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The purpose of this study is to evaluate the safety and effectiveness of the AXIUM Neurostimulator System for the treatment of chronic lower limb pain in persons diagnosed with Complex Regional Pain Syndrome (CRPS) or Peripheral Causalgia (PC).
The ACCURATE study is a prospective, randomized, controlled, multicenter clinical trial designed to assess the safety and efficacy of the Spinal Modulation Axium Neurostimulator System as an aid in the management of chronic, intractable pain of the lower limbs, including unilateral or bilateral pain associated with one of the following conditions: Complex Regional Pain Syndrome (CRPS) or Peripheral Causalgia (also referred to as CRPS Type II).
Enrolled subjects were diagnoses with CRPS or peripheral causalgia; experienced pain for at least six months; and failed to achieve adequate pain relief from at least two prior pharmacologic treatments.
All subjects had a temporary trial neurostimulator (TNS). If the subject was a treatment success at the end of TNS they were scheduled for the fully implantable neurostimulator (INS) implant procedure. If not, subjects were exited from the study.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| AXIUM Neurostimulator System | Experimental | The AXIUM Neurostimulator System is an investigational spinal cord stimulation device that is designed to stimulate the dorsal root ganglion (DRG) of the spine located on the back surface of the spinal cord where nerves exit the backbone. The device has 2 parts that are placed surgically (implanted) : 1) a pulse generator which is placed under the skin in the buttocks or abdomen, and 2) up to four wires (leads) that have one end attached to the pulse generator, and the other end secured to the tissue near the target treatment area. |
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| Control Spinal Cord Stimulation Device | Active Comparator | The Control Spinal Cord Stimulation Device is a commercially available spinal cord stimulator indicated for the treatment of chronic lower limb pain. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| AXIUM Neurostimulator System | Device |
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| |
| Measure | Description | Time Frame |
|---|---|---|
| Primary Composite Endpoint - Treatment Success | Treatment Success is defined as at least 50% lower limb pain relief (VAS score reduction) at the end of trial phase, received at least 50% lower limb pain relief at the 3-month visit post implant, and the absence of a stimulation related neurological deficit. Pain scores were measured using Visual Analog Scale (VAS). The VAS score ranges from 0-100 mm with a higher score indicating higher pain intensity ( 0 representing "No Pain" and 100 mm representing "Worst Imaginable Pain"). | 3 months |
| Measure | Description | Time Frame |
|---|---|---|
| Positional Effects on Paresthesia Intensities | Positional effects on paresthesia intensities at 3 months in the Control group versus the Treatment Group. This endpoint will compare the difference in paresthesia scores upright and supine between the AXIUM and Control groups. Paresthesia intensity was rated by subjects using a paresthesia intensity rating scale. Subjects rated the intensity of their perception of paresthesia, while upright and supine, on an 11-point numeric rating scale from 0 representing "No feeling" to 10 "Very intense." Perceived paresthesia intensity difference between supine and upright positions was calculated and averaged across each group. |
| Measure | Description | Time Frame |
|---|---|---|
| Primary Composite Endpoint - Treatment Success for Only Those Subjects With a Permanent Implant | Treatment Success is defined as a reduction in pain score greater than or equal to 50 percent and the absence of a stimulation related neurological deficit. Pain scores were measured using Visual Analog Scale (VAS). The VAS score ranges from 0-100 mm with a higher score indicating higher pain intensity ( 0 representing "No Pain" and 100 mm representing "Worst Imaginable Pain"). |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Robyn Capobianco, PhD | Abbott | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| HOPE Research - TPC | Phoenix | Arizona | 85018 | United States | ||
