二极管激光作为外周源性神经病理性疼痛的生物标志物。 (DLss)
研究概览
地位
条件
详细说明
周围神经病变引起的疼痛很常见。 了解患者对疼痛及其治疗的反应是开发减轻神经性疼痛的有效药物的最大障碍之一。 该项目将开发并验证一种非侵入性测试,该测试与患者因周围神经病变(一种“疼痛生物标志物”)引起的疼痛体验相关。 该生物标记装置将专门的光能施加到脚顶部的皮肤上,以选择性地刺激皮肤中感知和传递疼痛的神经纤维。 该测试将确定需要多少能量才能使人感受到刺激,或首先感受到刺激的疼痛。 刺激的感觉阈值和皮肤血流的短暂增强(耀斑)将与患者报告的持续足部疼痛相关。 使用实验设备、诊断测试和利多卡因的使用存在本文件中解释的风险,但可能包括过敏反应、不适和暂时麻木。
研究程序摘要 这项研究由 Drs. 进行。 犹他大学神经病学系的 J. Robinson Singleton 和斯坦福大学的 Mikhail Nemenov 博士开发了这种刺激皮肤神经的技术。 研究 1 将生物标志物与患者报告的持续神经病变足部相关联。 您可能还会被要求参加研究 2,其中生物标志物的变化将在一项简短的随机交叉试验中与疼痛体验的变化纵向相关,试验中将安慰剂或利多卡因贴片贴在脚背上。
健康受试者中 DLss 生物标志物的优化(斯坦福大学)
将对健康受试者进行筛查,排除神经病变、足部疼痛和糖尿病,然后在几天内进行 DLss 测量。 参观持续约3-4小时。
研究 1:生物标志物与持续疼痛的相关性(犹他州)
这项研究包括单次就诊,旨在评估可能的神经病变并通过病史、标准化简短检查和专门测试来评估其严重程度。 然后,所有参与者将评估他们持续的足部疼痛,并进行生物标志物测试。 整个参观需要2-3小时。 目的是将生物标志物与报告的持续神经性足部疼痛的患者相关联。
患有周围神经病变的人。 共有50人参加。
研究 2:生物标志物与利多卡因治疗期间疼痛变化的相关性(犹他州)
研究 2 旨在观察有效镇痛剂治疗后神经性疼痛的变化是否与生物标志物的变化相关。 利多卡因是一种局部麻醉剂,将使用贴片涂抹在脚背上。 该研究的结构为为期 4 周的盲法和随机交叉治疗试验,其中 5 项试验包括每周 5 次简短的研究访视,在 4 周的研究期间每周一次。 交叉意味着您将接受两种治疗各一周。 随机意味着您首先接受的治疗(安慰剂或利多卡因贴剂)将被随机选择。 盲法意味着您不会被告知您在治疗周期间接受的治疗是安慰剂还是利多卡因。 这些补丁看起来相似或相同。 您和研究协调员都无法辨别补丁的身份。
研究部分:每周进行研究部分,然后按顺序进行访问。 每次就诊将包括神经性疼痛的回顾以及 QST 和生物标记设备评估的表现。 有四个部分:
- 基线神经病理性疼痛评估。 每个参与者都将在诊所接受筛查,然后记录 7 天每天的疼痛严重程度。
- 治疗期1. 在此基线期之后,每位参与者将被随机分配接受 7 天的治疗,使用研究随机选择的贴剂(利多卡因或安慰剂)。
- 7 天的清除期,无需治疗。
- 治疗期2.每日使用第一个治疗期未接受的贴剂进行治疗。
总共 44 名患有神经病和相关神经性疼痛的人将参加
研究类型
注册 (估计的)
阶段
- 不适用
联系人和位置
学习联系方式
- 姓名:Cathy Revere
- 电话号码:8015585503
- 邮箱:cathy.revere@hsc.utah.edu
学习地点
-
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California
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Palo Alto、California、美国、94305
- 招聘中
- Stanford University
-
接触:
- Michael Klukinov
- 电话号码:650-736-1778
- 邮箱:klukinov@stanford.edu
-
首席研究员:
- David Yeomans, MD
-
-
Utah
-
Salt Lake City、Utah、美国、84132
- 尚未招聘
- University of Utah
-
接触:
- Cathy Revere
- 电话号码:801-558-5503
- 邮箱:cathy.revere@hsc.utah.edu
-
接触:
- Miguel Numa
- 邮箱:miguel.numa@hsc.utah.edu
-
首席研究员:
- J R Singleton, MD
-
-
参与标准
资格标准
