Tapentadol Prolonged Release (PR) Versus Oxycodone/Naloxone Prolonged Release in Severe Chronic Low Back Pain With a Neuropathic Component.
Condition: Back Pain; Low Back Pain; Neuropathic Pain
MeSH terms: Neuralgia; Back Pain; Low Back Pain
Intervention: Tapentadol Prolonged Release; Oxycodone/Naloxone Prolonged Release
Intervention description: All participants started with 50 mg tapentadol hydrochloride prolonged release (twice daily). The dose of tapentadol hydrochloride prolonged release will be adjusted in increments of 50 mg to a level that provided adequate analgesia. Titration will be after a minimum of 3 days on a dose. Participants are permitted a maximum dose of 250 mg twice a day (500 mg total daily dose). After titration participants will remain on the stable dose for 9 weeks.; All participants start with 10 mg/5 mg oxycodone/naloxone (twice daily). The dose of oxycodone/naloxone may be adjusted in increments of 10mg/ 5 mg oxycodone/naloxone to a level that provide adequate analgesia. Titration will be after a minimum of 3 days on a dose. Participants will be permitted a maximum dose of 50 mg/ 20 mg oxycodone/naloxone twice daily a day (100 mg/40 mg total daily dose). After titration participants will remain on the stable dose for 9 weeks.
Intervention MeSH terms: Oxycodone; Tapentadol; Naloxone
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Enrollment: 367.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Severe chronic low back pain; Neuropathic pain; Constipation

Summary:

      This was a clinical effectiveness trial designed to compare the effectiveness, safety, and
      tolerability of treatment with tapentadol prolonged release with that of oxycodone/naloxone
      prolonged release in non-opioid pre-treated subjects with severe chronic low back pain with a
      neuropathic pain component.

      Both tapentadol and the opioid oxycodone are effective in chronic severe pain and tapentadol
      and oxycodone/naloxone have shown advantages in gastrointestinal tolerability versus
      oxycodone. Therefore, it was of high scientific interest to compare the latter 2 analgesics
      with respect to gastrointestinal tolerability. Tapentadol may have advantages regarding the
      neuropathic pain-related symptoms of low back pain due to its 2 mechanisms of action.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Informed consent signed.

          -  Male or female 18 years of age or older.

          -  Women of childbearing potential must have a negative pregnancy test at the Enrollment
             Visit.

          -  Women of childbearing potential must practice medically acceptable methods of birth
             control during the trial.

          -  Participant must be appropriately communicative and able to differentiate with regard
             to location and intensity of the pain, and to complete the questionnaires used in this
             trial.

          -  Participants must have a diagnosis of chronic low back pain; chronic pain defined as
             pain lasting for at least 3 months prior to enrollment.

          -  Participant's pain must require a strong analgesic (defined as World Health
             Organization Step III) as judged by the investigator.

          -  Participants who require a washout of co-analgesics at enrolment must have an average
             pain score (NRS-3) of 5 points or higher. Participants who do not require a washout of
             co-analgesics at enrollment must have an average pain intensity score (NRS-3) during
             the last 3 days of 6 points or higher.

          -  The painDETECT diagnostic screening questionnaire must be either "positive" (score of
             19 to 38 inclusive) or "unclear" (score of 13 to 18 inclusive). If the participant is
             being treated with a stable regimen of centrally acting co-analgesics, a "negative"
             painDETECT score (score 9 points or higher).

        Inclusion criteria prior to allocation to treatment:

          -  Participants must have an average pain intensity score (NRS-3) during the last 3 days
             of 6 points or higher.

          -  Participants must score either "positive" (score of 19 to 38 inclusive) or "unclear"
             (score of 13 to 18 inclusive) on the painDETECT diagnostic screening questionnaire.

        Exclusion Criteria:

          -  Presence of a clinically significant disease or clinical laboratory values that in the
             investigator's opinion may affect effectiveness, quality of life, or
             safety/tolerability assessments.

          -  Presence of active systemic or local infections that may, in the opinion of the
             investigator, affect the effectiveness, quality of life, or safety/tolerability
             assessments.

          -  Employees of the investigator or trial site, with direct involvement in this trial or
             other trials under the direction of the investigator or trial site, as well as family
             members of employees of the investigator.

          -  Participation in another trial concurrently, or within 4 weeks prior to the Enrollment
             Visit.

          -  Known to or suspected of not being able to comply with the protocol and/or appropriate
             use of the Investigational Medicinal Products.

          -  Any painful procedures (e.g., major surgery) scheduled during the trial duration
             (Enrollment Visit until Final Evaluation Visit) that may, in the opinion of the
             investigator, affect the effectiveness, quality of life, or safety assessments.

          -  Pending litigation or application for insurance/governmental benefits due to chronic
             pain or disability and/or if the granted benefits might be influenced by a successful
             participation in the trial.

          -  Low back pain caused by cancer and/or metastatic diseases.

          -  History of alcohol or drug abuse, or suspicion thereof in the investigator's judgment.

          -  Presence of concomitant autoimmune inflammatory conditions.

          -  Participants with acute intoxication with alcohol, hypnotics, centrally acting
             analgesics, or psychotropic active substances.

          -  Participants with severe renal impairment, i.e., estimated glomerular filtration rate
             less than 30 mL/min (according to the National Kidney Foundation 2002).

          -  Known history of clinical laboratory values or current clinical laboratory values
             reflecting moderately or severely impaired hepatic function.

          -  History of seizure disorder or epilepsy.

          -  Any of the following within 1 year: mild/moderate traumatic brain injury, stroke,
             transient ischemic attack, or brain neoplasm (including brain metastases if present at
             the Enrollment Visit). Severe traumatic brain injury within 15 years (consisting of 1
             or more of the following: brain contusion, intracranial hematoma, either
             unconsciousness or post traumatic amnesia lasting more than 24 hours) or residual
             sequelae suggesting transient changes in consciousness.

          -  Pregnant or breast-feeding women.

          -  Severe respiratory depression with hypoxia and/or hypercapnia, acute or severe
             bronchial asthma or severe chronic obstructive pulmonary disease.

          -  Presence or suspicion of paralytic ileus.

          -  Participants with severe cardiac impairment, e.g., New York Heart Association class
             >3, myocardial infarction less than 6 months prior to the Enrollment Visit, and/or
             unstable angina pectoris and/or cor pulmonale.

          -  Participant with known history of rare hereditary problems of galactose intolerance,
             the Lapp lactase deficiency, or glucose-galactose malabsorption.

          -  History of allergy or hypersensitivity to tapentadol, oxycodone, naloxone, and their
             formulations.

          -  Participants with acute biliary obstruction or acute pancreatitis.

          -  Participants with hypothyroidism (including myxedema) or Addison's disease.

          -  Participants taking any prohibited concomitant medication.