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S30
C30 - Other (716) Sleep onset insomnia during acute burn injury predicts long-term pain T Kronfli, B Merry, B Klick, R Edwards, L Buenaver, J Fauerbach, M Smith; Johns Hopkins University, School of Medicine, Baltimore, MD Sleep deprivation experiments suggest that sleep disturbance may cause hyperalgesia. Few studies have assessed whether acute-pain related insomnia predicts the development of chronic pain. This study’s objectives were to 1) describe the two year course of clinical pain following hospitalization for burn injury and 2) evaluate whether in-hospital sleep onset insomnia modifies the trajectory of clinical pain report. We analyzed data on 524 subjects hospitalized for major burn injury (74.8% male; mean age ⫽ 40.1 years ⫹14) who were participating in an ongoing multi-site burn injury outcome study. Subjects completed various selfreport measures of health and function (SF-36) and psychological distress (Brief Symptom Inventory: BSI) while in-hospital, and at 6, 12, and 24 months postburn. Participants were categorized as with or without moderate to severe sleep onset insomnia based on in-hospital BSI. The SF-36 bodily pain index (BP) was the primary outcome measure. We conducted linear mixed effects analyses to model the effects of discharge insomnia on longitudinal pain. The majority (⬎90%) of subjects reported at least moderate pain at discharge. On long-term follow-up, the sample demonstrated significant elevations in bodily pain relative to population norms. Persons who reported moderate to severe sleep onset difficulties at discharge (44%) reported more pain at all time points (p⬍0.05). After controlling for premorbid health status, discharge pain severity, total burn surface area (TBSA), TBSA grafted, discharge mental health status, and demographics (age & sex), sleep onset difficulty predicted elevation in bodily pain severity over the 2-year follow up (F1,277 ⫽ 6.67, p⫽0.01). The findings document high rates of chronic pain after serious burn injury and indicate that sleep onset insomnia at discharge is associated with poorer pain–related outcomes. Future work is needed to ascertain whether aggressive treatment of insomnia and pain during acute painful injury can prevent or minimize chronic pain conditions.
Abstracts (718) Vitamin D deficiency, exercise tolerance, and health perception among chronic pain patients W Hooten, J Schmidt, J Kerkvliet, C Townsend, J Hodgson, B Bruce; Mayo Clinic College of Medicine, Rochester, MN Hypovitaminosis D is a common vitamin deficiency in the general population. The objective of this study was to investigate potential associations between vitamin D deficiency, physical functioning, and behavioral health variables in a population of chronic pain patients. Serum vitamin D levels were collected at admission from 162 consecutive patients admitted to the Mayo Clinic Comprehensive Pain Rehabilitation Center. Patients with vitamin D deficiency ( 20 ng/ml) were compared to patients who were not deficient (⬎20ng/ml) on demographics, pain duration, pain severity, body mass index (BMI), exercise tolerance, and muscle strength. Perceived general health was assessed using the MOSSF-36. The mean age was 47.6 years (SD⫽13.0). Seventy-nine percent (n⫽128) of patients were female and 97% (n⫽158) were Caucasian. The mean pain duration upon admission was 10.8 years (SD⫽13.1). The mean vitamin D serum level was 29.2 ng/ml (SD⫽12.0) and hypovitaminosis D was found in 24.7% (N⫽40) of patients. No significant differences in demographics, pain severity, or pain duration were identified between the two groups (p⬎.05). The patients in the non-deficient group demonstrated significantly greater exercise tolerance (p⬍.05) compared to the vitamin D deficient group. No differences were detected in muscle strength or BMI (p⬎.05). The vitamin D deficient group reported lower levels of general health perception (p⬍.05) compared to the non-deficient group. In this consecutive series of chronic pain patients, hypovitaminosis D was highly prevalent. Reduced exercise tolerance and poor health perception may be indicative of physical and general health behaviors that increase the risk of developing vitamin D deficiency in this patient population. Further research is needed to clarify the risk factors and clinical correlates of hypovitaminosis D among patients with chronic pain.
