- Email: [email protected]
(430) Associations between neurotransmitter candidate genes and persistent breast pain severity following breast cancer surgery
Abstracts
cancer and reported co-occurring pain, fatigue, and sleep disturbance upon recruitment. They were trained to use guided imagery, relaxation and distraction exercises at least once a day for their symptoms. Measures of stress, outcome expectations, perceived control over symptoms, and symptom cluster severity were completed before and 3-weeks after intervention training. At 3-weeks, PGIC was measured with a 7-option verbal response scale measuring overall change (no change – a great deal better), and a numeric rating measuring degree of change (0=much better to 10=much worse). The majority of participants (n=44, 63%) reported being at least ‘‘a little better’’ on the verbal response scale; similarly, a majority (n=51, 73%) scored # 4 on the numeric scale. In regression analyses, changes in stress (ß= -.24, p=.03), outcome expectancy (ß= .35, p=.00) and symptom severity ratings (ß= -.24, p=.04) predicted patients’ numeric ratings of change, but not their verbal ratings (all p > .10). Additional exploration of PGIC items and their meaning in the context of cognitive-behavioral interventions is warranted.
The Journal of Pain
S81
tive to other MS populations. The presence of these relationships so soon after the diagnosis, as well as the likelihood that the symptoms and their impact worsen over time, suggests an opportunity for preventive interventions that could maintain lower symptom intensity and minimize the negative impact on QOL as the disease progresses.
(429) Baseline pain intensity and pain interference moderate effects of cognitive behavioral stress management on leukocyte inflammatory gene expression in women with breast cancer C Taub, H Fisher, C Amiel, D Jutagir, L Bouchard, L Gudenkauf, B Blomberg, A Diaz, S Lechner, C Carver, and M Antoni; University of Miami, Coral Gables, FL
CRPS (Complex regional pain syndrome) is a debilitating pain disorder characterized by allodynia, hyperalgesia and trophic changes. It has been sub classified into CRPS type I and type II. While CRPS type II is considered to be caused by a prior nerve injury, CRPS type I, also known as reflex sympathetic dystrophy is a poorly understood medical condition with no definitive identifiable etiology. Studies have shown that patients with depression have an increased rate of having chronic pain, including CRPS. These patients also have poorer outcomes of recovery. No trials have however analyzed the differences in rates of depression between CRPS types I and II. The aim of our study was to identify whether depression could be an etiological factor in patients with CRPS type I. For this study, we consulted the Nationwide Inpatient Sample (HCUP) database between 2003 and 2011 and compared the incidence of depression between CRPS type I and II patients. Overall 95637 patients were found to have CRPS type I and 5012436 patients had CRPS type II. Of these patients 21% and 9.9% respectively had depression. The rate of depression was significantly higher amongst patients with CRPS type I vs. CRPS type II (P= < 0.001). Since patients with CRPS type I by definition have no known nerve injury, it may suggest depression as a causative agent for this disease. Our study is limited due to paucity of data and we have therefore not been able to analyze other confounding factors. A comprehensive retrospective chart analysis is needed for patients with CRPS type I to identify the validity of this study.
