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Individuaalinen kryoneurolyysi kipujen hoitoon spastisuuden yhteydessä ylä- ja alaraajoissa (ICE)

maanantai 2. marraskuuta 2026 päivittänyt: Oxford University Hospitals NHS Trust

Yksilöllistetty kryoneurolyysi kivun hoidossa spastisuuden yhteydessä ylä- ja alaraajoissa (ICE): pilottitutkimus satunnaistetulla kontrolloidulla tutkimusasetelmalla

Spasticity is an umbrella term for impairments of muscle tone and control in people with damage to the brain and spinal cord. It is highly prevalent and results in pain, stiffness, and contribute to difficulties in activities of daily living. Current treatment options are limited, and many people experience only partial reduction in spasticity and frequent repeated treatments are needed.

Cryoneurolysis is a medical technique which involves the controlled freezing of the nerves. It has been approved in the UK for the treatment of pain in the context of spasticity through the targeting of nerves which control problematic muscles. Oxford University Hospitals NHS Foundation Trust has been offering this treatment routinely since January 2024. This pilot study aims to improve the understanding of the potential effectiveness of this treatment and its potential side effects when compared with a more commonly used treatment (Botulinum Toxin).

Participants will be randomly allocated to receive usual care with Botulinum Toxin (control group) or usual care with Cryoneurolysis (intervention group). The investigators will assess pain, goal attainment, side effects, spasticity, disability and independence in daily activities, and movement of the arm and leg. Assessments will be at baseline and then 6-, 12-, 18-, and 24-weeks following treatment. Participants who are randomised to the control group will have the opportunity to receive cryoneurolysis treatment after the 12 week follow up assessment.

The results of this study will help to guide future studies to examine the effectiveness of this treatment.

Tutkimuksen yleiskatsaus

Tila

Rekrytointi

Ehdot

Interventio / Hoito

Yksityiskohtainen kuvaus

Spasticity is an umbrella term for impairments of muscle activity and control in the context of damage or dysfunction in the central nervous system, occurring in up to 87% of spinal cord injury patients, 42% of stroke patients, and 80% of patients with multiple sclerosis. Spasticity results in pain, stiffness, and restrictions to activity including difficulties in personal care and mobility and a significant impact on quality of life.

Treatments including oral medications, botulinum toxin injections, and physical therapies can provide some degree of relief, but effectiveness varies widely. Many patients experience only partial reduction in spasticity, contributing to ongoing functional limitations. Botulinum toxin injections provide temporary relief necessitating frequent treatments (every 3-4 months). This is burdensome for patients and healthcare providers, with associated time and treatment costs. Pharmacological treatments can lead to systemic side effects including drowsiness, dizziness, and cognitive impairments. Surgical interventions are resource-intensive and require specialised medical facilities. Their associated costs, in terms of financial resources and healthcare infrastructure, significantly limit access for certain patients.

Cryoneurolysis, a novel medical technique, involves the controlled freezing of nerve tissue to temporarily disrupt its function. While primarily used for pain, there is a growing interest in its application for managing spasticity and it is currently approved for the treatment of pain in the context of spasticity at Oxford University Hospitals NHS Trust. Observational studies suggest immediate relaxation of the affected muscles, resulting in improved joint range of motion, enhanced functional mobility, and reduced pain. The investigators' own open-label proof-of-principle clinical data suggest the potential for substantial improvements in the impact of spasticity on quality of life.

This pilot randomised controlled study aims to improve the understanding of the potential clinical effectiveness and side effect profile of cryoneurolysis as a treatment for pain in the context of spasticity in people with a range of neurological conditions (e.g. acquired brain injury (ABI), spinal cord injury, stroke, multiple sclerosis).

Opintotyyppi

Interventio

Ilmoittautuminen (Arvioitu)

50

Vaihe

  • Vaihe 4

Yhteystiedot ja paikat

Tässä osiossa on tutkimuksen suorittajien yhteystiedot ja tiedot siitä, missä tämä tutkimus suoritetaan.

Opiskeluyhteys

Tutki yhteystietojen varmuuskopiointi

Opiskelupaikat

      • Oxford, Yhdistynyt kuningaskunta, OX3 7HE
        • Rekrytointi
        • Oxford Centre for Enablement (OUH NHS-FT)
        • Ottaa yhteyttä:
        • Päätutkija:
          • Anton Pick, MBChB

Osallistumiskriteerit

Tutkijat etsivät ihmisiä, jotka sopivat tiettyyn kuvaukseen, jota kutsutaan kelpoisuuskriteereiksi. Joitakin esimerkkejä näistä kriteereistä ovat henkilön yleinen terveydentila tai aiemmat hoidot.

