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Clinical Study of a Micro-Implantable Pulse Generator for the Treatment of Peripheral Neuropathic Pain (COMFORT 2) (COMFORT 2)

Primary Purpose

Peripheral Neuralgia, Peripheral Neuropathy, Chronic Pain

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Nalu Neurostimulation System for PNS
Conventional Medical Management
Sponsored by
Nalu Medical, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Peripheral Neuralgia focused on measuring PNS, Peripheral nerve stimulation, micro-IPG, peripheral nerve stimulator, chronic pain

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Subject is between 18 to 80 years of age at the time of enrollment. Subject would have been prescribed PNS therapy regardless of participation in this study; the use of the Nalu device must be on-label. Subject has been diagnosed with one or more of the conditions listed below in the low back, shoulder, knee, or foot (including ankle): Post-surgical/post-traumatic peripheral neuralgia including but not limited to pain due to peripheral nerve injury, post-surgical scar formation, nerve entrapment Mononeuropathy, specified or unspecified or in diseases classified elsewhere Other neuralgia or neuropathic pain Osteoarthritic pain Subject has chronic (defined as at least 6 months duration), intractable peripheral neuropathic pain, exclusive of the craniofacial region; any nociceptive pain must be less prominent than the neuropathic pain. Pain should have a predominant neuropathic component as per the investigator's clinical assessment. Subject should have a pain score of at least 6, in the target area of pain, as recorded on the BPI-Q5 (NRS) at screening. Subject is willing to cooperate with the study requirements including, compliance with the study procedures and completion of all study visits. Subject reported stable pain (non-escalating) for 60 days prior to signing informed consent. Subject is currently receiving CMM and has had stable pain medication use and dosage for 30 days prior to signing informed consent. Subject is psychologically qualified to receive a peripheral nerve stimulator as per the clinician's standard clinical practice and judgment and does not have clinically relevant psychological condition(s) that would interfere with their ability to accurately report outcomes or complete study procedures. Subject has demonstrated the ability to appropriately place the adhesive clip in the location where the IPG is most likely to be implanted. Alternatively, subject is able to appropriately use the relief belt and/or limb cuff to keep the Therapy Disc in place. Exclusion Criteria: Subject currently has an active implantable medical device such as a drug pump, spinal cord stimulator, peripheral nerve stimulator, sacral nerve stimulator, deep brain stimulator, and/or cardiac pacemaker. 2. Subject has previously failed PNS or Spinal Cord Stimulation (SCS) or Dorsal Root Ganglion (DRG) therapy (trial or permanent implant). See note below. 3. Pain is completely absent at rest. 4. Patient has clinical evidence of complex regional pain syndrome (CRPS), peripheral neuralgia of metabolic origin, post-herpetic neuralgia, biochemical evidence of a metabolic or genetic neuropathy (e.g., Charcot'- Marie- Tooth Disease) or mixed motor/sensory polyneuropathy. 5. Subject has a medical condition that would prevent them from participating in the current study per investigator's or medical monitor's judgment. 6. Subject has had a successful (≥ 50% pain relief) interventional procedure within the past 3 months to treat the same pain condition(s) being examined in this study including, nerve blocks. 7. Uncontrolled depression or uncontrolled psychiatric disorders 8. Subject is currently participating in another clinical investigation with an active treatment arm. 9. Subject is allergic or sensitive to materials used in the device components including, skin adhesives or does not tolerate the wearable aspect of the device. 10. Subject has pending or ongoing legal issues (including unresolved worker's compensation claims or equivalent) or other conflicting secondary gain issues related to their chronic pain condition. 11. Subject has a current diagnosis of a coagulation disorder, bleeding diathesis, or progressive peripheral vascular disease that has not been medically corrected. 12. Subject has an active systemic infection. 13. Subject is unable to read and/or write in English or give informed consent. 14. Subject has a life expectancy of less than 1 year. 15. Subject has an active malignant neoplasm (metastatic or local) or evidence of paraneoplastic syndrome. 16. Subject with uncontrolled diabetes mellitus, showing signs of diabetic neuropathy, as evidenced by a neurological exam and a HbA1c test. 17. Subject has evidence of an alcohol or drug dependency within the last 6 months prior to enrollment. 18. Subject is pregnant (if female and sexually active, subject must be using a reliable form of birth control, be surgically sterile or be at least 1 year post-menopausal). 19. Subject is nursing/breastfeeding. 20. Subject is on ≥90 mg-morphine equivalents per 24 hours. 21. Subject has undergone an ablative treatment of the target peripheral nerve, or proximal nerve trunk giving rise to the target nerve, or dorsal roots (and DRGs) that ultimately make up the target nerve. No ablative procedures directed at the spinal cord, dorsal roots, or peripheral nerve(s) being treated in the study. To note, subjects who have undergone RF ablation of the dorsal rami, cool pulsed RF of the facet innervation may be considered for enrollment.

