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Postoperative PainPhase 2PRO_GENE_POPNCT02511483

Genetic Predictors of Analgesic Efficacy of Propranolol for Treating Postoperative Pain

A Phase 2 study testing Propranolol PO, IV-PCA morphine and Quantitative Sensory Testing (QST) in people with Postoperative Pain, run by McGill University Health Centre/Research Institute of the McGill University Health Centre at 2 sites in Canada.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

This study is a randomized, double-blind, placebo controlled clinical trial. The main purpose of this study is to determine if postsurgical pain ratings are improved with treatment with oral Propranolol, and if the effectiveness of treatment can be modified by the presence or absence of SNPs (Single Nucleotide… Read more about this study

Who is it for?
Ages 18 to 75 years
Conditions the study is for
Postoperative Pain
What is being tested?
Propranolol PO, IV-PCA morphine and Quantitative Sensory Testing (QST)
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
10 participants
Where
2 sitesCanada
Study dates
18 May 2015to 12 Nov 2016
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 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Elective laparoscopic hemicolectomy surgery.
  • Self-reported Caucasians.
  • ASA (American Society of Anesthesiologists) physical status of I or II.
  • Agrees to provide signed and dated informed consent form.
  • Willingness to agree with the Biobanking policy.

Who cannot join

  • Uncontrolled medical or psychiatric conditions.
  • Severe mental impairment.
  • History of major depressive disorder, psychotic disorder or schizophrenia, and/or manic episodes within the past year.
  • Active alcoholism within the past 6 months.
  • Psychoactive recreational drug abuse within the past 6 months including MDMA, Ketamine, hallucinogens such as LSD and/or sympathomimetics such as Cocaine.
  • Inability to comprehend pain assessment.
Show all 16Show fewer
  • Pregnancy and/or breast-feeding.
  • Known hypersensitivity to Beta Blockers or Opioids.
  • Currently taking Propranolol.
  • Currently taking other hypotensive treatments.
  • Currently taking Opioids.
  • Patients with asthma or reactive airway disease.
  • Patients with cardiac arrhythmia, coronary artery disease, congestive heart failure.
  • Patients with renal failure or dialysis.
  • Patients with liver insufficiency.
  • Heart rate less than 60bpm or diastolic blood pressure <50 mmHg during the preoperative visit.

Trial locations and contacts

2 sites in 1 country.

Canada2 sites
  • Montreal General Hospital

    Montreal, Quebec, H3G 1A4

  • Royal Victoria Hospital

    Montreal, Quebec, H4A 3J1

Other trials in Canada

About this study

Official title: Contribution of COMT Haplotypes in Propranolol Analgesic Efficacy for Treating Post-surgical Pain After Laparoscopic Hemicolectomy

This study is a randomized, double-blind, placebo controlled clinical trial. The main purpose of this study is to determine if postsurgical pain ratings are improved with treatment with oral Propranolol, and if the effectiveness of treatment can be modified by the presence or absence of SNPs (Single Nucleotide Polymorphism) associated with Cathecol-O-MethylTransferase (COMT) and mu-opioid receptor (MOR1) activity. The treatment period will last for three days and the observation period will last for six months. Effectiveness of treatment will be assessed by means of morphine consumption through quantitative evaluation of IV-PCA (Patient Controlled Analgesia) morphine as primary outcome measure.

Being tested
Propranolol PO, IV-PCA morphine, Placebo PO, Quantitative Sensory Testing (QST), Psychometric assessment
Keywords
COMT, Beta-blocker, Hemicolectomy
Medical subject headings
Pain, Postoperative

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Propranolol PODrug

    Also called CAS No 525-66-6, DINs: 00740675, 00496480

    20 mg PO BID Day of Surgery, 30 mg PO BID Day I and Day II post-op.

  • IV-PCA morphineDrug

    Also called Patient controlled Analgesia with intravenous morphine

    Morphine delivered via IV-PCA pump for 48 hours after surgery with standard program: bolus 1 mg, lock out 7 minutes, no background infusion.

