Supportive Care in Cancer

, Volume 24, Issue 4, pp 1649–1654 | Cite as

Pilot evaluation of scrambler therapy for pain induced by bone and visceral metastases and refractory to standard therapies

  • Paolo NotaroEmail author
  • Carlo Alberto Dell’Agnola
  • Alessandro J Dell’Agnola
  • Alessio Amatu
  • Katia Bruna Bencardino
  • Salvatore Siena
Original Article



Scrambler therapy is a non-invasive neurocutaneous electrical pain intervention, effective for the treatment of neuropathic pain. Currently, few data about the efficacy of this treatment in cancer pain induced by skeletal and visceral metastases are available. The aim of this single-center case series is to evaluate the efficacy of scrambler therapy in reducing this kind of cancer pain after failure of standard treatments, including pharmacological therapies and radiation therapy.


Twenty-five consecutive patients underwent scrambler therapy individually delivered by MC5-A Calmare for 10 daily sessions each of 30–40 min. Pain was measured by a numeric rating scale at baseline, as well as before and after each treatment session.


One hundred percent of patients reached a pain relief ≥50 %. Pain score was reduced from 8.4 at baseline to 2.9 after treatment, with a mean pain relief of 89 %. The sleeping hours improved from 4.4 ± 1.2 to 7.5 ± 1.1. The duration of pain control by scrambler therapy was 7.7 ± 5.3 weeks. No adverse events were observed.


Scrambler therapy does not present toxicity and allows opioids dosage reduction, and it is also a repeatable treatment. Present novel data support that scrambler therapy seems to be effective for the treatment of cancer pain. Further evaluation in randomized and controlled clinical trials should be performed to confirm our findings.


Scrambler therapy Untreatable cancer pain Metastatic bone and visceral pain Electroanalgesia Calmare® 



This data collection received no specific grant from any funding agency in the public, commercial or not-for-profit. Clinical investigators at Pain Unit and at the Niguarda Cancer Center are supported by Fondazione Oncologia Niguarda Ca’ Granda Onlus and NOPAIN onlus.

Compliance with Ethical Standards

Ethical approval

For this type of study, formal consent is not required.


This data collection received no specific grant from any funding agency in the public, commercial or not-for-profit. Clinical investigators at Pain Unit and at the Niguarda Cancer Center are supported by Fondazione Oncologia Niguarda Ca’ Granda Onlus and NOPAIN onlus.


