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Scrambler Therapy (also known as Calmare Therapy or Calmare Scrambler Therapy) is a treatment option that CRPS patients are considering.
Two young CRPS warriors, Phoebe and Adam, have shared the impact of Scrambler Therapy on their lives.
In this article, we examine the treatment in more depth, investigate its effectiveness for those with CRPS, and provide answers to the burning questions asked by our community.
To help understand Scrambler Therapy for CRPS, Burning Nights hosted a webinar with Dr. Michael Cooney. From his clinic in the USA, Dr. Cooney has used Scrambler Therapy to treat chronic nerve-related pain conditions, including CRPS, since 2011.
Burning Nights CRPS Support offer informative webinars on CRPS treatments and research. To stay up-to-date with upcoming events and webinars, please subscribe to the Burning Nights newsletter.
Scrambler Therapy (also known as Calmare Therapy) is a non-invasive, drug-free technique used to relieve chronic nerve pain (i.e. neuropathic pain).
It relies upon a medical device marketed under the brand name “Calmare” — which means to soothe or calm in Italian.
The machine is similar in appearance to an electrocardiogram (ECG) machine. Connected to it are small surface electrodes with pads — usually five in total. The pads are carefully and comfortably placed above and below the primary pain site. They transmit painless electric signals through the skin.
The intent is to interrupt, or scramble, the misfiring pain signal — which has become stuck in the ‘on’ position — and replace it with a message of “no-pain”.
The brain recognises the new signal and ‘learns’ that there is no pain stimulus to react to.
Over the course of treatment, the persistent pain pathway is ‘retrained’ and, ultimately, turned off.
In the USA, it has been approved for use by a trained practitioner by the Food and Drug Administration (FDA). It is not available through the NHS or in the UK
Scrambler Therapy was first used in the early 1990s by Giuseppe Marineo in Rome, Italy.
Treatment was focused on post-chemotherapy pain in cancer patients but was soon discovered to be successful in relieving the pain of other neuropathic conditions like CRPS.
Scrambler Therapy is founded on the theory that:
1) artificial nerve signals (delivered as electric pulses via electrodes on the skin) can be used to replace a natural, but incorrect, “pain” message to the brain with one of “no-pain”; and that,
2) chronic nerve pain is the result of a feedback loop fed by a set of complex chemical reactions. Interrupting the loop with a new signal recalibrates the chemical reactions to a message of no-pain and the whole pain pathway is reset.
Traditional approaches to pain-control rely on stopping the pain message from reaching the brain via drugs or through something known as 'gate control theory'. The gate theory of pain is why you rub your head when you bump it, or hold your toe when you stub it: fast nerve fibres (called A-beta fibres) are stimulated by touch and override the slower pain message — at least temporarily. This is the basis for TENS (transcutaneous electrical nerve stimulation).
If you imagine a pain message as an envelope, on the back of a bicycle, ready to be posted in the brain’s post box. Pain-relieving drugs are tape that has been stuck across the mail slot. Therapies like TENS are envelopes sent via motorcycle — they reach the post box and block it before the pain message can get there. In contrast, Scrambler Therapy replaces the envelope with a new one containing a different message.
For the new message to be relayed accurately, the placement of the Calmare device electrodes is critical. They are positioned away from the pain site but along the dermatone that supplies it — a dermatone being an area of skin that connects to a single spinal nerve. The electrodes must recruit (i.e. trigger or stimulate) enough healthy sensory nerves to communicate the no-pain message in full.
The experience and expertise of the physician placing the electrodes is vital to success.
The treatment was not intentionally designed for CRPS patients. However, Dr. Michael Cooney — an experienced practitioner of Scrambler Therapy — has treated more than 2,000 chronic pain patients since 2011, the majority of whom were diagnosed with CRPS (either Type I or Type II).
He has found that, in about 80% of cases, Scrambler Therapy significantly reduces the pain of CRPS, and sometimes eliminates it. Physical symptoms, including allodynia, hair loss, open sores, and skin discolouration, are also reduced or resolved.
Over time, some patients experience a return of pain. In these cases, a course of ‘booster’ treatments (generally 1-3 sessions) turns the pain back down again.
