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Sacroiliac Joint PainNCT03601949

Lateral Branch Cooled Radiofrequency Denervation vs. Conservative Therapy for Sacroiliac Joint Pain

A study testing SInergy Cooled Radiofrequency and Medical Management in people with Sacroiliac Joint Pain, run by Avanos Medical at 15 sites 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 is a prospective, randomized, controlled, multi-center clinical study. Approximately 208 subjects will be enrolled at approximately 12-15 active duty military, veterans' care, and civilian sites. Read more about this study

Who is it for?
Ages 21 to 110 years
Conditions the study is for
Sacroiliac Joint Pain
What is being tested?
SInergy Cooled Radiofrequency and Medical Management
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
210 participants
Where
15 sitesUnited States
Study dates
29 Jun 2018to 23 Jun 2022
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 21 to 110 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age greater than or equal to 21 years.
  • Able to understand the informed consent, and able to complete outcome measures.
  • Sacroiliac joint (SIJ) pain that is refractory to standard of care treatments such as non-steroidal anti-inflammatory drugs (NSAIDS), physical therapy, etc.
  • At least one positive SIJ pain provocation test (Distraction, Gaenslen's, FABER, Sacral Sulcus tenderness, thigh thrust, compression or sacral thrust).
  • Back pain is predominantly below the lumbar (L) 5 vertebrae.
  • Chronic low back pain lasting for longer than three months.
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  • Greater than 50% pain relief lasting for the expected duration of anesthetic or medication from a therapeutic or diagnostic SIJ injection.
  • Greater than 50% pain relief lasting the duration of anesthetic from lateral branch block (done on different days than SIJ injection).
  • Stabilized on pain medication regimen for > 2 months, as defined by a < 10% change in dosage.
  • Numeric rating scale indicating an average pain score of > 4 over the last seven days. (returned to pre-lateral branch block baseline pain).
  • All other possible sources of low back pain have been ruled out as the primary pain generator, including, but not limited to: suspected advanced degenerative joint disease, the intervertebral discs, bone fracture, the zygapophyseal joints, the hip joint, symptomatic spondylolisthesis, tumor, and other regional soft tissue structures (this is done by physical exam, medical history, and magnetic resonance imaging/computed tomography/X-ray, as required).
  • Willing to utilize double barrier contraceptive method, if of child-bearing potential.
  • Willingness to provide informed consent and to comply with the requirements of this protocol for the full duration of the study.
  • Physician believes ablation of the SIJ is an appropriate treatment for the patient.

Who cannot join

  • Poorly controlled severe psychiatric illness or ongoing psychological barriers to recovery, as determined by the treating physician.
  • Spinal pathology that may impede recovery such as spina bifida occulta, grade II or higher spondylolisthesis at vertebrae L5/sacroiliac (S) 1, or scoliosis.
  • Symptomatic moderate or severe foraminal or central canal stenosis.
  • Systemic infection or localized infection at anticipated introducer entry site.
  • Uncontrolled immunosuppression (e.g., acquired immune deficiency syndrome (AIDS), cancer, diabetes, etc.)
  • Chronic severe conditions such as rheumatoid/inflammatory arthritis.
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  • Pregnancy or recent delivery (within three months).
  • Active radiculopathy pain from lumbar spine.
  • Active hip pathology.
  • Major surgery within three months prior to signing informed consent.
  • Prior radiofrequency denervation of the lateral sacral nerves.
  • Ongoing/unresolved worker's compensation, injury litigation, military medical board, or disability remuneration claims.
  • Allergy to injected substances or medications used in procedure.
  • Body mass index (BMI) > 40 kilograms/meter (squared).
  • Current prescribed opioid medications equivalent to 90 mg of morphine per 24 hours or greater.
  • Subject is currently implanted with pacemaker, stimulator, or defibrillator.
  • Participation in another clinical trial/investigation that could interfere with this trial 30 days prior to signing informed consent.
  • Subject is unwilling or unable to comply with the protocol requirements.

Trial locations and contacts

15 sites in 1 country.

