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552 RESULTS OF RUSSIAN EPIDEMIOLOGICAL STUDY OF NEUROPATHIC PAIN (NEP) PREVALENCE AMONG PATIENTS APPLYING FOR NEUROLOGICAL CARE (EPIC)
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Poster Sessions / European Journal of Pain 13 (2009) S55–S285
Methods: In a pan-European study, the per protocol set comprised 88 patients with PHN and 193 patients with painful DPN, randomized to lidocaine plaster or oral pregabalin (titrated to effect: 300 or 600 mg/day). Primary efficacy endpoint was a ≥ 2 point reduction from baseline in NRS-3 or an overall score of ≤ 4 after 4 weeks’ treatment. Results: For PHN, higher response rates were observed for lidocaine plaster (61.2%;28/45) than for pregabalin (46.5%;20/43). For DPN, response rates were comparable for both treatment groups (lidocaine plaster: 66.7%;66/99; pregabalin: 69.1%;65/94). As expected, painful allodynia was more frequent with PHN compared to DPN at Baseline. Improvement in patients with PHN was statistically significant for lidocaine plaster, but not for pregabalin. Patients with DPN showed comparable improvement for both treatments. Significantly fewer patients in the lidocaine plaster group experienced drug-related adverse events: 5.8% (9/155) versus 41.2% (63/153; p < 0.0001). Overall, 36 pregabalin patients experienced drug-related adverse events leading to discontinuation, compared with 4 for lidocaine plaster. Conclusions: 5% lidocaine medicated plaster showed higher efficacy than pregabalin in patients with PHN. For DPN, efficacy was comparable for both treatments. 5% lidocaine medicated plaster showed a favourable efficacy/safety profile compared to pregabalin in patients with PHN or painful DPN supporting its first line position in the treatment of focal neuropathic pain. Funded by Grunenthal ¨ 551 NEURODIAGNOSTIC SKIN BIOPSY AND LASER-EVOKED POTENTIALS IN THE DIAGNOSIS OF DEAFFERENTATION PAIN FOLLOWING BRACHIAL PLEXUS INJURY: A CASE REPORT M. Buonocore *, A. Gatti, A. Bodini, G. Amato, C. Bonezzi. Fondazione Salvatore Maugeri, Scientific Institute of Pavia, Pavia, Italy Background and Aims: Physiopathological diagnosis of pain in patients with brachial plexus injury (BPI) is generally difficult. The association between Neurodiagnostic Skin Biopsy (NSB) and Laser-Evoked Potentials (LEPs) could improve the diagnosis of deafferentation pain. Methods: We describe the case of a 34-year-old male patient who complained of chronic, spontaneous pain in the left ulnar side of hand and forearm, following BPI. In the painful area and in the contralateral, mirror skin: 1) the tactile, pin-prick and warm sensations were investigated using respectively a soft brush, a needle, and a thermal roller (40º C); 2) the A-delta fibre pathways were assessed by YAP LEPs; 3) the epidermal innervation was evaluated by NSB using indirect immunofluorescence and a double staining with Protein Gene Product (PGP 9.5) and type IV collagen (Col IV). Results: The results showed, in the painful area: 1) anesthesia to tactile, pinprick and warm stimuli; 2) absence of LEPs; 3) reduction, but not loss, of the epidermal innervation (3.0 fibres/mm). Conclusion: The case reported here describes a typical pattern of “anaesthesia dolorosa”. The concomitance in the painful area of: 1) anaesthesia, 2) absence of the correspondent LEP and 3) reduced, but not lost, epidermal innervation, is suggestive for a mainly preganglionic damage of cervical roots (avulsion). This kind of lesion is the most important characteristic of deafferentation pain following BPI. Further studies, in larger populations, are needed.
