Division of Anesthesia, Critical Care and Pain Medicine, Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Curr Opin Anaesthesiol. 2021 Dec 1;34(6):768-773. doi: 10.1097/ACO.0000000000001073.
Therapeutic methods for neuropathic are limited; available drugs can be inadequate or have adverse effects that compromise quality of life. Interest has grown in alternatives to pharmacologic therapy for neuropathic pain. We present a focused review of the literature about the relatively novel noninvasive, nonpharmacologic electrocutaneous nerve stimulation technique called scrambler therapy for treating noncancer neuropathic pain.
Neuromodulation techniques targeting peripheral sites have changed rapidly in recent years. Several clinical studies have demonstrated the analgesic effect of scrambler therapy after 10 sessions of treatment for various types of pain. Although scrambler therapy was originally used for cancer pain, its indications have broadened to postoperative pain, chemotherapy-induced peripheral neuropathy, postherpetic neuralgia, low back pain, diabetic neuropathy, complex regional pain syndrome and central pain syndrome. That said, some of the studies are controversial owing to their small sample size, lack of appropriate scrambler therapy protocol and possible lack of experience of the operators.
We present the historical perspective, mechanism of action and trial outcomes of scrambler therapy, representing an avenue for managing neuropathic pain without drugs. Well designed phase II/III clinical trials must be conducted to confirm the positive findings reported using scrambler therapy technology. If validated, scrambler therapy could be a game changer.
治疗神经性疼痛的方法有限；现有的药物可能不够有效或有不良反应，从而影响生活质量。人们对神经性疼痛的药物治疗以外的替代方法越来越感兴趣。我们对一种相对较新的非侵入性、非药物性的电皮肤神经刺激技术—— scrambler 疗法治疗非癌性神经性疼痛的文献进行了重点回顾。
近年来，针对外周部位的神经调节技术发展迅速。多项临床研究表明， scrambler 疗法在 10 次治疗后对各种类型的疼痛均具有镇痛作用。尽管 scrambler 疗法最初用于治疗癌痛，但它的适应证已经扩大到术后疼痛、化疗引起的周围神经病变、带状疱疹后神经痛、腰痛、糖尿病性神经病变、复杂性区域疼痛综合征和中枢性疼痛综合征。尽管如此，由于样本量小、缺乏适当的 scrambler 治疗方案以及操作人员经验可能不足，一些研究仍存在争议。
我们介绍了 scrambler 疗法的历史背景、作用机制和试验结果，为治疗神经性疼痛提供了一种非药物治疗方法。必须进行精心设计的 II/III 期临床试验，以确认使用 scrambler 疗法技术报告的阳性发现。如果得到验证，scrambler 疗法可能会改变游戏规则。