| Pain Clinic of Monterey Bay |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31494275 | Derived | Levy RM, Mekhail N, Kramer J, Poree L, Amirdelfan K, Grigsby E, Staats P, Burton AW, Burgher AH, Scowcroft J, Golovac S, Kapural L, Paicius R, Pope J, Samuel S, McRoberts WP, Schaufele M, Kent AR, Raza A, Deer TR. Therapy Habituation at 12 Months: Spinal Cord Stimulation Versus Dorsal Root Ganglion Stimulation for Complex Regional Pain Syndrome Type I and II. J Pain. 2020 Mar-Apr;21(3-4):399-408. doi: 10.1016/j.jpain.2019.08.005. Epub 2019 Sep 5. |
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| ID | Title | Description |
|---|---|---|
| FG000 | AXIUM Neurostimulator System | The AXIUM Neurostimulator System is an investigational spinal cord stimulation device that is designed to stimulate the dorsal root ganglion (DRG) of the spine located on the back surface of the spinal cord where nerves exit the backbone. The device has 2 parts that are placed surgically (implanted) : 1) a pulse generator which is placed under the skin in the buttocks or abdomen, and 2) up to four wires (leads) that have one end attached to the pulse generator, and the other end secured to the tissue near the target treatment area. AXIUM Neurostimulator System |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
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| Control Spinal Cord Stimulation Device |
| Device |
|
|
| 3 months |
| 3 months |
| Primary Composite Endpoint - Treatment Success for Only Those Subjects With a Permanent Implant | Treatment Success is defined as a reduction in pain score greater than or equal to 50 percent and the absence of a stimulation related neurological deficit. Pain scores were measured using Visual Analog Scale (VAS). The VAS score ranges from 0-100 mm with a higher score indicating higher pain intensity ( 0 representing "No Pain" and 100 mm representing "Worst Imaginable Pain"). | 12 months |
| Aptos |
| California |
| 94025 |
| United States |
| Coastal Pain Research | Carlsbad | California | 94025 | United States |
| Neurovations, Inc. | Napa | California | 94558 | United States |
| Newport Beach Headache and Pain | Newport Beach | California | 94025 | United States |
| Eisenhower Medical Center | Rancho Mirage | California | 94025 | United States |
| Orthopaedic Pain Specialists | Santa Monica | California | 94025 | United States |
| IPM Medical Group, Inc. | Walnut Creek | California | 94598 | United States |
| Florida Pain Institute | Merritt Island | Florida | 32953 | United States |
| Holy Cross Hospital Orthopedic Institute | Oakland Park | Florida | 33334 | United States |
| Drug Studies of America | Marietta | Georgia | 30060 | United States |
| Comprehensive Pain and Rehabilitation | Pascagoula | Mississippi | 39581 | United States |
| Pain Management Associates | Independence | Missouri | 64055 | United States |
| HOPE Research - LVSP | Las Vegas | Nevada | 89106 | United States |
| Premier Pain Center | Shrewsbury | New Jersey | 07702 | United States |
| The Center for Clinical Research | Winston-Salem | North Carolina | 27103 | United States |
| Cleveland Clinic Foundation | Cleveland | Ohio | 44195 | United States |
| Clinical Trials of South Carolina | Charleston | South Carolina | 29406 | United States |
| Southeastern Spine Institute | Mt. Pleasant | South Carolina | 29464 | United States |
| Houston Pain Centers | Houston | Texas | 77030 | United States |
| Center for Pain Relief | Charleston | West Virginia | 25301 | United States |
| Center for Pain Relief Tri-State | Huntington | West Virginia | 25702 | United States |
| FG001 | Control Spinal Cord Stimulation Device | The Control Spinal Cord Stimulation Device is a commercially available spinal cord stimulator indicated for the treatment of chronic lower limb pain. Control Spinal Cord Stimulation Device |
| Modified Intent-to-treat | 6 subjects excluded from MITT (withdrew prior to trial phase): Axium N = 3, Control N = 3 |
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| COMPLETED |
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| NOT COMPLETED |
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| ID | Title | Description |
|---|---|---|
| BG000 | AXIUM Neurostimulator System | The AXIUM Neurostimulator System is an investigational spinal cord stimulation device that is designed to stimulate the dorsal root ganglion (DRG) of the spine located on the back surface of the spinal cord where nerves exit the backbone. The device has 2 parts that are placed surgically (implanted) : 1) a pulse generator which is placed under the skin in the buttocks or abdomen, and 2) up to four wires (leads) that have one end attached to the pulse generator, and the other end secured to the tissue near the target treatment area. AXIUM Neurostimulator System |
