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(101) Temporal daily associations among sleep and pain in treatment-seeking youth with acute musculoskeletal pain complaints
The Journal of Pain, Vol 17, No 4 (April), Suppl. 1, 2016: pp S1-S114 Available online at www.jpain.org and www.sciencedirect.com
Abstracts for Poster Presentations, American Pain Society’s 35th Annual Scientific Meeting, May 11-14, 2016, Austin, TX A. Diagnosis, Assessment & Reviews A01 Acute Pain (100) African Americans experience a greater burden of acute pain after motor vehicle collision than European Americans L Jones, A Borstov, R Fillingim, D Peak, M Kurz, P Hendry, N Rathlev, R Swor, R Domeier, K Damiron, C Pearson, S Kaushik, J Feldman, and S McLean; University of North Carolina, Chapel Hill, NC Several lines of evidence suggest that African Americans (AAs) may experience a greater burden of acute pain than European Americans (EAs) after traumatic events such as motor vehicle collision (MVC). The purpose of this study was to compare the severity, distribution, and quality of acute pain experienced by AAs (n=801) vs. EAs (n=948) presenting to the ED in the immediate aftermath of MVC. Data for analyses were obtained from two prospective studies (R01s AR060852 and AR056328) that used nearly identical ED recruitment and assessment protocols. Individuals who presented to the ED within 24 hours of MVC were enrolled. Individuals with fracture, substantial laceration, or other injury were excluded, as were those admitted to the hospital. ED assessment protocol included an evaluation of demographic characteristics, acute pain severity (0-10 NRS) in each body region (Regional Pain Scale), and neuropathic pain symptoms (DN4). Moderate to severe pain was defined as pain $4 on a 0-10 NRS. After adjusting for age, sex, educational attainment, and income, AA participants experienced greater overall pain severity than EA participants (6.92 [95%CI 6.72-7.12] vs. 5.61 [5.455.77], p < .001) and a greater number of body regions with moderate or severe pain (4.50 [4.23-4.77] vs. 3.35 [3.11-3.59], p < .001). Differences remained statistically significant after additional adjustment for study site. No significant differences in neuropathic pain symptoms were observed between EA and AA participants. These results suggest that AAs experience worse acute pain outcomes after MVC than EAs. Further studies are needed to better understand the reasons for these ethnic differences in acute pain outcomes.
(101) Temporal daily associations among sleep and pain in treatment-seeking youth with acute musculoskeletal pain complaints A Lewandowski Holley, J Rabbitts, L Durkin, C Zhou, and T Palermo; Oregon Health & Science University, Portland, OR
Acute musculoskeletal (MSK) pain is common in youth, with MSK pain accounting for 10% of primary care visits. Assessing sleep in children with new pain problems is important as longitudinal studies have identified poor sleep as a risk factor for pain persistence. In prior research in youth with chronic pain, poorer sleep predicts higher next-day pain, highlighting the temporal ordering of this complex association. We sought to extend this work and tested the hypothesis that the same temporal relationship among sleep and pain would emerge in youth with acute MSK pain complaints. Participants were youth (10-17 years, 63.5% female) presenting to the Emergency Department or an Orthopedics clinic (n=63) for evaluation of a new MSK pain complaint. Data were collected as part of a longitudinal study examining risk for development of chronic pain. Daily sleep duration and minutes awake after sleep onset (WASO) were assessed via actigraphy (7 nights). Self-reported sleep quality (0-10NRS) and pain intensity were assessed via morning and evening daily diaries (0-10NRS, 7 days). Linear mixed models tested daily associations among sleep variables and pain intensity, with age and sex included as covariates. Models tested bidirectional associations (e.g., nighttime sleep predicting morning pain, evening pain predicting nighttime sleep) using both dichotomous (yes/no)
and continuous (0-10NRS) pain variables. Analyses revealed significant bidirectional temporal associations among pain and sleep. Specifically presence of pain before sleep was associated with on average 29 minutes shorter sleep duration (p=.003) and 5 additional minutes of WASO (p=.05). Shorter sleep duration and poorer subjective sleep quality were also associated with higher morning pain ratings (p’s<.01). Findings revealing similar temporal daily associations between sleep and pain in children with new-onset MSK pain problems highlights sleep as a potential intervention target for children reporting high pain that may reduce risk for pain persistence.
