PainPhase 2NamiSurNCT01790555
Perioperative Δ9-THC for Postsurgical Pain
A Phase 2 study testing Namisol in people with Pain, run by Radboud University Medical Center at 1 site in Netherlands.
Trial summary
Adequate treatment of postsurgical pain leads to better mobilization, shorter hospital stay, lower costs and higher patient satisfaction. In its treatment, frequent use is made of opioids. However, opioids have many side-effects. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Pain
- What is being tested?
- Namisol
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 40 participants
- Where
- 1 siteNetherlands
- Study dates
- Jul 2013to Apr 2014
- Phase
- Phase 2
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patient is at least 18 years old on the day the informed consent form will be signed.
- Patient has persistent or intermittent abdominal pain due to underlying intra-abdominal pathology.
- If the patient uses concomitant analgesic medication the dosage intake is stable for at least two weeks prior to the day of screening. Stable dose intake is defined as a daily equivalent sum of intake according to medical prescription within a small deviation range as judged by the investigator.
- Patient is undergoing elective, open abdominal surgery with planned use of an epidural catheter. The surgical procedure has an estimated duration of at least two hours, excluding the time to induce anesthesia.
- Patient scores I to III in the American Society of Anesthesiologists physical status classification system (ASA I-III).
- Patient is willing and able to comply with the lifestyle guidelines, scheduled visits, treatment plan, laboratory tests and other trial procedures.
- Patient is able to speak, read and understand the local language of the investigational site, is familiar with the procedures of the study, and agrees to participate in the study program by giving oral and written informed consent prior to screening evaluations.
Who cannot join
- Patient is ineligible for the anesthesia protocol, as judged by the investigator.
- Patient is undergoing (abdominal wall) surgery with mesh implantation.
- Patient used any cannabinoids (by smoking cannabis or oral intake) for at least one month prior to the day of screening.
- Patient has (a history of) a medical disorder that, in the opinion of the investigator, may interfere with the study or may pose a risk for the patient.
- Patient uses amitriptyline or other concomitant medication that, in the opinion of the investigator, may interfere with the study or may pose a risk for the patient.
- Patient demonstrates clinically significant deviations in the electrocardiogram (ECG) parameters at screening.
Show all 14Show fewer
- Patient is at the moment of screening diagnosed with moderate to severe renal impairment as judged by the investigator.
- Patient is at the moment of screening diagnosed with moderate to severe hepatic failure as judged by the investigator.
- Patient has a presence or history of major psychiatric illness as judged by the investigator.
- Patient demonstrates clinically significant laboratory abnormalities that in the opinion of the investigator may increase the risk associated with trial participation or may interfere with the interpretation of the trial results.
- Patient has a history of sensitivity/idiosyncrasy to THC or diazepam, compounds related to these compounds, or to any other related drug used in the past.
- Patient demonstrates a positive urine drug screen at screening visit for THC, cocaine, MDMA, or amphetamines.
- Female patient intends to conceive a child, is pregnant or breastfeeding, or does not use acceptable birth control measures including oral contraceptives, intrauterine devices or mechanical methods during the course of the study.
- Patient participated in another investigational drug study within 90 days prior to the first dose and/or participated in more than 2 clinical trials in the last 365 days.
Trial locations and contacts
1 site in 1 country.
Netherlands1 site, 1 recruiting
- Recruiting
Radboud University Nijmegen Medical Center
Nijmegen, Gelderland, 6525GA
Dagmar CM van Rijckevorsel, MD
Marjan de Vries, MSc
About this study
Official title: The Analgesic Efficacy of Perioperative Δ9-THC (Namisol®) in Patients Undergoing Major Abdominal Surgery: A Randomized, Double Blinded, Placebo-controlled, Parallel Design
Adequate treatment of postsurgical pain leads to better mobilization, shorter hospital stay, lower costs and higher patient satisfaction. In its treatment, frequent use is made of opioids. However, opioids have many side-effects. A possible add-on can be sought in THC, which has been shown to have possible analgesic and/or pain modulating effects in preclinical research. The purpose of this study is to investigate the analgesic and pain modulating effects of perioperative Namisol, a tablet containing THC, in patients that will undergo major abdominal surgery.
Read the detailed description
Rationale: Early postsurgical pain is a consequence of tissue trauma during surgery, which can lead to hyperalgesia or allodynia. Adequate management of postsurgical pain leads to earlier mobilization, shortened hospital stay, reduced costs, and increased patient satisfaction. Treatment usually involves the use of opioids, which have many side effects. Besides the problem of acute surgical pain, surgery may lead to the development of persistent postsurgical pain.
