Reconsolidation Therapy With Propranolol as a Treatment for Chronic Pain

Phase 2

Recruiting

• Conditions: Chronic Low-back Pain; Fibromyalgia
• Interventions: Drug: Propranolol Hydrochloride; Drug: Placebo; Behavioral: Reactivation procedure; Behavioral: Pain neuroscience education

• Registration Number: NCT05085782
• Lead Sponsor: Université de Sherbrooke

Brief Summary

The primary aim of this study is to document the feasibility and acceptability of an intervention consisting of pain neuroscience education and reconsolidation therapy with propranolol in adults suffering from chronic pain (chronic low back pain or fibromyalgia).

The secondary aim of the study is to estimate the effect size of the intervention on pain and function one month post-intervention, and to obtain data for sample-size calculation for a subsequent randomized controlled trial.

Detailed Description

Background: Many patients with chronic pain exhibit abnormal synaptic changes in the central nervous system - including hyperactivity in the amygdala - reminiscent of those seen in post-traumatic stress disorder (PTSD). A recently developed psychiatric treatment for PTSD involves reactivating the synapses to make them temporarily malleable and then blocking their reconsolidation with propranolol, thereby reducing the hyperactivity in the amygdala and decreasing the intensity of the symptoms in a lasting way. Considering the similarities between PTSD and chronic pain, this treatment could also be beneficial for patients with chronic pain.

Objectives: The primary objective of this study will be to document the feasibility and acceptability of a combined pain neuroscience education and reconsolidation blockade intervention with oral propranolol (or placebo) in adult patients with chronic pain (specifically, low back pain or fibromyalgia). The secondary objective will be to estimate the effect size of the intervention on function and pain one month post-intervention, and to obtain the data necessary for a sample size calculation of a subsequent larger scale study.

Description: The research design is a quantitative, placebo-controlled clinical trial (Phase II) feasibility study. The sample will consist of French-speaking adults with chronic low back pain or fibromyalgia (n=24 per population; 12 control and 12 experimental participants for each population; allocation by minimization); participants with a contraindication to propranolol or a neurological diagnosis will be excluded. All participants will receive education on the neuroscience of pain (video vignettes) and will participate in 6 weekly intervention sessions. During these sessions, they will receive propranolol or placebo capsules (double-blind; dosing based on size) and participate in a reactivation procedure (description and/or visualization of painful movements). Feasibility measures will be collected throughout the study; acceptability and efficacy measures will be assessed 4 weeks post-intervention, with the exception of physical function (primary efficacy measure), which will also be measured at each intervention session.

Relevance: This study will be the first to use reconsolidation blockade for the treatment of chronic pain. The postulated mechanism of action is plausible and supported by scientific evidence, but to date has never been tested in humans with persistent pain. If our results demonstrate that the intervention is feasible, acceptable, and has the potential to be effective, randomized clinical trials may follow our study to robustly evaluate the effect of our intervention in the short and long term. The intervention could also be evaluated in other chronic pain populations with central sensitization, such as pelvic pain, chronic neck pain (whiplash), etc.

Study Timeline

• Study First Submitted: 2021-09-27
• Study First Submitted QC: 2021-10-07
• Study First Posted: 2021-10-20
• Study Start: 2022-02-07
• Status Verified: 2023-05
• Last Update Submitted: 2023-05-17
• Last Update Posted: 2023-05-22
• Primary Completion: 2024-09
• Study Completion: 2025-09

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 48

Inclusion Criteria

• French speaking
• Suffering from [chronic low back pain OR fibromyalgia] for >6 months
• Average pain at least 4/10
• Central sensitization (assessed via a standardized physiotherapy evaluation and the Central Sensitization Inventory)

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Exclusion Criteria

• Health condition for which propranolol is contra-indicated
• Medication with which co-administration of propranolol is contra-indicated
• Severe or uncontrolled neurological/psychiatric condition (including post-traumatic stress disorder, substance abuse, suicidal ideation, etc.)
• Surgery of the lower-back in the last 3 years
• Litigation surrounding the painful condition

