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| ID | Type | Description | Link |
|---|---|---|---|
| P01NS119159 | U.S. NIH Grant/Contract | View source | |
| 2024-519670-39-00 | EU Trial (CTIS) Number |
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| Name | Class |
|---|---|
| National Institute of Neurological Disorders and Stroke (NINDS) | NIH |
| Linkoeping University | OTHER_GOV |
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The goal of this clinical trial is to learn if oxytocin reduces pain in a small area of skin after pulses of non-burning heat by changing how nerves in the heated area react to pressing a thin, bendable plastic bristle and a thick, non-bending plastic bristle in adult, healthy participants. The man questions it aims to answer are:
Does oxytocin increase the number of times a fiber which normally responds only to the thin bristle fires (sends a signal) after the heat pulses.
Does oxytocin raise the number of times a fiber which normally responds only to the thick bristle fires (sends a signal) after the heat pulses.
Researchers will compare oxytocin to a placebo (a look-alike substance that contains no drug) to see if oxytocin ABC works to change how nerves react to light touch and painful pressing in an area of sensitized skin.
Participants will:
Receive an intravenous injection of oxytocin or placebo on one occasion On the same day, a needle will be put near nerve fibers to record their firing before and after a few cycles of short heating of the skin.
This protocol will utilize a randomized, triple-masked study design to compare intravenous (IV) oxytocin to placebo on peripheral nerve response to acute pain sensitization in healthy volunteers. Equal numbers of adult men and women; ages 18-65 will be recruited. Participants, recruited from the regional community will report to the Linköping University Neurophysiologic Research Laboratory (Linköping, Sweden) for a 2-hour visit to complete eligibility screening, informed consent, pregnancy and drug use laboratory tests, and questionnaires regarding drug and alcohol use, and receive training in the tests to be used on the study day.
On a subsequent study day, participants will come initially to the Linköping University Medical Center where an IV catheter will be inserted and they will receive either IV oxytocin (20 IU) or an equal volume of placebo. Study drug will be randomized and administered in two 30-minute infusions separated by the minutes. Rapid rates of oxytocin infusion can cause acute adverse events in the first minutes of infusion. Although these adverse events rapidly resolve despite continuing the infusion, one event (facial flushing) could negate the blind of study personnel. For that reason, the first infusion will be given at 2 rates, a very slow rate for the first 5 minutes and a greater rate for the remaining 25 minutes. This has been demonstrated to reduce the incidence of facial flushing with oxytocin to a rate similar to placebo. Participants will be continuously monitored for vital signs and intermittently queried for any subjective sensations or adverse events during infusion.
After study drug infusion is complete, the IV catheter will be removed and the participant accompanied to the Linköping University Neurophysiologic Research Laboratory, adjacent to the Medical Center, where they will complete psychologic questionnaires and cognitive tests and undergo sensory testing of the skin on the arm of brushing using a computer controlled, robotic system. Then, a 200 micrometer tungsten electrode will be inserted in the radial or peroneal nerve under real-time ultrasound guidance and manipulated until a single nerve fiber and its area of skin innervation (receptive field) are identified. The nerve fiber will be categorized by its speed of conduction and firing pattern to a variety of non-noxious and noxious sensory stimuli to the receptive field. A temperature controlled thermode will be placed on the skin adjacent to and overlapping with the receptive field and acute inflammation induced by 10-second cycles of heating the probe to 50°C with 10 seconds at a non-noxious temperature (30°C) between each heat pulse for a total of 2 minutes. The response of the nerve fiber to noxious and non-noxious stimuli will be repeated.
The primary analysis will compare fiber firing in response to a fixed intensity punctate stimulus in the fiber's receptive field between oxytocin and placebo and will be performed separately on touch-sensitive fibers (fast conducting, low threshold mechanoreceptors (A-LTMRs)) and pain-sensitive fibers (fast conducting, low threshold mechanoreceptors (A-HTMRs)).
