Reduction of Opioid Dose Using Conditioning & Open-Label Placebo (COLP) in Patients With Spinal Cord Injury, Polytrauma and Burn Injury
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|ClinicalTrials.gov Identifier: NCT03906721|
Recruitment Status : Recruiting
First Posted : April 8, 2019
Last Update Posted : April 8, 2021
|Condition or disease||Intervention/treatment||Phase|
|Spinal Cord Injuries Polytrauma Burn Injury||Drug: Placebo Drug: Oxycodone Other: Essential Oil||Phase 2|
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||60 participants|
|Intervention Model:||Parallel Assignment|
|Intervention Model Description:||This is a randomized single-blind open-label placebo clinical trial. 60 inpatients will be included from SRH, both men and women aged 18 or older with traumatic and non-traumatic SCI (ASIA A-D), polytrauma and burn injury patients from the Comprehensive Rehabilitation Program at Spaulding Rehabilitation Hospital who have; above, at, or sub-lesional neuropathic pain and/or nociceptive pain (musculoskeletal or visceral) that is moderate or severe in nature (average VAS scale score of 4 or greater at time of enrollment). All subjects must meet clinical criteria for the use of opioids as a treatment for pain management.|
|Masking:||Single (Outcomes Assessor)|
|Official Title:||Reduction of Opioid Dose Using Conditioning & Open-Label Placebo (COLP) in Patients With Spinal Cord Injury, Polytrauma and Burn Injury: A Pilot Study|
|Actual Study Start Date :||February 20, 2019|
|Estimated Primary Completion Date :||February 20, 2022|
|Estimated Study Completion Date :||June 20, 2022|
Experimental: Conditioning & Open-Label Placebo (COLP)
Days 1 to 3 will include the acquisition phase where oxycodone will be prescribed on a schedule of 3-4 times per day and paired with open-placebo and smelling the essential oil. Days 4 to 6 will be the evoked phase, and patients will receive full oxycodone dosage on alternating days with open placebo and smelling the essential oil.
Sugar pill used to condition patients.
An opioid used for analgesia.
Other Name: Oxycodone Hydrochloride Tablets
Other: Essential Oil
An aromatic oil used for conditioning.
For the duration of the study, days 1 to 6, oxycodone will be prescribed on a schedule of 3-4 times per day.
An opioid used for analgesia.
Other Name: Oxycodone Hydrochloride Tablets
- Morphine Equivalent Dose Conversion (MEDC) [ Time Frame: 6 days ]The opioid morphine equivalent conversion factor is used to standardized opioid usage having as a reference morphine as the main indicator for analgesic potency. For drug utilization, there is a need to present usage data consistently, considering dosing requirements. One method of representing opioid use at the population level is through the application of Defined Daily Doses (DDD), however, this represents a problem partly because opioids require highly individualized dosing and need to be titrated to pain response, rather than having standard therapeutic dose ranges. Oral morphine equivalents are based on the idea that different doses of different opioids may give a similar analgesic effect. Where the doses of two different opioids are considered to give a comparable analgesic effect, they are deemed to be equianalgesic doses.
- Modified Brief Pain Inventory (BPI) [ Time Frame: Day 1 and Day 6 ]The BPI is a short self-assessment questionnaire that provides information on various dimensions of pain including how pain developed, the types of pain a patient experiences, and time of day pain is experienced, as well as current ways of alleviating pain. The BPI also consists of the VAS Pain scale, a simple 10- point scale (0 = ''no pain'', 10 = ''pain as bad as you can imagine'') measuring a patient' worst pain and least pain, on average and at present time. The Brief Pain Inventory provides information on the intensity of pain (the sensory dimension) as well as the degree to which pain interferes with function (the reactive dimension).
