- Email: [email protected]
824 DO PAIN, DEPRESSION, AND INSOMNIA COMPRISE A CLUSTER OF SYMPTOMS AMONG PATIENTS WITH CHRONIC PAIN?
S236
Poster Sessions / European Journal of Pain 13 (2009) S55–S285
Conclusion: The normative values enable comparison of patients’ performances to these values. If the patients’ performances exceed the lowest scores in his/her corresponding demand category, the patients’ capacity is very likely to be sufficient to defy the work load. Further, clinicians can make more precise return to work recommendations and set goals for rehabilitation programs. Comparisons to normative values are useful for the fields of rehabilitation, occupational and insurance medicine. Further research is needed to test validity of the normative references with respect to work place assessments and return to work recommendations. 823 COGNITIVE ASSESSMENT IN COMPLEX REGIONAL PAIN SYNDROME PATIENTS M. Jeeyoun1 *, J. Heejin2 , K. Joonwoo1 , L. Pyungbok1 , L. Joonyong1 . 1 Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Sungnam-Si, Kyonggi-Do, South Korea; 2 Department of Anesthesiology and Pain medicine Seoul National University Hospital, Seoul, South Korea Background: Complex regional pain syndrome (CRPS) is characterized by severe neuropathic pain and disability, which can result in psychological and behavioral dysfunction. The goal of the present study was to evaluate neurocognitive disability, and to assess the relationship between clinical variables and neuropsychological features in CRPS patients. Methods: We investigated the neuropsychological features of 15 CRPS I patients. The neuropsychological tests that we made comprised of a full intelligence quotient, memory quotient, trailmaking test A (TMT-A), trail-making test B (TMT-B), and MMPI (Minnesota multiphasic personality inventory). Results: The results showed severe disability in performance on TMT-B. There was no significant correlation between specific cognitive variables and MMPI scales. Conclusions: Decreased performance on TMT-B which shows mental flexibility in the prefrontal lobe exists independently from depressive disorders in CRPS patients. 824 DO PAIN, DEPRESSION, AND INSOMNIA COMPRISE A CLUSTER OF SYMPTOMS AMONG PATIENTS WITH CHRONIC PAIN? K. Leao Ferreira1,2 *, C. Nishimura1 , M. Teixeira1 . 1 Multidisciplinary Pain Center. S˜ ao Paulo Cancer Institute. University of S˜ ao Paulo, S˜ ao Paulo, Brazil; 2 University of Guarulhos,UnG, Guarulhos, Brazil Introduction: Depression and insomnia are usually observed among patients with chronic pain. The mechanism that justifies the co-occurrence of these symptoms is still uncertain. Perhaps, they constitute a cluster; a group of concurrent symptoms that may have a synergistic effect between them, share biological mechanisms, and that, acting together, create an effect greater than that achieved by each symptom working separately. Aims: To identify groups of patients based on the intensity of pain, quality of sleep, and presence of depression to evaluate the relationship of these symptoms and their impact on QoL. Methods: 251 outpatients with chronic non-cancer pain were recruited in the Multidisciplinary Pain Center, Hospital das ClinicasFMUSP, Brazil. The instruments used were: Pain visual numeric scale, Pittsburgh Sleep Quality Index (PSQI, score≥ 8 = insomnia), Beck Depression Inventory (BDI, scores≥ 21 = depression) and WHOQOL-bref to evaluate the physical, psychologic, social, and environment domains of QoL. TwoStep cluster analysis and t-student test were used. Results: The TwoStep cluster procedure identified two subgroups: the first (n = 132) showed only insomnia (PSQI = 9.22±3.89) (Cluster 1) and the second, pain (VAS=8.24±1.57), insomnia (PSQI = 14.57±3.03), and depression (BDI=24.36±10.35) (Cluster 2). Cluster 2 showed worse QOL in all domains (p < 0.005).
Conclusions: The concomitant presence of symptoms and their intensity were associated with poor QoL and that the symptoms were related as a cluster, and had synergic effect among them. 825 20 YEARS OF DEPARTMENT OF ALGESIOLOGY IN F.D. ROOSEVELT UNIV. HOSP, BANSKA BYSTRICA, SLOVAKIA I. Martuliak *. Dpt. of Algesiology F.D. Roosevelt Univ. Hosp., Banska Bystrica, Slovakia Introduction: 20 years of continual Pain treatment is a good reason to look back. We want to illustrate the work of 10 physicians, nurses and staff at the leading Pain Center in Slovakia on the field of diagnostics and treating of chronic pain as well as educational, research and scientific activities. The dpt. of Algesiology in our Hosp. started working in Jan.11, 1989 as an Out-pts. clinic (1st Pain Clinic based in 1984 in Martin), since 1995 as a Pain Center with its own ward with 10 beds in this time. There is an out-pts. clinic, in-pts. ward, interventional room, consilliary service and Acute Pain Service. The personnel consists of the Head of the Dpt., 4 physicians, 4 nurses and 1 secretary. In a period of 20 years, we have treated over 8,100 pts, that means over as 72,000 examinations (avg. 18% Cancer pain). We have hospitalized more as 1,700 pt. in Algesiol. ward with performing appx. 6,200 Epidural (Intrath.) bl., thousands of muscule TPs, Joints, Nerve and Scar infiltrations, hundreds of Bier’s bl., Plexal bl. and some of Drug-pump implantations. We have cooperation with the regional Hospic. Our Algeziol. Dpt. is also the Teaching base for Algesiolog. graduation in Slovakia, our staff generates many publications, lectures, pre- and post-gradual teaching. Conclusion: 20 years of continual Pain treatment in the City of Banska Bystrica (and 25 years of consistent Pain Treatment in Slovakia) means tens of thousands of patients, examinations, diagnostic and treating procedures. But it also means less human pain and suffering. 