- Email: [email protected]
464 NEUROPATHIC PAIN ALLEVIATED WITH ACUPUNCTURE
Posters / European Journal of Pain Supplements 4 (2010) 47–146
diabetic neuropathy and peripheral nerve injury, and tocainide in trigeminal neuralgia. However, the data for IV Lidocaine infusion for neuropathic pain management remains sparse. Objectives: We will present series of case study demonstrating that Intravenous Lidocaine infusions can help reduce pain scores for the pelvic neuropathic pain. Methods: Reterospectively, 15 female patients with chronic pelvic pain unammenable to medications, pelvic PT and surgeries were treated with IV Lidocaine infusion. 500 mg were infused over 30 minutes intravenously. Patient was followed up in 4–6 weeks for a follow-up. On average 3–4 treatments were given to those 10 patients. Results: During the follow-up visit, patients had 40–70% pain relief for 1–3 weeks. 5 out of 15 patients discontinued their chronic opioid regimen after 3 treatments. All patient admitted to decreased stress and having better control of their intractable pelvic pain. Conclusions: Intravenous Lidocaine infusions can help reduce pain scores and anxiety level for chronic pelvic neuropathic pain with possibility of decreasing chronic opioid requirement. 462 ELECTRICAL STIMULATION FOR NEUROPATHIC ABDOMINAL PAIN L. Halley1 , C. Lahr2 , R. Schmieg1 , D. Spree1 , T. Abell1 . 1 University of Mississippi Medical Center, 2 Surgery, University of Mississippi, Jackson, MS, USA Introduction: Evaluate gastric electrical stimulation (GES) in the treatment of neuropathic abdominal pain. Methods: Authors performed temporary and permanent gastric electrical stimulation on 47 patients with severe abdominal pain (pain scores of 4&5). Other GI symptoms were recorded including anorexia and distension. Each symptom was scored 1 to 5 with 1 being absent and 5 being the most severe. 13 were diabetics. Temporary GES (tGES) was performed via a trans nasal electrode. Permanent GES (pGES) was performed with two electrodes placed in the seromuscular layer of the anterior wall of the body of the stomach placed at celiotomy attached to a subcutaneous electrical pulse generator. Low amplitude, high frequency settings were employed. Each patient was evaluated with luminal electrogastrography measuring frequency and amplitude. Neuropathic origin of pain was confirmed by full thickness biopsy of the stomach with quantitative measurement of neurons and interstitial cells of Cajal in the inner and outer muscle layers of the stomach. Results: Two tailed unpaired t tests were performed for abdominal pain, anorexia and distension scores. (See Table). All comparisons were found to be statistically significant. Luminal EGG frequency was 5.3 cycles per minutes (normal value 2.5–3.5) and luminal amplitude was 0.96. Conclusions: GES significantly reduces neuropathic abdominal pain, anorexia and distension. Comparison of Means Before and During GES
Abdominal Pain Score Anorexia Score Distension Score
Before tGES
After tGES
p value of difference
4.6 4.0 4.0
2.1 2.3 2.0
<0.0001 <0.0001 <0.0001
463 THE APPLICATION OF MICRO-CURRENT ELECTROTHERAPY (MET) THERAPY IN THE TREATMENT OF TREATMENT-RESISTANT DIABETIC POLYNEUROPATHY: A CASE SERIES G. Hans1,2 , K. Van Maldeghem1 , H. Van Kerckhoven1 . 1 Antwerp University Hospital, Edegem, 2 Antwerp University (UA), Wilrijk, Belgium Introduction: Pain resulting from diabetic polyneuropathy remains a difficult to treat clinical entity. In a majority of such patients
131
it is of interest to combine (low dose) pharmacological treatment options with non-pharmacological therapies. One of such therapies is the application of micro-current electrotherapy (MET). Objectives: To investigate the efficacy of different protocols of MET in the treatment of chronic diabetic polyneuropathy, which has been shown to be resistant to other standard therapies such as anti-depressants, anti-convulsants and analgesics. Methods: Three patients suffering from chronic diabetic polyneuropathy were treated, after failure of all other conventional treatment options, with repeated application of micro-current electrotherapy. Electrodes were positioned at both legs. All patients were treated during 30 minutes, 3 to 4 times a week. Patients were allowed to set the current level themselves, usually just at their comfort level. Intensities of spontaneous pain (measured by the Visual Analogue Scores) and intensities of neuropathic (evoked) pain (through the Leeds Assessment of Neuropathic Signs and Symptoms scale) were evaluated repetitively during the treatment. Results: The first results of this case-series indicate that microcurrent therapy can indeed be succesfull in the treatment of diverse conditions of neuropathic pain. Intensities of spontaneous pain and evoked (neuropathic) pain significantly decreased during treatment with MET. Analgesic effect appeared already after the first week of treatment, and was maintained during the entire observation period (12 weeks). Conclusions: Micro-current electrotherapy seems to be a promising therapy for the treatment of chronic, therapy-resistant, painful diabetic polyneuropathies. Of course its usefulness needs further investigation in large-scale randomized trials. 