CAN SCRAMBLER THERAPY BE USED TO TREAT REFRACTORY TRIGEMINAL NEURALGIA?

G. Pasian¹, M.L. Lissandron¹, L. Gumiero², P. Nosella¹ | ¹Asfo P.O. San Vito al Tagliamento, Pain Unit; ²Asfo P.O San Vito al Tagliamento Resuscitation and Intensive Therapy Unit

BACKGROUND
Trigeminal neuralgia (TN) is a severe facial pain characterized by electric shock-like pain triggered by innocuous stimuli and commonly affecting middle-age women. TN can be classified as classic, secondary and idiopathic. Typically, treatment begins with carbamazepine or oxacarbamazepine, the alternative treatment consists in a surgical treatment and botulinum toxin type A (BoNT-A). Scrambler Therapy (ST) is an electro-analgesia therapy for the non-invasive treatment of chronic neuropathic pain which, is resistant to other treatments. ST utilizes trans-cutaneous electrical stimulation of pain fibers with the intent of re-organizing maladaptive signaling pathways. This is a different theoretical mechanism than the traditional electric stimulation of A-Beta fibers which aims to produce paresthesia and/or block the conduction of nerve fibers that produce an analgesic. This occurs via Transcutaneous Electrical Nerve Stimulation (TENS). In our pilot study, we analysed the effectiveness of ST in the idiopathic TN which is resistant to all the pharmacological treatments.
STUDY DESIGN
We present a pilot study with a -24-month- follow up on 5 patients (4 female and 1 male) where the Idiopathic TN is treated to SC. We use software, hardware and indication of module OEM (original equipment manufacturer) developed for this purpose. All patients have been treated by a series of 10 consecutive treatments performed over a 2-week period. Follow-up to 6 months with monthly video calls. The criteria used for the study were:
-eligible patients must be at least 18 years old,
-patients need to fill out a medical informed-consent form,
-patients need to participate in all the scheduled follow-ups.
The criteria excluded for the study were:
-the ongoing systemic infection, pacemakers, metal prostheses.
RESULTS
Upon completion of the follow-up period the data collected are: the quality of life of patients enrolled in the study was assessed by SF 36 questionnaire, which shows that all the patients were satisfied after procedures; the reduction in the number of basal NRS pain was between 50-60%; the reduction in the number of adjuvant drugs, benzodiazepines or antidepressants, was between 50-60%.
CONCLUSION MESSAGE
ST is an intervention with potential analgesic benefit for neuropathic pain in idiopathic TN. We still need to complete large studies with major follow-up, but this pilot study may be considered a good option for idiopathic TN patients suffering from pain that does not respond to pharmacological treatment.