Qishe Pill for Cervical Radiculopathy

Study Overview
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Brief Summary
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Radiculopathy generally presents with pain, numbness, or weakness in a dermatomal distribution. Cervical radiculopathy results from impingement on a nerve root by either spondylotic narrowing of the neural foramen or a lateral intervertebral disc herniation. Specifically, it should be the goal of the treating physician to relieve pain, improve function, and prevent recurrence. Various studies have shown that nonoperative management of cervical radiculopathy leaves a substantial minority of patients with persistently troublesome symptoms. Pharmacologic agents treat the underlying condition and provide symptomatic relief. The various classes of medications used to treat radiculopathy include steroids, nonsteroidal antiinflammatory drugs (NSAIDs), muscle relaxants, narcotics, and antidepressants. Herbal medicines have been used for centuries in China. In China, many patients with cervical disc disease are increasingly turning to herbal medicines to alleviate their symptoms and reduce the side effects of medications. The goal of this study is to determine the efficacy and efficacy of an herbal medicine, Qishe Pill, to treat cervical radiculopathy.

Detailed Description
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Cervical radiculopathy is a distinct consideration in the evaluation of any patients who have neck pain and may be defined simply as an abnormality of a nerve root, which originates in the cervical spine. The initial approach to the management of cervical spondylopathy radiculopathy is nearly the same that the nonspecific neck or back pain can be found in most of patients. Conservative treatments include non-steroidal anti-inflammatory drugs (NSAIDs), narcotics, muscle relaxants, physical therapy and transcutaneous electrical nerve stimulation (TENS). The main objectives of conservative treatments are to relieve pain, improve function and improve health-related quality of life.However, these treatments for cervical radiculopathy are limited by their modest effectiveness. Surgical treatment for cervical disc disease is indicated when symptoms are refractory to conservative treatments and neurological symptoms are progressive. In terms of pharmacotherapy, there generally is no randomized, placebo-controlled trial available comparing the standard nonsurgical treatments. Therefore, care plans should be designed principally based on accumulated experience, the services available locally, and the respective preferences of patients. Treatment plans are developed to alleviate pain, improve function, and prevent recurrences. As a complementary and alternative medicine (CAM), herbal medicines have the potential to avoid the adverse effects of medications and surgery.In the basic theory of traditional Chinese medicine (TCM), the obstruction of Qi flow and blood circulation in the neck area caused by some pathogenic factors, such as Feng(wind), Han(cold), Shi(dampness), invading the neck, induces cervical degenerative disc diseases which are the cause of cervical radiculopathy. According to the four traditional methods of diagnosis - observation, listening, interrogation, and pulse-taking, on patients, TCM doctors can analyze the certain pathogenic factors which cause neck pain. And then they will prescribe herbal formulae based on the effect and the main indications of Chinese medicine. Natural substances, including herbal medicines, have being used to promote healing and alleviate neck pain in western countries. Previous studies have demonstrated that some active substances in herbal medicine can promote Qi flow and blood circulation to alleviate pain. A number of studies on the effects of the Chinese herbal medicine on cervical radiculopathy have been proposed, but useful empirical research is insufficiency. For chronic neck pain with or without radicular symptoms, there is low quality evidence that herbal is more effective than placebo for pain relief, which is measured at the end of the treatment. However, the size of the studies was small and the effect was measured in the short-term. Further research is very likely to change both the effect size and our confidence in the results. There is a need for trials with adequate numbers of participants that address long-term efficacy or effectiveness of herbal medicine compared to placebo. Qishe Pill is composed of processed Radix Astragali, Muscone, Szechuan Lovage Rhizome, Radix Stephaniae Tetrandrae, Ovientvine, Calculus Bovis Artifactus. Using a well-designed clinical trial, we will survey the effectiveness of concurrent use of this remedy in relieving neck pain. Therefore, the present study is to examine effectiveness and safety of Qishe Pill, a compound traditional Chinese herbal medicine, on neck pain in cervical spondylotic radiculopathy in a randomized, double-blind, placebo-controlled trial. Results of this study will provide evidence regarding the value of the Qishe Pill as an intervention to alleviate neck pain caused by cervical radiculopathy.

