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439 TENS in neuropathic and nociceptive pain
S194
Poster Presentations / Clinical – Other Treatments / European Journal of Pain 11(S1) (2007) S59–S207
a
Pijnkliniek, AZ Maria Middelares, Sint-Niklaas, Belgium b Neurochirurgie, CHU Rangueil, Toulouse, France c Neurochirurgie, Academisch Ziekenhuis Maastricht, The Netherlands d Neurochirurgie, Universitatsklinik Schleswig-Holstein Campus Lubeck, Germany e Neurochirurgie, St. Elisabeth Ziekenhuis, Tilburg, The Netherlands f Pabellon De Rehabilitacion Unidad Del Dolor, Hospital Universitario La Fe, Valencia, Spain g Neurochirurgie, Hopital Neurologique Et Neurochirurgical Pierre Wertheimer, Lyon, France h Unita Cure Palliative E Terapia Del Dolore, Az. Ospedale Garbagnate, Italy i Neurochirurgie, Medizinische Hochschule Hannover, Germany j Unidad Del Dolor, Hospital General De Valencia, Spain Background and aims. Spinal cord stimulation (SCS) is a treatment option for patients with chronic neuropathic pain. Patients enrolled in the study and implanted with the Restore rechargeable neurostimulation system were followed to characterize pain outcomes over 12 months. Methods. This prospective open-label study was conducted in 12 European centers. Patients’ ability to recharge was assessed one month post-implant. Outcome measurements including pain VAS, pain relief, Oswestry Disability Index and EQ-5D were collected 3, 6, and 12 months (12 months) post-implant. Overall satisfaction with SCS was collected at 12 months. Results. Of 45 patients enrolled, 42 were implanted. Of these, 41 met prospective analysis criteria for the primary objective assessing ability to recharge. All 41 successfully recharged independently. The majority of the patients (79%) rated recharging easy or somewhat easy. Comparing baseline to 12 months, the mean VAS score for the primary pain area was reduced from 7.2 ± 1.5 to 4.4 ± 2.8 (p < 0.001). Patients (80%) reported more than 50% pain relief at 12 months. EQ5D health status improved from 0.21 ± 0.32 to 0.46 ± 0.36 (p < 0.001). Oswestry scores improved from 52 ± 12, categorized as severe disability, to 38 ± 19 (p < 0.001), categorized as moderate disability. Physicians rated the system favorably for most patients (95%). Patients (93%) would elect SCS again for the same result, and 98% would recommend SCS to a friend with similar pain. Conclusions. All patients independently recharged the neurostimulator battery. Significant improvements in pain reduction, quality of life, and functional status were observed throughout 12 months post-implant, with a high rate of patient satisfaction with the therapy.
Keywords: Chronic pain; Post thoracotomy syndrome; Quality of life; Transforaminal injection; Magnesium; Intercostal nerve block; Steroid doi:10.1016/j.ejpain.2007.03.452
438 PULSED RADIOFREQUENCY (PRF) FOR THE TREATMENT OF OCCIPITAL NEURALGIA: A CLINICAL AUDIT P. Vanelderen *, M. Puylaert, P. De Vooght, J. Sterken, R. Heylen, J. Van Zundert Department of Anaesthesiology, Intensive Care Medicine and Multidisciplinary Pain Centre, Ziekenhuis Oost Limburg, Genk, Limburg, Belgium Introduction. Occipital neuralgia is a non-throbbing neck pain spreading ipsilaterally to the occipito-temporo-frontal area and is relieved by injection of local anaesthetics at the greater and or lesser occipital nerve. There is no gold standard for treatment. Methods and materials. Patients fulfilling the International Headache Society criteria for occipital neuralgia underwent PRF after a positive diagnostic block of the occipital nerves (>50% reduction on VAS). Target nerves were identified with the external landmarks described by Vital and needle position was controlled with electrical stimulation at 50 Hz (threshold <0.5 V) PRF was performed during 4 min. Results. Tabel 1. Conclusions. These preliminary data suggest PRF is a promissing treatment for occipital neuralgia and justifies further controlled trials. The vital surface landmarks are reliable for the greater and lesser occipital nerve localisation. doi:10.1016/j.ejpain.2007.03.453
439 TENS IN NEUROPATHIC AND NOCICEPTIVE PAIN T. Vemmer Pain Clinic, Wolfson Rehabilitation Centre, St George’s Hospital NHS Trust, London, UK This study aims to compare the pain relief provided by TENS in patients with neuropathic and nociceptive pain, and to find simple criteria predicting pain relief. Methods. Retrospective study of chronic pain outpatients seen from 2000 to 2006. Only patients who
Poster Presentations / Clinical – Other Treatments / European Journal of Pain 11(S1) (2007) S59–S207
received TENS as single treatment at their clinic visit were included. Patients completed the brief pain inventory at each visit. Pain relief was measured on a numerical rating scale (0–100%). R (Development Core Team, 2006) was used for statistical calculations. For predictive models regression trees were grown for neuropathic and nociceptive pain (function ‘‘rpart’’). Trees were pruned to three levels. Results. 478 Patients had predominantly neuropathic, 501 nociceptive pain. The pain relief was similar in both groups (X2 = 0.9354; p = 0.3335; ns): Pain type
Mean ± SD
Median
Range
Neuropathic Nociceptive
31.1 ± 26.79 28.6 ± 26.06
30 20
0–100 0–100
Recursive partitioning found the predictors impairment of activity (>5/10), lack of impairment of work (0/10), and maximal pain in the last week of >7/10 in neuropathic pain, while in nociceptive pain average pain over the last week (>6/10), impairment of work (>6/10), and moderate impairment of mood (<5/10) were more important. Conclusion. TENS is moderately successful in both neuropathic and nociceptive pain. Items of the brief pain inventory predict treatment outcome. Reference R Development Core Team. R Installation and Administration, version 2.3.1, 06/01/2006. doi:10.1016/j.ejpain.2007.03.454
440
´ S POSITION IN THE OPIOIDS AND THEIR TREATMENT FAILED BACK SURGERY SYNDROME I. Vrba *,a, J. Koza´k b, I. Stetka´rova´ c a
ICU Hospital Na Homolce, Czech Republic CVLB Faculty Hospital Motol, Czech Republic c Department of Neurology Hospital Na Homolce, Praha, Czech Republic b
Background and aims. Failed back surgery syndrome (FBSS) is very common and very complicated mixed pain condition. We have used the multidisciplinary approach, including opioids, for the treatment of FBSS. We have used opioids in various drug forms. When FBBS is not manageable with standard approaches we have used intrathecal drug delivery devices. Methods. We have treated more than 300 patients with FBSS in our two pain centers for last 5 years since we introduced drug delivery systems in our practice. Since 2001 we have implanted 28 port systems and 13
S195
pump systems (Synchromed) for delivery morphine in very carefully selected patients with severe FBSS. Results. Every approach has its own advantages and disadvantages. We describe our experience-results, achievements and complications with use of our approaches of opioids in the treatment of FBSS. Our results are good, but not satisfactorily good. It seems that implantable delivery devices allow more comfortable and more effective long-term morphine administration. Conclusions. It is hard to strictly decide whe and/or what approach of opioids is the best for using in each patient with FBSS. When the patients with FBSS cannot be controlled by less invasive opioid management than long-term delivery morphine systems, mainly pump systems, seem an appropriate analgetic method for strictly selected patients with severe FBBS. Acknowledgement Supported by Internal Grant Agency of the Czech Ministry of Health (IGA NF-8232/3, No: 8523/3), and the Czech Ministry of Education and Sports (RG 0021620816/2005-2011). doi:10.1016/j.ejpain.2007.03.455
441 COMPARING THE EFFICACY OF THORACIC TRANSFORAMINAL INJECTION OF MAGNESIUM VERSUS INTERCOSTAL NERVE BLOCK WITH METHYLPREDNISOLONE FOR CHRONIC POST THORACOTOMY PAIN SYNDROME M. Yosry Anesthesiology and Pain Management Department, Faculty of Medicine-Cairo University, Kasr El Aeni Hospital, Cairo, Egypt Pain therapy and quality of life (QOL) are very important in patients with post thoracotomy syndrome. I evaluated the pain relieving efficacy, and effects on QOL of thoracic transforaminal (i.e. nerve root approach) injection of magnesium diluted with lidocaine versus intercostal nerve block with methylprednisolone and lidocaine in management of chronic post thoracotomy pain syndrome. The study protocol was approved by the local ethics committee. Patients were randomly divided into two groups. Magnesium group; GM, N = 20 were treated with magnesium (transforaminal approach), whereas the patients in steroid group; GS, N = 20 were treated with methylprednisolone (intercostal nerve block). The VAS values, codeine consumption, and quality of life (QOL) (assessed by patient satisfaction scale, PSS; and perfor-
