Percutaneous Neuromuscular Electrical Stimulation in Patients With Chronic Low Back Pain

NCT ID: NCT04243915

Last Updated: 2023-05-15

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

64 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-04-10

Study Completion Date

2024-12-10

Brief Summary

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Chronic low back pain is a common musculoskeletal condition affects the general population. Low back pain constitutes a major burden to health care system and society. Several authors have found that the deep abdominal muscles and multifidus are affected in low back pain. Dry needling has shown improve the cross-sectional area of the multifidus. Percutaneous electrical nerve stimulation has shown reduce pain in several conditions. There are not studies that had investigated the impact of percutaneous neuromuscular electrical stimulation (PNMES) in the deep muscles in patients with chronic low back pain.

Hypothesis: PNMES in the multifidus muscle plus motor control exercise program in patients with chronic low back pain is better than sham PNMES plus exercise and transcutaneous electrical nerve stimulation (TENS) plus exercise

Detailed Description

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Randomized, double-blind, placebo controlled clinical trial, using percutaneous neuromuscular electrical stimulation (PNMES). PNMES is technique to provide a transcutaneous electrical nerve stimulation current throughout needling filaments place close to the nerve.

Study Aims:

Aim #1: The primary aim of the study is to compare the effect of the short, medium and long-term of PNMES on muscle activation (increased cross-sectional area in activation) and the function of multifidus and abdominal transverse muscle in patients with chronic low back pain with random assignment to four treatments: PENS plus motor control exercise program or Sham PNMES (introducing the needle) plus motor control exercise program or Transcutaneous Electrical Nerve Stimulation (TENS) plus motor control exercise program or Sham PNMES (without inserting the needle) plus motor control exercise program.

Aim #2: The secondary aim of the study is to compare the effect of the short, medium and long-term of PNMES on pain as measured by visual analogue scale (VAS), chronic Pain Grade Questionnaire, pressure pain threshold (PPT), area and distribution of pain, conditioned pain modulation and temporal summation in patients with chronic low back pain with random assignment to four treatments: PNMES plus motor control exercise program or Sham PNMES (introducing the needle) plus motor control exercise program or Transcutaneous Electrical Nerve Stimulation (TENS) plus motor control exercise program or Sham PNMES (without inserting the needle) plus motor control exercise program.

Aim #3: To compare the effect of the short, medium and long-term of PNMES on disability as measured by Oswestry Disability Index, strength and quality of life with random assignment to four treatments: PENS plus motor control exercise program or Sham PNMES (introducing the needle) plus motor control exercise program or Transcutaneous Electrical Nerve Stimulation (TENS) plus motor control exercise program or Sham PNMES (without inserting the needle) plus motor control exercise program.

Aim #4: To estimate the immediate effects of the PNMES technique after the first session.

Aim #5: To determine if psychological factors (anxiety, depression, kinesiophobia and catastrophism) change with any of the treatments and if is related with the primary and secondary outcomes.

Aim #6: To evaluate the change perceived by the patient measured with Global Rating of Change Scale (GROC).

Aim Aim #7: Validation of placebo groups by assessing patient blindness

Conditions

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Low Back Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized, double-blind, placebo controlled clinical trial.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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PNMES plus exercise

6-week intervention program with 3 treatment sessions of PNMES and motor control exercise program.

Group Type EXPERIMENTAL

Percutaneous neuromuscular electrical stimulation (PNMES) plus motor control exercise program

Intervention Type OTHER

The technique consists of a muscular stimulation of the deep lumbar multifidus by means of a TENS current applied through four dry needling or acupuncture needles introduced by ultrasound guidance in said muscle 30 minutes. This will add to a protocol of motor control exercises for deep abdominal and lumbar muscles.

Sham PNMES (introducing the needle) plus exercise

Sham PNMES (introducing the needle) plus motor control exercise program

Group Type SHAM_COMPARATOR

Sham PNMES (introducing the needle) plus motor control exercise program

Intervention Type OTHER

The same procedure will be performed as in the experimental treatment, but in this case, the electric current will be placebo and only the first 15 seconds will slightly notice it. This will add to a protocol of motor control exercises for deep abdominal and lumbar muscles.

