- Email: [email protected]
118
Posters
118. Placebo-controlled single blind study of short-term efficacy of spinal morphine in chronic non-malignant pain J.H. Raphael, T.V. Gnanadurai, J.L. Southall, H. Mutagi, S. Kapur [email protected] Dept of Pain Management, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Dudley, UK Aims/Background: Spinal morphine is used for the relief of chronic non-malignant pain syndromes when more conservative measures have failed 1. It is common to test patients with the spinal morphine before implanting an intrathecal drug-delivering pump; however, this has not been validated, there being no placebocontrolled trials on the effectiveness of this therapy. Methods: We recruited patients with non-malignant pain syndromes scheduled for spinal morphine test dosing. An intrathecal catheter (Co-span, Braun) was inserted between L1/2 and L3/4 with catheter inserted 3cm into the intrathecal space. Morphine was administered in single blind controlled fashion, with patients unaware of the drug or dose. Increasing doses of morphine (from 0.2mg in 0.2 mg increments up to 1.0 mg) or saline were administered. The maximum dose of morphine was determined by achievement of greater than 50% pain relief or unacceptable side effects. Pain score was recorded on visual analogue scale(VAS). Results: 11 patients were recruited. 6 female. Mean(range) age was 58.6(46-71)years. Diagnoses: degenerative low back pain (4), failed low back surgery syndrome(3), chronic pancreatitis(2), lumbar radiculitis(1), complex regional pain syndrome(1). Mean(range) duration of pain was 11 (4-20) years Mean (range) dose of morphine was 0.6(0.4-1.0)mg Mean(SD) pain reduction (VAS) with maximum dose of morphine was 5.1(1.9) and with saline was 0.91(1.3). Paired t test for samples of unequal variance ⫽ 2.23, p ⬍ 0.001. Discussion: This single blind placebo- controlled study demonstrates that morphine significantly reduces pain in a cohort with chronic non-malignant pain unresponsive to more conservative measures. It validates the use of saline as a placebo to determine effectiveness of this modality.
Reference 1. Winkelmuller M, Winkelmuller W. Long-term effects of continuous intrathecal opioid treatment in chronic pain of non-malignant aetiology. J Neurosurgery 1996;85:458-67.
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Chronic Pain Management
47
161. Satisfaction in healthcare at the Sao Joa˜o hospital chronic pain unit M. Barbosa, V. Rebelo, A. Gomes, P. Barbosa, J. Correia [email protected] Pain Unit Hospital Sa˜o Joa˜o, Porto, Portugal Aim: To determine what aspects of healthcare provision are most likely to influence satisfaction with care in the Chronic Pain Unit (CPU) of Hospital Sa˜o Joa˜o (HSJ). Methods: An anonymous questionnaire was handed out, to every patient attending the CPU at the HSJ, over the age of 18, in the month of April 2006. Healthcare satisfaction was evaluated with specific aspects such as: consultation without prior appointment, medication supplied by the hospital, ability to do daily tasks, medical team qualities (care-giver/ patient relationship). A statistical analysis was done using SPSS (p⬍0.05). Results: Questionnaires were given to 93 patients (3 did not respond) 72 women and 18 men (96.8%); average age: 49.4 years; occupational status: 9 active and 71 not active (27 medical leave, 29 retired, 25 unemployed); CPU pain type: 6 oncological and 84 non-oncological. 68.9% consider important that consultation does not necessarily require a prior appointment during the weekday and 87% of patients reported diminished visits to the emergency service (ES) during the month of the study. Because certain medication was directly supplied by the hospital, in an outpatient setting, 71.1% reported better pain control. With regards to quality of life, 41 patients were able to do some daily tasks they could not have done before, 26 reported a larger increased in daily tasks. 90.5% of the responders considered the CPU team to be well prepared and the care-giver/patient relationship to be excellent. Conclusions: Low levels of missing data suggest that the questionnaire was acceptable to patients. Results obtained indicated the patients were highly satisfied with the healthcare given in the CPU. An improved control of pain coupled with readily available daily outpatient health care professionals seems to decrease hospital costs by reducing ES visits.
