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412 P.A.I.N.WORKSHOP-INTERNATIONAL INTERDISCIPLINARY CONSENSUS ON EVIDENCE-BASED CLINICAL PATHWAYS IN LOW BACK PAIN
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European Journal of Pain 2006, Vol 10 (suppl S1)
411 TISSUE DOPPLER IMAGING: AN ALTERNATIVE TO FINE-WIRE EMG FOR RECORDING FEED-FORWARD ACTIVITY OF THE ABDOMINAL MUSCLES DURING SUDDEN ARM MOVEMENTS? N. Pulkovski1 , A.F. Mannion2 , P. Schenk3 , M. Gorelick2 , D. Gubler1 , T. Loupas4 , D. O’Riordan2 , H. Gerber3 , V. Toma1 ° , H. Sprott1 . 1 Dept Rheumatology and Institute of Physical Medicine, University Hospital Z¨urich; 2 Spine Unit, Schulthess Klinik, Z¨urich, 3 Swiss Federal Institute of Technology, Z¨urich, Switzerland, 4 Philips Medical Systems, The Netherlands Background: During rapid movements of the arm the transversus abdominis muscle (TA) is typically activated before the prime mover (deltoid), to stabilise the spine before the impending postural disturbance. This feedforward activity is compromised in patients with low back pain (LBP), although the phenomenon has not been investigated widely, because of the invasiveness of the assessment technique [fine-wire intramuscular electromyography (iEMG)]; we examined whether ultrasound tissue Doppler imaging (TDI) could represent a non-invasive alternative. Methods: 14 subjects (8M, 6F;23.0±2.0 yrs) performed 10 repetitions each of rapid shoulder flexion, extension and abduction, whilst surface EMG recordings from medial deltoid, and iEMG and M-mode TDI tissuevelocity recordings from the contralateral TA, internal (IO) and external (EO) oblique muscles were made. Muscle onsets were determined by visual inspection of blinded EMG and TDI signals using custom-built software (MATLAB) and expressed relative to the deltoid onset (values −150 ms to + 50 ms = feed-forward). Results: The TDI-determined onsets were later than those of iEMG by 32.5 (SD 32.8) ms for TA, 17.9 (SD 23.3) ms for IO, and 15.8 (SD 25.3) ms for EO. The methods showed moderately high, significant correlations: r = 0.55 (TA); r = 0.61 (IO); r = 0.56 (EO) (each p < 0.0002). Conclusion: The mean differences between the methods were likely due to electromechanical delay. The SDs of the differences were comparable to those for repeated measurements with either technique. TDI appears to be a valid means of assessing abdominal muscle feed-forward activity, and should allow this phenomenon to be investigated in larger numbers of LBP patients. Support: NFP53–405340–104787/1.
412 P.A.I.N. WORKSHOP – INTERNATIONAL INTERDISCIPLINARY CONSENSUS ON EVIDENCE-BASED CLINICAL PATHWAYS IN LOW BACK PAIN A.P. Vielvoye-Kerkmer1 , Z. de Jong2 , B.J. Morlion3 , D.J. Vermeij4 , M. Stanton-Hicks5 , J. De Andres6 , G. Yihune7 ° . 1 Dept. of Anesthesiology, Leiden University Medical Center, Leiden; 2 Rehabilitation Out-patient Clinic, Leiden University Medical Center, Leiden, The Netherlands, 3 Dept. for Pain Management, UZ Gasthuisberg, Leuven, Belgium, 4 Dirk Vermey Quality Management, Wijk bij Duurstede, The Netherlands, 5 Pain Management Center C-25, The Cleveland Clinic Foundation, Cleveland OH, USA, 6 Multidisciplinary Pain Management Departments, Valencia University General Hospital, Valencia, Spain, 7 International Healthcare Management, Gruenenthal GmbH, Aachen, Germany Background and Aims: Low back pain is a worldwide healthcare problem and its management is often inappropriate. The objective of the P.A.I.N. workshop was to develop feasible and outcome-orientated pathways on low back pain for daily routine low back pain management. Methods: 27 invited participants from 13 countries – international opinion leaders, experienced GP’s, medical specialists and paramedics concerned in pain diagnosis and treatment – met for a 2-day workshop in Basel, Switzerland. Their aim was to develop an integrated care plan for low back pain patients (clinical pathway). All information and medical decisions within the pathway were based on best available evidence such as pear reviews or validated guidelines. When studies were lacking clinicians’ experiences were considered and has been marked as “educated guesses”.
