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Pre-operative Pregabalin and Ketamine to Prevent Phantom Pain

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ClinicalTrials.gov Identifier: NCT02311777
Recruitment Status : Withdrawn (Preoperative period is very short time)
First Posted : December 8, 2014
Last Update Posted : April 24, 2018
Sponsor:
Collaborator:
Pfizer
Information provided by (Responsible Party):
Dawood Nasir, University of Texas Southwestern Medical Center

Brief Summary:

Phantom limb pain (PLP) is as painful sensations located to the missing limb and classified as neuropathic pain. In the United States, an estimated 1.7 million patients have undergone limb amputation, and 60% to 80% of these patients develop PLP (1-2) and it is usually resistant to a wide variety of treatments (1-4). Three factors may contribute to the development of persistent, post-amputation PLP by inducing central sensitization at different times relative to surgery: pre-amputation pain, noxious intraoperative stimuli, and acute postoperative pain (5-7).

Investigators hypothesis that pre-amputation period could be important in eliminating Phantom Limb Pain (PLP) in the patients in whom cortical reorganization is not yet established. The reduction of pre-operative pain and prevention of formation of pain memories may eliminate development of PLP by using dual networks treatment strategy. This Phase III, randomized, double-blind, placebo-controlled study is designed to evaluate the efficacy of pre-operative pregabalin (lyrica) and ketamine in eliminating phantom limb pain in patients undergoing lower limb amputation.


Condition or disease Intervention/treatment Phase
Phantom Pain Drug: Pregabalin Drug: Ketamine Drug: Placebo Phase 3

Detailed Description:

Patients undergoing unilateral lower extremity amputation (n=30) will be randomized in this double blind parallel placebo control clinical trial to evaluate the efficacy of pre-operative pregabalin (lyrica) and ketamine in eliminating phantom limb pain. Patient will receive either pregabalin and ketamine treatment (Group 1) or placebo (Group 2) during pre-operative period approximately 4 days (2-4 days).

Patients will be identified during their anesthesia preoperative clinic or orthopedic inpatient unit (Parkland Hospital or UT Southwestern University Hospital) for the eligibility. Data base (EPIC) will also be used for prescreening of potential subject by reviewing clinic visit daily schedule or operating room schedule. Then patients chart will be reviewed for initial data collection to determine the eligibility of potential subjects with the use of a HIPAA waiver form. Eligible subject will be approached by the study PI, investigators, or research coordinator and written consent obtained prior to any study procedures.

A pregnancy test will be performed before the preoperative treatment start for women in child-bearing age: exceptions include surgically sterile women or women with medically confirmed menopause. Women with a positive pregnancy test or who report unprotected heterosexual sex since their previous menses or not currently using and/or willing to use a medically approved form of contraception (e.g., birth control pill) will not enrolled to the study.

Pain will be documented using the visual analog pain score (0=no pain, 10=worst imaginary pain) during preoperative period before the treatment and daily on pain diary and on the day of surgery and during postoperative period at PACU, 24 and 48 hrs. and long-term follow-up 1, 3, and 6 months after the surgery.

Total opioid dose over the 48-h study period will be documented as PCA pump morphine consumption for postoperative first 24 hrs. and postoperative oral opioid usage for 48 hrs. after surgery. Patients will receive a standard general anesthetic for their surgery and postoperative standard of care pain treatment similar to all patients. Study does not limit standard post-operative pain medication.

Long-term analgesic success will be evaluated at 1, 3, and 6 months after surgery. At follow-up period, a pain diary will be used for the patients' self-assessment on pain occurrence, intensity, duration for phantom and stump pain, and documentation of oral analgesic usage. Analgesic medication use and daily pain scores will be documented on pain diary for 1 month period following surgery. At first follow-up visit, patient will be seen in Pain Clinic 1 month after the surgery. Patient will be called from home 3 and 6 months after the surgery for long-term follow-up.