Poster Presentations / Clinical – Other Treatments / European Journal of Pain 11(S1) (2007) S59–S207
a
Pijnkliniek, AZ Maria Middelares, Sint-Niklaas, Belgium b Neurochirurgie, CHU Rangueil, Toulouse, France c Neurochirurgie, Academisch Ziekenhuis Maastricht, The Netherlands d Neurochirurgie, Universitatsklinik Schleswig-Holstein Campus Lubeck, Germany e Neurochirurgie, St. Elisabeth Ziekenhuis, Tilburg, The Netherlands f Pabellon De Rehabilitacion Unidad Del Dolor, Hospital Universitario La Fe, Valencia, Spain g Neurochirurgie, Hopital Neurologique Et Neurochirurgical Pierre Wertheimer, Lyon, France h Unita Cure Palliative E Terapia Del Dolore, Az. Ospedale Garbagnate, Italy i Neurochirurgie, Medizinische Hochschule Hannover, Germany j Unidad Del Dolor, Hospital General De Valencia, Spain Background and aims. Spinal cord stimulation (SCS) is a treatment option for patients with chronic neuropathic pain. Patients enrolled in the study and implanted with the Restore rechargeable neurostimulation system were followed to characterize pain outcomes over 12 months. Methods. This prospective open-label study was conducted in 12 European centers. Patients’ ability to recharge was assessed one month post-implant. Outcome measurements including pain VAS, pain relief, Oswestry Disability Index and EQ-5D were collected 3, 6, and 12 months (12 months) post-implant. Overall satisfaction with SCS was collected at 12 months. Results. Of 45 patients enrolled, 42 were implanted. Of these, 41 met prospective analysis criteria for the primary objective assessing ability to recharge. All 41 successfully recharged independently. The majority of the patients (79%) rated recharging easy or somewhat easy. Comparing baseline to 12 months, the mean VAS score for the primary pain area was reduced from 7.2 ± 1.5 to 4.4 ± 2.8 (p < 0.001). Patients (80%) reported more than 50% pain relief at 12 months. EQ5D health status improved from 0.21 ± 0.32 to 0.46 ± 0.36 (p < 0.001). Oswestry scores improved from 52 ± 12, categorized as severe disability, to 38 ± 19 (p < 0.001), categorized as moderate disability. Physicians rated the system favorably for most patients (95%). Patients (93%) would elect SCS again for the same result, and 98% would recommend SCS to a friend with similar pain. Conclusions. All patients independently recharged the neurostimulator battery. Significant improvements in pain reduction, quality of life, and functional status were observed throughout 12 months post-implant, with a high rate of patient satisfaction with the therapy.
Keywords: Chronic pain; Post thoracotomy syndrome; Quality of life; Transforaminal injection; Magnesium; Intercostal nerve block; Steroid doi:10.1016/j.ejpain.2007.03.452
438 PULSED RADIOFREQUENCY (PRF) FOR THE TREATMENT OF OCCIPITAL NEURALGIA: A CLINICAL AUDIT P. Vanelderen *, M. Puylaert, P. De Vooght, J. Sterken, R. Heylen, J. Van Zundert Department of Anaesthesiology, Intensive Care Medicine and Multidisciplinary Pain Centre, Ziekenhuis Oost Limburg, Genk, Limburg, Belgium Introduction. Occipital neuralgia is a non-throbbing neck pain spreading ipsilaterally to the occipito-temporo-frontal area and is relieved by injection of local anaesthetics at the greater and or lesser occipital nerve. There is no gold standard for treatment. Methods and materials. Patients fulfilling the International Headache Society criteria for occipital neuralgia underwent PRF after a positive diagnostic block of the occipital nerves (>50% reduction on VAS). Target nerves were identified with the external landmarks described by Vital and needle position was controlled with electrical stimulation at 50 Hz (threshold <0.5 V) PRF was performed during 4 min. Results. Tabel 1. Conclusions. These preliminary data suggest PRF is a promissing treatment for occipital neuralgia and justifies further controlled trials. The vital surface landmarks are reliable for the greater and lesser occipital nerve localisation. doi:10.1016/j.ejpain.2007.03.453
439 TENS IN NEUROPATHIC AND NOCICEPTIVE PAIN T. Vemmer Pain Clinic, Wolfson Rehabilitation Centre, St George’s Hospital NHS Trust, London, UK This study aims to compare the pain relief provided by TENS in patients with neuropathic and nociceptive pain, and to find simple criteria predicting pain relief. Methods. Retrospective study of chronic pain outpatients seen from 2000 to 2006. Only patients who
