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Limb loss is frequently associated with postamputation pain that can be challenging to treat and often involves opioids. Advances in the field of neuromodulation has led to development of an intentionally reversible percutaneous peripheral nerve stimulation (PNS) system that has had promising results when treating chronic postamputation pain. PNS may offer sustained pain relief even after the treatment period has ended. Currently, there is no convincing evidence regarding the role of PNS in the acute postoperative period, which may be a critical time to control pain as those with higher pain appear to be at higher risk for developing persistent post-procedural pain. The investigators of this study aim to evaluate the feasibility and effects of PNS in the acute postoperative period and determine the feasibility of completing a randomized controlled treatment outcome study.
16 patients with new nontraumatic transfemoral or transtibial amputation will be enrolled in the study
Having met inclusion criteria, the patients will be randomized to experimental or control groups
Patients in the experimental group undergo placement of PNS leads within 7 days of amputation surgery
Patients in both groups will be treated with standard pharmacologic and nonpharmacologic pain therapies and evaluated weekly for 8 weeks, then at 3, 6, and 12 months postamputation
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group 1 | Experimental | Standard medical therapy and 30 to 60 days of peripheral nerve stimulation starting within 7 days after surgery |
|
| Group 2 | Active Comparator | Standard medical therapy only |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Peripheral nerve stimulation | Device | Up to 60 days of peripheral nerve stimulation |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Average Phantom Limb Pain (PLP) Score | Using the Brief Pain Inventory-Short Form (BPI-SF) questionnaire, subjects were asked to rate their PLP over the past 24 hours on a scale of "0"=no pain to "10"=worst pain they have ever experienced. A lower score is better. Data from Weeks 1-4 and Weeks 5-8 were averaged to obtain a numerical score for these time points. | Baseline, Weeks 1-4, Weeks 5-8, and Month 3. |
| Average Residual Limb Pain (RLP) Score | Using the Brief Pain Inventory-Short Form (BPI-SF) questionnaire, subjects were asked to rate their RLP over the past 24 hours on a scale of "0"=no pain to "10"=worst pain they have ever experienced. A lower score is better. Data from Weeks 1-4 and Weeks 5-8 were averaged to obtain a numerical score for these time points. | Baseline, Weeks 1-4, Weeks 5-8, and Month 3 |
| Worst Phantom Limb Pain (PLP) Score | Using the Brief Pain Inventory-Short Form (BPI-SF) questionnaire, subjects were asked to rate their PLP over the past 24 hours on a scale of "0"=no pain to "10"=worst pain they have ever experienced. A lower score is better. Data from Weeks 1-4 and Weeks 5-8 were averaged to obtain a numerical score for these time points. | Baseline, Weeks 1-4, 5-8, and Month 3 |
| Worst Residual Limb Pain (RLP) Score | Using the Brief Pain Inventory-Short Form (BPI-SF) questionnaire, subjects were asked to rate their RLP over the past 24 hours on a scale of "0"=no pain to "10"=worst pain they have ever experienced. A lower score is better. Data from Weeks 1-4 and Weeks 5-8 were averaged to obtain a numerical score for these time points. | Baseline, Weeks 1-4, Weeks 5-8, and Month 3 |
| Best Phantom Limb Pain (PLP) Score | Using the Brief Pain Inventory-Short Form (BPI-SF) questionnaire, subjects were asked to rate their PLP over the past 24 hours on a scale of "0"=no pain to "10"=worst pain they have ever experienced. A lower score is better. Data from Weeks 1-4 and Weeks 5-8 were averaged to obtain a numerical score for these time points. |
| Measure | Description | Time Frame |
|---|---|---|
| Number Taking Opioids | The number of subjects prescribed any opioid medication and any dose. Data from Weeks 1-4 and Weeks 5-8 were averaged to obtain a numerical score for these time points. | Preop, Hospital Discharge, Weeks 1-4, Weeks 5-8, Week 12 |
