A Phase II, Randomized, Double-blind, Sham-Controlled Clinical Trial of Transcutaneous Electrical Nerve Stimulation (TENS) Therapy for the Treatment of Neuropathic Pain in Neuromyelitis Optica Spectrum Disorders (P13-5.005)

Abstract

<h3>Objective:</h3> To determine whether Transcutaneous Electrical Nerve Stimulation (TENS) therapy is a safe, tolerable, and effective therapy for neuropathic pain in patients with Aquaporin-4 (AQP4) IgG positive Neuromyelitis Optica Spectrum Disorders (NMOSD). <h3>Background:</h3> NMOSD is a chronic relapsing neuroinflammatory disorder that preferentially targets the optic nerves and spinal cord. Pain due to the longitudinally extensive spinal cord lesions seen in NMOSD is a frequent, disabling, and difficult to treat component of the disease with up to 91% of patients reporting symptoms of central neuropathic pain. TENS therapy is a non-invasive pain-modifying intervention that utilizes transcutaneous electrical stimulation of ascending sensory fibers that has been investigated for the amelioration of peripheral neuropathic pain in several other conditions. <h3>Design/Methods:</h3> We conducted a 4-week, randomized, double-blind, sham-controlled, fully remote trial of the QUELL TENS in patients with NMOSD who have central neuropathic pain, followed by a 12-week open label extension period. The Numeric Rating Scale for Pain (NRS-P) was used as the primary outcome measure and was assessed at baseline and at weeks 1, 2, 3, 4, 5, 6, 7, 8, 12, and 16. <h3>Results:</h3> Forty-six patients (23 per arm) were enrolled in this trial, of which 37 completed the trial (3 in the intervention arm and 1 in the sham arm withdrew for adverse events possibly related to the device). Both the sham and intervention arms demonstrated a significant decrease in average pain, worst pain, and current pain between the baseline and 4 week periods, however there was no significant difference between the two arms on intention-to-treat primary or secondary efficacy outcomes. <h3>Conclusions:</h3> Both arms demonstrated significant decreases in reported pain between baseline and 4-week follow-up, however there was no demonstrated benefit of TENS over sham. Further trial analysis will be conducted analyzing responder groups, adverse events, and per-protocol results based on device usage data. <b>Disclosure:</b> The institution of Dr. Vishnevetsky has received research support from National MS Society. The institution of Dr. Vishnevetsky has received research support from NIH (NeuroNext). Ms. Romanow has received research support from Freeman Pain Award @ Harvard Medical School. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mitsubishi Pharma. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB Pharma. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Levy has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various law firms. The institution of Dr. Levy has received research support from National Institutes Health.