By Ted Swing, Ph.D
New treatments for many different medical conditions are being developed, tested, and approved all the time through the process of clinical research. We feel this research is incredibly important, and we are committed to advancing the practice of pain medicine by taking part in clinical trials. This means enrolling and treating certain selected patients and following up their progress for a specified period of time. We currently have several actively recruiting clinical trials.
Stem Cell Low Back Pain Study
Low back pain is the most common chronic pain condition. There are several different causes, such as degeneration of the bones in the spine, misalignment of the vertebrae or the bulging of an intervertebral disc. In other cases, a disc becomes degenerated and begins to cause pain. This can be associated with a distinct event such as an injury, but in many cases there is no clear cause. This condition, degenerative disc disease, is a common form of back pain, but it has proven difficult to treat effectively.
One promising new line of research involves treating this condition with an injection of stem cells into the degenerated disc. Adult bodies contain stem cells that play an important role in rebuilding damaged tissues, but these cells are not normally able to reach the inside of the disc. The sponsor of an ongoing clinical trial has developed a process for separating the stem cells from the bone marrow of healthy adult donors and allowing them to multiply. These stem cells can then be injected into a degenerated disc. Some early evidence indicates that this can restore the degenerated disc to a healthy state, alleviating pain. This treatment is being assessed in a clinical trial in which qualified patients are randomly assigned to receive a single injection into a degenerated disc of either stem cells, stem cells plus hyaluronic acid, or saline.
Complex Regional Pain Syndrome Research Study
In most cases when a person suffers an injury to an extremity, such as a sprain or a broken bone, the injury heals over time and the pain decreases. In certain rare cases, though, the injury triggers a process beginning with unusual sympathetic nervous system activity. This process can lead to a condition known as complex regional pain syndrome (or CRPS). Instead of becoming less painful over time, the injured limb becomes more painful and undergoes changes in color, temperature and sensitivity. This condition is complex and can be difficult to treat.
One of the promising methods for treating CRPS is a class of drugs called bisphosphonates. These drugs are widely used for treating bone conditions. We are taking part in a clinical trial that is ongoing in the U.S. and Europe of a bisphosphonate called neridronate for the treatment of CRPS. In this study, qualifying patients receive four intravenous infusions of either neridronate or saline over a period of a couple of weeks. A previous study found that patients experienced significant relief of their CRPS symptoms a year after receiving such infusions.
Amputation Pain Study
Patients who have undergone the amputation of a foot or leg sometimes continue to experience chronic pain, either in the stump of the amputated limb or phantom limb pain (pain perceived to be in the missing portion of the amputated limb). In cases where this pain does not respond to other treatments, it is sometimes treated with implanted devices called neurostimulators. These devices work by delivering electrical stimulation to the nerves that blocks out much of the pain signals that would be sent to the brain. The current standard neurostimulation devices deliver stimulation at a low to moderate frequencies that produces a mild tingling sensation in the targeted area.
We are currently working on a clinical trial testing a new type of neurostimulation device. This device delivers high frequency stimulation (10,000 Hz), which generally produces no sensation in the targeted limb at all. Some early research suggests that high frequency stimulation can be even more effective in alleviating pain. The current clinical trial is testing the device in patients who have had an amputation of a single lower limb that is causing them chronic pain. Qualifying patients will have this new device implanted. For a three-month period, half of these patients will receive high frequency stimulation and half will receive control stimulation. After that period, all implanted patients will have their device adjusted to deliver the high frequency stimulation as follow up continues.
If you are interested in learning more about one of these studies and whether you might qualify for it, you can discuss this study with your pain management providers. For additional information about this study you can contact me directly at TedS@arizonapain.com.
Ted Swing has more than 11 years of research experience in psychology and pain medicine and four years of teaching experience, has published in top psychology and medical journals, and has presented his research at major conferences. He received his Ph.D. in Social Psychology from Iowa State University and has been the Research Director at Arizona Pain since May 2012.
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