(102) Real-time epidural space identification with the Compufloâ epidural instrument is equivalent to loss of resistance technique coupled with the fluoroscopy confirmation T Moeller-Bertram, R Gephard, D Dobecki, M Walker, J Shi, and S Ilic; Desert Clinic Pain Institute and San Diego Pain Institute, Rancho Mirage, CA and San Diego, CA
Success of the epidural technique depends upon the correct identification of the epidural space (ES). The incidence of difficult epidural catheter placement and early failure is significantly more likely among the morbidly obese population. The increased amount of subcutaneous and epidural fat in the obese population can pose a significant challenge to successful epidural catheter placement. After IRB approval and under United States Food and Drug Administration Investigations Device Exemption, a total of 400 patients were scheduled to receive epidural needle placement, as part of their medical management, and were enrolled in prospective controlled multi-center trial. Patients were randomized to either have the ES identified by standard of care methods utilizing either Loss of Resistance Technique (LOR) or by utilizing real-time pressure measurement at the epidural needle tip via the CompuFloâ Epidural Instrument (EP Group). A blinded independent observer evaluated correct identification of the ES defined as correct spread of dye demonstrated by fluoroscopy. This is a preliminary report of 70 subject whose Body Mass Index exceeded 31 Kg/m2. Groups were similar in terms of demographics, average age 49.4 and 52.5 . Identification of the ES in Group EP resulted in equal success rates and number of required attempts as in Group SC (100%and 1) p=0.78 –NS). No evidence of clinically significant adverse events was seen in any patient. This initial data suggest that identification of the ES by utilizing a computerized injection pump technology and obtaining real-time pressure measurements from the needle tip, results in equivalent success rate and safety when compared to fluoroscopy. This compact and mobile technology may have the potential to avoid exposure of the patient to radiation without compromising procedure effectiveness. This study was implemented under US FDA IDE sponsored by Milestone Scientific, Inc.
(103) Sex differences in pain and functioning among Total Knee Arthroplasty patients M Nandi, M Cornelius, C Campbell, M Smith, J Haythornthwaite, J Wright, R Edwards, and G Strichartz, PhD, MDiv; Brigham and Woman’s Hospital, Harvard Medical School, Boston, MA
Osteoarthritis is one of the leading causes of pain and disability across the world. While Total Knee Arthroplasty (TKA) has been shown to result in significant improvements in both functioning and pain, a substantial subset of patients continue to experience pain and disability. One potentially important factor in predicting the trajectory of pain and function following TKA is sex; however, although arthritis pain is more frequent and disabling in women than in men, few studies have evaluated sex differences in outcomes following joint replacement. From our ongoing multi-site study, we selected a sample of 100 patients (50 men and 50 women, matched
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Abstracts for Poster Presentations, American Pain Society’s 35th Annual Scientific Meeting, May 11-14, 2016, Austin, TX A. Diagnosis, Assessment & Reviews A01 Acute Pain (100) African Americans experience a greater burden of acute pain after motor vehicle collision than European Americans L Jones, A Borstov, R Fillingim, D Peak, M Kurz, P Hendry, N Rathlev, R Swor, R Domeier, K Damiron, C Pearson, S Kaushik, J Feldman, and S McLean; University of North Carolina, Chapel Hill, NC Several lines of evidence suggest that African Americans (AAs) may experience a greater burden of acute pain than European Americans (EAs) after traumatic events such as motor vehicle collision (MVC). The purpose of this study was to compare the severity, distribution, and quality of acute pain experienced by AAs (n=801) vs. EAs (n=948) presenting to the ED in the immediate aftermath of MVC. Data for analyses were obtained from two prospective studies (R01s AR060852 and AR056328) that used nearly identical ED recruitment and assessment protocols. Individuals who presented to the ED within 24 hours of MVC were enrolled. Individuals with fracture, substantial laceration, or other injury were excluded, as were those admitted to the hospital. ED assessment protocol included an evaluation of demographic characteristics, acute pain severity (0-10 NRS) in each body region (Regional Pain Scale), and neuropathic pain symptoms (DN4). Moderate to severe pain was defined as pain $4 on a 0-10 NRS. After adjusting for age, sex, educational attainment, and income, AA participants experienced greater overall pain severity than EA participants (6.92 [95%CI 6.72-7.12] vs. 5.61 [5.455.77], p < .001) and a greater number of body regions with moderate or severe pain (4.50 [4.23-4.77] vs. 3.35 [3.11-3.59], p < .001). Differences remained statistically significant after additional adjustment for study site. No significant differences in neuropathic pain symptoms were observed between EA and AA participants. These results suggest that AAs experience worse acute pain outcomes after MVC than EAs. Further studies are needed to better understand the reasons for these ethnic differences in acute pain outcomes.
