- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04451252
Predicting Response to Interventional Pain Management Techniques in Chronic Low Back Pain in a Prospective Cohort. (PReTI-Back)
Observational Prospective Single Centre Study of the Response to Interventional Pain Management Techniques in Chronic Low Back Pain in Adults. 1 and 6 Months Follow-up. Multivariate Analysis of Predictors of Response. Predictive Model.
Study Overview
Status
Intervention / Treatment
- Procedure: Fluoroscopically guided lumbar medial branch nerve radiofrequency denervation.
- Procedure: Fluoroscopically guided lumbar facet joint injection.
- Procedure: Fluoroscopically guided lumbar epidural corticosteroid injection.
- Procedure: Fluoroscopically guided caudal epidural corticosteroid injection.
- Procedure: Fluoroscopically guided pulsed radiofrequency of the lumbar dorsal root ganglion.
- Procedure: Fluoroscopically guided transforaminal epidural corticosteroid injection or lumbar selective root block.
Detailed Description
Study Type
Enrollment (Anticipated)
Contacts and Locations
Study Locations
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-
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Madrid, Spain, 28007
- Hospital General Universitario Gregorio Maranon
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Patients older than 18 years old with chronic lumbar pain to whom one of the following interventional pain management techniques has been indicated:
- Radiofrequency lumbar facet joint injection
- Radiofrequency lumbar facet joint denervation
- Lumbar epidural corticosteroid injection
- Caudal epidural corticosteroid injection
- Pulsed radiofrequency of the lumbar dorsal root ganglion
- Dorsal root ganglion injection
Exclusion Criteria:
- Patients that have not undergone the interventional pain management technique. The interventional pain management technique is considered not performed if it is not done after a twelve month period after recruitment.
- Patients who are not willing to participate.
- Patients of whom it is impossible to obtain data of response.
- Patients who undergo low back surgery while they are in the study.
- Patients who suffer from an intercurrent disease that may interfere with the evaluation of chronic lumbar pain.
- Patients who suffer from myofascial pain syndromes.
- Patients who undergo pulsed radiofrequency denervation for the treatment of sacroiliac joint syndrome.
Study Plan
How is the study designed?
Design Details
- Observational Models: Other
- Time Perspectives: Prospective
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Clinical response to IPMT after 4 weeks follow-up after the IPMT is performed (composite outcome)
Time Frame: Baseline (prior to the Interventional Pain Management Therapy); Week 4 after IPMT
|
Clinical response after 4 week follow-up is going to be defined as composite outcomes:
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Baseline (prior to the Interventional Pain Management Therapy); Week 4 after IPMT
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Factors that may be associated with no response to the IPMT at 4 weeks follow-up.
Time Frame: Response will be measured after 4 weeks follow-up after the IPMT.
|
14 candidate variables will be analyzed for association to no response to the IPMT at 4 weeks (NR-4W). All the variables are qualitative, dichotomic, yes/no:
|
Response will be measured after 4 weeks follow-up after the IPMT.
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Factors that may be associated with a positive response to the IPMT (PSR-4W or PMR-4W).
Time Frame: Response will be measured after 4 weeks follow-up.
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14 candidate variables will be analyzed for association to PSR-4W or PMR-4W to the IPMT at 4 weeks. All the variables are qualitative, dichotomic, yes/no:
|
Response will be measured after 4 weeks follow-up.
|
Clinical response to IPMT after 24 weeks follow-up after the IPMT is performed (composite outcome).
Time Frame: Response will be measured after 24 weeks follow-up after the IPMT.
|
Clinical response after 24 week follow-up is going to be defined as composite outcomes:
|
Response will be measured after 24 weeks follow-up after the IPMT.
|
Factors that may be associated with no response to the IPMT at 24 weeks follow-up.
Time Frame: The factors will be recorded at baseline; the response will be measured at after 24 weeks follow-up.
|
14 candidate variables will be analyzed for association to no response to the IPMT at 24 weeks (NR-24W). All the variables are qualitative, dichotomic, yes/no:
|
The factors will be recorded at baseline; the response will be measured at after 24 weeks follow-up.
|
Factors that may be associated with a positive response to the IPMT after a 24 weeks follow-up (PSR-24W or PMR-24W).
Time Frame: Response will be measured after 24 weeks follow-up after the IPMT.
|
14 candidate variables will be analyzed for association to PSR-4W or PMR-4W to the IPMT at 24 weeks. All the variables are qualitative, dichotomic, yes/no:
|
Response will be measured after 24 weeks follow-up after the IPMT.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Validation a predictive model for positive response to the IPMT after 4 weeks
Time Frame: Response will be measured after 4 weeks follow-up after the IPMT.