Official Title
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Effectiveness of a Compound Traditional Chinese Herbal Medicine, Qishe Pill, on Cervical Radiculopathy: a Randomized, Double-blind, Placebo-controlled, Multicentre Trial

Conditions
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Cervical Radiculopathy

Intervention / Treatment
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* Drug: Qishe Pill
* Drug: Qishe Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: clinical diagnosis of chronic neck pain since at least 3 months and complaints for a maximum duration of 5 years. average pain intensity of the last 7 days more or equal to 25 points measured by a Neck Disability Index. intellectual and physical ability to participate in the study. informed consent. One positive result of Brachial Plexus Traction Test, Cervical compression test or Cervical distraction test Exclusion Criteria: cervical pain related to malignancy cervical pain due to an accident inflammatory joint disorders previous spine surgery protrusion/prolapse of a spinal disk, spondylolisthesis, with radicular symptomatology actually doing or planning to do other regular physical exercise during the study with possible positive effects on neck pain - such as swimming, yoga, pilates, tai chi, etc. use of pain drugs for other diseases (> 1x/week) pregnancy severe chronic or acute disease interfering with therapy attendance alcohol or substance abuse participation in another clinical trial in the last 6 months before study entry

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Qishe<br> | Drug: Qishe Pill<br>* Pill, 3.75 g, twice per day, four weeks<br>|
| Placebo Comparator: Control<br>Qishe Placebo | Drug: Qishe Placebo<br>* Pill, 3.75 g, twice per day, four weeks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pain severity(measured with a visual analogue scale, VAS) | Operationally, the VAS score display as a horizontal line, 100 mm in length, word descriptors anchored at each end. The patient marks on the line the point that they feel represents their perception of their current pain. The VAS score is then determined by measuring in millimetres from the left hand end of the line to the point that the patient marks. | changes from baseline at 2 weeks | 
| pain severity(measured with a visual analogue scale, VAS) | Operationally, the VAS score display as a horizontal line, 100 mm in length, word descriptors anchored at each end. The patient marks on the line the point that they feel represents their perception of their current pain. The VAS score is then determined by measuring in millimetres from the left hand end of the line to the point that the patient marks. | changes from baseline at 4 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| SF-36 | a composite of functional status | changes from baseline at 2 weeks | 
| Neck Disability Index（NDI） | a composite of functional status | changes from baseline at 2 weeks | 
| Patient satisfaction degree | To evaluate satisfaction | Changes from baseline at 4 weeks | 
| SF-36 | a composite of functional status | changes from baseline at 4 weeks | 
| Neck Disability Index（NDI） | a composite of functional status | changes from baseline at 4 weeks | 
| Neck Disability Index（NDI） | a composite of functional status | changes from baseline at 3 months | 
| Neck Disability Index（NDI） | a composite of functional status | changes from baseline at 6 months | 
| Safety evaluation | Safety evaluation | changes from baseline at 4 weeks | 
| The medicine issue |  | changes from baseline at 2 weeks | 
| Compliance assessment | To evaluate compliance | changes from baseline at 2 weeks | 
| Compliance assessment | To evaluate compliance | changes from baseline at 4 weeks | 
| Concomitant medication |  | changes from baseline at 2 weeks | 
| Concomitant medication |  | changes from baseline at 4 weeks | 
| X-ray(frontal and lateral) |  | changes from baseline at 4 weeks | 
| Kidney function test |  | changes from baseline at 4 weeks | 
| Liver function test |  | changes from baseline at 4 weeks | 
| ECG |  | changes from baseline at 4 weeks | 
| Occult Blood |  | changes from baseline at 4 weeks | 
| Excrement routine |  | changes from baseline at 4 weeks | 
| Urine routine |  | changes from baseline at 4 weeks | 
| Blood routine |  | changes from baseline at 4 weeks |