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Acute PainADOPT PGxNCT05966129

A Depression and Opioid Pragmatic Trial in Pharmacogenetics (Acute Pain Trial)

A study testing Pharmacogenetic testing and Clinical decisions support in people with Acute Pain, run by Duke University at 11 sites 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

This study is comprised of three separate pharmacogenetic trials grouped into a single protocol due to similarities in the intervention, the hypotheses, and the trial design. The three trials are the Acute Pain Trial, the Chronic Pain Trial, and the Depression Trial. Read more about this study

Who is it for?
Ages 8 years and older
Conditions the study is for
Acute Pain
What is being tested?
Pharmacogenetic testing and Clinical decisions support
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,602 participants
Where
11 sitesUnited States
Study dates
10 Mar 2021to 25 Mar 2024
Phase
Interventional
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 8 years and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Acute Pain Trial
  • Age ≥ 8 years
  • English speaking or Spanish speaking
  • Elective/planned surgery types with planned or anticipated to be treated with tramadol, hydrocodone, or codeine pain management at an enrolling site, which may include orthopedic surgeries (e.g. arthroplasty, spine, etc.), open abdominal surgery, or cardiothoracic surgery and others

Who cannot join

  • Trial-wide:
  • Life expectancy less than 12 months
  • Are too cognitively impaired to provide informed consent and/or complete study protocol
  • Are institutionalized or too ill to participate (i.e. mental or nursing home facility or incarcerated)
  • Have a history of allogeneic stem cell transplant or liver transplant
  • People with prior clinical pharmacogenetic test results for genes relevant for the study in which they will enroll (CYP2D6 for the pain studies and CYP2D6 or CYP2C19 for depression) or already enrolled in an ADOPT PGx trial
Show all 9Show fewer
  • Acute Pain Trial
  • Undergoing a laparoscopic surgery
  • Receiving chronic opioid therapy, defined as use of opioids on most days for >3 months

Trial locations and contacts

11 sites in 1 country.

11 sites in 1 country

United States11 sites
  • Duke University Medical Center

    Durham, North Carolina, 27710

  • Sanford Health

    Fargo, North Dakota, 58104

  • University of Florida - Gainesville

    Gainesville, Florida, 32610

  • Indiana University

    Indianapolis, Indiana, 46202

  • Nemours Children's Health System

    Jacksonville, Florida, 32207

  • Meharry Medical College

    Nashville, Tennessee, 37208

  • Nashville General Hospital

    Nashville, Tennessee, 37208

  • Vanderbilt University Medical Center

    Nashville, Tennessee, 37232

  • Icahn School of Medicine at Mount Sinai

    New York, New York, 10029

  • Nemours Children's Health System

    Orlando, Florida, 32827

  • Nemours Children's Health System

    Wilmington, Delaware, 19803

Other trials in United States

About this study

Official title: A Depression and Opioid Pragmatic Trial in Pharmacogenetics

This study is comprised of three separate pharmacogenetic trials grouped into a single protocol due to similarities in the intervention, the hypotheses, and the trial design. The three trials are the Acute Pain Trial, the Chronic Pain Trial, and the Depression Trial. Participants can enroll in only one of the three trials. All three trials were registered on ClinicalTrials.gov under NCT04445792. In July 2023 each of the three treatment trials was registered under a separate NCT# and NCT04445792 was converted to a screening record per recent guidance on master protocol research programs (MPRPs). This record is specific to the Acute Pain Trial within the ADOPT-PGx protocol.

The Acute Pain Trial is a prospective, multicenter, two arm randomized pragmatic trial. Participants meeting eligibility criteria will be randomly assigned to either immediate pharmacogenetic testing and genotype-guided post-surgical opioid therapy (Intervention arm) or standard care and pharmacogenetic testing after 6 months (Control arm). The investigators will test the hypothesis that pharmacogenetic testing and genotype guided pain management therapy improves pain control after surgery in participants who's body processes some pain medicines slower than normal.