15 sites in 1 country

United States15 sites
  • Shravani Durbhakula

    Baltimore, Maryland, 21287

  • Walter Reed National Military Medical Center

    Bethesda, Maryland, 20889

  • Millennium Pain Center

    Bloomington, Illinois, 61704

  • Lynn Kohan

    Charlottesville, Virginia, 22903

  • Brigham and Women's Hospital

    Chestnut Hill, Massachusetts, 02467

  • Clinical Investigations

    Edmond, Oklahoma, 73013

  • Womack Army Medical Center

    Fort Bragg, North Carolina, 28307

  • Ochsner Medical Center

    New Orleans, Louisiana, 70115

  • Oregon Health and Science University

    Portland, Oregon, 97239

  • Michael DePalma

    Richmond, Virginia, 23235

  • Adam Carinci

    Rochester, New York, 14642

  • Premier Pain Centers

    Shrewsbury, New Jersey, 07702

  • Mehul Desai

    Washington D.C., District of Columbia, 20037

  • The Center for Clinical Research

    Winston-Salem, North Carolina, 27103

  • Wake Forest Baptist Health

    Winston-Salem, North Carolina, 27157

Other trials in United States

About this study

Official title: A Prospective, Multi-center, Randomized, Assessor Blind, Controlled Study Comparing Lateral Branch Cooled Radiofrequency Denervation to Conservative Therapy as Treatment for Sacroiliac Joint Pain in a Military and Civilian Population

This is a prospective, randomized, controlled, multi-center clinical study. Approximately 208 subjects will be enrolled at approximately 12-15 active duty military, veterans' care, and civilian sites. Eligible subjects will be randomized in 1:1 ratio to receive either Sacroiliac denervation using CRF (treatment group) or standard medical management ("SMM," control group).

Read the detailed description

This study will be a 12-month prospective, randomized, controlled, prospective, open-label, multi-center clinical study. Adult subjects over the age of 21 with diagnosed chronic intractable sacroiliac joint pain (≥ 3 months), who have been previously unresponsive to conservative therapy and who meet the selection criteria are eligible to participate in this study. Approximately 208 subjects will be enrolled at up to 15 sites in a 1:1 randomization ratio to receive either denervation using the SInergy System (cooled radiofrequency (CRF), treatment group) or standard medical management (SMM, control group). Follow-up will be conducted for a total of 12 months post-Coolief (cooled radiofrequency ablation) procedure, with the primary endpoint being completed at month 3. The control arm will utilize physician prescribed standard medical management (SMM). For this protocol, this includes, but is not limited to, medications, physical therapy, lifestyle changes, acupuncture, yoga, chiropractic, and therapeutic injections. An optional crossover-to-treatment design was adopted for subjects randomized to standard medical management after their 3-month visit, because it would be considered unethical to withhold treatment that could potentially offer pain relief to those subjects undergoing standard medical management who continue to suffer from pain.

Eligibility includes BOTH of the following:

  • 50% pain relief lasting for the expected duration of anesthetic or medication from a therapeutic or diagnostic sacroiliac joint injection; AND
  • 50% pain relief lasting for the expected duration of anesthetic from a standardized set of lateral branch blocks, with total volume of no more than 1 milliliter (ml) of 0.5% Bupivacaine, Ropivacaine (or similar). Ideally, 0.5 ml will be utilized at L5 and the remaining 0.5 ml should be divided in at least two locations along the foramen line

After the CRF treatment, the CRF treatment group subjects will visit the blinded assessor for follow up at 1, 3, 6, 9, and 12 months. At the month 3 visit (three months post-randomization), subjects initially randomized to the conservative therapy group will be assessed to determine eligibility to receive CRF treatment.

  • If the conservative treatment subjects fail conservative therapy at 3 months (defined as failure to obtain a 2-point decrease in average pain score from baseline AND failure to obtain a rating of at least 5 on the Patient Global Impression of Change (PGIC) scale), they will be given the option of receiving CRF treatment.
  • Subjects who choose to cross-over will ideally receive treatment within 30 days of their 3-month visit but they must receive treatment within 90 days of their 3-month visit. They will then be followed-up at 1, 3, 6, 9, and 12 months following CRF denervation (new Day 0).
  • If the conservative treatment group subjects refuse or don't qualify for CRF treatment at 3 months, they will subsequently be followed-up at 6, 9, and 12 months from their Day 0.

Primary Analysis is planned after all initially treated subjects have completed their 3-month post-procedure visit.

Being tested
SInergy Cooled Radiofrequency, Medical Management
Keywords
Back Pain, Low Back Pain, Sacroiliac Back Pain
Medical subject headings
Back Pain, Low Back Pain

What participants receive

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

  • SInergy Cooled RadiofrequencyDevice

    Also called SInergy

    ablation of low back pain

  • Medical ManagementOther

    Also called Standard Medical Management

    physical therapy, medications, lifestyle changes

Study groups in NCT03601949
Study groupRoleWhat they receive
SInergy Cooled RadiofrequencyExperimentalHalyard Health SInergy Cooled Radiofrequency in addition to standard medical management
Receives: Device: SInergy Cooled Radiofrequency; Other: Medical Management
Medical ManagementActive comparatorStandard Medical Management
Receives: Other: Medical Management

What is being measured

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

  1. Change in average daily pain Numeric Rating Scale (NRS) score

    Numeric Rating Scale (NRS) - score range = 0 - 10. "0" corresponds to "no pain" and "10" indicates "worst pain imaginable". The means of these scores and their respective standard deviations are reported for each study group.

