How To Prepare for Your First Calmare Scrambler Treatment
Getting ready for your first appointment with Calmare Scrambler Therapy is easy! Here are a few things to keep in mind to ensure a smooth and productive experience:
As a pain therapy expert, Max recommends reviewing this list of medications that may interfere with the Calmare Scrambler Treatment’s effectiveness prior to starting treatment.
These medications can sometimes slow down or prevent the treatment from working optimally. To achieve the best possible results, we usually advise that you and your prescribing physician create a plan to safely taper off any listed medication. Ideally, your last dose should be 72 hours or more before your first visit. It is even more beneficial if you can plan to stop these interfering medications for a longer period (i.e., 2 full weeks) to ensure any lingering withdrawal symptoms have passed.
If you have any concerns about your ability to taper off your medications, please discuss this with our office and your prescribing physician.
Common Anticonvulsant and Anti-seizure medications that may interfere with treatment:
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Acetazolamide (Diamox)
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Adinazolam (Deracyn)
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Alprazolam (Xanax)
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Amitriptyline (Elavil)
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Brivaracetam (Briviact)
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Carbamazepine (Tegretol, Carbatrol, Epitol, Equetro)
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Cenobamate (Xcopri, Ontozry)
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Clobazam (Onfi, Frizium)
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Clonazepam (Klonopin, Rivotril, Clonpam)
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Diazepam (Valium)
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Eslicarbazepine (Aptiom)
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Ethosuximide (Zarontin)
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Ethotoin (Peganone)
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Etiracetam
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Everolimus (Afinitor, Votubia)
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Felbamate (Felbatol)
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Fosphenytoin (Cerebyx)
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Gabapentin (Neurontin, Gralise, Fanatrex, Gabarone, Horizant)
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Lacosamide (Vimpat)
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Lamotrigine (Lamictal)
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Levetiracetam (Keppra)
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Lorazepam (Ativan)
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Mesuximide (Petinutin, Celontin)
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Nortriptyline (Aventyl, Pamelor)
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Oxcarbazepine (Trileptal, Oxtellar)
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Phenytoin (Dilantin, Epanutin)
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Piracetam
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Pregabalin (Lyrica)
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Progabide
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Primidone (Mysoline)
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Rufinamide (Banzel, Inovelon)
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Stiripentol (Diacomit)
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Tiagabine (Gabitril)
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Topiramate (Topamax, Trokendi, Topiragen)
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Valproic Acid (Convulex, Depakote, Depakene, Epilim)
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Vigabatrin (Sabril, Vigpoder)
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Zonisamide (Zonegran)
Other Interfering Medications:
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Ketamine will prevent Scrambler from working entirely for 2-3 months from last infusion
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THC can impair effectiveness of treatment and decrease duration of relief after treatment
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Muscle-relaxant type medications may impede optimal response
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Some Serotonergic anti-depressants and anti-anxiety medications may slightly interfere with treatment
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Dextromethorphan (Robitussin, Delsym, etc.) Cough Syrup may entirely block Scrambler from working
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Methadone may completely block the Scrambler Signal similar to Ketamine
Helpful Medications:
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OTC or prescription anti-histamines such as hydroxyzine
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Prescription Steroid anti-inflammatories
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OTC or prescription NSAIDs such as ibuprofen, naproxen, or diclofenac
Opioids
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Usual opioids (morphine, hydrocodone, oxycodone, fentanyl, dilaudid) do not block the Scrambler signal, but they can blur or shrink the “true” pain area, which can make electrode placement harder.
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Our clinic does not require or ask patients to stop opioids before starting Scrambler Therapy; many patients naturally taper or stop them over the 2–3 weeks of treatment as they begin to get relief.
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If a patient wants to do everything possible to improve results, a voluntary, slow taper of opioids (with the prescribing provider’s guidance) may make it easier to clearly feel the stimulation from the machine and outline the real borders of their pain.
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If tapering opioids causes severe sleep problems or makes pain intolerable, we recommend returning to a comfortable dose and waiting until Scrambler treatments start providing relief before trying again.
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Low Dose Naltrexone (LDN) is commonly prescribed among our patients and has been observed to have very negligible interference with Scrambler Therapy if at all.
