Spontaneous and Evoked Pain in Parkinson's Disease With Motor Fluctuations: an Observational, Prospective, Clinical and Neurophysiological Study in Patients Under L-dopa Add on Therapies.
Overview
- Phase
- N/A
- Intervention
- safinamide metansolfonato (12 weeks)
- Conditions
- Parkinson Disease
- Sponsor
- Universita di Verona
- Enrollment
- 48
- Locations
- 1
- Primary Endpoint
- Latency (ms) of N2/P2 complex.
- Last Updated
- 7 years ago
Overview
Brief Summary
Pain (spontaneous pain) is a fundamental non-motor symptom (NMS) of Parkinson's disease (PD) that is prevalent throughout the condition and often unrecognized and undertreated. The study of the scalp laser-evoked potentials (LEPs) (evoked pain) allows a non-invasive exploration of pain central pathways in humans. This technique proved useful in elucidating the physiopathology underlying different pain syndromes. This study has been conceived to study spontaneous pain (and/or evoked pain by laser stimulation) in PD patients (with or without pain) with motor fluctuations under drugs-on (Safinamide Metansolfonato or Rasagilina Mesilato).
Detailed Description
Pain (spontaneous pain) is a fundamental non-motor symptom (NMS) of Parkinson's disease (PD) that is prevalent throughout the condition and often unrecognized and undertreated. Different types of pain have been described in association with PD including musculoskeletal, dystonic, central and neuropathic pain. Although musculoskeletal pain is the most commonly reported, a number of patients experience multiple types of pain which are more frequent and disabling in the intermediate phase of disease and which ultimately have a significant negative impact on the patient's quality of life. Despite its relevance, the pathophysiological mechanisms underlying pain in PD are yet to be fully understood. An abnormal nociceptive input processing in the central nervous system leading to hypersensitivity to evoked pain probably underlies all the different pain types experienced by PD patients and also intervene in pain-free PD patients. Additional factors including female gender, depression, disease duration, motor complications, postural abnormalities, medical conditions associated with painful symptoms (osteoporosis, rheumatic or degenerative joint disease,) probably contribute to the quality and distribution of spontaneous pain. Abnormalities in pain processing may be the consequence of decreased basal ganglia dopaminergic neurotransmission, as dopamine has been demonstrated to modulate pain perception in supraspinal regions involved in the pain pathways, including insula, anterior cingulate cortex, thalamus and periaqueductal grey. Furthermore, a neurodegeneration involving non-dopaminergic systems (such as g-aminobutyric acid, glutamate, noradrenaline, and serotonin) that modulate pain processing in other regions of the central nervous systems may also play a relevant role. The variegated pain dimension experienced by PD patients makes its therapeutic management a demanding challenge for clinicians. The study of the scalp laser-evoked potentials (LEPs) (evoked pain) allows a non-invasive exploration of pain central pathways in humans. This technique proved useful in elucidating the physiopathology underlying different pain syndromes. Some data show that LEPs are altered in PD, in both pain-free PD patients and in PD patients with different kinds of pain, with amplitude reduction in N2/P2 component. Acute levodopa challenge had no effect in normalizing the decreased pain threshold/LEPs observed in PD patients in early Parkinson's disease while in PD patients with motor complications it partially increased pain threshold. This is consistent with the hypothesis that motor complications and pain may share common pathophysiological mechanisms which include not only dopaminergic but also non-dopaminergic systems dysfunction (25).This study has been conceived to study spontaneous pain (and/or evoked pain by laser stimulation) in PD patients (with or without pain) with motor fluctuations under drugs-on (Safinamide Metansolfonato or Rasagilina Mesilato).
Investigators
Michele Tinazzi, MD, PhD
Full professor of Neurology
Azienda Ospedaliera Universitaria Integrata Verona
Eligibility Criteria
Inclusion Criteria
- •PD patients with or without pain willing to participate in this study and able to sign the written informed consent
- •To be included in the PD with pain group, the patient's intensity of pain must be moderate to severe over the last month, as reported by a numerical rating scores (NRS≥4) despite the optimal dopaminergic treatment
- •No modification of dopaminergic drugs and analgesic therapy with FANS during the 28 days before starting the enrollment in this study.