Breast cancer patients experience significant pain severity and pain interference during treatment. Little is known about the relationship between pain, stress, and inflammatory processes in this population. Since pain is known to be associated with inflammatory processes and stress management intervention may modulate inflammatory signaling in breast cancer patients, we tested whether pain experience in the post-surgical period related to stress management-associated changes in inflammatory signaling across the initial year of cancer treatment. Stage 0-III breast cancer patients were recruited 2-12 weeks post-surgery and assigned to 10-week Cognitive Behavioral Stress Management (CBSM) or psycho-education control. At baseline and 12-months follow-up, women completed the Brief Pain Inventory (BPI). An inflammatory gene composite (IGC) index was derived from a microarray analysis of leukocytes obtained from blood draws at baseline and 12 months. Clinically significant pain severity (CSPS) and pain interference (CSPI) were derived from the BPI (subscale scores $3). Regression analysis controlling for age, race, stage, type of surgery, days since surgery, and baseline IGC revealed a significant interaction of group condition and baseline CSPS on 12-month IGC, F(9, 23)=3.4, p<.01. Baseline CSPI also interacted with condition in predicting 12-month IGC, F(9, 23)=7.1, p<.01. Participants with baseline CSPS in the CBSM condition had higher IGC at 12-months compared to the control condition (p=.06). Participants with baseline non-CSPS in the CBSM condition had lower IGC at 12-months compared to the control condition (p=.03). A similar pattern was found for pain interference (p=.01; p=.003). These preliminary findings may indicate that for patients presenting with elevated pain post-surgery, CBSM may not show previously observed reductions in inflammatory gene expression because inflammation may be driven more by somatic factors than by stress/mood-related factors. Understanding how pain levels interact with stress processes to influence important biological outcomes will aid in targeting stress management interventions for specific populations.
(428) Independent associations of pain, fatigue, and depression with quality of life in individuals newly-diagnosed with multiple sclerosis
(430) Associations between neurotransmitter candidate genes and persistent breast pain severity following breast cancer surgery
(427) Could depression be a causative factor in the development of CRPS types I? A Danesh, S Jain, and Y AlKhalili; Drexel University, Philadelphia, PA
K Alschuler, D Ehde, A Kratz, and M Jensen; University of
M Knisely, Y Conley, J Levine, and C Miaskowski; University of
Washington, Seattle, WA
Pittsburgh School of Nursing, Pittsburgh, PA
Pain, fatigue, and depression are prevalent symptoms that have significant, negative impacts on function in individuals who have had multiple sclerosis (MS) for many years. Little is known regarding the presence and impact of these symptoms on quality of life (QOL) among individuals with a recent MS diagnosis. Understanding the evolution of these symptoms can inform efforts for early intervention. To address this knowledge gap, we assessed average pain intensity in the past week (0-10 NRS), depressive symptoms (PHQ-9), fatigue severity (FSS), and QOL (MSQOL-54) in 135 individuals who had been diagnosed with MS within the past month. On average, symptoms were in the mild range (pain NRS mean, 2.42 [SD = 2.40] PHQ-9 mean, 7.77 [SD = 5.62] FSS mean, 28.82 [SD = 24.01]) and QOL was higher than in previous studies (MSQOL-54 mean, 74.80 [SD = 14.84]). Pain, depression, fatigue, and QOL were all statistically significantly associated with one another (rs = 0.18 to 0.50). Results of a linear regression showed that, after controlling for age, gender, and MS subtype, pain intensity (t = -2.84, p < 0.01) and depressive symptoms (t = -4.64, p < 0.001) were associated significantly with QOL, but fatigue was not. Findings indicate that soon after an MS diagnosis, the intensity of pain, fatigue, and depressive symptoms is notably lower, and QOL is notably higher, relative to samples of people who have had MS for longer. However, despite the lower intensity, the symptoms have similar intercorrelations and similar relationships to QOL rela-
Persistent pain following breast cancer surgery is a common clinical problem. While the role of neurotransmitter genes has been examined in persistent neuropathic pain, no studies have evaluated for associations between these genes and persistent breast pain following cancer surgery. Identification of genetic factors that predispose patients to persistent breast pain may identify high risk patients and lead to new interventions. The purpose of this study was to identify associations between previously identified breast pain phenotypes and single nucleotide polymorphisms (SNPs) in neurotransmitter candidate genes. Sample consisted of 264 women who underwent breast cancer surgery. Breast pain occurrence and worst pain intensity scores (i.e., 0 to 10 numeric rating scale) were assessed monthly for six months following surgery. Distinct latent classes of patients were identified using growth mixture modeling. Genotyping was completed for 30 candidate genes involved in various aspects of neurotransmission, drug metabolism, or transport molecules using a custom array. Using logistic regression analyses, significant differences in a number of genotype or haplotype frequencies were found between the breast pain classes: No Breast Pain vs. Mild Breast Pain and No Breast Pain vs. Severe Breast Pain. Eleven SNPs and 2 haplotypes across 8 genes were associated with membership in the Mild Pain class: ADRB2 (rs240070), ADRBK2 (HapA04), BDNF (rs7124442, rs7127507); HTR3A (rs11214796), HTR3A (rs10160548), NOS1 (rs6490121), SLC6A2 (rs36017, rs47958, rs5568, rs1566652,
S82
Abstracts
The Journal of Pain
HapC10), and TPH2 (rs11179000). In addition, 4 SNPs and 4 haplotypes across 5 genes were associated with membership in the Severe Pain class: BDNF (rs7103411, rs6484320), COMT (Pain_HPS), NOS1 (rs2293052, HapD01), SLC6A2 (HapD01, HapD04), and SLC6A3 (rs464049). These findings suggest that a number of neurotransmitter genes play a role in the development and severity of persistent breast pain following breast cancer surgery. Additional studies are needed confirm these findings in patients with other persistent postsurgical pain syndromes.
