| E.1 Medical condition or disease under investigation | 
| E.1.1 | Medical condition(s) being investigated  | 
| Patients with multiple sclerosis associated with central neuropathic pain | 
 
 
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| MedDRA Classification | 
| E.1.2 Medical condition or disease under investigation | 
| E.1.2 | Version  | 16.0 | 
 
| E.1.2 | Level  | LLT | 
 
| E.1.2 | Classification code  | 10054095 | 
 
| E.1.2 | Term  | Neuropathic pain | 
 
| E.1.2 | System Organ Class  | 100000004852 | 
 
 
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| E.1.3 | Condition being studied is a rare disease  |  No  | 
| E.2 Objective of the trial | 
| E.2.1 | Main objective of the trial  | 
| The objective of this study is to examine whether the long-term administration of dronabinol leads to a statistically and clinically significant reduction of the chronic pain in patients with MS associated with central neuropathic pain. | 
 
 
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| E.2.2 | Secondary objectives of the trial  | 
•	Distribution of frequency, duration, and intensity of episodes with acute pain attacks
 •	Distribution of responder at visits E6, E7, E8 and E9 
 •	Distribution of responder at visits E6, E7, E8 and E9 by dosage group 
 •	NRS pain relief
 •	Pain- related sleep interference
 •	Length of treatment period
 •	Time to first response
 •	SF-36 (QOL-questionnaire)
 •	Clinical global impression
 •	Intake of rescue medication
 •	Adverse Events
 •	Safety laboratory parameters
 •	Vital parameters / weigh
 
 Criteria in follow-up phase 3: 
 •	Retrospective pain assessment for the past 4 weeks (11-NRS)
 •	Pain-related sleep interference
 •	SF-36 (QOL-questionnaire)
 •	CGI, Item A
 •	Adverse events 
 •	Assessment of dependence
 •	Safety laboratory
 •	Vital parameters
 •	Global assessment of tolerability
 •	ECG 
 •	EDSS | 
 
 
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| E.2.3 | Trial contains a sub-study  |  No  | 
| E.3 | Principal inclusion criteria  | 
•	Outpatients aged 18 to 70 years 
 •	Patients who meet the McDonald diagnostic criteria for definite MS 
 •	Patients with an EDSS score ≥3 and ≤8
 •	Patients who are in a stable phase of MS
 •	Patients with MS associated with central neuropathic pain for at least 3 months 
 •	Patients with central neuropathic pain characterized by pain in a body territory with abnormal sensation to pinprick, touch, or temperature evaluated by the bedside
 •	Patients with moderate to severe pain (= pain intensity score of at least 4 on the 11-point Likert Numerical Rating Scale (NRS) at the maximal pain site)
 
 Inclusion criteria for follow-up phase 3:
 •	Complete participation in main study, from visit E1 to visit E20
 •	Termination of study phase 2 with visit E20a taking place not more than 7 days later.
 Exception for all patients with E20 before implementation of Amendment No 11: Termination of study phase 2 with visit E20a taking place not more than 1 month later
 Exception for all patients with E20 taking place after 31.07.2008 and E20a taking place between December 1st and December 17th, 2008. 
 •	Treatment is still indicated  as per the investigator’s discretion
 •	Negative pregnancy test for female patients of childbearing potential at visit E20 or E20a respectively
 •	Willingness and capability to pass all required examinations over the entire time of the follow-up phase 3
 
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| E.4 | Principal exclusion criteria | 
•	Patients experiencing a relapse 
 ─	within 30 days prior to screening, or
 ─	during the run-in phase, or
 ─	at randomization
 •	Patients with mania or bipolar affective disorder
 •	Schizoid symptoms or history of schizophrenia or schizophrenia in the   family anamneses
 •	Patients with epilepsy
 •	Patients with trigeminal neuralgia
 •	Patients with severe cardiac diseases
 •	Advanced renal insufficiency (creatinine >2,2mg/100ml)
 •	Advanced hepatic insufficiency (SGOT/ASAT; SGPT/ALAT >2,5 x upper normal value)
 •	Treatment with dronabinol within the last 12 months
 •	Use of marihuana within the last 4 weeks and unwillingness to abstain from the use of marihuana for the duration of the study
 •	Known hypersensitivity to tramadol and excipients of Tramal® (in Germany and Austria) or Nobligan® (in Denmark) capsules
 
