- Email: [email protected]
Cervical myofascial pain syndrome - Is the ultrasound-guided needling approach a therapeutic option?
e114
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
A1.03 Pain - Complex regional pain syndromes ISPR8-0326
Could the complex regional pain syndrome (Sudeck atrophy), emerged as a distal radius at the typical site fracture complication, be prevented by physical therapy? D. Petrovic (Physical medicine, rehabilitation specialist) 1,∗ , M. Zlatkovic-Svenda 2 , B. Lazovic 3 1 The Belgrade City Institute of Gerontology/rehabilitation, Belgrade, Serbia 2 Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia 3 University Clinical Hospital Center “Zemun”, University of Belgrade School of Medicine, Belgrade, Serbia ∗ Corresponding author. E-mail address: [email protected] (D. Petrovic) Introduction/Background the complex regional pain syndrome (CRPS)-Sudeck disease is a frequent complication of a distal radius at the typical site fracture (DRF). Aim of the study was to evaluate the conventional physical agents application alone and combined with light therapy for treatment of distal radius at the typical site fracture and to follow-up patients for the CRPS occurrence in a six months period. Material and method Study comprised 52 female patients with DRF, involved after removing of the plaster and divided into two age-matched groups. Besides identical drug therapy, group 1 was treated with cryotherapy, exercises and group 2 with cryotherapy, exercises and the bioptron (polarized, polychromatic, non-coherent low energy radiation) light on the wrist and dorsal side of the hand. Patients were evaluated at 0, 7 and 15 days for pain [Visual Numerical Rating Scale (VAS)], range of the wrist motionsupination and pronation, and the hand fist forming capacity and followed up for 6 months. Results were analysed by computer statistic programme SPSS 20.0. Results Pain was significantly decreased in group 2 at 15th day of therapy. Significant improvement in supination was shown for group 2 on 7th (P = 0.019) and 15th day of treatment (P = 0.001). Both groups have shown significant improvement in VAS, supination and pronation on 15th day of therapy, as compared to baseline (P = 0.000). The complete hand fist forming capacity was achieved in 16 (61.5%) patients in group 1 and 19 (73.1%) in group 2. In a 6 months period of follow-up, CRPS was developed in 4 patients (15.4%) from group 1. Conclusion Bioptron light therapy combined with conventional therapy has shown good pain control, significant degree of pain reduction and improvement of the wrist motion range, with no CRPS development within the 6 months period of follow-up. Further studies would be beneficial. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.246 ISPR8-1951
Complex regional pain syndrome: New insight and therapeutic approach
L. Christophe ∗ , E. Chabanat , P. Revol , Y. Rossetti , S. Jacquin-Courtois Inserm, ImpAct U864, Lyon, France ∗ Corresponding author. E-mail address: [email protected] (L. Christophe) Introduction/Background CRPS implies sympathetic, inflammatory, neurogenic, vascular, peripheral and central mechanisms.
The pathophysiology of type 1 CRPS is complex and yet poorly understood. The relative part of each mechanism in CRPS type 1 development and resistance is not established, as their respective contribution varies amongst patients during the course of clinical evolution. A growing consensus has developped for a central participation to this pathology, even if the very nature of spatial and body representation alterations is still discussed. It has been clinically observed and repeatedly argued that CRPS implies pathological motor neglect. Material and method We reviewed the available literature about central pathophysiology and new therapeutic approaches and will illustrate new perspectives with our own clinical and research practice. Results Even if spatial cognition explorations has given rise to a variety of inconsistent results, it is now admitted that central participation, manifested as a spatial reference frame alteration plays a central role in CRPS. This new view blazed the trail to new therapeutic strategies targeting spatial reference frame alterations: mirror therapy, prism adaptation, rTMS. Conclusion Central participation to CRPS’ pathophysiology is nowadays admitted. Amongst the new therapeutic strategies rising from this recent comprehension, the most promising seems to be prismatic adaptation. Keywords Complex regional pain syndrome; Spatial and body representation; Prismatic adaptation Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.247 ISPR8-2007
Cervical myofascial pain syndrome - Is the ultrasound-guided needling approach a therapeutic option?
