Back to resultsA Study of Cannabis Based Medicine Extracts and Placebo in Patients With Pain Due to Spinal Cord Injury
Primary Purpose
Pain
Status
Completed
Phase
Phase 3
Locations
United Kingdom
Study Type
Interventional
Intervention
GW-1000-02
Placebo
Sponsored by
About this trial
This is an interventional treatment trial for Pain
Eligibility Criteria
Inclusion Criteria:
- Gave informed consent for participation in the study.
- Male or Female, aged 18 years or above.
- Diagnosis of non-acute spinal cord injury, with central neuropathic pain not wholly relieved by current therapy.
- Central neuropathic pain with a mean severity Numerical Rating Scale score at least four during last seven days of the baseline period.
- Relatively stable neurology during the preceding six months.
- Stable medication regimen during the preceding four weeks.
- Agreement, if female and of child bearing potential or if male with a partner of child bearing potential, to ensure that effective contraception was used during the study and for three months thereafter.
- Had not used cannabinoids for at least the preceding seven days and willing to abstain from any use of cannabinoids during the study.
- Clinically acceptable laboratory results at Visit 2.
- Ability (in the investigator's opinion) and willingness to comply with all study requirements.
- Agreement for the UK Home Office, their general practitioner, and their consultant if appropriate, to be notified of their participation in the study.
Exclusion Criteria:
- History of schizophrenia, other psychotic illness, severe personality disorder or other significant psychiatric disorder other than depression associated with their underlying condition.
- History of alcohol or substance abuse.
- Severe cardiovascular disorder, such as ischaemic heart disease, arrhythmias (other than well controlled atrial fibrillation), poorly controlled hypertension or severe heart failure.
- History of autonomic dysreflexia.
- History of epilepsy.
- If female, were pregnant or lactating, or were planning a pregnancy to occur during the course of the study.
- Significant renal or hepatic impairment.
- Elective surgery or other procedures requiring general anaesthesia scheduled to occur during the study.
- Terminal illness or were considered inappropriate for placebo medication.
- Any other significant disease or disorder which, in the opinion of the investigator, may have either put the subject at risk because of participation in the study, or may influenced the result of the study, or the subject's ability to participate in the study.
- Regular levodopa therapy within the seven days leading to study entry.
- If male, were receiving and were unwilling to stop sildenafil for the duration of the study.
- Known or suspected hypersensitivity to cannabinoids or any of the excipients of the study medications.
- Known or suspected adverse reaction to cannabinoids.
- Intention to travel internationally during the study.
- Intention to donate blood during the study.
- Participation in another research study in the 12 weeks leading to study entry.
- Previous randomisation into this study.
Sites / Locations
- The Royal National Orthopaedic Hospital
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Placebo Comparator
Arm Label
GW-1000-02
Placebo
Arm Description
Active treatment.
Placebo control.
Outcomes
Primary Outcome Measures
Change From Baseline in Mean Central Neuropathic Pain 11-Point Numerical Rating Scale Scores at the End of Treatment (up to 51 Days).
The Central Neuropathic Pain Numerical Rating Scale score was recorded three times daily, in the morning (on waking), at lunchtime and in the evening using the scale, 0 = 'No Pain' and 10 = 'Worst Possible Pain'. Patients were instructed to relate 'No Pain' to the time before the start of their spinal cord injury. End of Treatment was defined as the mean of the last seven days in the study or the mean of the last three days if the subject withdrew. A negative value indicates an improvement in pain score from baseline.
Secondary Outcome Measures
Change From Baseline in the Mean Percentage of Days on Which Escape Medication Was Used at the End of Treatment
The percentage of days that subjects used escape medication was analysed and is presented as the mean change from baseline at the end of treatment. A negative value from baseline indicates an improvement.
Change From Baseline in Mean Spasm Severity Numerical Rating Scale Score at the End of Treatment
Each day, just before going to bed, patients recorded in their patient diary whether they experienced any spasms that day and, if yes, recorded the overall level of the spasm(s) experienced using an Numerical Rating Scale spasm scale ranging from 0 = "Mildest ever spasm" to 10 = "Worst ever spasm". The mean spasm severity scores were summarised and analysed analogously to the primary endpoint. A negative value from baseline indicates an improvement.
Change From Baseline in the Percentage of Days on Which Spasm Was Experienced at the End of Treatment
Each day, just before going to bed, patients recorded in their patient diary whether they experienced any spasms that day. The percentage of days on which spasm was experienced were summarised and analysed analogously to the primary endpoint. A negative value from baseline indicates an improvement.
Change From Baseline in Mean Spasticity Severity Numerical Rating Scale Scores the End of Treatment.
Each day at bed time patients recorded whether they experienced any spasticity that day and, if yes, the overall level of spasticity experienced was quantified using an Numerical Rating Scale from 0 = "Mildest ever spasticity" to 10 = "Worst ever spasticity". The mean spasticity severity scores and the changes from baseline to End of Treatment were to be calculated. A negative value indicates an improvement from baseline.
Change From Baseline in the Percentage of Days on Which Spasticity Was Experienced at the End of Treatment
Each day, just before going to bed, patients recorded in their patient diary whether they had experienced any spasticity that day or not. The percentage of days on which spasticity was experienced (spasticity incidence) was calculated and summarised analogously to the primary efficacy parameter of Numerical Rating Scale pain score. A negative value from baseline indicates an improvement.
Change From Baseline in Modified Ashworth Scale Score at the End of Treatment
The Modified Ashworth Scale is a five-point scale conducted on four pre-identified muscle groups. Only the lower limb was assessed because not all Spinal Cord Injury patients upper limb disability. The assessor used the Modified Ashworth scale ranging from 0 ("No increase in muscle tone") to 4 ("Affected part(s) rigid in flexion or extension") to rate the muscle tone for knee and ankle for the left and right sides separately at a pre-dose visit and at the end of treatment. The average of the four individual scores and was taken. A negative value indicates an improvement from baseline.
Change From Baseline in the Mean Short Orientation Memory Function Concentration Test Score at the End of Treatment
Patients were asked at baseline and end of treatment, to complete the Short Orientation Memory Function Concentration Test as a measure of cognitive function. The minimum score is 0 and maximum of 28 which denoted good cognitive function .
A negative value from baseline indicates a deterioration.
Change From Baseline in Mean Spitzer Quality of Life Index Score at the End of Treatment
The Spitzer Quality of Life Index questionnaire consists of five sections, relating to activity, daily living, health, support and outlook. Each section has three choices (numbered 1, 2 and 3) and the patient is required to choose the one that best describes their quality of life during the last week. Choice 1 is scored 2, choice 2 is scored 1 and choice 3 is scored 0. The total Spitzer is the unweighted sum of the five scores. The scale is 0 (bad) to 10 (good). A positive value indicates an improvement from baseline.
Change From Baseline in the Mean Caregiver Strain Index Score at the End of Treatment
Carers were asked at baseline and end of treatment to complete the Caregiver Strain Index, as a measure of the strain they felt from being a carer, the maximum possible score being 13. A negative value from baseline indicates an improvement.
Number of Subjects Who Reported an Improvement in Their Overall Condition in the Patient Global Impression of Change at the End of Treatment
The Patient Global Impression of Change asked patients to give their impression of the overall change in their condition during the study at the end of treatment using the following scale: 1 = Very Much Improved, 2 = Much Improved, 3 = Minimally Improved, 4 = No Change, 5 = Minimally Worse, 6 = Much Worse, 7 = Very Much Worse. The number of patients who scored their condition as 1, 2, or 3 (improved) is presented.
Change From Baseline in the Mean Brief Pain Inventory Score at the End of Treatment
The Brief Pain Inventory is a 14-item questionnaire that asks patients to rate pain over the prior week and the degree to which it interferes with activities on a 0 to 10 scale, where 0=no pain and 10=pain as bad as you can imagine. Severity is measured as worst pain, least pain, average pain, and pain right now. The severity composite score is calculated as the arithmetic mean of the four severity items(range 0-10). A negative value indicates an improvement in worst pain score from baseline.
Change From Baseline in the Mean Sleep Disturbance Numerical Rating Scale Score at the End of Treatment
Each day patients recorded in their patient diary whether they woke during the previous night using the following scoring system: 0 = No, 1 = Once, 2 = Twice, 3 = More than twice, 4 = Awake most of the night. A negative value indicates an improvement from baseline.
Incidence of Adverse Events as a Measure of Patient Safety.
The number of patients who experienced an adverse event during the study is presented.
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT01606202
Brief Title
A Study of Cannabis Based Medicine Extracts and Placebo in Patients With Pain Due to Spinal Cord Injury
Official Title
A Randomised, Double Blind, Placebo Controlled, Parallel Group Comparative Study of the Efficacy, Safety and Tolerability of Sublingual Cannabis Based Medicine Extracts and Placebo in Patients With Intractable Neuropathic Pain Associated With Spinal Cord Injury
Study Type
Interventional
2. Study Status
Record Verification Date
December 2022
Overall Recruitment Status
Completed
Study Start Date
July 2002 (undefined)
Primary Completion Date
January 2005 (Actual)
Study Completion Date
January 2005 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Jazz Pharmaceuticals
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
A study to investigate the effects of sublingual cannabis based medicine extracts on neuropathic pain associated with spinal cord injury.
Detailed Description
This was a multi-centre, double-blind, randomised, placebo-controlled, parallel-group study to evaluate the efficacy and tolerability of GW-1000-02 in central neuropathic pain associated with spinal cord injury. Patients were screened to determine eligibility and completed a seven to 21 day baseline period. Patients then returned to the centre for assessment, randomisation and initial dosing. Visits occurred at the end of treatment week one and at the end of the study (treatment week three) or upon withdrawal. Throughout the study, patients were permitted to take paracetamol as escape analgesic to relieve breakthrough pain. Patients in this study could elect to be screened for an open label extension study of GW-1000-02.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pain
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
116 (Actual)
8. Arms, Groups, and Interventions
Arm Title
GW-1000-02
Arm Type
Experimental
Arm Description
Active treatment.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo control.
Intervention Type
Drug
Intervention Name(s)
GW-1000-02
Other Intervention Name(s)
Sativex
Intervention Description
Contained delta-9-tetrahydrocannabinol (THC) (27 mg/ml):cannabidiol (CBD) (25 mg/ml) as extract of Cannabis sativa L., with peppermint oil, 0.05% (v/v), in ethanol:propylene glycol (50:50) excipient. Each actuation delivered 100 μl (THC 2.7 mg and CBD 2.5 mg). The maximum permitted dose of study medication was eight actuations in any three-hour period, and 48 actuations in any 24 hour period.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Contained peppermint oil, 0.05% (v/v), quinoline yellow, 0.005% (w/v), sunset yellow, 0.0025% (w/v), in ethanol:propylene glycol (50:50) excipient. Each actuation delivered 100 μl. The maximum permitted dose of study medication was eight actuations in any three-hour period, and 48 actuations in any 24 hour period.
Primary Outcome Measure Information:
Title
Change From Baseline in Mean Central Neuropathic Pain 11-Point Numerical Rating Scale Scores at the End of Treatment (up to 51 Days).
Description
The Central Neuropathic Pain Numerical Rating Scale score was recorded three times daily, in the morning (on waking), at lunchtime and in the evening using the scale, 0 = 'No Pain' and 10 = 'Worst Possible Pain'. Patients were instructed to relate 'No Pain' to the time before the start of their spinal cord injury. End of Treatment was defined as the mean of the last seven days in the study or the mean of the last three days if the subject withdrew. A negative value indicates an improvement in pain score from baseline.
Time Frame
Up to 51 days
Secondary Outcome Measure Information:
Title
Change From Baseline in the Mean Percentage of Days on Which Escape Medication Was Used at the End of Treatment
Description
The percentage of days that subjects used escape medication was analysed and is presented as the mean change from baseline at the end of treatment. A negative value from baseline indicates an improvement.
