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Ehlers-Danlos Syndrome (EDS)Early Phase 1TPDNCT03686748

Two Point Discrimination

A Early Phase 1 study testing Two-point discrimination training and One-point discrimination training in people with Ehlers-Danlos Syndrome (EDS) and Complex Regional Pain Syndrome (CRPS), run by Children's Hospital Medical Center, Cincinnati at 1 site in United States.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

SPECIFIC AIMS Pain in both youth and adults is a complex, subjective and personal experience, and remains poorly understood. One particularly perplexing dimension of some forms of pain is the tendency of pain to spread outside of an affected body site to adjacent location, and then to unaffected body sites. Read more about this study

Who is it for?
Ages 10 to 17 yearsHealthy volunteers can take part
What is being tested?
Two-point discrimination training and One-point discrimination training
Could I receive a placebo?
No, everyone receives an active treatment
How many people
60 participants
Where
1 siteUnited States
Study dates
21 Jul 2018to 16 Jul 2027
Phase
Early Phase 1
Are there results?
Not yet: the study is under way

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 10 to 17 years
  • All sexes
  • Healthy volunteers accepted
  • Child

Who may be able to join

  • Chronic Pain Patients:
  • Somatically located chronic pain
  • amplified musculoskeletal pain syndrome
  • complex regional pain syndrome
  • low back pain
  • fibromyalgia
Show all 13Show fewer
  • other forms of chronic, widespread pain
  • Male or female, 10-17 years
  • High fluency in written and oral English language
  • Control Participants:
  • Youth in good general health
  • Male or female, 10-17 years
  • High fluency in written and oral English language

Who cannot join

  • Present significant mental health disorder as defined by DSM V (e.g. psychosis, bipolar disorder, major depression),
  • alcohol or drug dependence
  • documented developmental delays or impairments (e.g., autism, cerebral palsy, or mental retardation) of a magnitude that would interfere with adherence to study requirements or safe participation in the study
  • Primary complaint of migraine or visceral (abdominal) pain, with minimal somatic involvement.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Cincinnati Children's Hospital Medical Center

    Cincinnati, Ohio, 45229

Other trials in United States

About this study

Official title: Retuning the Nervous System in Youth With Chronic Pain

SPECIFIC AIMS

Pain in both youth and adults is a complex, subjective and personal experience, and remains poorly understood. One particularly perplexing dimension of some forms of pain is the tendency of pain to spread outside of an affected body site to adjacent location, and then to unaffected body sites. Such widespread pain may reflect an altered spatial tuning of somatosensory processing, such that lateral inhibition is diminished, thereby allowing pain to spread. To date, no therapies exist which are designed specifically to diminish or even reverse the spatial spread of pain. However, training in two-point discrimination holds the potential to retune spatial aspects of somatosensory processing and may represent a novel therapy for widespread pain. Thus, the present investigation will test the following aims:

Read more

Aim 1. Do youth with chronic pain have disrupted spatial tuning of somatosensory processing? Deficits in two point tactile discrimination have long been noted in adults with chronic pain, but such deficits remain poorly documented in pediatric chronic pain patients. In order to determine if such deficits exist, youth with both chronic pain and healthy youth will undergo assessment of two point discrimination thresholds.

Aim 2. Does two-point discrimination training result in diminished pain and disability in youth with somatic pain? After initial characterization of tactile discrimination thresholds, youth with chronic pain will participate in multiple sessions of either two-point discrimination training or a single-point spatially-directed attentional control condition. Training will involve up to 9 additional sessions. Efficacy of training will be assessed by 1) reductions in the spatial extent of pain, 2) reductions in pain intensity and unpleasantness, and 3) reductions in pain-related disability.

Read the detailed description

STUDY DESIGN Prior to commencing this investigation, investigators will optimize the tactile discrimination threshold testing (i.e. as per baseline visit, below), and the training conditions, in up to ten participants (patients and/or healthy controls). This will serve as a pilot to refine operational aspects of study procedures before investigators commence the main investigation proposed herein. Following this, youth with either chronic pain (ages 10-17, n=40) or healthy youth (ages 10-17, n=20) will undergo assessments of two-point and single-point discrimination thresholds in an initial session (Aim 1). After this initial session, youth with chronic pain will participate in up to 9 additional sessions of attentional training (Aim 2). These chronic pain patients will be randomized to either two-point discrimination training (n=20) or a single-point spatially-directed attentional control condition (n=20). Participants will not be informed of which intervention they will receive (single-blind study). Psychological questionnaires will be completed in the first and last sessions in order to determine how these variables relate to tactile discrimination and response to training.

