Lumbar Radiculopathy Clinical Trial
Official title:
Can Distraction Substitute for Procedural Sedation and Improve Tolerance in Patients Receiving Epidural Steroid Injection for Pain? A Randomized Controlled Trial
Verified date | October 2023 |
Source | Johns Hopkins University |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
This study examines the impact of virtual reality compared to sedation (midazolam and/or fentanyl) and no intervention on pain experienced from an epidural steroid injection (ESI). The intervention group (who receive virtual reality as a distraction modality) is compared to a sedation group and a control group.
Status | Completed |
Enrollment | 146 |
Est. completion date | August 15, 2023 |
Est. primary completion date | August 15, 2023 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 90 Years |
Eligibility | Inclusion Criteria: - Males and females; ages 18-90 years - Lumbosacral radicular pain with a baseline average of leg pain score of > 4/10, MRI findings (if available) consistent with symptoms, duration of pain > 6 weeks, and no previous lumbar spine surgery. - Documented diagnosis of radicular pain caused by herniated disc, central stenosis, foraminal stenosis, degenerative disk disease - Willingness to adhere to undergo ESI with either sedation (midazolam and or fentanyl) or with virtual reality - Able to appear for a follow up visit between 24-40 days following the intervention Exclusion Criteria: - MRI findings discordant with symptoms (absence of herniated disc, spinal stenosis or severe disc degeneration without nerve root impingement (e.g. annular tears) that could explain symptoms) - Previous lumbosacral spine surgery at the area affected - Prior ESI within the past 6 months - Allergy to contrast dye - Poorly controlled psychiatric conditions that could affect outcomes (e.g. active substance abuse) or impose a barrier to participation (e.g. anxiety disorder requiring procedural sedation) - Morbid obesity (BMI >40) |
Country | Name | City | State |
---|---|---|---|
United States | Johns Hopkins Medical Institutions | Baltimore | Maryland |
Lead Sponsor | Collaborator |
---|---|
Johns Hopkins University | Brigham and Women's Hospital, The Geneva Foundation, United States Department of Defense, United States Naval Medical Center, San Diego, Walter Reed National Military Medical Center |
United States,
Indovina P, Barone D, Gallo L, Chirico A, De Pietro G, Giordano A. Virtual Reality as a Distraction Intervention to Relieve Pain and Distress During Medical Procedures: A Comprehensive Literature Review. Clin J Pain. 2018 Sep;34(9):858-877. doi: 10.1097/A — View Citation
Mallari B, Spaeth EK, Goh H, Boyd BS. Virtual reality as an analgesic for acute and chronic pain in adults: a systematic review and meta-analysis. J Pain Res. 2019 Jul 3;12:2053-2085. doi: 10.2147/JPR.S200498. eCollection 2019. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Pain score during procedure | 0-10 verbal rating scale (higher scores indicate greater pain) | Immediately after procedure | |
Secondary | Amount of local anesthetic required | Volume of 1% lidocaine used to complete procedure | Immediately after procedure | |
Secondary | Subcutaneous skin wheal pain score | 0-10 verbal rating scale (higher scores indicate greater pain) | Immediately after skin wheal | |
Secondary | Procedure satisfaction | 1-5 Likert scale (1= very unsatisfied, 3= neither satisfied nor dissatisfied, 5= very satisfied) | In postanesthetic care unit (within 1 hour) | |
Secondary | Ability to communicate | 1-5 Likert scale (1= complete inability to communicate with physician, 2= markedly decreased ability to communicate, 3= slightly decreased ability to communicate, 4= no change in ability to communicate, 5= improved ability to communicate) | In postanesthetic care unit (within 1 hour) | |
Secondary | Procedure-related anxiety | 1-5 Likert scale (1=extreme anxiety, 2=high anxiety, 3=average or expected anxiety, 2=minimal or mild anxiety, 5=no anxiety | In postanesthetic care unit (within 1 hour) | |
Secondary | Time to discharge from postanesthetic care unit | Time to discharge from postanesthetic care unit, in minutes | At discharge from postanesthetic care unit assessed up to 6 hours | |
Secondary | Categorical outcome | Positive (2-point or greater reduction in average leg pain score coupled with score of 5 or greater on PGIC) or negative | 1-month | |
Secondary | Average leg pain score | Average leg pain score on 0-10 numerical rating scale over the last week (higher pain scores indicate greater pain) | 1-month | |