Time Frame
Up to 51 days
Title
Change From Baseline in Mean Spasm Severity Numerical Rating Scale Score at the End of Treatment
Description
Each day, just before going to bed, patients recorded in their patient diary whether they experienced any spasms that day and, if yes, recorded the overall level of the spasm(s) experienced using an Numerical Rating Scale spasm scale ranging from 0 = "Mildest ever spasm" to 10 = "Worst ever spasm". The mean spasm severity scores were summarised and analysed analogously to the primary endpoint. A negative value from baseline indicates an improvement.
Time Frame
Up to 51 days
Title
Change From Baseline in the Percentage of Days on Which Spasm Was Experienced at the End of Treatment
Description
Each day, just before going to bed, patients recorded in their patient diary whether they experienced any spasms that day. The percentage of days on which spasm was experienced were summarised and analysed analogously to the primary endpoint. A negative value from baseline indicates an improvement.
Time Frame
Up to 51 days
Title
Change From Baseline in Mean Spasticity Severity Numerical Rating Scale Scores the End of Treatment.
Description
Each day at bed time patients recorded whether they experienced any spasticity that day and, if yes, the overall level of spasticity experienced was quantified using an Numerical Rating Scale from 0 = "Mildest ever spasticity" to 10 = "Worst ever spasticity". The mean spasticity severity scores and the changes from baseline to End of Treatment were to be calculated. A negative value indicates an improvement from baseline.
Time Frame
0 - 51 days
Title
Change From Baseline in the Percentage of Days on Which Spasticity Was Experienced at the End of Treatment
Description
Each day, just before going to bed, patients recorded in their patient diary whether they had experienced any spasticity that day or not. The percentage of days on which spasticity was experienced (spasticity incidence) was calculated and summarised analogously to the primary efficacy parameter of Numerical Rating Scale pain score. A negative value from baseline indicates an improvement.
Time Frame
Up to 51 days
Title
Change From Baseline in Modified Ashworth Scale Score at the End of Treatment
Description
The Modified Ashworth Scale is a five-point scale conducted on four pre-identified muscle groups. Only the lower limb was assessed because not all Spinal Cord Injury patients upper limb disability. The assessor used the Modified Ashworth scale ranging from 0 ("No increase in muscle tone") to 4 ("Affected part(s) rigid in flexion or extension") to rate the muscle tone for knee and ankle for the left and right sides separately at a pre-dose visit and at the end of treatment. The average of the four individual scores and was taken. A negative value indicates an improvement from baseline.
Time Frame
Up to 51 days
Title
Change From Baseline in the Mean Short Orientation Memory Function Concentration Test Score at the End of Treatment
Description
Patients were asked at baseline and end of treatment, to complete the Short Orientation Memory Function Concentration Test as a measure of cognitive function. The minimum score is 0 and maximum of 28 which denoted good cognitive function .
A negative value from baseline indicates a deterioration.
Time Frame
Up to 51 days
Title
Change From Baseline in Mean Spitzer Quality of Life Index Score at the End of Treatment
Description
The Spitzer Quality of Life Index questionnaire consists of five sections, relating to activity, daily living, health, support and outlook. Each section has three choices (numbered 1, 2 and 3) and the patient is required to choose the one that best describes their quality of life during the last week. Choice 1 is scored 2, choice 2 is scored 1 and choice 3 is scored 0. The total Spitzer is the unweighted sum of the five scores. The scale is 0 (bad) to 10 (good). A positive value indicates an improvement from baseline.
Time Frame
Up to 51 days
Title
Change From Baseline in the Mean Caregiver Strain Index Score at the End of Treatment
Description
Carers were asked at baseline and end of treatment to complete the Caregiver Strain Index, as a measure of the strain they felt from being a carer, the maximum possible score being 13. A negative value from baseline indicates an improvement.
Time Frame
Up to 51 days
Title
Number of Subjects Who Reported an Improvement in Their Overall Condition in the Patient Global Impression of Change at the End of Treatment
Description
The Patient Global Impression of Change asked patients to give their impression of the overall change in their condition during the study at the end of treatment using the following scale: 1 = Very Much Improved, 2 = Much Improved, 3 = Minimally Improved, 4 = No Change, 5 = Minimally Worse, 6 = Much Worse, 7 = Very Much Worse. The number of patients who scored their condition as 1, 2, or 3 (improved) is presented.
