Study to Assess the Efficacy of Direct Observation and Mental Visualization of Foot Movements to Treat Bilateral Lower Limb Phantom Limb Pain

NCT ID: NCT00639431

Last Updated: 2014-08-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

42 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-12-31

Study Completion Date

2014-08-31

Brief Summary

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Because bilateral lower extremity amputees do not have an intact limb for use with the mirror, we are now proposing to conduct a pilot trial of two treatments for phantom limb pain (PLP) - direct observation of another person's foot moving versus mental visualization. The trial will last for 4 months and during the first month data will be gathered daily on the number of episodes of phantom limb pain, the average length of episodes, and the average intensity of pain in each phantom leg. In addition, the rapidity of pain relief, the length of therapy needed to sustain long-lasting pain relief, and whether use of these two treatment methods during rehabilitation can provide sustained and/or permanent pain relief will be determined. This study will test the hypothesis that direct observation of a limb while performing phantom limb movements will reduce phantom limb pain more than mental visualization of the phantom limb alone in subjects who have sustained a traumatic bilateral lower limb amputation.

Detailed Description

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A total of forty-two (42) subjects with bilateral lower extremity amputations will be enrolled. Subjects will be randomized for assignment into two treatment conditions: twenty-one (21) subjects will use direct observation of another person's foot movements while twenty-one (21) will use mental visualization of foot movements (which will serve as the control group). Subjects in each group will be further be randomized for assignment into six treatment groups: direct observation or mental visualization of right lower extremity movements alone, direct observation or mental visualization of left lower extremity movements alone, or direct observation or mental visualization of simultaneous bilateral lower extremity movements. Subjects will use their assigned therapy for 20 minutes daily. The subjects for this study will be recruited from the Walter Reed Army Medical Center (WRAMC) Amputee clinic. Up to sixty (50) subjects will be recruited and screened according to the inclusion and exclusion criteria since we expect that some may not qualify or drop-out sooner than the scheduled 4-month completion time.

Conditions

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Phantom Limb Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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1

Direct observation of a sequence of right foot movements performed by the experimenter while visualizing moving the amputated or phantom right foot.

Group Type EXPERIMENTAL

direct observation

Intervention Type BEHAVIORAL

direct observation of another person's foot moving

2

Direct observation of a sequence of left foot movements performed by the experimenter while visualizing moving the amputated or phantom left foot.

Group Type EXPERIMENTAL

direct observation

Intervention Type BEHAVIORAL

direct observation of another person's foot moving

3

Direct observation of a sequence of left and right foot movements performed by the experimenter while visualizing moving the amputated or phantom left and right feet.

Group Type EXPERIMENTAL

direct observation

Intervention Type BEHAVIORAL

direct observation of another person's foot moving

4

Mental visualization with closed eyes of a sequence movements performed with the right amputated or phantom foot.

Group Type EXPERIMENTAL

mental visualization

Intervention Type BEHAVIORAL

mentally imagining moving one's phantom foot/feet

5

Mental visualization with closed eyes of a sequence movements performed with the left amputated or phantom foot.

Group Type EXPERIMENTAL

mental visualization

Intervention Type BEHAVIORAL

mentally imagining moving one's phantom foot/feet

6

Mental visualization with closed eyes of a sequence movements performed with the left and right amputated or phantom feet.

Group Type EXPERIMENTAL

mental visualization

Intervention Type BEHAVIORAL

mentally imagining moving one's phantom foot/feet

Interventions

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direct observation

direct observation of another person's foot moving

Intervention Type BEHAVIORAL

mental visualization

mentally imagining moving one's phantom foot/feet

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Male or female subjects, 18 to 70 years of age, active duty military, beneficiary, or retiree.
* Written informed consent and written authorization for use or release of health and research study information.
* Traumatic bilateral lower limb amputation.
* No prior history of vertebral disk disease/condition, sciatica or radiculopathy.
* Normal neurological examination.
* Minimum of 3 phantom limb pain episodes each week in one phantom leg.
* Degree of pain evaluated by VAS scoring a minimum of 3 cm at time of screening for entry into study.
* Ability to follow study instructions and likely to complete all required visits.