TENS plus exercise

6-week intervention program with 3 treatment sessions of TENS plus motor control exercise program.

Group Type ACTIVE_COMPARATOR

TENS plus motor control exercise program

Intervention Type OTHER

Transcutaneous electrical nerve stimulation will be applied through 4 patches / adhesives placed in your lower back for 30 minutes. This will add to a protocol of motor control exercises for deep abdominal and lumbar muscles.

Placebo PNMES (without inserting the needle) plus exercise

6-week intervention program with 3 treatment sessions of placebo PNMES (without inserting the needle) and exercise

Group Type PLACEBO_COMPARATOR

Sham PNMES (without inserting the needle) plus motor control exercise program

Intervention Type OTHER

The same procedure will be performed as in the experimental treatment, but in this case, the needle will not be inserted and the electric current will be placebo and only the first 15 seconds will slightly notice it. This will add to a protocol of motor control exercises for deep abdominal and lumbar muscles.

Interventions

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Percutaneous neuromuscular electrical stimulation (PNMES) plus motor control exercise program

The technique consists of a muscular stimulation of the deep lumbar multifidus by means of a TENS current applied through four dry needling or acupuncture needles introduced by ultrasound guidance in said muscle 30 minutes. This will add to a protocol of motor control exercises for deep abdominal and lumbar muscles.

Intervention Type OTHER

Sham PNMES (introducing the needle) plus motor control exercise program

The same procedure will be performed as in the experimental treatment, but in this case, the electric current will be placebo and only the first 15 seconds will slightly notice it. This will add to a protocol of motor control exercises for deep abdominal and lumbar muscles.

Intervention Type OTHER

TENS plus motor control exercise program

Transcutaneous electrical nerve stimulation will be applied through 4 patches / adhesives placed in your lower back for 30 minutes. This will add to a protocol of motor control exercises for deep abdominal and lumbar muscles.

Intervention Type OTHER

Sham PNMES (without inserting the needle) plus motor control exercise program

The same procedure will be performed as in the experimental treatment, but in this case, the needle will not be inserted and the electric current will be placebo and only the first 15 seconds will slightly notice it. This will add to a protocol of motor control exercises for deep abdominal and lumbar muscles.

Intervention Type OTHER

Other Intervention Names

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Percutaneous electric nerve stimulation (PENS) Sham PENS TENS Sham PENS

Eligibility Criteria

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Inclusion Criteria

\- Low back pain more than 90 days of evolution

Exclusion Criteria

* Spondylarthrosis
* History of fractures, luxations, surgery and/or musculoskeletal disorders in low back and lower limb.
* Leg pain or neuropathic pain (LANSS \<12).
* Neurological disorders, inflammatory and/or degenerative diseases.
* Having received as treatment techniques that involve needles on the previous 6 months to study enrollment or having received percutaneous electrical stimulation as a treatment before.
* Physiotherapy treatment in the last 4 weeks.
* Specific lumbar pathology, fibromyalgia, unstable cardiovascular diseases, pregnant women or under suspect of pregnancy.
* Contraindications of needle's insertions: anticoagulant therapy, needle phobia, diabetes, hypothyroidism, lymphoedema, muscular diseases).
* Contraindications of electrical current.
* Drugs: morphine or opioids drugs.
* Depression
* Judicial dispute
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Universidad Rey Juan Carlos

OTHER

Sponsor Role lead

Responsible Party

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Josue Fernandez Carnero

PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Josue Fernández-Carnero, PhD

Role: PRINCIPAL_INVESTIGATOR

Universidad Rey Juan Carlos

Locations

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Universidad Rey Juan Carlos

Alcorcón, Madrid, Spain

Site Status RECRUITING

Countries

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Spain

Central Contacts

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Alberto Arribas-Roamno, MsC

Role: CONTACT

635937520

Facility Contacts

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Josue Fernández-Carnero, PhD

Role: primary

+34914888949

Other Identifiers

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EC 01/2019

Identifier Type: -

Identifier Source: org_study_id

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