1568 Low back pain in a rural community people of developing country nepal: How they come for clinical management

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Poster Abstracts

Friday, November 11, 2005

to ascertain the continuing presence of NeP and the ongoing need for treatment. Only patients who relapsed during a drug holiday (pain became moderately, nmch, or very much worse) resumed trial participation. Results: VAS pain scores for DPN and P H N patients were 73 m m and 75 nml at baseline and 47 nml and 48 m m after 15 months. At 3 months, 45% and 36% of DPN and P H N patients reported pain reductions _>50%, while at 15 months 36% and 38% of patients reported similar reductions. The median drug-holiday duration was 3 days. All but 4 patients experienced pain exacerbation (relapse) during drug holidays. Most common AEs were dizziness, somnolence, and peripheral edema. Ten patients withdrew because of AEs. Conclusion: D P N and P H N patients refractory to therapy with tricyclics, gabapentin, and 3"a-line analgesics experienced clinically meaningful and sustained pain relief with pregabalin on long-term exposure (>lyr). Pfizer-funded.

were measured by Von- Frey filaments and CO2 laser dividually 7 days after transplantation. Se~nent four and five of lumbar spinal cord was taken out and 15 ~tm freezing sections were made 7 days after transplantation. Sections were stained for nNOS according to standard immunocytochemistry. Results: The expression o f n N O S in the spinal cord of group CCI and group A P A was higher than that of group C. In group APA-BCCs, allodynia and hyperalgesia was significantly reduced and the expression of nNOS in the spinal cord was lower than that of group CCI and group APA. There was no difference the expression of nNOS between group APA-BCCs and group C. Conclusion: The expression of nNOS in the spinal cord of CCI rats was elevated. A P A rnicrocapsulized BCCs grafting can alleviate allodynia and hyperalgesia threshold of CC.I rats, meanwhile it can decrease the expression o f n N O S in the spinal cord of CCI rats. Spinal NO pathway takes part in the analgesic effect of A P A microcapsulized BCCs subarachnoid transplantation.

1565 Effectiveness of Oxcarbazepine in sTmptomatic treatment of painful Diabetic Neuropathy: an open label prospective trial

1567 Low back pain in Developing Country schoolchildren - how they respond

A, Kemal Erdemoglu 1, Ayhan Varlibas 1. 1Department of Neurology,

Faculty of Medicine, Kirikkale University, Kirikkale, Turkey Aim: Painful diabetic neuropathy causes considerable impact on quality of life. In this study, we investigated the long-term efficacy and safety of oxcarbazepine, a new antiepileptic, in symptoms of painful diabetic neuropathy. Methods: This study included tlffrty-eight patient aged 33-62 years with diabetic neuropathy. Patients are screened initially with Miclffgan Diabetic. Neuropathy Questionnaire, clinical assessment and electrophysiological studies. The efficacy and safety of oxcarbazepine in symptoms of painful diabetic neuropathy were evaluated according to the changes in pain intensity and social interference subitems of Short form-Brief pain Inventory (BPI) scores and electrophysiological studies at the end of six months of the treatment. Results: In BPI, there was a significant difference in all of subitems of pain intensity (worst, least, average and pain now) and social interference (general activity, mood, walk, work, people relations, sleep, and life enjoyment) at the end of six months. The mean of total pain intensity score decreased from 23.4 ± 3.4 to 11.9 ± 3.1 (p < 0.01), for a mean reduction 48.7± 11.9 and the total social interference scores, with a reduction from a mean score of 42.3 ± 5.8 at the initial to a mean score of 20.6±4.7 at the end of six months (iJ < 0.01) for a mean reduction was 51.1 ± 10.0. There was not any statistical difference in electrophysiological parameters (p > 0.05). None of these patients had any prominent side effect leading to discontinue the treatment. Conclusion: Long-term oxcarbazepine treatment was found to be effective and safe in the symptoms of painful diabetic neuropathy

