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Phantom Limb PainNCT02051959

Long-term Effects of Transcranial Direct Current Stimulation (tDCS) on Patients With Phantom Limb Pain (PLP)

A study of Phantom Limb Pain, run by Sheba Medical Center at 1 site in Israel.

Suspended

Paused. Enrolment is on hold for now and may resume.

Official record
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Trial summary

Phantom limb pain (PLP) refers to pain in a limb that has been amputated or deafferented. Phantom limb pain might be related to brain cortical plastic changes. The purpose of this study is to determine the efficacy of a series of transcranial direct current stimulation (tDCS) sessions, a non-invasive and focal brain… Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Phantom Limb Pain
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
24 participants
Where
1 siteIsrael
Study dates
May 2015to Dec 2017
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18 to 80
  • Limb amputation from at least 6 months before study enrollment
  • Presence of PLP at least 2 times a week and present 4 weeks prior to onset of study
  • Written informed consent

Who cannot join

  • Coexistence of major neurological or psychiatric diseases
  • Being actively enrolled in a separate study targeting pain relief
  • Post traumatic stress disorder (PTSD) diagnosed patients
  • Any contraindication to noninvasive brain stimulation such as past brain surgery, brain implants, cochlear implant, epilepsy or any past seizure
  • Pregnant women
  • Within the traumatic amputees group - subjects diagnosed with diabetes

Trial locations and contacts

1 site in 1 country.

Israel1 site
  • Department of Orthopedic Rehabilitation, Sheba Medical Center

    Ramat Gan

Other trials in Israel

About this study

Official title: Long-Term Treatment of Patients Experiencing Phantom Limb Pain With Transcranial Direct Current Stimulation (tDCS)

  • Phantom limb pain (PLP) refers to pain in a limb that has been amputated or deafferented. Phantom limb pain might be related to brain cortical plastic changes.
  • The purpose of this study is to determine the efficacy of a series of transcranial direct current stimulation (tDCS) sessions, a non-invasive and focal brain stimulation method, in producing long-term reduction of phantom limb pain among amputees who experience such pain.

This is a Crossover sham control.

Being tested
Anodal stimulation of M1 + sham, Sham + Anodal stimulation of M1, Cathodal stimulation of M1 + sham, Sham + Cathodal stimulation of M1
Keywords
Phantom Limb Pain, Transcranial Direct Current Stimulation, Amputation, Diabetes Mellitus
Medical subject headings
Phantom Limb, Diabetes Mellitus

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Anodal stimulation of M1 + shamDevice

    Also called tDCS

    8 active treatmments: 2mA anodal stimulation of M1 for 20 minutes (over the relevant cortex area) followed by 8 sham treatments.

  • Sham + Anodal stimulation of M1Device

    Also called tDCS

    8 sham treatments followed by 8 active treatmments: 2mA anodal stimulation of M1 for 20 minutes (over the relevant cortex area).

  • Cathodal stimulation of M1 + shamDevice

    Also called tDCS

    8 active treatmments: 2mA cathodal stimulation of M1 for 20 minutes (over the relevant cortex area) , followed by 8 sham treatments.

  • Sham + Cathodal stimulation of M1Device

    Also called tDCS

    8 sham treatments followed by 8 active treatmments: 2mA cathodal stimulation of M1 for 20 minutes (over the relevant cortex area).

