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Menthol In Neuropathy Trial (MINT)

Primary Purpose

Chemotherapy-induced Peripheral Neuropathy

Status
Completed
Phase
Phase 2
Locations
United Kingdom
Study Type
Interventional
Intervention
MINT study IMP
Sponsored by
University of Edinburgh
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chemotherapy-induced Peripheral Neuropathy focused on measuring CIPN, Peripheral neuropathy, Chemotherapy, Neuropathic pain

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Patients have received any neurotoxic chemotherapy.
  2. Patients have experienced post treatment Chemotherapy Induced Peripheral Neuropathy (CIPN) pain for a minimum of 3 months after completing chemotherapy.
  3. Patients reporting a distressing or uncomfortable neuropathic symptom (such as pain or tingling) with an average score in the last 24 hours of ≥5 on a scale of 0-10 with 0 being none, according to the Numeric Rating Scale for pain.
  4. Aged 18 years or over at study entry.
  5. Patient's Oncology team agrees to their taking part in the study.
  6. Patients are able to provide written informed consent to participation in the study after explanation of the study protocol.
  7. In the opinion of the investigator, the patient is able to complete the various assessments.
  8. Neuropathy must be confined to the distal extremities (distal to elbows and/or knees).

Exclusion Criteria:

  1. Pre-existing or history of peripheral neuropathy due to any cause other than chemotherapy (diabetes, alcohol, toxin, hereditary, etc.).
  2. Patients with any contraindication to the use of topical therapy or menthol.
  3. Neurological conditions which may influence findings (such as Multiple Sclerosis or residual signs/symptoms from a previous stroke).
  4. Skin conditions which prevent assessment of the relevant areas affected by peripheral neuropathy.
  5. Suffering from significant psychiatric illness, which would hinder their completion of the study in the opinion of the investigator.
  6. General medical condition is unstable or rapidly deteriorating, such that they are unlikely to be able to contribute to the study.
  7. In the opinion of the Research Team or their usual medical team, would be unable to complete the study protocol for any other reason.
  8. Current treatment of ≤ 30 days duration with topical lidocaine patch/gel or anticonvulsants, tricyclic antidepressants, MAO inhibitor, or other neuropathic pain medication agents such as carbamazepine, phenytoin, valproic acid, gabapentin/pregabalin, lamotrigine or amifostine. (If on the same dose of any of these medications for >31 days, patients will be asked to continue these for the duration of the study. Analgesic agents such as acetaminophen, nonsteroidal anti-inflammatory agents, or opioids, are allowed if on the same doses for >31 days).
  9. Application of capsaicin cream or patch (to the limb extremities) currently or within the last 30 days (as this would interfere with application of the menthol gel and potentially study outcome).
  10. Patients with significant pain other than CIPN (ie pain worse than the CIPN).
  11. Other medical conditions, which in the opinion of the treating physician/allied health professional would make this protocol unreasonably hazardous for the patient.
  12. Participants previously randomised into this study.
  13. Participants not prepared to stop using any other physical activity meter.
  14. Co-enrolment in any other pain treatment studies.

Sites / Locations

  • Western General Hospital
  • Western General Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Menthol

Placebo

Arm Description

Menthol gel to be applied twice a day for 6 weeks - toes to knees, fingertips to elbows, top and base of spine.

Placebo gel to be applied twice a day for 6 weeks - toes to knees, fingertips to elbows, top and base of spine.

Outcomes

Primary Outcome Measures

Reduction in CIPN symptoms
A clinically significant reduction in pain (at least a 30% decrease in total BPI SF score as relates to the index neuropathic pain) between baseline and 6 weeks.

Secondary Outcome Measures

Treatment effect on Chemotherapy Induced Peripheral Neuropathy
Changes in EORTC QLQ (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires) CIPN-20 (severity of 20 symptoms rated on 4 point scale from Not at all to Very much)
Treatment effect on quality of life functions
Changes in EORTC QLC-c30 scores (30 symptoms on same scale as CIPN)
Treatment effect on pain scores
Changes in Brief Pain Inventory - Short Form scores (13 symptoms rated from 0 None to 10 Worst)
Treatment effect on anxiety and depression
Changes in Hospital Anxiety and Depression Scale (HADS) scores
Treatment effect on pain catastrophisation
Changes in Pain Catastrophising Scale (PCS) scores
Treatment effect on side effects
Changes in side effects (Yes/No to any SEs, description of SE to be given)
Treatment effect on physical activity
Changes in Actigraph data (measures of step counts, amount of moderate/vigorous activity and sleep times/efficiency)
Perceived effects of IMP
Changes in perceived effects questions (How long participant thinks treatment takes to take effect and how long it lasts for)

