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Hydrocodone/Acetaminophen for Acute Pain Following Bunionectomy

A Randomized, Multicenter, Single-Blind Study Comparing Hydrocodone/Acetaminophen Extended Release 10/650, Morphine Extended Release, and Acetaminophen to Placebo in Subjects With Acute Pain Following Bunionectomy

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01038609
Enrollment
250
Registered
2009-12-24
Start date
2009-12-31
Completion date
2010-05-31
Last updated
2014-04-08

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Pain

Keywords

Postoperative Pain

Brief summary

The primary purpose of this study was to evaluate analgesic efficacy and safety of hydrocodone/acetaminophen extended release compared to placebo in moderate to severe pain following primary unilateral first metatarsal bunionectomy.

Detailed description

The bunionectomy was performed under regional anesthesia and propofol sedation. Perioperative anesthesia was standardized for all participants. Upon completion of surgery, designated study personnel ensured continued eligibility per the selection criteria of the protocol. After an appropriate period of time following bunionectomy, participants who had a pain intensity score of ≥ 40 mm on a 100 mm visual analog scale (VAS) and moderate or severe pain intensity per the categorical pain intensity scale were eligible for randomization, in equal numbers, into 1 of 5 treatment arms. In order to maintain the single-blind nature of the study, all participants were dosed with study drug (active and/or placebo) every 6 hours.

Interventions

DRUGMorphine Extended Release
DRUGPlacebo
DRUGAcetaminophen

Sponsors

AbbVie (prior sponsor, Abbott)
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)

Eligibility

Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No

Inclusion criteria

\- Subjects who were in general good health, experiencing moderate to severe pain following bunionectomy surgery and who were willing to remain confined for approximately 4 days following surgery for study procedures.

Exclusion criteria

* Subjects who underwent Base wedge osteotomy and/or Long-Z hart bunionectomy procedures * Allergic reaction to study medications * Pregnant or breastfeeding females * Clinically significant lab abnormalities at screening * Positive hepatitis testing at screening * Clinically significant or uncontrolled medical disorders or illness at screening * Active malignancy or chemotherapy * Any history of drug or alcohol abuse/addiction * Known or suspected history of human immunodeficiency virus (HIV); requires treatment with monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs) or butyrophenones * History of major depressive episode or major psychiatric disorder * Current systemic corticosteroid therapy * Inability to refrain from smoking during or alcohol during stay at investigative site

Design outcomes

Primary

MeasureTime frameDescription
Sum of Pain Intensity Difference (SPID) Using the Pain Intensity Visual Analogue Scale (VAS)From time of first study drug administration to 48 hours following first study drug administrationParticipants assessed pain intensity on a 100 mm visual analogue scale (VAS) with 0 meaning no pain and 100 meaning the worst pain imaginable. The SPID VAS score for 0 to 48 hours following initial study drug dose measured the cumulative pain intensity difference during treatment with higher mean SPID VAS scores indicating greater improvement from Baseline. The SPID score is a measure of the cumulative pain intensity difference during treatment and the area under the curve was estimated using the linear trapezoidal rule.

