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Investigation of Cannabidiol for Reduction of NeuroInflammation in Chronic Back Pain (CBD)

Primary Purpose

Back Pain, Low

Status
Terminated
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Cannabidiol
Sponsored by
Massachusetts General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Back Pain, Low

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • age ≥ 18 and ≤ 75;
  • the ability to give written, informed consent;
  • ongoing pain that averaged at least 4, on a 0-10 scale of pain during a typical week, and present for at least 50% of days during a typical week;
  • fluency in English;
  • on a stable pain treatment (pharmacological or otherwise) for the previous four weeks.
  • Medical records confirming diagnosis of low back pain
  • Chronic low back pain, ongoing for at least 6 months prior to enrollment.

Exclusion Criteria:

  • outpatient surgery within 2 months and inpatient surgery within 6 months from the time of scanning;
  • elevated baseline transaminase (ALT and AST) levels above 3 times the Upper Limit of Normal (ULN), accompanied by elevations in bilirubin above 2 times the ULN
  • any interventional pain procedures within 6 weeks prior to scanning procedure or at any point during study enrollment;
  • surgical intervention or introduction/change in opioid regimen at any point during study enrollment
  • contraindications to functional magnetic resonance imaging scanning and positron emission tomography scanning (including presence of a cardiac pacemaker or pacemaker wires, metallic particles in the body, vascular clips in the head or previous neurosurgery, prosthetic heart valves, claustrophobia);
  • current or past history within the last 5 years of major medical illness not affecting the central nervous system, other than chronic pain;
  • implanted spinal cord stimulator (SCS) for pain treatment;
  • any history of neurological illness or major medical illness affecting the central nervous system, unless clearly resolved without long-term consequences;
  • current or past history of major psychiatric illness;
  • PTSD, depression, and anxiety are exclusion criteria only if the conditions were so severe as to require hospitalization in the past year.
  • pregnancy or breast feeding;
  • history of head trauma requiring hospitalization;
  • major cardiac event within the past 10 years;
  • any use of recreational drugs in the past 3 months
  • any marijuana use, medical or recreational, in the past 3 months
  • an abnormal physical exam (e.g., peripheral edema);
  • routine use of opioids ≥ 60 mg morphine equivalents;
  • use of immunosuppressive medications, such as prednisone, TNF medications within 2 weeks of the visit;
  • current bacterial or viral infection;
  • Any other contraindications to CBD administration noted by the study physician.
  • If undergoing blood draws through an arterial line during scan, contraindications to placement of arterial line, such as abnormal result on modified Allen's test on both hands; Raynaud syndrome; bleeding disorder; use of anticoagulants such as Coumadin, Plavix or Lovenox

Sites / Locations

  • Massachusetts General Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

CBD Arm

Arm Description

Evaluation with Magnetic Resonance-Positron Emission Tomography Imaging and/or behavioral pain assessment before and after a 4-week trial of a liquid formulation of CBD.

Outcomes

Primary Outcome Measures

Changes in Brain Positron Emission Tomography Signal
The investigators will test for the presence of a significant treatment effect in the brain [11C]PBR28 signal.

Secondary Outcome Measures

Changes in Pain Outcomes as Measured by Self Report on a 0-10 Numerical Pain Rating Scale (Worst Pain in the Past 24 Hours).
The investigators will test for the presence of a significant treatment effect in pain outcomes on a self reported numerical (0-10) pain rating scale. Higher number indicates worse pain.

Full Information

First Posted
March 25, 2019
Last Updated
April 12, 2022
Sponsor
Massachusetts General Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT03891264
Brief Title
Investigation of Cannabidiol for Reduction of NeuroInflammation in Chronic Back Pain
Acronym
CBD
Official Title
Investigation of Cannabidiol for Reduction of NeuroInflammation in Chronic Back Pain
Study Type
Interventional

2. Study Status

Record Verification Date
April 2022
Overall Recruitment Status
Terminated
Why Stopped
Funding obtained to do a larger placebo-controlled trial
Study Start Date
November 13, 2019 (Actual)
Primary Completion Date
November 23, 2020 (Actual)
Study Completion Date
November 23, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Massachusetts General Hospital

