Calmare/Scrambler Therapy is a promising, non-invasive treatment for chronic neuropathic pain. It was developed in Italy in 2003 by Dr. Giuseppe Marineo, a neurophysiologist. The therapy emerged from the need to find effective treatments for patients suffering from chronic pain conditions, particularly those unresponsive to standard pain management techniques. The therapy utilizes a device that sends non-painful electrical signals through the skin to "scramble" the pain signals being sent to the brain. This mechanism effectively alters how the brain perceives pain, allowing for relief without the use of medication. But like any therapy, it works best under certain conditions. In this post, we’ll explore:

• Who makes an ideal candidate for Calmare/Scrambler Therapy;

• Which medications may interfere with its success;

• Why these medications may need to be adjusted or tapered during treatment;

IDEAL CANDIDATES FOR CALMARE/SCRAMBLER THERAPY

Calmare/Scrambler Therapy can benefit a wide range of patients—but its best results are seen in patients with chronic neuropathic pain that is:

• Localized or regional (not widespread fibromyalgia-type pain);

• Persistent despite medication;

• Present for at least 3 months;

• Not caused by ongoing active tissue damage;

CONDITIONS THAT RESPOND WELL

• Chemotherapy-induced peripheral neuropathy (CIPN);

• Post-surgical neuropathic pain (e.g., mastectomy, hernia repair);

• Postherpetic neuralgia;

• Diabetic peripheral neuropathy;

• Failed back surgery syndrome;

• CRPS (Complex Regional Pain Syndrome);

• Phantom limb pain;

• Peripheral Neuropathy;

• Trigeminal Neuralgia;

PATIENT CHARACTERISTICS THAT PREDICT SUCCESS

• Pain that’s neuropathic in nature (burning, tingling, shooting, numbness);

• Pain that’s static or improving, not worsening from a progressive condition;

• Skin intact over the treatment area (no open wounds or ulcers);

• Able to provide feedback during treatment sessions (the therapy is interactive);

• Willing and able to attend daily sessions for 10–12 days;

WHO MAY NOT BE A GOOD CANDIDATE?

Scrambler Therapy is not recommended for:

• Patients with mechanical or inflammatory pain only (e.g., arthritis without neuropathy);

• People with pacemakers or implanted defibrillators;

• Patients with significant cognitive impairment who can’t give reliable feedback;

• Areas with no sensation (the therapy relies on intact sensory pathways);

• Active, worsening disease processes like spreading cancer unless neuropathic pain is the main symptom

MEDICATIONS THAT MAY INTERFERE WITH CALMARE/SCRAMBLER THERAPY

While many medications can be continued during treatment, some drugs may reduce the effectiveness of Calmare/Scrambler Therapy by blunting the nervous system’s ability to respond and rewire.

These medications include:

1. Long-Acting Opioids (e.g. oxycontin, ms contin, fentanyl, patches)

• Why they interfere: Opioids dull the nervous system’s responsiveness and may impair the feedback loop that Calmare/Scrambler Therapy relies on to reprogram nerve signals.;

• What to do: Tapering or pausing long-acting opioids is often recommended prior to or during therapy, if clinically appropriate. Short-acting opioids may be used as needed, but should be spaced several hours away from treatment sessions.

2. Ketamine and NMDA Antagonists

• Why they interfere: Calmare/Scrambler Therapy engages NMDA receptor modulation to achieve central desensitization. Ketamine or other NMDA antagonists may interfere with this reprogramming process.;

• What to do: Delay Calmare/Scrambler Therapy until after ketamine infusions are completed, or allow a washout period.;

3. Benzodiazepines (e.g., Clonazepam, Lorazepam)

• Why they interfere: These suppress CNS activity and may impair neuroplasticity, making it harder for the therapy to take hold.;

• What to do: If used regularly, consider tapering under supervision. Occasional use may be acceptable, but should be spaced several hours from treatment.;

4. High-Dose Gabapentinoids (Gabapentin, Pregabalin)

• Why they interfere: While these drugs treat neuropathic pain, high doses may dull sensory input and hinder feedback during therapy sessions.;

• What to do: If the patient is on very high doses, a dose reduction may be considered. However, many patients still benefit from Scrambler Therapy while on gabapentinoids, especially at moderate doses.;

MEDICATIONS THAT ARE TYPICALLY COMPATIBLE

• Antidepressants (e.g., duloxetine, amitriptyline)p;

• NSAIDs

• Muscle relaxants (e.g., tizanidine, cyclobenzaprine);

• Acetaminophen;

• Topical agents (lidocaine patches, capsaicin);

• Low-dose opioids timed well outside of treatment sessions

Disclaimer: This blog is for informational purposes only and does not substitute professional medical advice. If you are experiencing chronic pain, please seek guidance from a qualified healthcare provider.