552 RESULTS OF RUSSIAN EPIDEMIOLOGICAL STUDY OF NEUROPATHIC PAIN (NEP) PREVALENCE AMONG PATIENTS APPLYING FOR NEUROLOGICAL CARE (EPIC) N. Yakhno1 , M. Kukushkin2 , O. Davidov3 *, A. Danilov4 , A. Amelin5 , V. Alexeev1 , I. Strokov1 , S. Kulikov6 . 1 Neurology Clinic, Moscow Medical Academy named after I.M. Sechenov, Moscow, Russia; 2 Algology Department, Scientific Research institute of General Pathology and Pathophysiology, Moscow, Russia; 3 Pfizer International LLC, Moscow, Russia; 4 Department of Postgraduate Education in Neurology, Moscow Medical Academy named after I.M. Sechenov, Moscow, Russia; 5 Department of Neurology and Neurosurgery, Saint-Petersburg Medical University named after I.P. Pavlov, Saint-Petersburg, Russia; 6 Biostatistical Department, Hematological Scientific Center, Moscow, Russia Aim: Recent epidemiological studies show steady growth of the number of patients suffering from NeP. The aim of the study was to evaluate prevalence of NeP among outpatient neurologists in the Russian Federation. Methods: 322 outpatient neurologists from 18 cities of Russia participated. Within 30 days, they registered all patients applied for care. For patients complaining of pain, the questionnaire DN4 was filled in. Patients with NeP, confirmed by DN4, underwent detailed questioning. Results: In total, 85,923 patients applied for neurological care were registered. 33,664 had complaints about pain (39% from total group). NeP according to DN4 questionnaire was revealed in 15,301 patients (17.8% from total group, 45.4% from patients with pain). The most frequent NeP states were low back and neck pain, diabetic polyneuropathy, trigeminal and post-herpetic neuralgia. Average pain intensity ranged from 5 to 7.2 points on the VAS. Comparative analysis of types of NeP treatment before a primary visit and of treatment planned further showed clear tendency to a decrease of the number of cases when analgesics (from 49 to 22%) and NSAIDs (from 67 to 52%) were administered and an increase of the proportion of patients, for whom it is planned to prescribe anticonvulsants (from 14 to 67%) and antidepressants (from 17 to 56%). Conclusion: Results of Russian epidemiological study support data about wide-spread prevalence of NeP, characterized by prolonged duration and high pain intensity in patients with neurological illnesses. Conversely, pattern of pharmacological treatment is still far from ideal with tendency to improve. The study was supported by independent research grant from Pfizer International LLC. 553 THE EVALUATION OF PERIPHERAL NERVE BLOCKS WITH STEROIDS IN THE MANAGEMENT OF ACUTE AND CHRONIC NEUROPATHIC PAIN DUE TO TRAUMA H.E. Eker1 *, O. Yalcin Cok1 , A. Aribogan1 , G. Arslan2 . 1 Baskent University Teaching and Research Hospital Department of Anesthesiology, Adana, Turkey; 2 Baskent University Ankara Teaching and Research Hospital Department of Anesthesiology, Ankara, Turkey Background and Aims: The steroids provide pain relief in 65–73% of patients with neuropathic pain following nerve injury by decreasing ectopic neuronal discharge, release of local neuroinflammatory mediators, and stabilizing effect on neuronal membrane. Peripheral nerve blocks with steroids performed at the proximal of injury may be effective in decreasing severity of pain. In this study, we evaluated the efficiency of peripheral nerve blocks with steroids in the management of acute and chronic neuropathic pain due to trauma. Method: Patients were enrolled into two groups according to duration of symptoms; symptoms existed for < 3 months in Group I (n = 22) and ≥ 3 months in Group II (n = 22). Demographic data, initial pain scores (VAS0), accompanying
Poster Sessions / European Journal of Pain 13 (2009) S55–S285
Methods: In a pan-European study, the per protocol set comprised 88 patients with PHN and 193 patients with painful DPN, randomized to lidocaine plaster or oral pregabalin (titrated to effect: 300 or 600 mg/day). Primary efficacy endpoint was a ≥ 2 point reduction from baseline in NRS-3 or an overall score of ≤ 4 after 4 weeks’ treatment. Results: For PHN, higher response rates were observed for lidocaine plaster (61.2%;28/45) than for pregabalin (46.5%;20/43). For DPN, response rates were comparable for both treatment groups (lidocaine plaster: 66.7%;66/99; pregabalin: 69.1%;65/94). As expected, painful allodynia was more frequent with PHN compared to DPN at Baseline. Improvement in patients with PHN was statistically significant for lidocaine plaster, but not for pregabalin. Patients with DPN showed comparable improvement for both treatments. Significantly fewer patients in the lidocaine plaster group experienced drug-related adverse events: 5.8% (9/155) versus 41.2% (63/153; p < 0.0001). Overall, 36 pregabalin patients experienced drug-related adverse events leading to discontinuation, compared with 4 for lidocaine plaster. Conclusions: 5% lidocaine medicated plaster showed higher efficacy than pregabalin in patients with PHN. For DPN, efficacy was comparable for both treatments. 5% lidocaine medicated plaster showed a favourable efficacy/safety profile compared to pregabalin in patients with PHN or painful DPN supporting its first line position in the treatment of focal neuropathic pain. Funded by Grunenthal ¨ 551 NEURODIAGNOSTIC SKIN BIOPSY AND LASER-EVOKED POTENTIALS IN THE DIAGNOSIS OF DEAFFERENTATION PAIN FOLLOWING BRACHIAL PLEXUS INJURY: A CASE REPORT M. Buonocore *, A. Gatti, A. Bodini, G. Amato, C. Bonezzi. Fondazione Salvatore Maugeri, Scientific Institute of Pavia, Pavia, Italy Background and Aims: Physiopathological diagnosis of pain in patients with brachial plexus injury (BPI) is generally difficult. The association between Neurodiagnostic Skin Biopsy (NSB) and Laser-Evoked Potentials (LEPs) could improve the diagnosis of deafferentation pain. Methods: We describe the case of a 34-year-old male patient who complained of chronic, spontaneous pain in the left ulnar side of hand and forearm, following BPI. In the painful area and in the contralateral, mirror skin: 1) the tactile, pin-prick and warm sensations were investigated using respectively a soft brush, a needle, and a thermal roller (40º C); 2) the A-delta fibre pathways were assessed by YAP LEPs; 3) the epidermal innervation was evaluated by NSB using indirect immunofluorescence and a double staining with Protein Gene Product (PGP 9.5) and type IV collagen (Col IV). Results: The results showed, in the painful area: 1) anesthesia to tactile, pinprick and warm stimuli; 2) absence of LEPs; 3) reduction, but not loss, of the epidermal innervation (3.0 fibres/mm). Conclusion: The case reported here describes a typical pattern of “anaesthesia dolorosa”. The concomitance in the painful area of: 1) anaesthesia, 2) absence of the correspondent LEP and 3) reduced, but not lost, epidermal innervation, is suggestive for a mainly preganglionic damage of cervical roots (avulsion). This kind of lesion is the most important characteristic of deafferentation pain following BPI. Further studies, in larger populations, are needed.
