The aim of this clinical trial is to assess the effectiveness of intratracheal analgesia on pain intensity in cancer patients, from the start of treatment up to 3 months. It will also investigate the safety of this technique. The main questions it seeks to answer are as follows: What is the impact on the use of opioid analgesics, and can this be measured? What is the quality of life? What is the quality of sleep, and can this be assessed? How does the patient's weight change? Is the patient satisfied? What is the patient's overall survival? The researchers will assess the equivalent daily dose of morphine (mg/day) between enrolment and follow-up visits, as well as the number of patients requiring an escalation of analgesic treatment. Overall quality of life score measured using the ESAS questionnaire between enrolment and follow-up visits; satisfaction assessed using a numerical satisfaction scale (0-10); sleep quality assessed using the ISI questionnaire; and the tolerability and safety of the technique assessed by monitoring adverse events. Eligible participants: Following implantation of the intrathecal pump, participants will have scheduled consultations at day 30, then at 3, 6, 9 and 12 months, with questionnaires to be completed.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
40
Epidural puncture (AL injection), followed by a lumbar puncture and collection of cerebrospinal fluid. Positioning of the catheter behind the spinal cord at the desired metameric level for the pancreas (T5-T7), and positioning of the pump in the flank or buttock.
Medications are administered via an intrathecal catheter connected to an implantable pump or via periodic injections; the patient is admitted to hospital with morphine (IV, PO, transdermal) discontinued on entry to the unit (the same applies to methadone). Depending on the condition of the patient's abdominal skin (stoma, multiple injections, etc.) and any foreseeable technical difficulties during MRI scanning (in the left or right lateral positions), the procedure is performed under fluoroscopy, with appropriate antibiotic prophylaxis, under local anaesthesia, epidural anaesthesia and light sedation. Product used, dosage and frequency: Opioids: μ and δ receptors: Morphine sulphate: 50 mg/ml Ca++ channels: ziconotide: initial dose 0.5 µg/day Sodium channels: 1% ropivacaine As with a patient-controlled analgesia (PCA) system: Continuous infusion + bolus or sequential boluses Patient education on the use of the pump during their hospital stay.
Benkessou
Paris, France
Bizet Clinic
Paris, France
Clinique Bizet
Paris, France
Change in Edmonton Symptom Assessment System (ESAS) - Pain Subscore
Change in pain intensity score measured by the ESAS subscale from baseline to follow-up visits. Unit of Measure: Score on a scale (0 to 10) Scale Range (Minimum and Maximum Values): 0 to 10 Direction of Scores: Higher scores mean a worse outcome (greater pain intensity).
Time frame: Telephone call between Week 1 and Week 12, and questionnaires at Day 30, 3 months, 6 months, 9 months and 12 months
Change in Edmonton Symptom Assessment System (ESAS) Overall Quality of Life Score
Change in overall score as measured by the Edmonton Symptom Assessment System (ESAS) from baseline to follow-up visits. Unit of Measure: Score on a scale (ESAS Score) Scale Range (Minimum and Maximum Values): 0 to 10 Direction of Scores: Higher scores mean a worse outcome (greater pain intensity).
Time frame: Telephone call between Week 1 and Week 12, and questionnaires at Day 30, 3 months, 6 months, 9 months and 12 months
Proportion of Patients Requiring Pain Treatment Escalation
Number of patients requiring an increase or escalation in pain management treatment during follow-up. Unit of Measure: Number of participants (or Percentage)
Time frame: Telephone call between Week 1 and Week 12, and questionnaires at Day 30, 3 months, 6 months, 9 months and 12 months
Change in Daily Morphine Equivalent Dose (MED)
Change in daily opioid dose from baseline to follow-up visits. Unit of Measure: mg/day
Time frame: Telephone call between Week 1 and Week 12, and questionnaires at Day 30, 3 months, 6 months, 9 months and 12 months
Change in Sleep Quality Score Insomnia Severity Index (ISI)
Change in insomnia severity measured by the Insomnia Severity Index (ISI) questionnaire from baseline to follow-up visits. Scale Range (Minimum and Maximum Values): 0 to 28 (Derived from summing the 7 individual items, each scored on a 0 to 4 scale evaluating sleep onset, maintenance, early morning awakening, satisfaction, daytime interference, noticeability, and distress) Direction of Scores: Higher score 4 means a worse outcome (greater insomnia severity and impaired quality of life) Unit of Measure: Score on a scale (ISI Score)
Time frame: Telephone call between Week 1 and Week 12, and questionnaires at Day 30, 3 months, 6 months, 9 months and 12 months
Change in Body Weight
Change in body weight from baseline to follow-up visits. Unit of Measure: Kilograms (kg)
Time frame: Telephone call between Week 1 and Week 12, and questionnaires at Day 30, 3 months, 6 months, 9 months and 12 months
Patient Satisfaction Clinical Global Impressions Scale (typically either CGI-Severity or CGI-Improvement)
Overall patient satisfaction Clinical Global Impressions (typically either CGI-Severity or CGI-Improvement) rated on a numerical scale. Unit of Measure: Score on a scale Scale Range (Minimum and Maximum Values): 1 to 7 Direction of Scores: Higher scores mean a worse outcome (e.g., greater illness severity or worsening condition).
Time frame: Telephone call between Week 1 and Week 12, and questionnaires at Day 30, 3 months, 6 months, 9 months and 12 months
Incidence of Adverse Events Related to Intratracheal Analgesia
Number of participants experiencing at least one adverse event related to the intratracheal analgesia technique. Unit of Measure: Number of participants
Time frame: Telephone call between Week 1 and Week 12, and questionnaires at Day 30, 3 months, 6 months, 9 months and 12 months
Incidence of Serious Adverse Events (SAEs)
Number of participants experiencing a serious adverse event during the study period. Unit of Measure: Number of participants
Time frame: Telephone call between Week 1 and Week 12, and questionnaires at Day 30, 3 months, 6 months, 9 months and 12 months
Bouchra BENKESSOU Chef de projet Recherche Clinique
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