According to study author Jee Youn Moon, MD, PhD, from the department of anesthesiology and pain medicine at Seoul National University Hospital College of Medicine in the Republic of Korea, other potential study limitations include barriers to CT access and placebo effect.

“Even though we included cancer patients who had life expectancy of greater than 3 months and tolerable health conditions, it might have been difficult for debilitated cancer patients to visit the outpatient department to obtain Calmare therapy for consecutive days, 2 weeks at a time,” Dr Moon pointed out.


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“In addition, our study was not controlled for a possible placebo effect, although the pain reduction was greater than that seen in previous placebo-controlled trials of cancer-related pain or chronic non-cancer pain,” he added.

Dr Moon also noted the need to investigate the effect of CT on specific symptoms, such as allodynia, hyperalgesia, tingling, and numbness. Studies are currently in development to evaluate the duration of CT efficacy in patients with various types of pain, and to determine its mechanism of action.

Multimodal Approach Remains Best

Similar devices, such as transcutaneous electrical nerve stimulation (TENS) units, have proven relatively ineffective in the treatment of pain conditions, Edward Michna, MD, anesthesiologist and director of pain clinical trials at Brigham and Women’s Hospital, and associate professor of anesthesia at Harvard Medical School in Boston Massachusetts, told Clinical Pain Advisor.

There is a possibility that Calmare therapy may decrease pain but not completely eliminate it. The best approach will continue to be a multimodal combination of medications, psychotherapy, and adjuvant therapies, Dr Michna added.

Although TENS was recently dropped from Medicare coverage, likely due to limited efficacy, this study suggests that there may be very good reasons to revisit that decision in certain circumstances, Dr Twillman pointed out.

“If this therapy is proven effective and covered by insurance companies, it could potentially revolutionize the treatment of cancer-related neuropathic pain. It could obviate the need to use opioids and other medications, with their potentially severe side effects, to treat this type of pain,” Dr Twillman concluded.

References

Lee SC, Park KS, Moon JY, et al. An exploratory study on the effectiveness of “Calmare therapy” in patients with cancer-related neuropathic pain: A pilot study. European Journal of Oncology Nursing. 2016;21:1-7. http://dx.doi.org/10.1016/j.ejon.2015.12.001.