Study Comparing Conventional, Burst and High Frequency (HF) Spinal Cord Stimulation (SCS) in Refractory Failed Back Surgery Syndrome (FBSS) Patients After a 32-contact Surgical Lead Implantation (MULTIWAVE)
Primary Purpose
Failed Back Surgery Syndrome
Status
Completed
Phase
Not Applicable
Locations
France
Study Type
Interventional
Intervention
Precision Spectra™ system
Sponsored by
About this trial
This is an interventional treatment trial for Failed Back Surgery Syndrome
Eligibility Criteria
Inclusion Criteria:
- Age ≥ 18 years or ≤ 80 years.
- Subject has FBSS and does not require further surgery. For the purposes of this study, FBSS is defined as persistent or recurrent low back and leg pain of at least 6 months duration following at least one decompression and/or fusion procedure.
- Subject has persistent low back and leg pain despite other treatment modalities (pharmacological, surgical, physical, or psychological therapies) that have been tried and did not prove satisfactory or are unsuitable or contraindicated for the subject.
- Average global pain is ≥ 50 mm as assessed by the baseline VAS.
- With significant back, with mean intensity on a back pain VAS ≥ 50 mm (mean daily VAS score calculated on 5 consecutive days).
- Meeting the criteria for spinal cord stimulation test according to HAS guidelines (multidisciplinary consultation, psychological assessment, etc.).
- Subject is a candidate for SCS.
- Absence of active psychosis or history of serious psychotic illness requiring hospitalisation.
- Understands and accepts the constraints of the study.
- Free subject, not under temporary or permanent guardianship and not subject to subordination.
- Patients covered by French national health insurance.
- Patients who have given their written consent to the study after having received clear information.
Exclusion Criteria:
- Age < 18 years or > 80 years
- Subject is or has been treated with SCS, subcutaneous or peripheral nerve stimulation, an intrathecal drug delivery system, requires back surgery at the location related to his/her original back pain complaint or experimental therapies.
- Cause of low back pain accessible to etiological "mechanical" surgical treatment (discogenic low back pain, vertebral instability, spinal deformity, etc.).
- Subject had most recent back surgery less than 6 months ago.
- Presenting a surgical, anaesthetic or psychiatric contraindication to implantation of a spinal cord stimulation system.
- Based on the opinion of the principal or sub-investigator, the subject is unable to operate the SCS equipment.
- Subject has a life expectancy of less than 24 months beyond study enrolment.
- Absence of signature of the informed consent form.
- Patients not covered by French national health insurance.
- Subjects requiring closer protection, i.e. minors, pregnant women, nursing mothers, subjects deprived of their freedom by a court or administrative decision, subjects admitted to a health or social welfare establishment, major subjects under legal protection, and finally patients in an emergency setting.
- Pregnant women, nursing mothers, women of childbearing potential not using effective contraception (hormonal/barrier: oral, parenteral, percutaneous, implantable, intrauterine device, or surgical: tubal ligation, hysterectomy, total ovariectomy).
Sites / Locations
- Poitiers University Hospital
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm 5
Arm 6
Arm Type
Experimental
Experimental
Experimental
Experimental
Experimental
Experimental
Arm Label
HF/TCS/BURST
HF/BURST/TCS
BURST/HF/TCS
BURST/TCS/HF
TCS/BURST/HF
TCS/HF/BURST
Arm Description
HF/TCS/BURST
HF/BURST/TCS
BURST/HF/TCS
BURST/TCS/HF
TCS/BURST/HF
TCS/HF/BURST
Outcomes
Primary Outcome Measures
Global Pain VAS Visual Analogic Scale (VAS)
Global pain intensity from 0 to 10.
Secondary Outcome Measures
Leg and back Pain Visual Analogic Scale (VAS)
Leg and back pain intensity from 0 to 10.
Oswestry Disability Index (ODI)
Self-administered questionnaire with 10 items. These items comprise assessments concerning pain intensity, degree of disability for personal care, lifting, walking, sitting, standing, sleeping, sex life, social life and travelling. The score is between 0 and 100% for which 0% is the best score.