(717) Postoperative mapping of sensitive dysesthesia and residual pain after sternotomy for cardiac surgery
(719) Alcohol use disorders among chronic pain patients prescribed oral opioid analgesics
M Momeni, P Baele, P Lavand’Homme; St Luc Hospital - Universite´ Catholique de Louvain, Brussels, Belgium Residual pain (RP) is not rare after sternotomy for cardiac surgery.1 Abnormal postoperative skin sensitivity seems associated with higher risk to develop RP after surgery. Although both hypoesthesia and hyperalgesia have been reported after heart surgery,2 their correlation with RP remains unknown. The study compares early postoperative dysesthesia (at day5 and day30) between patients presenting with RP (RP group) or not (control-C group) after sternotomy for cardiac surgery. 46 consecutive patients scheduled for CABG with IMA harvesting or valve replacement (VR) were included (redo-operation and preoperative analgesics intake were excluded). At postoperative day5 and 30, presence and area of both hypoesthesia and mechanical hyperalgesia surrounding sternotomy incision were assessed. Two months after surgery, incidence of chest RP was questioned by mail. 29 patients (63%) answered the questionnaire, of whom 10 (34.5%) presented with RP and 5 (17%) with discomfort but no pain. Demographic data did not differ between groups: average age 64⫾10 yrs, BMI 28⫾5. Respectively in C and RP group, M/F ratio was 13/1 vs 8/2 and CABG/VR ratio was 8/6 vs 6/4. While area did not differ, more patients with RP presented with hypoesthesia at both day 5 (70% vs 21%; p⫽0.01) and day 30 (71% vs 10%; p⫽0.001). Area and presence of mechanical hyperalgesia were not significantly different between C and RP groups at day5 (21% vs 30%) and day30 (40% vs 28.5%). Although postoperative hypoesthesia was significantly more frequent after CABG than VR at day5 (54 vs 9%) and day30 (70 vs 8.5%), the type of cardiac surgery was unrelated to RP development. In conclusion, presence of postoperative hypoesthesia may predict the risk to develop RP at 2 months after sternotomy, independently of cardiac surgical procedure (CABG or VR). (1 Meyerson, Acta Anaesthesiol Scand, 2001; 2. Alston, Br J Anaesth, 2005).
M Smith, J Haddox, L Palmer, J Margolis; Purdue Pharma L.P., Stamford, CT Concomitant use of alcohol and prescription opioids is risky, especially for patients using modified-release (MR) products as ethanol may compromise some delivery systems, causing “dose dumping.” The study purpose was to determine the prevalence of Alcohol Use Disorder (AUD) among chronic pain patients dispensed oral opioid analgesics (OOAs). Data on demographics, inpatient, ED, outpatient and outpatient prescription drug utilization were obtained from: (1) a commercial healthcare claims (CHC) (23.3M lives); and (2) Medicare Supplemental (MS) (2.7M lives). A list of chronic pain (CP) conditions was identified using ICD-9-CM codes. Inclusion criteria were: 18⫹ years; 1⫹ chronic pain diagnosis 7 days prior to an OOA prescription; 2⫹ chronic pain-related outpatient visits 90⫹ days apart; and 6 months of continuous enrollment post-index date between 01/01/99-06/30/05. Index date was defined as date of first OOA prescription dispensed with a chronic pain-related medical visit within prior 7 days. AUD was defined as any in-/outpatient visit in which alcohol abuse, dependence, or alcohol-induced disorders were cited. Percentage of patients meeting AUD criteria: 1.3% (CHC), and 0.67% (MS). AUD patients were predominantly male (CHC: 63%, MS: 63%, p⬍0.0001 all comparisons) and younger (mean age: CHC: 45.6 AUD versus 47.2 non-AUD; MS: 70.8 versus 73.8, p⬍0.0001, all comparisons). Of those taking MR OOAs, mean number inpatient/ED admissions involving opioid overdose was: 12.0 AUD versus 9.9 non-AUD, CHC (p⬍0.10); and 14.0 AUD versus 8.8 non-AUD, MS (p⬍0.2). A small percentage of CP patients dispensed OOAs had concurrent alcohol abuserelated disorders. This number likely underestimates the total number of CP patients using alcohol and OOAs together. Patients dispensed MR OOAs who abused alcohol trended towards higher healthcare utilization.
