title: A Double-Blind Placebo Randomized Controlled Trial of Minocycline to Reduce Pain After Carpal Tunnel and Trigger Finger Release.
abstract: OBJECTIVE
  Minocycline is a microglial cell inhibitor and decreases pain behaviors in animal models. Minocycline might represent an intervention for reducing postoperative pain. This trial tested whether perioperative administration of minocycline reduced time to pain resolution (TPR) after standardized hand surgeries with known prolonged pain profiles: carpal tunnel release (CTR) and trigger finger release (TFR).
  
  
  METHODS
  This double-blinded randomized controlled trial included patients undergoing CTR or TFR under local anesthesia. Before surgery, participants recorded psychological and pain measures. Participants received oral minocycline, 200 mg, or placebo 2 hours prior to procedure, and then 100 mg of minocycline or placebo 2 times a day for 5 days. After surgery, participants were called daily assessing their pain. The primary end point of TPR was when participants had 3 consecutive days of 0 postsurgical pain. Futility analysis and Kaplan-Meier analyses were performed.
  
  
  RESULTS
  A total of 131 participants were randomized and 56 placebo and 58 controls were analyzed. Median TPR for CTR was 3 weeks, with 15% having pain more than 6 weeks. Median TPR for TFR was 2 weeks with 18% having pain more than 6 weeks. The overall median TPR for the placebo group was 2 weeks (10% pain > 6 weeks) versus 2.5 weeks (17% pain > 6 weeks) for the minocycline group. Futility analysis found that the likelihood of a true underlying clinically meaningful reduction in TPR owing to minocycline was only 3.5%. Survival analysis found minocycline did not reduce TPR. However, subgroup analysis of those with elevated posttraumatic distress scores found the minocycline group had longer TPR.
  
  
  CONCLUSIONS
  Oral administration of minocycline did not reduce TPR after minor hand surgery. There was evidence that minocycline might increase length of pain in those with increased posttraumatic stress disorder symptoms.
  
  
  METHODS
  Therapeutic I.
authors.affiliation: Department of Surgery, Palo Alto VA, Palo Alto, CA; Division of Plastic Surgery, Department of Surgery, Stanford University, Palo Alto, CA. Electronic address: curtincatherine@yahoo.com.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Curtin
authors.affiliation: Department of Orthopedic Surgery, Stanford University, Palo Alto, CA.
authors.forename: Debbie
authors.initials: D
authors.lastname: Kenney
authors.affiliation: Department of Surgery, Stanford University, Palo Alto, CA.
authors.forename: Paola
authors.initials: P
authors.lastname: Suarez
authors.affiliation: Department of Surgery, Palo Alto VA, Palo Alto, CA; Division of Plastic Surgery, Department of Surgery, Stanford University, Palo Alto, CA.
authors.forename: Vincent R
authors.initials: VR
authors.lastname: Hentz
authors.affiliation: Department of Surgery, Stanford University, Palo Alto, CA.
authors.forename: Tina
authors.initials: T
authors.lastname: Hernandez-Boussard
authors.affiliation: Division of Pain Management, Department of Anesthesiology, Stanford University, Palo Alto, CA.
authors.forename: Sean
authors.initials: S
authors.lastname: Mackey
authors.affiliation: Division of Pain Management, Department of Anesthesiology, Stanford University, Palo Alto, CA.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Carroll
mesh_terms: D000328:Adult; D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000601:surgery*; D059350:Chronic Pain / Q000188:drug therapy* / Q000517:prevention & control; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control; D010865:Pilot Projects; D052582:Trigger Finger Disorder / Q000601:surgery*
keywords: Minocycline; carpal tunnel release; glial cell inhibitor; postoperative pain