适合学习的年龄
- 成人
- 年长者
接受健康志愿者
描述
纳入标准:
目标 1 的纳入标准(斯坦福大学)
- 18岁-70岁
- 无周围神经病变或其他足部疼痛的主诉
- 无与周围神经病变相关的疾病或药物使用史(例如, 糖尿病)
- 没有已知对利多卡因过敏
目标 2 的纳入标准
- 。 18岁及以上
- 由任何非急性获得性原因(例如,神经损伤)引起的长度依赖性、感觉为主的周围神经病变 糖尿病、糖尿病前期、化疗引起的),或足底筋膜炎或踝关节扭伤引起的肌肉骨骼疼痛。
目标 3 的纳入标准
- 18岁及以上
- 由任何非急性获得性原因(例如,神经损伤)引起的长度依赖性、感觉为主的周围神经病变 糖尿病、糖尿病前期、化疗引起的)。
- 视觉模拟评分 (VAS) 疼痛等级 > 30 毫米
排除标准:
排除标准目标 1(斯坦福大学)
- 主诉周围神经病变或其他足部疼痛
- 与周围神经病变相关的疾病或药物使用史(例如, 糖尿病)
- 已知对利多卡因或其他对氨基苯甲酸衍生物(即:普鲁卡因、丁卡因、苯佐卡因)过敏
排除标准目标 2 和 3
- 急性周围神经病(例如 吉兰巴利综合症,葡萄糖校正神经病),因为担心参与研究期间神经性疼痛的稳定性。
- 出血素质,或皮肤伤口严重出血史。
- 已知对利多卡因或其他对氨基苯甲酸衍生物(即:普鲁卡因、丁卡因、苯佐卡因)过敏
4. 服用与利多卡因相关或具有抗心律失常特性的排除药物,例如妥卡尼或美西律。
5.严重肝病
6. 目前正在接受化疗的人。
7. 根据研究者的判断,无法完成方案要求。-
学习计划
研究是如何设计的?
设计细节
- 主要用途:基础科学
- 分配:随机化
- 介入模型:顺序分配
- 屏蔽:双倍的
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
实验性的:生物标志物优化(斯坦福大学)
筛查神经病变、足部问题和糖尿病 二极管激光 C:Aδ 比值测试 非侵入性散斑成像 定量感觉测试 ZTlido 对某些受试者进行 1.8% 利多卡因斑贴测试
|
-每位患者都会接受 A 纤维和 C 纤维刺激。
将使用先前公布的刺激参数对足背进行刺激,以引起 C 纤维激活引起的“灼痛”和房颤引起的“针刺”疼痛
其他名称:
这是一种实时可视化组织血液灌注的方法。
LASCA 提供了以过去不可能的方式研究微循环的新方法。
PeriCam PSI 系统将动态响应和高空间分辨率结合在一台仪器中,提供所研究组织的实时图形和视频记录。
为了进一步增强其可用性,开发了专用应用软件PIMSoft。
其他名称:
定量感觉测试(QST)是一种根据受试者的反应定量测量感觉神经功能的方法。 周围感觉神经系统以特定方式对特定形式和强度的特定刺激做出反应,这在数十年的人类感觉研究中众所周知。 热 QST 提供有关小直径无髓鞘(C 纤维)和薄髓鞘(A-delta 纤维)神经纤维功能的信息,这些神经纤维不存在神经传导测试或其他客观测试。 小纤维神经损伤可表现为热感觉减退(感知阈值升高)或痛觉过敏(疼痛阈值降低)。
其他名称:
|
实验性的:神经病变评估和生物标志物测试(犹他州)
病史、体检和神经系统检查 神经传导研究 神经病史病历回顾 PROMIS 疼痛严重程度和干扰测试 简要疼痛清单 诺福克生活质量调查问卷 定量感觉测试 3mm 皮肤穿刺活检 二极管激光 C:Aδ 比值测试 非侵入性散斑成像
|
-每位患者都会接受 A 纤维和 C 纤维刺激。
将使用先前公布的刺激参数对足背进行刺激,以引起 C 纤维激活引起的“灼痛”和房颤引起的“针刺”疼痛
其他名称:
这是一种实时可视化组织血液灌注的方法。
LASCA 提供了以过去不可能的方式研究微循环的新方法。
PeriCam PSI 系统将动态响应和高空间分辨率结合在一台仪器中,提供所研究组织的实时图形和视频记录。
为了进一步增强其可用性,开发了专用应用软件PIMSoft。
其他名称:
定量感觉测试(QST)是一种根据受试者的反应定量测量感觉神经功能的方法。 周围感觉神经系统以特定方式对特定形式和强度的特定刺激做出反应,这在数十年的人类感觉研究中众所周知。 热 QST 提供有关小直径无髓鞘(C 纤维)和薄髓鞘(A-delta 纤维)神经纤维功能的信息,这些神经纤维不存在神经传导测试或其他客观测试。 小纤维神经损伤可表现为热感觉减退(感知阈值升高)或痛觉过敏(疼痛阈值降低)。
其他名称:
|
有源比较器:对患有疼痛性神经病的参与者进行交叉测试(ZTlido 1.8% 利多卡因贴片)