Full Information

First Posted
November 8, 2019
Last Updated
September 13, 2022
Sponsor
University of Edinburgh
Collaborators
NHS Lothian
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1. Study Identification

Unique Protocol Identification Number
NCT04276727
Brief Title
Menthol In Neuropathy Trial
Acronym
MINT
Official Title
A Phase II RCT of Topical Menthol Gel Versus Placebo in the Treatment of Chemotherapy Induced Peripheral Neuropathic Pain
Study Type
Interventional

2. Study Status

Record Verification Date
September 2022
Overall Recruitment Status
Completed
Study Start Date
November 4, 2019 (Actual)
Primary Completion Date
March 24, 2022 (Actual)
Study Completion Date
March 24, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Edinburgh
Collaborators
NHS Lothian

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Patients will be recruited who have peripheral neuropathy due to chemotherapy. They will be given a blinded treatment of gel containing either menthol (3%) or placebo to be applied for 6 weeks, twice a day. Assessments of pain, neuropathic symptoms and impact on quality of life will be done at baseline, 6 weeks and 12 weeks. Functional magnetic resonance imaging (fMRI) scans will be done at baseline and 6 weeks. Physical activity data will also be collected to be analysed in conjunction with pain assessments.
Detailed Description
Modern cancer treatments, while more effective at prolonging life, are associated with some long lasting effects, especially nerve pain. This occurs in up to 90% of patients and 50% of patients still experience nerve pain a year after treatment. Not only is this distressing in itself but the investigators now understand that this treatment-related pain is exacerbating other pains, making cancer pain more difficult to control. The problem with managing nerve pain caused by treatment is that there is no predictable and effective treatment. Our team has discovered that menthol cream or gel applied to the skin in the area of nerve pain can be effective. This trial seeks to provide better evidence of using this simple, cheap, non-toxic treatment. Participants will be given either menthol gel to the affected area or a placebo gel which smells, looks like and has the same texture as menthol but has no active drug. The gel will be applied twice a day for 6 weeks. Participants will initially be assessed for pain and its impact on function, mood and quality of life and, if possible, will also have an fMRI scan immediately before starting menthol treatment and after 6 weeks of treatment. They will also have some assessments a further 6 weeks after treatment finishes. As part of impact on function assessment, participants will be asked to wear a physical activity monitor for a few days prior to each of the three main assessment points. Our group has used special scans of the brain called fMRI to help identify if a treatment has real potential for patients. Sometimes, in early studies of a new treatment, patients can believe that the treatment has a real effect, but in fact it is a placebo effect. FMRI scans in this study will help to identify if menthol gel is having a true pain relieving effect, by comparing the patient's reports of pain with their scan findings. This will be very helpful in aiding the decision of how the research team conduct any future larger clinical trial.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chemotherapy-induced Peripheral Neuropathy
Keywords
CIPN, Peripheral neuropathy, Chemotherapy, Neuropathic pain