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In case that several predictive variables are identified, a predictive model will be developed, either for predicting good and/or bad response.
|
Response will be measured after 4 weeks follow-up after the IPMT.
|
Validation a predictive model for positive response to the IPMT after 24 weeks
Time Frame: Response will be measured after 24 weeks follow-up after the IPMT.
|
In case that several predictive variables are identified, a predictive model will be developed, either for predicting good and/or bad response.
|
Response will be measured after 24 weeks follow-up after the IPMT.
|
Identifying other variables that may be associated with a good or bad response to an interventional pain management therapy (IPMT) at 4 weeks
Time Frame: Response will be measured after 4 weeks follow-up after the IPMT
|
Other variables recorded in the Data Collection Logbook of our study will be analyzed looking for other associations:
|
Response will be measured after 4 weeks follow-up after the IPMT
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Identifying other variables that may be associated with a good or bad response to an interventional pain management therapy (IPMT) at 24 weeks
Time Frame: Response will be measured after 24 weeks follow-up after the IPMT
|
Other variables recorded in the Data Collection Logbook of our study will be analyzed looking for other associations:
|
Response will be measured after 24 weeks follow-up after the IPMT
|
Analyzing the response after 4 weeks to therapy of each interventional pain management therapy alone, and which variables may be associated with a better response to therapy.
Time Frame: Response will be measured after 4 weeks follow-up after the IPMT
|
The therapies that will be analyzed are:
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Response will be measured after 4 weeks follow-up after the IPMT
|
Analyzing the response after 24 weeks to therapy of each interventional pain management therapy alone, and which variables may be associated with a better response to therapy.
Time Frame: Response will be measured after 24 weeks follow-up after the IPMT
|
The therapies that will be analyzed are:
|
Response will be measured after 24 weeks follow-up after the IPMT
|
Studying the association between main clinical diagnosis and the response to therapy, globally and stratified by single IPMT, after 4 weeks of the IPMT
Time Frame: Response will be measured after 4 weeks follow-up after the IPMT
|
Main clinical diagnosis, response to therapy and IPMT performed are described separately as outcomes.
|
Response will be measured after 4 weeks follow-up after the IPMT
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Studying the association between main clinical diagnosis and the response to therapy, globally and stratified by single IPMT, after 24 weeks of the IPMT
Time Frame: Response will be measured after 24 weeks follow-up after the IPMT
|
Main clinical diagnosis, response to therapy and IPMT performed are described separately as outcomes.
|
Response will be measured after 24 weeks follow-up after the IPMT
|
Studying the satisfaction of the patients to the IPMT performed, after 24 weeks of IPMT
Time Frame: Satisfaction will be measured after 24 weeks follow-up after the IPMT
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Patient satisfaction will be assessed as two separate YES/NO questions:
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Satisfaction will be measured after 24 weeks follow-up after the IPMT
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Studying the satisfaction of the patients to the IPMT performed, after 4 weeks of IPMT
Time Frame: Satisfaction will be measured after 4 weeks follow-up after the IPMT
|
Patient satisfaction will be assessed as two separate YES/NO questions: - Are you satisfied with the pain-relief obtained after you underwent the Interventional Pain Management Technique? (YES/NO answer). Patient satisfaction will be assessed as two separate YES/NO questions:
|
Satisfaction will be measured after 4 weeks follow-up after the IPMT
|
Studying the correlation of both scales (Numeric Rating Scale and Oswestry Disability Index) and patient satisfaction after 4 weeks of the IPMT
Time Frame: Response and satisfaction will be measured after 4 weeks follow-up after the IPMT
|
Patient satisfaction will be assessed as two separate YES/NO questions:
|
Response and satisfaction will be measured after 4 weeks follow-up after the IPMT
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Studying the correlation of both scales (Numeric Rating Scale and Oswestry Disability Index) and patient satisfaction after 24 weeks of the IPMT
Time Frame: Response and satisfaction will be measured after 24 weeks follow-up after the IPMT
|
Patient satisfaction will be assessed as two separate YES/NO questions:
|
Response and satisfaction will be measured after 24 weeks follow-up after the IPMT
|
Studying the epidemiology and evolution of the pharmacological therapy of our population (Part I)
Time Frame: Drug therapy will be recorded at baseline
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Variable #1. Qualitative; is the patient taking any of the following medications (YES/NO for each treatment) at visit 0?:
Variable #2. Quantitative. 24 hour dose of each pharmacologic treatment the patient is taking at visit 0. |
Drug therapy will be recorded at baseline
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Studying the epidemiology and evolution of the pharmacological therapy of our population (Part II)
Time Frame: Drug therapy will be recorded at baseline; change in therapy will be recorded vs 4 weeks and vs 24 weeks.
