Department of Neurology, Seoul National University Hospital, Seoul, South Korea.
Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.
Sci Rep. 2021 May 12;11(1):10148. doi: 10.1038/s41598-021-89667-6.
Scrambler therapy is a noninvasive electroanalgesia technique designed to remodulate the pain system. Despite growing evidence of its efficacy in patients with neuropathic pain, little is known about the clinical factors associated with treatment outcome. We conducted a prospective, open-label, single-arm trial to assess the efficacy and safety of scrambler therapy in patients with chronic neuropathic pain of various etiologies. A post-hoc analysis was performed to investigate whether cluster analysis of the Neuropathic Pain Symptom Inventory (NPSI) profiles could identify a subgroup of patients regarding neuropathic pain phenotype and treatment outcome. Scrambler therapy resulted in a significant decrease in the pain numerical rating scale (NRS) score over 2 weeks of treatment (least squares mean of percentage change from baseline, - 15%; 95% CI - 28% to - 2.4%; p < 0.001). The mean score of Brief Pain Inventory (BPI) interference subdimension was also significantly improved (p = 0.022), while the BPI pain composite score was not. Hierarchical clustering based on the NPSI profiles partitioned the patients into 3 clusters with distinct neuropathic pain phenotypes. Linear mixed-effects model analyses revealed differential response to scrambler therapy across clusters (p = 0.003, pain NRS; p = 0.072, BPI interference subdimension). Treatment response to scrambler therapy appears different depending on the neuropathic pain phenotypes, with more favorable outcomes in patients with preferentially paroxysmal pain rather than persistent pain. Further studies are warranted to confirm that capturing neuropathic pain phenotypes can optimize the use of scrambler therapy.
scrambler 疗法是一种非侵入性的电镇痛技术，旨在重塑疼痛系统。尽管越来越多的证据表明其在治疗神经性疼痛患者方面的有效性，但对于与治疗结果相关的临床因素知之甚少。我们进行了一项前瞻性、开放标签、单臂试验，以评估 scrambler 疗法在各种病因的慢性神经性疼痛患者中的疗效和安全性。进行了事后分析，以调查神经性疼痛症状量表（NPSI）图谱的聚类分析是否可以确定与神经性疼痛表型和治疗结果相关的患者亚组。scrambler 疗法在 2 周的治疗过程中使疼痛数字评分量表（NRS）评分显著降低（从基线的最小二乘均数百分比变化，-15%；95%CI-28%至-2.4%；p<0.001）。简明疼痛量表（BPI）干扰分量表的平均评分也显著改善（p=0.022），而 BPI 疼痛综合评分则没有。基于 NPSI 图谱的分层聚类将患者分为具有不同神经性疼痛表型的 3 个聚类。线性混合效应模型分析显示，聚类之间对 scrambler 疗法的反应不同（p=0.003，疼痛 NRS；p=0.072，BPI 干扰分量表）。scrambler 疗法的治疗反应似乎因神经性疼痛表型而异，阵发性疼痛患者的治疗效果优于持续性疼痛患者。需要进一步的研究来证实捕捉神经性疼痛表型可以优化 scrambler 疗法的使用。
