Metabolic and Endocrine Effects of Repeated Epidural and Sacroiliac Joint Corticosteroid Injections
10 december 2014 uppdaterad av: Dr. Ryan Amadeo, University of Manitoba
Repeated Epidural and Sacroiliac Joint Glucocorticoid Injections and Their Effect on Hypothalamic-Pituitary-Adrenal Axis Suppression and Metabolic Status
Corticosteroid injections into the epidural space or sacroiliac joint are increasingly used for the treatment of chronic neck, low back, and leg pain. These injections may have several side effects, including suppression of the body's adrenal glands to produce steroids (adrenal suppression) and negative effects on metabolism (weight gain, increased blood pressure, and high blood sugar levels).
The purpose of this study is to determine the time course and predictors of adrenal suppression and the metabolic effects of corticosteroid injections for chronic pain.
The investigators hypothesize normalization of adrenal function to occur within three weeks of injection in most individuals. An increased frequency of injections is predicted to lead to prolonged adrenal suppression. Corticosteroid injections are also hypothesized to lead to increases in body weight, blood pressure, and blood sugar levels, particularly in diabetic individuals.
Studieöversikt
Status
Okänd
Betingelser
Detaljerad beskrivning
Interventional pain procedures using corticosteroid injections (CIs), such as epidural steroid injections (ESIs) and sacroiliac joint injections (SIJIs), may have adverse metabolic and endocrine effects, including suppression of the hypothalamic-pituitary-adrenal axis (HPAA), hypertension, weight gain, and hyperglycemia. Based on sparse data on these adverse effects following repeated, long-term CIs, current guidelines suggest a maximum frequency of four to six injections annually, even though patients may benefit from more frequent treatments.
This prospective cohort study will follow first-time or repeat ESI or SIJI patients receiving injections with 0.5 mL bupivacaine 0.25% and 15 mg dexamethasone sodium phosphate at a maximum frequency of once every six weeks in order to:
- determine the frequency and duration of HPAA suppression;
- determine the incidence and predictors of prolonged (≥ 3 weeks) HPAA suppression;
- determine the baseline incidence and predictors of HPAA suppression in chronic pain patients presenting for their first CI; and
- determine the effect of CIs on body weight, resting blood pressure, and glycemic control over a six-month period.
Studietyp
Observationell
Inskrivning (Förväntat)
126
Kontakter och platser
Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.
Studieorter
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Manitoba
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Winnipeg, Manitoba, Kanada, R3Y 1X1
- Rekrytering
- Health Sciences Centre
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Kontakt:
- Maria Loureiro
- Telefonnummer: 204-787-2404
- E-post: healthtrials@hsc.mb.ca
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Deltagandekriterier
Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.
Urvalskriterier
Åldrar som är berättigade till studier
18 år och äldre (Vuxen, Äldre vuxen)
Tar emot friska volontärer
Nej
Kön som är behöriga för studier
Allt
Testmetod
Icke-sannolikhetsprov
Studera befolkning
Patients receiving initial or repeated sacroiliac (SI) joint injections or single- or multi-level epidural injections with corticosteroids as part of their management plan for chronic SI joint, neck, back, or radicular pain.
Beskrivning
Inclusion Criteria:
- Patients receiving SI joint or epidural corticosteroid injections
- At least 18 years of age
Exclusion Criteria:
- Contraindication to corticosteroid injection (infection; pregnancy; uncontrolled diabetes mellitus [per patient's report]; active congestive heart failure; coagulopathy; medical conditions that prohibit holding anticoagulant or antiplatelet therapy, with the exception of aspirin, for at least two weeks prior to injection; and allergy to iodinated contrast dye, corticosteroids, or amide local anesthetics)
- Known disorder of the hypothalamic-pituitary-adrenal axis
- Corticosteroid injection within 6 weeks of study enrollment
Studieplan
Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.
Hur är studien utformad?
Designdetaljer
Kohorter och interventioner
Grupp / Kohort |
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Corticosteroid injection
Consecutive patients receiving initial or repeated sacroiliac joint or single or multi-level epidural corticosteroid injections as part of their management plan for SI joint, neck, back, or radicular pain.
Injections will be performed using 0.5 mL bupivacaine 0.25% and 15 mg dexamethasone sodium phosphate.
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Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
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Time to Normalization of Hypothalamic-Pituitary-Adrenal Axis (HPAA) Function Following Epidural or Sacroiliac Joint Corticosteroid Injection
Tidsram: From date of enrollment (Baseline) until the date of HPAA normalization assessed every 3 weeks up to 6 months
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The high-dose rapid adrenocorticotropic hormone (ACTH) stimulation test will be performed to determine if HPAA suppression is present.
Serum cortisol will be measured by electrochemiluminescence immunoassay immediately prior to and at 30 and 60 min following injection of 250 mcg cosyntropin IV.
A serum cortisol level <550 nmol/L (<20 mcg/dL) at either time point following cosyntropin administration will designate HPAA suppression.
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From date of enrollment (Baseline) until the date of HPAA normalization assessed every 3 weeks up to 6 months
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Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
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Incidence of Hypothalamic-Pituitary-Adrenal Axis (HPAA) Suppression in Patients Presenting for Corticosteroid Injection
Tidsram: Baseline
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The high-dose rapid ACTH stimulation test will be performed at Baseline to determine if HPAA suppression is present in patients presenting for corticosteroid injection.
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Baseline
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Incidence of Prolonged (≥ 3 weeks) Hypothalamic-Pituitary-Adrenal Axis (HPAA) Suppression Following Corticosteroid Injection
Tidsram: From date of injection until the date of HPAA normalization assessed every 3 weeks up to 6 months
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The high-dose rapid ACTH stimulation test will be performed to determine if HPAA suppression is present.
