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Pilot Study to Assess the Efficacy of Botulinum Toxin A Treatments on Pain and Disability in Sub-Acute Low Back Pain

Primary Purpose

Low Back Pain

Status
Terminated
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Botulinum Toxin A
Placebo
Sponsored by
United States Department of Defense
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Low Back Pain focused on measuring back, pain

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Male or female subjects, 18 to 60 years of age, active duty military.
  • Written informed consent and written authorization for use or release of health and research study information.
  • Clear history of an identifiable muscle strain or trauma preceding the onset of low back pain.
  • No prior history of vertebral disk disease/condition, sciatica or radiculopathy.
  • Normal neurological examination without evidence of radiculopathy.
  • History of low back pain lasting 6 to 16 weeks from the time of injury or strain.
  • VAS score minimum of 5 cm at time of entry into study.
  • Ability to follow study instructions and likely to complete all required visits.
  • Negative urine pregnancy test prior to the administration of study medication (for females of childbearing potential) (if applicable).

Exclusion Criteria:

  • Age less than 18 or greater than 60.
  • Not active duty.
  • Concomitant use of aminoglycoside antibiotics, curare-like agents, or other agents that might interfere with neuromuscular function.
  • Any medical condition that may put the subject at increased risk with exposure to BOTOX®, including diagnosed myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis/motor neuron disease, neuropathy, renal stones, or any other disorder that might interfere with neuromuscular function or produce a similar type of low back pain.
  • Females who are pregnant, breast-feeding, or planning a pregnancy during the study, or who think that they may be pregnant at the start of the study, or females of childbearing potential who are unable or unwilling to use a reliable form of contraception during the study.
  • Known allergy or sensitivity to any of the components in the study medication.
  • Evidence of alcohol or substance abuse in 6 months prior to enrollment.
  • Systemic medical conditions (such as thyroid disease, hypertension, bleeding disorders, diabetes, cancers, etc.) that are not currently medically managed or controlled.
  • Concurrent participation in another investigational drug or device study or participation in the 30 days immediately prior to study enrollment.
  • Any condition or situation that, in the investigator's opinion, may put the subject at significant risk, confound the study results, or interfere significantly with the subject's participation in the study.
  • Significant Axis I or II diagnosis determined by a neurologist or psychiatrist in the 6 months prior to entry into the study.
  • Duration of low back pain < 6 weeks or > 16 weeks.
  • Thoracic or cervical spine pain in the absence of sub-acute low back pain.
  • Anesthetic or corticosteroid injection to the lumbosacral spine within 8 weeks of enrollment.
  • Spine MRI (any region) positive for acute pathology or evidence of radiculopathy on neurological examination.
  • History of back surgery within one year or incomplete resolution of back pain due to a previous injury or surgery.
  • Subjects involved in litigation, seeking significant disability for low back pain, or with evident secondary gain as determined by the neurologist through chart review and subject interview.
  • Any previous use of BOTOX®, Dysport®, or Myobloc®.

Sites / Locations

  • Walter Reed Army Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

1

2

Arm Description

Botulinum Toxin A

Placebo

Outcomes

Primary Outcome Measures

Significant reduction of low back pain

Secondary Outcome Measures

Significant reduction in long term disability

Full Information

First Posted
October 4, 2006
Last Updated
March 4, 2009
Sponsor
United States Department of Defense
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1. Study Identification

Unique Protocol Identification Number
NCT00384371
Brief Title
Pilot Study to Assess the Efficacy of Botulinum Toxin A Treatments on Pain and Disability in Sub-Acute Low Back Pain
Official Title
Pilot Study to Assess the Efficacy of Botulinum Toxin A (BOTOX®) Treatment of Paravertebral Muscles on Pain and Disability in Subjects Suffering From Sub-Acute Low Back Pain.
Study Type
Interventional

2. Study Status

Record Verification Date
March 2009
Overall Recruitment Status
Terminated
Why Stopped
Funding was unable to be secured for this study
Study Start Date
June 2008 (undefined)
Primary Completion Date
September 2011 (Anticipated)
Study Completion Date
September 2011 (Anticipated)

3. Sponsor/Collaborators

Name of the Sponsor
United States Department of Defense

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will test the hypothesis that Botulinum toxin A (BOTOX®) treatment reduces pain and disability in subjects suffering from sub-acute low back pain due to an identifiable muscle strain or back trauma occurring 6 to 16 weeks prior to enrollment. The study will also delineate the duration of medication effect and control for any placebo or mechanical trigger-point injection effect by employing a prospective, double-blind, placebo-controlled design.
Detailed Description
This study will assess the efficacy of Botulinum Toxin A (BOTOX®) injected into the lumbar paravertebral muscles for reducing pain and disability in subjects suffering from sub-acute low back pain (duration 6 to 16 weeks) arising from an identifiable muscle strain injury or back trauma. The treatment modality and techniques used are based upon three successful prior open-labeled pilot studies done by this research group investigating the effect of BOTOX® on relief of chronic low back pain. This study, however, will employ a prospective, double-blind, randomized, placebo controlled trial to control for any placebo or mechanical trigger-point injection effects. Subjects will also be assessed for 6 months to define the duration of efficacy of BOTOX®. Sixty subjects will be randomly assigned to one of two arms. There will be two parts to this study. In the first both groups will receive either BOTOX® or placebo injection into the lumbar paravertebral muscles. The subjects will be assessed using validated scales for pain and disability prior to injection and weekly to monthly thereafter for three months. Subjects who improve will have a single follow-up visit at 6 months while those subjects who do not improve will enter the second, open-label part where they will receive BOTOX® injection and be monitored weekly to monthly for the next 3 months, giving a total subject participation period of 6 months. All subjects will continue to receive any medication or physiotherapy per standard of care but those treatments will be recorded and controlled for in the data analysis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Low Back Pain
Keywords
back, pain

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1
Arm Type
Experimental
Arm Description
Botulinum Toxin A
Arm Title
2
Arm Type
Placebo Comparator
Arm Description
Placebo
Intervention Type
Drug
Intervention Name(s)
Botulinum Toxin A
Other Intervention Name(s)
Botox
Intervention Description
Botulinum Toxin A
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo
Primary Outcome Measure Information:
Title
Significant reduction of low back pain
Time Frame
8 weeks
Secondary Outcome Measure Information:
Title
Significant reduction in long term disability
Time Frame
12 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Male or female subjects, 18 to 60 years of age, active duty military. Written informed consent and written authorization for use or release of health and research study information. Clear history of an identifiable muscle strain or trauma preceding the onset of low back pain. No prior history of vertebral disk disease/condition, sciatica or radiculopathy. Normal neurological examination without evidence of radiculopathy. History of low back pain lasting 6 to 16 weeks from the time of injury or strain. VAS score minimum of 5 cm at time of entry into study. Ability to follow study instructions and likely to complete all required visits. Negative urine pregnancy test prior to the administration of study medication (for females of childbearing potential) (if applicable). Exclusion Criteria: Age less than 18 or greater than 60. Not active duty. Concomitant use of aminoglycoside antibiotics, curare-like agents, or other agents that might interfere with neuromuscular function. Any medical condition that may put the subject at increased risk with exposure to BOTOX®, including diagnosed myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis/motor neuron disease, neuropathy, renal stones, or any other disorder that might interfere with neuromuscular function or produce a similar type of low back pain. Females who are pregnant, breast-feeding, or planning a pregnancy during the study, or who think that they may be pregnant at the start of the study, or females of childbearing potential who are unable or unwilling to use a reliable form of contraception during the study. Known allergy or sensitivity to any of the components in the study medication. Evidence of alcohol or substance abuse in 6 months prior to enrollment. Systemic medical conditions (such as thyroid disease, hypertension, bleeding disorders, diabetes, cancers, etc.) that are not currently medically managed or controlled. Concurrent participation in another investigational drug or device study or participation in the 30 days immediately prior to study enrollment. Any condition or situation that, in the investigator's opinion, may put the subject at significant risk, confound the study results, or interfere significantly with the subject's participation in the study. Significant Axis I or II diagnosis determined by a neurologist or psychiatrist in the 6 months prior to entry into the study. Duration of low back pain < 6 weeks or > 16 weeks. Thoracic or cervical spine pain in the absence of sub-acute low back pain. Anesthetic or corticosteroid injection to the lumbosacral spine within 8 weeks of enrollment. Spine MRI (any region) positive for acute pathology or evidence of radiculopathy on neurological examination. History of back surgery within one year or incomplete resolution of back pain due to a previous injury or surgery. Subjects involved in litigation, seeking significant disability for low back pain, or with evident secondary gain as determined by the neurologist through chart review and subject interview. Any previous use of BOTOX®, Dysport®, or Myobloc®.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jack W Tsao, MD
Organizational Affiliation
Walter Reed Army Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Walter Reed Army Medical Center
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20307
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
7877388
Citation
Wipf JE, Deyo RA. Low back pain. Med Clin North Am. 1995 Mar;79(2):231-46. doi: 10.1016/s0025-7125(16)30065-7.
Results Reference
background
PubMed Identifier
1534720
Citation
Frymoyer JW. Predicting disability from low back pain. Clin Orthop Relat Res. 1992 Jun;(279):101-9.
Results Reference
background
PubMed Identifier
8196691
Citation
Polo KB, Jabbari B. Effectiveness of botulinum toxin type A against painful limb myoclonus of spinal cord origin. Mov Disord. 1994 Mar;9(2):233-5. doi: 10.1002/mds.870090221.
Results Reference
background
PubMed Identifier
5319286
Citation
Rand MJ, Whaler BC. Impairment of sympathetic transmission by botulinum toxin. Nature. 1965 May 8;206(984):588-91. doi: 10.1038/206588a0. No abstract available.
Results Reference
background
PubMed Identifier
7604348
Citation
Haig AJ, LeBreck DB, Powley SG. Paraspinal mapping. Quantified needle electromyography of the paraspinal muscles in persons without low back pain. Spine (Phila Pa 1976). 1995 Mar 15;20(6):715-21.
Results Reference
background
PubMed Identifier
11376175
Citation
Foster L, Clapp L, Erickson M, Jabbari B. Botulinum toxin A and chronic low back pain: a randomized, double-blind study. Neurology. 2001 May 22;56(10):1290-3. doi: 10.1212/wnl.56.10.1290.
Results Reference
background

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Pilot Study to Assess the Efficacy of Botulinum Toxin A Treatments on Pain and Disability in Sub-Acute Low Back Pain

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