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Pain, ChronicNCT03380104

Intradural Percutaneous Stimulation

A study testing Intradural Spinal Cord Stimulation and Administration of Questionnaires in people with Pain, Chronic, run by Matthew Howard at 1 site in United States.

Withdrawn

Withdrawn. The study stopped before anyone enrolled.

Official record
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Trial summary

The purpose of the study is to test the effects of intradural, spinal cord stimulation using a device placed in the same manner as a lumbar drain performed during a standard epidural spinal cord stimulation (SCS) trial routinely performed prior permanent lead and stimulation device implantation. Read more about this study

Who is it for?
Ages 18 to 85 years
Conditions the study is for
Pain, Chronic
What is being tested?
Intradural Spinal Cord Stimulation and Administration of Questionnaires
Could I receive a placebo?
No, everyone receives an active treatment
How many people
0 participants
Where
1 siteUnited States
Study dates
1 Jun 2020to 1 Jun 2020
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 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients with neuropathic pain and concordant neurological findings previously consented for an epidural spinal cord stimulator trial
  • Patients greater than 18 years of agree
  • Must have one of the following:
  • Diagnosed with medically refractory chronic neuropathic pain, post laminectomy pain syndrome, or failed back surgery syndrome and planning to undergo a spinal cord stimulation trial
  • Been deemed refractory to all other treatments and would otherwise receive an intrathecal catheter/pump for chronic narcotic administration
  • Disease duration of at least 6 months with no lasting success with standard therapies or medications with exception of spinal cord stimulation
Show all 12Show fewer
  • Mean pain intensity of a least 5 (or greater) measured on a visual analogue scale from 0 (no pain) to 10 (severe pain)
  • MRI or CT Myelogram of the lumbar and thoracic spine (within 12 months prior to screening)
  • No compressive spinal pathology or intradural implants (eg., syrinx shunt tubes)
  • Psychological screening has been completed and the patient has been cleared by a psychologist or psychiatrist as a suitable SCS candidate
  • Female patients of childbearing potential must have a negative serum pregnancy test
  • Patients agree to comply with the study protocol and have reviewed and given written informed consent

Who cannot join

  • Patients who are unable or unwilling to provide feedback regarding the response
  • Subject has an existing intrathecal drug pump
  • Pain is attributed to: vascular disorder; musculoskeletal disorder; substance abuse or withdrawal; infection; disorder of homeostasis
  • Subject is currently enrolled in another trial
  • History of coagulation disorders or patients on chronic anticoagulant or antiplatelet therapy that is not able to be safely held for 14 days
  • History of thoracic trauma or spinal surgery extending into the thoracic spine
Show all 19Show fewer
  • History of arachnoiditis or intradural spinal surgery that would limit catheter insertion to the target site
  • Current clinically significant or disabling chronic pain problem or condition that is likely to confound evaluation of the study endpoints (i.e. chronic migraine, significant arthritis of the hip associated with primary groin pain complaint)
  • Radiographic evidence of frank spinal instability (gross mobile spondylolisthesis or abnormal subluxation requiring fusion, calcific arachnoiditis, or severe thoracic or lumbar stenosis
  • Subject has a condition that requires diathermy or repeated MRIs
  • New medication for pain initiated within 8 weeks prior to initial baseline research evaluation
  • Life expectancy less than 3 months
  • Systemic infection or local infection of the spine or skin in the anticipated region of catheter insertion.
  • Immune deficiency or history of post surgical infection
  • Female candidates of childbearing potential who are pregnant (confirmed with a positive serum pregnancy test), not using adequate contraception as determined by the investigator, or nursing (lactating) a child
  • Untreated or active psychiatric condition
  • Complex regional pain syndrome or other condition that could limit testing or aggravate an ongoing medical condition
  • Unresolved issues of secondary gain (i.e. litigation)
  • The investigator deems that the subject is not suitable for the study even if they meet all other inclusive/exclusion criteria

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Iowa Hospitals and Clinics

    Iowa City, Iowa, 52242

Other trials in United States

About this study

Official title: Intradural Percutaneous Stimulation - Inducing Physiological Responses.

The purpose of the study is to test the effects of intradural, spinal cord stimulation using a device placed in the same manner as a lumbar drain performed during a standard epidural spinal cord stimulation (SCS) trial routinely performed prior permanent lead and stimulation device implantation.

Read the detailed description

In this pilot study the investigators will test an ability of intradural electrical stimulation in humans to elicit physiological responses (paresthesia or tingling sensation) and decrease pain when placed in the region of the thoracic spinal cord in a controlled manner. This subject population is comprised of patients that had previously failed various conservative pain management treatment plans and are deemed candidates for treatment of pain by spinal cord stimulation. The investigators will use commercially available device to deliver an intradural electrical stimulation to the spinal cord. This device is FDA approved for intracranial electrophysiological monitoring and delivery of electrical stimulation of the subsurface level of the brain.

