CClinicalTrials.gg
CompletedNCT02260388PAIN-CONTRoLSUpdated Jul 6, 2018Results posted

Patient Assisted Intervention for Neuropathy: Comparison of Treatment in Real Life Situations

A Phase 4 interventional study of Nortriptyline and Duloxetine in Cryptogenic Sensory Polyneuropathy, sponsored by University of Kansas Medical Center. Completed at 46 sites in 2 countries. Open to participants aged 30 Years and older. Per ClinicalTrials.gov, last updated 2018-07-06.

Sponsored by University of Kansas Medical Center · Phase 4, Interventional, and Treatment

Phase
Phase 4
Study type
Interventional
Enrollment
402
Allocation
Randomized
Ages
30 Years and older
Sex
All
01

Study summary

The purpose of this large comparative effectiveness study led by Richard J. Barohn, MD, of the University of Kansas Medical Center, is to learn about the safety and effectiveness of nortriptyline, duloxetine, pregabalin and mexiletine in treating cryptogenic sensory polyneuropathy (CSPN).

Read the detailed description

The goal of this research project is to find the best drug for the treatment of pain in patients with CSPN. While the pharmaceutical industry has focused attention on drugs for treating diabetic sensory neuropathy (DSPN), and two drugs are now FDA approved, there have not been any prospective trials in CSPN. And, because there are no studies with CSPN patients, insurance carriers often reject authorizing prescriptions for some drugs for patients with CSPN.

There are four drugs that will be tested in this study: nortriptyline, duloxetine, pregabalin and mexiletine. These drugs are not approved by the FDA for the treatment of CSPN and are considered "investigational" in this study.

There are two periods in this study: Screening/Baseline and Study Drug. During the Screening/Baseline period the researchers will determine eligibility for potential subjects. During the second period, eligible patients who consented to participate will take the study drug. Participants will be randomized to receive one of the four drugs in this study. Participants will know which drug they are taking. Participants will not be allowed to switch groups and receive a different drug during the study.

This study uses an adaptive study design. This means the study can enroll less participants and provide better conclusions. The study design allows the researchers the ability to make changes to the approach of the study or to stop the study early if there are strong results.

02

Conditions studied

  • Cryptogenic Sensory Polyneuropathy

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Keywords

  • CSPN
  • neuropathy
  • pain
  • pain management
03

In context

Polyneuropathies

256 studies on the registry are indexed under Polyneuropathies; 50 are open to participants now.

This study's enrollment of 402 is above the median of 75 across 162 interventional studies indexed under Polyneuropathies.

Browse Polyneuropathies studies →

Lead sponsor

University of Kansas Medical Center is the lead sponsor of 483 studies on the registry; 113 are open to participants now.

Of its 38 completed or terminated interventional studies of FDA-regulated products, 24 (63%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
30 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Diagnosis of cryptogenic sensory polyneuropathy.
  • Likert Pain Score of greater than or equal to 4.
  • Must not currently be on nortriptyline, duloxetine, pregabalin or mexiletine or similar class of medication for at least 7 days from baseline study visit.

Exclusion criteria

Exclusion Criteria:

  • Any medical condition or current medication that would prevent them from taking either nortriptyline, duloxetine, pregabalin or mexiletine.
  • Unable to give consent.
  • Unable or not willing to comply with the study.
  • Other causes for polyneuropathy.
05

Study design

Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
402 participants (actual)

Study arms

  • Experimental
    Nortriptyline

    Nortriptyline - 25 mg daily for 1 week at bedtime, then 50 mg daily at bedtime for 1 week, then 75 mg daily at bedtime for the remainder of the study.

    Drug: Nortriptyline

  • Experimental
    Duloxetine

    Duloxetine - 20 mg daily for 1 week, then 40 mg daily for 1 week, then 60 mg daily for the remainder of the study.

    Drug: Duloxetine

  • Experimental
    Pregabalin

    Pregabalin - 100 mg at bedtime for 1 week, then 100 mg 2 times per day for 1 week, then 100 mg 3 times per day for the remainder of the study.

    Drug: Pregabalin

  • Experimental
    Mexiletine

    Mexiletine - 200 mg at bedtime for 1 week, then 200 mg 2 times per day for 1 week, then 200 mg 3 times per day for the remainder of the study.

