Harry J. Duffey Family Professor of Palliative Medicine and
Director of Palliative Medicine, Johns Hopkins Medical Institutions
Professor of Oncology, Sidney Kimmel Comprehensive Cancer Center
Training
University of Akron, B.S., summa cum laude 1971-74
Yale University School of Medicine, M.D. cum laude 1974-79
Yale University School of Organization and Management (core curriculum, one year) 1977-78
Special Visiting Fellow, National Cancer Center Biological Response Modifiers Program, Frederick, MD 1986
Virginia Commonwealth University Fellowship in Hematology/Oncology 1982-87
Project on Death in America Faculty Scholar, 1995-98
Current position
Professor of Oncology, Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins, and the Harry J. Duffey Family Professor of Palliative Medicine, and Director of Palliative Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
Dr. Smith is a medical oncologist and palliative care specialist with a lifelong interest in better symptom management, open and accurate communication, and improving access to high quality affordable care. He is the Director of Palliative Medicine for Johns Hopkins Medicine, charged with integrating palliative care into all the Johns Hopkins venues. The hospital wide PC consult service sees over 1500 patients a year, runs a 6-bed inpatient PC unit, and has a growing research agenda with “Scrambler Therapy” for pain, decision aids, integrated palliative care for patients on Phase I drug trials, and communication about serious illness.
Dr. Smith has a long track record of starting innovative programs with concurrent evaluation of their impact on care and costs, including the Virginia Rural Cancer Outreach Program, the Thomas Palliative Care Program, the Virginia Initiative on Palliative Care, and the Rural Palliative Care Program, among others. He attends on the Longcope Service of the Osler Medical Housestaff training program as well as in Palliative Care.
Dr. Smith received the national Humanism in Medicine Award in 2000, and in 2000 and 2006 was voted the Distinguished Clinician on the VCU-MCV Faculty. He has been recognized in “Best Doctors in America” for many years. He is a Fellow in the American College of Physician, the American Society of Clinical Oncology and the American Academy of Hospice and Palliative Medicine. In 2012 Bruce Hillner and he received the ABIM “Professionalism” Price for their NEJM article “Bending the Cost Curve in Cancer Care” and leading the “Choosing Wisely” initiatives for AAHPM and ASCO.
He is a 2010 ACS grantee to study the absorption of "ABH" gel as used for nausea; his other funded research includes an RO1 for a randomized trial of PC versus usual care for Phase I cancer patients, PC for pancreas cancer patients, patient-decision aids, and "scrambler" therapy for pain.
Symposium: Cancer pain management ‒ Up To Date
[Additional comment]
Possible Relief of Pain with Scrambler Therapy, a Type of External Neurocutaneous Stimulation
Abstract
Background: Pain affects about 70% of cancer patients, and is more common as the cancer is advanced. Chemotherapy-induced neuropathic pain (CIPN) affects 30-40% of cancer patients, with no good treatments. We tested Scrambler Therapy (ST) with the Calmare ® MC-5A that creates electrical impulses that represent “non-pain” information to replace the pain impulse, to relieve cancer-related pain.
Methods: Synthesis of 3 completed clinical trials. Treatment was given with external EKG electrodes above and below the pain, following the dermatome, for 30-45 minutes daily for 10 days. Treatment could be repeated if the pain returned.
Results: In our pilot trial of 16 patients with refractory CIPN the pain score fell 59% from 5.81±1.11 before treatment to 2.38±1.82 at the end of 10 days (P<0.0001 by paired t-test). No toxicity was seen, and some responses lasted months. (Smith TJ, et al. J Pain Symptom Manage. 2010;40:883-91) We repeated that study in an additional 39 patients with cancer pain. The "now" pain scores reduced from 6.6 before treatment to 4.5 at 14 days, 4.6, 4.8, and 4.6 at 1, 2, and 3 months, respectively (p < 0.001). Improvements were seen in average, least, and worst pain; BPI interference with life scores, and motor and sensory scales on the EORTC CIPN-20. (Coyne PJ, et al. J Pain Palliat Care Pharmacother. 2013;27:359-64) Other investigators have reported similar results. (Ricci M, et al. Support Care Cancer 2012;20:405-12) We completed a Phase II randomized trial comparing Scrambler Therapy to best medical management in 52 patients with spinal cord stenosis, failed back syndrome, and post-herpetic neuralgia. At one month, the mean VAS score was reduced from 8.1 to 5.8 (-28%) in the control group, and from 8 to 0.7 points (-91%) in the Scrambler group (P<0.0001). At two and three months, the mean pain scores in the control group were 5.7 and 5.9 points, respectively, and 1.4 and 2 points in the Scrambler group (P<0.0001). (Marineo G et al. J Pain Symptom Manage. 2012;43:87-95.) Reductions in pain are similar to those seen with invasive neuromodulation.(Verrills P, et al. Pain Med. 2011;12:1395-405.) We are starting a sham-control trial to control for the placebo response as one explanation for the good pain relief we have observed.
Conclusions: Patient-specific cutaneous electrostimulation with Scrambler Therapy done with the Calmare® MC-5A device appears to dramatically reduce pain in refractory pain patients with minimal toxicity. Further studies are underway to define the benefit compared to placebo or sham, the mechanisms of action, and optimal schedule.
