Changes in Radicular Pain and Pain Modulation

NCT ID: NCT04193969

Last Updated: 2022-05-09

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

COMPLETED

Clinical Phase

NA

Total Enrollment

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-11-01

Study Completion Date

2021-09-21

Brief Summary

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The objectives of this study are: 1)To investigate the difference in pain modulatory mechanisms using quantitative sensory testing (QST) between healthy controls and patients with radicular leg pain due to nerve root compression. 2) To investigate the association between changes in radiating leg pain and pain modulation among the patient group.

Detailed Description

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Few studies have investigated pain modulatory mechanisms using QST in patients with lumbar radiculopathy due to nerve root compression. Knowledge about the association between changes in the experience of pain and changes measures of pain modulation is to our knowledge limited. The results could potentially contribute to knowledge about mechanisms involved in lumbar radiculopathy and facilitate future studies. The hypotheses of the study are: 1) Measures of pain modulation will be less efficient among patients with lumbar radiculopathy showing reduced pain inhibition and facilitated temporal summation compared to healthy controls. 2) Improvements in pain modulation will be associated with improvements in clinical pain outcomes

Conditions

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Back Pain Back Pain With Radiation

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

The study has a cohort design and will include a patient group (male and female) attending a treatment program at the Spine Centre of Southern Denmark and an equally large control group matched on age and gender.
Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

SINGLE

Participants
The participants are not informed about test results during or after the sessions. The test equipment is computer controlled and user independent.

Study Groups

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Radiculopathy due to nerve root compression

Participants with radicular leg pain due to lumbar disc herniation or to foraminal- or recess stenosis.

Baseline assessments of pain intensities are performed through questionnaires prior to protocol. Data regarding initial pain, function, age, gender, pain-duration, weight and height is retrieved from the clinical registry SpineData.

Pain sensitivity, temporal summation and conditioned pain modulation are assessed at the first visit in the treatment program. The protocol is repeated at the last visit in the treatment program.

Group Type EXPERIMENTAL

Pressure pain assessment using computer controlled cuff algometry

Intervention Type DIAGNOSTIC_TEST

Pressure pain sensitivity is assessed. The pressure is gradually increased and pain is rated by the participant on an electronic visual analogue pain rating scale (VAS) which is connected to the equipment. The assessment is performed on the lower leg and the upper arm. The pain free leg and the left upper arm is used in the patient group. The leg used in the control group will be chosen in a balanced manner meaning that half will receive pressure on the left leg and the other half on the right leg. The pain detection threshold (PDT), pain pressure tolerance threshold (PPT) and pressure pain intensity perceived as 6 on the VAS (VAS6) at the leg site is registered. The PDT and PPT on the arm site is registered.

Temporal summation (TS)

Intervention Type DIAGNOSTIC_TEST

10 repeated inflations on the lower leg with a 1 sec interval. The pressure used at each pressure is equivalent the PPT measured at baseline. Each inflation is rated on the VAS. TS is registered as the increase pain intensity.

Conditioned pain modulation (CPM)

Intervention Type DIAGNOSTIC_TEST

The cuff on the upper arm is inflated until 70% of the PPT is reached. While the pressure on the arm is kept constant the cuff on the leg is inflated. PDT, PPT and VAS6 pressure at the leg site is registered during the tonic stimulation (pressure on the left arm). The procedure on the leg is repeated within 30 seconds after the pressure is released on the arm site.

Low back pain rating scale (LBPRS-pain)

Intervention Type DIAGNOSTIC_TEST

A questionnaire measuring the intensities of low back pain and leg pain currently, on average the last two weeks and the worst pain within the same period.

Oswestry Disability Index

Intervention Type DIAGNOSTIC_TEST

A questionnaire measuring the disability in relation to low back pain and leg pain.

Healthy controls

Healthy controls Healthy age and gender-matched controls. Gender, weight and height are registered on questionnaires prior to protocol.

Pain sensitivity, temporal summation and conditioned pain modulation are assessed at the first visit. The tests are repeated at the next visit. The interval between the two sessions will be determined by the averaged interval between tests in the patient group.

Group Type EXPERIMENTAL

Pressure pain assessment using computer controlled cuff algometry

Intervention Type DIAGNOSTIC_TEST

Pressure pain sensitivity is assessed. The pressure is gradually increased and pain is rated by the participant on an electronic visual analogue pain rating scale (VAS) which is connected to the equipment. The assessment is performed on the lower leg and the upper arm. The pain free leg and the left upper arm is used in the patient group. The leg used in the control group will be chosen in a balanced manner meaning that half will receive pressure on the left leg and the other half on the right leg. The pain detection threshold (PDT), pain pressure tolerance threshold (PPT) and pressure pain intensity perceived as 6 on the VAS (VAS6) at the leg site is registered. The PDT and PPT on the arm site is registered.

Temporal summation (TS)

Intervention Type DIAGNOSTIC_TEST

10 repeated inflations on the lower leg with a 1 sec interval. The pressure used at each pressure is equivalent the PPT measured at baseline. Each inflation is rated on the VAS. TS is registered as the increase pain intensity.

