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F218 MULTIMODAL APPROACH IN CHRONIC CERVICAL PAIN SYNDROME
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POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
analysis has shown the association of heterozygote genotype with LBP group, mutant homozygote genotype with PTSD group, while other two groups were associated with wild type homozygote genotype. SNP IL1B (rs2234677) heterozygous genotype was associated with the intensity of pain (P = 0.001; OR = 0.20, CI 95% 0.07–0.54). Conclusions: This study has shown the preliminary evidence of the role of cytokine network in the pathogenesis of chronic PTSD and LBP, although the direct causative pathway is not known. The alteration of cytokines network on various levels: the brain, spinal medulla and the spine may be responsible for our finding due to different effects these cytokines exhibit.
the 7 children having corresponding changes at the lumbar level. MRI exam revealed Schmorl disk herniations at thoracic level in 46 cases and at lumbar level in 6 patients, end-plates defects in all cases, spondylolysis and spondylolystezis in 3 cases, lumbar disk protrusion in 2 cases. Conclusion: Scheuermann’s disease is a common cause of back pain in adolescents. The lumbar pain is the most frequent clinical symptom of the disease with no neuroimaging changes at MRI exam. The thoracic level, being affected more often, remain a “mute” zone. This fact induce examination of both thoracic and lumbar levels in children with back pain to avoid missdiagnosis. Disclosure: None declared
Disclosure: None declared
F218 MULTIMODAL APPROACH IN CHRONIC CERVICAL PAIN SYNDROME I. Adanic-Mikloska *, B. Maldini, T. Kukin, N. Pukljak. Clinic for Anaesthesia and ICU, KB Zagreb, Rebro, Zagreb, Croatia Background and Aims: The main cause of very painfull chronic problems as severe headache, spasms of paraspinal neck musculature, shoulder or arm pain often comes in cervical disc degeneration, cervical strain or whiplash, pseudoarthrose or vascular disorders in cervical segments. Neurosurgical operation is neccessary if myelopathy egsist. Otherwise the pain could be lessning with conservative therapy. Methods: Our conservative approach consider pharmacotherapy, physiotherapy, peripheral neurostimulation and some special excersises and cervical manipulation. The article reports our noninvasive therapy at Clinic Rebro with 130 patients treated in last 4 years, 80 F, 30 M, average 55. There were 45 patients with headache, 45 patients of cervicobrachial problems and 40 patients with both problems, treated with electrical acupuncture 3 times weekly, 15 therapies all together, used frequency 1–100 Hz. Special manual manipulation as well as traction, mobilization and trust techniqe excersises had been used after electric acupuncture. Results: VAS scale showed significant analgesia in 60% of the patients /VAS changed from 9–2/, mild analgesia in 20% /VAS changed from 7–3 and 20% had no decisive improvement. Conclusions: Our approach had shown better circulation in attached dermatome and less spasm of paraspinal musculature with quicklier and better diminishing cervical pain problems. So, in our opinion multimodal therapy gave much more benefit to patients suffering from severe chronic cervical syndrome. Disclosure: None declared
F219 BACK PAIN IN ADOLESCENTS WITH SCHEUERMANN’S DISEASE S. Plesca1 *, M. Sangheli2 . 1 Department of Back Pain, Institute of Neurology and Neurosurgery, 2 State Medical and Pharmaceutical University, Chisinau, Moldova Background and Aim: Scheuermann’s disease (SD) is an important cause of back pain in childhood. The objective of this study was to establish the pecularites of pain syndrome in relationship with neuroimaging changes. Methods: The study included 64 children with SD age 11–18, that clinically presented back pain at thoracic and/or lumbar level. All the subjects were examined clinically, neurologically and paraclinically, the method of choice being spinal MRI and radiological examination. Results: Clinical findings showed the main localization of pain at the lumbar level (in 51 cases). The thoracic pain was the rare condition of the beginning of Scheuermann’s disease (in 7 cases). Six patients presented pain at the toracic and lumbar level. Radiological examination were performed to confirm the diagnosis of SD according to the international criteria. The thoracic form of the disease was found in the majority of cases (57 patients),
