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(371) Efficacy of an interdisciplinary pain management program with workers compensation patients
P68 (368) Fibromyalgia patients have high expectations of symptom relief during rheumatology office visits R Staud, E O’Brien, J Craggs, S Peak, E Koo, D Price, M Robinson; University of Florida, Gainesville, FL Fibromyalgia (FM) often results in significant impairments in physical functioning and emotional distress, as well as decreased quality of life. FM patients are often frustrated and dissatisfied with medical treatments resulting in greater numbers of medical visits and health care cost. Patient-centered treatment outcomes (PCO) represent an important approach to determine the treatment success and this model promotes satisfaction with health care, improves treatment compliance, and increases maintenance of patient-provider relationships. The purpose of this study was to investigate FM patients’ expectations regarding clinically relevant outcome measures in pain, fatigue, distress, and interference with daily activities (ADL) during a rheumatology clinic visit. PCO-questionnaires were used during a rheumatology-clinic visit to assess four domains relevant to FM (pain, fatigue, distress, interference with ADL) using a numerical rating-scale (0-10). PCO captures expected improvements of these domains during treatment. 294 FM patients (24 males, 270 females, 80% Caucasian; mean age: 46.91 years) rated their usual pain as 7.16 VAS, usual fatigue 7.6 VAS, usual distress 6.12 VAS, and usual interference with ADL 7.1 VAS during the last week. Reductions of 56% (3.20 VAS) in pain, 61% (2.97 VAS) in fatigue, 60% (2.45 VAS) in distress, and 63% (2.63 VAS) in interference were required by FM patients to consider treatment a success. This is consistent with previous findings in chronic musculoskeletal-pain-patients and underscores the need for examining success from the patient-perspective. FM patients have high expectations about reductions in pain (56%), fatigue (61%), distress (60%), and interference (63%) associated with rheumatologyoffice visits. In addition, they will consider only effects of this magnitude as therapeutic success. Benefits of incorporating patients’ treatment perspectives include prioritizing patients’ goals, making informed choices and maintaining realistic expectations about their treatment. PCO can guide health-care providers in clinical decision making and promote better relationships with their patients.
(369) Pain Outcomes Evaluation Tool (POET) – Preliminary opioid suitability screening data electronically acquired at an academic tertiary care pain center G Fanciullo, J Sorenson, T Washington, R Beasley, D Nampiaparampil, S Singleton; Dartmouth-Hitchcock Medical Center, Lebanon, NH Patients and clinicians provided Internet-based survey data at approximately 3,000 encounters at the DHMC Pain Center. Clinicians completed the surveys after seeing the patients. Preliminary data examination revealed the following information: Clinician-generated responses at the initial visit showed that clinicians felt there was objective evidence of a painful disorder in 71.5% of the pain patients they saw. They were “not sure” 18.3% of the time and there was not evidence of a painful disorder 10.2% of the time. In 62.7% of patients, there was no history of drug abuse or alcoholism; 13.7% of patients had a history of drug abuse or alcoholism. Clinicians were “not sure” 23.6% of the time. When asked whether clinicians felt the patient was a good candidate for treatment with opioids, 4.3% of responses were “definitely not”; 13.5% were probably not; 32.5% were “not sure”; 38.6% were “probably yes”, and; 11.3% were “definitely yes”. Mean dosages of opioids prescribed to patients who were almost entirely chronic pain patients were (dosages are reported as initial visit / follow-up visit): hydromorphone 18.6/29; fentanyl 62.2/50.8; hydrocodone 21.8/18; methadone 41.2/33.8; morphine 117.1/89.8 and; oxycodone 54.8/64.5. Patients could be taking more than one opioid concurrently. The frequencies of opioids used in percentages of initial visit / follow-up visit were: oxycodone 31.9/36.7; none 29.9/20.6; methadone 13/23.9; hydrocodone 11.3/9; morphine 9.1/ 12.3; tramadol 7.7/5.6; fentanyl 6.3/2.8 and; hydromorphone 5.3/7.8. Of note, only 29.9% of initial patients seen at the Pain Center were not already using opioids and only 20.6% were not using opioids at subsequent visits. Also notable is that only 13% of patients initially seen were using methadone while 23.9% of patients seen in follow-up were using methadone. Data reported are preliminary and no conclusions should be inferred until our data is further analyzed. Partial funding from Medtronic.