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From date of injection until the date of HPAA normalization assessed every 3 weeks up to 6 months
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Change in Glycosylated HbA1c (%) from Baseline to 3 months
Tidsram: Baseline and 3 months
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Percent glycosylated hemoglobin (HbA1c [%]) will be measured by turbidimetric inhibition immunoassay.
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Baseline and 3 months
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Change in Glycosylated HbA1c (%) from Baseline to 6 months
Tidsram: Baseline and 6 months
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Percent glycosylated hemoglobin (HbA1c [%]) will be measured by turbidimetric inhibition immunoassay.
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Baseline and 6 months
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Change in Systolic Blood Pressure from Baseline to 3 weeks
Tidsram: Baseline and 3 weeks
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Baseline and 3 weeks
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Change in Systolic Blood Pressure from Baseline to 6 weeks
Tidsram: Baseline and 6 weeks
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Baseline and 6 weeks
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Change in Systolic Blood Pressure from Baseline to 3 months
Tidsram: Baseline and 3 months
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Baseline and 3 months
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Change in Systolic Blood Pressure from Baseline to 6 months
Tidsram: Baseline and 6 months
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Baseline and 6 months
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Change in Diastolic Blood Pressure from Baseline to 3 weeks
Tidsram: Baseline and 3 weeks
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Baseline and 3 weeks
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Change in Diastolic Blood Pressure from Baseline to 6 weeks
Tidsram: Baseline and 6 weeks
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Baseline and 6 weeks
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Change in Diastolic Blood Pressure from Baseline to 3 months
Tidsram: Baseline and 3 months
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Baseline and 3 months
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Change in Diastolic Blood Pressure from Baseline to 6 months
Tidsram: Baseline and 6 months
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Baseline and 6 months
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Change in Body Weight from Baseline to 3 weeks
Tidsram: Baseline and 3 weeks
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Percent Change in Body Weight
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Baseline and 3 weeks
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Change in Body Weight from Baseline to 6 weeks
Tidsram: Baseline and 6 weeks
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Percent Change in Body Weight
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Baseline and 6 weeks
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Change in Body Weight from Baseline to 3 months
Tidsram: Baseline and 3 months
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Percent Change in Body Weight
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Baseline and 3 months
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Change in Body Weight from Baseline to 6 months
Tidsram: Baseline and 6 months
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Percent Change in Body Weight
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Baseline and 6 months
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Andra resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
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Pain Visual Analogue Scale (PVAS)
Tidsram: Baseline and 3, 6, 12, and 24 weeks
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11-point scale for average pain intensity over the preceding week.
Completed at Baseline, at 3 weeks following any corticosteroid injection, and at weeks 6, 12, and 24.
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Baseline and 3, 6, 12, and 24 weeks
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Functional Capacity Visual Analogue Scale (FVAS)
Tidsram: Baseline and 3, 6, 12, and 24 weeks
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11-point scale for average functional impairment over the preceding week.
Completed at Baseline, at 3 weeks following any corticosteroid injection, and at weeks 6, 12, and 24.
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Baseline and 3, 6, 12, and 24 weeks
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Brief Pain Inventory Short Form (BPI-SF) Pain Severity and Interference Scores
Tidsram: Baseline and 3, 6, 12, and 24 weeks
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Completed at Baseline, at 3 weeks following any corticosteroid injection, and at weeks 6, 12, and 24.
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Baseline and 3, 6, 12, and 24 weeks
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Medical Outcome Study Short Form 36 (SF-36) Health Survey Scores
Tidsram: Baseline and 3, 6, 12, and 24 weeks
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Completed at Baseline, at 3 weeks following any corticosteroid injection, and at weeks 6, 12, and 24.
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Baseline and 3, 6, 12, and 24 weeks
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Oswestry Disability Index (ODI) v2.0 Scores
Tidsram: Baseline and 3, 6, 12, and 24 weeks
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Completed at Baseline, at 3 weeks following any corticosteroid injection, and at weeks 6, 12, and 24.
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Baseline and 3, 6, 12, and 24 weeks
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North American Spine Society Patient Satisfaction Index (PSI)
Tidsram: Baseline and 3, 6, 12, and 24 weeks
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Completed at Baseline (for patients with previous corticosteroid injections), at 3 weeks following any corticosteroid injection, and at weeks 6, 12, and 24.
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Baseline and 3, 6, 12, and 24 weeks
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Samarbetspartners och utredare
Det är här du hittar personer och organisationer som är involverade i denna studie.
Sponsor
Utredare
- Huvudutredare: Ryan J Amadeo, MD, University of Manitoba
Studieavstämningsdatum
Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.
Studera stora datum
Studiestart
1 oktober 2012
Primärt slutförande (Förväntat)
1 juni 2016
Avslutad studie (Förväntat)
1 december 2016
Studieregistreringsdatum
Först inskickad
8 oktober 2012
Först inskickad som uppfyllde QC-kriterierna
25 oktober 2012
Första postat (Uppskatta)
30 oktober 2012
Uppdateringar av studier
Senaste uppdatering publicerad (Uppskatta)
12 december 2014
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
10 december 2014
Senast verifierad
1 december 2014
Mer information
Termer relaterade till denna studie
Nyckelord
Ytterligare relevanta MeSH-villkor
Andra studie-ID-nummer
- B2012:062
Denna information hämtades direkt från webbplatsen clinicaltrials.gov utan några ändringar. Om du har några önskemål om att ändra, ta bort eller uppdatera dina studieuppgifter, vänligen kontakta register@clinicaltrials.gov. Så snart en ändring har implementerats på clinicaltrials.gov, kommer denna att uppdateras automatiskt även på vår webbplats .