Based on numerous studies performed in rodents at Wake Forest University School of Medicine, we hypothesize that acute heat-induced inflammation will render A-LTMRs less responsive to a touch punctate stimulus and A-HTMRs more responsive to a noxious punctate stimulus and that both of these effects will be reduced by at least 50% in participants who receive IV oxytocin. If such results are obtained, they will challenge the existing paradigm that reduction in pain threshold (allodynia) after sensitization from peripheral injury is driven by increased A-LTMR input and support further exploration for the mechanisms by which oxytocin returns changes in touch and pain fibers towards normal to treat pain.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intravenous Oxytocin | Experimental | Oxytocin, 10 International Units (IU) will be administered by IV infusion over 30 minutes and, 30 minutes later, a second 10 IU will be administered over 30 min, for a total dose of 20 IU. The first infusion will be at a rate of 0.125 IU/min for the first 5 min, then at 0.375 IU/min for the remaining 25 min. The second 30-min infusion will be at a fixed rate of 0.333 IU/min. |
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| Intravenous Placebo | Placebo Comparator | Saline will be administered as two 30-min IV infusions separated by 30-min, using the same volume of infusion solution and rates of administration as in the intravenous oxytocin intervention. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Intravenous Oxytocin | Drug | Intravenous oxytocin, 20 IU will be administered via two 30-minute infusions separated by 30 minutes |
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| Measure | Description | Time Frame |
|---|---|---|
| Number of nerve fiber discharges with von Frey filament application | The number of nerve fiber discharges in response to a 5 second application of a 20 mN force von Frey filament and to a 1000 mN force von Frey filament to the area of skin responding to sensory stimulation. These are measured twice, once before and once after skin inflammation induced by heat pulses. | 2-8 hours after start of the first IV infusion |
| Measure | Description | Time Frame |
|---|---|---|
| Verbal pain intensity score with von Frey filament application | Verbal pain intensity score in response to a 5 second application of a 20 mN force von Frey filament and to a 1000 mN force von Frey filament to the area of skin responding to sensory stimulation. Pain scores are obtained twice, once before and once after skin inflammation induced by heat pulses. Pain intensity is rated on a 0-10 scale with 0 being no pain at all and 10 being the worst imaginable pain. |
| Measure | Description | Time Frame |
|---|---|---|
| Exploratory outcome: Score on Digit Symbol Substitution Test (DSST) | DSST is a measure of cognitive information processing speed. DSST is comprised of a paper sheet featuring a key at the top with numbers 1 to 9, each corresponding to a unique symbol. Below this key are five rows containing 25 randomly placed numbers without their associated symbols. Participants are given pencils to write the symbols, and are instructed to substitute as many numbers with their corresponding symbols as possible within a 90-second period, commencing with the leftmost symbol in the first row and proceeding from left to right. The test score is determined by accuracy: enumerating the quantity of correctly inserted symbols, with a range of 0 (no information processing) to 25 (highest information processing speed). It will be performed twice, once before and once after study drug administration in order to explore effects of oxytocin on information processing speed. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Hakan Olausson, MD, PhD | Contact | +46 13286788 | hakan.olausson@liu.se | |
| Saad Nagi, PhD | Contact | +46 13286823 | saad.nagi@liu.se |
| Name | Affiliation | Role |
|---|---|---|
| James Eisenach, MD | Atrium Health Wake Forest University School of Medicine | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Linköping University | Recruiting | Linköping | 58183 | Sweden |
Data will be anonymized and summarized in publications.
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| ID | Term |
|---|---|
| D059787 | Acute Pain |
| D000377 | Agnosia |
| ID | Term |
|---|---|
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D012965 | Sodium Chloride |
| ID | Term |
|---|---|
| D002712 | Chlorides |
| D006851 | Hydrochloric Acid |
| D017606 | Chlorine Compounds |
| D007287 | Inorganic Chemicals |
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Each participant will be randomized to receive an intravenous (IV) infusion of study drug, either IV saline (placebo) or IV oxytocin (20 IU).
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The Linkoeping University (Linkoeping, Sweden) research pharmacy will prepare solutions and dispense them on the day of each study using a randomization stratified by sex that will be concealed until the end of the clinical trial.
