Record any abnormal findings/ conditions identified during the exam on the appropriate form. For Screening/ Baseline visits, report abnormal findings/ conditions on the appropriate form (Medical History or Adverse Events). For Post-Baseline visits, record abnormal findings/ conditions that have worsened from Screening/ Baseline and are clinically significant on the Adverse Events form.
Description
Physical Examination: Comment
Data type
text
Alias
UMLS CUI [1,1]
C0031809
UMLS CUI [1,2]
C0947611
Vital signs
Description
Vital signs
Alias
UMLS CUI-1
C0518766
Form Not Done
Description
Vital signs
Data type
text
Alias
UMLS CUI [1]
C0518766
Scheduled Time (Within 15 minutes before topical anaesthetic application)
Description
Scheduled Time
Data type
boolean
Alias
UMLS CUI [1]
C0086960
Assessment Date
Description
Vital signs: Assessment Date
Data type
date
Measurement units
dd/MMM/yyyy
Alias
UMLS CUI [1,1]
C0518766
UMLS CUI [1,2]
C2985720
dd/MMM/yyyy
Assessment Time (00:00 - 23:59)
Description
Vital signs: Assessment Time
Data type
time
Alias
UMLS CUI [1,1]
C0518766
UMLS CUI [1,2]
C0040223
Position
Description
Position
Data type
text
Systolic Blood Pressure
Description
Systolic Blood Pressure
Data type
float
Measurement units
mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
Diastolic Blood Pressure
Description
Diastolic Blood Pressure
Data type
float
Measurement units
mmHg
Alias
UMLS CUI [1]
C0428883
mmHg
Pulse
Description
Pulse
Data type
float
Measurement units
Beats/Min
Alias
UMLS CUI [1]
C0232117
Beats/Min
Record any abnormal results on the appropriate form. For Screening/ Baseline visits, report abnormal resutls on the appropriate form (Medical History or Adverse Events). For Post-Baseline visits, record abnormal results that have worsened from Screening/ Baseline and are clinically significant on the Adverse Events form.
Description
Vitals signs: Comment
Data type
text
Measurement units
hh:mm
Alias
UMLS CUI [1,1]
C0518766
UMLS CUI [1,2]
C0947611
hh:mm
Height and Weight
Description
Height and Weight
Alias
UMLS CUI-1
C0005890
UMLS CUI-2
C0005910
Form Not Done
Description
Height and Weight
Data type
text
Alias
UMLS CUI [1,1]
C0005890
UMLS CUI [1,2]
C0005910
Assessment Date
Description
Height and Weight: Assessment Date
Data type
date
Measurement units
dd/MMM/yyyy
Alias
UMLS CUI [1,1]
C0005890
UMLS CUI [1,2]
C2985720
UMLS CUI [2,1]
C0005910
UMLS CUI [2,2]
C2985720
dd/MMM/yyyy
Height
Description
Height
Data type
float
Measurement units
cm
Alias
UMLS CUI [1]
C0005890
cm
Weight
Description
Weight
Data type
float
Measurement units
kg
Alias
UMLS CUI [1]
C0005910
kg
BMI
Description
BMI
Data type
text
Measurement units
kg/m^2
Alias
UMLS CUI [1]
C1305855
kg/m^2
Pregnancy Test
Description
Pregnancy Test
Alias
UMLS CUI-1
C0032976
Form Not Done (Mark Form Not Done only if the entire visit was not done, otherwise provide details below)
Description
Pregnancy Test
Data type
text
Alias
UMLS CUI [1]
C0032976
If Pregnancy Test was not done, please provide reason:
Description
Pregnancy Test: Reason
Data type
text
Alias
UMLS CUI [1,1]
C0032976
UMLS CUI [1,2]
C0392360
If `Other`, specify:
Description
Pregnancy Test: Reason Specification
Data type
text
Alias
UMLS CUI [1,1]
C0032976
UMLS CUI [1,2]
C0392360
UMLS CUI [1,3]
C2348235
Date of Sample Taken
Description
Pregnancy Test: Date
Data type
date
Measurement units
dd/MMM/yyyy
Alias
UMLS CUI [1,1]
C0032976
UMLS CUI [1,2]
C0011008
dd/MMM/yyyy
Result of Pregnancy Test
Description
Pregnancy Test: Result
Data type
text
Alias
UMLS CUI [1]
C0427777
Randomization
Description
Randomization
Alias
UMLS CUI-1
C0034656
Date of Randomization
Description
Date of Randomization
Data type
date
Measurement units
dd/MMM/yyyy
Alias
UMLS CUI [1,1]
C0034656
UMLS CUI [1,2]
C0011008
dd/MMM/yyyy
Assigned Treatment Group
Description
Treatment Group
Data type
text
Alias
UMLS CUI [1]
C1522541
Date of First Study Drug Taken
Description
Date of First Study Drug Taken
Data type
date
Measurement units
dd/MMM/yyyy
Alias
UMLS CUI [1]
C3899436
dd/MMM/yyyy
Painful Area: Change
Description
Painful Area: Change
Alias
UMLS CUI-1
C2032736
UMLS CUI-2
C0392747
Form Not Done (Form Not Done should only be marked for subjects that are `RANDOMIZED/REGISTERED BUT NEVER RECEIVED/DISPENSED STUDY DRUG`.)