Poster Presentations / Clinical – Other Treatments / European Journal of Pain 11(S1) (2007) S59–S207
received TENS as single treatment at their clinic visit were included. Patients completed the brief pain inventory at each visit. Pain relief was measured on a numerical rating scale (0–100%). R (Development Core Team, 2006) was used for statistical calculations. For predictive models regression trees were grown for neuropathic and nociceptive pain (function ‘‘rpart’’). Trees were pruned to three levels. Results. 478 Patients had predominantly neuropathic, 501 nociceptive pain. The pain relief was similar in both groups (X2 = 0.9354; p = 0.3335; ns): Pain type
Mean ± SD
Median
Range
Neuropathic Nociceptive
31.1 ± 26.79 28.6 ± 26.06
30 20
0–100 0–100
Recursive partitioning found the predictors impairment of activity (>5/10), lack of impairment of work (0/10), and maximal pain in the last week of >7/10 in neuropathic pain, while in nociceptive pain average pain over the last week (>6/10), impairment of work (>6/10), and moderate impairment of mood (<5/10) were more important. Conclusion. TENS is moderately successful in both neuropathic and nociceptive pain. Items of the brief pain inventory predict treatment outcome. Reference R Development Core Team. R Installation and Administration, version 2.3.1, 06/01/2006. doi:10.1016/j.ejpain.2007.03.454
440
´ S POSITION IN THE OPIOIDS AND THEIR TREATMENT FAILED BACK SURGERY SYNDROME I. Vrba *,a, J. Koza´k b, I. Stetka´rova´ c a
ICU Hospital Na Homolce, Czech Republic CVLB Faculty Hospital Motol, Czech Republic c Department of Neurology Hospital Na Homolce, Praha, Czech Republic b
Background and aims. Failed back surgery syndrome (FBSS) is very common and very complicated mixed pain condition. We have used the multidisciplinary approach, including opioids, for the treatment of FBSS. We have used opioids in various drug forms. When FBBS is not manageable with standard approaches we have used intrathecal drug delivery devices. Methods. We have treated more than 300 patients with FBSS in our two pain centers for last 5 years since we introduced drug delivery systems in our practice. Since 2001 we have implanted 28 port systems and 13
S195
pump systems (Synchromed) for delivery morphine in very carefully selected patients with severe FBSS. Results. Every approach has its own advantages and disadvantages. We describe our experience-results, achievements and complications with use of our approaches of opioids in the treatment of FBSS. Our results are good, but not satisfactorily good. It seems that implantable delivery devices allow more comfortable and more effective long-term morphine administration. Conclusions. It is hard to strictly decide whe and/or what approach of opioids is the best for using in each patient with FBSS. When the patients with FBSS cannot be controlled by less invasive opioid management than long-term delivery morphine systems, mainly pump systems, seem an appropriate analgetic method for strictly selected patients with severe FBBS. Acknowledgement Supported by Internal Grant Agency of the Czech Ministry of Health (IGA NF-8232/3, No: 8523/3), and the Czech Ministry of Education and Sports (RG 0021620816/2005-2011). doi:10.1016/j.ejpain.2007.03.455
441 COMPARING THE EFFICACY OF THORACIC TRANSFORAMINAL INJECTION OF MAGNESIUM VERSUS INTERCOSTAL NERVE BLOCK WITH METHYLPREDNISOLONE FOR CHRONIC POST THORACOTOMY PAIN SYNDROME M. Yosry Anesthesiology and Pain Management Department, Faculty of Medicine-Cairo University, Kasr El Aeni Hospital, Cairo, Egypt Pain therapy and quality of life (QOL) are very important in patients with post thoracotomy syndrome. I evaluated the pain relieving efficacy, and effects on QOL of thoracic transforaminal (i.e. nerve root approach) injection of magnesium diluted with lidocaine versus intercostal nerve block with methylprednisolone and lidocaine in management of chronic post thoracotomy pain syndrome. The study protocol was approved by the local ethics committee. Patients were randomly divided into two groups. Magnesium group; GM, N = 20 were treated with magnesium (transforaminal approach), whereas the patients in steroid group; GS, N = 20 were treated with methylprednisolone (intercostal nerve block). The VAS values, codeine consumption, and quality of life (QOL) (assessed by patient satisfaction scale, PSS; and perfor-