Scrambler Therapy for Patients with Cancer Pain - Case Series -
A 56-year-old male patient with a height of 166.6 cm and a weight of 59.9 kg was referred from the gastroenterology department for right chest pain caused by hepatocellular carcinoma and right chest fifth rib metastasis. The degree of pain was NRS 6/10, and it was characterized as a spontaneous splitting pain. Transarterial chemoembolization (TACE) chemotherapy had been performed on the patient for liver cancer for one year. Five months before visiting the cancer pain unit at our hospital, metastasis to the right chest fifth rib had been discovered, and the patient had received radiation therapy. In the subsequent MRI and bone scan of the thoracic vertebrae, right fifth rib metastasis with extraosseous mass formation had been observed. The patient had the underlying diseases of hepatitis B and liver cirrhosis and, at the time of referral, had been using Ultracet Tab™ (acetaminophen 325 mg tramadol hydrochloride 37.5 mg, Janssen Korea LTD, Korea) 2 tab tid for pain control. However, the right chest pain had gradually worsened and been causing sleep disturbance. Hence, a thoracic epidural injection had been performed during hospitalization, but 3 days after the procedure, the pain had worsened, with the NRS score increasing again to 6/10 from 2/10; thus scrambler therapy (MC5-A Calmare®) was planned for the patient. The patient complained of chest pain in the right fifth rib area, so the scrambler electrodes were attached to 2 normal sensory areas to the left and right of the right fifth rib pain area for treatment. As the 10 sessions of treatment progressed, it was clear that the pain area was gradually contracting, and the location of the electrodes was adjusted accordingly for treatment. After 2 sessions of scrambler therapy, the NRS score decreased to 2/10, and the treatment effect continued until the next morning. The administration of Ultracet Tab™ was stopped accordingly. After 10 sessions of scrambler therapy, the NRS score has been maintained at 2/10, and the pain area maintained at about 80% reduced state, for 2 months.