If you’re exploring non-pharmacologic options for chronic pain, you’ve likely come across two terms that sound similar but refer to different approaches: Calmare® Therapy or Scrambler Therapy and Transcutaneous Electrical Nerve Stimulation (TENS). Both use electrical stimulation to modulate pain signals, but their mechanisms, clinical use, and evidence base differ. This blog provides a detailed comparison, summarizes key research and statistics, and discusses potential adverse effects and interactions when using a TENS unit around Calmare/Scrambler Therapy sessions.

1) WHAT IS CALMARE/SCRAMBLER THERAPY?

Concept and Mechanism

Calmare/Scrambler Therapy is a non-invasive, neuromodulation approach intended to rewire the brain’s perception of pain. A key nuance is that Scrambler Therapy targets sensory pathways and uses signal patterns designed to influence how the central nervous system interprets pain signals carried by peripheral nerves, including c fibers. It delivers low-intensity, safe electrical signals designed to mimic “non-pain” information and replace or retrain pain signaling patterns, rather than simply blocking nerve conduction. The therapy typically uses surface electrodes placed on the skin around the painful region. The patient experiences sensory channels that are meant to be non-painful and soothing to engage somatosensory processing without triggering protective nociceptive responses. By repeatedly delivering these non-pain information signals across the affected dermatomes and adjacent areas, the aim is to promote plastic changes in pain processing circuits and reduce the brain’s amplification of pain signals, including those carried by C fibers.

Clinical Use

Approved or offered in various locations worldwide for chronic neuropathic pain conditions, including cancer-related neuropathic pain, post-surgical pain, low back pain, sciatic nerve pain, neuropathies, trigeminal neuralgia, complex regional pain syndrome (CRPS), migraines, and more! Treatment protocols commonly involve multiple sessions, typically daily, with a course lasting 10–14 sessions (though protocols vary by clinic and condition).

2) WHAT IS A TENS DEVICE?

Concept and Mechanism

Transcutaneous Electrical Nerve Stimulation (TENS) uses electrical impulses delivered via skin-contact electrodes to stimulate nerves. The buzzing or tingling from the TENS device distracts your brain from the pain signals coming from the painful area. It is like turning up a louder “noise” in a different channel by the time it reaches your brain. The signals from TENS can also trigger your body to release feel good chemicals that help reduce pain. The proposed mechanisms include gate-control theory and the stimulation of A-beta fibers inhibits transmission of nociceptive signals in the dorsal horn.

TENS is typically used for acute or chronic pain, sometimes self-administered at home for conditions like back pain, osteoarthritis, neuropathic pain, and post-surgical pain.

Clinical Use

Widely available over-the-counter or by prescription in many countries.

Various parameters can be adjusted: frequency (Hz), pulse width, intensity, mode (conventional, acupuncture-like, burst), and session duration.

Often used as a non-invasive, low-risk adjunct or stand-alone therapy.

3) KEY DIFFERENCES: CALMARE/SCRAMBLER THERAPY VS. TENS

4) RESEARCH AND STATISTICS: WHAT THE EVIDENCE SAYS

Calmare/Scrambler Therapy

• Studies indicate potential short- to mid-term pain reductions in chronic pain populations, including neuropathic pain and cancer-related pain.

• Randomized trials are fewer and have mixed results; some show benefit, others do not meet primary endpoints or show small effect sizes.

• Safety data generally favorable, with most adverse events being mild and localized (e.g., transient skin irritation).

TENS

• Systematic reviews and meta-analyses often report small but clinically meaningful reductions in pain for some conditions (e.g., osteoarthritis, postoperative pain) but not universal benefits.

• Heterogeneity in study design leads to wide confidence intervals and varying conclusions.

• Strong safety profile; most adverse events are skin-related. Electrical safety concerns are present in populations with implanted devices or electrical hazards.

Comparative perspective

There are relatively few direct head-to-head comparisons between Calmare/Scrambler Therapy and TENS. The therapies are conceptually adjacent but operationally distinct, with different purported mechanisms and clinical goals. For clinicians and patients, the choice often depends on pain type, prior response to neuromodulation, accessibility, cost, and clinician expertise.

5) FINAL THOUGHTS

Calmare/Scrambler Therapy and TENS are both non-pharmacologic approaches to pain modulation, but they operate on different principles, have distinct evidence bases, and carry different considerations for safety and interference. Calmare/Scrambler Therapy offers a neuromodulation strategy aimed at retraining pain signaling through non-pain information, with a structured course and generally favorable safety profile. The evidence base is growing but heterogeneous; more high-quality randomized trials are needed to establish robust, long-term benefits for specific pain conditions.

TENS is a well-established, widely accessible modality with mixed evidence, often providing modest pain relief for certain conditions. It is generally safe but can cause skin irritation or burns with improper use.

If you’re contemplating either therapy, consult with a qualified pain management specialist who can review your medical history, discuss current evidence in the context of your condition, and tailor a plan that balances potential benefits with safety considerations.