| BG001 | Control Spinal Cord Stimulation Device | The Control Spinal Cord Stimulation Device is a commercially available spinal cord stimulator indicated for the treatment of chronic lower limb pain. Control Spinal Cord Stimulation Device |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Median | Full Range | Years |
| |||||||||||||||
| Sex: Female, Male | Count of Participants | Participants | No |
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| Race/Ethnicity, Customized | Count of Participants | Participants |
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| Race/Ethnicity, Customized | Count of Participants | Participants |
| ||||||||||||||||
| Region of Enrollment | Number | participants |
| ||||||||||||||||
| Body Mass Index (BMI) | Median | Full Range | kg/m2 |
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| Primary Diagnosis | Count of Participants | Participants |
| ||||||||||||||||
| Duration of Lower Limb Pain | Median | Full Range | Years |
| |||||||||||||||
| Primary Region of Pain | Count of Participants | Participants |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Primary Composite Endpoint - Treatment Success | Treatment Success is defined as at least 50% lower limb pain relief (VAS score reduction) at the end of trial phase, received at least 50% lower limb pain relief at the 3-month visit post implant, and the absence of a stimulation related neurological deficit. Pain scores were measured using Visual Analog Scale (VAS). The VAS score ranges from 0-100 mm with a higher score indicating higher pain intensity ( 0 representing "No Pain" and 100 mm representing "Worst Imaginable Pain"). | Subjects excluded since they do not have evaluable data: Axium=4, Control=3. Seven subjects in the MITT analysis have no evaluable data for the study endpoints due to withdrawing prior to the 3-mo study visit and did not meeting criteria for treatment failure/success upon study exit. | Posted | Number | 95% Confidence Interval | percentage of subjects | 3 months |
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| Secondary | Positional Effects on Paresthesia Intensities | Positional effects on paresthesia intensities at 3 months in the Control group versus the Treatment Group. This endpoint will compare the difference in paresthesia scores upright and supine between the AXIUM and Control groups. Paresthesia intensity was rated by subjects using a paresthesia intensity rating scale. Subjects rated the intensity of their perception of paresthesia, while upright and supine, on an 11-point numeric rating scale from 0 representing "No feeling" to 10 "Very intense." Perceived paresthesia intensity difference between supine and upright positions was calculated and averaged across each group. | Posted | Mean | Standard Deviation | score on a scale | 3 months |
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| Other Pre-specified | Primary Composite Endpoint - Treatment Success for Only Those Subjects With a Permanent Implant | Treatment Success is defined as a reduction in pain score greater than or equal to 50 percent and the absence of a stimulation related neurological deficit. Pain scores were measured using Visual Analog Scale (VAS). The VAS score ranges from 0-100 mm with a higher score indicating higher pain intensity ( 0 representing "No Pain" and 100 mm representing "Worst Imaginable Pain"). | Posted | Number | 95% Confidence Interval | percentage of subjects | 3 months |
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| Other Pre-specified | Primary Composite Endpoint - Treatment Success for Only Those Subjects With a Permanent Implant | Treatment Success is defined as a reduction in pain score greater than or equal to 50 percent and the absence of a stimulation related neurological deficit. Pain scores were measured using Visual Analog Scale (VAS). The VAS score ranges from 0-100 mm with a higher score indicating higher pain intensity ( 0 representing "No Pain" and 100 mm representing "Worst Imaginable Pain"). | Posted | Number | 95% Confidence Interval | percentage of subjects | 12 months |
|
Adverse events were collected from the time of subject enrollment through completion of study follow-up or early discontinuation, whichever occured first, an average of 1 year.
