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Lumbosacral RadiculopathyPEACENCT07498140

Procedural Framing and Epidural Steroid Injection Outcomes

A study testing Behavioral manipulation of ESI expectations, No behavioral manipulation of ESI expectations and No behavioral manipulation of pharmacotherapy expectations in people with Lumbosacral Radiculopathy, run by Northwestern University at 4 sites in 3 countries.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Back pain is the leading cause of disability and military medical boards across the globe. Epidural steroid injections (ESI) are the most commonly performed pain procedure in the world. There is strong evidence that the placebo effect for all pain treatments, including ESI, is greater than the intrinsic effect. Read more about this study

Who is it for?
Any age
Conditions the study is for
Lumbosacral Radiculopathy
What is being tested?
Behavioral manipulation of ESI expectations, No behavioral manipulation of ESI expectations and No behavioral manipulation of pharmacotherapy expectations
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
210 participants
Where
4 sitesin 3 countries
Study dates
30 Mar 2026to 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 Any age
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Age > 18
  • Lumbosacral radicular pain based on history and physical exam (e.g. pain radiating into one or both lower extremities, sensory loss, muscle weakness, positive straight leg raising test etc.)
  • Duration of pain >6 weeks
  • NRS leg pain score >/= 4 (or if 3/10, greater or equal to back pain \& worst leg pain is >/=4)
  • MRI evidence of spinal pathology consistent with symptoms
  • Candidates for ESI and pharmacotherapy

Who cannot join

  • Untreated coagulopathy
  • Previous spine surgery
  • No MRI or non-concordant MRI study
  • Leg pain > 15 years duration
  • Epidural steroid injection within past 2 years
  • Signs or symptoms of cauda equina syndrome
Show all 12Show fewer
  • Previous failed trials with gabapentin and pregabalin and tricyclic antidepressants and duloxetine
  • Allergic reactions to contrast dye prohibiting injection (e.g., tranforaminal ESI), gabapentinoids, tricyclic antidepressants or duloxetine, and contraindications to all of the above medications
  • Referrals from surgery for diagnostic injections for surgical evaluation
  • Serious medical (e.g. congestive heart failure) or psychiatric (untreated depression) condition that might preclude optimal outcome
  • Pregnancy
  • Inability to understand basic English

Trial locations and contacts

4 sites in 3 countries. Contact the study team or a site near you to ask about taking part.

4 sites in 3 countries

United States2 sites, 2 recruiting
  • Walter Reed National Military Medical Center

    Bethesda, Maryland, 20814

    Enrolling by invitation
  • Northwestern University

    Chicago, Illinois, 60611

    Steven P Cohen, MD, 312-695-2500, steven.cohen@northwestern.edu

    Jordan Wood, BS, 3126952500, Jordan.Wood1@northwestern.edu

    Recruiting

Other trials in United States

Thailand1 site, 1 recruiting
  • Phramongkutklao Military Hospital

    Bangkok

    Chartchai Maschunchai, MD, 662-763-9300, oattee87@gmail.com

    Recruiting

Other trials in Thailand

Ukraine1 site, 1 recruiting
  • First Lviv Medical Union

    Lviv

    Roma Smolynets, MD, 380-32-258-1101, smoroman9@gmail.com

    Not yet recruiting

Other trials in Ukraine

About this study

Official title: PEACE Study: Psychophysical Enhancement to Augment Conservative and Epidural Steroid Injection Outcomes: A Multi-Center International Randomized Trial

Back pain is the leading cause of disability and military medical boards across the globe. Epidural steroid injections (ESI) are the most commonly performed pain procedure in the world.

There is strong evidence that the placebo effect for all pain treatments, including ESI, is greater than the intrinsic effect. The placebo effect is highly dependent on a patient's 'expectations', and therefore how the procedure is framed.

Read more

This study aims to compare ESI when the procedure is framed very positively- as is often done in clinical practice vs. more neutrally (which is less commonly done in clinical practice but consistent with evidence). The placebo effect is also stronger for procedures than medications. The evidence on the benefits of ESI is highly dependent on whether it is compiled by interventional doctors who perform the procedure or non-interventional researchers.

In order to determine how 'framing' a treatment affects pain outcomes, the investigative team will conduct a 3-arm randomized trial comparing positive framing of ESI, neutral framing of ESI, and medications, in patients with lumbosacral radiculopathy.

Read the detailed description

Two hundred and ten eligible individuals will be randomized in blocks of 10 in a 2:2:1 ratio to receive positive framing for ESI (treatment group), neutral framing for ESI (control group), or pharmacological therapy and instructions to exercise (active control group), respectively. There will suballocation based on whether the patient has unilateral or bilateral pain (i.e., whether the participant would receive a transforaminal ESI or an interlaminar ESI, respectively). This is because there may be differences in outcomes (transforaminal injections for unilateral pain may be more effective than an interlaminar injection for bilateral pain), as well as possible differences in side effects.

