The Effect of Outpatient Ketamine Infusion on Chronic Neuropathic Pain and PTSD

NCT06414356 | Recruiting Phase 4 FDA Drug

• 1 other identifier: 954942
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 1

Brief Summary

This study is aimed to evaluate outpatient ketamine infusion within a military chronic neuropathic pain population and its effect on PTSD. Currently, this is a pilot study with 30 participants. Participants will be randomized to (1) a moderate dose ketamine, (2) moderate dose ketamine +Mg, or (3) a magnesium control group. Participants will complete self-reported pain and PTSD questionnaires throughout the \~24-week study period. The outlined strategy will provide evidence for the utility of ketamine in neuropathic pain management and pain associated comorbidities within a military population.

Conditions

Neuropathic Pain; PTSD

Keywords

Ketamine Hydrochloride

Outcome Measures

Primary Outcomes (7)

• Defense and Veterans Pain Rating Score (DVPRS)

  The DVPRS is a self-report instrument used to assess pain intensity in military personnel, veterans, and other military populations. It was specifically developed for individuals with military backgrounds and is often used in clinical settings to monitor pain levels and treatment effectiveness. The DVPRS consists of a Numeric Rating Scale (NRS) from 0 to 10, where 0 represents "no pain" and 10 represents "worst possible pain." Respondents rate their pain intensity by selecting the number that best corresponds to their current level of pain. The DVPRS questionnaire will be used to determine how daily pain levels change throughout the study. Three questions assess current pain, worst pain in past 7 days, and worse pain in past month. These three questions are separately assessed for pain.

  Up to 32 weeks

• Brief Pain Inventory Scale (BPI)

  The BPI is a 15-item self-report measure of pain intensity and pain interference with daily life. The Brief Pain Inventory (BPI) is scored separately for its two main sections: Pain Severity and Pain Interference. It includes questions about the intensity of pain at its "worst," "least," "average," and "right now" over the past week. Respondents rate the severity of pain on a numeric rating scale (NRS) from 0 to 10. The Pain Interference section evaluates the extent to which pain interferes with various aspects of the individual's life. The Pain Severity Score is calculated with the average score of the four items assessing pain severity. This average represents the overall pain severity experienced by the individual. This questionnaire will be used to determine how current pain levels change throughout the study.

  Up to 32 weeks

• Life Satisfaction Questionnaire (LiSAT)

  The LiSAT is a self-report instrument used to assess overall satisfaction with various life domains. It provides a comprehensive assessment of life satisfaction. The LiSAT consists of items that assess satisfaction across several domains of life, such as: work, leisure activities and free time, economy, relationships with friends, relationships with relatives, sexual life/partner relationship, physical health, psychological health, and safety. Respondents rate their satisfaction within each domain using a Likert-type scale, with response options ranging from "very dissatisfied" to "very satisfied". Each response is assigned a numerical value. After completing the questionnaire, scores for each domain are summed or averaged to obtain a total score or subscale scores representing satisfaction within specific life domains. Higher scores indicate greater satisfaction within the respective domain.

  Up to 32 weeks

• Post-traumatic Stress Disorder Checklist (PCL-5)

  The PTSD Checklist (PCL-5) is a widely used self-report measure used to assess symptoms of post-traumatic stress disorder (PTSD). It consists of 20 items that correspond to the Diagnostic and Statistical criteria for PTSD. Respondents rate the frequency of symptoms over the past month on a scale from 0 (Not at all) to 4 (Extremely). There are different cutoff scores used for diagnosing PTSD or assessing the severity of symptoms, but higher total scores generally indicate more severe PTSD symptoms. * 0-31: Subclinical range (minimal to no PTSD symptoms) * 32-37: Mild PTSD symptoms * 38-43: Moderate PTSD symptoms * 44 and above: Severe PTSD symptoms

  Up to 32 weeks

• The Patient-Reported Outcomes Measurement Information System (PROMIS 29+2)

  The Patient-Reported Outcomes Measurement Information System (PROMIS 29+2) profile is a comprehensive assessment tool used to evaluate various aspects of health-related quality of life (HRQOL) across physical, mental, and social domains. Respondents rate their experiences over the past 7 days using a Likert-type scale, with response options ranging from 1 to 5. Higher scores indicate greater impairment or severity of symptoms, depending on the specific domain being assessed. For scoring, each item is scored based on the response provided by the respondent. Scores for items within each domain are aggregated to calculate domain scores. The questionnaire provides individual scores for each domain assessed, allowing for a comprehensive profile of the respondent's health-related quality of life. Total for each domain is assessed. Higher scores typically indicate greater impairment or symptom severity, while lower scores indicate better functioning or fewer symptoms.