| Average Oral Morphine Equivalents (OME) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Denise Lester, MD | Hunter Holmes McGuire VA Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hunter Holmes McGuire VA Medical Center | Richmond | Virginia | 23249 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 16949876 | Background | Hanley MA, Jensen MP, Smith DG, Ehde DM, Edwards WT, Robinson LR. Preamputation pain and acute pain predict chronic pain after lower extremity amputation. J Pain. 2007 Feb;8(2):102-9. doi: 10.1016/j.jpain.2006.06.004. Epub 2006 Sep 1. | |
| 21368651 | Background | Karanikolas M, Aretha D, Tsolakis I, Monantera G, Kiekkas P, Papadoulas S, Swarm RA, Filos KS. Optimized perioperative analgesia reduces chronic phantom limb pain intensity, prevalence, and frequency: a prospective, randomized, clinical trial. Anesthesiology. 2011 May;114(5):1144-54. doi: 10.1097/ALN.0b013e31820fc7d2. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Peripheral Nerve Stimulation (PNS) | Standard medical therapy and 30 to 60 days of peripheral nerve stimulation starting within 7 days after surgery Peripheral nerve stimulation: Up to 60 days of peripheral nerve stimulation Standard Medical Therapy: Medications, physical therapy, or other pain treatments |
| FG001 |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jun 11, 2018 |
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| Standard Medical Therapy |
| Other |
Medications, physical therapy, or other pain treatments |
|
| Baseline, Weeks 1-4, Weeks 5-8, and Month 3 |
| Best Residual Limb Pain (RLP) Score | Using the Brief Pain Inventory-Short Form (BPI-SF) questionnaire, subjects were asked to rate their RLP over the past 24 hours on a scale of "0"=no pain to "10"=worst pain they have ever experienced. A lower score is better. Data from Weeks 1-4 and Weeks 5-8 were averaged to obtain a numerical score for these time points. | Baseline, Weeks 1-4, Weeks 5-8, and Month 3 |
Opioid consumption (daily OME) over time was collected for all subjects. |
| Preoperative, Hospital discharge, Weeks 1-4, Weeks 5-8, and Week 12 |
| Functional Independence Measure (FIM) Scores | FIM mobility subscores were recorded by a physical therapist to measure the ability to walk, use a wheelchair, transfer to tub/shower, transfer to toilet, and mobility in bed, chair, and wheelchair. Scores range from "1" = subject requires total assistance for the task to "7" = complete independence. A higher score is better. | Preoperative, Week 4, and Week 8 |
| Pain Interference | Using the Brief Pain Inventory-Short Form (BPI-SF) questionnaire, subjects were asked to rate how much pain has interfered with daily activities over the past 24 hours on a scale of "0" = no interference to "10" = completely interferes with activities. A lower score is better. | Baseline, Weeks 4, 8, and 12 |
| Patient Global Impression of Change (PGIC) | Self-report measure PGIC reflects a patient's belief about the efficacy of treatment. PGIC is a 7 point scale depicting a patient's rating of overall improvement. Patients rate their change as 1 = "very much improved," 2 = "much improved," 3 = "minimally improved," 4 = "no change," 5 = "minimally worse," 6 = "much worse," or 7 = "very much worse." A lower score is better. | Weeks 4, 8, and 12 |
| Pain Catastrophizing Scale (PCS) | Pain catastrophizing is the tendency to magnify the threat value of a pain stimulus and to feel helpless in the presence of pain. This is further characterized by the inability to prevent or inhibit pain-related thoughts surrounding a painful event. Pain catastrophizing affects how individuals experience pain. The PCS is a 13-item inventory of statements in which the subject is asked to rate the degree to which they agree, on a scale of "0" = not at all to "4" = all the time. The responses for each item are added for a total PCS score (range 0-52). A lower score is better. | Baseline, Weeks 4, 8, and 12 |
| Pain Disability Index (PDI) | The PDI is designed to measure the degree to which aspects of life are disrupted by chronic pain. The impact of pain on various aspects of life (e.g. family/home responsibilities, recreation, social activity, occupation, sexual behavior, self-care, and life-support activities) are recorded on a 10-point scale from "0" = no disability to "10" = worst disability. The sum of scores is recorded for a total PDI score (range 0-70). A lower score is better. | Weeks 4, Week 8, and Week 12 |
| 30-day Readmission Rate | Percent of Group that was readmitted to the hospital within 30 days following hospital discharge. | 30 days from hospital discharge |
| Hospital Length of Stay (LOS) | Hospital LOS was calculated from day of surgery to day of discharge from inpatient hospital ward to rehabilitation facility. | Number of days from surgery to discharge |
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| 30024078 | Background | Ilfeld BM, Ball ST, Gabriel RA, Sztain JF, Monahan AM, Abramson WB, Khatibi B, Said ET, Parekh J, Grant SA, Wongsarnpigoon A, Boggs JW. A Feasibility Study of Percutaneous Peripheral Nerve Stimulation for the Treatment of Postoperative Pain Following Total Knee Arthroplasty. Neuromodulation. 2019 Jul;22(5):653-660. doi: 10.1111/ner.12790. Epub 2018 Jul 19. |
| 29905630 | Background | Ilfeld BM, Gabriel RA, Said ET, Monahan AM, Sztain JF, Abramson WB, Khatibi B, Finneran JJ 4th, Jaeger PT, Schwartz AK, Ahmed SS. Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation: Neuromodulation of the Sciatic Nerve for Postoperative Analgesia Following Ambulatory Foot Surgery, a Proof-of-Concept Study. Reg Anesth Pain Med. 2018 Aug;43(6):580-589. doi: 10.1097/AAP.0000000000000819. |
| 30770421 | Background | Ilfeld BM, Finneran JJ 4th, Gabriel RA, Said ET, Nguyen PL, Abramson WB, Khatibi B, Sztain JF, Swisher MW, Jaeger P, Covey DC, Meunier MJ, Hentzen ER, Robertson CM. Ultrasound-guided percutaneous peripheral nerve stimulation: neuromodulation of the suprascapular nerve and brachial plexus for postoperative analgesia following ambulatory rotator cuff repair. A proof-of-concept study. Reg Anesth Pain Med. 2019 Mar;44(3):310-318. doi: 10.1136/rapm-2018-100121. Epub 2019 Feb 15. |
| 30954936 | Background | Gilmore C, Ilfeld B, Rosenow J, Li S, Desai M, Hunter C, Rauck R, Kapural L, Nader A, Mak J, Cohen S, Crosby N, Boggs J. Percutaneous peripheral nerve stimulation for the treatment of chronic neuropathic postamputation pain: a multicenter, randomized, placebo-controlled trial. Reg Anesth Pain Med. 2019 Jun;44(6):637-645. doi: 10.1136/rapm-2018-100109. Epub 2019 Apr 5. |
| 31740443 | Background | Gilmore CA, Ilfeld BM, Rosenow JM, Li S, Desai MJ, Hunter CW, Rauck RL, Nader A, Mak J, Cohen SP, Crosby ND, Boggs JW. Percutaneous 60-day peripheral nerve stimulation implant provides sustained relief of chronic pain following amputation: 12-month follow-up of a randomized, double-blind, placebo-controlled trial. Reg Anesth Pain Med. 2019 Nov 17:rapm-2019-100937. doi: 10.1136/rapm-2019-100937. Online ahead of print. |
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| 34761694 | Derived | Albright-Trainer B, Phan T, Trainer RJ, Crosby ND, Murphy DP, Disalvo P, Amendola M, Lester DD. Peripheral nerve stimulation for the management of acute and subacute post-amputation pain: a randomized, controlled feasibility trial. Pain Manag. 2022 Apr;12(3):357-369. doi: 10.2217/pmt-2021-0087. Epub 2021 Nov 11. |
| Standard Medical Therapy (SMT) |
Standard medical therapy only Standard Medical Therapy: Medications, physical therapy, or other pain treatments |
| Postamputation Week 1-4 |
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| Postamputation Week 5-8 |
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| Postamputation Month 3 |
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| COMPLETED |
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| NOT COMPLETED |
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| ID | Title | Description |
|---|---|---|
| BG000 | Peripheral Nerve Stimulation (PNS) | Up to 60 days of PNS starting within 7 days after major lower limb amputation surgery. Subjects also received standard medical therapy (SMT). SMT is defined as pharmacotherapy, physical therapy, or other therapies. |
