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800 PREDICTORS OF PRESCRIBING PATTERNS AND POTENTIAL MEDICINES-RELATED PROBLEMS OF ANALGESIC AND ADJUVANT DRUGS IN CHRONIC NON-CANCER PAIN
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European Journal of Pain 2006, Vol 10 (suppl S1)
technique resulted in significantly less intense site pain and fewer and smaller bruises. It was concluded that administering a subcutaneous heparin injection over longer duration reduced injection site pain and bruising.
799 THE EFFECT OF CONTINUOUS LABOR SUPPORT BY A FEMALE COMPANION ON LABOR PAIN M. Javadnoori ° , P. Afshari, S. Montazeri. Faculty of Nursing & Midwifery, Ahwaz Jundishapur University of Medical Sciences, Ahwaz, Iran Objective: In the recent years, rate of elective caesarian sections has significantly increased in Iran. One of the most important causes is that the pain relief methods are not usually available. This study evaluate the effect of continuous labor support by a female companion on labor pain. Methods: A clinical trial was conducted on 150 eligible primigravid women, 18−30 years old. They were randomly assigned in to the either a supported group (n = 75) or a control group (n = 75). The women in the supported group continuously received support by a female companion, who was a relative or friend of the woman. The supports consisted of talking, touching, reassurance, soothing, encouragement, and physical comfort (e.g, position changing, to moisten lips. . . ). Results: Continuous labor support by a female companion, significantly reduced labor pain intensity (p = 0.026) and increased mother’s satisfaction of childbirth experience (p = 0.0001). Conclusion: Since in hospitals of Iran, the husbands are not allowed to accompany their wives during labor, the emotional support given by a female supporter can be useful. Applying this method may reduce numbers of elective caesarians. 800 PREDICTORS OF PRESCRIBING PATTERNS AND POTENTIAL MEDICINES-RELATED PROBLEMS OF ANALGESIC AND ADJUVANT DRUGS IN CHRONIC NON-CANCER PAIN P. Kittiboonyakun2 ° , L.M. McCracken1 , C. Eccleston1 , C.M. Bond2 , B.H. Smith2 , A.E. Elliott2 . 1 National UK Tertiary Care Pain Management Center, Royal National Hospital of Rheumatic Diseases, Bath, England, 2 Department of General Practice and Primary Care, University of Aberdeen, UK Background and Aims: Medicines management problems in chronic non-cancer pain present a key barrier to achieving health outcomes. This study aimed to explore potential medicines-related problems (MRPs) of analgesics and adjuvants prescribed for chronic non-cancer pain patients and to identify predictors of prescribing patterns and potential MRPs. Methods: The clinical assessment database of patients referred to a National UK Tertiary Care Pain Management Centre for assessment (200 profiles) was retrospectively reviewed between 2001 and 2003. MRPs were defined based on the Pharmaceutical Care Network Europe Classification Scheme for drug-related problems V 5.00. Results: Clinically significant drug-drug interactions were the most common potential MRPs (195/352, 55.4%). In addition, there were significant correlations between the number of potential MRPs and Sickness Impact Profile (r = 0.20, p = 0.005) and Beck Depression Inventory (r = 0.17, p = 0.018) respectively. The major predictors of analgesic prescribing were type of pain, potential MRPs and the total number of prescribed analgesics and adjuvants. Pain score, health-related quality of life scores, the number of all prescribed analgesic and adjuvant drugs, and drug-drug interactions were significant predictors of adjuvant prescribing. The predictive model of potential MRPs included the number of all prescribed analgesic and adjuvant drugs, antidepressants, weak opioids and anticonvulsants. Conclusions: In a sample of patients with complex chronic pain and disability referred for assessment at a UK national rehabilitation centre, potential MRPs were common and related to impaired quality of life, pain and depression. Optimal strategies for the primary care prevention of MRPs will be discussed.
