- Email: [email protected]
(131) Transitions among chronic pain and fibromyalgia patients: results from a two-year observational fibromyalgia study in the United States
S8
Abstracts
The Journal of Pain
(128) Somatic distributions of pain characterized with a pain registry (CHOIR) K Johnson, A Foote, M Kao, and S Mackey; Stanford University, Palo Alto, CA The Collaborative Health Outcomes Information Registry (CHOIR) is an NIHsponsored computer based registry to improve characterization and outcome tracking in clinical practice. Patients complete numerous inventories (including PROMIS measures and a body map with 74 segments), which can be linked to a variety of other medical records. We reviewed data from 2,082 adult patients in the Stanford tertiary care pain management center. We compared pain location(s) with respect to prevalence, gender, age, diagnosis, pain severity, and mood. We unexpectedly found that feet are the most frequently identified area of pain (30.5% of patients), followed by expected regions of knee and low back pain. Compared to men, we found that more women had pain in the abdomen, knee, and ankle. We also found interesting distributions of pain with aging, shifting from upper to lower body. With various diagnoses, we were able to characterize different patterns of focal pain, referred pain, or distributed pain. The distribution of pain by mood suggests a functional link between pain and mood. The CHOIR pain registry is an incredibly valuable tool for understanding patient needs, setting research priorities, and tracking outcomes. As our data come from a tertiary care setting, data from other populations will be useful. CHOIR is supported by the NIH Pain Consortium. Dr. Johnson is funded by NIH NIDA (K23). Dr. Mackey is supported by NIH NIDA (K24) and the Redlich Pain Endowment.
(129) The use of a non-invasive respiratory volume monitor to identify patients at high-risk for opioid-induced respiratory depression for a low-dose opioid regimen in the PACU C Voscopoulos, D Ladd, and E George; Massachusetts General Hospital, Boston, MA The use of opioids in the management of post-operative pain management strikes a delicate balance between effective pain control and maintaining adequate respiratory function. The introduction of patient controlled analgesia (PCA) has allowed for prompt delivery of pain medication at the onset of pain. Unfortunately, the use of PCA has not eliminated the incidence of opioid-induced respiratory depression (OIRD) as real-time quantitative measurements of respiratory status are not routinely present. A standard-dose and low-dose PCA protocol were compared across a broad population. 166 patients (age 65.5610.2 yrs, BMI 29.265.8 kg/m2) were studied. During the study the PACU PCA protocol changed from 0.2mg hydromorphone (standard dose) to 1 mg morphine (low-dose). 87 patients (age 64.3611.6, BMI 29.865.9) were managed with 0.2 mg hydromorphone and 79 patients (age 66.868.2, BMI 28.765.6) were managed with 1mg morphine. PCA lockout period and frequency were equivalent across the two groups. Patients were monitored with an impedance-based RVM for the duration of their PACU stay. Total opioid use in the PACU was collected. Respiratory depression at discharge (MV<40% for >10/30 min before discharge) was assessed. Patients in the low-dose group had, on average, marginally lower MV at discharge (6.760.4 vs. 7.160.4, p>0.3) and used significantly more opioids (in morphine equivalents) than the standard group (7.360.8 mg vs. 4.860.5 mg, p<0.01) during similar duration PACU stays (18868.4 min vs. 17067.0 min, p>0.05). An untargeted implementation of a low-dose protocol may not reduce the incidence of OIRD or total opioid use and may, possibly lead to increased opioid use. If instead, the lowdose protocol is targeted towards patients with a higher risk for respiratory depression (as determined by RVM measurements in the PACU), clinicians could more carefully titrate opioids dosing in this population, while also delivering more timely and effective pain relief to patients not-at-risk for OIRD.