  • Placebo PODrug

    Also called tablet containing microcrystalline cellulose

    Placebo tablets administered with the same schedule of Propranolol tablets

  • Quantitative Sensory Testing (QST)Procedure or surgery

    Also called Pressure Pain Threshold and Hyperalgesia test

    Assessment of PPT (Pressure Pain Threshold) by pressure algometer and assessment of the post-op area of hyperalgesia by von Frey hair no. 16.

  • Psychometric assessmentOther

    Also called PSQI, sfMGPQ, SCL-90-R, PQRS

    Questionnaires assessing for sleep quality (PSQI: Pittsburgh Sleep Quality Index), pain quality (sfMGPQ-Short Form-McGill Pain Questionnaire), somatization-depression-anxiety (SCL-90-R: Symptom Checklist 90 Revised), evolution of post-operative chronic pain (PQRS: Post-operative Quality of Recovery Scale)

  • COMT-haplotypesGenetic

    Also called HPS, APS, LPS

    Assessing of High Pain Sensitivity (HPS), Average Pain Sensitivity (APS) and Low Pain Sensitivity (LPS) haplotypes for COMT by genotyping peripheral blood samples.

Study groups in NCT02511483
Study groupRoleWhat they receive
IV-PCA morphine + Placebo POPlacebo comparatorPain control after surgery will be performed through IV-PCA morphine. Placebo will be administered with the same schedule of Propranolol in the experimental arm. Parallel evaluation of Quantitative Sensory Testing (QST), Psychometric assessment and COMT-haplotypes will be included along the trial.
Receives: Drug: IV-PCA morphine; Drug: Placebo PO; Procedure: Quantitative Sensory Testing (QST); Other: Psychometric assessment; Genetic: COMT-haplotypes
IV-PCA morphine + Propranolol POExperimentalThe morning of the surgery a dose of Propranolol 20 mg PO will be administered. After surgery pain control will be performed with IV-PCA morphine; in addition a second dose of Propranolol 20 mg PO will be administered . During the first and second postoperative day Propranolol 30 mg PO (BID) will be administered. Parallel assessment of Quantitative Sensory Testing (QST), Psychometric assessment and COMT-haplotypes will be included along the trial.
Receives: Drug: Propranolol PO; Drug: IV-PCA morphine; Procedure: Quantitative Sensory Testing (QST); Other: Psychometric assessment; Genetic: COMT-haplotypes

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Total morphine delivered by IV-PCA

    Measured: Day II Post-op

Secondary outcomes (7)
  1. Pressure Pain Threshold by digital pressure algometer

    Measured: Pre-op visit, Day I Post-op, Day II Post-op, four weeks Post-op

  2. Hyperalgesia test by von Frey hair

    Measured: Pre-op visit, Day I Post-op, Day II Post-op, four weeks Post-op

  3. Pain measured by the Numerical pain Rating Scale

    Measured: Pre-op visit, one evaluation during the first 8 Post-op hours, Day I Post-op, Day II Post-op, 4 weeks Post-op, 3 month Post-op, 6 months Post-op

  4. Somatization, depression and anxiety by SCL-90-R subscales

    Symptom Checklist 90 Revised (SCL-90-R) subscales for somatization, depression and anxiety

    Measured: Pre-op visit

  5. Sleep quality by PSQI

    Pittsburgh Sleep Questionnaire Index (PSQI)

    Measured: Pre-op visit, 4 weeks Post-op, 3 months Post-op, 6 months Post-op

  6. Pain quality by sfMGPQ

    Short Form-McGill Pain Questionnaire

    Measured: one evaluation during the first 8 Post-op hours, Day I Post-op, Day II Post-op

  7. Post-operative Chronic Pain by PQRS

    Post-operative Quality of Recovery Scale (PQRS)

    Measured: Pre-op visit, Day II Post-op, 4 weeks Post-op, 3 months Post-op, 6 months Post-op

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted30 Jul 2015 (estimated)
  2. Study start18 May 2015
  3. Primary completion12 Nov 2016
  4. Study completion12 Nov 2016

Why it stopped: Difficulty with recruitment

Resources

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
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
10 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02511483
Sponsor's protocol ID
15-169-MUHC
Acronym
PRO_GENE_POP
Status last verified
Sep 2021
First submitted
23 Jul 2015
Last updated
28 Sep 2021
Results posted
No
Data monitoring committee
No

Publications

  • Orrey DC, Halawa OI, Bortsov AV, Shupp JW, Jones SW, Haith LR, Hoskins JM, Jordan MH, Bangdiwala SI, Roane BR, Platts-Mills TF, Holmes JH, Hwang J, Cairns BA, McLean SA. Results of a pilot multicenter genotype-based randomized placebo-controlled trial of propranolol to reduce pain after major thermal burn injury. Clin J Pain. 2015 Jan;31(1):21-9. doi: 10.1097/AJP.0000000000000086.