F220 LUMBAR MODIC CHANGES AND THEIR ASSOCIATIONS WITH PAIN AND DISABILITY. CORRELATION OF SIZE OF MODIC CHANGES WITH SCIATIC PAIN E.I. Schistad1 *, A. Espeland2 , C. Røe1 , L.M. Jacobsen3 , J. Gjerstad3 . 1 Dep. of Physical Medicine and Rehabilitation, Oslo University Hospital-Ulleval, Oslo, 2 Dep. of Radiology, Haukeland University Hospital, Bergen, 3 National Institute of Occupational Health, Oslo, Norway Background and Aims: Many patients with severe disc degeneration have Modic changes (MO). MO, particularly MO type 1 indicating edema and inflammation, have been suggested to have an important role in the etiopathogenesis of LBP and sciatica pain. Our hypothesis was that also the size of MO may affect clinical symptoms. Methods: Totally 269 patients (147 male (46.1 %), 122 female (38.2%), mean age 41 years completed the study (15.7% – dropouts and excluded). The inclusion criteria were: Age 18–60 years, lumbar disc herniation on MRI with corresponding sciatica pain and positive Straight Leg Raising test. The original MO classification was used (Modic 1988, Modic and Ross 1991). Two physicians independently evaluated type and size at each of the 10 endplates L1-S1 and solved all disagreements in consensus. Craniocaudal (CC) size of MO <25%, 25–50%, and >50% of the vertebral body height was scored 1, 2 and 3, respectively. The total CC score for all endplates was compared to pain intensity on a VAS and the Oswestry Disability Index (ODI) (Pearson correlation). Results: Pain intensity of LBP and sciatica during activity correlated with high ODI (r = 0.6; p = 0.000). MO were most frequent at L4-L5 (41.1%) and L5-S1 (45.4%). It was no correlation between size of MO and pain intensity of LBP (r = −0.162, p = 0.008), pain intensity during activity (r = −0.082, p = 0.179) and ODI (r = 0.072, p = 0.238). Conclusions: The size of MO does not directly correlate with pain intensity and disability. Disclosure: None declared
F221 CLINICAL EVALUATION AND EPIDEMIOLOGY OF THE FAILED BACK SURGERY SYNDROME IN A BRAZILIAN CITY J.B.S. Garcia1 *, D.R.B. Leite2 , K.S.M. Neto2 , D.P. Rodrigues2 , A.B. Carvalho3 . 1 Anesthesiology, Pain and Palliative Care, 2 Academic Pain League, 3 Pain and Palliative Care/Academic Pain League, Federal University of Maranh˜ ao, S˜ ao Lu´ıs, Brazil Background and Aims: Despite of numerous studies about prevention and treatment of failed back surgery syndrome (FBSS), there few studies correlated epidemiology, anxiety, depression and quality of life these patients. The study aims at relating clinical and epidemiological characteristics of patients with FBSS. Methods: Lumbar disc hernia surgery was performed in a total of 92 patients, in S˜ao Luis (Brazil) public hospitals at January 2008 to December 2009. Patients were excluded if living in remote cities or without valid contacts. Thus, 30 patients underwent a detailed clinical evaluation and application of validated questionnaires (SF-
POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
analysis has shown the association of heterozygote genotype with LBP group, mutant homozygote genotype with PTSD group, while other two groups were associated with wild type homozygote genotype. SNP IL1B (rs2234677) heterozygous genotype was associated with the intensity of pain (P = 0.001; OR = 0.20, CI 95% 0.07–0.54). Conclusions: This study has shown the preliminary evidence of the role of cytokine network in the pathogenesis of chronic PTSD and LBP, although the direct causative pathway is not known. The alteration of cytokines network on various levels: the brain, spinal medulla and the spine may be responsible for our finding due to different effects these cytokines exhibit.
the 7 children having corresponding changes at the lumbar level. MRI exam revealed Schmorl disk herniations at thoracic level in 46 cases and at lumbar level in 6 patients, end-plates defects in all cases, spondylolysis and spondylolystezis in 3 cases, lumbar disk protrusion in 2 cases. Conclusion: Scheuermann’s disease is a common cause of back pain in adolescents. The lumbar pain is the most frequent clinical symptom of the disease with no neuroimaging changes at MRI exam. The thoracic level, being affected more often, remain a “mute” zone. This fact induce examination of both thoracic and lumbar levels in children with back pain to avoid missdiagnosis. Disclosure: None declared
Disclosure: None declared
F218 MULTIMODAL APPROACH IN CHRONIC CERVICAL PAIN SYNDROME I. Adanic-Mikloska *, B. Maldini, T. Kukin, N. Pukljak. Clinic for Anaesthesia and ICU, KB Zagreb, Rebro, Zagreb, Croatia Background and Aims: The main cause of very painfull chronic problems as severe headache, spasms of paraspinal neck musculature, shoulder or arm pain often comes in cervical disc degeneration, cervical strain or whiplash, pseudoarthrose or vascular disorders in cervical segments. Neurosurgical operation is neccessary if myelopathy egsist. Otherwise the pain could be lessning with conservative therapy. Methods: Our conservative approach consider pharmacotherapy, physiotherapy, peripheral neurostimulation and some special excersises and cervical manipulation. The article reports our noninvasive therapy at Clinic Rebro with 130 patients treated in last 4 years, 80 F, 30 M, average 55. There were 45 patients with headache, 45 