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1011 CONTROLLED 3-YEAR FOLLOW-UP OF A MULTIDISCIPLINARY PAIN REHABILITATION PROGRAM IN PRIMARY HEALTH CARE
Poster Sessions / European Journal of Pain 13 (2009) S55–S285
1008 POST-TRAUMATIC STRESS IN PATIENTS WITH INJURY-RELATED CHRONIC PAIN PARTICIPATING IN A MULTIDISCIPLINARY REHABILITATION PROGRAM, A PILOT STUDY ¨ A. Ostman, B.M. Stalnacke ˚ *. Department of Community Medicine and Rehabilitation, Rehabilitation medicine, Ume˚ a University, Ume˚ a, Sweden Background: Post-traumatic stress reactions with anxiety and avoidance behaviour have been reported in patients several years after traffic accidents. Relationships between pain and posttraumatic stress have been shown, and it has been proposed that in patients with chronic pain after accidents that these symptoms may co-exist and interact with each other (Bryant 2001, McCauley et al 2001). Aim: To investigate, in patients with injury-related chronic pain, pain intensity, level of post-traumatic stress, anxiety and depression before and after multidisciplinary rehabilitation. Methods: 28 patients, age 21–53 years, with injury-related chronic pain answered a set of questionnaires to assess post-traumatic stress on Impact of Event Scale (IES; Horowotz et al, 1979), pain intensity (VAS; Scott et al, 1977), depression and anxiety on Hospital Anxiety and Depression Scale (HAD; Zigmond and Snaith 1983) before and after participating in a multidisciplinary program Results: Total score of IES and pain intensity (VAS) were significantly decreased after the program (IES: p < 0.001; VAS: p = 0.009). Patients <40 years reported significantly higher IES-scores than patients >40 years, before (p = 0.023) and after rehabilitation (p = 0.029). The IES-scores were significantly correlated to the HAD-scores anxiety before (r = 0.570, p = 0.002) and after (r = 0.450, p = 0.016) rehabilitation. Conclusion: The multidisciplinary rehabilitation program was effective in reducing both pain intensity and posttraumatic stress. The experience of higher levels of posttraumatic stress in younger persons has to be taken into account when managing patients with injury-related chronic pain. 1009 LONGSTANDING PAIN AND BRIEF MOTIVATIONAL MULTIDISCIPLINARY INTERVENTION ˚ Lindstrom, C. Surtevall *, K.A. ¨ Y. Sterner. Department of Anaesthesiology and Intensive care, Pain Clinic, Danderyd Hospital, Stockholm, Sweden Background: Longstanding non cancer pain is a frequent and increasing health problem that causes suffering for the patients and increasing costs for society. The prevalence rates of longstanding pain in Sweden are approximately 35–50%. Around 18% have pain that severely reduce function and quality of life. The prognosis to cure is poor. Aim: The aim was to study pain, function and health related quality of life before and after a brief multidisciplinary intervention based on motivational interviewing in patients with longstanding non cancer pain. Method: Thirty-eight consecutive patients between 18–65 years old referred to a pain clinic participated. Pain duration ranged between 9–25 months. Multidisciplinary pain analyze and assessment was carried out to clarify the mechanism behind pain for the patients. Each patient received an individual plan including graded physical activity regarding personal preferences and adequate pain medication. The assessment and intervention was based on motivational interviewing, a method that relies on an active patient who is capable to change behavior. Result: Statistical significant positive changes in physical activity, work ability, sleep satisfaction, understanding pain, and quality of life was found on group level. Fatigue and mean pain intensity did not change but maximum and minimum pain intensity and mobility pain did. Interindividual variation of change was obvious.