(431) Characteristics of chemotherapy induced neuropathy (CIN) in cancer survivors who received taxol K Kober, J Mastick, S Paul, K Topp, B Smoot, G Abrams, L Chen, Y Conley, M Chesney, K Bolla, G Mausisa, M Azor, M Wong, M Schumacher, J Levine, and C Miaskowski; University of California San Francisco, San Francisco, CA
Taxol is a common chemotherapy drug that is associated with the development of CIN. The purposes of this study were to evaluate for differences in demographic and clinical characteristics, as well as measures of sensation, function, and postural control, in survivors who received taxol and did (n=153) and did not (n=58) develop CIN. Survivors completed a number of self-report questionnaires. Objective measures of sensation included: light touch, pain, cold, and vibration. Objective measures of motor function included: muscle strength, grip strength, manual dexterity, heel lift, and Achilles tendon reflex. Balance and postural control were evaluated. In survivors with CIN, 4.6% had CIN only in their hands, 25.0% only in their feet, and 69.9% in both hands and feet. Worst pain scores were 5.9 (+2.5) in the feet and 4.8 (+2.8) in the hands. No differences were found between the two groups in the total dose of taxol received. Survivors with taxol-induced CIN were significantly older, had a higher level of comorbidity and a lower functional status. A higher percentage of survivors with CIN reported a hand injury, hypertension, and osteoarthritis. Compared to survivors without taxol-induced CIN, survivors with CIN had significant decrements in light touch, pain, cold, and vibration sensations in both the upper and lower extremities. In terms of motor function, survivors with taxol-induced CIN had poorer grip strength, poorer performance on the Pegboard test, poorer heel lift time, and higher rates of loss of the Achilles tendon reflex. In addition, survivors with taxol-induced CIN had worse Timed Get Up and Go test scores and worse Fullerton Advanced Balance test scores. Given that the dose of taxol received did not differ between the two groups, additional research is warranted that evaluates for differences in molecular characteristics.
(432) Preliminary clinical characterization of men with chronic unexplained orchialgia S Quallich, J Miller, C Aslanian-Engoren, and D Williams; University of Michigan, Ann Arbor, MI
Men with chronic unexplained orchialgia (CUO chronic testicular pain) are an understudied population, for whom there are significant knowledge gaps related to prevalence, demographics, etiology, and reliable treatment. This small cross-sectional pilot study sought to characterize the pain experience in these men. Fourteen men were carefully diagnosed, with all other known etiological underpinnings being ruled out. Each participant was asked to complete a multidimensional self-report battery assessing demographics, clinical history, pain, allied symptoms, function, and trauma history. Instruments were evaluated with a sample of n = 12 in most cases. Median age was 48.5 years (range 24-64). Few men had undergone procedures or taken medication to manage their pain. The median pain score was 4/10, with a median pain duration of 38.7 months (3.5 years). Men did not report urinary symptoms, depression/anxiety, or catastrophizing. Results showed evidence for self-reported dyscognition, fatigue and decreased belief in their own ability to manage their pain. None of the participants reported a history of traumatic sexual experience. Many of the psychological traits and allied comorbid symptoms commonly reported with other chronic pain conditions were normal in this pilot study group not evident in this pilot sample. This is the first project of its kind to extensively evaluate men with precisely defined CUO using standardized psychometric tools, and serves as the foundation for future studies. Future research will include ongoing data collection to achieve a larger sample size.
