- Email: [email protected]
473 BIOMARKERS OF PAIN AND INFLAMMATION: A PRELIMINARY STUDY
134
Posters / European Journal of Pain Supplements 4 (2010) 47–146
neuropathic chronic low back pain. Effects of acupuncture can remain beneficial at least for 6 months period. 472 PERCUTANEOUS ELECTRICAL NERVE STIMULATION FOR CHRONIC HYPERALGESIA: INTERIM RESULTS OF A SHORT TERM SHAM-CONTROLLED DOUBLE-BLIND CROSS-OVER RANDOMISED CLINICAL TRIAL T.M.A. Raheem1,2 , J.H. Raphael1,2 , J.L. Southall2 , R.L. Ashford1 . 1 Birmingham City University, Birmingham, 2 Russells Hall Hospital, Dudley, UK Introduction: Chronic neuropathic conditions with hyperalgesia are often resistant to pharmacological treatment. Percutaneous electrical nerve stimulation (PENS) is a relatively new therapy for pain relief in which probes are placed under the skin to bypass the hyperalgesic areas and so aid compliance. The frequency of stimulation rapidly alternates between 2 and 100 Hz. Open studies and single-blinded controlled studies are suggestive of benefit in some chronic pain states. [1,2] Objectives: To investigate in a randomised, double-blinded, shamcontrolled study the short term effect of PENS on pain intensity in patients with chronic hyperalgesia. Methods: 13 patients with chronic hyperalgesia, unresponsive to conventional and adjuvant analgesic medications and to local anaesthetic/steroid infiltrations have presently been recruited to this double-blind cross-over randomised sham-controlled clinical trial. For each of the two arms of the study, the numerical rating scale (NRS) score for pain, was assessed immediately before and 1–7 days post-therapy.
Methods: 18 joint fluid specimens were aspirated from patients (n = 18; 17M, 1F; mean age (±standard deviation, 73±11 years) with painful joints prior to joint injections and categorized as: (1) inflammatory arthritis – chronically painful Total Knee Arthroplasty (n = 5), rheumatoid arthritis (n = 5), gout or pseudogout (n = 5); and (2) non-inflammatory arthritis, i.e. osteoarthritis (n = 3). Using the BioRad human 27-plex cytokine panel (Cat # 171A11127, Bio-Rad, San Diego CA) Multiplexed Microsphere Cytokine Immunoassay, we measured joint fluid concentrations of cytokines. We examined correlations of joint fluid cytokines with: (1) Joint pain severity on 0–10 numeric rating scale and (2) Markers of inflammation [Synovial fluid WBC, Erythrocyte sedimentation rate (ESR)] using Spearman correlations, a non-parametric test (due to non-normal data distribution) considering p < 0.05 significant. Results: Pain levels had moderate-high negative correlation with three cytokines: monocyte chemotactic protein-1: −0.64, p = 0.004; Platelet-derived growth factor (PDGF): −0.57, p = 0.014; and Regulated upon Activation Normal T-cell Expressed and Secreted (RANTES): −0.44, p = 0.066. Correlates of Inflammation: Synovial fluid white blood cell count had moderate correlation with: interleukin-10: 0.67, p = 0.024; tumornecrosis factor (TNF)-alpha: 0.60, p = 0.05; and vascular endothelial growth factor (VEGF): −0.52, p = 0.029. ESR correlated with PDGF levels with a coefficient of 0.69, p = 0.026. Conclusions: This study provides correlates of pain and inflammation in patients with arthritis. It is likely that modulation of these pain biomarkers by targeting different pathways can provide pain relief patients with painful arthritis. Further study in a larger sample is underway to confirm these findings. 474 EVALUATION OF THE SPINAL CORD STIMULATION FOR THE ASO PATIENT’S PERIPHERAL BLOOD FLOW: A CASE REPORT H. Takahara, K. Yamamoto, T. Wakabayashi. Himeji St. Mary’s Hospital, Himeji City, Japan
Box-plot: NRS pre & post-therapy. Results: For active therapy; the median NRS changed from 7.5/10 pre-therapy to 3/10 post-therapy, Z = −2.692, n = 13, P = 0.007 (2tailed); whilst for sham therapy; the median NRS remained at 7.5 pre- and post-therapy, Z = 0, n = 13, P = 1 (2-tailed) (Wilcoxon matched pairs signed rank sum test). Conclusions: From the interim results of this study, it appears that percutaneous electrical nerve stimulation may produce a significant reduction in pain intensity in the short term in patients with chronic hyperalgesia. Further data is being collected. Reference(s) [1] Borg-Stein J, et al. Pain Practice, 2003; 3(2): 125–34. [2] Ghoname E-SA, et al. Pain, 1999; 83: 193–9.
