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Fibromyalgia (FM) is a chronic disorder that affects the musculoskeletal system, causing widespread pain, tenderness, and fatigue. It is estimated to affect 1-5% of the population. The primary symptom of fibromyalgia is widespread pain throughout the body, accompanied by tenderness and sensitivity to pressure.
Pharmacological treatments include drugs such as antidepressants, anticonvulsants, and painkillers. Another treatment option for fibromyalgia is the use of devices such as Quell. Other non-pharmacological treatment options for fibromyalgia include cognitive-behavioral therapy (CBT), biofeedback, and relaxation techniques.
Remote Electrical Neuromodulation (REN) is a non-pharmacological technology that induces subthreshold, non-painful neurostimulation signals that activate an endogenic pain-management system termed Conditioned Pain Modulation (CPM), to produce generalized pain relief in remote body areas. Multiple studies have shown that REN is safe and effective for the acute treatment of migraine in adults and adolescents, as well as migraine prevention.
The current study examines the safety and efficacy of REN technology, implemented via the FibroNova device for treating fibromyalgia pain and related symptoms.
Background Fibromyalgia (FM) is a chronic disorder that affects the musculoskeletal system, causing widespread pain, tenderness, and fatigue. It is estimated to affect 1-5% of the population. The primary symptom of fibromyalgia is widespread pain throughout the body, accompanied by tenderness and sensitivity to pressure. Secondary symptoms include fatigue, sleep disturbances, cognitive difficulties, headaches, depression, and anxiety. The exact cause of fibromyalgia is unknown, but it is believed to involve a combination of neurobiological, genetic, and environmental factors.
There is no cure for fibromyalgia, and only a minority of fibromyalgia patients continue taking medications for more than a short period due to either lack of efficacy, side effects, or both. Pharmacological treatments include drugs such as antidepressants, anticonvulsants, and painkillers, and operate by modulating pain signals in the brain and nervous system. Another treatment option for fibromyalgia is the use of devices, such as the Quell device by Neurometrix 3. Other non-pharmacological treatment options for fibromyalgia include cognitive-behavioral therapy (CBT), biofeedback, and relaxation techniques 2.
Remote Electrical Neuromodulation (REN) is a non-pharmacological technology that induces subthreshold, non-painful neurostimulation signals that activate an endogenic pain-management system termed Conditioned Pain Modulation (CPM), to produce generalized pain relief in remote body areas. Multiple studies have shown that REN is safe and effective for the acute treatment of migraine in adults and adolescents, as well as migraine prevention.
The CPM system, which is deficient in patients with migraine, has been shown to be abnormal in fibromyalgia patients as well, suggesting that fibromyalgia patients could potentially benefit from activating the CPM via REN. The current study aims to examine the safety and efficacy of REN technology, implemented via the FibroNova device for the treatment of fibromyalgia pain and related symptoms.
The FibroNova device
The device is a wireless wearable battery-operated stimulation unit controlled by a smartphone software application. Treatments with FibroNova are self-administered by the user. The FibroNova device includes several main components:
The study design A prospective, randomized, double-blind, sham-controlled trial. The ratio between treatment and control groups will be 1:1, stratified by prior use of prescribed medications for FM (up to 2 vs. 3 or more). the following are considered as FM medications for the stratification: Dulloxetine, Pregabalin, Milnacipran, Amitriptyline.
The study will consist of two main phases and a voluntary open-label extension phase:
4-week baseline phase- in which participants will report their symptoms daily via an electronic app diary (with no intervention);
12-week intervention phase- in which eligible participants perform two treatments per day (using FibroNova/identical looking sham (placebo) device, according to randomization), and continue to report symptoms daily via the app.
12-week open-label extension phase (OLE)- upon completion of the intervention phase, eligible participants will be offered to participate in an additional voluntary 12-week period in which they will receive active treatment.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Treatment with active FibroNova device | Active Comparator | Treatment of Fibromyalgia pain and symptoms with active FibroNova device. Participants will treat with an active device twice a day. |
|
| Treatment with Sham FibroNova device | Placebo Comparator | Treatment of Fibromyalgia pain and symptoms with Sham FibroNova device. Participants will treat with a sham device twice a day. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| FibroNova (Active mode) | Device | FibroNova neurostimulator of conditional pain modulation (CPM) |
|
| Measure | Description | Time Frame |
|---|---|---|
| Mean reduction in pain level during the last 14 days of the treatment phase (weeks 15 through 16) compare to the last 14 days of baseline phase (weeks 3 through 4) | Mean change, from the last two weeks (weeks 3-4) of the baseline phase to the last two weeks (weeks 15-16) of the intervention phase, in the 2-week average of daily self-reported pain severity scores on NRS (0 to 10) that is based on the FIQR pain item. | 16 weeks |
| Device safety (rate of adverse events and device related adverse events) | The incidence of adverse events in general and by seriousness, severity and association to the device. | 28 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Mean change in the Revised Fibromyalgia Impact Questionnaire FIQR total score | Mean change in the Revised Fibromyalgia Impact Questionnaire FIQR total score from the end of the baseline phase (end of week 4) to the end of the intervention.phase (end of week 16) | 16 weeks |
