For people with CRPS who've been through the medications, the nerve blocks and the ketamine
You've been told to learn to live with CRPS.Before you do, give your nerves one session with the treatment nobody offered you.
Scrambler therapy is an FDA-cleared, drug-free treatment for nerve pain. For CRPS we run it inside a protocol built for the condition: the scrambler session, desensitizing work that starts almost at once, mirror therapy, and someone with you the entire time. The electrodes go on healthy skin outside the painful area — never on the part that hurts. No needles. No medication. Nothing implanted. No downtime.
It started with something that should have healed. A sprained ankle. A broken wrist. A routine surgery. Six weeks, they said.
Instead the pain grew bigger than the injury ever was. The skin changed color — red, then purple, then blotchy. Hot to the touch one day, ice-cold the next. The limb swelled. And then came the part nobody understands unless they live it: touch started to hurt. A sleeve. The air from a ceiling fan. The bedsheet.
So now the foot sleeps outside the covers, or you don't sleep much at all. You own one pair of socks you can stand. You flinch when someone walks too close. Maybe you've asked the people you love not to touch that side — and watched them wonder whether it's really that bad.
It probably took months to get a name for it. Maybe years. Somebody called it a slow sprain. Somebody called it stress. Somebody said it was in your head.
Then came the list. Gabapentin, and the fog. Lyrica, and the weight. Nerve blocks that worked for three days, then two, then not at all. Ketamine that took the pain to nothing in the chair — and handed it back on the drive home. And somewhere along the way, a brochure for a spinal cord stimulator.
Then the sentence you carry around now: there's nothing more we can do — you'll have to learn to live with it.
First: we believe you. The pain is real. It lives in the nerves, and the color, the heat and the swelling are your nervous system telling the truth. Second: that sentence meant the tools had run out — not your options. Few clinics own the machine, insurance rarely covers it, and it's new to most doctors — even though the New England Journal of Medicine reviewed it in 2023.1 The rest of this page is about that tool, and the protocol we built around it for CRPS.
The mechanism
How it works — in plain words
With CRPS, the injury may have healed long ago. The pain never got the message.
The nerves keep firing. The spinal cord and brain keep listening. And the whole circuit gets better and better at sending pain — until the volume is stuck all the way up, and even a light touch comes through as pain. Pain has become the habit, not the alarm.
That's why the usual tools fade. A pill turns the volume down but doesn't change the message — so the dose climbs. A nerve block numbs the line for a while, then the line comes back. An infusion can quiet the whole system for hours or days, and then the pattern is still there.
Scrambler therapy goes after the message.
Small sticky electrodes — the kind used for an EKG — go on healthy skin outside the painful area, on the nerve pathways that feed it.2 Never on the raw spot. Never on broken or numb skin.
The machine then sends its own signal up those nerves: changing sequences built to imitate the traffic a healthy nerve sends when nothing is wrong.2 Your nervous system gets a no-pain message on the same line that has been carrying pain — over and over, for about forty minutes.
While that's happening, most people feel their pain drop in the room. Then, for people who respond, relief tends to build over the course — each session's relief holding a little longer than the last.2
The questions people ask next
"Isn't this just a TENS unit?"
Fair question — the stickers look the same. They're different treatments. The NEJM review is clear that scrambler therapy is not a type of TENS.2
A TENS unit is built for you to adjust at home.
Its relief is meant to last while it's on. The scrambler's signal is shaped by the device's own program, and the device is restricted to physicians or trained people working under a physician.1
Scrambler therapy is given as a course.
It aims at relief that outlasts the session. If a TENS unit did nothing for you, that tells you nothing about this.
"Scrambler — does it scramble my brain?"
No. The name is about the signal, not about you. Nothing is done to your brain. Everything happens through small pads on the surface of your skin, and you can talk, read or nap through the whole session.
"Why ten sessions?"
Your nervous system learned this pain over months or years. It unlearns it through repetition — the same healthy message, day after day, while relief builds. But you don't commit to ten on day one. The first session tells us a great deal.
The CRPS protocol
Pain at zero in the chair — then we teach the limb it's safe
CRPS isn't like the other nerve pain we treat, so we don't treat it like the other nerve pain we treat.
You know the part that makes it different. The limb is so sensitive that the pain feeds itself. So you protect it. You stop moving it, stop letting anything touch it, stop looking at it. Every one of those choices makes sense — and every one of them teaches the nervous system that the limb is dangerous.
