- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04066933
Forms of Cervical Brachial Syndrome Treated With Plasma Concentrate Enriched for A2M (A2M)
Neurogenic Thoracic Outlet Syndrome and Other Forms of Cervical Brachial Syndrome Treated With Plasma Concentrate Enriched for Alpha 2 Macroglobulin
Study Overview
Status
Intervention / Treatment
Detailed Description
Regional pain in the neck, shoulder and arm is a common problem when there is exposure to repetitive work with a prevalence of about fifty percent. In the absence of a widespread pain conditions, and when cervical radiculopathy is ruled out with appropriate imaging, myalgia, tendinopathy or neurogenic sources of pain may predominate in a given case.
Myalgia (MTPS) may be characterized by muscles that are tight and tender to palpation and where there may be radiation of pain down the limb. A twitch may be elicited with stimulation of affected muscle. Numerous treatments for myalgia have been proposed with variable or incomplete success including local anesthetic injections, botulinum chemodenervation and platelet rich plasma injections.
Neuralgic complaints may be caused by chronic compression in the interscalene triangle as in Thoracic Outlet Syndrome (NTOS) and other patients may have injury from sudden stretch, electrocution, inflammatory diseases, penetrating wounds or acute or chronic post-operative conditions. Botulinum chemodenervation and surgical decompression has been applied for treating nerve compression due to Thoracic Outlet Syndrome with partial success. [9-13] Chemodenervation tends to be transient in effect and surgery may have significant complications.
Previous reports have demonstrated relatively poor outcomes with targeted treatments when there is a coexistence of conditions characterized by increased sensitivity as in complex regional pain syndrome (CRPS) or fibromyalgia. In the present retrospective review, it was anticipated that patients with CRPS may not respond as well to targeted treatment so that they were evaluated separately from patients with NTOS along.
Because existing therapies for myofascial and neuralgic forms of cervicobrachial pain may have unsatisfactory outcomes, alternative therapies may be considered, particularly, for individuals who have failed to respond. Contemporary conceptualizations of chronic pain mechanisms include the contribution of inflammatory factors. Mindful of these considerations, locally targeted anti-inflammatory administrations may be thought to play a potential role in treatment of cervicobrachial pain.
Alpha 2 macroglobulin is a plasma protein that acts as a molecular trap for inflammatory factors such as tumor necrosis factor, TNF. After plasma is enriched for A2M, it may be injected for treating chronic inflammation. Plasma enriched for A2M may be considered as a possible injectable agent to counteract inflammation that may occur with a cervicobrachial pain syndrome. The present paper reports on an experience using A2M for treating cervicobrachial syndrome which was predominant for either musculotendinous or neuralgic features.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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California
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Santa Monica, California, United States, 90403
- Neurological Associates of West Los Angeles
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusionary Criteria:
- All patients had daily disabling cervical brachial pain that was continuously present for at least six months.
- After examination by one or both of the authors, patients who were diagnosed as having a condition related to musculotendinous pain (MTPS), neuropathic Thoracic Outlet Syndrome (NTOS), or Complex Regional Pain Syndrome (CRPS) qualified for treatment and inclusion in the chart review.
Exclusionary Criteria:
- N/A
- (retrospective analysis of clinical treatment)
Study Plan
How is the study designed?
Design Details
- Observational Models: Cohort
- Time Perspectives: Other
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Brief Pain Inventory (BPI)
Time Frame: Baseline
|
Self-report measure containing a composite pain score and functional interference score.
The pain subscale contains 4 questions, each with answers ranging from 0 'no pain' to 10 'pain as bad as you can imagine.'
Total possible score for the pain subscale is 40 points.
The functional/interference subscale contains 7 questions, with each answer ranging from 0 'does not interfere' to 10 'completely interferes.'
The maximum possible score for the interference subscale is 70 points.
The total overall composite BPI score is out of 100 maximum points.
