Use of the Tx360 Nasal Applicator in the Treatment of Chronic Migraine
Migraine imposes a substantial burden on patients in terms of diminished daily functioning, quality of life, and financial loss. Pain severity and duration correlates with reduced measures of daily functioning, and overall health status. The sphenopalatine ganglion (SPG) has been implicated in a variety of cephalalgias. This has been well represented in the literature dating back over a century. Access to this structure can be gained via a small area of mucosa just posterior and superior to the tail of the middle turbinate on the lateral nasal wall. At this aspect, there is no bony boundary to the SPG. Blocking the SPG using local anesthetics relieves pain. Unfortunately, many current interventions are cumbersome, invasive, and expensive. The purpose of this study is to evaluate the efficacy of the Tx360™, a new nasal applicator device, in the treatment of head and face pain and to examine the economic implications. The Tx360™ is a single use device designed to deliver a topical local anesthetic to the specific area of mucosa associated with the SPG. A total of 42 study participants will be accepted into this double-blind placebo-controlled study. 28 will receive SPG blocks using a 0.3 mL of a 0.5% solution of Marcaine delivered by the Tx360™ while 14 will receive a placebo of saline substituted for the Marcaine. Both patient sets will also be given a piece of lemon hard candy as a taste distractor. Participants must have a chronic migraine history with over 15 symptomatic days per month over the past three months. The treatment plan consists of six weeks of treatment, two times per week. Short and longer term assessments will be retrieved and analyzed as detailed in the Study Design.
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
|Official Title:||Use of the Tx360 Nasal Applicator for Transnasal Sphenopalatine Ganglion Block in the Treatment of Chronic Migraine: A Double-blind Placebo-controlled Study|
- Numeric Rating Scale (NRS) [ Time Frame: Estimated 6 Weeks ] [ Designated as safety issue: No ]Compare Numeric Rating Scale (NRS) scores Before Procedure,15-Minute Post Treatment, 30-Minutes Post Treatment, 24-Hour Post Treatment for all 12 treatments (Marcaine vs. Saline). NRS is a likert scale ranging from 0-10 with 0 being no pain and 10 being worst possible pain. For each individual time point, all 12 treatments were averaged for that time point and a single value was used for comparison between the two groups.
- Change in Numeric Rating Scale (NRS) [ Time Frame: Estimated 6 Weeks ] [ Designated as safety issue: No ]Compare change in Numeric Rating Scale (NRS) score from Before Procedure to 15-Minutes, Before Procedure to 30-Minutes, Before Procedure to 24-Hours After Procedure for all 12 treatments (Group A vs. Group B). NRS is a likert scale ranging from 0-10 with 0 being no pain and 10 being worst possible pain.
- Patient's Global Impression of Change (PGIC) [ Time Frame: Estimated 6 Weeks ] [ Designated as safety issue: No ]Compare 24-Hour After Procedure Patient's Global Impression of Change (PGIC) score for 12 treatments (Group A vs. Group B). PGIC is a likert scale ranging from 1 to 7 with 1 being very much improved and 7 being very much worse.
- Modified Pain Characteristic Questionnaire [ Time Frame: 6 Months ] [ Designated as safety issue: No ]Compare Modified Pain Characteristic Questionnaire scores Before Procedure vs. 24-Hour After Procedure, Before Procedure vs. 1-Month Follow Up, and Before Procedure vs. 6-Month Follow Up (Group A vs. Group B). The modified pain characteristic questionnaire is a series of 11 questions on a likert scale ranging from 0 to 10 with 0 being no pain or does not interfere and 10 being worst pain or completely interferes.
- Migraine Headache Days [ Time Frame: Estimated 14 Weeks ] [ Designated as safety issue: No ]Compare change in the number of migraine headache days per month reported in Baseline Period Diary vs. Treatment Period Diary vs. Post-Treatment Period Diary.
- Acute Medications Usage [ Time Frame: Estimated 10 Weeks ] [ Designated as safety issue: No ]Number of acute medications used during Treatment period (estimated 6 weeks) and Follow-Up (estimated 4 weeks) (Group A vs. Group B).
- Adverse Events [ Time Frame: Estimated 14 weeks ] [ Designated as safety issue: No ]Number of adverse events over the entire length of study (Group A vs. Group B).
- Headache Impact Test (HIT-6) [ Time Frame: Estimated 10 Weeks ] [ Designated as safety issue: No ]Headache Impact Test (HIT-6) scores Pre-Treatment at Visit 2 vs. Post-Treatment (following final treatment), and at 1-Month Post-Treatment (Group A vs. Group B). HIT-6 is a series of 6 likert scale questions ranging from 1 to 5 with 1 being never and 5 being always.
- Overall Satisfaction [ Time Frame: Estimated 10 Weeks ] [ Designated as safety issue: No ]Satisfaction scores Visit 2 vs. following treatment (Treatment 12) and at 1-Month Post-Treatment (Group A vs. Group B). Satisfaction scores are a likert scale ranging from 1 to 5 with 1 being complete dissatisfaction and 5 being complete satisfaction.
|Study Start Date:||September 2012|
|Study Completion Date:||February 2014|
|Primary Completion Date:||February 2014 (Final data collection date for primary outcome measure)|
Active Comparator: Marcaine
Group A will receive treatment with 0.3 mL of 0.5% Marcaine delivered bilaterally with the Tx360™ device to the mucosa associated with the Sphenopalatine Ganglion (SPG)
Marcaine used as a topical local anesthetic to block the SPG by delivering Marcaine directly to the specific area of mucosa associated with the SPG.
Other Name: Bupivicane (generic)
Placebo Comparator: Saline
Group B will receive saline placebo delivered bilaterally with the Tx360TM device to the mucosa associated with the SPG.
Show Detailed Description
Please refer to this study by its ClinicalTrials.gov identifier: NCT01709708
|United States, Michigan|
|Michigan Head Pain & Neurological Institute|
|Ann Arbor, Michigan, United States, 48104|
|United States, Missouri|
|Clinvest/A Division of Banyan Group, Inc.|
|Springfield, Missouri, United States, 65807|
|Principal Investigator:||Tian Xia, MD||Tian Medical Inc.|