- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02127762
The Effect of Mindfulness Based Stress Reduction in Patients With Painful Diabetic Peripheral Neuropathy (AWARE)
The Effect of an Inter-Disciplinary Program, Including Mindfulness Based Stress Reduction, on Psychosocial Function, Pain and Metabolism in Patients With Painful Diabetic Peripheral Neuropathy
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The investigators will recruit 110 adults with painful diabetic peripheral neuropathy. All will have their medical treatment optimized by a pain medicine specialist before being randomly assigned to either an 8-week group MBSR program or a wait-list. All participants will complete self-report questionnaires, provide a hair sample for cortisol measurements and a blood sample to measure glycemic index. We will be collecting outcome data for both groups. Patients randomized to MBSR will have data collected at 4 time points: 1) before medical optimization; 2) after medical optimization and before the MBSR group intervention begins, 3) 2 weeks after the group intervention; and 4) 3 months following completion of MBSR. Patients randomized to control will have data collected at 6-7 time points depending on when are participants enrolled in the trial: 1) before medical optimization; 2) after medical optimization and before the MBSR group intervention begins; 3) 2 weeks after the group intervention; 4) 3 months following completion of MBSR; 5) Re-test before control group intervention begins; 6) 2 weeks after control group intervention; and 7) 3 months after control group intervention.
The primary hypothesis is that after all patients are medically optimized, those randomized to MBSR will have a 30% higher incidence of clinically significant (≥1.0 decrease in mean BPI interference score) improvement (responders) compared to controls measured 3 months following completion of MBSR. A significant change is defined as ≥ 1 decrease in BPI interference score. A one point change on the Interference Scale, has been recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) group as a minimally clinically important change. This design controls for the effect of time and disease fluctuation, regression to the mean, and the effect of testing. In this preliminary research, where our primary goal is to establish proof of concept and obtain data needed to plan a comparative trial, we are not controlling for the placebo effect. We believe that a wait-list controlled study is the necessary foundation on which to build a rigorous program of research.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Ontario
-
Ottawa, Ontario, Canada, K1H 8L6
- The Ottawa Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patient aged > 18 years
- Type 1 or Type 2 Diabetes Mellitus (receiving insulin or not)
- HbA1c 6.5%-9.9%
- Diagnosis of Diabetic Peripheral Neuropathy (DPN) > 1 year
- Report of pain > 6 months
- Score >3 on Douleur Neuropathique-4 Questionnaire
- VAS completed 5/7 days; Average VAS score >4 and <9 (i.e., moderate to severe pain).
- Ability to attend a minimum of 7 of 9 MBSR workshops
Exclusion Criteria:
- Peripheral vascular disease requiring revascularization of lower limb or amputation
- Pregnant or lactating
- Active alcohol or drug abuse/dependence
- Previous MBSR training
- Co-morbidity preventing assessment or understanding of questionnaires
- Inability to speak English or French
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Wait-listed Control Group
Participants assigned to this group after medical treatment optimization will act as wait-list controls for the MBSR group.
They will be enrolled in the MBSR workshop 3 months after the corresponding intervention group completes the program.
|
|
Experimental: Mindfulness Based Stress Reduction
Participants assigned to this group will be enrolled in an Mindfulness-Based Stress Reduction (MBSR) program following medical treatment optimization.
The MBSR program will be composed of eight weekly 2.5 hour sessions and one 6 hour session midway through the course.
|
Consists of eight weekly 2.5 hour sessions and one 6 hour session midway through the course.
All sessions will be conducted by a psychologist or social worker with experience in chronic pain, formal MBSR training and 5 years of experience leading MBSR groups.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change from baseline in pain-related disability, as measured by the Brief Pain Inventory. Pain interference scale at 3-month post-intervention.