Abstracts, 5th EFIC Congress, Free Presentations The Delphi method was used for consensus finding in an electronic multivoting format. Results: The results of the workshop are evidence-based clinical pathways for the management of acute and chronic low back pain including written checklists. To achieve wide acceptance and for transparency reasons the workshop has been documented as a consensus paper and is published online – www.pain-workshop.com. Conclusions: The development of an international multidisciplinary consensus on pathways for low back pain in a 2 day workshop is feasable. Next steps are: (1) Validation of the pathway’s feasibility in routine care. (2) Initiation of national spin-off for utilization of this format and (3) Development of a network of pratices aiming at documentation and evaluation of routine care. C07 MYOFASCIAL PAIN & FIBROMYALGIA 413 FIBROMYALGIA SUFFERERS’ PERSPECTIVES AND EXPERIENCES OF COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) R. Hardy-Pickering1 , N. Adams1 ° , B.H. Roe1 , J. Sim2 . 1 Centre for Public Health, Liverpool John Moores University, Liverpool; 2 School of Health and Rehabilitation, Keele University, Keele, Staffordshire, UK Background and Aims: There is currently little extant literature regarding the effectiveness or efficacy of CAM intervention for fibromyalgia (FM) in order to justify its usage within conventional medical services. Despite this, FM sufferers are documented as being high users of CAM. This study explores the experiences and perspectives of members of FM support groups regarding the use of CAM and provides information on perceived needs of FM sufferers with regard to CAM provision. Methods: An anonymous self-completion postal questionnaire was specifically devised for the study and was distributed to all members of the Fibromyalgia Association (FMA) UK (n = 2000). University ethical approval was obtained. Results: A response rate of 66% was obtained. A high percentage of respondents reported usage of CAM as an adjuvant strategy to conventional NHS treatment. Most accessed CAM outside the NHS with 70% of respondents reporting beneficial effects. Most frequently accessed interventions were herbal medicine (24%) and meditation (15%), though many respondents had accessed several forms of CAM. 75% of respondents considered that NHS health professionals were not well informed about FMS and that they did not receive appropriate treatment from the NHS. No statistically significant relationships were found between variables. Conclusions: FM sufferers perceive CAM to be a useful intervention though there are issues regarding the availability, accessibility and affordability of CAM and its integration within conventional medical services. In particular, there appear to be issues regarding patient-practitioner relationships and the role of CAM as a self-management strategy which are being explored in ongoing research.