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Baseline
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Patient Global Impression of Change Scale (PGIC)
Time Frame: 3 months
|
Qualitative assessment of meaningful change obtained by a brief interview to estimate patients' overall perceived benefit of study procedures.
The PGIC is structured as a 7-item scale ranging from 1 'very much improved' to 7 'very much worse.'
Scores of 1 and 2 reflected notable subjective perception of benefit.
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3 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Brief Pain Inventory (BPI)
Time Frame: 1 month
|
Self-report measure containing a composite pain score and functional interference score.
The pain subscale contains 4 questions, each with answers ranging from 0 'no pain' to 10 'pain as bad as you can imagine.'
Total possible score for the pain subscale is 40 points.
The functional/interference subscale contains 7 questions, with each answer ranging from 0 'does not interfere' to 10 'completely interferes.'
The maximum possible score for the interference subscale is 70 points.
The total overall composite BPI score is out of 100 maximum points.
A clinical improvement is considered a decrease in BPI overall composite score by at least 30% from baseline.
|
1 month
|
Brief Pain Inventory (BPI)
Time Frame: 3 months
|
Self-report measure containing a composite pain score and functional interference score.
The pain subscale contains 4 questions, each with answers ranging from 0 'no pain' to 10 'pain as bad as you can imagine.'
Total possible score for the pain subscale is 40 points.
The functional/interference subscale contains 7 questions, with each answer ranging from 0 'does not interfere' to 10 'completely interferes.'
The maximum possible score for the interference subscale is 70 points.
The total overall composite BPI score is out of 100 maximum points.
A clinical improvement is considered a decrease in BPI overall composite score by at least 30% from baseline.
|
3 months
|
Brief Pain Inventory (BPI)
Time Frame: 6 months
|
Self-report measure containing a composite pain score and functional interference score.
The pain subscale contains 4 questions, each with answers ranging from 0 'no pain' to 10 'pain as bad as you can imagine.'
Total possible score for the pain subscale is 40 points.
The functional/interference subscale contains 7 questions, with each answer ranging from 0 'does not interfere' to 10 'completely interferes.'
The maximum possible score for the interference subscale is 70 points.
The total overall composite BPI score is out of 100 maximum points.
A clinical improvement is considered a decrease in BPI overall composite score by at least 30% from baseline.
|
6 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Adverse Event (AE) and Serious Adverse Event (SAE) Reporting
Time Frame: Reported throughout study duration, up to 12 months
|
Any suspected adverse events possibly related to study procedures were noted.
Any serious adverse events were reported immediately.
[NONE REPORTED THROUGHOUT STUDY DURATION]
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Reported throughout study duration, up to 12 months
|
Collaborators and Investigators
Publications and helpful links
General Publications
- Soares A, Andriolo RB, Atallah AN, da Silva EM. Botulinum toxin for myofascial pain syndromes in adults. Cochrane Database Syst Rev. 2014 Jul 25;2014(7):CD007533. doi: 10.1002/14651858.CD007533.pub3.
- Waersted M, Hanvold TN, Veiersted KB. Computer work and musculoskeletal disorders of the neck and upper extremity: a systematic review. BMC Musculoskelet Disord. 2010 Apr 29;11:79. doi: 10.1186/1471-2474-11-79.
- Pascarelli EF, Hsu YP. Understanding work-related upper extremity disorders: clinical findings in 485 computer users, musicians, and others. J Occup Rehabil. 2001 Mar;11(1):1-21. doi: 10.1023/a:1016647923501.
- Simons DG. The nature of myofascial trigger points. Clin J Pain. 1995 Mar;11(1):83-4. No abstract available.
- Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Med Clin North Am. 2007 Mar;91(2):229-39. doi: 10.1016/j.mcna.2006.12.004.
- Cartagena-Sevilla J, Garcia-Fernandez MR, Vicente-Villena JP. Analgesic Effect of Botulinum Toxin A in Myofascial Pain Syndrome Patients Previously Treated with Local Infiltration of Anesthetic and Steroids. J Pain Palliat Care Pharmacother. 2016 Dec;30(4):269-275. doi: 10.1080/15360288.2016.1231742. Epub 2016 Nov 1.