P. Araujo ∗ , S. Serrano , A. Canelas Centro Hospitalar de Leiria, Medicina Física e de Reabilitac¸ão, Leiria, Portugal ∗ Corresponding author. E-mail address: [email protected] (P. Araujo) Introduction/Background Myofascial pain syndrome (MPS) is a frequent entity in clinical practice and is characterized by the presence of trigger points, limitation of joint mobility and neurological symptoms. The main purpose of this work was to evaluate the results obtained by perform an ultrasound-guided needling of the trapezius and levator scapulae muscles with simultaneous injection of steroids and local anesthetics, in the pain intensity and interference in daily life and the subjective benefits in patients with cervical MPS. Material and method Prospective longitudinal study, including patients with clinical diagnosis of unilateral or bilateral cervical MPS refractory to the conventional rehabilitation program, submitted to treatment during the year 2017. The technique included to pepper the trigger point with a fanlike manner under ultrasound guidance, using a 22G needle with simultaneous injection of 2% lidocaine and methylprednisolone acetate 40 mg/mL. A sociodemographic questionnaire, the pain numerical rating scale (NRS) and the brief pain inventory (BPI) were applied prior and 1 month after the procedure. In this last evaluation, a Likert scale was also applied to evaluate the subjective benefits. Results Eighteen patients were included, 82% female, with a mean of 54 years (SD = 8.2). No adverse effects were recorded. There was a statistically significant and clinically relevant reduction in the score obtained in the NRS (2.9, P < 0.001) and in all components of the BPI, including intensity (2.6, P < 0.001), pain interference in general activity (1.9, P < 0.001) and in the affective subdimension (1.7, P < 0.001). Fifty-four percent of the patients reported a very significant improvement with the procedure, but only 33% presented a ≤ 4 value in the NRS at 1 month reassessment.
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
Conclusion The results presented in this study show the importance of ultrasound-guided needling procedures in the treatment of myofascial pain and, at least, it short-term efficacy on reliefing pain, particularly in refractory cervical MPS. Keywords Ultrasound; Needling; Myofascial pain Disclosure of interest The authors declare that they have no competing interest.
ISPR8-0074
https://doi.org/10.1016/j.rehab.2018.05.248
W.C. Lien National Cheng Kung University Hospital, Physical Medicine and Rehabilitation, Tainan, Taiwan, ROC E-mail address: [email protected]
A1.04 Pain - Miscellaneous ISPR8-2736
Trackable pill digital technology in PRM & pain: Hype or hope? M.A. Young (Chair PMR) 1,∗ , L. Dimartino (BA) 2 The Workforce and Technology Vocational Rehabilitation Center, State of Maryland, Division of Rehabilitation Services Faculty, The Johns Hopkins School of Medicine, USA 2 University of West Florida, USA ∗ Corresponding author. E-mail address: [email protected] (M.A. Young)
1
Background Technological advances in the domain of wearable rehabilitation medical technology holds promise to optimize delivery and efficiency of healthcare. In no area of PRM is this more evident than in acute pain management. The combination of wearable technology with a “digital ingestion tracking program” (DITP) embedded within a pain pill may allow patients, caregivers as well as healthcare providers to track ingestion of pills through the web or a smartphone app. Monitoring of pill consumption compliance and adherence may be optimized. Method This study will explore the DITP system and assess its clinical utility and applicability to rehabilitation medicine. A systematic review of the literature will be presented along with the illuminating case history of a PMR patient who’s functional outcome was significantly impacted by the technology. Photos of DITP technology will be shared for didactic purposes. Results While there are many advantages of DITP including fostering enhanced compliance, improved adherence, empowerment of patients; several disadvantages exist such as cost and potential privacy concerns. Conclusions DITP can aide physiatrists in the daily management of pain patients by electronic verification of whether the patient has taken their prescribed pill and at what time. For patients on opioid medication, this is immensely important as compliance is a cornerstone of proper pain management. Enforcement and support of statutory safeguards can prevent improper diversion and abuse of pills. In an age of international concern over opioid abuse, DITP may offer an innovative strategy for enforcing proper use of pain medication in PRM. Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.249
e115
The impact of benzodiazepine on analgesic costs to treat spinal cord injury patients in Taiwan: A population-based retrospective cohort study
