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301: Low back pain—our multidisciplinary pain clinic reality
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Posters
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Chronic Pain Management
295. Effectiveness and safety of continuous intrathecal morphine delivery in chronic cancer pain before definitive implant of drug delivery system D. Quattrone1, G. Bottari1, T. Mandolfino1, M.A. Venia2, G. Mazzeo2, G. Bova2, F. Bellinghieri2 1Department of Neuroscience, Psychiatric Science, Anesthesiology, Policlinico G. Martino, Messina, Sicily, Italy, 2AUSL 5 - Presidio Ospedaliero San Vincenzo, Taormina, Messina, Sicily, Italy Background and Aims: Many studies have shown that intrathecal (IT) morphine provide pain relief in cancer pain. This study evaluated, over a 7 day follow-up period, the clinical effectiveness and safety of the IT morphine delivery through a variable rate elastomeric infusion pump in chronic cancer pain patients before the definitive implantation of IT drug delivery system. Methods: Forty-two consecutive patients, scheduled for implantation of spinal drug delivery system, were randomly allocated in two group. Group 1 (21 patients) received continuously IT morphine through an elastomeric infusion pump for one week. In group 2, 21 patients were been underwent to definitive implantation of drug delivery pump without preliminary evaluation with elastomeric pump infusion. The optimal intrathecal dose was defined as that providing effective analgesia and minimal side effects after its administration. Analgesia tested at rest, on movement and while coughing on a visual analogue pain scale and morphine consumption was recorded. Patients’ satisfaction, SaO2, respiratory rate, episodes of nausea, vomiting and itch were also noted. Results: Analgesia at rest, on movement and while coughing was significantly better in the continuous administration morphine dose test group (rest: P ⫽ 0.01; coughing: P ⫽ 0.005). Morphine constantly provided adequate analgesia and opioids consumption was lower in group 1 during this period as well (P ⫽ 0.001). Nausea and vomiting were more frequent with morphine continuous deliver on the first day. No respiratory depression occurred in either group. Conclusion: Spinal continuous delivery of morphine, before definitive implantation of drug delivery system, is an effective and safe method to test the optimal IT dose for analgesia, to evaluate the real effectiveness of the treatment, to up titrate morphine delivery or to change the type of drug delivery (adding local anesthetics, clonidine).
301. Low back pain— our multidisciplinary pain clinic reality S. Arantes1, C. Ferreira2, C. Baptista1, R. Moutinho1, A. Marcos1, C.J. Carvalho1 1Centro Hospitalar De Vila Nova De Gaia, VN Gaia, Portugal, 2Hospital De S. Marcos, Braga, Portugal Background and Aims: Low Back Pain (LBP) is an extremely common complaint and a major cause of work disability worldwide, increasing at an alarming exponential rate. Causes are multifactorial and include not only mechanical factors but psychological, social and behavioral. The aim of this retrospective study was to describe the patients with low back pain that are followed in our Multidisciplinary Pain Clinic (MPC), the kind of treatment that they are submitted to and the outcome of that treatment. Methods: Retrospective study that included all patients with LBP of our MPC, excepted those with cancer related low back pain or with diffuse ostheoarticular disease. Qualitative variables (age, sex, treatment, initial and final VAS) were characterized. Data were analyzed using chi square and Fisher Tests. Results: From the universe of 961 patients in our MPC, 92 (9.5%) were sent to us with LBP, 34.8% by family doctors and 33.7% by orthopaedics. 76.1% of these patients were women and 54.3% with age between 20 and 60 years old. Most patients had had low back pain for more than a year before first consultation, with moderate to severe pain (VAS⬎3) in 92% of the cases and 25.6% with Failed Back Syndrome. Treatment was carried out with invasive procedures in 31.5% patients and with non-invasive pharmacologic measures such strong opiate (12%), tramadol like (66.3%), NSAIDs (46.7%), tricycle antidepressants (42.4%) and anticonvulsivants (54.3%). Physical and psychological treatments were also used. There was an improvement of the VAS in 51% of the patients between the first and last consultations. Conclusions: LBP is one of the most common reasons for chronic disability and incapacity in our population.History and examination of the patient by appropriate healthcare professionals in MPC allow triage that guide management.Drugs, physical and psychological measures are, most of the times, sufficient to relieve pain and improve quality of life.