C30 - Other (716) Sleep onset insomnia during acute burn injury predicts long-term pain T Kronfli, B Merry, B Klick, R Edwards, L Buenaver, J Fauerbach, M Smith; Johns Hopkins University, School of Medicine, Baltimore, MD Sleep deprivation experiments suggest that sleep disturbance may cause hyperalgesia. Few studies have assessed whether acute-pain related insomnia predicts the development of chronic pain. This study’s objectives were to 1) describe the two year course of clinical pain following hospitalization for burn injury and 2) evaluate whether in-hospital sleep onset insomnia modifies the trajectory of clinical pain report. We analyzed data on 524 subjects hospitalized for major burn injury (74.8% male; mean age ⫽ 40.1 years ⫹14) who were participating in an ongoing multi-site burn injury outcome study. Subjects completed various selfreport measures of health and function (SF-36) and psychological distress (Brief Symptom Inventory: BSI) while in-hospital, and at 6, 12, and 24 months postburn. Participants were categorized as with or without moderate to severe sleep onset insomnia based on in-hospital BSI. The SF-36 bodily pain index (BP) was the primary outcome measure. We conducted linear mixed effects analyses to model the effects of discharge insomnia on longitudinal pain. The majority (⬎90%) of subjects reported at least moderate pain at discharge. On long-term follow-up, the sample demonstrated significant elevations in bodily pain relative to population norms. Persons who reported moderate to severe sleep onset difficulties at discharge (44%) reported more pain at all time points (p⬍0.05). After controlling for premorbid health status, discharge pain severity, total burn surface area (TBSA), TBSA grafted, discharge mental health status, and demographics (age & sex), sleep onset difficulty predicted elevation in bodily pain severity over the 2-year follow up (F1,277 ⫽ 6.67, p⫽0.01). The findings document high rates of chronic pain after serious burn injury and indicate that sleep onset insomnia at discharge is associated with poorer pain–related outcomes. Future work is needed to ascertain whether aggressive treatment of insomnia and pain during acute painful injury can prevent or minimize chronic pain conditions.
Abstracts (718) Vitamin D deficiency, exercise tolerance, and health perception among chronic pain patients W Hooten, J Schmidt, J Kerkvliet, C Townsend, J Hodgson, B Bruce; Mayo Clinic College of Medicine, Rochester, MN Hypovitaminosis D is a common vitamin deficiency in the general population. The objective of this study was to investigate potential associations between vitamin D deficiency, physical functioning, and behavioral health variables in a population of chronic pain patients. Serum vitamin D levels were collected at admission from 162 consecutive patients admitted to the Mayo Clinic Comprehensive Pain Rehabilitation Center. Patients with vitamin D deficiency ( 20 ng/ml) were compared to patients who were not deficient (⬎20ng/ml) on demographics, pain duration, pain severity, body mass index (BMI), exercise tolerance, and muscle strength. Perceived general health was assessed using the MOSSF-36. The mean age was 47.6 years (SD⫽13.0). Seventy-nine percent (n⫽128) of patients were female and 97% (n⫽158) were Caucasian. The mean pain duration upon admission was 10.8 years (SD⫽13.1). The mean vitamin D serum level was 29.2 ng/ml (SD⫽12.0) and hypovitaminosis D was found in 24.7% (N⫽40) of patients. No significant differences in demographics, pain severity, or pain duration were identified between the two groups (p⬎.05). The patients in the non-deficient group demonstrated significantly greater exercise tolerance (p⬍.05) compared to the vitamin D deficient group. No differences were detected in muscle strength or BMI (p⬎.05). The vitamin D deficient group reported lower levels of general health perception (p⬍.05) compared to the non-deficient group. In this consecutive series of chronic pain patients, hypovitaminosis D was highly prevalent. Reduced exercise tolerance and poor health perception may be indicative of physical and general health behaviors that increase the risk of developing vitamin D deficiency in this patient population. Further research is needed to clarify the risk factors and clinical correlates of hypovitaminosis D among patients with chronic pain.