Introduction/Background The aim of this study was to evaluate the impact of benzodiazepine (BZD) on analgesic costs to treat spinal cord injury (SCI) patients in Taiwan. Material and method The retrospective cohort study used a subset of the Taiwan National Health Insurance Research Database (NHIRD) comprising information on two million beneficiaries randomly sampled from the entire population of Taiwan. A total of 3170 patients aged 16 and above with newly diagnosed SCI were identified during a period from 2001–2010. Results The multivariate linear regression using average daily costs of prescription of nociceptive pain, including non-steroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics for 1 year and 4 years after SCI showed increased costs in benzodiazepine (BZD) user, especially in high-dose BZD users (cumulative defined daily dose [cDDD] > 0.3) (parameter estimate = 3.79 and 1.37 respectively. P-value < 0.05). The multivariate linear regression using average daily costs of prescription of neuropathic pain, including antidepressants and anti-epileptic drugs for the treatment of neuropathic pain for 1 year and 4 years after SCI showed increased costs in BZD user, especially in high-dose BZD users (parameter estimate = 5.95 and 3.85 respectively. P-value < 0.05). Conclusion This study showed that the baseline BZD exposure may significantly increase the analgesic costs in SCI patients. Keywords Spinal cord injury; Benzodiazepine; Analgesic costs Disclosure of interest This study was supported by grants from the Ministry of Science and Technology (MOST 105-2314-B-006-081-). https://doi.org/10.1016/j.rehab.2018.05.250 ISPR8-0072
Transcutaneous electrical nerve stimulation and placebo analgesia: Are young and older adults the same? I. Daguet 1,2,3,∗ , K. Bergeron-Vézina 1,2 , M.P. Harvey 1,2 , M. Martel 1,2 , G. Léonard 1,2 1 Research Center on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Canada 2 Université de Sherbrooke, Faculté de médecine et des sciences de la santé, Sherbrooke, Canada 3 Institut Celle Souche et Cerveau, Département de Chronobiologie, Lyon, France ∗ Corresponding author. E-mail address: [email protected] (I. Daguet) Introduction/Background Placebo analgesia refers to a perceived reduction in pain following the administration of a simulated or otherwise medically ineffective treatment. Previous studies have shown that many factors can influence placebo analgesia. However, few investigations have examined the effect of age on placebo analgesia, and none have done it in the context of rehabilitation interventions. The objective of this study was to compare the placebo response induced by sham transcutaneous electrical nerve stimulation (TENS) between young and older individuals, using an experimental heat-pain paradigm. Material and method Twenty-two young (21–39 years) and 22 older (58–76 years) healthy adults participated in this comparative study. Experimental heat-pain was evoked with a thermode
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
A1.03 Pain - Complex regional pain syndromes ISPR8-0326
Could the complex regional pain syndrome (Sudeck atrophy), emerged as a distal radius at the typical site fracture complication, be prevented by physical therapy? D. Petrovic (Physical medicine, rehabilitation specialist) 1,∗ , M. Zlatkovic-Svenda 2 , B. Lazovic 3 1 The Belgrade City Institute of Gerontology/rehabilitation, Belgrade, Serbia 2 Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia 3 University Clinical Hospital Center “Zemun”, University of Belgrade School of Medicine, Belgrade, Serbia ∗ Corresponding author. E-mail address: [email protected] (D. Petrovic) Introduction/Background the complex regional pain syndrome (CRPS)-Sudeck disease is a frequent complication of a distal radius at the typical site fracture (DRF). Aim of the study was to evaluate the conventional physical agents application alone and combined with light therapy for treatment of distal radius at the typical site fracture and to follow-up patients for the CRPS occurrence in a six months period. Material and method Study comprised 52 female patients with DRF, involved after removing of the plaster and divided into two age-matched groups. Besides identical drug therapy, group 1 was treated with cryotherapy, exercises and group 2 with cryotherapy, exercises and the bioptron (polarized, polychromatic, non-coherent low energy radiation) light on the wrist and dorsal side of the hand. Patients were evaluated at 0, 7 and 15 days for pain [Visual Numerical Rating Scale (VAS)], range of the wrist motionsupination and pronation, and the hand fist forming capacity and followed up for 6 months. Results were analysed by computer statistic programme SPSS 20.0. Results Pain was significantly decreased in group 2 at 15th day of therapy. Significant improvement in supination was shown for group 2 on 7th (P = 0.019) and 15th day of treatment (P = 0.001). Both groups have shown significant improvement in VAS, supination and pronation on 15th day of therapy, as compared to baseline (P = 0.000). The complete hand fist forming capacity was achieved in 16 (61.5%) patients in group 1 and 19 (73.1%) in group 2. In a 6 months period of follow-up, CRPS was developed in 4 patients (15.4%) from group 1. Conclusion Bioptron light therapy combined with conventional therapy has shown good pain control, significant degree of pain reduction and improvement of the wrist motion range, with no CRPS development within the 6 months period of follow-up. Further studies would be beneficial. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.246 ISPR8-1951
Complex regional pain syndrome: New insight and therapeutic approach
L. Christophe ∗ , E. Chabanat , P. Revol , Y. Rossetti , S. Jacquin-Courtois Inserm, ImpAct U864, Lyon, France ∗ Corresponding author. E-mail address: [email protected] (L. Christophe) Introduction/Background CRPS implies sympathetic, inflammatory, neurogenic, vascular, peripheral and central mechanisms.
