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Percutaneous Electrical Nerve Field Stimulation for Adults With Irritable Bowel Syndrome

Primary Purpose

Irritable Bowel Syndrome, Abdominal Pain, Autonomic Nervous System Imbalance

Status

Recruiting

Phase

Not Applicable

Locations

United States

Study Type

Interventional

Intervention

Peripheral Electrical Nerve Field Stimulation (PENFS) Device

Sham Device

About this trial

This is an interventional treatment trial for Irritable Bowel Syndrome

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Adults, aged 18-60 years, who are able to provide written, informed consent.
Patients must meet Rome IV criteria for IBS, confirmed by a gastroenterologist who specializes in functional GI disorders. Any of the IBS bowel habit subtypes (diarrhea, constipation, mixed bowel habits, unclassified) will be allowed.
Average daily worst abdominal pain score between 4 and 8 (on a 0-10-point rating scale).
Minimum of 2 days of abdominal pain/week prior to starting trial.
At least moderate IBS symptom severity with an IBS-SSS of at least 175 (total score range 0-500).
If receiving pharmacologic therapy for abdominal pain associated with IBS, doses must be stable for at least 60 days prior to enrollment in the trial.
If receiving pharmacologic therapy for IBS that does not have an effect on abdominal pain, doses must be stable for at least 30 days prior to enrollment in the trial.

Mandatory Exclusion Criteria:

Patients under the age of 18 years or over the age of 60 years
Patients who cannot provide informed consent or do not speak English
Co-morbid, organic medical conditions associated with abdominal pain, including: Inflammatory bowel disease, chronic liver disease, peptic ulcer disease, celiac disease, diverticulitis, appendicitis, colorectal cancer, endometriosis, pregnancy, other intestinal or extra-intestinal malignancies. Patients with overlapping functional GI disorders (i.e. functional dyspepsia) will not be excluded as long as IBS is their predominant disorder
History of surgery involving CN V, VII, IX, or X.
History of abdominal surgeries other than appendectomy or cholecystectomy at least 6 months before entry into trial.
Patients on chronic opioids, benzodiazepines, or with illicit substance use
Patients with underlying neurologic conditions, including history of: seizures, CVA, uncontrolled migraines, traumatic brain injury, multiple sclerosis
Patients with underlying psychiatric conditions
Patients with dermatologic conditions affecting the ear, face, or neck region (i.e. psoriasis), or with cuts or abrasions to the external ear that would interfere with needle placement
Patients with hemophilia or other bleeding disorders
Patients with any implanted electrical device
Patients who are pregnant or breastfeeding

Preferred, but not mandatory, exclusion criteria:

Movement disorder
Unwillingness to wear the SmartWatch on upper extremity (left or right wrist)

Sites / Locations

UCLARecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Sham Comparator

Arm Label

Peripheral Electrical Nerve Field Stimulation (PENFS) Device

Sham Device

Arm Description

The PENFS device has a battery activated generator and wire harness. Four leads are attached to the generator, each with a sterile 2 mm, titanium needle. The patient's ear is trans-illuminated to identify neurovascular bundles that are avoided during needle placement. The generator is attached with adhesive to the skin behind the patient's ear. Needles are inserted into the dorsal and ventral aspects of the ear, within 1-1.5 mm of the vascular branches to create a field effect. The device settings are standardized and deliver 3.2 volts with alternating frequencies (1 ms pulses of 1 Hz and 10 Hz) every 2 s. This stimulation targets central pain pathways through branches of cranial nerves V, VII, IX, and X, which innervate the external ear. The device is worn for 5 days/week for a total of 4 weeks. Patients remove devices at home on day 6 of each treatment cycle. Patients will be asked to wear a SmartWatch during the study to monitor heart rate.

The sham devices will be identical to the active devices but will not administer electrical charges. Per manufacturer design and patient anecdotal experience from previous studies, both active stimulation and sham are below detectable sensation threshold. Per report from previous studies, some patients may experience a sensation around the ear after percutaneous needle placement; however, this sensation can occur with equal likelihood in the active or sham device. The device is worn for 5 days a week for a total of 4 weeks. Patients remove devices at home on day 6 of each treatment cycle. Patients will also be asked to wear a SmartWatch as above.