    Drug: Mexiletine

Interventions

  • DrugNortriptyline
  • DrugDuloxetine
  • DrugPregabalin
  • DrugMexiletine
06

What researchers measure

Primary outcomes

  1. Co-Primary Measures: Percent of Patients With at Least a 50% Decrease in Likert Pain Scale From Baseline to Week 12 Follow Up and Percent of Patients That Quit

    The final outcome of the study is a combination of two endpoints, efficacy and quit or treatment discontinuation rates. The first endpoint was a patient responder-defined measure of efficacy. A patient was deemed efficacious if a 50% or more reduction was observed in the Likert pain-scale from the baseline visit to the 12 week visit (i.e. 6 at baseline to 3 or less at week 12). The second endpoint was the observed percentage of patients who discontinued treatment prior to the last follow up visit for any reason or were lost to follow up. The utility function, which combines efficacy and quit rates, was used to drive the adaptive randomization, stopping criteria, and final analysis conclusions.

    Time frame: 12 weeks

Secondary outcomes

  1. SF12 Health Composite Scores

    SF-12v2® Health Survey Standard The Optum™ SF-12v2® Health Survey is a shorter version of the SF-36v2® Health Survey that uses just 12 questions to measure functional health and well-being from the patient's point of view. Survey provides psychometrically-based physical component summary (PCS) and mental component summary (MCS) scores. Scores are calibrated so that 50 is the average score or norm, standard deviation = 10. Higher scores indicate better health for both mental and physical component summary scores.

    Time frame: 12 weeks

  2. PROMIS Pain Interference Short Form v1.0 8a T Score

    Higher scores for pain interference represents worse outcome (more pain interference) T-score metric: 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric: A score of 40 is one SD lower than the mean of the reference population; A score of 60 is one SD higher than the mean of the reference population.

    Time frame: 12 weeks

  3. PROMIS Fatigue Short Form v1.0 8a

    Higher scores for fatigue represents worse outcome (more fatigue). T-score metric: 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric: A score of 40 is one SD lower than the mean of the reference population; A score of 60 is one SD higher than the mean of the reference population.

    Time frame: 12 Weeks

  4. PROMIS Sleep Disturbance Short Form v1.0 8a

    Higher scores for sleep disturbance represents worse outcome (more sleep disturbance). T-score metric: 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric: A score of 40 is one SD lower than the mean of the reference population; A score of 60 is one SD higher than the mean of the reference population. Higher scores equals more of the concept being measured

    Time frame: 12 weeks

07

Results

Posted Jul 6, 2018

Participant flow

Participant flow — Overall Study
MilestoneNortriptylineDuloxetinePregabalinMexiletine
Started1341267369
Completed1321187065
Not completed2834
Withdrew: Lost to follow-up2834

Outcome measures

PrimaryCo-Primary Measures: Percent of Patients With at Least a 50% Decrease in Likert Pain Scale From Baseline to Week 12 Follow Up and Percent of Patients That Quit

The final outcome of the study is a combination of two endpoints, efficacy and quit or treatment discontinuation rates. The first endpoint was a patient responder-defined measure of efficacy. A patient was deemed efficacious if a 50% or more reduction was observed in the Likert pain-scale from the baseline visit to the 12 week visit (i.e. 6 at baseline to 3 or less at week 12). The second endpoint was the observed percentage of patients who discontinued treatment prior to the last follow up visit for any reason or were lost to follow up. The utility function, which combines efficacy and quit rates, was used to drive the adaptive randomization, stopping criteria, and final analysis conclusions.

Time frame:
12 weeks
Reported as:
Count of participants · Participants
Co-Primary Measures: Percent of Patients With at Least a 50% Decrease in Likert Pain Scale From Baseline to Week 12 Follow Up and Percent of Patients That Quit
ParticipantsNortriptylineDuloxetinePregabalinMexiletine
Efficacious and Non-Quit34291114
Non-Efficacious and Non-Quit49503115
Quit51473140
SecondarySF12 Health Composite Scores

SF-12v2® Health Survey Standard The Optum™ SF-12v2® Health Survey is a shorter version of the SF-36v2® Health Survey that uses just 12 questions to measure functional health and well-being from the patient's point of view. Survey provides psychometrically-based physical component summary (PCS) and mental component summary (MCS) scores. Scores are calibrated so that 50 is the average score or norm, standard deviation = 10. Higher scores indicate better health for both mental and physical component summary scores.

