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802 CHRONIC NONCANCER PAIN (CNCP) IN RUSSIA: DOCTORS' OPINION AND CLINICAL PRACTICE
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Poster Sessions / European Journal of Pain 13 (2009) S55–S285
801 MEASURING SELF REPORTED PAIN IN A MULTI-CULTURALLY BASED EMERGENCY DEPARTMENT IN SYDNEY, AUSTRALIA R. Forero *, L. Young, N. Santiano, S. McCarthy. Simpson Centre for Health Services Research level 2, Liverpool, NSW, Australia Background and Aims: Self-reported pain in a multicultural society is one of the most challenging issues facing Emergency Departments. The aims were to explore the prevalence and severity of self-reported pain in a multicultural population. Methods: Pain scores were collected using culturally sensitive pictographic COOP-WONCA charts. Variables included time of presentation, triage category, treatment time, country of birth, reason for presentation and diagnostic codes. Self-reported pain was recorded independently of the clinical assessment process. Results: In total 1143 adults reported pain scores. Twenty nine per cent reported no pain or very mild pain (score 1–2), and 71% reported mild to severe pain (score 3–5). The sample comprised 51% males and 49% females. Of these, 60% of males and 58% of females reported acute pain (scores 4–5). Acute pain decreased significantly by age; from over 60% in the younger groups to below 50% in people aged 70 years and over. People from US/Canada/NZ and people from Mediterranean countries were less likely to report moderate to severe pain than the overall sample, but these differences were not statistically significant. Conclusions: Self-reported pain follows a scale pattern regardless of age, gender, English proficiency, ethnicity and time of presentation to ED. It showed that in the ED setting about 80% of people reported some level of pain and 60% described moderate to severe pain. In this population 60% were born overseas and 15% speak little of no English. 802 CHRONIC NONCANCER PAIN (CNCP) IN RUSSIA: DOCTORS’ OPINION AND CLINICAL PRACTICE E. Galushko *, S. Erdes. Institute of Rheumatology, Moscow, Russia Introduction: There is no information about clinical peculiarities of CNCP among out-patients in Russia. Purposes: To define clinical peculiarities of CNCP in ambulatory practice. Materials and Methods: Interviews about the doctor’s opinion on CNCP and their out-patients clinical practice in this field were held. Before the interview, each doctor filled 5 clinic cards/CC on CNCP patients. 375 doctors (150 GP, 150 neurologists/N and 75 rheumatologists/R) were interviewed and 1875 CC were filled. Results: Each doctor cared for 100–120 patients weekly. By the doctors’ opinion 27% out-patients have CNCP (GP 20%, N 30%, R 40%), the intensity of CNCP in 23% of cases is weak, 49% moderate, 21% severe and in 7% very severe or intolerable. Doctors suggest in 28% (GP 38%, N 24%, R 16%) send patients with CNCP to consult by other specialists: more often to N (45%) and R (28%). By CC 7% of patients had weak pain, 61% moderate, 28% severe, and the rest very severe. In 36% the cause of CNCP was back pain, in 17% osteoarthritis, 9% rheumatoid-arthritis and 6% intercostals-neuralgis and headache for each (others <5%). Among CNCP pts 4% are younger 25 years old, 51% 25–50 and 45% older than 50y. 53% of patients came to the doctor for the first time, 14% were referred by other specialists for additional consultation, 33% came for the second (or more) time. Conclusion: More than 1 /4 of patients who come to out-patient clinics suffer from diseases accompanied by CNCP. The absence of pain specialists in Russia is the main reason to refer patients from one doctor to another.
803 CHRONIC PAIN FOLLOWING MAJOR TRAUMA N. Garrido *, C. Celestino, L. Ribeiro, A. Melo, F. Lima. Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal Background and Aims: Pain is expected in the period following acute trauma, which is increasingly recognized as a factor in the development of chronic pain. Complex regional pain syndrome and phantom limb pain are distinct chronic conditions associated with trauma. [1] Methods: To examine rates of pain 1 year after injury and predictive factors, we studied 100 patients who were admitted to emergency room due to trauma. At a 12 months phone interview, patients were asked about pain using questions from Chronic Pain Grade Scale. We also examine personal, injury and treatment factors that predict chronic pain. Results: 12 months after injury, 52% of patients reported injuryrelated pain. Patients had pain in more than 1 body region and mean severity of pain in the last month was 5.2 on a 10-point scale. The reported pain varied with age, was more common in women and those who had depression. Pain at 3 months was predictive of both presence and higher severity of pain at 12 months. Patients with pain were more likely to have been required ICU care, received assisted ventilation and underwent surgery. The severity of pain is higher in patients with multiple injuries. Conclusions: The findings of this study suggest that interventions to decrease chronic pain in trauma patients are needed. The high prevalence of pain, its severity and its effect on functioning warrant such interventions. This may consist of interventions during the acute phase of hospitalization to agressively treat early pain and better manage neuropathic pain. Reference(s) [1] Trauma 2005; vol7, No3, 123–131.
