Overview

This trial is active, not recruiting.

Condition pain
Treatments 2 mg iv hydromorphone, usual care
Phase phase 4
Sponsor Montefiore Medical Center
Start date March 2010
End date January 2012
Trial size 350 participants
Trial identifier NCT01429298, MMC 09-11-346

Summary

In this randomized controlled trial, 2 mg IV hydromorphone will be more efficacious than usual care (usual care is analgesic management according to the judgment of the attending physician caring for that patient) in emergency department (ED) patients aged 21-64 years. The primary efficacy outcomes are the proportion of patients in each arm who choose to forgo additional pain medication in 30 minutes of entry into the study and the change in NRS pain scores from baseline to 30 minutes post baseline.

United States No locations recruiting
Other Countries No locations recruiting

Study Design

Allocation randomized
Endpoint classification safety/efficacy study
Intervention model single group assignment
Masking single blind (subject)
Primary purpose treatment
Arm
(Experimental)
2 mg IV hydromorphone
2 mg iv hydromorphone Dilaudid
2 mg IV hydromorphone
(Active Comparator)
The attending physician administer whatever IV opioid he/she chooses in whatever dose he/she chooses
usual care
Attending administers IV opioid of his choosing

Primary Outcomes

Measure
Difference in successful treatment at 30 minutes
time frame: 30 minutes

Eligibility Criteria

Male or female participants from 21 years up to 65 years old.

Inclusion Criteria: 1. Age greater than 21 years and less than 65 years: This is a study of non-elderly adult patients. 2. Pain with onset within 7 days: Pain within seven days is the definition of acute pain that has been used in ED literature. 3. ED attending physician's judgment that patient's pain warrants IV opioids: The factors that influence the decision to use parenteral opioids are complex. An approach that is commonly taken to address the issue of patient selection in drug trials is to use a specific condition (e.g., renal colic) that would generally be thought to be appropriately treated with an opioid analgesic, thereby eliminating individual judgment about eligibility for the study. However in order to maximize the external validity of the role of opioids in the ED setting, the investigators decided to enroll patients with a variety of diagnoses, all with a complaint of acute pain. Opioids are not an appropriate treatment for all patients who present with a complaint of pain (e.g., gastroenteritis, migraine). Therefore, unless there is a restriction to patients with a specific diagnosis, either an extensive list of diagnoses and situations in which opioids are indicated must be specified, or clinical judgment needs to be used. The investigators have opted for the latter, since it most closely approximates the circumstances of clinical practice. Exclusion Criteria: 1. Use of other opioids or tramadol within past 24 hours: to avoid introducing assembly bias related to recent opioid use, since this may affect baseline levels of pain and need for analgesics. 2. Prior adverse reaction to opioids. 3. Chronic pain syndrome: frequently recurrent or daily pain for at least 3 months results in modulation of pain perception which is thought to be due to down-regulation of pain receptors. Examples of chronic pain syndromes include sickle cell anemia, osteoarthritis, fibromyalgia, and peripheral neuropathies. 4. Alcohol intoxication: the presence of alcohol intoxication as judged by the treating physician may alter pain perception. 5. SBP <90 mm Hg: Opioids can produce peripheral vasodilation that may result in orthostatic hypotension. 6. Oxygen saturation < 95% on room air: For this study, oxygen saturation must be 95% or above on room air in order to be enrolled. 7. Use of MAO inhibitors in past 30 days: MAO inhibitors have been reported to intensify the effects of at least one opioid drug causing anxiety, confusion and significant respiratory depression or coma. 8. C02 measurement greater than 46: In accordance with standard protocol, three subsets of patients will have their CO2 measured using a handheld capnometer prior to enrollment in the study. If the CO2 measurement is greater than 46 then the patient will be excluded from the study. The 3 subsets are as follows: - All patients who have a history of COPD - All patients who report a history of asthma together with greater than a 20 pack-year smoking history - All patients reporting less than a 20 pack-year smoking history who are having an asthma exacerbation

Additional Information

Official title Randomized Clinical Trial Comparing IV Hydromorphone to Usual Care
Trial information was received from ClinicalTrials.gov and was last updated in September 2011.
Information provided to ClinicalTrials.gov by Montefiore Medical Center.