Primary 3-Month Outcomes of a Double-Blind Randomized Prospective Study

• Published in: Journal of pain research Vol. 17
• Main Authors: Eidt, John, Petersen, Erika A, Garrett, H. Edward, Jr, Guirguis, Maged, Mekhail, Nagy, Rhee, Peter C, Wu, Jiang, Slavin, Konstantin V, Kapural, Leonardo, Sigdel, Abindra, Kim, Billy, Elshihabi, Said, Melton, Jim, Barolat, Giancarlo, Bautista, Alexander, Veizi, Elias, Schwalb, Jason Matthew, Mehta, Priyesh, Rajani, Ravi R
• Format: Journal Article
• Language: English
• Published: Dove Medical Press Limited 30.06.2024
• Subjects: Amputation; Analysis; Care and treatment; Pain; Safety and security measures
• ISSN: 1178-7090; 1178-7090

Purpose: This multicenter, randomized, double-blinded, active sham-controlled pivotal study was designed to assess the efficacy and safety of high-frequency nerve block treatment for chronic post-amputation and phantom limb pain. Patients and Methods: QUEST enrolled 180 unilateral lower-limb amputees with severe post-amputation pain, 170 of whom were implanted with the Altius device, were randomized 1:1 to active-sham or treatment groups and reached the primary endpoint. Responders were those subjects who received [greater than or equal to]50% pain relief 30 min after treatment in [greater than or equal to]50% of their self-initiated treatment sessions within the 3-month randomized period. Differences between the active treatment and sham control groups as well as numerous secondary outcomes were determined. Results: At 30-min, (primary outcome), 24.7% of the treatment group were responders compared to 7.1% of the control group (p=0.002). At 120-minutes following treatment, responder rates were 46.8% in the Treatment group and 22.2% in the Control group (p=0.001). Improvement in Brief Pain Inventory interference score of 2.3 [+ or -] 0.29 was significantly greater in treatment group than the 1.3 [+ or -] 0.26-point change in the Control group (p = 0.01). Opioid usage, although not significantly different, trended towards a greater reduction in the treatment group than in the control group. The incidence of adverse events did not differ significantly between the treatment and control groups. Conclusion: The primary outcomes of the study were met, and the majority of Treatment patients experienced a substantial improvement in PAP (regardless of meeting the study definition of a responder). The significant in PAP was associated with significantly improved QOL metrics, and a trend towards reduced opioid utilization compared to Control. These data indicate that Altius treatment represents a significant therapeutic advancement for lower-limb amputees suffering from chronic PAP. Keywords: post-amputation pain, phantom limb pain, neuromodulation, peripheral nerve stimulation, high-frequency nerve block