PMID- 28596150 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20200930 IS - 1929-0748 (Print) IS - 1929-0748 (Electronic) IS - 1929-0748 (Linking) VI - 6 IP - 6 DP - 2017 Jun 8 TI - Pain Improvement With Novel Combination Analgesic Regimens (PAIN-CARE): Randomized Controlled Trial Protocol. PG - e111 LID - 10.2196/resprot.7493 [doi] LID - e111 AB - BACKGROUND: Neuropathic pain (NP) (including painful diabetic neuropathy, postherpetic neuralgia, etc) affects approximately 7% to 8% of the population and is associated with a devastating symptom burden as well as a profound economic impact for patients, their families, and the health care system. Current therapies have limited efficacy and dose-limiting adverse effects (AEs). Rational combination therapy with carefully selected NP drugs has shown potential for measurable improvements in pain relief, quality of life, and health care use. Today, over half of NP patients concurrently receive 2 or more analgesics but combination use is based on little evidence. Research is urgently needed to identify safer, more effective combinations. OBJECTIVE: We hypothesize that analgesic combinations containing at least 1 nonsedating agent would be as safe but more effective than either monotherapy without increasing overall AEs because of additive pain relief. Pregabalin (PGB), a sedating anticonvulsant, is proven effective for NP; the antioxidant alpha-lipoic acid (ALA) is one of the only nonsedating systemic agents proven effective for NP. Thus, we will conduct a clinical trial to compare a PGB+ALA combination to each monotherapy for NP. METHODS: Using a double-blind, double-dummy, crossover design, 54 adults with NP will be randomly allocated to 1 of 6 sequences of treatment with PGB, ALA and PGB+ALA combination. During each of 3 different treatment periods, participants will take 2 sets of capsules containing (1) ALA or placebo and (2) PGB or placebo for 31 days, followed by an 11-day taper/washout period. The primary outcome will be mean daily pain intensity (0-10) at maximally tolerated dose (MTD) during each period. Secondary outcomes, assessed at MTD, will include global improvement, adverse events, mood, and quality of life. RESULTS: Participant recruitment is expected to begin September 1, 2017. The proposed trial was awarded external peer-reviewed funding by the Canadian Institutes of Health Research (Canada) on July 15, 2016. CONCLUSIONS: This trial will provide rigorous evidence comparing the efficacy of a PGB+ALA combination to PGB alone and ALA alone in the treatment of NP. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number ISRCTN14577546; http://www.isrctn.com/ISRCTN14577546?q=&filters=conditionCategory:Signs%20and%20Symptoms,trialStatus: Ongoing,recruitmentCountry:Canada&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search (Archived by WebCite at http://www.webcitation.org/6qvHFDc6m). CI - (c)Ian Gilron, Dongsheng Tu, Ronald Holden, Alan C Jackson, Nader Ghasemlou, Scott Duggan, Elizabeth Vandenkerkhof, Roumen Milev. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 08.06.2017. FAU - Gilron, Ian AU - Gilron I AUID- ORCID: 0000-0002-5293-8792 AD - Queen's University, Department of Anesthesiology and Perioperative Medicine, Kingston, ON, Canada. FAU - Tu, Dongsheng AU - Tu D AUID- ORCID: 0000-0003-4842-2184 AD - Queen's University, Kingston, ON, Canada. FAU - Holden, Ronald AU - Holden R AUID- ORCID: 0000-0002-9070-2510 AD - Queen's University, Kingston, ON, Canada. FAU - Jackson, Alan C AU - Jackson AC AUID- ORCID: 0000-0003-0413-4236 AD - University of Manitoba, Winnipeg, MB, Canada. FAU - Ghasemlou, Nader AU - Ghasemlou N AUID- ORCID: 0000-0002-1696-7342 AD - Queen's University, Kingston, ON, Canada. FAU - Duggan, Scott AU - Duggan S AUID- ORCID: 0000-0003-0161-2706 AD - Queen's University, Kingston, ON, Canada. FAU - Vandenkerkhof, Elizabeth AU - Vandenkerkhof E AUID- ORCID: 0000-0003-4287-346X AD - Queen's University, Kingston, ON, Canada. FAU - Milev, Roumen AU - Milev R AUID- ORCID: 0000-0001-6884-171X AD - Queen's University, Kingston, ON, Canada. LA - eng PT - Journal Article DEP - 20170608 PL - Canada TA - JMIR Res Protoc JT - JMIR research protocols JID - 101599504 PMC - PMC5481665 OTO - NOTNLM OT - alpha-lipoic acid OT - anticonvulsant OT - antioxidant OT - neuropathic pain OT - pregabalin COIS- Conflicts of Interest: IG has received support from Adynxx, TARIS Biomedical, AstraZeneca, Pfizer, and Johnson and Johnson and has received grants from the Canadian Institutes of Health Research, Physicians' Services Incorporated Foundation, and Queen's University. RRH has received research funding from the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council of Canada, the American Foundation for Suicide Prevention, and Queen's University. ACJ has received grants from the Canadian Institutes of Health Research, Research Manitoba (formerly the Manitoba Health Research Council), and the University of Manitoba. The remaining authors have no conflicts of interest to declare. EDAT- 2017/06/10 06:00 MHDA- 2017/06/10 06:01 PMCR- 2017/06/08 CRDT- 2017/06/10 06:00 PHST- 2017/02/10 00:00 [received] PHST- 2017/04/24 00:00 [accepted] PHST- 2017/04/21 00:00 [revised] PHST- 2017/06/10 06:00 [entrez] PHST- 2017/06/10 06:00 [pubmed] PHST- 2017/06/10 06:01 [medline] PHST- 2017/06/08 00:00 [pmc-release] AID - v6i6e111 [pii] AID - 10.2196/resprot.7493 [doi] PST - epublish SO - JMIR Res Protoc. 2017 Jun 8;6(6):e111. doi: 10.2196/resprot.7493.