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Effects of Hydrotherapy on Neuropathic Pain and Pain Catastrophization in Spinal Cord Injury

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ClinicalTrials.gov Identifier: NCT04164810
Recruitment Status : Unknown
Verified November 2019 by Universidad del Valle, Colombia.
Recruitment status was:  Recruiting
First Posted : November 15, 2019
Last Update Posted : November 15, 2019
Information provided by (Responsible Party):
Universidad del Valle, Colombia

Brief Summary:

Spinal Cord Injury (SCI) is a spinal cord injury of traumatic origin with its main etiology being violence, which constitutes one of the greatest social and health problems worldwide. One of the complications with the greatest impact in people with SCI is Neuropathic Pain (NP). Pain, mainly chronic pain, has an effect on emotional states, cognition regarding pain and anticipation which leads to the catastrophization of the pain. This form of pain is related to chronic diseases that develop with pain of poor prognosis and are detrimental to quality of life therefore having enormous impacts on health systems. The physiological mechanisms of Hydrotherapy on pain are clear and there is evidence of its use in the management of painful syndromes of difficult treatments such as that for fibromyalgia and chronic lumbar pain, as well as its positive effect on pain perception. However, the effects of hydrotherapy on the NP of patients with SCI are unknown.

Randomized, controlled clinical trial of parallel groups. A randomized sequence will be carried out in balanced blocks to assign the intervention (Hydrotherapy) or the control (Standard Physical Therapy), to a sample of 28 participants, 14 for each group. Each of the interventions (hydrotherapy and physical therapy) will last 9 weeks, for a total of 18 sessions (2 weekly sessions). Two measurements will be made, baseline (pre-intervention) and a second time one month after the end of the intervention. The validated Spanish scales will be used: NP-4 (NP Screening), Numerical Pain Scale (END), PCS (Pain Catastrophization), SF-36 (Health-related quality of life) and WHODAS 2.0 (Disability). The primary outcome is the level of NP and its catastrophization, and the secondary outcomes are level of disability and quality of life. With 28 participants fully measured, it is possible to have 80% power to find differences between the groups with respect to the primary outcomes. All information will be analyzed using average comparisons with 95% confidence. The analysis will be carried out by Intention to Treat (ITT) taking all the randomized participants. Missing data will be processed through multiple imputation chains. Generalized mixed linear models will be used comparing the standardized baseline and post-intervention averages of each group and between each group, obtaining 95% confidence intervals and p-values. Subgroup analysis will be performed adjusting confounders and interactions. A significant difference will be considered when the value of p is less than 0.05. Cohen´s D will be calculated to identify the size of the intervention effect.

Discussion: The results will reflect the effect of the hydrotherapy on NP in patients with SCI. They will also permit the identification of potential changes in functionality levels or quality of life in the intervened population.

Condition or disease Intervention/treatment Phase
Neuropathic Pain Spinal Cord Injuries Other: Hydrotherapy Other: Physical Therapy Not Applicable

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 40 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Treatment
Official Title: Effects of Hydrotherapy on Neuropathic Pain and Pain Catastrophization in Spinal Cord Injury: Study Protocol for a Randomized Controlled Trial
Actual Study Start Date : September 1, 2018
Estimated Primary Completion Date : May 2020
Estimated Study Completion Date : September 2020

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Hydrotherapy
Hydrotherapy intervention will receive the treatment for 9 weeks (2 days per week) , resulting in a total of 18 sessions of Hydrotherapy. Each session will be held for a duration of 45 minutes to 1 hour.
Other: Hydrotherapy
All sessions will be done by 3 physical therapists specialized in hydrotherapy under different modalities, and a pool equipped to perform this type of intervention. The most commonly used techniques in the institution are Bad Ragaz, for motor control, and the Watsu technique for relaxation and spasticity work.

Active Comparator: Physical therapy
Physical therapy inthervention will have 18 standard physical therapy treatment sessions during 9 weeks. Each session will be held for a duration of 45 minutes to 1 hour.
Other: Physical Therapy
All sessions will be done by 3 physical therapists expert in neurorehabilitation, following a physical therapy protocol, which includes stretching, aerobic excercise and muscle strengthening.