Read the detailed description

Pain and depression are conditions that impact substantial proportions of the US population. Finding safe and effective drug therapies for both conditions is challenging. In the case of treatment for acute and chronic pain, the challenge is finding effective therapy while minimizing adverse effects or opioid addiction (and the ensuing consequences). For depression, there are few clinically relevant predictors of successful treatment leading to multiple trials of inadequate therapy for some patients. Both opioid and antidepressant prescriptions can be guided by pharmacogenetics (PGx) data based on existing guidelines from the Clinical Pharmacogenetics Implementation Consortium (CPIC).

This study is designed to evaluate the impact of pharmacogenetic testing and genotype-guided pain or anti-depressant therapy on pain control or depression symptoms in a pragmatic setting.

The rationale for examining a genotype-guided approach to acute and chronic pain management is based on the importance of CYP2D6 for the bioactivation of tramadol, codeine, and hydrocodone and data from a pilot study supporting improved pain control in intermediate and poor CYP2D6 metabolizers in the genotype-guided arm who are taking these drugs at baseline. Similarly, the rationale for examining a genotype-guided approach to depression medication therapy is based on the demonstrated role of CYP2D6 in the bio inactivation and CYP2C19 oxidation of select, commonly used SSRIs. Secondly, data from industry sponsored trials support the hypothesis of improved depression symptom control in a genotype-guided arm.

Study objectives:

Determine if a genotype-guided approach to acute post-surgical pain therapy leads to improved pain control compared to usual care, as defined by a decrease in the SIA score. Secondarily, The investigators will evaluate whether this approach leads to reduced use of DEA Schedule II opioids and reduced pain intensity.

Conditions
Acute Pain
Being tested
Pharmacogenetic testing, Clinical decisions support
Keywords
Pharmacogenetic, CYP2D6, CYP2C19
Medical subject headings
Acute Pain

What participants receive

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

  • Pharmacogenetic testingOther

    Genetic testing of CYP2D6 and CYP2C19

  • Clinical decisions supportOther

    Prescribing recommendations to the provider based on the pharmacogenetic testing results

Study groups in NCT05966129
Study groupRoleWhat they receive
Acute Pain - Immediate PGx TestingExperimentalImmediate genetic testing of CYP2D6 and clinical decisions support for pain management prescribing to the healthcare provider
Receives: Other: Pharmacogenetic testing; Other: Clinical decisions support
Acute Pain - Delayed PGx TestingOtherDelayed genetic testing of CYP2D6 and return of results after the conclusion of the 6-month follow-up period
Receives: Other: Pharmacogenetic testing

What is being measured

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

  1. 10 Day Silverman Integrated Analgesic Assessment (SIA) Score

    A composite measure of pain and opioid usage, the Silverman Integrated Analgesic Assessment (SIA) score, at 10 days post-surgery in participants who have a genotypic or pheno-converted CYP2D6 activity score ≤ 0.75. The SIA has a total score range of -200 to 200, where a higher score corresponds with higher pain and opioid use.

    Measured: Day of surgery (baseline) to 10 days post surgery

Secondary outcomes (6)
  1. 10 Day Pain Intensity as Measured by the PROMIS Numeric Pain Rating Scale

    PROMIS (Patient-Reported Outcomes Measurement Information System) Numeric Pain Rating Scale Pain intensity at 10 days post-surgery in participants who have a genotypic or pheno-converted CYP2D6 activity score ≤ 0.75. Pain was measured on a scale of 0-10, where higher scores correspond to higher levels of pain.

    Measured: 10 days post-surgery

  2. Post-surgery Opioid Usage, Measured in Milligrams of Morphine Equivalents (MME) Per Day

    Opioid usage from surgery to 10 days post-surgery in participants who have a genotypic or pheno-converted CYP2D6 activity score ≤ 0.75.

    Measured: Day of surgery (baseline) to 10 days post surgery

  3. 3 Month Prescription Pain Medication Misuse

    The 7-item PROMIS Prescription Pain Medication Misuse questionnaire assesses the extent to which participants experience medication misuse symptoms over the past 3 months using a 5-point Likert scale. The 7 questions are converted to a raw score, ranging from 7 to 35. Raw scores are converted to T-scores using the PROMIS conversion tables and range from 36.3 to 55.8. Higher scores reflect greater medication misuse.

