Botulinum Toxin A for Shoulder Pain After Stroke

November 27, 2015 updated by: TAO WU, Sir Run Run Shaw Hospital

The Effectiveness of Ultrasound Guided Sub-acromial Bursa Injection With Botulinum Toxin A in for Refractory Shoulder Pain After Stroke.

Shoulder pain after stroke is a very common, causing significant morbidity disease. Subacromial and subdeltoid (SASD) bursitis are common causes of pain or disability of the shoulder joint in stroke patients. Traditional therapeutic approaches for the shoulder pain therapy including pharmacotherapy, injection therapy, physical therapy, and behavioural modification. Unfortunately, these therapy methods may not be effective in many patients and long term benefit after treatment is transient, the outcomes may also be incomplete or non-existent. Botulinum toxin A (BoNT-A) is a neurotoxin that can inhibit not only the acetylcholine at the neuromuscular junctions but also other neurotransmitters such as glutamate, substance P and calcitonin gene related peptide, all of which have been indicated in pain transmission. Despite the therapeutic benefit of BTX in alleviating painful muscle spasms, its efficacy in SASD bursitis conditions is less clear. So we perform this study to examine the efficacy of ultrasound guided SASD injection with BoNT-A in reducing refractory shoulder pain after stroke.

Study Overview

Status

Unknown

Conditions

Study Type

Interventional

Enrollment (Anticipated)

50

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

    • Zhejiang
      • Hang Zhou, Zhejiang, China, 310016
        • Sir Run Run Shaw Hospital, Medical College of Zhejiang University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 80 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Stroke patients with pain around the shoulder or lateral deltoid area and deteriorated during active or passive overhead activity;
  2. Neer and/or Hawkins tests (+);
  3. NRS>5 at rest;
  4. Symptoms lasted for at least for 2 months and were unresponsive to analgesic medication or physical therapy for 1 month.
  5. Subjects voluntarily sign the informed consent.
  6. Age between 18 and 80 years old. -

Exclusion Criteria:

  1. Received earlier subacromial injections of corticosteroids or botulinuim toxin in the last 6 months;
  2. Shoulder fracture, glenohumeral osteoarthritis, bone tumors or osteonecrosis in plain radiographs.
  3. Known allergy or sensitivity to study medication or its components.
  4. Infection or dermatological condition at the injection sites.
  5. Any medical condition that may put the subject at increased risk with exposure , including diagnosed myasthenia gravis, Eaton-Lambert syndrome, amyotrophic lateral sclerosis, or any other disorder that might have interfered with neuromuscular function.
  6. QTc criteria: QTc ≥ 450 millisecond (msec) or≥480msec for subjects with Bundle Branch Block-values based on either single electrocardiogram (ECG) values or triplicate ECG averaged QTc values obtained over a brief recording period
  7. Liver function tests: aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≥2xULN; alkaline phosphatase and bilirubin >1.5xULN (isolated bilirubin >1.5ULN is acceptable if bilirubin is fractionated and direct bilirubin <35%).
  8. Concurrent use of aminoglycoside antibiotics or other agents that might interfere with neuromuscular function.
  9. Patients with severe cognitive impairment or neurological diseases affecting the implementation or evaluation of the test, and drug-dependent patients.
  10. Presence of clinically unstable severe cardiovascular, renal or respiratory disease
  11. Researchers believe there are other factors unfit to participate in this study of patients.

    -

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: BoNT-A treatment group
Ultrasound guided sub-acromial bursa injection with BoNT-A (100 u);
Other Names:
  • BoNT-A
Active Comparator: Triamcinolone acetonide treatment group
Ultrasound guided sub-acromial bursa injection with Triamcinolone acetonide (40mg)+1% Lidocaine 2 ml;

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Change from baseline of pain score (Numeric Rating Scale, NRS)
Time Frame: The outcome will be undertaken at weeks 0 (baseline), 1,2,4,8, and 12 weeks after injection.
The outcome will be undertaken at weeks 0 (baseline), 1,2,4,8, and 12 weeks after injection.

Secondary Outcome Measures

Outcome Measure
Time Frame
Passive and/or active shoulder range of motion.
Time Frame: The outcome will be undertaken at weeks 0 (baseline), 1,2,4,8, and 12 weeks after injection.
The outcome will be undertaken at weeks 0 (baseline), 1,2,4,8, and 12 weeks after injection.
Change from baseline of should muscle modified Ashworth scale assess (MAS)
Time Frame: The outcome will be undertaken at weeks 0 (baseline), 1,2,4,8, and 12 weeks after injection.
The outcome will be undertaken at weeks 0 (baseline), 1,2,4,8, and 12 weeks after injection.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

February 1, 2016

Primary Completion (Anticipated)

June 1, 2018

Study Completion (Anticipated)

December 1, 2018

Study Registration Dates

First Submitted

November 27, 2015

First Submitted That Met QC Criteria

November 27, 2015

First Posted (Estimate)

December 1, 2015

Study Record Updates

Last Update Posted (Estimate)

December 1, 2015

Last Update Submitted That Met QC Criteria

November 27, 2015

Last Verified

November 1, 2015

More Information

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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