Evaluation of Bone Turnover Biomarkers, CB2 and TRPV1 Polymorphisms as Potential Preventive Data in Osteoporosis and Perception of Improvement in Quality of Life in Women With Chronic Pain Treated With Medicinal Cannabis
试验速览
- 阶段
- 2 期
- 状态
- 尚未招募
- 发起方
- 入组人数
- 80
- 试验地点
- 1
- 主要终点
- Change From Period Baseline in Chronic Pain Intensity on the Visual Analog Scale
研究概览
简要总结
Chronic pain disproportionately affects women and may coexist with impaired bone health, particularly during midlife and after menopause. The endocannabinoid system is involved in pain modulation and bone homeostasis; however, clinical studies that integrate pain outcomes, bone-related biomarkers, genetic variants, and salivary endocannabinoids remain limited.This randomized, triple-masked, placebo-controlled crossover trial will evaluate the effects of a full-spectrum medicinal cannabis extract with a cannabidiol to tetrahydrocannabinol ratio of 5:1 on chronic pain in women aged 45 to 80 years with chronic pain refractory to conventional treatment. Eighty participants will be randomly assigned to one of two treatment sequences: full-spectrum cannabis extract followed by matching placebo, or matching placebo followed by full-spectrum cannabis extract. The treatment periods, washout interval, and visit schedule will follow the final approved protocol.The primary outcome is change in chronic pain intensity measured using the Visual Analog Scale. Secondary outcomes include quality of life, sleep quality, functional impact, bone health biomarkers, bone mineral density measured by dualenergy X-ray absorptiometry, salivary endocannabinoids, the association of CB and TRPV genetic variants with treatment response, and adverse events. The study aims to generate evidence on the clinical effects and biological correlates of medicinal cannabis therapy in women with chronic pain.
详细描述
This is a randomized, triple-masked, placebo-controlled crossover clinical trial conducted in women aged 45 to 80 years with moderate to severe chronic pain that has persisted for at least 3 months and has not responded adequately to conventional pharmacological or non-pharmacological treatments. Participants will be randomlyallocated in permuted blocks to one of two treatments sequences. Sequence A will receive a full-spectrum medicinal cannabis extract with a cannabidiol to tetrahydrocannabinol ratio of 5:1 during the first treatment period, followed by a protocol-defined washout interval and matching placebo during the second treatment period. Sequence B will receive matching placebo during the first treatment period, followed by the washout interval and the full-spectrum medicinal cannabis extract during the second treatment period. The study product will be administered orally as softgel capsules. The target daily dose is 25 milligrams of cannabidiol and 5 milligrams of tetrahydrocannabinol. Dose titration during the first 2 weeks of each active treatment period will follow the final approved protocol.Participants, care providers, investigators, and outcome assessors will remain masked to treatment assignment as operationally applicable. Randomization will use a computer-generated sequence with permuted blocks of 4 and allocation concealment through opaque, sealed envelopes. The product and matching placebo will be supplied in indistinguishable presentations.Clinical evaluations will include pain intensity, quality of life, functional impact, sleep quality, concomitant medications, adherence, and adverse events. Laboratory assessments will include safety tests, selected bone metabolism biomarkers, inflammatory markers, and oxidative stress biomarkers. Bone mineral density and body composition will be assessed using dualenergy X-ray absorptiometry at protocol-defined baseline and final visits. Genetic analysis will evaluate CB and TRPV variants. Salivary anandamide, 2-arachidonoylglycerol, palmitoylethanolamide, and oleoylethanolamide will be quantified using liquid chromatography coupled with tandem mass spectrometry according to the final sample collection schedule.The primary efficacy analysis will compare pain outcomes across cannabis and placebo treatment periods while accounting for the crossover design. Secondary analyses will evaluate changes in patient-reported outcomes and biomarkers, treatment safety, and associations between genetic variants or salivary endocannabinoid profiles and treatment response.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Treatment
- 盲法
- Triple (Participant, Care Provider, Investigator)
盲法说明
The study uses triple masking. Participants, clinical care providers, and investigators involved in participant assessment and study conduct will remain unaware of treatment assignment. The statistician will analyze coded treatment groups until the prespecified unmasking procedure is completed. Study products and placebo will be matched in presentation and dispensing procedures.