(433) Associations between symptoms and signs of dry eye and evoked pain sensitivity E Felix, A McClellan, and A Galor; Miami VAHS, Miami, FL ‘‘Dry eye’’ is a heterogeneous condition with symptoms including visual disturbances and eye pain. Although many with dry eye symptoms have signs consistent with the disease (e.g., abnormal tear function, poor tear quality), others lack measurable signs of disease at the ocular surface. The present study examined associations between the degree of discordance between dry eye symptoms and dry eye signs and measures of somatosensory function. Participants with and without dry eye symptoms were recruited from the Miami VA eye clinic (n = 152), and completed questionnaires (demographic, pain, and dry eye symptom history), an ocular surface examination, and quantitative sensory testing (QST). A dry eye ‘‘discordance score’’ was calculated as the difference between the severity of dry eye symptoms and the severity of dry eye signs, so that high discordance scores were assigned to those with severe symptoms but minimal ocular signs of dry eye. Bivariate correlations showed that, although there was not a significant association between discordance score and pain thresholds on the cornea or forehead, discordance scores and pain thresholds on the forearm showed modest, but significant associations (cold pain threshold: r=0.197, p=0.015; hot pain threshold: r=-0.166, p=0.041). Additionally, discordance scores were also related to intensity ratings of cold pain after-sensations on the forehead (r=0.304, p<.01), and hot pain after-sensations on the forearm (r=0.175, p=0.034). These preliminary results suggest that evoked pain sensitivity at the site of clinical pain report (cornea) was independent of the degree of congruence between symptoms and signs of dry eye, but evoked pain sensitivity at a remote test site (forearm) was higher for those with greater dry eye symptom-to-sign discordance. Thus, our findings are in support of recent evidence suggesting that the subgroup of patients with seemingly ‘‘idiopathic’’ dry eye may be more appropriately classified as having a centralized chronic pain condition.
(434) Pain and function in head and neck cancer: a systematic literature review J Van Cleave, C DiMaria, S DiMaria, E Liang, C Long, and M Fu; New York University Meyers College of Nursing, New York, NY
Pain is prevalent in head and neck cancer. Studies indicate that up to 70% of patients will experience pain after diagnosis. Functional impairment resulting from head and neck cancer and its treatment is also prevalent. Studies show that between 17% and 59% of patients may discontinue work after cancer treatment. However, the impact of pain on function from head and neck cancer and its treatment remains unclear. We conducted a systematic literature review to examine the impact of symptoms on function in head and neck cancer. Using CINAHL, PsycINFO, PubMed, and Health and Psychosocial Instruments (HaPI) databases, the search generated 241 candidate articles. Two independent researchers examined these 241 articles for clinical studies that included symptom and function assessment questionnaires used in head and neck cancer. Ultimately, 32 articles were selected for review. In these articles, pain was most frequently measured by the Functional Assessment of Cancer Therapy – Head and Neck (31%, 10 of 32 articles) and the EORTC QLQ-C30 (19%, 6 of 32 articles) . Patients reported pain at differing sites, including neck and shoulder, that potentially impacted their lives up to five years after diagnosis. Interventions that significantly controlled pain or improved function were structured exercise regimens and oral pain medications. Study limitations included small populations and lack of clarity between symptom and function concepts. In conclusion, this literature review indicates an important association between pain and function in head and neck cancer. Large clinical trials are needed to test promising exercise and pharmacologic interventions. However, the limitations of current literature suggests the need for future research to clarify the concepts of symptoms and function in head and neck cancer. This work was supported by grants from the John A. Hartford Foundation and NYU University Research Challenge Fund.
cancer and reported co-occurring pain, fatigue, and sleep disturbance upon recruitment. They were trained to use guided imagery, relaxation and distraction exercises at least once a day for their symptoms. Measures of stress, outcome expectations, perceived control over symptoms, and symptom cluster severity were completed before and 3-weeks after intervention training. At 3-weeks, PGIC was measured with a 7-option verbal response scale measuring overall change (no change – a great deal better), and a numeric rating measuring degree of change (0=much better to 10=much worse). The majority of participants (n=44, 63%) reported being at least ‘‘a little better’’ on the verbal response scale; similarly, a majority (n=51, 73%) scored # 4 on the numeric scale. In regression analyses, changes in stress (ß= -.24, p=.03), outcome expectancy (ß= .35, p=.00) and symptom severity ratings (ß= -.24, p=.04) predicted patients’ numeric ratings of change, but not their verbal ratings (all p > .10). Additional exploration of PGIC items and their meaning in the context of cognitive-behavioral interventions is warranted.
The Journal of Pain
S81
tive to other MS populations. The presence of these relationships so soon after the diagnosis, as well as the likelihood that the symptoms and their impact worsen over time, suggests an opportunity for preventive interventions that could maintain lower symptom intensity and minimize the negative impact on QOL as the disease progresses.
(429) Baseline pain intensity and pain interference moderate effects of cognitive behavioral stress management on leukocyte inflammatory gene expression in women with breast cancer C Taub, H Fisher, C Amiel, D Jutagir, L Bouchard, L Gudenkauf, B Blomberg, A Diaz, S Lechner, C Carver, and M Antoni; University of Miami, Coral Gables, FL
CRPS (Complex regional pain syndrome) is a debilitating pain disorder characterized by allodynia, hyperalgesia and trophic changes. It has been sub classified into CRPS type I and type II. While CRPS type II is considered to be caused by a prior nerve injury, CRPS type I, also known as reflex sympathetic dystrophy is a poorly understood medical condition with no definitive identifiable etiology. Studies have shown that patients with depression have an increased rate of having chronic pain, including CRPS. These patients also have poorer outcomes of recovery. No trials have however analyzed the differences in rates of depression between CRPS types I and II. The aim of our study was to identify whether depression could be an etiological factor in patients with CRPS type I. For this study, we consulted the Nationwide Inpatient Sample (HCUP) database between 2003 and 2011 and compared the incidence of depression between CRPS type I and II patients. Overall 95637 patients were found to have CRPS type I and 5012436 patients had CRPS type II. Of these patients 21% and 9.9% respectively had depression. The rate of depression was significantly higher amongst patients with CRPS type I vs. CRPS type II (P= < 0.001). Since patients with CRPS type I by definition have no known nerve injury, it may suggest depression as a causative agent for this disease. Our study is limited due to paucity of data and we have therefore not been able to analyze other confounding factors. A comprehensive retrospective chart analysis is needed for patients with CRPS type I to identify the validity of this study.
Breast cancer patients experience significant pain severity and pain interference during treatment. Little is known about the relationship between pain, stress, and inflammatory processes in this population. Since pain is known to be associated with inflammatory processes and stress management intervention may modulate inflammatory signaling in breast cancer patients, we tested whether pain experience in the post-surgical period related to stress management-associated changes in inflammatory signaling across the initial year of cancer treatment. Stage 0-III breast cancer patients were recruited 2-12 weeks post-surgery and assigned to 10-week Cognitive Behavioral Stress Management (CBSM) or psycho-education control. At baseline and 12-months follow-up, women completed the Brief Pain Inventory (BPI). An inflammatory gene composite (IGC) index was derived from a microarray analysis of leukocytes obtained from blood draws at baseline and 12 months. Clinically significant pain severity (CSPS) and pain interference (CSPI) were derived from the BPI (subscale scores $3). Regression analysis controlling for age, race, stage, type of surgery, days since surgery, and baseline IGC revealed a significant interaction of group condition and baseline CSPS on 12-month IGC, F(9, 23)=3.4, p<.01. Baseline CSPI also interacted with condition in predicting 12-month IGC, F(9, 23)=7.1, p<.01. Participants with baseline CSPS in the CBSM condition had higher IGC at 12-months compared to the control condition (p=.06). Participants with baseline non-CSPS in the CBSM condition had lower IGC at 12-months compared to the control condition (p=.03). A similar pattern was found for pain interference (p=.01; p=.003). These preliminary findings may indicate that for patients presenting with elevated pain post-surgery, CBSM may not show previously observed reductions in inflammatory gene expression because inflammation may be driven more by somatic factors than by stress/mood-related factors. Understanding how pain levels interact with stress processes to influence important biological outcomes will aid in targeting stress management interventions for specific populations.
