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Spinal Cord Injury at T1-T12 LevelNCT04894734

Spinal Cord Stimulation (SCS) for Spinal Cord Injury (SCI)

A study testing EES on and EES off in people with Spinal Cord Injury at T1-T12 Level and Traumatic Thoracic Spinal Cord Contusion, run by Nandan Lad, M.D., Ph.D. 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

The purpose of this feasibility study is to compare the impact of Spinal cord stimulation [SCS] for Spinal Cord Injury (SCI) pain and rehabilitation. SCS, also known as Epidural Electrical Stimulation (EES), will be utilized along with conventional medical management (CMM) or CMM alone. Read more about this study

Who is it for?
Ages 18 to 80 years
What is being tested?
EES on and EES off
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
25 participants
Where
1 siteUnited States
Study dates
30 Dec 2021to 30 Jun 2028
Phase
Interventional
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 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Subjects enrolled in this study must meet all of the following inclusion criteria (based on investigator judgement):
  • Traumatic, thoracic SCI
  • Chronic neuropathic pain (i.e., Pain >3 for > 3 months)
  • Willing and able to provide informed consent, attend required study visits, and complete required assessments/questionnaires
  • 18-80 years of age
  • Medically stable enough to undergo surgical implantation of an SCS / participate in rehabilitation regimens

Who cannot join

  • Subjects enrolled in this study must not meet any of the following exclusion criteria (based on investigator judgement):
  • Complete cord transection
  • Persistent spinal instability or other injury preventing ability to participate
  • Active infection
  • Comorbid psychosis or psychotic disorder
  • Untreated, clinically significant depression
Show all 10Show fewer
  • Active drug or alcohol abuse
  • Pregnant women or women who intend to become pregnant during the duration of the study. Women of childbearing potential need a negative pregnancy test
  • Patients without symptoms of neuropathic pain >3/10 for > 3 months
  • Patient deemed not medically stable for surgery

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Duke University Health Systems

    Durham, North Carolina, 27710

Other trials in United States

About this study

Official title: The Feasibility of Epidural Electrical Stimulation (EES) for Improving Pain and Rehabilitation Outcomes in Patients With Spinal Cord Injury (SCI)

The purpose of this feasibility study is to compare the impact of Spinal cord stimulation [SCS] for Spinal Cord Injury (SCI) pain and rehabilitation. SCS, also known as Epidural Electrical Stimulation (EES), will be utilized along with conventional medical management (CMM) or CMM alone. Participation in this research study is expected to last approximately 24 months. All subjects will be evaluated and proceed with implantation of two SCS devices- one tailored based on the individual's SCI for the treatment of neuropathic pain of trunk and limb and a second near the bottom of the spinal cord (conus region) to study the impact on motor, sensory, bowel/bladder outcomes. All patients will also continue receiving CMM, such as medications and physical therapy.

Participating subjects will be allocated to one of two treatment groups:

Read more
  1. Placebo arm: SCS OFF + CMM. Under the direction of the study physician, the patient may receive a variety of treatments, such as medications and various forms of rehabilitation.
  2. Treatment arm: SCS ON + CMM. The study treatment Spinal Cord Stimulation [SCS]: the study physician will perform a trial procedure to see if the study procedure works for the patient and may implant a permanent device if it is successful. There is a temporary trial procedure, or a "test drive," which usually lasts 5-7 days. If this is successful, patients will discuss a more permanent implant. This study involves the concurrent placement of two SCS devices (one focused on pain and the second for rehabilitation).

For three months, treatment group subjects will have the SCS turned on and will have rehabilitation as part of their CMM. Participants in the placebo arm will have their SCS remain off and will undergo CMM with rehabilitation therapy similar to the treatment group. Neither the subjects nor the treatment team will know which patients are in the treatment or placebo arm.

At the end of three months, the study group will be revealed and the placebo group subjects will be allowed to crossover and have their SCS turned on. Rehabilitation visits may be remote and the study duration is approximately 24 months. There may be additional blood tests and clinical exams to collect data on the effectiveness of the therapy. Data at follow-up visits will be compared to the subjects' baseline data and that of the control group at the respective visits.

Read the detailed description

This study is a prospective, single center study. Data will be collected at baseline, time of procedure (trial and permanent), trial phase, and at 1, 3, 6, 12, 18, and 24 months post-implantation.