The pathophysiology of type 1 CRPS is complex and yet poorly understood. The relative part of each mechanism in CRPS type 1 development and resistance is not established, as their respective contribution varies amongst patients during the course of clinical evolution. A growing consensus has developped for a central participation to this pathology, even if the very nature of spatial and body representation alterations is still discussed. It has been clinically observed and repeatedly argued that CRPS implies pathological motor neglect. Material and method We reviewed the available literature about central pathophysiology and new therapeutic approaches and will illustrate new perspectives with our own clinical and research practice. Results Even if spatial cognition explorations has given rise to a variety of inconsistent results, it is now admitted that central participation, manifested as a spatial reference frame alteration plays a central role in CRPS. This new view blazed the trail to new therapeutic strategies targeting spatial reference frame alterations: mirror therapy, prism adaptation, rTMS. Conclusion Central participation to CRPS’ pathophysiology is nowadays admitted. Amongst the new therapeutic strategies rising from this recent comprehension, the most promising seems to be prismatic adaptation. Keywords Complex regional pain syndrome; Spatial and body representation; Prismatic adaptation Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.247 ISPR8-2007
Cervical myofascial pain syndrome - Is the ultrasound-guided needling approach a therapeutic option?
P. Araujo ∗ , S. Serrano , A. Canelas Centro Hospitalar de Leiria, Medicina Física e de Reabilitac¸ão, Leiria, Portugal ∗ Corresponding author. E-mail address: [email protected] (P. Araujo) Introduction/Background Myofascial pain syndrome (MPS) is a frequent entity in clinical practice and is characterized by the presence of trigger points, limitation of joint mobility and neurological symptoms. The main purpose of this work was to evaluate the results obtained by perform an ultrasound-guided needling of the trapezius and levator scapulae muscles with simultaneous injection of steroids and local anesthetics, in the pain intensity and interference in daily life and the subjective benefits in patients with cervical MPS. Material and method Prospective longitudinal study, including patients with clinical diagnosis of unilateral or bilateral cervical MPS refractory to the conventional rehabilitation program, submitted to treatment during the year 2017. The technique included to pepper the trigger point with a fanlike manner under ultrasound guidance, using a 22G needle with simultaneous injection of 2% lidocaine and methylprednisolone acetate 40 mg/mL. A sociodemographic questionnaire, the pain numerical rating scale (NRS) and the brief pain inventory (BPI) were applied prior and 1 month after the procedure. In this last evaluation, a Likert scale was also applied to evaluate the subjective benefits. Results Eighteen patients were included, 82% female, with a mean of 54 years (SD = 8.2). No adverse effects were recorded. There was a statistically significant and clinically relevant reduction in the score obtained in the NRS (2.9, P < 0.001) and in all components of the BPI, including intensity (2.6, P < 0.001), pain interference in general activity (1.9, P < 0.001) and in the affective subdimension (1.7, P < 0.001). Fifty-four percent of the patients reported a very significant improvement with the procedure, but only 33% presented a ≤ 4 value in the NRS at 1 month reassessment.
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
Conclusion The results presented in this study show the importance of ultrasound-guided needling procedures in the treatment of myofascial pain and, at least, it short-term efficacy on reliefing pain, particularly in refractory cervical MPS. Keywords Ultrasound; Needling; Myofascial pain Disclosure of interest The authors declare that they have no competing interest.