|
Variable #3. Qualitative. Is the patient taking any pharmacological treatment belonging to any of the following cathegories?:
Variable #4. Qualitative. Has it been any change in pharmacological treatment in the follow-up (baseline vs 4 weeks and vs 24 weeks) ; related to each pharmacological treatment)?:
Variable #5. Qualitative. Why was the pharmacological treatment changed (baseline vs 4 weeks and vs 24 weeks) ?:
|
Drug therapy will be recorded at baseline; change in therapy will be recorded vs 4 weeks and vs 24 weeks.
|
Studying the safety and potential adverse reactions to IPMT.
Time Frame: Potential adverse reactions will be measured at the end of follow-up (after 24 weeks of the IPMT)
|
Several cathegories:
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Potential adverse reactions will be measured at the end of follow-up (after 24 weeks of the IPMT)
|
Studying the epidemiology of radiological findings in our population, and its association with the IPMT performed and the response to therapy after 4 weeks.
Time Frame: Response will be measured after 4 weeks follow-up after the IPMT
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Several cathegories or radiological findings:
|
Response will be measured after 4 weeks follow-up after the IPMT
|
Studying the epidemiology of radiological findings in our population, and its association with the IPMT performed and the response to therapy after 24 weeks.
Time Frame: Response will be measured after 24 weeks follow-up after the IPMT
|
Several cathegories or radiological findings:
|
Response will be measured after 24 weeks follow-up after the IPMT
|
Studying the epidemiology of radiological findings in our population, and its association with clinical findings and clinical diagnosis.
Time Frame: Response will be measured after 24 weeks follow-up after the IPMT
|
Several cathegories:
Clinical findings are:
Clinical diagnosis are defined as another outcome measure. |
Response will be measured after 24 weeks follow-up after the IPMT
|
Analyzing the epidemiology of comorbidities (pain and not pain related) in our population:
Time Frame: Comorbidites will be recorded at baseline
|
Comorbities that will be analyzed are:
|
Comorbidites will be recorded at baseline
|
Analyzing the demographical data of the study population.
Time Frame: Demographical data will be obtained at baseline
|
Age, sex, marital status, working status at ethnic group and Medical Specialty that derivated the patient to our unit will be recorded at base line.
|
Demographical data will be obtained at baseline
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Studying the evolution in time of the response to the IPMT.
Time Frame: the response will be measured at +4weeks, +8weeks and +24 weeks
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Positive strong response, both strong (PSR) and moderate (PMR), as defined in "Primary outcomes" will be measured both at baseline vs 4 weeks follow-up, baseline vs 24 weeks follow-up and baseline vs 8 weeks follow-up. The evolution of the pain response will be studied; response and satisfaction will be measured at 4 different moments:
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the response will be measured at +4weeks, +8weeks and +24 weeks
|
Charlson comorbidity index
Time Frame: Calculated at baseline
|
Charlson comorbidity index will be calculated at baseline.
|
Calculated at baseline
|
Pain syndrome
Time Frame: Pain syndrome is diagnosed at baseline
|
Variable 1: presence of any of the following diagnosis:
Variable n3: number of pain syndromes present in the patient, of all the above. |
Pain syndrome is diagnosed at baseline
|
Main operator of the IPMT
Time Frame: Measured 4 weeks after IPMT is performed
|
Two cathegories:
|
Measured 4 weeks after IPMT is performed
|
Previous treatments, and success
Time Frame: Measured at baseline
|
Variables n1 and n 2 are qualitative. Measured at visit 0. Variable n 1: the patient has undergone any of these treatments:
Variable n 2: subjective satisfaction of the patient:
|
Measured at baseline
|
Numeric Rating Scale of pain at baseline
Time Frame: baseline
|
The 11-point numerical pain rating scale (NRS) is a measure of pain in which patients rate their pain ranging from 0 (no pain) to 10 (worst imaginable pain).
Validated in Childs JD, Piva SR, Fritz JM.
Responsiveness of the numeric pain rating scale in patients with low back pain.
Spine 2005;30:1331-4.
|
baseline
|
Numeric Rating Scale of pain at 4 weeks after the IPMT is performed
Time Frame: 4 weeks after the IPMT is performed
|
The 11-point numerical pain rating scale (NRS) is a measure of pain in which patients rate their pain ranging from 0 (no pain) to 10 (worst imaginable pain).
