Is the Government Still Blocking Calmare Pain Therapy: Intriguing Article

https://www.mdedge.com/oncologypractice/article/49042/patient-survivor-care/scrambler-device-reduces-refractory-neuropathic

And the appropriate billing code: 0278t
I spent 30 minutes trying to see if I could find out if Medicare covered it at all, and was unsuccessful. I send my patients for Calmare to either Dr. Gutierrez in San Ramon or Dr. Ellis in Emeryville, but they tend to have to self-pay for the treatments, not the evaluation.

https://calmaretherapynj.com/tag/cpt-0278t/

Calmare Therapy for Pain Relief

https://youtu.be/7DqvtlvHd4s

I can not write a foot blog too long without mentioning something that has the potential of changing chronic 8-10 pain and make it go away. Calmare pain therapy is still not FDA approved, although cleared as safe (whatever that really means). It does not work on all pain, and there is some technique to getting it right, and it is not offered in many locations. That being said, if I had severe chronic pain, and I could travel to a Calmare Pain Treatment Center, that would not be questioned. If you or your loved ones have chronic pain, please get informed about it. 

http://www.blbchronicpain.co.uk/news/ask-expert-dr-michael-j-cooney-calmare-therapy-chronic-pain/

Calmare for severe nerve pain: More news

https://www.clinicaltrials.gov/ct2/show/NCT03322007?term=scrambler+therapy&draw=1&rank=2

A Pilot Trial of Scrambler Therapy for Pain Associated With Pancreas Cancer - Full Text View - ClinicalTrials.gov www.clinicaltrials.gov A Pilot Trial of Scrambler Therapy for Pain Associated With Pancreas Cancer - Full Text View.

Calmare in the news:  https://njmonthly.com/articles/top-doctors/alternatives-to-opioids/2/

As Addiction Rises, Doctors Seek Pain-Relieving Alternatives to Opioids njmonthly.com Doctors seek new paths toward pain relief amid an epidemic of addiction and death.

Calmare Therapy
Four months after a botched podiatric surgery, Ridgewood resident Marilyn Green started to experience intense pain in her right foot. She was diagnosed with reflex sympathetic dystrophy (now largely known as complex regional pain syndrome type 1), a neurological disorder in which pain from damage to the soft tissues and/or peripheral nerves can spread to other parts of the body. Leery of narcotics, she self-prescribed a combination of B-complex vitamins and exercise that had proven beneficial to her mother after a case of shingles. The treatment offered some relief, but the gnawing pain persisted and began to spread. Green came across an article describing a rare procedure known as Calmare, designed to treat neuropathy, the nerve damage and concurrent chronic pain that can arise after chemotherapy, a shingles outbreak, or surgery. In cases like Green’s, says Michael Cooney, a chiropractor who is one of the few practitioners in the state to use the therapy, “we think there’s a hypersensitivity that’s developed within the pain center of the brain.” The Calmare device uses electrodes to move what Cooney calls “a no-pain signal” through the area of pain in order to “reboot” the brain, so that it’s no longer aware of the pain.

Cooney treated Green with 10 sessions of Calmare, and she is now pain free. “When I went in there, my pain level was at nine,” she says. “On day five of the treatments, it was down to zero.”

Calmare is effective only on true neuropathies; it appears to offer relief ranging from 6 to 18 months or longer.

Calmare Pain Therapy: Email Correspondance

Dear Dr. Rich,

Yes, I finally got through to Dr. Gutierrez and signed up for the treatment, starting Monday, March 21.  My symptoms were perhaps not typical; most people start with a lot of pain and it gradually reduces.  My neuropathy pains have always been intermittent and worse at night;  a major problem has been sensitivity of the soles of my feet.  So for the first treatment my pain level was zero  before treatment, but they did it anyway.  However, that same day I noticed a marked improvement in the sensitivity of the soles.  The second day I wore a pair of thin soled shoes and before the treatment walked around on rough ground including a gravel path, and it felt OK.  This was something I absolutely could not have done before.   Again zero pain at the start of the treatment, but I am sure the treatment was beneficial.  I don't know if Dr.Gutierrez though I was a hypocondriac, since I was supposed to have more pain.  I ended up having only 3 treatments;  I questioned  whether getting all 10 proposed treatments would be beneficial.  The shooting pains I had for the past year or more had been less lately and have not recurred.  Dr. Gutierrez agreed for me to stop after the 3rd session (and not have to pay for all 10) with the understanding that if pain returned I could "start over."

