Two-Point Discrimination Training for Chronic Pain

(TPD Trial)

Overseen By Robert C Coghill, PHD

Age: < 18

Sex: Any

Trial Phase: Phase < 1

Sponsor: Children's Hospital Medical Center, Cincinnati

Disqualifiers: Mental health disorders, Drug dependence, Developmental delays, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 10

Duration: 5 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new method to help children and teens with chronic pain through two-point discrimination training. The goal is to determine if this training can reduce the spread and intensity of pain by enhancing how the brain processes touch. Participants will be divided into groups; some will undergo this special training, while others will not, to compare the effects. Children aged 10 to 17 with chronic pain conditions like fibromyalgia or low back pain may be suitable for this study. As an Early Phase 1 trial, this research aims to understand how the treatment works in people, offering participants the chance to be among the first to experience this innovative approach.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that two-point discrimination training is safe for youth with chronic pain?

Research has shown that two-point discrimination training can safely improve pain conditions. This sensory training effectively helps individuals with chronic pain feel less pain and better distinguish between two points of touch, suggesting it is well-tolerated.

For one-point discrimination training, studies have found it sharpens the sense of touch and reduces pain. This training aims to restore sensory functions and relieve pain, indicating it is generally safe.

Both methods enhance the body's ability to differentiate touch sensations without using medications, resulting in fewer side effects compared to drug treatments. Existing studies suggest these methods are safe, but as these are early trials, more research is needed to confirm their long-term safety. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about two-point discrimination training for chronic pain because it offers a novel approach to pain management by focusing on sensory retraining rather than medication. Unlike typical treatments that rely on drugs like opioids or NSAIDs to dull pain, this technique aims to rewire the brain's perception of pain through targeted sensory exercises. This could potentially reduce pain without the side effects associated with long-term medication use. Additionally, it may offer insights into the differences in sensory processing between chronic pain patients and healthy individuals, opening up new avenues for personalized treatment strategies.

What evidence suggests that two-point discrimination training might be an effective treatment for chronic pain?

This trial will compare two-point discrimination training with one-point discrimination training for managing chronic pain. Research has shown that training to better distinguish between two close touches on the skin can enhance tactile perception. This improvement is linked to changes in the brain that might help reduce long-term pain. Specifically, studies have found that people with chronic neck pain who underwent this training reported reduced pain. Additionally, improved ability to distinguish between two close points of contact has been associated with better pain relief. Similarly, training to enhance the perception of a single touch has also been shown to reduce pain in various chronic pain conditions. Therefore, both types of training might help manage pain by improving tactile sensation. ^{3 6 7 8 9}

Who Is on the Research Team?

Robert C Coghill, Ph.D.

Principal Investigator

Children's Hospital Medical Center, Cincinnati

Are You a Good Fit for This Trial?

This trial is for youths aged 10-17 with chronic pain conditions like fibromyalgia, complex regional pain syndrome, and other widespread musculoskeletal pains. Participants must be in good health overall and fluent in English. It's not for those with drug/alcohol dependence, primary migraine or visceral pain complaints, significant mental health disorders as per DSM V, or developmental impairments.

Inclusion Criteria

You experience pain in your lower back.

Control Participants: Youth in good general health

High fluency in written and oral English language

Exclusion Criteria

You have a dependence on alcohol or drugs.

You experience headaches or stomach pain without a clear physical cause.

You have a serious mental health condition like bipolar disorder, major depression, or psychosis as defined by DSM V.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Initial Assessment

Participants undergo assessments of two-point and single-point discrimination thresholds

1 session

1 visit (in-person)

Treatment

Participants with chronic pain undergo up to 9 sessions of two-point discrimination training or single-point spatially-directed attentional control

5 weeks

Up to 9 visits (in-person)

Follow-up

Participants are monitored for changes in pain ratings, spatial extent of pain, and pain-related disability

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• One-point discrimination training
• Two-point discrimination training

Trial Overview The study tests if training in two-point discrimination can help reduce the spread of pain by retuning somatosensory processing. Youths will undergo assessments and then participate in multiple sessions of either two-point discrimination training or a control activity focusing on single-point attention.

How Is the Trial Designed?

Group I: Two-point intervention Experimental Treatment 1 Intervention

Two point discrimination training.

Group II: Healthy Controls Active Control 1 Intervention

Observational component of differences in discrimination between chronic pain patients and healthy controls.

Group III: One-point intervention Active Control 1 Intervention

One point discrimination of size of probe

Who Is Running the Clinical Trial?

Children's Hospital Medical Center, Cincinnati

Lead Sponsor

Trials

844

Recruited

6,566,000+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12107763/

The efficiency of tactile discrimination training and oculomotor ... This study aimed to determine the superiority of one intervention over another on pain outcomes in people with chronic neck pain. Methods.

2. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/40420069/

The efficiency of tactile discrimination training and ... This study aimed to determine the superiority of one intervention over another on pain outcomes in people with chronic neck pain. Methods ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0304395909002565

The effect of tactile discrimination training is enhanced ... In CRPS, tactile training increases tactile acuity and reduces pain [17] and recovery is also associated with normalisation of cortical reorganisation [13]. Now ...

4. diva-portal.org diva-portal.org/smash/get/diva2:1693130/FULLTEXT01.pdf

Validation of the Effectiveness of a Sensory Discrimination ... Besides improving the tactile acuity, sensory discrimination training has been proven to reduce pain in different types of chronic pain conditions, such as ...

5. jamanetwork.com jamanetwork.com/journals/jama/fullarticle/2794765

Effect of Graded Sensorimotor Retraining on Pain Intensity ... A graded sensorimotor retraining intervention, compared with a sham procedure and attention control, significantly improved pain intensity at 18 weeks.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9346551/

Effect of Graded Sensorimotor Retraining on Pain Intensity in ... Post hoc outcomes consisted of recovery, defined as pain intensity in the past week rated less than or equal to 1 on the 11-point numerical ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9341232/

Impaired pain-related threat and safety learning in patients ... Patients experiencing nonspecific chronic back pain showed impaired pain-related threat and safety learning in a classical differential conditioning heat pain ...

8. iasp-pain.org iasp-pain.org/publications/relief-news/article/tactile-acuity-pain/

A “protection mode” in pain costs Tactile acuity training, typically described as sensory discrimination training, has been suggested as a way to restore sensory functions and alleviate pain.

9. journals.lww.com journals.lww.com/ebp/fulltext/2024/08000/in_patients_with_chronic_low_back_pain,_does.16.aspx

In patients with chronic low back pain, does sensory... A 2020 systemic review evaluated 10 randomized controlled trials (RCTs; N=350) comparing the efficacy and safety of sensory discrimination training (SDT), a ...