(130) Comparisons of UWHC HCAHPS and PAIN OUT data T Chambers and M Donnelly; University of Wisconsin Hospital, Madison, WI With health care reimbursement increasingly tied to outcome measurements and patient satisfaction, optimizing postoperative analgesic control is of paramount importance. Achieving this goal requires the effort and coordination of a variety of health care professionals. In an effort to improve postoperative pain outcomes at the University of Wisconsin Hospitals and Clinics (UWHC), our institution started participating in the PAIN OUT project in 2010. PAIN OUT is a multi-national research project aimed to improve the clinical care of patients with postoperative pain.1 We discovered that our institution’s HCAHPS (July-September 2014) survey scores correlate with our PAIN OUT (2010-2014) data. The PAIN OUT survey asks patients to rate a percentage that best reflects how much pain relief they received from their treatments. Of the 84 general surgery patients surveyed, the average was 67%. The HCAHPS data revealed that 62.2% of the 37 patients reported their pain was always well controlled. On the PAIN OUT survey, when patients were asked if they would have wanted to receive more pain treatment, 61.63% of the 86 patients answered no. On the HCAHPS survey, 78.9% of the 38 patients believed hospital staff did everything they could to help with their pain control. This data proves that the general surgery patient population at UWHC needs to improve in pain management. Our goal is to identify a change in this specific patient population to improve HCAPHS pain scores. Once the change is identified and implemented, the effectiveness of the change will be immediately evaluated using the PAIN OUT tool rather than waiting for the delayed HCAHPS data. (1. PAIN OUT (n. d.). About PAIN OUT. Retrieved on March 28, 2014 from http://www.pain-out.eu/)
A05 Diagnostic Assessment - Clinical and Neurophysiologic Evaluation (131) Transitions among chronic pain and fibromyalgia patients: results from a two-year observational fibromyalgia study in the United States E Adams, H McElroy, M Udall, E Masters, R Mann, C Schaefer, J Cappelleri, A Clair, M Hopps, S Daniel, P Mease, S Silverman, and R Staud; Covance Market Access Services Inc., Gaithersburg, MD Fibromyalgia (FM) is characterized by chronic widespread pain (CWP), fatigue, and functional limitations. Previous research suggests remission from FM and its symptoms is rare, though some studies report 20%-47% of diagnosed patients may no longer meet the study definition of FM at 1-2 years after diagnosis.1 This study followed a cohort of 226 subjects recruited online to assess transitions into and out of FM over 2 years. At enrollment (Year 1) subjects completed a brief online questionnaire to screen for CWP (bilateral pain, above/below waist lasting $1 week) based on the 4 pain questions of the London Fibromyalgia Epidemiology Study Screening Questionnaire (LFESSQ), site visit for physician evaluation of FM, and another online questionnaire with several validated patient-reported outcome instruments. Subjects were classified into mutually-exclusive groups: FM (study definition required CWP-positive screen and physician diagnosis of FM), CWP+ (CWP-positive screen without physician diagnosis of FM), and CWP- (CWP-negative screen). At the follow-up visit (approximately 2 years later), subjects completed the same questionnaires and were reassessed by the physician. Among FM subjects who completed assessments at both time points (n=76), 56 (73.7%) met the study definition of FM at follow-up. Twenty subjects no longer met the FM study definition (11 switched to CWP-, 9 to CWP+). Ten subjects (2 from CWP-, 8 from CWP+) transitioned into the FM group; they reported greater number of tender points, lower physical function, and more sleep disturbance in Year 1 compared with subjects who did not transition to FM. Most subjects (23/30, 76.7%) who transitioned into/out of FM experienced corresponding changes in CWP, number of positive tender points ($11), or both. Results suggest some patients may experience fluctuation in symptoms over time, which may reflect the waxing and waning nature of FM and further complicate diagnosis. (1. White, Curr Pain Headache Rep, 2001) Research supported by Pfizer Inc.
Abstracts
The Journal of Pain
(128) Somatic distributions of pain characterized with a pain registry (CHOIR) K Johnson, A Foote, M Kao, and S Mackey; Stanford University, Palo Alto, CA The Collaborative Health Outcomes Information Registry (CHOIR) is an NIHsponsored computer based registry to improve characterization and outcome tracking in clinical practice. Patients complete numerous inventories (including PROMIS measures and a body map with 74 segments), which can be linked to a variety of other medical records. We reviewed data from 2,082 adult patients in the Stanford tertiary care pain management center. We compared pain location(s) with respect to prevalence, gender, age, diagnosis, pain severity, and mood. We unexpectedly found that feet are the most frequently identified area of pain (30.5% of patients), followed by expected regions of knee and low back pain. Compared to men, we found that more women had pain in the abdomen, knee, and ankle. We also found interesting distributions of pain with aging, shifting from upper to lower body. With various diagnoses, we were able to characterize different patterns of focal pain, referred pain, or distributed pain. The distribution of pain by mood suggests a functional link between pain and mood. The CHOIR pain registry is an incredibly valuable tool for understanding patient needs, setting research priorities, and tracking outcomes. As our data come from a tertiary care setting, data from other populations will be useful. CHOIR is supported by the NIH Pain Consortium. Dr. Johnson is funded by NIH NIDA (K23). Dr. Mackey is supported by NIH NIDA (K24) and the Redlich Pain Endowment.