I am happy about the outcome and grateful to you for telling me about it.  The other symptom of neuropathy, which they call "compression" or feeling like the feet are overstuffed sausages, with difficulty  flexing the toes, is apparently not helped by this treatment.  And then there's the arthritis which is still active.  However,  any progress is welcome and I am now able to wear all my shoes, some of which I could not get my feet into a few months ago, and walk much more comfortably.

So, many thanks, and I hope Calmare gets full approval.

Best regards,

Calmare Pain Therapy for Foot Nerve Pain: Email from Patient

This email was Happy New Years to me. I have been working with this patient for many years. I recommended Calmare Pain Therapy several years ago. She had to drive to the doctor's office, stay 2 weeks at a hotel, and get the 10 required treatments to help her very severe left foot nerve pain. She may require some booster treatments in the future. Right now she is very gradually testing out her new left foot!! 

Happy New Year!!! 

I’m emailing you with fabulous news about the effects of the Calmare pain scrambling treatments that I received in December. 

After 10 sessions, the intensely debilitating nerve pain has drastically dissipated! Words can’t even touch the depth of gratitude I feel and the degree of excitement I have with this increased mobility in my life. Since Dec. 22nd, I’ve danced for 10 minutes at least 3x, have walked with a friend for 50 min, have gone window shopping with another friend, and even baked muffins! 

I’m taking things s l o w l y and steadily to ensure that I remain on this healing path. Wow, there’s nothing like an absence of nerve pain to bring out the giddy “kid in a candy store” and the “where do I want to travel to first” parts of me. I’m embracing this moment fully with glee and at the same time, am humbly moving forward to stay within the zone of diminished nerve pain. I am sooooo thrilled!!!! I still have joint, tendon, and ligament pain in the ball of my big toe joint and throughout the tendons and ligaments that connect to it. However, now that the nerve pain has diminished, I trust I’ll be able to tend to these mechanical issues with greater and more rapid success. Aho!

Thank you from the bottom of my heart for your prayers. I deeply appreciate you holding my healing journey within your heart and for your prayers during these treatments. I connected to the web of support many times while receiving these treatments  and want you to know how palpable and significant your prayers were … and are. Thank you. Truly, thank you.

(And, if there is anyone who didn't receive my prior email, please forgive me as I’m sorting through my 800+ contacts and I very possibly missed you.)

For those of you from the Bay Area dance community, I hope to see you soon - even if for 10 minutes at first - on the dance floor. I look forward to being with you within the non-verbal depth of our meditation practice and welcome connecting with you there. And for all of you from the Bay Area, I’m now available for walks in nature - as long as you’re open to sitting together at the midway point to rest and commune with the elements.

I wish you a year of rich and heartful connection with all that brings joy to your world. And, I wish for this planet and for all sentient beings who live upon it, that this is a year when the human race acts on greater behalf of this generous, amazing, abundant, stunning, and interdependent orb of life.

Love to you,

Calmare Pain Therapy: Patients Please Tell Us Your Stories!!!

https://youtu.be/HfTs17ZQfrc

Another Video on Calmare Pain Therapy: CRPS and other forms of severe pain can benefit

http://www.calmarett.com/pain/howitworks.html

Complex Regional Pain Syndrome: Email Advice

Dear Dr.blake

Hope you are doing well .

Just wanted to update you regarding the progress of my algodystrophy (that struke me after my sesamoiditis ) Dr Blake: Algodystrophy is another name for complex regional pain syndrome.

As this might help other people who are in pain or experienced RSD symptoms.

-          I have followed your advice and went looking for calmare therapy – couldn’t find any around since I live In a small country – I found one center who have a PBK “Italian electro machine”

The owner claims that he have amended it’s program to do the effect of calmare/ since I had no choice I tried it /

To my surprise it worked wonderfully. And after only 6 sessions  . my pain was 50 % less . now I have high hopes , I think by Christmas my aldodystrophy will be gone  "6 month after the discovery of the RSD”

So I definitely recommend calmare or alternative calmare ,  since I have tried acupuncture and other  it helped only at first.   Dr Blake: Calmare works permanently on some and some seem to need booster sessions occasionally. Calmare is an electrical current and does not involve anything invasive, like IVs or injections. 

-          My main problem is that after I heal from the main full leg pain I would still have issues with my fingers and sesamoid bones ,  because of the non bearing issue – what shall I do or start doing to improve mineralization in

That area. And as per your  experience how much time it would take to get back to normal in that area after RSD is gone. I am seriously desperate to go back to normal and willing to do anything required.

Dr Blake's comment: This patients has had very bad disuse atrophy of the bones from months of non weight bearing and inactivity. The treatment needs to be directed towards gradual weight bearing. There is no time lines that I know. Set benchmarks on what you can do this month, and reset them in next month. By gradually increasing walking, biking, elliptical, core work, etc. the strength will come back, but never at the pace you want. 

