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555 A RETROSPECTIVE STUDY OF THE ETIOPATHOGENESIS & TREATMENT PROFILE IN METASTATIC BONE PAIN
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European Journal of Pain 2006, Vol 10 (suppl S1)
553 INTERVENTIONAL PAIN THERAPY IN PALLIATIVE CARE: A CASE SERIES M. Escher1 ° , A. Cahana2 , L. Robert2 , S. Pautex3 . 1 Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, 2 Interventional Pain Program, Division of Anesthesiology, Geneva University Hospitals, Geneva, 3 Pain and Palliative Care Consultation, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland Adequate pain control is achieved in most cancer patients. In complex situations interventional pain therapies offer new alternatives. Their place in palliative care is yet to be defined. Methods: chart review of all the cancer patients hospitalised in the Geneva University Hospitals since 2001, referred to a mobile palliative care team and the interventional pain team, who had a spinal catheter (SpC) inserted. Results: 14 patients, mean age 57±11 years, were included. Pain was due to bone metastasis (n = 9), peritoneal carcinomatosis (n = 3), visceral tumor (n = 1), and Pancoast syndrome (n = 1). Before SpC, all the patients had systemic opioids (mean oral morphine equivalent daily dose [MEDD] 917 mg (120–4200 mg)), 10 received anticonvulsant drugs for neuropathic pain, 7 had corticosteroids, and 1 NSAIDS. The reason for SpC was uncontrolled pain in 12 patients and unacceptable side effects in 2. All the patients had better pain control after SpC but ten of them experienced major anxiety. All the patients but one died during the hospital stay, a median of 34 days (7 to 103 days) after SpC. At the time of death 11 patients had systemic opioids (mean oral MEDD 1081 mg (20–3900 mg)), 9 received anticonvulsant drugs, 10 corticosteroids, and 1 NSAIDS. Conclusion: cancer patients had a spinal catheter inserted in the terminal phase of their illness. Although all experienced relief from pain, most still needed high doses of opioids. Anxiety emerged as a major concern. Prospective studies to better evaluate the role of interventional pain management in palliative care are needed.
554 A NEW METHOD FOR EPIDURAL CATHETER FIXATION N. Gulcu ° , K. Karaaslan, H. Kocoglu, E. Gumus. Abant Izzet Baysal University, Izzet Baysal Medical Faculty, Bolu, Turkey Background and Aims: The migration of the epidurale catheter can inconvenience both the anesthetist and patients. We describe a fixation method of epidural catheter that relies on a port obtained from a flexible intravenous catheter. Methods: The medication port of a flexible iv bag (Mediflex, EczacıbasıBaxter, Turkey) was cut to 1 cm in length distally (fig 1 a). The external transparent and stiff cover (produced by ployvinile chloride) was removed (fig 1 b). Therefore two tubes inserted into each other were obtained (fig 1 c). Then the part of soft and dark yellow named ‘stopper’ was retracted and used to obtain a fixator. It was extended to get final form as a tube of different diameters at both ends and filled in the middle section. After epidural catheter was inserted using an Epidural Minipack (SIMS Portex Ltd., Hythe, UK), the tuohy needle was advanced through into this soft tube. The end of the epidural catheter was placed inside the tuohy needle (fig 1 d). When the tuohy needle was removed, the catheter was placed into the tube. Finally the tube was cut at both ends to obtain four wings (fig 1 e). These wings were used for securing sutures.
Abstracts, 5th EFIC Congress, Free Presentations Conclusions: The simplicity, comfort, low-cost, durability in wet conditions are the advantages of this method. The sutured technique provided protection against migration.
555 A RETROSPECTIVE STUDY OF THE ETIOPATHOGENESIS & TREATMENT PROFILE IN METASTATIC BONE PAIN P.N. Jain ° , A. Ramavat, A. Chatterjee, R. Sareen. Dept of Anaesthesiology, Tata memorial Hospital, Mumbai, India Metastasis of cancer to bone is known to produce pain of moderate to severe intensity that is difficult to control with routine analgesics. The pain worsens with movement & positioning or may sponteneously occur at rest. An accurate assessment of the cause and the mechanism of the pain go a long way in the effective management of such pain. The Pain clinic at Tata Memorial Hospital, Mumbai received 910 new patients between april 2005 & April 2006. With the aim to identify the incidence, etiopathogenesis & the treatment profile of patients with metastatic bone disease, we retrospectively analyzed the data. One hundred and twelve of the 910 patients presented with metastatic bone pain of moderate to severe intensity (PS > 5 on a 0−10 VAS). The incidence of metastatic bone disease was higher in patients with carcinoma of breast, lung, kidney & prostate (74/112). Imaging methods e.g. bone scan (49/112), CT scan (44/112), MRI (25/112), X-rays (15/112) were used. A multidisciplinary approach comprising of radiotherapy (74/112), analgesics and bisphosphonates (37/112) were employed to relieve pain. Oral analgesics e.g. opioids (81/112), NSAIDS (112/112), and co-analgesics like tricyclic antidepressants (89/112) & corticosteroids (42/112) used. The Karnofsky score ranged 50−70% (97/112). Conclusion: Bone metastasis pain is a refractory type of pain unresponsive to routine analgesics. Multimodal approach is employed for optimum pain relief.
