810 COMPLEX REGIONAL PAIN SYNDROME DUE TO RADIATION INDUCED BRACHIAL PLEXOPATHY

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European Journal of Pain 2006, Vol 10 (suppl S1)

807 COGNITIVE PERFORMANCE, MEMORY COMPLAINTS, MEDICATION AND DEPRESSION IN A SAMPLE OF CHRONIC PAIN PATIENTS A. Padrol1,2 ° , A. Castel1,2 , T. Llop1 , M. P´erez1,2 , S. Cos´ı1 , M. Rull1 . Clinic and UFISS Palliative Care. Joan XXIII University Hospital. Tarragona, 2 Gesti´o i Prestaci´o de Serveis de Salut. Tarragona, Spain 1 Pain

Background and Aims: Memory and concentration complaints are usual in chronic pain patients. The aim is to compare cognitive performance and memory complaints in a sample of patients taking opioids: 1) with antidepressants; 2) with anticonvulsivants; 3) with antidepressants plus anticonvulsivants. Subjects: Sixty-seven patients (18−64 years old). Fibromyalgia 64.2%, back pain 29.8%, other 6%. Mean age 48.2. 27% men, 73% women. Method: Subjects were examined individually by a psychologist. Tests: Hospital Anxiety and Depression Scale, Memory Failure in Everyday Memory Test, Verbal Learning Test – TAVEC – Toulouse-Pi´eron Test, Stroop Color and Word Test. The clinic tolerance and other variables of medication were not collected. Results: There are not differences between the groups in age, duration of pain and educational level. The significant differences between opioids-antidepressants versus opioids-anticonvulsivants are: memory complaints: F(1,63) = 9.29 p < 0.003, depression: F(1,63) = 5.98 p < 0.017; TAVEC-RIA5: F(1,62) = 4.17 p < 0.045; TAVEC-RIAT: F(1,62) = 6.8 p < 0.011; TAVEC-RLCP: F(1,60) = 5.08 p < 0.028; TAVEC-RLLP: F(1,61) = 6.93 p < 0.011; TAVEC-ESEM-RIA: F(1,62) = 9.49 p < 0.003; TAVEC-ESEMRLCP: F(1,60) = 6.49 p < 0.013; TAVEC-ESEMRLLP: F(1,61) = 6.86 p < 0.011. There is not an additional effect in cognitive performance of patients taking antidepressants plus anticonvulsivants. Conclusions: 1) In our sample, patients taking anticonvulsivants have worse cognitive performance than patients taking antidepressants in memory of words. 2) The patients taking anticonvulsivants have less effective proceeding to memorize than patients taking antidepressants. 3) Paradoxically, patients taking antidepressants have more memory complaints than patients taking anticonvulsivants. 4) Memory complaints are related with depression.

Abstracts, 5th EFIC Congress, Free Presentations 5.18 (with the standard deviation of 1.15) in Entonox. The mean of the pain severity between the two groups was different significantly (p = 0.0001). Conclusion: Regarding the findings of the research, it seems that application of Entonox relieves the pain of the active phase of labor more than TENS. The two mentioned ways left no negative or harmful impressions on the fetus and mother. Father studies for comparing Entonox with other pain relieving methods are recommended. 809 POTENTIAL COMPLICATIONS (IMMEDIATE AND DELAYED) ACCORDING WITH IMPLANTATION OF VENOUS PORTS J. Podsednickova ° , M. Cernicka. Dept. of Anesthesia and Intensive Care, General University Hospital, Praha, Czech Republic

808 COMPARISON OF INHALATION OF ENTONOX WITH USE OF TENS ON THE SEVERITY OF PAIN IN THE ACTIVE PHASE OF LABOR, TEHRAN, 2004

Aim of investigation: implantable venous ports are used mainly for oncologic patients undergoing chemoterapy, parenteral nutrition and analgetic therapy in cases of bad venous access. At 408 implantations we had 8.26% cases with complications (immediate and delayed). Methods: We used per-cutaneous Seldinger aproach for punction subclavian vein under local anaesthesia. We prepare the port pocket at the chosen site above the major pector muscle, tunnel the catheter subcutaneously from the puncture to the port. After inserting the port into the port pocket and before closing the skin we confirm catheter patency. A radioraph is taken to verify catheter positron and exclude haemothorax or pneumotorax. Results: Potential complications (immediate and delayed) are: Air embolism Brachial plexus injury Cardiac arrhythmia, tamponade, puncture Catheter disconnection or fragmentation Catheter occlusion Catheter rupture Embolism Inflammatory reaction Fibrin sheath formation Haematoma Haemothorax Infection/sepsis Pneumothorax Port/catheter migration Thromboembolism/thrombophlebitis Thrombosis Duting the year 2005 we had 8.26% cases of complications:

