Each session included 30 minutes of stimulation after electrode placement. The patient was asked to rate his pain on a scale of 0–10 using a numeric rating scale pre- and posttreatment. Electrodes pairs were placed ( Figure 1B) in an “X” pattern across the areas of most pain, 2 cm distal from the pain, across the affected dermatomes ( Figure 1B and C). The MC-5A scrambler therapy device (GEOMC, Inc.) was used to provide treatment to this patient. (B) Lead placement on patient's right shoulder. (A) Computed tomography of this 69 year old man's right shoulder revealed a destructive lytic mass in the scapula with an associated surrounding soft tissue mass and multiple small lucent lesions in the right humeral head. This regimen remained unchanged over the course of his treatment with scrambler therapy. His pharmacologic regimen included extended release oxycodone 40 mg by mouth every 12 hours, oxycodone immediate release 40 mg by mouth every 4 hours, liquid gabapentin 750 mg by mouth every 8 hours, and acetaminophen 1,000 mg by mouth every 6 hours. Ineffective therapy before our intervention included radiation 5 months prior and cryoablation to the right scapular mass 1 month prior. Computed tomography (CT) imaging of the right shoulder revealed a destructive lytic mass in the right scapula with an associated surrounding soft tissue mass and multiple small lucent lesions in the right humeral head ( Figure 1A). Pain, along with allodynia, was elicited by any movement and severely limited functional use of the patient’s dominant right arm. Case descriptionĪ 69 year old man with a history of advanced non small cell lung cancer with hepatic and bony metastasis was referred to a palliative medicine clinic in October 2020 for management of intractable right shoulder pain. In this case report, we present a patient with a history of metastatic non small cell lung cancer experiencing incident bone pain who received successful scrambler therapy treatment and for whom conventional medical management was unsuccessful. Use of the device involves electrode placement surrounding the “proximal and distal limits of the cutaneous region over the pain region” to trigger the central nervous system to transform “pain information into nonpain information”.
Scrambler therapy employs electrocutaneous nerve stimulation that incorporates a variety of nerve action potentials responsible for nonpain information.
Scrambler therapy, a noninvasive procedure most frequently used in the setting of neuropathic pain, , is one possible intervention that may be beneficial for patients with incident pain.
Thus, the search for interventions to treat incident pain is essential. While opioids have proven partially effective in the treatment of incident bone pain, , higher doses – even to the point of sedation – are often required. The etiology of incident pain can include pathologic fractures and bone damage due to metastatic disease. Specifically, “incident pain,” one type of breakthrough pain defined as pain produced by movement, has proven remarkably challenging to control. Pain induced by bone metastasis is frequently encountered but difficult to treat.
0 kommentar(er)