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Conclusion: A motivational brief intervention can increase function, quality of life and influence pain intensity in patient with longstanding non cancer pain. Further research is needed to compare outcome with other multidisciplinary interventions. 1010 THE ADDITIONAL EFFECT OF PSYCHOMOTOR THERAPY IN TREATING CHRONIC MUSCULOSKELETAL PAIN: PRELIMINARY RESULTS ¨ 3 , T. Janssen4 , L. van der Maas1 *, R. Bosscher1 , M. Pont2 , A. Koke M. Peters5 . 1 Windesheim University of Applied Sciences, Zwolle, Netherlands; 2 Rehabilitation Centre Amsterdam, Amsterdam, Netherlands; 3 Hoensbroeck Rehabilitation Centre, Hoensbroek, Netherlands; 4 Duyvensz-Nagel Institute Rehabilitation Centre Amsterdam, Amsterdam, Netherlands; 5 University of Maastricht, Maastricht, Netherlands Aim: To investigate the short-term outcome of interdisciplinary group treatment of chronic musculoskeletal pain (treatment as usual; TAU) with or without psychomotor therapy (PMT). Methods: Sixty patients with chronic musculoskeletal pain at the Rehabilitation Centre Amsterdam were cluster randomized to a group with or without PMT. TAU consisted of a multicomponent treatment package; relaxation, graded activity, rational emotive therapy, occupational therapy, chronic pain education, sport sessions and partner sessions. This treatment was offered 3 days per week during 12 weeks. The PMT group received 10 sessions of 1.5 hour in addition to TAU. PMT is an experiential-based therapy in which through relational bodywork own behaviours, feelings and thoughts are explored. The themes body experience and interaction and communication are addressed. Exercises like drawing your own body in actual size and exploring your boundaries by creating your own space are two examples. Outcome was evaluated by the Pain Self-Efficacy Questionnaire, Beck Depression Inventory, Pain Disability Index, Tampa Scale of Kinesiophobia, catastrophic thinking, SF36, and patient satisfaction. Results: Results were analysed for 31 patients in the PMT group en 21 patients in the TAU group who completed the intervention and filled in pre- en post-treatment questionnaires. The PMT group reported greater pain self-efficacy and less catastrophic thinking compared to the TAU group. No significant differences were found on the other measures. Conclusion: PMT as an addition to the interdisciplinary group treatment seems a useful supplement to the treatment of people with chronic musculoskeletal pain with regard to self-reported pain self-efficacy and catastrophic thinking. 1011 CONTROLLED 3-YEAR FOLLOW-UP OF A MULTIDISCIPLINARY PAIN REHABILITATION PROGRAM IN PRIMARY HEALTH CARE 1 ¨ , P. Wahlen ´ 1, A. Westman1,2,3 *, S.J. Linton4 , T. Theorell5 , J. Ohrvik J. Leppert1 . 1 Center for Clinical Research, Uppsala University, Central Hospital, V¨ aster˚ as, Sweden; 2 Psychosomatic Medicine Clinic, V¨ aster˚ as, 3 ¨ Sweden; School of Health and Medical Sciences, Orebro University, ¨ Sweden; 4 Center for Health and Medical Psychology, Orebro University, Sweden; 5 Stress Research Institute, Stockholm University, Stockholm, Sweden Purpose: The high prevalence of musculoskeletal pain generates significant costs for primary health care and the whole of society. The development of appropriate interventions is therefore necessary. The aim of this effectiveness study was to assess the long-term effects of a primary health care multidisciplinary rehabilitation program in Sweden. Methods: An experimental group comprising 89 patients from two primary health care units received individualized treatment interventions after a multidisciplinary investigation. A control group of 69 patients with the same inclusion criteria from four other primary health care units were treated according to routine.