Secondary

MeasureTime frameDescription
Participant's Global Assessment of Study DrugFrom time of first study drug administration to 48 hours following first study drug administrationThe participant's overall impression of the study drug was obtained on a 5-point categorical scale: excellent; very good; good; fair; poor.
Time to Perceptible and Meaningful Pain ReliefFrom time of first study drug administration to 12 hours following first study drug administrationThe median time (minutes) from first perceptible pain relief (onset of pain relief) and time until first meaningful pain relief.
TOTPAR (Total Pain Relief)From time of first study drug administration to 48 hours following first study drug administrationTOTPAR was the time-interval weighted sum of pain relief. Pain relief was assessed by participants' responses to how their pain relief was compared with the pain they had just before receiving the first dose of study drug: no relief, a little relief, some relief, a lot of relief, or complete relief. Higher mean TOTPAR scores indicate better pain relief. The TOTPAR score is a measure of the cumulative pain intensity difference during treatment and the area under the curve was estimated using the linear trapezoidal rule.
Number of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaAt specified intervals from Screening through 7 days after first dose of study drugPotentially clinically significant criteria: Systolic blood pressure (BP) ≤90 mm Hg and ≥20 mm Hg decrease (low) or ≥180 mm Hg and ≥20 mm Hg increase (high); Diastolic BP ≤50 mm Hg and ≥15 mm Hg decrease (low) or ≥105 mm Hg and ≥15 mm Hg increase (high). Heart rate ≤50 beats per minute (bpm) and ≥15 bpm decrease (low) or ≥120 bpm and ≥15 bpm increase (high). Respiratory rate \<10 respirations per minute (rpm) (low) or \>24 rpm (high).
Number of Participants With Chemistry Values Meeting Potentially Clinically Significant CriteriaAt specified intervals from Screening through 7 days after first dose of study drugPotentially clinically significant criteria: alanine aminotransferase/aspartate aminotransferase (ALT/AST) ≥3 times upper limit of normal (ULN); calcium ≤1.8 mmol/L.
Participants With Adverse Events (AEs)AEs were recorded from study drug administration until 30 days following discontinuation of study drug (total 32 days); SAEs were recorded from the time informed consent was obtained until 30 days following discontinuation of study drug (total 51 days).An adverse event (AE) is defined as any untoward medical occurrence in a participant, which does not necessarily have a causal relationship with treatment. If an adverse event meets any of the following criteria, it is considered a serious adverse event (SAE): results in death or is life-threatening, results in admission or prolongation of hospitalization, results in congenital anomaly or persistent or significant disability/incapacity, or is an important medical event requiring medical or surgical intervention to prevent serious outcome. AEs were categorized by severity (mild, moderate, severe) and relationship to treatment (probably, possibly, probably not, not related). Please see Adverse Events section below for more details.

Countries

United States

Participant flow

Participants by arm

ArmCount
Acetaminophen
1 dose of 1 placebo capsule (for morphine extended release) plus 1 acetaminophen tablet, administered once every 12 hours, and 1 dose of 1 acetaminophen tablet, administered once every 6 hours (for a total of 8 doses).
50
Morphine Extended Release
1 dose of 1 placebo tablet (for hydrocodone/acetaminophen extended release) plus 1 morphine extended release capsule, administered once every 12 hours, and 1 dose of 1 placebo tablet (for hydrocodone/acetaminophen extended release), administered once every 6 hours (for a total of 8 doses).
52
Morphine Extended Release / Acetaminophen
1 dose of 1 morphine extended release capsule plus 1 acetaminophen tablet, administered once every 12 hours, and 1 dose of 1 acetaminophen tablet, administered once every 6 hours (for a total of 8 doses).
49
Hydrocodone/Acetaminophen Extended Release
1 dose of 1 hydrocodone/acetaminophen extended release tablet plus 1 placebo capsule (for morphine extended release), administered once every 12 hours, and 1 dose of 1 placebo tablet (for hydrocodone/acetaminophen extended release), administered once every 6 hours (for a total of 8 doses).
48
Placebo
1 dose of 1 placebo tablet (for hydrocodone/acetaminophen extended release) plus 1 placebo capsule (for morphine extended release), administered once every 12 hours, and 1 dose of 1 placebo tablet (for hydrocodone/acetaminophen extended release), administered once every 6 hours (for a total of 8 doses).
51
Total250

Withdrawals & dropouts

PeriodReasonFG000FG001FG002FG003FG004
Overall StudyAdverse Event00100
Overall StudyDeath in the Family10000
Overall StudyDosing Error00011
Overall StudyRefusal of Blood Draws01000