As a part of the study, the subject will be offered to complete the following questionnaires to assess quality of life and global function. These questionnaires will be completed prior the procedure and at specified time periods following the research intervention. The experimental portion of the procedure will follow the standard epidural spinal cord stimulator testing. Under fluoroscopic guidance, using a paramedian approach and shallow entry angle, the device will be placed percutaneously at the lumbar spine at L2-3 or L3-4 level into the intrathecal cerebrospinal fluid (CSF) space and advanced to the T8-10 disc space. The stimulation catheter will run through a standardized experimental algorithm further described in greater details. The initial stimulation will last approximately 30 minutes and involve testing for paresthesias (tingling) and measurement of the threshold signal strength for onset of this sensation at 60 hertz (Hz) and 10000 Hz frequences. During this portion the subject will be asked to describe the sensations and rate his or her pain on a 0 to 10 scale. Following this initial stimulation, the frequency will be changed to 10 kilohertz (KHz) to run over the period of 4 hours. The investigators will continue evaluating the effects of stimulation using visual analogue scores during this period of time.

Conditions
Pain, Chronic
Being tested
Intradural Spinal Cord Stimulation, Administration of Questionnaires
Keywords
Percutaneous Electrical Nerve Stimulation
Medical subject headings
Chronic Pain

What participants receive

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

  • Intradural Spinal Cord StimulationDevice

    The device will be placed percutaneously at the lumbar spine at L2-3 or L3-4 level into the intrathecal CSF space and advanced to the T8-10 disc space. After positioning of the intrathecal lead, the stimulation catheter will be run through a standardized experimental algorithm consisting on various frequencies.

  • Administration of QuestionnairesBehavioural

    Subjects will be administered questionnaires to evaluate pain, quality of life, and global function prior the study, at 1 hour after the completion of the study, and at 4 day follow-up appointment.

Study groups in NCT03380104
Study groupRoleWhat they receive
Single ArmExperimentalIntradural Spinal Cord Stimulation; Administration of Questionnaires
Receives: Device: Intradural Spinal Cord Stimulation; Behavioral: Administration of Questionnaires

What is being measured

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

  1. Establishment of paresthesia threshold

    Observe and record how various stimulation measures induce paresthesias and record this paresthesia threshold. This will be measured by having the patient state when they feel paresthesias as the stimulation amplitude is increased. This will be recorded as a raw number.

    Measured: 30 minutes

  2. Establishment of motor threshold

    Observe and record how various stimulation measures induce motor activity and record this motor threshold. This will be measured by having the patient state when they feel motor movement as the stimulation amplitude is increased. This will be recorded as a raw number.

    Measured: 30 minutes

  3. Acute Adverse Pain Responses using short-form McGill Pain Questionnaire

    Demonstrate that intradural stimulation does not induce adverse painful responses during acute stimulation. Participants will be administered the short-form McGill Pain Questionnaire prior to start of testing and one hour following testing has concluded. The McGill Pain Questionnaire has a range of scores from zero (min) to 45(max) with lower numbers being better.

    Measured: 5 hours

  4. Acute Adverse Pain Responses using long form Brief pain inventory (BPI)

    Demonstrate that intradural stimulation does not induce adverse painful responses during acute stimulation. Participants will be administered the long form BPI prior to start of testing and one hour following testing has concluded. The brief pain index creates a severity and interference score that ranges from zero (min) and 10 (max) with lower numbers being better.

    Measured: 5 hours

Secondary outcomes (2)
  1. Difference in Stimulation Intensity to induce paresthesias

    Record the threshold difference in stimulation intensity between epidural and intrathecal stimulation. This will take the data collected from the patient's clinical epidural trial (paresthesia threshold) and compared to the patient's intradural threshold testing.

    Measured: 90 minutes

  2. Unexpected/Chronic effects of stimulation

    Record unexpected or unanticipated effects of stimulation that may limit its utility or conceivably provide a new avenue for neuromodulation not achievable with epidural stimulation. Participants will be contacted via telephone interviewed to screen for any unexpected outcomes.

    Measured: 1 month

Timeline

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

  1. First posted20 Dec 2017
  2. Study start1 Jun 2020 (estimated)
  3. Primary completion1 Jun 2020 (estimated)
  4. Study completion1 Jun 2020 (estimated)

Why it stopped: Unable to obtain FDA IDE approval. Currently working on additional preclinical testing.

