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Pain ManagementNCT04866784

TENS for Testicular Pain (ICO): A Randomized Controlled Trial

A study testing Transcutaneous Electrical Nerve Stimulation (TENS) in people with Pain Management, run by Jennifer E. Lee 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

Idiopathic Chronic Orchialgia (i.e., testicular pain) is a challenging condition to treat, with unresolved testicular pain leading to distress, diminished activities of daily living and decreased quality of life. Read more about this study

Who is it for?
Ages 18 to 99 years, men onlyHealthy volunteers can take part
Conditions the study is for
Pain Management
What is being tested?
Transcutaneous Electrical Nerve Stimulation (TENS)
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
8 participants
Where
1 siteUnited States
Study dates
23 Dec 2020to 1 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 18 to 99 years
  • Men only
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Age >18 years to 99;
  • Diagnosis of Idiopathic Chronic Orchialgia (ICO)
  • English Speaking (does not need to be native language)

Who cannot join

  • Pain intensity rating less than 2/10 at time of first session
  • Inability to read or write
  • Inability to follow directions
  • 4 .Contraindications for TENS (Nickel allergy, pacemaker, open wound in TENS application area)
  • 5. TENS use in last 5 years.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Iowa

    Iowa City, Iowa, 52242

Other trials in United States

About this study

Official title: TENS for Patients With Chronic Testicular Pain (ICO)

Idiopathic Chronic Orchialgia (i.e., testicular pain) is a challenging condition to treat, with unresolved testicular pain leading to distress, diminished activities of daily living and decreased quality of life. Testicular Pain may be caused by a tumor, hernia, infection, trauma, vein compression, cysts, and/or postoperative or radiating pain, though is often times unknown. Non-pharmacologic, conservative pain reduction interventions include heat, ice, scrotal support, physical therapy, and/or counseling, and should often be used as first line of defense. More aggressive, invasive, and non-conservative medical treatment options include medications, nerve blocks, and/or surgery, each of which may be effective, but may be invasive and/or cause serious side effects. However, there is no standard of care for managing the testicular pain and many men do not respond to current biomedical or nonpharmacologic treatment options. Novel, non-invasive treatment options are needed for ICO to improve distress, daily living activities, and quality of life. Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacologic intervention for acute and chronic pain. This treatment involves the application of electric current through the skin; it is safe, easy to use, and inexpensive. Despite the impact and distress associated with Testicular Pain, only one known study examined the efficacy of TENS for this condition. A 2018 double-blind, randomized controlled study of people with Testicular Pain reported that TENS improved pain and quality of life significantly more than the control condition (analgesia only). This 2018 study lacked a placebo control condition (i.e., unknown whether pain relief was due to the placebo effect, where knowing an intervention is happening leads to an expectation that pain will decrease, and therefore pain perception decreases independent of the intervention). Thus, the aim of this study is to examine the efficacy of TENS on Testicular Pain using a randomized, placebo-controlled design. The results of this study will be used to inform a larger, federally-funded study.

  1. Primary Aim: To assess the efficacy of TENS for Testicular Pain ii. Secondary Aim: To assess the feasibility of TENS for Testicular Pain iii. Third Aim: To assess the tolerability of TENS for Testicular Pain iii. To assess associations between dispositional pain catastrophizing on responsiveness to the TENS intervention.
Read the detailed description

The overall aim of this study is to examine the efficacy of TENS on Testicular Pain using a randomized, placebo-controlled design. The results of this study will be used to inform a larger, federally-funded study. The study is a prospective, randomized, double-blinded and placebo-controlled crossover design (each participant completes all 3 study conditions) with randomization to 3 study conditions: 1) Active TENS; 2) Placebo TENS; or 3) No Treatment Control. Subjects will be tested 1x/week for 3 weeks. Each subject will receive the 3 treatments in randomized order. Importantly, the experimenter and subject will be blinded to the treatment condition. A second experimenter will administer the Active or Placebo TENS, or the Control to ensure appropriate blinding (to ensure no bias from knowing which TENS condition is given at each visit).

Participants. Thirty men with Testicular Pain (lasting >3 months), aged 18-99yrs will be recruited. Exclusion criteria includes: pain intensity rating ≤ 3/10, contraindications for TENS (pacemaker) or TENS use ≤ 5 years. Participants will provide written informed consent, as approved by the University of Iowa Biomedical Institutional Review Board. TENS Treatment. All subjects will receive each of the 3 TENS treatment conditions while sitting in an upright position. Four adhesive electrodes (2in x 2in) will be placed bilaterally on the: 1) sacrum (for pudendal nerve); and 2) groin (ilioinguinal nerve).