Baseline characteristics

CharacteristicAcetaminophenMorphine Extended ReleaseMorphine Extended Release / AcetaminophenHydrocodone/Acetaminophen Extended ReleasePlaceboTotal
Age, Continuous44.9 years
STANDARD_DEVIATION 13.83
44.0 years
STANDARD_DEVIATION 12.93
40.2 years
STANDARD_DEVIATION 11.31
40.4 years
STANDARD_DEVIATION 13.16
45.2 years
STANDARD_DEVIATION 12.47
43.0 years
STANDARD_DEVIATION 12.85
Sex: Female, Male
Female
45 Participants44 Participants39 Participants41 Participants45 Participants214 Participants
Sex: Female, Male
Male
5 Participants8 Participants10 Participants7 Participants6 Participants36 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
EG004
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —— / —— / —
other
Total, other adverse events
19 / 5021 / 5226 / 4927 / 4820 / 51
serious
Total, serious adverse events
0 / 500 / 520 / 490 / 480 / 51

Outcome results

Primary

Sum of Pain Intensity Difference (SPID) Using the Pain Intensity Visual Analogue Scale (VAS)

Participants assessed pain intensity on a 100 mm visual analogue scale (VAS) with 0 meaning no pain and 100 meaning the worst pain imaginable. The SPID VAS score for 0 to 48 hours following initial study drug dose measured the cumulative pain intensity difference during treatment with higher mean SPID VAS scores indicating greater improvement from Baseline. The SPID score is a measure of the cumulative pain intensity difference during treatment and the area under the curve was estimated using the linear trapezoidal rule.

Time frame: From time of first study drug administration to 48 hours following first study drug administration

Population: All randomized participants who received at least 1 dose of study drug. Analyses were performed based on the treatment participants actually received (as-treated).

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
AcetaminophenSum of Pain Intensity Difference (SPID) Using the Pain Intensity Visual Analogue Scale (VAS)720.5 scores on a scaleStandard Error 154.89
Morphine Extended ReleaseSum of Pain Intensity Difference (SPID) Using the Pain Intensity Visual Analogue Scale (VAS)239.9 scores on a scaleStandard Error 151.41
Morphine Extended Release / AcetaminophenSum of Pain Intensity Difference (SPID) Using the Pain Intensity Visual Analogue Scale (VAS)614.4 scores on a scaleStandard Error 156.92
Hydrocodone/Acetaminophen Extended ReleaseSum of Pain Intensity Difference (SPID) Using the Pain Intensity Visual Analogue Scale (VAS)450.8 scores on a scaleStandard Error 159.62
PlaceboSum of Pain Intensity Difference (SPID) Using the Pain Intensity Visual Analogue Scale (VAS)-57.6 scores on a scaleStandard Error 153.99
Secondary

Number of Participants With Chemistry Values Meeting Potentially Clinically Significant Criteria

Potentially clinically significant criteria: alanine aminotransferase/aspartate aminotransferase (ALT/AST) ≥3 times upper limit of normal (ULN); calcium ≤1.8 mmol/L.

Time frame: At specified intervals from Screening through 7 days after first dose of study drug

Population: All randomized participants who received at least 1 dose of study drug. Analyses were performed based on the treatment participants actually received (as-treated).