Time Frame: Baseline and 3 months post-intervention
|
The primary outcome is pain-related disability, as measured by the Brief Pain Inventory pain interference scale which consists of 7 numerical scales (0 to10) rating pain interference with general activity, mood, walking ability, work, relations with other people, sleep and enjoyment of life.
|
Baseline and 3 months post-intervention
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change from baseline in pain severity, as measured by the Brief Pain Inventory - Pain Severity scale, at 3 months post-intervention
Time Frame: Baseline and 3 months post-intervention
|
Pain Severity will be measured using the Brief Pain Inventory (BPI) - Pain Severity.
The BPI consists of 4 numerical scales (0 to 10) rating pain severity at its worst, at its least, on average, and at the time of filling out the measure.
Each severity question is analyzed individually.
|
Baseline and 3 months post-intervention
|
Change from baseline in pain catastrophizing, as measured by the Pain Catastrophizing Scale, at 3 months post-intervention.
Time Frame: Baseline and 3 months post-intervention
|
The Pain Catastrophizing Scale (PCS) is a 13-item instrument which will evaluate the degree to which patients have negative self-statements and catastrophizing thoughts and ideations when in pain.
The PCS uses a 5-point likert scale (0=not at all, 4=all the time) and consists of three subscales (rumination, magnification, helplessness).
|
Baseline and 3 months post-intervention
|
Change from baseline in quality of life, as measured by the Short-Form-12 Health Survey, at 3 months post-intervention.
Time Frame: Baseline and 3 months post-intervention
|
Quality of life will be measured by the Short-Form-12 Health Survey (SF-12v.2).
The SF-12v2 is a brief, twelve-item self-report measure based on the Short-Form-36.
It includes items assessing eight health domains, such as bodily pain, social functioning, role limitations due to physical health, and general health perceptions.
Two summary scores, the physical composite scale (PCS) and mental composite scale (MCS) are computed based on the 12 items.
Scores range from 0 to 100, with higher scores indicating greater quality of life.
|
Baseline and 3 months post-intervention
|
Change from baseline in mood states, as measured by the Profile of Mood States scale, at 3 months post-intervention.
Time Frame: Baseline and 3 months post-intervention
|
The Profile of Mood States (POMS-2A) will be used to measure mood disturbance.
Participants are asked to rate 65 adjectives using a 5-point likert scale (0= not at all, to 4 = extremely) based on how they have been feeling during the past week, including the day they are filling out the questionnaire.
A total mood disturbance score is calculated, as well as scores for 6 subscales: depression, tension-anxiety,anger-hostility, vigor-activity, fatigue, confusion-bewilderment.
|
Baseline and 3 months post-intervention
|
Overall change in status from baseline, as measured by Patient Global Impression of Change scale, at 3 months post-intervention.
Time Frame: Baseline and 3 months post-intervention
|
The participants perceived degree of change in overall status will be measured using the Patient Global Impression of Change (PGIC) scale.
The PGIC uses a 7-point likert scale (very much worse, to very much better) to measure how much the participant feels their overall status has changed since the start of the study.
|
Baseline and 3 months post-intervention
|
Change from baseline in stress, as measured by the Perceived Stress Scale, at 3 months post-intervention.
Time Frame: Baseline and 3 months post-intervention
|
The Perceived Stress Scale (PSS) will be used to measure the participants' perceived stress levels.
The PSS uses a 5-point likert scale (0=Never, to 4=Very often) to measure the degree of stress a participant has experienced over the past month.
A total perceived stress score is obtained by reversing the scores on items 4, 5, 7, and 8, and then summing across all 10 items.
Higher scores indicate higher perceived stress.
|
Baseline and 3 months post-intervention
|
Change from baseline in depressive symptoms, as measured by the Patient Health Questionnaire - 9 scale, at 3 months post-intervention
Time Frame: Baseline and 3 months post-intervention
|
The Patient Health Questionnaire - 9 (PHQ-9) is a 9-item scale used to assess the severity of depressive symptoms over the past two weeks and is based on Diagnostic and Statistical Manual (DSM- V) diagnostic criteria for major depression.
Total scores range from 0 to 27, and clinical cut-points correspond to mild, moderate, moderately severe, and severe depression.
|
Baseline and 3 months post-intervention
|
Change from baseline in mindfulness, as measured by the Five Facet Mindfulness Questionnaire, at 3 months post-intervention.