804 SPASTICITY, SPASMS AND CHRONIC PAIN FOLLOWING STROKE: A PROSPECTIVE STUDY A. Hansen1 *, H. Klit1 , N. Brix Finnerup1 , G. Andersen2 , T. Staehelin Jensen1 . 1 Danish Pain Research Center, Aarhus University, Aarhus, Denmark; 2 Department of Neurology, Aarhus University Hospital, Aarhus, Denmark Background: Chronic post-stroke pain, such as shoulder pain and central pain, is a known consequence of stroke. The relation between spasticity, spasms and pain is not clear. Aims: The objectives of this study were to determine the incidence of spasticity, spasms and chronic pain after stroke and the relation between these phenomena. Methods: All consecutively eligible patients admitted to the Stroke Unit, F2, Aarhus University Hospital from 1 February to 1 August 2008 were asked about pain, spasms and spasticity prior to and at stroke onset and subjected to a brief examination of sensory abnormalities, reflex activities and muscle tone and strength. The patients were contacted and interviewed by phone or mail after three and six months and asked about pain status, spasms and spasticity. Results: Of 164 acute stroke patients, 157 and 152 patients completed three and six months follow-up respectively. After six months, 15.2% (24/152) reported spasticity or spasms; 33.3% (8/24) of them reported pain due to their spasticity or spasms and 20.8% (5/24) reported discomfort. Central pain was reported by 6.6% (10/152) and was more common in those with spasticity and spasms while shoulder pain was not related to spasticity and spasms (Fisher’s exact test, P = 0.001). Conclusion: Spasticity, spasms and central pain may be associated.
Poster Sessions / European Journal of Pain 13 (2009) S55–S285
801 MEASURING SELF REPORTED PAIN IN A MULTI-CULTURALLY BASED EMERGENCY DEPARTMENT IN SYDNEY, AUSTRALIA R. Forero *, L. Young, N. Santiano, S. McCarthy. Simpson Centre for Health Services Research level 2, Liverpool, NSW, Australia Background and Aims: Self-reported pain in a multicultural society is one of the most challenging issues facing Emergency Departments. The aims were to explore the prevalence and severity of self-reported pain in a multicultural population. Methods: Pain scores were collected using culturally sensitive pictographic COOP-WONCA charts. Variables included time of presentation, triage category, treatment time, country of birth, reason for presentation and diagnostic codes. Self-reported pain was recorded independently of the clinical assessment process. Results: In total 1143 adults reported pain scores. Twenty nine per cent reported no pain or very mild pain (score 1–2), and 71% reported mild to severe pain (score 3–5). The sample comprised 51% males and 49% females. Of these, 60% of males and 58% of females reported acute pain (scores 4–5). Acute pain decreased significantly by age; from over 60% in the younger groups to below 50% in people aged 70 years and over. People from US/Canada/NZ and people from Mediterranean countries were less likely to report moderate to severe pain than the overall sample, but these differences were not statistically significant. Conclusions: Self-reported pain follows a scale pattern regardless of age, gender, English proficiency, ethnicity and time of presentation to ED. It showed that in the ED setting about 80% of people reported some level of pain and 60% described moderate to severe pain. In this population 60% were born overseas and 15% speak little of no English. 802 CHRONIC NONCANCER PAIN (CNCP) IN RUSSIA: DOCTORS’ OPINION AND CLINICAL PRACTICE E. Galushko *, S. Erdes. Institute of Rheumatology, Moscow, Russia Introduction: There is no information about clinical peculiarities of CNCP among out-patients in Russia. Purposes: To define clinical peculiarities of CNCP in ambulatory practice. Materials and Methods: Interviews about the doctor’s opinion on CNCP and their out-patients clinical practice in this field were held. Before the interview, each doctor filled 5 clinic cards/CC on CNCP patients. 375 doctors (150 GP, 150 neurologists/N and 75 rheumatologists/R) were interviewed and 1875 CC were filled. Results: Each doctor cared for 100–120 patients weekly. By the doctors’ opinion 27% out-patients have CNCP (GP 20%, N 30%, R 40%), the intensity of CNCP in 23% of cases is weak, 49% moderate, 21% severe and in 7% very severe or intolerable. Doctors suggest in 28% (GP 38%, N 24%, R 16%) send patients with CNCP to consult by other specialists: more often to N (45%) and R (28%). By CC 7% of patients had weak pain, 61% moderate, 28% severe, and the rest very severe. In 36% the cause of CNCP was back pain, in 17% osteoarthritis, 9% rheumatoid-arthritis and 6% intercostals-neuralgis and headache for each (others <5%). Among CNCP pts 4% are younger 25 years old, 51% 25–50 and 45% older than 50y. 53% of patients came to the doctor for the first time, 14% were referred by other specialists for additional consultation, 33% came for the second (or more) time. Conclusion: More than 1 /4 of patients who come to out-patient clinics suffer from diseases accompanied by CNCP. The absence of pain specialists in Russia is the main reason to refer patients from one doctor to another.
