Chronic Pain, Complex Regional Pain Syndrome (CRPS), Low Back Pain, Radiculopathy
Conditions
Keywords
Spinal cord stimulation, Chronic pain, Chronic low back pain, Radiculopathy, Complex Regional Pain Syndrome (CRPS), High Frequency stimulation
Brief summary
Study designed to compare the conventional stimulation programming versus the high frequency stimulation programming of the spinal cord stimulator for subjects who already have a spinal cord stimulator.
Detailed description
Subject with Precision models of spinal cord stimulators will be invited to take part in the study that will compare the high frequency stimulation versus low frequency stimulation to look for any changes in efficacy, and preferability between high and low frequency stimulation program for the spinal cord stimulator (SCS) system. The study is designed as 7 week study that can take up to 9 weeks per subject. 7 weeks are divided into 3 segments. First segment will be 3 weeks of spinal cord stimulation followed by second segment of wash off period, which will take 1 week (7 days), then the last segment with 3 weeks of spinal cord stimulation. At the end of each segments, there will be a follow up visits. Each follow up visits can occur up to 5 business days after the follow up due date for post spinal cord stimulation follow ups, and up to 3 business days after the follow up due date for the post wash off visit. At each visits, including baseline, subject will be asked to answer Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), and Patients Global Impression of Change (PGIC) to assess interval effect of the programming parameter for the spinal cord stimulator. Visit schedule and assessment summary: Visit 1: Screening and Baseline * Review inclusion and exclusionary criteria (I&E) * Informed Consent * Demographics, Medical History * Physical examination, Vital signs. * Randomization (A, or B) and programming of devices according to randomization * Baseline questionnaires * Numeric Pain Rating Scale (NPRS) to measure the pain experienced by the subject over 1 week prior to enrolling in the study. this will include best pain, worse pain, and average pain as well as pain at the time of enrollment. * Oswestry disability index (ODI) will measure the average disability caused by the painful condition approximately 3 weeks prior to the enrollment in to the study. Subject will be asked on 10 different categories of activities of daily living. They are: pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sex life, social life, and traveling. * Patients Global Impression of Change (PGI-C) will be asked to assess the subject's impression of their painful condition, since the implanting of the spinal cord stimulator. * Concomitant medications Visit 2: (end of 3 week assessments, + 5 days) End of first treatment period * Interim Questionnaires: * NPRS: We will measure pain experienced by the subject over 3 weeks since the last research visit (visit 1),prior to visit 2. This will include best pain, worse pain, and average pain as well as pain at the time of enrollment. * Oswestry disability index will measure the disability caused by the painful condition since last visit of the study (visit 1), which covers 3 weeks of duration after the last research visit. Subject will be asked on 10 different categories of activities of daily living. They are: pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sex life, social life, and traveling. * PGI-C will be asked to assess the subject's impression of their painful condition, since the last visit of the study (visit 1), which covers 3 weeks of duration since the last research visit, prior to visit 2. * Device Interrogation and turn off SCS for 7 to 10 days * Start wash off period for 7 to 10 days * Review Adverse Events (AE) and Concomitant medications (Con meds) Visit 3: (end of wash off period, +3 days) Beginning of second treatment period * Questionnaires: * NPRS to measure the pain experienced by the subject over 1 week since visit 2, prior to visit 3, this will include best pain, worse pain, and average pain as well as pain at the time of enrollment. * Oswestry disability index will measure the disability caused by the painful condition 1 week since last visit 2, prior to the visit 3. Subject will be asked on 10 different categories of activities of daily living. They are: pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sex life, social life, and traveling. * PGI-C will be asked to assess the subject's impression of their painful condition, during the last 1 week since visit 2, prior to visit 3. * Device interrogation and programming; start of next treatment period. * Review AE and Con meds. Visit 4: (end of 3 week assessment +5 days) End of Treatment * End of second treatment period. * End of treatment Questionnaires: * NPRS: We will measure pain experienced by the subject over 3 weeks since the last research visit (visit 3) prior to visit 4. This will include best pain, worse pain, and average pain as well as pain at the time of enrollment. * Oswestry disability index will measure the disability caused by the painful condition since last visit of the study, which covers 3 weeks of duration after the last research visit (visit 3). Subject will be asked on 10 different categories of activities of daily living. They are: pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sex life, social life, and traveling. * PGI-C will be asked to assess the subject's impression of their painful condition, since the last visit of the study, which covers 3 weeks of duration since the last research visit (visit 3), prior to visit 4. * Device Interrogation and re-programming if necessary. * Review AE's and Con meds
Interventions
Implanted pulse generator of a spinal cord stimulator will programmed to deliver high frequency stimulation for pain relief. For our purposes, high frequency stimulation will be defined as 1000 hertz.
