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(533) Functional restoration in a military chronic pain population: first year outcomes from the SAMMC Functional Restoration Program
Abstracts
(532) Implications of pain interference on restoration of physical function for people with chronic pain N Karayannis, M Kao, R Prasad, C Cooley, and S Mackey; Stanford University, Palo Alto, CA The Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) item bank and Pain Interference (PI) item bank in the chronic pain population are conceptually similar domains. We leveraged the learning health care system platform Collaborative Health Outcomes Information Registry (CHOIR) at our institution to characterize their relationships. As part of routine clinical care, patients seen at an academic medical center were enrolled in CHOIR and their PF and PI assessed using computer adaptive testing algorithm. Our previous cross-sectional data of 3,257 chronic pain patients seeking healthcare at a specialty pain management center demonstrated that PF was strongly correlated with lower PI (r=-0.64). This current study aimed to longitudinally examine the outcomes of PF and PI over the course of a 90-day time period of treatment. In total, 693 new patients with at least 3 follow-up treatments within a 90-day time period were considered. Of these, only 167 patients (24%) had both improved PF and PI at the 4th follow-up compared to the 1st visit. The mean improvements at follow-ups are 3.2, 4.7, and 6.1 for PF, respectively; and 3.9, 6.0, and 8.0 for PI, respectively. There was a statistically significant but small correlation between improvements in PF and PI at each time point (R2 0.22, 0.28, and 0.18; p<0.001). These data suggests divergence between these two domains and their differential natural course in the chronic pain population. Further lagged correlation analysis revealed that changes in PI at the first follow-up predicts changes in PF at second follow-up (beta=0.4 on PROMIS scale; R2 0.21; p<0.001). Future studies will focus on the distinction and time course in improvement in these two domains.
(533) Functional restoration in a military chronic pain population: first year outcomes from the SAMMC Functional Restoration Program L Sussman, J Clapp, B Keizer, H Gill, J Boge, and B Goff; San Antonio Military Medical Center, Fort Sam Houston, TX Historically, management of loss of function due to chronic pain in the military has focused on interventional and medical treatment modalities. Recent attention has been given to interdisciplinary care for Service Members with chronic pain conditions. Functional Restoration Programs (FRPs) have been shown to be effective in the civilian sector but until recently have not been employed in military medicine. The San Antonio Military Medical Center (SAMMC) FRP is a 3 week, 8 hour per day program aimed at restoring physical and psychological function to Service Members who have been injured during their military careers. The proposed poster is a presentation of the physical and psychological outcomes for the first year of the program. Service Members (SM) were selected for the FRP by physician referral and evaluation by a psychologist and physical therapist. The program consists of 4 hours of therapist guided group exercise and 3 hours of pain management education and skills training per day. Standardized instruments measuring pain, disability, fear avoidance, catastrophizing, depression, and anxiety were administered. The physical evaluation includes cervical and lumbar maximum lift, total power, 3 min step test, grip strength, balance, and progressive isoinertial lift. Pre-post measures for each test were compared. Early results, while not statistically meaningful due to the small sample (n=14) were presented at the 2014 Military Health System Research Symposium and revealed clinically meaningful changes in pain intensity (6.5/10 to 4.5/10) and pain interference in life activities. All other preliminary measures showed improvement, to include physical measures of cervical and lumbar max lift (139% and 219% increase respectively), balance, and progressive isoinertial lift. All preliminary results pointed toward measureable gains in function. The proposed poster will present new data accumulated after a year of running the program. The sample size should be large enough at that time to allow for meaningful statistical analysis.
The Journal of Pain
S109
(534) A novel strategy to improve opioid prescribing safety in chronic pain patients: evaluation by addiction psychiatry fellow rotators W Ko, R Slowik, S Burns, K Krivy, C Maxwell, C Perkel, and R Cruciani; Department of Psychiatry, Beth Israel Medical Center, New York City, NY The goal of the evaluation was to assist pain providers with safe opioid prescribing. 95% of the consultations were requested by the pain fellows and NPs. Seven addiction Psychiatry fellows evaluated opioid prescribing risk in chronic pain patients at the Pain Clinic, Beth Israel Medical Center, an academic center. This one time evaluation was performed as part of their training in a once a week ½ a day session. The Chief of the Pain Division and the Director of the Addiction Psychiatry Fellowship supervised the evaluations. Two hundred and two patients were evaluated; 80 were female; age range 26 to 72 years (mean 52). Most evaluation requests (63 %) were for continuation of opioid therapy. Diagnoses were obtained at the time of the visit and grouped as: Spinal disorders including neck and back pain 110 patients (55%), Musculoskeletal pain or other unspecified joint pain 44 (22%), Non-diabetic neuropathic pain 20 (10%), Osteoarthritis or degenerative arthritis 9 (4%), Fibromyalgia or chronic fatigue syndrome 5 (2%), Migraine or other chronic headache 4 (2%), Rheumatoid arthritis 2 (1%), Diabetic neuropathy 2 (1%), Pain related to cancer 10 (5%) and Other 33 (16%). In 2 patients (1%) the pain diagnosis was not recorded. Forty-two patients reported more than 1 pain diagnosis with a majority having a combination of Spinal disorders and musculoskeletal pain. One hundred and twenty eight patients had abnormal toxicology results and 128 patients were stratified as high risk. Forty-eight patients (24%) were on methadone for pain or for maintenance. Treatment recommendations were continuation of current treatment in 84 patients (42%); methadone 17 (8%), opioids 4 (2%) or nonopioids for pain 51 (25%); discharge 13 (6%) and psychiatric treatment in 9 (4%). While rehab/detox was recommended in 60 patients, only 23 agreed.
