Chronic Pain Clinical Trial
— PERIPATEIOfficial title:
A Rehabilitation Walking Program With the Help of a Transient Intake of Nonsteroidal Anti-inflammatory Drug for Patients With Painful Hip/Knee Osteoarthritis - A Pilot Cohort Study With Objectives of Short Walks in the Real Life.
There is a lack of effective analgesic treatments to help walking patients with painful hip/knee osteoarthritis. Our team therefore imagined a new strategy lying on a multimodal rehabilitation walking program with the help of a transient intake of nonsteroidal anti-inflammatory drug (NSAID). NSAIDs are indeed known to act specifically on pain at movement, but their continuous intake would induce unacceptable side effects. To optimize the benefit/risk balance, the molecule to be chosen must fit to the patient's profile, and its intake should cover only the period of interest, i.e. planned walks. Our multimodal rehabilitation program will also include physical techniques such as appropriate footwear, a patient's education aiming at reducing fear/avoidance and spotting side effects of NSAIDs, and a prescription frame to avoid any overdosing. This clinical study is a single-center, non-randomized, open label, one-arm trial, using drugs prescribed according to their label (i.e. osteoarthritis pain), pending a reinforced monitoring of side effects. The primary endpoint is to evaluate efficacy and tolerance of a tailored and transient administration of NSAID within a rehabilitation walking program in patients with painful hip/knee osteoarthritis. Secondary endpoints are to evaluate the adherence to the program and the factors influencing adherence; to identify the less well tolerated conditions of treatment (one condition being one molecule for one patient profile); to identify the factors of success among a set of baseline demographic, morphometric and psychometric variables; and to study the role of central sensitization (assessed by temporal summation) on the efficacy of treatment.
Status | Not yet recruiting |
Enrollment | 55 |
Est. completion date | November 1, 2025 |
Est. primary completion date | July 1, 2025 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 50 Years to 70 Years |
Eligibility | Inclusion Criteria: - Uni- or bilateral hip or knee idiopathic osteoarthrosis (ACR criteria, Kellgren-Lawrence grade 2 or more on recent X-ray), responsible for pain since 3 at least months, and pain at walking which intensity is at least 4/10 on a numerical rating scale. - Less than 3 relevant walks (at least 20 minutes or 1000 km) a week. - Ability to understand and to follow the protocol, and to answer the questionnaires Exclusion Criteria: - Pregnancy or breastfeeding - Legal protection - Body weight < 40 kg or underweight - Body weight >120 kg or obesity - Unability to walk, or unability to walk without support devices (sticks, crutches, orthoses and knee pads are allowed) - Secondary osteoarthrosis (rheumatism, septic arthritis, recent osteonecrosis, hemochromatosis, gout, acromegalia…). - Concomitant general bone disease (Paget, Reiter…). - Concomitant and relevant painful disease else than due to osteoarthrosis (e.g. neuropathic pain, fibromyalgia…) - Previous recent intervention (e.g. surgery, arthroscopy, joint infiltration) expected to relief osteoarthrosis pain throughout the study period. - Planned intervention similar to those abovementioned, during the study period. - Recent initiation of any new analgesic treatment (including systemic steroids). - Planned initiation of any program expected to relief osteoarthrosis pain during the study period, such as physiotherapy, cognitive behavioral therapy…). - Planned major surgery during the study period. - Current cancer disease. - Immunosuppression. - Autoimmune disease. - Concomitant topical or systemic NSAID treatment. - Chronic strong opioid intake. - Concomitant insulin therapy. - Any absolute or relevant contraindication to NSAIDs or acetaminophen, according to the French drug agency |