Kelpoisuusvaatimukset

Opintokelpoiset iät

18 vuotta ja vanhemmat (Aikuinen, Vanhempi Aikuinen)

Hyväksyy terveitä vapaaehtoisia

Ei

Sukupuolet, jotka voivat opiskella

Kaikki

Kuvaus

Inclusion Criteria:

  • Participant is willing and able to give informed consent for participation in the trial OR a positive opinion from a consultee is provided by a family member or carer (relative or friend) willing to provide personal consultee (PC) advice.
  • Male or Female, aged 18 years or above.
  • Diagnosed with a central neurological condition, including acquired brain injury (e.g. from ischaemic stroke, trauma, or haemorrhage), multiple sclerosis, and spinal cord injury.
  • Clinical indication for Botulinum Toxin and Cryoneurolysis treatment, including pain associated with spasticity and with a clinically meaningful response to diagnostic nerve block to specific nerves or nerve branches that can be treated with cryoneurolysis.
  • At least one rehabilitation goal related to management of pain resulting from spasticity.

Exclusion Criteria:

  • Participant has received Botulinum toxin or cryoneurolysis within the last 90 days.
  • Raynaud's syndrome.
  • Cryoglobulinaemia.
  • Cold urticaria.
  • Bleeding disorders.
  • Localised infection at intended treatment site.
  • Planned oral antispasmodic medication dose changes.
  • Pregnancy, breastfeeding, or planning pregnancy in the trial period.
  • Scheduled elective surgery or other procedures requiring general anaesthesia during the trial.
  • Any other significant disease or disorder which, in the opinion of the Investigator, may either put the participants at risk because of participation in the trial, or may influence the result of the trial, or the participant's ability to participate in the trial.
  • Participants who are currently enrolled in another trial may be excluded if it is deemed (in the investigator's opinion) that participation could influence the results for either study.

Opintosuunnitelma

Tässä osiossa on tietoja tutkimussuunnitelmasta, mukaan lukien kuinka tutkimus on suunniteltu ja mitä tutkimuksella mitataan.

Miten tutkimus on suunniteltu?

Suunnittelun yksityiskohdat

  • Ensisijainen käyttötarkoitus: Hoito
  • Jako: Satunnaistettu
  • Inventiomalli: Crossover-tehtävä
  • Naamiointi: Yksittäinen

Aseet ja interventiot

Osallistujaryhmä / Arm
Interventio / Hoito
Kokeellinen: Kryoneurolyysi (+ tavanomainen hoito)

Nerves that require treatment, and the number of treatments required for each nerve will be identified by routine clinical judgement. Nerve targets are identified using an ultrasound machine. The handheld Iovera cryoneurolysis device will be used for treatment.

Participants will receive up to 4 treatments of cryoneurolysis for each nerve or nerve branch that requires treatment. It is anticipated that participants will have between 1 and 5 nerves or nerve branches per limb treated. Each Cryoneurolysis treatment takes 110 seconds. Total treatment time will be determined by number of nerves targeted and number of cryoneurolysis treatments per nerve. The shortest duration, with setup, is likely to be 60 minutes and the longest 120 minutes.

Muut nimet:
  • Iovera
  • Kryoangesia
  • Kryoneurotomia
  • Kryoneurektomia
Active Comparator: Botuliinitoksiini (+ tavanomainen hoito)

Muscles that require treatment with Botulinum Toxin will be identified by routine clinical assessment. Muscle targets will be identified using an ultrasound machine.

It is anticipated that participants will have between 2 and 8 muscles identified for target. The participant will receive up to 200 units of Xeomin (Botulinum Toxin) per muscle that requires treatment. Treatment session of Botulinum Toxin will take 60 to 90 minutes.

Muut nimet:
  • Botox
  • Xeomin
  • BoNT-A
  • Kemodenervaatio

Mitä tutkimuksessa mitataan?

Ensisijaiset tulostoimenpiteet

Tulosmittaus
Toimenpiteen kuvaus
Aikaikkuna
Goal Attainment Scale
Aikaikkuna: 6-weeks post-treatment

An individualised outcome measure involving goal selection and goal scaling that is standardised in order to calculate the extent to which a patient's goals are met. GAS comprises of goals divided into a 5-point scale of level of expected outcome: from -2 (much less than expected) to +2 (much more than expected).