(535) Functional disability, anxiety, and depression in chronic pediatric headache patients A Caruso, J Rabner, E Mahoney, A McCarthy, L Lazdowsky, and A LeBel; Boston Children’s Hospital, Waltham, MA Chronic pediatric headache is becoming an increasingly prevalent pain condition in children and adolescents in the United States. It is often associated with impairment in daily functioning, including school attendance and activity limitations.1 Few studies have examined the relationship between anxiety, depression and functional disability in chronic headache patients. In pediatric patients with abdominal pain, depression predicted functional disability.2 In adults, depression and comorbid anxiety were found to be the strongest predictors of dysfunction.3 Prior research on the pediatric headache population has resulted in inconclusive evidence. Significant positive correlations between depressive symptoms and functional disability have been found in children, but not in adolescents.4 Additionally, there are no studies examining this relationship for specific headache diagnoses. This study aims to investigate the potential associations between functional disability and chronic head pain in pediatric patients. Analysis will look at possible moderation of this relationship between pain scores, child anxiety, child depression, parental protective and encouraging responses, and parental pain catastrophizing. Participants include 500 new patients (66.1% female) from the Pediatric Headache Program (PHP) at Boston Children’s Hospital who underwent initial evaluation with a neurologist, pain psychologist, and nurse for chronic head pain. Of the patients evaluated at the PHP, 31.2% were diagnosed with migraine, 17.8% with tension-type headache, and 9.20% with new daily persistent headache. Prior to the visit, patients completed the Functional Disability Inventory (FDI), the Revised Child Manifest Anxiety Scale (RCMAS), and the Child Depression Inventory (CDI) questionnaires, and their parents completed the Adult Response to Children’s Symptoms (ARCS) and the Pain Catastrophizing Scale (PCS) questionnaires. Analysis of these associations is currently underway. (1. Hershey et al., Neurology, 2001; 2. Wendland, et al., Child: Care, Health and Development, 2010; 3. Spijker et al., Acta Psychiatrica Scandinavica, 2004; 4. Lewandowski et al., Headache, 2006.)
(532) Implications of pain interference on restoration of physical function for people with chronic pain N Karayannis, M Kao, R Prasad, C Cooley, and S Mackey; Stanford University, Palo Alto, CA The Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) item bank and Pain Interference (PI) item bank in the chronic pain population are conceptually similar domains. We leveraged the learning health care system platform Collaborative Health Outcomes Information Registry (CHOIR) at our institution to characterize their relationships. As part of routine clinical care, patients seen at an academic medical center were enrolled in CHOIR and their PF and PI assessed using computer adaptive testing algorithm. Our previous cross-sectional data of 3,257 chronic pain patients seeking healthcare at a specialty pain management center demonstrated that PF was strongly correlated with lower PI (r=-0.64). This current study aimed to longitudinally examine the outcomes of PF and PI over the course of a 90-day time period of treatment. In total, 693 new patients with at least 3 follow-up treatments within a 90-day time period were considered. Of these, only 167 patients (24%) had both improved PF and PI at the 4th follow-up compared to the 1st visit. The mean improvements at follow-ups are 3.2, 4.7, and 6.1 for PF, respectively; and 3.9, 6.0, and 8.0 for PI, respectively. There was a statistically significant but small correlation between improvements in PF and PI at each time point (R2 0.22, 0.28, and 0.18; p<0.001). These data suggests divergence between these two domains and their differential natural course in the chronic pain population. Further lagged correlation analysis revealed that changes in PI at the first follow-up predicts changes in PF at second follow-up (beta=0.4 on PROMIS scale; R2 0.21; p<0.001). Future studies will focus on the distinction and time course in improvement in these two domains.