ISPR8-0074
https://doi.org/10.1016/j.rehab.2018.05.248
W.C. Lien National Cheng Kung University Hospital, Physical Medicine and Rehabilitation, Tainan, Taiwan, ROC E-mail address: [email protected]
A1.04 Pain - Miscellaneous ISPR8-2736
Trackable pill digital technology in PRM & pain: Hype or hope? M.A. Young (Chair PMR) 1,∗ , L. Dimartino (BA) 2 The Workforce and Technology Vocational Rehabilitation Center, State of Maryland, Division of Rehabilitation Services Faculty, The Johns Hopkins School of Medicine, USA 2 University of West Florida, USA ∗ Corresponding author. E-mail address: [email protected] (M.A. Young)
1
Background Technological advances in the domain of wearable rehabilitation medical technology holds promise to optimize delivery and efficiency of healthcare. In no area of PRM is this more evident than in acute pain management. The combination of wearable technology with a “digital ingestion tracking program” (DITP) embedded within a pain pill may allow patients, caregivers as well as healthcare providers to track ingestion of pills through the web or a smartphone app. Monitoring of pill consumption compliance and adherence may be optimized. Method This study will explore the DITP system and assess its clinical utility and applicability to rehabilitation medicine. A systematic review of the literature will be presented along with the illuminating case history of a PMR patient who’s functional outcome was significantly impacted by the technology. Photos of DITP technology will be shared for didactic purposes. Results While there are many advantages of DITP including fostering enhanced compliance, improved adherence, empowerment of patients; several disadvantages exist such as cost and potential privacy concerns. Conclusions DITP can aide physiatrists in the daily management of pain patients by electronic verification of whether the patient has taken their prescribed pill and at what time. For patients on opioid medication, this is immensely important as compliance is a cornerstone of proper pain management. Enforcement and support of statutory safeguards can prevent improper diversion and abuse of pills. In an age of international concern over opioid abuse, DITP may offer an innovative strategy for enforcing proper use of pain medication in PRM. Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.249
e115
The impact of benzodiazepine on analgesic costs to treat spinal cord injury patients in Taiwan: A population-based retrospective cohort study
Introduction/Background The aim of this study was to evaluate the impact of benzodiazepine (BZD) on analgesic costs to treat spinal cord injury (SCI) patients in Taiwan. Material and method The retrospective cohort study used a subset of the Taiwan National Health Insurance Research Database (NHIRD) comprising information on two million beneficiaries randomly sampled from the entire population of Taiwan. A total of 3170 patients aged 16 and above with newly diagnosed SCI were identified during a period from 2001–2010. Results The multivariate linear regression using average daily costs of prescription of nociceptive pain, including non-steroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics for 1 year and 4 years after SCI showed increased costs in benzodiazepine (BZD) user, especially in high-dose BZD users (cumulative defined daily dose [cDDD] > 0.3) (parameter estimate = 3.79 and 1.37 respectively. P-value < 0.05). The multivariate linear regression using average daily costs of prescription of neuropathic pain, including antidepressants and anti-epileptic drugs for the treatment of neuropathic pain for 1 year and 4 years after SCI showed increased costs in BZD user, especially in high-dose BZD users (parameter estimate = 5.95 and 3.85 respectively. P-value < 0.05). Conclusion This study showed that the baseline BZD exposure may significantly increase the analgesic costs in SCI patients. Keywords Spinal cord injury; Benzodiazepine; Analgesic costs Disclosure of interest This study was supported by grants from the Ministry of Science and Technology (MOST 105-2314-B-006-081-). https://doi.org/10.1016/j.rehab.2018.05.250 ISPR8-0072
Transcutaneous electrical nerve stimulation and placebo analgesia: Are young and older adults the same? I. Daguet 1,2,3,∗ , K. Bergeron-Vézina 1,2 , M.P. Harvey 1,2 , M. Martel 1,2 , G. Léonard 1,2 1 Research Center on Aging, University Institute of Geriatrics of Sherbrooke, Sherbrooke, Canada 2 Université de Sherbrooke, Faculté de médecine et des sciences de la santé, Sherbrooke, Canada 3 Institut Celle Souche et Cerveau, Département de Chronobiologie, Lyon, France ∗ Corresponding author. E-mail address: [email protected] (I. Daguet) Introduction/Background Placebo analgesia refers to a perceived reduction in pain following the administration of a simulated or otherwise medically ineffective treatment. Previous studies have shown that many factors can influence placebo analgesia. However, few investigations have examined the effect of age on placebo analgesia, and none have done it in the context of rehabilitation interventions. The objective of this study was to compare the placebo response induced by sham transcutaneous electrical nerve stimulation (TENS) between young and older individuals, using an experimental heat-pain paradigm. Material and method Twenty-two young (21–39 years) and 22 older (58–76 years) healthy adults participated in this comparative study. Experimental heat-pain was evoked with a thermode