  Up to 32 weeks

• Patient Health Questionnaire-9 (PHQ-9)

  The Patient Health Questionnaire-9 (PHQ-9) is a widely used screening tool for depression. It consists of nine questions that ask about symptoms experienced over the past two weeks. Each question is scored on a scale from 0 to 3, with responses ranging from "not at all" to "nearly every day." To score the PHQ-9: 1. Assign a score from 0 to 3 for each question based on the response: * "Not at all" = 0 * "Several days" = 1 * "More than half the days" = 2 * "Nearly every day" = 3 2. Sum the scores for all nine questions to obtain a total score, which can range from 0 to 27. Interpretation of the total PHQ-9 score is as follows: * 0-4: Minimal depression symptoms * 5-9: Mild depression symptoms * 10-14: Moderate depression symptoms * 15-19: Moderately severe depression symptoms * 20-27: Severe depression symptoms

  Up to 32 weeks

• Generalized Anxiety Disorder Scale

  The Generalized Anxiety Disorder 7-item scale (GAD-7) is a widely used screening tool designed to assess the severity of generalized anxiety disorder (GAD) symptoms. It consists of seven questions that ask about symptoms experienced over the past two weeks. Each question is scored on a scale from 0 to 3, with responses ranging from "not at all" to "nearly every day." To score the GAD-7 questions are rated from 0 to 3. * "Not at all" = 0 * "Several days" = 1 * "More than half the days" = 2 * "Nearly every day" = 3 The sum of the scores for all seven questions obtain a total score, which can range from 0 to 21. Interpretation of the total GAD-7 score is as follows: * 0-4: Minimal anxiety symptoms * 5-9: Mild anxiety symptoms * 10-14: Moderate anxiety symptoms * 15-21: Severe anxiety symptoms

  Up to 32 weeks

Secondary Outcomes (3)

• Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) Tool

  Up to 32 weeks

• Richmond Agitation-Sedation Scale (RASS)

  Up to 26 weeks

• Clinician-Administered Dissociative States Scale (CADSS)

  Up to 26 weeks

Study Arms (3)

Moderate Dose Ketamine

EXPERIMENTAL

0.5 mg/kg/hr The total amount of ketamine for each participant is dependent on their body weight in kg per ideal body weight (IBW) formula. This total ketamine dose will be injected into one 250 ml normal saline 0.9% solution with a rate of 62.5 ml/hr over four hours or until the contents of the bag are infused and flushed with 20 ml of normal saline

Drug: Ketamine

Moderate dose ketamine + magnesium sulfate

EXPERIMENTAL

0.50 mg/kg/hr ketamine + 750 mg/hr Mg

Drug: Ketamine + Magnesium sulfate

Magnesium sulfate

ACTIVE COMPARATOR

750 mg/hr

Drug: Magnesium sulfate

Interventions

Ketamine DRUG

Ketamine will be placed in 250 mL normal saline and infused at a rate of 62.5 mL/hr. Participants will receive intravenous infusions of ketamine for 4 hours each day in diminishing number of dosing events per week for the full 24-week infusion regime in an outpatient setting. (ketamine 0.5 mg/kg IBW/hr)

Also known as: Ketalar

Moderate Dose Ketamine

Magnesium sulfate DRUG

Magnesium sulfate 3 grams will be diluted into 250 mL normal saline and infused at a rate of 62.5 mL/hr (over 4 hours until the entire contents are infused and then flushed with 20 mL of normal saline). The Mg only group will be randomly assigned to one of the treatment groups (moderate dose ketamine, or moderate dose ketamine +Mg) after 2 weeks and complete the full 24-week infusion treatment regime of the randomly selected treatment group in an outpatient setting.

