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PainNCT02608463

Neuropathic Pain in Pregnancy

A study testing painDETECT Questionnaire, Pain Catastrophizing Scale and Pain Intensity Scale, Pain Interference Scale, Pain Behavior Scale in people with Pain and Pregnancy, run by University of Arkansas at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This will be the first study to investigate the use of rTMS in the treatment of neuropathic pain in pregnancy. This study will enroll 60 pregnant subjects, age 18-45. All participants will receive treatment as usual. Subjects diagnosed with neuropathic pain will be offered rTMS as a treatment option. Read more about this study

Who is it for?
Ages 18 to 45 years, women only
Conditions the study is for
Pain, Pregnancy
What is being tested?
painDETECT Questionnaire, Pain Catastrophizing Scale and Pain Intensity Scale, Pain Interference Scale, Pain Behavior Scale
Could I receive a placebo?
No, everyone receives an active treatment
How many people
15 participants
Where
1 siteUnited States
Study dates
1 Jan 2016to 19 Apr 2019
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

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 45 years
  • Women only
  • No healthy volunteers
  • Adult

Who may be able to join

  • age 18-45 years old,
  • ability to give informed consent,
  • viable pregnancy, and
  • enrollment prior or equal to 24 weeks gestation
  • Subjects enrolled in Part A and willing to consent to Part B of this protocol
  • Pregnant with current chronic neuropathic pain
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  • Subjects failed treatment with amitriptyline or nortriptyline as defined by one of the following:
  • no clinical improvement following a 4-week trial of amitriptyline or nortriptyline (i.e., CGI-I score ≥4)
  • an inability to tolerate the medication (i.e., side effects)
  • Subjects must pass the TMS Safety Checklist Adult Safety Screen (TASS).
  • Subjects should be off medication, which can lower seizure thresholds (e.g., amitriptyline and nortriptyline) for at least two weeks prior to study entry.
  • Subjects with neuropathic pain including those with diagnosis of spinal cord injury, fibromyalgia, compression neuropathies (including diabetic peripheral neuropathy), post stroke pain, and multiple sclerosis
  • Subjects with a baseline VAS score greater than 30

Who cannot join

  • Active or history of substance use disorder within the past year
  • Non-English speaking
  • Part B
  • Current or past history of a seizure disorder (e.g., epilepsy)
  • Current history of preeclampsia
  • Current or history of brain lesions (e.g., aneurysm)
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  • History of major head trauma (e.g., stroke; previous cranial neurosurgery)
  • Ferromagnetic metal in the head, neck, or chest (e.g., plates or pins, bullets, shrapnel)
  • Microprocessor implants in the head (e.g., cochlear implants) or life-sustaining microprocessor implants anywhere in the body (e.g., prosthetic cardiac valves)
  • Cardiac pacemaker
  • Active or inactive implants (e.g., deep brain stimulators, vagus nerve stimulators)
  • Active treatment with medications that lower seizure threshold (e.g., bupropion, amitriptyline, nortriptyline, or other TCA)
  • Increased intracranial pressure (which lowers seizure threshold)
  • Implanted medication pumps
  • Intracardiac lines
  • Significant heart disease defined as heart disease that causes moderate to severe symptoms and/or is characterized by moderate to severe pathology, including a recent history of myocardial infarction and heart failure with an ejection fraction of less than 30% or with a New York Heart Association Functional Classification of Class III or IV.
  • Bipolar disorder (to reduce the risk of mania)
  • History of suicide attempt(s)
  • Family history of epilepsy
  • Heavy alcohol consumption within the past 48 hours
  • Permanent makeup or tattoos with metallic dyes

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Arkansas For Medical Sciences

    Little Rock, Arkansas, 72205

Other trials in United States

About this study

This will be the first study to investigate the use of rTMS in the treatment of neuropathic pain in pregnancy. This study will enroll 60 pregnant subjects, age 18-45. All participants will receive treatment as usual. Subjects diagnosed with neuropathic pain will be offered rTMS as a treatment option.

Read the detailed description

Neuropathic pain is a common pain disorder that is caused by problems in the nervous system. It affects more women than men and commonly occurs in pregnancy. Physicians have little information to guide their treatment of neuropathic pain in pregnancy. The overall goal of this study is to define the course, management, and pregnancy outcomes of neuropathic pain in pregnancy and the acute postpartum period. It is difficult to manage neuropathic pain in pregnancy as treatment options must minimize their risk to the unborn child as they have a direct effect on infant outcomes through their exposure in utero. Thus, other treatments are needed. Repetitive transcranial magnetic stimulation (rTMS) may be an acceptable alternative to medications. Transcranial magnetic stimulation uses a magnetic force to change the way nerves work in the brain. This non-invasive and localized mechanism of action makes it attractive for use in special populations, such as pregnancy. Study visits will occur approximately every 4-6 weeks during pregnancy until approximately 3 months postpartum for a maximum of 12 visits.

