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Shoulder PainPhase 2BISPNCT02620579

Biopsychosocial Influence on Shoulder Pain

A Phase 2 study testing Propranolol LA (60 mg), Shoulder Anatomy Education and Pain Processing Education in people with Shoulder Pain, run by Duke University at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Chronic shoulder pain is a common, costly, and disabling problem for society. The identification of factors predictive of the development of chronic shoulder pain is necessary to develop innovative and effective treatments to reduce the societal impact of shoulder disorders. Read more about this study

Who is it for?
Ages 18 to 64 yearsHealthy volunteers can take part
Conditions the study is for
Shoulder Pain
What is being tested?
Propranolol LA (60 mg), Shoulder Anatomy Education and Pain Processing Education
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
264 participants
Where
1 siteUnited States
Study dates
Jan 2016to 5 Nov 2021
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 64 years
  • All sexes
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • English speaking

Who cannot join

  • chronic pain (> 3 months) in any area,
  • currently experiencing neck or shoulder pain,
  • previous history of neck or shoulder pain (operationally defined as experiencing neck or shoulder pain for longer than 48 hours or seeking medical treatment for neck or shoulder pain),
  • neurological impairment of the in the upper-extremity (determined by loss of sensation, muscle weakness, and reflex changes),
  • regular participation in upper-extremity weight training,
  • currently or regular use of pain medication, and
Show all 22Show fewer
  • previous history of upper-extremity surgery.
  • Additional exclusion criteria for propranolol administration are reported history of or presence of any of the following cardiovascular conditions:
  • clinically significant abnormal 12-lead ECG,
  • sinus bradycardia (resting heart rate below 55 beats per minute),
  • greater than first degree heart block,
  • cardiac failure,
  • coronary artery disease,
  • uncontrolled hypertension (resting systolic blood pressure above 140 mm Hg), or hypotension (resting systolic blood pressure below 90 mm Hg),
  • Wolff-Parkinson-White syndrome.
  • Non-cardiovascular reasons for study exclusion include:
  • bronchial asthma,
  • nonallergic bronchospasm,
  • history of recent major surgery requiring general anesthesia,
  • diabetes,
  • pregnancy,
  • major depression.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Florida Clinical and Translational Science Institute

    Gainesville, Florida, 32610

Other trials in United States

About this study

Official title: Biopsychosocial Influence on Shoulder Pain: a Randomized, Pre-clinical Trial

Chronic shoulder pain is a common, costly, and disabling problem for society. The identification of factors predictive of the development of chronic shoulder pain is necessary to develop innovative and effective treatments to reduce the societal impact of shoulder disorders. In previous work the investigators identified a genetic and psychological subgroup that robustly predicted heightened shoulder pain responses in a pre-clinical cohort and poor 12 month shoulder pain recovery rates in a clinical surgical cohort. In this follow-up study the investigator proposes to test how interventions tailored to the high risk subgroup affect pain responses in a pre-clinical cohort.

The optimal theorized match for the identified high-risk subgroup is a combination of personalized pharmaceutical and education interventions. This combined personalized intervention versus a placebo pharmaceutical and general education intervention group is the primary comparison of interest. Also, an evaluation of the individual effect of personalized pharmaceutical and educational interventions will be part of the study. Such comparisons will provide important information on what the active portion of the combined personalized intervention may be.

Read the detailed description

Potential subjects will be screened and those meeting the high-risk criteria based on COMT genotype for high pain sensitivity and pain catastrophizing questionnaire score will be eligible for randomization into intervention groups (stratified by sex). Exercise induced shoulder injury will serve as the pain generating mechanism on Day 1 and participants will receive pharmaceutical and education interventions over Days 1-4, and Days 2-4 respectively. Statistical analysis will determine whether the combined personalized intervention group experienced shorter shoulder pain duration, lower peak pain intensity, or decreased upper-extremity disability and determine which molecular, psychological, and pain sensitivity regulation mechanisms are associated with pain relief. A preliminary analysis is planned after the first 300 subjects are equally randomized to the 4 intervention groups. The comparison of interest for the preliminary analysis is the combined personalized intervention group with the placebo and general education group for the primary outcome. Depending on the results of this preliminary analysis the randomization pattern may change, with details of these changes available in the protocol paper.

