Ignite Creation Date:
2024-05-06 @ 6:28 PM
Last Modification Date:
2024-10-26 @ 2:48 PM
Study NCT ID:
NCT05674604
Status:
RECRUITING
Last Update Posted:
2024-06-14
First Post:
2022-12-09
Brief Title:
Cryoneurolysis for Knee and Shoulder Pain in an Inpatient Setting
Sponsor:
Vancouver Island Health Authority
Organization:
Vancouver Island Health Authority
Study Overview
Official Title:
Cryoneurolysis as a Drug Free Novel Treatment for Knee and Shoulder Pain Impairing Inpatient Neurological Rehabilitation
Status:
RECRUITING
Status Verified Date:
2024-06
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
The purpose of the study is to measure the outcomes of a standard care an ultrasound guided mini-invasive percutaneous procedure performed on recent stroke patients on reduces pain increases function quality of life
The primary objective of the project is to reduce shoulder andor knee pain in patients who have had a stroke so that they can more readily engage in rehabilitation
Secondary objectives are to reduce analgesic medications increase independence and improve range of motion to promote non-drug treatment measures in the medical toolkit and to include an interdisciplinary care team in patient selection for interventions
The primary objective of the project is to reduce shoulder andor knee pain in patients who have had a stroke so that they can more readily engage in rehabilitation
Secondary objectives are to reduce analgesic medications increase independence and improve range of motion to promote non-drug treatment measures in the medical toolkit and to include an interdisciplinary care team in patient selection for interventions
Detailed Description:
Hemiplegic shoulder pain HSP is the most common pain disorder after stroke and one of the four most common complications The estimated incidence ranges from of 30-70 HSP is associated with reductions in function interference with rehabilitation efforts and a reduced quality of life Onset of HSP is rapid occurring as soon as a week after stroke in 17 of patientsWhile ubiquitous the management of HSP represents a complex treatment pathway that has insufficient evidence supporting one particular treatment
The pain associated with HSP may be due to heterogeneous causes In the acute setting decreased ROM in the shoulder may represent several processes including the early onset of spasticity capsular pattern stiffness glenohumeral pathology or a component of complex regional pain syndrome CRPS Effective management of the HSP with decreased ROM requires assessment of each possible contributor The suprascapular nerve provides up to 70 of the sensory fibers to the shoulder Targeting the suprascapular nerve to reduce pain from stroke has been study with both nerve blocks and radiofrequency ablation Cryoneurolysis to treat shoulder pain has also been proposed in recent years
The lack of early recognition and treatment of HSP can lead to worsening limb function increased pain and may impair the rehabilitation and recovery process Early intervention may reduce the risk and onset of contracture which can lead to significant impairments and a reduced quality of life The incidence of developing at least one contracture in stroke patients within six months of their stroke is estimated at 52Contractures are a source of pain and limited ROM and limit function while stretching has not been shown to be clinically effective Patients with contractures and limited volitional control of their shoulder muscles can experience maceration skin dehiscence impaired hygiene and difficulty dressing thus more invasive surgery may be required
Knee osteoarthritis is ubiquitous in the aging population Many stroke patients may have been pre-stroke poor candidates for a total knee arthroplasty due to medical frailty Participants recovering from stroke with pre-existing arthritis perceived that their arthritis held them back from an expected stroke recovery trajectoryIn this study This slowed stroke recovery was attributed to daily pain frustration mobility limitations and the required extra coping due to arthritis As a result comorbid arthritis increased the complexity of stroke recovery and rehabilitation
This group has been global pioneers in the use of cryoneurolysis to treat spasticityThe process first involves isolating the nerves with ultrasound guidance and e-stimulation for motor nerves A diagnostic nerve block is then performed to assess if spasticity is reduced and range of motion and ease of movement occurs as well as pain reduction After a successful nerve block the patient then goes on to have cryoneurolysis which is performed using a small 12 to 13 mm diameter cryoprobe that is inserted percutaneously to targeted peripheral nerves It has an established history over more than fifty years for lasting pain relief from months to years when used for sensory nerves Cryoneurolysis is possible due to the process of throttling a gas through an orifice from high to low pressure resulting in a rapid expansion of the gas and a drop in temperature known as the Joule-Thomson effect The rapid cooling generates an ice ball or oval between 35 and 18 mm that is formed at the tip of the with compressed CO2 or N2O at temperatures typically between -60 to -88 C The ball or oval creates a targeted zone of axon and myelin disruption This results in loss of axon continuity due to Wallerian degeneration of the targeted nerve extending outward from the lesion over a limited distance However the basal lamina epineurium and perineurium of the targeted nerve remain intact and serve as a conduit or tube for neural regeneration
Development of the ViVe algorithm to create a team based assessment tool to isolate the sources of Hemiplegic pain This allows us to select patient that would benefit from cryoneurolysis to both the suprascapular nerve as well as the nerves to the spasticity muscles of the upper limb Similarly cryoneurolysis has been shown to be effective in managing osteoarthritis a limiting factor for stroke rehabilitation
