Research

Current Studies

Open and Recruiting:

The effect of spinal cord stimulation on the weekly step count of patients with back and leg pain.

Ref: HREC/15/PH/11

Taverner, MG, Monagle JP and Salmon, JB.

Investigator Sponsored Study. Trial Id: ACTRN12610000171011

 

General activity level in patients being considered for spinal stimulation and the improvement in activity levels after stimulator insertion have not been documented and both are unknown. In this study physical activity measurements, as measured by the Garmin Vivofit device, will be compared to usual questionnaires that you complete for assessment of pain, pain relief and functional improvement before and after the insertion of spinal cord stimulator leads. This study involves wearing a wrist band (Vivofit, Garmin Ltd) for 2 weeks before and 1-2 weeks after the insertion of the spinal cord stimulator lead. The primary endpoint will be comparing Vivofit baseline (pre-neurostimulation therapy) total step count for 1 week prior to lead insertion to weekly total step count in the last week of the trial of stimulation. Secondary endpoints will compare Vivofit baseline step counts to self-report questionnaires (BPI, Dass21, ESS, PCS, PSEQ, SF36, OSW), TUG, 6MWT, in addition to medication usage at the same time points.

 

 

Ongoing but Closed to Recruitment

PRODIGY-I Study. A Pre-Market Study Evaluating the Prodigy Neuromodulation System for the Management of Failed Back Surgery Syndrome or Chronic Intractable Pain of the Trunk and/or Limbs.

 

Multicentre, St Jude Medical Sponsored Study.

SJM-CIP-10052 A.0, NM-13-038-ID-SC_CIP_AU_V1.2_18 FEB2015

Frankston Site Investigators: Taverner, MG and Monagle JP.

The purpose of this study is to confirm long term efficacy and safety of the ProdigyTM neuromodulation system in the management of failed back surgery syndrome or chronic intractable pain of the trunk and/or limbs. The secondary objectives are: to demonstrate an improvement in patient awareness of pain and quality of life, to demonstrate a reduction in use of analgesics and paraesthesia with Burst V Tonic stimulation and assess overall occurrence of serious adverse events.

 

Past Studies:

Dorsal Root Ganglion Stimulation Post-Surgical Knee Pain.

Taverner, MG and Monagle, JP.

Neuromodulation Society of Australia and New Zealand ASM, Perth 12-13 March 2016


Management Acute Implanted Drug Pump Failures.

Taverner, MG and Monagle, JP.

Neuromodulation Society of Australia and New Zealand ASM, Perth 12-13 March 2016

 

3D Printing–An Aid to Neuromodulation.

Chae, M; Bronsema, D; Monagle, JP and Taverner, MG.

 

Neuromodulation Society of Australia and New Zealand ASM, Perth 12-13 March 2016

 


Right Patient, Wrong Drug.

Taverner, MG and Monagle JP.

Australian Pain Society ASM 15-18 March 2015, Brisbane.

Click to download the poster.

 

 

Is Ketamine and Magnesium better than ketamine alone for chronic pain?

Taverner, MG, Monagle, JP.

RACS, ANZCA & FPM ASM 5-8May 2014, Singapore.

Click to download the poster.

 

 

Screening Psychological Health with K10, K6 & Face Scales. How Small Can We Get?

Taverner, MG, Monagle, JP and Stone J.

Australian Pain Society ASM, 15April 2014, Hobart.

Click to download the poster.

 


Short or long ketamine infusions – does it matter?

Taverner, MG, Monagle, JP Research Week,

Australian Pain Society ASM, 15April 2014, Hobart.

Click to download the poster.

 

 

Sub Anaesthetic Intravenous Propofol Infusions In A Patient With Severe Refractory Chronic Headache.

Taverner MG, LoughnanTE and Raghav, S.

Research Week, Peninsula Health, November 2013, Frankston.

Click to download the poster.

 

 

What Is The Data We Collect From Our Psychometric Screening Tests Telling Us?

Taverner, MG, Monagle, JP and Stone J.

Australian Pain Society ASM, Canberra 18-20 March 2013

We examined the questions in several formats used to assess mood, coping and impact of pain on total health to determine if they added useful information or duplicated similar information. The K10 scale showed a strong correlation with the DASS21 and the Mental Health segment of the SF36, suggesting it collects the same information as the other 2 instruments. The other instruments correlated weakly suggesting they were measuring different information.