Sites / Locations

  • Comprehensive Spine & Pain PhysiciansRecruiting
  • Northwest Pain CareRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

PNS Therapy plus Conventional Medical Management (CMM)

Conventional Medical Management

Arm Description

Subjects in this arm will receive a peripheral nerve stimulator and conventional medical management

Subjects will receive only CMM

Outcomes

Primary Outcome Measures

Effectiveness: Responder Rates between the 2 groups
Difference in responder rates between groups. Responder rate is defined as the percent of subjects with 50% or greater pain relief from baseline, based on the Numeric Rating Scale (0-10; 0=no pain, 10=worst pain imaginable)
Safety: Rate of serious and non-serious device effects
Rate of serious and non-serious adverse device events between groups

Secondary Outcome Measures

Responder Rates
Difference in responder rates between groups. Responder rate is defined as the percent of subjects with 50% or greater pain relief from baseline, based on the BPI-Q5 (NRS,0-10 where, 0= no pain; 10=worst pain imaginable).
Functional Outcomes: Change in Oswestry Disability Index (ODI) score from baseline to protocol defined timepoints
Change in patient reported ODI from baseline with comparisons between groups. The ODI is scored from 0-100% disability. A lower score, compared to baseline, indicates improvement in ODI.
Functional Outcomes: Change in Beck's Depression Inventory (BDI) score from baseline
Change in patient reported depression from baseline with comparison between groups. The BDI is scored from 0-63. A lower score at follow-up, compared to baseline, indicates an improvement in depression symptoms and mood.
Functional Outcomes: Patient Global Impression of Change (PGIC)
PGIC is reported by the patient post-implant, on a 7-point likert scale to indicate overall changes in mood, activity, emotional well-being and quality of life. Proportion of patients showing improvement, worsening or no change, will be collected and reported at protocol specified time points.
Safety Assessment
Rate of serious and non-serious device effects

Full Information

First Posted
May 1, 2023
Last Updated
May 24, 2023
Sponsor
Nalu Medical, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT05870124
Brief Title
Clinical Study of a Micro-Implantable Pulse Generator for the Treatment of Peripheral Neuropathic Pain (COMFORT 2)
Acronym
COMFORT 2
Official Title
Clinical Study Of a Micro-Implantable Pulse Generator For The Treatment of Peripheral Neuropathic Pain (COMFORT 2)
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Recruiting
Study Start Date
April 28, 2023 (Actual)
Primary Completion Date
October 31, 2024 (Anticipated)
Study Completion Date
April 30, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Nalu Medical, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This post market study is being conducted to document the comparative effectiveness and safety of peripheral nerve stimulation plus conventional medical management versus conventional medical management alone in the treatment of chronic, intractable peripheral neuralgia of post-traumatic or postsurgical origin. This is a prospective, minimal risk, multi-center, randomized control trial.
Detailed Description
Multi-center, prospective, open-label, randomized controlled trial (RCT) comparing PNS plus CMM with CMM alone. Subjects will be randomized to receive: Arm 1: Nalu Neurostimulation System for PNS plus CMM Arm 2: CMM alone Consented subjects will receive a baseline evaluation and then be randomized 2:1 into one of two arms: 1) PNS+CMM arm or 2) CMM arm. Subjects assigned to Arm 1 will undergo a trial implant period using best clinical practices. Those subjects who pass the trial implant will receive the permanent implant. At the 3-month end point, subjects in Arm 2 will be given the option to crossover into Arm 1 beginning with a trial implant. All Arm 1 patients receiving a permanent implant will be followed for a total of 12 months after permanent implantation.Arm 2 patients who do not crossover will be followed for a total of 12 months from randomization.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Peripheral Neuralgia, Peripheral Neuropathy, Chronic Pain
Keywords
PNS, Peripheral nerve stimulation, micro-IPG, peripheral nerve stimulator, chronic pain