473 BIOMARKERS OF PAIN AND INFLAMMATION: A PRELIMINARY STUDY J. Singh1 , S. Gabriel2 , K. Knutson2 . 1 Minneapolis VA Medical Center and University of Minnesota, Minneapolis, 2 Mayo Clinic College of Medicine, Rochester, MN, USA Objective: To identify joint fluid pain biomarkers in arthritis pain.
Introduction: In the treatment of Spinal Cord Stimulation (SCS), we sometimes encounter an elder people with severe pain, who can’t express another emotion except pain. In these cases, it’s sometimes difficult to assess the efficacy of SCS.Ordinary in these cases, TcPo2, dermal temperature or thermography was used to assess the effect of SCS.But for these patients, contact of probe usually causes a pain, which may reduce a blood flow. Measuring the temperature of the tissue, off course it’s very useful, but the temperature is the secondary information of blood flow. Objectives: We use a new device to measures a superficial blood flow directly using laser speckle imaging. Methods: Case report. 90 years old female, who suffered ASO several years ago. Her rt. foot was gradually become necrotic and pain increase. But because of several complications, amputation is difficult. So we performed SCS, which reduced pain and improve rt. leg blood flow remarkably measured by OMEGAZONE OZ-1 laser speckle imaging blood flow detector. Conclusions: We got an almost real-time blood flow data which indicate the remarkable increase of blood flow with impressive visual images by OMEGA ZONE OZ-1. During or after the operation, it makes possible to assess the efficacy of the therapy objectively if general anesthesia is needed for the treatment. But it does not still evaluated the reliability, correlation between other methods, we should make further examination. Results: We observed a remarkable increase of blood flow for the ASO patient using SCS measured by laser speckle imaging. It’s very useful to access the superficial blood flow objectively without any invasive method.
Posters / European Journal of Pain Supplements 4 (2010) 47–146
neuropathic chronic low back pain. Effects of acupuncture can remain beneficial at least for 6 months period. 472 PERCUTANEOUS ELECTRICAL NERVE STIMULATION FOR CHRONIC HYPERALGESIA: INTERIM RESULTS OF A SHORT TERM SHAM-CONTROLLED DOUBLE-BLIND CROSS-OVER RANDOMISED CLINICAL TRIAL T.M.A. Raheem1,2 , J.H. Raphael1,2 , J.L. Southall2 , R.L. Ashford1 . 1 Birmingham City University, Birmingham, 2 Russells Hall Hospital, Dudley, UK Introduction: Chronic neuropathic conditions with hyperalgesia are often resistant to pharmacological treatment. Percutaneous electrical nerve stimulation (PENS) is a relatively new therapy for pain relief in which probes are placed under the skin to bypass the hyperalgesic areas and so aid compliance. The frequency of stimulation rapidly alternates between 2 and 100 Hz. Open studies and single-blinded controlled studies are suggestive of benefit in some chronic pain states. [1,2] Objectives: To investigate in a randomised, double-blinded, shamcontrolled study the short term effect of PENS on pain intensity in patients with chronic hyperalgesia. Methods: 13 patients with chronic hyperalgesia, unresponsive to conventional and adjuvant analgesic medications and to local anaesthetic/steroid infiltrations have presently been recruited to this double-blind cross-over randomised sham-controlled clinical trial. For each of the two arms of the study, the numerical rating scale (NRS) score for pain, was assessed immediately before and 1–7 days post-therapy.
