Opioid Induced Gait Variability

NCT ID: NCT03121547

Last Updated: 2017-11-06

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE1/PHASE2
• Total Enrollment: 24 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2015-05-19
• Study Completion Date: 2016-01-29

Brief Summary

While the analgesic effects of opioids are well known, evidence suggest that there are differences in the adverse dizziness of the different opioid types, which may influence the gait function differently. However, this has not been investigated scientifically under controlled conditions. Normal gait function is characterized by cyclic movements with a high degree of predictability. As such, the amount of kinematic variability can provide important information about a condition or an intervention that may affect the gait function . Three-dimensional gait analysis is a recognized method to assess changes in stride-to-stride variability associated with a medical condition or caused by an intervention. Thus, opioid induced changes in gait variability, and possible differences between opioid types, can be assessed objectively from differences in the variability of movements obtained from a three-dimensional gait analysis.

The purpose of this study is to investigate differences in gait variability induced by two different single-dose opioid formulations and an inert placebo in healthy volunteers and knee osteoarthritis patients.

Detailed Description

The study is designed as an experimental single center, double-blind treatment, cross-over study with inert placebo, Tapentadol (Palexia Depot), and Tramadolhydrochlorid (Mandolgin Retard), with a minimum of 7days wash-out periods.

At day 1 (Visit 1), baseline measurements are carried out before tablet administration. Immediately after baseline measurements one tablet is administered, and hourly measurements are performed for 6 hours. Subsequently all participants enter a minimum 7 day washout period, after which they return to the facility to repeat the procedures at Visit 2 (day 8+) and Visit 3 (day 15+). The order of treatments will be randomized (1:1:1).

Conditions

Opioid Induced Motor Disturbances

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: CROSSOVER
• Primary Study Purpose: BASIC_SCIENCE
• Blinding Strategy: TRIPLE

Study Groups

Placebo oral tablet

One inert calcium tablet is administered after a set of baseline measurements are performed. Subsequently outcomes are assessed every hour for 6 hours, yielding a total of 7 hourly measurements.

Group Type: PLACEBO_COMPARATOR

Placebo Oral Tablet

Intervention Type: DRUG

calcium tablet

Tramadol Hydrochloride 100 mg Extended Release Oral Tablet

One tablet containing 100 milligrams (mg) Mandolgin Retard, Sandoz is administered after a set of baseline measurements are performed. Subsequently outcomes are assessed every hour for 6 hours, yielding a total of 7 hourly measurements.

Group Type: EXPERIMENTAL

Tramadol Hydrochloride 100 mg Extended Release Oral Tablet

Intervention Type: DRUG

1 tablet administered

Tapentadol 50 mg Oral Tablet

One tablet containing 50 milligrams (mg) Palexia Depot, Grünenthal is administered after a set of baseline measurements are performed. Subsequently outcomes are assessed every hour for 6 hours, yielding a total of 7 hourly measurements.

Group Type: EXPERIMENTAL

Tapentadol 50 mg Oral Tablet

Intervention Type: DRUG

1 tablet administered

Interventions

Tapentadol 50 mg Oral Tablet

1 tablet administered

Intervention Type: DRUG

Tramadol Hydrochloride 100 mg Extended Release Oral Tablet

1 tablet administered

Intervention Type: DRUG

Placebo Oral Tablet

calcium tablet

Intervention Type: DRUG

Other Intervention Names

Palexia Depot (50 mg); Mandolgin Retard (100 mg); Calcium tablet

Eligibility Criteria

Inclusion Criteria

Healthy subjects:

• In general good health, in the opinion of the Investigator, based on medical history and physical examination.
• Ability to comprehend and a willingness to provide written informed consent
• Age between 50 and 75 years
• No opioid usage 3 months prior to the study
• No musculoskeletal pain requiring medical attention during the previous 3 months
• Willing and able to complete study visits and procedures
• Willing to hold activity, exercise level, and concurrent treatments/therapies generally consistent during the study
• A body mass index (BMI) of ≤30

Patients with knee osteoarthritis (OA)

• Diagnosis of knee OA
• Ability to comprehend and a willingness to provide written informed consent
• Age between 50 and 75 years
• No opioid usage 3 months prior to the study
• Knee pain of at least 40 mm on a 0-100 mm visual analog scale (without analgesics) representing the average pain intensity during the previous week
• Willing to discontinue all pain medications 24 hours before and during examination visits
• Willing and able to complete study visits and procedures
• Willing to hold activity, exercise level, and concurrent treatments/therapies generally consistent during the study
• In general good health, in the opinion of the Investigator, based on medical history and physical examination.
• A body mass index (BMI) of ≤30

Exclusion Criteria

• Clinical signs of gait ataxia assessed by clinical neurological examination
• Independent or unsteady walking (i.e. dependence on walking device or stumbling gait)
• Counter indications to either of the investigational products, including but not restricted to:

• Allergy towards one or more of the investigational products or their excipient(s).
• Significant respiratory depression
• Current or serious asthma
• Hypercapnia
• Suspected or diagnosed paralytic ileus
• Acute intoxication by alcohol, hypnotica, centrally acting analgesics, psychopharmaca or other pharmaceuticals.
• Renal dysfunction
• Hepatic dysfunction
• Diseases of the biliary tract
• Acute pancreatitis
• Usage of monoamine oxidase inhibitors within the last 14 days
• Galactose intolerance
• Lactase deficiency
• Glucose/galactose malabsorption
• Epilepsy
• Previous usage of opioids without pain reliving effect.
• Patients who have a documented history of an allergic reaction or a clinically significant intolerance to opioids
• Malignant pain
• Excessive joint laxity in the lower extremities indicative of functional ligamentous deficiency.
• Dependency of walking aid (stick, cane, roller etc.).
• Positive Clock Drawing Test
• Abuse of alcohol, medicine and narcotics within past 5 years.
• History of symptoms of autoimmune disorders
• Diabetes
• Pregnancy or breast feeding
• History, diagnosis, or signs and symptoms of clinically significant neurological disease
• History, diagnosis, signs or symptoms of any clinically significant psychiatric disorder

• Minimum Eligible Age: 50 Years
• Maximum Eligible Age: 75 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Frederiksberg University Hospital

OTHER

Sponsor Role: lead

Responsible Party

Henning Bliddal

Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Henning Bliddal, DMSc

Role: PRINCIPAL_INVESTIGATOR

The Parker Institute

Locations

The Parker Institute, Frederiksberg Hospital

Copenhagen, , Denmark

Countries

Denmark

References

Henriksen M, Alkjaer T, Raffalt PC, Jorgensen L, Bartholdy C, Hansen SH, Bliddal H. Opioid-Induced Reductions in Gait Variability in Healthy Volunteers and Individuals with Knee Osteoarthritis. Pain Med. 2019 Nov 1;20(11):2106-2114. doi: 10.1093/pm/pny286.

Reference Type: DERIVED

PMID: 30649458 (View on PubMed)

Other Identifiers

131

Identifier Type: -

Identifier Source: org_study_id