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All participants completed a battery of questionnaires at baseline and at 3-year follow-up. Results: After three years, utilization of primary health care was significantly lower in the experimental group and work capacity was slightly but not significantly higher. The use of analgesic drugs at start in both groups predicted such drug consumption after three years. The control group had a 70% higher risk of high drug consumption at three years compared to the intervention group but there was no significant difference between the two groups concerning remaining variables such as function, catastrophizing and pain. Conclusion: Both groups demonstrated considerable improvement over the course of three years. The experimental group had lower health care utilization and a reduced risk of using large amounts of medication at the three year follow-up, indicating that compared with participants in the control group they were coping in a better way with pain. 1012 SYSTEMATIC REVIEW AND META-ANALYSIS OF PSYCHOLOGICAL TREATMENTS FOR PERSISTENT PAIN IN ADULTS, EXCLUDING HEADACHE A. Williams1 *, C. Eccleston2 , S. Morley3 . 1 University College London, London, United Kingdom; 2 University of Bath, Bath, United Kingdom; 3 University of Leeds, Leeds, United Kingdom Background and Aims: An updated systematic review and metaanalysis of randomized controlled trials (RCTs) of psychological treatments for persistent non-cancer pain (excluding headache) in adults was completed in the Cochrane format. Methods: We included RCTs of credible psychological treatments for pain compared to active control or usual/no treatment, up to September 2008. All trials were rated for quality of design and of treatment. Results: 52 trials met criteria; 40 had extractable data on outcomes of pain, disability, and/or mood. We classified treatment as behavioral therapy (BT) or cognitive behavioural therapy (CBT), and control groups as active treatment or treatment as usual/waiting list. BT compared to treatment as usual/waiting list improved pain (effect size = 0.55) but not disability or mood by end of treatment, with no change at follow-up; few studies compared BT and active treatment. CBT showed more changes, but all smaller. Compared to treatment as usual/waiting list, CBT improved pain at the end of treatment and mood only at follow-up: effect sizes were small. Compared to active treatment, CBT improved disability by the end of treatment (e.s. = 0.16) and at follow-up, with improvement also in pain and mood (e.s.s from 0.15 to 0.21). Quality ratings showed improved methodology, but no improvement in treatment quality, over time. Conclusions: Recommendations are made for improving treatment effectiveness and trial design. 1013 SYSTEMATIC REVIEW AND META-ANALYSIS OF PSYCHOLOGICAL TREATMENTS FOR PERSISTENT OR RECURRENT PAIN IN CHILDREN AND ADOLESCENTS A.C.C. Williams1 *, C. Eccleston2 , S. Morley3 , T. Palermo4 , A. Lewandowski4 . 1 University College London, Research Department of Clinical, Educational & Health Psychology, London, United Kingdom; 2 University of Bath, Bath, United Kingdom; 3 University of Leeds, Leeds, United Kingdom; 4 Division of Psychology, Children’s Hospital Boston, Boston, United States Background and Aims: The psychological treatment of children and adolescents with persistent and recurrent pain, mainly headache and abdominal pain, is expanding so that a 2003 systematic review and meta-analysis required updating. This was completed in the Cochrane format using only randomized controlled trials (RCTs). Pain can be rated as severe and can cause distressed mood, and reduced participation in normal activities.
Methods: We searched widely for RCTs up to August 2008 comparing a psychological treatment with placebo, waiting list or standard medical care. All studies were rated for quality, and data were extracted on pain, disability, and mood outcomes. Results: Thirty-four RCTs were recovered; 29 met the inclusion criteria, 20 of which treated headache (including migraine); the remainder (non-headache) treated abdominal pain, fibromyalgia, and pain from sickle cell disease. The total number of participants was 1432. For headache pain, treatment versus control gave an NNT of 2.57 (CI 2.2 to 3.13) immediately post-treatment and 1.99 (CI 1.63 to 2.72) at follow-up. For non-headache pain, the effect size was −0.94 (95% CI −1.43 to −0.44) immediately after treatment, and −1.08 (95% CI −1.84 to −0.33) at follow-up. Where measured, there were no significant improvements in distress or disability. Conclusions: Psychological treatments are effective in pain control for children with headache, musculoskeletal and recurrent abdominal pain and benefits appear to be maintained. There is little evidence available to estimate effects on disability or mood. 1014 PAIN SCHOOL FOR TORTURE SURVIVORS – PHYSIOTHERAPY INTERVENTIONS A. Zerne *, A. Pehrsson. Department of Pain Management, Capio