    Measured: Baseline and 3 months

Secondary outcomes (5)
  1. The proportion of subjects with at least a 2 points decrease or 30% drop in average daily pain related NRS score AND a rating of at least 5 on the Patient Global Impression of Change (PGIC)

    Numeric Rating Scale (NRS) - score range = 0 - 10. "0" corresponds to "no pain" and "10" indicates "worst pain imaginable". The means of these scores and their respective standard deviations are reported for each study group. PGIC - score range = 1 - 7. "1" corresponds to "very much improved" and "7" indicates "very much worse" pertaining to overall activity, symptoms, emotions, and quality of life. The means of these scores and their respective standard deviations are reported for each study group.

    Measured: Baseline and 3 months

  2. Mean change in score of Patient Global Impression of Change (PGIC)

    PGIC - score range = 1 - 7. "1" corresponds to "very much improved" and "7" indicates "very much worse" pertaining to overall activity, symptoms, emotions, and quality of life. The means of these scores and their respective standard deviations are reported for each study group.

    Measured: Baseline and 3 months

  3. Mean change in score of Short Form 36-Physical Functioning (SF36-PF)

    Short Form 36-PF - score range = 0 - 100. "0" corresponds to "greatest disability" and "100" indicates "no disability". The means of these scores and their respective standard deviations are reported for each study group.

    Measured: Baseline and 3 months

  4. Mean change in score of Oswestry Disability Index (ODI)

    ODI - score range = 0 - 100. "0" corresponds to "no disability" and "100" indicates the "maximum disability possible". The means of these scores and their respective standard deviations are reported for each study group.

    Measured: Baseline and 3 months

  5. Mean change in score of EuroQuol (EQ) 5D-5L

    This tool involves two components: 1) descriptive system - five questions that are scored 1-5, each with "1" indicating no problems and "5" indicating the worst problem related to the question, and 2) EQ-Visual Analog Scale (VAS) - score range = 0 - 100. "0" corresponds to the "worst imaginable health state" and "100" indicates the "best imaginable health state". The means of these scores and their respective standard deviations are reported for each study group.

    Measured: Baseline and 3 months

Timeline

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

  1. First posted26 Jul 2018
  2. Study start29 Jun 2018
  3. Primary completion9 Aug 2021
  4. Study completion23 Jun 2022

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
Single blind
Who is masked
Outcomes assessor
Enrolment
210 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03601949
Sponsor's protocol ID
105-17-0002
Status last verified
Mar 2023
First submitted
18 Jul 2018
Last updated
22 Mar 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes

Publications

  • Cohen SP, Kapural L, Kohan L, Li S, Hurley R, Vallejo R, Eshraghi Y, Dinakar P, Durbhakula S, Beall DP, Desai MJ, Reece D, Christiansen S, Chang MH, Carinci AJ, DePalma M. Cooled radiofrequency ablation provides extended clinical utility in the management of chronic sacroiliac joint pain: 12-month follow-up results from the observational phase of a randomized, multicenter, comparative-effectiveness crossover study. Reg Anesth Pain Med. 2026 Jun 5;51(6):660-669. doi: 10.1136/rapm-2024-106315.

    PubMed 40089310
  • Cohen SP, Kapural L, Kohan L, Li S, Hurley RW, Vallejo R, Eshraghi Y, Dinakar P, Durbhakula S, Beall DP, Desai MJ, Reece D, Christiansen S, Chang MH, Carinci AJ, DePalma M. Cooled radiofrequency ablation versus standard medical management for chronic sacroiliac joint pain: a multicenter, randomized comparative effectiveness study. Reg Anesth Pain Med. 2024 Mar 4;49(3):184-191. doi: 10.1136/rapm-2023-104568.

    PubMed 37407279

Questions about this trial

What is this clinical trial studying?

A study testing SInergy Cooled Radiofrequency and Medical Management in people with Sacroiliac Joint Pain, run by Avanos Medical at 15 sites 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 14 inclusion and 18 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 22 Mar 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 15 sites 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 is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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 in average daily pain Numeric Rating Scale (NRS) score (time frame: Baseline and 3 months). 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 NCT03601949, which also lists 2 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 22 Mar 2023.

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