Double-blind, Placebo-controlled Study of the Safety and Efficacy of Eszopiclone in the Treatment of Insomnia in Patients With Chronic Low Back Pain
Overview
- Phase
- Phase 4
- Intervention
- Placebo
- Conditions
- Primary Insomnia
- Sponsor
- Duke University
- Enrollment
- 58
- Locations
- 1
- Primary Endpoint
- Mean Subjective Sleep Diary Derived Total Sleep Time (TST)
- Status
- Completed
- Last Updated
- 10 years ago
Overview
Brief Summary
The purpose of this study is to examine whether insomnia due to chronic low back pain can improve with use of eszopiclone.
Detailed Description
There is a great need to develop effective treatments for insomnia in patients with chronic low-back pain. Chronic low-back pain is among the most prevalent of all health complaints, is associated with enormous health-care and productivity costs, reduced quality of life, and limitation of function and is almost universally associated with insomnia (Rives and Douglas, 2004). While it had long been believed that insomnia was a symptom of pain conditions and of little consequence in its' own right, a growing literature suggests that insomnia has important effects on the clinical course of pain syndromes (Smith and Haythornthwaite, 2004). While pain may disrupt sleep, it appears that problems with sleep increase pain and are associated with impairments in daytime function. The emerging point of view is that specific treatment for both pain and insomnia is needed for optimal clinical management (Smith and Haythornthwaite, 2004). Surprisingly, despite the fact that chronic low-back pain is the most common pain condition, the treatment of insomnia in this disease has never been studied. As a result, we propose to carry out the first double-blind placebo-controlled study of the treatment insomnia in patients with chronic low back pain. Comparison(s): We will test the hypothesis that treating the insomnia with eszopiclone 3 mg (ESZ) along with management of pain with naproxen 500 mg bid (NAP) will result in statistically significantly improved sleep compared with placebo. We also propose to test as a secondary hypothesis that treatment with ESZ will lead to significant improvement in pain and daytime function vs. placebo.
Investigators
Eligibility Criteria
Inclusion Criteria
- •• Diagnosis of insomnia based on DSM-IV criteria for insomnia due to a general medical condition (low-back pain);
- •The insomnia must not predate the onset of low-back pain by more than 1 month;
- •Usual nightly TST (Total Sleep Time) \< 6.5 hours and/or usual SOL (Sleep Onset Latency) \> 30 minutes for the last month prior to screening;
- •ISI (Insomnia Severity Index) \> 14 (at least moderate insomnia);
- •Age 21-64 years;
- •Greater than 40 on VAS (Visual Analog Scale) for pain (scale is 0-no pain to 100-worst imaginable pain);
- •Patient Global Impression of Pain of at least 3 (on a 1-5 scale, indicating at least moderate severity);
- •reported Back pain must be greater than reported leg pain, and there must be no signs of spinal nerve root compression;
- •presence of normal motor strength on exam;
- •duration of chronic low back pain of greater than three months;
Exclusion Criteria
- •• Significant medical or neurological illness in excess of that which is directly responsible for the chronic low back pain;
- •the presence of an active and significant psychiatric disease with a substantive impact on sleep;
- •meeting DSM-IV criteria for an Axis I disorder within the last three months, or meeting criteria for substance abuse within the last 12 months;
- •current pregnancy; history of hypersensitivity, intolerance, or contraindication to Naproxen/Lansoprazole or Eszopiclone;
- •baseline creatinine of 2.0 or greater; patient taking other medications having significant renal effects (e.g. lithium, ACE inhibitor, angiotensin receptor antagonist, or thiazide/loop diuretics);
- •patients taking other anticoagulants; patients having an allergy to aspirin; history of diagnosed gastric or duodenal ulcer;
- •history of bleeding or clotting diathesis; lifetime history of myocardial infarction or cerebrovascular accident;
- •Elevated PT/PTT/INR (Prothrombin Time, Partial Thromboplastin Time, International Normalized Ratio)at screening;
- •Abnormal kidney function detected in screening labs;
- •history of back related surgery within the past 3 months; history of corticosteroid use in the past 30 days;
Arms & Interventions
1
Placebo
Intervention: Placebo
2
Eszopiclone
Intervention: Eszopiclone
Outcomes
Primary Outcomes
Mean Subjective Sleep Diary Derived Total Sleep Time (TST)
Time Frame: Postnaprosyn baseline, Week 1, week 2, week 4
Nightly total sleep time was averaged from diary entries.
Secondary Outcomes
- Mean Sleep Onset Latency (SOL)(Postnaprosyn Baseline, Week 1, Week 2 week 4)
- Sleep Quality Ratings(Postnaprosyn Baseline, Week 1, Week 2 week 4)
- Visual Analog Scale Pain Ratings (VAS)(Postnaprosyn baseline, Week 1, Week 2, Week 4)
- Wake Time After Sleep Onset(Postnaprosyn Baseline, Week 1, Week 2 week 4)
- Number of Awakenings(Postnaprosyn Baseline, Week 1, Week 2 week 4)
- Insomnia Severity Index (ISI)(Prenaprosyn Baseline, Postnaprosyn Baseline, Week 1, Week 2 week 4)
- Patient Global Impression of Pain Ratings(postnaprosyn Baseline, Week 1, Week 2 week 4)
- Hamilton Depression Rating Scale (HAM-D-24)(prenaprosyn baseline, postnaprosyn Baseline, Week 1, Week 2, week 4)
- Roland Morris Low Back Pain Inventory (RMLBPI)(prenaprosyn baseline, postnaprosyn Baseline, Week 1, Week 2, week 4)
- Short Form 36 Health Survey Questionnaire (SF-36)(Baseline, week 1, week 2, week 4)
- State-Trait Anxiety Inventory (STAI)(Baseline, week 1, week 2, week 4)