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Crioneurolisi individualizzata per trattare il dolore nel contesto della spasticità negli arti superiori e inferiori (ICE)

2 novembre 2026 aggiornato da: Oxford University Hospitals NHS Trust

Crioneurolisi Individualizzata per il Trattamento del Dolore nel Contesto della Spasticità degli Arti Superiori e Inferiori (ICE): uno Studio Pilota Randomizzato Controllato

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.

Panoramica dello studio

Stato

Reclutamento

Condizioni

Intervento / Trattamento

Descrizione dettagliata

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).

Tipo di studio

Interventistico

Iscrizione (Stimato)

50

Fase

  • Fase 4

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Contatto studio

Backup dei contatti dello studio

Luoghi di studio

      • Oxford, Regno Unito, OX3 7HE
        • Reclutamento
        • Oxford Centre for Enablement (OUH NHS-FT)
        • Contatto:
        • Investigatore principale:
          • Anton Pick, MBChB

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

18 anni e precedenti (Adulto, Adulto più anziano)

Accetta volontari sani

No

Sessi ammissibili allo studio

Tutto

Descrizione

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.

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Trattamento
  • Assegnazione: Randomizzato
  • Modello interventistico: Assegnazione incrociata
  • Mascheramento: Separare

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Sperimentale: Crioneurolisi (+ cura abituale)

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.

Altri nomi:
  • Iovera
  • Crioanalgesia
  • Crioneurotomia
  • Crioneurectomia
Comparatore attivo: Tossina Botulinica (+ cure abituali)

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.

Altri nomi:
  • Botox
  • Xeomin
  • BoNT-A
  • Denervazione chimica

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Goal Attainment Scale
Lasso di tempo: 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

Misure di risultato secondarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Self-reported Pain
Lasso di tempo: 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)
Lasso di tempo: 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)
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 6- and 12-weeks post treatment

Assessed using a goniometer

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

Altre misure di risultato

Misura del risultato
Misura Descrizione
Lasso di tempo
Feedback Questionnaire/Interview
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 18- and 24-weeks post-treatment

Assessed using a goniometer

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

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Sponsor

Collaboratori

Pubblicazioni e link utili

La persona responsabile dell'inserimento delle informazioni sullo studio fornisce volontariamente queste pubblicazioni. Questi possono riguardare qualsiasi cosa relativa allo studio.

Pubblicazioni generali

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio (Effettivo)

2 dicembre 2025

Completamento primario (Stimato)

1 novembre 2027

Completamento dello studio (Stimato)

1 aprile 2028

Date di iscrizione allo studio

Primo inviato

10 settembre 2025

Primo inviato che soddisfa i criteri di controllo qualità

10 dicembre 2025

Primo Inserito (Effettivo)

26 dicembre 2025

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Effettivo)

5 novembre 2026

Ultimo aggiornamento inviato che soddisfa i criteri QC

2 novembre 2026

Ultimo verificato

1 novembre 2026

Maggiori informazioni

Termini relativi a questo studio

Altri numeri di identificazione dello studio

  • PID 18403

Piano per i dati dei singoli partecipanti (IPD)

Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?

SÌ

Descrizione del piano IPD

De-identified data are available upon reasonable request.

Periodo di condivisione IPD

Following publication of results

Criteri di accesso alla condivisione IPD

Available upon reasonable request

Tipo di informazioni di supporto alla condivisione IPD

  • STUDIO_PROTOCOLLO

Informazioni su farmaci e dispositivi, documenti di studio

Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti

No

Studia un dispositivo regolamentato dalla FDA degli Stati Uniti

No

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .