FibromyalgiaPhase 3NCT01391598
Lidocaine on Pain Relief and IL and Substance P in Fibromyalgia
A Phase 3 study testing Lidocaine in people with Fibromyalgia, run by Federal University of São Paulo at 1 site in Brazil.
Trial summary
The study's primary objective is to evaluate the effect of intravenous lidocaine on pain and plasma interleukin-1 (IL-1), interleukin-6 (IL-6) and substance P in patients with fibromyalgia. As secondary objectives: evaluate the clinical manifestations, and plasma concentration of lidocaine. Read more about this study
- Who is it for?
- Ages 18 to 60 years
- Conditions the study is for
- Fibromyalgia
- What is being tested?
- Lidocaine
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 40 participants
- Where
- 1 siteBrazil
- Study dates
- Jan 2010to Dec 2012
- Phase
- Phase 3
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 60 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- Patients with fibromyalgia will be included in the study through the classification criteria proposed by the American College of Rheumatology (generalized hypersensitivity and pain or stiffness in 11 of 18 musculotendinous insertions sites for at least three months in the four quadrants of the body, absence of traumatic injury, rheumatic disease, neuromuscular or infectious arthropathy).
Who cannot join
- Will be excluded from the study patients who had: no cognitive or language comprehension; abnormal laboratory tests, trauma, psychiatric illness, rheumatic or neuromuscular another pain syndrome, infectious arthropathy, hypersensitivity to drugs and pregnant. Also will be excluded patients with arrhythmia, myocardial infarction, concomitant use of cisapride or monoamine oxidase inhibitor, bundle branch block or atrio-ventricular heart failure, acute, angle glaucoma, myasthenia gravis, severe liver disease and hyperthyroidism; and those who are using centrally acting analgesic medication (antidepressants, anticonvulsants, opioids, neuroleptics) for at least 4 weeks from baseline.
- Patients who experience severe side effects related to the infusion of lidocaine (severe hypotension and seizure) will be excluded from the study.
Trial locations and contacts
1 site in 1 country.
Brazil1 site, 1 recruiting
- Recruiting
Federal Unifesrity of Sao Paulo
São Paulo, São Paulo
Ana Laura A Giraldes, Md, 50847463 ext. 55(11), analgiraldes@hotmail.com
About this study
Official title: Evaluation of the Effect of Intravenous Lidocaine on Pain Relief and Plasma Concentrations of Interleukins (IL-1 and IL-6) and Substance P in Patients With Fibromyalgia
The study's primary objective is to evaluate the effect of intravenous lidocaine on pain and plasma interleukin-1 (IL-1), interleukin-6 (IL-6) and substance P in patients with fibromyalgia.
As secondary objectives: evaluate the clinical manifestations, and plasma concentration of lidocaine.
Read the detailed description
Fibromyalgia is a painful syndrome characterized by chronic diffuse pain and involvement of multiple muscles and soft tissues 1. The pain is very common, with prevalence around 2% in the adult population.
In fibromyalgia, there is an increase of both somatic and visceral nociception, and dysfunction of central nervous.system According to the American College of Rheumathology diagnostic criteria for fibromyalgia are widespread pain and the presence of 11 of 18 typical tender points 3.
Minor criteria in the inclusion of patients for the diagnosis of fibromyalgia, such as pain that changes with physical activity, sleep disturbance, fatigue, anxiety, depression, paresthesia, cramps, sensation of swelling 4. Several co-morbidities may be associated with pain such as migraine, myofascial pain syndrome, and irritable bowel syndrome.
The symmetry of these conditions shows that fibromyalgia is associated with central sensitization 5. The pathophysiological mechanisms of fibromyalgia are related to changes in neurotransmitters 6,7,8. Cytokines may be involved in modulation of symptoms such as hyperalgesia, fatigue and depression, and maintenance of sympathetic pain 9.
] The substance P ( SP ) levels are increased in cerebrospinal fluid of patients with fibromyalgia compared to control groups 10.
Antidepressants are the most widely used drugs for its treatment. The drug most commonly used is amitriptyline.
Other drugs (muscle relaxants, anticonvulsants, NSAIDs, tramadol) are also employed. Physical activity is essential to control the symptoms. Physical measures, psychotherapy, occupational therapy are other treatments, but the effectiveness is variable 14.15. Sometimes a combination of drugs and techniques are needed to obtain satisfactory results.
The infusion of local anesthetic is given intravenously for fibromyalgia when oral medication does not produce the proper effect. It promotes sympathetic blockade, vasodilation, anesthesia of the nerve endings in the vascular endothelium, stabilization of membrane and breaks the vicious circle that keeps pain 16.
Local anesthetics are membrane-stabilizing and prevent the generation of ectopic impulses in lower concentrations than those needed to block the normal driving. The dose used by different authors ranged from 1 to 5 mg / kg, administered in 30-60 minutes 17-24. Side effects of lidocaine are: sedation, vertigo, dizziness, blurred vision, nausea and vomiting 25.
The effectiveness of intravenous lidocaine in neuropathic pain is well established 26. Despite evidence of analgesic effect, there is controversy in conditions without nerve injury. It may be that the selectivity of the effect for non-neuropathic and neuropathic pain is relative and depends on the plasma concentration reached25.
For the use of systemic lidocaine in fibromyalgia, there are no well-controlled studies, and to assess changes of cytokines and substance P, which stimulated this research.
- Conditions
- Fibromyalgia
- Being tested
- Lidocaine
- Keywords
- fibromyalgia, intravenous lidocaine, substance P, interleukins
- Medical subject headings
- Fibromyalgia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
LidocaineDrug
After completion of the inclusion criteria all patients receive a dose of amitriptyline 12.5 mg in the first week, and 25 mg in the eight subsequent weeks, orally, once daily at night. At lidocaine group 20 pacients will receive lidocaine at a dose of 4 mg / kg, not exceeding a dose of 240 mg diluted in 125ml of solution 0.9% saline.The solutions will be infused in 1 hour once a week in the four weeks following the start of the study..:Patients may use as additional analgesics up to 4g/day acetaminophen, and if necessary, they can use tramadol, recording the dose
lidocaineDrug
After completion of the inclusion criteria all patients receive a dose of amitriptyline 12.5 mg in the first week, and 25 mg in the eight subsequent weeks, orally, once daily at night. At saline group 20 pacients will receive 125ml of solution 0.9% saline.The solutions will be infused in 1 hour once a week in the four weeks following the start of the study. Patients may use as additional analgesics up to 4g/day acetaminophen, and if necessary, they can use tramadol, recording the dose
| Study group | Role | What they receive |
|---|---|---|
| Lidocaine | Active comparator | After completion of the inclusion criteria all patients receive a dose of amitriptyline 12.5 mg in the first week, and 25 mg in the eight subsequent weeks, orally, once daily at night. At lidocaine group 20 pacients will receive lidocaine at a dose of 4 mg / kg, not exceeding a dose of 240 mg diluted in 125ml of solution 0.9% saline.The solutions will be infused in 1 hour once a week in the four weeks following the start of the study..:Patients may use as additional analgesics up to 4g/day acetaminophen, and if necessary, they can use tramadol, recording the dose Receives: Drug: Lidocaine |
| Saline | Placebo comparator | After completion of the inclusion criteria all patients receive a dose of amitriptyline 12.5 mg in the first week, and 25 mg in the eight subsequent weeks, orally, once daily at night. At saline group 20 pacients will receive 125ml of solution 0.9% saline.The solutions will be infused in 1 hour once a week in the four weeks following the start of the study. Patients may use as additional analgesics up to 4g/day acetaminophen, and if necessary, they can use tramadol, recording the dose Receives: Drug: lidocaine |
What is being measured
The primary outcome is the main question the study is designed to answer.