 Exclusion criteria for follow-up phase 3:
 •	Critical adverse events during time interval between E20 and E20a including:
 ─	Schizoid symptoms
 ─	Mania or bipolar affective disorder
 ─	Epilepsy
 •	Abuse of or dependence on Dronabinol 
 •	Reevaluation of main criteria such as 
 ─	Advanced renal insufficiency (creatinine >2,2mg/100ml)
 ─	Advanced hepatic insuffiency (SGOT/ASAT; SGPT/ALAT >2,5 x upper normal value)
 ─	Known severe cardiac diseases (e.g. cardiac insufficiency NYHA IV, severe arrhythmia, severe CHD, myocardial infarction within the last 6 months)
 ─	Known HIV-infection
 ─	Known alcohol, narcotics or drug abuse
 ─	Unwillingness to abstain from use of marihuana
 ─	Concurrent participation in other studies
 ─	Patients with major peripheral pain syndromes
 ─	Legal incompetence or limited legal competence
 ─	Patients who do not sign a consent form after thorough medical consultation  | 
 
 
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| E.5 End points | 
| E.5.1 | Primary end point(s) | 
| The primary endpoint of efficacy will be the mean change of baseline pain severity score taken from the initial patient assessment and the daily patient recordings of his/her average chronic pain on the 11-point NRS within a maximum of 16 weeks | 
 
 
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| E.6 and E.7 Scope of the trial | 
| E.6 | Scope of the trial | 
| E.6.1 | Diagnosis |  No  | 
| E.6.2 | Prophylaxis |  No  | 
| E.6.3 | Therapy |  Yes  | 
| E.6.4 | Safety |  Yes  | 
| E.6.5 | Efficacy |  Yes  | 
| E.6.6 | Pharmacokinetic |  No  | 
| E.6.7 | Pharmacodynamic |  No  | 
| E.6.8 | Bioequivalence |  No  | 
| E.6.9 | Dose response |  Yes  | 
| E.6.10 | Pharmacogenetic |  No  | 
| E.6.11 | Pharmacogenomic |  No  | 
| E.6.12 | Pharmacoeconomic |  No  | 
| E.6.13 | Others |  No  | 
| E.7 | Trial type and phase | 
| E.7.1 | Human pharmacology (Phase I) |  No  | 
| E.7.1.1 | First administration to humans |  No  | 
| E.7.1.2 | Bioequivalence study |  No  | 
| E.7.1.3 | Other |  No  | 
| E.7.1.3.1 | Other trial type description |  | 
| E.7.2 | Therapeutic exploratory (Phase II) |  No  | 
| E.7.3 | Therapeutic confirmatory (Phase III) |  Yes  | 
| E.7.4 | Therapeutic use (Phase IV) |  No  | 
| E.8 Design of the trial | 
| E.8.1 | Controlled |  Yes  | 
| E.8.1.1 | Randomised |  Yes  | 
| E.8.1.2 | Open |  Yes  | 
| E.8.1.3 | Single blind |  No  | 
| E.8.1.4 | Double blind  |  Yes  | 
| E.8.1.5 | Parallel group |  Yes  | 
| E.8.1.6 | Cross over  |  No  | 
| E.8.1.7 | Other |  No  | 
| E.8.2 |  Comparator of controlled trial | 
| E.8.2.1 | Other medicinal product(s) |  No  | 
| E.8.2.2 | Placebo  |  Yes  | 
| E.8.2.3 | Other |  No  | 
| E.8.3 | 
                                The trial involves single site in the Member State concerned
                             |  No  | 
| E.8.4 |  The trial involves multiple sites in the Member State concerned  |  Yes  | 
| E.8.4.1 | Number of sites anticipated in Member State concerned | 3 | 
| E.8.5 | The trial involves multiple Member States |  Yes  | 
| E.8.5.1 | Number of sites anticipated in the EEA | 40 | 
| E.8.6 Trial involving sites outside the EEA | 
| E.8.6.1 | Trial being conducted both within and outside the EEA |  No  | 
| E.8.6.2 | Trial being conducted completely outside of the EEA |  Information not present in EudraCT  | 
| E.8.7 | Trial has a data monitoring committee |  Yes  | 
| E.8.8 | 
                        Definition of the end of the trial and justification where it is not the last
                        visit of the last subject undergoing the trial
                     | 
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| E.8.9 Initial estimate of the duration of the trial | 
| E.8.9.1 | In the Member State concerned years | 2 | 
| E.8.9.1 | In the Member State concerned months | 1 | 
| E.8.9.1 | In the Member State concerned days |  | 
| E.8.9.2 | In all countries concerned by the trial years | 2 | 
| E.8.9.2 | In all countries concerned by the trial months | 1 |