Addressing challenges of clinical trials in acute pain: The Pain Management of Vaso-occlusive Crisis in Children and Young Adults with Sickle Cell Disease Study.

BACKGROUND/AIMS: Neuropathic pain is a known component of vaso-occlusive pain in sickle cell disease; however, drugs targeting neuropathic pain have not been studied in this population. Trials of acute pain are complicated by the need to obtain consent, to randomize participants expeditiously while optimally treating pain. We describe the challenges in designing and implementing the Pain Management of Vaso-occlusive Crisis in Children and Young Adults with Sickle Cell Disease Study (NCT01954927), a phase II, randomized, double-blind, placebo-controlled trial to determine the effect of gabapentin for vaso-occlusive crisis. METHODS: In the Pain Management of Vaso-occlusive Crisis in Children and Young Adults with Sickle Cell Disease Study, we aim to assess the analgesic effect of gabapentin during vaso-occlusive crisis. Difficulties we identified included avoiding delay of notification of study staff of potential participants which we resolved by automated notification. Concern for rapid randomization and drug dispensation was addressed through careful planning with an investigational pharmacy and a single liquid formulation. We considered obtaining consent during well-visits to avoid the time constraints with acute presentations, but the large number of patients and limited duration that consent is valid made this impractical. RESULTS: In all, 79% of caregivers/children approached have agreed to participate. The trial is currently active, and enrollment is at 45.8% of that targeted (76 of 166) and expected to continue for two more years. Maintaining staff availability after-hours remains problematic, with 8% of screened patients missed for lack of available staff. LESSONS LEARNED: Lessons learned in designing a trial to expedite procedures in the acute pain setting include (1) building study evaluations upon a standard-of-care backbone; (2) implementing a simple study design to facilitate consent and data capture; (3) assuring ample, well-trained study staff; and (4) utilizing technology to automate procedures whenever possible. CONCLUSION: This study design has circumvented many of the logistical barriers usually associated with acute pain trials and may serve as a prototype for future studies.

1H NMR studies of aerosol-OT reverse micelles with alkali and magnesium counterions: preparation and analysis of MAOTs.

Simple procedures and characterization of a series of well-defined precursors are described for preparation of a unique microenvironment in nanoreactors, reverse micelles. The Na(+), K(+), Rb(+), Cs(+), and Mg(2+) surfactants were prepared using liquid-liquid ion exchange using chloride and nitrate salts. The surfactants were characterized using (1)H NMR spectroscopy and a variety of other techniques. (1)H NMR spectroscopy was found to be a sensitive probe for characterization of the size of the nanoreactor as well as its water content. (1)H NMR spectra can be used for detailed characterization of reactions in confined environments when counterion effects are likely to be important. (1)H NMR spectroscopy revealed two separate peaks corresponding to water in Mg(AOT)2 samples; one peak arises from water coordinated to the Mg(2+) ion while the other peak arises from bulk water. The two water signals arise directly from the slow exchange of the water coordinated to Mg(2+) in these microemulsions with water in the water pool, and provide an opportunity to study hydration of Mg(2+). This work thus extends the potential use of MAOT microemulsions for applications such as in green chemistry.