入排标准
- 年龄范围
- 45 Years 至 80 Years（Adult, Older Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •Female sex, age 45 to 80 years
- •Moderate to severe chronic pain, defined as a pain score of at least 4 on a 0 to 10 Visual Analog Scale, persisting for more than 3 months
- •Documented inadequate response to at least 2 classes of analgesic treatments or non-pharmacological treatments
- •Willingness to abstain from smoked cannabis and non-study cannabinoid products during the study
- •Ability to understand the informed consent form and study questionnaires
- •Willingness and ability to attend scheduled visits and biological sample collections during the study follow-up period
排除标准
- •Cognitive impairment that precludes understanding of the informed consent form or study questionnaires
- •Uncontrolled psychiatric condition, including uncontrolled psychotic disorder or bipolar disorder
- •Pregnancy, breastfeeding, or intention to become pregnant during the study
- •Current use of medicinal cannabis, smoked cannabis, or other cannabinoid products
- •Known hypersensitivity to cannabinoids or formulation excipients
- •Clinically significant hepatic impairment, defined as aspartate aminotransferase or alanine aminotransferase greater than 3 times the upper limit of normal, or severe heart failure classified as New York Heart Association class III or IV
- •History of substance use disorder that, in the investigator's judgment, may interfere with study participation
- •Use of medications that may interfere with bone metabolism, including bisphosphonates, systemic corticosteroids, or sex hormones, within 6 months before enrollment
结局指标
主要结局
Change From Period Baseline in Chronic Pain Intensity on the Visual Analog Scale
时间窗: At the baseline and end of each treatment period, approximately 6 months per period.
Chronic pain intensity will be measured using a 0 to 10 Visual Analog Scale, where 0 indicates no pain and 10 indicates the worst imaginable pain. The baseline score will be the mean pain intensity reported over the preceding 7 days. A clinical response is defined as a reduction of at least 30 percent from the baseline score of the corresponding treatment period.
次要结局
- Change From Period Baseline in Fibromyalgia Impact Questionnaire Score Among Participants With Fibromyalgia.(At baseline and at Months 3 and 6 of each treatment period.)
- Change From Baseline in Bone Mineral Density Measured by Dual-Energy X-Ray Absorptiometry.(At baseline and at the final study visit, approximately 12 months after enrollment.)
- Change From Period Baseline in Serum Bone Turnover Biomarkers.(At baseline and at protocol-defined follow-up visits through final study completion, approximately 12 months.)
- Association of CB2 and TRPV1 Genetic Variants With Pain Treatment Response.(Genotyping at baseline; association with pain response through the end of each treatment period, approximately 12 months.)
- Change From Baseline in Salivary Endocannabinoid Concentrations.(Use the final collection schedule; do not submit this entry until the protocol is harmonized as baseline-only or serial sampling.)
- Number of Participants With Treatment-Emergent Adverse Events.(From first study product administration through the end of each treatment period, approximately 6 months per period.)
- Change From Period Baseline in Hepatic and Renal Safety Laboratory Values.(At baseline and at protocol-defined follow-up visits through final study completion, approximately 12 months.)
- Change From Period Baseline in Sleep Quality on the Pittsburgh Sleep Quality Index.(At baseline and at 3 and 6 Months each treatment period.)
- Change From Period Baseline in Health-Related Quality of Life on the 36-Item Short Form Survey.(At baseline and at Months 3 and 6 of each treatment period.)
- Change From Period Baseline in Pain-Related Quality of Life on the WHOQOL-Pain Instrument.(At baseline and at Months 3 and 6 of each treatment period.)