Investigating Botulinum Toxin A to Treat Acute Neck/Upper Shoulder Pain Following a New Spinal Cord Injury. - Full Text View

Sponsors and Collaborators:	Craig Hospital The Craig H. Neilsen Foundation Allergan
Information provided by:	Craig Hospital
ClinicalTrials.gov Identifier:	NCT00320281

Purpose

As clinicians, it is often a struggle to find effective pain control for a certain subgroup of patients with tetraplegia. These patients often have severe upper back, neck, and shoulder pain, limiting rehabilitation productivity and potential, and always limiting quality of life.

This pain appears to be primarily musculoskeletal. Muscles in the upper back and neck become shortened, rock hard, and extremely tender with even the slightest touch or stretch. Refractory to multiple classes of medications, modalities, and other treatments, patients truly suffer-not only from pain, but from fatigue, sedation, expense, and loss of useful rehabilitation time due to attempted remedies. Unfortunately, this subgroup of patients is not small and the problem is significant, as anyone who specializes in the treatment of spinal cord injury patients will recognize.

In search for another form of treatment, botulinum toxin A (BTXA) may be promising for pain control in that group of patients with tetraplegia whose pain has proven to be refractory to treatment. It did not take long searching the literature to find compelling evidence that BTXA may have another mechanism of action for direct pain control, apart from its well known mechanism for spasticity control. Clinically, it is increasingly being recommended and used for this purpose. In fact, one of the specific indications now recognized by most for BTXA treatment is for myogenic pain due to short, tight, strained muscles-just as we see with our population. Yet, it's application has not been studied in people with tetraplegia. Thus, the genesis of the project and the hope to help our patients evolved.

Study hypotheses:

In addition to traditional treatments used for pain control, injection of BTXA into cervical and upper back muscles will effectively reduce cervical/shoulder pain severity reported by individuals with cervical spinal cord injuries, regardless of the etiology of pain.
Pain reduction secondary to the use of BTXA will be associated with a decrease in total analgesic medication use among SCI patients during acute inpatient rehabilitation.
BTXA to treat cervical/shoulder pain will increase active participation in the rehabilitation program for individuals with tetraplegia during inpatient rehabilitation.

Condition	Intervention
Spinal Cord Injury Pain	Drug: botulinum toxin A

MedlinePlus related topics: Rehabilitation Spinal Cord Injuries

Drug Information available for: Botulinum toxin A Clostridium botulinum toxin

U.S. FDA Resources

Study Type:	Interventional
Study Design:	Treatment, Randomized, Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Placebo Control, Parallel Assignment, Safety/Efficacy Study
Official Title:	Botulinum Toxin A for the Treatment of Cervical/Shoulder Pain Following Acute Spinal Cord Injury.

Further study details as provided by Craig Hospital:

Primary Outcome Measures:

Visual Analog Scale (pain scale) [ Time Frame: 2 weeks, 6 weeks, and 6 months post injection ] [ Designated as safety issue: No ]
Brief Pain Inventory-SF [ Time Frame: 2 weeks, 6 weeks, and 6 months post-injection ] [ Designated as safety issue: No ]
Short-Form McGill Pain Questionnaire [ Time Frame: 2 weeks, 6 weeks, and 6 months post-injection ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Modified Leeds Neuropathic Symptoms and Signs Scale [ Time Frame: 2 weeks, 6 weeks, and 6 months post-injection ] [ Designated as safety issue: No ]
Beck Depression Inventory [ Time Frame: 2 weeks and 6 weeks post-injection ] [ Designated as safety issue: No ]
Cervical range of motion measurements [ Time Frame: 2 weeks and 6 weeks post-injection ] [ Designated as safety issue: No ]
Patient global outcome ratings [ Time Frame: 2 weeks, 6 weeks, and 6 months post-injection ] [ Designated as safety issue: No ]
Respiratory function measures [ Time Frame: 2 weeks and 6 weeks post-injection ] [ Designated as safety issue: No ]
Rehabilitation Interference Scale (RIS) [ Time Frame: 2 weeks and 6 weeks post-injection ] [ Designated as safety issue: No ]

Estimated Enrollment:	20
Study Start Date:	April 2006
Estimated Study Completion Date:	August 2008
Estimated Primary Completion Date:	August 2008 (Final data collection date for primary outcome measure)

Intervention Details:

Injection of BTXA into cervical and upper back muscles

Eligibility

Ages Eligible for Study:	15 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Inpatient at Craig Hospital for initial rehabilitation following a traumatic spinal cord injury.
Cervical Injury at C4-C8
ASIA classification score of A,B,or C
May still be in halo immobilization device and range of motion scores will therefore not be collected
Report at least a 6/10 on the VAS for pain in the previous 24 hours prior to randomization
Orthopedically stable
Approval of attending physician
Standard of care management with oral analgesic agents has not resulted in pain symptom resolution
May not be enrolled in other clinical trial

Exclusion Criteria:

Pregnant
Concurrent use of aminoglycoside antibiotics at the time of injection
Diagnosis of myasthenia gravis or Eaton-Lambert Syndrome
Known sensitivities to toxins
Severe bradycardia (HR<50 bpm) or hypotension (systolic blood pressure of <80 mmHg)
Deep vein thrombosis treatment doses of anticoagulants or coumadin
History of recent dysphagia
Ventilator dependent
Unstable cervical fracture or not surgically stabilized

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00320281

Contacts

Contact: Amy M Dannels-McClure, ND

303-789-8562

adannels-mcclure@craighospital.org

Locations

United States, Colorado
Craig Hospital	Recruiting
Englewood, Colorado, United States, 80113

Sponsors and Collaborators

Craig Hospital

The Craig H. Neilsen Foundation

Allergan

Investigators

Principal Investigator:

Gary Maerz, MD

Craig Hospital

More Information

No publications provided

Responsible Party:	Craig Hospital ( Gary Maerz, MD )
Study ID Numbers:	2691
Study First Received:	April 28, 2006
Last Updated:	June 18, 2008
ClinicalTrials.gov Identifier:	NCT00320281 History of Changes
Health Authority:	United States: Institutional Review Board

Keywords provided by Craig Hospital:

Botox

Study placed in the following topic categories:

Spinal Cord Diseases
Shoulder Pain
Joint Diseases
Wounds and Injuries
Central Nervous System Diseases
Disorders of Environmental Origin
Pain

Trauma, Nervous System
Spinal Cord Injuries
Signs and Symptoms
Botulinum Toxins
Musculoskeletal Diseases
Botulinum Toxin Type A
Arthralgia

Additional relevant MeSH terms:

Spinal Cord Diseases
Anti-Dyskinesia Agents
Shoulder Pain
Joint Diseases
Nervous System Diseases
Wounds and Injuries
Central Nervous System Diseases
Disorders of Environmental Origin
Pain

Trauma, Nervous System
Pharmacologic Actions
Spinal Cord Injuries
Signs and Symptoms
Botulinum Toxins
Musculoskeletal Diseases
Therapeutic Uses
Central Nervous System Agents
Arthralgia

ClinicalTrials.gov processed this record on May 07, 2009