Click to download the poster.

 

 

Using the CAGE-AID Instrument To Measure Substance Abuse Risk In Patients Attending A Private Pain Clinic.

Taverner, MG, Monagle, JP and Stone J.

Australian Pain Society ASM, Canberra, 18-20 March 2013

Click to download the poster.

 


Standardising Outcome Measures in Persistent Pain.

Taverner, MG and Monagle, JP.

 

Australian Pain Society ASM, Perth 14-16 March 2016

 


Can Radiowaves Cure Pain? An audit of one practitioner’s experience in three hospitals
Low C, Taverner M

Peninsula Health Research Week, Frankston, November 2012

Click to download the poster

 

 

Published Studies:

Transcutaneous Pulsed Radiofrequency Treatment for patients with Shoulder Pain Booked for Surgery: A Double Blind, Randomised Controlled Trial.

Taverner, MG and Loughnan, TE. Pain Pract. 2014;14(2):101-8

 

Abstract

Shoulder pain is the third most common musculoskeletal problem and accounts for 5% of general practitioner consultations. Although many treatments are described, there is no consensus on optimal treatment and up to 40% of patients still have pain 12 months after initially seeking help for pain. Previously, the effect of transcutaneous pulsed radiofrequency treatment (TCPRFT) was evaluated in a retrospective audit that showed good pain relief for a mean 395 days and justified this randomized sham controlled trial.

Methods: In this study, 51 patients entered into a randomized double-blinded, placebo controlled study of TCPRFT. Patients were assessed at 4 and 12 weeks by a blinded observer and compared with baseline.

Results: We observed sustained reductions in pain at night, pain with activity, and functional improvement at 4 and 12 weeks with active but not sham TCPRFT. The 25 subjects who received active treatment showed statistically significant reductions of 24/100 in pain at night and 20/100 of pain with activity at 4 weeks and 18/100 and 19/100, respectively, at 12 weeks from baseline. Statistically significant lower Brief Pain Inventory pain and function scores (4 and 12 weeks), improved pain self-efficacy (4 weeks), Oxford Shoulder scores (12 weeks), and internal rotation (12 weeks) were seen. Pain at both rest and shoulder elevation were not improved by active treatment. No complications were seen.

Discussion: This study of a simple, low risk, outpatient treatment confirms the findings of our earlier study of TCPRFT for knee pain and shoulder pain audit that transcutaneous pulsed radiofrequency treatment may help some people with painful shoulders.

 

A Case of an Allergic Reaction to a Spinal cord Stimulator: Identification of the Antigen with Epicutaneous Patch Testing, Allowing Successful Reimplantation.

Taverner, MG. Neuromodulation. 2013;16(6):595-9.

 

 

Abstract:

Introduction: This report describes an allergic reaction to an Advanced Neuromodulation Series 90 spinal cord stimulator receiver and the use of epicutaneous patch testing to identify the offending allergen.
Methods: Intradermal skin tests using a ‘standard Australian test battery’ were performed by an allergy specialist. Epicutaneous patch tests using material supplied by Medtronic and ANS were performed by the author.
Results:
Epicutaneous patch testing of a time expired ANS ‘Series 90’ stimulator produced widespread pruritic rash at 5 days. The allergen was identified to be a silicone in the “header block” and “boot sleeve” of the receiver. Intradermal testing only confirmed a known allergy to nickel and costume jewellery. There were no skin reactions during a two week epicutaneous trial of material in a 12 item ‘test kit’ supplied by Medtronic. There was no skin reaction during a two week epicutaneous trial of sample material used to make the new Renew and Genesis stimulators (which had by then replaced the old ‘Series90’ model) supplied by ANS.
Conclusions: An allergic reaction to an implanted spinal cord stimulator is a rare, expensive and distressing complication. Epicutaneous patch testing that identified the allergen in this case and the non-reactivity of the proposed system, was able to correctly predict the subsequent long term viability of the replacement spinal cord stimulator system. The case also highlights the need for model specific ‘test kits’ to be available by equipment manufacturers that contain appropriately sized samples of all material used to make a device.

 

 

Transcutaneous Application of Pulsed Radiofrequency Treatment for Shoulder Pain.

Taverner, MG, Loughnan, TE and Soon CW. Pain Practice 2013, Apr;13(4):310-5.

