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418 Successful control of back and leg pain with a next generation spinal cord stimulation (SCS) device following initial treatment failure
Poster Presentations / Clinical – Other Treatments / European Journal of Pain 11(S1) (2007) S59–S207
according with traditional Chinese medicine, for 20 min, by applying 5.6 mm wave length, with devices ‘‘Iavi-1’’ and ‘‘KVC-MTA’’. The treatment cure was 10 procedures. The Control group (20 patients) have received only drug treatment, same as the base group. Treatment efficiency appreciation was made using the analogical visual pain scale it 1st, 5th and 10th day of treatment. Results. Positive treatment effect was obtained in both cases. In the base group, compared to the control group, the recovery was faster and more evidenced at all evaluation steps. Conclusion. Very high frequency millimetric waves treatment method proved to be efficient and can be included in the vertebrogen radiculopathy pain syndrome complex treatment.
Total number of visits
(1) Oral medication (2) Oral medication plus epidural steroids (3) Acupuncture
S185
64 visits
121 visits
Year 2005 24 patients
Year 2006 57 patients
13 9
54.17% 37.5%
25 28
43.85% 49.13%
2
8.33%
4
7.02%
Conclusions. The systematic and more frequent use of pregabalin or the increase of the number of epidurals performed during 2006 compared to 2005 could have contributed in the reduction of patients who paid a forth or a fifth visit to the pain management specialist.
doi:10.1016/j.ejpain.2007.03.431 doi:10.1016/j.ejpain.2007.03.432
417 PAIN MANAGEMENT OF LOW BACK PAIN IN A DISTRICT HOSPITAL E. Kapota *,a, C. Savvidou b, I. Serpetinis a, I. Lykoudi a, L. Baltatzi a, A. Kouta a a
Anesthesiology Department, University of Konstadopouleio General Hospital of Nea Ionia, Greece b 2nd Orthopaedic Department, University of Konstadopouleio General Hospital of Nea Ionia, Greece
Athens, Athens, Athens, Athens,
Background and goal of the study. The objective of this study was to document the therapeutic options in a district hospital for patients with radicular leg symptoms or neuropathic low back pain (LBP). Materials and methods. We pooled data from 71 patients who visited the pain department. We noted the number of visits needed for a patient to have a pain reduction greater than 50% and the type of treatment which was performed. Results. We observed a reduction of 17% in the number of patients who required more than three visits for adequate pain relief to the pain department during 2006. The available methods included oral medication with non steroid anti-inflammatory drugs plus pregabalin when indicated, combination of drugs with epidural steroids and acupuncture.
1st visit 2nd visit 3rd visit 4th visit 5th visit
Year 2005 24 patients
Year 2006 57 patients
6 6 5 4 3
22 16 12 4 3
25% 25% 20.8% 16.7% 12.5%
38.7% 28% 21% 7% 5.3%
418 SUCCESSFUL CONTROL OF BACK AND LEG PAIN WITH A NEXT GENERATION SPINAL CORD STIMULATION (SCS) DEVICE FOLLOWING INITIAL TREATMENT FAILURE A.C. Khodavirdi *,a, J.M. Epstein b, S.B. Khan c, R.M. Rosenthal d, A. Foster a a
Boston Scientific Neuromodulation, Valencia, CA, USA Comprehensive Pain Care, Babylon, NY, USA c Health Care Center of Tampa, Inc. Offices, Lakeland, FL, USA d Nexus Pain Care, Provo, UT, USA b
SCS is an effective treatment for chronic intractable back and leg pain. SCS systems produced by different manufacturers vary in their technical capabilities. These differences, which include current vs. voltage control and independent contact control vs. splitting pulses between contacts, may determine the ability of a given system to address particular pain patterns. Hence, device selection is key in achieving satisfactory outcomes. Outcomes, based on cases in medical practice, were reported after replacement of each patient’s original constant voltage (Cases 1 and 2) or constant current (Case 3) SCS system with another, having 16 independently current-controlled contacts. Case 1: Two SCS systems were trialed sequentially in the operating room. With the first system, coverage of painful areas could not be achieved. The second system achieved complete coverage in 20 s. Case 2: The patient classified paresthesia with the replacement system as a ‘‘massage’’, with broader and more complete coverage of painful areas.
