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Trial registered on ANZCTR
Registration number
ACTRN12619000418178p
Ethics application status
Submitted, not yet approved
Date submitted
18/02/2019
Date registered
14/03/2019
Date last updated
26/03/2019
Date data sharing statement initially provided
14/03/2019
Type of registration
Prospectively registered
Titles & IDs
Public title
Palmitoylethanolamide for the treatment of centralised chronic pain
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Scientific title
Palmitoylethanolamide for the treatment of chronic nociplastic pain: a randomised double-blind placebo-controlled trial.
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Secondary ID [1]
297436
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Nil known
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Universal Trial Number (UTN)
U1111-1228-7941
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Chronic Pain
311616
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Condition category
Condition code
Anaesthesiology
310242
310242
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0
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Pain management
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Palmitoylethanolamide 300mg capsules. 300mg orally twice daily for 2 weeks then 600mg orally twice daily for further 24 weeks.
Patients will be reviewed at 3 months and 6 months and asked to bring in medications to monitor adherence.
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Intervention code [1]
313691
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Treatment: Drugs
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Comparator / control treatment
Placebo capsule containing lacose. one capsule orally twice daily for 2 weeks then two capsules orally twice daily for further 24 weeks.
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Control group
Placebo
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Outcomes
Primary outcome [1]
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Mean pain interference as assessed by the Brief Pain Inventory (BPI)
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Assessment method [1]
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Timepoint [1]
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6 months post baseline
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Secondary outcome [1]
367039
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Mean Pain Interference as measured by BPI
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Assessment method [1]
367039
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Timepoint [1]
367039
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3 months post baseline
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Secondary outcome [2]
367040
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Average pain as measure by BPI
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Assessment method [2]
367040
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Timepoint [2]
367040
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3 months post baseline
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Secondary outcome [3]
367041
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Average pain as measure by BPI
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Assessment method [3]
367041
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Timepoint [3]
367041
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6 months post baseline
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Secondary outcome [4]
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DASS21 score
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Assessment method [4]
367042
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Timepoint [4]
367042
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3 months post baseline
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Secondary outcome [5]
367043
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DASS21 score
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Assessment method [5]
367043
0
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Timepoint [5]
367043
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6 months post baseline
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Secondary outcome [6]
367044
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Pain Catastrophising Scale (PCS) score
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Assessment method [6]
367044
0
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Timepoint [6]
367044
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3 months post baseline
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Secondary outcome [7]
367045
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PCS score
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Assessment method [7]
367045
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Timepoint [7]
367045
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6 months post baseline
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Secondary outcome [8]
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Patient Self Efficacy Questionnaire (PSEQ) score
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Assessment method [8]
367046
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Timepoint [8]
367046
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3 months post baseline
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Secondary outcome [9]
367047
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PSEQ score
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Assessment method [9]
367047
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Timepoint [9]
367047
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6 months post baseline
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Secondary outcome [10]
367048
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Global assessment of change
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Assessment method [10]
367048
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Timepoint [10]
367048
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3 months post baseline
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Secondary outcome [11]
367049
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Global assessment of change
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Assessment method [11]
367049
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Timepoint [11]
367049
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6 months post baseline
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Secondary outcome [12]
367050
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Change in daily opioid dose in oral morphine equivalents. The patients use of opioid medications be ascertained from a medication list. Dosing of opioid medications will converted to oral morphine equivalents (OME) using the Australian and New Zealand Collage of Anaesthetists Faculty of Pain Medicine Opioid Calculator . The change (increase or reduction) between baseline and 3 months time point.
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Assessment method [12]
367050
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Timepoint [12]
367050
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Baseline to 3 months post baseline
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Secondary outcome [13]
367051
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Change in daily opioid dose in oral morphine equivalents. The patients use of opioid medications be ascertained from a medication list. Dosing of opioid medications will converted to oral morphine equivalents (OME) using the Australian and New Zealand Collage of Anaesthetists Faculty of Pain Medicine Opioid Calculator . The change (increase or reduction) between baseline and 6 months time point.
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Assessment method [13]
367051
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Timepoint [13]
367051
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Baseline to 6 months post baseline
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Secondary outcome [14]
367052
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Symptom Severity Score (SSS) from 2011 ACR Fibromyalgia Survey questionnaire
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Assessment method [14]
367052
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Timepoint [14]
367052
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3 months post baseline
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Secondary outcome [15]
367053
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Symptom Severity Score (SSS) from 2011 ACR Fibromyalgia Survey questionnaire
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Assessment method [15]
367053
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Timepoint [15]
367053
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6 months post baseline
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Eligibility
Key inclusion criteria
• Chronic pain at least 3 months duration AND
• Evidence of centralised pain/ neuroinflammatory response as evidenced by Symptom Severity Score (from Fibromyalgia Survey Score) greater than or equal to 7/12 AND
• Average pain intensity as measured by modified BPI greater than or equal to 5/10 (moderate or severe) AND
• Pain interference as measure by BPI greater than or equal to 5/10 (moderate or severe)
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
• Daily opioids > 120 OME
• Planned procedural intervention within 6 months
• Pre-study use of PEA
• Workers compensation or other ongoing compensation claim
• Major psychiatric disease (BPAD, Psychosis, PTSD)
• Pregnancy or breastfeeding
• Non-English speaking
• Cognitive impairment significant enough to impair informed consent
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
numbered containers
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Permuted block randomisation
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 4
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
Statistical analysis
Continuous outcomes will be assessed for normality using the SK test. Normal data will be presented as mean (SD) and analysed by Student T-test. Non-normal data will be presented as median (IQR) and assessed by Mann-Whitney U-test. Categorical data will be assessed by Chi-Squared test or Fisher’s exact test as appropriate.
