Fibromyalgia Activity Study With Transcutaneous Electrical Nerve Stimulation (FAST)

NCT ID: NCT01888640

Last Updated: 2019-10-31

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

301 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-09-30

Study Completion Date

2018-04-02

Brief Summary

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Pain associated with fibromyalgia interferes with daily function, work, and social activities resulting in a decreased quality of life. People with fibromyalgia also have a significant amount of fatigue and a fear of movement. People with fibromyalgia show enhanced excitability of pain neurons in the central nervous system and reduced pain inhibition. Therefore, one of the main treatments for patients with fibromyalgia must focus on pain relief to allow the person to function more independently both at home and at work. Transcutaneous electrical nerve stimulation is used by health professionals to deliver electrical stimulation through the skin for pain control. Basic science studies, from the PI's laboratory show that TENS activates descending pain inhibitory pathways to inhibit excitability of pain neurons. Thus the ideal patient population for the treatment of TENS would be one in which there is enhanced central excitability and reduced inhibition; fibromyalgia is such a condition.

Hypothesis: The investigators hypothesize that application of Transcutaneous Electrical Nerve Stimulation (TENS) to patients with fibromyalgia will reduce resting and movement-related pain and reduce central excitability by restoring diffuse noxious inhibitory controls (DNIC), and that this decrease in pain and/or central excitability will reduce fatigue and fear of movement, thereby improving function and quality of life

Detailed Description

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This is a phase II randomized, double-blind, placebo controlled multi-center clinical trial involving a device, Transcutaneous Electrical Nerve Stimulation (TENS). TENS is a non-pharmacological agent which delivers electrical stimulation by a battery operated device via electrodes placed on the skin. TENS is considered to be a safe, inexpensive and non-invasive modality used to treat a variety of acute and chronic pain conditions. The initial phase of the study will randomly allocate subjects to receive active TENS, placebo TENS or standard care (No TENS). After participating in the 1 month random assignment, all subjects will receive active TENS for 1 month. The subjects will make 4 visits to the clinic approximately 2 to 3 1/2 hours each visit. Visits will entail questionnaires, functional tasks, accelerometry, TENS, pain and fatigue assessments.

Study Aims:

Aim #1: The primary aim of the study is to test the effectiveness of repeated TENS use on movement-related pain in people with fibromyalgia with random assignment to three treatments: standard care, placebo TENS and active Aim #2: A secondary aim will test if pain reduction by TENs results in a concomitant decrease in fatigue and fear of movement, and an increase in function and quality of life. Outcome measures will include physical function by directly assessing daily activity with an accelerometer, as well as performing specific functional tasks

Conditions

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Fibromyalgia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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ActiveTENS

Active TENS for 4 weeks of the study and will add an additional 4 weeks of active TENS for the last 4 weeks of the study.

Group Type ACTIVE_COMPARATOR

TENS

Intervention Type DEVICE

TENS Parameters: Active TENS and Placebo TENS

* TENS Frequency - 2-125 Hz
* TENS Pulse Width - 200 µs
* TENS Intensity - Maximal tolerable intensity
* Duration: 2 hours per day. The 2 hours may be broken into smaller segments of time with a minimum of 30 minutes.
* Administration - Daily
* TENS Location: TENS electrode on the skin will be a 4 x 7 butterfly electrode to the cervical and lumbar region.

Placebo TENS Unit Active TENS unit No TENS - Standard Care

Placebo TENS

This group will receive placebo TENS for the first 4 weeks of the study and then active TENS for the last four weeks of the study.

Group Type PLACEBO_COMPARATOR

TENS

Intervention Type DEVICE

TENS Parameters: Active TENS and Placebo TENS

* TENS Frequency - 2-125 Hz
* TENS Pulse Width - 200 µs
* TENS Intensity - Maximal tolerable intensity
* Duration: 2 hours per day. The 2 hours may be broken into smaller segments of time with a minimum of 30 minutes.
* Administration - Daily
* TENS Location: TENS electrode on the skin will be a 4 x 7 butterfly electrode to the cervical and lumbar region.

Placebo TENS Unit Active TENS unit No TENS - Standard Care

No TENS (Standard Care)

Participants will not receive TENS intervention during the first 4 weeks of the trial but will complete all testing procedures as the other two arms. This group will receive active TENS during the last 4 weeks of the study.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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TENS

TENS Parameters: Active TENS and Placebo TENS

* TENS Frequency - 2-125 Hz
* TENS Pulse Width - 200 µs
* TENS Intensity - Maximal tolerable intensity
* Duration: 2 hours per day. The 2 hours may be broken into smaller segments of time with a minimum of 30 minutes.
* Administration - Daily
* TENS Location: TENS electrode on the skin will be a 4 x 7 butterfly electrode to the cervical and lumbar region.

