Cognitive Function and Addiction Under Opioid Tapering

NCT ID: NCT03365817

Last Updated: 2017-12-07

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

PHASE3

Total Enrollment

75 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-02-02

Study Completion Date

2014-12-01

Brief Summary

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This study evaluates the effects of opioid dose reduction in the treatment of chronic pain in adults. Participants were divided in two groups: 1) patients that reduced opioid dose and 2) patients that kept the same opioid dose for six months.

Detailed Description

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BACKGROUND The indications for initiating long-term opioid treatment for chronic non-cancer pain are often unclear and may be associated with poor outcomes and problematic use. Few available studies demonstrated that opioids do not provide advantages regarding pain control, quality of life and functional capacity in this population and may have numerous serious adverse effects and consequences.

AIMS

This study aimed at:

1. evaluating the feasibility of a opioid tapering off program to patients with chronic pain,
2. investigating the influence of opioid tapering off on cognitive function, pain, symptoms of opioid withdrawal, anxiety , depression, and health related quality of life,
3. investigating the prevalence of addiction in chronic pain patients in a long-term treatment,
4. determining the predictive value of the Pain Medication Questionnaire (PMQ) in patients with chronic pain,
5. investigating how opioid tapering off influences PMQ.

METHODS

Study design

This is a prospective, single centre, open-label, parallel-group randomized controlled trial (1:1) conducted at the Multidisciplinary Pain Centre of Rigshospitalet, Copenhagen University Hospital, Denmark.

Two phases with nine assessments were planned. The Phase 1 was the stabilization phase and consisted of two assessments: the first assessment (baseline) was done when patients were admitted to the pain centre and the second assessment was done when medical treatment was considered stable for at least three weeks (stable dose levels and regular intervals). In the following patients went through Phase 2 and were randomized to receive the intervention (Taper off Group) or continue the same stable treatment (Control Group). Seven assessments were planned to this phase: third and fourth assessments were done in intervals of two to three weeks and the following assessments (fifth to ninth) with intervals of one month in between.

Intervention

The taper-off intervention consisted of a reduction of 10% of the daily opioid dose every 1-2 weeks until discontinuation of opioid treatment for up to six months. Clonidine use (25mg - 150mg/day) was allowed in cases of opioid withdrawal symptoms, according to medical prescription.

Analysis

Statistical analysis will be performed to compare baseline characteristics between groups (patients that complete the study vs. patients that dropped out and intervention vs. control group). Comparative analysis of primary and secondary outcomes between groups will also be performed to identify significant differences associated with the intervention.

Conditions

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Chronic Pain Opioid Use

Keywords

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cognitive function opioid dependence opioid withdrawal quality of life side effect

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Random assignment
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Taper off

Decrease of opioid daily dose until discontinuation for up to six months.

Group Type EXPERIMENTAL

Opioids taper off

Intervention Type DRUG

Decrease of 10% of opioid daily dose every one to two weeks until discontinuation for up to six months.

Control Group

No changes on opioids and adjuvant medication for up to six months.

Group Type ACTIVE_COMPARATOR

Opioid stable treatment

Intervention Type DRUG

No changes on prescribed opioids and adjuvant medication for the next six months

Interventions

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Opioids taper off

Decrease of 10% of opioid daily dose every one to two weeks until discontinuation for up to six months.

Intervention Type DRUG

Opioid stable treatment

No changes on prescribed opioids and adjuvant medication for the next six months

Intervention Type DRUG

Other Intervention Names

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Morphine, oxycodone, metadone, fentanyl, tramadol

Eligibility Criteria

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Inclusion Criteria

* age 18 years old or more
* at least seven years of schooling
* pain duration of at least six months,
* treatment with oral opioids for more than three months
* daily opioid dose ≥ 60 mg of oral morphine equivalent

Exclusion Criteria

* not fluent in Danish language
* cancer disease
* poor general health condition
* pregnancy, dementia
* encephalopathy
* brain damage
* cranial base trauma
* enrolled in other studies
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Ministry of Science, Technology and Innovation, Denmark

OTHER_GOV

Sponsor Role collaborator

Hørslev-Fonden

UNKNOWN

Sponsor Role collaborator

Rigshospitalet, Denmark

OTHER

Sponsor Role lead

Responsible Party

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Per Sjogren

Professor in palliative Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Per Sjøgren, DMSc

Role: PRINCIPAL_INVESTIGATOR

Rigshospitalet, Denmark

Jette Højsted, MD

Role: PRINCIPAL_INVESTIGATOR

Rigshospitalet, Denmark

Other Identifiers

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H-B-2008-061

Identifier Type: -

Identifier Source: org_study_id