Fibromyalgia Clinical Trial
— FINALOfficial title:
Fibromyalgia and Naltrexone: The FINAL Study
Verified date | December 2022 |
Source | Odense University Hospital |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
This study evaluates the effect of low dose naltrexone (LDN) on pain in women with fibromyalgia (FM). The study is designed as a parallel randomized (1:1) double blind, placebo-controlled superiority trial. Half of the participants will receive treatment with LDN while the other half will receive treatment with placebo.
Status | Completed |
Enrollment | 99 |
Est. completion date | December 27, 2022 |
Est. primary completion date | December 27, 2022 |
Accepts healthy volunteers | No |
Gender | Female |
Age group | 18 Years to 64 Years |
Eligibility | Inclusion Criteria: - Women aged 18-64 years - Understands and writes Danish - Fulfills the American College of Rheumatology 1990 criteria for fibromyalgia - A minimum score of 4 in self-reported average pain during the last 7 days on a 0-10 numeric rating scale at baseline - All fertile women have to use safe anti conception (Spiral, birth control pills, contraceptive patch, contraceptive vaginal ring or gestagen injections) for 3 weeks before and 1 week after the trial. If the patients' normal lifestyle includes sexual abstinence, they do not have to use anti conception. Instead they can give an oral informed consent, that they will be sexually abstinent during the trial. A woman is considered non-fertile if she is sterilized, hysterectomized, bilateral oophorectomized or is postmenopausal. A woman is considered postmenopausal when vaginal bleeding has been absent for 1 year and is confirmed by measurement of follicle-stimulating hormone. Exclusion Criteria: - Known allergy against naltrexonehydroclorid - Pregnancy or breastfeeding. A negative pregnancy test has to be available for all fertile subjects at baseline - Use of opioids or NSAIDs during the 4 weeks before inclusion in the trial - Abuse of alcohol or other substances - Inflammatory rheumatic diseases - Demyelinating diseases - Active cancer - Liver dysfunction - Kidney dysfunction - Psychotic diseases - History of suicide attempts - Suicide ideation - evaluated using Patient Health Questionnaire-9 (Item 9 has to be answered "never") |
Country | Name | City | State |
---|---|---|---|
Denmark | Pain centre, Odense University Hospital | Odense |
Lead Sponsor | Collaborator |
---|---|
Odense University Hospital | University Hospital Bispebjerg and Frederiksberg, University of Southern Denmark |
Denmark,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Variation in pain | Measured using a diary of daily average pain rated on an 11 point rating scale, ranging from 0-10, during 7 days before visits at baseline, and after 8 and 12 weeks of treatment. The variation in pain is characterized by the highest score minus the lowest score. A lower score indicates a lower variation. | Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Other | Muscle exhaustion | Measured by an isometric muscle exhaustion test of the deltoid muscle. Measured by asking the participant to complete an isometric muscle exhaustion task by maintaining 90° shoulder abduction (dominant arm) for as long as possible with the elbow extended and the hand pronated (hand facing downwards). Task failure (test position can no longer be maintained) defines the test duration. The participants are instructed to maintain the position until they feel maximal muscle exhaustion (corresponding to a score of 10 on a 0-10 scale with 0 being "no muscle fatigue" and 10 being 'maximal muscle fatigue/exhaustion'). Surface electromyography (EMG) will be recorded from the anterior, middle and posterior deltoid muscle at 3000 Hz during the entire test. A longer duration of test is indicative of lower levels of exhaustion. | Change from baseline when assessed after 12 weeks of treatment with LDN or LDN-placebo | |
Other | Physical fitness | Measured by the 30-second chair stand test. The test starts with the subject seated on a chair with her back touching the backrest. Subjects rise to a full stand with the back straight and then sit down again to regain this cycle as many times as they can within 30 seconds. A higher number of cycles is indicative of better physical fitness. | Change from baseline when assessed after 12 weeks of treatment with LDN or LDN-placebo | |
Other | Pain sensitivity | Assessments are conducted as recommended by the 'International Association for the Study of Pain'. Computer-controlled cuff algometry is performed on lower legs in all patients to assess pressure pain threshold and pressure pain tolerance. Pressure pain threshold and pressure pain tolerance are measured in kilopascal (kPa). A higher value is indicative of lower severity. | Change from baseline when assessed after 12 weeks of treatment with LDN or LDN-placebo | |
Other | Inhibition of pain | Measured by Conditioned pain modulation (CPM). Assessments are conducted as recommended by the 'International Association for the Study of Pain'. Computer-controlled cuff algometry is performed on lower legs to assess increase in pressure pain threshold during cuff pain conditioning on the contralateral leg. Pressure pain threshold and pressure pain tolerance are measured in kilopascal (kPa). A higher value is indicative of lower severity. | Change from baseline when assessed after 12 weeks of treatment with LDN or LDN-placebo | |
