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Trial registered on ANZCTR
Registration number
ACTRN12613000549729
Ethics application status
Approved
Date submitted
23/04/2013
Date registered
15/05/2013
Date last updated
17/05/2013
Type of registration
Prospectively registered
Titles & IDs
Public title
Radiofrequency Treatment of Phantom and Residual Limb Pain in Persons with a Lower Limb Amputation: A Randomised Double Blinded Control Trial
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Scientific title
Radiofrequency Treatment of Phantom and Residual Limb Pain in Persons with a Lower Limb Amputation: A Randomised Double Blinded Control Trial.
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Secondary ID [1]
282391
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Nil
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Phantom and Residual Limb Pain in Persons with a Lower Limb Amputation
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Condition category
Condition code
Anaesthesiology
289310
289310
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0
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Pain management
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Physical Medicine / Rehabilitation
289479
289479
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0
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Other physical medicine / rehabilitation
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Pulsed Radiofrequency Treatment (PRF)
This will be delivered via percutaneous radio frequency needle which will be inserted under ultrasound guidance with the tip positioned next to the neuroma.
PRF will be performed at a frequncy of 2Hz, 20msec pulses in a 1 second cycle of 120 seconds duration at a temperature of 42 C. This will be repeated three times whilst the needle is rotated until a 360 degree area of neuroma is covered.
Before the needle is removed, a 2mL mixture of 1.5mL 1% lignocaine and 0.5mL Celestone will be injected around the neuroma.
The estimated total duration of the procedure will be 30 minutes.
There will be one treatment session.
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Intervention code [1]
287024
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Treatment: Devices
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Comparator / control treatment
Same radiofrequency needle will be inserted under ultrasound guidance.
No pulsed radiofrequency will be delivered through the needle.
Before the needle is removed, a 2mL mixture of 1.5mL 1% lignocaine and 0.5mL Celestone will be injected.
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Control group
Placebo
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Outcomes
Primary outcome [1]
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Brief Pain Inventory (BPI) including Verbal Numerical Rating Score (VNRS)
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Assessment method [1]
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Timepoint [1]
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1 week, 4 weeks, 12 weeks post intervention
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Primary outcome [2]
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Depression Anxiety Stress Scale (DASS)
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Assessment method [2]
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Timepoint [2]
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1 week, 4 weeks, 12 weeks post intervention
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Primary outcome [3]
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Trinity Amputation and Prosthesis Experience Scale-Revised (TAPES-R)
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Assessment method [3]
289421
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Timepoint [3]
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1 week, 4 weeks, 12 weeks post intervention
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Secondary outcome [1]
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The Patient Global Expression of Pain (PGIC) Scale
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Assessment method [1]
302438
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Timepoint [1]
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1 week, 4 weeks, 12 weeks post intervention
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Secondary outcome [2]
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Short-Form MacGill Pain Questionnaire
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Assessment method [2]
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Timepoint [2]
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1 week, 4 weeks, 12 weeks post intervention
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Secondary outcome [3]
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Healthcare Utilisation (Information about medical attendance/s will be asked and recorded)
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Assessment method [3]
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Timepoint [3]
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1 week, 4 weeks, 12 weeks post intervention
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Eligibility
Key inclusion criteria
Inclusion criteria will be age >18, at least 1 major amputation above the ankle, the presence of persistent residual limb or phantom limb pain for at least 3 months with a peripheral trigger clinically +/- ultrasound (US) confirmation
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Exclusion criteria are previous radiofrequency denervation of neuroma, contraindications to steroid, local anaesthetic and sedative agent administration, bleeding dyscrasias, immunosuppression, concomitant active infection of the procedure site or systemic infection, fragile residual limb skin prone to non-healing and breakdown, and severe cognitive impairment
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Sealed opaque envelops will be used for allocation concealment.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Participants will be randomly assigned to receive percutaneous PRF neurotomy or the same procedure without effective neurotomy using a computer-generated randomisation schedule
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
Based on a power of 80% and a two-tailed alpha of 0.05, the sample size required for the present study will be 30 per group for a total of 60 patients to detect a standardised difference of 0.75.