S:t G¨ oran’s Hospital, Stockholm, Sweden Background: Persons with persisting pain often develop fear avoidance and a compensatory movement pattern. The result might be a decreased activity level and maintained pain. Persisting pain in torture survivors is common. Departure of Pain Management, Capio S:t Goran’s ¨ Hospital, Sweden offers torture survivors with persisting pain a multidisciplinary “Pain School” where the physiotherapist take an active part. Aim: The aim of the physiotherapy intervention is to give the participants coping strategies for pain management and thereby also improve their function, level of activity and participation in everyday life. Method: Two lectures with the topic “physical activity” are given by the physiotherapist. The participant’s conceptions of their bodyfunction and structure are the base for the lecture. The lectures mix theory and practical exercises. The theoretical part addresses basic anatomy and how the body is functioning, benefits of physical activity, physical and psychological issues for avoidance of physical activity and how to be active although persistent pain. Practical exercises focus on relaxation-, breathing- and body awareness exercises. Conclusion: Our experience is that torture survivors have a decreased body awareness and lack of anatomy knowledge. It often results in negative beliefs of body function and in inadequate coping strategies. We believe that education is a good foundation for further interventions with the purpose of improving function, level of activity and participation in everyday life in torture survivors. 1015 ASSESSMENT OF NEGATIVE LIFE EVENTS AND OPIOID USE IN PATIENTS WITH FIBROMYALGIA A. Coutinho1 *, M. Barbosa2 , V´ı. Rebelo2 , P. Barbosa2 , A. Gomes2 . 1 Hospital S. Teot´ onio, EPE, Viseu, Portugal; 2 Chronic Pain Unit, Hospital S˜ ao Jo˜ ao, EPE, Porto, Portugal Background and Aims: Fibromyalgia patients describe more negative life events (NLE). Conflicts with partner/parents, psychological/physical abuse and death of close friends/relatives are the most common events [1,2]. The aim of the study was to assess the relationship between the prevalence of NLE and opioid use in these patients. Methods: Patients who fulfilled the criteria for fibromyalgia were included in a prospective study in the Chronic Pain Unit from January 1st , 2006 until July 31st , 2008. We applied the following questionnaires: Visual Analogic Scale (VAS), Hospital Anxiety and Depression Scale (HADS) and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Statistical analysis: SPSS 17.0.
1008 POST-TRAUMATIC STRESS IN PATIENTS WITH INJURY-RELATED CHRONIC PAIN PARTICIPATING IN A MULTIDISCIPLINARY REHABILITATION PROGRAM, A PILOT STUDY ¨ A. Ostman, B.M. Stalnacke ˚ *. Department of Community Medicine and Rehabilitation, Rehabilitation medicine, Ume˚ a University, Ume˚ a, Sweden Background: Post-traumatic stress reactions with anxiety and avoidance behaviour have been reported in patients several years after traffic accidents. Relationships between pain and posttraumatic stress have been shown, and it has been proposed that in patients with chronic pain after accidents that these symptoms may co-exist and interact with each other (Bryant 2001, McCauley et al 2001). Aim: To investigate, in patients with injury-related chronic pain, pain intensity, level of post-traumatic stress, anxiety and depression before and after multidisciplinary rehabilitation. Methods: 28 patients, age 21–53 years, with injury-related chronic pain answered a set of questionnaires to assess post-traumatic stress on Impact of Event Scale (IES; Horowotz et al, 1979), pain intensity (VAS; Scott et al, 1977), depression and anxiety on Hospital Anxiety and Depression Scale (HAD; Zigmond and Snaith 1983) before and after participating in a multidisciplinary program Results: Total score of IES and pain intensity (VAS) were significantly decreased after the program (IES: p < 0.001; VAS: p = 0.009). Patients <40 years reported significantly higher IES-scores than patients >40 years, before (p = 0.023) and after rehabilitation (p = 0.029). The IES-scores were significantly correlated to the HAD-scores anxiety before (r = 0.570, p = 0.002) and after (r = 0.450, p = 0.016) rehabilitation. Conclusion: The multidisciplinary rehabilitation program was effective in reducing both pain intensity and posttraumatic stress. The experience of higher levels of posttraumatic stress in younger persons has to be taken into account when managing patients with injury-related chronic pain. 1009 LONGSTANDING PAIN AND BRIEF MOTIVATIONAL MULTIDISCIPLINARY INTERVENTION ˚ Lindstrom, C. Surtevall *, K.A. ¨ Y. Sterner. Department of Anaesthesiology and Intensive care, Pain Clinic, Danderyd Hospital, Stockholm, Sweden Background: Longstanding non cancer pain is a frequent and increasing health problem that causes suffering for the patients and increasing costs for society. The prevalence rates of longstanding pain in