(129) The use of a non-invasive respiratory volume monitor to identify patients at high-risk for opioid-induced respiratory depression for a low-dose opioid regimen in the PACU C Voscopoulos, D Ladd, and E George; Massachusetts General Hospital, Boston, MA The use of opioids in the management of post-operative pain management strikes a delicate balance between effective pain control and maintaining adequate respiratory function. The introduction of patient controlled analgesia (PCA) has allowed for prompt delivery of pain medication at the onset of pain. Unfortunately, the use of PCA has not eliminated the incidence of opioid-induced respiratory depression (OIRD) as real-time quantitative measurements of respiratory status are not routinely present. A standard-dose and low-dose PCA protocol were compared across a broad population. 166 patients (age 65.5610.2 yrs, BMI 29.265.8 kg/m2) were studied. During the study the PACU PCA protocol changed from 0.2mg hydromorphone (standard dose) to 1 mg morphine (low-dose). 87 patients (age 64.3611.6, BMI 29.865.9) were managed with 0.2 mg hydromorphone and 79 patients (age 66.868.2, BMI 28.765.6) were managed with 1mg morphine. PCA lockout period and frequency were equivalent across the two groups. Patients were monitored with an impedance-based RVM for the duration of their PACU stay. Total opioid use in the PACU was collected. Respiratory depression at discharge (MV<40% for >10/30 min before discharge) was assessed. Patients in the low-dose group had, on average, marginally lower MV at discharge (6.760.4 vs. 7.160.4, p>0.3) and used significantly more opioids (in morphine equivalents) than the standard group (7.360.8 mg vs. 4.860.5 mg, p<0.01) during similar duration PACU stays (18868.4 min vs. 17067.0 min, p>0.05). An untargeted implementation of a low-dose protocol may not reduce the incidence of OIRD or total opioid use and may, possibly lead to increased opioid use. If instead, the lowdose protocol is targeted towards patients with a higher risk for respiratory depression (as determined by RVM measurements in the PACU), clinicians could more carefully titrate opioids dosing in this population, while also delivering more timely and effective pain relief to patients not-at-risk for OIRD.
(130) Comparisons of UWHC HCAHPS and PAIN OUT data T Chambers and M Donnelly; University of Wisconsin Hospital, Madison, WI With health care reimbursement increasingly tied to outcome measurements and patient satisfaction, optimizing postoperative analgesic control is of paramount importance. Achieving this goal requires the effort and coordination of a variety of health care professionals. In an effort to improve postoperative pain outcomes at the University of Wisconsin Hospitals and Clinics (UWHC), our institution started participating in the PAIN OUT project in 2010. PAIN OUT is a multi-national research project aimed to improve the clinical care of patients with postoperative pain.1 We discovered that our institution’s HCAHPS (July-September 2014) survey scores correlate with our PAIN OUT (2010-2014) data. The PAIN OUT survey asks patients to rate a percentage that best reflects how much pain relief they received from their treatments. Of the 84 general surgery patients surveyed, the average was 67%. The HCAHPS data revealed that 62.2% of the 37 patients reported their pain was always well controlled. On the PAIN OUT survey, when patients were asked if they would have wanted to receive more pain treatment, 61.63% of the 86 patients answered no. On the HCAHPS survey, 78.9% of the 38 patients believed hospital staff did everything they could to help with their pain control. This data proves that the general surgery patient population at UWHC needs to improve in pain management. Our goal is to identify a change in this specific patient population to improve HCAPHS pain scores. Once the change is identified and implemented, the effectiveness of the change will be immediately evaluated using the PAIN OUT tool rather than waiting for the delayed HCAHPS data. (1. PAIN OUT (n. d.). About PAIN OUT. Retrieved on March 28, 2014 from http://www.pain-out.eu/)
A05 Diagnostic Assessment - Clinical and Neurophysiologic Evaluation (131) Transitions among chronic pain and fibromyalgia patients: results from a two-year observational fibromyalgia study in the United States E Adams, H McElroy, M Udall, E Masters, R Mann, C Schaefer, J Cappelleri, A Clair, M Hopps, S Daniel, P Mease, S Silverman, and R Staud; Covance Market Access Services Inc., Gaithersburg, MD Fibromyalgia (FM) is characterized by chronic widespread pain (CWP), fatigue, and functional limitations. Previous research suggests remission from FM and its symptoms is rare, though some studies report 20%-47% of diagnosed patients may no longer meet the study definition of FM at 1-2 years after diagnosis.1 This study followed a cohort of 226 subjects recruited online to assess transitions into and out of FM over 2 years. At enrollment (Year 1) subjects completed a brief online questionnaire to screen for CWP (bilateral pain, above/below waist lasting $1 week) based on the 4 pain questions of the London Fibromyalgia Epidemiology Study Screening Questionnaire (LFESSQ), site visit for physician evaluation of FM, and another online questionnaire with several validated patient-reported outcome instruments. Subjects were classified into mutually-exclusive groups: FM (study definition required CWP-positive screen and physician diagnosis of FM), CWP+ (CWP-positive screen without physician diagnosis of FM), and CWP- (CWP-negative screen). At the follow-up visit (approximately 2 years later), subjects completed the same questionnaires and were reassessed by the physician. Among FM subjects who completed assessments at both time points (n=76), 56 (73.7%) met the study definition of FM at follow-up. Twenty subjects no longer met the FM study definition (11 switched to CWP-, 9 to CWP+). Ten subjects (2 from CWP-, 8 from CWP+) transitioned into the FM group; they reported greater number of tender points, lower physical function, and more sleep disturbance in Year 1 compared with subjects who did not transition to FM. Most subjects (23/30, 76.7%) who transitioned into/out of FM experienced corresponding changes in CWP, number of positive tender points ($11), or both. Results suggest some patients may experience fluctuation in symptoms over time, which may reflect the waxing and waning nature of FM and further complicate diagnosis. (1. White, Curr Pain Headache Rep, 2001) Research supported by Pfizer Inc.