Study groups in NCT02051959
Study groupRoleWhat they receive
Crossover 1a: anodal stimulation of M1 + shamActive comparator6 amputees will undergo 8 active treatments of 20 min 2mA anodal stimulation of M1 localized to the contralateral amputation area followed by 8 sham treatments. Total duration and frequency of treatments: 8 weeks, 2 sessions per week. Each session will last approximately one hour which will consist of: * EEG and pain measurements * 20 minutes of stimulation * EEG and pain measurements after completion of stimulation
Receives: Device: Anodal stimulation of M1 + sham
Crossover 1b: sham + anodal stimulation of M1Active comparator6 amputees will undergo 8 sham treatments followed by 8 active treatments of 20 min 2mA anodal stimulation of M1 localized to the contralateral amputation area. Total duration and frequency of treatments: 8 weeks, 2 sessions per week. Each session will last approximately one hour which will consist of: * EEG and pain measurements * 20 minutes of stimulation * EEG and pain measurements after completion of stimulation
Receives: Device: Sham + Anodal stimulation of M1
Crossover 2a: cathodal stimulation of M1 + shamActive comparator6 amputees will undergo 8 active treatments of 20 min 2mA cathodal stimulation of M1 localized to the contralateral amputation area followed by 8 sham treatments. Total duration and frequency of treatments: 8 weeks, 2 sessions per week. Each session will last approximately one hour which will consist of: * EEG and pain measurements * 20 minutes of stimulation * EEG and pain measurements after completion of stimulation
Receives: Device: Cathodal stimulation of M1 + sham
Crossover 2b: sham + cathodal stimulation of M1Active comparator6 amputees will undergo 8 sham treatments followed by 8 active treatments of 20 min 2mA cathodal stimulation of M1 localized to the contralateral amputation area. Total duration and frequency of treatments: 8 weeks, 2 sessions per week. Each session will last approximately one hour which will consist of: * EEG and pain measurements * 20 minutes of stimulation * EEG and pain measurements after completion of stimulation
Receives: Device: Sham + Cathodal stimulation of M1

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Reduced phantom limb pain

    Reduction of phantom limb pain compared to phantom limb pain before treatment, according to Visual Analog Scales (VAS) evaluation

    Measured: 5 months after last stimulation session

Secondary outcomes (2)
  1. Adverse effects of treatment

    Severity of any adverse effects related to the transcranial direct current stimulation treatment will be checked after each stimulation session

    Measured: Up to 5 weeks

  2. Effects of treatment on the electrical activity of the brain

    Measurement of the electrical activity of the brain before, during and after each stimulation using an electroencephalography (EEG) device.

    Measured: Up to 5 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted31 Jan 2014 (estimated)
  2. Study startMay 2015
  3. Primary completionJun 2017 (estimated)
  4. Study completionDec 2017 (estimated)

Why it stopped: Signing a contract with the company owning the equipment

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
24 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02051959
Sponsor's protocol ID
SHEBA-13-0733-IS-CTIL
Status last verified
Jan 2016
First submitted
28 Jan 2014
Last updated
27 Jan 2016
Results posted
No
Data monitoring committee
No

Publications

  • Flor H. Phantom-limb pain: characteristics, causes, and treatment. Lancet Neurol. 2002 Jul;1(3):182-9. doi: 10.1016/s1474-4422(02)00074-1.

    PubMed 12849487
  • Cohen LG, Bandinelli S, Findley TW, Hallett M. Motor reorganization after upper limb amputation in man. A study with focal magnetic stimulation. Brain. 1991 Feb;114 ( Pt 1B):615-27. doi: 10.1093/brain/114.1.615.

    PubMed 2004259
  • Lotze M, Flor H, Grodd W, Larbig W, Birbaumer N. Phantom movements and pain. An fMRI study in upper limb amputees. Brain. 2001 Nov;124(Pt 11):2268-77. doi: 10.1093/brain/124.11.2268.

    PubMed 11673327
  • Poreisz C, Boros K, Antal A, Paulus W. Safety aspects of transcranial direct current stimulation concerning healthy subjects and patients. Brain Res Bull. 2007 May 30;72(4-6):208-14. doi: 10.1016/j.brainresbull.2007.01.004. Epub 2007 Jan 24.

    PubMed 17452283
  • Nitsche MA, Liebetanz D, Lang N, Antal A, Tergau F, Paulus W. Safety criteria for transcranial direct current stimulation (tDCS) in humans. Clin Neurophysiol. 2003 Nov;114(11):2220-2; author reply 2222-3. doi: 10.1016/s1388-2457(03)00235-9. No abstract available.

