St. PETERsburg Pain and Alcohol Intervention With Naltrexone and Gabapentin

Boston Medical Center45 enrolled

Overview

This study is a 3-arm pilot, randomized, double-blinded, placebo-controlled study of low-dose naltrexone and gabapentin versus placebo among HIV-positive persons with heavy alcohol use and chronic pain to provide estimates of their effects on 1) pain; 2) inflammation; and 3) measures of HIV control. Participants will be followed for 12 weeks. Assessments of study outcomes will be compared at week 8 (end of treatment phase).

Pain is a common co-morbidity for HIV-positive patients.Prevalence studies suggest that, on average, half of all HIV-positive persons suffer pain. Chronic pain can lead to heavy alcohol use among HIV-positive persons, which may in turn be a barrier to treatment/control of HIV and contribute to spread of HIV. Thus there is an urgent need to address pain among persons with HIV. It is timely and relevant to conduct research on gabapentin, as it has emerged as one of the most commonly prescribed non-opioid medications for pain despite the fact that gabapentin is only FDA approved for "post-herpetic neuralgia" and the literature to support its use for generalized chronic pain is limited. And yet, gabapentin has demonstrated benefits for treatment of alcohol use disorder, and therefore, like naltrexone, it could have a specific role for treating patients with chronic pain and unhealthy alcohol use. This study is a 3-arm pilot, randomized, double-blinded, placebo-controlled study of low-dose naltrexone and gabapentin vs. placebo among HIV-positive persons with heavy alcohol use and chronic pain to provide estimates of their effects on 1) pain (both self-reported and experimental/cold pressor test; 2) inflammation (i.e., levels of inflammatory cytokines IL-6, IL-1β, IL-10, and TNF-α); and 3) measures of HIV control (CD4 count and viral load).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

TRIPLE

Enrollment

Conditions

Chronic Pain Alcohol Use, Unspecified HIV Infections

Interventions

Low-dose naltrexoneDRUG

4.5 mg of low dose naltrexone taken once daily for 8 weeks. In week 1, participants will take 4.5mg of naltrexone once daily. In week 2, participants will take 4.5mg of naltrexone once daily, and a placebo capsule twice daily. In weeks 3 through 7, participants will take 1 placebo capsule with 4.5 mg mg of naltrexone once daily, and 2 placebo capsules twice daily. In week 8, in days 1-4 participants will take 4.5 mg of naltrexone with a placebo capsule once daily and 2 placebo capsules twice daily; in days 5-7, participants will take 4.5 mg of naltrexone once daily, and a placebo capsule twice daily.

GabapentinDRUG

Dose will begin at 300 mg daily (300 mg qd), in week 2 the dose will be titrated up to 900 mg daily (300 mg tid). In week 3, the dose will be titrated to 1800 mg daily ( 2 capsules of 300 mg tid) and participants will remain on that dose until week 8. In week 8, in days 1-4 participants will take 1800 mg daily (300 mg+300 mg tid); in days 5-7, participants will take 900 mg daily (300 mg of gabapentin three times daily).

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 18 years or older * HIV-positive * Chronic pain (present ≥3 mo) of moderate to severe intensity * Heavy drinking past year (Based on NIAAA criteria: \> 14 standard drinks per week/ \> 4 drinks in a day for men; \> 7 drinks in the past week/ \> 3 drinks in a day for women) * If female, negative pregnancy test and willing to use adequate birth control * Provision of contact information for 2 contacts to assist with follow-up * Stable address within 100 kilometers of St. Petersburg * Possession of a telephone (home or cell) * Able and willing to comply with all study protocols and procedures Exclusion Criteria: * Not fluent in Russian * Cognitive impairment resulting in inability to provide informed consent based on research assessor (RA) assessment * Known active TB or current febrile illness * Breastfeeding * Known uncontrolled psychiatric illness (such as active psychosis) * Current suicidal ideation * History of hypersensitivity to naltrexone, gabapentin, or naloxone * Current use (past week) of illicit or prescribed opiates as documented by either self-report or positive urine drug test * Unwilling to abstain from opiates during the treatment period * Current use of neuroleptics * History of seizure disorder * Known liver failure * AST/ALT levels \>5x normal * CrCl\< 60mL/min * History of Reynaud's disease * Planned surgeries in the next 3 months * Enrolled in another HIV and/or substance use medication intervention study * Taking naltrexone in the past 30 days * Taking gabapentin in the past 30 days * Taking pregabalin in the past 30 days * Diagnosis of chronic obstructive pulmonary disease (COPD)

Locations (1)

First St. Petersburg Pavlov State Medical University

Saint Petersburg, Russia

Outcomes

Primary Outcomes

Change in Past Week Pain Severity

Change in past week pain severity (score 0 \[no pain\] -10 \[high pain\]) from baseline to week 8. Pain severity will be measured using the Brief Pain Inventory, which allows patients to rate the severity of their pain and the degree to which their pain interferes with common dimensions of feeling and function

Time frame: Baseline, 8-weeks

Change in Past Week Pain Interference

Change in past week pain interference (score 0 \[no pain\]-10 \[high pain\]) from baseline to week 8. Pain interference will be measured using the Brief Pain Inventory, which allows patients to rate the severity of their pain and the degree to which their pain interferes with common dimensions of feeling and function

Time frame: Baseline, 8-weeks

Secondary Outcomes

Change in Cold Pain Tolerance

Mean change in the number of seconds a participant can keep their hand submerged in a container of iced water. Participants were instructed to keep their hand in as long as they could, up to 3 minutes.

Time frame: Baseline, 8-weeks

Change in Percentage of Past Month Heavy Drinking Days

Mean percentage of change in self-reported heavy drinking in the past 30 days of alcohol consumption obtained via the Timeline Followback (TLFB) method. The NIAAA definition of heavy drinking is used (\> 4 drinks in a day for men; \> 3 drinks in a day for women). Participants were asked about their alcohol consumption on each day in the previous 30 days.

Time frame: Baseline, 8-weeks

Change in CD4 Count

Defined as mean change in CD4 values from lab assay

Time frame: Baseline, 8-weeks

Number of Participants With a Change in HIV Viral Load Suppression Status

Data from ClinicalTrials.gov

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