Magnesium sulfate

Ketamine + Magnesium sulfate DRUG

Participants will receive intravenous infusions of ketamine and magnesium sulfate in combination. Ketamine will be placed in 250 mL normal saline and infused at a rate of 62.5 mL/hr Participants will receive intravenous infusions of ketamine and magnesium sulfate for 4 hours each day in diminishing number of dosing events per week for the full 24-week infusion regime in an outpatient setting. (Ketamine 0.5 mg/kg IBW/hr + magnesium sulfate 3 grams diluted into 250 mL normal saline)

Also known as: ketalar + Magnesium Sulfate

Moderate dose ketamine + magnesium sulfate

Eligibility Criteria

• Age: 18 Years - 70 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• years old with Chronic Neuropathic Pain \>= 3 months
• Biologic male or biologic female
• Women of childbearing age will be included if there are no plans of pregnancy within the study period, the participant agrees to actively utilize contraception throughout the study, and agrees to pregnancy tests
• Active Duty, Veterans, and retirees
• Ketamine naïve for 1 year
• Moderate Neuropathic pain Scale 4-7

You may not qualify if:

• Cognitive dysfunction
• Psychiatric illness involving psychosis
• Neurocognitive disorder
• Patients with Traumatic Brain Injury (TBI)
• Acute cardiovascular disease or poorly controlled hypertension
• Untreated or uncontrolled thyroid disease
• Hyperthyroidism
• Severe liver or renal disease
• Renal impairment
• History of recent heart attack, vascular disease, or any other medical condition that may be deemed by a provider as a contraindication to receiving ketamine
• Active substance abuse
• Pregnant or lactating
• Patients who are planning to become pregnant within 12 weeks of treatment completion
• Elevated Blood Pressure/hypertension
• Known hypersensitivity to Ketamine

Sponsors & Collaborators

• Margaux M. Salas, PhD: lead

Study Sites (1)

Brooke Army Medical Center

San Antonio, Texas, 78234, United States

RECRUITING

Related Publications (2)

• Urits I, Jung JW, Amgalan A, Fortier L, Anya A, Wesp B, Orhurhu V, Cornett EM, Kaye AD, Imani F, Varrassi G, Liu H, Viswanath O. Utilization of Magnesium for the Treatment of Chronic Pain. Anesth Pain Med. 2021 Feb 6;11(1):e112348. doi: 10.5812/aapm.112348. eCollection 2021 Feb.

  PMID: 34221945 BACKGROUND

• Orhurhu V, Orhurhu MS, Bhatia A, Cohen SP. Ketamine Infusions for Chronic Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Anesth Analg. 2019 Jul;129(1):241-254. doi: 10.1213/ANE.0000000000004185.

  PMID: 31082965 BACKGROUND

MeSH Terms

Conditions

Neuralgia; Stress Disorders, Post-Traumatic

Interventions

Ketamine; Magnesium Sulfate

Condition Hierarchy (Ancestors)

Peripheral Nervous System Diseases; Neuromuscular Diseases; Nervous System Diseases; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Stress Disorders, Traumatic; Trauma and Stressor Related Disorders; Mental Disorders

Intervention Hierarchy (Ancestors)

Cyclohexanes; Cycloparaffins; Hydrocarbons, Alicyclic; Hydrocarbons, Cyclic; Hydrocarbons; Organic Chemicals; Magnesium Compounds; Inorganic Chemicals; Sulfates; Sulfuric Acids; Sulfur Acids; Sulfur Compounds

Central Study Contacts

Margaux M Salas, PhD

CONTACT

210-473-7447; margaux.m.salas.ctr@health.mil

Kevin C Peterson, MD

CONTACT

210-916-7331; kevin.c.peterson3.mil@health.mil

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: FACTORIAL
• Sponsor Type: FED
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Senior Scientist Expert

Model Details: (1) Moderate-dose ketamine (0.50 mg/kg/hr) (Orhurhu et al., 2019), and (2) moderate-dose ketamine in combination with magnesium (750 mg/hr) (Urits et al., 2021) and (3) magnesium control (750mg/hr) will be assessed. Of note, we are adapting a delayed control treatment group design. The control group (Mg only control) will be randomly assigned to one of the treatment groups (moderate dose ketamine, or moderate dose ketamine +Mg) after 2 weeks and complete the full infusion treatment regime of the randomly selected treatment group.

Study Record Dates

• First Submitted: April 29, 2024
• First Posted: May 16, 2024
• Study Start: October 2, 2024
• Primary Completion: April 1, 2025
• Study Completion (Estimated): May 1, 2027
• Last Updated: February 25, 2025

Record last verified: 2025-02

Locations

US (1)