This is the first of our interviews with professionals from around the world who are expert in the treatment of CRPS and other chronic pain conditions. In this interview, Libby Parfitt spoke to Dr Michael J. Cooney of New Jersey in the United States about his specialist treatment: Calmare Therapy.
What is Calmare Therapy?
Calmare (also known as scrambler therapy) is a non-invasive electrical treatment, whereby patients are attached to a machine through the placement of small electrodes on the painful parts of the body. The machine then produces a very low electrical current which flows through the electrodes, disrupting the pain signals being sent from the faulty nerves and thus aiming to get rid of the pain right at its source. Calmare Therapy is FDA and European CE-Mark approved, non-invasive, drug-free, pain-free and without side effects. It is suitable for a range of chronic pain conditions, including CRPS, phantom limb pain and various nerve pains (neuropathies).
How does it work?
As Dr Cooney explains, the aim of the treatment is to “retrain the brain”. Once the electrodes have been carefully placed on the skin around the part that hurts, “the electrodes transmit a ‘no pain’ message to the brain from the nerves in the painful area using a very low electrical current.”
This might sound a bit like a TENS machine or a Spinal Cord Stimulator, but the crucial difference is in the way the Calmare signal works. “The machine uses 16 different algorithms which are constantly changing”, Dr Cooney explains. “With an SCS, one single current is sent, based on one particular nerve, and the brain becomes accustomed to it.” With Calmare, those continually shifting 16 algorithms mean the brain can’t get used to the stimulus as it’s never the same from one second to the next.
Why could it work for CRPS?
CRPS is an illness involving malfunction of the central nervous system; CRPS patients experience constant ongoing pain, often from an area that was injured several years ago but is better now, and in some cases from a body part that never had any identifiable injury. Regardless of the initial cause, the similarity is that there is no physiological reason for the pain to be felt anymore. In my own case, my CRPS was triggered by a fall that snapped the ligaments in my ankle. At the time it was an excruciating injury that caused massive pain, swelling and bruising, but the reality is that injury healed itself years ago now. Unfortunately, my brain doesn’t see it that way.
The pain I constantly feel is caused by the nerves in my ankle sending ever more panicked warning signals that something is really very wrong when the truth is that there is no injury anymore. Every second of every day I experience the pain and associated effects of that fall from years ago, even though the snapped ligaments are long since repaired. And unfortunately, the longer this faulty signal continues, the more powerful it becomes, with the brain and central nervous system becoming more and more wound up and highly sensitized, eventually creating a vicious circle that constantly heightens and reinforces the pain.
As Dr Cooney explains: “The brain believes an injury is there. The other symptoms you see in CRPS, like swelling and colour change, are all signs of the brain trying to heal this injury it believes exists.” Dr Cooney believes that Calmare is exactly suited to break this pattern of faulty nerve signals that perpetuate the illness in order to convince the brain that actually, there is nothing wrong and nothing to be fixed in the painful area. Like other CRPS treatments, the aim is to normalise the body part and the brain’s relation with it.
What does the treatment involve?
Generally, ten initial sessions of Calmare therapy are prescribed, with the electrical signal running for about 35 minutes per session. These are normally conducted Monday to Friday over two weeks. Calmare is not suitable for everyone; you can find a list of possible contraindications here.
Does it work?
Dr Cooney believes that he can help “75-80%” of CRPS patients and he generally knows if it’s going to benefit someone within the first two or three treatments. If it does work, the effects can be dramatic.
Dr Cooney has now treated “hundreds and hundreds” of CRPS sufferers since introducing Calmare Therapy in 2011, with a significant number travelling across the world to see him. You can find many case studies on his website, and if you check out his Youtube channel there’s video after video of CRPS patients talking candidly to the camera about the improvements they’ve experienced through Calmare.
