Erector Spinae Plane Block Versus Trigger Point Injection for Chronic Thoracic Myofascial Pain
Ultrasound-guided Erector Spinae Plane (ESP) Block Versus Trigger Point Injection (TPI) for Chronic Thoracic Myofascial Pain: A Randomized Controlled Trial
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 4
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Ryan D'Souza, MD
- Telefonnummer: 507-284-9696
- E-mail: dsouza.ryan@mayo.edu
Studiesteder
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Florida
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Jacksonville, Florida, Forenede Stater, 32224
- Ikke rekrutterer endnu
- Mayo Clinic
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Kontakt:
- Eva Kubrova, MD
- Telefonnummer: 904-956-2043
- E-mail: kubrova.eva@mayo.edu
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Ledende efterforsker:
- Eva Kubrova, MD
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Maryland
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Baltimore, Maryland, Forenede Stater, 21201
- Ikke rekrutterer endnu
- University of Maryland
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Kontakt:
- Jay Karri, MD
- Telefonnummer: 410-706-3100
- E-mail: jkarri@som.umaryland.edu
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Ledende efterforsker:
- Jay Karri, MD
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Minnesota
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Rochester, Minnesota, Forenede Stater, 55905
- Rekruttering
- Mayo Clinic
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Ledende efterforsker:
- Ryan D'Souza, MD
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Kontakt:
- Ryan D'Souza, MD
- Telefonnummer: 507-284-9696
- E-mail: dsouza.ryan@mayo.edu
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Ohio
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Columbus, Ohio, Forenede Stater, 43210
- Ikke rekrutterer endnu
- The Ohio State University Wexner Medical Center
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Kontakt:
- Nasir Hussain, MD
- Telefonnummer: 614-293-8000
- E-mail: nasir.hussain@osumc.edu
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Ledende efterforsker:
- Nasir Hussain, MD
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Texas
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Houston, Texas, Forenede Stater, 77030
- Ikke rekrutterer endnu
- MD Anderson Cancer Center
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Ledende efterforsker:
- Saba Javed, MD
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Kontakt:
- Saba Javed, MD
- Telefonnummer: 877-632-6789
- E-mail: sjaved@mdanderson.org
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Beskrivelse
Inclusion Criteria:
- Adults aged 18-80 years
- Chronic thoracic myofascial pain lasting at least three months
- Pain intensity of ≥4 on 11-point NRS
- At least two of three following conditions: Focal thoracic paraspinal pain, palpable taut band, referred pain pattern with palpation
Exclusion Criteria:
- Thoracic radiculopathy
- Cervical myelopathy with neurological deficit
- Prior cervicothoracic spine surgery
- Pregnancy or lactation
- Contraindication to local anesthetic
- Active malignancy
- Fibromyalgia
- BMI >40 kg/m2
- Workers' compensation or active litigation related to thoracic pain
- Acute herpes zoster or history of postherpetic neuralgia involving thoracic dermatomes
- Current opioid use >50 morphine milligram equivalents daily
- Severe psychiatric or cognitive disorders, specifically history of schizophrenia, chronic psychotic disorders, dementia
- History of substance use disorder
- Inability to provide informed consent
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Enkelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
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Eksperimentel: Erector Spinae Plane (ESP) Block
Participants will receive an ultrasound-guided thoracic erector spinae plane (ESP) block at the thoracic level corresponding to the location of maximal pain.
Under ultrasound guidance, a 22-gauge needle will be advanced into the fascial plane deep to the erector spinae muscle and superficial to the transverse process.
Participants will receive 5 mL of 0.5% plain bupivacaine per side, with bilateral injections performed when clinically indicated for bilateral thoracic pain.
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Participants will receive an ultrasound-guided thoracic erector spinae plane (ESP) block at the thoracic level corresponding to the location of maximal pain.
Under ultrasound guidance, a 22-gauge needle will be advanced into the fascial plane deep to the erector spinae muscle and superficial to the transverse process.
Participants will receive 5 mL of 0.5% plain bupivacaine per side, with bilateral injections performed when clinically indicated for bilateral thoracic pain.
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Aktiv komparator: Trigger Point Injection (TPI)
Participants will receive ultrasound-guided trigger point injection(s) into the thoracic paraspinal musculature at the site(s) of maximal tenderness.