Based on preclinical research, it is hypothesized that Δ9-THC may improve outcomes of early postsurgical pain due to pain modulatory effects and may lower the incidence of persistent postsurgical pain through modulation of central pain processing, e.g. reduction of central sensitization. From clinical studies, evidence for the value of Δ9-THC in this context is, to date, scarce. Indeed, research in a patient group with a major nociceptive load - i.e. major abdominal surgery - and an extended perioperative treatment schedule has not been performed so far. Both a major nociceptive load and an extended perioperative treatment schedule are necessary for adequate assessment of the analgesic efficacy of Δ9-THC in this context. Thus, the question regarding the perioperative analgesic efficacy of Δ9-THC in major abdominal surgery remains unresolved.
Objectives: The primary aim of this study is to investigate the analgesic effect of perioperatively administered Namisol® to reduce postsurgical pain on the day of major abdominal surgery and in the first five days after major abdominal surgery. A secondary aim is to investigate the effect of perioperatively administered Namisol® on the incidence of persistent postsurgical pain in the first 12 postoperative weeks.
Study design: A randomized, double-blind, placebo-controlled, parallel-group study design with an perioperative add-on treatment of Namisol or placebo and a follow-up period of 24 weeks.
Study population: Forty patients will be recruited from the outpatient clinic of the department of surgery of the Radboud University Nijmegen Medical Center. Patients will have persistent or intermittent abdominal pain, due to underlying intra-abdominal pathology including diverticulitis, Crohn's disease, chronic pancreatitis, ulcerative colitis, endometriosis, or abdominal adhesions. Other intra-abdominal pathology may be included if causing pain and if judged appropriate by the investigator. Patients will be planned to undergo elective, open abdominal surgery with planned use of an epidural catheter for perioperative analgesia. The surgical procedure will have an estimated duration of at least two hours, excluding the time to induce anesthesia.
Intervention: Namisol®, a tablet with standardized Δ9-THC content, or identical matching placebos will be administered orally to evaluate the analgesic properties of Namisol® administered as add-on perioperative treatment. The study medication is given from the day before surgery (day -1: 5 mg in the afternoon and in the evening) up to the fifth day after surgery (day 0 to +5: 5 mg four times daily).
Primary and secondary study parameters: The primary study outcome is postsurgical pain intensity during the first five postoperative days, reflected by the primary endpoint: the area under the curve of the VAS scores in the first five days (AUC5days) after surgery. The secondary outcome is the incidence of persistent postsurgical pain 12 weeks after surgery.
Other study parameters: In addition to the primary and secondary outcomes, several other outcome parameters will be collected. These include measures of postsurgical pain intensity at 24 weeks after surgery, measures of analgesic efficacy (postoperative consumption of other analgesics), central nervous system processing and sensitization in the first 5 days and after 6 and 12 weeks after surgery (QST, Von Frey testing, and brush stroke testing), postoperative sedation level (Ramsay Scale), and immune system response during 72 hours after surgery and after 6 weeks (ILs, MMPs) are investigated. In addition, questionnaires are filled out to examine parameters related to side effects and postoperative recovery (VAS Bond\&Lader, VAS Bowdle, HADS, SF-36, PCS, PASS, QoR-40, AppLe, and TSQM). Two variants in genetic CYP2C9 polymorphisms will be genotyped and three variants in genetic CYP2C19 polymorphisms will be genotyped.
Nature and extent of the burdens, risks, and benefits: Participation means three or four visits to the outpatient clinic in addition to usual care, including the screening visit. Various measurements, including blood samples (seven additional samples over the entire study period), will be conducted during each visit. The participating patients may experience better pain relief in the postoperative period and may benefit from a reduced incidence of persistent postsurgical pain, but are subject to more intense diagnostics and observation.
- Conditions
- Pain
- Being tested
- Namisol, Diazepam/placebo
- Keywords
- Postsurgical, Pain, THC, Sensitization
- Medical subject headings
- Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
NamisolDrug
Also called delta-9-tetrahydrocannabinol
Diazepam/placeboDrug
| Study group | Role | What they receive |
|---|---|---|
| Namisol | Experimental | The study medication is given from the day before surgery (day -1: 5 mg in the afternoon and in the evening) up to the fifth day after surgery (day 0 to +5: 5 mg four times daily). Receives: Drug: Namisol |
| Diazepam/Placebo | Other | The study medication is given from the day before surgery (day -1: 5 mg in the afternoon and in the evening) up to the fifth day after surgery (day 0 to +5: 5 mg four times daily).
Before surgery, diazepam is used as an active comparator, to aid in blinding. After surgery, an inactive placebo is used as an inactive comparator. Receives: Drug: Diazepam/placebo |
What is being measured
The primary outcome is the main question the study is designed to answer.
Analgesic efficacy
To investigate the analgesic efficacy of perioperative Namisol® for postsurgical pain at the day of surgery and in the first 5 days after abdominal surgery. Analgesic efficacy is measured as the difference in visual analog scale (VAS) area under the curve (AUC) for the day of surgery and the first 5 postoperative days between placebo and Namisol®.