Josifi, S D ~, Pandit, N a, S. Kunlar B.K a. 1Nepal Medical College and

Teaching Hospital, Kathman~u, Nepal Background: Developing country like Nepal has poor health status in school students. Low back pain (LBP) in schoolchildren with no apparent clinical causes is known to be a common problem. Aim: To assess the role o f both mechanical and psychosocial factors (including emotional and behavioral problems and other somatic pain complaints) in clffldhood LBP. Methods: A cross sectional study was carried out in a population of 850 schoolchildren aged 11-16 years. Information on these potential risk factors for LBP was sought using a self complete questionnaire and a five day bag weight diary. Specific scores was given in each criteria. The data were analyzed and edited in epi info program. At last, psychosocial counseling was given to the teachers. Results: Mechanical factors such as physical activity and school bag weight were not associated with LBP. However, strong assodations with LBP were observed for emotional problems, conduct problems, troublesome headaches, abdominal pain, sore throats, and daytime tiredness. Conclusion: Results suggest that psychosocial factors rather than mechanical factors are more important in LBP occurring in young populations and could possibly be a reflection of distress in schoolchildren. Recommendation: There should be such as psychosocial counseling, good ventilation, limited student in a class, awareness among teachers and parents to reduce LBP and other health problems. Last but not the least, tiffs type of programs is helpful to prevent from occupational health hazards also.

1566 Spinal NO pathway takes part in the analgesic efl~ct of APA Microcapstdized BCCs Subaraehnoid Transplantation

1568 Low Back Pain in a Rural Commmdty People of Developing Country Nepal: How They Come for Clinical Management

Yuge Jiang ~, Longhe Xu ~, Yilong Xue 1, Hong Zhang ~.

Joshi, S D ~, Pandit, N 1, S.Kumar B.K ~. 1Nepal Medical College and

~Anesthesiology, PLA General Hospital, Beijing, China.

Teaching Hospital, Kathmandu, Nepal

Background: To study A P A microcapsulized bovine chromaffin cells (BCCs) subarachnoid transplantation on the changes of neural nitric oxid synthase (nNOS) in spinal cord of chronic constriction injury (CCI) rats. Methods: SD rats were randomly divided into four groups, each has five. Normal rats were used as control group (group C). Rats that right sciatic nerve was ligated were used as CCI group. Five to six hundred empty APA microcapsules(group APA) or 5 × 106 APA mJcrocapsulized BCCs ( group APA-BCCs) were grated into subarachnoid space of CCI rats 7 days after operation. Allodytria and hyperalgesia

Aim of Investigation: Pain is one of the great problems in Nepali commmffty. Most of the time, the patient go to traditional healers or home based medical treatment, tiffs study was mostly to find out the nature and responses of pain among the community people and lastly refer them to the hospital. Methods: A cross sectional study in Nepal to determine the prevalence and risk factors for low back pain within the community. Nine hundred adults were selected using a multistage sampling technique. A questionnaire was adnffnistered wlffch sought information on demographic characteristics, smoking status, presence o f low back

Poster Abstracts pain in the last 12 months and at the time o f the survey and the duration and severity of the low back pain. Results: 11tree hundred and sixty one (40% of the population) had low back pain in the last 12 months while (1303) 33% had low back pain at the time of the study. The prevalence among males was higher than among females; 44.7% and 35.6% respectively. Conclusions: The prevalence of low back pain was highest among farmers (mostly men) and lowest among petty traders (mostly women). The severity and mean duration of low back pain was also highest among farmers. Risk factors highlighted on bivariate analysis were male sex and farming as an occupational category but neither o f those was sustained in multivariate analysis, an indication that male preponderance in this study is related to occupational factors. This study concludes that low back pain is prevalent in rural income conmmnities and may occur at levels similar to those reported in high income countries. 1569 Comparison of Prednisolone with Piroxicam in Complex Regional Pain Syndrome Following Stroke: A Randomized Controlled Trial

Kalita, j1. 1Sanjay Gandhi PGI, Uttar Pradesh, India Background: Complex regional pain syndrome (CRPS) frequently occurs following stroke but there is no study comparing prednisolone with piroxicam in its management. This study therefore compares the effect of prednisolone over piroxicam in the patients with CRPS following stroke. Method: Randomized controlled trial in a tertiary care teaching hospital. Patients anti Methods: Sixty patients with CRPSr fulfilling the inclusion criteria were included. All the patients underwent a detailed neurological examination, cranial CT scan, radiograph of chest and shoulder joint, blood count and serum chemistry. The severity of stroke was assessed by Canadian Neurological Stroke (CNS) scale, CRPS by scoring sensory, autonomic and motoric symptoms and activity of daily living by Barthel index (BI) score. Patients were randomly assigned prednisolone 40 mg or piroxicam 20 mg daily and outcome was assessed at one month on the basis of CRPS and BI Score. Results: The mean age of the patients was 56 years and 20 were females. The baseline clinical and radiological parameters were comparable between the two groups. 83.3% patients showed significant improvement following prednisolone whereas only 16.7% in piroxicam group showed improvement. The odds ratio for prednisolone was 25 (95%CI 6.43-97.2). In the prednisolone group total CRPS score and its components improved siguificantly at lmonth whereas in piroxicam group only autonomic component improved. The mean difference in CRPS score in prednJsolone group improved significantly compared to piroxicam group. The improvement in BI score however was not significantly different between the two groups. Conclusion: Prednisolone results significant improvement in symptoms and signs o f CRPSI following stroke compared to piroxicam. 1570 Treatment for Refractory Meralgia Paresthetica Kanrran, S 1. 1Hamad General Hospital, Qatar