An AE is an untoward medical occurrence in a patient or subject implanted with a study device whether or not the event has causal relationship to the device; can be any unfavorable or unintended sign, symptom, disease temporally associated with device use. An AE is serious if it meets any of the following: immediately life threatening, results in disability, requires invasive intervention to preclude permanent impairment or death, results in or prolongs hospitalization, or results in death.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | AXIUM Neurostimulator System | The AXIUM Neurostimulator System is an investigational spinal cord stimulation device that is designed to stimulate the dorsal root ganglion (DRG) of the spine located on the back surface of the spinal cord where nerves exit the backbone. The device has 2 parts that are placed surgically (implanted) : 1) a pulse generator which is placed under the skin in the buttocks or abdomen, and 2) up to four wires (leads) that have one end attached to the pulse generator, and the other end secured to the tissue near the target treatment area. AXIUM Neurostimulator System | 0 | 76 | 8 | 76 | 5 | 76 |
| EG001 | Control Spinal Cord Stimulation Device | The Control Spinal Cord Stimulation Device is a commercially available spinal cord stimulator indicated for the treatment of chronic lower limb pain. Control Spinal Cord Stimulation Device | 0 | 76 | 15 | 76 | 5 | 76 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Abnormal blood chemistry | Blood and lymphatic system disorders | Systematic Assessment |
| ||
| Lower extremity/bilateral leg pain | Musculoskeletal and connective tissue disorders | Systematic Assessment |
| ||
| Substance relayed disorder/overdose or withdrawal | Psychiatric disorders | Systematic Assessment |
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| Wound infection | Infections and infestations | Systematic Assessment |
| ||
| Arthritis | Musculoskeletal and connective tissue disorders | Systematic Assessment |
| ||
| Injury/ADL | Musculoskeletal and connective tissue disorders | Systematic Assessment |
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| Bone infection | Musculoskeletal and connective tissue disorders | Systematic Assessment |
| ||
| Cardiac Arrhythmia | Cardiac disorders | Systematic Assessment |
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| Nausea/vomiting | Gastrointestinal disorders | Systematic Assessment |
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| Joint or muscle surgery | Surgical and medical procedures | Systematic Assessment |
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| Hypertension | Cardiac disorders | Systematic Assessment |
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| Bone fracture | Musculoskeletal and connective tissue disorders | Systematic Assessment |
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| Cardiac valve | Cardiac disorders | Systematic Assessment |
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| Heart failure | Cardiac disorders | Systematic Assessment |
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| Dermatologic | Skin and subcutaneous tissue disorders | Systematic Assessment |
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| Eyes or ears or nose or throat | General disorders | Systematic Assessment |
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| Cholecystectomy | Hepatobiliary disorders | Systematic Assessment |
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| Cellulitis | Skin and subcutaneous tissue disorders | Systematic Assessment |
| ||
| Systemic infection or general | Infections and infestations | Systematic Assessment |
| ||
| Fall injury | Injury, poisoning and procedural complications | Systematic Assessment |
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| Diverticulitis | Gastrointestinal disorders | Systematic Assessment |
| ||
| Cirrhosis | Hepatobiliary disorders | Systematic Assessment |
| ||
| Trunk or rib pain | Musculoskeletal and connective tissue disorders | Systematic Assessment |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Side effect/Procedure medication | General disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Robyn Capobianco | Abbott | 512-286-4274 | robyn.capobianco@abbott.com |
| Male |
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| Black or African American |
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| Native Hawaiian or Other Pacific Islander |
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| White |
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| Other |
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| Not Hispanic or Latino |
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| Peripheral Causalgia |
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| Region 3 - Left Groin |
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| Region 4 - Right Buttock |
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| Region 5 - Left Buttock |
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| Region 6 - Right Leg |
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| Region 7 - Left Leg |
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| Region 8 - Right Foot |
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| Region 9 - Left Foot |
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The non-inferiority margin, which is pre-specified at 10%. If non-inferiority is achieved at a one-sided alpha of 0.05, a one-sided superiority test is performed at the significance level of 0.025. |
| The primary hypothesis tested was: H0: p1 ≤ p0 - δ vs. H1: p1> p0 - δ, where p0 is the success rate in the Control group, p1 is the success rate in the Axium group, and δ is the non-inferiority margin, which is pre-specified at 10%. | Chi-squared | =0.0004 | Superiority | The non-inferiority margin, which is pre-specified at 10%. If non-inferiority is achieved at a one-sided alpha of 0.05, a one-sided superiority test is performed at the significance level of 0.025 |
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| Units | Counts |
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| Participants |
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| Units | Counts |
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| Participants |
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