Country | Name | City | State |
---|---|---|---|
France | CHU Clemront-Ferrand | Clermont-Ferrand |
Lead Sponsor | Collaborator |
---|---|
University Hospital, Clermont-Ferrand | Direction de la Recherche Clinique et des Innovations, CHU de Clermont-Ferrand, France, Fondation Apicil, Inserm U1107 " Neuro-Dol ", Clermont-Ferrand, France, Médecine du Sport et Explorations Fonctionnelles, CHU de Clermont-Ferrand, France, Médecine Physique et Réadaptation, CHU de Clermont-Ferrand, France, Plateforme d'Investigation Clinique, INSERM CIC1405, CHU de Clermont-Ferrand, France, Rhumatologie, CHU de Clermont-Ferrand, France, SARL BOUCHARENC, Saint-Chély d'Apcher, France, Université Clermont-Auvergne, France |
France,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | impairment of renal function (tolerance outcome) | either a 15%-increase (or more) of creatininemia from baseline, or a glomerular filtration rate <60 mL.min-1 (MDRD), or creatininemia exceeding 1.5-times the upper limit of the lab's normative values | V0 (inclusion) | |
Other | impairment of renal function (tolerance outcome) | either a 15%-increase (or more) of creatininemia from baseline, or a glomerular filtration rate <60 mL.min-1 (MDRD), or creatininemia exceeding 1.5-times the upper limit of the lab's normative values | V1 (pre-intervention visit) + 6 weeks | |
Other | impairment of renal function (tolerance outcome) | either a 15%-increase (or more) of creatininemia from baseline, or a glomerular filtration rate <60 mL.min-1 (MDRD), or creatininemia exceeding 1.5-times the upper limit of the lab's normative values | V1 (pre-intervention visit)+ 12 weeks | |
Other | impairment of liver function (tolerance outcome) | blood transaminase levels exceeding 2.5-times the upper limit of the lab's normative values, or the occurrence of any relevant abnormality on the liver blood parameters | V0 (inclusion) | |
Other | impairment of liver function (tolerance outcome) | blood transaminase levels exceeding 2.5-times the upper limit of the lab's normative values, or the occurrence of any relevant abnormality on the liver blood parameters | V1 (pre-intervention visit) + 6 weeks | |
Other | impairment of liver function (tolerance outcome) | blood transaminase levels exceeding 2.5-times the upper limit of the lab's normative values, or the occurrence of any relevant abnormality on the liver blood parameters | V1 (pre-intervention visit) + 12 weeks | |
Other | search for anemia (tolerance outcome) | 15%-decrease (or more) of hemoglobinemia from baseline | V0 (inclusion) | |
Other | search for anemia (tolerance outcome) | 15%-decrease (or more) of hemoglobinemia from baseline | V1 (pre-intervention visit) + 6 weeks | |
Other | search for anemia (tolerance outcome) | 15%-decrease (or more) of hemoglobinemia from baseline | V1 (pre-intervention visit) + 12 weeks | |
Other | relevant digestive event (tolerance outcome) | persistent gastralgia despite proton-pump inhibitor treatment, or any symptom of hematemesis or rectal bleeding | V1 (pre-intervention visit) + 6 weeks | |
Other | relevant digestive event (tolerance outcome) | persistent gastralgia despite proton-pump inhibitor treatment, or any symptom of hematemesis or rectal bleeding | V1 (pre-intervention visit) + 12 weeks | |
Other | bleeding event (tolerance outcome) | any abnormal bleeding event if the prescribed NSAID (Non-steroidal anti-inflammatory drugs) is COX (Cyclo-OXygenase inhibitors)-1 selective | V1 (pre-intervention visit) + 6 weeks | |
Other | bleeding event (tolerance outcome) | any abnormal bleeding event if the prescribed NSAID (Non-steroidal anti-inflammatory drugs) is COX (Cyclo-OXygenase inhibitors)-1 selective | V1 (pre-intervention visit) + 12 weeks | |
Other | thrombotic event (tolerance outcome) | any thrombotic event if the prescribed NSAID is COX-2 selective | V1 (pre-intervention visit) + 6 weeks | |
