- Email: [email protected]
(713)
Abstracts
S29
C12 - Pain in the Elderly
C14 - Postherpetic Neuralgia
(712) Predictors of patterns of pain, fatigue and insomnia in the elderly during the first year following a cancer diagnosis
(714) Immunochemical characteristics of cutaneous innervation in patients with severe Post Herpetic Neuralgia: A case-control study
S Kozachik, K Bandeen-Roche, V Mock; Johns Hopkins University, Baltimore, MD Pain, fatigue and insomnia (PFI) are among the most prevalent, distressing, and under managed symptoms experienced by cancer patients. Research has demonstrated that PFI co-occur; what remains unclear are the patterning and stability of PFI patterns, and the patient, disease and treatment characteristics that predict PFI patterns over time. Specifically, do patient age, sex, comorbidity, cancer site or stage, or treatment regimen predict patterns of PFI and their changes over time? This study was a secondary analysis of a dataset comprised of 867 elders (46% female) who were newly diagnosed with breast (27%), colorectal (18%), lung (26%) or prostate (29%) cancer and followed at 6-8, 12-16, 24 and 52 weeks following diagnosis. The Johns Hopkins Medicine IRB approved this study. Measures included sociodemographics, comorbidity, and symptoms; medical record audits confirmed cancer and treatment. Descriptive statistics and multi-state transition models using multinomial logistic regression were employed. The typical participant was 72.6 years, Caucasian, married/living with spouse, and reported 7.9 symptoms and 2.7 comorbidities. Attrition numbered 255 (death, n ⫽ 88; lost to follow-up, n ⫽ 167). Prior PFI pattern was consistently associated with significantly increased risks for subsequent PFI pattern. At observations 1-3, lung cancer, treatment, higher comorbidity with breast cancer, and late stage colorectal cancer were significantly associated with increased risks for PFI patterns. Advancing age was not significantly associated with increased risks for PFI patterns at any observation. PFI co-occurrence declined over time, shifting from 18% to 6% from observations 1 to 4. PFI co-occurrence was associated with significantly increased risks for death or loss to follow-up at observations 2-4. Additionally, elders without PFI reported, on average, 3 other symptoms; elders with PFI co-occurrence reported 9 other symptoms. Among elder cancer patients, PFI co-occurrence is associated with adverse outcomes and should be proactively targeted for intervention.
C Jensen-Dahm, F Rice, K Petersen; University of California San Francisco - Pain Clinical Research Center, San Francisco, CA Post-herpetic neuralgia (PHN) is a common complication after herpes zoster (HZ). The severity of neuronal injury may predict development of PHN. The changes in cutaneous innervation following HZ are poorly understood. There are signs of denervation in the painful skin in most, but not all, patients with PHN. Previous studies have focused on quantification of the cutaneous innervation. In a large piece of skin from a patient with chronic severe PHN we demonstrated a distinctly abnormal pattern of cutaneous nerve morphology and immunohistochemistry which were much more complex than what had been suggested by assessment of fiber density. The aim of this study was to assess if abnormal patterns of cutaneous nerve immunohistochemistry were associated with severe PHN. We compared immunochemical characteristics of cutaneous innervation in skin biopsies collected in two groups: 1. Twelve patients without pain 40 months (range 23-50 months) after HZ onset and 2. Twelve patients with chronic severe PHN (mean pain rating 65 on the 0-100 pain VAS [range 40 - 80]) 40 months after HZ onset (range 8-73 months).1 Using double labeling immunohistochemistry we stained the biopsies using PGP 9.5, CGRP, and NF. The biopsies were analyzed blindly, in random and by one observer. Outcome measures included: density of CGRP positive (CGRP⫹/PGP⫹) fibers as a measure of peptidergic fibers; density of CGRP negative (CGRP-/PGP⫹) fibers as a measure of non-peptidergic fibers and density of NF-positive (NF⫹/PGP⫹) fibers as a measure for the density of myelinated fibers in the epidermis, subepidermis and dermis. Preliminary analysis suggests that there is an abnormal expression of CGRP and NF in the PHN skin compared to mirrorimage skin. Immunochemical analyses are in progress. (1. Petersen, Pain, 2000).