| Intravenous Placebo | Drug | Intravenous placebo will be infused in the same volume and timing as the intravenous oxytocin intervention |
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| 2-8 hours after start of the first IV infusion |
| Pattern of nerve fiber discharges with von Frey filament application | The pattern of spikes in response to a 5 second application of 20 mN force von Frey filament and to a 1000 mN force von Frey filament to the area of skin responding to sensory stimulation. Pattern is categorized as one of 4 choices (rapidly adapting, slow adapting, continuous, or on-off) according to standard neurophysiological definitions. These will be measured twice, once before and once after heat-induced inflammation | 2-8 hours after start of the first IV infusion |
| Number of nerve fiber burst discharges with tuning fork application | The number of spike bursts in response to a 2 second application of a 128 Hz tuning fork to the receptive field. If there are any bursts to 128 Hz, then the test will be repeated with, separately, a 75 Hz tuning fork and a 512 Hz tuning fork to the area of skin responding to sensory stimulation. Spike bursts are defined as multiple spikes coinciding with each vibration of the tuning fork. These will be measured twice, once before and once after heat-induced inflammation | 2-8 hours after start of the first IV infusion |
| Number of nerve fiber discharges with warming and cooling | The number of discharges in response to slow warming to 50 degrees C and slow cooling to 0 degrees C by application of a Peltier-controlled thermode to the area of skin responding to sensory stimulation. Spike bursts are defined as multiple spikes coinciding with each vibration of the tuning fork. These will be measured twice, once before and once after heat-induced inflammation | 2-8 hours after start of the first IV infusion |
| Number of nerve fiber discharges with soft brushing | The number of discharges in response to brushing in the receptive field using a computer controlled robotic device at various pressures and speeds. Total discharges with each brush will be measured. The brushing tests will be performed twice, once before and once after heat-induced inflammation | 2-8 hours after start of the first IV infusion |
| Number of nerve fiber discharges with von Frey filament application: stimulus response relationship | The number of discharges in response to 5 sec application of von Frey filaments of 8 different forces from 4-3000 mN, presented in random order to the area of skin responding to sensory stimulation. Threshold will be determined as the lowest force resulting in any discharge. A stimulus response curve will be created using number of discharges to 5 second von Frey application at each of the 8 forces. This stimulus response is measured twice, once before and once after skin inflammation induced by heat pulses. | 2-8 hours after start of the first IV infusion |
| Inflammation response to skin heating | The area of erythema immediately after skin heating to 6 cycles of 50 degrees C for 10 sec over a total of 2 minutes will be calculated by measurement of height and width in mm, with values expressed in mm squared. | 2-8 hours after start of the first IV infusion |
| 1 hour before to 2 hr after start of the first IV infusion |
| Exploratory outcome: Digit Span Test (DST) | DST is a cognitive test of verbal working memory. Sequences are constructed of seven digits for forward recall and six digits for backward recall. Digits are not repeated within a sequence. A forward sequence is first read to the participant and they respond be repeating them in order. A backward sequence is first read to the participant and they respond by repeating them in reverse order, starting with the last digit. The maximum scored without making a mistake on the sequence is scored with a range 0 = no memory to 7 or 6 (maximum memory in forward and backward sequences, respectively) and the sum of these two (0-13) is the outcome score. DST will be performed twice, once before and once after study drug administration in order to explore effects of oxytocin on information processing speed. | 1 hour before to 2 hr after start of the first IV infusion |
| Exploratory outcome: Rey Auditory Verbal Learning Test (RAVLT) | RAVLT assesses verbal learning and memory. A list of 15 words (list A) is read 5o participants 5 times. After each reading (trial), participants are asked to recall as many words as they can (trials 1-5). Then a different list of 15 words is read to the participants, and they are asked to recall words from this list, (trial 6). Participants then are asked to recall words they had learned from List A without cues 5 min (short delayed recall; trial 7) and 30 min (long delayed recall; trial 8) after trial 6. Scores are calculated for (1) Total Immediate Recall (sum of words recalled in trials 1 to 5: range 0 = no recall, 15 = maximum recall); (2) Rate of Learning (trial 5 minus trial 1: range 0 = no learning, 15 = maximum learning); (3) Short Delayed Recall and Long Delayed Recall (at 5 and 30 min after trial 6, respectively) with range 0 - no long delayed recall to 15 - maximum delayed recall. | 30-60 minutes after completing the second IV infusion |
| Exploratory outcome: Perceptual Aberrations Scale (PAS) | PAS is a 35-item self-report questionnaire measuring body image and visual perception aberrations. It is scored on a True/False scale. Its total score ranges from 0 to 35 and it is calculated as the sum of the 'True' responses to all items, except four (i.e. items 6, 13, 24, 25) that are reverse-keyed. Scores range from 0 (no aberrations) to 35 (extreme aberrations). | 1 hour before to 2 hr after start of the first IV infusion |
| Exploratory outcome: State-Trait Anxiety Scale (STAI) | STAI is a 6-item self-report questionnaire measuring anxiety. It is scored on a 4 point Likert scale with positive items (calm, relaxed, content) reverse scored. Total score ranges from 20 (no anxiety) to 80 (severe anxiety) | 1 hour before to 2 hr after start of the first IV infusion |
| Blood pressure | Blood pressure will be measured non-invasively using an automated blood pressure cuff and values for systolic and diastolic pressure measured in mm Hg. | 0 to 6 hr after start of first IV infusion |
| Heart rate | Heart rate will be measured by the same device used to non-invasively measure blood pressure and will be expressed as beats per minute. | 0 to 6 hr after start of first IV infusion |
| D010468 | Perceptual Disorders |
| D019954 | Neurobehavioral Manifestations |
| D009422 | Nervous System Diseases |
| D017670 |
| Sodium Compounds |