  1. 1.
    Park HS, Sin WK, Kim HY, Moon JY, Park SY, Kim YC, Lee SC (2013) Scrambler therapy for patients with cancer pain. Kor J Pain 26(1):65–71. doi: 10.3344/kjp.2013.26.1.65 CrossRefGoogle Scholar
  2. 2.
    Pachman DR, Watson JC, Loprinzi CL (2014) Therapeutic strategies for cancer treatment related peripheral neuropathies. Curr Treat Options in Oncol 15(4):567–580. doi: 10.1007/s11864-014-0303-7 CrossRefGoogle Scholar
  3. 3.
    Portenoy RK (2011) Treatment of cancer pain. Lancet 377(9784):2236–2247. doi: 10.1016/S0140-6736(11)60236-5 CrossRefPubMedGoogle Scholar
  4. 4.
    Arai YP, Nishihara M, Yamamoto Y, Arakawa M, Kondo M, Suzuki C, Kinoshita A, Kambara K, Ikemoto T (2015) Dorsal root ganglion pulsed radiofrequency for the management of intractable vertebral metastatic pain: a case series. Pain Med 16(5):1007–1012. doi: 10.1111/pme.12629 CrossRefPubMedGoogle Scholar
  5. 5.
    Pachman DR, Weisbrod BL, Seisler DK, Barton DL, Fee-Schroeder KC, Smith TJ, Lachance DH, Liu H, Shelerud RA, Cheville AL, Loprinzi CL (2015) Pilot evaluation of scrambler therapy for the treatment of chemotherapy-induced peripheral neuropathy. Support Care Cancer 23(4):943–951. doi: 10.1007/s00520-014-2424-8 PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Marineo G, Iorno V, Gandini C, Moschini V, Smith TJ (2012) Scrambler therapy may relieve chronic neuropathic pain more effectively than guideline-based drug management: results of a pilot, randomized, controlled trial. J Pain Symptom Manag 43(1):87–95. doi: 10.1016/j.jpainsymman.2011.03.015 CrossRefGoogle Scholar
  7. 7.
    Smith TJ, Coyne PJ, Parker GL, Dodson P, Ramakrishnan V (2010) Pilot trial of a patient-specific cutaneous electro-stimulation device (MC5A-a calmare®) for chemotherapy induced peripheral neuropathy. J Pain Symptom Manag 40(6):883–891. doi: 10.1016/j.jpainsymman.2010.03.022 CrossRefGoogle Scholar
  8. 8.
    Ricci M, Pirotti S, Scarpi E, Burgio M, Maltoni M, Sansoni E, Amadori D (2011) Managing chronic pain: results from an open-label study using MC5-a calmare(R) device. Support Care Cancer 20(2):405–412. doi: 10.1007/s00520-011-1128-6 CrossRefPubMedGoogle Scholar
  9. 9.
    Ko YK, Lee HY, Lee WY (2013) Clinical experiences on the effect of scrambler therapy for patients with postherpetic neuralgia. Kor J Pain 26(1):98–101. doi: 10.3344/kjp.2013.26.1.98 CrossRefGoogle Scholar
  10. 10.
    Coyne PJ, Wan W, Dodson P, Swainev C, Smith TJ (2013) A trial of scrambler therapy in the treatment of cancer pain syndromes and chronic chemotherapy-induced peripheral neuropathy. J Pain Palliat Care Pharmacother 27(4):359–364. doi: 10.3109/15360288.2013.847519 PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Campbell TC, Nimunkar AJ, Retseck J, Eickhoff JC, Backonja M, Cleary JF, Kwekkeboom KL, Yen TY (2013) A randomized, doubleblind study of “Scrambler” therapy versus sham for painful chemotherapy-induced peripheral neuropathy (CIPN). J Clin Oncol 31: suppl abstr 963Google Scholar
  12. 12.
    Marineo G (2003) Untreatable pain resulting from abdominal cancer: new hope from biophysics? J Pancreas 4(1):1–10Google Scholar
  13. 13.
    Moon JY, Kurihara C, Beckels JP, Williams KE, Jamison DE, Cohen SP (2015) Predictive factors associated with success and failure for calmare (scrambler) therapy: a multicenter analysis. Clin J Pain 31(8):750–756CrossRefPubMedGoogle Scholar
  14. 14.
    Attal N, Cruccu G, Haanpää M, Hansson P, Jensen TS, Nurmikko T, Sampaio C, Sindrup S, Wiffen P, Task Force EFNS (2006) EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol 13(11):1153–1169CrossRefPubMedGoogle Scholar
  15. 15.
    Swarm RA, Abernethy AP, Anghelescu DL, Benedetti C, Buga S, Cleeland C, Deleon-Casasola OA, Eilers JG, Ferrell B, Green M, Janjan NA, Kamdar MM, Levy MH, Lynch M, McDowell RM, Moryl N, Nesbit SA, Paice JA, Rabow MW, Syrjala KL, Urba SG, Weinstein SM, Dwyer M, Kumar R, National Comprehensive Cancer Network (2013) Adult cancer pain. J Natl Compr Canc Netw 11(8):992–1022PubMedGoogle Scholar
  16. 16.
    Chao YH, Wang SY, Hsu TH, Wang KW (2015) The desire to survive: the adaptation process of adult cancer patients undergoing radiotherapy. Jpn J Nurs Sci 12(1):79–86. doi: 10.1111/jjns.12050 CrossRefPubMedGoogle Scholar
  17. 17.
    Starkweather AR, Coyne P, Lyon DE, Elswick RK, An K, Sturgill J (2015) Differential gene expression following calmare®: results from a double-blinded randomized sham-controlled study. Res Nurs Health 38(1):29–38. doi: 10.1002/nur.21632 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Paolo Notaro
    • 1
    • 3
    Email author
  • Carlo Alberto Dell’Agnola
    • 1
  • Alessandro J Dell’Agnola
    • 1
  • Alessio Amatu
    • 2
  • Katia Bruna Bencardino
    • 2
  • Salvatore Siena
    • 2
  1. 1.Pain Medicine, Dipartimento di Anestesiologia- Ospedale Niguarda Ca’ GrandaMilanoItaly
  2. 2.Dipartimento di Ematologia e OncologiaNiguarda Cancer Center, Ospedale Niguarda Ca’ GrandaMilanoItaly
  3. 3.Dipartimento di Terapia del doloreOspedale Niguarda Ca’ GrandaMilanoItaly

Personalised recommendations