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454 THE VALIDITY OF A QUESTIONNAIRE STUDY OF BIZARRE SYMPTOMS IN COMPLEX REGIONAL PAIN SYNDROME (CRPS)
Topic C: DISEASE ENTITIES (HUMAN)
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bizarre phenomenon – visuo-spatial disturbances – was able to reproduce and again uncover more detailed accounts than those uncovered by this questionnaire (49% reporting symptoms in the questionnaire, 77% in the study). Further elucidation of these reports of dream pain is therefore possible, and desirable.
454 THE VALIDITY OF A QUESTIONNAIRE STUDY OF BIZARRE SYMPTOMS IN COMPLEX REGIONAL PAIN SYNDROME (CRPS) Blake1,2 ,
Harrison1 ,
Lewis1 ,
McCabe1 ,
Jerina1,2 ° .
D.R. S.J. J. C.S. H.S.L. 1 The Royal National Hospital for Rheumatic Diseases, Bath; 2 Department of Medical Sciences, School for Health, University of Bath, Bath, UK Background and Aims: Bizarre symptoms have been reported in CRPS. As described in Sunderland’s 1976 review of causalgia which highlights “disturbing visual stimuli” and pain exacerbated by “tearing of paper”. Such reports are hard to investigate, first because of methodological doubts, and secondly because of the difficulty of getting access to patients with CRPS. Here we assess the use of a questionnaire format in investigating these reports. Methods: 52 patients with CRPS satisfying the IASP criteria attended a National Patient Support Symposium (RSD-UK). Disease duration ranged from 0.5–32 years (median: 5 years). Patients were shown bi-stable images, such as the Necker cube, and then asked to complete a questionnaire designed to investigate distressing symptomatology including questions relating to visual stimuli. In a more formal second study, patients attending RNHRD CRPS clinics were shown, individually, some of the images and interviewed. Results: 24 of the 52 (46.3%) conference attendees reported exacerbation of their symptoms upon viewing the bi-stable illusions. 30 patients with CRPS were interviewed according to the more formal protocol, of these 23 (77%) reported exacerbations. Conclusions: These results suggest that the questionnaire was almost as good as the second study in eliciting reports. The questionnaire, however, has several advantages. It is relatively cheap, easy to administer, and very importantly, is a constructive way of working with patient organisations.
455 Accepted for oral presentation PERSISTENT PAIN AFTER BREAST AUGMENTATION SURGERY – A LONG TERM FOLLOW UP T. Kaasa ° , A. Stubhaug, L. Romundstad, H. Breivik. Department of Anaesthesiology, Rikshospitalet/UiO, Oslo, Norway Background and Aims: In a recent study [1], the prevalence of spontaneous and evoked pain one year after breast augmentation surgery was 13% and 20%, respectively. Sensory changes was present in 46%. The present study has two aims: (1) To study the prevalence of pain and sensory changes three to four years after augmentation mammoplasty, and their impact on quality of life. (2) To investigate the mechanisms behind persistent pain and sensibility changes in this patient group. Methods: This study was a long term follow-up of 219 women, who had cosmetic breast augmentation surgery three to four years ago. All the women participated in a randomized study of acute and chronic postoperative pain [1]. In the present study the women (n = 219) have been mailed questionnaires about pain, sensory changes, affection of daily life, quality of life and pain catastrophizing. Results: 114 answered the questionnaire. Preliminary results show that 22% (n = 25) report the presence of pain at rest or during activity. 68% (n = 78) report sensory changes; 22 women have increased sensitivity, 34 have hyposensitivity, and 22 report both hypo- and hypersensitivity. Conclusions: The prevalence of pain and sensory changes after breast augmentation surgery is disturbingly high, on the same level as described after other types of surgery. No indication of decrease in prevalence of symptoms from one year after surgery till three to four years is seen.
References [1] Romundstad L et al: Chronic pain and sensory changes after augmentation mammoplasty: Long term effects of preincisional administration of methylprednisolone. Pain, In Press.