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Randomised, double-blind placebo controlled
Masking
ParticipantInvestigatorOutcomes Assessor
Masking Description
Gel tubes will be supplied with similar labelling, identified by blinded drug pack numbers which can be linked to the treatment allocation if an emergency need arises. The menthol and placebo gels have a similar blue colour and both have a minty odour.
Allocation
Randomized
Enrollment
52 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Menthol
Arm Type
Active Comparator
Arm Description
Menthol gel to be applied twice a day for 6 weeks - toes to knees, fingertips to elbows, top and base of spine.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo gel to be applied twice a day for 6 weeks - toes to knees, fingertips to elbows, top and base of spine.
Intervention Type
Drug
Intervention Name(s)
MINT study IMP
Intervention Description
Application of gel for 6 weeks.
Primary Outcome Measure Information:
Title
Reduction in CIPN symptoms
Description
A clinically significant reduction in pain (at least a 30% decrease in total BPI SF score as relates to the index neuropathic pain) between baseline and 6 weeks.
Time Frame
6 weeks
Secondary Outcome Measure Information:
Title
Treatment effect on Chemotherapy Induced Peripheral Neuropathy
Description
Changes in EORTC QLQ (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires) CIPN-20 (severity of 20 symptoms rated on 4 point scale from Not at all to Very much)
Time Frame
6 weeks
Title
Treatment effect on quality of life functions
Description
Changes in EORTC QLC-c30 scores (30 symptoms on same scale as CIPN)
Time Frame
6 weeks
Title
Treatment effect on pain scores
Description
Changes in Brief Pain Inventory - Short Form scores (13 symptoms rated from 0 None to 10 Worst)
Time Frame
6 weeks
Title
Treatment effect on anxiety and depression
Description
Changes in Hospital Anxiety and Depression Scale (HADS) scores
Time Frame
6 weeks (14 symptoms rated from 0 to 3 in severity)
Title
Treatment effect on pain catastrophisation
Description
Changes in Pain Catastrophising Scale (PCS) scores
Time Frame
6 weeks (13 questions rated from 0-4 in severity)
Title
Treatment effect on side effects
Description
Changes in side effects (Yes/No to any SEs, description of SE to be given)
Time Frame
6 weeks
Title
Treatment effect on physical activity
Description
Changes in Actigraph data (measures of step counts, amount of moderate/vigorous activity and sleep times/efficiency)
Time Frame
6 weeks
Title
Perceived effects of IMP
Description
Changes in perceived effects questions (How long participant thinks treatment takes to take effect and how long it lasts for)
Time Frame
6 weeks
Other Pre-specified Outcome Measures:
Title
Changes in Functional Magnetic Imaging data
Description
Changes in FMRI data pre and post treatment
Time Frame
6 weeks
Title
Post treatment changes in CIPN
Description
Changes in CIPN-20 scores (see secondary outcomes above for details of all questionnaire measures)
Time Frame
12 weeks (from baseline)
Title
Post treatment changes in quality of life measures
Description
Changes in QLQ-c30
Time Frame
12 weeks (from baseline)
Title
Post treatment changes in pain scores
Description
Changes in BPI-SF
Time Frame
12 weeks (from baseline)
Title
Post treatment changes in anxiety and depression
Description
Changes in HADS scores
Time Frame
12 weeks (from baseline)
Title
Post treatment changes in pain catastrophising
Description
Changes in PCS
Time Frame
12 weeks (from baseline)
Title
Post treatment changes in side effects
Description
Changes in Side effects
Time Frame
12 weeks (from baseline)
Title
Post treatment changes in physical activity
Description
Changes in Actigraph data
Time Frame
12 weeks (from baseline)
Title
Changes in sensory measures
Description
Changes in QST data
Time Frame
6 weeks and 12 weeks (from baseline)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients have received any neurotoxic chemotherapy. Patients have experienced post treatment Chemotherapy Induced Peripheral Neuropathy (CIPN) pain for a minimum of 3 months after completing chemotherapy. Patients reporting a distressing or uncomfortable neuropathic symptom (such as pain or tingling) with an average score in the last 24 hours of ≥5 on a scale of 0-10 with 0 being none, according to the Numeric Rating Scale for pain. Aged 18 years or over at study entry. Patient's Oncology team agrees to their taking part in the study. Patients are able to provide written informed consent to participation in the study after explanation of the study protocol. In the opinion of the investigator, the patient is able to complete the various assessments. Neuropathy must be confined to the distal extremities (distal to elbows and/or knees). Exclusion Criteria: Pre-existing or history of peripheral neuropathy due to any cause other than chemotherapy (diabetes, alcohol, toxin, hereditary, etc.). Patients with any contraindication to the use of topical therapy or menthol. Neurological conditions which may influence findings (such as Multiple Sclerosis or residual signs/symptoms from a previous stroke). Skin conditions which prevent assessment of the relevant areas affected by peripheral neuropathy. Suffering from significant psychiatric illness, which would hinder their completion of the study in the opinion of the investigator. General medical condition is unstable or rapidly deteriorating, such that they are unlikely to be able to contribute to the study. In the opinion of the Research Team or their usual medical team, would be unable to complete the study protocol for any other reason. Current treatment of ≤ 30 days duration with topical lidocaine patch/gel or anticonvulsants, tricyclic antidepressants, MAO inhibitor, or other neuropathic pain medication agents such as carbamazepine, phenytoin, valproic acid, gabapentin/pregabalin, lamotrigine or amifostine. (If on the same dose of any of these medications for >31 days, patients will be asked to continue these for the duration of the study. Analgesic agents such as acetaminophen, nonsteroidal anti-inflammatory agents, or opioids, are allowed if on the same doses for >31 days). Application of capsaicin cream or patch (to the limb extremities) currently or within the last 30 days (as this would interfere with application of the menthol gel and potentially study outcome). Patients with significant pain other than CIPN (ie pain worse than the CIPN). Other medical conditions, which in the opinion of the treating physician/allied health professional would make this protocol unreasonably hazardous for the patient. Participants previously randomised into this study. Participants not prepared to stop using any other physical activity meter. Co-enrolment in any other pain treatment studies.
Facility Information:
Facility Name
Western General Hospital
City
Edinburgh
ZIP/Postal Code
EH4 2XR
Country
United Kingdom
Facility Name
Western General Hospital
City
Edinburgh
ZIP/Postal Code
EH4 2XU
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
Anyone interested in secondary analysis of the data should contact the Chief Investigator in the first instance.

Learn more about this trial

Menthol In Neuropathy Trial

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