 

Abstract

We report a retrospective audit of transcutaneous pulsed radiofrequency treatment therapy (TCPRFT) for shoulder pain over a 4-year period.

Methods: Electronic and manual case review revealed that TCPRFT had been performed on 13 patients, with 15 painful shoulders, using a single treatment session between 2006 and 2010 in an outpatient setting.

Results: Of the 15 shoulders treated, 10 (two-thirds) had pain relief for over 3 months with an average pain score reduction of 6.1 of 10 and an average duration of pain relief of 395 days. Two experienced pain relief of < 3 months with an average reduction in pain score of 4.3 of 10 and an average duration of effect of 11 days. Three cases experienced no pain relief from the treatment.

Summary: These results suggest TCPRFT may provide clinically useful pain relief and be another treatment modality for shoulder pain. Our findings justifies further research, and we are proceeding with a double-blind placebo randomized controlled studies to determine the efficacy of TCPRFT in chronic shoulder pain.

 

 

Analgesic effect of subanesthetic intravenous ketamine in refractory neuropathic pain: a case report.

Elsewaisy O, Slon B, Monagle J. Pain Med. 2010;11(6):946-50

 

Abstract:

A 59-year-old male patient with progressive neuropathic pain secondary to chronic idiopathic axonal polyneuropathy responded poorly to conventional therapies including gabapentin, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors and opioids. Following continuous intravenous administration of low dose ketamine, an N-methyl-D-aspartic acid receptor antagonist, 20 mg/h for 5 days, almost complete pain relief was obtained without significant side effects. The analgesic effect lasted 10-12 weeks and the ketamine infusion was repeated, with this pattern being maintained for 3.5 years. This supports the growing body of evidence that ketamine may be useful in the management of refractory chronic neuropathic pain. We discuss chronic idiopathic axonal polyneuropathy, neuropathic pain mechanisms, and the use of ketamine in this report.


 

Transcutaneous Pulsed Radiofrequency Treatment in Patients with a Painful Knee Awaiting Total Knee Joint Replacement.

Taverner, M.G., T.L. Ward, and T.E. Loughnan, Clin J Pain, 2010. 26(5): p.429-32.

 

Abstract:

Objective: Our study was designed to determine if transcutaneous-pulsed radiofrequency

treatment (TCPRFT) was able to reduce the pain experienced by patients awaiting total knee

joint replacement (TKJR). We conducted a randomized, double-blinded, placebo controlled trial of

TCPRFT in patients referred for TKJR to our hospital's Orthopaedic Outpatient Clinic.

Methods: Patients on the waiting list for assessment for TKJR were invited to participate and were

examined in the clinic if they satisfied the inclusion criteria. Patients were randomized to receive

active or sham TCPRFT. The alteration in pain and function of the treated knee after a single

TCPRFT was assessed at examination at 1 and 4 weeks using visual analogue pain score (VAS) at

rest and after 20 and 400 m walks.

Results: The results of 50 patients showed a statistically significant reduction in VAS at 1 and 4

weeks compared with baseline in the group who received active treatment. We also demonstrated

what is considered a clinically significant improvement in this group that became more pronounced

at week 4 compared with week 1 and also more after a 400 m walk compared with a 20 m

walk. Maximum improvement observed in group data was 19/100 VAS. Patients receiving sham

treatment showed no statistically significant improvement.

Discussion: We believe this to be the first report of a controlled study of TCPRFT. This pilot study

shows a benefit of the technique that justifies future research.

 

 

A pilot study comparing three pulsed radiofrequency treatment techniques for knee pain in

patients awaiting knee replacement.

Taverner, M. and T. Loughnan. Pain Medicine, 2008. 9(6): p. 763-764.

 

Abstract

Aim: To determine if patients with painful knees awaiting joint replacement (TKR) can obtain pain

relief from a pulsed radiofrequency treatment (PRFT) to the knee.

Method: 12 patients awaiting knee replacement obtaining pain relief from intradermal injections

of 1% lignocaine or N-saline, participated in this follow-on study of PRFT. The first three patients

(3 knees) received 3 Unipolar Fixed Time (UFT) two-minute 60V treatments, the next two patients

(two knees) received two Unipolar Fixed Dose (UFD) 240 pulse-dose 45V treatments and the next

seven patients (9 knees) received two Bipolar 240 (BFD) pulse-dose 45V treatments, immediately

beneath areas of cutaneous tenderness. Pain was assessed using a 0-100 visual analogue pain

scale (VAPS) at rest and after walking 40 m and satisfaction was measured on a seven point Likert

scale. Patients completed assessment at baseline, 1 hour, 1 week, 4 weeks and 12 weeks after

treatment.