6-weeks post-treatment

Toissijaiset tulostoimenpiteet

Tulosmittaus
Toimenpiteen kuvaus
Aikaikkuna
Self-reported Pain
Aikaikkuna: 6, 12, 18, and 24 weeks post-treatment

Self-report, as measured by a numerical rating scale (range 0 - 10, higher scores indicating higher pain levels).

6, 12, 18, and 24 weeks post-treatment
Douleur Neuropathique en 4 (DN4)
Aikaikkuna: 6, 12, 18, and 24 weeks post-treatment

Questionnaire used to determine whether pain is neuropathic in origin (range 0 - 10; a score of 4 or more suggests the presence of neuropathic pain).

6, 12, 18, and 24 weeks post-treatment
Neuropathic Pain Symptom Inventory (NPSI)
Aikaikkuna: 6, 12, 18, and 24 weeks post-treatment

Questionnaire used to quantify neuropathic pain (range 0 - 100, higher scores reflect worse neuropathic pain).

6, 12, 18, and 24 weeks post-treatment
Side Effects
Aikaikkuna: 6, 12, 18, and 24 weeks post-treatment

As measured by self-report side effects questionnaire

6, 12, 18, and 24 weeks post-treatment
Goal Attainment Scale
Aikaikkuna: 12-weeks post treatment

An individualised outcome measure involving goal selection and goal scaling that is standardised in order to calculate the extent to which a patient's goals are met. GAS comprises of goals divided into a 5-point scale of level of expected outcome: from -2 (much less than expected) to +2 (much more than expected).

12-weeks post treatment
Modified Ashworth Scale
Aikaikkuna: 6- and 12-weeks post treatment

Assessment which requires the researcher to passively move the person's affected limb(s) and assess their resistance to movement (score range 0 - 4, higher score indicating increased in tone).

6- and 12-weeks post treatment
Modified Tardieu Scale
Aikaikkuna: 6- and 12-weeks post treatment

Assessment which requires the researcher to passively move the person's affected limb(s) and assess their resistance to movement (score range 0 - 4, higher score indicating increased resistance).

6- and 12-weeks post treatment
Spasticity
Aikaikkuna: 6- and 12-weeks post treatment

Directly assessed by measuring the muscle activity to a passive stretch

6- and 12-weeks post treatment
Range of Motion
Aikaikkuna: 6- and 12-weeks post treatment

Assessed using a goniometer

6- and 12-weeks post treatment
Patient Reported Impact of Spasticity Measure (PRISM)
Aikaikkuna: 6- and 12-weeks post treatment

Questionnaire assessing spasticity related quality of life (41 items that describe impacts of spasticity, each of which is rated on a scale of 0-4 from "never true for me" to "very often true for me").

6- and 12-weeks post treatment
EQ5D
Aikaikkuna: 6- and 12-weeks post treatment

Questionnaire assessing quality of life across 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels which are scored 1 - 5, with higher scores indicating worse outcome.

6- and 12-weeks post treatment
Spasticity Related Quality of Life instrument (SQoL-6D)
Aikaikkuna: 6- and 12-weeks post treatment

Questionnaire assessing spasticity related quality of life (range 0 - 24, higher score indicating worse condition)

6- and 12-weeks post treatment
Barthel Index
Aikaikkuna: 6- and 12-weeks post treatment

Scale measuring a person's ability to complete activities of daily living (range 0 - 100, higher scores indicating more independence)

6- and 12-weeks post treatment
Gait assessment - Walking Speed
Aikaikkuna: 6- and 12-weeks post treatment

Kinematic assessment of lower extremity function, using EMG and motion capture cameras. Walking speed is measured in meters per second (m/s), with slower speed indicating worse outcome.

6- and 12-weeks post treatment
Gait assessment - Gait profile score
Aikaikkuna: 6- and 12-weeks post treatment

Kinematic assessment of lower extremity function using EMG and motion capture cameras. The gait profile score is measured in degrees, with higher scores indicating more abnormality, and no maximum score.

6- and 12-weeks post treatment
Leg Activity Measure (LEG-A)
Aikaikkuna: 6- and 12-weeks post treatment

Questionnaire assessing lower extremity function (3 sections: Section A range: 0-36; Section B range 0-60; Section C range 0 - 36. Higher score indicates more difficulty/severity.)

6- and 12-weeks post treatment
Shriners Hospital Upper Extremity Evaluation (SHUEE)
Aikaikkuna: 6- and 12-weeks post treatment

Kinematic assessment of upper extremity function using motion capture cameras.