    PubMed 25084070
  • Tchivileva IE, Lim PF, Smith SB, Slade GD, Diatchenko L, McLean SA, Maixner W. Effect of catechol-O-methyltransferase polymorphism on response to propranolol therapy in chronic musculoskeletal pain: a randomized, double-blind, placebo-controlled, crossover pilot study. Pharmacogenet Genomics. 2010 Apr;20(4):239-48. doi: 10.1097/FPC.0b013e328337f9ab.

    PubMed 20216107
  • Zaugg M, Tagliente T, Lucchinetti E, Jacobs E, Krol M, Bodian C, Reich DL, Silverstein JH. Beneficial effects from beta-adrenergic blockade in elderly patients undergoing noncardiac surgery. Anesthesiology. 1999 Dec;91(6):1674-86. doi: 10.1097/00000542-199912000-00020.

    PubMed 10598610
  • Schweinhardt P, Abulhasan YB, Koeva V, Balderi T, Kim DJ, Alhujairi M, Carli F. Effects of intravenous propranolol on heat pain sensitivity in healthy men. Eur J Pain. 2013 May;17(5):704-13. doi: 10.1002/j.1532-2149.2012.00231.x. Epub 2012 Oct 16.

    PubMed 23070986
  • Pranevicius M, Pranevicius O. Non-opioid anesthesia with esmolol avoids opioid-induced hyperalgesia and reduces fentanyl requirement after laparoscopy. Anesth Analg. 2009 Mar;108(3):1048. doi: 10.1213/ane.0b013e3181938f3f. No abstract available.

    PubMed 19224829
  • Chia YY, Chan MH, Ko NH, Liu K. Role of beta-blockade in anaesthesia and postoperative pain management after hysterectomy. Br J Anaesth. 2004 Dec;93(6):799-805. doi: 10.1093/bja/aeh268. Epub 2004 Sep 17.

    PubMed 15377583
  • Chen YW, Chu CC, Chen YC, Hung CH, Wang JJ. Propranolol elicits cutaneous analgesia against skin nociceptive stimuli in rats. Neurosci Lett. 2012 Aug 30;524(2):129-32. doi: 10.1016/j.neulet.2012.07.036. Epub 2012 Jul 26.

    PubMed 22842397
  • Zhang F, Tong J, Hu J, Zhang H, Ouyang W, Huang D, Tang Q, Liao Q. COMT gene haplotypes are closely associated with postoperative fentanyl dose in patients. Anesth Analg. 2015 Apr;120(4):933-40. doi: 10.1213/ANE.0000000000000563.

    PubMed 25532715
  • Diatchenko L, Slade GD, Nackley AG, Bhalang K, Sigurdsson A, Belfer I, Goldman D, Xu K, Shabalina SA, Shagin D, Max MB, Makarov SS, Maixner W. Genetic basis for individual variations in pain perception and the development of a chronic pain condition. Hum Mol Genet. 2005 Jan 1;14(1):135-43. doi: 10.1093/hmg/ddi013. Epub 2004 Nov 10.

    PubMed 15537663

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Propranolol PO, IV-PCA morphine and Quantitative Sensory Testing (QST) in people with Postoperative Pain, run by McGill University Health Centre/Research Institute of the McGill University Health Centre at 2 sites in Canada.

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 5 inclusion and 16 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: stopped early, as of the sponsor's last update on 28 Sep 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Canada. 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. Some participants in this study may receive a placebo. 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?

The study was stopped early (reason given: Difficulty with recruitment). Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Total morphine delivered by IV-PCA (time frame: Day II Post-op). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02511483, which also lists 9 linked publications.

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 28 Sep 2021.

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