| BG001 | Control | Subjects received SMT only after major lower limb amputation surgery. SMT is defined as pharmacotherapy, physical therapy, or other therapies. |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants | Participants |
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| Sex: Female, Male | Count of Participants | Participants |
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| Race and Ethnicity Not Collected | Race and Ethnicity were not collected from any participant. | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| Perineural Catheter Infusion | Mean | Standard Deviation | Days |
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| Taking Opioids Preoperatively | Count of Participants | Participants |
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| Level of Amputation | Count of Participants | Participants |
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| Indication for Surgery | 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 | Average Phantom Limb Pain (PLP) Score | Using the Brief Pain Inventory-Short Form (BPI-SF) questionnaire, subjects were asked to rate their PLP over the past 24 hours on a scale of "0"=no pain to "10"=worst pain they have ever experienced. A lower score is better. Data from Weeks 1-4 and Weeks 5-8 were averaged to obtain a numerical score for these time points. | Subjects who completed up to 60 days of peripheral nerve stimulation (PNS) and standard medical therapy (SMT) or (SMT) only. | Posted | Mean | Standard Deviation | score on a scale | Baseline, Weeks 1-4, Weeks 5-8, and Month 3. |
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| Primary | Average Residual Limb Pain (RLP) Score | Using the Brief Pain Inventory-Short Form (BPI-SF) questionnaire, subjects were asked to rate their RLP over the past 24 hours on a scale of "0"=no pain to "10"=worst pain they have ever experienced. A lower score is better. Data from Weeks 1-4 and Weeks 5-8 were averaged to obtain a numerical score for these time points. | Subjects who completed up to 60 days of peripheral nerve stimulation (PNS) and standard medical therapy (SMT) or (SMT) only. | Posted | Mean | Standard Deviation | score on a scale | Baseline, Weeks 1-4, Weeks 5-8, and Month 3 |
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| Primary | Worst Phantom Limb Pain (PLP) Score | Using the Brief Pain Inventory-Short Form (BPI-SF) questionnaire, subjects were asked to rate their PLP over the past 24 hours on a scale of "0"=no pain to "10"=worst pain they have ever experienced. A lower score is better. Data from Weeks 1-4 and Weeks 5-8 were averaged to obtain a numerical score for these time points. | Subjects who completed up to 60 days of peripheral nerve stimulation (PNS) and standard medical therapy (SMT) or (SMT) only. | Posted | Mean | Standard Deviation | score on a scale | Baseline, Weeks 1-4, 5-8, and Month 3 |
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| Primary | Worst Residual Limb Pain (RLP) Score | Using the Brief Pain Inventory-Short Form (BPI-SF) questionnaire, subjects were asked to rate their RLP over the past 24 hours on a scale of "0"=no pain to "10"=worst pain they have ever experienced. A lower score is better. Data from Weeks 1-4 and Weeks 5-8 were averaged to obtain a numerical score for these time points. | Subjects who completed up to 60 days of peripheral nerve stimulation (PNS) and standard medical therapy (SMT) or (SMT) only. | Posted | Mean | Standard Deviation | score on a scale | Baseline, Weeks 1-4, Weeks 5-8, and Month 3 |
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| Primary | Best Phantom Limb Pain (PLP) Score | Using the Brief Pain Inventory-Short Form (BPI-SF) questionnaire, subjects were asked to rate their PLP over the past 24 hours on a scale of "0"=no pain to "10"=worst pain they have ever experienced. A lower score is better. Data from Weeks 1-4 and Weeks 5-8 were averaged to obtain a numerical score for these time points. | Subjects who completed up to 60 days of peripheral nerve stimulation (PNS) and standard medical therapy (SMT) or (SMT) only. | Posted | Mean | Standard Deviation | score on a scale | Baseline, Weeks 1-4, Weeks 5-8, and Month 3 |