STUDY INTERVENTIONS 5.1 Two Point Discrimination Training: Two-point discrimination threshold (TPD) training may be performed 1) at spatial locations remote from pain, 2) at spatial locations adjacent to the region of pain, and/or 3) at spatial locations in the site of pain, if the participant will tolerate it. TPD is defined as the smallest distance between two points at which someone can recognize two points, and not one, touching their skin. As such this is a test of one's ability to identify separate stimulation of two discrete areas, and relies heavily on lateral inhibition. Highly precise mechanical calipers will be gently placed onto the skin and the distance between the prongs will be increased/decreased. After repeated decreases and increases in the distance between the prongs, the TPD will be deemed as the distance at which participants consistently report two points instead of one. One-point stimuli will be interleaved to serve as a control condition. Participants will be informed immediately of correct and incorrect responses as part of the discrimination training.

5.2 Control Stimulation: Participants will undergo a single-point discrimination training at the same sites as described above. Probes of different sizes will be used for this portion - a small diameter probe (~1-5 mm) and a large diameter probe (~6-50mm). The probes will be gently placed in contact with the participants' skin, and the participant will be instructed to respond if they were contacted with the small or large probe. Participants will be informed immediately of correct and incorrect responses as part of the discrimination training.

Being tested
Two-point discrimination training, One-point discrimination training
Keywords
Pain
Medical subject headings
Ehlers-Danlos Syndrome, Complex Regional Pain Syndromes, Chronic Pain, Low Back Pain, Fibromyalgia, Pain

What participants receive

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

  • Two-point discrimination trainingBehavioural

    Patients will undergo multiple sessions of two-point discrimination training.

  • One-point discrimination trainingBehavioural

    Patients will undergo multiple sessions of one-point discrimination training.

Study groups in NCT03686748
Study groupRoleWhat they receive
Two-point interventionExperimentalTwo point discrimination training.
Receives: Behavioral: Two-point discrimination training
One-point interventionActive comparatorOne point discrimination of size of probe
Receives: Behavioral: One-point discrimination training
Healthy ControlsNo interventionObservational component of differences in discrimination between chronic pain patients and healthy controls.

What is being measured

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

  1. Change in spatial extent of pain from baseline visit to final visit

    total area of body affected by pain

    Measured: baseline to final visit which is up to 5 weeks from baseline

  2. Change in pain ratings from baseline visit to final visit

    Ratings of current pain intensity on a non-numerical visual analog scale ranging from "not at all intense" to "most intense pain sensation imaginable" and of pain unpleasantness on a non-numerical visual analog scale ranging from "not at all unpleasant" to "most unpleasant pain imaginable".

    Measured: baseline to final visit which is up to 5 weeks from baseline

  3. Change in pain-related disability from baseline visit to final visit

    pain-related disability as assessed by the Functional Disability Index

    Measured: baseline to final visit which is up to 5 weeks from baseline

Secondary outcomes (1)
  1. Change in two point discrimination threshold from baseline visit to final visit

    Calipers moving at fixed distances to determine threshold of two point detection

    Measured: baseline to final visit which is up to 5 weeks from baseline

Timeline

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

  1. First posted27 Sep 2018
  2. Study start21 Jul 2018
  3. Primary completion17 Jul 2026 (estimated)
  4. Study completion16 Jul 2027 (estimated)

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
Early Phase 1
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Two group, single blind for chronic pain patients receiving intervention, additional basic science component with baseline comparisons between patients and healthy controls.
Masking
Single blind
Who is masked
Participant
Enrolment
60 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03686748
Sponsor's protocol ID
CIN_TPD_001
Acronym
TPD
Status last verified
Jan 2025
First submitted
27 Jun 2018
Last updated
6 Jan 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: All collected deidentified IPD that underlie results in a publication

Publications

  • Flor H, Nikolajsen L, Staehelin Jensen T. Phantom limb pain: a case of maladaptive CNS plasticity? Nat Rev Neurosci. 2006 Nov;7(11):873-81. doi: 10.1038/nrn1991.

