- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05661903
From Nerve to Brain: Toward a Mechanistic Understanding of Spinal Cord Stimulation in Human Subjects
June 13, 2023 updated by: Brian Wainger, Massachusetts General Hospital
This is a multicenter prospective study of patients who currently have stably implanted spinal cord simulators.
Patients will be randomly assigned to turn on or off their spinal cord stimulators for two week intervals up to six weeks after enrollment, and on the final day of study participation, for one hour intervals, in a multi-crossover design.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
The fundamental hypothesis for this study is that spinal cord stimulators modulate the excitability of primary afferent neurons to reduce pain, and that these changes can be detected by measurement of axonal excitability.
For the primary outcome, the study investigators will leverage the sensitivity and reproducibility of threshold tracking nerve conduction studies to detect changes in the excitability of thickly myelinated nerve fibers.
The study investigators will use microneurography to record directly from primary nociceptive afferents.
Finally, the study investigators will perform plasma inflammatory cytokine profiles to measure changes due to spinal cord stimulators.
By correlating changes in outcome measurements with subject pain levels during therapeutic versus minimal spinal cord stimulators settings, this study will determine which effects may be mechanistically relevant and which are unrelated to reduction in pain.
Thus, this study will use robust, reproducible techniques to define the peripheral, central, and systemic effects of spinal cord stimulators.
Study Type
Interventional
Enrollment (Estimated)
180
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Brian Wainger, MD PhD
- Phone Number: 617-726-8810
- Email: BWAINGER@PARTNERS.ORG
Study Locations
-
-
Massachusetts
-
Boston, Massachusetts, United States, 02114
- Recruiting
- Massachusetts General Hospital
-
Contact:
- Brian Wainger, MD PhD
-
Sub-Investigator:
- Marco Loggia, PhD
-
Boston, Massachusetts, United States, 02215
- Recruiting
- Beth Israel Deaconess Medical Center
-
Contact:
- Roy Freeman, MD
-
Boston, Massachusetts, United States, 02215
- Recruiting
- Brigham and Women's Hospital
-
Contact:
- Christopher Gilligan, MD
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
16 years to 78 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Aged 18 to 80
- Capable of providing informed consent and following trial procedures, including capacity to complete self-reported measures of pain, function, and other outcomes
- Stably implanted spinal cord or dorsal root ganglion stimulator
- Device is to treat failed back surgery syndrome with back and radicular lower extremity pain
- Device with a paresthesia-free setting
Exclusion Criteria:
- Patients who are not on a stable dose of opioids or are on a stable dose greater than 100 morphine equivalents/day per day within the two months prior to enrollment, or those who are unwilling to maintain a stable dose of opioids throughout the duration of the study
- The investigator concludes that the participant is unable to differentiate failed back surgery syndrome pain from other pains, or the primary cause of pain is unrelated to failed back surgery syndrome.
- Systemic or psychiatric illness that in the opinion of the site investigator would interfere with the individual's ability to participate in the trial
- Other factor that in the opinion of the site investigator would interfere with the individual's ability to participate in the trial or tolerate the study procedures
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Patients with Implanted Devices on Minimal/No Stimulation Settings
Patients in this arm will be randomized to turn off their spinal cord stimulator (or to minimal settings).
|
Patients in this intervention group will have their spinal cord stimulator turned off or to the minimal settings possible.
|
Other: Patients with Implanted Devices on Usual Stimulation Settings
Patients in this arm will be randomized to turn on their spinal cord stimulator to their usual stimulation settings.
|
Patients in this intervention group will have their spinal cord stimulator turned on to their usual stimulation settings.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Supraexcitability
Time Frame: From baseline (enrollment) to six weeks
|
The primary outcome will be superexcitability (indicating paired pulse facilitation) measured by threshold tracking nerve conduction.
|
From baseline (enrollment) to six weeks
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Brian Wainger, MD PhD, Massachusetts General Hospital
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
May 23, 2023
Primary Completion (Estimated)
December 31, 2026
Study Completion (Estimated)
August 31, 2027
Study Registration Dates
First Submitted
December 14, 2022
First Submitted That Met QC Criteria
December 14, 2022
First Posted (Actual)
December 22, 2022
Study Record Updates
Last Update Posted (Actual)
June 15, 2023
Last Update Submitted That Met QC Criteria
June 13, 2023
Last Verified
June 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2022P001803
- 1RM1NS128741-01 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
YES
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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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