414 THE EFFECT OF HIGH POWER PAIN THRESHOLD ULTRASOUND THERAPY ON THE ELECTRICAL ACTIVITY OF TRIGGER POINTS AND LOCAL TWITCH RESPONSE C. Bahadir1 ° , J. Majlesi2 , H. Unalan3 . 1 Physical Medicine and Rehabilitation Department, Haydarpasa Numune Training and Research Hospital, Istanbul; 2 Formed Physical Medicine and Rehabilitation Clinic, Istanbul; 3 Physical Medicine and Rehabilitation Department, Cerrahpa¸sa Medical Faculty, Istanbul University, Istanbul, Turkey We aimed to study the effects of High Power Pain Threshold Ultrasound (HPPTUS) technique on the SA of trigger points, local twitch response (LTR) and clinical improvement in patients with myofascial pain syndrome with a randomized clinical trial. Study design: Twenty female patients with acute myofascial trigger points were randomly assigned into 2 groups. The cases in the study group
European Journal of Pain 2006, Vol 10 (suppl S1)
411 TISSUE DOPPLER IMAGING: AN ALTERNATIVE TO FINE-WIRE EMG FOR RECORDING FEED-FORWARD ACTIVITY OF THE ABDOMINAL MUSCLES DURING SUDDEN ARM MOVEMENTS? N. Pulkovski1 , A.F. Mannion2 , P. Schenk3 , M. Gorelick2 , D. Gubler1 , T. Loupas4 , D. O’Riordan2 , H. Gerber3 , V. Toma1 ° , H. Sprott1 . 1 Dept Rheumatology and Institute of Physical Medicine, University Hospital Z¨urich; 2 Spine Unit, Schulthess Klinik, Z¨urich, 3 Swiss Federal Institute of Technology, Z¨urich, Switzerland, 4 Philips Medical Systems, The Netherlands Background: During rapid movements of the arm the transversus abdominis muscle (TA) is typically activated before the prime mover (deltoid), to stabilise the spine before the impending postural disturbance. This feedforward activity is compromised in patients with low back pain (LBP), although the phenomenon has not been investigated widely, because of the invasiveness of the assessment technique [fine-wire intramuscular electromyography (iEMG)]; we examined whether ultrasound tissue Doppler imaging (TDI) could represent a non-invasive alternative. Methods: 14 subjects (8M, 6F;23.0±2.0 yrs) performed 10 repetitions each of rapid shoulder flexion, extension and abduction, whilst surface EMG recordings from medial deltoid, and iEMG and M-mode TDI tissuevelocity recordings from the contralateral TA, internal (IO) and external (EO) oblique muscles were made. Muscle onsets were determined by visual inspection of blinded EMG and TDI signals using custom-built software (MATLAB) and expressed relative to the deltoid onset (values −150 ms to + 50 ms = feed-forward). Results: The TDI-determined onsets were later than those of iEMG by 32.5 (SD 32.8) ms for TA, 17.9 (SD 23.3) ms for IO, and 15.8 (SD 25.3) ms for EO. The methods showed moderately high, significant correlations: r = 0.55 (TA); r = 0.61 (IO); r = 0.56 (EO) (each p < 0.0002). Conclusion: The mean differences between the methods were likely due to electromechanical delay. The SDs of the differences were comparable to those for repeated measurements with either technique. TDI appears to be a valid means of assessing abdominal muscle feed-forward activity, and should allow this phenomenon to be investigated in larger numbers of LBP patients. Support: NFP53–405340–104787/1.
412 P.A.I.N. WORKSHOP – INTERNATIONAL INTERDISCIPLINARY CONSENSUS ON EVIDENCE-BASED CLINICAL PATHWAYS IN LOW BACK PAIN A.P. Vielvoye-Kerkmer1 , Z. de Jong2 , B.J. Morlion3 , D.J. Vermeij4 , M. Stanton-Hicks5 , J. De Andres6 , G. Yihune7 ° . 1 Dept. of Anesthesiology, Leiden University Medical Center, Leiden; 2 Rehabilitation Out-patient Clinic, Leiden University Medical Center, Leiden, The Netherlands, 3 Dept. for Pain Management, UZ Gasthuisberg, Leuven, Belgium, 4 Dirk Vermey Quality Management, Wijk bij Duurstede, The Netherlands, 5 Pain Management Center C-25, The Cleveland Clinic Foundation, Cleveland OH, USA, 6 Multidisciplinary Pain Management Departments, Valencia University General Hospital, Valencia, Spain, 7 International Healthcare Management, Gruenenthal GmbH, Aachen, Germany Background and Aims: Low back pain is a worldwide healthcare problem and its management is often inappropriate. The objective of the P.A.I.N. workshop was to develop feasible and outcome-orientated pathways on low back pain for daily routine low back pain management. Methods: 27 invited participants from 13 countries – international opinion leaders, experienced GP’s, medical specialists and paramedics concerned in pain diagnosis and treatment – met for a 2-day workshop in Basel, Switzerland. Their aim was to develop an integrated care plan for low back pain patients (clinical pathway). All information and medical decisions within the pathway were based on best available evidence such as pear reviews or validated guidelines. When studies were lacking clinicians’ experiences were considered and has been marked as “educated guesses”.