Description
Painful Area
Data type
text
Alias
UMLS CUI [1,1]
C2032736
UMLS CUI [1,2]
C0392747
Is there any change in the painful area since Screening visit?
Description
Painful Area: Change since Screening visit
Data type
boolean
Alias
UMLS CUI [1,1]
C2032736
UMLS CUI [1,2]
C0392747
UMLS CUI [1,3]
C1409616
If "Yes", please provide details on "Identifacation of Painful Area".
Description
Painful Area: Change Specification
Data type
text
Alias
UMLS CUI [1,1]
C2032736
UMLS CUI [1,2]
C0392747
UMLS CUI [1,3]
C2348235
Painful Area
Description
Painful Area
Alias
UMLS CUI-1
C2032736
Form Not Done (Form Not Done should only be marked for subjects that are `RANDOMIZED/REGISTERED BUT NEVER RECEIVED/DISPENSED STUDY DRUG`.)
Description
Painful Area
Data type
text
Alias
UMLS CUI [1]
C2032736
Assessment Date
Description
Painful Area: Assessment Date
Data type
date
Measurement units
dd/MMM/yyyy
Alias
UMLS CUI [1,1]
C2032736
UMLS CUI [1,2]
C2985720
dd/MMM/yyyy
Treatment area: Plase tick all that apply
Description
Treatment Area
Data type
text
Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C0205146
Total Painful/ Sensitive area Size
Description
Painful Area: Size
Data type
float
Measurement units
cm^2
Alias
UMLS CUI [1,1]
C2032736
UMLS CUI [1,2]
C0456389
cm^2
Dynamic Mechanical Allodynia
Description
Dynamic Mechanical Allodynia
Alias
UMLS CUI-1
C2936719
Form Not Done
Description
Dynamic Mechanical Allodynia
Data type
text
Alias
UMLS CUI [1]
C2936719
Intensity of dynamic mechanical allodynia (0=No Pain; 10=Pain as bad as patient can imagine)
If No, please list each Inclusion Criterion not met that makes the subject ineligible by adding as many log lines necessary.
CL Item
1.Male or female between 18 and 80 years of age, inclusive (1.Male or female between 18 and 80 years of age, inclusive)
CL Item
2. In good health as determined by the investigator (2. In good health as determined by the investigator)
CL Item
3. Documented diagnosis of probable or definite PNP (Treede et al, 2008) (3. Documented diagnosis of probable or definite PNP (Treede et al, 2008))
CL Item
4. Localized and well-defined area of PNP, suitable for treatment with QUTENZA (4. Localized and well-defined area of PNP, suitable for treatment with QUTENZA)
CL Item
5a. Documented diagnosis at the Baseline Visit of either: a. PHN with pain persisting at least 6 months since shingles vesicle crusting (5a. Documented diagnosis at the Baseline Visit of either: a. PHN with pain persisting at least 6 months since shingles vesicle crusting)
CL Item
5b. PNI including post-surgical or post-traumatic neuropathic pain, persisting for a minimum of 3 months (5b. PNI including post-surgical or post-traumatic neuropathic pain, persisting for a minimum of 3 months)
CL Item
5c. Non-diabetic painful peripheral polyneuropathy with pain which has persisted for a minimum of 3 months, including I. small-fiber neuropathy, as confirmed by QST, laser evoked potentials (LEP), or skin biopsy, II. chemotherapy induced neuropathy in subjects with stable neoplastic disease, III. other, adequately characterized painful peripheral (5c. Non-diabetic painful peripheral polyneuropathy with pain which has persisted for a minimum of 3 months, including I. small-fiber neuropathy, as confirmed by QST, laser evoked potentials (LEP), or skin biopsy, II. chemotherapy induced neuropathy in subjects with stable neoplastic disease, III. other, adequately characterized painful peripheral)
CL Item
polyneuropathy, based on clinical history and examination (polyneuropathy, based on clinical history and examination)
CL Item
4 during screening period, over a minimum of at least 4 consecutive days (using the “average pain for the past 24 hours” (NPRS) score (6. Average pain score >)
CL Item
7. Intact, non-irritated, dry skin over the painful area(s) to be treated (7. Intact, non-irritated, dry skin over the painful area(s) to be treated)
CL Item
8a. Naïve to treatment with pregabalin and gabapentin (8a. Naïve to treatment with pregabalin and gabapentin)
CL Item
8b. In the opinion of the investigator, has not received an adequate trial of treatment with pregabalin or gabapentin (8b. In the opinion of the investigator, has not received an adequate trial of treatment with pregabalin or gabapentin)
CL Item
9. Subject is willing to receive pregabalin or QUTENZA as part of the trial. (9. Subject is willing to receive pregabalin or QUTENZA as part of the trial.)