Implanted pulse generator of a spinal cord stimulator will programmed to deliver low frequency stimulation for pain relief. Low frequency stimulation will be defined as conventional stimulation pulse generator programming.
Sponsors
Study design
Eligibility
Inclusion criteria
1. Subject must be 18 years and older, and younger than 70 years of age. 2. Subject has had a Precision® spinal cord stimulator system implanted for chronic painful condition. 3. Subject pain scores \>5 on NPRS
Exclusion criteria
1. Currently diagnosed with cognitive impairment, or exhibits any characteristic, that would limit study candidate's ability to assess pain 2. Unstable medical or psychiatric illness 3. Lifetime history of psychosis, hypomania, or mania. 4. Epilepsy, or dementia 5. Substance abuse in the last 6 months 6. Pregnant or breastfeeding 7. Not on contraception for those of childbearing age. (Barrier methods, oral contraception, hormone injections, or surgical sterilization) 8. Treatment with investigational drug within 30 days of screening. 9. Concomitant medication exclusions consisting of medications or herbal agents with central nervous system (CNS) effects with exception of episodic use of sedating antihistamines
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Numeric Pain Rating Scale (NPRS) | Baseline (visit 1), and at each follow up visits (visits 2, 3, and 4) | Digital pain rating system that scores patient's subjective pain rating from 0 to 10; with greater number indicating progressively worsening pain. NPRS were measured at baseline (visit1), and at each follow ups visits at visit 2, 3 and 4. Visit 2 and 4 captured post treatment (either 1000 Hz or standard stimulation depending on the randomization) results, and visit 3 captured NPRS after the wash off from the spinal cord stimulation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Oswestry Disability Index Questionnaire (ODI). | Baseline (visit 1), and at each follow up visits (visits 2, 3, and 4) | ODI is a outcome metrics that is design to assess the severity of disability based on 10 activity categories. ODI is based on 0 to 100% scale, where larger percentage implies worse disability. (There are 5 categories: 0-20%: Minimal disability, 21-40%: Moderate disability, 41-60%: Severe disability, 61-80%: Crippled. 81-100%: Either bed bound or exaggerating symptoms). ODI were measured at baseline (visit1), and at each follow ups visits at visit 2, 3 and 4. Visit 2 and 4 captured post treatment (either 1000 Hz or standard stimulation depending on the randomization) results, and visit 3 captured NPRS after the wash off from the spinal cord stimulation. |
| Patient's Global Impression of Change (PGIC) | Baseline (visit 1), and at each follow up visits (visits 2, 3, and 4) | PGIC is a 7-point scale that requires study subjects to rate the severity of their illness or medical condition after a specific treatment. 1: No change, 2: Almost the same, 3: A little better, 4: Somewhat better, 5: Moderately better, 6: Better, 7: A great deal better. Study subjects were asked to report their impression of changes at baseline visit, visit 2 through 4. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Preferability | End of treatment visit on visit 4 | At the conclusion of the study, subjects were asked to report which spinal cord stimulation modes they preferred. Subjects were presented with two boxes (1000 Hz. stimulation and Standard stimulation) and asked to check one. |
Countries
United States
Participant flow
Recruitment details
All study subjects were recruited from the Carolinas Pain Institute who were implanted with Boston Scientific's Precision Plus spinal cord stimulation (SCS) system for chronic axial pain, and at the time of recruitment, was not receiving adequate pain relief from SCS system with baseline numeric pain rating scale of 5 or greater.
Pre-assignment details
Randomization scheme was 1 to 1 ratio. Randomization assignment was generated using random number generator, and individual results were sealed in an envelope. If subject needed to be replaced, the replacement subject will receive the same randomization assignment.