Other | Augmentation of pain | Measured by Temporal Summation of Pain (TSP). Assessments are conducted as recommended by the 'International Association for the Study of Pain'. Computer-controlled cuff algometry is performed on lower legs to assess increase in pain scores to ten repeated stimulations. Pain is rated on a 0-100 Visual Analogue Scale. A lower value indicates a lower severity. | Change from baseline when assessed after 12 weeks of treatment with LDN or LDN-placebo | |
Primary | Average pain during the last 7 days | Assessed by asking the participants about the level of average pain during the last 7 days on a 11 point rating scale, ranging from 0-10 (0 = "no pain" and 10 = "unbearable pain") using the first item from the symptom part of the Fibromyalgia Impact Questionnaire Revised. A lower score indicates lower severity. | Change from baseline when assessed after 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Global assessment | Measured by Patient Global Impression of Change on a 1-7 Verbal Rating Scale. The participants are asked how they rate their overall fibromyalgia symptoms after 4, 8 and 12 weeks of treatment compared with before treatment. A score of 4 indicates "no change", a score of 1 is characterized by "a lot worse" and a score of 7 is characterized by "a lot better." A higher score indicates higher degree of improvement. | Change in overall fibromyalgia symptoms from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Impact of fibromyalgia | Measured by the Fibromyalgia Impact Questionnaire Revised (FIQR) total score. The FIQR asks patients to rate how difficult it is to perform a list of 9 common activities over the previous 7 days on an 11 point scale, ranging from 0-10 (0 = "no difficulty" and 10 = "very difficult"). The FIQR then asks patients to indicate how often their fibromyalgia impacts their quality of life over the last 7 days on an 11 point scale, ranging from 1-10 (0 = "never" and 10 = "always"). Finally, the FIQR asks patients to assess the severity of 10 different symptoms on an 11 point scale, ranging from 0-10 (0 = "no symptoms" and 10 = "extreme symptoms"). These three sub-scales are summed to represent an overall FIQR score. A lower score indicates lower severity. | Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Pain distribution | Assessed by the Widespread Pain Index (WPI) from The American College of Rheumatology 2016 revised criteria for fibromyalgia (ACR-2016). The body is divided into 19 body parts and number of pain full body parts during the last 7 days is counted, giving rise to the WPI. A lower score indicates lower spreading of pain. | Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Level of pain | Assessed by the Fibromyalgia Impact Questionnaire Revised "level of pain" question, asking the participants to rate the average level of pain during the last 7 days on a 11 point rating scale, ranging from 0-10 (0 = "no pain" and 10 = "unbearable pain"). A lower score indicates lower severity. | Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Level of tenderness | Assessed by the Fibromyalgia Impact Questionnaire Revised "level of tenderness to touch" question, asking the participants to rate the average level of tenderness to touch during the last 7 days on an 11 point rating scale, ranging from 0-10 (0 = "no tenderness" and 10 = "very tender"). A lower score indicates a lower severity. AND Assessed by measurement of pressure pain threshold, using a handheld algometer. Points measured: Right Quadriceps 15 cm proximal of apex patella and left Trapezius 10 cm from acromion. Each point is measured 3 times. Pressure pain threshold is measured in kilopascal (kPa). A higher value indicates a lower severity. |
Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Level of fatigue | Assessed by the Fibromyalgia Impact Questionnaire Revised "level of energy" question, asking the participants to rate the average level of energy during the last 7 days on an 11 point rating scale, ranging from 0-10 (0 = "lots of energy" and 10 = "no energy"). A lower score indicates a lower severity. | Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Level of sleep disturbance | Assessed by the Fibromyalgia Impact Questionnaire Revised "quality of sleep" question asking the participants to rate the average quality of sleep during the last 7 days on an 11 point rating scale, ranging from 0-10 (0 = "awoke well rested" and 10 = "awoke very tired"). A lower score indicates a lower severity. | Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Level of depression | Assessed by the Fibromyalgia Impact Questionnaire Revised "level of depression" question, asking the participants to rate the average level of depression during the last 7 days on an 11 point rating scale, ranging from 0-10 (0 = "no depression" and 10 = "very depressed"). A lower score indicates a lower severity. | Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Level of anxiety | Assessed by the Fibromyalgia Impact Questionnaire Revised "level of