EuroQol 5-Dimension 5 items (EQ-5D-5L)
EQ-5D is a generic quality of life scale that is not specific for low back pain. The scale comprises 5 questions assessing mobility, self-care, usual activities, pain/discomfort and anxiety/depression. A global index with a maximum score of 1 is calculated from the responses to these 5 dimensions by means of nomograms. The maximum score of 1 indicates the best possible quality of life.
Paraesthesia perception Visual Analogic Scale (VAS)
Paraesthesia perception scale intensity from 0 to 10.
Adverse Events and Serious Adverse Events Collection
Any harmful event occurring in a person participating in a clinical trial, which is not necessarily related to the clinical trial or to the medical device used in this clinical trial
Hospital Anxiety and Depression Scale (HADS)
The HADS scale investigates symptoms of anxiety and depression and their severity. Each answer corresponds to a number between 0 and 3. Adding these numbers together gives a total score per column (anxiety and depression). If the score of a column is greater than or equal to 11, this means that you are suffering from anxiety or depression.
Lead Performance and Lead Selectivity
Lead performance: Overlapped surface ratios between paraesthesia coverage and painful area.
Lead specificity: Overlapped surface ratios between paraesthesia coverage and non-painful area, unwanted to be covered.
Patient satisfaction via Patient Global Impression of Change (PGIC)
The self-report measure Patient Global Impression of Change (PGIC) reflects a patient's belief about the efficacy of treatment. Although widely used in chronic pain clinical trials, PGIC's validity has not been formally assessed. PGIC is a 7 point scale depicting a patient's rating of overall improvement. Patients rate their change as "very much improved," "much improved," "minimally improved," "no change," "minimally worse," "much worse," or "very much worse."
Full Information
NCT ID
NCT03014583
First Posted
December 13, 2016
Last Updated
November 26, 2021
Sponsor
Poitiers University Hospital
1. Study Identification
Unique Protocol Identification Number
NCT03014583
Brief Title
Study Comparing Conventional, Burst and High Frequency (HF) Spinal Cord Stimulation (SCS) in Refractory Failed Back Surgery Syndrome (FBSS) Patients After a 32-contact Surgical Lead Implantation
Acronym
MULTIWAVE
Official Title
Prospective, Randomized Study Comparing Conventional, Burst And High Frequency (HF) Spinal Cord Stimulation (SCS) in Refractory Failed Back Surgery Syndrome (FBSS) Patients After a 32-contact Surgical Lead Implantation
Study Type
Interventional
2. Study Status
Record Verification Date
November 2021
Overall Recruitment Status
Completed
Study Start Date
January 19, 2017 (Actual)
Primary Completion Date
September 21, 2021 (Actual)
Study Completion Date
September 21, 2021 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Poitiers University Hospital
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
5. Study Description
Brief Summary
Chronic Back and/or Leg Pain (CBLP) after spinal surgical procedures, a condition commonly labelled Failed Back Surgery Syndrome (FBSS), affects between 15% and 40% of patients after a spine surgery. Treatment of this chronic condition by further operation or medical management has a heavy financial impact on health care systems.
Many studies have demonstrated the efficacy and economic value of Spinal Cord Stimulation (SCS) for chronic neuropathic pain, and randomized controlled trials (RCTs) have shown SCS to be a clinically effective adjunct to medical management. SCS has the advantages of being reversible and less invasive than surgery and may cause fewer issues over time than long-term pharmacological treatments.
Despite variable levels of success in the literature, approximately 30-55% of the patients treated with traditional SCS for neuropathic pain disorders will not receive adequate long term pain relief. Therefore, technical SCS system refinements, as well as new techniques have emerged.
Two new stimulation waveforms based on traditional SCS technology have appeared to further optimize the outcome for specific painful conditions;
Burst stimulation mode: which generates constant-current stimuli with 5 spikes at 500 Hz per burst and pulse width and interspike intervals of 1 ms.
High-frequency stimulation (from 1 to 10 kHz) mode.
Several studies have demonstrated the potential interest of these 2 new waveforms to treat FBSS patients compared to traditional SCS.