S186
Poster Presentations / Clinical – Other Treatments / European Journal of Pain 11(S1) (2007) S59–S207
Moreover, he described reduced use of medications, and ‘‘100%’’ improvement in quality of life. Case 3: Three months after SCS system replacement, the patient reported complete discontinuation of pain medications, a dramatic increase in quality of life, and stimulation perceived as ‘‘smoother and softer’’. SCS technologies of different manufacturers may produce differences in pain coverage and sensations of paresthesia in the same patients. Selecting the ‘best’ system for each individual can have implications for quality of life and concomitant health care utilization, such as medication use. We suggest judicious consideration of technical capabilities when selecting an SCS system. doi:10.1016/j.ejpain.2007.03.433
study and pedography. All collected data were statistically analyzed by SPSS 10 software. Results. There was a statistically significant improvement in UK score (P = 0.016), MNSI (P = 0.007), DNS (P = 0.001), and VAS (P = 0.024) and monofilament perception (P = 0.02). Neuropathy score with electrodiagnostic criteria was significantly improved (P = 0.003). Balance improvement by Tinetti score was significant (P = 0.04). There was an apparent, but not statistically significant (P = 0.07) improvement in dynamic balance parameters evaluated by biodex system (Model945320). Static forefoot plantar pressure distribution also improved (P = 0.02), but there was no significant change in other aspects of plantar pressure distribution. We conclude that the use of MIRE is associated with significant improvement in diabetic neuropathy and this is apparent and significant within six weeks of treatment. This can be expected to reduce complications from diabetic neuropathy including foot ulceration and amputation. doi:10.1016/j.ejpain.2007.03.434
419 EFFECT OF MONOCHROMATIC NEAR INFRARED ENERGY ON NEUROPATHY, PLANTAR PRESSURE DISTRIBUTION AND BALANCE IN PATIENTS WITH DIABETIC NEUROPATHY S.P Madani *,a,b, N. Lessan b, M. Akbari c, S. Amirimoghaddam b, R. Heshmat b, B. Larijani b a
Physical Medicine and Rehabilitation, Iran University of Medical Sciences, Shafayahyaian Rehabilitation Hospital, Iran b Endocrine and Metabolism Research Center, Tehran University of Medical Sciences, Doctor Shariati Hospital, Iran c Physical Therapy Department, Iran University of Medical Sciences, Rehabilitation Faculty, Tehran, Iran Background and aims. This study investigates whether treatment with monochromatic near infrared energy (MIRE, Anodyne Therapy LLC) for six weeks is associated with an improvement of peripheral neuropathy, plantar pressure distribution and balance indices in patients with diabetic polyneuropathy. Methods. Fifteen consecutive subjects with diabetic peripheral neuropathy were recruited from Diabettic Clinic and treated with MIRE at the frequency of three sessions per week. Assessment at baseline and six weeks included: United Kingdom screening score, Michigan neuropathy screening index (MNSI), Michigan diabetic neuropathy score (DNS), Tinetti balance score, visual analog scale (VAS), Semmes–Weinstein monofilament examination by 10-g monofilament in five standard points of each foot, vibration perception with 128 Hz tuning fork, electrodiagnostic study, biodex balance
420 DEVELOPMENT AND IMPLEMENTATION OF AN INTERDISCIPLINARY PAIN COURSE E.L. Manning *,a, H. Martin b, J. Baisden a, A. Smith b a
Medical College of Wisconsin, Froedtert Hospital, Milwaukee, WI, USA b Medical University of South Carolina, MUSC Hospital, Charleston, SC, USA Background. Research has shown that pain is not adequately addressed in health care education, including medicine, pharmacy, and nursing, occupational therapy and physical therapy. Pain education is only minimally addressed in these programs, particularly at the undergraduate level. Given this lack of education, concerns are reasonable, regarding levels of preparedness for working with this challenging population. Methods. This course was designed as a one semester program (36 class hours), based on the International Association for the Study of Pain guidelines for pain education, offered as an elective at the Medical University of South Carolina. This program was designed to facilitate: (1) basic pain education, (2) pain assessment techniques, (3) interdisciplinary pain education (guest speakers) and (4) implementation of multidisciplinary case studies/practicals to assist students in learning to work collaboratively. The pilot course employed 10 students, five medical students, three nursing students, and two physician assistants. The second implementation involved 45 students, including 12 physical and occupational therapy students, eight medical students, 13 nurs-
according with traditional Chinese medicine, for 20 min, by applying 5.6 mm wave length, with devices ‘‘Iavi-1’’ and ‘‘KVC-MTA’’. The treatment cure was 10 procedures. The Control group (20 patients) have received only drug treatment, same as the base group. Treatment efficiency appreciation was made using the analogical visual pain scale it 1st, 5th and 10th day of treatment. Results. Positive treatment effect was obtained in both cases. In the base group, compared to the control group, the recovery was faster and more evidenced at all evaluation steps. Conclusion. Very high frequency millimetric waves treatment method proved to be efficient and can be included in the vertebrogen radiculopathy pain syndrome complex treatment.