F. Pazandeh1 ° , F. Firozehchian1 , M. Sharafi2 , H. Alavi3 . 1 Faculty of Nursing and Midwifery, 2 Department of Obstetrics and Gynecology, 3 Faculty of Para Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Pneumothorax Inflammatory reaction Haematoma Catheter occlusion Thrombosis Together

Background and Aims: Pain relieving is one of the main parts of obstetrics. Mental and physiologic complications of acute labor pains on the fetus and mother as well are perfectly known. In majority maternity hospitals in Asia, no way for relieving the labor pain applied for some different reasons. Hence, it seems necessary to evaluate the cheap, safe methods in this regard, which need no specialist. This research has been accomplished in 2004 on those referring to Tehran’s Mahdieh maternity hospital, with the aim of comparing the impact of inhalation of a mixture of oxygen and nitrous oxide (Entonox) with Transcutaneous Electrical Nerve Stimulation (TENS) on the labor pain. Methods: 60 pregnant women, volunteered to take part, were randomly placed in two groups of TENS and Entonox. The two groups were the matched regarding the labor stimulation and the number of pregnancies. The relevant data were collected via the questionnaires, observing and physical examination, data form, Visual AnalogueScale (VAS), TENS unit, and Entonox capsule and other accessories. Mothers of both groups applied each method in the form of self administering and showed their pain severity in certain intervals (4−5 cm, 6−7 cm, 8−9 cm, 10 cm dilatations) to the researcher using visual analog scale.. Results: The mean of the pain severity in the whole active phase of labor was 6.9083 (with the standard deviation of 1.03) in the TENS group and

4.13% 1.37% 1.37% 1.11% 0.28% 8.26%

Conclusions: Usual number of complications under the circunstances with venous port implantation is 11%, in our hospital it is 8.26%. The reason of such results is great opinion due to the number of implantations. 810 COMPLEX REGIONAL PAIN SYNDROME DUE TO RADIATION INDUCED BRACHIAL PLEXOPATHY S. Sahin1 ° , G. Bademci2 , F.U. Tan3 , O.M. Kocak4 . 1 Department of Anesthesiology, 2 Department of Neurosurgery, 3 Department of Neurology, 4 Department of Psychiatry, Kirikkale University, School of Medicine, Kirikkale, Turkey Background and Aims: To determine the importance of multidisciplinary evaluation in chronic pain due to radiation induced brachial plexopathy (RIBP). Methods: We presented a 43-year-old woman, treated by radiation therapy for breast cancer, who exhibited two years later progressive left upper extremity weakness, paresthesia, left arm edema, discoloration and hyperhydrosis, thenar and hypothenar atrophy, severe motion restriction in the

Topic E: TREATMENT APPROACHES (PHYSICAL) wrist and forearm and chronic pain. EMG study revealed a conduction block at the level of the brachial plexus. MRI could not demonstrate any lesion. She was referred from neurosurgery to the algology. The patients was evaluated complex regional pain syndrome (CRPS) with pain, sensory changes, edema, sweating, and temperature disturbance in the afflicted extremity. The patient received several analgesics currently available in clinical practice to palliate pain including transdermal fentanyl. Treatment was rearranged by cervical sympathetic ganglion blocks combined with gabapentin, tramadol and physical therapy. Although the patient succesfully responded to the therapy at the first week, she developed symptoms indicating addiction to fentanyl and underwent psychiatric therapy for 2 months. Results: Edema and discoloration of the arm disappeared completely after repeated cervical ganglion blocks. Neuropathic pain, motor weakness and trophic changes were consistently reduced with the use of combined treatment modality. Conclusion: The response to therapy is modest and generally shortlived. Efforts should be aimed to provide adequate pain control, maximize remaining neurological function and prevent complications of immobility produced by the neuromuscular dysfunction in the CRPS. Treatment should be based on a multidisciplinary experienced team approach. 811 TREATMENT APPROACHES FOR POSTHERPETIC NEURALGIA M. Akbas, H. Ulugol ° , B. Karslı, M.A. Yegin. Anesthesiology and Reanimation, Clinical of Pain, Akdeniz University Medical Faculty Antalya, Turkey Background and Aims: Postherpetic neuralgia (PHN) is a complication of acute herpes zoster, which is emerging as a preferred clinical trial model for chronic neuropathic pain. The most commonly prescribed medications are strong pain relievers containing opioids, antidepressants, anticonvulsants, and a newly approved topical lidocaine patch. We aim to present our experience of treatment in cases of PHN. Method: Sixty consecutive PHN admissions to the clinical of pain between March 2004 and January 2006 were identified retrospectively. These patients were assessed for the visual analog score (VAS), allodynia, age, drugs and surgical treatment. Treatment was completed if visual analog scores are zero. Results: PHN particularly in elderly persons who are debilitated or arteriosclerotic. The risk of developing PHN increases with age. Likewise, average age are sixty-four in this study. VAS in this cases were between three to eight. VAS have dramatically decreasing after treatment in two week. We determined the allodynia 32% patient of PHN. Allodynia have decreasing after treatment in two week. Five patients treated by topical lidocaine technique. Patients have to relief dramatically after procedure. Fourteen patients (%25) were taking a anti-viral drug. All of PHN were treated drug combinations that consist of opioids, antidepressants, anticonvulsants and sometimes topical lidocain. Conclusions: We aim to review treatment application to be treated PHN in our pain clinic. Nerve blockage with medical therapy can be preferred for the patients who don’t reveal with medical therapy alone References Postherpetic neuralgia Clin. Evid 2005 Dec; (14): 1017−25.

