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NCT03520387: SELECT LBP

Selecting Effective Combinations of Treatment for Low Back Pain

Completed NA Results posted Last updated 5 September 2021
What this trial tests

NA trial testing Lumbar medial branch nerve radiofrequency ablation (LRFA) in Low Back Pain in 16 participants. Completed in 30 August 2020.

Timeline
15 November 2018
Primary endpoint
30 June 2020
30 August 2020

Quick facts

Lead sponsorVA Office of Research and Development
PhaseNA
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designfactorial
Maskingtriple
Primary purposetreatment
Enrollment16
Start date15 November 2018
Primary completion30 June 2020
Estimated completion30 August 2020
Sites1 location across United States

Drugs / interventions tested

Conditions studied

Sponsor

VA Office of Research and Development — full company profile →

Who can join

18 and older, any sex, with Low Back Pain. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Roland-Morris Disability Questionnaire Primary · 3 months

The RMDQ is a validated, commonly used, and widely accepted 'legacy' measure of back-related functional limitations (range 0 to 24, with higher scores representing greater functional limitations).

GroupValue95% CI
Group A (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + AcTIVE-CBT)9.8± 4.1
Group B (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + AcTIVE-CBT)5.3± 5.9
Group C (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + TBSCE)13.3± 3.1
Group D (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + TBSCE)16.7± 4.2
Activity Tracker-assessed Average Daily Step Counts (Change Scores) Secondary · 3 months

Change scores will be calculated as compared to average daily step count pre-randomization.

GroupValue95% CI
Group A (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + AcTIVE-CBT)-1445.8± 5984.0
Group B (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + AcTIVE-CBT)5617.2± 5963.4
Group C (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + TBSCE)42.02± 448.3
Group D (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + TBSCE)-842.4± 3105.5
Low Back Pain Intensity (0-10 Numerical Pain Rating Scale) Secondary · 3 months

Higher numerical pain ratings reflect greater pain intensity.

GroupValue95% CI
Group A (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + AcTIVE-CBT)4.8± 4.5
Group B (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + AcTIVE-CBT)4.7± 1.2
Group C (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + TBSCE)4.7± 3.5
Group D (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + TBSCE)5.3± 1.5
PROMIS Global Health Short Form 10 Secondary · 3 months

Global quality of life measure. There are two subscales, the physical component summary score and the mental component summary score. Each range from 4-20, with higher scores reflecting greater quality of life

PROMIS physical health
GroupValue95% CI
Group A (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + AcTIVE-CBT)40.5± 5.2
Group B (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + AcTIVE-CBT)44.3± 5.8
Group C (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + TBSCE)37.4± 9.3
Group D (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + TBSCE)38.2± 3.8
PROMIS mental health
GroupValue95% CI
Group A (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + AcTIVE-CBT)47.8± 5.4
Group B (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + AcTIVE-CBT)50.9± 5.1
Group C (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + TBSCE)55.3± 4.2
Group D (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + TBSCE)38.6± 7.3
Average Morphine Equivalent Daily Dose Secondary · 3 months

Self-reported average morphine equivalent daily dose over the past 3 days.

GroupValue95% CI
Group A (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + AcTIVE-CBT)0± 0
Group B (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + AcTIVE-CBT)0± 0
Group C (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + TBSCE)0± 0
Group D (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + TBSCE)6.7± 5.8
Global Perceived Effect (How Back Pain Has Changed Since Baseline) Secondary · 3 months

7-point Likert scale where 3 represents 'complete recovery', 0 represents 'not changed', and -3 represents 'become worse than ever'

GroupValue95% CI
Group A (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + AcTIVE-CBT)0.3± 1.7
Group B (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + AcTIVE-CBT)0.7± 0.6
Group C (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + TBSCE)0.7± 1.2
Group D (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + TBSCE)0± 0
Expected Low Back Pain Intensity (0-10 Numerical Pain Rating Scale) if Not Using Pain Medications Secondary · 3 months

Higher numerical pain ratings reflect greater pain intensity.

GroupValue95% CI
Group A (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + AcTIVE-CBT)5.0± 4.2
Group B (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + AcTIVE-CBT)5.0± 1.7
Group C (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + TBSCE)5.7± 4.0
Group D (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + TBSCE)7.0± 1.7
Participant-reported Satisfaction Secondary · 3 months

5-point Likert scale where 2 represents 'completely satisfied', 0 represents 'neutral', and -2 represents 'completely dissatisfied'

GroupValue95% CI
Group A (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + AcTIVE-CBT)1.0± 1.4
Group B (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + AcTIVE-CBT)0.3± 0.6
Group C (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + TBSCE)0.3± 1.5
Group D (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + TBSCE)-1.3± 0.6
BRFSS Self-reported Physical Activity Per Week Secondary · 3 months

