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 |
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