(428) Independent associations of pain, fatigue, and depression with quality of life in individuals newly-diagnosed with multiple sclerosis
(430) Associations between neurotransmitter candidate genes and persistent breast pain severity following breast cancer surgery
(427) Could depression be a causative factor in the development of CRPS types I? A Danesh, S Jain, and Y AlKhalili; Drexel University, Philadelphia, PA
K Alschuler, D Ehde, A Kratz, and M Jensen; University of
M Knisely, Y Conley, J Levine, and C Miaskowski; University of
Washington, Seattle, WA
Pittsburgh School of Nursing, Pittsburgh, PA
Pain, fatigue, and depression are prevalent symptoms that have significant, negative impacts on function in individuals who have had multiple sclerosis (MS) for many years. Little is known regarding the presence and impact of these symptoms on quality of life (QOL) among individuals with a recent MS diagnosis. Understanding the evolution of these symptoms can inform efforts for early intervention. To address this knowledge gap, we assessed average pain intensity in the past week (0-10 NRS), depressive symptoms (PHQ-9), fatigue severity (FSS), and QOL (MSQOL-54) in 135 individuals who had been diagnosed with MS within the past month. On average, symptoms were in the mild range (pain NRS mean, 2.42 [SD = 2.40] PHQ-9 mean, 7.77 [SD = 5.62] FSS mean, 28.82 [SD = 24.01]) and QOL was higher than in previous studies (MSQOL-54 mean, 74.80 [SD = 14.84]). Pain, depression, fatigue, and QOL were all statistically significantly associated with one another (rs = 0.18 to 0.50). Results of a linear regression showed that, after controlling for age, gender, and MS subtype, pain intensity (t = -2.84, p < 0.01) and depressive symptoms (t = -4.64, p < 0.001) were associated significantly with QOL, but fatigue was not. Findings indicate that soon after an MS diagnosis, the intensity of pain, fatigue, and depressive symptoms is notably lower, and QOL is notably higher, relative to samples of people who have had MS for longer. However, despite the lower intensity, the symptoms have similar intercorrelations and similar relationships to QOL rela-
Persistent pain following breast cancer surgery is a common clinical problem. While the role of neurotransmitter genes has been examined in persistent neuropathic pain, no studies have evaluated for associations between these genes and persistent breast pain following cancer surgery. Identification of genetic factors that predispose patients to persistent breast pain may identify high risk patients and lead to new interventions. The purpose of this study was to identify associations between previously identified breast pain phenotypes and single nucleotide polymorphisms (SNPs) in neurotransmitter candidate genes. Sample consisted of 264 women who underwent breast cancer surgery. Breast pain occurrence and worst pain intensity scores (i.e., 0 to 10 numeric rating scale) were assessed monthly for six months following surgery. Distinct latent classes of patients were identified using growth mixture modeling. Genotyping was completed for 30 candidate genes involved in various aspects of neurotransmission, drug metabolism, or transport molecules using a custom array. Using logistic regression analyses, significant differences in a number of genotype or haplotype frequencies were found between the breast pain classes: No Breast Pain vs. Mild Breast Pain and No Breast Pain vs. Severe Breast Pain. Eleven SNPs and 2 haplotypes across 8 genes were associated with membership in the Mild Pain class: ADRB2 (rs240070), ADRBK2 (HapA04), BDNF (rs7124442, rs7127507); HTR3A (rs11214796), HTR3A (rs10160548), NOS1 (rs6490121), SLC6A2 (rs36017, rs47958, rs5568, rs1566652,
S82
Abstracts
The Journal of Pain
HapC10), and TPH2 (rs11179000). In addition, 4 SNPs and 4 haplotypes across 5 genes were associated with membership in the Severe Pain class: BDNF (rs7103411, rs6484320), COMT (Pain_HPS), NOS1 (rs2293052, HapD01), SLC6A2 (HapD01, HapD04), and SLC6A3 (rs464049). These findings suggest that a number of neurotransmitter genes play a role in the development and severity of persistent breast pain following breast cancer surgery. Additional studies are needed confirm these findings in patients with other persistent postsurgical pain syndromes.