Evaluation of the effect of intravenous lidocaine on pain relief and plasma concentrations of interleukins (IL-1 and IL-6) and substance P in patients with fibromyalgia
Measured: 60 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted12 Jul 2011 (estimated)
- Study startJan 2010
- Primary completionJul 2012 (estimated)
- Study completionDec 2012 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for FibromyalgiaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 40 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Federal University of São Paulo
- Sponsor type
- University, hospital or other
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01391598
- Sponsor's protocol ID
- FibromialgiaGiraldes
- Status last verified
- Dec 2009
- First submitted
- 11 Jul 2011
- Last updated
- 12 Jul 2011
- Results posted
- No
- Data monitoring committee
- Yes
Study at a glance
From the registry record, last updated by the sponsor on 12 Jul 2011. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Evaluation of the Effect of Intravenous Lidocaine on Pain Relief and Plasma Concentrations of Interleukins (IL-1 and IL-6) and Substance P in Patients With Fibromyalgia
- ClinicalTrials.gov ID
- NCT01391598
- Acronym / sponsor ID
- FibromialgiaGiraldes
- Conditions
- Fibromyalgia
- Keywords
- fibromyalgia, intravenous lidocaine, substance P, interleukins
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 40 participants (estimated)
- Lead sponsor
- Federal University of São PauloUniversity, hospital or other
- Study start
- Jan 2010
- Primary completion
- Jul 2012 (estimated)
- Study completion
- Dec 2012 (estimated)
- First posted
- 12 Jul 2011 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The study's primary objective is to evaluate the effect of intravenous lidocaine on pain and plasma interleukin-1 (IL-1), interleukin-6 (IL-6) and substance P in patients with fibromyalgia.
As secondary objectives: evaluate the clinical manifestations, and plasma concentration of lidocaine.
Detailed description
Fibromyalgia is a painful syndrome characterized by chronic diffuse pain and involvement of multiple muscles and soft tissues 1. The pain is very common, with prevalence around 2% in the adult population.
In fibromyalgia, there is an increase of both somatic and visceral nociception, and dysfunction of central nervous.system According to the American College of Rheumathology diagnostic criteria for fibromyalgia are widespread pain and the presence of 11 of 18 typical tender points 3.
Minor criteria in the inclusion of patients for the diagnosis of fibromyalgia, such as pain that changes with physical activity, sleep disturbance, fatigue, anxiety, depression, paresthesia, cramps, sensation of swelling 4. Several co-morbidities may be associated with pain such as migraine, myofascial pain syndrome, and irritable bowel syndrome.
The symmetry of these conditions shows that fibromyalgia is associated with central sensitization 5. The pathophysiological mechanisms of fibromyalgia are related to changes in neurotransmitters 6,7,8. Cytokines may be involved in modulation of symptoms such as hyperalgesia, fatigue and depression, and maintenance of sympathetic pain 9.
] The substance P ( SP ) levels are increased in cerebrospinal fluid of patients with fibromyalgia compared to control groups 10.
Antidepressants are the most widely used drugs for its treatment. The drug most commonly used is amitriptyline.
Other drugs (muscle relaxants, anticonvulsants, NSAIDs, tramadol) are also employed. Physical activity is essential to control the symptoms. Physical measures, psychotherapy, occupational therapy are other treatments, but the effectiveness is variable 14.15. Sometimes a combination of drugs and techniques are needed to obtain satisfactory results.
The infusion of local anesthetic is given intravenously for fibromyalgia when oral medication does not produce the proper effect. It promotes sympathetic blockade, vasodilation, anesthesia of the nerve endings in the vascular endothelium, stabilization of membrane and breaks the vicious circle that keeps pain 16.
Local anesthetics are membrane-stabilizing and prevent the generation of ectopic impulses in lower concentrations than those needed to block the normal driving. The dose used by different authors ranged from 1 to 5 mg / kg, administered in 30-60 minutes 17-24. Side effects of lidocaine are: sedation, vertigo, dizziness, blurred vision, nausea and vomiting 25.
The effectiveness of intravenous lidocaine in neuropathic pain is well established 26. Despite evidence of analgesic effect, there is controversy in conditions without nerve injury. It may be that the selectivity of the effect for non-neuropathic and neuropathic pain is relative and depends on the plasma concentration reached25.