Placebo TENS Unit Active TENS unit No TENS - Standard Care

Intervention Type DEVICE

Other Intervention Names

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Empi Select Unit

Eligibility Criteria

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Inclusion Criteria

* Participants will be 18 to 70 years of age
* Women may participate in the study, with the understanding that within the clinical population of fibromyalgia the there is a 7:1 ratio of female to male.
* Diagnosis of Fibromyalgia by 1990 ACR criteria (11/18 tender points)
* History of cervical or lumbar pain with fibromyalgia (this is expected in all patients since axial pain is required for diagnosis)
* Current stable treatment regimen for the last 4 weeks and projected stable treatment regimen for the next 2 months.
* English speaking

Exclusion Criteria

* Current or history of cardiovascular, pulmonary, neurological, endocrine, or renal disease that would preclude the involvement in the study.
* TENS use in the last 5 years
* Pacemaker
* Uncontrolled blood pressure or diabetes
* Neuropathic pain condition
* Systemic autoimmune disorder (Lupus, PMR, RA, Psoriasis, Psoriatic arthritis)
* Spinal fusion - cervical or lumbar
* Metal implants in cervical or lumbar region
* Severe skin allergy to adhesive
* Allergy to nickel
* Pain level less than 4
* Pregnancy
* Epilepsy
* Change in or new drug or treatment program within the last month or in the next 2months, i.e. must have a stable treatment plan
* Unstable medical or psychiatric condition which in the opinion of the investigator could compromise the subject's welfare or confound the study results
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Vanderbilt University

OTHER

Sponsor Role collaborator

Kathleen Sluka

OTHER

Sponsor Role lead

Responsible Party

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Kathleen Sluka

Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Kathleen A Sluka, PhD, PT

Role: PRINCIPAL_INVESTIGATOR

University of Iowa

Leslie J. Crofford, MD

Role: PRINCIPAL_INVESTIGATOR

Vanderbilt University

Locations

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University of Iowa

Iowa City, Iowa, United States

Site Status

Vanderbilt University

Nashville, Tennessee, United States

Site Status

Countries

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United States

References

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Sluka KA, Vance CG, Lisi TL. High-frequency, but not low-frequency, transcutaneous electrical nerve stimulation reduces aspartate and glutamate release in the spinal cord dorsal horn. J Neurochem. 2005 Dec;95(6):1794-801. doi: 10.1111/j.1471-4159.2005.03511.x. Epub 2005 Oct 17.

Reference Type BACKGROUND
PMID: 16236028 (View on PubMed)

Rakel B, Cooper N, Adams HJ, Messer BR, Frey Law LA, Dannen DR, Miller CA, Polehna AC, Ruggle RC, Vance CG, Walsh DM, Sluka KA. A new transient sham TENS device allows for investigator blinding while delivering a true placebo treatment. J Pain. 2010 Mar;11(3):230-8. doi: 10.1016/j.jpain.2009.07.007. Epub 2009 Nov 27.

Reference Type BACKGROUND
PMID: 19945354 (View on PubMed)

Liebano RE, Rakel B, Vance CGT, Walsh DM, Sluka KA. An investigation of the development of analgesic tolerance to TENS in humans. Pain. 2011 Feb;152(2):335-342. doi: 10.1016/j.pain.2010.10.040. Epub 2010 Dec 8.

Reference Type BACKGROUND
PMID: 21144659 (View on PubMed)

Moran F, Leonard T, Hawthorne S, Hughes CM, McCrum-Gardner E, Johnson MI, Rakel BA, Sluka KA, Walsh DM. Hypoalgesia in response to transcutaneous electrical nerve stimulation (TENS) depends on stimulation intensity. J Pain. 2011 Aug;12(8):929-35. doi: 10.1016/j.jpain.2011.02.352. Epub 2011 Apr 9.

Reference Type BACKGROUND
PMID: 21481649 (View on PubMed)

Pantaleao MA, Laurino MF, Gallego NL, Cabral CM, Rakel B, Vance C, Sluka KA, Walsh DM, Liebano RE. Adjusting pulse amplitude during transcutaneous electrical nerve stimulation (TENS) application produces greater hypoalgesia. J Pain. 2011 May;12(5):581-90. doi: 10.1016/j.jpain.2010.11.001. Epub 2011 Feb 1.

Reference Type BACKGROUND
PMID: 21277840 (View on PubMed)

DeSantana JM, Walsh DM, Vance C, Rakel BA, Sluka KA. Effectiveness of transcutaneous electrical nerve stimulation for treatment of hyperalgesia and pain. Curr Rheumatol Rep. 2008 Dec;10(6):492-9. doi: 10.1007/s11926-008-0080-z.

