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168: Fibromyalgia Treatment With Escitalopram
206
Posters
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Chronic Pain Management
168. Fibromyalgia treatment with escitalopram O. Carreras Salcedo, R.M. Vidal Sicart, J.M. Vazquez Ignacio, J. Guitart Vela Hospital Plato´, Pain Managment, Barcelona, Spain Aim: To assess the treatment effects with escitalopram in 23 patients with fibromyalgia. Method: Prospective,descriptive study in 23 patients with clinical diagnosis fibromyalgia and without antidepressive treatment and now drug use contraindications. The patients took their usual treatment except in knowing side effects plus the recommended escitalopram doses during 3 months. Demographic data instruction level level and concomitant medication were recorded. Baseline, at month and 3 months EVA score, Mc Guill pain Questionnaire (Spanish Adapted), morning stiffness, higher or lower than 30 minutes, sleeping quality by Lattinen Scale and dose and side effects of Escitalopram were registered. Results: A discrete decrease of the initial EVA score (8,22) was observed, 19,1% at first month and 17.03% at 3 months. The McGuill Score variation was negligible from 8.5% to 8.7% at first and 3 months respective (Initial score 18,13), being the affective component the item with highest change during time (14,14 to 13,47 and 13,71 at 1 and 3 month respective). The sleeping quality presented a mild amelioration at first month, going back to baseline value at 3 months. Morning stiffness was better at first month (16.62% difference) returning to closer baseline values at 3 months (4.86% difference). Six patients abandoned the study, 3 of them for inadequate follow-up, another one due to a surgical procedure, other abandoned the treatment by herself, and the last one withdrawn the therapy during the first week by nausea. Only one patient presents mouth dryness as side effects but she completed the study. Conclusions: Escitalopram is well tolerated by the patients but its utility in the symptomatic treatment of fibromyalgia is limited although further studies are needed to confirm this issue.
172. Safety and accuracy of lumbar epidural injection in the treatment of radiculopathy S. Alemo1, A. Sayadipour2 1Drexel College of Medicine, Neurosurgery, Philadelphia, USA, 2University Neurosurgical Pain Clinic, Neurosurgery, Philadelphia, USA Background and Aims: This is a retrospective study of 371cases who had Lumbar Epidural Steroid Injection (ESI) from 03/01/2004 to 11/30/2005. The safety and accuracy of the procedure was the subject of this report. Methods: Each patient had clinical and imaging evidence of radiculopathy. There were 134 male (36%) and 237 female (64%). Range of age was from 18 to 89 years (mean 52.7years). The procedure was carried out under Monitored Anesthesia Care. Fluoroscopy and LOR were used for locating of the needle. For confirmation of epidural injection, we injected 0.5cc of lopamidol contrast medium. Each patient received 5cc of 0.25% Bupivacaine mixed with 80mg of Methylprednisolone. Results: We detected false LOR in 10.7% of our patients by lopamidol injection. The procedure was found relatively safe; however, certain rare potential complications such as meningitis, epidural hematoma, epidural abscess, epidural lipomatosis, subdural hematoma, allergic reaction to lopamidol, weight gain, steroid myopathy, hypersensitivity to steroid (hypertension and tachycardia), avascular necrosis of bone, osteoporosis, fluid retension, cushing syndrome, hypercorticism, chemical meningitis due to steroid, nerve root injury, arachnoiditis, retinal hemorrhage, acute retinal necrosis, pneumocephalus, transient blindness and death or brain injury were not seen in our series. Our total morbidity was 5.1% which includes: Cerebrospinal fluid (CSF) leak (12) that caused transient headache, transient paraplegia with full recovery in 6 to 8 hours (5), steroid allergy (1), and hyperglycemia in patient with type I Diabetes Mellitus (1). Conclusion: We strongly recommend all patients with lumbar radiculopathy be treated with ESI before considering spinal surgery, except for those that have progressive motor deficit or cauda equina compression requiring urgent spinal surgery. Based on 10.7% of false LOR and potentially serious complications, we believe LOR technique along with image intensifier and lopamidol injection in the sterile operation room is the gold standard technique.
