Joo So Young, Cho Yoon Soo, Cho Sung-Rae, Kym Dohern, Seo Cheong Hoon
Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine Hallym University, Seoul, Republic of Korea.
Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
Burns. 2017 May;43(3):514-519. doi: 10.1016/j.burns.2016.09.028. Epub 2016 Oct 15.
Pain Scrambler therapy is a patient-specific electrocutaneous nerve stimulation device. Burn pruritus is a common form of chronic and disabling neuropathic pain that is often difficult to treat effectively. Pruritus is mediated by histamines, which are effector molecules stored in mast cells and released locally during injury or inflammation. Burn pruritus may be accompanied by peripheral neuropathic pain, which may result from injury to sensory nerves that hampers conductance of neuronal messages along the large A and small C afferent fibers to the spinal cord. In this study, we investigated the effect of pain Scrambler therapy on burn scar pruritus.
Sixteen subjects were recruited to participate in this study. The subjects complained of severe pruritus that was rated at least 5 on the visual analogue scale (VAS), despite treatments with antihistamines, gabapentin medication, and other physical modalities. Each Scrambler Therapy with the MC-5A Pain Scrambler Therapy technology device was performed for 40min daily (Monday through Friday) for 10 consecutive days. The stimulus was increased to the maximum intensity bearable by the individual patient without causing any additional pain or discomfort. The numerical rating scale (NRS), 5-D Itch Scale, and Leuven Itch Scale were administered and evaluated immediately before Scrambler therapy, and then immediately after 5 and 10 therapy sessions.
For all 16 patients, NRS showed mean values of 6.75±1.13 before therapy, 5.06±1.53 after 5 sessions, and 4.13±1.45 after 10 sessions. The NRS values before therapy and after 10 sessions were significantly different (p<0.05). Pruritus frequency, severity, and consequences scores on the Leuven Itch Scale after Scrambler therapy were also significantly different (p<0.05). Duration, degree, direction, and disability scores on the 5-D Itch Scale were also significantly different (p<0.05).
Scrambler therapy is a non-invasive, non-medicinal modality that significantly reduced burn-associated pruritus. Scrambler therapy should be considered as a treatment option for burn survivors with severe pruritus.
疼痛干扰疗法是一种针对患者的经皮神经电刺激设备。烧伤瘙痒是慢性致残性神经性疼痛的常见形式，通常难以有效治疗。瘙痒由组胺介导，组胺是储存于肥大细胞中的效应分子，在损伤或炎症期间于局部释放。烧伤瘙痒可能伴有周围神经性疼痛，这可能源于感觉神经损伤，从而妨碍神经元信息沿大A类和小C类传入纤维向脊髓的传导。在本研究中，我们调查了疼痛干扰疗法对烧伤瘢痕瘙痒的影响。
招募了16名受试者参与本研究。尽管使用了抗组胺药、加巴喷丁药物及其他物理治疗方法，这些受试者仍主诉严重瘙痒，视觉模拟量表（VAS）评分至少为5分。使用MC - 5A疼痛干扰疗法技术设备进行的每次干扰疗法，每天（周一至周五）进行40分钟，连续进行10天。刺激强度增加至个体患者可耐受的最大强度，且不会引起任何额外疼痛或不适。在干扰疗法前、5次治疗后及10次治疗后立即使用数字评定量表（NRS）、5 - D瘙痒量表和鲁汶瘙痒量表进行评定和评估。
对于所有16例患者而言，NRS在治疗前的平均值为6.75±1.13，5次治疗后的平均值为5.06±1.53，10次治疗后的平均值为4.13±1.45。治疗前与10次治疗后的NRS值存在显著差异（p<0.05）。干扰疗法后鲁汶瘙痒量表上的瘙痒频率、严重程度及后果评分也存在显著差异（p<0.05）。5 - D瘙痒量表上的持续时间、程度、方向及残疾评分同样存在显著差异（p<0.05）。
干扰疗法是一种非侵入性、非药物性的治疗方式，可显著减轻烧伤相关瘙痒。对于有严重瘙痒的烧伤幸存者，应考虑将干扰疗法作为一种治疗选择。
