Low Back Pain
Conditions
Keywords
back pain, sciatic pain, biomarkers
Brief summary
The main purpose of the trial is to identify biomarkers from the blood as well as electrophysiologic and morphometric features (chemical, electrophysiologic and ultrasound biomarkers) that reflect the intensity of pain and/or foretell the efficacy of pharmacological (non-surgical) treatment in patients with acute low back pain.
Detailed description
The investigators include patients aged 18-80 years with acute (less than 1-month) low back pain with or without radicular signs, who do not have severe diseases (abscess, tumor, etc) in the background, already had CT or MRI scan during routine workup, and who have given written consent to participate in the study. Exclusion criteria are pregnancy, hypersensitivity to tolperisone in the history, severe liver or kidney disease, other severe diseases (abscess, tumor, etc) in the background of pain. The patients will be given 3 times daily 150 mg tolperisone or placebo in addition to standard therapy in a randomized double-blind design. Treatment will last for 14 days and a final follow-up is performed at 21 days. Clinical condition and biomarkers will be tested before treatment and at 14 days. Patients fill in a diary on a daily basis.
Interventions
Tolperisone Hydrochloride tablets of 150 mg, administered three times a day
DRUGPlacebo
matching placebo administered three times a day
Sponsors
National Research Develpment and Innovation Fund, Hungary
MEDITOP Pharmaceutical LTD, Hungary
Semmelweis University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Masking description
Randomization is done by non-transparent (opaque) sequentially numbered envelopes, prepared independently from the trial site. The number on the envelope corresponds to the number on the boxes of the trial medication (tolperisone or matching placebo). The envelopes can be opened only at the end of the trial, or in case of emergency. No interim analysis is planned.
Intervention model description
Single center, randomized double blind study. Randomization is done separately for those with and those without radicular signs.
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
Yes
Inclusion criteria
* Healthy pain-free volunteers (n=30) outside of the randomized study, will participate to establish normal values of blood biomarkers.
Exclusion criteria
* pain, inflammation,
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in the level of biomarkers by the end of the treatment period compared to the pretreatment values. | 14 days | Changes in the values of blood biomarkers (nociceptin/orphanin FQ, Met-Enkephalin-Arg6-Phe7 (MEAP), pro-inflammatory cytokines (IL-1β, IL-6, IL-2, IL-8, IL-12, IL-33, CCL3, CXCL1, CCR5, és TNF-α), anti-inflammatory cytokines (IL-10 and IL-4), monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory proteins-1b (MIP-1b), platelet-derived growth factor (PDGF AA), vascular endothelial growth factor (VEGF), GM-CSF=granulocyte-macrophage colony-stimulating factor, CGRP (calcitonin gene related peptide), substance P, noradrenalin (norepinephrine), in electrophysiologic markers (quantitative electromyography with surface electrodes in the paravertebral muscles in prone and standing position) and ultrasound markers (bilateral measurements of cross sectional area and antero-posterior diameter of paravertebral muscles in prone and standing position) |
| Patient reported change in pain features | daily for 14 days | Self evaluation of pain by the patient on a visual scale from zero (no pain at all) to 10 (the most severe pain the patient can imagine) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in the intensity of pain by the end of the treatment period | 14 days | Self evaluation of pain by the patient on a visual scale from zero (no pain at all) to 10 (the most severe pain the patient can imagine) |
| Change in the level of biomarkers enlisted in Primary Outcome 1 by the end of the treatment period in the tolperisone group | 14 days | Subgroup analysis of changes in blood, electrophysiological and ultrasound biomarkers by 14 days in the tolperisone group |
| Change in the level of paravertebral muscle contraction by the end of the treatment period | 14 days | Analysis restricted to the electrophysiological and ultrasound biomarkers enlisted in Primary Outcome 1 |
| Global impression of change by the patient | 14 days | Patient self evaluation of changes by the end of treatment on a 6-grade scale (has become symptom-free; major improvement; minor improvement; no change; minor worsening; major worsening) |
| Global clinical impression of change (GCI) by the investigator | 14 days | Subjective evaluation of changes by the end of treatment on a 6-grade scale by the investigator (has become symptom-free; major improvement; minor improvement; no change; minor worsening; major worsening) |
| Number of participants with treatment-related adverse events | 21 days (14 days treatment plus 7 days post-treatment) | Any adverse events reported during the 14 days of treatment and the 7-day post-treatment period |
| Predictive value of the initial levels of biomarkers enlisted in Primary Outcome 1 | 14 days | Evaluation of the association of the initial biomarker values enlisted in Primary Outcome 1 with the 14-day pain features |
| Change in the level of biomarkers enlisted in Primary Outcome 1 in the subgroup of those with ceased or greatly reduced pain | 14 days | Subgroup analysis of the change in biomarkers restricted to those with ceased or greatly reduced pain |
Other
| Measure | Time frame | Description |
|---|---|---|
| Patient reported sleep quality | Daily from 1-14 days | Changes in sleep quality reported in patient diary on a 4-grade scale (1: undisturbed sleep; 2: woke up once due to pain; 3: woke up more than once due to pain; 4: could not sleep at all due to pain). |
| Fingertip-to-floor distance | 14 days | The patient is asked to bend forward and attempt to reach for the floor with their fingertips. The distance between the patient's right long finger and the floor is measured using a standard measuring tape in centimeters. |
Countries
Hungary
Outcome results
None listed