    PubMed 14580622
  • Nuti C, Peyron R, Garcia-Larrea L, Brunon J, Laurent B, Sindou M, Mertens P. Motor cortex stimulation for refractory neuropathic pain: four year outcome and predictors of efficacy. Pain. 2005 Nov;118(1-2):43-52. doi: 10.1016/j.pain.2005.07.020. Epub 2005 Oct 7.

    PubMed 16214292
  • Khedr EM, Ahmed MA, Fathy N, Rothwell JC. Therapeutic trial of repetitive transcranial magnetic stimulation after acute ischemic stroke. Neurology. 2005 Aug 9;65(3):466-8. doi: 10.1212/01.wnl.0000173067.84247.36.

    PubMed 16087918
  • Bolognini N, Olgiati E, Maravita A, Ferraro F, Fregni F. Motor and parietal cortex stimulation for phantom limb pain and sensations. Pain. 2013 Aug;154(8):1274-80. doi: 10.1016/j.pain.2013.03.040. Epub 2013 Apr 19.

    PubMed 23707312
  • Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol. 2000 Sep 15;527 Pt 3(Pt 3):633-9. doi: 10.1111/j.1469-7793.2000.t01-1-00633.x.

    PubMed 10990547
  • O'Connell NE, Cossar J, Marston L, Wand BM, Bunce D, Moseley GL, De Souza LH. Rethinking clinical trials of transcranial direct current stimulation: participant and assessor blinding is inadequate at intensities of 2mA. PLoS One. 2012;7(10):e47514. doi: 10.1371/journal.pone.0047514. Epub 2012 Oct 17.

    PubMed 23082174
  • Nitsche MA, Liebetanz D, Antal A, Lang N, Tergau F, Paulus W. Modulation of cortical excitability by weak direct current stimulation--technical, safety and functional aspects. Suppl Clin Neurophysiol. 2003;56:255-76. doi: 10.1016/s1567-424x(09)70230-2. No abstract available.

    PubMed 14677403
  • Gandiga PC, Hummel FC, Cohen LG. Transcranial DC stimulation (tDCS): a tool for double-blind sham-controlled clinical studies in brain stimulation. Clin Neurophysiol. 2006 Apr;117(4):845-50. doi: 10.1016/j.clinph.2005.12.003. Epub 2006 Jan 19.

    PubMed 16427357
  • Kew JJ, Ridding MC, Rothwell JC, Passingham RE, Leigh PN, Sooriakumaran S, Frackowiak RS, Brooks DJ. Reorganization of cortical blood flow and transcranial magnetic stimulation maps in human subjects after upper limb amputation. J Neurophysiol. 1994 Nov;72(5):2517-24. doi: 10.1152/jn.1994.72.5.2517.

    PubMed 7884476
  • Chen R, Corwell B, Yaseen Z, Hallett M, Cohen LG. Mechanisms of cortical reorganization in lower-limb amputees. J Neurosci. 1998 May 1;18(9):3443-50. doi: 10.1523/JNEUROSCI.18-09-03443.1998.

    PubMed 9547251
  • Karl A, Birbaumer N, Lutzenberger W, Cohen LG, Flor H. Reorganization of motor and somatosensory cortex in upper extremity amputees with phantom limb pain. J Neurosci. 2001 May 15;21(10):3609-18. doi: 10.1523/JNEUROSCI.21-10-03609.2001.

    PubMed 11331390

Questions about this trial

What is this clinical trial studying?

A study of Phantom Limb Pain, run by Sheba Medical Center at 1 site in Israel.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: paused, as of the sponsor's last update on 27 Jan 2016. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Israel. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Reduced phantom limb pain (time frame: 5 months after last stimulation session). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02051959, which also lists 28 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Jan 2016.

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