From Nerve to Brain: Toward a Mechanistic Understanding of Spinal Cord Stimulation in Human Subjects
Study Details
Study Description
Brief Summary
This is a multicenter prospective study in two patient cohorts, namely patients who currently have stably implanted spinal cord simulators. Patients will be randomly assigned to turn on or off their spinal cord stimulators for two week intervals up to six weeks after enrollment, and on the final day of study participation, for two hour intervals, in a multi-crossover design.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
The fundamental hypothesis for this study is that spinal cord stimulators modulate the excitability of primary afferent neurons to reduce pain, and that these changes can be detected by measurement of axonal excitability. For the primary outcome, we will leverage the sensitivity and reproducibility of threshold tracking nerve conduction studies to detect changes in the excitability of thickly myelinated nerve fibers. We will use microneurography to record directly from primary nociceptive afferents. Finally, we will perform plasma inflammatory cytokine profiles to measure changes due to spinal cord stimulators. By correlating changes in outcome measurements with subject pain levels during therapeutic versus minimal spinal cord stimulators settings, we will determine which effects may be mechanistically relevant and which are unrelated to reduction in pain. Thus, our study will use robust, reproducible techniques to define the peripheral, central, and systemic effects of spinal cord stimulators.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Other: Patients with Implanted Devices on Minimal/No Stimulation Settings Patients in this arm will be randomized to turn off their spinal cord stimulator (or to minimal settings). |
Other: Spinal Cord Stimulator Set to Minimal/No Stimulation Setting
Patients in this intervention group will have their spinal cord stimulator turned off or to the minimal settings possible.
|
| Other: Patients with Implanted Devices on Usual Stimulation Settings Patients in this arm will be randomized to turn on their spinal cord stimulator to their usual stimulation settings. |
Other: Usual Care
Patients in this intervention group will have their spinal cord stimulator turned on to their usual stimulation settings.
|
Outcome Measures
Primary Outcome Measures
- Supraexcitability [From baseline (enrollment) to six weeks]
The primary outcome will be superexcitability (indicating paired pulse facilitation) measured by threshold tracking nerve conduction studies.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Aged 18 to 80
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Capable of providing informed consent and following trial procedures, including capacity to complete self-reported measures of pain, function, and other outcomes
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Stably implanted spinal cord or dorsal root ganglion stimulator
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Device is to treat failed back surgery syndrome with back and radicular lower extremity pain
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Device with a paresthesia-free setting
Exclusion Criteria:
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Patients who are not on a stable dose of opioids or are on a stable dose greater than 100 morphine equivalents/day per day within the two months prior to enrollment, or those who are unwilling to maintain a stable dose of opioids throughout the duration of the study
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The investigator concludes that the participant is unable to differentiate failed back surgery syndrome pain from other pains, or the primary cause of pain is unrelated to failed back surgery syndrome.
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Systemic or psychiatric illness that in the opinion of the site investigator would interfere with the individual's ability to participate in the trial
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Other factor that in the opinion of the site investigator would interfere with the individual's ability to participate in the trial or tolerate the study procedures
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Massachusetts General Hospital | Boston | Massachusetts | United States | 02114 |
| 2 | Beth Israel Deaconess Medical Center | Boston | Massachusetts | United States | 02215 |
| 3 | Brigham and Women's Hospital | Boston | Massachusetts | United States | 02215 |
Sponsors and Collaborators
- Massachusetts General Hospital
- National Institute of Neurological Disorders and Stroke (NINDS)
Investigators
- Principal Investigator: Brian Wainger, MD PhD, Massachusetts General Hospital
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 2022P001803
- 1RM1NS128741-01