Pain Alleviation With Testosterone in Opioid-Induced Hypogonadism
- Conditions
- PainOpioid UseHypogonadism, Male
- Interventions
- Drug: Placebo
- Registration Number
- NCT04798469
- Lead Sponsor
- Brigham and Women's Hospital
- Brief Summary
The aim of this trial is to evaluate whether testosterone replacement results in greater improvement in pain perception, pain tolerance, sexual function, fatigue, and quality of life when compared with placebo in men with chronic spinal pain treated with opioids who have opioid-induced hypogonadism (low testosterone).
- Detailed Description
This single-center, randomized, double-blind, placebo-controlled, parallel-group trial will evaluate pain and quality of life outcomes associated with 6 months of treatment with testosterone or placebo in men aged 18 years or older with chronic non-cancer spinal pain who are taking opioid analgesics for at least 6 months and have opioid-induced hypogonadism.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- Male
- Target Recruitment
- 150
- Men, age 18 years and older.
- Chronic non-cancer spinal pain.
- Use of opioid analgesics for at least 6 months.
- Serum total testosterone (measured by mass spectrometry) <348 ng/dL and/or free testosterone <70 pg/mL.
- Ability and willingness to provide informed consent.
- History of prostate cancer or breast cancer.
- Known history of organic hypogonadism (e.g., due to hypothalamic, pituitary or testicular disease).
- Use of testosterone within the past 6 months.
- Baseline hematocrit >48%.
- Prostate-specific antigen (PSA) level >4 ng/mL in Caucasians or >3 ng/mL in African-Americans.
- Presence of prostate nodule or induration on digital rectal examination.
- Uncontrolled congestive heart failure.
- Myocardial infarction, acute coronary syndrome, revascularization surgery or stroke within 3 months.
- Serum creatinine >2.5 mg/dL.
- Alanine aminotransferase (ALT) level 3 times above the upper limit of normal.
- Diagnosis of bipolar disorder or schizophrenia.
- Presence of metallic implants (pacemakers, aneurysm clips, etc.) that preclude the patient from undergoing functional magnetic resonance imaging (MRI). In subjects who are otherwise eligible and either do not qualify for MRI or are reluctant to undergo imaging, the investigators may consider enrolling such participants on a case-by-case basis.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Testosterone Testosterone Undecanoate 250 MG/ML Intramuscular injections of testosterone undecanoate 750 mg. Placebo Placebo Intramuscular injections of placebo.
- Primary Outcome Measures
Name Time Method Changes in scores in the Pain Interference Subscale of the Brief Pain Inventory (BPI) questionnaire Baseline, 3 months, and 6 months The Pain Interference Subscale of the BPI is specifically relevant to patients with chronic back pain who are using opioids and correlates strongly with the patient's quality of life.
- Secondary Outcome Measures
Name Time Method Changes in response to quantitative sensory testing of pain under pressure stimulus Baseline, 3 months, and 6 months Responses to pressure stimulation (pressure pain threshold) will be evaluated using a digital pressure algometer.
Changes in default mode network connectivity Baseline and 6 months Patients with chronic pain show increased default mode network (DMN) connectivity to the anterior/mid-insula, a brain region that integrates multiple dimensions of pain, while reduced DMN connectivity to the insula has been significantly associated with pain reduction. In this trial, we plan to determine the influence of testosterone replacement on DMN connectivity by performing functional magnetic resonance imaging (MRI) before and after testosterone/placebo administration and correlate changes in pain with changes in DMN connectivity.
Changes in response to quantitative sensory testing of pain under a mechanical stimulus Baseline, 3 months, and 6 months Responses to mechanical pain will be assessed using repetitive stimuli (temporal summation or "windup") with a set of punctate mechanical probes.
Changes in response to quantitative sensory testing of pain under heat stimulus Baseline, 3 months, and 6 months Responses to heat pain will be assessed using a contact thermode that will deliver thermal stimulation to the skin.
Changes in response to quantitative sensory testing of pain under deep pressure stimulus Baseline, 3 months, and 6 months Response to deep pressure pain will be ascertained using cuff pressure algometry.
Changes in response to quantitative sensory testing of pain under cold stimulus Baseline, 3 months, and 6 months Responses to cold pain will be assessed using a cold pressor task, which involves immersion of the dominant hand in a circulating water bath at a temperature of 4°C.
Trial Locations
- Locations (1)
Brigham and Women's Hospital
🇺🇸Boston, Massachusetts, United States