Total number of visits
(1) Oral medication (2) Oral medication plus epidural steroids (3) Acupuncture
S185
64 visits
121 visits
Year 2005 24 patients
Year 2006 57 patients
13 9
54.17% 37.5%
25 28
43.85% 49.13%
2
8.33%
4
7.02%
Conclusions. The systematic and more frequent use of pregabalin or the increase of the number of epidurals performed during 2006 compared to 2005 could have contributed in the reduction of patients who paid a forth or a fifth visit to the pain management specialist.
doi:10.1016/j.ejpain.2007.03.431 doi:10.1016/j.ejpain.2007.03.432
417 PAIN MANAGEMENT OF LOW BACK PAIN IN A DISTRICT HOSPITAL E. Kapota *,a, C. Savvidou b, I. Serpetinis a, I. Lykoudi a, L. Baltatzi a, A. Kouta a a
Anesthesiology Department, University of Konstadopouleio General Hospital of Nea Ionia, Greece b 2nd Orthopaedic Department, University of Konstadopouleio General Hospital of Nea Ionia, Greece
Athens, Athens, Athens, Athens,
Background and goal of the study. The objective of this study was to document the therapeutic options in a district hospital for patients with radicular leg symptoms or neuropathic low back pain (LBP). Materials and methods. We pooled data from 71 patients who visited the pain department. We noted the number of visits needed for a patient to have a pain reduction greater than 50% and the type of treatment which was performed. Results. We observed a reduction of 17% in the number of patients who required more than three visits for adequate pain relief to the pain department during 2006. The available methods included oral medication with non steroid anti-inflammatory drugs plus pregabalin when indicated, combination of drugs with epidural steroids and acupuncture.
1st visit 2nd visit 3rd visit 4th visit 5th visit
Year 2005 24 patients
Year 2006 57 patients
6 6 5 4 3
22 16 12 4 3
25% 25% 20.8% 16.7% 12.5%
38.7% 28% 21% 7% 5.3%
418 SUCCESSFUL CONTROL OF BACK AND LEG PAIN WITH A NEXT GENERATION SPINAL CORD STIMULATION (SCS) DEVICE FOLLOWING INITIAL TREATMENT FAILURE A.C. Khodavirdi *,a, J.M. Epstein b, S.B. Khan c, R.M. Rosenthal d, A. Foster a a
Boston Scientific Neuromodulation, Valencia, CA, USA Comprehensive Pain Care, Babylon, NY, USA c Health Care Center of Tampa, Inc. Offices, Lakeland, FL, USA d Nexus Pain Care, Provo, UT, USA b
SCS is an effective treatment for chronic intractable back and leg pain. SCS systems produced by different manufacturers vary in their technical capabilities. These differences, which include current vs. voltage control and independent contact control vs. splitting pulses between contacts, may determine the ability of a given system to address particular pain patterns. Hence, device selection is key in achieving satisfactory outcomes. Outcomes, based on cases in medical practice, were reported after replacement of each patient’s original constant voltage (Cases 1 and 2) or constant current (Case 3) SCS system with another, having 16 independently current-controlled contacts. Case 1: Two SCS systems were trialed sequentially in the operating room. With the first system, coverage of painful areas could not be achieved. The second system achieved complete coverage in 20 s. Case 2: The patient classified paresthesia with the replacement system as a ‘‘massage’’, with broader and more complete coverage of painful areas.