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| Primary | Best Residual Limb Pain (RLP) Score | Using the Brief Pain Inventory-Short Form (BPI-SF) questionnaire, subjects were asked to rate their RLP over the past 24 hours on a scale of "0"=no pain to "10"=worst pain they have ever experienced. A lower score is better. Data from Weeks 1-4 and Weeks 5-8 were averaged to obtain a numerical score for these time points. | Subjects who completed up to 60 days of peripheral nerve stimulation (PNS) and standard medical therapy (SMT) or (SMT) only. | Posted | Mean | Standard Deviation | score on a scale | Baseline, Weeks 1-4, Weeks 5-8, and Month 3 |
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| Secondary | Number Taking Opioids | The number of subjects prescribed any opioid medication and any dose. Data from Weeks 1-4 and Weeks 5-8 were averaged to obtain a numerical score for these time points. | Between Weeks 1-4 and Weeks 5-8, three subjects in the PNS Group terminated due to unrelated medical events (2) or withdrew consent (1). After Week 12, two subjects in the Control Group terminated due to unrelated medical events or withdrew consent (data for one subject was collected prior to withdrawal). | Posted | Count of Participants | Participants | Preop, Hospital Discharge, Weeks 1-4, Weeks 5-8, Week 12 |
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| Secondary | Average Oral Morphine Equivalents (OME) | Opioid consumption (daily OME) over time was collected for all subjects. | All study participants were evaluated. | Posted | Mean | Standard Deviation | oral morphine equivalents (mg) | Preoperative, Hospital discharge, Weeks 1-4, Weeks 5-8, and Week 12 |
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| Secondary | Functional Independence Measure (FIM) Scores | FIM mobility subscores were recorded by a physical therapist to measure the ability to walk, use a wheelchair, transfer to tub/shower, transfer to toilet, and mobility in bed, chair, and wheelchair. Scores range from "1" = subject requires total assistance for the task to "7" = complete independence. A higher score is better. | All qualifying subjects were evaluated. | Posted | Mean | Standard Deviation | score on a scale | Preoperative, Week 4, and Week 8 |
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| Secondary | Pain Interference | Using the Brief Pain Inventory-Short Form (BPI-SF) questionnaire, subjects were asked to rate how much pain has interfered with daily activities over the past 24 hours on a scale of "0" = no interference to "10" = completely interferes with activities. A lower score is better. | Subjects who were enrolled in the study and for whom this data was collected. | Posted | Mean | Standard Deviation | score on a scale | Baseline, Weeks 4, 8, and 12 |
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| Secondary | Patient Global Impression of Change (PGIC) | Self-report measure PGIC reflects a patient's belief about the efficacy of treatment. PGIC is a 7 point scale depicting a patient's rating of overall improvement. Patients rate their change as 1 = "very much improved," 2 = "much improved," 3 = "minimally improved," 4 = "no change," 5 = "minimally worse," 6 = "much worse," or 7 = "very much worse." A lower score is better. | Subjects who were enrolled in the study and for whom this data was collected. | Posted | Mean | Standard Deviation | score on a scale | Weeks 4, 8, and 12 |
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| Secondary | Pain Catastrophizing Scale (PCS) | Pain catastrophizing is the tendency to magnify the threat value of a pain stimulus and to feel helpless in the presence of pain. This is further characterized by the inability to prevent or inhibit pain-related thoughts surrounding a painful event. Pain catastrophizing affects how individuals experience pain. The PCS is a 13-item inventory of statements in which the subject is asked to rate the degree to which they agree, on a scale of "0" = not at all to "4" = all the time. The responses for each item are added for a total PCS score (range 0-52). A lower score is better. | Subjects who were enrolled in the study and for whom this data was collected. | Posted | Mean | Standard Deviation | score on a scale | Baseline, Weeks 4, 8, and 12 |