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
100 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
PNS Therapy plus Conventional Medical Management (CMM)
Arm Type
Active Comparator
Arm Description
Subjects in this arm will receive a peripheral nerve stimulator and conventional medical management
Arm Title
Conventional Medical Management
Arm Type
Active Comparator
Arm Description
Subjects will receive only CMM
Intervention Type
Device
Intervention Name(s)
Nalu Neurostimulation System for PNS
Other Intervention Name(s)
Nalu PNS
Intervention Description
The Nalu Neurostimulation System for PNS is a peripheral nerve stimulator
Intervention Type
Other
Intervention Name(s)
Conventional Medical Management
Intervention Description
Conventional Medical Management is the best standard of care treatment for the patient
Primary Outcome Measure Information:
Title
Effectiveness: Responder Rates between the 2 groups
Description
Difference in responder rates between groups. Responder rate is defined as the percent of subjects with 50% or greater pain relief from baseline, based on the Numeric Rating Scale (0-10; 0=no pain, 10=worst pain imaginable)
Time Frame
3-months
Title
Safety: Rate of serious and non-serious device effects
Description
Rate of serious and non-serious adverse device events between groups
Time Frame
3-months
Secondary Outcome Measure Information:
Title
Responder Rates
Description
Difference in responder rates between groups. Responder rate is defined as the percent of subjects with 50% or greater pain relief from baseline, based on the BPI-Q5 (NRS,0-10 where, 0= no pain; 10=worst pain imaginable).
Time Frame
6-months and 12 months
Title
Functional Outcomes: Change in Oswestry Disability Index (ODI) score from baseline to protocol defined timepoints
Description
Change in patient reported ODI from baseline with comparisons between groups. The ODI is scored from 0-100% disability. A lower score, compared to baseline, indicates improvement in ODI.
Time Frame
3, 6 and 12 months
Title
Functional Outcomes: Change in Beck's Depression Inventory (BDI) score from baseline
Description
Change in patient reported depression from baseline with comparison between groups. The BDI is scored from 0-63. A lower score at follow-up, compared to baseline, indicates an improvement in depression symptoms and mood.
Time Frame
3, 6 and 12 months
Title
Functional Outcomes: Patient Global Impression of Change (PGIC)
Description
PGIC is reported by the patient post-implant, on a 7-point likert scale to indicate overall changes in mood, activity, emotional well-being and quality of life. Proportion of patients showing improvement, worsening or no change, will be collected and reported at protocol specified time points.
Time Frame
3, 6 and 12 months
Title
Safety Assessment
Description
Rate of serious and non-serious device effects
Time Frame
6 and 12 months