Sweden are approximately 35–50%. Around 18% have pain that severely reduce function and quality of life. The prognosis to cure is poor. Aim: The aim was to study pain, function and health related quality of life before and after a brief multidisciplinary intervention based on motivational interviewing in patients with longstanding non cancer pain. Method: Thirty-eight consecutive patients between 18–65 years old referred to a pain clinic participated. Pain duration ranged between 9–25 months. Multidisciplinary pain analyze and assessment was carried out to clarify the mechanism behind pain for the patients. Each patient received an individual plan including graded physical activity regarding personal preferences and adequate pain medication. The assessment and intervention was based on motivational interviewing, a method that relies on an active patient who is capable to change behavior. Result: Statistical significant positive changes in physical activity, work ability, sleep satisfaction, understanding pain, and quality of life was found on group level. Fatigue and mean pain intensity did not change but maximum and minimum pain intensity and mobility pain did. Interindividual variation of change was obvious.
S283
Conclusion: A motivational brief intervention can increase function, quality of life and influence pain intensity in patient with longstanding non cancer pain. Further research is needed to compare outcome with other multidisciplinary interventions. 1010 THE ADDITIONAL EFFECT OF PSYCHOMOTOR THERAPY IN TREATING CHRONIC MUSCULOSKELETAL PAIN: PRELIMINARY RESULTS ¨ 3 , T. Janssen4 , L. van der Maas1 *, R. Bosscher1 , M. Pont2 , A. Koke M. Peters5 . 1 Windesheim University of Applied Sciences, Zwolle, Netherlands; 2 Rehabilitation Centre Amsterdam, Amsterdam, Netherlands; 3 Hoensbroeck Rehabilitation Centre, Hoensbroek, Netherlands; 4 Duyvensz-Nagel Institute Rehabilitation Centre Amsterdam, Amsterdam, Netherlands; 5 University of Maastricht, Maastricht, Netherlands Aim: To investigate the short-term outcome of interdisciplinary group treatment of chronic musculoskeletal pain (treatment as usual; TAU) with or without psychomotor therapy (PMT). Methods: Sixty patients with chronic musculoskeletal pain at the Rehabilitation Centre Amsterdam were cluster randomized to a group with or without PMT. TAU consisted of a multicomponent treatment package; relaxation, graded activity, rational emotive therapy, occupational therapy, chronic pain education, sport sessions and partner sessions. This treatment was offered 3 days per week during 12 weeks. The PMT group received 10 sessions of 1.5 hour in addition to TAU. PMT is an experiential-based therapy in which through relational bodywork own behaviours, feelings and thoughts are explored. The themes body experience and interaction and communication are addressed. Exercises like drawing your own body in actual size and exploring your boundaries by creating your own space are two examples. Outcome was evaluated by the Pain Self-Efficacy Questionnaire, Beck Depression Inventory, Pain Disability Index, Tampa Scale of Kinesiophobia, catastrophic thinking, SF36, and patient satisfaction. Results: Results were analysed for 31 patients in the PMT group en 21 patients in the TAU group who completed the intervention and filled in pre- en post-treatment questionnaires. The PMT group reported greater pain self-efficacy and less catastrophic thinking compared to the TAU group. No significant differences were found on the other measures. Conclusion: PMT as an addition to the interdisciplinary group treatment seems a useful supplement to the treatment of people with chronic musculoskeletal pain with regard to self-reported pain self-efficacy and catastrophic thinking. 1011 CONTROLLED 3-YEAR FOLLOW-UP OF A MULTIDISCIPLINARY PAIN REHABILITATION PROGRAM IN PRIMARY HEALTH CARE 1 ¨ , P. Wahlen ´ 1, A. Westman1,2,3 *, S.J. Linton4 , T. Theorell5 , J. Ohrvik J. Leppert1 . 1 Center for Clinical Research, Uppsala University, Central Hospital, V¨ aster˚ as, Sweden; 2 Psychosomatic Medicine Clinic, V¨ aster˚ as, 3 ¨ Sweden; School of Health and Medical Sciences, Orebro University, ¨ Sweden; 4 Center for Health and Medical Psychology, Orebro University, Sweden; 5 Stress Research Institute, Stockholm University, Stockholm, Sweden Purpose: The high prevalence of musculoskeletal pain generates significant costs for primary health care and the whole of society. The development of appropriate interventions is therefore necessary. The aim of this effectiveness study was to assess the long-term effects of a primary health care multidisciplinary rehabilitation program in Sweden. Methods: An experimental group comprising 89 patients from two primary health care units received individualized treatment interventions after a multidisciplinary investigation. A control group of 69 patients with the same inclusion criteria from four other primary health care units were treated according to routine.