Scrambler therapy quiets the pain signal. On its own, that leaves the rest of the pattern in place: the guarding, the fear of touch, a brain that has stopped trusting the limb. So for CRPS we built a protocol that goes after all of it, out of what we've learned treating this condition:
1. We aim for your pain at zero during every session.
Not lower. Zero — or as close as your body will go that day. That's also how the device's own instructions describe a treatment done right.3 When it isn't happening, we haven't found the right setup yet, so we keep working.
2. We start desensitizing almost at once.
Once the pain is down during a session, there's a window where the limb will accept touch — and that's exactly when we use it. Gentle, graded contact, starting with whatever the limb will take and building from there. Doing this while the pain is quiet, instead of asking a flaring limb to put up with it, is the whole idea.
3. We use mirror therapy during treatment.
A mirror is set so the healthy limb's reflection sits where the painful one is. Your brain gets to watch a limb that moves normally and doesn't hurt. It sounds strange the first time you hear it. It's a well-established approach for CRPS — and doing it while the pain is already down gives your brain a far better picture than it has had in years.
4. Someone is with you the whole session — and the setup keeps changing until it works.
We don't put the pads on and walk away. Placement, level, sequence, what we add and when: we vary the protocol across the course instead of repeating one setup ten times.
All of it is part of the protocol. The desensitizing and the mirror therapy aren't add-ons, and there's no separate charge. They're simply how a CRPS course runs here. We also use parts of it for other nerve pain that's stubborn against the scrambler alone — including shingles pain and phantom limb pain.
If you're weighing a spinal cord stimulator: nothing here is implanted, nothing has to be surgically removed later, and every door stays open. Find out what this does first — before a decision that can't be undone.
For the limb that can't take a bedsheet
Nothing touches the part that hurts until you're ready
"Electricity, on a limb that can't stand a sock?" If that's your first thought, it should be. Here's how we handle it.
The pads go on calm skin.
Electrodes go on healthy skin outside the painful area — above it, around it, along the nerve pathways that feed it. Never on the raw spot. Never on broken, fragile or numb skin. If your whole foot can't bear a sheet, the pads go where the skin is quiet.
You set the level.
It comes up slowly, one channel at a time, and you do the talking: first tell me when you feel something, then tell me when it's enough.2 The target is a clear, comfortable tingle. People call it fizzing, a light buzz, or — the phrase in the published description — tiny electrical ants.2
It should never hurt.
If anything we do makes the pain go up, we stop and change something. That's the instruction that comes with the machine, and it's how this is done here.
Touch starts where the limb is.
The desensitizing only begins once the pain is down during the session, starts with whatever the limb will accept, and goes only as far as you say.
"Could it flare my CRPS — or make it spread?"
It's the fear almost every CRPS patient brings through the door, and it's the reason our protocol is built the way it is. Nothing here is pushed through pain — not the level, not the placement, not the desensitizing. The pain in the chair is supposed to go down, and someone sitting beside you is watching it the whole time. Tell us how every evening and night went; the next day's setup is built on your answer.
What to expect
A session, a course, and an early answer
You keep your clothes on. You sit back in a treatment chair — no gown, no straps, nothing to climb into. The pads go on by hand, patient by patient, and if the first placement doesn't do the job, they come off and go somewhere else. Then the level comes up the way described above.
The session runs about forty minutes.3 People read, scroll, nap, talk. For CRPS, this is when the desensitizing and mirror work happen — while the pain is down. When it ends, the pads come off and you drive yourself home. Nothing to recover from, no drowsiness, no restrictions. The next day you do it again, and the placement is worked out fresh, because skin and nerves change from one day to the next.
A full course is ten sessions on consecutive weekdays — five days a week for two weeks.3
That's the protocol the device is built around. It's also why we run scrambler sessions on Fridays, when the rest of the clinic is closed — a ten-day course doesn't fit a four-day week. Driving in from out of town? Plan on two weeks in San Antonio.
What "working" tends to look like
For people who respond, relief builds across the course rather than arriving all at once. The published reports describe relief lasting weeks, months, and in some cases longer after a course ends — and people whose pain returns responding again to a short round of booster sessions, usually a couple of days rather than a full course.2 In San Antonio, a booster is a drive, not a flight.
How we measure it
Not just the number on the pain scale. We track how bad the pain is, how often it comes, and what you can do — stand longer, walk farther, wear a real shoe, sleep under the sheet. You fill out standard questionnaires at the start and at follow-ups, and at each check we watch how you walk, sit and carry yourself. We listen to our patients, and we never ignore what you tell us.
Why this works
Why this works — and what we stand behind
Scrambler therapy retrains the pain signal instead of masking it. For CRPS, the protocol goes after the rest of the pattern. Here's what makes it work here.