Other | thrombotic event (tolerance outcome) | any thrombotic event if the prescribed NSAID is COX-2 selective | V1 (pre-intervention visit) + 12 weeks | |
Other | serious adverse event (SAE) (tolerance outcome) | any SAE considered as relevant by the principal investigator, and possibly due to the intervention | V1 (pre-intervention visit) + 6 weeks | |
Other | serious adverse event (SAE) (tolerance outcome) | any SAE considered as relevant by the principal investigator, and possibly due to the intervention | V1 (pre-intervention visit) + 12 weeks | |
Other | EPICES scale (Evaluation of Precariousness and Health Inequalities in Health Examination Centers) (tolerance outcome) | social precarity | V0 (inclusion) | |
Other | Pain Catastrophizing Scale (PCS) (tolerance outcome) | pain catastrophizing | V0 (inclusion) | |
Other | Tampa Scale of Kinesiophobia (TSK) (tolerance outcome) | kinesiophobia | V0 (inclusion) | |
Other | level of anxious state (tolerance outcome) | Hospital Anxiety and Depression scale (HADS) | V0 (inclusion) | |
Other | level of depressive state (tolerance outcome) | Hospital Anxiety and Depression scale (HADS) | V0 (inclusion) | |
Other | temporal summation of pain (tolerance outcome) | measurement both at the forearm ipsilateral to the most painful joint and at the skin area referred to the most painful joint; temporal summation is measured by repeated stimuli with a von Frey filament (180g). | V0 (inclusion ) + 4 weeks | |
Primary | Success | success of the therapeutic program (defined by a 30%-increase (or more) of the monthly number of target moves from the baseline observation values, with no treatment discontinuation for NSAID side effects) | V1 (pre-intervention visit) + 12 weeks | |
Secondary | Self-declared physical activity (efficacy outcome) | Global Physical Activity Questionnaire (GPAQ) | V1 (pre-intervention visit) | |
Secondary | Self-declared physical activity (efficacy outcome) | Global Physical Activity Questionnaire (GPAQ) | V1 (pre-intervention visit) + 6 weeks | |
Secondary | Self-declared physical activity (efficacy outcome) | Global Physical Activity Questionnaire (GPAQ) | V1 (pre-intervention visit) + 12 weeks | |
Secondary | Actual physical activity (efficacy outcome) | Number of steps per day assessed by pedometer | V1 (pre-intervention visit) | |
Secondary | Actual physical activity (efficacy outcome) | Number of steps per day assessed by pedometer | V1 (pre-intervention visit)+ 6 weeks | |
Secondary | Actual physical activity (efficacy outcome) | Number of steps per day assessed by pedometer | V1 (pre-intervention visit) + 12 weeks | |
Secondary | Pain at walk during the two last weeks (efficacy outcome) | Visual Analogic Scale VAS (11-point numerical rating scale (from 0 = "no pain" to 10) "the worst pain imaginable") | V1 (pre-intervention visit) | |
Secondary | Pain at walk during the two last weeks (efficacy outcome) | Visual Analogic Scale VAS (11-point numerical rating scale (from 0 = "no pain" to 10) "the worst pain imaginable") | V1 (pre-intervention visit) + 6 weeks | |
Secondary | Pain at walk during the two last weeks (efficacy outcome) | Visual Analogic Scale VAS (11-point numerical rating scale (from 0 = "no pain" to 10) "the worst pain imaginable") | V1 (pre-intervention visit)+ 12 weeks | |
Secondary | Patient's Global Impression of Change (efficacy outcome) | 7-item scale | V1 (pre-intervention visit) + 12 weeks | |
Secondary | kinesiophobia (efficacy outcome) | Tampa Scale of Kinesiophobia (TSK) | V1 (pre-intervention visit) + 12 weeks | |
Secondary | level of anxious state (efficacy outcome) | Hospital Anxiety and Depression scale (HADS) | V1 (pre-intervention visit) + 12 weeks | |
Secondary | level of depressive state (efficacy outcome) | Hospital Anxiety and Depression scale (HADS) | V1 (pre-intervention visit)+ 12 weeks |
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