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Pain in Fibrous Dysplasia

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ClinicalTrials.gov Identifier: NCT04125862
Recruitment Status : Not yet recruiting
First Posted : October 14, 2019
Last Update Posted : July 28, 2020
Sponsor:
Collaborator:
National Institutes of Health (NIH)
Information provided by (Responsible Party):
Jaymin Upadhyay, Boston Children's Hospital

Study Description
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Brief Summary:
Pain remains a common and frequently debilitating symptom, particularly during adulthood of Fibrous Dysplasia/McCune-Albright Syndrome (FD/MAS). For many FD/MAS patients, the amount of pain perceived is not commensurate with the level of detectable musculoskeletal pathology. Using a combination of clinical and biological assessments, this investigation aims to understand what drives pain in FD/MAS.

Condition or disease Intervention/treatment Phase
Fibrous Dysplasia/McCune-Albright Syndrome Diagnostic Test: MRI-based Neuroimaging Diagnostic Test: Non-contrast MRI Diagnostic Test: 18F-FDG-PET/CT Diagnostic Test: 18F-NaF-PET/CT Not Applicable

Detailed Description:
In Fibrous Dysplasia/McCune-Albright Syndrome (FD/MAS), healthy bone tissue and marrow is replaced with pre-osteoblastic, fibrous tissue, yielding skeletal deformities and an increased propensity towards fracture, musculoskeletal weakness and bone pain. Despite the frequent use of pharmacological and non-pharmacological analgesic strategies, pain in FD remains common and frequently debilitating, particularly during adulthood. Moreover, for many patients there is a discordance between perceived pain levels and detectable musculoskeletal pathology. To elucidate the mechanism underlying pain in FD/MAS patients, investigators at the National Institute of Dental and Craniofacial Research (NIDCR), National Center for Complementary and Integrative Heath (NCCIH) and Boston Children's Hospital (BCH) aim to probe three inter-related domains that are projected to underlie pain experience(s) in FD/MAS patients. These include (i.) the presence of maladaptive central nervous system processes that amplify afferent pain or somatosensory signals, and also facilitate persistent pain; (ii.) aberrant interplay between neurological and musculoskeletal systems; (iii.) a mental health status shaped by the overall burden of living with FD and (iv.) the influence of childhood, FD-related complications on adulthood pain phenotypes. To investigate these four domains hypothesized to underlie FD pain as well as inform on the disconnect between pain and FD disease burden, the investigators will employ methods that complement routine clinical evaluation and diagnostic tests (i.e., 18F-NaF PET/CT or 18F-FDG PET/CT) such as neuroimaging, musculoskeletal MRI and such as neuroimaging, musculoskeletal MRI and assessment of inflammatory and pain mediator expression in blood samples.
Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 40 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: 2 parallel cohorts (FD/MAS patients and matched, healthy controls)
Masking: Single (Participant)
Masking Description: Individual performing data analyses will be blinded to whether dataset corresponds to FD/MAS patient or matched healthy control
Primary Purpose: Basic Science
Official Title: Elucidating Mechanisms of Pain in Adolescent and Adult Fibrous Dysplasia Patients
Estimated Study Start Date : October 2020
Estimated Primary Completion Date : November 2021
Estimated Study Completion Date : December 2021

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Arms and Interventions
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Arm Intervention/treatment
Fibrous Dysplasia/McCune-Albright Syndrome
20, Fibrous Dysplasia/McCune-Albright Syndrome Patients with or without pain
 Diagnostic Test: MRI-based Neuroimaging
During evoked pain fMRI, noxious pressure and heat stimuli will be applied in the two anatomical sites noted above. During fMRI data acquisition, a total of 5 pressure stimulations and 5 heat stimulations will be delivered. Both types of pain stimuli will be applied in a 36/17-sec off/on cycle. The off-condition will correspond to a baseline temperature of 35C and the on condition will match the subject-specific and site-specific 7/10 pressure and heat pain thresholds defined during QST procedures. VAS pain ratings associated with evoked pain stimulation will be collected at the end of each scan. The investigators will also explore the structural properties of the CNS by implementing high-resolution anatomical MRI (gray matter volumes) and diffusion tensor imaging (white matter pathway integrity). All CNS imaging will take approximately 50-60 minutes to complete

Diagnostic Test: Non-contrast MRI
Musculoskeletal imaging of the affected lower extremity. Patients will be allowed to watch a movie during data acquisition. The following MRI procedures will be completed in order to identify soft tissue lesions in active or painful regions. Fast spin echo (FSE) T2 fat saturated, T1 weighted MRI, FSE proton density MRI, Short-TI Inversion Recovery (STIR), Diffusion weighted MRI (DW-MRI) and 3D Double Echo Steady State (DESS) will be collected. All musculoskeletal MRI will take approximately 30 minutes to complete.