Abstracts, 5th EFIC Congress, Free Presentations The Delphi method was used for consensus finding in an electronic multivoting format. Results: The results of the workshop are evidence-based clinical pathways for the management of acute and chronic low back pain including written checklists. To achieve wide acceptance and for transparency reasons the workshop has been documented as a consensus paper and is published online – www.pain-workshop.com. Conclusions: The development of an international multidisciplinary consensus on pathways for low back pain in a 2 day workshop is feasable. Next steps are: (1) Validation of the pathway’s feasibility in routine care. (2) Initiation of national spin-off for utilization of this format and (3) Development of a network of pratices aiming at documentation and evaluation of routine care. C07 MYOFASCIAL PAIN & FIBROMYALGIA 413 FIBROMYALGIA SUFFERERS’ PERSPECTIVES AND EXPERIENCES OF COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) R. Hardy-Pickering1 , N. Adams1 ° , B.H. Roe1 , J. Sim2 . 1 Centre for Public Health, Liverpool John Moores University, Liverpool; 2 School of Health and Rehabilitation, Keele University, Keele, Staffordshire, UK Background and Aims: There is currently little extant literature regarding the effectiveness or efficacy of CAM intervention for fibromyalgia (FM) in order to justify its usage within conventional medical services. Despite this, FM sufferers are documented as being high users of CAM. This study explores the experiences and perspectives of members of FM support groups regarding the use of CAM and provides information on perceived needs of FM sufferers with regard to CAM provision. Methods: An anonymous self-completion postal questionnaire was specifically devised for the study and was distributed to all members of the Fibromyalgia Association (FMA) UK (n = 2000). University ethical approval was obtained. Results: A response rate of 66% was obtained. A high percentage of respondents reported usage of CAM as an adjuvant strategy to conventional NHS treatment. Most accessed CAM outside the NHS with 70% of respondents reporting beneficial effects. Most frequently accessed interventions were herbal medicine (24%) and meditation (15%), though many respondents had accessed several forms of CAM. 75% of respondents considered that NHS health professionals were not well informed about FMS and that they did not receive appropriate treatment from the NHS. No statistically significant relationships were found between variables. Conclusions: FM sufferers perceive CAM to be a useful intervention though there are issues regarding the availability, accessibility and affordability of CAM and its integration within conventional medical services. In particular, there appear to be issues regarding patient-practitioner relationships and the role of CAM as a self-management strategy which are being explored in ongoing research.
414 THE EFFECT OF HIGH POWER PAIN THRESHOLD ULTRASOUND THERAPY ON THE ELECTRICAL ACTIVITY OF TRIGGER POINTS AND LOCAL TWITCH RESPONSE C. Bahadir1 ° , J. Majlesi2 , H. Unalan3 . 1 Physical Medicine and Rehabilitation Department, Haydarpasa Numune Training and Research Hospital, Istanbul; 2 Formed Physical Medicine and Rehabilitation Clinic, Istanbul; 3 Physical Medicine and Rehabilitation Department, Cerrahpa¸sa Medical Faculty, Istanbul University, Istanbul, Turkey We aimed to study the effects of High Power Pain Threshold Ultrasound (HPPTUS) technique on the SA of trigger points, local twitch response (LTR) and clinical improvement in patients with myofascial pain syndrome with a randomized clinical trial. Study design: Twenty female patients with acute myofascial trigger points were randomly assigned into 2 groups. The cases in the study group