(533) Functional restoration in a military chronic pain population: first year outcomes from the SAMMC Functional Restoration Program L Sussman, J Clapp, B Keizer, H Gill, J Boge, and B Goff; San Antonio Military Medical Center, Fort Sam Houston, TX Historically, management of loss of function due to chronic pain in the military has focused on interventional and medical treatment modalities. Recent attention has been given to interdisciplinary care for Service Members with chronic pain conditions. Functional Restoration Programs (FRPs) have been shown to be effective in the civilian sector but until recently have not been employed in military medicine. The San Antonio Military Medical Center (SAMMC) FRP is a 3 week, 8 hour per day program aimed at restoring physical and psychological function to Service Members who have been injured during their military careers. The proposed poster is a presentation of the physical and psychological outcomes for the first year of the program. Service Members (SM) were selected for the FRP by physician referral and evaluation by a psychologist and physical therapist. The program consists of 4 hours of therapist guided group exercise and 3 hours of pain management education and skills training per day. Standardized instruments measuring pain, disability, fear avoidance, catastrophizing, depression, and anxiety were administered. The physical evaluation includes cervical and lumbar maximum lift, total power, 3 min step test, grip strength, balance, and progressive isoinertial lift. Pre-post measures for each test were compared. Early results, while not statistically meaningful due to the small sample (n=14) were presented at the 2014 Military Health System Research Symposium and revealed clinically meaningful changes in pain intensity (6.5/10 to 4.5/10) and pain interference in life activities. All other preliminary measures showed improvement, to include physical measures of cervical and lumbar max lift (139% and 219% increase respectively), balance, and progressive isoinertial lift. All preliminary results pointed toward measureable gains in function. The proposed poster will present new data accumulated after a year of running the program. The sample size should be large enough at that time to allow for meaningful statistical analysis.
The Journal of Pain
S109
(534) A novel strategy to improve opioid prescribing safety in chronic pain patients: evaluation by addiction psychiatry fellow rotators W Ko, R Slowik, S Burns, K Krivy, C Maxwell, C Perkel, and R Cruciani; Department of Psychiatry, Beth Israel Medical Center, New York City, NY The goal of the evaluation was to assist pain providers with safe opioid prescribing. 95% of the consultations were requested by the pain fellows and NPs. Seven addiction Psychiatry fellows evaluated opioid prescribing risk in chronic pain patients at the Pain Clinic, Beth Israel Medical Center, an academic center. This one time evaluation was performed as part of their training in a once a week ½ a day session. The Chief of the Pain Division and the Director of the Addiction Psychiatry Fellowship supervised the evaluations. Two hundred and two patients were evaluated; 80 were female; age range 26 to 72 years (mean 52). Most evaluation requests (63 %) were for continuation of opioid therapy. Diagnoses were obtained at the time of the visit and grouped as: Spinal disorders including neck and back pain 110 patients (55%), Musculoskeletal pain or other unspecified joint pain 44 (22%), Non-diabetic neuropathic pain 20 (10%), Osteoarthritis or degenerative arthritis 9 (4%), Fibromyalgia or chronic fatigue syndrome 5 (2%), Migraine or other chronic headache 4 (2%), Rheumatoid arthritis 2 (1%), Diabetic neuropathy 2 (1%), Pain related to cancer 10 (5%) and Other 33 (16%). In 2 patients (1%) the pain diagnosis was not recorded. Forty-two patients reported more than 1 pain diagnosis with a majority having a combination of Spinal disorders and musculoskeletal pain. One hundred and twenty eight patients had abnormal toxicology results and 128 patients were stratified as high risk. Forty-eight patients (24%) were on methadone for pain or for maintenance. Treatment recommendations were continuation of current treatment in 84 patients (42%); methadone 17 (8%), opioids 4 (2%) or nonopioids for pain 51 (25%); discharge 13 (6%) and psychiatric treatment in 9 (4%). While rehab/detox was recommended in 60 patients, only 23 agreed.
(535) Functional disability, anxiety, and depression in chronic pediatric headache patients A Caruso, J Rabner, E Mahoney, A McCarthy, L Lazdowsky, and A LeBel; Boston Children’s Hospital, Waltham, MA Chronic pediatric headache is becoming an increasingly prevalent pain condition in children and adolescents in the United States. It is often associated with impairment in daily functioning, including school attendance and activity limitations.1 Few studies have examined the relationship between anxiety, depression and functional disability in chronic headache patients. In pediatric patients with abdominal pain, depression predicted functional disability.2 In adults, depression and comorbid anxiety were found to be the strongest predictors of dysfunction.3 Prior research on the pediatric headache population has resulted in inconclusive evidence. Significant positive correlations between depressive symptoms and functional disability have been found in children, but not in adolescents.4 Additionally, there are no studies examining this relationship for specific headache diagnoses. This study aims to investigate the potential associations between functional disability and chronic head pain in pediatric patients. Analysis will look at possible moderation of this relationship between pain scores, child anxiety, child depression, parental protective and encouraging responses, and parental pain catastrophizing. Participants include 500 new patients (66.1% female) from the Pediatric Headache Program (PHP) at Boston Children’s Hospital who underwent initial evaluation with a neurologist, pain psychologist, and nurse for chronic head pain. Of the patients evaluated at the PHP, 31.2% were diagnosed with migraine, 17.8% with tension-type headache, and 9.20% with new daily persistent headache. Prior to the visit, patients completed the Functional Disability Inventory (FDI), the Revised Child Manifest Anxiety Scale (RCMAS), and the Child Depression Inventory (CDI) questionnaires, and their parents completed the Adult Response to Children’s Symptoms (ARCS) and the Pain Catastrophizing Scale (PCS) questionnaires. Analysis of these associations is currently underway. (1. Hershey et al., Neurology, 2001; 2. Wendland, et al., Child: Care, Health and Development, 2010; 3. Spijker et al., Acta Psychiatrica Scandinavica, 2004; 4. Lewandowski et al., Headache, 2006.)