Time frame:
12 weeks
Reported as:
Mean · Norm-Based Standardization Score
SF12 Health Composite Scores
Norm-Based Standardization ScoreNortriptylineDuloxetinePregabalinMexiletine
Mental Component Score51.0 ± 8.950.9 ± 9.947.2 ± 11.251.3 ± 10.8
Physical Component Score42.8 ± 8.742.1 ± 9.540.0 ± 8.243.7 ± 9.6
SecondaryPROMIS Pain Interference Short Form v1.0 8a T Score

Higher scores for pain interference represents worse outcome (more pain interference) T-score metric: 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric: A score of 40 is one SD lower than the mean of the reference population; A score of 60 is one SD higher than the mean of the reference population.

Time frame:
12 weeks
Reported as:
Mean · T-Score
PROMIS Pain Interference Short Form v1.0 8a T Score
T-ScoreNortriptylineDuloxetinePregabalinMexiletine
PROMIS Pain Interference Short Form v1.0 8a T Score56.4 ± 8.456.5 ± 8.360.0 ± 7.554.5 ± 8.8
SecondaryPROMIS Fatigue Short Form v1.0 8a

Higher scores for fatigue represents worse outcome (more fatigue). T-score metric: 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric: A score of 40 is one SD lower than the mean of the reference population; A score of 60 is one SD higher than the mean of the reference population.

Time frame:
12 Weeks
Reported as:
Mean · T-Score
PROMIS Fatigue Short Form v1.0 8a
T-ScoreNortriptylineDuloxetinePregabalinMexiletine
PROMIS Fatigue Short Form v1.0 8a53.6 ± 9.555.4 ± 10.256.7 ± 10.651.6 ± 10.7
SecondaryPROMIS Sleep Disturbance Short Form v1.0 8a

Higher scores for sleep disturbance represents worse outcome (more sleep disturbance). T-score metric: 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric: A score of 40 is one SD lower than the mean of the reference population; A score of 60 is one SD higher than the mean of the reference population. Higher scores equals more of the concept being measured

Time frame:
12 weeks
Reported as:
Mean · T-Score
PROMIS Sleep Disturbance Short Form v1.0 8a
T-ScoreNortriptylineDuloxetinePregabalinMexiletine
PROMIS Sleep Disturbance Short Form v1.0 8a58.9 ± 2.558.9 ± 2.658.3 ± 2.359.1 ± 2.0

Adverse events

Collected over 12 Weeks Post Randomization. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Nortriptyline0/134 (0%)0/134 (0%)75/134 (56%)
Duloxetine0/126 (0%)0/126 (0%)59/126 (46.8%)
Pregabalin0/73 (0%)0/73 (0%)29/73 (39.7%)
Mexiletine0/69 (0%)0/69 (0%)27/69 (39.1%)
Most frequent other events
Most frequent other events
EventNortriptylineDuloxetinePregabalinMexiletine
Dry MouthNervous system disorders27/1343/1261/733/69
OtherNervous system disorders3/13413/12612/739/69
Drowsiness/SleepinessNervous system disorders16/1347/1268/733/69
InsomniaGeneral disorders5/13412/1261/732/69
NauseaEar and labyrinth disorders3/13411/1261/736/69
Bloating/ConstipationGastrointestinal disorders10/1343/1261/732/69
FatigueNervous system disorders7/1348/1263/731/69
HeadacheNervous system disorders4/1342/1262/731/69