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Poster Sessions / European Journal of Pain 13 (2009) S55–S285
All participants completed a battery of questionnaires at baseline and at 3-year follow-up. Results: After three years, utilization of primary health care was significantly lower in the experimental group and work capacity was slightly but not significantly higher. The use of analgesic drugs at start in both groups predicted such drug consumption after three years. The control group had a 70% higher risk of high drug consumption at three years compared to the intervention group but there was no significant difference between the two groups concerning remaining variables such as function, catastrophizing and pain. Conclusion: Both groups demonstrated considerable improvement over the course of three years. The experimental group had lower health care utilization and a reduced risk of using large amounts of medication at the three year follow-up, indicating that compared with participants in the control group they were coping in a better way with pain. 1012 SYSTEMATIC REVIEW AND META-ANALYSIS OF PSYCHOLOGICAL TREATMENTS FOR PERSISTENT PAIN IN ADULTS, EXCLUDING HEADACHE A. Williams1 *, C. Eccleston2 , S. Morley3 . 1 University College London, London, United Kingdom; 2 University of Bath, Bath, United Kingdom; 3 University of Leeds, Leeds, United Kingdom Background and Aims: An updated systematic review and metaanalysis of randomized controlled trials (RCTs) of psychological treatments for persistent non-cancer pain (excluding headache) in adults was completed in the Cochrane format. Methods: We included RCTs of credible psychological treatments for pain compared to active control or usual/no treatment, up to September 2008. All trials were rated for quality of design and of treatment. Results: 52 trials met criteria; 40 had extractable data on outcomes of pain, disability, and/or mood. We classified treatment as behavioral therapy (BT) or cognitive behavioural therapy (CBT), and control groups as active treatment or treatment as usual/waiting list. BT compared to treatment as usual/waiting list improved pain (effect size = 0.55) but not disability or mood by end of treatment, with no change at follow-up; few studies compared BT and active treatment. CBT showed more changes, but all smaller. Compared to treatment as usual/waiting list, CBT improved pain at the end of treatment and mood only at follow-up: effect sizes were small. Compared to active treatment, CBT improved disability by the end of treatment (e.s. = 0.16) and at follow-up, with improvement also in pain and mood (e.s.s from 0.15 to 0.21). Quality ratings showed improved methodology, but no improvement in treatment quality, over time. Conclusions: Recommendations are made for improving treatment effectiveness and trial design. 1013 SYSTEMATIC REVIEW AND META-ANALYSIS OF PSYCHOLOGICAL TREATMENTS FOR PERSISTENT OR RECURRENT PAIN IN CHILDREN AND ADOLESCENTS A.C.C. Williams1 *, C. Eccleston2 , S. Morley3 , T. Palermo4 , A. Lewandowski4 . 1 University College London, Research Department of Clinical, Educational & Health Psychology, London, United Kingdom; 2 University of Bath, Bath, United Kingdom; 3 University of Leeds, Leeds, United Kingdom; 4 Division of Psychology, Children’s Hospital Boston, Boston, United States Background and Aims: The psychological treatment of children and adolescents with persistent and recurrent pain, mainly headache and abdominal pain, is expanding so that a 2003 systematic review and meta-analysis required updating. This was completed in the Cochrane format using only randomized controlled trials (RCTs). Pain can be rated as severe and can cause distressed mood, and reduced participation in normal activities.
