CARES-Spine (Comprehensive Analgesic, Recovery, and Education Support for Spine Surgery) Trial
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ClinicalTrials.gov Identifier: NCT06027099 |
Recruitment Status :
Not yet recruiting
First Posted : September 7, 2023
Last Update Posted : September 11, 2023
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Condition or disease | Intervention/treatment | Phase |
---|---|---|
Chronic Pain Back Pain Neck Pain Opioid Misuse | Drug: Tizanidine Behavioral: MI-Opioid Taper Drug: Placebo Behavioral: Enhanced Usual Care | Phase 3 |
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 375 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) |
Primary Purpose: | Treatment |
Official Title: | Integrating Tailored Postoperative Opioid Tapering and Pain Management Support for Patients on Long-Term Opioid Use Presenting for Spine Surgery |
Estimated Study Start Date : | February 2024 |
Estimated Primary Completion Date : | January 2028 |
Estimated Study Completion Date : | July 2028 |
Arm | Intervention/treatment |
---|---|
Experimental: MI-Opioid Taper and tizanidine |
Drug: Tizanidine
Tizanidine 2mg three times a day for 5 weeks after surgery Behavioral: MI-Opioid Taper Motivational Interviewing (MI) and guided Opioid Tapering support adapting MI principles for enhancing motivation to change in pain treatment and tailoring key MI tools to postoperative opioid use delivered through weekly phone calls from weeks 2 to 7, and at week 11. The guided opioid tapering protocol will be a 25% total daily opioid dose reduction every 7 days with opioid discontinuation 7 days after reaching 1 opioid pill per day. |
Experimental: MI-Opioid Taper and placebo |
Behavioral: MI-Opioid Taper
Motivational Interviewing (MI) and guided Opioid Tapering support adapting MI principles for enhancing motivation to change in pain treatment and tailoring key MI tools to postoperative opioid use delivered through weekly phone calls from weeks 2 to 7, and at week 11. The guided opioid tapering protocol will be a 25% total daily opioid dose reduction every 7 days with opioid discontinuation 7 days after reaching 1 opioid pill per day. Drug: Placebo 1 tablet three times a day for 5 weeks after surgery |
Active Comparator: Enhanced Usual Care |
Behavioral: Enhanced Usual Care
Participants will receive weekly phone calls from weeks 2 to 7, and at week 11. 1 topic per call will be reviewed in this sequence:1) standardized instructions on taking opioid medications after surgery, 2) safe opioid use, 3) avoiding medication errors, 4) local mental health resources and 988 Suicide & Crisis lifeline, 5) disposal of unused medications, 6) prescription drug abuse, and 7) complementary health approaches for chronic pain. Education materials will be reviewed in a didactic style without a tailored discussion. |
- Time to baseline opioid use [ Time Frame: Assessed after surgery up to 1 year after surgery ]Defined as the 1st of 2 consecutive reports of return to preoperative daily OME use or lower on the modified BPI.Preoperative daily OME use is defined as average daily OME assessed over 3 days, on days 7 to 9 before surgery.
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Ages Eligible for Study: | 18 Years to 64 Years (Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
-
Adults aged 18-64 scheduled for elective spine surgery for lumbar or cervical degenerative disease (e.g. lumbar or cervical disc herniation, lumbar or cervical spinal stenosis, lumbar or cervical degenerative spondylolisthesis, lumbar or cervical disc degeneration, or degenerative cervical myelopathy including cervical spondylotic myelopathy).
- Preoperative long-term opioid use (Defined as ≥ 90-day duration of use in the 4 months preceding surgery either via self-report or state PDMP.
- Participants must report at least one of the following on preoperative assessments:
Current Opioid Misuse Measure (COMM) score greater than or equal to 9 Answering "Yes" to any of the following items on the modified Brief Pain Inventory (BPI)1) Over the past 24 hours have you needed to take your pain medication to help you sleep; 2)Have you taken any pain medications for any reason other than your pain, such as to reduce anxiety or improve mood? 3) Have you taken more pain medication than was prescribed to you in the past 24 hours? Score of greater than or equal to 2 on any Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS-1) item Positive Alcohol Use Disorders Identification Test (AUDIT-C) score (greater than or equal to 4 for men, greater than or equal to 3 for women)
- Elevated opioid use 14 days after surgery compared to baseline daily OME Defined as average daily OME assessed over 3 days 1 week before surgery compared to average daily OME reported on postoperative days 12 to 14 to account for as-needed dosing and day-to-day variations in opioid use.
- English-speaking
- Ability and willingness to complete online assessments
Exclusion Criteria:
- Infection, tumor, or fracture at the operative site
- Allergy or intolerance to tizanidine
- Current use of tizanidine
- Renal impairment
- Hepatic impairment including cirrhosis or elevated enzymes
- Concurrent use of other α2-adrenergic agonists, skeletal muscle relaxants
- Concurrent use of: fluvoxamine, ciprofloxacin,zileuton, fluoroquinolones, antiarrhythmics (amiodarone, mexiletine, propafenone, verapamil), cimetidine, famotidine, oral contraceptive pills, acyclovir, ticlopidine, and fexinidazole
- Pre-existing hypotension, sedation, dizziness, severe respiratory insufficiency.
- Opioid Use Disorder
- Suicidality as assessed by the Patient Health Questionnaire-9 (PHQ-9) Question 9 score ≥ 1
- Pregnancy, breastfeeding, or planning to conceive
- Cancer diagnosis, active malignant neoplasm (metastatic or local) or evidence of paraneoplastic syndrome
- Conditions causing inability to complete assessments (education, cognitive ability, mental status, medical status)
- Participating in another clinical trial with an active treatment arm
Responsible Party: | Jennifer Hah, Associate Professor, Stanford University |
ClinicalTrials.gov Identifier: | NCT06027099 |
Other Study ID Numbers: |
71909 |
First Posted: | September 7, 2023 Key Record Dates |
Last Update Posted: | September 11, 2023 |
Last Verified: | September 2023 |
Studies a U.S. FDA-regulated Drug Product: | Yes |
Studies a U.S. FDA-regulated Device Product: | No |
Product Manufactured in and Exported from the U.S.: | Yes |
Chronic Pain Neck Pain Opioid-Related Disorders Pain Neurologic Manifestations Narcotic-Related Disorders Substance-Related Disorders Chemically-Induced Disorders Mental Disorders Tizanidine Physiological Effects of Drugs Analgesics Sensory System Agents |
Peripheral Nervous System Agents Anticonvulsants Muscle Relaxants, Central Neuromuscular Agents Parasympatholytics Autonomic Agents Adrenergic alpha-2 Receptor Agonists Adrenergic alpha-Agonists Adrenergic Agonists Adrenergic Agents Neurotransmitter Agents Molecular Mechanisms of Pharmacological Action |