There are 50000 new strokes in Canada every year Direct costs for 12-month stroke survivors are 4 times higher than direct costs for patients with stroke without spasticity during the first year after the event
It has been demonstrating that cryoneurolysis has long lasting effects Over 100 patients mostly with chronic neurologic disorders received cryoneurolysis as a part of their standard care in this center and their outcomes are being measured and assessed The number of these patients exceeding rapidly and it is essential to assess treating patients much earlier in acute phase to assess the reduction in pain disability and lengths of stay
PURPOSE The purpose of this study is to measure the outcomes of a standard care procedure called cryoneurolysis This will include any changes in pain and spasticity in an inpatient setting and for adult patients with an acute neurological condition who suffer from Hemiplegic Shoulder Pain HSP and or osteoarthritis of the knee and will receive this procedure as a part of their treatment and based on available guidelines
The pain associated with HSP may be due to heterogeneous causes In the acute setting decreased ROM in the shoulder may represent several processes including the early onset of spasticity capsular pattern stiffness glenohumeral pathology or a component of complex regional pain syndrome CRPS Effective management of the HSP with decreased ROM requires assessment of each possible contributor The suprascapular nerve provides up to 70 of the sensory fibers to the shoulder Targeting the suprascapular nerve to reduce pain from stroke has been study with both nerve blocks and radiofrequency ablation Cryoneurolysis to treat shoulder pain has also been proposed in recent years
The lack of early recognition and treatment of HSP can lead to worsening limb function increased pain and may impair the rehabilitation and recovery process Early intervention may reduce the risk and onset of contracture which can lead to significant impairments and a reduced quality of life The incidence of developing at least one contracture in stroke patients within six months of their stroke is estimated at 52Contractures are a source of pain and limited ROM and limit function while stretching has not been shown to be clinically effective Patients with contractures and limited volitional control of their shoulder muscles can experience maceration skin dehiscence impaired hygiene and difficulty dressing thus more invasive surgery may be required
Knee osteoarthritis is ubiquitous in the aging population Many stroke patients may have been pre-stroke poor candidates for a total knee arthroplasty due to medical frailty Participants recovering from stroke with pre-existing arthritis perceived that their arthritis held them back from an expected stroke recovery trajectoryIn this study This slowed stroke recovery was attributed to daily pain frustration mobility limitations and the required extra coping due to arthritis As a result comorbid arthritis increased the complexity of stroke recovery and rehabilitation
This group has been global pioneers in the use of cryoneurolysis to treat spasticityThe process first involves isolating the nerves with ultrasound guidance and e-stimulation for motor nerves A diagnostic nerve block is then performed to assess if spasticity is reduced and range of motion and ease of movement occurs as well as pain reduction After a successful nerve block the patient then goes on to have cryoneurolysis which is performed using a small 12 to 13 mm diameter cryoprobe that is inserted percutaneously to targeted peripheral nerves It has an established history over more than fifty years for lasting pain relief from months to years when used for sensory nerves Cryoneurolysis is possible due to the process of throttling a gas through an orifice from high to low pressure resulting in a rapid expansion of the gas and a drop in temperature known as the Joule-Thomson effect The rapid cooling generates an ice ball or oval between 35 and 18 mm that is formed at the tip of the with compressed CO2 or N2O at temperatures typically between -60 to -88 C The ball or oval creates a targeted zone of axon and myelin disruption This results in loss of axon continuity due to Wallerian degeneration of the targeted nerve extending outward from the lesion over a limited distance However the basal lamina epineurium and perineurium of the targeted nerve remain intact and serve as a conduit or tube for neural regeneration
Development of the ViVe algorithm to create a team based assessment tool to isolate the sources of Hemiplegic pain This allows us to select patient that would benefit from cryoneurolysis to both the suprascapular nerve as well as the nerves to the spasticity muscles of the upper limb Similarly cryoneurolysis has been shown to be effective in managing osteoarthritis a limiting factor for stroke rehabilitation
There are 50000 new strokes in Canada every year Direct costs for 12-month stroke survivors are 4 times higher than direct costs for patients with stroke without spasticity during the first year after the event
It has been demonstrating that cryoneurolysis has long lasting effects Over 100 patients mostly with chronic neurologic disorders received cryoneurolysis as a part of their standard care in this center and their outcomes are being measured and assessed The number of these patients exceeding rapidly and it is essential to assess treating patients much earlier in acute phase to assess the reduction in pain disability and lengths of stay
PURPOSE The purpose of this study is to measure the outcomes of a standard care procedure called cryoneurolysis This will include any changes in pain and spasticity in an inpatient setting and for adult patients with an acute neurological condition who suffer from Hemiplegic Shoulder Pain HSP and or osteoarthritis of the knee and will receive this procedure as a part of their treatment and based on available guidelines
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None