patients of cervicobrachial problems and 40 patients with both problems, treated with electrical acupuncture 3 times weekly, 15 therapies all together, used frequency 1–100 Hz. Special manual manipulation as well as traction, mobilization and trust techniqe excersises had been used after electric acupuncture. Results: VAS scale showed significant analgesia in 60% of the patients /VAS changed from 9–2/, mild analgesia in 20% /VAS changed from 7–3 and 20% had no decisive improvement. Conclusions: Our approach had shown better circulation in attached dermatome and less spasm of paraspinal musculature with quicklier and better diminishing cervical pain problems. So, in our opinion multimodal therapy gave much more benefit to patients suffering from severe chronic cervical syndrome. Disclosure: None declared
F219 BACK PAIN IN ADOLESCENTS WITH SCHEUERMANN’S DISEASE S. Plesca1 *, M. Sangheli2 . 1 Department of Back Pain, Institute of Neurology and Neurosurgery, 2 State Medical and Pharmaceutical University, Chisinau, Moldova Background and Aim: Scheuermann’s disease (SD) is an important cause of back pain in childhood. The objective of this study was to establish the pecularites of pain syndrome in relationship with neuroimaging changes. Methods: The study included 64 children with SD age 11–18, that clinically presented back pain at thoracic and/or lumbar level. All the subjects were examined clinically, neurologically and paraclinically, the method of choice being spinal MRI and radiological examination. Results: Clinical findings showed the main localization of pain at the lumbar level (in 51 cases). The thoracic pain was the rare condition of the beginning of Scheuermann’s disease (in 7 cases). Six patients presented pain at the toracic and lumbar level. Radiological examination were performed to confirm the diagnosis of SD according to the international criteria. The thoracic form of the disease was found in the majority of cases (57 patients),
F220 LUMBAR MODIC CHANGES AND THEIR ASSOCIATIONS WITH PAIN AND DISABILITY. CORRELATION OF SIZE OF MODIC CHANGES WITH SCIATIC PAIN E.I. Schistad1 *, A. Espeland2 , C. Røe1 , L.M. Jacobsen3 , J. Gjerstad3 . 1 Dep. of Physical Medicine and Rehabilitation, Oslo University Hospital-Ulleval, Oslo, 2 Dep. of Radiology, Haukeland University Hospital, Bergen, 3 National Institute of Occupational Health, Oslo, Norway Background and Aims: Many patients with severe disc degeneration have Modic changes (MO). MO, particularly MO type 1 indicating edema and inflammation, have been suggested to have an important role in the etiopathogenesis of LBP and sciatica pain. Our hypothesis was that also the size of MO may affect clinical symptoms. Methods: Totally 269 patients (147 male (46.1 %), 122 female (38.2%), mean age 41 years completed the study (15.7% – dropouts and excluded). The inclusion criteria were: Age 18–60 years, lumbar disc herniation on MRI with corresponding sciatica pain and positive Straight Leg Raising test. The original MO classification was used (Modic 1988, Modic and Ross 1991). Two physicians independently evaluated type and size at each of the 10 endplates L1-S1 and solved all disagreements in consensus. Craniocaudal (CC) size of MO <25%, 25–50%, and >50% of the vertebral body height was scored 1, 2 and 3, respectively. The total CC score for all endplates was compared to pain intensity on a VAS and the Oswestry Disability Index (ODI) (Pearson correlation). Results: Pain intensity of LBP and sciatica during activity correlated with high ODI (r = 0.6; p = 0.000). MO were most frequent at L4-L5 (41.1%) and L5-S1 (45.4%). It was no correlation between size of MO and pain intensity of LBP (r = −0.162, p = 0.008), pain intensity during activity (r = −0.082, p = 0.179) and ODI (r = 0.072, p = 0.238). Conclusions: The size of MO does not directly correlate with pain intensity and disability. Disclosure: None declared
F221 CLINICAL EVALUATION AND EPIDEMIOLOGY OF THE FAILED BACK SURGERY SYNDROME IN A BRAZILIAN CITY J.B.S. Garcia1 *, D.R.B. Leite2 , K.S.M. Neto2 , D.P. Rodrigues2 , A.B. Carvalho3 . 1 Anesthesiology, Pain and Palliative Care, 2 Academic Pain League, 3 Pain and Palliative Care/Academic Pain League, Federal University of Maranh˜ ao, S˜ ao Lu´ıs, Brazil Background and Aims: Despite of numerous studies about prevention and treatment of failed back surgery syndrome (FBSS), there few studies correlated epidemiology, anxiety, depression and quality of life these patients. The study aims at relating clinical and epidemiological characteristics of patients with FBSS. Methods: Lumbar disc hernia surgery was performed in a total of 92 patients, in S˜ao Luis (Brazil) public hospitals at January 2008 to December 2009. Patients were excluded if living in remote cities or without valid contacts. Thus, 30 patients underwent a detailed clinical evaluation and application of validated questionnaires (SF-