It goes after the message, not the volume. That's the difference between retraining the signal and turning it down for a few hours.
The protocol works on the whole pattern. The pain drops in the chair, and that quiet window is put to use — for touch, for movement, for a brain that needs to see the limb as safe again.
Who runs it matters. Where the pads go, and whether the level is set by someone paying attention to your answers, is everything. Dr. Barton trained in Rome with the inventor, and every course runs under the medical supervision of Lisa D. Persyn, M.D.
Your first session answers the biggest question. The fastest way to know whether your nerves respond is to treat them.
What we stand behind
- A $19 consultation that gives you a straight answer — including "this isn't for you," if that's the answer.
- A full first session for $99, credited toward the course, before you're asked to invest in anything more.
- Progress measured, not guessed — questionnaires, daily activities, and your own account.
- If it isn't working, we tell you, and we stop. Nobody runs you through ten sessions to finish a program.
Candidacy
Who this is for — and who we won't treat
Who this is for
CRPS — complex regional pain syndrome, once called reflex sympathetic dystrophy or RSD — is a chronic pain condition that most often affects an arm or a leg, usually after an injury or surgery, with pain far greater than the original injury would explain.4
If that's your diagnosis, and the pain has outlasted the medications, the blocks or the infusions, you're who this page was written for.
- Burning, electric or crushing pain far bigger than the injury that started it
- Color and temperature changes — red, purple, blotchy; hot one day, ice-cold the next
- A limb that can't stand to be touched — the sheet, a sock, a breeze
- Swelling, stiffness, and a limb you've stopped using to protect it
Who cannot have this treatment
These are absolute. They come from the device's own instructions, and no exam changes them:3
- An implanted pacemaker or defibrillator
- A spinal cord stimulator or peripheral nerve stimulator, implanted or in trial
- Aneurysm clips, vena cava clips, or skull plates
- A seizure disorder — epilepsy, or a tendency to seizures
- Pregnancy — the treatment hasn't been studied in pregnancy, so it isn't used
- Undiagnosed pain — pain nobody has worked up yet needs a diagnosis first, not a treatment. If you think you have CRPS but no one has diagnosed it, we'll help you get to the right person.
Where we take extra care
Heart problems, diagnosed or suspected — we talk to you about it, and there are placements we don't use. Skin that has lost normal sensation, or is broken, infected or fragile where pads would go. A tendency to bleed or bruise easily, or a recent fracture. Some anticonvulsant medications can change how the course is run — bring your full medication list to the consultation. And occasionally, skin irritation where the pads sit: it's the most common side effect there is, and moving the placement usually solves it.3
Cost & insurance
What it costs — and what you get for it
You've already spent a great deal on things that didn't hold. So the front end is built around one question: does this work for you?
The consultation is $19.
History, examination, a real conversation about whether this is the right treatment for your CRPS, and the candidacy screen above. If the answer is no, you hear it at the consultation.
A first full session is $99 — and it counts toward the course.
Not a demo, not five minutes — a full session, run properly. Continue with a course and the $99 comes off it.
The full course is an investment we quote in person.
Scrambler therapy isn't a covered insurance benefit, so the course is an out-of-pocket investment — and you'll know exactly what it is, in writing, after your first session and before you agree to anything. If your CRPS came from a work injury, or your plan has covered it before, tell us at the consultation and we'll check what's possible.
Your care team
Who does the treatment
With scrambler therapy, who holds the electrodes matters as much as the machine. So here's our answer before you ask.
Kevin S. Barton, D.C. has practiced in San Antonio since 2003. He manages the scrambler program and does the treatments himself. He completed advanced scrambler therapy training in Rome, Italy, with Dr. Giuseppe Marineo — the biophysicist who invented this treatment.5 Training with the person whose research created the device.
The program is medically supervised by Lisa D. Persyn, M.D., board certified in Physical Medicine and Rehabilitation — the specialty built around restoring function to people living with pain and nerve injury. That's how the treatment is meant to be delivered: the device is restricted to physicians, or to trained personnel under a physician's supervision.1
What that looks like in the room for CRPS: placement worked out fresh every visit; the level set by your answers; the desensitizing and mirror work done by someone who knows where your pain is that day; and the willingness to say, out loud, "this isn't doing what it should — let's change it."
Patients
Hear it from a CRPS patient
Shannon came to us after the medications, the nerve blocks and the ketamine. Watch her tell it in her own words — the scrambler sessions, the desensitizing work, and where her pain ended up. In her video: "Shannon's pain had reduced to a 1."
Every patient's story is their own. Results vary. These are real Texas Spine Clinic patients, sharing their experiences with their permission — watch them tell it in their own words.