Time Frame: Baseline and 3 months post-intervention
|
Mindfulness will be measured using the Five Facet Mindfulness Questionnaire (FFMQ).
The FFMQ is a 39-item instrument measuring five aspects of mindfulness: Non-reactivity to inner experience, observing, describing, acting with awareness, and non-judging of experience.
Participants are asked to use a 5-point Likert-type scale (1 = never or rarely true 5 = very often or always true) to rate how true of them they believe each statement to be.
|
Baseline and 3 months post-intervention
|
Change from baseline in quality of life, as measured by the Neuropathy-Specific Quality of Life Questionnaire (NeuroQOL).
Time Frame: Baseline and 3 months post-intervention
|
The NeuroQoL was designed for and validated in patients with diabetic peripheral neuropathy and it captures the key dimensions of the patient's experience.
Factor analysis revealed 3 physical symptom measures and 2 psychosocial functioning measures with good reliability (α = 0.86 - 0.95).
This instrument was more strongly associated with severity of DPN than the SF-12 and more fully mediated the relationship between DPN and overall quality of life.
|
Baseline and 3 months post-intervention
|
Change from baseline in quality of health and life, as measured by the The Summary of Diabetes Self-Care Activities (SDSCA).
Time Frame: Baseline and 3 months post-intervention
|
The SDSCA is an 11-item self-report measure used to assess the diet, exercise, smoking, blood glucose testing and footcare habits of patients with diabetes.
The scale has been found to be valid with moderate test-retest reliability.
|
Baseline and 3 months post-intervention
|
Change from baseline in adverse reactions as a result of their glycemic control, as measured by the Blood Sugar Reactions Questionnaire.
Time Frame: Baseline and 3 months post-intervention
|
These 5 questions were developed using the "Diabetes Care Profile" from the Michigan Diabetes Research and Training Centre as a guide.
|
Baseline and 3 months post-intervention
|
Change from pre-intervention in biomarkers of stress, as measured by hair cortisol levels, at 3 months post-intervention.
Time Frame: Baseline and 3 months post-intervention
|
Cortisol is a useful biomarker of stress levels.
One cm hair samples will allow us to collect data on cortisol exposure over the past month.
Hair cortisol will allow us to explore the relationship between systemic exposure to a potential mediator of the interaction between pain, stress, and glucose control in patients with diabetes.
This novel aspect of the present proposal may help validate an important biomarker for investigating the neuro-endocrine correlates of chronic pain.
|
Baseline and 3 months post-intervention
|
Change from baseline in glycemic control, as measured by blood levels of Hemoglobin A1c.
Time Frame: Baseline and 3 months post-intervention
|
Blood samples will be obtained from participants and the measurement of Hemoglobin A1c performed.
The concentrations Hemoglobin A1c will be quantified and recorded.
|
Baseline and 3 months post-intervention
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Howard Nathan, MD, Ottawa Hospital Research Institute
Publications and helpful links
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
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
- Glucose Metabolism Disorders
- Metabolic Diseases
- Nervous System Diseases
- Immune System Diseases
- Autoimmune Diseases
- Pain
- Neurologic Manifestations
- Endocrine System Diseases
- Diabetes Complications
- Neuromuscular Diseases
- Diabetes Mellitus
- Diabetes Mellitus, Type 2
- Diabetes Mellitus, Type 1
- Chronic Pain
- Peripheral Nervous System Diseases
- Diabetic Neuropathies
Other Study ID Numbers
- 20120541-01H
- # OG-2-12-3722-HN (Other Grant/Funding Number: Canadian Diabetes Association Grant)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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.