Outcomes

Primary Outcome Measures

Mean change in IBS symptom severity from baseline

To compare the efficacy of PENFS therapy versus sham therapy on the change in IBS symptom severity in adult IBS patients after 4 weeks of treatment, assessed through a mean change in the IBS-SSS.

Secondary Outcome Measures

Mean change in IBS symptom severity from baseline

To compare the efficacy of PENFS therapy versus sham therapy on the change in IBS symptom severity in adult IBS patients at extended follow-up (8 weeks), assessed through a mean change in the IBS-SSS.

IBS symptom severity responder rate

To compare the efficacy of PENFS therapy versus sham therapy on the change in IBS symptom severity in adult IBS patients after 4 weeks of treatment compared to baseline. Participants will be considered responders if there is at least a 50-point reduction on the IBS-SSS.

Daily worst abdominal pain responder rate

To compare the proportion of adult patients with IBS who experience a change of ≥ 30% from baseline in average daily worst abdominal pain scores after 4 weeks of treatment (measured using a validated, 11-point numeric rating scale). Participants who have a reduction in daily worst abdominal pain scores of ≥ 30% from baseline will be considered clinical responders.

Mean change in average daily worst abdominal pain from baseline

To compare the efficacy of PENFS therapy versus sham therapy on mean worst daily abdominal pain scores after 4 weeks compared to baseline in adult patients with IBS

Change in average weekly abdominal pain symptoms from baseline

To compare the efficacy of PENFS therapy versus sham therapy on the change in average weekly abdominal pain symptoms after 4 weeks of treatment and at extended follow-up (8 weeks) compared to baseline, assessed through the PROMIS Gastrointestinal Belly Pain Scale (percentiles 2-100%; higher percentiles indicate worse abdominal pain).

Change in average daily stool consistency from baseline

To compare the efficacy of PENFS therapy versus sham therapy on the change in average daily stool consistency after 4 weeks of treatment compared to baseline, assessed using the Bristol Stool Form Scale (BSFS) (stool types 1-7; types 1 and 2 indicate constipation, types 3 and 4 are normal consistency stools, type 5 indicates stool lacking fiber, types 6 and 7 indicate diarrhea).

Change in average weekly bowel habits from baseline

To compare the efficacy of PENFS therapy versus sham therapy on the change in average weekly bowel habits after 4 weeks of treatment and at extended follow-up (8 weeks) compared to baseline, assessed through the PROMIS Gastrointestinal Constipation Scale (percentiles 0.3-100%; higher percentiles indicate greater constipation) and Gastrointestinal Diarrhea Scale (percentiles 1-100%; higher percentiles indicate greater diarrhea).

Change in average weekly bloating symptoms from baseline

To compare the efficacy of PENFS therapy versus sham therapy on the change in average weekly bloating symptoms after 4 weeks of treatment and at extended follow-up (8 weeks) compared to baseline, assessed through the PROMIS Gastrointestinal Gas and Bloating Scale (percentiles 0.1-100%; higher percentiles indicate greater gas and bloating).

Change in quality of life from baseline

To compare the efficacy of PENFS therapy versus sham therapy on the change in IBS-quality of life (IBS-QOL) in adult patients with IBS after 4 weeks of treatment and at extended follow-up (8 weeks) compared to baseline. IBS QOL will be assessed on a scale from 0-100, with higher scores indicating better IBS specific quality of life.

Change in heart rate variability from baseline

To compare the change in resting cardio-autonomic tone, i.e. heart rate variability (HRV), at baseline and after 4 weeks of treatment in responders vs. non-responders in adult patients with IBS.

Incidence of treatment-related adverse events as assessed by a weekly adverse events questionnaire

To compare the incidence of treatment-related adverse events from PENFS therapy versus sham therapy in adult patients with IBS. Adverse events will be assessed by a weekly adverse events questionnaire that determines the severity of the adverse event, the relationship to the study intervention, the action taken regarding the study intervention, the outcome of the adverse event, whether or not the adverse event was expected, and if the event was considered a serious adverse event (SAE).