Methods: We searched widely for RCTs up to August 2008 comparing a psychological treatment with placebo, waiting list or standard medical care. All studies were rated for quality, and data were extracted on pain, disability, and mood outcomes. Results: Thirty-four RCTs were recovered; 29 met the inclusion criteria, 20 of which treated headache (including migraine); the remainder (non-headache) treated abdominal pain, fibromyalgia, and pain from sickle cell disease. The total number of participants was 1432. For headache pain, treatment versus control gave an NNT of 2.57 (CI 2.2 to 3.13) immediately post-treatment and 1.99 (CI 1.63 to 2.72) at follow-up. For non-headache pain, the effect size was −0.94 (95% CI −1.43 to −0.44) immediately after treatment, and −1.08 (95% CI −1.84 to −0.33) at follow-up. Where measured, there were no significant improvements in distress or disability. Conclusions: Psychological treatments are effective in pain control for children with headache, musculoskeletal and recurrent abdominal pain and benefits appear to be maintained. There is little evidence available to estimate effects on disability or mood. 1014 PAIN SCHOOL FOR TORTURE SURVIVORS – PHYSIOTHERAPY INTERVENTIONS A. Zerne *, A. Pehrsson. Department of Pain Management, Capio S:t G¨ oran’s Hospital, Stockholm, Sweden Background: Persons with persisting pain often develop fear avoidance and a compensatory movement pattern. The result might be a decreased activity level and maintained pain. Persisting pain in torture survivors is common. Departure of Pain Management, Capio S:t Goran’s ¨ Hospital, Sweden offers torture survivors with persisting pain a multidisciplinary “Pain School” where the physiotherapist take an active part. Aim: The aim of the physiotherapy intervention is to give the participants coping strategies for pain management and thereby also improve their function, level of activity and participation in everyday life. Method: Two lectures with the topic “physical activity” are given by the physiotherapist. The participant’s conceptions of their bodyfunction and structure are the base for the lecture. The lectures mix theory and practical exercises. The theoretical part addresses basic anatomy and how the body is functioning, benefits of physical activity, physical and psychological issues for avoidance of physical activity and how to be active although persistent pain. Practical exercises focus on relaxation-, breathing- and body awareness exercises. Conclusion: Our experience is that torture survivors have a decreased body awareness and lack of anatomy knowledge. It often results in negative beliefs of body function and in inadequate coping strategies. We believe that education is a good foundation for further interventions with the purpose of improving function, level of activity and participation in everyday life in torture survivors. 1015 ASSESSMENT OF NEGATIVE LIFE EVENTS AND OPIOID USE IN PATIENTS WITH FIBROMYALGIA A. Coutinho1 *, M. Barbosa2 , V´ı. Rebelo2 , P. Barbosa2 , A. Gomes2 . 1 Hospital S. Teot´ onio, EPE, Viseu, Portugal; 2 Chronic Pain Unit, Hospital S˜ ao Jo˜ ao, EPE, Porto, Portugal Background and Aims: Fibromyalgia patients describe more negative life events (NLE). Conflicts with partner/parents, psychological/physical abuse and death of close friends/relatives are the most common events [1,2]. The aim of the study was to assess the relationship between the prevalence of NLE and opioid use in these patients. Methods: Patients who fulfilled the criteria for fibromyalgia were included in a prospective study in the Chronic Pain Unit from January 1st , 2006 until July 31st , 2008. We applied the following questionnaires: Visual Analogic Scale (VAS), Hospital Anxiety and Depression Scale (HADS) and Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Statistical analysis: SPSS 17.0.