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Propranolol	Propranolol Hydrochloride	1. Pain neuroscience education (10 short videos - 2 to 4 mins each) 2. 6 weekly sessions of Reconsolidation therapy with propranolol. At the beginning of each session, participants will take 2 to 4 capsules of 20 mg propranolol (dose calculated based on sex and height). One hour after ingestion of the propranolol, participants will undergo a reactivation procedure, wherein they will be asked to describe/visualize painful movements/activities.
Placebo	Pain neuroscience education	1. Pain neuroscience education (10 short videos - 2 to 4 mins each) 2. 6 weekly sessions of Reconsolidation therapy with a placebo. At the beginning of each session, participants will take 2 to 4 capsules of 20 mg placebo (dose calculated based on sex and height). One hour after ingestion of the placebo, participants will undergo a reactivation procedure, wherein they will be asked to describe/visualize painful movements/activities.
Propranolol	Reactivation procedure	1. Pain neuroscience education (10 short videos - 2 to 4 mins each) 2. 6 weekly sessions of Reconsolidation therapy with propranolol. At the beginning of each session, participants will take 2 to 4 capsules of 20 mg propranolol (dose calculated based on sex and height). One hour after ingestion of the propranolol, participants will undergo a reactivation procedure, wherein they will be asked to describe/visualize painful movements/activities.
Propranolol	Pain neuroscience education	1. Pain neuroscience education (10 short videos - 2 to 4 mins each) 2. 6 weekly sessions of Reconsolidation therapy with propranolol. At the beginning of each session, participants will take 2 to 4 capsules of 20 mg propranolol (dose calculated based on sex and height). One hour after ingestion of the propranolol, participants will undergo a reactivation procedure, wherein they will be asked to describe/visualize painful movements/activities.
Placebo	Placebo	1. Pain neuroscience education (10 short videos - 2 to 4 mins each) 2. 6 weekly sessions of Reconsolidation therapy with a placebo. At the beginning of each session, participants will take 2 to 4 capsules of 20 mg placebo (dose calculated based on sex and height). One hour after ingestion of the placebo, participants will undergo a reactivation procedure, wherein they will be asked to describe/visualize painful movements/activities.
Placebo	Reactivation procedure	1. Pain neuroscience education (10 short videos - 2 to 4 mins each) 2. 6 weekly sessions of Reconsolidation therapy with a placebo. At the beginning of each session, participants will take 2 to 4 capsules of 20 mg placebo (dose calculated based on sex and height). One hour after ingestion of the placebo, participants will undergo a reactivation procedure, wherein they will be asked to describe/visualize painful movements/activities.

Primary Outcome Measures

Name	Time	Method
Feasibility outcome 4 : % participants in each group who believe they received the experimental treatment (propranolol)	At follow-up (on average,12 weeks after recruitment)	This percentage will be compared between the two groups to assess blinding
Acceptability outcome 2 : perceived ethicality of the intervention (prospective and retrospective)	Prospective rating : at baseline ; Retrospective rating : at follow-up (on average,12 weeks after recruitment)	Rated on an 11-point numerical rating scale (0-10; 10 = better outcome)
Feasibility outcome 2 : Rate of study completion	Through data collection phase (estimated 6 months per population)	Percentage of sample with perfect attendance vs partial attendance vs withdrawal vs exclusion vs loss to follow-up.
Feasibility outcome 1 : Weekly recruitment rate	Through recruitment phase (estimated 3 months per population)	Number of prospective participants successfully recruited every week, vs number of participants excluded and number of refusals
Feasibility outcome 3 : Number of participants with adverse events (observed and self-reported)	Through data collection phase (estimated 6 months per population)	For all adverse even, the following will be reported : Type \& severity (according to the CTCAE), attribution, expected vs unexpected
Acceptability outcome 1 : perceived burden of the intervention (prospective and retrospective)	Prospective rating : at baseline ; Retrospective rating : at follow-up (on average,12 weeks after recruitment)	Rated on an 11-point numerical rating scale (0-10; 10 = worse outcome)
Acceptability outcome 3 : perceived coherence of the intervention (prospective and retrospective)	Prospective rating : at baseline ; Retrospective rating : at follow-up (on average,12 weeks after recruitment)	Rated on an 11-point numerical rating scale (0-10; 10 = better outcome)
Acceptability outcome 4 : perceived effectiveness of the intervention (prospective and retrospective)	Prospective rating : at baseline ; Retrospective rating : at follow-up (on average,12 weeks after recruitment)	Rated on an 11-point numerical rating scale (0-10; 10 = better outcome)
Acceptability outcome 5 : perceived self-efficacy relating to the intervention (prospective and retrospective)	Prospective rating : at baseline ; Retrospective rating : at follow-up (on average,12 weeks after recruitment)	Rated on an 11-point numerical rating scale (0-10; 10 = better outcome)

Secondary Outcome Measures

Name	Time	Method
Change in Emotional functioning	From baseline to follow-up (on average, 12 weeks)	Measured using the self-reported Profile of mood states (-32 to 200; 200 = worse outcome)
Change in Physical functioning	From baseline to follow-up (approx 12 weeks)	Measured using the self-reported Brief pain inventory (short form); (0-70; 70 = worse outcome)
Change in Central sensitization	From baseline to follow-up (on average, 12 weeks)	Measured using the self-reported Central sensitization inventory (0-100; 100=worse outcome)
Change in Symptoms of fibromyalgia	From baseline to follow-up (on average, 12 weeks)	Measured using the self-reported Fibromyalgia impact questionnaire(for the fibromyalgia population only) (0=100; 100 = worse outcome)
Change in Pain intensity	From baseline to follow-up (approx 12 weeks)	Measured using the self-reported Brief pain inventory (short form) (0-40; 40 = worse outcome)
Participant ratings of global improvement and satisfaction with treatment	Follow-up (on average, 12 weeks after recruitment)	Measured using the self-reported Patient global impression of change (1-7; 7 = better outcome)

Trial Locations

Locations (2)

Centre de recherche sur le vieillissement (CdRV); 🇨🇦 Sherbrooke, Quebec, Canada

CRCHUS: Centre de recherche du centre hospitalier universitaire de Sherbrooke; 🇨🇦 Sherbrooke, Quebec, Canada