Conditions
Shoulder Pain
Being tested
Propranolol LA (60 mg), Placebo, Shoulder Anatomy Education, Pain Processing Education
Keywords
Personalized Pharmaceutical, Personalized Education
Medical subject headings
Shoulder Pain

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Propranolol LA (60 mg)Drug

    Also called Personalized Pharmaceutical

    Long-acting propranolol (Propranolol LA) 60 mg to be administered orally daily for Days 1 (before exercise induced muscle injury) and Days 2-4 following exercise induced muscle injury.

  • PlaceboDrug

    Also called Placebo Pharmaceutical

    Placebo capsules will be prepared by the University of Florida Investigational Drug Service to be visually indistinguishable from the active medication and delivered orally. Placebo administration will be done in the same fashion as propranolol - administered on Days 1 (before exercise induced muscle injury) and the Days 2-4 after the exercise induced muscle injury.

  • Shoulder Anatomy EducationBehavioural

    Also called General Education

    Shoulder anatomy education modules will be administered Days 2-4 (after exercised induced muscle injury) following exercise enhance injury with the goal of participant understanding shoulder anatomy and injury while reviewing: a) structure and arthrokinematics of the shoulder joint; b) muscle anatomy of the shoulder with emphasis on the rotator cuff; and c) potential shoulder pain generators from the exercise-induced injury. This education component will be devoid of information related to pain signaling and cognitive restructuring that characterizes Pain Processing Education modules. These education modules will be scripted and structured so they are provided in a standardized manner for all subjects.

  • Pain Processing EducationBehavioural

    Also called Personalized Education

    Pain processing education modules will be administered Days 2-4 (after exercised induced muscle injury) following exercise enhance injury with the goal of better understanding of pain processing and psycho-education. This information will encourage shoulder activation by: a) reducing the threat of muscle injury; b) encouraging normal use of the shoulder and arm; and c) addressing specific concerns expressed by the subject (e.g. pain with shoulder motion is a sign of re-injury). This education component will be devoid of detailed information on shoulder anatomy, movement, and injury that characterizes the Shoulder Anatomy Education modules. These education modules will be scripted and structured so they are provided in a standardized manner for all subjects.

Study groups in NCT02620579
Study groupRoleWhat they receive
Personalized Pharmaceutical and EducationExperimentalThis group will have propranolol (Propranolol LA) 60 mg administered orally and receive the pain processing education modules as the combined intervention for this arm.
Receives: Drug: Propranolol LA (60 mg); Behavioral: Pain Processing Education
Placebo Pharmaceutical, General EducationPlacebo comparatorThis group will have the placebo pharmaceutical administered orally and receive general shoulder anatomy education modules as the interventions for this arm.
Receives: Drug: Placebo; Behavioral: Shoulder Anatomy Education
Placebo Pharmaceutical, Personalized EducationActive comparatorThis group will have the placebo pharmaceutical administered orally and receive the pain processing education modules as the combined intervention for this arm.
Receives: Drug: Placebo; Behavioral: Pain Processing Education
Personalized Pharmaceutical, General EducationActive comparatorThis group will have propranolol (Propranolol LA) 60 mg administered orally and receive general shoulder anatomy education modules as the interventions for this arm.
Receives: Drug: Propranolol LA (60 mg); Behavioral: Shoulder Anatomy Education

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of Participants Who Met the Recovery Criterion for Shoulder Pain Intensity

    The outcome has a range between 0 and 1, the higher scores mean a better outcome. Successful recovery was determined based on meeting the recovery criterion for shoulder pain intensity by at least 6 days. Specifically, recovery (Yes or No) was defined using Brief Pain Inventory (BPI) ratings as a current pain intensity rating of 0/10 and a worst pain intensity rating of less than 2/10.

