A Randomised, Single-blind, Sham-controlled, Crossover Pilot Study Assessing the Effect of Non-invasive Vagus Nerve Stimulation (nVNS) on Autonomic Symptoms and Pain Management in Patients With Chronic Musculoskeletal Pain and Autonomic Dysfunction
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 12
- 试验地点
- 1
- 主要终点
- Composite Autonomic Symptom Score-31 (COMPASS-31) total score
研究概览
简要总结
Chronic musculoskeletal (MSK) pain affects an estimated 20-33% of the global population and is frequently associated with autonomic nervous system dysfunction, characterised by symptoms such as orthostatic intolerance, palpitations, gastrointestinal dysmotility, and fatigue. Conventional treatments often fail to address this autonomic component, limiting their effectiveness. This pilot study investigates whether non-invasive vagus nerve stimulation (nVNS) using the gammaCore Sapphire device can reduce autonomic symptom severity and improve pain in adults with chronic MSK pain and confirmed autonomic dysfunction.
RESTORE-MSK is a randomised, single-blind, sham-controlled, crossover pilot study. Twelve participants with chronic MSK pain (lasting 12 weeks or longer) and autonomic dysfunction (COMPASS-31 score of 17 or more) will be recruited from musculoskeletal clinics at Chapel Allerton Hospital, Leeds. Participants will be randomly allocated to receive either active nVNS or sham stimulation first, followed by a 2-week washout period, then crossover to the alternative treatment. Each treatment period lasts 14 days, with participants self-administering the device twice daily (morning and evening).
The primary outcome is change in autonomic symptom severity measured by the Composite Autonomic Symptom Score-31 (COMPASS-31). Secondary outcomes include physiological response to the NASA Lean Test, pain severity and interference (Brief Pain Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), quality of life (EQ-5D-5L), intervention acceptability, and recruitment feasibility.
This pilot study aims to establish feasibility and proof of concept for a larger randomised controlled trial investigating nVNS as a non-pharmacological treatment option for chronic MSK pain with autonomic dysfunction.
详细描述
BACKGROUND: Musculoskeletal pain affects approximately 1.75 billion individuals worldwide. In the United Kingdom alone, chronic pain is reported in at least 28 million individuals. Chronic musculoskeletal pain (CMP) may arise from physical injury, muscular overuse, inflammatory processes, or degenerative changes, and is frequently associated with comorbid conditions such as fibromyalgia, osteoarthritis, and rheumatoid arthritis.
Emerging evidence suggests that autonomic dysfunction (AD), described as altered sympathetic nervous system reactivity, has been implicated in the pathogenesis of chronic pain. Despite this, conventional therapies often fail to address the autonomic component. Non-invasive vagus nerve stimulation (nVNS) offers a non-pharmacological means to influence autonomic tone and central pain processing, with studies demonstrating analgesic effects across conditions including fibromyalgia, chronic pelvic pain, and migraine.
The GammaCore device is a CE-marked, non-invasive vagus nerve stimulator approved for primary headaches and supported by NICE for migraine and cluster headache treatment. However, its therapeutic potential in chronic MSK pain with autonomic dysfunction remains underexplored.
STUDY DESIGN: This is a randomised, single-blind, sham-controlled, crossover pilot study conducted at a single site (Chapel Allerton Hospital, Leeds). The crossover design allows each participant to serve as their own control, enhancing statistical efficiency in this small feasibility study.
INTERVENTION: Participants will self-administer the GammaCore device bilaterally under the angle of the mandible, guided by the carotid pulse. Each stimulation consists of a two-minute application per side. Participants will complete two stimulations per day (morning and evening) for two 14-day treatment periods, separated by a 2-week washout period. The same device is used with intensity set at subtherapeutic level.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Treatment
- 盲法
- Single (Participant)
盲法说明
Participants are blinded to treatment allocation. The same gammaCore Sapphire device is used for both conditions, with intensity adjusted to therapeutic or subtherapeutic levels. A blinding assessment will be conducted at study completion.
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Individuals diagnosed with musculoskeletal (MSK) conditions and currently experiencing MSK pain lasting for 12 weeks or longer, in line with the ICD-11 criteria for chronic pain.
- •Identified as having autonomic dysfunction (AD) defined as a score of 17 or more on the Composite Autonomic Symptom Score-31 (COMPASS-31) questionnaire.
- •Ability to understand and willingness to sign a written informed consent document.
- •Stated willingness to comply with all study procedures and be available for the duration of the study (approximately 6 weeks).
- •Ability to read and understand English sufficiently to complete study questionnaires.
排除标准
- •Pregnancy (self-reported; safety of nVNS in pregnancy not established).
- •Advanced heart disease, including: severe heart failure (NYHA Class III-IV), myocardial infarction within the preceding 6 months, or ongoing investigations for cardiac arrhythmias.