Two-way repeated measures analysis of variance (ANOVA) with Tukey tests for multiple comparisons will be used to compare the changes from baseline VNRS pain scores among baseline, post-procedure 1, 4, and 12 weeks. To compare the differences of VAS pain scores and satisfaction between groups, the Mann–Whitney U test will be used at each time point. To compare patients’ characteristics variables,
the Fisher’s exact test will be used for sex, treatment sites. The unpaired t-test will be used for body weight, height, body mass index, duration. Data analysis will be performed using SPSS 11.0 for window (SPSS Inc) on a personal computer. Values will be estimated as mean +/- standard deviation. A P value of <0.05 will be taken to indicate a significant difference.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
4/06/2013
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
60
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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Royal Melbourne Hospital - City campus - Parkville
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Recruitment hospital [2]
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Royal Melbourne Hospital - Royal Park campus - Parkville
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Recruitment hospital [3]
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Western Hospital - Footscray
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Recruitment postcode(s) [1]
6798
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3050 - Royal Melbourne Hospital
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Recruitment postcode(s) [2]
6799
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3052 - Parkville
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Funding & Sponsors
Funding source category [1]
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Hospital
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Name [1]
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The Royal Melbourne Hospital
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Address [1]
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Grattan Street
Parkville, VIC
3050
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Country [1]
287163
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Australia
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Primary sponsor type
Hospital
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Name
The Royal Melbourne Hospital
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Address
Grattan Street
Parkville
VIC 3050
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
285930
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Address [1]
285930
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Country [1]
285930
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
289160
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Melbourne Health
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Ethics committee address [1]
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Grattan Street Parkville, VIC 3050
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Ethics committee country [1]
289160
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Australia
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Date submitted for ethics approval [1]
289160
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Approval date [1]
289160
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04/12/2012
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Ethics approval number [1]
289160
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2012.090
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Summary
Brief summary
Multicentre randomised double-blinded sham-lesion control trial to evaluate the role and effectiveness of pulsed radiofrequency treatment (PRF) of a peripheral nociceptive trigger (i.e. neuroma) in the management of phantom and residual limb pain. Participants will be recruited through the Victorian Artificial Limb Program Outpatient Clinic at Royal Park Campus RMH. Eligible patients will undergo perineuromal injections with local anaesthetic performed under ultrasound. Responses will be recorded as positive if the participant experiences a decrease in pain intensity of at least 50%. Patients with a positive response will proceed to PRF or placebo assigned in a random manner. Participants will be followed up at 1 week, 4 weeks and 3 months. Measures of pain intensity (BPI), pain quality (SF MacGill Pain Questionaire), physical functioning (BPI), emotional functioning (DASS), patients global rating of improvement and satisfaction (PGIC), health-related quality of life, prosthetic use (TAPES-R), healthcare utilisation will be obtained at each review.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Kevin Young
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Address
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Royal Park Campus, Royal Melbourne Hospital
34-54 Poplar Rd
Parkville, VIC 3052, Australia
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Country
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Australia
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Phone
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+61 3 8387 2194
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Kevin Young
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Address
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Royal Park Campus, Royal Melbourne Hospital
34-54 Poplar Rd
Parkville, VIC 3052, Australia
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Country
39531
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Australia
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Phone
39531
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+61 3 8387 2194
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Fax
39531
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Email
39531
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[email protected]
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Contact person for scientific queries
Name
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Kevin Young
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Address
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Royal Park Campus, Royal Melbourne Hospital
34-54 Poplar Rd
Parkville, VIC 3052, Australia
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Country
39532
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Australia
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Phone
39532
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+61 3 8387 2194
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Fax
39532
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Email
39532
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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