Date of Award

7-2017

Degree Type

Thesis

Degree Name

Master of Science in Biomedical Sciences

First Advisor

Frederick J. Goldstein, PhD

Second Advisor

Katherine E. Galluzzi, DO

Third Advisor

Heather L. Montie, PhD

Abstract

An investigational clinical research pilot study is being conducted at a nursing facility and an academic primary care office to evaluate memantine as an adjunct to opioid therapy for treatment of chronic pain. Memantine can be beneficial in reducing pain because it is an N-methyl-D-aspartate receptor (NMDAr) antagonist with a pivotal action in the hippocampus: it initiates long-term potentiation in the anterior cingulate cortex and forebrain. These areas of action have a high probability for reducing the affective quality of pain.

This open-label, non-randomized pilot study is designed to observe any effects which may occur during addition of memantine to the therapeutic regimen of nursing home patients and office patients who take daily opioids (oxycodone, oxycodone/acetaminophen combination or hydromorphone) on an as-needed basis (prn) for chronic pain. The objective is to gauge, preliminarily, whether patients benefit from using memantine as an adjunct to their daily oxycodone/acetaminophen or hydromorphone treatment by increased analgesia, a reduction of opioid used, and increased bowel movements.

Memantine efficacy was assessed using pain diaries where patients recorded on a daily basis the amount of opioid used, pain scores (from '0' [no pain] to '10' [worst pain ever]), and number of bowel movements. Data are collected for six weeks; initially a two-week, no-memantine observation period, followed by a four-week treatment phase. Collected data are then analyzed.

With the first patient to complete the study, a trend of decreased pain scores over the six-week study was observed. There was also an indication of decreased opioid use but may be due to inconsistencies; bowel movements fluctuated and did not show a trend. The second patient showed trends of a decreased pain score with a decrease in opioid dosage over the course of the study and slightly lower bowel movements per week.

This pilot study presented insight to the plausible use of memantine as an adjunct to treat chronic pain patients. Although the number of patients that participated in this pilot was small, the trends observed may help to launch this type of study into a larger scale. Thus, these initial data present insight to the plausible use of memantine as an adjunct to treat chronic non-malignant pain patients who take an opioid daily.

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