The primary objective of this study is to to determine if neuromodulation can be used to augment pain relief and rehabilitation in spinal cord injury (SCI) in a real-world population while further characterizing neurophysiological measures and clinical outcomes.

The following data will be collected:

  • Medical history and demographics
  • Procedure characteristics
  • Medications
  • Visual Analog Scale (VAS) for pain intensity Guy/Farrar Patient Global Impression of Change (PGIC) scale ASIA motor and sensory scores and impairment grade
  • QoL survey (PROMIS 29)
  • Electromyography (EMG) / Nerve Conduction Studies (NCS)
  • Spinal Cord Independence Measure (SCIM) survey
  • Bladder control using standard clinical urodynamic studies
  • For sleep, self-reported quality and average hours per night will be collected in a diary
  • Programming parameters and characteristics
  • Safety events (adverse events, device deficiencies, protocol deviations)

The outcome variables of interest will be collected and assessed across study visits. No pre-planned formal statistical hypothesis tests will be performed. Multivariable regression modeling and descriptive statistics will be utilized.

Being tested
EES on, EES off
Keywords
Spinal Cord Injury
Medical subject headings
Spinal Cord Injuries

What participants receive

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

  • EES onDevice

    Also called SCS (Spinal Cord Stimulation)

    Epidural electrical stimulation (EES), also known as spinal cord stimulation (SCS), is a common FDA-approved therapy for chronic neuropathic pain of trunk and limb.

  • EES offDevice

    Also called SCS

    Epidural electrical stimulation (EES), also known as spinal cord stimulation (SCS), is a common FDA-approved therapy for chronic neuropathic pain of trunk and limb.

Study groups in NCT04894734
Study groupRoleWhat they receive
EES onExperimentalPatients will undergo epidural electrical stimulation (EES) and be allocated 1:1 to EES on.The patient and their family will be formally blinded to treatment assignment. The provider, research team, biostatistician and programming team will be unblinded to treatment assignments.
Receives: Device: EES on
EES offPlacebo comparatorPatients will undergo epidural electrical stimulation (EES) and allocated 1:1 to EES off.The patient and their family will be formally blinded to treatment assignment. The provider, research team, biostatistician and programming team will be unblinded to treatment assignments. Those in the EES off category will have their EES turned on at the 9-month time point.
Receives: Device: EES off

What is being measured

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

  1. Change in Multidimensional Pain Inventory (MPI)-SCI average activity score

    The MPI-SCI consists of twelve 7-point subscales in three sections: (1) pain impact, (2) responses by significant others, and (3) activity. Our primary outcome is the average score of the 4 pain subscales (household activities, activities away from home, social activities, and outdoor work) for pain and consequences of SCI. These 4 scales are commonly used to create a single general activity scale. To define the degree to which pain and other consequences of injury reduced participation in a specific activity, 2 additional validated items will be used in section 3: (1) "Pain has reduced my participation in this activity," and (2) "Other consequences of SCI have reduced my participation in this activity." The response range from 0 (not at all) to 6 (extremely).

    Measured: Baseline, 3 months

Secondary outcomes (9)
  1. Change in pain as measured by Visual Analog Scales (VAS)

    Validated assessment of pain severity (0-10 scale), 0 being no pain to 10 being the worst pain, in the past 7 days.

    Measured: Baseline, and then months 1, 3, 6, 9, 12, 18 and 24

  2. Change in Quality of Life (QOL) as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) 29

    The PROMIS-29 is a generic health-related quality of life survey that assesses each of the 7 PROMIS domains with 4 questions. The questions are ranked on a 5-point Likert Scale. PROMIS instruments contain a fixed number of items from seven PROMIS domains: depression; anxiety; physical function; pain interference; fatigue; sleep disturbance; and ability to participate in social roles and activities. The seven domains cover the most relevant areas of self-reported health for the greatest majority of people with chronic illness.

    Measured: Baseline, and then months 1, 3, 6, 9, 12, 18 and 24

  3. Change in the overall improvement as measured by Guy/Farrar Patient Global Impression of Change (PGIC) scale

    The self-report measure PGIC reflects a patient's belief about the efficacy of treatment. PGIC is a 7 point scale depicting a patient's rating of overall improvement.