For the 84 individuals randomized to the study group (positive framing of ESI), the investigators will provide 5 slides with bullet points and images outlining peer-reviewed studies, reviews and guidelines on ESI that present the treatment in a more positive light (consistent with the views of most people who perform ESIs), but still consistent with evidence. These slides will contain references to high-quality articles and there will be an investigator present to answer questions. There is a very wide range in how a procedure is presented to patients, and this framework is consistent with how ESI are presented to patients by pain practitioners from all over the world. This material is all publicly available but has been compiled in presentation form.

For the 84 individuals in the ESI control group, the investigative team will provide a 1-slide overview on ESI that is slightly less optimistic, consistent with how many non-pain-physicians view ESI including that the evidence for surgery reduction is questionable.

For the 42 individuals in the active control group who will receive a first-line medication for neuropathic and non-structured instructions to exercise, the investigators will provide a 1-side overview that presents the raw, neutral facts on adjuvants for sciatica (some guidelines recommend them, others do not, but some recommend a trial of conservative care for back pain before interventions; there are no medications across the globe approved for lumbosacral radiculopathy).

Being tested
Behavioral manipulation of ESI expectations, No behavioral manipulation of ESI expectations, No behavioral manipulation of pharmacotherapy expectations
Keywords
Back pain, Lumbar radiculopathy, Epidural steroid injection, Placebo effect, Sciatica, Positive framing
Medical subject headings
Back Pain, Radiculopathy, Sciatica

What participants receive

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

  • Behavioral manipulation of ESI expectationsBehavioural

    5-slide summary of ESI portrayed in a positive light, accompanied by a study investigator.

  • No behavioral manipulation of ESI expectationsOther

    1-slide summary of ESI portrayed in a neutral light.

  • No behavioral manipulation of pharmacotherapy expectationsOther

    1-slide summary of medications for neuropathic pain portrayed in a neutral light.

Study groups in NCT07498140
Study groupRoleWhat they receive
Positive framing- ESIExperimentalPatients will review around 5 slides detailing ESI in a very positive light and references, with study personnel available to answer questions.
Receives: Behavioral: Behavioral manipulation of ESI expectations
Neutral framing- ESIPlacebo comparatorPatients will review 1 slide that portrays ESI in a neutral light.
Receives: Other: No behavioral manipulation of ESI expectations
Pharmacotherapy with gabapentin, nortriptyline and/or duloxetinePlacebo comparatorPatients will review 1 neutrally-framed slide that portrays adjuvant medications for neuropathic pain in a neutral light.
Receives: Other: No behavioral manipulation of pharmacotherapy expectations

What is being measured

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

  1. Mean reduction in average leg pain

    Mean reduction in average leg pain on a 0-10 numerical rating pain scale over the past week. This is the study's primary endpoint. 0=no pain, 10= worst pain imaginable.

    Measured: 4 weeks

Secondary outcomes (25)
  1. Leg pain at rest

    Leg pain at rest on a 0-10 verbal rating scale while in the recovery area. 0=no pain, 10= worst pain imaginable.

    Measured: Up to 15 minutes after the procedure

  2. Leg pain with activity

    Leg pain with walking and bending on a 0-10 verbal rating scale while in the recovery area

    Measured: Up to 15 minutes after the procedure

  3. Back pain at rest

    Back pain at rest on a 0-10 verbal rating scale while in the recovery area

    Measured: Up to 15 minutes after the procedure

  4. Back pain with activity

    Back pain with activity (walking, bending) on a 0-10 verbal rating scale while in the recovery area

    Measured: Up to 15 minutes after the procedure

  5. Patient satisfaction

    Patient satisfaction with ESI on 1-5 Likert scale (1= very unsatisfied, 3= neutral, 5= very satisfied), recorded upon recovery area discharge

    Measured: Up to 15 minutes after the procedure

  6. Average leg pain

    Average leg pain on a 0-10 numerical rating scale over the past week

    Measured: 4 weeks

  7. Average back pain

    Average back pain on a 0-10 numerical rating scale over the past week

    Measured: 4 weeks

  8. Worst leg pain

    Worst leg pain on a 0-10 numerical rating scale over the past week

    Measured: 4 weeks

  9. Worst back pain

    Worst back pain on a 0-10 numerical rating scale over the past week

    Measured: 4 weeks

  10. Oswestry Disability Index (ODI)

    Oswestry Disability Index on 0-50 scale (converted to %), with higher scores indicating greater back pain-related disability

    Measured: 4 weeks

  11. Hospital Anxiety and Depression Scale (HADS)

    Anxiety and Depression scores (0-21 for each subscale), with higher scores indicating greater disease burden (anxiety and depression)

