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Abstracts (941) A new tool for assessing the functional and emotional impact of pain and effects of treatment: The goal attainment scale J Farrar, J Messina, G Niebler; Cephalon, Inc., Frazer, PA Pain is a highly individual experience that interferes with many aspects of life in a patient-specific manner. Measures that account for individual variability may be more sensitive to the effects of pain therapy on patients’ lives. Goal attainment scaling (GAS) enables respondents to individualize their responses to reflect factors that are important to them and may help to obtain more meaningful measures of their chronic pain experience and of the impact of treatment. We have developed a GAS instrument for pain patients. To select the potential factors for patients to consider, we built on years of experience using the 7 pain interference categories of the Brief Pain Inventory-Short Form (BPI-SF). Patients are asked to identify the three factors that are most important to them and for each provide the following: 3 recent examples of how pain interfered with function, 3 specific improvements they would expect with better pain control, and completion of the sentence, “If I could do/feel _____, it would significantly reduce the impact my pain has on my [selected factor].” At monthly visits, patients answer the same set of questions for each of the three factors previously identified. To test this instrument, our Chronic Pain GAS has been included in an ongoing study evaluating fentanyl effervescent buccal tablets for the treatment of breakthrough pain in patients with chronic pain. At each assessment, the patient is shown his/her responses to the questions at the baseline visit and then is asked to rate the impression of change using a measurement scale modeled after the Patient Global Impression of Change scale. The GAS results will be validated by comparing them to appropriate subscales of the SF-36, POMS, and Oswestry instruments.

S85 (943) Opioid blood levels in high dose, chronic pain patients F Tennant; Veract Intractable Pain Centers, West Covina, CA There is scant information concerning opioid blood concentrations in chronic pain patients treated with high doses of opioids. Blood concentrations, however, have the potential to monitor compliance with prescribing instructions, assess clinical effectiveness, and resolve medicolegal issues of tolerance, toxicity, and overdose. Physician readers of Practical Pain Management were asked to voluntarily submit a data sheet without a patient’s name and report opioid blood concentrations of chronic pain patients treated with opioids. Data collected included age, sex, weight, cause of pain, opioid and daily dosage, and the patient’s function status including the ability to drive and work. Patients had blood samples taken approximately 1 to 2 hours after a regularly, prescribed opioid dosage. The physician utilized his/her usual commercial laboratory. To date, 10 to 30 blood concentrations have been reported for each of the following opioids: methadone, morphine, oxycodone, hydromorphone, hydrocodone, fentanyl, and meperidine. Patients had well-known chronic, painful conditions such as spine degeneration, autoimmune disorders, and neuropathies. All patients were described as functional in that they could care for themselves, and over 80% could drive a car. Dosages of opioids were high. Daily morphine dosage ranged from 60 to 600mg, oxycodone ranged from 60 to 960mg, and methadone 80 to 400mg. The majority of blood concentrations were above the therapeutic ranges published for non-tolerant persons, and many concentrations were above levels often described as “toxic” or “lethal.” Blood concentrations collected in this survey suggest that determination of opioid blood concentration should become routine clinical practice to aid in determining compliance with prescribing instructions, determination of therapeutic effectiveness, and medicolegal protection for the prescribing physician and pharmacist.

(942) Chronic illness and pain problems related to self efficacy in pain management and rehabilitation

(944) Relationships between physical and cognitive performance in individuals with and without back pain

D Byreddy, P Davis, N Smith; The Stress Medicine Clinic, Sandy, UT A recent study performed at the University of Utah Medical School compared a measure of self-efficacy being developed and provisionally described as the “Automatic Thoughts Inventory” (ATI) with a well validated instrument describing the range and impact of problems related to the course of chronic illness and pain, the Chronic Illness Problem Inventory (CIPI) in a sample of 70 patients. Discrete CIPI problem areas of: sleeping, eating, finances/employment, medication use, interaction with medical staff, focus on personal illness, cognitive functioning, physical appearance, bodily deterioration, inactivity, social activity, family/ friends and assertion were associated with summary items from the ATI of: affirmation of life/coping, finality/coming to terms, life satisfaction, sense of well-being and belief in/access to meaning using Structural Equation Modeling analysis and the program Analysis of Moment Structures (AMOS 4). The model converged successfully (CFI⫽ .98, RMSEA⫽ .06), describing dynamic relationships between CIPI problem areas and self-efficacy factors from the ATI. This pilot study revealed important impacts of self-efficacy on patient ADLs and social functioning, and indicated the important relationships between factors comprising the two instruments. Clinical implications and the relationships of factors with demographic variables and pain and symptom measures are discussed.

M Simmonds, N Wilson, M Davies; University of Southampton, Southampton, United Kingdom Aging, illness, injury, and symptoms such as pain and fatigue are associated with generalized psychomotor slowing and compromised physical and cognitive function. The relationship between physical and cognitive function across disorders is not completely understood. The purpose of this preliminary study is to characterize physical and cognitive function in individuals with and without back pain and examine the relationships among and between measures of physical and cognitive function. Ten subjects with back pain (6 male and 4 female) mean age 41.5⫹14.5 and twenty pain free subjects (10 male and 10 female) mean age 38.0⫹5.3 participated. All subjects completed a battery of five physical performance tests (five-minute distance walk, 50-foot speed walk, repeated sit-to-stand, repeated trunk flexion and a loaded reach test); and five cognitive performance tests (grammatical transformation test, psychomotor vigilance task, memory search test, manikin test, and a four choice reaction time test). Physical performance of subjects with back pain was 60 – 70% that of control subjects. There was a significant difference in performance between groups on all physical performance measures (F1,28 range p⬍.005). In contrast there was no difference between groups on cognitive task performance (speed or accuracy) except on the four choice reaction test (F1,28 6.6,p⬍.05). The pattern of correlations among test measures was similar within each group. Moderate to strong correlations were generally evident among physical performance measures (r ⫽.3 to .8). Correlations were slightly lower among most cognitive tasks (r ⫽ .2 to .6). Correlations between physical and cognitive tasks were more variable (r ⫽ .1 to .7). The relationship between physical and cognitive function is evident and warrants further study to assess the robustness of the relationships across patient groups and conditions as well as following specific physical and/or psychological interventions.