Transcutaneous Spinal Cord Stimulation for Chronic Low Back Pain
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: tSpinalStim.
- Who it may be relevant to
- Registry conditions: Chronic Low-back Pain. Basic parameters: 21 years — 85 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- United States
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Overview
As a leading cause of disability worldwide, chronic low back pain (cLBP) represents a significant medical and socioeconomic problem with estimated health care spending of $87 billion/annually. The efficacy of dorsal column electrical stimulation to inhibit pain was first described over 50 years ago. Since then, several large clinical trials have investigated the therapeutic potential of electrical spinal cord stimulation (SCS) and found that over 70% of patients with intractable pain had over 50% pain relief after 1 year of treatment. Thus, SCS is a promising therapeutic intervention that has superior patient outcomes when compared to traditional modalities for the treatment of cLBP. To date, SCS for treatment of cLBP has been delivered via epidural electrodes, requiring neurosurgical implantation. Although, the implantable stimulators have a low rate of adverse events, secondary complications associated with surgical intervention still occur.Transcutaneous spinal cord stimulation (tSCS) is a rapidly developing non invasive neuromodulation technique in the field of spinal cord injury. Its application potentiates lumbosacral spinal cord excitability enabling motor functions, (e.g. independent standing, postural control) in patients with chronic complete motor paralysis. Given that epidural and transcutaneous SCS activate similar neuronal networks, tSCS for cLBP treatment may be advantageous due to its non-invasive nature which may also allow for a mass market production and rapid patient availability if tSCS is proven efficacious. In this pilot study we will establish the feasibility of tSCS to acutely improve patient reported outcomes (pain scores) and several objective measures, including sit-to-stand biomechanics, neurophysiological and neuroimaging outcomes.
Interventions
- Device tSpinalStim
Patients will undergo 12-21 sessions of spinal cord stimulation therapy (30 minutes per session, 3 times a week). Up to five round stimulating electrodes will be placed on the skin midline between spinous processes in cervical, thoracic and/or lumbar region, as cathodes and rectangular pads will be placed symmetrically on the skin over the iliac crests as anodes. The stimulator generates pain-free biphasic rectangular waveform with 1 ms width pulses filled with 5-10 kHz (kilohertz) carrier frequ
Primary outcome measures
- Visual Analogue Scale (VAS) score [Time frame: 3 hours]
- Max Sagittal Vertical Axis [Time frame: 3 hours]
- L5S1/Torso Max Flex/Ext angle [Time frame: 3 hours]
- L5S1/Torso Max velocity [Time frame: 3 hours]
- Hip/Pelvis Max Flex/Ext angle [Time frame: 3 hours]
- Hip/Pelvis Max velocity [Time frame: 3 hours]
- Thing/Knee Max Flex/Ext angle [Time frame: 3 hours]
- Thing/Knee Max Velocity [Time frame: 3 hours]
- Insula - Cingulate connectivity [Time frame: 3 hours]
- Default Mode Network connectivity [Time frame: 3 hours]
Secondary outcome measures (3)
- Shank/Ankle Max Flex/Ext angle [Time frame: 3 hours]
- Shank/Ankle Max velocity [Time frame: 3 hours]
- Erector Spinae activation (Root Mean Square) [Time frame: 3 hours]
Eligibility criteria
Inclusion criteria
- Low back pain
- Able to get in and out of chair unassisted
- No changes in medication within 2 weeks of study enrollment
- Stable dose of their medications within 2 weeks of study enrollment
Exclusion criteria
- Body Mass Index (BMI) > 28
- Hardware in the spine from prior surgeries
- Presence of epidural stimulation leads
- Presence of any additional neuromuscular pain unrelated to spinal condition
- Intolerance to any form of electrical stimulation, such as neuromuscular stimulation in the past
- Lack of perceived endurance to go through multiple experimental assessments in one day/complete the study which may take up to 3 hours
- Changes in medications within 2 weeks of study enrollment
- Moderate/severe depression (Beck Depression Inventory score > 20)
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: Yes
Study design
- Allocation
- N/A
- Model
- Single group
- Masking
- Open label
- Primary purpose
- Treatment
Study locations
United States · 1 center
- San Francisco VA Medical Center — San Francisco
Identifiers
NCT: NCT05265000 · tSCS4LBP