Clinical study of a micro-implantable pulse generator for the treatment of peripheral neuropathic pain: 12-month results from the COMFORT-randomized controlled trial.

IF 5.1 2区 医学 Q1 ANESTHESIOLOGY Regional Anesthesia and Pain Medicine Pub Date : 2024-11-20 DOI:10.1136/rapm-2024-106099
John Hatheway, Alexander Hersel, Mitchell Engle, Genaro Gutierrez, Vishal Khemlani, Leonardo Kapural, Gregory Moore, Reginald Ajakwe, Drew Trainor, Jennifer Hah, Peter S Staats, James Makous, Gary Heit, Shilpa Kottalgi, Mehul J Desai
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Abstract

Background: There is paucity of data from randomized controlled trials supporting the use of peripheral nerve stimulation, a well-established therapy for the treatment of chronic pain. This study was undertaken, in part, to provide randomized controlled trial data in support of patient access to appropriate peripheral nerve stimulation therapy. The COMFORT study is the first large, postmarket, multicenter randomized controlled trials investigating the use of a Food and Drug Administration-cleared micro-implantable pulse generator (IPG) for treating chronic pain via peripheral nerve stimulation therapy.

Methods: Consented, eligible subjects were randomized to either the active arm, which received peripheral nerve stimulation and conventional medical management, or the control arm, which received conventional medical management alone and were allowed to cross over to the active arm, after 3 months. Pain and patient-reported outcomes were captured. Therapy responders were subjects who achieved at least a 50% reduction in pain scores compared with baseline. We are reporting the 12-month results of this 36-month study.

Results: At 12 months, the responder rate was 87% with a 69% average reduction in pain compared with baseline (7.5±1.2 to 2.3±1.7; p<0.001). Statistical significance was achieved for all patient-reported outcomes. There was an excellent safety profile with no serious adverse device effects or reports of pocket pain. A majority of subjects used unique programming options and found this device easy to use and comfortable to wear.

Conclusions: These 12-month results are consistent with previously reported 6-month outcomes from this study, showing durability of peripheral nerve stimulation treatment with the micro-IPG system; subjects realized sustained large reduction in pain and improvement in patient-reported outcomes following treatment with this micro-IPG system.

Trial registration number: NCT05287373.

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治疗周围神经痛的微型植入式脉冲发生器临床研究:COMFORT 随机对照试验 12 个月的结果。
背景:外周神经刺激疗法是治疗慢性疼痛的一种行之有效的疗法,但支持这种疗法的随机对照试验数据却很少。开展这项研究的部分目的是提供随机对照试验数据,以支持患者获得适当的外周神经刺激疗法。COMFORT研究是首个大型的、上市后的多中心随机对照试验,该试验调查了使用经食品药品管理局批准的微型植入式脉冲发生器(IPG)通过外周神经刺激疗法治疗慢性疼痛的情况:经同意的合格受试者被随机分配到积极治疗组(接受外周神经刺激和常规药物治疗)或对照组(仅接受常规药物治疗,3 个月后可转入积极治疗组)。研究人员采集了疼痛和患者报告结果。与基线相比,治疗应答者的疼痛评分至少降低了 50%。我们报告的是这项为期 36 个月研究的 12 个月结果:结果:12 个月时,应答率为 87%,与基线相比,疼痛平均减轻 69%(7.5±1.2 到 2.3±1.7;p 结论:12 个月的结果与之前的研究结果一致:这些为期 12 个月的研究结果与之前报告的为期 6 个月的研究结果一致,显示了使用微型 IPG 系统进行周围神经刺激治疗的持久性;受试者在使用该微型 IPG 系统进行治疗后,疼痛持续大幅减轻,患者报告的结果也有所改善:NCT05287373.
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来源期刊
CiteScore
8.50
自引率
11.80%
发文量
175
审稿时长
6-12 weeks
期刊介绍: Regional Anesthesia & Pain Medicine, the official publication of the American Society of Regional Anesthesia and Pain Medicine (ASRA), is a monthly journal that publishes peer-reviewed scientific and clinical studies to advance the understanding and clinical application of regional techniques for surgical anesthesia and postoperative analgesia. Coverage includes intraoperative regional techniques, perioperative pain, chronic pain, obstetric anesthesia, pediatric anesthesia, outcome studies, and complications. Published for over thirty years, this respected journal also serves as the official publication of the European Society of Regional Anaesthesia and Pain Therapy (ESRA), the Asian and Oceanic Society of Regional Anesthesia (AOSRA), the Latin American Society of Regional Anesthesia (LASRA), the African Society for Regional Anesthesia (AFSRA), and the Academy of Regional Anaesthesia of India (AORA).
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