S186
Poster Presentations / Clinical – Other Treatments / European Journal of Pain 11(S1) (2007) S59–S207
Moreover, he described reduced use of medications, and ‘‘100%’’ improvement in quality of life. Case 3: Three months after SCS system replacement, the patient reported complete discontinuation of pain medications, a dramatic increase in quality of life, and stimulation perceived as ‘‘smoother and softer’’. SCS technologies of different manufacturers may produce differences in pain coverage and sensations of paresthesia in the same patients. Selecting the ‘best’ system for each individual can have implications for quality of life and concomitant health care utilization, such as medication use. We suggest judicious consideration of technical capabilities when selecting an SCS system. doi:10.1016/j.ejpain.2007.03.433
study and pedography. All collected data were statistically analyzed by SPSS 10 software. Results. There was a statistically significant improvement in UK score (P = 0.016), MNSI (P = 0.007), DNS (P = 0.001), and VAS (P = 0.024) and monofilament perception (P = 0.02). Neuropathy score with electrodiagnostic criteria was significantly improved (P = 0.003). Balance improvement by Tinetti score was significant (P = 0.04). There was an apparent, but not statistically significant (P = 0.07) improvement in dynamic balance parameters evaluated by biodex system (Model945320). Static forefoot plantar pressure distribution also improved (P = 0.02), but there was no significant change in other aspects of plantar pressure distribution. We conclude that the use of MIRE is associated with significant improvement in diabetic neuropathy and this is apparent and significant within six weeks of treatment. This can be expected to reduce complications from diabetic neuropathy including foot ulceration and amputation. doi:10.1016/j.ejpain.2007.03.434
419 EFFECT OF MONOCHROMATIC NEAR INFRARED ENERGY ON NEUROPATHY, PLANTAR PRESSURE DISTRIBUTION AND BALANCE IN PATIENTS WITH DIABETIC NEUROPATHY S.P Madani *,a,b, N. Lessan b, M. Akbari c, S. Amirimoghaddam b, R. Heshmat b, B. Larijani b a
Physical Medicine and Rehabilitation, Iran University of Medical Sciences, Shafayahyaian Rehabilitation Hospital, Iran b Endocrine and Metabolism Research Center, Tehran University of Medical Sciences, Doctor Shariati Hospital, Iran c Physical Therapy Department, Iran University of Medical Sciences, Rehabilitation Faculty, Tehran, Iran Background and aims. This study investigates whether treatment with monochromatic near infrared energy (MIRE, Anodyne Therapy LLC) for six weeks is associated with an improvement of peripheral neuropathy, plantar pressure distribution and balance indices in patients with diabetic polyneuropathy. Methods. Fifteen consecutive subjects with diabetic peripheral neuropathy were recruited from Diabettic Clinic and treated with MIRE at the frequency of three sessions per week. Assessment at baseline and six weeks included: United Kingdom screening score, Michigan neuropathy screening index (MNSI), Michigan diabetic neuropathy score (DNS), Tinetti balance score, visual analog scale (VAS), Semmes–Weinstein monofilament examination by 10-g monofilament in five standard points of each foot, vibration perception with 128 Hz tuning fork, electrodiagnostic study, biodex balance
420 DEVELOPMENT AND IMPLEMENTATION OF AN INTERDISCIPLINARY PAIN COURSE E.L. Manning *,a, H. Martin b, J. Baisden a, A. Smith b a
Medical College of Wisconsin, Froedtert Hospital, Milwaukee, WI, USA b Medical University of South Carolina, MUSC Hospital, Charleston, SC, USA Background. Research has shown that pain is not adequately addressed in health care education, including medicine, pharmacy, and nursing, occupational therapy and physical therapy. Pain education is only minimally addressed in these programs, particularly at the undergraduate level. Given this lack of education, concerns are reasonable, regarding levels of preparedness for working with this challenging population. Methods. This course was designed as a one semester program (36 class hours), based on the International Association for the Study of Pain guidelines for pain education, offered as an elective at the Medical University of South Carolina. This program was designed to facilitate: (1) basic pain education, (2) pain assessment techniques, (3) interdisciplinary pain education (guest speakers) and (4) implementation of multidisciplinary case studies/practicals to assist students in learning to work collaboratively. The pilot course employed 10 students, five medical students, three nursing students, and two physician assistants. The second implementation involved 45 students, including 12 physical and occupational therapy students, eight medical students, 13 nurs-