- •Diagnosis of idiopathic PD of ≥3 years duration
- •Hoehn and Yahr stage I-III during OFF time
- •Motor fluctuations (\>1.5 hours' OFF time/day)
- •Patients who would have been treated with add-on therapy irrespective to the present protocol
Exclusion Criteria
- •Patients under (or with previous assumptions) monoamine oxidase inhibitor therapy.
- •Late-stage PD experiencing severe, disabling peak-dose or biphasic dyskinesia, or unpredictable or widely swinging symptom fluctuations
- •"de novo" patients, patients in early stage or non-fluctuating patients
- •Evidence of dementia (MMSE \<24)
- •Sign and symptoms suggestive of atypical parkinsonism
- •Major psychiatric illnesses
- •Severe and progressive medical illnesses
- •Concomitant diseases potentially causing acute or chronic pain (i.e., rheumatologic conditions, severe polyneuropathy, and spine injuries)
- •Treatments with tri-tetracyclic antidepressants, serotonin-norepinephrine reuptake inhibitors (SNRIs), opioids, neuroleptics, barbiturates and phenothiazines, pregabalin and gabapentin
- •Any type of retinopathy
Arms & Interventions
PD with PAIN
12 patients will undergo add-on drugs therapy with safinamide metansolfonato.
Intervention: safinamide metansolfonato (12 weeks)
PD without PAIN
12 patients will undergo add-on drugs therapy with safinamide metansolfonato.
Intervention: safinamide metansolfonato (12 weeks)
PD with PAIN rasagilina
12 patients will undergo add-on drugs therapy with rasagilina mesilato.
Intervention: rasagilina mesilato (12 weeks)
PD without PAIN rasagilina
12 patients will undergo add-on drugs therapy with rasagilina mesilato.
Intervention: rasagilina mesilato (12 weeks)
Outcomes
Primary Outcomes
Latency (ms) of N2/P2 complex.
Time Frame: Change from baseline at 12 weeks
Laser-evoked potentials (LEPs) to explore the primary pain pathway will be assessed at each visit (V0 and V1). The technique of LEPs recording will be carried out as previously performed by our research group.
Amplitude (microvolt) of N2/P2 complex.
Time Frame: Change from baseline at 12 weeks
Laser-evoked potentials (LEPs) to explore the primary pain pathway will be assessed at each visit (V0 and V1). The technique of LEPs recording will be carried out as previously performed by our research group.
Amplitude (microvolt) of N1/P1 complex.
Time Frame: Change from baseline at 12 weeks
Laser-evoked potentials (LEPs) to explore the primary pain pathway will be assessed at each visit (V0 and V1). The technique of LEPs recording will be carried out as previously performed by our research group.
Latency (ms) of N1/P1 complex.
Time Frame: Change from baseline at 12 weeks
Laser-evoked potentials (LEPs) to explore the primary pain pathway will be assessed at each visit (V0 and V1). The technique of LEPs recording will be carried out as previously performed by our research group.
Secondary Outcomes
- Dominant phenotype(One timepoint)
- Italian version of the brief pain inventory short form(Change from baseline at 12 weeks)
- Unified Parkinson's Disease Rating Scale(Change from baseline at 12 weeks)
- Total daily off time(Change from baseline at 12 weeks)
- Job(One timepoint)
- Mini-Mental State Examination(One timepoint)
- King's Pain Scale for Parkinson's Disease(Change from baseline at 12 weeks)
- The 39-Item Parkinson's Disease Questionnaire (PDQ-39)(Change from baseline at 12 weeks)
- Numeric Rating Scale (NRS)(Change from baseline at 12 weeks)
- Age at PD onset(One timepoint)
- Disease duration(One timepoint)
- Most Affected Side(One timepoint)
- Pain symptoms at PD onset(One timepoint)
- Pharmacologic therapy for PD(One timepoint)
- Clinical global impression of change(Change from baseline at 12 weeks)
- Off time following the first morning L-dopa dose(Change from baseline at 12 weeks)
- Age(One timepoint)
- Gender(One timepoint)
- Body localization(Change from baseline at 12 weeks)
- Schooling(One timepoint)
- Weight(One timepoint)
- Comorbilities(One timepoint)
- Laterality of PD symptom onset(One timepoint)
- Montreal Cognitive Assessment (MoCA)(One timepoint)
- Modified H&Y(One timepoint)