Discontinuation vs Continuation of Long-term Opioid Therapy in Suboptimal and Optimal Responders With Chronic Pain
Condition: Opioid-Related Disorders; Opiate Addiction; Narcotic Abuse; Drug Abuse
MeSH terms: Chronic Pain; Substance-Related Disorders; Opioid-Related Disorders; Narcotic-Related Disorders
Intervention: Structured discontinuation of opioid therapy (morphine sulfate ER, oxycodone ER, oxymorphone ER); Continuation of opioid therapy (morphine sulfate ER, oxycodone ER, oxymorphone ER)
Intervention description: Structured discontinuation of opioid therapy (morphine sulfate ER, oxycodone ER, oxymorphone ER); Continuation of opioid therapy (morphine sulfate ER, oxycodone ER, oxymorphone ER)
Intervention MeSH terms: Oxymorphone; Morphine; Oxycodone; Analgesics, Opioid
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Enrollment: 44.0
Sex: All
Minimum age: 18 Years
Maximum age: 75 Years
Healthy volunteers: No

Summary:

      The purpose of this study is to evaluate the effect on pain intensity (PI) of structured
      discontinuation of long-term opioid analgesic therapy compared to continuation of opioid
      therapy in Suboptimal and Optimal Responders to high-dose, long-term opioid analgesic therapy
      for chronic low back pain (CLBP).
    

Eligibility criteria:

        Inclusion Criteria:

          1. Be male or non-pregnant, non-lactating female aged 18 to 75 years, inclusive.

          2. Have a clinical diagnosis of non-radicular CLBP (pain that occurs in an area with
             boundaries between the lowest rib and the crease of the buttocks) of Class 1 or
             proximal radicular (above the knee) pain of Class 2 based on the Quebec Task Force
             Classification for Spinal Disorders (subjects with previous surgery or chronic pain
             syndrome, i.e., classes 9.2 or 10, will be allowed if their pain does not radiate or
             radiates only proximally) for a minimum of 12 months and

               1. For the Suboptimal Responder group, pain must have been present for at least
                  several hours a day and have an Average PI score of 6-9 on an 11-point NRS within
                  the past 24 hours of screening.

               2. For the Optimal Responder group, subjects must have an Average PI score of 1-4 on
                  an 11-point NRS within the past 24 hours of screening.

          3. Have been taking ER/LA opioids or immediate release opioids (at least 4 times at day)
             for at least 12 months.

          4. Have been taking one of the 3 index ER opioid drugs around-the-clock at a twice-a-day
             frequency for at least 3 consecutive months at a total daily dose within the range
             shown below.

             Daily Dose Range

               1. Morphine sulfate extended-release: 120-540mg

               2. Oxycodone extended-release: 80-360mg

               3. Oxymorphone extended-release: 40-180mg

          5. Be considered, in the opinion of the Investigator, to be in generally good health
             other than CLBP at screening based upon the results of a medical history, physical
             examination, 12-lead ECG, and laboratory profile.

          6. Speak, read, write, and understand English (to reduce heterogeneity of data),
             understand the consent form, and be able to effectively communicate with the study
             staff.

          7. Have access to the Internet (to access the patient support program).

          8. Voluntarily provide written informed consent.

          9. Be willing and able to complete study procedures.

        Exclusion Criteria:

          1. Have any clinically significant condition that would, in the opinion of the
             Investigator, preclude study participation or interfere with the assessment of pain
             and other symptoms of CLBP or increase the risk of opioid-related AEs.

          2. Have a primary diagnosis of fibromyalgia, complex regional pain syndrome, neurogenic
             claudication due to spinal stenosis, spinal cord compression, acute nerve root
             compression, severe or progressive lower extremity weakness or numbness, bowel or
             bladder dysfunction as a result of cauda equina compression, diabetic amyotrophy,
             meningitis, diskitis, back pain because of secondary infection or tumor, or pain
             caused by a confirmed or suspected neoplasm.

          3. Have undergone a surgical procedure for back pain within 6 months prior to the
             Screening Visit.

          4. Have had a nerve or plexus block, including epidural steroid injections or facet
             blocks, within 1 month prior to the Screening Visit or botulinum toxin injection in
             the lower back region within 3 months prior to screening.

          5. Have a history of confirmed malignancy within past 2 years, with exception of basal
             cell or squamous cell carcinoma of the skin that has been successfully treated.

          6. Have uncontrolled blood pressure, i.e., subject has a sitting systolic blood pressure
             >180 mm Hg or <90 mm Hg, or a sitting diastolic blood pressure >110 mmHg or <40 mm Hg
             at screening.

          7. Have a body mass index (BMI) >45 kg/m2. Anyone with a BMI >40 but <45 will complete a
             screening tool (STOPBang Questionnaire) to rule out high risk of obstructive sleep
             apnea.

          8. Have clinically significant depression based on a score of ≥20 on the Patient Health
             Questionnaire (PHQ-8)

          9. Have suicidal ideation associated with actual intent and a method or plan in the past
             year: "Yes" answers on items 4 or 5 of the Columbia-Suicide Severity Rating Scale
             (C-SSRS).

         10. Have a previous history of suicidal behaviors in the past 5 years: "Yes" answer (for
             events that occurred in the past 5 years) to any of the suicidal behavior items of the
             C-SSRS.

         11. Have any lifetime history of serious or recurrent suicidal behavior. (Non-suicidal
             self-injurious behavior is not a trigger for a risk assessment unless in the
             Investigator's judgment it is indicated.)

         12. Have clinically significant abnormality in clinical chemistry, hematology or
             urinalysis, including serum glutamic-oxaloacetic transaminase/aspartate
             aminotransferase or serum glutamic pyruvic transaminase/alanine aminotransferase ≥3
             times the upper limit of the reference range or a serum creatinine >2 mg/dL at
             screening.

         13. Have severe enough psychiatric or substance abuse disorder to compromise the subject's
             safety or scientific integrity of the study.

         14. Have on-going litigation associated with back pain or pending applications for workers
             compensation or disability issues or subjects who plan on filing litigation or claims
             within the next 12 months; subjects with settled past litigations will be allowed as
             will subjects who have been on workers compensation or disability claims for at least
             3 months.

         15. Have used a monoamine oxidase inhibitor within 14 days prior to the start of study
             medication.

         16. Are taking agonist-antagonists (pentazocine, butorphanol or nalbuphine),
             buprenorphine, methadone, barbiturates, or more than one type of benzodiazepine within
             1 month prior to screening.

         17. Have a positive urine drug test (UDT) for illicit drugs (including marijuana),
             non-prescribed controlled substances (opioid or non-opioid), or alcohol at screening.

         18. Have taken any investigational drug within 30 days prior to the Screening Visit or are
             currently enrolled in another investigational drug study.