At all-time points, the Self-Rating Depression Scale will be used to assess depression and the patients will complete the Pain-Related Self-Statement Scale (PRSS).

The duration of the involvement in the study will be 6 months.

Randomization:

This is randomized double-blinded placebo controlled clinical trial. Investigational Drug Pharmacy (IDS) will randomize subjects either treatment group or placebo. IDS will dispense the drugs/placebo.


Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 0 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
Official Title: Effects of Pre-operative Pregabalin and Ketamine to Prevent Development of Phantom Pain in Patients Undergoing Lower Extremity Amputation
Actual Study Start Date : May 15, 2015
Estimated Primary Completion Date : September 20, 2016
Actual Study Completion Date : September 20, 2017

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Active Comparator: Pregabalin-ketamine
Pregabalin and ketamine will be given preoperative period
Drug: Pregabalin
Pregabalin will be given orally during preoperative period
Other Name: Lyrica

Drug: Ketamine
Ketamine will be given on the surgery day before the anesthesia induction
Other Name: Ketamine hydrocloride

Placebo Comparator: Placebo
Placebo will be given preoperative period
Drug: Placebo
Placebo will be given orally during preoperative period
Other Name: Placebo pregabalin/placebo ketamine




Primary Outcome Measures :
  1. Visual Analog Pain Scores (VAS) [ Time Frame: Postoperaive 6 months ]
    Pain will be evaluated immediate postoperative period and 6 months after surgery


Secondary Outcome Measures :
  1. Oral analgesic consumption [ Time Frame: 1 months after surgery ]
    Amounts of rescue analgesic use



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Ager 18-65 years old
  2. Unilateral lower-limb amputations
  3. Able to understand study procedures
  4. If on opioids, patient should be on a stable dose for at least one week prior to enrolment.
  5. Subject with normal renal function (CrCI > 60 mL/min).

Exclusion Criteria:

  1. Cases with only digits amputation
  2. Current or recent history of alcohol and drug abuse
  3. Concomitant use of CYP 3A4 medications
  4. Unstable hypertension
  5. Abnormal EKG
  6. Increased intracranial pressure currently or in the past six months
  7. Increased intraocular pressure currently or in the past six months
  8. Liver disease or AST/ALT ≥ 3 ULN or total bilirubin >2 x ULN
  9. Poorly controlled psychiatric illness.
  10. A history of seizure
  11. Using other anticonvulsant drug
  12. Renal impairment as determined by clinically significant labs
  13. Women of childbearing age who either has:

    1. A positive pregnancy test
    2. Unprotected heterosexual sex since their previous menses or;
    3. Not currently using and/or willing to use a medically approved form of contraception (e.g., birth control pill)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02311777


Locations
United States, Texas
UTSW, Parkland Hospital
Dallas, Texas, United States, 75390
Sponsors and Collaborators
University of Texas Southwestern Medical Center
Pfizer

Responsible Party: Dawood Nasir, Associate Professor, University of Texas Southwestern Medical Center
ClinicalTrials.gov Identifier: NCT02311777     History of Changes
Other Study ID Numbers: STU 092014-050
First Posted: December 8, 2014    Key Record Dates
Last Update Posted: April 24, 2018
Last Verified: June 2016
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes

Additional relevant MeSH terms:
Phantom Limb
Perceptual Disorders
Neurobehavioral Manifestations
Neurologic Manifestations
Nervous System Diseases
Pain, Postoperative
Pain
Postoperative Complications
Pathologic Processes
Signs and Symptoms
Ketamine
Pregabalin
Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Anesthetics, Dissociative
Anesthetics, Intravenous
Anesthetics, General
Anesthetics
Central Nervous System Depressants
Excitatory Amino Acid Antagonists
Excitatory Amino Acid Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Anticonvulsants
Calcium Channel Blockers
Membrane Transport Modulators
Anti-Anxiety Agents
Tranquilizing Agents