CL Item
10. Females of child bearing potential must be willing to use highly effective methods of birth control during the study and for 30 days following study termination (a highly effective method of birth control is defined as those which result in a low failure rate (CHMP/ICH/286/95 modified) of less that 1% per year when used consistently and correctly such as implants, injectables, combined oral contraceptives, some intrauterine devices (IUDs), sexual abstinence or vasectomized partner). (10. Females of child bearing potential must be willing to use highly effective methods of birth control during the study and for 30 days following study termination (a highly effective method of birth control is defined as those which result in a low failure rate (CHMP/ICH/286/95 modified) of less that 1% per year when used consistently and correctly such as implants, injectables, combined oral contraceptives, some intrauterine devices (IUDs), sexual abstinence or vasectomized partner).)
CL Item
11. Willing and able to comply with protocol requirements for the duration of study participation (11. Willing and able to comply with protocol requirements for the duration of study participation)
CL Item
12. Given written informed consent (12. Given written informed consent)
If No, please list each Exclusion Criterion that makes the subject ineligible by adding as many log lines necessary.
CL Item
1. Significant ongoing or recurrent pain of etiology other than PHN, PNI or non-diabetic painful peripheral polyneuropathy, for example: compression-related neuropathies (e.g. spinal stenosis), radiculopathy, tumor related pain, fibromyalgia or arthritis (1. Significant ongoing or recurrent pain of etiology other than PHN, PNI or non-diabetic painful peripheral polyneuropathy, for example: compression-related neuropathies (e.g. spinal stenosis), radiculopathy, tumor related pain, fibromyalgia or arthritis)
CL Item
2. Complex Regional Pain Syndrome (CRPS, Type I or II) (2. Complex Regional Pain Syndrome (CRPS, Type I or II))
CL Item
3. Neuropathic pain related to previously administered radiotherapy, diabetes mellitus or HIV-AN (3. Neuropathic pain related to previously administered radiotherapy, diabetes mellitus or HIV-AN)
CL Item
4. Neuropathic pain areas located only on the face, above the hairline of the scalp, and/or in proximity to mucous membranes (4. Neuropathic pain areas located only on the face, above the hairline of the scalp, and/or in proximity to mucous membranes)
CL Item
5. Severe loss of heat sensation in the painful area, indicative of C-fiber denervation (5. Severe loss of heat sensation in the painful area, indicative of C-fiber denervation)
CL Item
6. Reported daily pain score of 10 on the NPRS for at least 4 days during the screening period (6. Reported daily pain score of 10 on the NPRS for at least 4 days during the screening period)