Secondary | Worst leg pain score | Worst leg pain score on 0-10 numerical rating scale over the last week (higher pain scores indicate greater pain) | 1-month | |
Secondary | Average back pain score | Average back pain score on 0-10 numerical rating scale over the last week (higher pain scores indicate greater pain) | 1-month | |
Secondary | Worst back pain score | Worst back pain score on 0-10 numerical rating scale over the last week (higher pain scores indicate greater pain) | 1-month | |
Secondary | Patient global impression of change (PGIC) | Patient global impression of change on 7-point Likert scale (from 1= no change, 3= a little better 5= moderately better, a slight but noticeable change, to 7=a great deal better, a considerable improvement that has made all the difference) | 1-month | |
Secondary | Analgesic reduction | Categorical reduction in analgesic usage (cessation of non-opioid analgesic and/ or > 20% reduction in opioid use) | 1-month | |
Secondary | Oswestry disability index (ODI) score | Functional measurement of back and leg pain disability on 0-100% scale (higher levels indicate greater disability) | 1-month | |
Secondary | Hospital anxiety and depression scale (HADS) scores | Instrument to measure depression and anxiety, each on 21-point scale (higher levels indicate greater anxiety and depression) | 1-month | |
Secondary | Complications | Complications related to the procedure, sedation or use of virtual reality | 1-month | |
Secondary | Processed electroencephalogram (pEEG) and continuous colored density spectral array | Frontal EEG sensor will be placed with electrode positions corresponding to Fp1, Fp2, F7, and F8 in the international 10-20 system. The median power across channels is computed across different wave forms (delta through beta). Power spectral analysis and spectral edge frequency calculations will be performed. | During the procedure for up to 20 minutes |
Status | Clinical Trial | Phase | |
---|---|---|---|
Terminated |
NCT05047679 -
The Effectiveness of Pain Neuroscience Education in At-risk Patients Following Surgery for Lumbar Radiculopathy
|
N/A | |
Withdrawn |
NCT03543033 -
Preoperative Corticosteroid Epidural Injection and Lumbar Decompression Surgery Outcomes
|
N/A | |
Recruiting |
NCT06076408 -
Effects of SNAGS With and Without Pilates in Lumbar Disc Bulge Patients
|
N/A | |
Completed |
NCT03133845 -
Shaping Anesthetic Techniques to Reduce Post-operative Delirium
|
N/A | |
Completed |
NCT06087107 -
Comparative Effects Of High Intensity Spinal Decompression Exercises And Eldoa In Patients Of Lumbar Radiculopathy
|
N/A | |
Completed |
NCT04852900 -
Different Dosage of Decompression Therapy on Symptoms of Lumbar Radiculopathy
|
N/A | |
Terminated |
NCT05022251 -
Identifying Pain Generators and Potentiators of Residual Complaints Following Lumbar Discectomy
|
||
Recruiting |
NCT04212949 -
The Effect of Transcranial Magnetic Stimulation Therapy in Patients With Lumbar Radiculopathy
|
N/A | |
Terminated |
NCT03952377 -
Safety and Efficacy of SX600 Administered by Lumbosacral Transforaminal Epidural Injection for Radicular Pain
|
Phase 1/Phase 2 | |
Recruiting |
NCT06339931 -
Lumber Spine Mobilization and Spinal Traction on Lumber Radiculopathy.
|
N/A | |
Recruiting |
NCT04540068 -
Prediction of TEI Success in Sciatica
|
||
Recruiting |
NCT05922228 -
Effects of Neural Flossing and PNF on Lumbar Radiculopathy
|
N/A | |
Recruiting |
NCT05953727 -
Low Level LASER Therapy With and Without Proprioceptive Stimulation Among Discogenic Lumbar Radiculopathy Patients
|
N/A | |
Completed |
NCT05449288 -
Urdu Version Of Modified Oswestry Low Back Pain Scale; A Reliability And Validity Study
|
||
Completed |
NCT05874427 -
Comparison Between the Imaging Consent Form and the Existing Narrative Consent Form
|
N/A | |
Terminated |
NCT01443819 -
Lumbar Transforaminal Epidural Corticosteroid Injection(s) Versus Defined Physical Therapy
|
Phase 3 | |
Recruiting |
NCT05535010 -
The Effect of the Presence of Active Trigger Points in the Muscles Innervated by the Affected Nerve Roots on the Treatment Results of Transforaminal Epidural Steroid Injection in Patients With Lumbar Radiculopathy.
|
N/A | |
Recruiting |
NCT06154005 -
OsteoAdapt SP Advanced Bone Graft Feasibility Study - Transforaminal Interbody Lumbar Fusion
|
Phase 1/Phase 2 | |
Completed |
NCT04674917 -
Effects of Decompression in Patient With Acute vs Chronic Lumbar Radiculopathy
|
N/A | |
Not yet recruiting |
NCT06296303 -
Effect of Pulsed Magnetic Therapy Versus Phonophoresis in Discogenic Lumbar Radiculopathy Patients
|
N/A |