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(124) Adverse effects associated with higher opioid use
Abstracts
which factors could be associated to non-adherence behaviour. Median age was 70 years (27-98) and 67% were men. Global rate of medication non-adherence was 51%; of them 75% was intentional and 25% unintentional. In the univariate analysis factors such as living alone (p=0.008), self-administration of medication (p=0.038), higher cognitive impairment (assessed with the Pfeiffer test) score (p=0.035) were correlated with analgesic regime nonadherence. The use of Fast Onset Opioids (FOOs) (p=0.029) was related to fail question A (forgetting to take medication); age (p=0.038) was associated with failing question B (taking medication at the time indicated); age (p=0.014) and higher doses of ROOs (p=0.003) were related to mistake question C (they stop taking medication if they feel well); patients attended at the OPC (p=0.015) failed to question D (if they don’t feel well, don’t take medication). In the multivariate analysis only cognitive impairment (p=0.034) and living alone (p=0.038) were associated with non-adherence. Nonpharmacological related issues play an important role when determining issues related to non-adherence behaviour in our sample.
(124) Adverse effects associated with higher opioid use N Joseph, A Pace, A Skojec, V Gordin, C Xu, V Chinchilli, D DeKorte, and J Caldwell; Penn State Hershey Medical Center, Hershey, PA Opioid abuse and prescription drug abuse is a nationwide epidemic. In this study, we examined the preliminary results of 135 patients and the effects of higher doses of opioids on physical and mental functioning. We used the RAND-36 quality of life instrument, as well the PHQ-9 to evaluate psychological well-being. Patient history and drug abuse (prescription or illicit) by the patient and/or the patient’s family was also measured. Risk assessment tools such as the DIRE, ORT and PADT were used as well, and a questionnaire was distributed to determine the patient’s history of childhood and adult abuse. Higher levels of opioid use are associated with worse DIRE risk psychological assessment (p = 0.0002) and chemical assessments (p = 0.0009). Higher opioid doses also correlated with higher depression as measured by the PHQ-9 (p = 0.05). In comparing those who took greater than 100 mg of morphine equivalents daily in contrast to all other groups, the morphine cohort was found to be more likely to have self-reported physical limitations on ability to work (p= 0.0009), difficulty performing tasks of daily living (p= 0.0017), and emotionally unable to accomplish normal tasks (p = 0.0002). This group was also placed at much higher risk on the DIRE psychological risk score by their providers (p =0.0001), as well as the DIRE chemical risk score (p=0.009) and DIRE social risk score (p<0.0001). Overall, both providers and the patients themselves described poorer mental and physical functioning and reliability with higher levels of opioids.
The Journal of Pain
S7
differences related to the causes of pain of diagnoses of the participants). Additional research is needed to help determine the reliability of the results. Nevertheless, the findings suggest that there are pain qualities that are both shared by different cultures (e.g., tingling, burning), as well as the potential for pain qualities that are unique to some cultures (e.g., cloudy pain in individuals from Nepal). Practically, the results suggest that measures of pain quality developed in one culture are not necessarily valid for use in another culture, and therefore need to be adapted to and validated in the new culture before being used by individuals from that culture.
(126) Submaximal Effort Tourniquet: a test of pain and motor function M Simmonds, N Bernussi, R Espey, G Loza, and J Suarez; University of Texas, Health Science Center, San Antonio, San Antonio, TX
The links between pain and movement are complex and incompletely understood. The submaximal effort tourniquet test (SMET) used to study experimental and clinical pain involves both pain and movement. Ischemia and mechanical pressure contribute to the overall putative pain experience and participants contract and relax their grip during the test (specified by some as 70% of maximum). However, the effect of ischemia, mechanical compression, and pain on motor function/grip strength is neither characterized nor clear. The study was part of a project designed to evaluate the analgesic effects of pulsed radiofrequency fields on different types of experimental pain. This abstract evaluates the effect of pain and motor function during SMET. Methods. A convenience sample of 42 (24m/18f) healthy pain free individuals with mean age of 29.986 5.39 years participated. The SMET test was applied to the non-dominant arm. A grip dynamometer was used to measure maximum grip strength pre cuff inflation at the end of the test. In addition, grip strength and pain ratings on a 0-10 NRS were also obtained at 30 second intervals until pain tolerance or 5 minutes was reached. Initial analysis included the calculation of descriptive statistics and graphical analysis of pain and grip strength slopes over time. Main results were: pre- and post-test grip strength was 42lbs (min 20 and max 68) and 26.21lbs (min 10 and max 38), respectively. Pain ratings increased during the test to a mean of 6.54 (min 1 max 10) at test end. The rate of change (slope) in pain and muscle strength during the test varied with the individual but was consistent in regards to inverse relationship and direction. It is plausible that the SMET can be used as a means to evaluate the efficacy of a variety of interventions on both pain and motor function.
(127) Can viral infections cause sudden-onset of intractable pain? F Tennant; Veract Intractable Pain Clinic, West Covina, CA
A05 Diagnostic Assessment - Clinical and Neurophysiologic Evaluation (125) The words people use to describe chronic pain: A cross-cultural comparison S Sharma and M Jensen; Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
Pain quality is an important outcome in clinical practice and research. However, little is known regarding how pain qualities are similar or different across different languages and cultures. To address this question, we asked 60 adults in Nepal with chronic pain to describe their pain. Their descriptions were then translated into English and compared with the descriptions used by 334 individuals with chronic pain from the USA. Descriptors used by both samples included aching, tingling, burning, numb, sharp, shooting, and cold. Descriptors unique to the Nepalese sample that to our knowledge are not on any existing English measure of pain quality include catching and cloudy. Interestingly, a majority (91.7%) of the Nepalese participants used a metaphor (‘‘My pain is like..’’) to describe their pain. While use of metaphors in patients from the USA is not unheard of, it appears to be much less common than this. A key limitation of the present analyses is that it is likely that some of the differences found between the current sample and previous research with patients from the USA could be due to differences other than just language and culture (for example,
Pain associated with human immunodeficiency virus (HIV), polio, hepatitis C, and herpes zoster is well known, so it is likely that other viruses may precipitate pain. There are some intractable pain patients whose condition appeared suddenly, without warning, and with no apparent pre-disposing condition. The on-going pain is usually severe headache, upper torso muscle and joint pain, or pelvic pain. The sudden onset in these cases suggests a possible viral etiology. Six adult (three male and three female) intractable pain patients who suddenly developed their condition without warning or precipitating event were tested for these viral titers: EpsteinBarr, varicella, rubella, rubeola, cytomegalus, herpes I & II, and coxsackie. All patients recalled the precise day and date their intractable pain began and remained persistent despite multiple pain treatment measures. Two had onset of constant headaches, one had pelvic pain, and three had upper torso, myofacial pain. All six patients had two or more viral titers which were 5 to 40 times above the normal range. The high titers were Epstein-Barr, varicella, cytomegalus, or rubella viruses. The mechanism of sudden persistent pain following a viral infection is unclear. Possible mechanisms include on-going viral activity, microglial cell activation and centralized pain, and the initiation of a systemic autoimmune disorder. It is unknown if the initiating virus is still active in the patients studied here. The extremely high viral titers found in these patients who had a sudden onset of intractable pain are compatible with the notion that a viral infection may cause intractable pain and that viral suppression therapy is indicated.
which factors could be associated to non-adherence behaviour. Median age was 70 years (27-98) and 67% were men. Global rate of medication non-adherence was 51%; of them 75% was intentional and 25% unintentional. In the univariate analysis factors such as living alone (p=0.008), self-administration of medication (p=0.038), higher cognitive impairment (assessed with the Pfeiffer test) score (p=0.035) were correlated with analgesic regime nonadherence. The use of Fast Onset Opioids (FOOs) (p=0.029) was related to fail question A (forgetting to take medication); age (p=0.038) was associated with failing question B (taking medication at the time indicated); age (p=0.014) and higher doses of ROOs (p=0.003) were related to mistake question C (they stop taking medication if they feel well); patients attended at the OPC (p=0.015) failed to question D (if they don’t feel well, don’t take medication). In the multivariate analysis only cognitive impairment (p=0.034) and living alone (p=0.038) were associated with non-adherence. Nonpharmacological related issues play an important role when determining issues related to non-adherence behaviour in our sample.
(124) Adverse effects associated with higher opioid use N Joseph, A Pace, A Skojec, V Gordin, C Xu, V Chinchilli, D DeKorte, and J Caldwell; Penn State Hershey Medical Center, Hershey, PA Opioid abuse and prescription drug abuse is a nationwide epidemic. In this study, we examined the preliminary results of 135 patients and the effects of higher doses of opioids on physical and mental functioning. We used the RAND-36 quality of life instrument, as well the PHQ-9 to evaluate psychological well-being. Patient history and drug abuse (prescription or illicit) by the patient and/or the patient’s family was also measured. Risk assessment tools such as the DIRE, ORT and PADT were used as well, and a questionnaire was distributed to determine the patient’s history of childhood and adult abuse. Higher levels of opioid use are associated with worse DIRE risk psychological assessment (p = 0.0002) and chemical assessments (p = 0.0009). Higher opioid doses also correlated with higher depression as measured by the PHQ-9 (p = 0.05). In comparing those who took greater than 100 mg of morphine equivalents daily in contrast to all other groups, the morphine cohort was found to be more likely to have self-reported physical limitations on ability to work (p= 0.0009), difficulty performing tasks of daily living (p= 0.0017), and emotionally unable to accomplish normal tasks (p = 0.0002). This group was also placed at much higher risk on the DIRE psychological risk score by their providers (p =0.0001), as well as the DIRE chemical risk score (p=0.009) and DIRE social risk score (p<0.0001). Overall, both providers and the patients themselves described poorer mental and physical functioning and reliability with higher levels of opioids.
