NIH Clinical Research Studies

Protocol Number: 08-M-0052

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Title:
fMRI Investigation of Cortical Reorganization and Phantom Limb Pain Following Amputation
Number:
08-M-0052
Summary:
This study, conducted at the National Institutes of Health (NIH) and at Walter Reed Army Medical Center (WRAMC), will explore the phenomenon of phantom limb pain (a continued feeling of pain in an amputated limb) and will use functional magnetic resonance imaging (fMRI) to investigate the effect of mirror therapy on phantom limb pain.

Right-handed people between 18 and 75 years of age who are in the WRAMC Military Amputee Research Program and healthy control subjects may be eligible for this study. Participants undergo the following procedures:

Amputees

-Questionnaires to assess strength of handedness and footedness and pain perception.

-Mirror therapy for phantom limb pain five times a week for 4 weeks in 15-minute sessions.

-MRI and fMRI scans before starting mirror therapy, after 2 weeks of therapy and after 4 weeks of therapy. MRI uses a magnetic field and radio waves to image brain tissue. The subject lies on a table that can slide in and out of the scanner (a metal cylinder). The structural MRI scan lasts about 30 minutes. For fMRI, the subject performs tasks while in the scanner in order to show changes in brain activity involved in performing those tasks. Subjects are shown pictures of feet and other body parts, are asked to move their feet, and receive tactile (touch) stimulation of the foot or other body parts.

Control Subjects

One group of control subjects undergoes a single fMRI procedure. A second group of control subjects undergoes the same sequence of three fMRIs over the same time period as the amputee subjects. None of the control subjects undergo mirror therapy.

Sponsoring Institute:
National Institute of Mental Health (NIMH)
Recruitment Detail
Type: Participants currently recruited/enrolled
Gender: Male & Female
Referral Letter Required: Yes
Population Exclusion(s): Children

Eligibility Criteria:
INCLUSION CRITERIA:

For amputee subjects with PLP:

-Male or female subjects, 18 to 75 years of age, active duty military, military healthcare beneficiary, or military retiree

-Written informed consent and written authorization for use or release of health and research study information

-Unilateral limb amputation

-Any level of prosthetic experience

-No prior history of vertebral disk disease/condition, sciatica or radiculopathy.

-No evidence of traumatic brain injury (TBI - permanent or temporary impairments of cognitive, physical and psychosocial functions with an associated diminished or altered state of consciousness)

-No known neurological disease or brain damage

-No neurological condition that would interfere with participation in the study

-Minimum of 3 phantom limb pain episodes each week

-Degree of pain evaluated by VAS scoring of a minimum 3 cm at time of screening for entry into study

-Ability to follow study instructions and likely to complete all required visits.

For healthy control subjects:

-Male or female subjects, 18 to 75 years of age.

-Written informed consent and written authorization for use or release of health and research study information.

-No prior history of vertebral disk disease/condition, sciatica or radiculopathy.

-Normal neurological examination.

Ability to follow study instructions and likely to complete all required visits.

EXCLUSION CRITERIA:

For amputee subjects with PLP:

-Age less than 18 or greater than 75 years.

-Multiple limb amputation.

-Amputation due to diabetes or vascular claudication

-Pending revision surgeries.

-Presence of embedded metallic shrapnel or other metal not compatible with MRI scanning.

-Presence of traumatic brain injury

-Known uncontrolled systemic disease-- known cancer not in remission, known on-going infection, lupus, kidney disease requiring dialysis, any other systemic disease which might affect ability to participate in this study to its conclusion

-Concurrent participation in another investigational drug or device study for phantom limb pain or participation in the 30 days immediately prior to study enrollment.

-Any condition or situation that, in the investigator's opinion, may put the subject at significant risk, confound the study results, or interfere significantly with the subject's participation in the study.

-Current Axis I or II diagnosis determined by a neurologist or psychiatrist in the 6 months prior to entry into the study.

-Subjects with lack of effort as determined by the neurologist or physiatrist. Subjects will be screened for effort using the Test of Memory Malingering (TOMM) first in order to exclude those with blatant exaggeration or malingering.

-Positive pregnancy test at the time of scanning (within 24 hours prior to the scheduled MRI scan, female subjects of child-bearing age will be given a pregnancy test)

For amputee subjects without PLP:

-Age less than 18 or greater than 75 years.

-Multiple limb amputation.

-Amputation due to diabetes or vascular claudication

-Pending revision surgeries.

-Presence of embedded metallic shrapnel or other metal not compatible with MRI scanning.

-Presence of traumatic brain injury

-Known uncontrolled systemic disease- known cancer not in remission, known on-going infection, lupus, kidney disease requiring dialysis, any other systemic disease which might affect ability to participate in this study to its conclusion

-Concurrent participation in another investigational drug or device study for phantom limb pain or participation in the 30 days immediately prior to study enrollment.

-Any condition or situation that, in the investigator's opinion, may put the subject at significant risk, confound the study results, or interfere significantly with the subject's participation in the study.

-Current Axis I or II diagnosis determined by a neurologist or psychiatrist in the 6 months prior to entry into the study.

-Subjects with lack of effort as determined by the neurologist or physiatrist. Subjects will be screened for effort using the Test of Memory Malingering (TOMM) first in order to exclude those with blatant exaggeration or malingering.

-Positive pregnancy test at the time of scanning (within 24 hours prior to the scheduled MRI scan, female subjects of child-bearing age will be given a pregnancy test)

For healthy control subjects:

-Age less than 18 or greater than 75 years

-Presence of an amputation

-Presence of embedded metallic shrapnel or other metal not compatible with MRI scanning.

-Presence of traumatic brain injury

-Known uncontrolled systemic disease-- known cancer not in remission, known on-going infection, lupus, kidney disease requiring dialysis, any other systemic disease which might affect ability to participate in this study to its conclusion

-Any condition or situation that, in the investigator's opinion, may put the subject at significant risk, confound the study results, or interfere significantly with the subject's participation in the study

-Current Axis I or II diagnosis determined by a neurologist or psychiatrist in the 6 months prior to entry into the study

-Positive pregnancy test at the time of scanning (within 24 hours prior to the scheduled MRI scan, female subjects of child-bearing age will be given a pregnancy test)

Special Instructions:
Currently Not Provided
Keywords:
Phantom Limb Pain
Visual and Motor Integration
Cortical Reorganization
Amputees
Functional Magnetic Resonance Imaging (fMRI)
Recruitment Keyword(s):
Phantom Limb Pain
Amputee
Healthy Volunteer
HV
Condition(s):
Phantom Limb Pain
Amputee
Investigational Drug(s):
None
Investigational Device(s):
None
Intervention(s):
None
Supporting Site:
National Institute of Mental Health

Contact(s):
Patient Recruitment and Public Liaison Office
Building 61
10 Cloister Court
Bethesda, Maryland 20892-4754
Toll Free: 1-800-411-1222
TTY: 301-594-9774 (local),1-866-411-1010 (toll free)
Fax: 301-480-9793

Electronic Mail:prpl@mail.cc.nih.gov

Citation(s):
Ramachandran VS, Hirstein W. The perception of phantom limbs. The D. O. Hebb lecture. Brain. 1998 Sep;121 ( Pt 9):1603-30. Review.

Sherman RA, Sherman CJ, Parker L. Chronic phantom and stump pain among American veterans: results of a survey. Pain. 1984 Jan;18(1):83-95.

Jensen TS, Krebs B, Nielsen J, Rasmussen P. Phantom limb, phantom pain and stump pain in amputees during the first 6 months following limb amputation. Pain. 1983 Nov;17(3):243 56.

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