(789)

S48 (787) Intra-articular Myobloc (botulinum toxin type b) may be effective in moderate knee osteoarthritis: Preliminary case series D Figa, A Lang; Emory School of Medicine, Lawrenceville, GA Myobloc® (Botulinum toxin type B or BT-B) is FDA-approved for the treatment of cervical dystonia (CD). However, BTs have also demonstrated utility in treating a number of chronic pain conditions. Preliminary reports have demonstrated that intra-articular BT-A may be of benefit for joint pain. This is the first report of the use of intra-articular BT-B in moderate knee osteoarthritis (OA). Patient 1 is a 67yof with mod/severe OA of both knees, patient 2: 65yof/mod/both, patient 3: 57yof/mod/both, patient 4: 64yom/mod/right, patient 5: 62yof/mod/ right, patient 6: 52yof/mod/right, and patient 7: 72yof/mod/left. All had prior steroid and viscosupplementation injections and were tried on a variety of medications including NSAIDs and glucosamine. The injections were performed using a 25g needle (inferomedial or inferolateral approach). The first 4 patients received BT-B 5,000U with 1mL of 0.5% bupivacaine into the affected knee joint (each knee if bilateral). The next 3 patients received 7,500U with 1mL of 0.5% bupivacaine. Patients were followed weekly and responses were assessed using pain VAS (010), patient global subjective response (⫺4 to ⫹4) and pain interference scores (0-10) with various daily activities. Safety was assessed by spontaneous adverse event reports. The first 4 patients had 3 month follow up data: 1 had a minimal response, 1- moderate response lasting for 1 month and 2 - substantial reduction in pain VAS lasting between 2-4 months (response still ongoing). The remaining 3 patients were demonstrating early substantial pain reductions at the time of submission. Subjective global responses and functional measures paralleled the VAS scores. The injections were well tolerated. Full data on these patients and additional ones planned for future injections will be presented. These cases demonstrate that BT-B may be of benefit in treating moderate knee OA pain. Randomized controlled trials are warranted.

Abstracts (789) Analgesic efficacy and safety of oxycodone 5 mg/ibuprofen 400 mg compared with oxycodone 5 mg/acetaminophen 325 mg and hydrocodone 7.5 mg/acetaminophen 500 mg in the dental and orthopedic pain models K Newman, J Carsi, S Han; Forest Research Institute, Jersey City, NJ The efficacy and tolerability of combination oxycodone 5 mg/ibuprofen 400 mg (OXY/IBU) was compared with oxycodone 5 mg/acetaminophen 325 mg (OXY/APAP), hydrocodone 7.5 mg/ acetaminophen 500 mg (HYD/APAP), and placebo in 2 double-blind, placebo- and active-controlled, single-dose studies, one following dental surgery (OXY MD-16) and the other following orthopedic surgery (OXY MD-14). The main outcome measures of these studies were 6-hour total pain relief (TOTPAR6), 6-hour sum of pain intensity difference (SPID6), and adverse events. A total of 458 patients experiencing moderate to severe pain following their surgical procedures were randomized to receive OXY/ IBU (n ⫽ 115), OXY/APAP (n ⫽ 113), HYD/APAP (n ⫽ 114), or placebo (n ⫽ 116). In the 2 studies combined, OXY/IBU provided significantly greater analgesia than OXY/APAP, HYD/APAP, or placebo (P⬍ 0.002 OXY/IBU vs any other treatment for both TOTPAR6 and SPID6). When analyzed separately, only the dental pain study showed significantly greater analgesia over placebo, perhaps highlighting the more sensitive nature of the dental pain model vs the orthopedic model. The typical opioid side effects of nausea and vomiting were lowest in the placebo (7.8 % and 3.4 %, respectively) and OXY/IBU (13.0 % and 4.3 %, respectively) groups. The rates of nausea and vomiting were comparatively higher in the OXY/APAP (20.4% and 14.2%, respectively) and HYD/APAP (14.8% and 6.1%, respectively) groups. In conclusion, in pooled data from dental and orthopedic studies, combination oxycodone 5 mg/ibuprofen 400 mg provided superior analgesia over the other opioid/nonopioid combinations studied, with fewer adverse events.

(788) Cannabis: A unique immunoanalgesic

(790) Botulinum toxins in the treatment of occipital neuralgia

T Mikuriya; California Cannabis Research Medical Group, Berkeley, CA Diagnostic examinations of medically protected California cannabis selfusers for management of chronic pain through the substitution of cannabis for conventional drugs for treatment discloses a list of conditions of immunologic etiology or expression. These conditions control pain by increasing mobility and promoting vegetative functionality. Inhaling, oral, rectal and topical routes are utilized. The wide individual variability encountered in clinical experience is notable.

M Ansarinia, B Carpentier; Pain Medicine Associates, Salinas, CA Myobloc® (Botulinum toxin type B) is FDA-approved for the treatment of cervical dystonia(CD). However, Myobloc has also demonstrated utility in treating a number of chronic pain conditions, including myofascial and low back pain, headache and neuropathic pain. The following case reports represent its use in the treatment of occipital neuralgia. GN was a 43 year-old right-handed female with a nine-year history of daily headaches localized to the forehead and occipital area. Initial neurological exam showed spasms tenderness over the occipitocervical junctions. MRI of the brain with and without contrast was normal. Numerous medications including nortriptyline, gabapentin, topiramate, levatiracetam, nadolol, phenobarbital, tramadol were ineffective or not tolerated. She had word-finding difficulty with topiramate. A series or three bilateral occipital nerve blocks (combination of local anesthetic and steroid) provided complete headache relief for two weeks each. Myobloc (5000 units) was added to local anesthetic and provided headache relief for greater than 2 months. PG was a 53 year-old female with right occipital neuralgia. She failed oral agents and was treated with BT-A 100 units and local anesthetic, which produced 6 weeks of pain relief with an onset 2 weeks after injection. Her next injection with Myobloc 5000 units (combined with local anesthetic) produced an increased duration of pain relief of 3 months. TW was a 55 year-old man with occipital neuralgia. His pain was intractable to oral agents and was injected with Myobloc 5000 units mixed with local anesthetic. His pain relief has lasted beyond 1.5 months. These 3 case reports demonstrate the potential use of BTs in treating occipital neuralgia. Additional clinical trials are warranted.