Active TENS includes high frequency TENS delivered for 30mins at a frequency of 100 Hz and pulse duration of 100μsec using the EMPI Select TENS unit (calibrated using an oscilloscope prior to study). The intensity will be increased until patients feel a "maximally strong but comfortable sensation" to ensure an analgesic effect.

Placebo TENS parameters will be identical to Active TENS (100 Hz and 100 μsec), but a novel placebo TENS unit, previously tested and validated will be used. The placebo device provides a current for 30sec and ramps off over 15sec to zero output. An indicator light remains on so it appears to the subject that the unit is still producing current. This unit has demonstrated nearly 100% blinding of investigators such that the investigator applying the TENS is unable to distinguish between the active and the placebo unit; approximately ~50% of subjects are successfully blinded using this unit.

The No Treatment Control includes application of TENS electrodes identical to the other 2 conditions, but the unit remains off. This condition will control for potential effects of repeat testing and any placebo effect.

Patient Measures. Pain will be assessed before and after TENS each session to measure any within visit changes in pain from the TENS intervention. Pain change will be measured using the: 1) Short-Form McGill Pain Questionnaire 27 with qualitative (i.e., sharp, distressing) and quantitative pain scales; and 2) 10-point numeric pain intensity rating scale (NRS) ranging from 0 (no pain) to 10 (worst pain imaginable); These pain measures are valid and reliable. Pain medication intake will also be assessed. Finally, pain-related catastrophizing (i.e., coping) will be measured using the Pain Catastrophizing Scale to determine if any responsiveness to TENS intervention is related to dispositional catastrophizing (i.e., their general catastrophizing levels prior to initiating the TENS study interventions).

Conditions
Pain Management
Being tested
Transcutaneous Electrical Nerve Stimulation (TENS)
Keywords
Transcutaneous electric nerve stimulation, Idiopathic chronic orchialgia, Testicular Pain, Chronic Pain, Testicular, Scrotum
Medical subject headings
Agnosia, Chronic Pain

What participants receive

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

  • Transcutaneous Electrical Nerve Stimulation (TENS)Device

    Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacologic intervention for acute and chronic pain. This treatment involves the application of electric current through the skin; it is safe, easy to use, and inexpensive

Study groups in NCT04866784
Study groupRoleWhat they receive
High Sensation TENSExperimentalActive TENS is delivered for 30mins at a frequency of 100 Hz and pulse duration of 100μsec using the EMPI Select TENS unit (calibrated using an oscilloscope prior to study). The intensity will be increased until patients feel a "maximally strong but comfortable sensation" to ensure an analgesic effect.
Receives: Device: Transcutaneous Electrical Nerve Stimulation (TENS)
Low Sensation TENSPlacebo comparatorPlacebo TENS parameters will be identical to Active TENS (100 Hz and 100 μsec), but a novel placebo TENS unit, previously tested and validated will be used (Rakel et al., 2010). The placebo device provides a current for 30sec and ramps off over 15sec to zero output. An indicator light remains on so it appears to the subject that the unit is still producing current. This unit has demonstrated nearly 100% blinding of investigators such that the investigator applying the TENS is unable to distinguish between the active and the placebo unit; approximately ~50% of subjects are successfully blinded using this unit.
Receives: Device: Transcutaneous Electrical Nerve Stimulation (TENS)
No Treatment ControlNo interventionThe No Treatment Control includes application of TENS electrodes identical to the other 2 conditions, but the unit remains off. This condition will control for potential effects of repeat testing and any placebo effect.

What is being measured

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

  1. Change in Short-Form McGill Pain Questionnaire (MPQ) Pain Scores

    Qualitative (e.g.sharp, distressing) and quantitative pain scales. Quantitative pain scale consists of 15 descriptors (11 sensory, 4 affective) which are rated on an intensity scale of 0 = none, 1=mild, 2=moderate, 3=severe.

    Measured: This outcome measure will be used within 10 minutes of the start of each visit (right before TENS is applied) and 30 minutes after TENS is applied (within visit MPQ change) to assess the within visit change in MPQ pain.

  2. Change in 10-point Numeric Pain Intensity Rating Scale (NRS) pain scores

    Quantitative pain scale ranging from 0 (no pain) to 10 (worst pain imaginable)

    Measured: This outcome measure will be used within 10 minutes of the start of each visit (right before TENS is applied) and 30 minutes after TENS is applied (within visit NRS change) to assess the within visit change in NRS pain.