-          I have another issue , with orthotics ,  I have tried a dozen with a collection of shoes . and paid of fortune on these . still I have a problem that when I stand more than 20 minutes in these ,  I feel like I have been standing all day, and

I have to sit for a while before I can walk pain free. Also walking for more than 15 minutes give the same feeling.

I got some weird pain till the point that I thought I have RSD in the second leg . but I don’t /

I know orthotics are not supposed to be 100% comftable and that they changed our gait .   but this is really frustrating and I feel it in both legs , if I have to wear orthotics for a year or so , I really need to find a solution.

An orthopedic doctor told me that my calfs became weak and there’s too much pressure on the feets and heels= he said that  after a year of wearing orthotics my gait changed and my muscles got weaker and that I need to do stationary biking – I cannot do biking now and waiting for a month or so when RSD is fully gone.

Is that kind of pain and discomfort normal when wearing orthotics ,  what can I do to reduce it ???

Dr Blake's comment: All you can expect orthotic devices to do is protect the joint that was injured. Your symptoms seem to be bone fatigue and muscle fatigue and nerve irritability. You seem to be on the right path to restrengthen. Find the most comfortable orthotic you have and experiment with more padding, more arch support, more dancer's pads, etc. See if anything mechanical really improves the tissue threshold you are experiencing now. 

-          Regarding Vitamins .  the doctor told me to reduce smoking and it helped . he gave me raw honey since he said some new researches revealed that RSD is linked to a deficit in the immune system.

And I am taking multivitamins with extra calcium and magnesium.  For how long do you think I should continue taking vitamins ? ? is it ok to take for long months or years or this could be harmful.

Dr Blake's comment: I think that you should sit down with a registered nutritionist and attempt a game plan to reduce inflammation, improve nerve and bone health, and strengthen your immune system. 

Sorry for the long email.

I thank you a lot for your support and wish you happy holidays . Jesus bless for being such a hope for many people around.

Dr Blake's comment: Thank you, I have been so blessed by God that it is hard to ask for anything else. Merry Christmas to you. 

Nerve Pain: Email about Calmare and MRI

This is an email that I received after letting one of my patients know that Calmare Pain Therapy for neuropathic pain was finally being offered in the San Francisco Bay Area by an MD Dr Susan Gutierrez in Danville and San Ramon areas. 

http://www.yelp.com/biz/susan-gutierrez-md-san-ramon

Hey Dr Blake, thank you for thinking of me.  Have you had patients experience success with calmare pain therapy? (the success of one patient's treatment with Calmare has a link below)

Here is the post from my one patient so far. 

http://www.drblakeshealingsole.com/2014/03/calmare-therapy-rising-star-for-nerve.html

I am also sending all my nerve patients to Dr Lee Wolfer now if I can get approval/insurance coverage to see her. My other favorite docs are Dr Michael Moskowitz and Dr Michael Savella in Marin County. Thanks to your recommendation. 

  i'm asking because overall the CRPS pain is doing much better, thanks to dr. wolfer's dextrose nerve blocks since feb of this year..  these are done with ultrasound guidance.  i've had blocks on my femoral nerve, sciatic nerve,  sapenous nerve, and the most stubborn, oldest pain site - the tibial nerve. lee actually would love if you called her.  she believes she can help some CRPS patients if you are open to talking with her, that is.

Dr Blake's comment: Dr Lee Wolfer is an amazing pain specialist. Here are several links referring to her.

http://www.drblakeshealingsole.com/2014/05/neural-prolotherapy-potential-help-for.html

http://www.drblakeshealingsole.com/2014/05/complex-regional-pain-syndrome-email.html

i had a classic prolo injection into my big toe joint about two weeks ago. it helped quite a bit.  i will most likely need a few more as well as a repeat tibial nerve block.  man, this condition is stubborn.  as i wait for an appt with lee, i continue to do everything else:

accupuncture

homeopathic remedies with accupuncturist who does muscle response testing (this is fascinating stuff!)

