(Kiosk 5) Use of Scrambler Therapy to Treat Debilitating Neuropathic Pain in a Patient with Rosai-dorfman Disease: A Case Report

Case Diagnosis: This is a case of a patient with Rosai-Dorfman disease who experienced significant pain relief with the use of scrambler therapy.

Case Description or Program Description: Despite surgical resection of her Rosai-Dorfman lesion, the patient continued to experience neuropathic pain in her left lower extremity that impacted her ability to function independently. She could not walk over one block without severe pain limiting her and could barely tolerate 30 minutes of sitting, even with cushion support.

Multiple treatment regimens, including the use of a steroid dose pack, gabapentin, hydrocodone-acetaminophen, celecoxib, and physical therapy were tried with no relief. On dermal biopsy, no evidence of Rosai-Dorfman disease was noted. Other differentials that were investigated and ruled out include seroma, complex regional pain syndrome, and nerve root impingement. Acupuncture and aquatic therapy were also attempted with no sustainable relief.

We decided to try scrambler therapy for a total of five sessions. Electrodes were placed around her areas of pain, which were stimulated for 45 minutes. The patient gradually noted significant and lasting improvements in her pain, numbness, and function.

Setting: Academic Cancer Institute

Assessment/Results: The patient's pretreatment pain intensity level was 7 out of 10, and 6 out of 10, post-treatment. At her final visit, her pretreatment pain intensity level was 3 out of 10 and 0 out of 10 post-treatment. On post-therapy survey, she expressed 65% improvement in her overall pain, complete improvement in her numbness, and 80% overall satisfaction with her results. She was able to maintain this for the next 8 months, now able to resume exercise, walk several blocks, and sit for several hours at a time.

Discussion (relevance): This is the first reported case, to our knowledge, of scrambler therapy being applied to treat the rare presentation of persisting neuropathic pain in Rosai-Dorfman disease.

Conclusions: Rosai-Dorfman disease, while rare, can have long-term consequences that affect the quality-of-life patients can return to. It is worth expanding our use of scrambler therapy to new settings of intractable pain, such as this case. This treatment modality can meaningfully improve patients’ pain outcomes and lead them to achieve greater levels of independent function.