| Mean change in FIQR functionality sub-scale score |
| Measure | Description | Time Frame |
|---|---|---|
| Improvement in quality of life | Mean change, from baseline to end of the intervention phase according to SF-36 quality of life questionnaire total score. | 16 weeks |
| Improvement in sleep quality | Mean change, from the last two weeks of the baseline phase (weeks 3-4) to the last two weeks of the intervention phase (weeks 15-16), in the 2-week average of daily self-reported level of sleep quality, on an 11-level scale (based on the FIQR item), where 0 is "perfect sleep" and 10 is "could not sleep at all". |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Dagan Harris | Contact | +97272 3909752 | daganh@theranica.com | |
| Liron Rabani | Contact | +97272 3909752 | Lironr@theranica.com |
| Name | Affiliation | Role |
|---|---|---|
| Daniel Clauw, MD | University of Michigan | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Clinical Research Professionals | Recruiting | Chesterfield | Missouri | 63005 | United States |
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| ID | Term |
|---|---|
| D005356 | Fibromyalgia |
| ID | Term |
|---|---|
| D009135 | Muscular Diseases |
| D009140 | Musculoskeletal Diseases |
| D012216 | Rheumatic Diseases |
| D009468 | Neuromuscular Diseases |
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Parallel Assignment. Randomized, double-blind, sham-controlled
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| FibroNova (Sham mode) | Device | FibroNova neurostimulator with an electrical output not intended for neurostimulation |
|
Mean change in FIQR functionality sub-scale score from the end of the baseline phase (end of week 4) to the end of the intervention.phase (end of week 16) |
| 16 weeks |
| Mean change in FIQR pain item score | Mean change in FIQR pain item score from the end of the baseline phase (end of week 4) to the end of the intervention.phase (end of week 16) | 16 weeks |
| Mean change in Brief Pain Inventory (BPI) score | Mean change in Brief Pain Inventory (BPI) from the end of the baseline phase (end of week 4) to the end of the intervention.phase (end of week 16) | 16 weeks |
| Improvement in patient global impression according to PGIC score | Percentage of participants who were categorized as "Improved (Very Much Improved, Much Improved, or Minimally Improved)" According to the Patient Global Impressions of Change (PGIC) at the end of week 12. | 16 weeks |
| Mean reduction in functional disability during the last 14 days of the treatment phase (weeks 15 through 16) compare to the last 14 days of baseline phase (weeks 3 through 4) | Mean change, from the last two weeks of the baseline phase (weeks 3-4 to the last two weeks of the intervention phase (weeks 15-16), in the 2-week average of daily self-reported functional disability scores on NRS (0 to 10) that is based on the FIQR disability item. | 16 weeks |
| 16 weeks |
| Mean change in level of depression | Mean change, from the last two weeks of the baseline phase (weeks 3-4) to the last two weeks of the intervention phase (weeks 15-16), in the 2-week average of daily self-reported level of depression on a 11-level scale (based on the FIQR item), where 0 is "not depressed at all" and 10 is "most depressed ever". | 16 weeks |
| Mean change in level of anxiety | Mean change, from the last two weeks of the baseline phase (weeks 3-4) to the last two weeks of the intervention phase (weeks 15-16), in the 2-week average of daily self-reported level of anxiety, on a 11-level scale (based on the FIQR item), where 0 is "not anxious at all" and 10 is "most extremely anxious". | 16 weeks |
| Mean change in level of cognitive impairment | Mean change, from the last two weeks of the baseline phase (weeks 3-4) to the last two weeks of the intervention phase (weeks 15-16), in the 2-week average of daily self-reported level of cognitive impairment on an 11-level scale (based on the FIQR item), where 0 is "no cognitive impairment at all" and 10 is "most severe impairment". | 16 weeks |
| Mean change in level of cognitive presenteeism | Mean change, from the last two weeks of the baseline phase (weeks 3-4) the the last two weeks of the intervention phase (weeks 15-16), in the 2-week average daily self-reported occurrence of presenteeism on a dichotomous answer (based on the FIQR item), where 0 is "No, I felt as productive as usual at work (or school)" and 1 is "Yes, I felt greatly unproductive at work (or school). | 16 weeks |
| Mean reduction of at least 30% in pain level | Percentage of patients with average reduction of 30% or more in pain intensity (NRS) - from the last two weeks of the baseline phase (weeks 3-4) the the last two weeks of the intervention phase (weeks 15-16). | 16 weeks |
| Rate of treatment tolerability | Percentage of participants who indicated that the treatment was well tolerated or above, according to a multiple-choice question filled out at the end of the study (end of OLE/ upon withdrawal). | 28 weeks |
| User experience | Percentage of participants that reported a positive user experience, based on the self-report user experience questions. | 28 weeks |
| Patient Global Impression- change (PGI-C | Percentage of patients with an 'improved' PGI-C score at the end of week 12 of the intervention phase. | 28 weeks |
| Patient Global Impression- change (PGI-C)- mid study: | Percentage of patients with an 'improved' PGI-C score at the mid-intervention phone call follow-up. | 16 weeks |
| ClinVest Headlands Research | Recruiting | Springfield | Missouri | 65807 | United States |
|
| Gershon Pain Specialists | Recruiting | Virginia Beach | Virginia | 23454 | United States |
|
| Tel Aviv Sourasky Medical Center | Not yet recruiting | Tel Aviv | 6423906 | Israel |
|
| D009422 |
| Nervous System Diseases |