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
Basic science
Allocation
Not applicable
Intervention model
Single group
Model description
All subjects enrolled in this study will undergo Intradural Spinal Cord Stimulation.
Masking
None (open label)
Enrolment
0 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03380104
Sponsor's protocol ID
201708754
Status last verified
May 2021
First submitted
24 Oct 2017
Last updated
11 May 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
Undecided

Publications

  • Charghi R, Chan SY, Kardash KJ, Finlayson RJ, Tran DQ. Electrical stimulation of the epidural space using a catheter with a removable stylet. Reg Anesth Pain Med. 2007 Mar-Apr;32(2):152-6. doi: 10.1016/j.rapm.2006.10.006.

    PubMed 17350527
  • Crews JC, Chan VWS. Perioperative management of patients and equipment selection for neural blockade. In: Cousins MJ, Horlocker TT, Bridenbaugh PO, Carr DB, Eds., Neural Blockade in Clinical Anesthesia and Pain Medicine (Wolters Kluwer, Philadelphia, 2009), Chap. 8, 160-180. ISBN-13: 978-0-7817-7388-1

  • Flouty O, Oya H, Kawasaki H, Wilson S, Reddy CG, Jeffery ND, Brennan TJ, Gibson-Corley KN, Utz M, Gillies GT, Howard MA 3rd. A new device concept for directly modulating spinal cord pathways: initial in vivo experimental results. Physiol Meas. 2012 Dec;33(12):2003-15. doi: 10.1088/0967-3334/33/12/2003. Epub 2012 Nov 15.

    PubMed 23151433
  • Gibson-Corley KN, Flouty O, Oya H, Gillies GT, Howard MA. Postsurgical pathologies associated with intradural electrical stimulation in the central nervous system: design implications for a new clinical device. Biomed Res Int. 2014;2014:989175. doi: 10.1155/2014/989175. Epub 2014 Apr 1.

    PubMed 24800260
  • Howell B, Lad SP, Grill WM. Evaluation of intradural stimulation efficiency and selectivity in a computational model of spinal cord stimulation. PLoS One. 2014 Dec 23;9(12):e114938. doi: 10.1371/journal.pone.0114938. eCollection 2014.

    PubMed 25536035
  • Lena P, Martin R. Subdural placement of an epidural catheter detected by nerve stimulation. Can J Anaesth. 2005 Jun-Jul;52(6):618-21. doi: 10.1007/BF03015772.

    PubMed 15983148
  • Pope JE, Stanton-Hicks M. Accidental subdural spinal cord stimulator lead placement and stimulation. Neuromodulation. 2011 Jan;14(1):30-2; discussion 33. doi: 10.1111/j.1525-1403.2010.00299.x. Epub 2010 Oct 7.

    PubMed 21992159
  • Reddy CG, Dalm BD, Flouty OE, Gillies GT, Howard MA 3rd, Brennan TJ. Comparison of Conventional and Kilohertz Frequency Epidural Stimulation in Patients Undergoing Trialing for Spinal Cord Stimulation: Clinical Considerations. World Neurosurg. 2016 Apr;88:586-591. doi: 10.1016/j.wneu.2015.10.088. Epub 2015 Nov 14.

    PubMed 26585728
  • Sharpe AN, Jackson A. Upper-limb muscle responses to epidural, subdural and intraspinal stimulation of the cervical spinal cord. J Neural Eng. 2014 Feb;11(1):016005. doi: 10.1088/1741-2560/11/1/016005.

    PubMed 24654267
  • Toma AK, Papadopoulos MC, Stapleton S, Kitchen ND, Watkins LD. Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus. Acta Neurochir (Wien). 2013 Oct;155(10):1977-80. doi: 10.1007/s00701-013-1835-5. Epub 2013 Aug 23.

    PubMed 23975646
  • Tsui BC, Gupta S, Finucane B. Detection of subarachnoid and intravascular epidural catheter placement. Can J Anaesth. 1999 Jul;46(7):675-8. doi: 10.1007/BF03013957.

    PubMed 10442964
  • Williams MA, Malm J. Diagnosis and Treatment of Idiopathic Normal Pressure Hydrocephalus. Continuum (Minneap Minn). 2016 Apr;22(2 Dementia):579-99. doi: 10.1212/CON.0000000000000305.

    PubMed 27042909

Questions about this trial

What is this clinical trial studying?

A study testing Intradural Spinal Cord Stimulation and Administration of Questionnaires in people with Pain, Chronic, run by Matthew Howard 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 12 inclusion and 19 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: withdrawn, as of the sponsor's last update on 11 May 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?

The study was withdrawn before enrolling participants, so there are no results.

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?

Establishment of paresthesia threshold (time frame: 30 minutes). The study lists 4 primary outcomes in all. 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 NCT03380104, which also lists 12 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 11 May 2021.

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