PT exercises to the point i can bear the pain

supplements - more than i can bear at times; pill fatigue is real

bike or swim 

anti-inflammatory diet and moderate paleo

contrast baths

In regards to my left big toe joint, i do the spica taping and cluffy wedge daily.  and i walk in my orthotics all the time except when going to client meetings. i continue to scan the web for womens shoes with removable footbeds.  my foot doesn't fit well into a lot of the brands.  so i continue to search, order, and return shoes.

anyway, this is a long update to say i'll hold off on seeing dr. gutierrez.  but i will post her name on the facebook CRPS support group.  should i get to a point where i was pre-february 2014 then i will definitely make a consultation.  i'm spending so much money (~ $1,200/month easily cash) as it is.  the thought of adding another cash consult/procedure overwhelms and stresses me even more.  not to mention the added coordination and travel.  i've tried four PTs, several MDs, three accupuncutirsts before landing on the multi-disciplinary team i have now.

thanks again so much for thinking of me.  i need to make an appt with you after i get my hands on my some shoes that fit my feet. did my MRI show anything besides big toe joint OA and inflammation?

hope all is well with you,

Here is the image of the left big toe joint on MRI. The sensor is along the second toe side. The fluid in the medial side of the first metatarsal signifies substantial bunion joint arthritis. No wonder the nerves around the big toe joint get upset and painful.

This MRI of the left foot focuses on the inflammation in the 3rd intermetatarsal space where a Morton's neuroma may reside. Definitely a cortisone shot can calm that down and prevent the nerve triggering.

Another image of the big toe first metatarsal head. The white within the bone is not healthy. The sensor overlies swelling in the space between the first and second toe which irritates the deep peroneal nerve in that area. This is the second trigger of left foot nerve pain.

Here the image highlights the first metatarsal bone swelling on the bunion side of the joint. The swelling is plantar (bottom of the foot), making weight bearing hard, and making the spica taping, dancer's padding,  Cluffy Wedge, and Hannaford orthotic devices crucial.

http://www.drblakeshealingsole.com/2013/02/sesamoiditis-and-hallux-limitus-email.html

This last image also highlights all the intense swelling right where the intermetatarsal nerve runs. This can produce Morton's neuroma symptoms without actually being a neuroma. Cortisone injections are considered for this.

And here my patient's response: 

very thoughtful response, as always, dr. blake.  i especially love how you educated me (and all the other readers of your blog) on what my MRI means.  

a few quick names i want to pass along.  srinika is my acupuncturist and nutrition/supplement advisor.  she did a nutrition response testing on me and i was fascinated by the results:

1. my body needs to detox itself before it can absorb any supplements
2. the toxins in my system are due to a category called air pollution.  see her blog entry --> http://srinikahealing.com/atmospheric-spraying-destroying-health/
3. my body responds to the homeopathic remedies!  my skin started itching as a result of the toxins trying to escape my system.  
4. the homeopathic detoxification remedies along with weekly acupuncture are extremely helpful in improving pain

this is her site:

http://srinikahealing.com/nutrition-response-testing/

interestingly enough, lee used to work in the same office as lee years ago!

i also like my PT, rachel feinberg, in palo alto.  she has 13 years experience in CRPS and tailors a functional restoration program for each patient.  link is below, which also has her CV.

http://www.feinbergmedicalgroup.com/#!our-providers/vstc1=rachel-feinberg

still shoe searching!

Calmare Therapy: A Rising Star for Nerve Pain (even CRPS)!?

Hi Dr. Blake, I have some very exciting news to share. I have been on the East Coast having some experimental treatments for the last three weeks. A new generation of electronic device that delivers healthy nervous system signals to the brain, somehow erasing old pain pathways.
I was very skeptical initially, seemed like one more silly Tens kind of gizmo, but I have been completely astounded at the results.

The technology does not rely on the Gate theory  of pain, but rather on a different kind of signal theory.

Almost all of the pain and allodynia has been eliminated from my foot.
It is like a miracle.

I don't know how long this improvement will endure. Most patients experience some regression over time, and need additional treatments. and I also will have a lot of rehab to do to get a normal sock and shoe on that foot, and very gradually rebuild strength and endurance in walking.

But for right now it has given me so much hope to have relief from that horrible neuropathy that was like the worst kind of torture.

The name of the machine is called Calmar. There have been some small scale studies demonstrating efficacy, and larger scale trials, including at the Mayo Clinic, are now underway. It is effective with CRPS, post herpetic neuralgia, diabetic neuropathy, and post chemo therapy neuropathy. Goodness knows these are all patients who need help and hope.

I know you care so much about your patients and have been trying very hard to find solutions for me and others. I will send you more information when I get home.

Unfortunately my L5 – S1 disc issue, which was a sleeping tiger, has been set off by the travels, so I am having very painful sciatica now And  will have to get that calmed down. But even that is nothing compared to the CRPS.

I'll be in touch with more information about Calmar, when I'm home and doing a little better.

I hope you are doing well and thank you again for all your care and concern.

Best to you, 


http://youtu.be/GzbbkS-Imm0

http://youtu.be/KFkTEr-uz78

http://youtu.be/NElvi0ZYhYY

http://www.calmarett.com/pain/index.html