Dr. Cooney is careful to highlight that Scrambler Therapy is not a “miracle cure” and does not work for every CRPS warrior. He carefully assesses each potential patient, using the Budapest Criteria, to try and ensure that the treatment will be effective for them.
However, the mechanisms on which Scrambler Therapy is based are not well understood. Plus — as CRPS warriors will know — there is a gap in the scientific knowledge around chronic nerve pain, particularly the specific causes for each patient. It is therefore difficult to predict whether Scrambler Therapy will be successful for an individual.
For personal experiences of this treatment, read Adam Cowan’s story of Calmare Scrambler Therapy at Dr. Cooney’s clinic or find out more from Phoebe, who was treated by Dr. Markus Seuther in Germany
Much of our insight into Scrambler Treatment of CRPS has come from the first-hand experience of Dr. Michael Cooney.
He is the Clinical Director at the Calmare Pain Therapy Centre in New Jersey, USA and has over a decade of experience treating CRPS warriors.
For more information on Scrambler Therapy and the treatment options available at his clinic contact info@calmoretherapynj.com.
We have answered common queries from the Burning Nights community below. If you have another question on Scrambler Therapy, please contact us and we will do our best to respond or put you in touch with the relevant experts.
No.
Scrambler Therapy and TENS (Transcutaneous Electrical Nerve Stimulation) use electrical stimulation via electrodes placed on the skin, but the similarities end there.
The treatments vary significantly in:
(i) the type of electrical signal used,
(ii) the mechanism by which pain is relieved, and
(iii) the method by which the therapies are administered.
In summary:
A detailed review, by two pain experts, of the differences between TENS and Scrambler Therapy is available.
No — treatment does not cause pain nor are there any significant reported side effects.
Instead, treatment is described by patients as a buzzing; a vibration on the skin; or sometimes an itch.
Scrambler Therapy transmits signals along nerves, known as C-type fibres, that are involved in the transfer of “itch” (as well as temperature and burning pain) — hence an itching sensation can indicate that the treatment electrodes are correctly positioned.
Dr. Michael Cooney emphasises that pain is the absolute opposite of what is desired during treatment. Discomfort reinforces, rather than interrupts, the CRPS pain signal. Pain indicates that the electrodes are incorrectly positioned.
The main reported side effect is fatigue — patients will often want to nap immediately after, or even during, treatment.
Standard treatment across clinics worldwide is a course of 10 sessions of 30-60 minutes a day, with a twoday break after 5 sessions.
However, some patients need a longer course of treatment to take pain levels down to zero.
CRPS warrior, Adam Cowan, had 14 sessions at Dr. Cooney’s clinic in the USA to put his pain into remission. Patients who have had CRPS for a lont time may require even more — but, in general, it is a 10-day course.
The standard 10-day course is only extended if progress is evident with each additional session.
Why there is variation between patients is not understood, partly because there is no clear view of the factors causing CRPS and how they differ between individuals.
Some CRPS patients require no further treatment after the standard 10-day course: their pain is in remission.
For others, pain eventually returns — sometimes after years of being pain-free. These individuals can opt to have top-up treatment sessions, generally one to three, to turn their CRPS symptoms back down.
UK-based CRPS warrior, Phoebe, experienced her pain re-emerging 9 months after her Scrambler Treatment in Germany. She returned for a short top-up course.
Dr. Cooney recommends that, for effective and long-lasting results, booster sessions begin as soon as pain is felt again — rather than waiting for it to reach a particular threshold. In his experience, the periods between top-up sessions get longer and longer.
Scrambler Therapy is not used prophylactically i.e. it is not applied unless the patient is already experiencing pain.
Dr. Cooney has treated patients from 8 years old to 91.
It is particularly helpful in the treatment of young people with CRPS because it is non-invasive, pain-free, and does not involve additional medications. Plus, there are no needles involved which is a relief for many young people!
We do not have a specific response from the NHS on Scrambler Therapy.
However, for the NHS to approve and fund a new treatment an appointed committee must consider there to be:
(i) sufficient high-quality published clinical evidence of the effectiveness of the treatment, and
(ii) that its use represents value in terms of NHS financial resources vs the improvement to a patient’s quality of life.