For the use of systemic lidocaine in fibromyalgia, there are no well-controlled studies, and to assess changes of cytokines and substance P, which stimulated this research.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Lidocaine | Active comparator | Drug: LidocaineAfter completion of the inclusion criteria all patients receive a dose of amitriptyline 12.5 mg in the first week, and 25 mg in the eight subsequent weeks, orally, once daily at night. At lidocaine group 20 pacients will receive lidocaine at a dose of 4 mg / kg, not exceeding a dose of 240 mg diluted in 125ml of solution 0.9% saline.The solutions will be infused in 1 hour once a week in the four weeks following the start of the study..:Patients may use as additional analgesics up to 4g/day acetaminophen, and if necessary, they can use tramadol, recording the dose |
| Saline | Placebo comparator | Drug: lidocaineAfter completion of the inclusion criteria all patients receive a dose of amitriptyline 12.5 mg in the first week, and 25 mg in the eight subsequent weeks, orally, once daily at night. At saline group 20 pacients will receive 125ml of solution 0.9% saline.The solutions will be infused in 1 hour once a week in the four weeks following the start of the study. Patients may use as additional analgesics up to 4g/day acetaminophen, and if necessary, they can use tramadol, recording the dose |
Who may qualify
- Ages
- 18 to 60 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (1 listed)
- Patients with fibromyalgia will be included in the study through the classification criteria proposed by the American College of Rheumatology (generalized hypersensitivity and pain or stiffness in 11 of 18 musculotendinous insertions sites for at least three months in the four quadrants of the body, absence of traumatic injury, rheumatic disease, neuromuscular or infectious arthropathy).
Key exclusion criteria (2 listed)
- Will be excluded from the study patients who had: no cognitive or language comprehension; abnormal laboratory tests, trauma, psychiatric illness, rheumatic or neuromuscular another pain syndrome, infectious arthropathy, hypersensitivity to drugs and pregnant. Also will be excluded patients with arrhythmia, myocardial infarction, concomitant use of cisapride or monoamine oxidase inhibitor, bundle branch block or atrio-ventricular heart failure, acute, angle glaucoma, myasthenia gravis, severe liver disease and hyperthyroidism; and those who are using centrally acting analgesic medication (antidepressants, anticonvulsants, opioids, neuroleptics) for at least 4 weeks from baseline.
- Patients who experience severe side effects related to the infusion of lidocaine (severe hypotension and seizure) will be excluded from the study.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| LidocaineAfter completion of the inclusion criteria all patients receive a dose of amitriptyline 12.5 mg in the first week, and 25 mg in the eight subsequent weeks, orally, once daily at night. At lidocaine group 20 pacients will receive lidocaine at a dose of 4 mg / kg, not exceeding a dose of 240 mg diluted in 125ml of solution 0.9% saline.The solutions will be infused in 1 hour once a week in the four weeks following the start of the study..:Patients may use as additional analgesics up to 4g/day acetaminophen, and if necessary, they can use tramadol, recording the dose | Drug | Lidocaine |
| lidocaineAfter completion of the inclusion criteria all patients receive a dose of amitriptyline 12.5 mg in the first week, and 25 mg in the eight subsequent weeks, orally, once daily at night. At saline group 20 pacients will receive 125ml of solution 0.9% saline.The solutions will be infused in 1 hour once a week in the four weeks following the start of the study. Patients may use as additional analgesics up to 4g/day acetaminophen, and if necessary, they can use tramadol, recording the dose | Drug | Saline |
Primary outcome
Evaluation of the effect of intravenous lidocaine on pain relief and plasma concentrations of interleukins (IL-1 and IL-6) and substance P in patients with fibromyalgia
Time frame: 60 days
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 12 Jul 2011.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing Lidocaine in people with Fibromyalgia, run by Federal University of São Paulo at 1 site in Brazil.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 12 Jul 2011. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Brazil. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Ana Laura A Giraldes, Md (50847463 ext. 55, analgiraldes@hotmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Evaluation of the effect of intravenous lidocaine on pain relief and plasma concentrations of interleukins (IL-1 and IL-6) and substance P in patients with fibromyalgia (time frame: 60 days). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Jul 2011.