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303 UREMIC POLYNEUROPATHY – DIAGNOSIS AND THERAPY OF PAIN
Posters / European Journal of Pain Supplements 4 (2010) 47–146
Conclusions: These preliminary results suggest a significant impairment of a number of cognitive functions in older patients suffering from PHN with potential consequences on their everyday life. Drug cognitive side-effects, neuronal degeneration due to chronic pain and old age vulnerability are important contributing factors that will be discussed. 302 TREATMENTS OF PAINTFUL NEUROPATHY IN GERIATRIC PATIENTS WITH DIABETES MELLITUS B. Potic1 , S. Zdravkovic1 , D. Milosevic1 , S. Tomic1 , J. Stojanovic1 , J. Potic2 . 1 Department of Geriatric, 2 Department of Neurology, Clinical Hospital Centre ‘Zvezdara’, Medical Faculty University of Belgrade, Belgrade, Serbia Introduction: Pain is the most disturbing symptom of diabetic peripheral neuropathy. Usualy 45% of patients with diabetes mellitus develop peripheral neuropathies. Objectives: Evaluation of the effect of gabapentin, NSAID (nonstereoidalantiinflamatory drugs) and alfa lipoin acid on neuropathic pain. Methods: We analysed group of 50 geriatric patients with diabetes mellitus aged from 65 to 80 years. Duration of diabettes was 15 to 20 years. In this group 52% of patients developed neuropathy. The patients with diabetic polyneuropathy commonly presents with numbness and paraesthesiae (frequently with a burning quality). This pain may develop as a burning pain in the feet, a spontaneous, deep, aching pain or lighting stabs of pain. Hyperalgesia may also occur. NSAID were used occasionally when the pain was intensive. Gabapentin was used in 900 mg. daily dose during six months continuous. Alfa lipoin acid was used in daly dose of 600 mg. during six months continuous. The primary efficacy was measured on an Likert scale (0-non pain; 10-worst possible pain). Results: In group of patients who recived alfa lipon acid intensity of pain was decreased from 10 to 5 (Likert scale). In group of patients who were treated with gabapentin, 900 mg. daily, pain was decreased from 10 to 7 (Likert scale). Conclusions: Monotherapy with alfa lipon acid or monotherapy with gabapentin appears to be efficacious for the treatment of pain and sleep interference associated with diabetic peripheral neuropathy and exhibits positive effects on mood and quality of life.
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UP could be detected only by ET (11.8%). Arteriovenous shunt lowered conduction velocities and influenced carpal tunnel syndrome development (48.3%). The average conduction velocity was 29±2 m/s. McGill testing and numerical scale rated the pain for each applied medication with the declining score sequence: B vitamins>sertaline>alfa lipoic acid. Conclusions: HD and PD halt the progression of UP but, unlike renal transplantation, do not result in complete and definite recovery. The best effect in the pain treatment was obtained with alfa lipoic acid, lasting longer than six months. 304 PREVALENCE AND CHARACTERISTIC OF NEUROPATHIC PAIN AMONG PATIENTS WITH DIABETIC POLYNEUROPATHY (DPN) M. Rakusa1 , M. Cokolic2 , M. Rakusa2 . 1 Department of Neurology, 2 Department of Endocrinology and Diabetes, University Medical Centre Maribor, Maribor, Slovenia Introduction: DPN is common complications of diabetes and is frequently accompanied with neuropathic pain (DPN-P). Both were associated with poor diabetes control, duration of disease, age, low HDL cholesterol (HDL) and high triglyceride levels. Objectives: To evaluate prevalence and surrogate factors for DPN-P in our population. Methods: We identified 126 patients with diabetes type 2 who were diagnosed DPN in the diabetic outpatient clinic Maribor (north-east Slovenia), 37 were at the same time diagnosed with DPN-P. Six patients were excluded due to heavy drinking. Pain was evaluated with Douleur neuropathique 4 questions (DN4), demographic data and data on diabetes duration, HbA1c, morning serum glucose and lipids level were collected for the visit when diagnose was made. Results: There were 24 females. Mean age was 66.6, SD10.9, mean duration of diabetes 20.38 years (SD8.82). The prevalence of DPN-P was 30.8%. Several patients with DPN-P had more than one sensory descriptor: burning 65%; painful cold 35%; electric shocks 8%; tingling 65%; pins and needles 15%; itching 49%; numbness 24%. Mean DN4 score was 4.5, SD1.6. Serum values were elevated for glucose 8.39, SD2.85 and HbA1c 7.60, SD1.38%, while lipid levels were in normal range; cholesterol 4.97, SD0.95 mmol/l; triglyceride 1.78, SD0.89 mmol/l; HDL 1.30, SD0.33 mmol/l; LDL 2.92, SD0.81 mmol/l. Conclusions: Our results may indicate that despite relatively good diabetes control, without other surrogate factors such as high lipids, almost every third patient had DPN-P and DPN. We should therefore do our best, to keep serum glucose level as low as possible.
303 UREMIC POLYNEUROPATHY – DIAGNOSIS AND THERAPY OF PAIN J. Potic1 , T. Smiljkovic1 , B. Potic2 , A. Potic3 . 1 Department of Neurology, 2 Department of Gerontology, Clinical Hospital Centre ‘Zvezdara’, Medical Faculty University of Belgrade, 3 University Clinic for Paediatric Neurology and Psychiatry, Medical Faculty University of Belgrade, Belgrade, Serbia
S. Raoul. Neurosurgery Department, CHU Nantes, Nantes, France
Introduction: Uremic polyneuropathy (UP), with axonal degeneration and segmental demyelination, is a well known cause of disability in uremic patients. Objectives: To asses the impact of peritoneal dialysis (PD) and haemodialysis (HD) on peripheral nerves injury in UP patients and the effect of different therapies on neuropathic pain. Methods: The study included 300 patients on PD or HD, aged 18–56 years, with renal failure lasting from 2 to 23 years. Electromyographic testing (ET) of four peripheral nerves (medianus, ulnaris, peronaeus, tibialis) was performed. Amplitudes of sensory and motor response, conduction velocity, evoked response latency and F wave latency were estimated. The diagnosis of UP was made if ET was abnormal in at least two out of four nerves. Medications used for the pain management were B vitamins, alfa lipoic acid (600 mg daily), antidepressants (sertaline 50 mg daily). Results: UP was diagnosed in 86.8% of the patients. Revealed neurological disturbances (weakness, diminished reflexes, sensory alterations) correlated with motor and sensory velocity abnormalities – more pronounced in lower limbs (91%). Subclinical
Objective: The goal of this study is to evaluate the effect of lateral nerve blocks of C1-C2, radiofrequency thermolesions, selective intradural rhizotomies of C2 and occipital nerve stimulation on intractable occipital neuralgias and to product guide-lines for the treatment. Methods: From 2000 to 2008, two thousands ten patients were referred to our center and treated for severe occipital neuralgias. Visual analogic scale was performed before after after treatment. All patients have medical treatment and lateral nerve blocks. If this treatment was efficient no complementary treatment was proposed. If the treatment was not suffisant thermolesions or intradural radicotomies were performed. 26 patients were treated with radiofrequency lesions and 25 were treated with selective radicotomies and 22 patients were treated with stimulations. Follow-up was 6 months to 7 years (mean 34 months). Results: All of the 210 patients had temporary relief of symptoms. 69% of the patients were improved by nerves blocks only and medical treatment. 31% of patients are not improved by this treatment and need surgical treatment. 20 patients (76%) were
305 TREATMENT OF REFRACTORY OCCIPITAL NEURALGIAS
Conclusions: These preliminary results suggest a significant impairment of a number of cognitive functions in older patients suffering from PHN with potential consequences on their everyday life. Drug cognitive side-effects, neuronal degeneration due to chronic pain and old age vulnerability are important contributing factors that will be discussed. 302 TREATMENTS OF PAINTFUL NEUROPATHY IN GERIATRIC PATIENTS WITH DIABETES MELLITUS B. Potic1 , S. Zdravkovic1 , D. Milosevic1 , S. Tomic1 , J. Stojanovic1 , J. Potic2 . 1 Department of Geriatric, 2 Department of Neurology, Clinical Hospital Centre ‘Zvezdara’, Medical Faculty University of Belgrade, Belgrade, Serbia Introduction: Pain is the most disturbing symptom of diabetic peripheral neuropathy. Usualy 45% of patients with diabetes mellitus develop peripheral neuropathies. Objectives: Evaluation of the effect of gabapentin, NSAID (nonstereoidalantiinflamatory drugs) and alfa lipoin acid on neuropathic pain. Methods: We analysed group of 50 geriatric patients with diabetes mellitus aged from 65 to 80 years. Duration of diabettes was 15 to 20 years. In this group 52% of patients developed neuropathy. The patients with diabetic polyneuropathy commonly presents with numbness and paraesthesiae (frequently with a burning quality). This pain may develop as a burning pain in the feet, a spontaneous, deep, aching pain or lighting stabs of pain. Hyperalgesia may also occur. NSAID were used occasionally when the pain was intensive. Gabapentin was used in 900 mg. daily dose during six months continuous. Alfa lipoin acid was used in daly dose of 600 mg. during six months continuous. The primary efficacy was measured on an Likert scale (0-non pain; 10-worst possible pain). Results: In group of patients who recived alfa lipon acid intensity of pain was decreased from 10 to 5 (Likert scale). In group of patients who were treated with gabapentin, 900 mg. daily, pain was decreased from 10 to 7 (Likert scale). Conclusions: Monotherapy with alfa lipon acid or monotherapy with gabapentin appears to be efficacious for the treatment of pain and sleep interference associated with diabetic peripheral neuropathy and exhibits positive effects on mood and quality of life.