Measured: Daily until +5 days after surgery
Secondary outcomes (1)
Incidence of persistent continuous or intermittent postsurgical abdominal pain
To investigate the effect of perioperative Namisol® for the incidence of persistent continuous of intermittent postsurgical abdominal pain 12 weeks after abdominal surgery.
Measured: 12 weeks after surgery
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted13 Feb 2013 (estimated)
- Study startJul 2013
- Primary completionOct 2013 (estimated)
- Study completionApr 2014 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for PainStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 2
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind
- Who is masked
- Participant, Care provider, Investigator, Outcomes assessor
- Enrolment
- 40 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Radboud University Medical Center
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Harry van Goor, PhD MD FRCS, Principal investigator, Radboud University Nijmegen Medical Center
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT01790555
- Sponsor's protocol ID
- HEEL-2012-04
- Other IDs
- 2012-005808-17, NL43115.091.13
- Acronym
- NamiSur
- Status last verified
- Feb 2013
- First submitted
- 7 Feb 2013
- Last updated
- 23 Oct 2013
- Results posted
- No
- Data monitoring committee
- Yes
Study at a glance
From the registry record, last updated by the sponsor on 23 Oct 2013. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Analgesic Efficacy of Perioperative Δ9-THC (Namisol®) in Patients Undergoing Major Abdominal Surgery: A Randomized, Double Blinded, Placebo-controlled, Parallel Design
- ClinicalTrials.gov ID
- NCT01790555
- Acronym / sponsor ID
- NamiSur / HEEL-2012-04
- Conditions
- Pain
- Keywords
- Postsurgical, Pain, THC, Sensitization
- Phase
- Phase 2
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 40 participants (estimated)
- Lead sponsor
- Radboud University Medical CenterUniversity, hospital or other
- Study start
- Jul 2013
- Primary completion
- Oct 2013 (estimated)
- Study completion
- Apr 2014 (estimated)
- First posted
- 13 Feb 2013 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Adequate treatment of postsurgical pain leads to better mobilization, shorter hospital stay, lower costs and higher patient satisfaction. In its treatment, frequent use is made of opioids. However, opioids have many side-effects. A possible add-on can be sought in THC, which has been shown to have possible analgesic and/or pain modulating effects in preclinical research. The purpose of this study is to investigate the analgesic and pain modulating effects of perioperative Namisol, a tablet containing THC, in patients that will undergo major abdominal surgery.
Detailed description
Rationale: Early postsurgical pain is a consequence of tissue trauma during surgery, which can lead to hyperalgesia or allodynia. Adequate management of postsurgical pain leads to earlier mobilization, shortened hospital stay, reduced costs, and increased patient satisfaction. Treatment usually involves the use of opioids, which have many side effects. Besides the problem of acute surgical pain, surgery may lead to the development of persistent postsurgical pain.
Based on preclinical research, it is hypothesized that Δ9-THC may improve outcomes of early postsurgical pain due to pain modulatory effects and may lower the incidence of persistent postsurgical pain through modulation of central pain processing, e.g. reduction of central sensitization. From clinical studies, evidence for the value of Δ9-THC in this context is, to date, scarce. Indeed, research in a patient group with a major nociceptive load - i.e. major abdominal surgery - and an extended perioperative treatment schedule has not been performed so far. Both a major nociceptive load and an extended perioperative treatment schedule are necessary for adequate assessment of the analgesic efficacy of Δ9-THC in this context. Thus, the question regarding the perioperative analgesic efficacy of Δ9-THC in major abdominal surgery remains unresolved.
Objectives: The primary aim of this study is to investigate the analgesic effect of perioperatively administered Namisol® to reduce postsurgical pain on the day of major abdominal surgery and in the first five days after major abdominal surgery. A secondary aim is to investigate the effect of perioperatively administered Namisol® on the incidence of persistent postsurgical pain in the first 12 postoperative weeks.
Study design: A randomized, double-blind, placebo-controlled, parallel-group study design with an perioperative add-on treatment of Namisol or placebo and a follow-up period of 24 weeks.
Study population: Forty patients will be recruited from the outpatient clinic of the department of surgery of the Radboud University Nijmegen Medical Center. Patients will have persistent or intermittent abdominal pain, due to underlying intra-abdominal pathology including diverticulitis, Crohn's disease, chronic pancreatitis, ulcerative colitis, endometriosis, or abdominal adhesions. Other intra-abdominal pathology may be included if causing pain and if judged appropriate by the investigator. Patients will be planned to undergo elective, open abdominal surgery with planned use of an epidural catheter for perioperative analgesia. The surgical procedure will have an estimated duration of at least two hours, excluding the time to induce anesthesia.