ArmMeasureGroupValue (NUMBER)
AcetaminophenNumber of Participants With Chemistry Values Meeting Potentially Clinically Significant CriteriaAST >= 3 * ULN1 participants
AcetaminophenNumber of Participants With Chemistry Values Meeting Potentially Clinically Significant CriteriaALT >= 3 * ULN1 participants
AcetaminophenNumber of Participants With Chemistry Values Meeting Potentially Clinically Significant CriteriaCalcium <= 1.8 mmol/L0 participants
Morphine Extended ReleaseNumber of Participants With Chemistry Values Meeting Potentially Clinically Significant CriteriaAST >= 3 * ULN2 participants
Morphine Extended ReleaseNumber of Participants With Chemistry Values Meeting Potentially Clinically Significant CriteriaALT >= 3 * ULN2 participants
Morphine Extended ReleaseNumber of Participants With Chemistry Values Meeting Potentially Clinically Significant CriteriaCalcium <= 1.8 mmol/L0 participants
Morphine Extended Release / AcetaminophenNumber of Participants With Chemistry Values Meeting Potentially Clinically Significant CriteriaAST >= 3 * ULN3 participants
Morphine Extended Release / AcetaminophenNumber of Participants With Chemistry Values Meeting Potentially Clinically Significant CriteriaALT >= 3 * ULN3 participants
Morphine Extended Release / AcetaminophenNumber of Participants With Chemistry Values Meeting Potentially Clinically Significant CriteriaCalcium <= 1.8 mmol/L1 participants
Hydrocodone/Acetaminophen Extended ReleaseNumber of Participants With Chemistry Values Meeting Potentially Clinically Significant CriteriaALT >= 3 * ULN0 participants
Hydrocodone/Acetaminophen Extended ReleaseNumber of Participants With Chemistry Values Meeting Potentially Clinically Significant CriteriaCalcium <= 1.8 mmol/L0 participants
Hydrocodone/Acetaminophen Extended ReleaseNumber of Participants With Chemistry Values Meeting Potentially Clinically Significant CriteriaAST >= 3 * ULN0 participants
PlaceboNumber of Participants With Chemistry Values Meeting Potentially Clinically Significant CriteriaAST >= 3 * ULN0 participants
PlaceboNumber of Participants With Chemistry Values Meeting Potentially Clinically Significant CriteriaALT >= 3 * ULN0 participants
PlaceboNumber of Participants With Chemistry Values Meeting Potentially Clinically Significant CriteriaCalcium <= 1.8 mmol/L2 participants
Secondary

Number of Participants With Vital Signs Values Meeting Potentially Clinically Significant Criteria

Potentially clinically significant criteria: Systolic blood pressure (BP) ≤90 mm Hg and ≥20 mm Hg decrease (low) or ≥180 mm Hg and ≥20 mm Hg increase (high); Diastolic BP ≤50 mm Hg and ≥15 mm Hg decrease (low) or ≥105 mm Hg and ≥15 mm Hg increase (high). Heart rate ≤50 beats per minute (bpm) and ≥15 bpm decrease (low) or ≥120 bpm and ≥15 bpm increase (high). Respiratory rate \<10 respirations per minute (rpm) (low) or \>24 rpm (high).

Time frame: At specified intervals from Screening through 7 days after first dose of study drug

Population: All randomized participants who received at least 1 dose of study drug. Analyses were performed based on the treatment participants actually received (as-treated).

ArmMeasureGroupValue (NUMBER)
AcetaminophenNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaSystolic BP decrease3 participants
AcetaminophenNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaSystolic BP increase1 participants
AcetaminophenNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaDiastolic BP decrease2 participants
AcetaminophenNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaDiastolic BP increase0 participants
AcetaminophenNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaHeart rate decrease3 participants
AcetaminophenNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaHeart rate increase1 participants
AcetaminophenNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaRespiratory rate < 10 rpm0 participants
AcetaminophenNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaRespiratory rate > 24 rpm0 participants
Morphine Extended ReleaseNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaDiastolic BP decrease5 participants
Morphine Extended ReleaseNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaHeart rate increase0 participants
Morphine Extended ReleaseNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaSystolic BP decrease6 participants
Morphine Extended ReleaseNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaDiastolic BP increase0 participants
Morphine Extended ReleaseNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaSystolic BP increase0 participants
Morphine Extended ReleaseNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaRespiratory rate > 24 rpm0 participants
Morphine Extended ReleaseNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaHeart rate decrease1 participants
Morphine Extended ReleaseNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaRespiratory rate < 10 rpm0 participants
Morphine Extended Release / AcetaminophenNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaRespiratory rate < 10 rpm0 participants
Morphine Extended Release / AcetaminophenNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaRespiratory rate > 24 rpm0 participants
Morphine Extended Release / AcetaminophenNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaDiastolic BP increase2 participants
Morphine Extended Release / AcetaminophenNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaHeart rate increase0 participants
Morphine Extended Release / AcetaminophenNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaDiastolic BP decrease6 participants
Morphine Extended Release / AcetaminophenNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaSystolic BP increase0 participants
Morphine Extended Release / AcetaminophenNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaSystolic BP decrease8 participants
Morphine Extended Release / AcetaminophenNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaHeart rate decrease0 participants
Hydrocodone/Acetaminophen Extended ReleaseNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaSystolic BP increase0 participants
Hydrocodone/Acetaminophen Extended ReleaseNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaDiastolic BP decrease5 participants
Hydrocodone/Acetaminophen Extended ReleaseNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaDiastolic BP increase0 participants
Hydrocodone/Acetaminophen Extended ReleaseNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaHeart rate decrease2 participants
Hydrocodone/Acetaminophen Extended ReleaseNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaHeart rate increase1 participants
Hydrocodone/Acetaminophen Extended ReleaseNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaRespiratory rate > 24 rpm0 participants
Hydrocodone/Acetaminophen Extended ReleaseNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaSystolic BP decrease2 participants
Hydrocodone/Acetaminophen Extended ReleaseNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaRespiratory rate < 10 rpm0 participants
PlaceboNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaDiastolic BP increase0 participants
PlaceboNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaRespiratory rate > 24 rpm0 participants
PlaceboNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaDiastolic BP decrease2 participants
PlaceboNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaRespiratory rate < 10 rpm0 participants
PlaceboNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaSystolic BP decrease5 participants
PlaceboNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaHeart rate increase0 participants
PlaceboNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaSystolic BP increase1 participants
PlaceboNumber of Participants With Vital Signs Values Meeting Potentially Clinically Significant CriteriaHeart rate decrease0 participants
Secondary