C13 - Pain in Women
(715) A single one-hour application of NGX-4010 (Capsaicin Dermal Patch) significantly reduced pain for up to 12 weeks: Results of a randomized, double-blind, 12-week controlled study in postherpetic neuralgia patients
(713) Pain after partial mastectomy, complete mastectomy or reconstructive breast surgery K Fecho, S Merritt, N Miller, N Klauber-DeMore, S McKenney, C Hultman, C Lee, W Blau, E Norfleet; University of North Carolina at Chapel Hill, Chapel Hill, NC The present study aimed to determine the incidence and magnitude of acute and chronic pain after partial or complete mastectomy and reconstructive breast surgery. Medical records were reviewed from 174 randomly sampled female patients undergoing partial (n⫽79) or complete mastectomy (n⫽46) or reconstructive breast surgery after mastectomy (n⫽49) between 1/1/03 and 12/31/05. The data that were collected included demographics, radiation/chemotherapy, and pre- and post-operative pain scores (0-10 scale). Frequencies of events and mean ⫹ SEM values were calculated. Pre-operative pain scores were very low (0.52 ⫹ 0.21 for partial mastectomy, 1.27 ⫹ 0.43 for complete mastectomy and 0.05 ⫹ 0.05 for reconstructive surgery patients). Post-operative pain scores taken within two weeks of surgery were higher than pre-operative pain scores, but generally low (2.36 ⫹ 0.56 for partial mastectomy, 1.21 ⫹ 0.39 for complete mastectomy and 2.20 ⫹ 0.96 for reconstruction). Post-operative pain scores taken 6-12 months after surgery were lower than those taken within two weeks of surgery (0.69 ⫹ 0.34 for partial mastectomy, 0.29 ⫹ 0.29 for complete mastectomy and 1.18 ⫹ 0.55 for reconstruction). While mean post-operative pain scores were low, more women experienced severe pain (defined as a pain score of ⬎5) after surgery than before. Pre-operative pain scores qualified as severe in 2.6% of partial mastectomy, 4.4% of complete mastectomy, and 0.0% of reconstructive surgery patients. Two weeks post-operatively, severe pain was reported by 27.3% of partial mastectomy, 5.3% of complete mastectomy, and 20.0% of reconstructive surgery patients. Six to twelve months after surgery, severe pain was reported by 6.2% of partial mastectomy, 0.0% of complete mastectomy, and 11.8% of reconstructive surgery patients. These results suggest that while post-surgical pain is not problematic for the majority of breast surgery patients, a subset of women will experience severe post-operative pain.
M Wallace; Multi-centered (52 centers) study throughout the U.S. sponsored by NeurogesX, Inc. Society for Neuroscience abstract
S29
C12 - Pain in the Elderly
C14 - Postherpetic Neuralgia
(712) Predictors of patterns of pain, fatigue and insomnia in the elderly during the first year following a cancer diagnosis
(714) Immunochemical characteristics of cutaneous innervation in patients with severe Post Herpetic Neuralgia: A case-control study
S Kozachik, K Bandeen-Roche, V Mock; Johns Hopkins University, Baltimore, MD Pain, fatigue and insomnia (PFI) are among the most prevalent, distressing, and under managed symptoms experienced by cancer patients. Research has demonstrated that PFI co-occur; what remains unclear are the patterning and stability of PFI patterns, and the patient, disease and treatment characteristics that predict PFI patterns over time. Specifically, do patient age, sex, comorbidity, cancer site or stage, or treatment regimen predict patterns of PFI and their changes over time? This study was a secondary analysis of a dataset comprised of 867 elders (46% female) who were newly diagnosed with breast (27%), colorectal (18%), lung (26%) or prostate (29%) cancer and followed at 6-8, 12-16, 24 and 52 weeks following diagnosis. The Johns Hopkins Medicine IRB approved this study. Measures included sociodemographics, comorbidity, and symptoms; medical record audits confirmed cancer and treatment. Descriptive statistics and multi-state transition models using multinomial logistic regression were employed. The typical participant was 72.6 years, Caucasian, married/living with spouse, and reported 7.9 symptoms and 2.7 comorbidities. Attrition numbered 255 (death, n ⫽ 88; lost to follow-up, n ⫽ 167). Prior PFI pattern was consistently associated with significantly increased risks for subsequent PFI pattern. At observations 1-3, lung cancer, treatment, higher comorbidity with breast cancer, and late stage colorectal cancer were significantly associated with increased risks for PFI patterns. Advancing age was not significantly associated with increased risks for PFI patterns at any observation. PFI co-occurrence declined over time, shifting from 18% to 6% from observations 1 to 4. PFI co-occurrence was associated with significantly increased risks for death or loss to follow-up at observations 2-4. Additionally, elders without PFI reported, on average, 3 other symptoms; elders with PFI co-occurrence reported 9 other symptoms. Among elder cancer patients, PFI co-occurrence is associated with adverse outcomes and should be proactively targeted for intervention.