(431) Characteristics of chemotherapy induced neuropathy (CIN) in cancer survivors who received taxol K Kober, J Mastick, S Paul, K Topp, B Smoot, G Abrams, L Chen, Y Conley, M Chesney, K Bolla, G Mausisa, M Azor, M Wong, M Schumacher, J Levine, and C Miaskowski; University of California San Francisco, San Francisco, CA
Taxol is a common chemotherapy drug that is associated with the development of CIN. The purposes of this study were to evaluate for differences in demographic and clinical characteristics, as well as measures of sensation, function, and postural control, in survivors who received taxol and did (n=153) and did not (n=58) develop CIN. Survivors completed a number of self-report questionnaires. Objective measures of sensation included: light touch, pain, cold, and vibration. Objective measures of motor function included: muscle strength, grip strength, manual dexterity, heel lift, and Achilles tendon reflex. Balance and postural control were evaluated. In survivors with CIN, 4.6% had CIN only in their hands, 25.0% only in their feet, and 69.9% in both hands and feet. Worst pain scores were 5.9 (+2.5) in the feet and 4.8 (+2.8) in the hands. No differences were found between the two groups in the total dose of taxol received. Survivors with taxol-induced CIN were significantly older, had a higher level of comorbidity and a lower functional status. A higher percentage of survivors with CIN reported a hand injury, hypertension, and osteoarthritis. Compared to survivors without taxol-induced CIN, survivors with CIN had significant decrements in light touch, pain, cold, and vibration sensations in both the upper and lower extremities. In terms of motor function, survivors with taxol-induced CIN had poorer grip strength, poorer performance on the Pegboard test, poorer heel lift time, and higher rates of loss of the Achilles tendon reflex. In addition, survivors with taxol-induced CIN had worse Timed Get Up and Go test scores and worse Fullerton Advanced Balance test scores. Given that the dose of taxol received did not differ between the two groups, additional research is warranted that evaluates for differences in molecular characteristics.
(432) Preliminary clinical characterization of men with chronic unexplained orchialgia S Quallich, J Miller, C Aslanian-Engoren, and D Williams; University of Michigan, Ann Arbor, MI
Men with chronic unexplained orchialgia (CUO chronic testicular pain) are an understudied population, for whom there are significant knowledge gaps related to prevalence, demographics, etiology, and reliable treatment. This small cross-sectional pilot study sought to characterize the pain experience in these men. Fourteen men were carefully diagnosed, with all other known etiological underpinnings being ruled out. Each participant was asked to complete a multidimensional self-report battery assessing demographics, clinical history, pain, allied symptoms, function, and trauma history. Instruments were evaluated with a sample of n = 12 in most cases. Median age was 48.5 years (range 24-64). Few men had undergone procedures or taken medication to manage their pain. The median pain score was 4/10, with a median pain duration of 38.7 months (3.5 years). Men did not report urinary symptoms, depression/anxiety, or catastrophizing. Results showed evidence for self-reported dyscognition, fatigue and decreased belief in their own ability to manage their pain. None of the participants reported a history of traumatic sexual experience. Many of the psychological traits and allied comorbid symptoms commonly reported with other chronic pain conditions were normal in this pilot study group not evident in this pilot sample. This is the first project of its kind to extensively evaluate men with precisely defined CUO using standardized psychometric tools, and serves as the foundation for future studies. Future research will include ongoing data collection to achieve a larger sample size.