Secondary outcomes (1)
  1. Pain Catastrophizing Scale (PCS)

    Measurement of pain-related coping

    Measured: This outcome measure will be used at the start of the study (after they consent; baseline). PCS scores range from 0-52 and higher scores mean worse catastrophizing. A decrease in PCS scores is a good outcome.

Timeline

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

  1. First posted30 Apr 2021
  2. Study start23 Dec 2020
  3. Primary completion1 Jun 2022
  4. Study completion1 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
Crossover
Model description
The study is a prospective, randomized, double-blinded and placebo-controlled crossover design (all participants complete each of the 3 conditions) with randomization to: 1) Active TENS; 2) Placebo TENS; or 3) No Treatment Control. Each subject will receive the 3 TENS treatments in randomized order (one visit per week in three separate weeks). The visits do not have to take place in three consecutive weeks (will depend on participant scheduling preferences), but all three visits must take place within one year
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
8 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04866784
Sponsor's protocol ID
202004356
Status last verified
Jun 2022
First submitted
22 Dec 2020
Last updated
23 Jun 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Publications

  • Levine L. Chronic orchialgia: evaluation and discussion of treatment options. Ther Adv Urol. 2010 Oct;2(5-06):209-14. doi: 10.1177/1756287210390409.

    PubMed 21789076
  • Granitsiotis P, Kirk D. Chronic testicular pain: an overview. Eur Urol. 2004 Apr;45(4):430-6. doi: 10.1016/j.eururo.2003.11.004.

    PubMed 15041105
  • Belanger GV, VerLee GT. Diagnosis and Surgical Management of Male Pelvic, Inguinal, and Testicular Pain. Surg Clin North Am. 2016 Jun;96(3):593-613. doi: 10.1016/j.suc.2016.02.014.

    PubMed 27261797
  • Kavoussi PK, Costabile RA. Orchialgia and the chronic pelvic pain syndrome. World J Urol. 2013 Aug;31(4):773-8. doi: 10.1007/s00345-013-1092-5. Epub 2013 May 5.

    PubMed 23645410
  • Masarani M, Cox R. The aetiology, pathophysiology and management of chronic orchialgia. BJU Int. 2003 Mar;91(5):435-7. doi: 10.1046/j.1464-410x.2003.04094.x. No abstract available.

    PubMed 12603394
  • Tojuola B, Layman J, Kartal I, Gudelogul A, Brahmbhatt J, Parekattil S. Chronic orchialgia: Review of treatments old and new. Indian J Urol. 2016 Jan-Mar;32(1):21-6. doi: 10.4103/0970-1591.173110.

    PubMed 26941490
  • Lee JE, Anderson CM, Perkhounkova Y, Sleeuwenhoek BM, Louison RR. Transcutaneous Electrical Nerve Stimulation Reduces Resting Pain in Head and Neck Cancer Patients: A Randomized and Placebo-Controlled Double-Blind Pilot Study. Cancer Nurs. 2019 May/Jun;42(3):218-228. doi: 10.1097/NCC.0000000000000594.

    PubMed 29649082
  • Osiri M, Welch V, Brosseau L, Shea B, McGowan J, Tugwell P, Wells G. Transcutaneous electrical nerve stimulation for knee osteoarthritis. Cochrane Database Syst Rev. 2000;(4):CD002823. doi: 10.1002/14651858.CD002823.

    PubMed 11034768
  • Tantawy SA, Kamel DM, Abdelbasset WK. Does transcutaneous electrical nerve stimulation reduce pain and improve quality of life in patients with idiopathic chronic orchialgia? A randomized controlled trial. J Pain Res. 2017 Dec 27;11:77-82. doi: 10.2147/JPR.S154815. eCollection 2018.

    PubMed 29343983

Questions about this trial

What is this clinical trial studying?

A study testing Transcutaneous Electrical Nerve Stimulation (TENS) in people with Pain Management, run by Jennifer E. Lee 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 3 inclusion and 5 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 2022. 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. Some participants in this study may receive a placebo. 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 Short-Form McGill Pain Questionnaire (MPQ) Pain Scores (time frame: This outcome measure will be used within 10 minutes of the start of each visit (right before TENS is applied) and 30 minutes after TENS is applied (within visit MPQ change) to assess the within visit change in MPQ pain.). The study lists 2 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 NCT04866784, which also lists 9 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 23 Jun 2022.

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