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Kryoneurolyse bei schmerzhafter diabetischer Neuropathie des Fußes
Our objective is to investigate the therapeutic benefits of cryoneurolysis for research participants with painful diabetic neuropathy of the feet via a pilot study of 30 research participants. We hypothesize that ultrasound-guided cryoneurolysis of the superficial peroneal nerve will improve pain outcomes in research participants with painful diabetic neuropathy of the foot. The aims of this study will be to:
Primary Specific Aim. Demonstrate the potential efficacy of ultrasound-guided percutaneous cryoneurolysis of the superficial peroneal nerve, sural, distal saphenous, and/or deep peroneal nerve to treat painful diabetic neuropathy of the foot in reducing neuropathic pain 1 month after the procedure compared to baseline. This will be performed as a pilot study and executed as a randomized sham-controlled clinical trial of 30 subjects.
Hypothesis 1: Diabetic neuropathic pain intensity will be decreased relative to baseline 1 month following a cryoneurolysis procedure (as measured by the Neuropathic Pain Scale).
Secondary Specific Aim: To test the influence of a cryoanalgesia treatment as compared to sham/placebo on the long term measurements related to pain, quality of life, and analgesic usage.
Hypothesis 2a: Perception of well-being will be improved 1 month following one cryoneurolysis procedure (as measured with the Patient Global Impression of Change Scale).
Hypothesis 2b: Physical and emotional functioning will be improved relative to baseline 1 month following one cryoneurolysis procedure (as measured with the Interference Subscale of the Brief Pain Inventory).
Hypothesis 2c: Pain and opioid consumption will be reduced in the cryoneurolysis group compare to sham at multiple post-procedure time points, including 1 week, 1 month, 3 months, and 6 months after.
Ultrasound-guided Percutaneous Cryoneurolysis for Management of Chronic Painful Diabetic Neuropathy: A Randomized Sham-controlled Pilot Study
- Yoon JH, Grechushkin V, Chaudhry A, Bhattacharji P, Durkin B, Moore W. Cryoneurolysis in Patients with Refractory Chronic Peripheral Neuropathic Pain. J Vasc Interv Radiol. 2016 Feb;27(2):239-43. doi: 10.1016/j.jvir.2015.11.027. Epub 2015 Dec 17.
- Jay GW, Barkin RL. Neuropathic pain: etiology, pathophysiology, mechanisms, and evaluations. Dis Mon. 2014 Jan;60(1):6-47. doi: 10.1016/j.disamonth.2013.12.001. No abstract available.
- Gabriel RA, Seng EC, Curran BP, Winston P, Trescot AM, Filipovski I. A Narrative Review of Ultrasound-Guided and Landmark-based Percutaneous Cryoneurolysis for the Management of Acute and Chronic Pain. Curr Pain Headache Rep. 2024 Nov;28(11):1097-1104. doi: 10.1007/s11916-024-01281-z. Epub 2024 Jul 4.
- Filipovski I, Gabriel RA, Kestenholz R. Ultrasound-Guided Cryoneurolysis for the Treatment of Painful Diabetic Neuropathy of the Foot: A Case Series. Cureus. 2024 Mar 16;16(3):e56267. doi: 10.7759/cureus.56267. eCollection 2024 Mar.
- 811212
Diabetic Peripheral Neuropathy of the Foot
Chronic Pain
Ultrasound-Guided Percutaneous Cryoneurolysis
| Teilnehmergruppe/Studienarm | Intervention/Behandlung |
|---|---|
Aktives VergleichspräparatCryoneurolysis For participants randomized to active treatment, the probe placed in the research participant will be triggered and the nitrous oxide passed through the probe and then back into the machine, and finally vented out from the console. This will result in a freeze-thaw cycle. This may be repeated, as necessary, to ensure the entire cross-section of each nerve is fully treated. | Kryoneurolyse Peripheral nerve cryoneurolysis of the foot |
Schein-VergleichspräparatSham Patients in this arm will also receive a diagnostic block with local anesthetic. If pain relief is satisfactory, the patients in this arm will undergo the procedure but the cryo probe will simply not be activated. | Sham Cryoneurolysis a sham probe will be placed percutaneously proximal to target nerves. No cryoneurolysis will be given. |
| Ergebnismessung | Beschreibung der Messung | Zeitrahmen |
|---|---|---|
Pain Intensity | Change in pain intensity compared to baseline due to diabetic neuropathy of the foot as measured by the score of the Neuropathic Pain Scale. The primary outcome will be at 1 month following the study procedure. The primary statistic will be comparing the median change in the neuropathic pain scale score between both cohorts. | 1 month |
| Ergebnismessung | Beschreibung der Messung | Zeitrahmen |
|---|---|---|
Perception of Well-Being | Perception of well-being will be improved 1 month following one cryoneurolysis procedure (as measured with the Patient Global Impression of Change Scale). | 1 month |
Physical and Emotional Functioning | Physical and emotional functioning will be improved relative to baseline 1 month following one cryoneurolysis procedure (as measured with the Interference Subscale of the Brief Pain Inventory). | 1 month |
Pain intensity - 1 month | Pain intensity as measured by Brief Pain Inventory | 1 month |
Pain Intensity - 1 week | Pain intensity as measured by Neuropathic Pain Scale and Brief Pain Inventory) | 1 week |
Pain Intensity - 3 months | Pain intensity as measured by the Brief Pain Inventory and Neuropathic Pain Scale | 3 months |
Pain Intensity - 6 months | Pain intensity as measured by the Brief Pain Inventory and Neuropathic Pain Scale | 6 months |
Opioid consumption - 1 week | opioid consumption as measured by the Quantitative Analgesic Questionnaire | 1 week |
Opioid consumption - 1 month | opioid consumption as measured by the Quantitative Analgesic Questionnaire | 1 month |
Opioid consumption - 3 months | opioid consumption as measured by the Quantitative Analgesic Questionnaire | 3 months |
Opioid consumption - 6 months | opioid consumption as measured by the Quantitative Analgesic Questionnaire | 6 months |
- Research participants with diabetes mellitus and painful diabetic neuropathy of the foot (unilateral or bilateral)
- HgbA1c <10 (to avoid any increased risk of site infection)
- Adult patients of at least 18 years of age
- Experiencing at least moderate diabetic neuropathic pain in the foot - defined as 3 or higher on the numeric rating scale (NRS; 0-10, 0=no pain; 10=worse imaginable pain) - at least daily for the previous 2 months.
- Diabetic neuropathy not in the distribution of the superficial peroneal nerve, sural nerve, deep peroneal, and/or distal saphenous nerve.
- Comorbidities that are contraindication to cryoneurolysis (e.g., Reynaud syndrome, cryoglobulinemia, cold urticaria)
- Allergy to local anesthetic
- Pregnancy
- Incarceration
- Inability to communicate to investigators due to lack of capacity
- Local infection in the foot/ankle where cryoneurolysis will be performed
California