Successful Treatment of Diabetic Neuropathy with Scrambler Therapy

Dear Editor:

Diabetic neuropathy (DN) is a common complication of diabetes, increasing as the disease progresses. In a community-based palliative care study, 28% of those enrolled had diabetes as their most serious comorbidity.¹ Current treatments are modestly helpful with an average pain reduction of only 8%–13% (Ref.²). Spinal cord stimulation is highly effective for DN³ but is invasive and expensive. Scrambler therapy (ST)⁴ is a noninvasive neuromodulation that sends “nonpain” information along the existing nerve pathways to modify central sensitization, with success in several randomized controlled trials treating as low-back pain; spinal cord stenosis and postherpetic neuropathy; chemotherapy-induced neuropathy; and neuromyelitis optica spectrum disorder.

We used ST to treat an 80-year-old woman with several years of severe DN manifest as symmetric stocking-glove electric shocks that caused pain with walking or gripping. Electrode placement is shown in Figure 1. On day 1, her pain reduced from 8/10 to 0 in 40 minutes and lasted 10 hours. On day 2, the pain went from 2 to 0 and the pain relief lasted overnight. She went to bed free of pain for the first time in years. On day 3, she had minimal pain that again went to 0 (Fig. 2). She had no ST side effects but did develop cystitis and then recurrent atrial fibrillation on day 4, postponing further treatment. The only other interventions that occurred after ST were a gluten-free diet and a daily glass of celery juice, neither known to affect DN. Four and 11 months later, she and her daughter report no significant neuropathy pain. Case reports of three or fewer persons are exempt from institutional review board requirements at Johns Hopkins.

FIG. 1.

Placement of the electrode pairs. Placement across both wrists captured dermatomes for C6, C7, and C8. Placement on L5 captured the dermatome that supplied most of the sole. Placement anteriorly on L4 and posteriorly on S1 (dotted lines) captured parts of both L4 and S1, the remaining innervation of the sole.

FIG. 2.

Pain scores pre- and postscrambler therapy days 1, 2, and 3.

There is one other report of successful treatment of DN; weekly ST reduced pain scores from 6/10 to 2 lasting over six months.⁵ One randomized trial of ST for low-back pain noted significant improvements in pain, but also marked improvements in quantitative neurosensory testing at sites distant from the site of treatment, and marked lower serum neuroinflammatory markers such as nerve growth factor that may explain the long-lasting benefit.⁶

In summary, a woman with DN attained significant and lasting benefit with just three daily treatments of ST, adding to the list of disorders that are treatable with superficial neuromodulation. Further research is needed to fully assess the benefit, but this may be a possible solution to a common and disabling problem. We are beginning a Phase II expanded trial shortly.

Funding Information

This study was supported by grants NCI P 30 006973; 1 R01 CA177562-01A1, PCORI IHS 1609-36518; the Harry J. Duffey Family Fund for Palliative Care; and The Lerner Foundation, Washington DC.