Altering The Transition From Acute to Chronic Pain (ATTAC-Pain)

• Status: Completed
• Trial end date: 2019-04-01
• Target enrollment: 0
• Participant gender: All

Summary

The current way that pain is treated after trauma and injury is problematic. Most often pain after trauma is treated with opioids (ex. Percocet® or Vicodin®) or anti-inflammatories (ex. ibuprofen). Both of these medications can cause side effects and opioids have been related to the development of addiction. In addition, there are not any treatments that prevent pain from going on to become persistent (last beyond it is supposed to) or chronic (lasting 3 months or longer).

Chronic pain is an enormous problem and there an urgent need to find both alternatives to opioid pain medications and medications that prevent pain from becoming chronic. The ATTAC-Pain (Altering The Transition from Acute to Chronic Pain) study proposes to examine whether duloxetine (a medication that is marketed for depression, anxiety, and specific types of pain conditions), can reduce acute and chronic pain among adults who come to the emergency department (ED)with muscular pain (such as neck pain after a car accident or low back pain). Investigators will enroll 60 patients who come to the ED. Patients will be eligible if they report moderate to severe muscular pain (such as pain in the back, neck, or shoulders). Consenting patients will be randomized to receive duloxetine 30mg, duloxetine 60mg, or placebo (2/3rd chance of being in one of the duloxetine groups). The study team will follow patients for six weeks and collect information on pain outcomes and use of pain medications. Investigators aim to determine if duloxetine can (1) reduce acute pain symptoms following the ED visit, (2) prevent the transition to persistent pain (having pain 6 weeks after the initial ED visit), and (3) decrease opioid use following a motor vehicle collision (MVC). The results of this study will ultimately help determine if duloxetine can be used as a non-opioid pain treatment option that reduces acute pain and prevents the transition to chronic pain. This in turn can improve recovery, reduce opioid use and its consequences, and decrease health care costs.

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Rhode Island Hospital
• Collaborators: Mayday Fund; National Institute of General Medical Sciences (NIGMS)
• Treatments: Duloxetine Hydrochloride

Criteria

Inclusion Criteria:

• generally in good health, are between the ages of 18 and 65, present to the ED with acute (present for <7 days) musculoskeletal pain, and have a current pain score of >4 without a history of pain in the past month.

Exclusion Criteria:

• Musculoskeletal pain lasting > 7days

• ED pain score <4

• Chronic pain: Pain present on most days of the week, with an average score >1 in past month, in the same location as presenting pain

• Clinically unstable

• Fracture (except fracture of the phalanges)

• Substantial soft tissue injury†

• Hepatic failure (acute or chronic)

• Renal failure (acute or chronic)

• Coronary artery disease, including previous myocardial infarction, Angina, percutaneous transluminal coronary angioplasty, etc.

• History of glaucoma

• Previous congestive heart failure

• History of seizure disorder

• History of mania or psychotic disorder

• History of suicidal ideation

• Prisoner

• History and behavior indicates, in the investigator's judgment, that the participant would likely be noncompliant with the study

• Any other condition that, in the investigator's judgment, would indicate that the patient in unsuitable for the study (e.g. might interfere with the study, confound interpretation, or endanger patient)

• Does not have a telephone

• Does not have regular internet access and email address

• Unable to speak and read English

• Blood pressure reading(s) in ED that, when considered in the context of patient past and current history, in the investigator's judgment exceeds acceptable level

• Currently taking a monoamine oxidase inhibitor (MAOI)

• Currently taking medication with substantial interaction with duloxetine (Table 1).

• Breastfeeding

• If female, either not postmenopausal (having menses within past year), or, if childbearing potential, positive pregnancy test prior to randomization and not using a medically acceptable form of contraception

• Exceeds acceptable chronic daily opioid use prior to MVC*

• Previously on duloxetine

• Previous allergic reaction to duloxetine

• Antidepressant use within 2 weeks of study start (4 week if Prozac)

• Allergy to lactose

• Intoxicated