Primary Outcome Measures :
  1. DN-4 (Douleur Neuropathique-4 items) [ Time Frame: it going to be apply in the session number 1 and 18, and the application time is 10 minutes ]
    consists of 10 items: 7 related to the quality of pain through an interview and the other 3 items through a clinical exam. This questionnaire, which is validated in Spanish (27), consists of descriptions and signs of pain that are evaluated dichotomously (Yes / No) to identify patients who have a high probability of having a neuropathic pain component. The scores of the individual items are added together to obtain a maximum total score of 10, with a cut-off point ≥ 4

  2. Pain Catastrophization Scale (PCS - Pain Catastrophizing Scale) [ Time Frame: it going to be apply in the session number 1 and 18, and the application time is 20 minutes ]
    The PCS is an instrument validated in Spanish for pathologies such as fibromyalgia and amputee patients, which inquires about the thoughts and feelings that arise in the presence of physical pain caused by diseases, wounds, surgeries, etc. This scale has 13 items rated on a Likert scale from 0 to 4 (0 = Nothing at all; 1 = A little; 2 = Moderately; 3 = A lot; 4 = All time)

  3. Numerical Pain Scale (END) [ Time Frame: it going to be apply in the session number 1 and 18, and the application time is 1 minute ]
    used in various clinical settings for multiple health conditions, and measures pain intensity subjectively through a rating of 0 to 10, where 0 means no pain and 10 the worst pain experienced .

Secondary Outcome Measures :
  1. Spanish version of the Quality Short-Form Health Survey 36 (SF-36) [ Time Frame: it going to be apply in the session number 1 and 18, and the application time is 20 minutes ]
    It is made up of 36 items distributed in sub-scales of physical functioning, physical role, body pain, general health, vitality, social function, emotional role and mental health, all with Likert questions and dichotomous (Yes / No) questions with the minimum score being 0 and the maximum 100

  2. WHODAS 2.0 questionnaire of the World Health Organization (WHO) [ Time Frame: it going to be apply in the session number 1 and 18, and the application time is 10 minutes ]
    it is used worldwide and inquires about the difficulties that the individual has due to a particular health condition. For this study, the 12-item version will be used, which is made up of a Likert scale ranging from 'no difficulty" (1) to 'extreme difficulty' / 'cannot do it' (5). The scores will be averaged for analysis

Information from the National Library of Medicine

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

Inclusion Criteria:

  • Patient with spinal cord injury.
  • Over 18 years of age.
  • A DN-score 4 (Douleur Neuropathique-4) equal to or greater than 4.
  • level of injury below C3.

Exclusion Criteria:

  • Active pressure ulcers
  • An E classification in the ASIA (American Spinal Cord Injury Association)
  • Cognitive impairment
  • Ostomies
  • Permanent bladder catheter
  • Signs of systemic inflammatory response
  • Urinary symptoms

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): NCT04164810

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Contact: Sara G Pacichana, MSc +57 3122128016 sara.pacichana@correounivalle.edu.co

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Hospital Universitario del Valle "Evaristo García" ESE Recruiting
Santiago de Cali, Valle Del Cauca, Colombia
Contact: Maria Ana Tovar-Sánchez, Physiatrist    +57 3104096531    ana.tovar@correounivalle.edu.co   
Sponsors and Collaborators
Universidad del Valle, Colombia
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Universidad del Valle, Colombia
ClinicalTrials.gov Identifier: NCT04164810    
Other Study ID Numbers: CI-1845
First Posted: November 15, 2019    Key Record Dates
Last Update Posted: November 15, 2019
Last Verified: November 2019

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Universidad del Valle, Colombia:
Spinal cord injury
Neuropathic pain
Quality of life
Additional relevant MeSH terms:
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Spinal Cord Injuries
Wounds and Injuries
Spinal Cord Diseases
Central Nervous System Diseases
Nervous System Diseases
Trauma, Nervous System
Peripheral Nervous System Diseases
Neuromuscular Diseases
Neurologic Manifestations