Vestibular Caloric Stimulation and the Modulation of Pain in Fibromyalgia

Vestibular Caloric Stimulation and the Modulation of Pain in Fibromyalgia: An Open Label Pilot Study

The management of chronic pains is challenging and fraught with limitations. Fibromyalgia is a common pain disorder characterized by chronic widespread pains, associated with fatigue and impaired quality of life. Fibromyalgia affects millions of people and is among the most common reasons for consulting with a rheumatologist. The food and drug administration (FDA) approved three medications to treat fibromyalgia, though there are many patients for whom these medications are ineffective, poorly tolerated or cost-prohibitive. Accordingly, there exists a need for novel therapeutics.

The researchers would like to test the therapeutic efficacy of a non-pharmacologic non-interventional bedside technique called vestibular caloric stimulation (VCS). VCS, irrigating the external ear canal with water, is a simple, non-invasive, cost-free procedure with preliminary data suggesting potential for improving pain. VCS is a form of neuromodulation and there are anatomically defined pathways elucidated to help explain how this works. There currently exists limited data on the topic, only case reports and case series. Given a clear need for additional therapeutics in many patients with fibromyalgia, the researchers have elected to conduct this trial.

Study Overview

• Status: Completed
• Conditions: Fibromyalgia
• Intervention / Treatment: Procedure: Vestibular Caloric Stimulation

Detailed Description

This is an open label pilot study testing the potential therapeutic efficacy of vestibulocortical stimulation via cold water calorics in fibromyalgia. The trial will entail 6 weeks of total involvement for each participant including 3 weeks of active participation, with 4 weeks follow up: the irrigation happens at the beginning of week 2, so 4 weeks later is week 6.

• Study Type: Interventional
• Enrollment (Actual): 21
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • New York
    • New York, New York, United States, 10029
      • Icahn School of Medicine at Mount Sinai

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• At least 18 years old with ability to comprehend and consent to protocol.
• Diagnosis of fibromyalgia by American College of Rheumatology (ACR) criteria (questionnaire).
• At least a 4/10 baseline on the visual analogue pain scale (VAS).
• Stable fibromyalgia medications for at least 4 weeks.
• Owns or has access to a smart phone or computer to complete outcome measures.

Exclusion Criteria:

• Use of opioids
• Otitis externa or media within the past six months.
• Current ear pain with or without other symptoms of otitis externa.
• History of tympanic membrane rupture or surgery.
• Current pregnancy.
• Inability to lay supine for 30 minutes.
• Limited decision making capacity.
• Engaged in litigation, currently or prior, related to FMS.
• Inability to commute to clinic once.
• Primary language not English.
• Clinically significant or unstable medical or psychological conditions that, in the opinion of the investigator, would compromise participation in the study
• Treatment with the medication meclizine for vertigo
• History of seizures
• Diagnosis of bipolar disorder (treated or untreated)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cold water caloric stimulation; 50 cc of ice-cold water irrigation into the right ear at 1-2 cc/second, once per participant.	Procedure: Vestibular Caloric Stimulation; Irrigation of the right external ear canal; Other Names: VCS; Cold water caloric stimulation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Numeric Rating Scale (NRS)	Change in average diary pain scores assessed by daily report on a 11 point numeric rating scale at 1 week after VCS as compared to baseline. Full scale range from 0-10, higher score indicates more pain.	baseline and 1 week after VCS

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Acute change in NRS	Acute effect of VCS assessed by acute change in pain scores post VCS 5, 15 and 30 minutes post irrigation compared to baseline. Full scale range from 0-10, higher score indicates more pain.	baseline and 5, 15 and 30 minutes after VCS
Percentage of participants with NRS pain scores >= to 30% and 50%	Percentage of patients with change in pain assessed by NRS pain scores > or equal to 30% and 50%.	30 minutes, 24 hours, 1 week, 2 weeks after VCS
Patient Global Impression of Change (PGIC)	Full score from 0-7, with higher score indicating more improvement.	at 1 weeks, 2 weeks and 4 weeks after VCS
Change in Multidimensional Assessment of Fatigue (MAF)	MAF is a 16 item instrument, full scale from 0-50, with higher score indicating more fatigue.	baseline and at 1, 2 and 4 weeks after VCS
Michigan Neuropathy Screening Instrument (MNSI)	15 "yes or no" questions - full score from 0-13, with higher score indicating more neuropathic symptoms.	baseline and at 1, 2 and 4 weeks after VCS
Change in Brief Pain Inventory Short Form 36 (BPI SF36)	A 9-item instrument with total score from 0 to 10, with higher score indicating worse outcomes. Will exclude question 2 which is a diagram and question 7 which asks about medications.	baseline and at 24 hours, 1 week, 2 weeks, 4 weeks after VCS
Change in Fibromyalgia Impact Questionnaire (FIQ)	Full scale from 0-100, with higher score indicating a greater impact of fibromyalgia syndrome.	baseline and at 1, 2 and 4 weeks after VCS
Change in Numeric Rating Scale (NRS) for pain in different regions of the body	Pain measured on a numeric rating scale in different regions of the body: the left upper extremity, right upper extremity, left lower extremity, right lower extremity, front of torso, back of torso, head/neck. Full scale range from 0-10, higher score indicates more pain.	baseline and at 24 hours, 1 week, 2 week, 4 week after VCS
VCS Tolerability Survey	A seventeen question tolerability instrument developed specifically for caloric stimulation to assess tolerability by measuring the frequency and intensity of headaches, nausea, and vertigo. the tolerability scale does not have a total score just individual questions re headache nausea vertigo discomfort and grades intensities rated on a 0-10 scale, higher numbers reflecting higher severity of symptoms.	24 hours post VCS
Number of participants willing to trial VCS again	Number of participants expressing willingness to trial VCS again	24 hours post VCS
Change in Subjective Overall Well Being Scale	Subjective Overall Well Being Scale is a 11 point scale with full scale from 0-10, with higher score reflecting the best possible overall subjective disposition	at baseline and at 30 minutes after VCS, 24 hours, 1 week, 2 week and 4 weeks after VCS relative

Collaborators and Investigators

• Sponsor: Icahn School of Medicine at Mount Sinai
• Investigators: Principal Investigator: Ioannis Tassiulas, MD, Icahn School of Medicine at Mount Sinai

Study record dates

Study Major Dates

• Study Start (Actual): March 19, 2021
• Primary Completion (Actual): July 2, 2021
• Study Completion (Actual): July 2, 2021

Study Registration Dates

• First Submitted: August 9, 2021
• First Submitted That Met QC Criteria: August 9, 2021
• First Posted (Actual): August 13, 2021

Study Record Updates

• Last Update Posted (Actual): August 19, 2021
• Last Update Submitted That Met QC Criteria: August 12, 2021
• Last Verified: August 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nervous System Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Muscular Diseases; Neuromuscular Diseases; Fibromyalgia; Myofascial Pain Syndromes
• Other Study ID Numbers: GCO 20-2730

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No