Patients will be requested to complete the full 6 months of study drug therapy, and will be requested to complete follow up questionnaires regardless of compliance with use of study drug. Missing data will be filled using last data carried forward. Outcomes will be analysed in an intention to treat analysis, and an alpha of 0.01 will be used to determine statistical significance.
Sample size calculation.
Given a mean baseline pain interference of 7.0, and reductions in pain interference of 30% and 50% in the placebo and PEA groups respectively and an expected SD of 2.0, 100 patients will give 82.4% power with an alpha of 0.01.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
15/04/2019
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Actual
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Date of last participant enrolment
Anticipated
28/02/2020
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Actual
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Date of last data collection
Anticipated
29/08/2019
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Actual
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Sample size
Target
100
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
WA
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Recruitment hospital [1]
13171
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Sir Charles Gairdner Hospital - Nedlands
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Recruitment postcode(s) [1]
25726
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6009 - Nedlands
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Funding & Sponsors
Funding source category [1]
302005
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Charities/Societies/Foundations
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Name [1]
302005
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ANZCA Research Foundation
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Address [1]
302005
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630 St Kilda Rd, Melbourne VIC 3004
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Country [1]
302005
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Australia
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Funding source category [2]
302007
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Hospital
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Name [2]
302007
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Sir Charles Gairdner Hospital
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Address [2]
302007
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Hospital Ave Nedlands WA 6009
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Country [2]
302007
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Australia
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Primary sponsor type
Individual
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Name
Daniel Ellyard
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Address
Department of Pain Medicine
Sir Charles Gairdner Hospital
Nedlands WA 6009
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Country
Australia
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Secondary sponsor category [1]
301789
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None
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Name [1]
301789
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Address [1]
301789
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Country [1]
301789
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Ethics approval
Ethics application status
Submitted, not yet approved
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Ethics committee name [1]
302681
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Sir Charles Gairdner Osborne Park Health Care Group Human Research Ethics Committee
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Ethics committee address [1]
302681
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Hospital Ave, Nedlands WA 6009
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Ethics committee country [1]
302681
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Australia
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Date submitted for ethics approval [1]
302681
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14/02/2019
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Approval date [1]
302681
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Ethics approval number [1]
302681
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Summary
Brief summary
Chronic low level inflammation within the central nervous system (CNS) is increasingly being recognised as a potential contributor to many types of persistent pain. Through the activation of glia, especially microglia and astrocytes, it is thought that alterations in synaptic function lead to changes in the way that pain is processed within the CNS. It is believed that these changes play a significant part in the development of central sensitisation. There is also evidence that this glial activation may also account for many of the neuro-vegetative features common in persistent pain such as anxiety, depression, fatigue, poor sleep and cognitive problems. It is hoped that medicines that are able to suppress CNS inflammation might help relieve pain, improve function and associated psychiatric symptoms in patients with chronic pain. Palmitoylethanolamide (PEA) is a naturally occurring fatty acid involved with known anti-inflammatory properties and has been suggested to be involved in the regulation and termination of inflammatory responses within the CNS. It is currently classed as a nutraceutical and available from compounding chemists without prescription. There is some evidence that administration of PEA has analgesic benefits in a variety of causes of persistent pain, although evidence is limited by significant industry support. It does have anecdotal evidence of positive effects and appears to be very well tolerated, with a low risk of serious adverse effects. Given the limitations in current pharmacologic options in the management of persistent pain, it represents a potential useful addition to the current therapeutic options. The aim of this study is to assess the ability of daily oral administration of PEA to achieve long lasting improvements pain and function in patients being treated in a tertiary hospital pain clinic. Patients will be selected based on evidence of neuro- vegetative features as assessed by the Symptom Severity Score (SSS ) from the 2011 revised ACR Fibromyalgia Criteria regardless of primary pain diagnosis. The study aims to have high external validity. Patients will be randomised to PEA or placebo in addition to their current therapy for a period of 6 months. Outcomes will be assessed via the electronic Persistent Pain Outcomes Collaborative (ePPOC) questionnaires, with a primary outcome of Pain Interference as assessed by the Brief Pain Inventory (BPI) at 6 months.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Daniel Ellyard
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Address
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Department of Pain Medicine
Sir Charles Gairdner Hospital
Hospital Ave, Nedlands WA 6009
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Country
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Australia
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Phone
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+61 8 6457 3333
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Fax
91046
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Email
91046
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[email protected]
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Contact person for public queries
Name
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Daniel Ellyard
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Address
91047
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Department of Pain Medicine
Sir Charles Gairdner Hospital
Hospital Ave, Nedlands WA 6009
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Country
91047
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Australia
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Phone
91047
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+61 8 6457 3333
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Fax
91047
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Email
91047
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[email protected]
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Contact person for scientific queries
Name
91048
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Daniel Ellyard
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Address
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Department of Pain Medicine
Sir Charles Gairdner Hospital
Hospital Ave, Nedlands WA 6009
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Country
91048
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Australia
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Phone
91048
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+61 8 6457 3333
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Fax
91048
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Email
91048
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
Individual scores for each of the primary and secondary outcomes.
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When will data be available (start and end dates)?
Following publications of results, no end date
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Available to whom?
Journal editors, Researches conducting systemic reviews/meta-analysis
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Available for what types of analyses?
systemic reviews/meta-analysis
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How or where can data be obtained?
Following written request - de-identified data spread sheets will be supplied
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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