Methods: 18 joint fluid specimens were aspirated from patients (n = 18; 17M, 1F; mean age (±standard deviation, 73±11 years) with painful joints prior to joint injections and categorized as: (1) inflammatory arthritis – chronically painful Total Knee Arthroplasty (n = 5), rheumatoid arthritis (n = 5), gout or pseudogout (n = 5); and (2) non-inflammatory arthritis, i.e. osteoarthritis (n = 3). Using the BioRad human 27-plex cytokine panel (Cat # 171A11127, Bio-Rad, San Diego CA) Multiplexed Microsphere Cytokine Immunoassay, we measured joint fluid concentrations of cytokines. We examined correlations of joint fluid cytokines with: (1) Joint pain severity on 0–10 numeric rating scale and (2) Markers of inflammation [Synovial fluid WBC, Erythrocyte sedimentation rate (ESR)] using Spearman correlations, a non-parametric test (due to non-normal data distribution) considering p < 0.05 significant. Results: Pain levels had moderate-high negative correlation with three cytokines: monocyte chemotactic protein-1: −0.64, p = 0.004; Platelet-derived growth factor (PDGF): −0.57, p = 0.014; and Regulated upon Activation Normal T-cell Expressed and Secreted (RANTES): −0.44, p = 0.066. Correlates of Inflammation: Synovial fluid white blood cell count had moderate correlation with: interleukin-10: 0.67, p = 0.024; tumornecrosis factor (TNF)-alpha: 0.60, p = 0.05; and vascular endothelial growth factor (VEGF): −0.52, p = 0.029. ESR correlated with PDGF levels with a coefficient of 0.69, p = 0.026. Conclusions: This study provides correlates of pain and inflammation in patients with arthritis. It is likely that modulation of these pain biomarkers by targeting different pathways can provide pain relief patients with painful arthritis. Further study in a larger sample is underway to confirm these findings. 474 EVALUATION OF THE SPINAL CORD STIMULATION FOR THE ASO PATIENT’S PERIPHERAL BLOOD FLOW: A CASE REPORT H. Takahara, K. Yamamoto, T. Wakabayashi. Himeji St. Mary’s Hospital, Himeji City, Japan
Box-plot: NRS pre & post-therapy. Results: For active therapy; the median NRS changed from 7.5/10 pre-therapy to 3/10 post-therapy, Z = −2.692, n = 13, P = 0.007 (2tailed); whilst for sham therapy; the median NRS remained at 7.5 pre- and post-therapy, Z = 0, n = 13, P = 1 (2-tailed) (Wilcoxon matched pairs signed rank sum test). Conclusions: From the interim results of this study, it appears that percutaneous electrical nerve stimulation may produce a significant reduction in pain intensity in the short term in patients with chronic hyperalgesia. Further data is being collected. Reference(s) [1] Borg-Stein J, et al. Pain Practice, 2003; 3(2): 125–34. [2] Ghoname E-SA, et al. Pain, 1999; 83: 193–9.
473 BIOMARKERS OF PAIN AND INFLAMMATION: A PRELIMINARY STUDY J. Singh1 , S. Gabriel2 , K. Knutson2 . 1 Minneapolis VA Medical Center and University of Minnesota, Minneapolis, 2 Mayo Clinic College of Medicine, Rochester, MN, USA Objective: To identify joint fluid pain biomarkers in arthritis pain.
Introduction: In the treatment of Spinal Cord Stimulation (SCS), we sometimes encounter an elder people with severe pain, who can’t express another emotion except pain. In these cases, it’s sometimes difficult to assess the efficacy of SCS.Ordinary in these cases, TcPo2, dermal temperature or thermography was used to assess the effect of SCS.But for these patients, contact of probe usually causes a pain, which may reduce a blood flow. Measuring the temperature of the tissue, off course it’s very useful, but the temperature is the secondary information of blood flow. Objectives: We use a new device to measures a superficial blood flow directly using laser speckle imaging. Methods: Case report. 90 years old female, who suffered ASO several years ago. Her rt. foot was gradually become necrotic and pain increase. But because of several complications, amputation is difficult. So we performed SCS, which reduced pain and improve rt. leg blood flow remarkably measured by OMEGAZONE OZ-1 laser speckle imaging blood flow detector. Conclusions: We got an almost real-time blood flow data which indicate the remarkable increase of blood flow with impressive visual images by OMEGA ZONE OZ-1. During or after the operation, it makes possible to assess the efficacy of the therapy objectively if general anesthesia is needed for the treatment. But it does not still evaluated the reliability, correlation between other methods, we should make further examination. Results: We observed a remarkable increase of blood flow for the ASO patient using SCS measured by laser speckle imaging. It’s very useful to access the superficial blood flow objectively without any invasive method.