CL Item
7. Past or current history of diabetes mellitus. (7. Past or current history of diabetes mellitus.)
CL Item
8. Unstable or poorly controlled hypertension or a recent history of a cardiovascular event which, in the opinion of the investigator, would put the subject at risk of adverse cardiovascular reactions related to the patch application procedure (8. Unstable or poorly controlled hypertension or a recent history of a cardiovascular event which, in the opinion of the investigator, would put the subject at risk of adverse cardiovascular reactions related to the patch application procedure)
CL Item
9. Creatinine clearance (CLcr) < 60mL/min according to the Cockcroft-Gault formula (9. Creatinine clearance (CLcr) < 60mL/min according to the Cockcroft-Gault formula)
CL Item
10. Untreated ongoing generalized anxiety disorder according to DSM-IV or ICD-10 criteria (10. Untreated ongoing generalized anxiety disorder according to DSM-IV or ICD-10 criteria)
CL Item
11. Severe ongoing depression according to DSM-IV or ICD-10 criteria (11. Severe ongoing depression according to DSM-IV or ICD-10 criteria)
CL Item
12. Evidence of cognitive impairment including dementia that may interfere with subject’s ability to complete study evaluations and recall pain levels in the past 24 hours (12. Evidence of cognitive impairment including dementia that may interfere with subject’s ability to complete study evaluations and recall pain levels in the past 24 hours)
CL Item
13. Planned elective surgery during the trial (13. Planned elective surgery during the trial)
CL Item
14. Changes to stable neuropathic pain background medication in the 4 weeks prior to the Baseline Visit (14. Changes to stable neuropathic pain background medication in the 4 weeks prior to the Baseline Visit)
CL Item
15. Any prior receipt of QUTENZA patches, including blinded patches administered as part of a clinical trial (15. Any prior receipt of QUTENZA patches, including blinded patches administered as part of a clinical trial)
CL Item
16. Hypersensitivity to capsaicin (i.e., chilli peppers or Over-the-counter [OTC] capsaicin products), any QUTENZA excipients, local anesthetics, or adhesives (16. Hypersensitivity to capsaicin (i.e., chilli peppers or Over-the-counter [OTC] capsaicin products), any QUTENZA excipients, local anesthetics, or adhesives)
CL Item
17. Treatment with pregabalin or gabapentin within 2 months prior to the Baseline Visit. (17. Treatment with pregabalin or gabapentin within 2 months prior to the Baseline Visit.)
CL Item
18. Hypersensitivity to pregabalin or any of the excipients (18. Hypersensitivity to pregabalin or any of the excipients)
CL Item
19. Use of opioids exceeding a total daily dose of morphine of 200 mg/day, or equivalent o r any intravenous opioids or tapentadol, regardless of dose, within 7 days preceding the Baseline Visit. (19. Use of opioids exceeding a total daily dose of morphine of 200 mg/day, or equivalent o r any intravenous opioids or tapentadol, regardless of dose, within 7 days preceding the Baseline Visit.)
CL Item
20. Use of any topical pain medication, such as non-steroidal anti-inflammatory drugs, menthol, methyl salicylate, local anesthetics (including patch containing lidocaine), steroids or capsaicin products on the painful areas to be treated within 7 days preceding the Baseline Visit (20. Use of any topical pain medication, such as non-steroidal anti-inflammatory drugs, menthol, methyl salicylate, local anesthetics (including patch containing lidocaine), steroids or capsaicin products on the painful areas to be treated within 7 days preceding the Baseline Visit)
CL Item
21. Chemotherapy within 3 months of the Baseline Visit, except maintenance hormone treatment (21. Chemotherapy within 3 months of the Baseline Visit, except maintenance hormone treatment)
CL Item
22. Use of any investigational agent within 30 days prior to Baseline Visit (22. Use of any investigational agent within 30 days prior to Baseline Visit)
CL Item
23. Active substance abuse or history of chronic substance abuse within 1 year prior to screening; or any prior chronic substance abuse (including alcoholism) likely to re-occur during the study period as judged by the investigator (23. Active substance abuse or history of chronic substance abuse within 1 year prior to screening; or any prior chronic substance abuse (including alcoholism) likely to re-occur during the study period as judged by the investigator)
CL Item
24. Female subjects of child-bearing potential with a positive serum or urine pregnancy test prior to treatment (24. Female subjects of child-bearing potential with a positive serum or urine pregnancy test prior to treatment)
CL Item
25. Subject, who in th eopinion of the investigator, is not suitable for the study for any reason. (25. Subject, who in th eopinion of the investigator, is not suitable for the study for any reason.)
Record any abnormal findings/ conditions identified during the exam on the appropriate form. For Screening/ Baseline visits, report abnormal findings/ conditions on the appropriate form (Medical History or Adverse Events). For Post-Baseline visits, record abnormal findings/ conditions that have worsened from Screening/ Baseline and are clinically significant on the Adverse Events form.
text
C0031809 (UMLS CUI [1,1]) C0947611 (UMLS CUI [1,2])
Record any abnormal results on the appropriate form. For Screening/ Baseline visits, report abnormal resutls on the appropriate form (Medical History or Adverse Events). For Post-Baseline visits, record abnormal results that have worsened from Screening/ Baseline and are clinically significant on the Adverse Events form.
text
C0518766 (UMLS CUI [1,1]) C0947611 (UMLS CUI [1,2])