464 NEUROPATHIC PAIN ALLEVIATED WITH ACUPUNCTURE E. Kapota, I. Lykoudi, D. Papadopoulos, A. Kouta. Anaesthesiology, Konstadopouleio General Hospital of Nea Ionia, Athens, Greece Introduction: Neck pain affects 30% of men and 43% of women at some time in their lives and is one that becomes chronic among 10% of men and 17% of women. Objectives: In this retrospective study we evaluated the analgesic effect of a standard protocol of acupuncture as it was applied in the pain department of a district hospital. Methods: We retrospectively retrieved data from 15 women and 6 men of mean age 38±7 who had experienced neuropathic neck pain (assessed with DN4 questionnaire) mainly caused by mechanical factors more than 6 months. The protocol (GB 20,21,39, BL 10,41, LI 4, TB 5, SI 3, ST 36 bilateral) consisted of 12 sessions of acupuncture over a period of 40 days. The needles were kept in place for 30 minutes. The pain intensity was recorded using the Numerous Rating Scale (NRS) before the first session and after the 12th session. Results: 15 patients (71.4%) reported pain reduction more than 50% in the NRS and asked for more sessions of acupuncture. 5 patients (24%) reported no significant pain reduction and 1 patient (0.6%) reported aggregation of symptoms. 3 patients complained of dizziness after the first session. More data are expected from studying thoroughly the DN4 questionnaires. Conclusions: From our preliminary results acupuncture proved to be efficacious for neuropathic neck pain. Furthermore, the treatment was safe and produced few, and only mild, side effects. 465 PERIOPERATIVE USE OF GABAPENTIN/PREGABALIN FOR THE MANAGEMENT OF ACUTE POSTOPERATIVE PAIN: A REGIONAL SURVEY A. Karmarkar1 , S. Karmarkar2 . 1 Department of Anaesthetics, Fairfield General Hospital, Manchseter, 2 Anaesthetic, Central Manchester University Hospitals, Manchester, UK Introduction: There has been a growing recognition of presence of neuropathic component to acute postoperative pain in addition to nociceptive component.
diabetic neuropathy and peripheral nerve injury, and tocainide in trigeminal neuralgia. However, the data for IV Lidocaine infusion for neuropathic pain management remains sparse. Objectives: We will present series of case study demonstrating that Intravenous Lidocaine infusions can help reduce pain scores for the pelvic neuropathic pain. Methods: Reterospectively, 15 female patients with chronic pelvic pain unammenable to medications, pelvic PT and surgeries were treated with IV Lidocaine infusion. 500 mg were infused over 30 minutes intravenously. Patient was followed up in 4–6 weeks for a follow-up. On average 3–4 treatments were given to those 10 patients. Results: During the follow-up visit, patients had 40–70% pain relief for 1–3 weeks. 5 out of 15 patients discontinued their chronic opioid regimen after 3 treatments. All patient admitted to decreased stress and having better control of their intractable pelvic pain. Conclusions: Intravenous Lidocaine infusions can help reduce pain scores and anxiety level for chronic pelvic neuropathic pain with possibility of decreasing chronic opioid requirement. 462 ELECTRICAL STIMULATION FOR NEUROPATHIC ABDOMINAL PAIN L. Halley1 , C. Lahr2 , R. Schmieg1 , D. Spree1 , T. Abell1 . 1 University of Mississippi Medical Center, 2 Surgery, University of Mississippi, Jackson, MS, USA Introduction: Evaluate gastric electrical stimulation (GES) in the treatment of neuropathic abdominal pain. Methods: Authors performed temporary and permanent gastric electrical stimulation on 47 patients with severe abdominal pain (pain scores of 4&5). Other GI symptoms were recorded including anorexia and distension. Each symptom was scored 1 to 5 with 1 being absent and 5 being the most severe. 13 were diabetics. Temporary GES (tGES) was performed via a trans nasal electrode. Permanent GES (pGES) was performed with two electrodes placed in the seromuscular layer of the anterior wall of the body of the stomach placed at celiotomy attached to a subcutaneous electrical pulse generator. Low amplitude, high frequency settings were employed. Each patient was evaluated with luminal electrogastrography measuring frequency and amplitude. Neuropathic origin of pain was confirmed by full thickness biopsy of the stomach with quantitative measurement of neurons and interstitial cells of Cajal in the inner and outer muscle layers of the stomach. Results: Two tailed unpaired t tests were performed for abdominal pain, anorexia and distension scores. (See Table). All comparisons were found to be statistically significant. Luminal EGG frequency was 5.3 cycles per minutes (normal value 2.5–3.5) and luminal amplitude was 0.96. Conclusions: GES significantly reduces neuropathic abdominal pain, anorexia and distension. Comparison of Means Before and During GES