Posters
•
Chronic Pain Management
295. Effectiveness and safety of continuous intrathecal morphine delivery in chronic cancer pain before definitive implant of drug delivery system D. Quattrone1, G. Bottari1, T. Mandolfino1, M.A. Venia2, G. Mazzeo2, G. Bova2, F. Bellinghieri2 1Department of Neuroscience, Psychiatric Science, Anesthesiology, Policlinico G. Martino, Messina, Sicily, Italy, 2AUSL 5 - Presidio Ospedaliero San Vincenzo, Taormina, Messina, Sicily, Italy Background and Aims: Many studies have shown that intrathecal (IT) morphine provide pain relief in cancer pain. This study evaluated, over a 7 day follow-up period, the clinical effectiveness and safety of the IT morphine delivery through a variable rate elastomeric infusion pump in chronic cancer pain patients before the definitive implantation of IT drug delivery system. Methods: Forty-two consecutive patients, scheduled for implantation of spinal drug delivery system, were randomly allocated in two group. Group 1 (21 patients) received continuously IT morphine through an elastomeric infusion pump for one week. In group 2, 21 patients were been underwent to definitive implantation of drug delivery pump without preliminary evaluation with elastomeric pump infusion. The optimal intrathecal dose was defined as that providing effective analgesia and minimal side effects after its administration. Analgesia tested at rest, on movement and while coughing on a visual analogue pain scale and morphine consumption was recorded. Patients’ satisfaction, SaO2, respiratory rate, episodes of nausea, vomiting and itch were also noted. Results: Analgesia at rest, on movement and while coughing was significantly better in the continuous administration morphine dose test group (rest: P ⫽ 0.01; coughing: P ⫽ 0.005). Morphine constantly provided adequate analgesia and opioids consumption was lower in group 1 during this period as well (P ⫽ 0.001). Nausea and vomiting were more frequent with morphine continuous deliver on the first day. No respiratory depression occurred in either group. Conclusion: Spinal continuous delivery of morphine, before definitive implantation of drug delivery system, is an effective and safe method to test the optimal IT dose for analgesia, to evaluate the real effectiveness of the treatment, to up titrate morphine delivery or to change the type of drug delivery (adding local anesthetics, clonidine).
301. Low back pain— our multidisciplinary pain clinic reality S. Arantes1, C. Ferreira2, C. Baptista1, R. Moutinho1, A. Marcos1, C.J. Carvalho1 1Centro Hospitalar De Vila Nova De Gaia, VN Gaia, Portugal, 2Hospital De S. Marcos, Braga, Portugal Background and Aims: Low Back Pain (LBP) is an extremely common complaint and a major cause of work disability worldwide, increasing at an alarming exponential rate. Causes are multifactorial and include not only mechanical factors but psychological, social and behavioral. The aim of this retrospective study was to describe the patients with low back pain that are followed in our Multidisciplinary Pain Clinic (MPC), the kind of treatment that they are submitted to and the outcome of that treatment. Methods: Retrospective study that included all patients with LBP of our MPC, excepted those with cancer related low back pain or with diffuse ostheoarticular disease. Qualitative variables (age, sex, treatment, initial and final VAS) were characterized. Data were analyzed using chi square and Fisher Tests. Results: From the universe of 961 patients in our MPC, 92 (9.5%) were sent to us with LBP, 34.8% by family doctors and 33.7% by orthopaedics. 76.1% of these patients were women and 54.3% with age between 20 and 60 years old. Most patients had had low back pain for more than a year before first consultation, with moderate to severe pain (VAS⬎3) in 92% of the cases and 25.6% with Failed Back Syndrome. Treatment was carried out with invasive procedures in 31.5% patients and with non-invasive pharmacologic measures such strong opiate (12%), tramadol like (66.3%), NSAIDs (46.7%), tricycle antidepressants (42.4%) and anticonvulsivants (54.3%). Physical and psychological treatments were also used. There was an improvement of the VAS in 51% of the patients between the first and last consultations. Conclusions: LBP is one of the most common reasons for chronic disability and incapacity in our population.History and examination of the patient by appropriate healthcare professionals in MPC allow triage that guide management.Drugs, physical and psychological measures are, most of the times, sufficient to relieve pain and improve quality of life.