Participant's Global Assessment of Study Drug

The participant's overall impression of the study drug was obtained on a 5-point categorical scale: excellent; very good; good; fair; poor.

Time frame: From time of first study drug administration to 48 hours following first study drug administration

Population: All randomized participants who received at least 1 dose of study drug. Analyses were performed based on the treatment participants actually received (as-treated).

ArmMeasureGroupValue (NUMBER)
AcetaminophenParticipant's Global Assessment of Study DrugExcellent9 participants
AcetaminophenParticipant's Global Assessment of Study DrugFair10 participants
AcetaminophenParticipant's Global Assessment of Study DrugPoor0 participants
AcetaminophenParticipant's Global Assessment of Study DrugGood16 participants
AcetaminophenParticipant's Global Assessment of Study DrugVery Good15 participants
Morphine Extended ReleaseParticipant's Global Assessment of Study DrugGood14 participants
Morphine Extended ReleaseParticipant's Global Assessment of Study DrugPoor11 participants
Morphine Extended ReleaseParticipant's Global Assessment of Study DrugFair3 participants
Morphine Extended ReleaseParticipant's Global Assessment of Study DrugExcellent8 participants
Morphine Extended ReleaseParticipant's Global Assessment of Study DrugVery Good16 participants
Morphine Extended Release / AcetaminophenParticipant's Global Assessment of Study DrugPoor3 participants
Morphine Extended Release / AcetaminophenParticipant's Global Assessment of Study DrugGood12 participants
Morphine Extended Release / AcetaminophenParticipant's Global Assessment of Study DrugExcellent4 participants
Morphine Extended Release / AcetaminophenParticipant's Global Assessment of Study DrugFair11 participants
Morphine Extended Release / AcetaminophenParticipant's Global Assessment of Study DrugVery Good19 participants
Hydrocodone/Acetaminophen Extended ReleaseParticipant's Global Assessment of Study DrugPoor2 participants
Hydrocodone/Acetaminophen Extended ReleaseParticipant's Global Assessment of Study DrugVery Good20 participants
Hydrocodone/Acetaminophen Extended ReleaseParticipant's Global Assessment of Study DrugFair4 participants
Hydrocodone/Acetaminophen Extended ReleaseParticipant's Global Assessment of Study DrugExcellent7 participants
Hydrocodone/Acetaminophen Extended ReleaseParticipant's Global Assessment of Study DrugGood15 participants
PlaceboParticipant's Global Assessment of Study DrugExcellent3 participants
PlaceboParticipant's Global Assessment of Study DrugVery Good17 participants
PlaceboParticipant's Global Assessment of Study DrugPoor4 participants
PlaceboParticipant's Global Assessment of Study DrugGood12 participants
PlaceboParticipant's Global Assessment of Study DrugFair15 participants
Secondary