Posters
•
Chronic Pain Management
168. Fibromyalgia treatment with escitalopram O. Carreras Salcedo, R.M. Vidal Sicart, J.M. Vazquez Ignacio, J. Guitart Vela Hospital Plato´, Pain Managment, Barcelona, Spain Aim: To assess the treatment effects with escitalopram in 23 patients with fibromyalgia. Method: Prospective,descriptive study in 23 patients with clinical diagnosis fibromyalgia and without antidepressive treatment and now drug use contraindications. The patients took their usual treatment except in knowing side effects plus the recommended escitalopram doses during 3 months. Demographic data instruction level level and concomitant medication were recorded. Baseline, at month and 3 months EVA score, Mc Guill pain Questionnaire (Spanish Adapted), morning stiffness, higher or lower than 30 minutes, sleeping quality by Lattinen Scale and dose and side effects of Escitalopram were registered. Results: A discrete decrease of the initial EVA score (8,22) was observed, 19,1% at first month and 17.03% at 3 months. The McGuill Score variation was negligible from 8.5% to 8.7% at first and 3 months respective (Initial score 18,13), being the affective component the item with highest change during time (14,14 to 13,47 and 13,71 at 1 and 3 month respective). The sleeping quality presented a mild amelioration at first month, going back to baseline value at 3 months. Morning stiffness was better at first month (16.62% difference) returning to closer baseline values at 3 months (4.86% difference). Six patients abandoned the study, 3 of them for inadequate follow-up, another one due to a surgical procedure, other abandoned the treatment by herself, and the last one withdrawn the therapy during the first week by nausea. Only one patient presents mouth dryness as side effects but she completed the study. Conclusions: Escitalopram is well tolerated by the patients but its utility in the symptomatic treatment of fibromyalgia is limited although further studies are needed to confirm this issue.
172. Safety and accuracy of lumbar epidural injection in the treatment of radiculopathy S. Alemo1, A. Sayadipour2 1Drexel College of Medicine, Neurosurgery, Philadelphia, USA, 2University Neurosurgical Pain Clinic, Neurosurgery, Philadelphia, USA Background and Aims: This is a retrospective study of 371cases who had Lumbar Epidural Steroid Injection (ESI) from 03/01/2004 to 11/30/2005. The safety and accuracy of the procedure was the subject of this report. Methods: Each patient had clinical and imaging evidence of radiculopathy. There were 134 male (36%) and 237 female (64%). Range of age was from 18 to 89 years (mean 52.7years). The procedure was carried out under Monitored Anesthesia Care. Fluoroscopy and LOR were used for locating of the needle. For confirmation of epidural injection, we injected 0.5cc of lopamidol contrast medium. Each patient received 5cc of 0.25% Bupivacaine mixed with 80mg of Methylprednisolone. Results: We detected false LOR in 10.7% of our patients by lopamidol injection. The procedure was found relatively safe; however, certain rare potential complications such as meningitis, epidural hematoma, epidural abscess, epidural lipomatosis, subdural hematoma, allergic reaction to lopamidol, weight gain, steroid myopathy, hypersensitivity to steroid (hypertension and tachycardia), avascular necrosis of bone, osteoporosis, fluid retension, cushing syndrome, hypercorticism, chemical meningitis due to steroid, nerve root injury, arachnoiditis, retinal hemorrhage, acute retinal necrosis, pneumocephalus, transient blindness and death or brain injury were not seen in our series. Our total morbidity was 5.1% which includes: Cerebrospinal fluid (CSF) leak (12) that caused transient headache, transient paraplegia with full recovery in 6 to 8 hours (5), steroid allergy (1), and hyperglycemia in patient with type I Diabetes Mellitus (1). Conclusion: We strongly recommend all patients with lumbar radiculopathy be treated with ESI before considering spinal surgery, except for those that have progressive motor deficit or cauda equina compression requiring urgent spinal surgery. Based on 10.7% of false LOR and potentially serious complications, we believe LOR technique along with image intensifier and lopamidol injection in the sterile operation room is the gold standard technique.