They aren’t just minor changes either; there’s patients with lower limb CRPS arriving in wheelchairs and leaving by walking out the door. There are those with upper limb problems who have a pain score of 0 by the end of the treatment. There are even those with full body CRPS (generally viewed as the hardest to treat) who have become pain-free. As a CRPS sufferer who’s tried literally every treatment available to me without a huge amount of success, it’s emotional and a bit overwhelming to watch.
Dr Cooney doesn’t claim that it’s a cure, and individuals may need to come back for further booster sessions. As with every case of CRPS, the treatment protocol required may differ for each individual patient. And it’s also important to acknowledge that for up to 25% of patients it might not help at all.
Are there clinical trials in Calmare Therapy?
At the moment, there’s no medical research available showing the effects of Calmare Therapy on CRPS. There are however a number of clinical studies testing out the treatment for other types of chronic nerve pain and the results are certainly impressive. For example, one study found that Calmare relieved longstanding nerve pain significantly more effectively than drug treatment. In that study, 21 of the 26 patients treated with Calmare became pain-free; it vastly outperformed Spinal Cord Stimulators, implanted drug pumps and conventional painkillers. These clinical studies are not entirely perfect, but there are several high quality trials currently underway and if these confirm the results, Calmare certainly has the potential to be one of the very best CRPS treatments available.
How much does it cost?
A course of ten treatments with Dr Cooney is currently $3,000 USD. For anyone outside New Jersey, there are also the costs of travel and accommodation for the fortnight of the initial treatment (and any boosters required). Dr Cooney does try to help with these additional costs, offering a range of discounted rates with local hotels.
Where can I get it?
Unfortunately, Calmare Therapy is not yet widely available. There’s no-one in the UK; our nearest practitioner is in Ireland. In Europe, it is also offered in Italy. If you’re in the USA, there are around 15-20 centres across the country.
Too good to be true?
Calmare Therapy appears to have massive potential and there don’t seem to be any side effects at all. If I had the chance to try it I would certainly do so in a heartbeat and I’d have high hopes for my treatment too.
I do wonder though whether all of these amazing results are entirely down to the actual Calmare treatment alone. It’s easy to underestimate the beneficial effect of your interaction with the treatment provider.
As all CRPS patients know, it’s sadly unbelievably rare to find a treatment provider who both understands the condition and properly respects your pain; I found Dr Cooney to be a warm, caring and authoritative man who undoubtedly has these qualities. That, in and of itself, would be enough to make most CRPS sufferers’ meeting with him a positive one. And we also all know that you simply cannot disentangle the effect your mental state has on your pain; a stressful day always makes it worse and a good day means you can manage the pain that much better.
In Dr Cooney’s practice, a caring, understanding professional spends two weeks treating you, listening to you, respecting you and telling you this treatment they’re giving you will hopefully help so much just like it’s helped hundreds of people just like you. You just can’t deny that simply this affirmation and support will have a positive effect on your mental state and thus on your pain, regardless of what impact the Calmare process itself actually has. It’s also true that many of us (and I am totally guilty of this) want to be ‘good students’, showing the doctor that yes, we really are getting so much better. If a clinical trial achieves the same results with a treatment provider who doesn’t show warmth, encouragement or interest in his patients then I will be totally convinced!
But I also wonder, given all those amazing testimonials, all those people arriving in wheelchairs and leaving on their own two feet, all those whose pain has diminished or even vanished, whether the ‘how’ of how he helps people is even slightly as important as the fact that he really does help them. The analytical writer in me thinks that perhaps it is, but the CRPS sufferer who was wide awake at 5am this morning for the second night in a row, exhausted and desperate to sleep but unable to do so because the pain was crippling; well, she really couldn’t care less how it works as long as it works. And I suspect many people reading this would feel exactly the same.
Dr Cooney is on a mission to help CRPS sufferers and it’s hard to walk away from a conversation with him believing that Calmare doesn’t have the potential to help and help significantly. And 75-80% of his patients experience just that, with clinical trials beginning to validate the results he’s been seeing for years. And at the end of the day, perhaps that’s all any of us really need to know.
For more information, please visit Dr Cooney’s website.