Clinical Trials on Diabetes Mellitus
-
University of Colorado, DenverMassachusetts General Hospital; Beta Bionics, Inc.CompletedDiabetes Mellitus, Type 1 | Type 1 Diabetes | Diabetes type1 | Type 1 Diabetes Mellitus | Autoimmune Diabetes | Diabetes Mellitus, Insulin-Dependent | Juvenile-Onset Diabetes | Diabetes, Autoimmune | Insulin-Dependent Diabetes Mellitus 1 | Diabetes Mellitus, Insulin-Dependent, 1 | Diabetes Mellitus, Brittle | Diabetes Mellitus, Juvenile-Onset and other conditionsUnited States
-
Guang NingRecruitingType 2 Diabetes Mellitus | Type1 Diabetes Mellitus | Monogenetic Diabetes | Pancreatogenic Diabetes | Drug-Induced Diabetes Mellitus | Other Forms of Diabetes MellitusChina
-
Meir Medical CenterCompletedDiabetes Mellitus Type 2 | Diabetes Mellitus, Non-insulin Dependant | Diabetes Mellitus, on Oral Hypoglycemic Treatment | Adult Type Diabetes MellitusIsrael
-
Medical College of WisconsinMedical University of South CarolinaCompletedDiabetes Mellitus | Type 2 Diabetes Mellitus | Adult-Onset Diabetes Mellitus | Non-Insulin-Dependent Diabetes Mellitus | Noninsulin Dependent Diabetes Mellitus, Type IIUnited States
-
Hanmi Pharmaceutical Company LimitedUnknownType2 Diabetes Mellitus | Type1 Diabetes MellitusUnited States
-
Peking Union Medical College HospitalUnknownType 2 Diabetes Mellitus | Type 1 Diabetes Mellitus | Gestational Diabetes Mellitus | Pancreatogenic Diabetes Mellitus | Pregestational Diabetes Mellitus | Diabetes Patients in Perioperative PeriodChina
-
SanofiCompletedType 1 Diabetes Mellitus-Type 2 Diabetes MellitusHungary, Russian Federation, Germany, Poland, Japan, United States, Finland
-
Joslin Diabetes CenterCambridge Medical Technologies, LLCCompletedType 2 Diabetes Mellitus | Type1 Diabetes MellitusUnited States
-
Medical College of WisconsinMedical University of South Carolina; National Institute of Diabetes and Digestive...Active, not recruitingDiabetes Mellitus, Type 2 | Diabetes Mellitus, Type II | Diabetes Mellitus, Adult-Onset | Diabetes Mellitus, Non-Insulin-Dependent | Diabetes Mellitus, Noninsulin DependentUnited States
-
Medical College of WisconsinNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)CompletedDiabetes Mellitus, Type 2 | Diabetes Mellitus, Type II | Diabetes Mellitus, Adult-Onset | Diabetes Mellitus, Non-Insulin-Dependent | Diabetes Mellitus, Noninsulin DependentUnited States
Clinical Trials on Mindfulness Based Stress Reduction
-
Duke UniversityNational Center for Complementary and Integrative Health (NCCIH)CompletedCardiovascular Diseases | Inflammation | Stress, Psychological | SleepUnited States
-
University of California, San FranciscoCompletedDementia | Frontotemporal Dementia | Frontotemporal Lobar Degeneration | Caregiver Stress Syndrome | Caregiver Burnout | Dementia Frontal | Mindfulness Based Stress ReductionUnited States
-
University of California, San FranciscoNational Center for Complementary and Integrative Health (NCCIH)Active, not recruiting
-
Oregon Health and Science UniversityPortland VA Medical CenterCompleted
-
Chang Gung Memorial HospitalRecruitingLate Life DepressionTaiwan
-
Schneider Children's Medical Center, IsraelCompletedInflammatory Bowel DiseasesIsrael
-
Clemson UniversityUniversity of California, Los Angeles; Prisma Health-UpstateCompletedQuality of Life | Diabetes | Stress | Health Behavior | Pre-DiabetesUnited States
-
University of AarhusVU University of AmsterdamUnknown
-
Johns Hopkins UniversityCompleted
-
Spaulding Rehabilitation HospitalCompletedStress | Brain Injury | Traumatic Brain InjuryUnited States