Participants by arm
| Arm | Count |
|---|---|
| Treatment Group A Subjects randomized to the treatment group A will begin the 7 week study with high frequency (1000Hz) sub-perception stimulation for first 3 weeks of the study. After first 3 weeks, subject will return to clinic to turn off the SCS device, and will start 7-10 days of wash off period. At the end of the wash off period, subject will return to clinic and have the SCS device turned on to have it programmed to deliver the low frequency stimulation for the next 3 weeks. At the end of the 7th week, the subject will return for final end of treatment visit for conclusion of the study. | 11 |
| Treatment Group B Subjects randomized to the treatment group B will begin the 7 week study with low frequency (40 to 50Hz) paresthesia capture stimulation for first 3 weeks of the study. After first 3 weeks, subject will return to clinic to turn off the SCS device, and will start 7-10 days of wash off period. At the end of the wash off period, subject will return to clinic and have the SCS device turned on to have it programmed to deliver the high frequency (1000Hz) sub-perception stimulation for the next 3 weeks. At the end of the 7th week, the subject will return for final end of treatment visit for conclusion of the study. | 11 |
| Total | 22 |
Baseline characteristics
| Characteristic | Treatment Group A | Treatment Group B | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 3 Participants | 2 Participants | 5 Participants |
| Age, Categorical Between 18 and 65 years | 8 Participants | 9 Participants | 17 Participants |
| Age, Continuous | 59 years | 56 years | 57 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 11 Participants | 11 Participants | 22 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 1 Participants | 2 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 10 Participants | 10 Participants | 20 Participants |
| Region of Enrollment United States | 11 participants | 11 participants | 22 participants |
| Sex: Female, Male Female | 5 Participants | 3 Participants | 8 Participants |
| Sex: Female, Male Male | 6 Participants | 8 Participants | 14 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 11 | 0 / 11 |
| serious Total, serious adverse events | 0 / 11 | 0 / 11 |
Outcome results
Numeric Pain Rating Scale (NPRS)
Digital pain rating system that scores patient's subjective pain rating from 0 to 10; with greater number indicating progressively worsening pain. NPRS were measured at baseline (visit1), and at each follow ups visits at visit 2, 3 and 4. Visit 2 and 4 captured post treatment (either 1000 Hz or standard stimulation depending on the randomization) results, and visit 3 captured NPRS after the wash off from the spinal cord stimulation.
Time frame: Baseline (visit 1), and at each follow up visits (visits 2, 3, and 4)
Population: All study subjects were implanted with Boston Scientific's Precision Plus spinal cord stimulation system for treatment of chronic axial pain.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Treatment Group A | Numeric Pain Rating Scale (NPRS) | Average Baseline NPRS Score | 6.09 units on a scale |
| Treatment Group A | Numeric Pain Rating Scale (NPRS) | Average NPRS after 1000 Hz. stimulation | 3.73 units on a scale |
| Treatment Group A | Numeric Pain Rating Scale (NPRS) | Average NPRS after standard stimulation | 5.64 units on a scale |
| Treatment Group A | Numeric Pain Rating Scale (NPRS) | Average NPRS after Wash off | 6.45 units on a scale |
| Treatment Group A | Numeric Pain Rating Scale (NPRS) | Best Baseline NPRS score | 3.72 units on a scale |
| Treatment Group A | Numeric Pain Rating Scale (NPRS) | Best NPRS score after 1000 Hz. stimulation | 2.64 units on a scale |
| Treatment Group A | Numeric Pain Rating Scale (NPRS) | Best NPRS score after standard stimulation | 3.46 units on a scale |
| Treatment Group A | Numeric Pain Rating Scale (NPRS) | Best NPRS after Wash off | 4.54 units on a scale |
| Treatment Group A | Numeric Pain Rating Scale (NPRS) | Worst Baseline NPRS score | 7.90 units on a scale |
| Treatment Group A | Numeric Pain Rating Scale (NPRS) | Worst NPRS score after 1000 Hz. stimulation | 6.64 units on a scale |
| Treatment Group A | Numeric Pain Rating Scale (NPRS) | Worst NPRS score after standard stimulation | 8.18 units on a scale |
| Treatment Group A | Numeric Pain Rating Scale (NPRS) | Worst NPRS after Wash off | 8.72 units on a scale |
| Treatment Group B | Numeric Pain Rating Scale (NPRS) | Worst NPRS score after standard stimulation | 8.36 units on a scale |
| Treatment Group B | Numeric Pain Rating Scale (NPRS) | Average Baseline NPRS Score | 6.27 units on a scale |
| Treatment Group B | Numeric Pain Rating Scale (NPRS) | Best NPRS score after standard stimulation | 4.45 units on a scale |
| Treatment Group B | Numeric Pain Rating Scale (NPRS) | Average NPRS after 1000 Hz. stimulation | 3.82 units on a scale |
| Treatment Group B | Numeric Pain Rating Scale (NPRS) | Worst NPRS score after 1000 Hz. stimulation | 6.64 units on a scale |
| Treatment Group B | Numeric Pain Rating Scale (NPRS) | Average NPRS after standard stimulation | 6.09 units on a scale |
| Treatment Group B | Numeric Pain Rating Scale (NPRS) | Best NPRS after Wash off | 5.36 units on a scale |
| Treatment Group B | Numeric Pain Rating Scale (NPRS) | Average NPRS after Wash off | 7.18 units on a scale |
| Treatment Group B | Numeric Pain Rating Scale (NPRS) | Worst NPRS after Wash off | 8.81 units on a scale |
| Treatment Group B | Numeric Pain Rating Scale (NPRS) | Best Baseline NPRS score | 4.45 units on a scale |
| Treatment Group B | Numeric Pain Rating Scale (NPRS) | Worst Baseline NPRS score | 8.09 units on a scale |
| Treatment Group B | Numeric Pain Rating Scale (NPRS) | Best NPRS score after 1000 Hz. stimulation | 2.18 units on a scale |
Oswestry Disability Index Questionnaire (ODI).