Full Information

NCT ID

NCT04428619

First Posted

May 28, 2020

Last Updated

January 9, 2023

Sponsor

University of California, Los Angeles

Collaborators

Innovative Health Solutions

1. Study Identification

Unique Protocol Identification Number

NCT04428619

Brief Title

Percutaneous Electrical Nerve Field Stimulation for Adults With Irritable Bowel Syndrome

Official Title

Neuromodulation With Percutaneous Electrical Nerve Field Stimulation for Adults With Irritable Bowel Syndrome: A Randomized, Double-Blind, Sham-Controlled Pilot Study

Study Type

Interventional

2. Study Status

Record Verification Date

January 2023

Overall Recruitment Status

Recruiting

Study Start Date

August 1, 2020 (Actual)

Primary Completion Date

May 1, 2024 (Anticipated)

Study Completion Date

November 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Principal Investigator

Name of the Sponsor

University of California, Los Angeles

Collaborators

Innovative Health Solutions

4. Oversight

Studies a U.S. FDA-regulated Drug Product

Studies a U.S. FDA-regulated Device Product

Yes

Product Manufactured in and Exported from the U.S.

5. Study Description

Brief Summary

This is a prospective, double-blind, randomized, sham-controlled pilot study evaluating the efficacy of percutaneous electrical nerve field stimulation for the treatment of adult patients with irritable bowel syndrome (IBS).

Detailed Description

IBS has a worldwide prevalence around 11% and is characterized by chronic or recurrent abdominal pain associated with altered bowel habits. Abnormalities within the brain-gut axis, visceral hypersensitivity, and dysfunction of the autonomic nervous system are important components contributing to the pathophysiology of IBS. Despite recent advances in medical therapies for IBS, a significant subgroup of patients fails to experience satisfactory relief of abdominal pain. Given evidence of anti-inflammatory and anti-nociceptive components of vagal nerve pathways, peripheral field stimulation of the vagus nerve may help reduce abdominal pain in patients with IBS. Percutaneous electrical nerve field stimulation (PENFS) administered via the IB-Stim device (Innovative Health Solutions, Versailles, IN, USA) has been shown to be efficacious in adolescent patients with abdominal-pain-related functional GI disorders, including IBS. This device uses discontinuous frequencies of stimulation to target central pain pathways through branches of cranial nerves V, VII, IX, and X that innervate the external ear and project to certain brainstem nuclei, including the nucleus tractus solitarius (NTS). The NTS then acts as a relay station to other brain areas involved in pain modulation and autonomic control, including the rostral ventral medulla, locus coeruleus, hypothalamus, and amygdala. In adolescent studies, PENFS was associated with a greater reduction in worst abdominal pain and composite abdominal pain scores from baseline as well as compared with a sham device after three weeks of treatment. These effects were sustained over an extended follow-up period with minimal to no side effects. In addition, a greater proportion of adolescents in the PENFS arm achieved at least a 30% reduction in worst abdominal pain scores from baseline after 3 weeks of treatment. The IB-Stim is the first device to be approved by the Food and Drug Administration (FDA) for the treatment of functional abdominal pain in adolescents aged 11-18 with IBS. However, the efficacy of PENFS in adults with IBS is not currently known. This study is a double-blind, randomized, sham-controlled pilot study evaluating the efficacy of PENFS using IB-Stim for the treatment of IBS symptoms in adult patients with IBS.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Irritable Bowel Syndrome, Abdominal Pain, Autonomic Nervous System Imbalance

7. Study Design

Primary Purpose

Treatment

Study Phase

Not Applicable

Interventional Study Model

Parallel Assignment

Masking

Investigator

Masking Description

Patients who meet study eligibility criteria will be randomly assigned (1:1) in blocks of two and four, using a code generated by a randomization program to 4 weeks of stimulation with an active or inactive (sham) PENFS device. Per manufacturer design, both active stimulation and sham are below a detectable sensation threshold. Allocation will be concealed, and all physicians, statisticians, participants, and research coordinators will be unaware of device codes. One research coordinator who has no patient contact will be unblinded and handle allocation and storage of devices. At the end of 4 weeks, patients will be asked to which device arm they believe they were randomized.