(433) Associations between symptoms and signs of dry eye and evoked pain sensitivity E Felix, A McClellan, and A Galor; Miami VAHS, Miami, FL ‘‘Dry eye’’ is a heterogeneous condition with symptoms including visual disturbances and eye pain. Although many with dry eye symptoms have signs consistent with the disease (e.g., abnormal tear function, poor tear quality), others lack measurable signs of disease at the ocular surface. The present study examined associations between the degree of discordance between dry eye symptoms and dry eye signs and measures of somatosensory function. Participants with and without dry eye symptoms were recruited from the Miami VA eye clinic (n = 152), and completed questionnaires (demographic, pain, and dry eye symptom history), an ocular surface examination, and quantitative sensory testing (QST). A dry eye ‘‘discordance score’’ was calculated as the difference between the severity of dry eye symptoms and the severity of dry eye signs, so that high discordance scores were assigned to those with severe symptoms but minimal ocular signs of dry eye. Bivariate correlations showed that, although there was not a significant association between discordance score and pain thresholds on the cornea or forehead, discordance scores and pain thresholds on the forearm showed modest, but significant associations (cold pain threshold: r=0.197, p=0.015; hot pain threshold: r=-0.166, p=0.041). Additionally, discordance scores were also related to intensity ratings of cold pain after-sensations on the forehead (r=0.304, p<.01), and hot pain after-sensations on the forearm (r=0.175, p=0.034). These preliminary results suggest that evoked pain sensitivity at the site of clinical pain report (cornea) was independent of the degree of congruence between symptoms and signs of dry eye, but evoked pain sensitivity at a remote test site (forearm) was higher for those with greater dry eye symptom-to-sign discordance. Thus, our findings are in support of recent evidence suggesting that the subgroup of patients with seemingly ‘‘idiopathic’’ dry eye may be more appropriately classified as having a centralized chronic pain condition.
(434) Pain and function in head and neck cancer: a systematic literature review J Van Cleave, C DiMaria, S DiMaria, E Liang, C Long, and M Fu; New York University Meyers College of Nursing, New York, NY
Pain is prevalent in head and neck cancer. Studies indicate that up to 70% of patients will experience pain after diagnosis. Functional impairment resulting from head and neck cancer and its treatment is also prevalent. Studies show that between 17% and 59% of patients may discontinue work after cancer treatment. However, the impact of pain on function from head and neck cancer and its treatment remains unclear. We conducted a systematic literature review to examine the impact of symptoms on function in head and neck cancer. Using CINAHL, PsycINFO, PubMed, and Health and Psychosocial Instruments (HaPI) databases, the search generated 241 candidate articles. Two independent researchers examined these 241 articles for clinical studies that included symptom and function assessment questionnaires used in head and neck cancer. Ultimately, 32 articles were selected for review. In these articles, pain was most frequently measured by the Functional Assessment of Cancer Therapy – Head and Neck (31%, 10 of 32 articles) and the EORTC QLQ-C30 (19%, 6 of 32 articles) . Patients reported pain at differing sites, including neck and shoulder, that potentially impacted their lives up to five years after diagnosis. Interventions that significantly controlled pain or improved function were structured exercise regimens and oral pain medications. Study limitations included small populations and lack of clarity between symptom and function concepts. In conclusion, this literature review indicates an important association between pain and function in head and neck cancer. Large clinical trials are needed to test promising exercise and pharmacologic interventions. However, the limitations of current literature suggests the need for future research to clarify the concepts of symptoms and function in head and neck cancer. This work was supported by grants from the John A. Hartford Foundation and NYU University Research Challenge Fund.