The Journal of Pain
S7
differences related to the causes of pain of diagnoses of the participants). Additional research is needed to help determine the reliability of the results. Nevertheless, the findings suggest that there are pain qualities that are both shared by different cultures (e.g., tingling, burning), as well as the potential for pain qualities that are unique to some cultures (e.g., cloudy pain in individuals from Nepal). Practically, the results suggest that measures of pain quality developed in one culture are not necessarily valid for use in another culture, and therefore need to be adapted to and validated in the new culture before being used by individuals from that culture.
(126) Submaximal Effort Tourniquet: a test of pain and motor function M Simmonds, N Bernussi, R Espey, G Loza, and J Suarez; University of Texas, Health Science Center, San Antonio, San Antonio, TX
The links between pain and movement are complex and incompletely understood. The submaximal effort tourniquet test (SMET) used to study experimental and clinical pain involves both pain and movement. Ischemia and mechanical pressure contribute to the overall putative pain experience and participants contract and relax their grip during the test (specified by some as 70% of maximum). However, the effect of ischemia, mechanical compression, and pain on motor function/grip strength is neither characterized nor clear. The study was part of a project designed to evaluate the analgesic effects of pulsed radiofrequency fields on different types of experimental pain. This abstract evaluates the effect of pain and motor function during SMET. Methods. A convenience sample of 42 (24m/18f) healthy pain free individuals with mean age of 29.986 5.39 years participated. The SMET test was applied to the non-dominant arm. A grip dynamometer was used to measure maximum grip strength pre cuff inflation at the end of the test. In addition, grip strength and pain ratings on a 0-10 NRS were also obtained at 30 second intervals until pain tolerance or 5 minutes was reached. Initial analysis included the calculation of descriptive statistics and graphical analysis of pain and grip strength slopes over time. Main results were: pre- and post-test grip strength was 42lbs (min 20 and max 68) and 26.21lbs (min 10 and max 38), respectively. Pain ratings increased during the test to a mean of 6.54 (min 1 max 10) at test end. The rate of change (slope) in pain and muscle strength during the test varied with the individual but was consistent in regards to inverse relationship and direction. It is plausible that the SMET can be used as a means to evaluate the efficacy of a variety of interventions on both pain and motor function.
(127) Can viral infections cause sudden-onset of intractable pain? F Tennant; Veract Intractable Pain Clinic, West Covina, CA
A05 Diagnostic Assessment - Clinical and Neurophysiologic Evaluation (125) The words people use to describe chronic pain: A cross-cultural comparison S Sharma and M Jensen; Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
Pain quality is an important outcome in clinical practice and research. However, little is known regarding how pain qualities are similar or different across different languages and cultures. To address this question, we asked 60 adults in Nepal with chronic pain to describe their pain. Their descriptions were then translated into English and compared with the descriptions used by 334 individuals with chronic pain from the USA. Descriptors used by both samples included aching, tingling, burning, numb, sharp, shooting, and cold. Descriptors unique to the Nepalese sample that to our knowledge are not on any existing English measure of pain quality include catching and cloudy. Interestingly, a majority (91.7%) of the Nepalese participants used a metaphor (‘‘My pain is like..’’) to describe their pain. While use of metaphors in patients from the USA is not unheard of, it appears to be much less common than this. A key limitation of the present analyses is that it is likely that some of the differences found between the current sample and previous research with patients from the USA could be due to differences other than just language and culture (for example,
Pain associated with human immunodeficiency virus (HIV), polio, hepatitis C, and herpes zoster is well known, so it is likely that other viruses may precipitate pain. There are some intractable pain patients whose condition appeared suddenly, without warning, and with no apparent pre-disposing condition. The on-going pain is usually severe headache, upper torso muscle and joint pain, or pelvic pain. The sudden onset in these cases suggests a possible viral etiology. Six adult (three male and three female) intractable pain patients who suddenly developed their condition without warning or precipitating event were tested for these viral titers: EpsteinBarr, varicella, rubella, rubeola, cytomegalus, herpes I & II, and coxsackie. All patients recalled the precise day and date their intractable pain began and remained persistent despite multiple pain treatment measures. Two had onset of constant headaches, one had pelvic pain, and three had upper torso, myofacial pain. All six patients had two or more viral titers which were 5 to 40 times above the normal range. The high titers were Epstein-Barr, varicella, cytomegalus, or rubella viruses. The mechanism of sudden persistent pain following a viral infection is unclear. Possible mechanisms include on-going viral activity, microglial cell activation and centralized pain, and the initiation of a systemic autoimmune disorder. It is unknown if the initiating virus is still active in the patients studied here. The extremely high viral titers found in these patients who had a sudden onset of intractable pain are compatible with the notion that a viral infection may cause intractable pain and that viral suppression therapy is indicated.