Milnacipran for Lumbosacral Radicular Pain - Full Text View

Purpose

This study investigates whether milnacipran reduces radicular pain ("sciatica") in patients with lumbosacral disc disease.

Condition	Intervention	Phase
Radicular Pain Related to Lumbosacral Disc Disease	Drug: Milnacipran Drug: Placebo	Phase 4

Study Type:	Interventional
Study Design:	Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Investigator) Primary Purpose: Treatment
Official Title:	A Ten-Week, Randomized, Double-Blind, Placebo-Controlled Parallel-Group Study of Milnacipran for Radicular Pain Associated With Lumbosacral Disk Disease

Resource links provided by NLM:

MedlinePlus related topics: Sciatica

Drug Information available for: Milnacipran Milnacipran hydrochloride

U.S. FDA Resources

Further study details as provided by Duke University:

Primary Outcome Measures:

Change in Visual Analogue Scale Score referring to radicular pain (VAS-rad) [ Time Frame: Measured at screen and baseline and weeks 1, 2, 4, 6, 8, and 10 ] [ Designated as safety issue: No ]
as above

Secondary Outcome Measures:

Change in VAS related to nociceptive pain component (VAS-Noc) [ Time Frame: Measured at screen, baseline, and weeks 1, 2, 4, 6, 8, and 10 ] [ Designated as safety issue: No ]
as above
Patient Global Rating (improvement) [ Time Frame: Measured at week 10 ] [ Designated as safety issue: No ]
Self-report of amount improved to be completed by subjects
Change in Oswestry Low Back Pain Disability Questionnaire [ Time Frame: Measured at screen and baseline and weeks 1, 2, 4, 6, 8, and 10 ] [ Designated as safety issue: No ]
Self report evaluation of various back pain symptoms
Change in Neuropathic Pain Questionnaire [ Time Frame: Measured at screen and baseline and weeks 1, 2, 4, 6, 8, and 10 ] [ Designated as safety issue: No ]
Self-report evaluation of nerve pain symptoms.
Change in Beck Depression Inventory (BDI-II) [ Time Frame: Measured at screen and baseline and weeks 1, 2, 4, 6, 8, and 10 ] [ Designated as safety issue: No ]
Self-report evaluation of depressive symptoms.
Change in State-trait anxiety inventory (STAI) [ Time Frame: Measured at screen and baseline and weeks 1, 2, 4, 6, 8, and 10 ] [ Designated as safety issue: No ]
Self-report evaluation of anxiety symptoms.

Enrollment:	13
Study Start Date:	March 2010
Study Completion Date:	October 2011
Primary Completion Date:	October 2011 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: milnacipran Milnacipran, flexibly dosed	Drug: Milnacipran Other Name: Savella
Placebo Comparator: Sugar pill (placebo) Placebo	Drug: Placebo

Detailed Description:

The current study evaluates the potential efficacy of milnacipran in reducing lower extremity radicular pain associated with lumbar disk disease. Milnacipran will be titrated based on efficacy and tolerability aimed at the higher end of the therapeutic range; a recent study of a serotonin norepinephrine reuptake inhibitor in patients with osteoarthritis pain suggests efficacy may be dose related. Patients are likely to have concomitant nociceptive lower back pain, and cotreatment with opioids, muscle relaxants, benzodiazepines, or nonsteroidal anti-inflammatory drugs at stable doses will be permitted. Patients participating in stable regimen of physical therapy or biofeedback will be eligible. Procedural interventions (e.g. epidural steroid injection, nerve block, facet radioablation, acupuncture) during the study and 3 months prior will be exclusionary. Anticonvulsants, tramadol, and other antidepressant drugs will be excluded.

The study is a ten-week randomized, double-blind, placebo-controlled trial (RCT) of milnacipran (100-200 mg/day dosed twice a day) for radicular pain associated with lumbosacral disk disease.

Outcome measures and safety assessments will be obtained at weeks 1, 2, 4, 6, 8, and 10 according to the protocol schedule of assessments.