Participants With Adverse Events (AEs)

An adverse event (AE) is defined as any untoward medical occurrence in a participant, which does not necessarily have a causal relationship with treatment. If an adverse event meets any of the following criteria, it is considered a serious adverse event (SAE): results in death or is life-threatening, results in admission or prolongation of hospitalization, results in congenital anomaly or persistent or significant disability/incapacity, or is an important medical event requiring medical or surgical intervention to prevent serious outcome. AEs were categorized by severity (mild, moderate, severe) and relationship to treatment (probably, possibly, probably not, not related). Please see Adverse Events section below for more details.

Time frame: AEs were recorded from study drug administration until 30 days following discontinuation of study drug (total 32 days); SAEs were recorded from the time informed consent was obtained until 30 days following discontinuation of study drug (total 51 days).

Population: All randomized participants who received at least 1 dose of study drug. Analyses were performed based on the treatment participants actually received (as-treated).

ArmMeasureGroupValue (NUMBER)
AcetaminophenParticipants With Adverse Events (AEs)Any AE28 participants
AcetaminophenParticipants With Adverse Events (AEs)Death0 participants
AcetaminophenParticipants With Adverse Events (AEs)Any AE leading to death0 participants
AcetaminophenParticipants With Adverse Events (AEs)Any severe AE1 participants
AcetaminophenParticipants With Adverse Events (AEs)Any AE at least possibly drug related23 participants
AcetaminophenParticipants With Adverse Events (AEs)Any SAE0 participants
AcetaminophenParticipants With Adverse Events (AEs)Any AE leading to discontinuation of study drug0 participants
Morphine Extended ReleaseParticipants With Adverse Events (AEs)Any AE leading to discontinuation of study drug0 participants
Morphine Extended ReleaseParticipants With Adverse Events (AEs)Any SAE0 participants
Morphine Extended ReleaseParticipants With Adverse Events (AEs)Any AE at least possibly drug related23 participants
Morphine Extended ReleaseParticipants With Adverse Events (AEs)Any AE29 participants
Morphine Extended ReleaseParticipants With Adverse Events (AEs)Any AE leading to death0 participants
Morphine Extended ReleaseParticipants With Adverse Events (AEs)Any severe AE1 participants
Morphine Extended ReleaseParticipants With Adverse Events (AEs)Death0 participants
Morphine Extended Release / AcetaminophenParticipants With Adverse Events (AEs)Any SAE0 participants
Morphine Extended Release / AcetaminophenParticipants With Adverse Events (AEs)Any AE28 participants
Morphine Extended Release / AcetaminophenParticipants With Adverse Events (AEs)Any AE at least possibly drug related23 participants
Morphine Extended Release / AcetaminophenParticipants With Adverse Events (AEs)Any severe AE2 participants
Morphine Extended Release / AcetaminophenParticipants With Adverse Events (AEs)Any AE leading to discontinuation of study drug1 participants
Morphine Extended Release / AcetaminophenParticipants With Adverse Events (AEs)Any AE leading to death0 participants
Morphine Extended Release / AcetaminophenParticipants With Adverse Events (AEs)Death0 participants
Hydrocodone/Acetaminophen Extended ReleaseParticipants With Adverse Events (AEs)Any severe AE5 participants
Hydrocodone/Acetaminophen Extended ReleaseParticipants With Adverse Events (AEs)Any AE leading to discontinuation of study drug0 participants
Hydrocodone/Acetaminophen Extended ReleaseParticipants With Adverse Events (AEs)Any AE at least possibly drug related24 participants
Hydrocodone/Acetaminophen Extended ReleaseParticipants With Adverse Events (AEs)Death0 participants
Hydrocodone/Acetaminophen Extended ReleaseParticipants With Adverse Events (AEs)Any AE leading to death0 participants
Hydrocodone/Acetaminophen Extended ReleaseParticipants With Adverse Events (AEs)Any AE33 participants
Hydrocodone/Acetaminophen Extended ReleaseParticipants With Adverse Events (AEs)Any SAE0 participants
PlaceboParticipants With Adverse Events (AEs)Any severe AE1 participants
PlaceboParticipants With Adverse Events (AEs)Death0 participants
PlaceboParticipants With Adverse Events (AEs)Any AE leading to death0 participants
PlaceboParticipants With Adverse Events (AEs)Any AE leading to discontinuation of study drug0 participants
PlaceboParticipants With Adverse Events (AEs)Any AE at least possibly drug related19 participants
PlaceboParticipants With Adverse Events (AEs)Any AE28 participants
PlaceboParticipants With Adverse Events (AEs)Any SAE0 participants
Secondary

Time to Perceptible and Meaningful Pain Relief

The median time (minutes) from first perceptible pain relief (onset of pain relief) and time until first meaningful pain relief.

Time frame: From time of first study drug administration to 12 hours following first study drug administration

Population: All randomized participants who received at least 1 dose of study drug. Analyses were performed based on the treatment participants actually received (as-treated).

ArmMeasureGroupValue (MEDIAN)
AcetaminophenTime to Perceptible and Meaningful Pain ReliefTime to Onset of Meaningful Pain Relief62.5 minutes
AcetaminophenTime to Perceptible and Meaningful Pain ReliefTime to Onset of Perceptible Pain Relief25.5 minutes
Morphine Extended ReleaseTime to Perceptible and Meaningful Pain ReliefTime to Onset of Perceptible Pain Relief32.0 minutes
Morphine Extended ReleaseTime to Perceptible and Meaningful Pain ReliefTime to Onset of Meaningful Pain Relief142.0 minutes
Morphine Extended Release / AcetaminophenTime to Perceptible and Meaningful Pain ReliefTime to Onset of Meaningful Pain Relief101.0 minutes
Morphine Extended Release / AcetaminophenTime to Perceptible and Meaningful Pain ReliefTime to Onset of Perceptible Pain Relief31.0 minutes
Hydrocodone/Acetaminophen Extended ReleaseTime to Perceptible and Meaningful Pain ReliefTime to Onset of Perceptible Pain Relief22.5 minutes
Hydrocodone/Acetaminophen Extended ReleaseTime to Perceptible and Meaningful Pain ReliefTime to Onset of Meaningful Pain Relief60.5 minutes
PlaceboTime to Perceptible and Meaningful Pain ReliefTime to Onset of Meaningful Pain Relief220.0 minutes
PlaceboTime to Perceptible and Meaningful Pain ReliefTime to Onset of Perceptible Pain Relief23.0 minutes
Secondary

TOTPAR (Total Pain Relief)

TOTPAR was the time-interval weighted sum of pain relief. Pain relief was assessed by participants' responses to how their pain relief was compared with the pain they had just before receiving the first dose of study drug: no relief, a little relief, some relief, a lot of relief, or complete relief. Higher mean TOTPAR scores indicate better pain relief. The TOTPAR score is a measure of the cumulative pain intensity difference during treatment and the area under the curve was estimated using the linear trapezoidal rule.

Time frame: From time of first study drug administration to 48 hours following first study drug administration

Population: All randomized participants who received at least 1 dose of study drug. Analyses were performed based on the treatment participants actually received (as-treated).

ArmMeasureValue (LEAST_SQUARES_MEAN)Dispersion
AcetaminophenTOTPAR (Total Pain Relief)65.9 scores on a scaleStandard Error 7.17
Morphine Extended ReleaseTOTPAR (Total Pain Relief)42.7 scores on a scaleStandard Error 7.01
Morphine Extended Release / AcetaminophenTOTPAR (Total Pain Relief)49.5 scores on a scaleStandard Error 7.24
Hydrocodone/Acetaminophen Extended ReleaseTOTPAR (Total Pain Relief)56.3 scores on a scaleStandard Error 7.34
PlaceboTOTPAR (Total Pain Relief)32.9 scores on a scaleStandard Error 7.12

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026