Investigating pain relief with cryoneurolysis for trigeminal neuralgia

A Randomized, Parallel Arm, Sham-controlled, Double-blinded, Investigator-initiated Trial to Investigate the Safety and Efficacy of Percutaneous Peripheral Cryoneurolysis Therapy in Medically Refractory Trigeminal Neuralgia: a Pilot Study

This study is testing if a freezing treatment called cryoneurolysis can help adults with trigeminal neuralgia find relief from their severe facial pain.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 24 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: St. Olavs Hospital (Academic / other)
• Locations: 1 site (Trondheim)
• Trial ID: NCT06213155 on ClinicalTrials.gov

What this trial studies

This study evaluates the effectiveness of cryoneurolysis, a freezing technique, in reducing pain for adults suffering from trigeminal neuralgia, a condition characterized by severe facial pain. Participants will be randomly assigned to receive either the actual treatment or a sham treatment, with neither the participants nor the assessors aware of which treatment is being administered. Over a four-week period, participants will document their pain levels, followed by an extension phase where all participants can receive treatment as needed for up to two years. The goal is to determine if cryoneurolysis is a viable option for pain management in this patient population.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 and older with a diagnosis of primary trigeminal neuralgia who experience frequent and severe pain.

Not a fit: Patients who do not have trigeminal neuralgia or those who have not experienced sufficient pain intensity may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment could provide significant pain relief for patients suffering from trigeminal neuralgia.

How similar studies have performed: While this approach is relatively novel, similar studies exploring cryoneurolysis for pain management have shown promising results.

Eligibility criteria

Inclusion Criteria:

1. Participant must be 18 years at the time of signing the informed consent
2. A diagnosis of primary (classic and idiopathic) trigeminal neuralgia affecting the mandibular and/or maxillary division, verified by a neurologist
3. Ability to subclassify the trigeminal neuralgia according to the The International Classification of Headache Disorders, 3rd edition, i.e. sufficient magnetic resonance (MR) evaluation is mandatory
4. History of minimum mean of three trigeminal neuralgia related pain paroxysms per day last 4 weeks
5. History of minimum average daily pain intensity NRS score (ADP) of 4 to10 last 4 weeks
6. In baseline minimum average daily pain intensity NRS score (ADP) of 4 to 10
7. In baseline minimum mean of three trigeminal neuralgia related pain paroxysms per day
8. Treatment refractory as defined in this study as failure to respond, pending an adequate trial in the opinion of the investigator, contraindications or intractable side effect to one of two medications:

   1. Carbamazepine
   2. Oxcarbazepine
9. Unaltered prophylactic TN medication regime 2 weeks prior to baseline, and be willing to keep regime unaltered during the baseline and the blinded study period.
10. Be an appropriate candidate for the study intervention required in this study on the basis of the clinical judgment of the investigator
11. Capable of giving signed informed consent as which includes compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol.

Exclusion Criteria:

1. Diagnosed with demyelinating inflammatory disorders such as e.g. multiple sclerosis.
2. Other pain conditions, not intended to be treated in this study, that in the opinion of the investigator could interfere with study procedures, accurate pain reporting, and/or confound evaluation of study endpoints.
3. High probability of neurological deterioration due to other medical conditions, that in the opinion of the investigator may confound outcome assessment.
4. Patients exhibiting a high degree of comorbidity and/or frailty associated with reduced life expectancy or high likelihood of hospitalization, at the discretion of the investigator.
5. Other coexisting current medical conditions, including, but not limited to, bleeding diathesis and thrombophilia, that presents excess procedural risk, in the opinion of the investigator.
6. Have within 6 months of enrollment a significant untreated addiction to dependency- producing medications, alcohol, or illicit drugs.
7. Abnormal pain behavior, inappropriate medication use and/or unresolved psychiatric illness, that in the opinion of the investigator are significant enough to impact perception of pain, compliance with intervention and/or ability to evaluate treatment outcome.
8. Subject has had previous radiofrequency ablation (including non-lesional pulsed radiofrequency), balloon compression, gamma knife, or chemical denervation (e.g. glycerol treatments) of the Gasserian ganglion.
9. Subject has had previous radiofrequency ablation (including non-lesional pulsed radiofrequency), balloon compression, gamma knife, or chemical denervation (e.g. glycerol treatments) of a division or branch of the trigeminal nerve being targeted in this study.
10. Facial anomaly or trauma which renders the planned procedure difficult.
11. Subject currently has an active oral or dental abscess or a local infection at the site of injection based on present symptoms.
12. Subject has been diagnosed with any major infectious processes such as osteomyelitis, or primary or secondary malignancies involving the face that have been active or required treatment in the past 6 months.
13. Current participation in another treatment study
14. Sensory deficits and/or pain configuration supporting, in the opinion of the neurologist, trigeminal neuropathy as more likely diagnosis.
15. Patients with any kind of conductive implant with contraindication for nerve stimulation according to study innervation.

Where this trial is running

Trondheim

• St. Olavs University Hospital — Trondheim, Norway (Recruiting)

Study contacts

• Study coordinator: Irina Aschehoug

Conditions Trigeminal Neuralgia