Background: Treatment for refi'actory meralgia paresthetica (IMP) is surgery with a significant failure rate. Purpose: To report successful use of percutaneous radiofrequency technique (RFTC) for refractory MP. Patients and Method: We identified n -- 3 patients (1 man, 2 women) from pain database with the diagnosis of MP. All patients had failed conservative management and local injections. These patients underwent percutaneous radiofrequency of the lateral femoral cutaneous

Friday, November 11, 2005

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nerve. Patients were followed prospectively for 8 months and evaluated neurologically. Results: Patients had undergone four (monthly) local anesthetic infiltration with complete pain relief for mean 6days (range 1 to 10 days). Two patients had severe pain (VAS 9), allodynia and numbness; one had severe pain (8) and numbness. The R F probe was placed 3 cnn inferior and medial to the anterior superior iliac spine. Stimulation at 50 Hz was carried out and probe adjusted to obtain a stimulation threshold below 0.5my. RFTC performed using pulse mode at 40 Celsius for 120 seconds. Two additional lesions made lateral and medial to the original point o f stimulation. Patients evaluated every two months. Post treatment pain relief was immediate with allodynia resolving within first week. At 8 months two patients are pain free, one mild pain (VAS 3). The numbness resolved in one and improved moderately in two. N o post procedure neurological deficit observed. Conclusion: RFTC is a safe and effective procedure for MP but requires a larger study to prove its efficacy. RFTC should be considered in the treatment of refractory MP before surgery.

1571 Long-lasting Antalgic etteets of daffy sessions of Repetitive Transcratfial Magnetic Slimulafion in central and peripheral Neuropafftic pain

Khedr E 1. 1Egyptian Society of Neurology, Egypt Background: There have been several reports that a single session of repetitive transcranial magnetic stimulation (rTMS) over motor cortex can produce short-term relief of some types of chrordc pain. Here we studied whether 5 consecutive days of rTMS would lead to longer lasting pain relief in unilateral chronic intractable neuropathic pain. Methods: Forty-eight patients with therapy-resistant chronic unilateral pain syndromes, 24 had trigeminal neuralgia (TGN) and 24 had poststroke pain syndrome (PSP) were included in tiffs study. Fourteen patients from each group received 10 min real rTMS over the hand area of motor cortex (120 Hz, 10 x 10 s trains, intensity 80% of motor threshold) every day for 5 consecutive days. The remaining patients of each group received sham stimulation. Pain was assessed using a visual analogue scale (VAS) and the Leeds assessment of neuropathic symptoms and signs scale (LANSS), before, after the 1st, 4ta, and 5± sessions and 2 weeks after the last session. Results: There were no significant differences in basal pain ratings between patients receiving real and sham rTMS. However, a two factor A N O V A on each of the clinical measures revealed a significant " + / - T M S ' " X "time" interaction indicating that real and sham rTMS had different effects on VAS and LANSS scales. Post hoc testing showed that in both groups of patients, real-rTMS led to a greater improvement in scales than sham-rTMS, and that tiffs was evident even 2 weeks after the end of the treatment. No subject experienced adverse effects during the study. Conclusion: Our results confirm that 5 daily sessions of rTMS over moto r cortex can produce long lasting pain relief in patients with T G N or PSP.

1572 The Choice of Treatment of Chronic Pain Syndromes (CPS) in Patients with Cervical and Lumbar Osteodlondrosis (C-LO) Depending on Intervertebral Discs (ID) Damage Khelimsldy, A M 1. 1Far Eastern State Ivledieal University, Khabarovsk,

Russia Background: The treatment of CPS, caused by C-LO often associated with indications to standard operation's methods, leading to unsatisfactory results. Objective: To detemfinate indications to treatment of CPS in patients with C-LO, depending of ID damage.