Eligibility

Ages Eligible for Study:	18 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Subject is a male or female adult outpatient age 18 or older at the time of consent.
Subject experiences chronic (> 6 months) radicular pain at least 5 days a week described as sharp or shooting below the level of the knee associated with lumbar or sacral disk disease without suspicion of recent injury; remote (>1 year ago) history of surgical intervention (e.g. "failed back syndrome") is allowed provided current symptoms meet severity criterion.
Subject-rated VAS specifically related to radicular pain > or = 40 mm at screen and baseline visits
Subject has an understanding, ability and willingness to fully comply with study procedures and restrictions.
Subject has the ability to provide written, personally signed and dated informed consent to participate in the study, in accordance with the International Conference on Harmonisation (ICH) Good Clinical Practice (GCP) Guideline E6 and applicable regulations, before completing any study-related procedures.

Exclusion Criteria:

Subjects unable to complete assessments due to language or cognitive impairment
Subjects treated with antidepressant or anticonvulsant medication within 4 weeks of screening visit (6 weeks for fluoxetine).
Subjects taking monoamine oxidase inhibitors
Subjects who have received procedural intervention within 3 months of screen.
Subjects with known sensitivity to milnacipran.
Subjects unable to complete the questionnaires due to language or cognitive impairment.
Subjects with a history of bipolar disorder or psychosis as confirmed by the Mini International Neuropsychiatric Interview (MINI).
Subject currently has (or had a history within the last 6 months of) a drug dependence or substance abuse disorder according to Diagnostic and Statistical Manual for Mental Disorders, Text Revision (DSM-IV-TR™) criteria (excluding nicotine).
Subjects who are currently considered a suicide risk, any subject who has previously made a suicide attempt or who has a prior history of or are currently demonstrating active suicidal ideation.
Subject has any clinically significant electrocardiogram (ECG) or clinically significant laboratory abnormality (including a positive urine drug screen) at Screening.
Subject has a concurrent chronic or acute illness, disability, or other condition that might confound the results of safety assessments administered in the study or that might increase risk to the subject. Similarly, the subject will be excluded if he or she has any additional condition(s) that in the Investigator's opinion would prohibit the subject from completing the study or would not be in the best interest of the subject. This would include any significant illness or unstable medical condition that could lead to difficulty complying with the protocol.
Subjects who are pregnant or who are nursing
Subjects who do not agree to use adequate and reliable contraception throughout the study.
Subject previously completed, discontinued or was withdrawn from this study.
Subject has taken an investigational drug or taken part in a clinical trial within 30 days prior to Screening.
Subjects with liver disease or reduced liver function
Subjects with obstructive uropathies
Subjects who consume alcohol in amounts viewed by the Investigator to be contraindicated
Subjects with uncontrolled narrow angle glaucoma
Subjects with seizure disorders
Subjects with bleeding disorders or use of other medications that may cause bleeding

Contacts and Locations

No Contacts or Locations Provided

More Information

No publications provided

Responsible Party:	Duke University
ClinicalTrials.gov Identifier:	NCT01777581 History of Changes
Other Study ID Numbers:	Pro00020888 (SAV-MD-12)
Study First Received:	November 30, 2012
Last Updated:	January 24, 2013
Health Authority:	United States: Food and Drug Administration United States: Institutional Review Board

Keywords provided by Duke University:

sciatica radiculopathy lumbar disc lumbosacral disc

Additional relevant MeSH terms:

Spinal Diseases
Bone Diseases
Musculoskeletal Diseases
Milnacipran
Antidepressive Agents
Psychotropic Drugs
Central Nervous System Agents
Therapeutic Uses
Pharmacologic Actions

Serotonin Uptake Inhibitors
Neurotransmitter Uptake Inhibitors
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Serotonin Agents
Physiological Effects of Drugs
Adrenergic Uptake Inhibitors
Adrenergic Agents

ClinicalTrials.gov processed this record on May 22, 2013