- Spinal Cord Injury - Quality of Life measurement system (SCI-QOL) [ Time Frame: Day 1 and Day 6 ]This measurement system was developed to address the shortage of relevant and psychometrically sound patient reported outcome measures available for clinical care and research in spinal cord injury (SCI) rehabilitation. For the purpose of this research, the Pain Behavior subdomain will be the primary component of this scale to be used. This 7-item fixed-length scale measures manifestations of pain. These actions or reactions can be verbal or non-verbal and involuntary or deliberate. They include observable displays, and verbal reports of pain. This scale includes a small subset of the Patient-Reported Outcomes Measurement Information System (PROMIS ) Pain Behavior item bank (i = 4) and three new items.
- Numerical Opioid Side Effects (NOSE) [ Time Frame: Day 1 and Day 6 ]Opioid therapy may be associated with adverse effects-which may affect the patient's perception of the overall satisfaction with opioid therapy. The Numerical Opioid Side Effect (NOSE) assessment tool is a simple, rapid, self-administered instrument which has the potential to be utilized in a busy pain clinic setting in efforts to document and longitudinally follow trends of opioid adverse effects.
- Electroencephalography [ Time Frame: Day 1 and Day 6 ]Electroencephalography (EEG) is an electrophysiological monitoring method to record the electrical activity of the brain. Quantitative electroencephalography (qEEG) stands out as a valuable, non-invasive tool because it provides reliable and relevant information about brain functioning during rest, sensory stimulation, and cognitive tasks. Besides, this technique is safe, low-cost, and employs a straightforward methodology, making it an appropriate tool for clinical practice. EEG at rest and during pain processing event-related potentials (ERP's) at the patient's bedside. The EEG and ERP recordings will be processed for analytical purposes by the investigators will explore standard EEG metrics (e.g., spectral analysis, connectivity, source localization). At the same time, ERPs will provide information related to pain and values of valence and arousal.
- Near-infrared spectroscopy (NIRS) [ Time Frame: Day 1 and Day 6 ]
NIRS is a spectroscopic method that uses the near-infrared region of the electromagnetic spectrum. This method is based on near-infrared light absorption fluctuations that depend on concentration changes of the chromophores O2Hb and HHb in the tissue under investigation. The investigators will use it to investigate the cerebral metabolism of oxygenated (O2Hb), deoxygenated (HHb), and total hemoglobin (tHb) during pain processing ERP. Changes in tHb, defined as the sum of the changes in O2Hb and HHb, can be used to measure blood volume changes. Functional Near-Infrared Spectroscopy (fNIRS) can provide the equivalent of cortical Blood-oxygen-level-dependent (BOLD) signal, similar to functional magnetic resonance imaging (fMRI).
By combination qEEG and fNIRS data, the investigators will explore the effects of conditioning from a mechanistic perspective; we expect to find some reliable neurophysiological markers associated with the processing of placebo analgesia at a cortical level.
- Metabolomics assessment [ Time Frame: Day 1 and Day 6 ]Metabolomics is the large-scale study of small molecules, commonly known as metabolites, within cells, biofluids, tissues, or organisms. Collectively, these small molecules and their interactions within a biological system are known as the metabolome. The analysis will focus on pathways associated with cognitive and cellular metabolism, metabolites such as indole-3 propionic acid, tryptophan, serotonin, kynurenine, and tyrosine will be analyzed, seeking for alteration associated with cognition. In contrast, uric acid, xanthine, tyrosine, kynurenine, and tryptophan will provide energetic efficiency information. The investigators will collect samples by pinprick system, and analysis will be done using liquid chromatography (LC) technique and by employing Electrochemical Array Detection (ECA).
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): NCT03906721
|Contact: Leon Morales-Quezada, MD/PhDfirstname.lastname@example.org|
|United States, Massachusetts|
|Spaulding Rehabilitation Hospital||Recruiting|
|Charlestown, Massachusetts, United States, 02129|
|Principal Investigator:||Ross D Zafonte, DO||Spaulding Rehabilitation Hospital|