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Methadone has a different mechanism of action and is more likely to significantly disrupt the Scrambler signal, so it may reduce the chances of success or prevent a response at all.
We understand that for some people, it's not possible to completely stop their current medications due to other health issues beyond just pain or severe disruptions with sleep.
If you cannot safely taper off your medication completely:
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Only two medications have been shown to completely block the Calmare Scrambler's pain relief signals: Ketamine and Dextromethorphan (the active ingredient in many common cough syrups). If you are taking either of these, your treatment will likely not work. Methadone is also suspected (but not proven) to completely block effectiveness of Scrambler treatments.
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If you experience severe difficulty with sleep, then patients are advised to pause their taper or go back up a step in dosage depending on their prescribing physician's recommendation.
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However, having these medications in your system usually means the treatment will be less effective, and you will likely need many more treatment sessions to achieve the lasting pain relief you're looking for.
Benzodiazepine Withdrawal: A Critical Warning
If you take benzodiazepines (commonly recognized by the generic name endings "azepam" or "azolam," such as Valium, Xanax, or Klonopin), it is critically important that you work closely with your prescribing doctor to taper off slowly.
❌ Never stop taking benzodiazepines "cold turkey." Abruptly stopping or tapering too quickly can lead to severe and potentially dangerous withdrawal symptoms.
For all benzodiazepine users, we must stress this point: Rapid withdrawal can dramatically increase symptoms of anxiety, depression, and agitation. This increased severity of symptoms is associated with a significantly heightened risk of suicidal thoughts and actions.
Tapering should be done slowly and strictly according to the advice of your prescribing physician. It is vital that the patient, family members, and close friends monitor for any sign of worsening anxiety or depression during the tapering process so that the symptoms can be managed properly and safely.
Precautions and Contraindications:
Your safety is our priority. To ensure you're a suitable candidate for Calmare Scrambler Treatment, we have a list of precautions and contraindications from the device manufacturer that are similar to all other forms of electrical stimulation. Please review the list below and call our office to discuss any concerns you might have.
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You have a Pacemaker or Automatic Defibrillator;
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You have an implanted device such as a spinal nerve stimulator or implanted drug delivery system;
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You have a history of epilepsy, brain damage, use of anti-convulsant medications for purposes other than pain control;
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You are restricted from using an MRI (magnetic resonance imaging) device;
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You have a history of, or have recently been treated for myocardial infarction (heart attack) or ischemic heart disease within the past six months;
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You have a heart stent, aneurysm clip, vena cava clip, or other coronary or vascular stent;
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You have a skull plate; (metal implants for orthopedic repair, e.g. pins, plates, joint replacements are allowed)
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You have, or believe that you may have, severe heart arrhythmia or any form of equivalent heart disease;
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You are, or could be, nursing or pregnant;
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You have wounds or skin irritation in areas where the electrodes are required to be placed;
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You have a history of allergic reactions or previous intolerance to transcutaneous electrical nerve stimulation.
Comfortable Clothing:
For optimal electrode placement during your sessions, please wear loose-fitting clothing that allows easy access to the areas experiencing pain or numbness. We understand some situations might require a change of clothes. Don't worry, we have a large handicap-accessible bathroom where you can comfortably change into something more suitable, such as shorts or a loose-fitting top.
Additional Tips:
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To ensure your body conducts electricity effectively during treatment, we recommend arriving well-rested and well-hydrated. This will optimize the results of your initial session.
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Also be sure to thoroughly cleanse the skin around the area of pain to be treated, remove any lotion or oil present on the area to be treated as well as along your spine. These products should be discontinued during treatment in the area where pads are to be placed.
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If needed, skin lotion can be applied shortly after treatment each day so that your skin has 23 hours to absorb the oil/lotion to minimize electrical resistance to conduction of the Calmare signal.
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Feel free to bring a notebook or notepad to jot down any questions or key points discussed during your consultation.
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We encourage open communication throughout your treatment journey. Don't hesitate to ask questions or share any concerns you might have!
By following these simple steps, you'll be well-prepared for your first visit and ready to embark on your path towards potential chronic pain relief with Calmare Scrambler Therapy.