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: Subject is between 18 to 80 years of age at the time of enrollment. Subject would have been prescribed PNS therapy regardless of participation in this study; the use of the Nalu device must be on-label. Subject has been diagnosed with one or more of the conditions listed below in the low back, shoulder, knee, or foot (including ankle): Post-surgical/post-traumatic peripheral neuralgia including but not limited to pain due to peripheral nerve injury, post-surgical scar formation, nerve entrapment Mononeuropathy, specified or unspecified or in diseases classified elsewhere Other neuralgia or neuropathic pain Osteoarthritic pain Subject has chronic (defined as at least 6 months duration), intractable peripheral neuropathic pain, exclusive of the craniofacial region; any nociceptive pain must be less prominent than the neuropathic pain. Pain should have a predominant neuropathic component as per the investigator's clinical assessment. Subject should have a pain score of at least 6, in the target area of pain, as recorded on the BPI-Q5 (NRS) at screening. Subject is willing to cooperate with the study requirements including, compliance with the study procedures and completion of all study visits. Subject reported stable pain (non-escalating) for 60 days prior to signing informed consent. Subject is currently receiving CMM and has had stable pain medication use and dosage for 30 days prior to signing informed consent. Subject is psychologically qualified to receive a peripheral nerve stimulator as per the clinician's standard clinical practice and judgment and does not have clinically relevant psychological condition(s) that would interfere with their ability to accurately report outcomes or complete study procedures. Subject has demonstrated the ability to appropriately place the adhesive clip in the location where the IPG is most likely to be implanted. Alternatively, subject is able to appropriately use the relief belt and/or limb cuff to keep the Therapy Disc in place. Exclusion Criteria: Subject currently has an active implantable medical device such as a drug pump, spinal cord stimulator, peripheral nerve stimulator, sacral nerve stimulator, deep brain stimulator, and/or cardiac pacemaker. 2. Subject has previously failed PNS or Spinal Cord Stimulation (SCS) or Dorsal Root Ganglion (DRG) therapy (trial or permanent implant). See note below. 3. Pain is completely absent at rest. 4. Patient has clinical evidence of complex regional pain syndrome (CRPS), peripheral neuralgia of metabolic origin, post-herpetic neuralgia, biochemical evidence of a metabolic or genetic neuropathy (e.g., Charcot'- Marie- Tooth Disease) or mixed motor/sensory polyneuropathy. 5. Subject has a medical condition that would prevent them from participating in the current study per investigator's or medical monitor's judgment. 6. Subject has had a successful (≥ 50% pain relief) interventional procedure within the past 3 months to treat the same pain condition(s) being examined in this study including, nerve blocks. 7. Uncontrolled depression or uncontrolled psychiatric disorders 8. Subject is currently participating in another clinical investigation with an active treatment arm. 9. Subject is allergic or sensitive to materials used in the device components including, skin adhesives or does not tolerate the wearable aspect of the device. 10. Subject has pending or ongoing legal issues (including unresolved worker's compensation claims or equivalent) or other conflicting secondary gain issues related to their chronic pain condition. 11. Subject has a current diagnosis of a coagulation disorder, bleeding diathesis, or progressive peripheral vascular disease that has not been medically corrected. 12. Subject has an active systemic infection. 13. Subject is unable to read and/or write in English or give informed consent. 14. Subject has a life expectancy of less than 1 year. 15. Subject has an active malignant neoplasm (metastatic or local) or evidence of paraneoplastic syndrome. 16. Subject with uncontrolled diabetes mellitus, showing signs of diabetic neuropathy, as evidenced by a neurological exam and a HbA1c test. 17. Subject has evidence of an alcohol or drug dependency within the last 6 months prior to enrollment. 18. Subject is pregnant (if female and sexually active, subject must be using a reliable form of birth control, be surgically sterile or be at least 1 year post-menopausal). 19. Subject is nursing/breastfeeding. 20. Subject is on ≥90 mg-morphine equivalents per 24 hours. 21. Subject has undergone an ablative treatment of the target peripheral nerve, or proximal nerve trunk giving rise to the target nerve, or dorsal roots (and DRGs) that ultimately make up the target nerve. No ablative procedures directed at the spinal cord, dorsal roots, or peripheral nerve(s) being treated in the study. To note, subjects who have undergone RF ablation of the dorsal rami, cool pulsed RF of the facet innervation may be considered for enrollment.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Shilpa Kottalgi, BDS, MAS
Phone
760 827 6467
Email
skottalgi@nalumed.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Patrick Martin
Organizational Affiliation
Nalu Medical, Inc.
Official's Role
Study Director
Facility Information:
Facility Name
Comprehensive Spine & Pain Physicians
City
Burbank
State/Province
California
ZIP/Postal Code
91505
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Breana Valencia
Facility Name
Northwest Pain Care
City
Spokane
State/Province
Washington
ZIP/Postal Code
99201
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Crystal Stevens

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Clinical Study of a Micro-Implantable Pulse Generator for the Treatment of Peripheral Neuropathic Pain (COMFORT 2)

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