Trial of Minocycline to Reduce Pain after A1 Pulley and Carpal Tunnel Release

米诺环素减轻 A1 滑车和腕管松解后疼痛的试验

• 批准号: 8198349
• 负责人: Catherine Mills Curtin
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8198349
• 关键词: Acute; Acute Pain; Age; Aging; American; Analgesics; Animal Model; Anxiety; Blinded; Brain; Brief Pain Inventory; Carpal Tunnel Syndrome; Cell physiology; Chronic; Clinical; Complex Regional Pain Syndromes; Development; Diabetes Mellitus; Diagnosis; Environment; Feasibility Studies; Fright; Hand; Healed; Health system; Hour; Human; Incidence; Injury; Intervention; Lead; Literature; Local Anesthetics; Mental Depression; Minocycline; Modeling; Morbidity - disease rate; Multicenter Trials; Nerve; Neuraxis; Neuroglia; Neurons; Operative Surgical Procedures; Oral Administration; Pain; Participant; Pathology; Pathway interactions; Patients; Peripheral; Peripheral Nervous System; Pharmaceutical Preparations; Phenotype; Physiology; Pilot Projects; Placebo Control; Play; Population; Postoperative Pain; Procedures; Randomized; Rattus; Recovery; Research; Resolution; Role; Secondary to; Surgeon; Survival Analysis; Techniques; Testing; Tetracyclines; Time; Tissues; Upper Extremity; Veterans; Work; arm; chronic pain; design; effective therapy; efficacy trial; healing; improved; inhibitor/antagonist; injured; interest; nerve injury; novel; painful neuropathy; prescription opioid; prophylactic; randomized placebo controlled trial

DESCRIPTION (provided by applicant): Post-operative pain is an enormous problem. Currently 10% of Americans will develop chronic pain following surgery, despite adequate tissue healing. In hand surgery, about 20% of patients who undergo carpal tunnel release have prolonged post-operative pain. Surgeons have tried changing their technique with little improvement in the rate of post- operative pain. There is now a growing body of literature that suggests that the dominating factors, determining whether acute pain will progress to chronic pain, are patient specific factors rather than factors of surgical technique. For example, in humans, fear, anxiety, and depression reflect brain physiology that appears to have a significant impact on pain. Glial cell activation may explain why these supraspinal states best predict who will develop post-injury chronic pain. Glial cells are non-neuronal cells that play an active role in modulating the activation of the central and peripheral nervous system. This study looks at whether a pharmacologic intervention that would "prep" glial cells can reduce post-operative pain after carpal tunnel release. The drug to be studied will be minocycline, a tetracycline antibiotic that is a glial cell inhibitor and in animal models, minocycline has shown promise inhibiting neuropathic pain This study's hypothesis is that subjects who take peri-operative minocycline will have faster time to pain resolution after carpal tunnel release. This will be a randomized placebo controlled trial. All participants will be veterans undergoing carpal tunnel release at the Palo Alto VA using local anesthetic. Participants will be randomized and those in the intervention arm will receive 200mg of minocycline at least 1 hour prior to their procedure and then 100mg twice a day for 5 days. All subjects will be called daily and asked about their level of pain and pain medication use. We will have two primary endpoints. The primary will be the Time-to-Pain-Resolution (TPR) defined as zero 24- hour average pain for three consecutive days, as assessed by a daily-administered Brief Pain Inventory. The second will be time-to-prescription-opioid-cessation defined as the zero use of prescription opioids for three consecutive days. We plan to explicitly study pain chronicity by using TPR as our primary endpoint and survival analysis to identify predictors of transitioning from acute to chronic pain. This novel work could open new pathways to managing surgical patients and have a profound impact on veterans who undergo elective surgery.

描述（由申请人提供）：