Baclofen/Diazepam Supps for Treatment of Pelvic Floor Myalgia (BDS)
Primary Purpose
Pelvic Floor Dyssynergia
Status
Unknown status
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Baclofen/diazepam
Vaginal placebo
Sponsored by
About this trial
This is an interventional treatment trial for Pelvic Floor Dyssynergia
Eligibility Criteria
Inclusion Criteria:
- Patients with significant pelvic floor dyssynergia and pain during sexual activity.
Exclusion Criteria:
- Decide you do not wish to participate
- Are pregnant
- Have active pelvic inflammatory disease
- Have an active sexually transmitted infection (STI)
- Have a known or suspected cancer of the genital tract
- Have untreated or unevaluated changes in your Pap smear
- Are not currently sexually active
- Have an allergy to either baclofen or valium
- Are unable to complete the necessary study questionnaires
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Placebo Comparator
Arm Label
Vaginal Baclofen/diazepam supp
Vaginal Placebo supp
Arm Description
Insert vaginal suppository once daily
Insert vaginal suppository once daily
Outcomes
Primary Outcome Measures
Change in Visual Analogue Scale for Pain (VAS-P) scores before and after treatment
The scale ranges from 0 (no pain) to 10 (worst pain ever experienced)
Secondary Outcome Measures
Change in Female Sexual Function Index (FSFI)
Self report measure of female sexual dysfunction
Patient Global Impression of Improvement (PGI-I)
Ranks patients overall feeling about health from 1 (very much better) to 7 (very much worse)
Short form Health Survey (SF-12)
Standardized self assessment tool to measure overall health status
Full Information
NCT ID
NCT03427216
First Posted
January 26, 2018
Last Updated
June 5, 2018
Sponsor
Dr. John A. Thiel Medical Professional Corporation
1. Study Identification
Unique Protocol Identification Number
NCT03427216
Brief Title
Baclofen/Diazepam Supps for Treatment of Pelvic Floor Myalgia
Acronym
BDS
Official Title
A Randomized Double Blind Placebo Controlled Cross-over Trial of Baclofen and Diazepam Suppositories for the Management of Pelvic Floor Myalgia
Study Type
Interventional
2. Study Status
Record Verification Date
June 2018
Overall Recruitment Status
Unknown status
Study Start Date
September 1, 2018 (Anticipated)
Primary Completion Date
December 31, 2018 (Anticipated)
Study Completion Date
December 31, 2018 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Dr. John A. Thiel Medical Professional Corporation
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
This study is a randomized, placebo controlled double blind cross over trial. Patients presenting with pelvic floor myalgia will be asked to complete a series of standardized questionnaires to assess their pain, quality of life and sexual function and satisfaction. They will be randomized to either a treatment group or placebo group and will use the supplied suppositories once daily for 2 months. They will then undergo a one month "washout" after which they will be placed in the cross over group for a second two months of treatment.
Primary outcome measure: change in Visual Analogue Scale for Pain (VAS-P) scores before and after treatment Secondary outcome measures: change in Female Sexual Function Index (FSFI), Patient Global Impression of Improvement (PGI-I), and Short Form Health Survey (SF-12) before and after treatment
Detailed Description
Chronic pelvic pain is a complex multi-faceted problem that places a substantial burden on the healthcare resources. In Canada, the average hospital related cost for women requiring surgery or inpatient admission for chronic pelvic pain is $25 million each year. Chronic pelvic pain is defined as either persistent pain for at least 6 months or "recurrent episodes of abdominal/pelvic pain, hypersensitivity, or discomfort, often associated with elimination changes and sexual dysfunction in the absence of an organic etiology." Chronic pelvic pain is common and affects women of all ages and backgrounds. 15-20% of women have chronic pelvic pain lasting for more than 1 year.
Pelvic floor myalgia is an important and common contributor to chronic pelvic pain that may be present alone or may co-exist with other gynecological, urological, colorectal, and musculoskeletal medical conditions. The International Urogynecological Association/International Continence Society joint report published in February 2017 defines pelvic floor myalgia as pain in the musculature of the pelvic floor.6 Patients with high-tone pelvic floor dysfunction (HTPFD) have levator hypercontractility and present with pain with internal vaginal examination and intercourse. In a 2011 prospective cross-sectional study by Fitzgerald et al., 63% of patients with self-reported chronic pelvic pain examined by a physician and 73.7% of patients examined by a physiotherapist were found to have pelvic floor myalgia. Although pelvic floor myalgia is a common condition encountered in gynecology, it is frequently an unrecognized and under-treated component of chronic pelvic pain. Pelvic floor myalgia has a significant impact on the patient's quality of life. Persistent chronic pain may result in patient's anxiety, low mood, depression, sleep disturbances, feeling of hopelessness and helplessness, frustration, and psychological distress.
The first line of treatment for pelvic floor myalgia is pelvic floor muscle relaxation. Reducing the resting tone of pelvic floor musculature has been shown to improve chronic pelvic pain. Current treatment options for pelvic floor myalgia include pelvic floor physiotherapy, Thiele massage, biofeedback with electrical stimulation, behavioural modifications, acupuncture, medications such as antidepressants,1 trigger point injections with botulin A toxin, warm sitz baths, and neuromodulation.
Recently, intravaginal diazepam has been used an off-label treatment option for high-tone pelvic floor myalgia. Diazepam is a benzodiazepine derivative that has both antispasmotic and anxiolytic activity. It is used as a muscle relaxant and enhances the inhibitory action of gamma-amino butyric acid (GABA) on neuronal excitability, resulting in decreased action potentials. The benefit of local therapy is the avoidance of the common side effects of benzodiazepines such as drowsiness, fatigue, and ataxia. Currently, evidence is lacking in regards to the effectiveness of intravaginal diazepam on treatment of chronic pelvic pain. The 2010 retrospective chart review of 26 patients by Rogalski et al. revealed clinically significant reduction in Visual Analogue Scale for Pain (VAS-P) and Female Sexual Function Index (FSFI) with diazepam suppositories used for 30 days as an adjuvant therapy to pelvic floor physiotherapy and intramuscular trigger point injections. Similarly, the 2011 study revealed 62% improvement in symptoms with intravaginal diazepam.
Baclofen is a skeletal muscle relaxant. It is a GABA-B receptor agonist which is commonly used for treating spasticity. The literature on topical baclofen use in pelvic floor dysfunction is minimal. Topical therapy is advantageous to avoid the common systemic side effects such as drowsiness, hypotonia, hypotension, and headache. A retrospective study examining the use of topical baclofen for provoked vulvodynia showed an improvement in pain and sexual function.
Baclofen may also be used in combination with diazepam for treatment of pelvic floor myalgia. A 2016 retrospective chart review performed at the University of Saskatchewan revealed a reduction in both dyspareunia and pelvic floor muscle spasm with the use of baclofen and diazepam vaginal suppositories.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pelvic Floor Dyssynergia
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
60 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Vaginal Baclofen/diazepam supp
Arm Type
Active Comparator
Arm Description
Insert vaginal suppository once daily
Arm Title
Vaginal Placebo supp
Arm Type
Placebo Comparator
Arm Description
Insert vaginal suppository once daily
Intervention Type
Drug
Intervention Name(s)
Baclofen/diazepam
Other Intervention Name(s)
Lioresal
Intervention Description
Vaginal suppository placed once daily, patients will record pelvic pain daily on a VAS scale, sexual satisfaction and quality of life on a standardized questionnaire weekly
Intervention Type
Drug
Intervention Name(s)
Vaginal placebo
Other Intervention Name(s)
suppository
Intervention Description
Vaginal suppository placed once daily, patient will record pelvic pain daily on a VAS scale, sexual satisfaction and quality of life on a standardized questionnaire weeky.
Primary Outcome Measure Information:
Title
Change in Visual Analogue Scale for Pain (VAS-P) scores before and after treatment
Description
The scale ranges from 0 (no pain) to 10 (worst pain ever experienced)
Time Frame
5 months
Secondary Outcome Measure Information:
Title
Change in Female Sexual Function Index (FSFI)
Description
Self report measure of female sexual dysfunction
Time Frame
5 months
Title
Patient Global Impression of Improvement (PGI-I)
Description
Ranks patients overall feeling about health from 1 (very much better) to 7 (very much worse)
Time Frame
5 months
Title
Short form Health Survey (SF-12)
Description
Standardized self assessment tool to measure overall health status
Time Frame
5 months
10. Eligibility
Sex
Female
Gender Based
Yes
Gender Eligibility Description
46XX women
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
Patients with significant pelvic floor dyssynergia and pain during sexual activity.
Exclusion Criteria:
Decide you do not wish to participate
Are pregnant
Have active pelvic inflammatory disease
Have an active sexually transmitted infection (STI)
Have a known or suspected cancer of the genital tract
Have untreated or unevaluated changes in your Pap smear
Are not currently sexually active
Have an allergy to either baclofen or valium
Are unable to complete the necessary study questionnaires
12. IPD Sharing Statement
Plan to Share IPD
No
IPD Sharing Plan Description
only pooled data will be shared outside of the research team
Learn more about this trial
Baclofen/Diazepam Supps for Treatment of Pelvic Floor Myalgia
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