Allocation

Randomized

Enrollment

54 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title

Peripheral Electrical Nerve Field Stimulation (PENFS) Device

Arm Type

Active Comparator

Arm Description

Arm Title

Sham Device

Arm Type

Sham Comparator

Arm Description

Intervention Type

Device

Intervention Name(s)

Peripheral Electrical Nerve Field Stimulation (PENFS) Device

Intervention Description

Patients will complete daily worst abdominal pain and bowel habit questionnaires for 1 week prior to initial PENFS device placement to provide a baseline. At visit 1, patients will complete the Bowel Symptom Questionnaire, IBS Symptom Severity Scale (IBS-SSS), PROMIS Belly Pain Scale, Gas and Bloating, Constipation, and Diarrhea Scales, Hospital Anxiety and Depression Scale, and Visceral Sensitivity Index, heart rate variability will be measured, and they will have the initial PENFS device placed. Patients will complete daily worst abdominal pain (scale 0-10) questionnaires throughout the duration of the study. They will return every 7 days for a total of 4 visits for device replacement and additional questionnaires, including the IBS-SSS. Four devices will be placed in total (start of weeks 1, 2, 3, and 4). Stimulation time is 5 days/week during each of the 4 consecutive weeks. Additional questionnaires will be completed at the end of week 4 and at extended follow-up (8 weeks).

Intervention Type

Device

Intervention Name(s)

Sham Device

Intervention Description

Patients will complete daily worst abdominal pain and bowel habit questionnaires for 1 week prior to initial sham device placement to provide a baseline. At visit 1, patients will complete the Bowel Symptom Questionnaire, IBS Symptom Severity Scale (IBS-SSS), PROMIS Belly Pain Scale, Gas and Bloating, Constipation, and Diarrhea Scales, Hospital Anxiety and Depression Scale, and Visceral Sensitivity Index, heart rate variability will be measured, and they will have the initial sham device placed. Patients will complete daily worst abdominal pain (scale 0-10) questionnaires throughout the duration of the study. They will return every 7 days for a total of 4 visits for device replacement and additional questionnaires, including the IBS-SSS. Four devices will be placed in total (start of weeks 1, 2, 3, and 4). Stimulation time is 5 days/week during each of the 4 consecutive weeks. Additional questionnaires will be completed at the end of week 4 and at extended follow-up (8 weeks).

Primary Outcome Measure Information:

Title

Mean change in IBS symptom severity from baseline

Description

To compare the efficacy of PENFS therapy versus sham therapy on the change in IBS symptom severity in adult IBS patients after 4 weeks of treatment, assessed through a mean change in the IBS-SSS.

Time Frame

Week 4

Secondary Outcome Measure Information:

Title

Mean change in IBS symptom severity from baseline

Description

Time Frame

Week 8

Title

IBS symptom severity responder rate

Description

Time Frame

Week 4

Title

Daily worst abdominal pain responder rate

Description

Time Frame

Week 4

Title

Mean change in average daily worst abdominal pain from baseline

Description

To compare the efficacy of PENFS therapy versus sham therapy on mean worst daily abdominal pain scores after 4 weeks compared to baseline in adult patients with IBS

Time Frame

Week 4

Title

Change in average weekly abdominal pain symptoms from baseline

Description

Time Frame

Week 4, week 8

Title

Change in average daily stool consistency from baseline

Description

Time Frame

Week 4

Title

Change in average weekly bowel habits from baseline

Description

Time Frame

Week 4, week 8

Title

Change in average weekly bloating symptoms from baseline

Description

Time Frame

Week 4, week 8

Title

Change in quality of life from baseline

Description

Time Frame

Week 4, week 8

Title

Change in heart rate variability from baseline

Description

To compare the change in resting cardio-autonomic tone, i.e. heart rate variability (HRV), at baseline and after 4 weeks of treatment in responders vs. non-responders in adult patients with IBS.