Until recently there has been very few randomised clinical trials of Scrambler Therapy, and none conducted in the UK. We can assume that, without these, the NHS will not fund the treatment.
The research on Scrambler Therapy has been limited by small sample sizes (i.e. the number of people taking part) and incorrect use of the Calmare scrambler device (Abdi et al., 2021).
However, published articles supporting the treatment are increasing.
A 2023 review of the academic literature concluded that Scrambler Therapy is:
“a safe intervention with potential for significant analgesic [i.e. pain-relieving] benefit for neuropathic [i.e. nerve-related] pain conditions” (Karri et al., 2023).
One of the challenges in trialling Scrambler Therapy is the critical importance of patient feedback in correctly positioning the Calmare device electrodes. It is difficult to design clinical trials that are single-blind (where the patient does not know whether they are receiving the treatment) or double-blind (where neither the patient nor the physician knows whether the treatment is ‘real’ or placebo).
A double-blind clinical trial substantially alters the effectiveness of Scrambler Therapy by preventing the physician and patient from working together to determine the proper placement of the electrodes.
For further information on the science of Scrambler Therapy, we have listed below the primary sources used in researching this article.
Background Sources
Abdi, S., Chung, M. and Marineo, G. (2021) 'Scrambler therapy for noncancer neuropathic pain: a focused review,' Current Opinion in Anesthesiology, With Evaluated MEDLINE/Current Opinion in Anaesthesiology, 34(6), pp. 768–773. https://doi.org/10.1097/aco.0000000000001073
Karri, J., Marathe, A., Smith, T.J. and Wang, E.J. (2022). The Use of Scrambler Therapy in Treating Chronic Pain Syndromes: A Systematic Review. Neuromodulation: Technology at the Neural Interface. https://doi.org/10.1016/j.neurom.2022.04.045.
Majithia, N. et al. (2016) 'Scrambler Therapy for the management of chronic pain,' Supportive Care in Cancer, 24(6), pp. 2807–2814. https://doi.org/10.1007/s00520-016-3177-3
Marineo, G. (2019) 'Inside the Scrambler Therapy, a noninvasive treatment of chronic neuropathic and cancer pain: from the gate control theory to the active principle of information,' Integrative Cancer Therapies, 18, p. 153473541984514. https://doi.org/10.1177/1534735419845143
Nair, A. (2022) 'Scrambler therapy: An opioid-sparing, non-invasive modality for chronic pain in patients,' Saudi Journal of Anaesthesia, 16(4), p. 525. https://doi.org/10.4103/sja.sja_366_22
Ricci, M. et al. (2019) 'Scrambler therapy: what’s new after 15 years? The results from 219 patients treated for chronic pain,' Medicine, 98(2), p. e13895. https://doi.org/10.1097/md.0000000000013895
Smith, T.J., Wang, E.J. and Loprinzi, C.L. (2023) 'Cutaneous electroanalgesia for relief of chronic and neuropathic pain,' New England Journal of Medicine, 389(2), pp. 158–164. https://doi.org/10.1056/nejmra2110098
Team, S.D. (no date) Simplified model of scrambler therapy. https://www.scramblertherapy.info/scrambler-therapy-theory-bases.htm
Prices will vary depending on the clinic but, by way of example, in 2024 the cost of treatment at Dr. Cooney’s clinic in New Jersey is $3,850 US dollars.
This includes all consultations and 10 treatment sessions. Contact info@calmoretherapynj.com for up-to-date pricing.
Dr. Cooney advises that anti-convulsant and anti-depressant medication is stopped 72 hours before treatment. This is because they affect the pain centres of the brain and can alter the effectiveness of the treatment.
Yes. Dr. Cooney confirms that he has treated CRPS warriors with a Spinal Cord Stimulator (SCS), but that it must be turned off during treatment
Dr. Cooney states that Scrambler Therapy cannot be used to treat patients that:
• have epilepsy;
• are pregnant;
• have a pacemaker or automatic defibrillator; or
• suffer from severe arrhythmia or any form of equivalent heart disease.