Scrambler Therapy for Patients with Cancer Pain - Case Series -
A 49-year-old female patient with a height of 152 cm and a weight of 45 kg was referred by her Obstetrics and gynaecology for bilateral sacral area pain caused by uteuterine sarcoma and bilateral sacral bone metastasis. The patient complained of a spontaneous, throbbing pain with an NRS score of 8/10, and it worsened with changes in position or movement. Total laparoscopic hysterectomy had been performed on the patient for uterine sarcoma one year before. Because discomfort in the lower abdomen and symptoms of tenesmus had continued after surgery, a CT scan of the abdomen had been performed one month after surgery. In the scan, a heterogeneously enhancing mass lesion of 14.6 × 7.7 cm in the pelvic cavity and numerous lymph node enlargements in the abdominal cavity had been observed, as well as a soft mass lesion of 3.7 × 2.9 cm in the left pelvic bone and a lesion of 2.5 cm2 in the right pelvic bone (). Doxorubicin and cisplatin chemotherapy had been started and further radiation therapy scheduled. At the time of referral, the patient was taking oxycodone PR 20 mg bid, as well as oxycodone IR 5 mg when pain increased, as prescribed by the referring department. However, severe opioid-induced constipation developed, and the patient was refusing an increase in opioids despite the increase in pain level. Thus, scrambler therapy was planned for the patient. As the patient's area of pain was located on the bilateral S3-5dermatome, the scrambler electrodes were attached to 6 normal sensory areas to the left and right of the S3-5dermatome pain area for treatment. Scrambler therapy was performed 10 times for 40 minutes once every day, and oral pain medication was continually administered without a change in dosage. From the first day of treatment, the NRS score of the affected area decreased from NRS 8/10 to 0/10, and the NRS score at home after the procedure decreased to 2.5/10; this was maintained for approximately 2 weeks after treatment. During the 10 sessions of scrambler therapy, the dermatome location of pain did not change, but the painful area slowly contracted; thus, the patient's area of pain was consulted daily before attaching the electrodes. The pain medications were continually administered without a change in dosage during the scrambler therapy. One week after completion of scrambler therapy, the patient developed symptoms of diarrhea as she started radiation therapy. In addition, the pain in the sacral area worsened. The patient was re-hospitalized, as she wanted a second round of scrambler therapy. There was no pain during the subsequent scrambler therapy, and the chronic diarrhea improved. Her pain at home was maintained at around NRS 3/10 for one month. Afterwards, the patient was transferred to another hospital near her hometown.