Time Frame

Week 4

Title

Incidence of treatment-related adverse events as assessed by a weekly adverse events questionnaire

Description

Time Frame

Week 4

10. Eligibility

Sex

All

Minimum Age & Unit of Time

18 Years

Maximum Age & Unit of Time

60 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: Adults, aged 18-60 years, who are able to provide written, informed consent. Patients must meet Rome IV criteria for IBS, confirmed by a gastroenterologist who specializes in functional GI disorders. Any of the IBS bowel habit subtypes (diarrhea, constipation, mixed bowel habits, unclassified) will be allowed. Average daily worst abdominal pain score between 4 and 8 (on a 0-10-point rating scale). Minimum of 2 days of abdominal pain/week prior to starting trial. At least moderate IBS symptom severity with an IBS-SSS of at least 175 (total score range 0-500). If receiving pharmacologic therapy for abdominal pain associated with IBS, doses must be stable for at least 60 days prior to enrollment in the trial. If receiving pharmacologic therapy for IBS that does not have an effect on abdominal pain, doses must be stable for at least 30 days prior to enrollment in the trial. Mandatory Exclusion Criteria: Patients under the age of 18 years or over the age of 60 years Patients who cannot provide informed consent or do not speak English Co-morbid, organic medical conditions associated with abdominal pain, including: Inflammatory bowel disease, chronic liver disease, peptic ulcer disease, celiac disease, diverticulitis, appendicitis, colorectal cancer, endometriosis, pregnancy, other intestinal or extra-intestinal malignancies. Patients with overlapping functional GI disorders (i.e. functional dyspepsia) will not be excluded as long as IBS is their predominant disorder History of surgery involving CN V, VII, IX, or X. History of abdominal surgeries other than appendectomy or cholecystectomy at least 6 months before entry into trial. Patients on chronic opioids, benzodiazepines, or with illicit substance use Patients with underlying neurologic conditions, including history of: seizures, CVA, uncontrolled migraines, traumatic brain injury, multiple sclerosis Patients with underlying psychiatric conditions Patients with dermatologic conditions affecting the ear, face, or neck region (i.e. psoriasis), or with cuts or abrasions to the external ear that would interfere with needle placement Patients with hemophilia or other bleeding disorders Patients with any implanted electrical device Patients who are pregnant or breastfeeding Preferred, but not mandatory, exclusion criteria: Movement disorder Unwillingness to wear the SmartWatch on upper extremity (left or right wrist)

Central Contact Person:

First Name & Middle Initial & Last Name or Official Title & Degree

Jessica Sohn

Phone

310-206-1656

JessicaSohn@mednet.ucla.edu

First Name & Middle Initial & Last Name or Official Title & Degree

Lin Chang, MD

Phone

310-206-1656

LinChang@mednet.ucla.edu

Overall Study Officials:

First Name & Middle Initial & Last Name & Degree

Lin Chang, MD

Organizational Affiliation

University of California, Los Angeles

Official's Role

Principal Investigator

Facility Information:

Facility Name

UCLA

City

Los Angeles

State/Province

California

ZIP/Postal Code

90095

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Jessica Sohn

Phone

310-206-1656

JessicaSohn@mednet.ucla.edu

First Name & Middle Initial & Last Name & Degree

Lin Chang, MD

12. IPD Sharing Statement

Plan to Share IPD

Citations:

PubMed Identifier

28826627

Citation

Kovacic K, Hainsworth K, Sood M, Chelimsky G, Unteutsch R, Nugent M, Simpson P, Miranda A. Neurostimulation for abdominal pain-related functional gastrointestinal disorders in adolescents: a randomised, double-blind, sham-controlled trial. Lancet Gastroenterol Hepatol. 2017 Oct;2(10):727-737. doi: 10.1016/S2468-1253(17)30253-4. Epub 2017 Aug 18.

Results Reference

background

PubMed Identifier

31622740

Citation

Krasaelap A, Sood MR, Li BUK, Unteutsch R, Yan K, Nugent M, Simpson P, Kovacic K. Efficacy of Auricular Neurostimulation in Adolescents With Irritable Bowel Syndrome in a Randomized, Double-Blind Trial. Clin Gastroenterol Hepatol. 2020 Aug;18(9):1987-1994.e2. doi: 10.1016/j.cgh.2019.10.012. Epub 2019 Oct 14.

Results Reference

background

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Percutaneous Electrical Nerve Field Stimulation for Adults With Irritable Bowel Syndrome

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