    Measured: 3 months post surgery

  4. 1 Month PROMIS Mobility Score

    PROMIS mobility score at 1 month post-surgery in participants who have a genotypic or pheno-converted CYP2D6 activity score ≤ 0.75 in the adult population only. The score ranges from 15 to 75, where a higher score corresponds to higher mobility.

    Measured: 1 month post surgery

  5. Number of Participants With Opioid Persistence

    Opioid persistence defined as a filled prescription for an opioid medication 3-6 months post-surgery in participants who have a genotypic or pheno-converted CYP2D6 activity score ≤ 0.75.

    Measured: 3-6 months post-surgery, assessed at 6 months

  6. Participants With Drug-Gene Concordance

    Drug-Gene Concordance defined as an agreement between the Pharmacogenomics (PGx) Test and the prescribed opioids post surgery for pain management in participants who have a genotypic or pheno-converted CYP2D6 activity score ≤ 0.75

    Measured: Within 10 days post-surgery

Timeline

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

  1. First posted28 Jul 2023
  2. Study start10 Mar 2021
  3. Primary completion25 Mar 2024
  4. Study completion25 Mar 2024

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 N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Immediate vs. delayed pharmacogenetic testing and genotype-guided pain or depression therapy
Masking
None (open label)
Enrolment
1,602 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05966129
Sponsor's protocol ID
PRO00104948_A
Other IDs
U01HG010225
Acronym
ADOPT PGx
Status last verified
Mar 2026
First submitted
21 Jul 2023
Last updated
19 Mar 2026
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Cavallari LH, Cicali E, Wiisanen K, Fillingim RB, Chakraborty H, Myers RA, Blake KV, Asiyanbola B, Baye JF, Bronson WH, Cook KJ, Elwood EN, Gray CF, Gong Y, Hines L, Kannry J, Kucher N, Lynch S, Nguyen KA, Obeng AO, Pratt VM, Prieto HA, Ramos M, Sadeghpour A, Singh R, Rosenman M, Starostik P, Thomas CD, Tillman E, Dexter PR, Horowitz CR, Orlando LA, Peterson JF, Skaar TC, Van Driest SL, Volpi S, Voora D, Parvataneni HK, Johnson JA; IGNITE Pragmatic Trials Network. Implementing a pragmatic clinical trial to tailor opioids for acute pain on behalf of the IGNITE ADOPT PGx investigators. Clin Transl Sci. 2022 Oct;15(10):2479-2492. doi: 10.1111/cts.13376. Epub 2022 Aug 4.

    PubMed 35899435
  • Cavallari LH, Myers RA, Chakraborty H, Skaar TC, Gray CF, Baye JF, Volpi S, Rider R, Cicali EJ, Elwood EN, Harris EC, Hines LJ, Nahid NA, Nguyen KA, Obeng AO, Parr JA, Ramos MA, Orlando LA, Prieto HA, Sadeghpour A, Singh R, Starostik P, Tillman EM, Wyatt C, Horowitz CR, Voora D, Blake KV, Parvataneni HK, Fillingim RB, Dexter PR, Peterson JF, Johnson JA; IGNITE Pragmatic Trials Network. CYP2D6-Guided Opioid Management and Postoperative Pain Control: A Randomized Clinical Trial. JAMA Netw Open. 2026 Feb 2;9(2):e2558299. doi: 10.1001/jamanetworkopen.2025.58299.

    PubMed 41719044

Questions about this trial

What is this clinical trial studying?

A study testing Pharmacogenetic testing and Clinical decisions support in people with Acute Pain, run by Duke University at 11 sites 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 4 inclusion and 9 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 19 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 11 sites 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. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 5 Jun 2025). 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?

10 Day Silverman Integrated Analgesic Assessment (SIA) Score (time frame: Day of surgery (baseline) to 10 days post surgery). 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 NCT05966129, which also lists 2 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 19 Mar 2026.

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