Recently we had the honor of meeting a doctor who is currently doing Calmare. Dr. Robert Chalmers was kind enough to take his time and answer some questions we had about the Treatment so we could make an educated decision on trying it.
We hope you enjoy!
Q-First off, Other then the Spinal Cord Stimulator, what medical devices are incompatible with Calmare?
Any other implantable electric device such as Heart Pacemakers/Defibrillators or Interstim Device.
Q-How do you do Calmare , Exactly?
The treatment is actually quite simple. It involved the machine, wires and surface electrodes that deliver the electrical waveforms. The surface electrodes are the same used in heart monitoring such as an EKG. The patients sits or lies comfortable during each 45 minute treatment session. The electrodes are placed OUTSIDE the area of pain so they will not increase the pain in patients with allodynia from CRPS
The mechanism is completely unique. The primary issue with CPRS is the so called physiologic “wind-up” in the brain. This is a complicated change in the nervous system and can be traced at least in part to changes in NMDA receptors in the brain. We need to get to the brain to help with this disease. The use of electricity for the management of pain is not unique to the Calmare system and I am sure many RSD sufferers have tried traditional TENS therapy. However, the Calmare system is not anything like a TENS unit. Injury or other noxious stimulus in the body creates pain chemicals. These chemicals in turn get converted into electrical impulses by your nerves which get transmitted to the brain and get INTERPRETED by the brain. When we use the Calmare system we “control” the electrical impulses that the brain is recieving. By manipulating the input into the brain we “convince” the brain that the area of the body where pain was present is now normal. We know that the brain can be taught, in medicine we refer to thoses changes as Neuroplasticity and there is quite a bit of interesting reading on that topic on the internet if you have the time. I was the worlds biggest cynic prior to actually treating patients with the machine. I thought it was TENS or Placebo but nearly every patient I have treated has already tried TENS therapy and they can tell you this is nothing like TENS.It works!
Q-Should the patient be weaned off of any Narcotics or Pain Medication before getting treatment?
I don’t recommend that patient change there narcotics prior to the treatment. Narcotics need to be weaned slowly and that can happen once the pain is reduced. There are issues with using Lyrica and Neurontin with the therapy. The biggest problem is that we want to “speak” to the brain and then we want the brain to change. Lyrica and Neurontin are seizure medicines which quiet down nerve impulses and they impede the Calmare system from talking to the brain and stimulating thoses changes. I have seen success in patient on Lyrica and Neurontin but it doesn’t seem to last as long as other patients. I usually recommend tapering the doses of these medications if possible prior to treatment even if it means more narcotics.
Q-How many treatments do you have to have before you see results?
We will know if we can “find” and reduce you pain 15-30 minutes into the first treatment. YOu should be almost completely pain free during the treatments. Each time we treat you you will get a little longer duration of pain relief. Most people are feeling minimal pain by treatment 3 or 4.
Q-Why did it take so long for Calmare to come over from Europe and get approved by the FDA?
I think this issue comes down to dollars and cents. How much money can be made off a machine that insurance will not pay for treatment and scentific studies are lacking. The studies published in Europe are case reports and case series. There are no randomized trials and no blinded studies so the scientific evidence was of pretty poor quality The only U.S. study that is published is also a case series and most physicians are skeptical prior to seeing some “good” scientific data. Fortunately someone at Competitive Technologies saw the place for this therapy and started the process to get FAD clearance.
Q-As of right now how much does Calmare cause per treatment?
$1500 for 10 treatments. I have not been charging people who need to be retreated in less than 3 months.
Q-When do you think it will be covered by insurance?
The one thing we know about RSD is it is an expensive disease between procedures, medications not to mention time-off work and pain and suffering. A single SCS will pay for many, many Calmare treatments. I do believe insurance will pay for this therapy simply as a cost saving measure. The challenge is convincing them that it works. The more patients that get treated, the easier this will be to prove. The company that manufactures Calmare has applied for a CPT or produce code, that is the first step. I would predict 18 months before we start to get some coverage.
Q- What caused you to add Calmare to your practice?
I originally started investigating the therapy as a favor to a family member who has severe sciatica. I read the research and although I didn’t believe it would work initially I was intrigued. I did a 30 day trial of the device and treated only the most complicated pain patients. In the initial group they ALL got better. They had tried every therapy imaginable from surgery, meds, acupuncture and even traveling overseas for chelation therapy. I thought about all of the gynecologic pain patients I had treated over the years and the sense of frustration I would feel in someone in severe pain that we couldn’t help without invasive procedures and addictive medications. I love my primary occupation and I will never stop delivering babies but someone needed to champion this Calmare system in the West and after the trial with the machine I did not feel like I could send the machine back. I think this will be in every pain clinic in the U..S within the next 2-3 years but someone needed to get things started. I am currently amazed by the therapy and find it incredibly rewarding to see people get relief their pain.
Q- Without breaking Doctor Patient confidentiality, have you had any RSD/CRPS patients who you treated with Calmare? Did it relieve their pain and how much?
I have only had the device since June, 2010 and I have treated a total of 4 CRPS patients and all have seen some improvement. The average pain score was 7-8 prior to treatment and 2-3 after treatment. I am hoping to get a large case series of about 20-30 patients so I can give you more concrete data and get it published in the medical literature. Most physicians will not be convinced until they see it published in a Peer reviewed journal.
Q- Do you recommend any Chronic Pain Patient or RSD/CRPS Patient to get Calmare? If so Why? If Not Why?
Calmare is indicated for Neuropathic or Nerve pain. It is not meant for regular body pains like sore muscles or arthritis. I have also had only minimal success with fibromyalgia patients. It is best used when the pain is in a discrete area of the body. The larger the area that is in pain the less likely we are to have success. This is the struggle with fibromyalgia, often the pain spans large areas and we cannot isolate or eliminate the pain.
Q-What are the side effects of Calmare?
I had one patient have a mild skin irritation under the electrodes. I have had a few patients complain about fatigue and headache after the treatment. I have not had a single person have even a slight increase in pain. Most patients experience a soothing feeling during their treatments. The “old” name of RSD/CPRS is Causalgia which as you know essentially means burning pain. Patient reports the burning fades away during the treatments.
Q-What do you think of RSD/CRPS in general?
My first exposure to RSD/CRPS was during my residency training. I took care of 2 patients who were pregnant and also had the disease. I will fully admit I did not understand the disease during that time since I was in the beginning of my training but I have never seen a disease in which the patient endures more suffering than those with CRPS. We want to help you!
Q-Do you think that this is the beginning of bigger and better treatments for Chronic pain?
I hope so. We need to do better. Chronic pain is an epidemic in the United States.
Q-Is there anything that you would like to add related about Calmare or RSD/CRPS that I didn’t ask?
I thank you for your interest in this new therapy. I am happy to respond to any questions through Facebook mail or traditional e-mail at email@example.com