The Precision Spectra™ system allows MultiWave Technology by offering a broad spectrum of waveform options (from Tonic Conventional Stimulation (TCS), BURST stimulation to High Frequency stimulation (HF)).
To date, literature data comparing these 3 stimulation patterns is lacking but it is suggested the pain relief in some of non-responsive patients can be "recaptured" by increasing the SCS frequency to 500 Hz by BURST stimulation or beyond by HF stimulation. It seems important to conduct RCT in crossover, thanks to the new Precision SCS Stimulator, to compare the effects of these 3 different SCS modalities in FBSS patients and to determine which concept is the most effective in terms of pain reduction and energy consumption.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Failed Back Surgery Syndrome
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
28 (Actual)
8. Arms, Groups, and Interventions
Arm Title
HF/TCS/BURST
Arm Type
Experimental
Arm Description
HF/TCS/BURST
Arm Title
HF/BURST/TCS
Arm Type
Experimental
Arm Description
HF/BURST/TCS
Arm Title
BURST/HF/TCS
Arm Type
Experimental
Arm Description
BURST/HF/TCS
Arm Title
BURST/TCS/HF
Arm Type
Experimental
Arm Description
BURST/TCS/HF
Arm Title
TCS/BURST/HF
Arm Type
Experimental
Arm Description
TCS/BURST/HF
Arm Title
TCS/HF/BURST
Arm Type
Experimental
Arm Description
TCS/HF/BURST
Intervention Type
Device
Intervention Name(s)
Precision Spectra™ system
Intervention Description
Neurostimulation procedures
Primary Outcome Measure Information:
Title
Global Pain VAS Visual Analogic Scale (VAS)
Description
Global pain intensity from 0 to 10.
Time Frame
Month 3
Secondary Outcome Measure Information:
Title
Leg and back Pain Visual Analogic Scale (VAS)
Description
Leg and back pain intensity from 0 to 10.
Time Frame
Inclusion, Implantation, Month 0, Month 1, Month 2, Month 3, Month 6, Month 9, Month 15
Title
Oswestry Disability Index (ODI)
Description
Self-administered questionnaire with 10 items. These items comprise assessments concerning pain intensity, degree of disability for personal care, lifting, walking, sitting, standing, sleeping, sex life, social life and travelling. The score is between 0 and 100% for which 0% is the best score.
Time Frame
Inclusion, Implantation, Month 0, Month 1, Month 2, Month 3, Month 6, Month 9, Month 15
Title
EuroQol 5-Dimension 5 items (EQ-5D-5L)
Description
EQ-5D is a generic quality of life scale that is not specific for low back pain. The scale comprises 5 questions assessing mobility, self-care, usual activities, pain/discomfort and anxiety/depression. A global index with a maximum score of 1 is calculated from the responses to these 5 dimensions by means of nomograms. The maximum score of 1 indicates the best possible quality of life.
Time Frame
Inclusion, Implantation, Month 0, Month 1, Month 2, Month 3, Month 6, Month 9, Month 15
Title
Paraesthesia perception Visual Analogic Scale (VAS)
Description
Paraesthesia perception scale intensity from 0 to 10.
Time Frame
Implantation, Month 0, Month 1, Month 2, Month 3, Month 6, Month 9, Month 15
Title
Adverse Events and Serious Adverse Events Collection
Description
Any harmful event occurring in a person participating in a clinical trial, which is not necessarily related to the clinical trial or to the medical device used in this clinical trial
Time Frame
from Inclusion to Month 15 (End Of Study)
Title
Hospital Anxiety and Depression Scale (HADS)
Description
The HADS scale investigates symptoms of anxiety and depression and their severity. Each answer corresponds to a number between 0 and 3. Adding these numbers together gives a total score per column (anxiety and depression). If the score of a column is greater than or equal to 11, this means that you are suffering from anxiety or depression.
Time Frame
Inclusion, Implantation, Month 0, Month 1, Month 2, Month 3, Month 6, Month 9, Month 15
Title
Lead Performance and Lead Selectivity
Description
Lead performance: Overlapped surface ratios between paraesthesia coverage and painful area.