ODI is a outcome metrics that is design to assess the severity of disability based on 10 activity categories. ODI is based on 0 to 100% scale, where larger percentage implies worse disability. (There are 5 categories: 0-20%: Minimal disability, 21-40%: Moderate disability, 41-60%: Severe disability, 61-80%: Crippled. 81-100%: Either bed bound or exaggerating symptoms). ODI were measured at baseline (visit1), and at each follow ups visits at visit 2, 3 and 4. Visit 2 and 4 captured post treatment (either 1000 Hz or standard stimulation depending on the randomization) results, and visit 3 captured NPRS after the wash off from the spinal cord stimulation.
Time frame: Baseline (visit 1), and at each follow up visits (visits 2, 3, and 4)
Population: All study subjects were implanted with Boston Scientific's Precision Plus spinal cord stimulation system for treatment of chronic axial pain.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Treatment Group A | Oswestry Disability Index Questionnaire (ODI). | Baseline ODI score | 47.49 units on a scale |
| Treatment Group A | Oswestry Disability Index Questionnaire (ODI). | ODI after 1000 Hz. stimluation | 39.23 units on a scale |
| Treatment Group A | Oswestry Disability Index Questionnaire (ODI). | ODI after standard stimulation | 49.63 units on a scale |
| Treatment Group A | Oswestry Disability Index Questionnaire (ODI). | ODI after wash off | 52.87 units on a scale |
| Treatment Group B | Oswestry Disability Index Questionnaire (ODI). | ODI after wash off | 56.77 units on a scale |
| Treatment Group B | Oswestry Disability Index Questionnaire (ODI). | Baseline ODI score | 51.25 units on a scale |
| Treatment Group B | Oswestry Disability Index Questionnaire (ODI). | ODI after standard stimulation | 49.05 units on a scale |
| Treatment Group B | Oswestry Disability Index Questionnaire (ODI). | ODI after 1000 Hz. stimluation | 33.77 units on a scale |
Patient's Global Impression of Change (PGIC)
PGIC is a 7-point scale that requires study subjects to rate the severity of their illness or medical condition after a specific treatment. 1: No change, 2: Almost the same, 3: A little better, 4: Somewhat better, 5: Moderately better, 6: Better, 7: A great deal better. Study subjects were asked to report their impression of changes at baseline visit, visit 2 through 4.
Time frame: Baseline (visit 1), and at each follow up visits (visits 2, 3, and 4)
Population: All study subjects were implanted with Boston Scientific's Precision Plus spinal cord stimulation system for treatment of chronic axial pain.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Treatment Group A | Patient's Global Impression of Change (PGIC) | PGIC After 1000 Hz. stimulation | 4.27 units on a scale |
| Treatment Group A | Patient's Global Impression of Change (PGIC) | PGIC after standard stimulation | 2.54 units on a scale |
| Treatment Group A | Patient's Global Impression of Change (PGIC) | PGIC after Wash off | 1.45 units on a scale |
| Treatment Group B | Patient's Global Impression of Change (PGIC) | PGIC after Wash off | 1.27 units on a scale |
| Treatment Group B | Patient's Global Impression of Change (PGIC) | PGIC After 1000 Hz. stimulation | 5.91 units on a scale |
| Treatment Group B | Patient's Global Impression of Change (PGIC) | PGIC after standard stimulation | 2.45 units on a scale |
Preferability
At the conclusion of the study, subjects were asked to report which spinal cord stimulation modes they preferred. Subjects were presented with two boxes (1000 Hz. stimulation and Standard stimulation) and asked to check one.
Time frame: End of treatment visit on visit 4
Population: All study subjects were implanted with Boston Scientific's Precision Plus spinal cord stimulation system for treatment of chronic axial pain.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Treatment Group A | Preferability | Subjects who prefer 1000 Hz. stimulation | 8 participants |
| Treatment Group A | Preferability | Subjects who prefer standard stimulation | 3 participants |
| Treatment Group B | Preferability | Subjects who prefer 1000 Hz. stimulation | 10 participants |
| Treatment Group B | Preferability | Subjects who prefer standard stimulation | 1 participants |