Use of PET/MR Imaging in Chronic Pain
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|ClinicalTrials.gov Identifier: NCT03195270|
Recruitment Status : Recruiting
First Posted : June 22, 2017
Last Update Posted : December 17, 2018
|Condition or disease||Intervention/treatment||Phase|
|Chronic Pain||Drug: [18F]FDG Device: PET/MRI||Phase 1|
The diagnosis and management of chronic and neuropathic pain syndromes remains a major clinical challenge, and this failure is partly attributed to our inability to identify the hypersensitive and inflammatory changes in the pain-sensing part of our nervous system that is thought to contribute to these syndromes. The lack of a specific, objective diagnostic test for chronic and neuropathic pain syndromes can result in a delay of diagnosis and suboptimal management decisions. This delay in diagnosis is quite unfortunate since the early diagnosis and treatment of a disease is attributed to the highest probability of remission in certain chronic pain syndromes. Additionally, identifying the correct source of pain is of paramount importance since the clinical course and therapeutic interventions are different depending on cause.
Evidence in the literature points strongly toward an active inflammatory component in chronic pain. For example, soft tissue and bony inflammation is known to be an important pathophysiological mechanism for the symptoms of certain neuropathic pain syndromes. Similarly, individuals suffering from chronic sciatica or radiculopathy may suffer from a combination of inflammation and compression of lumbar or cervical spinal nerves. It is also established that inflammatory lesions have increased metabolism and energy requirements and, therefore, are more glucose-avid than normal tissues, showing increased uptake of radiolabeled glucose analogs, such as [18F]fluorodeoxyglucose ([18F]FDG). Correspondingly, [18F]FDG positron emission tomography-magnetic resonance imaging (PET/MRI) represent leading FDA-approved clinical imaging modalities to longitudinally study metabolic changes in the nervous system and non-neural tissues (e.g., muscle, blood vessels, joints, bone, scar tissue, etc.) in patients with chronic pain conditions. One of the goals of the study is to determine whether [18F]FDG PET/MRI can identify sources of inflammation with greater sensitivity, accuracy and objectivity than current diagnostic methods.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||60 participants|
|Intervention Model:||Single Group Assignment|
|Intervention Model Description:||Participants will be recruited based on established criteria for chronic pain. For the PET/MRI scan, the participants will be injected with 10 mCi±1 mCi of [18F]FTC-146 via the antecubital vein in a bolus injection. PET and MRI scans will be acquired simultaneously using a hybrid PET/MRI scanner. Following the scan, participants will be contacted to check for adverse drug events, and any events will be recorded in the case report. The biodistribution of radiotracer will be analyzed using regions of interest (ROI) marked on anatomical structures on magnetic resonance images and quantifying the signal in PET images within the same ROIs. Pharmacokinetic information will be derived using mathematical modeling. Data from chronic pain patients will be compared to historical data from asymptomatic controls.|
|Masking:||None (Open Label)|
|Official Title:||Use of [18F]FDG PET/MRI in the Diagnosis of Pain Generators and/or Sites of Inflammation and to Monitor Treatment Effects in Patients With Chronic Pain|
|Actual Study Start Date :||November 24, 2014|
|Estimated Primary Completion Date :||November 2019|
|Estimated Study Completion Date :||November 2019|
Experimental: Single Arm
10 mCi of [18F]FDG via the antecubital vein in a bolus injection
Other Name: [18F]Fluorodeoxyglucose
PET/MRI hybrid scanner used as diagnostic device
Other Name: Positron emission tomography/magnetic resonance imaging
- [18F]FDG PET/MRI as a spatial biomarker for chronic pain [ Time Frame: 5 years ]Identification of structures with increased [18F]FDG uptake (SUVmax) corresponding to pain.
- [18F]FDG Biodistribution in Healthy Subjects [ Time Frame: 5 years ]We will use PET/MRI to establish the normal range of [18F]FDG uptake. (SUVmax) in various anatomic structures, such as the spinal cord, peripheral nerves, dorsal root ganglia, muscle, bones, joints, blood vessels, of asymptomatic subjects.
- 36 point Study Short-Form Health Survey [ Time Frame: 5 years ]Patient-reported state of health.
- Oswestry Disability Index [ Time Frame: 5 years ]Measure of disability, quality of life.
- Visual Analog Scale [ Time Frame: 5 years ]A visual, semi-quantitative method for patient-derived self-assessment of pain intensity.
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): NCT03195270
|Contact: Sandip Biswal, MDfirstname.lastname@example.org|
|Contact: Peter W Cipriano, BAemail@example.com|
|United States, California|
|Stanford, California, United States, 94305|
|Sub-Investigator: Ian Carroll, MD|
|Sub-Investigator: Catherine Curtin, MD|
|Sub-Investigator: Vivanne Tawfik, MD, PhD|
|Sub-Investigator: Matthew Smuck, MD|
|Sub-Investigator: Ivan Cheng, MD|
|Sub-Investigator: Stuart Goodman, MD, PhD|
|Sub-Investigator: Erik Mittra, MD, PhD|
|Sub-Investigator: DaeHyun Yoon, PhD|
|Sub-Investigator: Garry Gold, MD|
|Principal Investigator:||Sandip Biswal, MD||Associate Professor of Radiology|