Abstracts, 5th EFIC Congress, Free Presentations 801 EPIDURAL STEROID INJECTION FOR THE TREATMENT OF CERVICAL RADICULITIS L. Georgiou, G. Fotiou, V. Zobolas, T. Papavassiolopoulou, F. Kremastinou, A. Louizos, I. Kouroukli ° . Hippocratio General Hospital, Athens, Greece Aim: to determine the effectiveness of injecting long acting steroids into the cervical epidural space in patients (pts) suffering from cervical radiculitis. Material and Methods: 40 pts with clinical signs of cervical radiculitis during the last two months, that was confirmed by MRI. The pts had failed trials of conservative therapy. Each pt underwent an epidural steroid injection at C6-C7 or C7-T1 interspace, via a midline approach with an 18 gauge Tuohy using the loss of resistance to saline technique. 3 ml of normal saline and 12 mg betamethasone were slowly injected. An 20 G cannula was inserted and all pts received 0.6 mg atropine before the procedure while they were monitored by ECG and SpO2. Pain intensity was recorded using VAS before VAS1, 15 days (VAS 2), 3 (VAS 3) and 6 (VAS 4) months after the treatment. Statistical analysis was performed using one way anova and t-test. Results: Demographic data and mean duration of neck pain were comparable between the pts. VAS 1 was 8.25 (7−10). All pts improved immediately after the injection. 15 days after the treatment 6 pts (15%) referred pain VAS 8 and the injection was repeated. For the rest of the 34 pts (85%) VAS 2, VAS 3, VAS 4 were statistically significant lower (p < 0.001) than VAS 1 [2 (1−4), 1 (0−2), 0 (0−1) respectively]. Conclusion: Epidural steroid injection has long been used to treat lumbar root inflammation with excellent outcome. There are few references regarding the same procedure to the cervical region. Epidural steroid injection is safe and effective treatment for cervical radiculitis and a nonsurgical option for these pts.
802 THE MANAGEMENT OF SPASTICITY ASSOCIATED PAIN IN STROKE WITH BOTULINUM TOXIN A H. Koyuncu ° , M.G. Erden, N. Bozok, S. Yalgın, H. Aksoy. Istanbul University Cerrahpasa Medical Faculty, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey Painful spasms, paresis and spasticity are often resulted in upper motor neuron diseases. Pharmacological treatment and physical therapy are frequently used. Antispasticity drugs have side effects. Botulinum toxin A is frequently used in spastic muscles. This medicine is benefit in pain relief. We investigated the effects of local botulinum toxin A injections in seven patients spasticity and pain in patients with stroke. The patients were between 17−78 years. Target muscles were selected with clinical examination. Injections were placed in increased muscle tones with pain during passive joint movement. Doses were between 100–400 units botox.. Per treatment sessions companse in mean four muscles. Baseline, fourth week and twelveth week measures were included spasticity degree, a patient self-assesment of pain and functional five-level scale, a physicians evaluation of function anda global rating of response to botox. Spasticity, pain, function scores were improved significantly. Important adverse events were not observed. In conclusion we found that botox injections are potent and well-tolerated treatment modality in pain with spasticity. It can be preffered according to oral anti-spasticity drugs.
European Journal of Pain 2006, Vol 10 (suppl S1)
technique resulted in significantly less intense site pain and fewer and smaller bruises. It was concluded that administering a subcutaneous heparin injection over longer duration reduced injection site pain and bruising.
799 THE EFFECT OF CONTINUOUS LABOR SUPPORT BY A FEMALE COMPANION ON LABOR PAIN M. Javadnoori ° , P. Afshari, S. Montazeri. Faculty of Nursing & Midwifery, Ahwaz Jundishapur University of Medical Sciences, Ahwaz, Iran Objective: In the recent years, rate of elective caesarian sections has significantly increased in Iran. One of the most important causes is that the pain relief methods are not usually available. This study evaluate the effect of continuous labor support by a female companion on labor pain. Methods: A clinical trial was conducted on 150 eligible primigravid women, 18−30 years old. They were randomly assigned in to the either a supported group (n = 75) or a control group (n = 75). The women in the supported group continuously received support by a female companion, who was a relative or friend of the woman. The supports consisted of talking, touching, reassurance, soothing, encouragement, and physical comfort (e.g, position changing, to moisten lips. . . ). Results: Continuous labor support by a female companion, significantly reduced labor pain intensity (p = 0.026) and increased mother’s satisfaction of childbirth experience (p = 0.0001). Conclusion: Since in hospitals of Iran, the husbands are not allowed to accompany their wives during labor, the emotional support given by a female supporter can be useful. Applying this method may reduce numbers of elective caesarians. 800 PREDICTORS OF PRESCRIBING PATTERNS AND POTENTIAL MEDICINES-RELATED PROBLEMS OF ANALGESIC AND ADJUVANT DRUGS IN CHRONIC NON-CANCER PAIN P. Kittiboonyakun2 ° , L.M. McCracken1 , C. Eccleston1 , C.M. Bond2 , B.H. Smith2 , A.E. Elliott2 . 