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812 SLEEP DISTURBANCES AND USE OF MEDICATION
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.
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.