552 RESULTS OF RUSSIAN EPIDEMIOLOGICAL STUDY OF NEUROPATHIC PAIN (NEP) PREVALENCE AMONG PATIENTS APPLYING FOR NEUROLOGICAL CARE (EPIC) N. Yakhno1 , M. Kukushkin2 , O. Davidov3 *, A. Danilov4 , A. Amelin5 , V. Alexeev1 , I. Strokov1 , S. Kulikov6 . 1 Neurology Clinic, Moscow Medical Academy named after I.M. Sechenov, Moscow, Russia; 2 Algology Department, Scientific Research institute of General Pathology and Pathophysiology, Moscow, Russia; 3 Pfizer International LLC, Moscow, Russia; 4 Department of Postgraduate Education in Neurology, Moscow Medical Academy named after I.M. Sechenov, Moscow, Russia; 5 Department of Neurology and Neurosurgery, Saint-Petersburg Medical University named after I.P. Pavlov, Saint-Petersburg, Russia; 6 Biostatistical Department, Hematological Scientific Center, Moscow, Russia Aim: Recent epidemiological studies show steady growth of the number of patients suffering from NeP. The aim of the study was to evaluate prevalence of NeP among outpatient neurologists in the Russian Federation. Methods: 322 outpatient neurologists from 18 cities of Russia participated. Within 30 days, they registered all patients applied for care. For patients complaining of pain, the questionnaire DN4 was filled in. Patients with NeP, confirmed by DN4, underwent detailed questioning. Results: In total, 85,923 patients applied for neurological care were registered. 33,664 had complaints about pain (39% from total group). NeP according to DN4 questionnaire was revealed in 15,301 patients (17.8% from total group, 45.4% from patients with pain). The most frequent NeP states were low back and neck pain, diabetic polyneuropathy, trigeminal and post-herpetic neuralgia. Average pain intensity ranged from 5 to 7.2 points on the VAS. Comparative analysis of types of NeP treatment before a primary visit and of treatment planned further showed clear tendency to a decrease of the number of cases when analgesics (from 49 to 22%) and NSAIDs (from 67 to 52%) were administered and an increase of the proportion of patients, for whom it is planned to prescribe anticonvulsants (from 14 to 67%) and antidepressants (from 17 to 56%). Conclusion: Results of Russian epidemiological study support data about wide-spread prevalence of NeP, characterized by prolonged duration and high pain intensity in patients with neurological illnesses. Conversely, pattern of pharmacological treatment is still far from ideal with tendency to improve. The study was supported by independent research grant from Pfizer International LLC. 553 THE EVALUATION OF PERIPHERAL NERVE BLOCKS WITH STEROIDS IN THE MANAGEMENT OF ACUTE AND CHRONIC NEUROPATHIC PAIN DUE TO TRAUMA H.E. Eker1 *, O. Yalcin Cok1 , A. Aribogan1 , G. Arslan2 . 1 Baskent University Teaching and Research Hospital Department of Anesthesiology, Adana, Turkey; 2 Baskent University Ankara Teaching and Research Hospital Department of Anesthesiology, Ankara, Turkey Background and Aims: The steroids provide pain relief in 65–73% of patients with neuropathic pain following nerve injury by decreasing ectopic neuronal discharge, release of local neuroinflammatory mediators, and stabilizing effect on neuronal membrane. Peripheral nerve blocks with steroids performed at the proximal of injury may be effective in decreasing severity of pain. In this study, we evaluated the efficiency of peripheral nerve blocks with steroids in the management of acute and chronic neuropathic pain due to trauma. Method: Patients were enrolled into two groups according to duration of symptoms; symptoms existed for < 3 months in Group I (n = 22) and ≥ 3 months in Group II (n = 22). Demographic data, initial pain scores (VAS0), accompanying