Mechanistically Informed Non-invasive Peripheral Nerve Stimulation for Peripheral Neuropathic Pain: a Randomised Double-blind Sham-controlled Trial.



johnson, selina, Marshall, Anne, Hughes, Dyfrig, Holmes, Emily, Henrich, Florian, Nurmikko, Turo, Sharma, Manohar, Frank, Bernhard, Bassett, Paul, Marshall, Andrew
et al (show 2 more authors) (2021) Mechanistically Informed Non-invasive Peripheral Nerve Stimulation for Peripheral Neuropathic Pain: a Randomised Double-blind Sham-controlled Trial.

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Abstract

<h4>Background: </h4> Induction of long-term synaptic depression (LTD) is proposed as a treatment mechanism for chronic pain but remains untested in clinical populations. Two interlinked studies; 1. A patient-assessor blinded, randomised, sham-controlled clinical trial and 2. an open-label mechanistic study, sought to examine therapeutic LTD for persons with chronic peripheral nerve injury pain. <h4>Methods: </h4>: 1. Patients were randomised using a concealed, computer-generated schedule to either active or sham non-invasive low-frequency nerve stimulation (LFS), for 3 months (minimum 10 mins/day). The primary outcome was average pain intensity (0-10 Likert scale) recorded over one week, at three months, compared between study groups. 2. On trial completion, consenting subjects entered a mechanistic study assessing somatosensory changes in response to LFS. <h4>Results: </h4>: 1. 76 patients were randomised (38 per group), with 65 (31 active, 34 sham) included in the intention to treat analysis. The primary outcome was not significant, pain scores were 0·3 units lower in active group (95% CI -1·0, 0·3; p=0·30) giving an effect size of 0·19 (Cohen’s D). Two non-device related serious adverse events were reported. 2. In the mechanistic study (n=19) primary outcomes of mechanical pain sensitivity (p=0.006) and dynamic mechanical allodynia (p=0.043) significantly improved indicating reduced mechanical hyperalgesia. <h4>Conclusions: </h4>: Results from the RCT failed to reach significance. Results from the mechanistic study provide new evidence for effective induction of LTD in a clinical population. Taken together results add to mechanistic understanding of LTD and help inform future study design and approaches to treatment. Funding: National Institute for Health Research. ISRCTN53432663

Item Type: Article
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 11 Apr 2022 10:18
Last Modified: 06 May 2022 16:12
DOI: 10.21203/rs.3.rs-809958/v1
Open Access URL: https://translational-medicine.biomedcentral.com/a...
URI: https://livrepository.liverpool.ac.uk/id/eprint/3152606