Neuropathic Pain Caused by Radiation Therapy

Condition(s) targeted: Neuropathic Pain Secondary to Radiation Therapy

Intervention: topical amitriptyline 2%, ketamine 1%, and lidocaine 5% in pluronic lecitine organogel(AKL in PLO gel) (Drug)

Phase: Phase 3

Status: Recruiting

Sponsored by: British Columbia Cancer Agency

Official(s) and/or principal investigator(s):
Isabella Uzaraga, MD, Principal Investigator, Affiliation: BC Cancer Agency - Vancouver Island Centre

Overall contact:
Isabella Uzaraga, Phone: 250 519 5500, Email: iuzaraga@bccancer.bc.ca

To investigate if topical amitriptyline 2%, ketamine 1%, and lidocaine 5% in pluronic lecitine organogel (AKL in PLO gel) can improve management of neuropathic pain from radiation skin reactions adjunctively or better than standard treatment.

Official title: Topical Amitriptyline, Ketamine and Lidocaine in Neuropathic Pain Caused by Radiation Skin Reaction: a Pilot Study

Study design: Treatment, Open Label, Single Group Assignment, Safety/Efficacy Study

Primary outcome: The primary outcome measure will to use the validated University of Washington Neuropathic Pain Scale (UWNPS) on all radiation skin reaction subjects requiring standard intervention.

Secondary outcome: Skin Toxicity Assessment Tool (STAT)

Detailed description: 1. Topical amitriptyline and ketamine and topical lidocaine alone have been shown to improve management of neuropathic pain in nonmalignant subjects. Anecdotal experience has shown improvement in use of all three topical drugs combined in radiation skin reactions. There currently is no research evidence for the use of all three compounded interventions. This study aims to target subjects with pain from radiation therapy who are not receiving adequate relief with standard interventions and may be eligible to receive this alternate intervention.

2. Hypothesis: Topical AKL in PLO gel can effectively and safely reduce neuropathic pain experienced by patients with radiotherapy induced skin reactions.

3. Justification: Standard treatment of painful radiation skin reactions such as moist desquamation consists of saline soaks, silver sulfadiazine and oral analgesics. However, sometimes the pain exceeds this standard intervention, patients are sulfa allergic or patients are intolerant to oral analgesics such as opioids. AKL in PLO gel is targeted for neuropathic pain and may be used alternatively to standard interventions. The participation rate will help to further estimate the feasibility of a larger sample size study to look at efficacy.

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Age greater or equal to 18 years with ability to provide written informed consent.

- Subjects currently receiving radiation therapy or having completed radiotherapy in

less than 4 weeks from study entry, who have developed skin reactions that are painful.

- Radiation skin reaction pain has qualities of burning as scored on UWNPS of 1 or more

- Skin toxicity Assessment Tool showing dry desquamation or worse

- Presence of objective dynamic allodynia and/or pinprick hyperalgesia as assessed by

physician

- Subjects show less than 1 point decrease in UWNPS after 2 days of using standard

intervention.

- Subjects are allergic or intolerant to standard intervention.

- Subjects must be available by telephone 2 and 6 weeks after RT treatment is

completed.

Exclusion Criteria:

- Allergy to amitriptyline, ketamine or lidocaine

- Untreated severe major depression

- Ongoing use of monoamine oxidase inhibitor

- Pain from another source as severe or greater than the pain under study

- Evidence of another type of neuropathic pain not included in this study.

- Normal cognitive and communicative ability as judged by clinical assessment and

ability to complete self-report questionnaires

- Not pregnant or breastfeeding

Isabella Uzaraga, Phone: 250 519 5500, Email: iuzaraga@bccancer.bc.ca

BC Cancer Agency Vancouver Island BCCA, Victoria, British Columbia V8R 6V5, Canada; Recruiting
Isabella Uzaraga, Phone: 250 519 5500, Email: iuzaraga2@bccancer.bc.ca

Starting date: April 2008
Ending date: April 2010
Last updated: May 29, 2009