Pain and Neurological Function Improvements With 10 kHz Spinal Cord Stimulation Treatment of Painful Diabetic Neuropathy

NCT ID: NCT05777317

Last Updated: 2024-11-06

Basic Information

• Recruitment Status: ACTIVE_NOT_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 143 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-04-24
• Study Completion Date: 2026-08-31

Brief Summary

The purpose of this post-market study is to evaluate changes in pain and neurological function with high frequency, 10 kHz spinal cord stimulation (SCS) therapy in patients with chronic, intractable lower limb pain associated with diabetic peripheral neuropathy, a condition known as painful diabetic neuropathy (PDN). This is a multi-center, prospective, randomized controlled study to evaluate improvement in pain and neurological function in PDN patients, with neurological function assessed via objective measures. Patients will be randomized to conventional medical management (CMM) or 10 kHz SCS plus CMM.

Conditions

Painful Diabetic Neuropathy

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

10 kHz SCS plus CMM

Treatment with high frequency, 10 kHz spinal cord stimulation (SCS) in addition to conventional medical management (CMM)

Group Type: EXPERIMENTAL

10 kHz SCS

Intervention Type: DEVICE

Spinal cord stimulation programmed to a frequency of 10 kHz

CMM alone

Treatment with conventional medical management (CMM) alone

Group Type: ACTIVE_COMPARATOR

CMM alone

Intervention Type: OTHER

Conventional medical management alone

Interventions

10 kHz SCS

Spinal cord stimulation programmed to a frequency of 10 kHz

Intervention Type: DEVICE

CMM alone

Conventional medical management alone

Intervention Type: OTHER

Other Intervention Names

Nevro HFX therapy programmed to a frequency of 10 kHz or high frequency, 10 kHz SCS

Eligibility Criteria

Inclusion Criteria

• Has been clinically diagnosed with diabetes, according to the American Diabetes Association guidelines, as well as painful diabetic neuropathy (PDN) of the lower limbs.
• Has pain intensity (over the last 7 days) of ≥5 out of 10 cm on the Visual Analog Scale (VAS) in the lower limbs at both the Enrollment and Baseline Visits.
• Has PDN symptoms that have been present ≥12 months.
• Is currently taking or has tried in the past a gabapentinoid and at least one other class of analgesic with insufficient pain relief or intolerable side effects.
• Has been on a stable analgesic regimen, as determined by the Investigator, for at least 30 days prior to assessing pain intensity as described in inclusion criterion #2.
• Has painful diabetic sensorimotor polyneuropathy confirmed by modified Toronto Clinical Neuropathy Score (mTCNS) >5 at enrollment. The total score must include presence of foot pain (≥1) and sensory exam findings (≥ 2).
• Has hemoglobin A1c ≤10% as measured at enrollment.
• Is 22 years of age or older at the time of enrollment.
• Is an appropriate candidate for the surgical procedures required in this study based on the clinical judgment of the study physician.
• Is willing to and capable of giving written informed consent.
• Is willing and able to comply with study-related requirements and procedures and attend all scheduled visits.

Exclusion Criteria

• Has a diagnosis of a lower limb mononeuropathy (e.g., causalgia, tibial or peroneal neuropathies), has had a lower limb amputation other than toes due to diabetes, or has large (≥3 cm) and/or gangrenous ulcers or active infection of the lower limbs.
• Has an average pain intensity of ≥ 3 out of 10 cm on the VAS in the upper limbs due to diabetic neuropathy at enrollment.
• Has a history of glycemia-related hospitalizations or emergency ward visits including ketoacidosis, hyperosmolar state, severe hypoglycemia in the previous 6 months.
• Uses anticoagulants or antiplatelet agents that cannot be temporarily discontinued prior to the procedure.
• Has unstable cardiovascular disease, including untreated cardiac arrhythmias, myocardial infarction within last 12 months, New York Heart Association (NYHA) Functional Class III or IV heart failure.
• Is currently prescribed a daily opioid dosage > 120 mg morphine equivalents.
• Has a medical condition or diagnosis that is inconsistent with the Senza System guidelines in the Physician's Manual or as per standard clinical practice.
• Has a medical condition or pain in other area(s), not intended to be treated in this study, that could interfere with study procedures, accurate pain reporting, and/or confound evaluation of study endpoints, as determined by the Investigator (such as primary headache, fibromyalgia, post-herpetic neuralgia, osteoarthritis, critical limb ischemia due to peripheral vascular disease or small vessel disease).
• Has prior experience with SCS, dorsal root ganglion (DRG) stimulation, peripheral nerve field stimulation (PNfS), or peripheral nerve stimulation (PNS) for chronic intractable pain.
• Has an existing drug pump and/or another active implantable device such as a pacemaker (ok to have an insulin pump or continuous glucose monitor that remains externalized).
• Has a condition currently requiring or likely to require the use of diathermy or MRI that is inconsistent with Senza System guidelines in the Physician's Manual.
• Has a life expectancy of less than one year.
• Has a local infection at the anticipated surgical entry site or an active systemic infection.
• Is pregnant or plans to become pregnant during the study (participants of child-bearing potential that are sexually active must use a reliable form of birth control).
• Has had within 6 months of enrollment a significant untreated addiction to dependency producing medications, alcohol or illicit drugs.
• Is concomitantly participating in another interventional clinical study.
• Is involved in an injury claim for study-related chronic pain that is under current litigation.
• Is a recipient of temporary Social Security Disability Insurance (SSDI) benefits due to study-related chronic pain.
• Has a pending or approved worker's compensation claim for study-related chronic pain.
• Has evidence of an active disruptive psychological or psychiatric disorder or other known condition significant enough to impact perception of pain, compliance with intervention and/or ability to evaluate treatment outcome, as determined by the investigator in the last 12 months.
• Has a BMI > 45 at enrollment.

• Minimum Eligible Age: 22 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Nevro Corp

INDUSTRY

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

Atrium Health Wake Forest Baptist

Winston-Salem, North Carolina, United States

Touchstone Interventional Pain Center

Medford, Oregon, United States

Countries

United States

Other Identifiers

CA2022-2 US PDN-Sensory RCT

Identifier Type: -

Identifier Source: org_study_id