- Tsikopoulos K, Tsikopoulos I, Simeonidis E, Papathanasiou E, Haidich AB, Anastasopoulos N, Natsis K. The clinical impact of platelet-rich plasma on tendinopathy compared to placebo or dry needling injections: A meta-analysis. Phys Ther Sport. 2016 Jan;17:87-94. doi: 10.1016/j.ptsp.2015.06.003. Epub 2015 Jun 18.
- Jordan SE, Ahn SS, Gelabert HA. Combining ultrasonography and electromyography for botulinum chemodenervation treatment of thoracic outlet syndrome: comparison with fluoroscopy and electromyography guidance. Pain Physician. 2007 Jul;10(4):541-6.
- Jordan SE, Ahn SS, Gelabert HA. Differentiation of thoracic outlet syndrome from treatment-resistant cervical brachial pain syndromes: development and utilization of a questionnaire, clinical examination and ultrasound evaluation. Pain Physician. 2007 May;10(3):441-52. Erratum In: Pain Physician. 2007 Jul;10(4):599.
- Christo PJ, Christo DK, Carinci AJ, Freischlag JA. Single CT-guided chemodenervation of the anterior scalene muscle with botulinum toxin for neurogenic thoracic outlet syndrome. Pain Med. 2010 Apr;11(4):504-11. doi: 10.1111/j.1526-4637.2010.00814.x. Epub 2010 Mar 1.
- Torriani M, Gupta R, Donahue DM. Botulinum toxin injection in neurogenic thoracic outlet syndrome: results and experience using a ultrasound-guided approach. Skeletal Radiol. 2010 Oct;39(10):973-80. doi: 10.1007/s00256-010-0897-1. Epub 2010 Feb 26.
- Thompson RW, Petrinec D. Surgical treatment of thoracic outlet compression syndromes: diagnostic considerations and transaxillary first rib resection. Ann Vasc Surg. 1997 May;11(3):315-23. doi: 10.1007/s100169900053. No abstract available.
- Cuellar JM, Cuellar VG, Scuderi GJ. alpha2-Macroglobulin: Autologous Protease Inhibition Technology. Phys Med Rehabil Clin N Am. 2016 Nov;27(4):909-918. doi: 10.1016/j.pmr.2016.06.008.
- Wang S, Wei X, Zhou J, Zhang J, Li K, Chen Q, Terek R, Fleming BC, Goldring MB, Ehrlich MG, Zhang G, Wei L. Identification of alpha2-macroglobulin as a master inhibitor of cartilage-degrading factors that attenuates the progression of posttraumatic osteoarthritis. Arthritis Rheumatol. 2014 Jul;66(7):1843-53. doi: 10.1002/art.38576.
- Pasquale, X.M., Jason, M.C., Gaetano, J.S., Intradiscal injection of an Autologous Alpha-2-Macroglobulin (A2M) Concentrate Alleviates Back Pain in FAC-Positive Patients. Ortho and Rheum, 2017. 4(2).
- Eltayeb S, Staal JB, Kennes J, Lamberts PH, de Bie RA. Prevalence of complaints of arm, neck and shoulder among computer office workers and psychometric evaluation of a risk factor questionnaire. BMC Musculoskelet Disord. 2007 Jul 14;8:68. doi: 10.1186/1471-2474-8-68.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pathologic Processes
- Cardiovascular Diseases
- Vascular Diseases
- Nervous System Diseases
- Pain
- Neurologic Manifestations
- Disease
- Neuromuscular Diseases
- Peripheral Nervous System Diseases
- Nerve Compression Syndromes
- Autonomic Nervous System Diseases
- Syndrome
- Neuralgia
- Complex Regional Pain Syndromes
- Reflex Sympathetic Dystrophy
- Thoracic Outlet Syndrome
Other Study ID Numbers
- 33237/1
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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