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Pain Prevention and Treatment Through the Enhancement of the Anti-nociceptive Component of Pain Modulation Profiles

NCT ID: NCT02020122

Last Updated: 2017-10-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

5 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-01-31

Study Completion Date

2015-01-31

Brief Summary

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To utilize the plasticity of the central pain pathways in order to (i) shift individuals with a pro-nociceptive pain modulation profile towards an anti-nociceptive one, and (ii) assess its relevance in minimizing pain-derived morbidity.

Detailed Description

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In the project proposed here our main aim is to shift pain modulation towards anti-nociception as a novel approach to pain prevention and treatment. Our first hypothesis is that individual's modulation profile, when not anti-nociceptive, can be pharmacologically shifted into being anti-nociceptive. We assert (the first hypothesis) that such shift can be optimized by coupling the drug's mode of action with the individual's pain modulation profile; based on limited available data, it is suggested that less efficient inhibitory pain modulation will be modified best by serotonin-norepinephrine reuptake inhibitors (SNRIs), whereas enhanced facilitatory modulation will be modified best by Ca++ channel ligands. Pain modulation will be assessed by psychophysical tools, and will include dynamic tests of pain modulation. The conditioned pain modulation (CPM) test protocol will be used for assessing pain inhibition, and the temporal summation (TS) test protocol will be used for assessment of pain facilitation. Our second hypothesis is that SNRIs will be most efficacious in shifting individuals into being antinociceptive if these individuals had lower activation of the anterior brain pain network in the CPM test paradigm. In turn, Ca++ channel ligands will be most efficacious for individuals showing enhanced activation of the posterior pain network sites in response to the TS test protocol. Our third hypothesis is that an anti-nociceptive pain modulation profile protects individuals from acquiring pain. The model we chose for this study is surgery for coronary artery bypass grafting (CABG). Individuals scheduled for surgery, who are pain free, will be assigned to 3 arms - (1) duloxetine (DUL) (SNRI), (2) pregabalin (PGB) (Ca++ channel ligand) and (3) placebo. Drugs will be taken for 48 hours prior to surgery in a double-blind non cross-over parallel design. Pain modulation will be assessed before treatment, 2-4 hours prior to surgery and at its end, 6 weeks before surgery. Post operative acute and chronic pain will be assessed up to 2 month after surgery.

Conditions

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Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Duloxetine

DUL 60mg x once a day x 2 days. This arm will also take 2 non-active placebo x once a day x 2 days

Group Type ACTIVE_COMPARATOR

Duloxetine

Intervention Type DRUG

duloxetine 60mg

Placebo

Intervention Type DRUG

non active placebo

Pregabalin

PGB 150mg x twice a day x 2 days

Group Type ACTIVE_COMPARATOR

Pregabalin

Intervention Type DRUG

pregabalin 150mg

Placebo

Non active placebo x twice a day x 2 days

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

non active placebo

Interventions

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Duloxetine

duloxetine 60mg

Intervention Type DRUG

Pregabalin

pregabalin 150mg

Intervention Type DRUG

Placebo

non active placebo

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Otherwise healthy, age 18-75.

Exclusion Criteria

* Regular use of analgesia for any purpose, including SNRIs, gabapentins, COX inhibitors.
* Presence of diagnosed chronic pain disorders, psychiatric disorders, cognitive and /or neurological deficit.
* Inability to give informed consent, communicate and understand the purpose and instructions of this study.
* Pregnant or nursing women.
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Rambam Health Care Campus

OTHER

Sponsor Role lead

Responsible Party

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d_yarnitsky

Professor, Head of Neurology Deapartment

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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David Yarnitsky, Professor

Role: PRINCIPAL_INVESTIGATOR

Rambam Health Care Campus

Locations

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Rambam Health Care Campus

Haifa, , Israel

Site Status

Countries

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Israel

Other Identifiers

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0472-13-RMB.CTIL

Identifier Type: -

Identifier Source: org_study_id