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TENS and Opioid Use After Cesarean Delivery

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ClinicalTrials.gov Identifier: NCT03843788
Recruitment Status : Recruiting
First Posted : February 18, 2019
Last Update Posted : February 18, 2019
Sponsor:
Information provided by (Responsible Party):
Adrienne Simonds PT PhD, Rutgers, The State University of New Jersey

Brief Summary:

We propose to explore the effects of Transcutaneous Electrical Nerve Stimulation (TENS) therapy in the pain management of postpartum women.

A. Objectives

  • To determine if the addition of TENS therapy to the pain management of women post-cesarean section leads to less opioid medication use.
  • To evaluate the efficacy of TENS therapy as a means of alternative pain relief for women post-cesarean section with a history of opioid use.

B. Hypotheses / Research Question(s) We hypothesize that patients that receive TENS therapy will report lower pain scores and request less opioid medication than the control group. We anticipate improved control in particular in the group of women with a history of opioid use.

Additionally, we believe that the TENS therapy will show benefits in other postpartum outcomes including time to bowel movement, level of sedation, and time to out of bed.

Overall, we anticipate that this pilot study will support the application of TENS therapy in postpartum pain management.


Condition or disease Intervention/treatment Phase
Cesarean Section Complications Opioid Use Device: Transcutaneous Electrical Nerve Stimulation (TENS) Not Applicable

Detailed Description:

OVERVIEW. This study is a pilot randomized interventional trial. Two categories of participants will be randomly assigned to an invention or control group, using a random number generator: normal cesarean without associated comorbidity, or cesarean in women with a history of opioid addiction. The control group will receive usual care. The intervention group will receive usual care plus TENS therapy beginning 8 hours after cesarean section and continuing to discharge. Both groups will receive medications for pain as requested or ordered by the doctor.

RESEARCH PROCEDURES. Patients will be identified for participation in their prenatal visit, and will be approached for study inclusion. Physicians that have a direct treatment relationship with the patient will inform the patient about the study and invite them to enroll. Consent for participation will be reviewed with the principal investigator and signed prior to delivery hospitalization. Randomization will follow consent, and patients randomized to intervention will have teaching performed about how to use the device at the time of consent.

Following cesarean delivery, subjects will be re-approached in the Postpartum Unit at Robert Wood Johnson University Hospital by study staff. The TENS device will be again reviewed, and provided to the patient, with review of instructions for use. The patients in the intervention group will be educated on the proper way to utilize the TENS unit. They will apply the the patches of the TENS unit around the C-section site. Starting 8 hours after C-Section, the TENS unit will be turned on and will remain on until the patient is discharged, to be removed for toilet and showering at the patient's discretion. Once the TENS unit is applied and turned on, the patient will not have to do anything else to maintain the therapy. Study staff will provide a record for documentation of time on/off for the unit. On the day of discharge, study staff will collect the device, and conduct a short survey about pain score. They will then review pain scores, pain medication usage and other secondary outcomes in the patient's chart. Finally, pain will be reassessed at the subject's outpatient postpartum visits by study staff.

DATA COLLECTION. Our research team members will collect the following data points from the patient's inpatient medical record: pain scale scores, medication requests/prescriptions (including name, type, and amount), time to first bowel movement, subjective incision complaints, and time to OOB. Participants will complete a survey before discharge which will solicit additional information about the postpartum recovery experience with or without TENS therapy.

DURATION OF STUDY. Study duration will be no more than 12 weeks. This will include up to 6 weeks prior to delivery for study approach and consent, delivery hospitalization, and 6 weeks postpartum for pain assessments at postpartum visits. There will be no long term follow up.

PRIMARY and SECONDARY ENDPOINTS. Primary endpoint of this pilot study is a total of 10 normal patients undergoing cesarean, and 10 patients with history of opioid addiction. Intervention will be performed in 5 patients in each group. Safety data will be reviewed following the first 10 patients to evaluate for worsening patient scores relative to controls.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 20 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: This is a pilot feasibility study to evaluate effectiveness and acceptability in our patient population of TENS use throughout delivery hospitalization. We aim to have 20 participants total: 5 in control and 5 in intervention without history of opioid addiction, and 5 in control and 5 in intervention with history of opioid addiction/misuse. This sample size is comparable to other shorter term pilot studies. This pilot study will serve as the basis for larger trials in the future, with larger sample size powered to demonstrate reduction in pain scores. We anticipate recruitment for this trial will take approximately 6-9 months.
Masking: None (Open Label)
Masking Description: Not able to be masked
Primary Purpose: Treatment
Official Title: Transcutaneous Electrical Nerve Stimulation and Maternal Opioid Use After Cesarean Delivery
Actual Study Start Date : November 9, 2018
Estimated Primary Completion Date : December 2019
Estimated Study Completion Date : June 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Cesarean Section

Arm Intervention/treatment
Experimental: Post-CS TENS
The patients in the intervention group will be educated on the proper way to utilize the transcutaneous electrical nerve stimulation (TENS) unit. They will apply the the patches of the TENS unit around the C-section site. Starting 8 hours after C-Section, the TENS unit will be turned on and will remain on until the patient is discharged, to be removed for toilet and showering at the patient's discretion. Once the TENS unit is applied and turned on, the patient will not have to do anything else to maintain the therapy. Routine pharmacologic care will also be available.
Device: Transcutaneous Electrical Nerve Stimulation (TENS)
Starting 8 hours after cesarean section, the TENS unit will be applied with charges above and below the incision. The device will be set to high frequency (>75 Hz) for pain relief. Intensity of stimulation will be set to patient threshold using the forearm as a guide. Stimulation will be turned on titrated to the level which is felt but not painful for the patient. It will remain on until the patient is discharged, to be removed for toilet and showering at the patient's discretion. Once the TENS unit is applied and turned on, the patient will not have to do anything else to maintain the therapy.