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| Secondary | Pain Disability Index (PDI) | The PDI is designed to measure the degree to which aspects of life are disrupted by chronic pain. The impact of pain on various aspects of life (e.g. family/home responsibilities, recreation, social activity, occupation, sexual behavior, self-care, and life-support activities) are recorded on a 10-point scale from "0" = no disability to "10" = worst disability. The sum of scores is recorded for a total PDI score (range 0-70). A lower score is better. | Subjects who were enrolled in the study and for whom this data was collected. | Posted | Mean | Standard Deviation | score on a scale | Weeks 4, Week 8, and Week 12 |
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| Secondary | 30-day Readmission Rate | Percent of Group that was readmitted to the hospital within 30 days following hospital discharge. | Posted | Count of Participants | Participants | 30 days from hospital discharge |
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| Secondary | Hospital Length of Stay (LOS) | Hospital LOS was calculated from day of surgery to day of discharge from inpatient hospital ward to rehabilitation facility. | Posted | Mean | Standard Deviation | days | Number of days from surgery to discharge |
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Week 4 and Week 8, Month 3, Month 6, and Month 12
Subjects in the Control Group were not at risk for PNS Lead Reimplantation because they did not undergo implantation of any peripheral nerve stimulator leads. Other [Not Including Serious] Adverse Events were not monitored/assessed in the Control Arm/Group.
Not provided
| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Peripheral Nerve Stimulation (PNS) | Up to 60 days of PNS starting within 7 days after major lower limb amputation surgery. Subjects also received standard medical therapy (SMT). SMT is defined as pharmacotherapy, physical therapy, or other therapies. | 1 | 8 | 0 | 8 | 2 | 8 |
| EG001 | Control | Subjects received SMT only after major lower limb amputation surgery. SMT is defined as pharmacotherapy, physical therapy, or other therapies. | 0 | 8 | 0 | 8 | 0 | 0 |
Not provided
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| PNS Lead Reimplantation | Surgical and medical procedures | Non-systematic Assessment | Two subjects in the PNS group required reimplantation of PNS leads due to dislodgement. No suspected lead fractures were observed during the treatment period or lead removal. |
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Several participants underwent unanticipated amputation revisions, which has the potential to contribute to worsening pain and the need for increased opioids, which may significantly confound results. Subjects were instructed to use the device continuously, and the effects of PNS therapy may be impacted by the number of hours the device was utilized by the patient. Variations in subject compliance with device usage may impact outcomes.
Not provided
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Denise Lester | Central Virginia Veterans Affairs Health Care System | 804-675-5000 | denise.lester@va.gov |
| Feb 9, 2021 |
| Prot_SAP_000.pdf |
| ICF | No | No | Yes | Informed Consent Form | Jun 20, 2018 | Feb 9, 2021 | ICF_001.pdf |
Not provided
| ID | Term |
|---|---|
| D010591 | Phantom Limb |
| D010149 | Pain, Postoperative |
| D009463 | Neuroma |
| D059787 | Acute Pain |
| D059350 | Chronic Pain |
| ID | Term |
|---|---|
| D010468 | Perceptual Disorders |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012816 | Signs and Symptoms |
| D010146 | Pain |
| D018317 | Nerve Sheath Neoplasms |
| D009380 | Neoplasms, Nerve Tissue |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
Not provided
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| Between 18 and 65 years |
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| >=65 years |
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| Weeks 1-4 |
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