Lead specificity: Overlapped surface ratios between paraesthesia coverage and non-painful area, unwanted to be covered.
Time Frame
Implantation, Month 0, Month 1, Month 2, Month 3, Month 6, Month 9, Month 15
Title
Patient satisfaction via Patient Global Impression of Change (PGIC)
Description
The self-report measure Patient Global Impression of Change (PGIC) reflects a patient's belief about the efficacy of treatment. Although widely used in chronic pain clinical trials, PGIC's validity has not been formally assessed. PGIC is a 7 point scale depicting a patient's rating of overall improvement. Patients rate their change as "very much improved," "much improved," "minimally improved," "no change," "minimally worse," "much worse," or "very much worse."
Time Frame
Month 0, Month 1, Month 2, Month 3, Month 6, Month 9, Month 15
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Age ≥ 18 years or ≤ 80 years.
Subject has FBSS and does not require further surgery. For the purposes of this study, FBSS is defined as persistent or recurrent low back and leg pain of at least 6 months duration following at least one decompression and/or fusion procedure.
Subject has persistent low back and leg pain despite other treatment modalities (pharmacological, surgical, physical, or psychological therapies) that have been tried and did not prove satisfactory or are unsuitable or contraindicated for the subject.
Average global pain is ≥ 50 mm as assessed by the baseline VAS.
With significant back, with mean intensity on a back pain VAS ≥ 50 mm (mean daily VAS score calculated on 5 consecutive days).
Meeting the criteria for spinal cord stimulation test according to HAS guidelines (multidisciplinary consultation, psychological assessment, etc.).
Subject is a candidate for SCS.
Absence of active psychosis or history of serious psychotic illness requiring hospitalisation.
Understands and accepts the constraints of the study.
Free subject, not under temporary or permanent guardianship and not subject to subordination.
Patients covered by French national health insurance.
Patients who have given their written consent to the study after having received clear information.
Exclusion Criteria:
Age < 18 years or > 80 years
Subject is or has been treated with SCS, subcutaneous or peripheral nerve stimulation, an intrathecal drug delivery system, requires back surgery at the location related to his/her original back pain complaint or experimental therapies.
Cause of low back pain accessible to etiological "mechanical" surgical treatment (discogenic low back pain, vertebral instability, spinal deformity, etc.).
Subject had most recent back surgery less than 6 months ago.
Presenting a surgical, anaesthetic or psychiatric contraindication to implantation of a spinal cord stimulation system.
Based on the opinion of the principal or sub-investigator, the subject is unable to operate the SCS equipment.
Subject has a life expectancy of less than 24 months beyond study enrolment.
Absence of signature of the informed consent form.
Patients not covered by French national health insurance.
Subjects requiring closer protection, i.e. minors, pregnant women, nursing mothers, subjects deprived of their freedom by a court or administrative decision, subjects admitted to a health or social welfare establishment, major subjects under legal protection, and finally patients in an emergency setting.
Pregnant women, nursing mothers, women of childbearing potential not using effective contraception (hormonal/barrier: oral, parenteral, percutaneous, implantable, intrauterine device, or surgical: tubal ligation, hysterectomy, total ovariectomy).
Facility Information:
Facility Name
Poitiers University Hospital
City
Poitiers
Country
France
12. IPD Sharing Statement
Citations:
PubMed Identifier
32746899
Citation
Billot M, Naiditch N, Brandet C, Lorgeoux B, Baron S, Ounajim A, Roulaud M, Roy-Moreau A, de Montgazon G, Charrier E, Misbert L, Maillard B, Vendeuvre T, Rigoard P. Comparison of conventional, burst and high-frequency spinal cord stimulation on pain relief in refractory failed back surgery syndrome patients: study protocol for a prospective randomized double-blinded cross-over trial (MULTIWAVE study). Trials. 2020 Aug 3;21(1):696. doi: 10.1186/s13063-020-04587-6.
Results Reference
derived
Learn more about this trial
Study Comparing Conventional, Burst and High Frequency (HF) Spinal Cord Stimulation (SCS) in Refractory Failed Back Surgery Syndrome (FBSS) Patients After a 32-contact Surgical Lead Implantation
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