803 CHRONIC PAIN FOLLOWING MAJOR TRAUMA N. Garrido *, C. Celestino, L. Ribeiro, A. Melo, F. Lima. Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Vila Nova de Gaia, Portugal Background and Aims: Pain is expected in the period following acute trauma, which is increasingly recognized as a factor in the development of chronic pain. Complex regional pain syndrome and phantom limb pain are distinct chronic conditions associated with trauma. [1] Methods: To examine rates of pain 1 year after injury and predictive factors, we studied 100 patients who were admitted to emergency room due to trauma. At a 12 months phone interview, patients were asked about pain using questions from Chronic Pain Grade Scale. We also examine personal, injury and treatment factors that predict chronic pain. Results: 12 months after injury, 52% of patients reported injuryrelated pain. Patients had pain in more than 1 body region and mean severity of pain in the last month was 5.2 on a 10-point scale. The reported pain varied with age, was more common in women and those who had depression. Pain at 3 months was predictive of both presence and higher severity of pain at 12 months. Patients with pain were more likely to have been required ICU care, received assisted ventilation and underwent surgery. The severity of pain is higher in patients with multiple injuries. Conclusions: The findings of this study suggest that interventions to decrease chronic pain in trauma patients are needed. The high prevalence of pain, its severity and its effect on functioning warrant such interventions. This may consist of interventions during the acute phase of hospitalization to agressively treat early pain and better manage neuropathic pain. Reference(s) [1] Trauma 2005; vol7, No3, 123–131.
804 SPASTICITY, SPASMS AND CHRONIC PAIN FOLLOWING STROKE: A PROSPECTIVE STUDY A. Hansen1 *, H. Klit1 , N. Brix Finnerup1 , G. Andersen2 , T. Staehelin Jensen1 . 1 Danish Pain Research Center, Aarhus University, Aarhus, Denmark; 2 Department of Neurology, Aarhus University Hospital, Aarhus, Denmark Background: Chronic post-stroke pain, such as shoulder pain and central pain, is a known consequence of stroke. The relation between spasticity, spasms and pain is not clear. Aims: The objectives of this study were to determine the incidence of spasticity, spasms and chronic pain after stroke and the relation between these phenomena. Methods: All consecutively eligible patients admitted to the Stroke Unit, F2, Aarhus University Hospital from 1 February to 1 August 2008 were asked about pain, spasms and spasticity prior to and at stroke onset and subjected to a brief examination of sensory abnormalities, reflex activities and muscle tone and strength. The patients were contacted and interviewed by phone or mail after three and six months and asked about pain status, spasms and spasticity. Results: Of 164 acute stroke patients, 157 and 152 patients completed three and six months follow-up respectively. After six months, 15.2% (24/152) reported spasticity or spasms; 33.3% (8/24) of them reported pain due to their spasticity or spasms and 20.8% (5/24) reported discomfort. Central pain was reported by 6.6% (10/152) and was more common in those with spasticity and spasms while shoulder pain was not related to spasticity and spasms (Fisher’s exact test, P = 0.001). Conclusion: Spasticity, spasms and central pain may be associated.