Results: All knees in UFT & UFD groups and 8 of nine knees in the BFD group were described

as improved at one hour. In the UFT and UFD groups improvement was not sustained beyond

7days (range 3-7 days). In the BFD group improvement was described in 5/9 knees at one week,

in 6/9 knees at four weeks and in 3/9 at 12 weeks (range 0-270+ days). Two patients in the

bipolar group had bilateral treatments, one patient, who obtained 49 days from local anaesthetic

injections had no relief in either leg from PRFT; the other patient has ongoing complete pain

relief in the most painful knee, but obtained no relief in the other leg and proceeded to knee

replacement three weeks after PRFT.

Conclusion: Subcutaneous Bipolar Fixed Dose PRFT provided better short and medium term pain

relief in this study than Unipolar Fixed Time or fixed dose PRFT. Bipolar Fixed Dose PRFT may

have a role in treating knee pain unsuitable or unresponsive to other therapy. Further studies are

planned to confirm these findings.

 

 

Randomized, double blinded comparative trial of intradermal injections of lignocaine versus N-

saline around the knee to relieve pain in patients awaiting total knee replacement.

Loughnan, T.E., M.G. Taverner, and A. Webb, Clin J Pain, 2009. 25(4): p. 269-72.

 

Abstract:

Objectives: We report a randomized, double-blinded comparative study assessing the efficacy of local anaesthetic with N-saline intradermal blocks around the knee to reduce pain and improve

patient satisfaction while waiting for a total knee joint replacement.

Methods: Patients were offered involvement in this study while on the hospital waiting list for a

knee replacement. Eligible patients, after completing a prestudy assessment, received an average

of 6.3 (range: 1 to 10) intradermal injections of 0.5 mL either saline or 1% lignocaine injections

into tender points around the knee. Patients were assessed at 2 hours and 1 week after the

injections. Pain was assessed using 0 to 100 visual analogue pain scale. Global perceived effect

(satisfaction) was measured on a 7-point Likert scale.

Results: Thirty-two of 34 patients attended at 1-week assessment, 24 (75%) felt that they

were improved, and 8 (25%) considered they were unchanged or worse. In both the saline and

lignocaine groups, 12 of 16 patients felt that they had improved.

Conclusion: N-saline proved as effective as lignocaine in reducing knee pain when injected

intradermally. Seventy-five percent of patients were improved at 1 week.

 

 

Chronic Pain, Drugs & Oral Hygiene.

Taverner, M. Australasian Musculoskeletal Medicine, 2006(Nov): p. 77-82.

 

Abstract:

This literature review examining the relationship between chronic pain, medication, and oral

hygiene/dental caries has been prompted by an apparent high incidence of advanced dental

decay seen in a pain clinic population. The complaint of dry mouth (xerostomia) has been a constant antecedent feature along with medication causing hyposalivation (for example, opioids, clonidine, antidepressants) or conditions associated with hyposalivation (for example, depression and inflammatory disorders). Pathophysiology, clinical features, prevention and treatment are discussed.

 

 

Sacroiliac Joint Pain.

Taverner, M. Australasian Musculoskeletal Medicine, 2006. May: p. 39-43.

 

Abstract:

Sacroiliac joint (a.k.a. posterior pelvic) pain is a challenging condition affecting 15-25% of patients

with axial low back pain, for which there is no gold standard long-term treatment. Diagnosing

sacroiliac joint-mediated pain is difficult because the presenting complaints are similar to those

of other causes of back pain. Recent studies have demonstrated that histological and physical

examination findings and radiological imaging are insufficient to diagnose sacroiliac joint pain.

The most commonly used method of diagnosing sacroiliac joint pain as a pain generator is small

volume local anaesthetic blocks. Treatment modalities include medications, physical therapy,

bracing, manual therapy, injections, radiofrequency denervation, and arthrodesis; however, no

published prospective data compared the efficacy of these modalities. In this paper, I review the

anatomy, function, pathophysiology, diagnosis and treatment of painful sacroiliac joints.

 

 

 

Banner
Banner