Pain in Parkinson's Disease With Motor Fluctuations.

NCT ID: NCT03648671

Last Updated: 2018-08-27

Basic Information

• Recruitment Status: UNKNOWN
• Total Enrollment: 48 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2018-03-28
• Study Completion Date: 2019-11-30

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).

Conditions

Parkinson Disease

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

PD with PAIN

12 patients will undergo add-on drugs therapy with safinamide metansolfonato.

safinamide metansolfonato (12 weeks)

Intervention Type: DRUG

safinamide metansolfonato

PD without PAIN

12 patients will undergo add-on drugs therapy with safinamide metansolfonato.

safinamide metansolfonato (12 weeks)

Intervention Type: DRUG

safinamide metansolfonato

PD with PAIN rasagilina

12 patients will undergo add-on drugs therapy with rasagilina mesilato.

rasagilina mesilato (12 weeks)

Intervention Type: DRUG

rasagilina mesilato

PD without PAIN rasagilina

12 patients will undergo add-on drugs therapy with rasagilina mesilato.

rasagilina mesilato (12 weeks)

Intervention Type: DRUG

rasagilina mesilato

Interventions

safinamide metansolfonato (12 weeks)

safinamide metansolfonato

Intervention Type: DRUG

safinamide metansolfonato (12 weeks)

safinamide metansolfonato

Intervention Type: DRUG

rasagilina mesilato (12 weeks)

rasagilina mesilato

Intervention Type: DRUG

rasagilina mesilato (12 weeks)

rasagilina mesilato

Intervention Type: DRUG

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

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 80 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Azienda Ospedaliera Universitaria Integrata Verona

OTHER

Sponsor Role: collaborator

Universita di Verona

OTHER

Sponsor Role: lead

Responsible Party

Michele Tinazzi, MD, PhD

Full professor of Neurology

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Michele Tinazzi, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Azienda Ospedaliera Universitaria Integrata Verona

Locations

Azienda ospedaliera universitaria integrata verona

Verona, , Italy

Site Status: RECRUITING

Countries

Italy

Central Contacts

Michele Tinazzi, MD, PhD

Role: CONTACT

michele.tinazzi@univr.it

0458027472 ext. +39

Christian Geroin, PhD

Role: CONTACT

christian.geroin@univr.it

0458027472 ext. +39

Facility Contacts

Michele Tinazzi, MD, PhD

Role: primary

michele.tinazzi@univr.it

0458027472

References

Defazio G, Berardelli A, Fabbrini G, Martino D, Fincati E, Fiaschi A, Moretto G, Abbruzzese G, Marchese R, Bonuccelli U, Del Dotto P, Barone P, De Vivo E, Albanese A, Antonini A, Canesi M, Lopiano L, Zibetti M, Nappi G, Martignoni E, Lamberti P, Tinazzi M. Pain as a nonmotor symptom of Parkinson disease: evidence from a case-control study. Arch Neurol. 2008 Sep;65(9):1191-4. doi: 10.1001/archneurol.2008.2.

Reference Type: BACKGROUND

PMID: 18779422 (View on PubMed)

Tinazzi M, Recchia S, Simonetto S, Tamburin S, Defazio G, Fiaschi A, Moretto G, Valeriani M. Muscular pain in Parkinson's disease and nociceptive processing assessed with CO2 laser-evoked potentials. Mov Disord. 2010 Jan 30;25(2):213-20. doi: 10.1002/mds.22932.

Reference Type: BACKGROUND

PMID: 20063386 (View on PubMed)

Tinazzi M, Recchia S, Simonetto S, Defazio G, Tamburin S, Moretto G, Fiaschi A, Miliucci R, Valeriani M. Hyperalgesia and laser evoked potentials alterations in hemiparkinson: evidence for an abnormal nociceptive processing. J Neurol Sci. 2009 Jan 15;276(1-2):153-8. doi: 10.1016/j.jns.2008.09.023. Epub 2008 Oct 26.

Reference Type: BACKGROUND

PMID: 18954878 (View on PubMed)

Tinazzi M, Del Vesco C, Defazio G, Fincati E, Smania N, Moretto G, Fiaschi A, Le Pera D, Valeriani M. Abnormal processing of the nociceptive input in Parkinson's disease: a study with CO2 laser evoked potentials. Pain. 2008 May;136(1-2):117-24. doi: 10.1016/j.pain.2007.06.022. Epub 2007 Aug 31.

Reference Type: BACKGROUND

PMID: 17765400 (View on PubMed)

Zambito-Marsala S, Erro R, Bacchin R, Fornasier A, Fabris F, Lo Cascio C, Ferracci F, Morgante F, Tinazzi M. Abnormal nociceptive processing occurs centrally and not peripherally in pain-free Parkinson disease patients: A study with laser-evoked potentials. Parkinsonism Relat Disord. 2017 Jan;34:43-48. doi: 10.1016/j.parkreldis.2016.10.019. Epub 2016 Oct 24.

Reference Type: BACKGROUND

PMID: 27836714 (View on PubMed)

Other Identifiers

1470CESC

Identifier Type: -

Identifier Source: org_study_id