Baseline characteristics

Age, Categorical
Age, Categorical(Participants)NortriptylineDuloxetinePregabalinMexiletineTotal
<=18 years00000
Between 18 and 65 years91865041268
>=65 years43402328134
Age, Continuous
Age, Continuous(years)NortriptylineDuloxetinePregabalinMexiletineTotal
Mean60.3 ± 12.759.9 ± 14.059.5 ± 13.660.7 ± 13.760.1 ± 13.4
Sex: Female, Male
Sex: Female, Male(Participants)NortriptylineDuloxetinePregabalinMexiletineTotal
Female59683428189
Male75583941213
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)NortriptylineDuloxetinePregabalinMexiletineTotal
Hispanic or Latino864321
Not Hispanic or Latino1261196866379
Unknown or Not Reported01102
Race (NIH/OMB)
Race (NIH/OMB)(Participants)NortriptylineDuloxetinePregabalinMexiletineTotal
American Indian or Alaska Native10001
Asian644317
Native Hawaiian or Other Pacific Islander00000
Black or African American10114126
White1131046264343
More than one race00000
Unknown or Not Reported473115
Region of Enrollment
Region of Enrollment(Participants)NortriptylineDuloxetinePregabalinMexiletineTotal
United States1341267369402
Patient-Reported Outcomes Measurement Information System (PROMIS) Scale T-Scores
Patient-Reported Outcomes Measurement Information System (PROMIS) Scale T-Scores(T-Score)NortriptylineDuloxetinePregabalinMexiletineTotal
PROMIS Pain Interference T-Score63.1 ± 7.062.4 ± 6.863.3 ± 5.560.9 ± 7.962.5 ± 6.9
PROMIS Fatigue T-Score59.6 ± 3.459.7 ± 3.359.1 ± 3.759.7 ± 3.259.6 ± 3.4
PROMIS Sleep Disturbance T-Score59.1 ± 9.860.6 ± 8.359.8 ± 8.757.0 ± 11.459.3 ± 9.5
SF12 Health Component Scores
SF12 Health Component Scores(Norm-Based Standardization Score)NortriptylineDuloxetinePregabalinMexiletineTotal
Physical Component Score38.0 ± 9.338.5 ± 9.337.9 ± 9.141.1 ± 10.138.7 ± 9.4
Mental Component Score48.0 ± 10.446.7 ± 10.146.8 ± 11.347.2 ± 11.147.2 ± 10.6

1 further baseline measures are reported on the registry.

08

Study locations

46 sites
  • Barrow Neurological Institute
    Phoenix, Arizona 85013, United States
  • Phoenix Neurological Associates
    Phoenix, Arizona 85018, United States
  • Cedars-Sinai Medical Center
    Los Angeles, California 90048, United States
  • California Pacific Medical Center
    San Francisco, California 94107, United States
  • University of California San Francisco
    San Francisco, California 94143, United States
  • University of Colorado Denver Anschutz Campus
    Aurora, Colorado 80045, United States
  • Colorado Springs Neurological Associates
    Colorado Springs, Colorado 80907, United States
  • University of Florida - Gainesville
    Gainesville, Florida 10236, United States
  • University of Florida Health Science Center - Jacksonville
    Jacksonville, Florida 32209, United States
  • University of Miami Miller School of Medicine
    Miami, Florida 33136, United States
  • Neurological Services of Orlando Research
    Orlando, Florida 32806, United States
  • University of South Florida
    Tampa, Florida 33612, United States
  • NorthShore Neurological Institute
    Glenview, Illinois 60026, United States
  • Indiana University
    Indianapolis, Indiana 46202, United States
  • Mercy Medical Center - Des Moines
    Des Moines, Iowa 50314, United States
  • University of Iowa Hospitals and Clinics
    Iowa City, Iowa 52242, United States
  • Hutchinson Clinic, PA
    Hutchinson, Kansas 67502, United States
  • University of Kansas Medical Center
    Kansas City, Kansas 66160, United States
  • Norton Neurology Services
    Louisville, Kentucky 40207, United States
  • Brigham and Women's Hospital
    Boston, Massachusetts 02115, United States
  • University of Michigan
    Ann Arbor, Michigan 48105, United States
  • Henry Ford Hospital
    Detroit, Michigan 48202, United States
  • Spectrum Health System
    Grand Rapids, Michigan 49525, United States
  • University of Minnesota
    Minneapolis, Minnesota 55414, United States
  • Saint Louis University
    Saint Louis, Missouri 63103, United States
  • University of Nebraska Medical Center
    Omaha, Nebraska 68198, United States
  • University of Buffalo School of Medicine and Biomedical Sciences
    Buffalo, New York 14203, United States
  • Mount Sinai Beth Israel
    New York, New York 10029, United States
  • University of Cincinnati
    Cincinnati, Ohio 45221, United States
  • Cleveland Clinic
    Cleveland, Ohio 44195, United States
  • The Ohio State University Wexner Medical Center
    Columbus, Ohio 43210, United States
  • Oregon Health & Science University
    Portland, Oregon 97239, United States
  • Penn State Medical Center
    Hershey, Pennsylvania 17033, United States
  • Austin Neuromuscular Center
    Austin, Texas 78703, United States
  • Sara Austin, MD, PA
    Austin, Texas 78705, United States
  • Seton Brain and Spine Institute
    Austin, Texas 78705, United States
  • Texas Neurology
    Dallas, Texas 75214, United States
  • University of Texas Southwestern
    Dallas, Texas 75390, United States
  • University of Texas Health Science Center at Houton
    Houston, Texas 77030, United States
  • Grand Medical Clinic
    Katy, Texas 77494, United States
  • Neurology Clinic of Central Texas
    New Braunfels, Texas 78132, United States
  • University of Texas Health Science Center in San Antonio
    San Antonio, Texas 78229, United States
  • University of Utah
    Salt Lake City, Utah 84112, United States
  • University of Vermont Medical Center
    Burlington, Vermont 05403, United States
  • University of Virginia
    Charlottesville, Virginia 22908, United States
  • Toronto General Hospital
    Toronto, Ontario M5G 2C4, Canada
09