Abstracts (370) Outcomes in obese and non-obese patients with chronic osteoarthritis (OA) pain treated with tramadol HCl extended-release (tramadol ER) J Hanlon, C Benson, K Gajria, D Ng, P Lin, J Schein, M Kosinski, J Freedman; Ortho McNeil Janssen Scientific Affairs, Raritan, NJ This study was conducted to compare the outcomes of obese versus non-obese patients with moderate-to-moderately-severe chronic OA pain treated with tramadol ER or placebo. Two randomized, doubleblind, placebo controlled parallel-group, fixed-dose studies included 1,405 adults with OA of the knee or hip. Patients with a baseline pain intensity of ⬎40mm on a 100mm visual analogue scale (VAS; 0⫽no pain, 100⫽extreme pain) were randomly assigned to receive placebo or tramadol ER once daily. Enrollees completed the following patient reported outcome (PRO) instruments: Chronic Pain Sleep Inventory, Pain VAS, Western Ontario and McMaster Osteoarthritis Index (WOMAC), and Short-Form (SF)-36. Outcomes studied were the mean change from baseline to week 12 and the proportion of patients achieving a clinically meaningful improvement (CMI) on each PRO measure. Statistical comparisons between obese (BMI ⬎⫽30) and non-obese patients were performed using Student’s t-tests or chi-square test. Obese and non-obese patients’ demographics were comparable at baseline. Both patient groups showed significant improvement in sleep, pain, and functioning. Significant improvement was also observed on the SF-36 physical functioning, role physical, bodily pain, and physical summary scales in both groups. More than half of patients in both groups achieved CMI in sleep, pain intensity, and WOMAC scale scores. Approximately 30% of both obese and non-obese patients achieved CMI in SF-36 functioning, role physical, bodily pain, and physical summary scales. Obese patients demonstrated better outcomes on the WOMAC global and stiffness scales (p⬍0.05) and on the SF-36 vitality and social functioning scales (p⬍0.01). The rates of adverse events (AE) between groups were comparable. Overall, both obese and non-obese patients treated with tramadol ER improved in sleep, pain, and functional status outcomes. Study supported by Ortho-McNeil Janssen Scientific Affairs, LLC, Raritan, NJ.
(371) Efficacy of an interdisciplinary pain management program with workers compensation patients C Gagnon, S Stanos, G Van der Ende, L Rader, R Harden; Rehabilitation Institute of Chicago, Chicago, IL There are many obstacles and challenges to the successful treatment or management of chronic pain; one of which is the potential for secondary gain emanating from a workers compensation claim. We assessed the efficacy of an interdisciplinary pain management program with 101 workers compensation patients treated in 2005 - 2007. Treatment included individual appointments with psychologists, physical therapist, occupational therapist, biofeedback therapists, vocational counselors, and physicians. Patients also participated in group psychology, pool therapy, recreational therapy, nursing lectures and Feldenkrais classes. Outcome measures included program completion status, return to work status, total scores on the Beck Depression Inventory, State-Trait Anxiety Inventory, Pain Catastrophizing Scale, and the MPQ VAS was used to assess pain intensity. The majority of the patients (65%) graduated from the program, 31% were discharged early, and 4% withdrew. Most patients (83%) were released to return to work; with 74% released to full-time status and 9% were released gradual. Pre – post outcome data was available for those who graduated from the program. Additionally, the obtained MPQ VAS scores for the non-completers were compared to their initial MPQ VAS scores. Paired-samples t-tests showed significant reductions in depression [t37 ⫽ 4.071, p ⫽ .001], pain-related catastrophizing [t36 ⫽ 2.223, p ⫽ .033], and pain intensity [t50 ⫽ 5.866, p ⫽ .000], but not in anxiety [t35 ⫽ 1.701, p ⫽ .098]. Interestingly, the last obtained (at early discharge/withdrawal) pain intensity scores (M ⫽ 70.33) were higher than at baseline (M ⫽ 61.20) in the non-completers. This difference was not statistically significant [t14 ⫽ -1.621, p ⫽ .127] but is clinically meaningful. Our results support the efficacy of an interdisciplinary pain management program in decreasing emotional distress, reducing pain intensity, and improving return to work status in the majority of this challenging pain population.
(369) Pain Outcomes Evaluation Tool (POET) – Preliminary opioid suitability screening data electronically acquired at an academic tertiary care pain center G Fanciullo, J Sorenson, T Washington, R Beasley, D Nampiaparampil, S Singleton; Dartmouth-Hitchcock Medical Center, Lebanon, NH Patients and clinicians provided Internet-based survey data at approximately 3,000 encounters at the DHMC Pain Center. Clinicians completed the surveys after seeing the patients. Preliminary data examination revealed the following information: Clinician-generated responses at the initial visit showed that clinicians felt there was objective evidence of a painful disorder in 71.5% of the pain patients they saw. They were “not sure” 18.3% of the time and there was not evidence of a painful disorder 10.2% of the time. In 62.7% of patients, there was no history of drug abuse or alcoholism; 13.7% of patients had a history of drug abuse or alcoholism. Clinicians were “not sure” 23.6% of the time. When asked whether clinicians felt the patient was a good candidate for treatment with opioids, 4.3% of responses were “definitely not”; 13.5% were probably not; 32.5% were “not sure”; 38.6% were “probably yes”, and; 11.3% were “definitely yes”. Mean dosages of opioids prescribed to patients who were almost entirely chronic pain patients were (dosages are reported as initial visit / follow-up visit): hydromorphone 18.6/29; fentanyl 62.2/50.8; hydrocodone 21.8/18; methadone 41.2/33.8; morphine 117.1/89.8 and; oxycodone 54.8/64.5. Patients could be taking more than one opioid concurrently. The frequencies of opioids used in percentages of initial visit / follow-up visit were: oxycodone 31.9/36.7; none 29.9/20.6; methadone 13/23.9; hydrocodone 11.3/9; morphine 9.1/ 12.3; tramadol 7.7/5.6; fentanyl 6.3/2.8 and; hydromorphone 5.3/7.8. Of note, only 29.9% of initial patients seen at the Pain Center were not already using opioids and only 20.6% were not using opioids at subsequent visits. Also notable is that only 13% of patients initially seen were using methadone while 23.9% of patients seen in follow-up were using methadone. Data reported are preliminary and no conclusions should be inferred until our data is further analyzed. Partial funding from Medtronic.