556 KNOWLEDGE AND ATTITUDES OF ONCOLOGY NURSES ABOUT PAIN MANAGEMENT Y. Kuzeyli Yildirim1 ° , C. Fadiloglu1 , M. Uyar2 . 1 Department of Internal Medicine Nursing, Ege University Nursing School, Izmir, 2 Department of Algology, Ege University School of Medicine, Izmir, Turkey Purpose: Effective pain management requires accurate knowledge, attitudes and assessment skills. The purpose of the study was to examine information about the knowledge and attitudes of oncology nurses’ concerning cancer pain management. Methods: The sample of study consisted of sixty seven oncology nurses employed in oncology and hematology units in two university hospitals located in Izmir, Turkey. Ferrell’s Nurses’ Knowledge and Attitudes Survey Regarding Pain (NKASRP) was used to measure nurses’ pain management knowledge and attitudes. Data were analyzed by using descriptive statistics, t test, Kruskal Wallis analysis, and Pearson’s correlation test. Results: Of the nurses that participating in the study, 57.4% were between the ages of 21 and 30 years, 58.8% were unmarried and 55.9% had an associate degree. The average correct response rate was 35.41%, with rates ranging from 5.13−56.41% for each survey question. Among the 39 pain knowledge questions assessed, the mean number of correctly answered questions was 13.81±5.02, with a range of 2 to 22 items correctly answered. When the knowledge scores were further analyzed by nurses’ background characteristics, nurses’ pain knowledge was only positively correlated to length of working experience in oncology units (r = 0.263, P < 0.05). Conclusions: This findings of our study support the concern of inadequate knowledge and attitudes in relation to cancer pain management. We believed that basic and continuing education programme may improve knowledge level of nursing about pain management. Continued research is needed to document improvements in pain management by nurses.
European Journal of Pain 2006, Vol 10 (suppl S1)
553 INTERVENTIONAL PAIN THERAPY IN PALLIATIVE CARE: A CASE SERIES M. Escher1 ° , A. Cahana2 , L. Robert2 , S. Pautex3 . 1 Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, 2 Interventional Pain Program, Division of Anesthesiology, Geneva University Hospitals, Geneva, 3 Pain and Palliative Care Consultation, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland Adequate pain control is achieved in most cancer patients. In complex situations interventional pain therapies offer new alternatives. Their place in palliative care is yet to be defined. Methods: chart review of all the cancer patients hospitalised in the Geneva University Hospitals since 2001, referred to a mobile palliative care team and the interventional pain team, who had a spinal catheter (SpC) inserted. Results: 14 patients, mean age 57±11 years, were included. Pain was due to bone metastasis (n = 9), peritoneal carcinomatosis (n = 3), visceral tumor (n = 1), and Pancoast syndrome (n = 1). Before SpC, all the patients had systemic opioids (mean oral morphine equivalent daily dose [MEDD] 917 mg (120–4200 mg)), 10 received anticonvulsant drugs for neuropathic pain, 7 had corticosteroids, and 1 NSAIDS. The reason for SpC was uncontrolled pain in 12 patients and unacceptable side effects in 2. All the patients had better pain control after SpC but ten of them experienced major anxiety. All the patients but one died during the hospital stay, a median of 34 days (7 to 103 days) after SpC. At the time of death 11 patients had systemic opioids (mean oral MEDD 1081 mg (20–3900 mg)), 9 received anticonvulsant drugs, 10 corticosteroids, and 1 NSAIDS. Conclusion: cancer patients had a spinal catheter inserted in the terminal phase of their illness. Although all experienced relief from pain, most still needed high doses of opioids. Anxiety emerged as a major concern. Prospective studies to better evaluate the role of interventional pain management in palliative care are needed.