C Jensen-Dahm, F Rice, K Petersen; University of California San Francisco - Pain Clinical Research Center, San Francisco, CA Post-herpetic neuralgia (PHN) is a common complication after herpes zoster (HZ). The severity of neuronal injury may predict development of PHN. The changes in cutaneous innervation following HZ are poorly understood. There are signs of denervation in the painful skin in most, but not all, patients with PHN. Previous studies have focused on quantification of the cutaneous innervation. In a large piece of skin from a patient with chronic severe PHN we demonstrated a distinctly abnormal pattern of cutaneous nerve morphology and immunohistochemistry which were much more complex than what had been suggested by assessment of fiber density. The aim of this study was to assess if abnormal patterns of cutaneous nerve immunohistochemistry were associated with severe PHN. We compared immunochemical characteristics of cutaneous innervation in skin biopsies collected in two groups: 1. Twelve patients without pain 40 months (range 23-50 months) after HZ onset and 2. Twelve patients with chronic severe PHN (mean pain rating 65 on the 0-100 pain VAS [range 40 - 80]) 40 months after HZ onset (range 8-73 months).1 Using double labeling immunohistochemistry we stained the biopsies using PGP 9.5, CGRP, and NF. The biopsies were analyzed blindly, in random and by one observer. Outcome measures included: density of CGRP positive (CGRP⫹/PGP⫹) fibers as a measure of peptidergic fibers; density of CGRP negative (CGRP-/PGP⫹) fibers as a measure of non-peptidergic fibers and density of NF-positive (NF⫹/PGP⫹) fibers as a measure for the density of myelinated fibers in the epidermis, subepidermis and dermis. Preliminary analysis suggests that there is an abnormal expression of CGRP and NF in the PHN skin compared to mirrorimage skin. Immunochemical analyses are in progress. (1. Petersen, Pain, 2000).
C13 - Pain in Women
(715) A single one-hour application of NGX-4010 (Capsaicin Dermal Patch) significantly reduced pain for up to 12 weeks: Results of a randomized, double-blind, 12-week controlled study in postherpetic neuralgia patients
(713) Pain after partial mastectomy, complete mastectomy or reconstructive breast surgery K Fecho, S Merritt, N Miller, N Klauber-DeMore, S McKenney, C Hultman, C Lee, W Blau, E Norfleet; University of North Carolina at Chapel Hill, Chapel Hill, NC The present study aimed to determine the incidence and magnitude of acute and chronic pain after partial or complete mastectomy and reconstructive breast surgery. Medical records were reviewed from 174 randomly sampled female patients undergoing partial (n⫽79) or complete mastectomy (n⫽46) or reconstructive breast surgery after mastectomy (n⫽49) between 1/1/03 and 12/31/05. The data that were collected included demographics, radiation/chemotherapy, and pre- and post-operative pain scores (0-10 scale). Frequencies of events and mean ⫹ SEM values were calculated. Pre-operative pain scores were very low (0.52 ⫹ 0.21 for partial mastectomy, 1.27 ⫹ 0.43 for complete mastectomy and 0.05 ⫹ 0.05 for reconstructive surgery patients). Post-operative pain scores taken within two weeks of surgery were higher than pre-operative pain scores, but generally low (2.36 ⫹ 0.56 for partial mastectomy, 1.21 ⫹ 0.39 for complete mastectomy and 2.20 ⫹ 0.96 for reconstruction). Post-operative pain scores taken 6-12 months after surgery were lower than those taken within two weeks of surgery (0.69 ⫹ 0.34 for partial mastectomy, 0.29 ⫹ 0.29 for complete mastectomy and 1.18 ⫹ 0.55 for reconstruction). While mean post-operative pain scores were low, more women experienced severe pain (defined as a pain score of ⬎5) after surgery than before. Pre-operative pain scores qualified as severe in 2.6% of partial mastectomy, 4.4% of complete mastectomy, and 0.0% of reconstructive surgery patients. Two weeks post-operatively, severe pain was reported by 27.3% of partial mastectomy, 5.3% of complete mastectomy, and 20.0% of reconstructive surgery patients. Six to twelve months after surgery, severe pain was reported by 6.2% of partial mastectomy, 0.0% of complete mastectomy, and 11.8% of reconstructive surgery patients. These results suggest that while post-surgical pain is not problematic for the majority of breast surgery patients, a subset of women will experience severe post-operative pain.
M Wallace; Multi-centered (52 centers) study throughout the U.S. sponsored by NeurogesX, Inc. Society for Neuroscience abstract