- •Use of an active implantable medical device, including: cardiac pacemaker, implantable cardioverter-defibrillator (ICD), cochlear implant, hearing aid implant, or any other implanted electronic device.
- •Concurrent use of another electrical stimulation device, including: transcutaneous electrical nerve stimulation (TENS) unit, muscle stimulator, or any other portable electronic stimulation device.
- •Inability to provide informed consent.
研究组 & 干预措施
Arm 1: Active nVNS then Sham
Participants receive active vagus nerve stimulation (intervention)(Days 1-14) followed by 2-week washout (Days 15-28), then subtherapeutic (sham) stimulation (Days 29-42).
干预措施: Subtherapeutic Stimulation (Sham Control) (Device)
Arm 1: Active nVNS then Sham
Participants receive active vagus nerve stimulation (intervention)(Days 1-14) followed by 2-week washout (Days 15-28), then subtherapeutic (sham) stimulation (Days 29-42).
干预措施: Active Vagus Nerve Stimulation (Device)
Arm 2: Sham then Active nVNS
Participants receive subtherapeutic (sham) stimulation (Days 1-14) followed by 2-week washout (Days 15-28), then active vagus nerve stimulation (intervention)(Days 29-42).
干预措施: Active Vagus Nerve Stimulation (Device)
Arm 2: Sham then Active nVNS
Participants receive subtherapeutic (sham) stimulation (Days 1-14) followed by 2-week washout (Days 15-28), then active vagus nerve stimulation (intervention)(Days 29-42).
干预措施: Subtherapeutic Stimulation (Sham Control) (Device)
结局指标
主要结局
Composite Autonomic Symptom Score-31 (COMPASS-31) total score
时间窗: Measured at baseline (Day 0), end of first treatment period (Day 15 ±2 days), end of washout/start of second treatment period (Day 28 ±2 days), and end of second treatment period/final visit (Day 43 ±2 days).
Description: The COMPASS-31 is a validated 31-item self-administered questionnaire measuring autonomic symptom severity across six domains: orthostatic intolerance, vasomotor, secretomotor, gastrointestinal, bladder, and pupillomotor symptoms. Each item is scored based on severity and frequency, with domain scores weighted and summed to produce a total score ranging from 0 to 100. Higher scores indicate greater autonomic dysfunction. The questionnaire will be modified to assess symptoms over the preceding 2 weeks (rather than the standard 1 year) to capture treatment effects within the study timeframe. Measurement: Self-reported questionnaire completed on paper or electronically via REDCap. Primary analysis will compare change from immediately pre-treatment to immediately post-treatment for active versus sham periods.
次要结局
- Positive overall response to the NASA Lean Test procedure(Measured at baseline (Day 0), end of first treatment period (Day 15 ±2 days, in-person visits only), end of washout (Day 28 ±2 days), and final visit (Day 43 ±2 days, in-person visits only).)
- Maximum increase in heart rate during NASA Lean Test procedure(Measured at baseline (Day 0), end of first treatment period (Day 15 ±2 days, in-person visits only), end of washout (Day 28 ±2 days), and final visit (Day 43 ±2 days, in-person visits only).)
- Brief Pain Inventory - Short Form (BPI-SF): Pain Severity Score(Measured at baseline (Day 0), end of first treatment period (Day 15 ±2 days), end of washout (Day 28 ±2 days), and final visit (Day 43 ±2 days).)
- Brief Pain Inventory - Short Form (BPI-SF): Pain Interference Score(Measured at baseline (Day 0), end of first treatment period (Day 15 ±2 days), end of washout (Day 28 ±2 days), and final visit (Day 43 ±2 days).)
- Hospital Anxiety and Depression Scale (HADS): Anxiety subscale score(Measured at baseline (Day 0), end of first treatment period (Day 15 ±2 days), end of washout (Day 28 ±2 days), and final visit (Day 43 ±2 days).)
- Hospital Anxiety and Depression Scale (HADS): Depression subscale score(Measured at baseline (Day 0), end of first treatment period (Day 15 ±2 days), end of washout (Day 28 ±2 days), and final visit (Day 43 ±2 days).)
- EuroQol EQ-5D-5L: Index value(Measured at baseline (Day 0), end of first treatment period (Day 15 ±2 days), end of washout (Day 28 ±2 days), and final visit (Day 43 ±2 days).)
- EuroQol EQ-5D-5L: Visual Analogue Scale (EQ-VAS)(Measured at baseline (Day 0), end of first treatment period (Day 15 ±2 days), end of washout (Day 28 ±2 days), and final visit (Day 43 ±2 days).)
- Intervention acceptability: Theoretical Framework of Acceptability (TFA) questionnaire(Measured once at final visit (Day 43 ±2 days).)
研究者
Darren Greenwood
Senior Lecturer in Biostatistics
University of Leeds