Questions patients actually ask
Before you call
How soon will I know if it's working?
Often during the first session — many people feel the pain fall in the room. What matters most is whether the relief starts holding longer between visits. That's usually clear within the first several days, which is exactly why the first full session is $99.
I've had CRPS for years. Is it too late to try?
The calendar doesn't answer that — your nerves do. Most of the CRPS patients we see have lived with it a long time and tried a lot first. The $99 session is how you find out what your nerves do with this, instead of guessing.
Do I have to do the desensitizing and mirror therapy? Is that extra?
It's part of the CRPS protocol, with no separate charge. And it's paced to you: it only starts once the pain is down during the session, and it only goes as far as the limb — and you — will allow.
Can I keep taking gabapentin or my other medications?
Keep taking them for now, and don't stop anything on your own. Gabapentin, Lyrica (pregabalin) and Cymbalta (duloxetine) can all interfere with the signal scrambler therapy sends, so we'll work with the doctor who prescribed them to wean you off safely. That has to be done gradually: gabapentin and Lyrica are anticonvulsants, and stopping them all at once can cause seizures. Cymbalta can cause withdrawal symptoms if it's stopped suddenly. Bring your full medication list to the consultation.
I've had nerve blocks and ketamine infusions. Does that matter?
Most of the CRPS patients we see have had both. Bring the names and dates of what you've had to the consultation — your history helps us decide when to start and how to set up the course.
I have a spinal cord stimulator — or a trial scheduled. Can I do this?
An implanted stimulator — or one in trial — rules this treatment out. If you're considering a stimulator but haven't had it placed, talk to us before you decide. This is the treatment people often want to try first, because there's nothing to implant and nothing to remove.
Is it covered by insurance or workers' comp?
Scrambler therapy is almost never a covered benefit. If your CRPS came from a work injury, or your plan has covered it before, tell us at the consultation and we'll check what's possible.
I live out of town. Can I still do this?
Yes. Plan on two weeks in San Antonio for the course — sessions run Monday through Friday. If you ever need a booster later, it's usually a couple of days, not another full course.
What if it doesn't work for me?
Then we tell you, and we stop. You'll have put $19 and $99 toward a real answer instead of another year of wondering.
Footnotes
- Smith TJ, Wang EJ, Loprinzi CL. Cutaneous Electroanalgesia for Relief of Chronic and Neuropathic Pain. New England Journal of Medicine 2023;389:158–64. Review by physicians at Johns Hopkins and the Mayo Clinic. ↩
- Same review — mechanism and application: electrode placement on unaffected skin along the affected dermatomes; the continuously varied waveform sequences; the operator's step-by-step level-setting dialogue; session length; relief typically lengthening over a course; reported durability and retreatment; and the statement that scrambler therapy is distinct from TENS. ↩
- ST-5A device instruction manual (Delta International Services & Logistics, rev. 2020) — indications, warnings, contraindications, precautions and treatment protocol, including session length, the ten-treatment course structure, and the exclusions listed above. ↩
- National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health — "Complex Regional Pain Syndrome." ↩
- Dr. Barton completed advanced scrambler therapy training in Rome, Italy, with Dr. Giuseppe Marineo, who developed scrambler therapy at the University of Rome Tor Vergata. ↩
Primary sources on file at the clinic.
The ask
Find out what your nerves do with this — before you learn to live with it.
Call (210) 741-9166. The consultation is $19 — and it isn't a sales pitch.
- The $19 consultation. About an hour: roughly thirty minutes of history and examination — what you've been diagnosed with, what you've tried, and the candidacy list — then about thirty minutes of treatment. Consultations run Monday through Thursday. If you're not a candidate, you hear it at that visit.
- A $99 first session — credited toward the course. A full session, run properly, so you see what your own body does with it before anyone talks about a program.
- You decide, with the number in front of you. If you responded, we walk you through the full course and you decide with everything in writing. If you didn't, we say so.
Texas Spine Clinic · 3212 Napier Park, San Antonio, TX 78231
Monday–Thursday, 8 a.m.–5 p.m. · Friday: scrambler therapy sessions only, by
appointment.
Book your $19 consultation
No referral needed. Same-day appointments available.
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Rather book by phone? Call (210) 741-9166.
P.S. If you've had CRPS for a while, you've heard "this might help" more times than you can count — and you've paid for most of them in pain, money and hope. So here's the one thing on this page that matters most: there is a quick, low-cost way to find out whether this works for you. A $19 consultation and a $99 session, with someone beside you the whole time and your pain as the target — zero, in the chair. Call (210) 741-9166.