Morphine Modulation of The Brain's Pain Matrix
Condition: Pain
Study type: Interventional
Phase: Phase 4

Summary: 
      The aim of the current project is to use a model of painful stimulation of skin, muscles and
      internal organs, where it is possible to measure activity in the brain centers that process
      pain simultaneously. Magnetic resonance imaging and electroencephalography are combined to
      optimize the anatomical and physiological description of brain activation. During
      administration of morphine we will identify how different brain areas are affected. This
      knowledge will be used to:

      1. Understand the mechanisms of morphine to a greater extent than is possible today,
      including:

        1. to investigate the mechanisms of morphine versus placebo on pain signals in the spinal
           cord and brain. This is done by a combination of experimental pain models,
           neurophysiological and imaging techniques (EEG and fMRI). This can be achieved as both
           subjective and objective measures of the analgesic effect.

        2. to examine morphines effect on communication between the centers of the brain that are
           involved in painprocessing .

        3. modeling of morphine pharmacokinetics (the understanding of what the body does to the
           drug, such as. concentration in the blood and the brain), since this is central to
           understand the pharmacodynamics (the description of what the drug does to the body and
           thus the effect it has).

        4. to identify biomarkers that can predict whether healthy subjects respond to morphine by
           experiencing an analgesic effect.
    

Detailed description: 
      The tests will consist of one main study (I) and one sub-study (i):

      I) Experiments in the painlaboratory in the gastroenterology clinic, where 40 healthy
      subjects will be examined with different pain tests i) Experiments in the MRI scanner, where
      only 20 of the 40 from the main study will be investigated in a more simple pain model. The
      individuals who also participate in MRI studies, will consist of those who first sign up

      An equal distribution of men and women is wanted. The trial will be a double-blind,
      placebo-controlled crossover study in which all subjects will be investigated on two seperate
      days and receive respectively placebo or morphine in random order

      Skin stimulation

      Skin will be stimulated with thermal and electrical stimuli. Stimulated by:

        -  Thermal stimuli by the skin stimulated with heat with an approved termotester (Medoc
           termotest) or with cold, by a hand or foot immersed in ice water. This harmless ice
           water test is further possible to evaluate DNIC (diffuse noxious Inhibitory controls)
           which is part of the pain system descending inhibitory system.

        -  Electrical stimulation of the skin will be done by: 1) to the skin of the forearm
           stimulated electrically through two small surface electrodes (each approx. One cm2).
           There are stimulated to pain threshold, 2) via surface electrodes placed under the foot.
           This activates the nociceptive avert reflex as recorded by electrodes placed on the leg.

      Muscle stimulation

      The muscles can be stimulated by:

      • mechanical stimuli by pressing the muscle with an approved pressure algometer (Somedic
      produktion AB, Sweden). There is an upper limit for the pressure to avoid injury.

      Bone stimulation

      Bone associated pain can be studied by:

      • mechanical stimuli by pressing the right shin bone 15cm below the patella, medial of the
      tibia. Pressed with a handheld trykalgometer (Type 2, Somedic produktion AB, Sweden) with a
      probe size of 2mm in diameter until trial participants reach their pain tolerance threshold.

      Visceral stimuli Stimuli to the rectum will be performed through the probe specifically
      designed for this purpose.

        -  mechanical stimuli will be applied by water filling a balloon which is glued on the
           probe. The balloon on the probe is extended to moderate pain. The expansion is done by
           slowly filling the balloon with 37 degrees hot water.

        -  Thermal stimuli will be applied by flushing the balloon with hot water (60 ° C)

        -  Electrical stimuli will be applied by stimulation of the mucosa with weak electrical
           currents (Less than 80 mA) through electrodes on the probe. This stimulus is also used
           for recording of evoked brain potentials.
    

Intervention name(s): Morphine; orange juice
Intervention type(s): Drug; Other
Intervention description(s): Morphine oral mixture; orange juice
Other intervention name(s): Morphine hydrochloride oral solution 2 mg/ml; orange juice solution
Intervention MeSH terms: Morphine; Pharmaceutical Solutions
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Basic Science