Diagnostic Test: 18F-FDG-PET/CT
Data will be collected 30 min after the intravenous administration of 18F-FDG with an expected average dose of approximately 200 MBq. CT data will be collected at a low-dose to minimize radiation exposure. Patients will be positioned supine head-first with arms on the side. The investigators project whole body data to be collected, but in some cases, the field of view may be limited to the patient's skull to below the knees. The data acquisition period is expected to last between 15-30 minutes and total radiation dose will be ~3-4 mSv.

Diagnostic Test: 18F-NaF-PET/CT
Data will be collected 30 min after the intravenous administration of 18F-NaF with an expected average dose of approximately 200 MBq. CT data will be collected at a low-dose to minimize radiation exposure. Patients will be positioned supine head-first with arms on the side. The investigators project whole body data to be collected, but in some cases, the field of view may be limited to the patient's skull to below the knees. The data acquisition period is expected to last between 15-30 minutes and total radiation dose will be ~3-4 mSv.
Healthy Controls
20, matched healthy controls
 Diagnostic Test: MRI-based Neuroimaging
During evoked pain fMRI, noxious pressure and heat stimuli will be applied in the two anatomical sites noted above. During fMRI data acquisition, a total of 5 pressure stimulations and 5 heat stimulations will be delivered. Both types of pain stimuli will be applied in a 36/17-sec off/on cycle. The off-condition will correspond to a baseline temperature of 35C and the on condition will match the subject-specific and site-specific 7/10 pressure and heat pain thresholds defined during QST procedures. VAS pain ratings associated with evoked pain stimulation will be collected at the end of each scan. The investigators will also explore the structural properties of the CNS by implementing high-resolution anatomical MRI (gray matter volumes) and diffusion tensor imaging (white matter pathway integrity). All CNS imaging will take approximately 50-60 minutes to complete


Outcome Measures
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Primary Outcome Measures :
  1. % signal difference in BOLD signal [ Time Frame: 50-60 Minutes ]
    • % signal difference within striatal and limbic network structures during evoked-heat pain fMRI between FD/MAS patients with pain, FD/MAS patients without pain and matched, healthy volunteers.


Secondary Outcome Measures :
  1. Numerical clinical pain rating score [ Time Frame: 8 weeks ]
    • Numerical clinical pain rating score (NPRS, 0-10 scale) at weeks 0, 1, 4 and 8.


Other Outcome Measures:
  1. 18F-FDG or 18F-NaF uptake in FD lesion site [ Time Frame: 15-30 Minutes ]
    18F-FDG or 18F-NaF Standard uptake value ratio in FD lesion site


Eligibility Criteria
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Ages Eligible for Study:   10 Years to 45 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria (FD/MAS patients):

  • Male and Female subjects
  • 10-45 years of age
  • English Speaking ability sufficient to comprehend consent (with parental assistance if minor)
  • Diagnosis of Fibrous Dysplasia

Exclusion Criteria for patients:

  • Younger than 10 or older than 45 years old
  • Weight > 285 lbs (weight limit of the MRI table and < 36lbs)
  • Surgery leaving implanted material
  • Contraindications to MRI scanning and PET scanning (including presence of a cardiac pacemaker or pacemaker wires, metallic particles in the body, vascular clips in the head or previous neurosurgery, prosthetic heart valves, claustrophobia, previous significant research related exposure to ionizing radiation)

Exclusion Criteria for healthy controls:

Same as for the patients, with the addition of the following:

• Use of recreational or illicit drugs History of chronic pain

Contacts and Locations
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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): NCT04125862


Locations
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United States, Massachusetts
Boston Children's Hospital
Boston, Massachusetts, United States, 02115
Contact: Jaymin Upadhyay, PhD         
Sponsors and Collaborators
Boston Children's Hospital
National Institutes of Health (NIH)
More Information
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Responsible Party: Jaymin Upadhyay, Assistant Professor, BCH, Boston Children's Hospital
ClinicalTrials.gov Identifier: NCT04125862    
Other Study ID Numbers: P00030755
First Posted: October 14, 2019    Key Record Dates
Last Update Posted: July 28, 2020
Last Verified: July 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: A two-way material transfer agreement has been executed between collaborating parties (Boston Children's Hospital and NIH)
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Informed Consent Form (ICF)
Clinical Study Report (CSR)
Analytic Code
Time Frame: Individual data will start to become available 12/2019 and last for 1.5 years.
Access Criteria: A two-way material transfer agreement

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: Yes
Product Manufactured in and Exported from the U.S.: No
Additional relevant MeSH terms:
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Fibrous Dysplasia of Bone
Fibrous Dysplasia, Polyostotic
Osteochondrodysplasias
Bone Diseases, Developmental
Bone Diseases
 Musculoskeletal Diseases
Fluorodeoxyglucose F18
Radiopharmaceuticals
Molecular Mechanisms of Pharmacological Action