Under ultrasound guidance, 0.5% plain bupivacaine will be injected in volumes of 1-2 mL per injection site, with a maximum total volume of 5 mL per side and up to five injection sites per laterality.
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Participants will receive ultrasound-guided trigger point injection(s) into the thoracic paraspinal musculature at the site(s) of maximal tenderness.
Under ultrasound guidance, 0.5% plain bupivacaine will be injected in volumes of 1-2 mL per injection site, with a maximum total volume of 5 mL per side and up to five injection sites per laterality.
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Numeric Rating Scale (NRS) Pain Score
Tidsramme: baseline, 6 weeks
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A Numeric Rating Scale (NRS) for pain is a patient-reported item regarding the level of pain experienced and is measured on a Likert scale from 0 to 10, where 0 represents "no pain" and 10 represents "the worst pain imaginable".
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baseline, 6 weeks
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Modified Oswestry Disability Index
Tidsramme: baseline, 6 weeks
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Oswestry Disability Index (ODI) is a validated 10-item questionnaire assessing functional limitations in daily activities across spinal disorders, with total scores ranging from 0 to 100, where higher scores indicate greater disability.
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baseline, 6 weeks
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Center for Epidemiologic Studies Depression Scale (CES-D)
Tidsramme: baseline, 6 weeks
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Center for Epidemiologic Studies Depression Scale (CES-D) is a 20-item questionnaire with scores ranging from 0 to 60, with higher scores indicating greater depressive symptom burden.
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baseline, 6 weeks
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Pain Catastrophizing Scale (PCS)
Tidsramme: baseline, 6 weeks
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The PCS is a 13-item instrument measuring catastrophic thinking related to pain, with scores ranging from 0 to 52, and scores of 30 or higher indicating clinically significant levels of catastrophizing.
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baseline, 6 weeks
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Patient Global Impression of Change (PGIC)
Tidsramme: 6 weeks
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The PGIC questionnaire is a 7-point Likert scale ranging from "very much worse" to "very much improved."
This measure provides a global assessment of treatment benefit from the patient's perspective.
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6 weeks
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Repeat Injections
Tidsramme: 12 weeks
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This measure will assess the number of patients requiring repeat injection(s) within 12 weeks following the index procedure.
Measurement: Binary outcome (yes/no), obtained via follow-up assessment of medical record review (no patient questionnaire).
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12 weeks
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Adverse Events
Tidsramme: Day 0 (procedure day), 6 weeks
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We will assess the occurrence of procedure-related adverse events within 6 weeks following the index procedure.
This will involve categorical recording of adverse events including but not limited to: injection site pain, hematoma, infection, vasovagal reaction, allergic reaction, pneumothorax, and new or worsening neurologic symptoms.
All adverse events will be recorded and categorized according to severity and relatedness to the procedure.
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Day 0 (procedure day), 6 weeks
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Andre resultatmål
Andre resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Fasciculation (in Trigger Point Injection Cohort Only)
Tidsramme: Day 0 (procedure day)
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Proceduralist will document occurrence (yes/no) of muscle fasciculation while performing trigger point injection.
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Day 0 (procedure day)
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Taut band Visualization (in Trigger Point Injection Cohort Only)
Tidsramme: Day 0 (procedure day)
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The proceduralist will document ultrasound visualization of a taut band (yes/no) while performing trigger point injection only.
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Day 0 (procedure day)
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Numeric Rating Scale (NRS) Pain Score During and After Injection
Tidsramme: Day 0 (procedure day)
|
A Numeric Rating Scale (NRS) for pain is a patient-reported item regarding the level of pain experienced and is measured on a Likert scale from 0 to 10, where 0 represents "no pain" and 10 represents "the worst pain imaginable".
Participants will be asked to rate their worst injection pain experienced during the procedure, and also to rate their immediate post-procedural pain intensity.
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Day 0 (procedure day)
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Efterforskere
Efterforskere
- Ledende efterforsker: Ryan D'Souza, MD, Mayo Clinic
Publikationer og nyttige links
Hjælpsomme links
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- 26-004708
Plan for individuelle deltagerdata (IPD)
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