anxiety" question, asking the participants to rate the average level of anxiety during the last 7 days on an 11 point rating scale, ranging from 0-10 (0 = "not anxious" and 10 = "very anxious"). A lower score indicates a lower severity. | Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Level of cognition | Assessed by the Fibromyalgia Impact Questionnaire Revised "level of memory problems" question, asking the participants to rate the average level of memory problems during the last 7 days on an 11 point rating scale, ranging from 0-10 (0 = "good memory" and 10 = "very poor memory"). A lower score indicates a lower severity. | Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Level of stiffness | Assessed by the Fibromyalgia Impact Questionnaire Revised "level of stiffness" question, asking the participants to rate the average level of stiffness during the last 7 days on an 11 point rating scale, ranging from 0-10 (0 = "no stiffness" and 10 = "severe stiffness"). A lower score indicates a lower severity. | Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Level of physical function | Assessed by the physical function domain of Fibromyalgia Impact Questionnaire Revised; asking participants to rate how difficult it is to perform a list of 9 common activities over the previous 7 days on an 11 point scale, ranging from 0-10 (0 = "no difficulty" and 10 = "very difficult"). The score is characterized by the sum of the 9 scores (0-90). A lower score indicates better function. | Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Health-related quality of life - mobility | Measured by the European Quality of Life 5 Dimensions (EQ-5D) mobility domain; asking the participants to rate their mobility on a 1-5 Verbal Rating Scale, a score of 1 indicating no problems, and a score of 5 indicating extreme problems. A lower score indicates a lower severity. | Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Health-related quality of life - self care | Measured by the European Quality of Life 5 Dimensions (EQ-5D) self care domain; asking the participants to rate their ability for self care on a 1-5 Verbal Rating Scale, a score of 1 indicating no problems, and a score of 5 indicating extreme problems. A lower score indicates a lower severity. | Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Health-related quality of life - usual activities | Measured by the European Quality of Life 5 Dimensions (EQ-5D) usual activities domain; asking the participants to rate their ability to perform usual activities on a 1-5 Verbal Rating Scale, a score of 1 indicating no problems, and a score of 5 indicating extreme problems. A lower score indicates a lower severity. | Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Health-related quality of life - pain/discomfort | Measured by the European Quality of Life 5 Dimensions (EQ-5D) pain/discomfort domain; asking the participants to rate their level of pain or discomfort on a 1-5 Verbal Rating Scale, a score of 1 indicating no problems, and a score of 5 indicating extreme problems. A lower score indicates a lower severity. | Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Health-related quality of life - anxiety/depression | Measured by the European Quality of Life 5 Dimensions (EQ-5D) anxiety/depression domain; asking the participants to rate their level of anxiety or depression on a 1-5 Verbal Rating Scale, a score of 1 indicating no problems, and a score of 5 indicating extreme problems. A lower score indicates a lower severity. | Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Health-related quality of life - global | Measured by European Quality of Life Visual Analogue Scale (EQ-VAS), which asks the participant to rate their overall health 'today' on a 0-100 VAS. A higher score indicates a better quality of life. | Change from baseline when assessed after 4, 8, and 12 weeks of treatment with LDN or LDN-placebo | |
Secondary | Number of responders with a more than 15% improvement of pain | A responder is defined as a subject who reports a more than 15% improvement of the primary outcome (average pain during the last 7 days) after 12 weeks of treatment with LDN or LDN-placebo. Number of responders are calculated for both the LDN group and the LDN-placebo group. | Number of responders after 12 weeks of treatment with LDN or LDN placebo | |
Secondary | Number of responders with a more than 30% improvement of pain | A responder is defined as a subject who reports a more than 30% improvement of the primary outcome (average pain during the last 7 days) after 12 weeks of treatment with LDN or LDN-placebo. Number of responders are calculated for both the LDN group and the LDN-placebo group. | Number of responders after 12 weeks of treatment with LDN or LDN placebo | |
Secondary | Number of responders with a more than 50% improvement of pain | A responder is defined as a subject who reports a more than 50% improvement of the primary outcome (average pain during the last 7 days) after 12 weeks of treatment with LDN or LDN-placebo. Number of responders are calculated for both the LDN group and the LDN-placebo group. | Number of responders after 12 weeks of treatment with LDN or LDN placebo |
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