Experimental: Opioid Addicted Post-CS TENS
Subjects will be targeted on the basis of opioid addiction and usage of methadone maintenance. The patients in the intervention group will be educated on the proper way to utilize the transcutaneous electrical nerve stimulation (TENS) unit. They will apply the the patches of the TENS unit around the C-section site). Starting 8 hours after C-Section, the TENS unit will be turned on and will remain on until the patient is discharged, to be removed for toilet and showering at the patient's discretion. Once the TENS unit is applied and turned on, the patient will not have to do anything else to maintain the therapy. Routine pharmacologic care will also be available.
Device: Transcutaneous Electrical Nerve Stimulation (TENS)
Starting 8 hours after cesarean section, the TENS unit will be applied with charges above and below the incision. The device will be set to high frequency (>75 Hz) for pain relief. Intensity of stimulation will be set to patient threshold using the forearm as a guide. Stimulation will be turned on titrated to the level which is felt but not painful for the patient. It will remain on until the patient is discharged, to be removed for toilet and showering at the patient's discretion. Once the TENS unit is applied and turned on, the patient will not have to do anything else to maintain the therapy.

No Intervention: Post-CS Routine Care
Routine pharmacologic care will be provided.
No Intervention: Opioid Addicted Post-CS Routine Care
Routine pharmacologic care will be provided.



Primary Outcome Measures :
  1. Post-operative Pain Ratings [ Time Frame: 3-4 post-operative days ]
    Post-operative pain rating (1-10 scale)


Secondary Outcome Measures :
  1. Post-operative opioid use [ Time Frame: 3-4 post-operative days ]
    Number and type of pain medications used

  2. Post-operative opioid side-effects [ Time Frame: 3-4 post-operative days ]
    Time to get out of bed (hours)

  3. Post-operative opioid side-effects [ Time Frame: 3-4 post-operative days ]
    Time to first bowel movement (hours)

  4. Post-operative opioid side-effects [ Time Frame: 3-4 post-operative days ]
    Level of sedation (1-10 scale)

  5. Subjective Pain and Acceptability Questionnaire [ Time Frame: 3-4 days postoperatively, to encompass acute pain since surgery ]
    McGill and Neuropathic pain survey, with questions about device acceptability

  6. Subjective Pain and Acceptability Questionnaire [ Time Frame: 6 week postpartum visit, to encompass chronic pain since surgery ]
    McGill and Neuropathic pain survey, with questions about device acceptability



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 45 Years   (Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Women aged between 18 and 45 years
  • Understand and be able to follow written and oral instructions in English
  • Provide written informed consent
  • History of prior opioid addiction for half of the patients.

Exclusion Criteria:

- History of cardiac arrhythmia or pacemaker usage


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 ClinicalTrials.gov identifier (NCT number): NCT03843788


Contacts
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Contact: Adrienne Simonds, PT PhD 609-477-8538 simondad@shp.rutgers.edu
Contact: Christina M Duzyj Buniak, MD MPH 7324928503 cmb466@rwjms.rutgers.edu

Locations
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United States, New Jersey
Robert Wood Johnson University Hospital Recruiting
New Brunswick, New Jersey, United States, 08901
Contact: Christina M Duzyj Buniak, MD MPH    732-492-8503    cmb466@rwjms.rutgers.edu   
Sponsors and Collaborators
Rutgers, The State University of New Jersey
Investigators
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Principal Investigator: Adrienne Simonds, PT PhD Rutgers School of Health Professions
  Study Documents (Full-Text)

Documents provided by Adrienne Simonds PT PhD, Rutgers, The State University of New Jersey:
Informed Consent Form  [PDF] July 28, 2018


Publications:

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Responsible Party: Adrienne Simonds PT PhD, Assistant Professor of Rehabilitation and Movement Sciences,, Rutgers, The State University of New Jersey
ClinicalTrials.gov Identifier: NCT03843788     History of Changes
Other Study ID Numbers: Pro2018001008
First Posted: February 18, 2019    Key Record Dates
Last Update Posted: February 18, 2019
Last Verified: February 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: Yes
Device Product Not Approved or Cleared by U.S. FDA: No
Pediatric Postmarket Surveillance of a Device Product: No
Product Manufactured in and Exported from the U.S.: Yes

Keywords provided by Adrienne Simonds PT PhD, Rutgers, The State University of New Jersey:
Post-cesarean pain
Transcutaneous Electrical Nerve Stimulation

Additional relevant MeSH terms:
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Analgesics, Opioid
Narcotics
Central Nervous System Depressants
Physiological Effects of Drugs
Analgesics
Sensory System Agents
Peripheral Nervous System Agents