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| Name | Class |
|---|---|
| National Research Develpment and Innovation Fund, Hungary | UNKNOWN |
| MEDITOP Pharmaceutical LTD, Hungary | UNKNOWN |
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The main purpose of the trial is to identify biomarkers from the blood as well as electrophysiologic and morphometric features (chemical, electrophysiologic and ultrasound biomarkers) that reflect the intensity of pain and/or foretell the efficacy of pharmacological (non-surgical) treatment in patients with acute low back pain.
The investigators include patients aged 18-80 years with acute (less than 1-month) low back pain with or without radicular signs, who do not have severe diseases (abscess, tumor, etc) in the background, already had CT or MRI scan during routine workup, and who have given written consent to participate in the study. Exclusion criteria are pregnancy, hypersensitivity to tolperisone in the history, severe liver or kidney disease, other severe diseases (abscess, tumor, etc) in the background of pain. The patients will be given 3 times daily 150 mg tolperisone or placebo in addition to standard therapy in a randomized double-blind design. Treatment will last for 14 days and a final follow-up is performed at 21 days. Clinical condition and biomarkers will be tested before treatment and at 14 days. Patients fill in a diary on a daily basis.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Tolperisone | Experimental | Tolperisone 3 times 150 mg daily, i.e. a daily dose of 450 mg. Treatment lasts for 14 days |
|
| Placebo | Placebo Comparator | Matching placebo 3 times daily. Treatment lasts for 14 days |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Tolperisone Hydrochloride | Drug | Tolperisone Hydrochloride tablets of 150 mg, administered three times a day |
|
| Measure | Description | Time Frame |
|---|---|---|
| Change in the level of biomarkers by the end of the treatment period compared to the pretreatment values. | Changes in the values of blood biomarkers (nociceptin/orphanin FQ, Met-Enkephalin-Arg6-Phe7 (MEAP), pro-inflammatory cytokines (IL-1β, IL-6, IL-2, IL-8, IL-12, IL-33, CCL3, CXCL1, CCR5, és TNF-α), anti-inflammatory cytokines (IL-10 and IL-4), monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory proteins-1b (MIP-1b), platelet-derived growth factor (PDGF AA), vascular endothelial growth factor (VEGF), GM-CSF=granulocyte-macrophage colony-stimulating factor, CGRP (calcitonin gene related peptide), substance P, noradrenalin (norepinephrine), in electrophysiologic markers (quantitative electromyography with surface electrodes in the paravertebral muscles in prone and standing position) and ultrasound markers (bilateral measurements of cross sectional area and antero-posterior diameter of paravertebral muscles in prone and standing position) | 14 days |
| Patient reported change in pain features | Self evaluation of pain by the patient on a visual scale from zero (no pain at all) to 10 (the most severe pain the patient can imagine) | daily for 14 days |
| Measure | Description | Time Frame |
|---|---|---|
| Change in the level of biomarkers enlisted in Primary Outcome 1 in the subgroup of those with ceased or greatly reduced pain | Subgroup analysis of the change in biomarkers restricted to those with ceased or greatly reduced pain | 14 days |
| Change in the intensity of pain by the end of the treatment period |
| Measure | Description | Time Frame |
|---|---|---|
| Patient reported sleep quality | Changes in sleep quality reported in patient diary on a 4-grade scale (1: undisturbed sleep; 2: woke up once due to pain; 3: woke up more than once due to pain; 4: could not sleep at all due to pain). | Daily from 1-14 days |
| Fingertip-to-floor distance |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Daniel Bereczki, MD, POhD,DSc | Semmelweis University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Neurology, Semmelweis University | Budapest | H-1083 | Hungary |
After trial completion the investigators will be ready to share data with other researchers based on reasonable request.
Infinite afer trial completion
request should be discussed by email of the principal investigator
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| ID | Term |
|---|---|
| D017116 | Low Back Pain |
| D001416 | Back Pain |
| ID | Term |
|---|---|
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D014049 | Tolperisone |
| ID | Term |
|---|---|
| D011427 | Propiophenones |
| D007659 | Ketones |
| D009930 | Organic Chemicals |
| D011725 | Pyridines |
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Single center, randomized double blind study. Randomization is done separately for those with and those without radicular signs.
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Randomization is done by non-transparent (opaque) sequentially numbered envelopes, prepared independently from the trial site. The number on the envelope corresponds to the number on the boxes of the trial medication (tolperisone or matching placebo). The envelopes can be opened only at the end of the trial, or in case of emergency. No interim analysis is planned.
| Placebo | Drug | matching placebo administered three times a day |
|
Self evaluation of pain by the patient on a visual scale from zero (no pain at all) to 10 (the most severe pain the patient can imagine) |
| 14 days |
| Change in the level of biomarkers enlisted in Primary Outcome 1 by the end of the treatment period in the tolperisone group | Subgroup analysis of changes in blood, electrophysiological and ultrasound biomarkers by 14 days in the tolperisone group | 14 days |
| Change in the level of paravertebral muscle contraction by the end of the treatment period | Analysis restricted to the electrophysiological and ultrasound biomarkers enlisted in Primary Outcome 1 | 14 days |
| Predictive value of the initial levels of biomarkers enlisted in Primary Outcome 1 | Evaluation of the association of the initial biomarker values enlisted in Primary Outcome 1 with the 14-day pain features | 14 days |
| Global impression of change by the patient | Patient self evaluation of changes by the end of treatment on a 6-grade scale (has become symptom-free; major improvement; minor improvement; no change; minor worsening; major worsening) | 14 days |
| Global clinical impression of change (GCI) by the investigator | Subjective evaluation of changes by the end of treatment on a 6-grade scale by the investigator (has become symptom-free; major improvement; minor improvement; no change; minor worsening; major worsening) | 14 days |
| Number of participants with treatment-related adverse events | Any adverse events reported during the 14 days of treatment and the 7-day post-treatment period | 21 days (14 days treatment plus 7 days post-treatment) |
The patient is asked to bend forward and attempt to reach for the floor with their fingertips. The distance between the patient's right long finger and the floor is measured using a standard measuring tape in centimeters. |
| 14 days |
| D006573 |
| Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |