Androgen Deficiency, Back Pain, Opioid Use, Pain
Conditions
Keywords
Opioid Use, Pain, Women, Testosterone, Back Pain
Brief summary
The aim of this trial is to evaluate whether testosterone replacement results in greater improvement in pain perception, pain tolerance, sexual function, physical function and quality of life when compared with placebo in women with chronic back pain treated with opioids who have low testosterone.
Detailed description
This single-center, randomized, double-blind, placebo-controlled, parallel-group trial will evaluate pain and quality of life outcomes associated with 3 months of treatment with testosterone or placebo in women aged 60 years or older with chronic non-cancer back pain who are taking opioid analgesics for at least 6 months and have low testosterone.
Interventions
DRUGTestosterone Cypionate
Weekly intramuscular administration of testosterone at a dose of 3 mg
DRUGPlacebo
Weekly intramuscular administration of Placebo
Sponsors
Brigham and Women's Hospital
National Institutes of Health (NIH)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Women, age 60 years and older. * Chronic non-cancer back pain. * Use of opioid analgesics for at least 6 months. * Serum total testosterone \<8.7 ng/dL and/or free testosterone \<0.47 pg/mL. * Normal mammogram within the last 12 months * Endometrial thickness of \<4 mm in women with an intact uterus assessed by endometrial ultrasound. * Ability and willingness to provide informed consent.
Exclusion criteria
* History of breast or endometrial cancer * Estrogen therapy in the past 3 months * Baseline hematocrit \>48%. * Serum creatinine \>2.5 mg/dL. * HbA1c \>9.0%. Subjects on insulin therapy will be excluded. * BMI \>40 kg/m2. * Uncontrolled congestive heart failure. * Myocardial infarction, acute coronary syndrome, revascularization surgery or stroke within the past 3 months. * History of genetic thromboembolic disorder. * Diagnosis of bipolar disorder or schizophrenia. * Use of testosterone, spironolactone, finasteride or systemic ketoconazole in the past 3 months.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain Interference Subscale score of the Brief Pain Inventory (BPI) questionnaire | 3 months | The Pain Interference Subscale of the BPI is specifically relevant to patients with chronic back pain who are using opioids and correlates strongly with the patient's quality of life. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Algometer-induced Pressure Pain | 3 months | A digital pressure algometer at the trapezius muscle and the metacarpophalangeal joint of the thumb was used to measure pressure pain thresholds. Higher values represent a better tolerance of pressure pain. |
| Weighted Pinprick Stimulator-induced Mechanical Pain | 3 months | Weighted pinprick stimulators are used to assess mechanical pain. Lower values represent better tolerance of pain |
| Ice Water-induced Cold Pain and Its After-sensation | 3 months | Cold-pressor tests measure cold-induced pain and its sensation. Time was measured when a participant reached pain tolerance in cold water and after sensation. Higher values of time in Cold pain tolerance and lower values of time in Cold pain after-sensation (30 seconds) represent better tolerance of pain. |
| Health Quality of Life (QoL) as Assessed by Short Form 36 (SF-36) | 3 months | The SF-36 measures 8 domains of the QoL: physical function, bodily pain, vitality, role limitations due to physical problems, general health perceptions, emotional well-being, social function, and role limitations due to emotional problems. Each domain is scored separately from 0 to 100 with higher scores representing better health-related QoL. |
| Mood and well-being, assessed using the by Positive and Negative Affect Scale (PANAS) affectivity balance scale | 3 months | The PANAS affectivity balance scale includes 10 questions evaluating positive and negative affect. |
| Physical function, assessed using the 6-minute walk test (6-MWT) | 3 months | Subjects will be asked to walk for 6 minutes at a comfortable pace on a premeasured flat surface; gait speed will be calculated by the distance walked (m) in 6 minutes. The 6-minute walk test (6-MWT) is an objective test of physical function validated in older adults and in women with chronic low back pain. |
| Sexual Function assessed by the Female Sexual Distress Scale (FSDS) | 3 months | For this 13-item questionnaire, women rate each item in terms of frequency from 0 (never) to 4 (always). Items are summed to create a total score ranging from 0 to 52, with higher scores indicating more sexually related distress |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORShehzad Basaria, M.D.
Brigham and Women's Hospital
Outcome results
None listed