    Measured: 4 weeks

  12. Athens Insomnia Scale

    Measure of insomnia scored from 0-24, with higher scores indicating greater sleep dysfunction

    Measured: 4 weeks

  13. Analgesic medication reduction

    >20% reduction in opioids or cessation of non-opioid analgesic

    Measured: 4 weeks

  14. Patient global impression of change (PGIC)

    Patient satisfaction with ESI on 1-7 Likert scale (1= no change, 3= a little better, 4= somewhat better 5= moderately better, 7= a great deal better)

    Measured: 4 weeks

  15. Positive categorical outcome

    >/=30% reduction in average leg pain (or worst leg pain if average leg pain </=4) with a PGIC >/=4

    Measured: 4 weeks

  16. Average leg pain

    Average leg pain on a 0-10 numerical rating scale over the past week

    Measured: 12 weeks

  17. Average back pain

    Average back pain on a 0-10 numerical rating scale over the past week

    Measured: 12 weeks

  18. Worst leg pain

    Worst leg pain on a 0-10 numerical rating scale over the past week

    Measured: 12 weeks

  19. Worst back pain

    Worst back pain on a 0-10 numerical rating scale over the past week

    Measured: 12 weeks

  20. Oswestry Disability Index (ODI)

    Oswestry Disability Index on 0-50 scale (converted to %)

    Measured: 12 weeks

  21. Hospital Anxiety and Depression Scale (HADS)

    Anxiety and Depression scores (0-21 for each subscale)

    Measured: 12 weeks

  22. Athens Insomnia Scale

    Measure of insomnia scored from 0-24

    Measured: 12 weeks

  23. Analgesic medication reduction

    >20% reduction in opioids or cessation of non-opioid analgesic

    Measured: 12 weeks

  24. Patient global impression of change (PGIC)

    Patient satisfaction with ESI on 1-7 Likert scale (1= no change, 3= a little better, 4= somewhat better 5= moderately better, 7= a great deal better)

    Measured: 12 weeks

  25. Positive categorical outcome

    >/=30% reduction in average leg pain (or worst leg pain if average leg pain </=4) with a PGIC >/=4

    Measured: 12 weeks

Timeline

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

  1. First posted27 Mar 2026
  2. Study start30 Mar 2026
  3. Primary completion25 Mar 2028 (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
Parallel groups
Masking
None (open label)
Enrolment
210 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07498140
Sponsor's protocol ID
STU00225684
Acronym
PEACE
Status last verified
Aug 2026
First submitted
23 Mar 2026
Last updated
18 Aug 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided: Military (U.S. and Thai) will require special permission to shar.

Publications

  • Schmidt S, Loef M, Ostermann T, Walach H. Treatment effects in pharmacological clinical randomized controlled trials are mainly due to placebo. J Clin Epidemiol. 2025 Mar;179:111658. doi: 10.1016/j.jclinepi.2024.111658. Epub 2024 Dec 27.

    PubMed 39733973
  • Kaptchuk TJ, Stason WB, Davis RB, Legedza AR, Schnyer RN, Kerr CE, Stone DA, Nam BH, Kirsch I, Goldman RH. Sham device v inert pill: randomised controlled trial of two placebo treatments. BMJ. 2006 Feb 18;332(7538):391-7. doi: 10.1136/bmj.38726.603310.55. Epub 2006 Feb 1.

    PubMed 16452103
  • Sebastian A, Wyld L, Morgan JL. Examining the variation in consent in general surgery. Ann R Coll Surg Engl. 2024 Feb;106(2):140-149. doi: 10.1308/rcsann.2023.0020. Epub 2023 May 23.

    PubMed 37218649
  • Kern A, Kramm C, Witt CM, Barth J. The influence of personality traits on the placebo/nocebo response: A systematic review. J Psychosom Res. 2020 Jan;128:109866. doi: 10.1016/j.jpsychores.2019.109866. Epub 2019 Nov 7.

    PubMed 31760341
  • Kang H, Miksche MS, Ellingsen DM. Association between personality traits and placebo effects: a preregistered systematic review and meta-analysis. Pain. 2023 Mar 1;164(3):494-508. doi: 10.1097/j.pain.0000000000002753. Epub 2022 Aug 10.

    PubMed 35947877

Questions about this trial

What is this clinical trial studying?

A study testing Behavioral manipulation of ESI expectations, No behavioral manipulation of ESI expectations and No behavioral manipulation of pharmacotherapy expectations in people with Lumbosacral Radiculopathy, run by Northwestern University at 4 sites in 3 countries.

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 12 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: looking for participants now, as of the sponsor's last update on 18 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in United States, Thailand, Ukraine. 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?

Contact Steven P Cohen, MD (312-695-2500, steven.cohen@northwestern.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Mean reduction in average leg pain (time frame: 4 weeks). 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 NCT07498140, which also lists 5 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 18 Aug 2026.

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