Intervention: Namisol®, a tablet with standardized Δ9-THC content, or identical matching placebos will be administered orally to evaluate the analgesic properties of Namisol® administered as add-on perioperative treatment. The study medication is given from the day before surgery (day -1: 5 mg in the afternoon and in the evening) up to the fifth day after surgery (day 0 to +5: 5 mg four times daily).
Primary and secondary study parameters: The primary study outcome is postsurgical pain intensity during the first five postoperative days, reflected by the primary endpoint: the area under the curve of the VAS scores in the first five days (AUC5days) after surgery. The secondary outcome is the incidence of persistent postsurgical pain 12 weeks after surgery.
Other study parameters: In addition to the primary and secondary outcomes, several other outcome parameters will be collected. These include measures of postsurgical pain intensity at 24 weeks after surgery, measures of analgesic efficacy (postoperative consumption of other analgesics), central nervous system processing and sensitization in the first 5 days and after 6 and 12 weeks after surgery (QST, Von Frey testing, and brush stroke testing), postoperative sedation level (Ramsay Scale), and immune system response during 72 hours after surgery and after 6 weeks (ILs, MMPs) are investigated. In addition, questionnaires are filled out to examine parameters related to side effects and postoperative recovery (VAS Bond\&Lader, VAS Bowdle, HADS, SF-36, PCS, PASS, QoR-40, AppLe, and TSQM). Two variants in genetic CYP2C9 polymorphisms will be genotyped and three variants in genetic CYP2C19 polymorphisms will be genotyped.
Nature and extent of the burdens, risks, and benefits: Participation means three or four visits to the outpatient clinic in addition to usual care, including the screening visit. Various measurements, including blood samples (seven additional samples over the entire study period), will be conducted during each visit. The participating patients may experience better pain relief in the postoperative period and may benefit from a reduced incidence of persistent postsurgical pain, but are subject to more intense diagnostics and observation.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Quadruple blind (participant, care provider, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Namisol | Experimental | Drug: NamisolThe study medication is given from the day before surgery (day -1: 5 mg in the afternoon and in the evening) up to the fifth day after surgery (day 0 to +5: 5 mg four times daily). |
| Diazepam/Placebo | Other | Drug: Diazepam/placeboThe study medication is given from the day before surgery (day -1: 5 mg in the afternoon and in the evening) up to the fifth day after surgery (day 0 to +5: 5 mg four times daily). Before surgery, diazepam is used as an active comparator, to aid in blinding. After surgery, an inactive placebo is used as an inactive comparator. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (7 listed)
- Patient is at least 18 years old on the day the informed consent form will be signed.
- Patient has persistent or intermittent abdominal pain due to underlying intra-abdominal pathology.
- If the patient uses concomitant analgesic medication the dosage intake is stable for at least two weeks prior to the day of screening. Stable dose intake is defined as a daily equivalent sum of intake according to medical prescription within a small deviation range as judged by the investigator.
- Patient is undergoing elective, open abdominal surgery with planned use of an epidural catheter. The surgical procedure has an estimated duration of at least two hours, excluding the time to induce anesthesia.
- Patient scores I to III in the American Society of Anesthesiologists physical status classification system (ASA I-III).
Key exclusion criteria (14 listed)
- Patient is ineligible for the anesthesia protocol, as judged by the investigator.
- Patient is undergoing (abdominal wall) surgery with mesh implantation.
- Patient used any cannabinoids (by smoking cannabis or oral intake) for at least one month prior to the day of screening.
- Patient has (a history of) a medical disorder that, in the opinion of the investigator, may interfere with the study or may pose a risk for the patient.
- Patient uses amitriptyline or other concomitant medication that, in the opinion of the investigator, may interfere with the study or may pose a risk for the patient.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| NamisolAlso: delta-9-tetrahydrocannabinol | Drug | Namisol |
| Diazepam/placebo | Drug | Diazepam/Placebo |
Primary outcome
Analgesic efficacy
Time frame: Daily until +5 days after surgery
To investigate the analgesic efficacy of perioperative Namisol® for postsurgical pain at the day of surgery and in the first 5 days after abdominal surgery. Analgesic efficacy is measured as the difference in visual analog scale (VAS) area under the curve (AUC) for the day of surgery and the first 5 postoperative days between placebo and Namisol®.
1 secondary outcome
Incidence of persistent continuous or intermittent postsurgical abdominal pain
Time frame: 12 weeks after surgery
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 23 Oct 2013.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Harry van Goor, PhD MD FRCS principal investigator
Radboud University Nijmegen Medical Center
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2 study testing Namisol in people with Pain, run by Radboud University Medical Center at 1 site in Netherlands.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 7 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 23 Oct 2013. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Dagmar CM van Rijckevorsel, MD (0243617365, d.vanrijckevorsel@student.ru.nl), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Analgesic efficacy (time frame: Daily until +5 days after surgery). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 23 Oct 2013.