EFFICACY OF SCRAMBLER THERAPY IN POSTHERPETIC NEURALGIA

C.M. Spinello, G. Palmeri, E. Cascino, G.P. Alario | Hospice-Terapia del Dolore-Cure Palliative P.O."Vittorio Emanuele" Gela ASP CL

Introduction. Postherpetic neuralgia (PHN) is a painful syndrome associated with the herpes zoster rash. It persists even after the rush has resolved, giving rise to chronic neuropathic pain (1). The pain is superficial, characterized by burning, electric shocks upon touch, and unpleasant sensations that can be continuous, and is typically localized to a specific, hypersensitive area. Pharmacological therapy is only partially effective in alleviating pain (2). In our study, we treated 19 patients suffers of PHN using Scrambler Therapy (ST), a neurocutaneous stimulation method that delivers non-painful stimuli through surface electrodes. It does not block painful information, but replaces it with compatible, non-painful information (3). In this way, the neurological circuits sensitized by chronic pain stimuli are re-educated toward a non-painful state (5). The objective of our observational clinical study was to evaluate the analgesic efficacy of ST in patients with PHN.
Methods. Twenty patients were enrolled in the study: 12 women and 8 men, aged between 18 and 80, with a recent herpes zoster infection and treated with antivirals, who were left with PHN. Exclusion criteria were: age <18 or >80 years, regular opioid use, and allergy with skin reaction to the adhesive electrodes. One female patient was withdrawn from the study due to an allergic skin reaction after applying the adhesive electrodes. All patients had been taking NSAIDs for pain without relief. 13 of 19 used adjuvants such as pregabalin 75 mg twice daily. Of these, 5 patients used lidocaine patches and another 8 patients used tapentadol 50 mg twice daily. Despite pharmacological therapy, the patients came to us with Numerical Rating Scale (NRS): 9-10. All patients were informed about the use of ST and its mechanism of action. After obtaining informed consent, the therapeutic approach included 10 ST sessions of 50 minutes each for all 19 patients. Pain was assessed using the Numerical Rating Scale (NRS) and recorded before and after treatment.
Results. All patients who underwent Scrambler Therapy reported improvement in their pain symptoms. Pain measured by NRS at the end of treatment was NRS: 2 in 16 of 19 patients. The remaining 3 patients had residual pain with an NRS: 5. They underwent a further cycle of 5 50-minute Scrambler Therapy sessions, with significant improvement in symptoms and a final NRS of 2.
Conclusion. Therapeutic options for PHN are limited; available medications may be inadequate or have intolerable side effects. ST represents an effective treatment option for patients with PHN. The analgesia is safe and long-lasting, and no patients experienced side effects.