(101) Temporal daily associations among sleep and pain in treatment-seeking youth with acute musculoskeletal pain complaints A Lewandowski Holley, J Rabbitts, L Durkin, C Zhou, and T Palermo; Oregon Health & Science University, Portland, OR
Acute musculoskeletal (MSK) pain is common in youth, with MSK pain accounting for 10% of primary care visits. Assessing sleep in children with new pain problems is important as longitudinal studies have identified poor sleep as a risk factor for pain persistence. In prior research in youth with chronic pain, poorer sleep predicts higher next-day pain, highlighting the temporal ordering of this complex association. We sought to extend this work and tested the hypothesis that the same temporal relationship among sleep and pain would emerge in youth with acute MSK pain complaints. Participants were youth (10-17 years, 63.5% female) presenting to the Emergency Department or an Orthopedics clinic (n=63) for evaluation of a new MSK pain complaint. Data were collected as part of a longitudinal study examining risk for development of chronic pain. Daily sleep duration and minutes awake after sleep onset (WASO) were assessed via actigraphy (7 nights). Self-reported sleep quality (0-10NRS) and pain intensity were assessed via morning and evening daily diaries (0-10NRS, 7 days). Linear mixed models tested daily associations among sleep variables and pain intensity, with age and sex included as covariates. Models tested bidirectional associations (e.g., nighttime sleep predicting morning pain, evening pain predicting nighttime sleep) using both dichotomous (yes/no)
and continuous (0-10NRS) pain variables. Analyses revealed significant bidirectional temporal associations among pain and sleep. Specifically presence of pain before sleep was associated with on average 29 minutes shorter sleep duration (p=.003) and 5 additional minutes of WASO (p=.05). Shorter sleep duration and poorer subjective sleep quality were also associated with higher morning pain ratings (p’s<.01). Findings revealing similar temporal daily associations between sleep and pain in children with new-onset MSK pain problems highlights sleep as a potential intervention target for children reporting high pain that may reduce risk for pain persistence.
(102) Real-time epidural space identification with the Compufloâ epidural instrument is equivalent to loss of resistance technique coupled with the fluoroscopy confirmation T Moeller-Bertram, R Gephard, D Dobecki, M Walker, J Shi, and S Ilic; Desert Clinic Pain Institute and San Diego Pain Institute, Rancho Mirage, CA and San Diego, CA
Success of the epidural technique depends upon the correct identification of the epidural space (ES). The incidence of difficult epidural catheter placement and early failure is significantly more likely among the morbidly obese population. The increased amount of subcutaneous and epidural fat in the obese population can pose a significant challenge to successful epidural catheter placement. After IRB approval and under United States Food and Drug Administration Investigations Device Exemption, a total of 400 patients were scheduled to receive epidural needle placement, as part of their medical management, and were enrolled in prospective controlled multi-center trial. Patients were randomized to either have the ES identified by standard of care methods utilizing either Loss of Resistance Technique (LOR) or by utilizing real-time pressure measurement at the epidural needle tip via the CompuFloâ Epidural Instrument (EP Group). A blinded independent observer evaluated correct identification of the ES defined as correct spread of dye demonstrated by fluoroscopy. This is a preliminary report of 70 subject whose Body Mass Index exceeded 31 Kg/m2. Groups were similar in terms of demographics, average age 49.4 and 52.5 . Identification of the ES in Group EP resulted in equal success rates and number of required attempts as in Group SC (100%and 1) p=0.78 –NS). No evidence of clinically significant adverse events was seen in any patient. This initial data suggest that identification of the ES by utilizing a computerized injection pump technology and obtaining real-time pressure measurements from the needle tip, results in equivalent success rate and safety when compared to fluoroscopy. This compact and mobile technology may have the potential to avoid exposure of the patient to radiation without compromising procedure effectiveness. This study was implemented under US FDA IDE sponsored by Milestone Scientific, Inc.
(103) Sex differences in pain and functioning among Total Knee Arthroplasty patients M Nandi, M Cornelius, C Campbell, M Smith, J Haythornthwaite, J Wright, R Edwards, and G Strichartz, PhD, MDiv; Brigham and Woman’s Hospital, Harvard Medical School, Boston, MA
Osteoarthritis is one of the leading causes of pain and disability across the world. While Total Knee Arthroplasty (TKA) has been shown to result in significant improvements in both functioning and pain, a substantial subset of patients continue to experience pain and disability. One potentially important factor in predicting the trajectory of pain and function following TKA is sex; however, although arthritis pain is more frequent and disabling in women than in men, few studies have evaluated sex differences in outcomes following joint replacement. From our ongoing multi-site study, we selected a sample of 100 patients (50 men and 50 women, matched
S1