    Measured: Baseline, and then months 1, 3, 6, 9, 12, 18 and 24

  4. Change in motor recovery as measured by the Total American Spinal Injury Association (ASIA) motor score

    ASIA Upper Extremity and Lower Extremity Motor Score (UEMS \& LEMS), combine to give Total ASIA Motor Score.

    Measured: Baseline, and then months 1, 3, 6, 9, 12, 18 and 24

  5. Change in motor recovery as measured by the ASIA impairment grades

    The ASIA Impairment Scale (AIS), based on the Frankel scale, is a clinician-administered scale used to classify the severity (completeness) of injury in individuals with SCI. It identifies sensory and motor levels indicative of the highest spinal level demonstrating "unimpaired" function. Preservation of function in the sacral segments (S4-S5) is a key for determining the AIS grade. AIS scores are considered essential when classifying persons with SCI as to their neurological status.

    Measured: Baseline, and then months 1, 3, 6, 9, 12, 18 and 24

  6. Change in independence of activities of daily living (ADLs) as measured by the Spinal Cord Independence Measure (SCIM) survey

    SCIM Disability scale developed to specifically address the ability of SCI patients to perform basic activities of daily living independently. Three versions of the SCIM (I-III) have been consecutively developed and assess three areas: 1) self-care (feeding, grooming, bathing, and dressing); 2) respiration and sphincter management; 3) mobility (bed and transfers and indoor/outdoor). The item scores are weighted related to the assumed clinical relevance.

    Measured: Baseline, and then months 1, 3, 6, 9, 12, 18 and 24

  7. Change in bladder control using urodynamics

    A urodynamic test is used to measure nerve and muscle function, pressure around and in the bladder, flow rates, and other factors. These tests look at how well the bladder, sphincters, and urethra are storing and releasing urine. All measures are combined to give one overall score of bladder control.

    Measured: Baseline, and then months 1, 3, 6, 9, 12, 18 and 24

  8. Change in motor recovery as measured by Transcranial Magnetic Stimulation Motor Evoked Potentials (TMS MEPs)

    To evaluate the connectivity of descending motor signals passing through the injury, TMS MEPs are recorded bilaterally over the rectus femoris (RF), vastus lateralis (VL), medial hamstring (MH), tibialis anterior (TA), medial gastrocnemius (MG), and soleus (SOL) muscles using skin surface EMG at a sampling rate of 4 kHz.

    Measured: Baseline, and then months 1, 3, 6, 9, 12, 18 and 24

  9. Change in motor recovery as measured by EMG

    EMGs will be recorded using surface or needle electrodes placed over/in the following muscles: bilateral gluteus maximus, bilateral rectus femoris, bilateral vastus lateralis, bilateral medial hamstrings, bilateral anterior tibialis and bilateral gastrocnemius. When clinically appropriate, bilateral extensor carpi radialis, bilateral biceps, and bilateral abdominal muscles will be used as controls.

    Measured: Baseline, and then months 1, 3, 6, 9, 12, 18 and 24

Timeline

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

  1. First posted20 May 2021
  2. Study start30 Dec 2021
  3. Primary completion30 Sep 2026 (estimated)
  4. Study completion30 Jun 2028 (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
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Crossover
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
25 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04894734
Sponsor's protocol ID
Pro00106738
Status last verified
Jun 2026
First submitted
7 May 2021
Last updated
4 Jun 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Publications

  • O'Connell NE, Ferraro MC, Gibson W, Rice AS, Vase L, Coyle D, Eccleston C. Implanted spinal neuromodulation interventions for chronic pain in adults. Cochrane Database Syst Rev. 2021 Dec 2;12(12):CD013756. doi: 10.1002/14651858.CD013756.pub2.

    PubMed 34854473

Questions about this trial

What is this clinical trial studying?

A study testing EES on and EES off in people with Spinal Cord Injury at T1-T12 Level and Traumatic Thoracic Spinal Cord Contusion, run by Nandan Lad, M.D., Ph.D. 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 6 inclusion and 10 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 4 Jun 2026. 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?

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 Multidimensional Pain Inventory (MPI)-SCI average activity score (time frame: Baseline, 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 NCT04894734, which also lists 1 linked publication.

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 4 Jun 2026; AzTrials last refreshed its copy on 31 Oct 2026.

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