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  • Sheila Johnson
    Walton Centre NHS Trust, Liverpool
  • Anne Marshall
    University of Liverpool
  • Dyfrig Hughes
  • Emily Holmes
  • Florian Henrich
    Ruprecht Karls-University
  • Turo Nurmikko
    Walton Centre NHS Trust, Liverpool
  • Manohar Sharma
    Walton Centre NHS Trust, Liverpool
  • Bernhard Frank
    Walton Centre NHS Trust, Liverpool
  • Paul Bassett
    Statsconsultancy Ltd
  • Andrew Marshall
    Walton Centre NHS Trust, Liverpool
  • Andreas Goebel
    Walton Centre NHS Trust, Liverpool

BACKGROUND: Induction of long-term synaptic depression (LTD) is proposed as a treatment mechanism for chronic pain but remains untested in clinical populations. Two interlinked studies; (1) A patient-assessor blinded, randomised, sham-controlled clinical trial and (2) an open-label mechanistic study, sought to examine therapeutic LTD for persons with chronic peripheral nerve injury pain.

METHODS: (1) Patients were randomised using a concealed, computer-generated schedule to either active or sham non-invasive low-frequency nerve stimulation (LFS), for 3 months (minimum 10 min/day). The primary outcome was average pain intensity (0-10 Likert scale) recorded over 1 week, at 3 months, compared between study groups. (2) On trial completion, consenting subjects entered a mechanistic study assessing somatosensory changes in response to LFS.

RESULTS: (1) 76 patients were randomised (38 per group), with 65 (31 active, 34 sham) included in the intention to treat analysis. The primary outcome was not significant, pain scores were 0.3 units lower in active group (95% CI - 1.0, 0.3; p = 0.30) giving an effect size of 0.19 (Cohen's D). Two non-device related serious adverse events were reported. (2) In the mechanistic study (n = 19) primary outcomes of mechanical pain sensitivity (p = 0.006) and dynamic mechanical allodynia (p = 0.043) significantly improved indicating reduced mechanical hyperalgesia.

CONCLUSIONS: Results from the RCT failed to reach significance. Results from the mechanistic study provide new evidence for effective induction of LTD in a clinical population. Taken together results add to mechanistic understanding of LTD and help inform future study design and approaches to treatment. Trial registration ISRCTN53432663.


  • Peripheral nerve stimulation, Peripheral neuropathic pain, Long term depression, cHRONIC PAIN, Low frequency
Original languageEnglish
Article number458
JournalJournal of Translational Medicine
Issue number1
Publication statusPublished - 6 Nov 2021

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