118. Placebo-controlled single blind study of short-term efficacy of spinal morphine in chronic non-malignant pain J.H. Raphael, T.V. Gnanadurai, J.L. Southall, H. Mutagi, S. Kapur [email protected] Dept of Pain Management, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Dudley, UK Aims/Background: Spinal morphine is used for the relief of chronic non-malignant pain syndromes when more conservative measures have failed 1. It is common to test patients with the spinal morphine before implanting an intrathecal drug-delivering pump; however, this has not been validated, there being no placebocontrolled trials on the effectiveness of this therapy. Methods: We recruited patients with non-malignant pain syndromes scheduled for spinal morphine test dosing. An intrathecal catheter (Co-span, Braun) was inserted between L1/2 and L3/4 with catheter inserted 3cm into the intrathecal space. Morphine was administered in single blind controlled fashion, with patients unaware of the drug or dose. Increasing doses of morphine (from 0.2mg in 0.2 mg increments up to 1.0 mg) or saline were administered. The maximum dose of morphine was determined by achievement of greater than 50% pain relief or unacceptable side effects. Pain score was recorded on visual analogue scale(VAS). Results: 11 patients were recruited. 6 female. Mean(range) age was 58.6(46-71)years. Diagnoses: degenerative low back pain (4), failed low back surgery syndrome(3), chronic pancreatitis(2), lumbar radiculitis(1), complex regional pain syndrome(1). Mean(range) duration of pain was 11 (4-20) years Mean (range) dose of morphine was 0.6(0.4-1.0)mg Mean(SD) pain reduction (VAS) with maximum dose of morphine was 5.1(1.9) and with saline was 0.91(1.3). Paired t test for samples of unequal variance ⫽ 2.23, p ⬍ 0.001. Discussion: This single blind placebo- controlled study demonstrates that morphine significantly reduces pain in a cohort with chronic non-malignant pain unresponsive to more conservative measures. It validates the use of saline as a placebo to determine effectiveness of this modality.
Reference 1. Winkelmuller M, Winkelmuller W. Long-term effects of continuous intrathecal opioid treatment in chronic pain of non-malignant aetiology. J Neurosurgery 1996;85:458-67.
•
Chronic Pain Management
47
161. Satisfaction in healthcare at the Sao Joa˜o hospital chronic pain unit M. Barbosa, V. Rebelo, A. Gomes, P. Barbosa, J. Correia [email protected] Pain Unit Hospital Sa˜o Joa˜o, Porto, Portugal Aim: To determine what aspects of healthcare provision are most likely to influence satisfaction with care in the Chronic Pain Unit (CPU) of Hospital Sa˜o Joa˜o (HSJ). Methods: An anonymous questionnaire was handed out, to every patient attending the CPU at the HSJ, over the age of 18, in the month of April 2006. Healthcare satisfaction was evaluated with specific aspects such as: consultation without prior appointment, medication supplied by the hospital, ability to do daily tasks, medical team qualities (care-giver/ patient relationship). A statistical analysis was done using SPSS (p⬍0.05). Results: Questionnaires were given to 93 patients (3 did not respond) 72 women and 18 men (96.8%); average age: 49.4 years; occupational status: 9 active and 71 not active (27 medical leave, 29 retired, 25 unemployed); CPU pain type: 6 oncological and 84 non-oncological. 68.9% consider important that consultation does not necessarily require a prior appointment during the weekday and 87% of patients reported diminished visits to the emergency service (ES) during the month of the study. Because certain medication was directly supplied by the hospital, in an outpatient setting, 71.1% reported better pain control. With regards to quality of life, 41 patients were able to do some daily tasks they could not have done before, 26 reported a larger increased in daily tasks. 90.5% of the responders considered the CPU team to be well prepared and the care-giver/patient relationship to be excellent. Conclusions: Low levels of missing data suggest that the questionnaire was acceptable to patients. Results obtained indicated the patients were highly satisfied with the healthcare given in the CPU. An improved control of pain coupled with readily available daily outpatient health care professionals seems to decrease hospital costs by reducing ES visits.