What to Expect
Initial Consulation
Your first visit includes a full 45-minute treatment session with your evaluation. During this initial session we will evaluate whether the Calmare device will have a meaningful impact on your symptoms. We have a simple consent and release form that is one page long that we require before initiating treatment. This document lists important precautions and contraindications that must be taken into account before treatment. These precautions are listed at the bottom of this page.
We want to hear your entire story and will take the time to truly listen. Everything that you tell us will guide our decisions for establishing the correct protocol tailored to your individual experience of pain and/or numbness. We also want to help you understand the neuroscience behind your pain experience and teach you why the brain behaves the way it does in your specific case.
Then we will perform a full 45-minute session right away during your first visit. We will start by placing surface skin electrodes on the area of your greatest pain or numbness. The device has 5 channels that will allow us to place up to 10 electrodes to cover all of the areas where you are hurting or numb.
Most patients usually report a reduction in symptoms during the first visit, more serious conditions and conditions that have a prolonged duration (greater than 10 years typically) may require more than one visit to begin experiencing relief. The best indication that the device will help is when the patient feels the electric buzz being pulled towards their area of pain/numbness from where the electrode is placed. The minimum we are looking for is any kind of change in sensation within the affected pain/numbness area.
Initial Treatment Plan
After it has been determined that you are a good candidate for Calmare therapy, we will then plan on you coming in for 10* visits on consecutive workweek days. Saturday and Sunday treatments are available upon request for those patients traveling from far away.
*The amount of visits required will vary per patient. When the relief of symptoms persists for a full 24 hours, we will cease treatment. If that relief lasts a full 48 hours then we can be reasonably assured that the non-pain message has "stuck" and will be expected to stay that way for at least 3 months before requiring a maintenance visit. Particularly serious conditions or patients that are unable to taper off of their anti-convulsant medications (under supervision of their prescribing provider) 72 hours prior to beginning their treatment plan will frequently require 15+ visits to reach maximum relief. The list of anti-convulsant medications that impede the effectiveness of the device are listed at the end of this page.
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Throughout your treatment plan we should be observing a reduction in the severity of your pain/numbness and a decrease in size of your affected areas. We will be checking in daily about your pain/numbness areas and adjusting our electrode placement to get you better, faster. If indicated, we will recommend exercises and activities to help improve your sensory integration and recalibrate to your "new normal".
Maintenance Visits
Once you have completed your initial treatment plan, we can expect your relief to last for 3-6 months. Most patients will end up requiring maintenance visits to reset their pain or numbness back to baseline. Some patients will experience permanent relief and never require a maintenance visit. After each visit, patients will experience longer and longer intervals between maintenance visits as the brain is able to hold onto the non-pain message longer after each repeated session.
Precautions / Contraindications
Because of the manner in which the Calmare pain therapy treatment operates, you should not have the treatment if you suffer from and/or have any of the following contraindications including symptoms, conditions, or devices:
• you have a pacemaker or automatic defibrillator;
• you have a heart stent, aneurysm clip, vena cava clip, or any other coronary or vascular stent;
• you have a skull plate, (metal implants for orthopedic repair, e.g. pins, plates, joint replacements are allowed)
• you are, or could be, pregnant;
• you are nursing;
• you have a history of epilepsy, brain damage, use of anti-convulsants for purposes other than pain control;
• you have a history of, or have been treated for myocardial infarction or ischemic heart disease within the past six months;
• you have, or believe that you may have, severe heart arrhythmia or any form of equivalent heart disease;
• you have any implanted device such as a spinal nerve stimulator or implanted drug delivery system;
• you have wounds or skin irritation in areas where the electrodes are required to be placed;
• you have a history of an allergic reaction or previous intolerance to transcutaneous electronic nerve stimulation.
List of Adjuvant Analgesics for Neuropathic Pain
Commonly used anticonvulsants and anti-seizure medications that may impede Calmare pain therapy treatment:
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• Carbamazepine (Tegretol, Carbatrol, Epitol, Equetro)
• Clonazepam (Rivitrol, Clonpam)
• Diazepam (Valium)
• Eslicarbazepine (Aptiom)
• Felbamate (Felbatol)
• Gabapentin (Neurontin, Gralise, Fanatrex, Gabarone, Horizant)
• Lacosamide (Vimpat)
• Lamotrigine (Lamictal)
• Levetiracetam (Keppra)
• Nortriptyline (Aventyl, Pamelor)
• Amitriptyline (Elavil)
• Oxcarbazepine (Trileptal, Oxtellar XR)
• Phenytoin (Dilantin)
• Pregabalin (Lyrica)
• Primidone (Mysoline)
• Tiagabine (Gabitril)
• Topiramate (Topamax, Trokendi XR, Topiragen)
• Valproic Acid (Depakote, Depakene)
• Zonisamide (Zonegran)