456 AMYOTROPHIC NEURALGIA AND UNILATERAL PHRENIC NERVE INVOLVEMENT ASSOSIATED WITH ZONA ZOSTER: A CASE REPORT A.B. Kalpakcioglu ° , C. Bahadir, D. Kurtulus. Physical Medicine and Rehabilitation Department, Haydarpa¸sa Numune Training and Research Hospital, Istanbul, Turkey Diaphragm paralysis due to phrenic nerve involvement associated with zona zoster or neuralgic amyotrophy has been described previously. We report 73 years old female patient, applied to our clinic with the complaints of severe sudden onset pain, dyspnea and muscle weakness of left arm muscles. The patient was diagnosed 1 week earlier as zona zoster due to painful lesions which erupted in supraclaviculer region and shoulder on left side. In physical examination, severe muscle weakness was found in the shoulder and proximal arm muscles. EMG examination revealed axonal involvement mainly impacting upper truncus at left brachial plexus and denervation of the related muscles. Chest X-ray showed unilateral elevation of the diaphragm on the left side. Pulmonary function test demonstrated restrictive pattern. Phrenic nerve conduction studies carried out by both surface and monopolar needle stimulation and needle EMG documented left diaphragmatic paralysis. Patient had no systemic disease and imaging studies of thorax showed no abnormality. Due to clinical and electromyographic findings, zone zoster is thought to be the only possible reason for the patient’s clinical situation considering relevant literature. Following medical treatment and physiotherapy of 2 months, muscle weakness improved in the patient whose pain healed as well. However, radiograhic findings of diaphragma paralysis did not remarkably improve. This case is the sole zona zoster concomitant with unilateral phrenic nerve paralysis and amyotrophic neuralgia ever encountered in the relevant literature.
457 SENSITIVITY OF NON-INVASIVE TESTS OF SMALL-FIBER FUNCTION IN NEUROPATHY WITH AND WITHOUT PAIN B. Karim´e ° , K. Thoresen, E. Jørum. Laboraroy of Clinical Neurophysiology, Dept of Neurology, Rikshospitalet University Hospital, Oslo, Norway Background and Aims: Pain in neuropathy has mainly been explained by an affection of small nerve fibers. Several non-invasive methods are now available for the evaluation of small fiber dysfunction, testing both afferent and efferent fibers. However not many studies have been performed comparing the different methods. The aim of the present study was to compare sensitivity of various methods for small fiber dysfunction in patients with neuropathy with and without pain. Methods: Patients were investigated with clinical neurological examination, EMG/neurography, assessment of thermal thresholds (warm and – cold detection as well as heat – and cold pain detection) and QSART (quantitative sudomotor axon reflex test). Results: A total of 45 patients, all with verified thick-fiber neuropathy (by EMG/neurography) were included. 26 patients suffered from pain in their feet/legs while 19 were pain-free. QSART was pathological bilaterally in 10 and unilaterally in 3 of the patients with pain and only bilaterally in 2 patients without pain (unilaterally in 5 patients). Elevated thermal thresholds were found in almost all patients. Thermal thresholds were significantly elevated at the dorsum of the foot in the neuropathy-group with pain compared with the group without pain. Conclusions: Assessment of thermal thresholds is the most sensitive noninvasive test of small fiber dysfunction. There is little correlation between tests of afferent and efferent small fiber function.
S121
bizarre phenomenon – visuo-spatial disturbances – was able to reproduce and again uncover more detailed accounts than those uncovered by this questionnaire (49% reporting symptoms in the questionnaire, 77% in the study). Further elucidation of these reports of dream pain is therefore possible, and desirable.
454 THE VALIDITY OF A QUESTIONNAIRE STUDY OF BIZARRE SYMPTOMS IN COMPLEX REGIONAL PAIN SYNDROME (CRPS) Blake1,2 ,
Harrison1 ,
Lewis1 ,
McCabe1 ,
Jerina1,2 ° .
D.R. S.J. J. C.S. H.S.L. 1 The Royal National Hospital for Rheumatic Diseases, Bath; 2 Department of Medical Sciences, School for Health, University of Bath, Bath, UK Background and Aims: Bizarre symptoms have been reported in CRPS. As described in Sunderland’s 1976 review of causalgia which highlights “disturbing visual stimuli” and pain exacerbated by “tearing of paper”. Such reports are hard to investigate, first because of methodological doubts, and secondly because of the difficulty of getting access to patients with CRPS. Here we assess the use of a questionnaire format in investigating these reports. Methods: 52 patients with CRPS satisfying the IASP criteria attended a National Patient Support Symposium (RSD-UK). Disease duration ranged from 0.5–32 years (median: 5 years). Patients were shown bi-stable images, such as the Necker cube, and then asked to complete a questionnaire designed to investigate distressing symptomatology including questions relating to visual stimuli. In a more formal second study, patients attending RNHRD CRPS clinics were shown, individually, some of the images and interviewed. Results: 24 of the 52 (46.3%) conference attendees reported exacerbation of their symptoms upon viewing the bi-stable illusions. 30 patients with CRPS were interviewed according to the more formal protocol, of these 23 (77%) reported exacerbations. Conclusions: These results suggest that the questionnaire was almost as good as the second study in eliciting reports. The questionnaire, however, has several advantages. It is relatively cheap, easy to administer, and very importantly, is a constructive way of working with patient organisations.