554 A NEW METHOD FOR EPIDURAL CATHETER FIXATION N. Gulcu ° , K. Karaaslan, H. Kocoglu, E. Gumus. Abant Izzet Baysal University, Izzet Baysal Medical Faculty, Bolu, Turkey Background and Aims: The migration of the epidurale catheter can inconvenience both the anesthetist and patients. We describe a fixation method of epidural catheter that relies on a port obtained from a flexible intravenous catheter. Methods: The medication port of a flexible iv bag (Mediflex, EczacıbasıBaxter, Turkey) was cut to 1 cm in length distally (fig 1 a). The external transparent and stiff cover (produced by ployvinile chloride) was removed (fig 1 b). Therefore two tubes inserted into each other were obtained (fig 1 c). Then the part of soft and dark yellow named ‘stopper’ was retracted and used to obtain a fixator. It was extended to get final form as a tube of different diameters at both ends and filled in the middle section. After epidural catheter was inserted using an Epidural Minipack (SIMS Portex Ltd., Hythe, UK), the tuohy needle was advanced through into this soft tube. The end of the epidural catheter was placed inside the tuohy needle (fig 1 d). When the tuohy needle was removed, the catheter was placed into the tube. Finally the tube was cut at both ends to obtain four wings (fig 1 e). These wings were used for securing sutures.
Abstracts, 5th EFIC Congress, Free Presentations Conclusions: The simplicity, comfort, low-cost, durability in wet conditions are the advantages of this method. The sutured technique provided protection against migration.
555 A RETROSPECTIVE STUDY OF THE ETIOPATHOGENESIS & TREATMENT PROFILE IN METASTATIC BONE PAIN P.N. Jain ° , A. Ramavat, A. Chatterjee, R. Sareen. Dept of Anaesthesiology, Tata memorial Hospital, Mumbai, India Metastasis of cancer to bone is known to produce pain of moderate to severe intensity that is difficult to control with routine analgesics. The pain worsens with movement & positioning or may sponteneously occur at rest. An accurate assessment of the cause and the mechanism of the pain go a long way in the effective management of such pain. The Pain clinic at Tata Memorial Hospital, Mumbai received 910 new patients between april 2005 & April 2006. With the aim to identify the incidence, etiopathogenesis & the treatment profile of patients with metastatic bone disease, we retrospectively analyzed the data. One hundred and twelve of the 910 patients presented with metastatic bone pain of moderate to severe intensity (PS > 5 on a 0−10 VAS). The incidence of metastatic bone disease was higher in patients with carcinoma of breast, lung, kidney & prostate (74/112). Imaging methods e.g. bone scan (49/112), CT scan (44/112), MRI (25/112), X-rays (15/112) were used. A multidisciplinary approach comprising of radiotherapy (74/112), analgesics and bisphosphonates (37/112) were employed to relieve pain. Oral analgesics e.g. opioids (81/112), NSAIDS (112/112), and co-analgesics like tricyclic antidepressants (89/112) & corticosteroids (42/112) used. The Karnofsky score ranged 50−70% (97/112). Conclusion: Bone metastasis pain is a refractory type of pain unresponsive to routine analgesics. Multimodal approach is employed for optimum pain relief.
556 KNOWLEDGE AND ATTITUDES OF ONCOLOGY NURSES ABOUT PAIN MANAGEMENT Y. Kuzeyli Yildirim1 ° , C. Fadiloglu1 , M. Uyar2 . 1 Department of Internal Medicine Nursing, Ege University Nursing School, Izmir, 2 Department of Algology, Ege University School of Medicine, Izmir, Turkey Purpose: Effective pain management requires accurate knowledge, attitudes and assessment skills. The purpose of the study was to examine information about the knowledge and attitudes of oncology nurses’ concerning cancer pain management. Methods: The sample of study consisted of sixty seven oncology nurses employed in oncology and hematology units in two university hospitals located in Izmir, Turkey. Ferrell’s Nurses’ Knowledge and Attitudes Survey Regarding Pain (NKASRP) was used to measure nurses’ pain management knowledge and attitudes. Data were analyzed by using descriptive statistics, t test, Kruskal Wallis analysis, and Pearson’s correlation test. Results: Of the nurses that participating in the study, 57.4% were between the ages of 21 and 30 years, 58.8% were unmarried and 55.9% had an associate degree. The average correct response rate was 35.41%, with rates ranging from 5.13−56.41% for each survey question. Among the 39 pain knowledge questions assessed, the mean number of correctly answered questions was 13.81±5.02, with a range of 2 to 22 items correctly answered. When the knowledge scores were further analyzed by nurses’ background characteristics, nurses’ pain knowledge was only positively correlated to length of working experience in oncology units (r = 0.263, P < 0.05). Conclusions: This findings of our study support the concern of inadequate knowledge and attitudes in relation to cancer pain management. We believed that basic and continuing education programme may improve knowledge level of nursing about pain management. Continued research is needed to document improvements in pain management by nurses.