Abdominal Pain Score Anorexia Score Distension Score
Before tGES
After tGES
p value of difference
4.6 4.0 4.0
2.1 2.3 2.0
<0.0001 <0.0001 <0.0001
463 THE APPLICATION OF MICRO-CURRENT ELECTROTHERAPY (MET) THERAPY IN THE TREATMENT OF TREATMENT-RESISTANT DIABETIC POLYNEUROPATHY: A CASE SERIES G. Hans1,2 , K. Van Maldeghem1 , H. Van Kerckhoven1 . 1 Antwerp University Hospital, Edegem, 2 Antwerp University (UA), Wilrijk, Belgium Introduction: Pain resulting from diabetic polyneuropathy remains a difficult to treat clinical entity. In a majority of such patients
131
it is of interest to combine (low dose) pharmacological treatment options with non-pharmacological therapies. One of such therapies is the application of micro-current electrotherapy (MET). Objectives: To investigate the efficacy of different protocols of MET in the treatment of chronic diabetic polyneuropathy, which has been shown to be resistant to other standard therapies such as anti-depressants, anti-convulsants and analgesics. Methods: Three patients suffering from chronic diabetic polyneuropathy were treated, after failure of all other conventional treatment options, with repeated application of micro-current electrotherapy. Electrodes were positioned at both legs. All patients were treated during 30 minutes, 3 to 4 times a week. Patients were allowed to set the current level themselves, usually just at their comfort level. Intensities of spontaneous pain (measured by the Visual Analogue Scores) and intensities of neuropathic (evoked) pain (through the Leeds Assessment of Neuropathic Signs and Symptoms scale) were evaluated repetitively during the treatment. Results: The first results of this case-series indicate that microcurrent therapy can indeed be succesfull in the treatment of diverse conditions of neuropathic pain. Intensities of spontaneous pain and evoked (neuropathic) pain significantly decreased during treatment with MET. Analgesic effect appeared already after the first week of treatment, and was maintained during the entire observation period (12 weeks). Conclusions: Micro-current electrotherapy seems to be a promising therapy for the treatment of chronic, therapy-resistant, painful diabetic polyneuropathies. Of course its usefulness needs further investigation in large-scale randomized trials. 464 NEUROPATHIC PAIN ALLEVIATED WITH ACUPUNCTURE E. Kapota, I. Lykoudi, D. Papadopoulos, A. Kouta. Anaesthesiology, Konstadopouleio General Hospital of Nea Ionia, Athens, Greece Introduction: Neck pain affects 30% of men and 43% of women at some time in their lives and is one that becomes chronic among 10% of men and 17% of women. Objectives: In this retrospective study we evaluated the analgesic effect of a standard protocol of acupuncture as it was applied in the pain department of a district hospital. Methods: We retrospectively retrieved data from 15 women and 6 men of mean age 38±7 who had experienced neuropathic neck pain (assessed with DN4 questionnaire) mainly caused by mechanical factors more than 6 months. The protocol (GB 20,21,39, BL 10,41, LI 4, TB 5, SI 3, ST 36 bilateral) consisted of 12 sessions of acupuncture over a period of 40 days. The needles were kept in place for 30 minutes. The pain intensity was recorded using the Numerous Rating Scale (NRS) before the first session and after the 12th session. Results: 15 patients (71.4%) reported pain reduction more than 50% in the NRS and asked for more sessions of acupuncture. 5 patients (24%) reported no significant pain reduction and 1 patient (0.6%) reported aggregation of symptoms. 3 patients complained of dizziness after the first session. More data are expected from studying thoroughly the DN4 questionnaires. Conclusions: From our preliminary results acupuncture proved to be efficacious for neuropathic neck pain. Furthermore, the treatment was safe and produced few, and only mild, side effects. 465 PERIOPERATIVE USE OF GABAPENTIN/PREGABALIN FOR THE MANAGEMENT OF ACUTE POSTOPERATIVE PAIN: A REGIONAL SURVEY A. Karmarkar1 , S. Karmarkar2 . 1 Department of Anaesthetics, Fairfield General Hospital, Manchseter, 2 Anaesthetic, Central Manchester University Hospitals, Manchester, UK Introduction: There has been a growing recognition of presence of neuropathic component to acute postoperative pain in addition to nociceptive component.