Abstracts (370) Outcomes in obese and non-obese patients with chronic osteoarthritis (OA) pain treated with tramadol HCl extended-release (tramadol ER) J Hanlon, C Benson, K Gajria, D Ng, P Lin, J Schein, M Kosinski, J Freedman; Ortho McNeil Janssen Scientific Affairs, Raritan, NJ This study was conducted to compare the outcomes of obese versus non-obese patients with moderate-to-moderately-severe chronic OA pain treated with tramadol ER or placebo. Two randomized, doubleblind, placebo controlled parallel-group, fixed-dose studies included 1,405 adults with OA of the knee or hip. Patients with a baseline pain intensity of ⬎40mm on a 100mm visual analogue scale (VAS; 0⫽no pain, 100⫽extreme pain) were randomly assigned to receive placebo or tramadol ER once daily. Enrollees completed the following patient reported outcome (PRO) instruments: Chronic Pain Sleep Inventory, Pain VAS, Western Ontario and McMaster Osteoarthritis Index (WOMAC), and Short-Form (SF)-36. Outcomes studied were the mean change from baseline to week 12 and the proportion of patients achieving a clinically meaningful improvement (CMI) on each PRO measure. Statistical comparisons between obese (BMI ⬎⫽30) and non-obese patients were performed using Student’s t-tests or chi-square test. Obese and non-obese patients’ demographics were comparable at baseline. Both patient groups showed significant improvement in sleep, pain, and functioning. Significant improvement was also observed on the SF-36 physical functioning, role physical, bodily pain, and physical summary scales in both groups. More than half of patients in both groups achieved CMI in sleep, pain intensity, and WOMAC scale scores. Approximately 30% of both obese and non-obese patients achieved CMI in SF-36 functioning, role physical, bodily pain, and physical summary scales. Obese patients demonstrated better outcomes on the WOMAC global and stiffness scales (p⬍0.05) and on the SF-36 vitality and social functioning scales (p⬍0.01). The rates of adverse events (AE) between groups were comparable. Overall, both obese and non-obese patients treated with tramadol ER improved in sleep, pain, and functional status outcomes. Study supported by Ortho-McNeil Janssen Scientific Affairs, LLC, Raritan, NJ.
(371) Efficacy of an interdisciplinary pain management program with workers compensation patients C Gagnon, S Stanos, G Van der Ende, L Rader, R Harden; Rehabilitation Institute of Chicago, Chicago, IL There are many obstacles and challenges to the successful treatment or management of chronic pain; one of which is the potential for secondary gain emanating from a workers compensation claim. We assessed the efficacy of an interdisciplinary pain management program with 101 workers compensation patients treated in 2005 - 2007. Treatment included individual appointments with psychologists, physical therapist, occupational therapist, biofeedback therapists, vocational counselors, and physicians. Patients also participated in group psychology, pool therapy, recreational therapy, nursing lectures and Feldenkrais classes. Outcome measures included program completion status, return to work status, total scores on the Beck Depression Inventory, State-Trait Anxiety Inventory, Pain Catastrophizing Scale, and the MPQ VAS was used to assess pain intensity. The majority of the patients (65%) graduated from the program, 31% were discharged early, and 4% withdrew. Most patients (83%) were released to return to work; with 74% released to full-time status and 9% were released gradual. Pre – post outcome data was available for those who graduated from the program. Additionally, the obtained MPQ VAS scores for the non-completers were compared to their initial MPQ VAS scores. Paired-samples t-tests showed significant reductions in depression [t37 ⫽ 4.071, p ⫽ .001], pain-related catastrophizing [t36 ⫽ 2.223, p ⫽ .033], and pain intensity [t50 ⫽ 5.866, p ⫽ .000], but not in anxiety [t35 ⫽ 1.701, p ⫽ .098]. Interestingly, the last obtained (at early discharge/withdrawal) pain intensity scores (M ⫽ 70.33) were higher than at baseline (M ⫽ 61.20) in the non-completers. This difference was not statistically significant [t14 ⫽ -1.621, p ⫽ .127] but is clinically meaningful. Our results support the efficacy of an interdisciplinary pain management program in decreasing emotional distress, reducing pain intensity, and improving return to work status in the majority of this challenging pain population.