Conditions
Pain, Pregnancy
Being tested
painDETECT Questionnaire, Pain Catastrophizing Scale, Pain Intensity Scale, Pain Interference Scale, Pain Behavior Scale, Beck Depression Inventory, Visual Analogue Scale
Keywords
neuropathic pain, pregnancy
Medical subject headings
Pain, Neuralgia

What participants receive

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

  • painDETECT QuestionnaireBehavioural

    Also called PDQ

    This self-report questionnaire consists of 7 questions that address the quality of neuropathic pain syndromes. The first 5 questions ask about the gradation of pain, question 6 asks about the pain course pattern and question 7 asks about radiating pain. There are 4 additional questions (not counted in the total score) which asks the subject to rate their pain now and over the last 4 weeks and to mark on a body chart if there is pain radiating into other parts of the body.

  • Pain Catastrophizing ScaleBehavioural

    Also called PCS

    The PCS is a 13-item self-report scale. It asks subjects to reflect on past painful experiences, and to indicate the degree to which they experienced each of 13 thoughts or feelings when experiencing pain, on 5-point scales with the end points (0) not at all and (4) all the time. The PCS yields a total score and three subscale scores assessing rumination, magnification, and helplessness.

  • Pain Intensity Scale, Pain Interference Scale, Pain Behavior ScaleBehavioural

    Also called Pain Measures

    The 3-item, self-report Pain Intensity assesses how much a person hurts. The first 2 items assess pain intensity over the past 7 days; the last item asks subject to rate pain intensity "right now." The 4-item, self-report Pain Interference measures the consequences of pain on relevant aspects of subject's life. It includes impairment in subject's social, cognitive, emotional, physical, \& recreational activities. It also incorporates items about sleep and enjoyment of life. It assesses pain interference over the past 7 days.

    The 7-item, self-report Pain Behavior measures behaviors that typically indicate to others that an individual is experiencing pain. Measures include observations (sighing, crying), behaviors (resting, guarding, facial expressions, asking for help), \& verbal reports of pain. It assesses pain interference over the past 7 days.

    All three scales, derived from the Patient Reported Outcomes Measurement Information System (PROMIS), are not disease specific.

  • Beck Depression InventoryBehavioural

    Also called BDI

    The BDI is a widely used instrument that has been used in both clinical and non-clinical setting measuring depressive symptoms. It is a 21 item questionnaire with 4-5 responses for each question. Responses are coded 0-3 for the 4 point scales. The 5 point scales include an additional 2a and 2b response code. The symptom categories reflect overt behavioral manifestations of depression. The instrument has both a high degree of reliability and validity (Beck, Ward, Mendelson, Mock \& Erbaugh, 1961).

  • Visual Analogue ScaleBehavioural

    Also called VAS

    100 mm line scale that is subject administered to subjectively rate current pain symptoms. The subject will be instructed to draw a single vertical line that best describes current state.

  • Patient's Global Impression of Change Scale & Clinical Global Impression-Global Improvement ScaleBehavioural

    Also called PGIC & CGI-I

    The PGIC gives a global rating of change in symptoms, activities, emotion, and overall quality of life related to the subject's pain condition. This is a self-rated scale.

    The CGI-I gives a global rating of the improvement/change in the symptoms since the last study visit. This is administered by the MD.

  • Transcranial Magnetic StimulationDevice

    Also called NeuroStar® TMS

    Subjects will undergo daily repetitive transcranial magnetic stimulation (rTMS), defined as Monday through Friday, for a total of 10 consecutive sessions. rTMS will be applied using the NeuroStar TMS Therapy System through a figure-8 coil connected to a magnetic stimulator, which provides a biphasic pulse. The coil is applied to the primary motor cortex, M1, contralateral to the painful side. The optimal stimulus site, motor hot spot, will be determined according to visual detection of muscle twitches, and a resting motor threshold is defined as the minimal intensity necessary to induce at least one visible muscle twitch. An rTMS session consists of 10 trains at 90% intensity of resting motor threshold (one train, 100 pulses at 10 Hz; intertrain interval, 50s).