Exclusion Criteria

* Age less than 18 or greater than 70.
* Unilateral upper or lower limb amputation.
* Severe traumatic brain injury (TBI) - permanent or temporary impairments of cognitive, physical, and psychosocial functions with an associated diminished or altered state of consciousness - as indicated by neuropsychological screening which is currently performed routinely on patients by the TBI program at WRAMC and noted in the patient's medical record. Subjects with diagnosis of mild TBI following TBI testing, but with a normal score (\>42) on the Test of Memory Malingering (TOMM) (parts 1 or 2) can be included in the study.
* Known uncontrolled systemic disease- known cancer not in remission, known on-going infection, lupus, kidney disease requiring dialysis, any other systemic disease which might affect ability to participate in this study to its conclusion
* Concurrent participation in another investigational drug or device study for phantom limb pain or participation in the 30 days immediately prior to study enrollment.
* Any condition or situation that, in the investigator's opinion, may put the subject at significant risk, confound the study results, or interfere significantly with the subject's participation in the study.
* Significant Axis I or II diagnosis determined by a neurologist in the 6 months prior to entry into the study, defined as a condition requiring initiation of medications or hospitalization with continuing medical treatment for the condition.
* Subjects with lack of effort as determined by the neurologist. Subjects will be screened for effort using the TOMM first in order to exclude those with blatant exaggeration or malingering.
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Walter Reed Army Medical Center

FED

Sponsor Role lead

Responsible Party

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Jack Tsao, MD

Neurologist

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jack W Tsao, MD

Role: PRINCIPAL_INVESTIGATOR

Walter Reed Army Medical Center

Locations

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Walter Reed Army Medical Center

Washington D.C., District of Columbia, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Jack W Tsao, MD

Role: CONTACT

301-295-3643

Richard L Witt, PA-C

Role: CONTACT

202-782-8705

Facility Contacts

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Jack W Tsao, MD

Role: primary

301-295-3643

References

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Carlen PL, Wall PD, Nadvorna H, Steinbach T. Phantom limbs and related phenomena in recent traumatic amputations. Neurology. 1978 Mar;28(3):211-7. doi: 10.1212/wnl.28.3.211.

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PMID: 16858476 (View on PubMed)

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Reference Type BACKGROUND
PMID: 2293143 (View on PubMed)

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Lotze M, Montoya P, Erb M, Hulsmann E, Flor H, Klose U, Birbaumer N, Grodd W. Activation of cortical and cerebellar motor areas during executed and imagined hand movements: an fMRI study. J Cogn Neurosci. 1999 Sep;11(5):491-501. doi: 10.1162/089892999563553.

Reference Type BACKGROUND
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Reference Type BACKGROUND
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Reference Type BACKGROUND
PMID: 7777055 (View on PubMed)

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Ramachandran VS, Rogers-Ramachandran D, Stewart M. Perceptual correlates of massive cortical reorganization. Science. 1992 Nov 13;258(5085):1159-60. doi: 10.1126/science.1439826. No abstract available.

Reference Type BACKGROUND
PMID: 1439826 (View on PubMed)

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Reference Type BACKGROUND
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Reference Type BACKGROUND
PMID: 8637922 (View on PubMed)

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Reference Type BACKGROUND
PMID: 10196540 (View on PubMed)

Jackson PL, Lafleur MF, Malouin F, Richards CL, Doyon J. Functional cerebral reorganization following motor sequence learning through mental practice with motor imagery. Neuroimage. 2003 Oct;20(2):1171-80. doi: 10.1016/S1053-8119(03)00369-0.

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Reference Type BACKGROUND
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Bone M, Critchley P, Buggy DJ. Gabapentin in postamputation phantom limb pain: a randomized, double-blind, placebo-controlled, cross-over study. Reg Anesth Pain Med. 2002 Sep-Oct;27(5):481-6. doi: 10.1053/rapm.2002.35169.

Reference Type BACKGROUND
PMID: 12373695 (View on PubMed)

Other Identifiers

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DCI P07-71044

Identifier Type: -

Identifier Source: org_study_id

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