Johns Hopkins Medical Institutions, Baltimore, MD
Thomas J. Smith, Charles L. Loprinzi, Andrea L. Cheville
Background: cPMP is chronic pain in the front thorax, axilla, and/or upper half of the arm beginning after mastectomy or lumpectomy persisting > 3 months after treatment and presents with pain, allodynia and disability. cPMP occurs in half of all patients with breast cancer and is severe in 13% (Gartner R JAMA 2009). Epidural bupivacaine, memantine, gabapentin or venlafaxine may help prevent cPMP, but there are no established proven treatments. (Shen J, Up to Date 2016) Scrambler therapy (ST) is an FDA-cleared treatment for neuropathic pain supported by multiple trials in over 800 patients with cancer pain, chemotherapy induced neuropathic pain, back pain, and post herpetic neuropathy (PHN). (Majithia N JSSC 2016) Methods: We treated 2 women with cPMP with standard ST, with repeated treatment if the pain returned. ST was done with ECG pads above and below the pain for 45 minutes daily, until pain resolved, and repeated if/when pain recurred. Results: Case 1: A 60 year-old woman had bilateral mastectomy 2 years prior with cPMP like “a barbed wire bra”. Before treatment, her pain was 8, which decreased to 0-2 after 5 treatments. Her pain returned 4 months later and was successfully retreated. She resumed a more normal life and was able to taper and eventually stop her opioids. Case 2: A 56 year-old woman had deep aching cPMP for a year following chemo, Mastectomy, and RT. Her pain was 10, decreased to 0-1/10. Her pain returned 1 month later; 3 treatments reduced her pain from 4/10 to 0/10 and improved her quality of life, which lasted for several months until cancer recurrence. Conclusions: Scrambler therapy successfully treated cPMP in 2 patients with improved pain and quality of life, and enabled one patient to stop her opioids in line with new CDC guidelines. Scrambler therapy appears to hold promise, as it does in chemotherapy-induced neuropathy, failed back syndrome, PHN, low back pain and other conditions; prospective trials are indicated to further evaluate this treatment modality.
Case 1 Pain Scores (ST = Scrambler Therapy given that day) | |||||||||
Day | 1 ST | 2 ST | 3 ST | 4 ST | 5 ST | 30,90 | 100 ST | 101 ST | 130 |
6-8 | 5 | 2 | 1 | 0 | 1 | 4 | 0 | 0 | |
Case 2 Pain Scores | |||||||||
Day | 1 ST | 2 ST | 3 ST | 7 | 14 | 21 ST | 22 | 42 | 49 |
10 | 3 | 2 | 2 | 2 | 4 | 0 | 1 | 1 |
Disclaimer
This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org
Abstract Disclosures
2022 ASCO Annual Meeting
First Author: Jingran Ji
2023 ASCO Annual Meeting
First Author: Shuo Wang
2023 ASCO Annual Meeting
First Author: Maria Alice B Franzoi
2024 ASCO Breakthrough
First Author: Hea Lim Choi