812 SLEEP DISTURBANCES AND USE OF MEDICATION S. Venø ° , G. Handberg, A.G. Christiansen. Multidisciplinary Pain Clinic, University Hospital Odense, Denmark Background: The goal was to study possible interaction between use of medication and sleeping problems in non-malign chronic pain patients. Method: The Pittsburgh Sleep Quality Index (PSQI) 1 measures sleep quality retrospectively over a one-month period using self-reports. PSQI gives a sleeping score between 0 and 21 where a score over 5 indicates

S211 poor sleep quality. This study included 100 patients who completed PSQI. For each patient we registered sleeping score and use of selected types of medicine (see table) at their first consultation. Mean values for sleeping score were calculated, together with t-tests for significant difference, for users and non-users. Results: See Table. There were no significant differences in mean sleeping score for users versus non users for any type of medicine, except for users of benzodiazepine who had a significant lower sleeping score than nonusers. Nevertheless, the score in this group was still above 5, indicating poor sleep. Type of medicine

Mean sleeping score (SD) Users

Non-users

Morphine Paracetamol NSAID Benzodiazepine Antidepressant drugs Anticonvulsant drugs

10.70 (3.8) 10.36 (3.6) 10.20 (4.0) 9.56 (4.8)* 10.22 (4.1) 9.68 (5.2)

9.65 (4.5) 10.11 (4.7) 10.40 (4.6) 11.59 (4.5)* 10.30 (4.4) 10.38 (3.9)

*There was significant difference in mean values (P < 0.05).

Conclusion: Despite the use of medicine capable of influencing sleep, chronic pain patients are generally poor sleepers. The difference in mean score for users of benzodiazepine is low, although significant. The difference is probably without clinical importance. With the exception of benzodiazepine, we conclude that these types of medicine do not affect sleep. References [1] Buysse DJ et Al. The Piitsburgh Sleep Quality Index: A new Instrument for Psychiatric Practice and Research. Psychiatry Research. 1988; Vol. 28: 193– 213.

Topic E: TREATMENT APPROACHES (PHYSICAL) E01 Acupuncture 813 ACUTE AND CHRONIC PAIN H.C. Dung ° , C.C. Huang. Acupuncture Teaching & Research Center, Meiho Institute of Technology, Neipu, Pingtung, Taiwan The duration of three months is the accepted time to divide the acute and chronic pain. The division, obviously, is more as a convenient assumption than a scientific reality. To differentiate acute from chronic pain by mere temporal dimension is not as succient as we may want to believe. There is still room to miff for a more reliable way to separate them. This presentation is intended just for that purported puroose. Volunteers from the audience will be recruited to demonstrate empirically the method to determine if an individual suffers from chronic pain. The test is easy to conduct under any circumstance at any time using only one finger tip in examination. The result of the examination is repeatable and reproducible by any second person at other locations. The method is based on the well known principle of the existence of trigger points. Any person with chronic pain will have detectable trigger points at definitive loci of the body. The locations of the points are, in most instances, not perceived subjectively. They can be objectively dectected and discovered, if we know their precise anatomical localities. The unique anatomical features of each trigger point appear to dictate the sequence in which they become sensitive with tenderness which is detectable with an appropriate force of finger tip pressure. In other words, trigger points can be quantified in a mathematical number for each individuals with or without perceivable pain. A subjectively perceived pain with no detectable trigger point can be considered as in an acute stage, regardless of how long that pain has been presented in the body. Contrary, a subjective pain with a number of trigger points detected can be taken as an indication in having the pain developed into a chronic stage. More the trigger points there are, more the pain is in the chronic stage.