Study groups in NCT02608463
Study groupRoleWhat they receive
Part A - Neuropathic PainOtherSubjects with a score of ≥ 13 on the painDETECT Questionnaire (PDQ) will be assigned to the Neuropathic Pain group.
Receives: Behavioral: painDETECT Questionnaire; Behavioral: Pain Catastrophizing Scale; Behavioral: Pain Intensity Scale, Pain Interference Scale, Pain Behavior Scale; Behavioral: Beck Depression Inventory; Behavioral: Visual Analogue Scale; Behavioral: Patient's Global Impression of Change Scale & Clinical Global Impression-Global Improvement Scale
Part A - Non-Neuropathic PainOtherSubjects with a score of ≥ 1 or ≤ 12 on the painDETECT Questionnaire (PDQ) will be assigned to the Non-Neuropathic Pain group.
Receives: Behavioral: painDETECT Questionnaire; Behavioral: Pain Catastrophizing Scale; Behavioral: Pain Intensity Scale, Pain Interference Scale, Pain Behavior Scale; Behavioral: Beck Depression Inventory; Behavioral: Visual Analogue Scale; Behavioral: Patient's Global Impression of Change Scale & Clinical Global Impression-Global Improvement Scale
Part A - ControlOtherSubjects with a score of score = 0 on the painDETECT Questionnaire (PDQ) will be assigned to the Control group.
Receives: Behavioral: painDETECT Questionnaire; Behavioral: Pain Catastrophizing Scale; Behavioral: Pain Intensity Scale, Pain Interference Scale, Pain Behavior Scale; Behavioral: Beck Depression Inventory; Behavioral: Visual Analogue Scale; Behavioral: Patient's Global Impression of Change Scale & Clinical Global Impression-Global Improvement Scale
Part B - rTMSExperimentalSubjects from the Neuropathic Pain group will be invited to participate in the Part B rTMS group to receive repetitive transcranial magnetic stimulation (rTMS).
Receives: Behavioral: Beck Depression Inventory; Behavioral: Visual Analogue Scale; Behavioral: Patient's Global Impression of Change Scale & Clinical Global Impression-Global Improvement Scale; Device: Transcranial Magnetic Stimulation

What is being measured

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

  1. Change From Baseline Visual Analogue Scale for Pain

    100 mm line scale that is subject administered to subjectively rate current pain symptoms. The subject will be instructed to draw a single vertical line that best describes current state. The total score ranges from 0-100 with higher numbers indicating worse outcomes. The VAS will be administered at every subject visit.

    Measured: Baseline and end of study participation, an average of 194 days

Timeline

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

  1. First posted18 Nov 2015 (estimated)
  2. Study start1 Jan 2016
  3. Primary completion19 Apr 2019
  4. Study completion19 Apr 2019

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
Supportive care
Allocation
Non-randomised
Intervention model
Parallel groups
Model description
All subjects will participate in Part A, receive standard of care and complete the painDETECT Questionnaire (PDQ) to be assigned to 1 of 3 groups based on the PDQ score. Subjects in Part A will complete the following at study entry and each study visit: the Beck Depression Inventory (BDI), Visual Analogue Scale (VAS), Pain Catastrophizing Scale (PCS), and measures of pain intensity, interference, behavior. At each visit after study entry, subjects will complete the Patients' Global Impression of Change scale (PGIC); clinicians will complete the Clinical Global Impression-Global Improvement scale (CGI-I). Subjects in Part B will receive rTMS and be followed daily until day 29 after last rTMS session. For each session, subjects will complete a VAS prior, immediately after, and 60 minutes post, day 22 \& day 29; a BDI on Days 1, 5, 12, 22, \& 29; on days 5, 12, 22, \& 29 subjects will complete the PGIC; clinicians will complete the CGI-I.
Masking
None (open label)
Enrolment
15 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02608463
Sponsor's protocol ID
204737
Status last verified
May 2021
First submitted
13 Nov 2015
Last updated
23 Jun 2021
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing painDETECT Questionnaire, Pain Catastrophizing Scale and Pain Intensity Scale, Pain Interference Scale, Pain Behavior Scale in people with Pain and Pregnancy, run by University of Arkansas at 1 site in United States.

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 13 inclusion and 21 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: finished, as of the sponsor's last update on 23 Jun 2021. 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 United States. 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?

Yes. Results are posted in the registry (first posted 2 Sep 2020). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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?

Change From Baseline Visual Analogue Scale for Pain (time frame: Baseline and end of study participation, an average of 194 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 23 Jun 2021; AzTrials last refreshed its copy on 4 Nov 2026.

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