87
UP could be detected only by ET (11.8%). Arteriovenous shunt lowered conduction velocities and influenced carpal tunnel syndrome development (48.3%). The average conduction velocity was 29±2 m/s. McGill testing and numerical scale rated the pain for each applied medication with the declining score sequence: B vitamins>sertaline>alfa lipoic acid. Conclusions: HD and PD halt the progression of UP but, unlike renal transplantation, do not result in complete and definite recovery. The best effect in the pain treatment was obtained with alfa lipoic acid, lasting longer than six months. 304 PREVALENCE AND CHARACTERISTIC OF NEUROPATHIC PAIN AMONG PATIENTS WITH DIABETIC POLYNEUROPATHY (DPN) M. Rakusa1 , M. Cokolic2 , M. Rakusa2 . 1 Department of Neurology, 2 Department of Endocrinology and Diabetes, University Medical Centre Maribor, Maribor, Slovenia Introduction: DPN is common complications of diabetes and is frequently accompanied with neuropathic pain (DPN-P). Both were associated with poor diabetes control, duration of disease, age, low HDL cholesterol (HDL) and high triglyceride levels. Objectives: To evaluate prevalence and surrogate factors for DPN-P in our population. Methods: We identified 126 patients with diabetes type 2 who were diagnosed DPN in the diabetic outpatient clinic Maribor (north-east Slovenia), 37 were at the same time diagnosed with DPN-P. Six patients were excluded due to heavy drinking. Pain was evaluated with Douleur neuropathique 4 questions (DN4), demographic data and data on diabetes duration, HbA1c, morning serum glucose and lipids level were collected for the visit when diagnose was made. Results: There were 24 females. Mean age was 66.6, SD10.9, mean duration of diabetes 20.38 years (SD8.82). The prevalence of DPN-P was 30.8%. Several patients with DPN-P had more than one sensory descriptor: burning 65%; painful cold 35%; electric shocks 8%; tingling 65%; pins and needles 15%; itching 49%; numbness 24%. Mean DN4 score was 4.5, SD1.6. Serum values were elevated for glucose 8.39, SD2.85 and HbA1c 7.60, SD1.38%, while lipid levels were in normal range; cholesterol 4.97, SD0.95 mmol/l; triglyceride 1.78, SD0.89 mmol/l; HDL 1.30, SD0.33 mmol/l; LDL 2.92, SD0.81 mmol/l. Conclusions: Our results may indicate that despite relatively good diabetes control, without other surrogate factors such as high lipids, almost every third patient had DPN-P and DPN. We should therefore do our best, to keep serum glucose level as low as possible.
303 UREMIC POLYNEUROPATHY – DIAGNOSIS AND THERAPY OF PAIN J. Potic1 , T. Smiljkovic1 , B. Potic2 , A. Potic3 . 1 Department of Neurology, 2 Department of Gerontology, Clinical Hospital Centre ‘Zvezdara’, Medical Faculty University of Belgrade, 3 University Clinic for Paediatric Neurology and Psychiatry, Medical Faculty University of Belgrade, Belgrade, Serbia
S. Raoul. Neurosurgery Department, CHU Nantes, Nantes, France
Introduction: Uremic polyneuropathy (UP), with axonal degeneration and segmental demyelination, is a well known cause of disability in uremic patients. Objectives: To asses the impact of peritoneal dialysis (PD) and haemodialysis (HD) on peripheral nerves injury in UP patients and the effect of different therapies on neuropathic pain. Methods: The study included 300 patients on PD or HD, aged 18–56 years, with renal failure lasting from 2 to 23 years. Electromyographic testing (ET) of four peripheral nerves (medianus, ulnaris, peronaeus, tibialis) was performed. Amplitudes of sensory and motor response, conduction velocity, evoked response latency and F wave latency were estimated. The diagnosis of UP was made if ET was abnormal in at least two out of four nerves. Medications used for the pain management were B vitamins, alfa lipoic acid (600 mg daily), antidepressants (sertaline 50 mg daily). Results: UP was diagnosed in 86.8% of the patients. Revealed neurological disturbances (weakness, diminished reflexes, sensory alterations) correlated with motor and sensory velocity abnormalities – more pronounced in lower limbs (91%). Subclinical
Objective: The goal of this study is to evaluate the effect of lateral nerve blocks of C1-C2, radiofrequency thermolesions, selective intradural rhizotomies of C2 and occipital nerve stimulation on intractable occipital neuralgias and to product guide-lines for the treatment. Methods: From 2000 to 2008, two thousands ten patients were referred to our center and treated for severe occipital neuralgias. Visual analogic scale was performed before after after treatment. All patients have medical treatment and lateral nerve blocks. If this treatment was efficient no complementary treatment was proposed. If the treatment was not suffisant thermolesions or intradural radicotomies were performed. 26 patients were treated with radiofrequency lesions and 25 were treated with selective radicotomies and 22 patients were treated with stimulations. Follow-up was 6 months to 7 years (mean 34 months). Results: All of the 210 patients had temporary relief of symptoms. 69% of the patients were improved by nerves blocks only and medical treatment. 31% of patients are not improved by this treatment and need surgical treatment. 20 patients (76%) were
305 TREATMENT OF REFRACTORY OCCIPITAL NEURALGIAS