455 Accepted for oral presentation PERSISTENT PAIN AFTER BREAST AUGMENTATION SURGERY – A LONG TERM FOLLOW UP T. Kaasa ° , A. Stubhaug, L. Romundstad, H. Breivik. Department of Anaesthesiology, Rikshospitalet/UiO, Oslo, Norway Background and Aims: In a recent study [1], the prevalence of spontaneous and evoked pain one year after breast augmentation surgery was 13% and 20%, respectively. Sensory changes was present in 46%. The present study has two aims: (1) To study the prevalence of pain and sensory changes three to four years after augmentation mammoplasty, and their impact on quality of life. (2) To investigate the mechanisms behind persistent pain and sensibility changes in this patient group. Methods: This study was a long term follow-up of 219 women, who had cosmetic breast augmentation surgery three to four years ago. All the women participated in a randomized study of acute and chronic postoperative pain [1]. In the present study the women (n = 219) have been mailed questionnaires about pain, sensory changes, affection of daily life, quality of life and pain catastrophizing. Results: 114 answered the questionnaire. Preliminary results show that 22% (n = 25) report the presence of pain at rest or during activity. 68% (n = 78) report sensory changes; 22 women have increased sensitivity, 34 have hyposensitivity, and 22 report both hypo- and hypersensitivity. Conclusions: The prevalence of pain and sensory changes after breast augmentation surgery is disturbingly high, on the same level as described after other types of surgery. No indication of decrease in prevalence of symptoms from one year after surgery till three to four years is seen.
References [1] Romundstad L et al: Chronic pain and sensory changes after augmentation mammoplasty: Long term effects of preincisional administration of methylprednisolone. Pain, In Press.
456 AMYOTROPHIC NEURALGIA AND UNILATERAL PHRENIC NERVE INVOLVEMENT ASSOSIATED WITH ZONA ZOSTER: A CASE REPORT A.B. Kalpakcioglu ° , C. Bahadir, D. Kurtulus. Physical Medicine and Rehabilitation Department, Haydarpa¸sa Numune Training and Research Hospital, Istanbul, Turkey Diaphragm paralysis due to phrenic nerve involvement associated with zona zoster or neuralgic amyotrophy has been described previously. We report 73 years old female patient, applied to our clinic with the complaints of severe sudden onset pain, dyspnea and muscle weakness of left arm muscles. The patient was diagnosed 1 week earlier as zona zoster due to painful lesions which erupted in supraclaviculer region and shoulder on left side. In physical examination, severe muscle weakness was found in the shoulder and proximal arm muscles. EMG examination revealed axonal involvement mainly impacting upper truncus at left brachial plexus and denervation of the related muscles. Chest X-ray showed unilateral elevation of the diaphragm on the left side. Pulmonary function test demonstrated restrictive pattern. Phrenic nerve conduction studies carried out by both surface and monopolar needle stimulation and needle EMG documented left diaphragmatic paralysis. Patient had no systemic disease and imaging studies of thorax showed no abnormality. Due to clinical and electromyographic findings, zone zoster is thought to be the only possible reason for the patient’s clinical situation considering relevant literature. Following medical treatment and physiotherapy of 2 months, muscle weakness improved in the patient whose pain healed as well. However, radiograhic findings of diaphragma paralysis did not remarkably improve. This case is the sole zona zoster concomitant with unilateral phrenic nerve paralysis and amyotrophic neuralgia ever encountered in the relevant literature.
457 SENSITIVITY OF NON-INVASIVE TESTS OF SMALL-FIBER FUNCTION IN NEUROPATHY WITH AND WITHOUT PAIN B. Karim´e ° , K. Thoresen, E. Jørum. Laboraroy of Clinical Neurophysiology, Dept of Neurology, Rikshospitalet University Hospital, Oslo, Norway Background and Aims: Pain in neuropathy has mainly been explained by an affection of small nerve fibers. Several non-invasive methods are now available for the evaluation of small fiber dysfunction, testing both afferent and efferent fibers. However not many studies have been performed comparing the different methods. The aim of the present study was to compare sensitivity of various methods for small fiber dysfunction in patients with neuropathy with and without pain. Methods: Patients were investigated with clinical neurological examination, EMG/neurography, assessment of thermal thresholds (warm and – cold detection as well as heat – and cold pain detection) and QSART (quantitative sudomotor axon reflex test). Results: A total of 45 patients, all with verified thick-fiber neuropathy (by EMG/neurography) were included. 26 patients suffered from pain in their feet/legs while 19 were pain-free. QSART was pathological bilaterally in 10 and unilaterally in 3 of the patients with pain and only bilaterally in 2 patients without pain (unilaterally in 5 patients). Elevated thermal thresholds were found in almost all patients. Thermal thresholds were significantly elevated at the dorsum of the foot in the neuropathy-group with pain compared with the group without pain. Conclusions: Assessment of thermal thresholds is the most sensitive noninvasive test of small fiber dysfunction. There is little correlation between tests of afferent and efferent small fiber function.