1 National UK Tertiary Care Pain Management Center, Royal National Hospital of Rheumatic Diseases, Bath, England, 2 Department of General Practice and Primary Care, University of Aberdeen, UK Background and Aims: Medicines management problems in chronic non-cancer pain present a key barrier to achieving health outcomes. This study aimed to explore potential medicines-related problems (MRPs) of analgesics and adjuvants prescribed for chronic non-cancer pain patients and to identify predictors of prescribing patterns and potential MRPs. Methods: The clinical assessment database of patients referred to a National UK Tertiary Care Pain Management Centre for assessment (200 profiles) was retrospectively reviewed between 2001 and 2003. MRPs were defined based on the Pharmaceutical Care Network Europe Classification Scheme for drug-related problems V 5.00. Results: Clinically significant drug-drug interactions were the most common potential MRPs (195/352, 55.4%). In addition, there were significant correlations between the number of potential MRPs and Sickness Impact Profile (r = 0.20, p = 0.005) and Beck Depression Inventory (r = 0.17, p = 0.018) respectively. The major predictors of analgesic prescribing were type of pain, potential MRPs and the total number of prescribed analgesics and adjuvants. Pain score, health-related quality of life scores, the number of all prescribed analgesic and adjuvant drugs, and drug-drug interactions were significant predictors of adjuvant prescribing. The predictive model of potential MRPs included the number of all prescribed analgesic and adjuvant drugs, antidepressants, weak opioids and anticonvulsants. Conclusions: In a sample of patients with complex chronic pain and disability referred for assessment at a UK national rehabilitation centre, potential MRPs were common and related to impaired quality of life, pain and depression. Optimal strategies for the primary care prevention of MRPs will be discussed.
Abstracts, 5th EFIC Congress, Free Presentations 801 EPIDURAL STEROID INJECTION FOR THE TREATMENT OF CERVICAL RADICULITIS L. Georgiou, G. Fotiou, V. Zobolas, T. Papavassiolopoulou, F. Kremastinou, A. Louizos, I. Kouroukli ° . Hippocratio General Hospital, Athens, Greece Aim: to determine the effectiveness of injecting long acting steroids into the cervical epidural space in patients (pts) suffering from cervical radiculitis. Material and Methods: 40 pts with clinical signs of cervical radiculitis during the last two months, that was confirmed by MRI. The pts had failed trials of conservative therapy. Each pt underwent an epidural steroid injection at C6-C7 or C7-T1 interspace, via a midline approach with an 18 gauge Tuohy using the loss of resistance to saline technique. 3 ml of normal saline and 12 mg betamethasone were slowly injected. An 20 G cannula was inserted and all pts received 0.6 mg atropine before the procedure while they were monitored by ECG and SpO2. Pain intensity was recorded using VAS before VAS1, 15 days (VAS 2), 3 (VAS 3) and 6 (VAS 4) months after the treatment. Statistical analysis was performed using one way anova and t-test. Results: Demographic data and mean duration of neck pain were comparable between the pts. VAS 1 was 8.25 (7−10). All pts improved immediately after the injection. 15 days after the treatment 6 pts (15%) referred pain VAS 8 and the injection was repeated. For the rest of the 34 pts (85%) VAS 2, VAS 3, VAS 4 were statistically significant lower (p < 0.001) than VAS 1 [2 (1−4), 1 (0−2), 0 (0−1) respectively]. Conclusion: Epidural steroid injection has long been used to treat lumbar root inflammation with excellent outcome. There are few references regarding the same procedure to the cervical region. Epidural steroid injection is safe and effective treatment for cervical radiculitis and a nonsurgical option for these pts.
802 THE MANAGEMENT OF SPASTICITY ASSOCIATED PAIN IN STROKE WITH BOTULINUM TOXIN A H. Koyuncu ° , M.G. Erden, N. Bozok, S. Yalgın, H. Aksoy. Istanbul University Cerrahpasa Medical Faculty, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey Painful spasms, paresis and spasticity are often resulted in upper motor neuron diseases. Pharmacological treatment and physical therapy are frequently used. Antispasticity drugs have side effects. Botulinum toxin A is frequently used in spastic muscles. This medicine is benefit in pain relief. We investigated the effects of local botulinum toxin A injections in seven patients spasticity and pain in patients with stroke. The patients were between 17−78 years. Target muscles were selected with clinical examination. Injections were placed in increased muscle tones with pain during passive joint movement. Doses were between 100–400 units botox.. Per treatment sessions companse in mean four muscles. Baseline, fourth week and twelveth week measures were included spasticity degree, a patient self-assesment of pain and functional five-level scale, a physicians evaluation of function anda global rating of response to botox. Spasticity, pain, function scores were improved significantly. Important adverse events were not observed. In conclusion we found that botox injections are potent and well-tolerated treatment modality in pain with spasticity. It can be preffered according to oral anti-spasticity drugs.