Time Frame
Up to 51 days
Title
Change From Baseline in the Mean Brief Pain Inventory Score at the End of Treatment
Description
The Brief Pain Inventory is a 14-item questionnaire that asks patients to rate pain over the prior week and the degree to which it interferes with activities on a 0 to 10 scale, where 0=no pain and 10=pain as bad as you can imagine. Severity is measured as worst pain, least pain, average pain, and pain right now. The severity composite score is calculated as the arithmetic mean of the four severity items(range 0-10). A negative value indicates an improvement in worst pain score from baseline.
Time Frame
0 - 51 days
Title
Change From Baseline in the Mean Sleep Disturbance Numerical Rating Scale Score at the End of Treatment
Description
Each day patients recorded in their patient diary whether they woke during the previous night using the following scoring system: 0 = No, 1 = Once, 2 = Twice, 3 = More than twice, 4 = Awake most of the night. A negative value indicates an improvement from baseline.
Time Frame
0 - 51 days
Title
Incidence of Adverse Events as a Measure of Patient Safety.
Description
The number of patients who experienced an adverse event during the study is presented.
Time Frame
Up to 61 days
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Gave informed consent for participation in the study.
Male or Female, aged 18 years or above.
Diagnosis of non-acute spinal cord injury, with central neuropathic pain not wholly relieved by current therapy.
Central neuropathic pain with a mean severity Numerical Rating Scale score at least four during last seven days of the baseline period.
Relatively stable neurology during the preceding six months.
Stable medication regimen during the preceding four weeks.
Agreement, if female and of child bearing potential or if male with a partner of child bearing potential, to ensure that effective contraception was used during the study and for three months thereafter.
Had not used cannabinoids for at least the preceding seven days and willing to abstain from any use of cannabinoids during the study.
Clinically acceptable laboratory results at Visit 2.
Ability (in the investigator's opinion) and willingness to comply with all study requirements.
Agreement for the UK Home Office, their general practitioner, and their consultant if appropriate, to be notified of their participation in the study.
Exclusion Criteria:
History of schizophrenia, other psychotic illness, severe personality disorder or other significant psychiatric disorder other than depression associated with their underlying condition.
History of alcohol or substance abuse.
Severe cardiovascular disorder, such as ischaemic heart disease, arrhythmias (other than well controlled atrial fibrillation), poorly controlled hypertension or severe heart failure.
History of autonomic dysreflexia.
History of epilepsy.
If female, were pregnant or lactating, or were planning a pregnancy to occur during the course of the study.
Significant renal or hepatic impairment.
Elective surgery or other procedures requiring general anaesthesia scheduled to occur during the study.
Terminal illness or were considered inappropriate for placebo medication.
Any other significant disease or disorder which, in the opinion of the investigator, may have either put the subject at risk because of participation in the study, or may influenced the result of the study, or the subject's ability to participate in the study.
Regular levodopa therapy within the seven days leading to study entry.
If male, were receiving and were unwilling to stop sildenafil for the duration of the study.
Known or suspected hypersensitivity to cannabinoids or any of the excipients of the study medications.
Known or suspected adverse reaction to cannabinoids.
Intention to travel internationally during the study.
Intention to donate blood during the study.
Participation in another research study in the 12 weeks leading to study entry.
Previous randomisation into this study.
Facility Information:
Facility Name
The Royal National Orthopaedic Hospital
City
Middlesex
ZIP/Postal Code
HA7 4LP
Country
United Kingdom
12. IPD Sharing Statement
Citations:
PubMed Identifier
33465022
Citation
Thomas PA, Carter GT, Bombardier CH. A scoping review on the effect of cannabis on pain intensity in people with spinal cord injury. J Spinal Cord Med. 2022 Sep;45(5):656-667. doi: 10.1080/10790268.2020.1865709. Epub 2021 Jan 19.
Results Reference
derived
Learn more about this trial
A Study of Cannabis Based Medicine Extracts and Placebo in Patients With Pain Due to Spinal Cord Injury
We'll reach out to this number within 24 hrs