Proximal Nerve Cryoablation Versus Perineuroma Cryoablation for Chronic Neuroma Pain After Combat-Related Amputation (AXON-FREEZE)
atients with combat-related amputations frequently develop chronic neuroma pain that interferes with rehabilitation, prosthesis use, mobility, sleep, and quality of life. Cryoablation is a minimally invasive treatment that produces controlled nerve injury using extreme cold. Although the freezing effect is localized around the cryoprobe, axonal interruption followed by distal Wallerian degeneration may extend functional denervation distal to the ablation site.
This study aims to compare two ultrasound-guided cryoablation strategies for chronic neuroma pain after combat-related amputation: cryoablation performed directly near the neuroma and cryoablation performed proximal to the neuroma along the affected nerve.
The study will evaluate whether proximal nerve cryoablation produces greater or longer-lasting analgesic effects compared with perineuroma cryoablation.
Studieoversikt
Status
Status
Forhold
Forhold
Intervensjon / Behandling
Intervensjon / Behandling
Detaljert beskrivelse
Chronic neuroma pain is a common and disabling complication following combat-related limb trauma and amputation. Persistent neuroma pain may contribute to residual limb pain, phantom limb pain, impaired prosthesis tolerance, reduced mobility, sleep disturbance, and decreased quality of life. Current treatment strategies frequently provide incomplete or temporary analgesia.
Cryoablation is an ultrasound-guided minimally invasive technique that induces controlled axonal injury using extreme cold temperatures. Although the direct freezing zone extends only a few millimeters around the cryoprobe, cryo-induced axonotmesis may trigger distal Wallerian degeneration along the affected nerve pathway while preserving connective tissue structures that support potential nerve regeneration.
The optimal anatomical target for cryoablation in painful neuromas remains unclear. Cryoablation performed directly adjacent to the neuroma may interrupt local nociceptive signaling, whereas proximal nerve cryoablation may produce broader distal analgesic effects by interrupting axonal conduction proximal to the neuroma-bearing segment.
The AXON-FREEZE Trial is a prospective multicenter controlled study designed to compare proximal nerve cryoablation versus perineuroma cryoablation for chronic neuroma pain after combat-related amputation.
Participants with ultrasound-confirmed painful neuromas will undergo ultrasound-guided cryoablation using one of the two treatment strategies according to study allocation and local clinical practice. Clinical follow-up will include assessment of neuroma pain intensity, neuropathic pain characteristics, phantom limb pain, residual limb pain, prosthesis tolerance, analgesic consumption, patient-reported improvement, and adverse events.
The study aims to improve understanding of cryoablation targeting strategies and evaluate whether proximal nerve cryoablation may provide stronger or longer-lasting pain relief compared with cryoablation performed adjacent to the neuroma.
Studietype
Studietype
Registrering (Antatt)
Registrering
Fase
Fase
- Ikke aktuelt
Kontakter og plasseringer
Studiekontakt
Studiekontakt
- Navn: Dmytro Dmytriiev, PhD.Professor
- Telefonnummer: +380674309449
- E-post: mddmytriiev@gmail.com
Studiesteder
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Вінницька
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Vinnytsia, Вінницька, Ukraina, 21000
- Vinnitsya university hospital
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Ta kontakt med:
- Dmytro Dmytriiev, Phd
- Telefonnummer: 0674309449
- E-post: mddmytriiev@gmail.com
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-
Deltakelseskriterier
Kvalifikasjonskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
- Voksen
Tar imot friske frivillige
Beskrivelse
Inclusion Criteria:
- Age ≥18 years
- Combat-related limb amputation
- Chronic neuroma pain lasting ≥3 months
- Ultrasound-confirmed painful neuroma
- Average pain intensity ≥4/10 on Numeric Rating Scale
- Positive Tinel sign
- Ability to undergo ultrasound-guided cryoablation
- Stable analgesic regimen for at least 14 days
- Ability to provide written informed consent
Exclusion Criteria:
- Active infection at the treatment site
- Open wound preventing safe procedure
- Previous cryoablation of the target nerve within 6 months
- Neuroma surgery within 3 months
- Severe coagulopathy or anticoagulation contraindicating procedure
- Pregnancy or breastfeeding
- Severe uncontrolled systemic disease
- Inability to complete follow-up assessments
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Ikke-randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Enkelt
Antall våpen
Våpen og intervensjoner
Deltakergruppe / ArmDeltakergruppe / Arm |
Intervensjon / BehandlingIntervensjon / Behandling |
|---|---|
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Eksperimentell: Perineuroma Cryoablation
Ultrasound-guided cryoablation performed adjacent to the painful neuroma.
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Ultrasound-guided cryoablation performed adjacent to the painful neuroma.
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Aktiv komparator: Proximal Nerve Cryoablation
Ultrasound-guided cryoablation performed proximal to the neuroma along the affected nerve.
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Ultrasound-guided cryoablation performed proximal to the neuroma along the affected nerve.
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Hva måler studien?
Primære resultatmål
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
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Change in Chronic Neuroma Pain Intensity
Tidsramme: Baseline to 12 weeks
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Change in average neuroma pain intensity measured using the Numeric Rating Scale (NRS).
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Baseline to 12 weeks
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
|---|---|---|
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DN4 neuropathic pain score
Tidsramme: : Baseline to 24 weeks
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Assessment of neuropathic pain characteristics using the Douleur Neuropathique 4 (DN4) questionnaire.
Higher scores indicate greater neuropathic pain involvement associated with chronic neuroma pain after combat-related amputation.
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: Baseline to 24 weeks
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Samarbeidspartnere og etterforskere
Sponsor
Sponsor
Studierekorddatoer
Studer hoveddatoer
Studiestart (Antatt)
Studiestart
Primær fullføring (Antatt)
Primær fullføring
Studiet fullført (Antatt)
Studiet fullført
Datoer for studieregistrering
Først innsendt
Først innsendt
Først innsendt som oppfylte QC-kriteriene
Først innsendt som oppfylte QC-kriteriene
Først lagt ut (Faktiske)
Først lagt ut
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
Sist oppdatering lagt ut
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Siste oppdatering sendt inn som oppfylte QC-kriteriene
Sist bekreftet
Sist bekreftet
Mer informasjon
Begreper knyttet til denne studien
Nøkkelord
Ytterligere relevante MeSH-vilkår
- Smerte
- Nevrologiske manifestasjoner
- Sykdommer i nervesystemet
- Sår og skader
- Postoperative komplikasjoner
- Patologiske prosesser
- Neoplasmer
- Nevromuskulære sykdommer
- Sykdommer i det perifere nervesystemet
- Neoplasmer etter histologisk type
- Nevroatferdsmanifestasjoner
- Neoplasmer, nervevev
- Traumer, nervesystemet
- Neoplasmer i nerveskjede
- Perseptuelle forstyrrelser
- Smerter, postoperativt
- Patologiske tilstander, tegn og symptomer
- Tegn og symptomer
- Nerve degenerasjon
- Neurom
- Perifere nerveskader
- Fantomlem
- Wallerian Degeneration
Andre studie-ID-numre
Andre studie-ID-numre
- 10v213022026
- USRA (Annen identifikator: Ukranian Society of Regional Anesthesia and Pain Therapy)
Plan for individuelle deltakerdata (IPD)
Planlegger du å dele individuelle deltakerdata (IPD)?
IPD-planbeskrivelse
Tilgangskriterier for IPD-deling
IPD-deling Støtteinformasjonstype
- STUDY_PROTOCOL
Legemiddel- og utstyrsinformasjon, studiedokumenter
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Studerer et amerikansk FDA-regulert enhetsprodukt
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