    PubMed 17053811
  • Defrin R, Pope G, Davis KD. Interactions between spatial summation, 2-point discrimination and habituation of heat pain. Eur J Pain. 2008 Oct;12(7):900-9. doi: 10.1016/j.ejpain.2007.12.015. Epub 2008 Feb 14.

    PubMed 18280188
  • Flor H, Denke C, Schaefer M, Grusser S. Effect of sensory discrimination training on cortical reorganisation and phantom limb pain. Lancet. 2001 Jun 2;357(9270):1763-4. doi: 10.1016/S0140-6736(00)04890-X.

    PubMed 11403816
  • Gardner EP, Martin JH, Jessell TM, Kandel ER, Schwartz JH (2000) Principles of neural science. New York: McGraw-Hill.

  • Groenewald CB, Essner BS, Wright D, Fesinmeyer MD, Palermo TM. The economic costs of chronic pain among a cohort of treatment-seeking adolescents in the United States. J Pain. 2014 Sep;15(9):925-33. doi: 10.1016/j.jpain.2014.06.002. Epub 2014 Jun 19.

    PubMed 24953887
  • Hechler T, Wager J, Zernikow B. Chronic pain treatment in children and adolescents: less is good, more is sometimes better. BMC Pediatr. 2014 Oct 13;14:262. doi: 10.1186/1471-2431-14-262.

    PubMed 25308551
  • Hestbaek L, Leboeuf-Yde C, Kyvik KO, Manniche C. The course of low back pain from adolescence to adulthood: eight-year follow-up of 9600 twins. Spine (Phila Pa 1976). 2006 Feb 15;31(4):468-72. doi: 10.1097/01.brs.0000199958.04073.d9.

    PubMed 16481960
  • Huguet A, Miro J. The severity of chronic pediatric pain: an epidemiological study. J Pain. 2008 Mar;9(3):226-36. doi: 10.1016/j.jpain.2007.10.015. Epub 2007 Dec 21.

    PubMed 18088558
  • King S, Chambers CT, Huguet A, MacNevin RC, McGrath PJ, Parker L, MacDonald AJ. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain. 2011 Dec;152(12):2729-2738. doi: 10.1016/j.pain.2011.07.016.

    PubMed 22078064
  • Lotze M, Moseley GL. Role of distorted body image in pain. Curr Rheumatol Rep. 2007 Dec;9(6):488-96. doi: 10.1007/s11926-007-0079-x.

    PubMed 18177603
  • Maihofner C, Handwerker HO, Neundorfer B, Birklein F. Patterns of cortical reorganization in complex regional pain syndrome. Neurology. 2003 Dec 23;61(12):1707-15. doi: 10.1212/01.wnl.0000098939.02752.8e.

    PubMed 14694034
  • Maihofner C, Handwerker HO, Neundorfer B, Birklein F. Cortical reorganization during recovery from complex regional pain syndrome. Neurology. 2004 Aug 24;63(4):693-701. doi: 10.1212/01.wnl.0000134661.46658.b0.

    PubMed 15326245
  • Moseley LG, Zalucki NM, Wiech K. Tactile discrimination, but not tactile stimulation alone, reduces chronic limb pain. Pain. 2008 Jul 31;137(3):600-608. doi: 10.1016/j.pain.2007.10.021. Epub 2007 Dec 3.

    PubMed 18054437
  • O'Sullivan PB, Beales DJ, Smith AJ, Straker LM. Low back pain in 17 year olds has substantial impact and represents an important public health disorder: a cross-sectional study. BMC Public Health. 2012 Feb 5;12:100. doi: 10.1186/1471-2458-12-100.

    PubMed 22304903
  • Price DD (1999) Psychological mechanisms of pain and analgesia, 0 Edition. Seattle: IASP Press.

Questions about this trial

What is this clinical trial studying?

A Early Phase 1 study testing Two-point discrimination training and One-point discrimination training in people with Ehlers-Danlos Syndrome (EDS) and Complex Regional Pain Syndrome (CRPS), run by Children's Hospital Medical Center, Cincinnati 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 4 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: under way, not looking for participants, as of the sponsor's last update on 6 Jan 2025. 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.

What does this phase mean?

Early Phase 1 (sometimes called Phase 0) studies give a very small amount of a treatment to a few people, mainly to see how the body handles it.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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 spatial extent of pain from baseline visit to final visit (time frame: baseline to final visit which is up to 5 weeks from baseline). The study lists 3 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 NCT03686748, which also lists 20 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 6 Jan 2025.

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