病史、体检和神经系统检查 神经传导研究 神经病史病历回顾 PROMIS 疼痛严重程度和干扰测试 简要疼痛清单 诺福克生活质量调查问卷 定量感觉测试 3mm 皮肤穿刺活检 二极管激光 C:Aδ 比值测试 非侵入性散斑成像将 ZTlido 1.8% 利多卡因贴片涂抹在双脚上,持续 7 天,每天最多 12 小时。
|
-每位患者都会接受 A 纤维和 C 纤维刺激。
将使用先前公布的刺激参数对足背进行刺激,以引起 C 纤维激活引起的“灼痛”和房颤引起的“针刺”疼痛
其他名称:
这是一种实时可视化组织血液灌注的方法。
LASCA 提供了以过去不可能的方式研究微循环的新方法。
PeriCam PSI 系统将动态响应和高空间分辨率结合在一台仪器中,提供所研究组织的实时图形和视频记录。
为了进一步增强其可用性,开发了专用应用软件PIMSoft。
其他名称:
定量感觉测试(QST)是一种根据受试者的反应定量测量感觉神经功能的方法。 周围感觉神经系统以特定方式对特定形式和强度的特定刺激做出反应,这在数十年的人类感觉研究中众所周知。 热 QST 提供有关小直径无髓鞘(C 纤维)和薄髓鞘(A-delta 纤维)神经纤维功能的信息,这些神经纤维不存在神经传导测试或其他客观测试。 小纤维神经损伤可表现为热感觉减退(感知阈值升高)或痛觉过敏(疼痛阈值降低)。
其他名称:
ZTLI(二乙氨基)-N-(2,6-二甲基苯基)在pH 7.4时辛醇:水分配比为43。
每个 ZTLIDO 在非水基质中含有 36 毫克利多卡因(每克粘合剂 18 毫克),还含有以下非活性成分:丁基羟基甲苯、二丙二醇、异硬脂酸、矿物油、聚异丁烯、二氧化硅、苯乙烯/异戊二烯/苯乙烯嵌段共聚物和萜烯树脂。
DO(利多卡因局部系统)1.8% 是一种单层粘合剂药物局部给药系统,由含有 36 毫克利多卡因的粘合剂材料组成,涂在柔韧的无纺布背衬上,并覆盖有聚对苯二甲酸乙二醇酯薄膜防粘衬里。
在应用到皮肤上之前去除防粘衬里。
ZTLIDO的尺寸为10厘米×14厘米×0.08厘米。
利多卡因是一种酰胺局部麻醉剂,化学名称为乙酰胺,2-
|
安慰剂比较:对患有疼痛性神经病的参与者进行交叉测试(安慰剂贴片)
病史、体格检查和神经系统检查 神经传导研究 神经病史病历回顾 PROMIS 疼痛严重程度和干扰测试 简要疼痛清单 诺福克生活质量调查问卷 定量感觉测试 3mm 皮肤穿刺活检 二极管激光 C:Aδ 比值测试 非侵入性散斑成像将安慰剂贴剂涂抹在双脚上,持续 7 天,每天最多 12 小时。
|
-每位患者都会接受 A 纤维和 C 纤维刺激。
将使用先前公布的刺激参数对足背进行刺激,以引起 C 纤维激活引起的“灼痛”和房颤引起的“针刺”疼痛
其他名称:
这是一种实时可视化组织血液灌注的方法。
LASCA 提供了以过去不可能的方式研究微循环的新方法。
PeriCam PSI 系统将动态响应和高空间分辨率结合在一台仪器中,提供所研究组织的实时图形和视频记录。
为了进一步增强其可用性,开发了专用应用软件PIMSoft。
其他名称:
定量感觉测试(QST)是一种根据受试者的反应定量测量感觉神经功能的方法。 周围感觉神经系统以特定方式对特定形式和强度的特定刺激做出反应,这在数十年的人类感觉研究中众所周知。 热 QST 提供有关小直径无髓鞘(C 纤维)和薄髓鞘(A-delta 纤维)神经纤维功能的信息,这些神经纤维不存在神经传导测试或其他客观测试。 小纤维神经损伤可表现为热感觉减退(感知阈值升高)或痛觉过敏(疼痛阈值降低)。
其他名称:
非活性、非药物局部系统由含有粘合剂的材料组成,该系统涂在柔韧的无纺布背衬上,并覆盖有聚对苯二甲酸乙二醇酯薄膜防粘衬里。
在应用到皮肤上之前去除防粘衬里。
系统尺寸为10厘米×14厘米×0.08厘米。
其他名称:
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
CMi:Aδ 二极管激光刺激后感官知觉阈值的安培数比率
大体时间:4年
|
参与者将报告二极管激光刺激足背后的感觉阈值和疼痛阈值,以安培数测量上升功率。
|
4年
|
重复阈下二极管激光刺激后神经源性耀斑反应的面积(平方毫米)。
大体时间:24个月
|
足背皮肤将被二极管激光反复刺激,并使用散斑成像仪使用红细胞反射率测量神经源性耀斑区域。
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24个月
|
合作者和调查者
出版物和有用的链接
一般刊物
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