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
No

5. Study Description

Brief Summary
In this research, the study team will use brain imaging to evaluate the presence of neuroinflammation in the brains and spinal cords of patients with low back pain, and whether CBD effects levels of neuroinflammation. The efficacy of CBD use for low back pain treatment will also be evaluated by observing whether CBD administration will reduce neuroinflammation and low back pain symptoms.
Detailed Description
The goal of this research study is to test whether "glial cells" (the immune cells of the brain and spinal cord) that are active in patients with low back pain can be reduced with CBD. Previous studies have showed that patients with chronic low back pain demonstrated elevations in brain levels of the 18kDa translocator protein (TSPO), a marker of glial activation. To test this hypothesis, the study team will image the brains and spinal cords of patients suffering from low back pain using integrated magnetic resonance- positron emission tomography (MR-PET), and a radiotracer called [11C]PBR28, which tracks levels of glial activation. The efficacy of CBD as a treatment for chronic low back pain will be evaluated. The study team will observe whether 4 weeks of CBD treatment may reduce glial activation along with self-reported low back pain symptoms. To this end, patients will be evaluated clinically and/or re-scanned after completing the 4-week trial of minocycline. This study will be enrolling individuals who have been suffering from chronic low back pain.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Back Pain, Low

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
7 (Actual)

8. Arms, Groups, and Interventions

Arm Title
CBD Arm
Arm Type
Experimental
Arm Description
Evaluation with Magnetic Resonance-Positron Emission Tomography Imaging and/or behavioral pain assessment before and after a 4-week trial of a liquid formulation of CBD.
Intervention Type
Drug
Intervention Name(s)
Cannabidiol
Other Intervention Name(s)
Epidiolex
Intervention Description
Epidiolex, an agent within the anti-epileptic drug class, will be used. Epidiolex, Greenwich Biosciences Inc.'s CBD formulation, is a 100 mg/mL purified oral solution. The recommended starting dosage is 2.5mg/kg taken twice daily (5mg/kg/day). After one week, the dosage will be increased to a maintenance dosage of 10 mg/kg twice daily (20 mg/kg/day). At the end of the first week, the patient will increase the dose to 10 mg/kg twice daily for the following week.
Primary Outcome Measure Information:
Title
Changes in Brain Positron Emission Tomography Signal
Description
The investigators will test for the presence of a significant treatment effect in the brain [11C]PBR28 signal.
Time Frame
4 weeks
Secondary Outcome Measure Information:
Title
Changes in Pain Outcomes as Measured by Self Report on a 0-10 Numerical Pain Rating Scale (Worst Pain in the Past 24 Hours).
Description
The investigators will test for the presence of a significant treatment effect in pain outcomes on a self reported numerical (0-10) pain rating scale. Higher number indicates worse pain.
Time Frame
4 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: age ≥ 18 and ≤ 75; the ability to give written, informed consent; ongoing pain that averaged at least 4, on a 0-10 scale of pain during a typical week, and present for at least 50% of days during a typical week; fluency in English; on a stable pain treatment (pharmacological or otherwise) for the previous four weeks. Medical records confirming diagnosis of low back pain Chronic low back pain, ongoing for at least 6 months prior to enrollment. Exclusion Criteria: outpatient surgery within 2 months and inpatient surgery within 6 months from the time of scanning; elevated baseline transaminase (ALT and AST) levels above 3 times the Upper Limit of Normal (ULN), accompanied by elevations in bilirubin above 2 times the ULN any interventional pain procedures within 6 weeks prior to scanning procedure or at any point during study enrollment; surgical intervention or introduction/change in opioid regimen at any point during study enrollment contraindications to functional magnetic resonance imaging scanning and positron emission tomography scanning (including presence of a cardiac pacemaker or pacemaker wires, metallic particles in the body, vascular clips in the head or previous neurosurgery, prosthetic heart valves, claustrophobia); current or past history within the last 5 years of major medical illness not affecting the central nervous system, other than chronic pain; implanted spinal cord stimulator (SCS) for pain treatment; any history of neurological illness or major medical illness affecting the central nervous system, unless clearly resolved without long-term consequences; current or past history of major psychiatric illness; PTSD, depression, and anxiety are exclusion criteria only if the conditions were so severe as to require hospitalization in the past year. pregnancy or breast feeding; history of head trauma requiring hospitalization; major cardiac event within the past 10 years; any use of recreational drugs in the past 3 months any marijuana use, medical or recreational, in the past 3 months an abnormal physical exam (e.g., peripheral edema); routine use of opioids ≥ 60 mg morphine equivalents; use of immunosuppressive medications, such as prednisone, TNF medications within 2 weeks of the visit; current bacterial or viral infection; Any other contraindications to CBD administration noted by the study physician. If undergoing blood draws through an arterial line during scan, contraindications to placement of arterial line, such as abnormal result on modified Allen's test on both hands; Raynaud syndrome; bleeding disorder; use of anticoagulants such as Coumadin, Plavix or Lovenox
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jodi Gilman, PhD
Organizational Affiliation
Massachusetts General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
We will make this data available upon request
IPD Sharing Time Frame
Data will become available after 2 years
IPD Sharing Access Criteria
Researchers, not for commercial use

Learn more about this trial

Investigation of Cannabidiol for Reduction of NeuroInflammation in Chronic Back Pain

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