War Wounded, a Comparison of Two Pain Management Approaches

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01620411
Recruitment Status : Withdrawn (Site was never activated by sponsor)
First Posted : June 15, 2012
Last Update Posted : June 19, 2013
Information provided by (Responsible Party):
Tobias Moeller-Bertram, University of California, San Diego

Brief Summary:
This study aims to investigate the relative effectiveness of two different pain management plans for injuries sustained while active duty in the military. One arm of the study has subjects undergo standard comprehensive medical management, while the other adds the placement of a spinal cord stimulator, a common procedure for the alleviation of pain.

Condition or disease Intervention/treatment Phase
Injuries Pain Other: Comprehensive Medical Management Procedure: Spinal Cord Stimulator Phase 4

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 0 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Management of Chronic Pain in Military Patients With Injuries Sustained During Active Duty. Comparison of Spinal Cord Stimulation and Comprehensive Medical Management.
Study Start Date : June 2012
Primary Completion Date : June 2016

Arm Intervention/treatment
Experimental: CMM
This arm will receive standard of care treatment for injuries sustained while on active duty. Non-Invasive.
Other: Comprehensive Medical Management
Standard of care for failed back surgery syndrome sustained while on active duty, primarily focused on physical therapy, medication including: opioid analgesics, muscle relaxants, non-opioid analgesics, etc.
Experimental: CMM + SCS
This arm will combine comprehensive medical management with placement of a spinal cord stimulator.
Procedure: Spinal Cord Stimulator
This arm combines comprehensive medical management (as above) with the trial and possible eventual permenant placement of a spinal cord stimulator, a common pain management procedure.

Primary Outcome Measures :
  1. Decreased Pain Ratings [ Time Frame: 3 years ]

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Subject is a veteran or active duty service member injured while on active military duty receiving care for pain related to the injury(ies) in the Department of Defense health care system or through the Department of Veteran's Affairs.
  2. Subject is 18 years of age or older.
  3. The elapsed time since the active-duty injury leading to chronic pain is not less than 3 months.
  4. Subject reports constant or daily episodes of injury-related pain of at least moderate severity, graded 4 or higher on an 11-point NPRS (point estimate by subject and Investigator at time of enrolment based on overall pain or pain at a specific site). Pain may be nociceptive, neuropathic, or mixed. Phantom pain associated with amputation of an extremity or extremities is allowed.
  5. Attempts to control pain with commercially available systemic analgesics have not provided adequate relief, in the judgment of the managing physician and subject.
  6. Subject is able to localize site(s) of pain. At least one site of daily pain contributing to moderate severity (Inclusion Criterion 4) and intractability (Inclusion Criterion 5) must be in an extremity, or phantom pain at the site of an amputated extremity. If the extremity site of pain is not an amputated limb, then the pain must have a neuropathic component. This site is identified as the site of Target Pain (TP) for efficacy evaluations during the trial.
  7. Subject is an acceptable candidate for surgical placement of an indwelling spinal cord stimulation device.
  8. Subject is judged an appropriate candidate for treatment using the available techniques and interventions encompassed within the protocol's definition of comprehensive medical management.
  9. For the duration of the trial, subject is willing to limit interventions for control of chronic pain to those approved by the Investigator.
  10. The subject is judged psychologically appropriate for either treatment intervention, based on the impression of an interviewing psychologist or psychiatrist.
  11. Subject provides informed consent.

Exclusion Criteria:

  1. Subject experiences phantom pain associated with amputation of both an upper and lower extremity.
  2. Subject has headache or visceral truncal pain or other non-musculoskeletal pain as the only pain that results in constant or daily scores of ≥4 on the 11-point NPRS.
  3. Subject has spinal disease that would, in the judgment of the investigator, preclude placement of a spinal cord stimulator.
  4. Subject has ongoing chronic infection or a medical condition associated with an unacceptably increased risk of infection related to device implantation.
  5. Subject has a current diagnosis or history of psychosis, cognitive impairment, hallucinations, or unexplained loss of consciousness, whether or not related to a combat injury that, in the opinion of the investigator, would exclude the patient from participating in the trial.
  6. Subject has a cardiac pacemaker.
  7. Subject has any significant medical or psychiatric condition that would interfere with the conduct of the study or with the outcome measures.
  8. Subject is pregnant or is breast feeding.
  9. Subject has participated in any drug or device trial in the past 30 days.
  10. Subject has any planned elective or semi-elective surgery during the 6 months of the Primary Treatment Phase, including stump revisions or grafting.
  11. Subject has a psychological condition of great enough severity that it would unacceptably increase the medical risks associated with implantation and care of the devices required for the treatment on the CMM + SCS arm, or would likely interfere with the subject's ability to sustain participation in a research study of long duration. Investigators are encouraged to include the medical monitor and the coordinating investigator in discussions about individual candidate subjects who have psychological diagnoses as part of the polytrauma syndrome before enrollment or treatment on this protocol.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01620411

United States, California
VA Hospital San Diego
La Jolla, California, United States, 92093
Sponsors and Collaborators
University of California, San Diego

Additional Information:
Responsible Party: Tobias Moeller-Bertram, Associate Clinical Professor of Anesthesiology, University of California, San Diego Identifier: NCT01620411     History of Changes
Other Study ID Numbers: 120565
First Posted: June 15, 2012    Key Record Dates
Last Update Posted: June 19, 2013
Last Verified: June 2013

Keywords provided by Tobias Moeller-Bertram, University of California, San Diego:
Active Duty
Comprehensive Medical Management
Spinal Cord Stimulator