Conditioned pain modulation (CPM)

Intervention Type DIAGNOSTIC_TEST

The cuff on the upper arm is inflated until 70% of the PPT is reached. While the pressure on the arm is kept constant the cuff on the leg is inflated. PDT, PPT and VAS6 pressure at the leg site is registered during the tonic stimulation (pressure on the left arm). The procedure on the leg is repeated within 30 seconds after the pressure is released on the arm site.

Interventions

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Pressure pain assessment using computer controlled cuff algometry

Pressure pain sensitivity is assessed. The pressure is gradually increased and pain is rated by the participant on an electronic visual analogue pain rating scale (VAS) which is connected to the equipment. The assessment is performed on the lower leg and the upper arm. The pain free leg and the left upper arm is used in the patient group. The leg used in the control group will be chosen in a balanced manner meaning that half will receive pressure on the left leg and the other half on the right leg. The pain detection threshold (PDT), pain pressure tolerance threshold (PPT) and pressure pain intensity perceived as 6 on the VAS (VAS6) at the leg site is registered. The PDT and PPT on the arm site is registered.

Intervention Type DIAGNOSTIC_TEST

Temporal summation (TS)

10 repeated inflations on the lower leg with a 1 sec interval. The pressure used at each pressure is equivalent the PPT measured at baseline. Each inflation is rated on the VAS. TS is registered as the increase pain intensity.

Intervention Type DIAGNOSTIC_TEST

Conditioned pain modulation (CPM)

The cuff on the upper arm is inflated until 70% of the PPT is reached. While the pressure on the arm is kept constant the cuff on the leg is inflated. PDT, PPT and VAS6 pressure at the leg site is registered during the tonic stimulation (pressure on the left arm). The procedure on the leg is repeated within 30 seconds after the pressure is released on the arm site.

Intervention Type DIAGNOSTIC_TEST

Low back pain rating scale (LBPRS-pain)

A questionnaire measuring the intensities of low back pain and leg pain currently, on average the last two weeks and the worst pain within the same period.

Intervention Type DIAGNOSTIC_TEST

Oswestry Disability Index

A questionnaire measuring the disability in relation to low back pain and leg pain.

Intervention Type DIAGNOSTIC_TEST

Other Intervention Names

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Assessment of pain sensitivity Repeated pressure pain Pain inhibition Pain intensity Disability

Eligibility Criteria

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Inclusion Criteria

Patient group

* Radiating leg pain due to nerve root compression verified by MRI
* Clinical findings in accordance with MRI findings
* Average leg pain ≥ 3/10 on a numeric pain rating scale Controls
* No current or previous history of ongoing musculoskeletal pain

Exclusion Criteria

Applies for both groups.

* Other specific medical conditions e.g. rheumatologic disease, diabetes or vascular diseases.
* Pregnancy
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Spine Centre of Southern Denmark

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Berit Schiøtzz-Christensen, Professor

Role: PRINCIPAL_INVESTIGATOR

Research department of Spine Center of Southern Denmark

Locations

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Spine Centre of Southern Denmark

Middelfart, , Denmark

Site Status

Countries

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Denmark

References

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Vaegter HB, Palsson TS, Graven-Nielsen T. Facilitated Pronociceptive Pain Mechanisms in Radiating Back Pain Compared With Localized Back Pain. J Pain. 2017 Aug;18(8):973-983. doi: 10.1016/j.jpain.2017.03.002. Epub 2017 Mar 24.

Reference Type BACKGROUND
PMID: 28344100 (View on PubMed)

Mehta V, Snidvongs S, Ghai B, Langford R, Wodehouse T. Characterization of peripheral and central sensitization after dorsal root ganglion intervention in patients with unilateral lumbosacral radicular pain: a prospective pilot study. Br J Anaesth. 2017 Jun 1;118(6):924-931. doi: 10.1093/bja/aex089.

Reference Type BACKGROUND
PMID: 28575334 (View on PubMed)

Yarnitsky D. Role of endogenous pain modulation in chronic pain mechanisms and treatment. Pain. 2015 Apr;156 Suppl 1:S24-S31. doi: 10.1097/01.j.pain.0000460343.46847.58.

Reference Type BACKGROUND
PMID: 25789433 (View on PubMed)

Graven-Nielsen T, Izumi M, Petersen KK, Arendt-Nielsen L. User-independent assessment of conditioning pain modulation by cuff pressure algometry. Eur J Pain. 2017 Mar;21(3):552-561. doi: 10.1002/ejp.958. Epub 2016 Nov 11.

Reference Type BACKGROUND
PMID: 27859944 (View on PubMed)

Graven-Nielsen T, Vaegter HB, Finocchietti S, Handberg G, Arendt-Nielsen L. Assessment of musculoskeletal pain sensitivity and temporal summation by cuff pressure algometry: a reliability study. Pain. 2015 Nov;156(11):2193-2202. doi: 10.1097/j.pain.0000000000000294.

Reference Type BACKGROUND
PMID: 26172551 (View on PubMed)

Other Identifiers

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S-20190091

Identifier Type: -

Identifier Source: org_study_id

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