Validated in Childs JD, Piva SR, Fritz JM.
Responsiveness of the numeric pain rating scale in patients with low back pain.
Spine 2005;30:1331-4.
|
4 weeks after the IPMT is performed
|
Numeric Rating Scale of pain at 8 weeks after the IPMT is performed
Time Frame: 8 weeks after the IPMT is performed
|
The 11-point numerical pain rating scale (NRS) is a measure of pain in which patients rate their pain ranging from 0 (no pain) to 10 (worst imaginable pain).
Validated in Childs JD, Piva SR, Fritz JM.
Responsiveness of the numeric pain rating scale in patients with low back pain.
Spine 2005;30:1331-4.
|
8 weeks after the IPMT is performed
|
Numeric Rating Scale of pain at 24 weeks after the IPMT is performed
Time Frame: 24 weeks after the IPMT is performed
|
The 11-point numerical pain rating scale (NRS) is a measure of pain in which patients rate their pain ranging from 0 (no pain) to 10 (worst imaginable pain).
Validated in Childs JD, Piva SR, Fritz JM.
Responsiveness of the numeric pain rating scale in patients with low back pain.
Spine 2005;30:1331-4.
|
24 weeks after the IPMT is performed
|
Oswestry Disability Index at baseline
Time Frame: baseline
|
Original version 1 (1980), translated and adapted to Spanish (1995), validated.
|
baseline
|
Oswestry Disability Index at 4 weeks after the IPMT is performed
Time Frame: 4 weeks after the IPMT is performed
|
Original version 1 (1980), translated and adapted to Spanish (1995), validated.
|
4 weeks after the IPMT is performed
|
Oswestry Disability Index at 8 weeks after the IPMT is performed
Time Frame: 8 weeks after the IPMT is performed
|
Original version 1 (1980), translated and adapted to Spanish (1995), validated.
|
8 weeks after the IPMT is performed
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Oswestry Disability Index at 24 weeks after the IPMT is performed
Time Frame: 24 weeks after the IPMT is performed
|
Original version 1 (1980), translated and adapted to Spanish (1995), validated.
|
24 weeks after the IPMT is performed
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Clinical Frailty Scale at baseline
Time Frame: Obtained at baseline
|
As described by Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I et al.
A global clinical measure of fitness and frailty in elderly people.
CMAJ 2005;173:489-95.
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Obtained at baseline
|
Previous treatments, and success
Time Frame: Mesured at baseline
|
Variables n1 and n 2 are qualitative. Measured at visit 0. Variable n 1: the patient has undergone any of these treatments:
Variable n 2: subjective satisfaction of the patient:
|
Mesured at baseline
|
Interventional Pain Management Technique indicated at visit 0.
Time Frame: Baseline
|
Several cathegories:
|
Baseline
|
Interventional Pain Management Technique performed.
Time Frame: Measured 4 weeks after the IPMT
|
Several cathegories:
|
Measured 4 weeks after the IPMT
|
Imaging modality
Time Frame: Baseline
|
Qualitative:
|
Baseline
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Santiago Garcia-Hernandez, Hospital General Universitario Gregorio Maranon
- Study Chair: Ana Esther Lopez Perez, Hospital General Universitario Gregorio Maranon
- Principal Investigator: Fernando Higuero-Cantonero, Hospital General Universitario Gregorio Maranon
Publications and helpful links
General Publications
- Sivaganesan A, Chotai S, Parker SL, Asher AL, McGirt MJ, Devin CJ. Predictors of the efficacy of epidural steroid injections for structural lumbar degenerative pathology. Spine J. 2016 Aug;16(8):928-34. doi: 10.1016/j.spinee.2015.11.058. Epub 2015 Dec 9.
- Manchikanti L, Buenaventura RM, Manchikanti KN, Ruan X, Gupta S, Smith HS, Christo PJ, Ward SP. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician. 2012 May-Jun;15(3):E199-245.
- Cyteval C, Fescquet N, Thomas E, Decoux E, Blotman F, Taourel P. Predictive factors of efficacy of periradicular corticosteroid injections for lumbar radiculopathy. AJNR Am J Neuroradiol. 2006 May;27(5):978-82.
- Park DY, Kang S, Park JH. Factors Predicting Favorable Short-Term Response to Transforaminal Epidural Steroid Injections for Lumbosacral Radiculopathy. Medicina (Kaunas). 2019 May 18;55(5):162. doi: 10.3390/medicina55050162.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- PRETI-DOL-V1
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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