Self-reported activity equivalent minutes per week

GroupValue95% CI
Group A (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + AcTIVE-CBT)487.5± 306.2
Group B (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + AcTIVE-CBT)1650.0± 297.0
Group C (Lumbar Medial Branch Nerve Radiofrequency Ablation [LRFA] + TBSCE)201.7± 97.8
Group D (Simulated Lumbar Radiofrequency Ablation [Simulated LRFA] + TBSCE)398.3± 530.1

Adverse events — posted to ClinicalTrials.gov

Time frame: 3 months. Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Pre-Randomizaton Run-In Period
Serious: 0/16 (0%)
Deaths: 0/16
Lumbar Medial Branch Nerve Radiofrequency Ablation (LRFA) + AcTIVE-CBT
Serious: 0/4 (0%)
Deaths: 0/4
Simulated Lumbar Radiofrequency Ablation (Simulated LRFA) + AcTIVE-CBT
Serious: 0/3 (0%)
Deaths: 0/3
Lumbar Medial Branch Nerve Radiofrequency Ablation (LRFA) + TBSCE
Serious: 0/3 (0%)
Deaths: 0/3
Simulated Lumbar Radiofrequency Ablation (Simulated LRFA) + TBSCE
Serious: 0/3 (0%)
Deaths: 0/3
Other adverse events (6 terms — click to expand)

ReactionSystemPre-Randomizaton Run-In Pe…Lumbar Medial Branch Nerve…Simulated Lumbar Radiofreq…Lumbar Medial Branch Nerve…Simulated Lumbar Radiofreq…
ED/Urgent CareSurgical and medical procedures
Allergic ReactionImmune system disorders
SurgerySurgical and medical procedures
Other ComplicationsGeneral disorders
HospitalizationSurgical and medical procedures
ICUSurgical and medical procedures

Data from ClinicalTrials.gov NCT03520387 adverse events section.

Sponsor's own description

Back pain is the #1 contributor to disability in the United States (US), and second only to hearing problems as a reason for new Veteran disability compensation. The societal burden of back pain is driven mainly by chronic low back pain (CLBP), defined as low back pain persisting for 3 months. Since most individual treatments for CLBP have only small effects on functional recovery, combining CLBP treatments has recently been recommended as a priority area for research. However, few prior studies of CLBP have been properly designed to evaluate the effects of treatment combinations. Large effects on functional recovery from CLBP may require combining interventions that each target different points on a theoretical pathway to functional recovery. Procedural treatments for CLBP aim primarily to address early stages in the pathway to functional recovery, such as problems with the lumbar spinal structures or low back pain itself. In contrast, behavioral interventions for CLBP generally have effects not only on pain itself, but also work by mitigating the degree to which the sensation of low back pain impacts function, well-being, and quality of life. These represent later stages in the pathway to functional recovery from CLBP. Combining procedural and behavioral treatments may have great potential for achieving large magnitude treatment effects for CLBP in Veterans. The proposed research assesses the feasibility of using a 2 x 2 factorial randomized controlled trial (RCT) design to examine the individual and combined effects of 1) lumbar medial branch nerve radiofrequency ablation (LRFA), a commonly used procedural intervention to target low back pain severity, and 2) a novel video telehealth tablet- and personal computer (PC)-based Activity Tracker-Informed Video-Enabled Cognitive Behavioral Therapy program ("AcTIVE-CBT"), a behavioral intervention designed primarily to target functional limitations both secondary to, and independent of, improvements in pain. The LRFA treatment to be used in the proposed study addresses the major patient selection, procedural/technical, methodologic and reporting limitations of prior studies. AcTIVE-CBT addresses problems with Veteran access and compliance associated with conventional cognitive behavioral therapy (CBT) delivered in clinic, and uses currently available activity tracking technology to better promote activity and behavior change as compared to conventional CBT. This pilot RCT involves recruitment of up to 30 Veterans with CLBP who will be followed to evaluate functional recovery for up to 3 months, to reach a goal of 20 Veterans completing the 3-month primary outcome. The primary outcome is participant-reported back-related functional limitations (mobility and ADLs) at 3 months, as measured by the validated Roland-Morris Disability Questionnaire. Secondary outcomes include activity tracker-assessed step counts, back pain intensity, reduction in opioid use, and quality of life. Although the proposed pilot study is unlikely to definitively address whether these treatments alone or in combination have significant effects on functional recovery, it will inform a future large-scale multicenter RCT to determine the efficacy of LRFA, AcTIVE-CBT, or combined LRFA + AcTIVE-CBT, for Veterans with CLBP.

Publications & conference data

2 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Combining procedural and behavioral treatments for chronic low back pain: A pilot feasibility randomized controlled trial.
    Tanus AD, Nishio I, Williams R, Friedly J, et al · · 2025 · cited 1× · PMID 39902653 · DOI 10.1002/pmrj.13323
  2. Combining Procedural and Behavioral Treatments for Chronic Low Back Pain: A Pilot Feasibility Randomized Controlled Trial
    Tanus AD, Nishio I, Williams R, Friedly J, et al · · 2023 · DOI 10.1101/2023.06.02.23290392

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Other recruiting trials for Low Back Pain

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