(717) Postoperative mapping of sensitive dysesthesia and residual pain after sternotomy for cardiac surgery
(719) Alcohol use disorders among chronic pain patients prescribed oral opioid analgesics
M Momeni, P Baele, P Lavand’Homme; St Luc Hospital - Universite´ Catholique de Louvain, Brussels, Belgium Residual pain (RP) is not rare after sternotomy for cardiac surgery.1 Abnormal postoperative skin sensitivity seems associated with higher risk to develop RP after surgery. Although both hypoesthesia and hyperalgesia have been reported after heart surgery,2 their correlation with RP remains unknown. The study compares early postoperative dysesthesia (at day5 and day30) between patients presenting with RP (RP group) or not (control-C group) after sternotomy for cardiac surgery. 46 consecutive patients scheduled for CABG with IMA harvesting or valve replacement (VR) were included (redo-operation and preoperative analgesics intake were excluded). At postoperative day5 and 30, presence and area of both hypoesthesia and mechanical hyperalgesia surrounding sternotomy incision were assessed. Two months after surgery, incidence of chest RP was questioned by mail. 29 patients (63%) answered the questionnaire, of whom 10 (34.5%) presented with RP and 5 (17%) with discomfort but no pain. Demographic data did not differ between groups: average age 64⫾10 yrs, BMI 28⫾5. Respectively in C and RP group, M/F ratio was 13/1 vs 8/2 and CABG/VR ratio was 8/6 vs 6/4. While area did not differ, more patients with RP presented with hypoesthesia at both day 5 (70% vs 21%; p⫽0.01) and day 30 (71% vs 10%; p⫽0.001). Area and presence of mechanical hyperalgesia were not significantly different between C and RP groups at day5 (21% vs 30%) and day30 (40% vs 28.5%). Although postoperative hypoesthesia was significantly more frequent after CABG than VR at day5 (54 vs 9%) and day30 (70 vs 8.5%), the type of cardiac surgery was unrelated to RP development. In conclusion, presence of postoperative hypoesthesia may predict the risk to develop RP at 2 months after sternotomy, independently of cardiac surgical procedure (CABG or VR). (1 Meyerson, Acta Anaesthesiol Scand, 2001; 2. Alston, Br J Anaesth, 2005).
M Smith, J Haddox, L Palmer, J Margolis; Purdue Pharma L.P., Stamford, CT Concomitant use of alcohol and prescription opioids is risky, especially for patients using modified-release (MR) products as ethanol may compromise some delivery systems, causing “dose dumping.” The study purpose was to determine the prevalence of Alcohol Use Disorder (AUD) among chronic pain patients dispensed oral opioid analgesics (OOAs). Data on demographics, inpatient, ED, outpatient and outpatient prescription drug utilization were obtained from: (1) a commercial healthcare claims (CHC) (23.3M lives); and (2) Medicare Supplemental (MS) (2.7M lives). A list of chronic pain (CP) conditions was identified using ICD-9-CM codes. Inclusion criteria were: 18⫹ years; 1⫹ chronic pain diagnosis 7 days prior to an OOA prescription; 2⫹ chronic pain-related outpatient visits 90⫹ days apart; and 6 months of continuous enrollment post-index date between 01/01/99-06/30/05. Index date was defined as date of first OOA prescription dispensed with a chronic pain-related medical visit within prior 7 days. AUD was defined as any in-/outpatient visit in which alcohol abuse, dependence, or alcohol-induced disorders were cited. Percentage of patients meeting AUD criteria: 1.3% (CHC), and 0.67% (MS). AUD patients were predominantly male (CHC: 63%, MS: 63%, p⬍0.0001 all comparisons) and younger (mean age: CHC: 45.6 AUD versus 47.2 non-AUD; MS: 70.8 versus 73.8, p⬍0.0001, all comparisons). Of those taking MR OOAs, mean number inpatient/ED admissions involving opioid overdose was: 12.0 AUD versus 9.9 non-AUD, CHC (p⬍0.10); and 14.0 AUD versus 8.8 non-AUD, MS (p⬍0.2). A small percentage of CP patients dispensed OOAs had concurrent alcohol abuserelated disorders. This number likely underestimates the total number of CP patients using alcohol and OOAs together. Patients dispensed MR OOAs who abused alcohol trended towards higher healthcare utilization.