References and documents

Publications

  • Barohn RJ, Gajewski B, Pasnoor M, Brown A, Herbelin LL, Kimminau KS, Mudaranthakam DP, Jawdat O, Dimachkie MM; Patient Assisted Intervention for Neuropathy: Comparison of Treatment in Real Life Situations (PAIN-CONTRoLS) Study Team; Iyadurai S, Stino A, Kissel J, Pascuzzi R, Brannagan T, Wicklund M, Ahmed A, Walk D, Smith G, Quan D, Heitzman D, Tobon A, Ladha S, Wolfe G, Pulley M, Hayat G, Li Y, Thaisetthawatkul P, Lewis R, Biliciler S, Sharma K, Salajegheh K, Trivedi J, Mallonee W, Burns T, Jacoby M, Bril V, Vu T, Ramchandren S, Bazant M, Austin S, Karam C, Hussain Y, Kutz C, Twydell P, Scelsa S, Kushlaf H, Wymer J, Hehir M, Kolb N, Ralph J, Barboi A, Verma N, Ahmed M, Memon A, Saperstein D, Lou JS, Swenson A, Cash T. Patient Assisted Intervention for Neuropathy: Comparison of Treatment in Real Life Situations (PAIN-CONTRoLS): Bayesian Adaptive Comparative Effectiveness Randomized Trial. JAMA Neurol. 2021 Jan 1;78(1):68-76. doi: 10.1001/jamaneurol.2020.2590. Erratum In: JAMA Neurol. 2020 Nov 1;77(11):1453. doi: 10.1001/jamaneurol.2020.3416. PubMed 32809014 ↗
  • Brown AR, Gajewski BJ, Aaronson LS, Mudaranthakam DP, Hunt SL, Berry SM, Quintana M, Pasnoor M, Dimachkie MM, Jawdat O, Herbelin L, Barohn RJ. A Bayesian comparative effectiveness trial in action: developing a platform for multisite study adaptive randomization. Trials. 2016 Aug 31;17(1):428. doi: 10.1186/s13063-016-1544-5. PubMed 27577191 ↗

Study documents

  • Protocol and statistical analysis plan · Feb 15, 2015

Documents are hosted by the registry — open the source record to download them.

10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jul 6, 2018, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT02260388
Lead sponsor
University of Kansas Medical Center
Collaborators
Patient-Centered Outcomes Research Institute
Responsible party
Sponsor
First posted
Oct 9, 2014
Start date
Oct 2014
Primary completion
Sep 2017
Completion
Sep 2017
Results posted
Jul 6, 2018
Last update
Jul 6, 2018

Study contacts

Richard Barohn, MD
principal investigator · University of Kansas Medical Center

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

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