles Tendon!

References 
https://rapm.bmj.com/content/rapm/early/2024/07/16/rapm-2024-105593.full.pdf

Disclaimer

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