    Measured: Approximately 6 days

Secondary outcomes (3)
  1. Brief Pain Inventory (BPI) for Pain Duration

    The Brief Pain Inventory (BPI) consists of rating pain intensity on an 11-point numerical rating scale ranging from 0 (no pain) to 10 (worst pain intensity imaginable). BPI will be recorded daily and the recovery criterion used for this study will be a BPI rating of current pain 0/10 and worst pain rating of less than 2/10. The pain duration is number of days from the date of induced pain to date of recovery. The longer the duration means a worse outcome.

    Measured: Daily until recovery criterion met, approximately 5-15 days

  2. Brief Pain Inventory (BPI) for Worst Shoulder Pain Intensity (Highest Daily Pain Intensity Rating) Recorded During Recovery.

    The Brief Pain Inventory (BPI) which consists of rating pain intensity on an 11-point numerical rating scale ranging from 0 (no pain) to 10 (worst pain intensity imaginable). Participants will rate their current, best, and worst pain intensity on the BPI. This measure will be recorded daily through study completion, an average of 5 days. The worst pain intensity rating at Day 2 (when participants usually had the Peak Shoulder Pain Intensity) is reported.

    Measured: Day 2 value of the worst pain intensity is reported

  3. Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH)

    The abridged version of the DASH (the QuickDASH) which consists of 11 functional items, with total scores ranging from 0 (not disability) to 100 (complete disability) will be used to assess upper-extremity disability. The primary outcome will be the highest DASH score recorded during the pain intensity recovery period.

    Measured: Daily until recovery criterion met, approximately 5-15 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Dec 2015 (estimated)
  2. Study startJan 2016
  3. Primary completion5 Nov 2021
  4. Study completion5 Nov 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
264 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02620579
Sponsor's protocol ID
Pro00078287
Other IDs
2R01AR055899
Acronym
BISP
Status last verified
Dec 2022
First submitted
13 Nov 2015
Last updated
13 Jan 2023
Data monitoring committee
No
Individual data sharing
No

Publications

  • George SZ, Staud R, Borsa PA, Wu SS, Wallace MR, Greenfield WH, Mackie LN, Fillingim RB. Biopsychosocial influence on shoulder pain: Rationale and protocol for a pre-clinical trial. Contemp Clin Trials. 2017 May;56:9-17. doi: 10.1016/j.cct.2017.03.005. Epub 2017 Mar 14.

    PubMed 28315479
  • Borsa PA, Parr JJ, Wallace MR, Wu SS, Dai Y, Fillingim RB, George SZ. Genetic and psychological factors interact to predict physical impairment phenotypes following exercise-induced shoulder injury. J Pain Res. 2018 Oct 23;11:2497-2508. doi: 10.2147/JPR.S171498. eCollection 2018.

    PubMed 30425562
  • Butera KA, George SZ, Borsa PA, Dover GC. Prolonged Reduction in Shoulder Strength after Transcutaneous Electrical Nerve Stimulation Treatment of Exercise-Induced Acute Muscle Pain. Pain Pract. 2018 Nov;18(8):954-968. doi: 10.1111/papr.12690. Epub 2018 Apr 6.

    PubMed 29505689
  • George SZ, Bishop MD, Wu SS, Staud R, Borsa PA, Wallace MR, Greenfield WH 3rd, Dai Y, Fillingim RB. Biopsychosocial influence on shoulder pain: results from a randomized preclinical trial of exercise-induced muscle injury. Pain. 2023 Feb 1;164(2):305-315. doi: 10.1097/j.pain.0000000000002700. Epub 2022 May 23.

    PubMed 35604152

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Propranolol LA (60 mg), Shoulder Anatomy Education and Pain Processing Education in people with Shoulder Pain, run by Duke University at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 22 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 13 Jan 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 13 Jan 2023). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of Participants Who Met the Recovery Criterion for Shoulder Pain Intensity (time frame: Approximately 6 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02620579, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Jan 2023.

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