February 24, 2024
Advancing pain management: exploring the limits of electroanalgesia.


This story is part of a series on current advances in regenerative medicine. This article discusses advances in electrotherapy.

In 1999, I defined regenerative medicine as a collection of interventions that restore normal function to tissues and organs damaged by disease, injured by trauma, or worn out over time. I include a full spectrum of chemical, gene and protein-based drugs, cell-based therapies, and biomechanical interventions that achieve that goal.

Chronic pain is one of the most common diseases in the United States, affecting approximately 100 million adult Americans. Chronic pain, or persistent pain lasting three months or longer, is a common side effect of the primary condition as well as other chronic diseases. This collective pain fuels the ongoing opioid epidemic and plays a role in disability-related unemployment, poverty, and homelessness.

As such a significant hurdle in our health care system, all efforts should be made to investigate possible ways to treat chronic pain and reduce the epidemic.

In recent years, electroanalgesia, or electrotherapy, has emerged as a promising potential solution. Thousands of years before the Greco-Roman days of Aristotle and Plutarch, electroanalgesia involves precise electrical impulses targeted toward specific nerve endings involved in the reception of pain.

In a recent review for The New England Journal of Medicine, Dr. Thomas J. Smith of the Johns Hopkins School of Medicine and colleagues investigated two forms of electroanalgesia: TENS therapy and scrambler therapy. Here, I will analyze their reviews and discuss the potential effects of these treatments.

Before discussing the intricacies of TENS and Scrambler therapy, we must first understand the basics of cutaneous electroanalgesia, which is the use of electrical stimulation applied to the skin. When we feel pain, nerve receptors signal the brain that something is wrong or damaged. These receptors, called nociceptors, are triggered by pressure, heat, and chemical stimuli, among other threats. Chronic pain is a continuous overstimulation of nociceptors.

Cutaneous electroanalgesia applies electricity to overloaded nociceptors in the skin to counteract pain signals transmitted to the brain. The technique is completely non-invasive, meaning there are no needles, surgery or wounds, providing patient comfort. Non-invasive techniques are also less expensive, ensuring that electroanalgesia is more accessible to all people experiencing chronic pain.

Transcutaneous electrical nerve stimulation, or TENS, is a more traditional electroanalgesia treatment than scrambler therapy. It involves a TENS device that delivers electrical stimulation through targeted patches on the skin. Its purpose is to prevent signals from leaving the nerve centers and reaching the brain.

Scrambler therapy, on the other hand, takes a different approach. Instead of blocking signals from reaching the brain, a scrambler unit provides electrical impulses that transmit artificial signals to the brain. These synthetic signals reach the same brain area that processes real pain signals, effectively scrambling the incoming data and reducing the perception of pain.

Scrambler therapy gives better results than its TENS counterpart. Studies reviewed by Smith and colleagues show that there is 80–90% effectiveness in reducing chronic pain symptoms over time with the Scrambler system. The introduction of Scrambler signals reduces pain during ongoing treatment cycles, and it has been documented that long-term pain reduction lasts for months or years after Scrambler treatment. TENS, on the other hand, requires continued treatment for continued pain relief.

However, TENS treatment is the more accessible of the two. The main advantage is that TENS treatment is typically self-administered and costs as little as $20, meaning anyone with access to the system can perform their own treatment whenever necessary. A scrambler device can cost more than $65,000 and must be administered by a professional, making treatment more expensive and less time-flexible.

Both treatments have the usual minimal side effects that would be expected from an electrotherapy, including muscle pain, fatigue, and skin irritation, but no moderate or severe reactions have been reported.

How, then, should we proceed to develop and implement these treatments into the United States health care system?

Nearly three million Americans struggle with opioid addiction, the majority of whom are poor. In my estimation, the TENS system is an immediate bandage that needs to be applied to the situation. Although not as effective as the scrambler system, it is still far more affordable and accessible to those who need it most.

In the meantime, we must continue to develop the Scrambler system and reduce the cost of the device to allow low- and middle-income Americans to access its benefits. Ultimately, if the Scrambler can be adapted to the point of affordability and self-administration found with the TENS system, the long-term benefits of providing chronic pain relief to millions of people will be numerous.

To read more in this series, please visit www.williamhaseltine.com

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