Gabapentin and Tizanidine for Insomnia in Chronic Pain

NCT ID: NCT04429347

Last Updated: 2025-01-03

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

PHASE2

Total Enrollment

9 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-07-29

Study Completion Date

2024-12-01

Brief Summary

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This is a double-blind, placebo-controlled, randomized, crossover trial aimed at assessing the effect of gabapentin and tizanidine, two pain medications, on insomnia in chronic pain patients.

Detailed Description

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Chronic pain and insomnia are highly prevalent conditions affecting 10-25% and 6-10% of the general population, respectively. Importantly, these two conditions frequently co-occur, with 50-80% of chronic pain patients reporting sleep disturbances. Identifying medication that alleviates pain and insomnia simultaneously may help reduce risks associated with polypharmacy, including drug-drug interactions.

In this double-blind, placebo-controlled, randomized, crossover trial, gabapentin and tizanidine, two drugs which are respectively commonly used to treat neuropathic and musculoskeletal pain, will be compared to each other and to placebo in their ability to alleviate insomnia in chronic pain patients.

In each week, patients will receive 3-night (Friday-Sunday) trials each of placebo, gabapentin or tizanidine in a randomized, double-blind order and will monitor their insomnia using the Athens Insomnia Scale (AIS) questionnaire (adapted to fit the time frame of this trial). The primary outcome consists of the difference in mean AIS scores between the 3 treatments at the primary time point, which is Monday of each week (after 3 nights of drug intake).

Patients will also monitor their sleepiness, pain relief and overall improvement as secondary variants using the Stanford Sleepiness Scale (SSS), Visual Analog Scale (VAS), and Patient's Global Impression of Change (PGIC) questionnaires respectively.

Scores on the Monday preceding the first treatment will serve as baseline and the period between treatments (i.e. Monday-Thursday nights) will serve as a 4-day washout period between treatments.

Our hypothesis is that gabapentin and tizanidine will both be more effective than placebo in alleviating insomnia in chronic pain patients but will not be different from one another.

Conditions

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Insomnia Due to Medical Condition Chronic Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Randomized, Double-bind, Placebo-controlled, Crossover Trial
Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors
Each participant will have an identification number and randomization of drug sequence allocation will be performed a priori using a random number generator by the study pharmacist. The 3 treatments will be identically encapsulated by the study pharmacist. The study pharmacist will place the drug capsules in identical sealed plastic bags labeled "Treatment 1" through "Treatment 3".

Study Groups

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Tizanidine 2mg

Friday night: 1 capsule Saturday night: 2 capsules Sunday night: Subject chooses 1-2 capsules

Group Type EXPERIMENTAL

Tizanidine

Intervention Type DRUG

Friday night: 1 capsule of 2 mg, Saturday night: 2 capsule of 2 mg (total 4 mg), Sunday night: choice of 1 or 2 capsules of 2 mg (total of 2 or 4 mg)

Gabapentin 300mg

Friday night: 1 capsule Saturday night: 2 capsules Sunday night: Subject chooses 1-2 capsules

Group Type EXPERIMENTAL

Gabapentin

Intervention Type DRUG

Friday night: 1 capsule of 300 mg, Saturday night: 2 capsule of 300 mg (total 600 mg), Sunday night: choice of 1 or 2 capsule of 300 mg (total of 300 or 600 mg)

Placebo

Friday night: 1 capsule Saturday night: 2 capsules Sunday night: Subject chooses 1-2 capsules

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

Friday night: 1 capsule, Saturday night: 2 capsule, Sunday night: choice of 1 or 2 capsules

Interventions

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Gabapentin

Friday night: 1 capsule of 300 mg, Saturday night: 2 capsule of 300 mg (total 600 mg), Sunday night: choice of 1 or 2 capsule of 300 mg (total of 300 or 600 mg)

Intervention Type DRUG

Placebo

Friday night: 1 capsule, Saturday night: 2 capsule, Sunday night: choice of 1 or 2 capsules

Intervention Type DRUG

Tizanidine

Friday night: 1 capsule of 2 mg, Saturday night: 2 capsule of 2 mg (total 4 mg), Sunday night: choice of 1 or 2 capsules of 2 mg (total of 2 or 4 mg)

Intervention Type DRUG

Other Intervention Names

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Neurontin Sham Sugar Pill Zanaflex

Eligibility Criteria

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Inclusion Criteria

* BMI ≤ 35
* Any ethnicity
* Must be able to communicate in English
* Must have access to email and be able to respond to REDCap questionnaires in English
* Has a chronic pain condition (≥ 3 months of pain)
* Reports sleep disturbance and scores ≥ 6 on AIS questionnaire
* Ability to provide informed consent

Exclusion Criteria

* Pregnancy
* Breastfeeding
* Has diagnosis of chronic kidney disease
* Has known QT prolongation \>500 msec on prior EKG
* Inability to complete daily questionnaires
* Allergy to, or intolerance of, any of tizanidine or gabapentin
* Shift workers
* Anticipated travel across multiple time zones (jetlag) during the duration of the trial
* Circadian misalignment
* Prior syncope experience and/or fear of blood/needles (if a blood draw is required)
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Center for Advancing Translational Sciences (NCATS)

NIH

Sponsor Role collaborator

University of California, San Diego

OTHER

Sponsor Role lead

Responsible Party

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Nathaniel Schuster

Assistant Profesor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Nathaniel Schuster, MD

Role: PRINCIPAL_INVESTIGATOR

UC San Diego

Locations

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Center for Pain Medicine, UC San Diego

La Jolla, California, United States

Site Status

Countries

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United States

Other Identifiers

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UL1TR000100

Identifier Type: NIH

Identifier Source: secondary_id

View Link

191167

Identifier Type: -

Identifier Source: org_study_id

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