6- and 12-weeks post treatment
Arm Activity Measure (ARM-A)
Aikaikkuna: 6- and 12-weeks post treatment

Questionnaire assessing upper extremity function (2 sections: Section A range: 0-32; Section B range 0-52. Higher score indicates more difficulty.)

6- and 12-weeks post treatment
Functional Assessment Test for Upper Limb (FAST-UL)
Aikaikkuna: 6- and 12-weeks post treatment

Assessment of upper extremity function (selected movements assessed and scored between 0 - 3, with higher scores indicating ability to complete movement more fully).

6- and 12-weeks post treatment
Pressure Pain Thresholds (PPT)
Aikaikkuna: 6, 12, 18, and 24 weeks post-treatment

Sensory testing using a manual algometer to assess pain thresholds.

6, 12, 18, and 24 weeks post-treatment

Muut tulostoimenpiteet

Tulosmittaus
Toimenpiteen kuvaus
Aikaikkuna
Feedback Questionnaire/Interview
Aikaikkuna: 24 weeks post treatment

Qualitative feedback using either a semi-structured interview or a self-reported questionnaire (using the same questions as interview schedule), as per preference of participant, used to explore the satisfaction, experience, and anticipated barriers/facilitators to clinical implementation for the treatments.

24 weeks post treatment
Sleep Condition Indicator
Aikaikkuna: 6, 12, 18, and 24 weeks post-treatment

Questionnaire assessing self-reported insomnia symptoms (range 0-32, higher numbers indicate less symptoms of insomnia)

6, 12, 18, and 24 weeks post-treatment
Goal Attainment Scale
Aikaikkuna: 18- and 24-weeks post-treatment

An individualised outcome measure involving goal selection and goal scaling that is standardised in order to calculate the extent to which a patient's goals are met. GAS comprises of goals divided into a 5-point scale of level of expected outcome: from -2 (much less than expected) to +2 (much more than expected).

18- and 24-weeks post-treatment
Modified Ashworth Scale
Aikaikkuna: 18- and 24-weeks post-treatment

Assessment which requires the researcher to passively move the person's affected limb(s) and assess their resistance to movement (score range 0 - 4, higher score indicating increased in tone).

18- and 24-weeks post-treatment
Modified Tardieu Scale
Aikaikkuna: 18- and 24-weeks post-treatment

Assessment which requires the researcher to passively move the person's affected limb(s) and assess their resistance to movement (score range 0 - 4, higher score indicating increased resistance).

18- and 24-weeks post-treatment
Spasticity
Aikaikkuna: 18- and 24-weeks post-treatment

Directly assessed by measuring the muscle activity to a passive stretch

18- and 24-weeks post-treatment
Range of motion
Aikaikkuna: 18- and 24-weeks post-treatment

Assessed using a goniometer

18- and 24-weeks post-treatment
Patient Reported Impact of Spasticity Measure (PRISM)
Aikaikkuna: 18- and 24-weeks post-treatment

Questionnaire assessing spasticity related quality of life (41 items that describe impacts of spasticity, each of which is rated on a scale of 0-4 from "never true for me" to "very often true for me")

18- and 24-weeks post-treatment
EQ5D
Aikaikkuna: 18- and 24-weeks post-treatment

Questionnaire assessing quality of life across 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels which are scored 1 - 5, with higher scores indicating worse outcome.

18- and 24-weeks post-treatment
Spasticity Related Quality of Life instrument (SQoL-6D)
Aikaikkuna: 18- and 24-weeks post-treatment

Questionnaire assessing spasticity related quality of life (range 0 - 24, higher score indicating worse condition)

18- and 24-weeks post-treatment
Barthel Index
Aikaikkuna: 18- and 24-weeks post-treatment

Scale measuring a person's ability to complete activities of daily living (range 0 - 100, higher scores indicating more independence)

18- and 24-weeks post-treatment
Leg Activity Measure (LEG-A)
Aikaikkuna: 18- and 24-weeks post-treatment

Questionnaire assessing lower extremity function (3 sections: Section A range: 0-36; Section B range 0-60; Section C range 0 - 36. Higher score indicates more difficulty/severity.)

18- and 24-weeks post-treatment
Arm Activity Measure (ARM-A)
Aikaikkuna: 18- and 24-weeks post-treatment

Questionnaire assessing upper extremity function (2 sections: Section A range: 0-32; Section B range 0-52. Higher score indicates more difficulty.)

18- and 24-weeks post-treatment

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