Reference Type BACKGROUND
PMID: 19007541 (View on PubMed)

Arnold LM, Crofford LJ, Mease PJ, Burgess SM, Palmer SC, Abetz L, Martin SA. Patient perspectives on the impact of fibromyalgia. Patient Educ Couns. 2008 Oct;73(1):114-20. doi: 10.1016/j.pec.2008.06.005. Epub 2008 Jul 21.

Reference Type BACKGROUND
PMID: 18640807 (View on PubMed)

Choy EH, Arnold LM, Clauw DJ, Crofford LJ, Glass JM, Simon LS, Martin SA, Strand CV, Williams DA, Mease PJ. Content and criterion validity of the preliminary core dataset for clinical trials in fibromyalgia syndrome. J Rheumatol. 2009 Oct;36(10):2330-4. doi: 10.3899/jrheum.090368.

Reference Type BACKGROUND
PMID: 19820222 (View on PubMed)

Walsh DM, Howe TE, Johnson MI, Sluka KA. Transcutaneous electrical nerve stimulation for acute pain. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD006142. doi: 10.1002/14651858.CD006142.pub2.

Reference Type BACKGROUND
PMID: 19370629 (View on PubMed)

Noehren B, Dailey DL, Rakel BA, Vance CG, Zimmerman MB, Crofford LJ, Sluka KA. Effect of transcutaneous electrical nerve stimulation on pain, function, and quality of life in fibromyalgia: a double-blind randomized clinical trial. Phys Ther. 2015 Jan;95(1):129-40. doi: 10.2522/ptj.20140218. Epub 2014 Sep 11.

Reference Type BACKGROUND
PMID: 25212518 (View on PubMed)

Chimenti RL, Rakel BA, Dailey DL, Vance CGT, Zimmerman MB, Geasland KM, Williams JM, Crofford LJ, Sluka KA. Test-Retest Reliability and Responsiveness of PROMIS Sleep Short Forms Within an RCT in Women With Fibromyalgia. Front Pain Res (Lausanne). 2021 Jun 8;2:682072. doi: 10.3389/fpain.2021.682072. eCollection 2021.

Reference Type DERIVED
PMID: 35295526 (View on PubMed)

Vance CGT, Zimmerman MB, Dailey DL, Rakel BA, Geasland KM, Chimenti RL, Williams JM, Golchha M, Crofford LJ, Sluka KA. Reduction in movement-evoked pain and fatigue during initial 30-minute transcutaneous electrical nerve stimulation treatment predicts transcutaneous electrical nerve stimulation responders in women with fibromyalgia. Pain. 2021 May 1;162(5):1545-1555. doi: 10.1097/j.pain.0000000000002144.

Reference Type DERIVED
PMID: 33230010 (View on PubMed)

Merriwether EN, Agalave NM, Dailey DL, Rakel BA, Kolker SJ, Lenert ME, Spagnola WH, Lu Y, Geasland KM, Allen LH, Burton MD, Sluka KA. IL-5 mediates monocyte phenotype and pain outcomes in fibromyalgia. Pain. 2021 May 1;162(5):1468-1482. doi: 10.1097/j.pain.0000000000002089.

Reference Type DERIVED
PMID: 33003107 (View on PubMed)

Dailey DL, Vance CGT, Rakel BA, Zimmerman MB, Embree J, Merriwether EN, Geasland KM, Chimenti R, Williams JM, Golchha M, Crofford LJ, Sluka KA. Transcutaneous Electrical Nerve Stimulation Reduces Movement-Evoked Pain and Fatigue: A Randomized, Controlled Trial. Arthritis Rheumatol. 2020 May;72(5):824-836. doi: 10.1002/art.41170. Epub 2020 Mar 18.

Reference Type DERIVED
PMID: 31738014 (View on PubMed)

Merriwether EN, Frey-Law LA, Rakel BA, Zimmerman MB, Dailey DL, Vance CGT, Golchha M, Geasland KM, Chimenti R, Crofford LJ, Sluka KA. Physical activity is related to function and fatigue but not pain in women with fibromyalgia: baseline analyses from the Fibromyalgia Activity Study with TENS (FAST). Arthritis Res Ther. 2018 Aug 29;20(1):199. doi: 10.1186/s13075-018-1671-3.

Reference Type DERIVED
PMID: 30157911 (View on PubMed)

Dailey DL, Frey Law LA, Vance CG, Rakel BA, Merriwether EN, Darghosian L, Golchha M, Geasland KM, Spitz R, Crofford LJ, Sluka KA. Perceived function and physical performance are associated with pain and fatigue in women with fibromyalgia. Arthritis Res Ther. 2016 Mar 16;18:68. doi: 10.1186/s13075-016-0954-9.

Reference Type DERIVED
PMID: 26979999 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Related Links

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Other Identifiers

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201110717

Identifier Type: -

Identifier Source: org_study_id

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