826 AN EVALUATION OF THE IMPLEMENTATION OF A MULTIDISCIPLINARY SERVICE FOR PERSISTENT PAIN IN A LONDON BOROUGH D. Carnes1 *, J. Gallagher4 , S. Leake2 , J. Wardell2 , D. York2 , M. Underwood3 . 1 Barts and the London School of Medicine and Dentistry, London, United Kingdom; 2 Tower Hamlets PCT, London, United Kingdom; 3 Warwick Medical School, Warwick, United Kingdom; 4 Barts and the London NHS Trust, London, United Kingdom Background: A multidisciplinary persistent pain service in the London Borough of Tower Hamlets was established in January 2008. All patients are referred into the service via their GP. We aimed evaluated the implementation of the service, over the first nine months. Method: We collected data using patient questionnaires, monthly activity reports from clinicians and the service administrator, and patient and staff interviews. Results: The activity data showed a steady increase in referrals to the service to full capacity after 9 months. 82% of Tower Hamlets GPs referred patients to the service, the referrals were appropriate.5% had been discharged at 9 months and a further 9% failed to attend or declined. The majority of patients were female (64%), between 41 and 60 years old, 79% were unemployed, 28% were registered disabled, 27% had their pain for more than 10 years and 37% of patients were not fluent in English. Generally the patients had high levels of distress, low self efficacy and high levels of pain and disability. The estimated cost per patient entering the PPS was ~£610.00, using recurrent cost data, and ~£440.00 per patient, using estimated notional costs. The patient and practitioner interviews highlighted the need for efficient administration, good communication with patients,
Poster Sessions / European Journal of Pain 13 (2009) S55–S285
Conclusion: The normative values enable comparison of patients’ performances to these values. If the patients’ performances exceed the lowest scores in his/her corresponding demand category, the patients’ capacity is very likely to be sufficient to defy the work load. Further, clinicians can make more precise return to work recommendations and set goals for rehabilitation programs. Comparisons to normative values are useful for the fields of rehabilitation, occupational and insurance medicine. Further research is needed to test validity of the normative references with respect to work place assessments and return to work recommendations. 823 COGNITIVE ASSESSMENT IN COMPLEX REGIONAL PAIN SYNDROME PATIENTS M. Jeeyoun1 *, J. Heejin2 , K. Joonwoo1 , L. Pyungbok1 , L. Joonyong1 . 1 Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Sungnam-Si, Kyonggi-Do, South Korea; 2 Department of Anesthesiology and Pain medicine Seoul National University Hospital, Seoul, South Korea Background: Complex regional pain syndrome (CRPS) is characterized by severe neuropathic pain and disability, which can result in psychological and behavioral dysfunction. The goal of the present study was to evaluate neurocognitive disability, and to assess the relationship between clinical variables and neuropsychological features in CRPS patients. Methods: We investigated the neuropsychological features of 15 CRPS I patients. The neuropsychological tests that we made comprised of a full intelligence quotient, memory quotient, trailmaking test A (TMT-A), trail-making test B (TMT-B), and MMPI (Minnesota multiphasic personality inventory). Results: The results showed severe disability in performance on TMT-B. There was no significant correlation between specific cognitive variables and MMPI scales. Conclusions: Decreased performance on TMT-B which shows mental flexibility in the prefrontal lobe exists independently from depressive disorders in CRPS patients. 824 DO PAIN, DEPRESSION, AND INSOMNIA COMPRISE A CLUSTER OF SYMPTOMS AMONG PATIENTS WITH CHRONIC PAIN? K. Leao Ferreira1,2 *, C. Nishimura1 , M. Teixeira1 . 1 Multidisciplinary Pain Center. S˜ ao Paulo Cancer Institute. University of S˜ ao Paulo, S˜ ao Paulo, Brazil; 2 University of Guarulhos,UnG, Guarulhos, Brazil Introduction: Depression and insomnia are usually observed among patients with chronic pain. The mechanism that justifies the co-occurrence of these symptoms is still uncertain. Perhaps, they constitute a cluster; a group of concurrent symptoms that may have a synergistic effect between them, share biological mechanisms, and that, acting together, create an effect greater than that achieved by each symptom working separately. Aims: To identify groups of patients based on the intensity of pain, quality of sleep, and presence of depression to evaluate the relationship of these symptoms and their impact on QoL. Methods: 251 outpatients with chronic non-cancer pain were recruited in the Multidisciplinary Pain Center, Hospital das ClinicasFMUSP, Brazil. The instruments used were: Pain visual numeric scale, Pittsburgh Sleep Quality Index (PSQI, score≥ 8 = insomnia), Beck Depression Inventory (BDI, scores≥ 21 = depression) and WHOQOL-bref to evaluate the physical, psychologic, social, and environment domains of QoL. TwoStep cluster analysis and t-student test were used. Results: The TwoStep cluster procedure identified two subgroups: the first (n = 132) showed only insomnia (PSQI = 9.22±3.89) (Cluster 1) and the second, pain (VAS=8.24±1.57), insomnia (PSQI = 14.57±3.03), and depression (BDI=24.36±10.35) (Cluster 2). Cluster 2 showed worse QOL in all domains (p < 0.005).
Conclusions: The concomitant presence of symptoms and their intensity were associated with poor QoL and that the symptoms were related as a cluster, and had synergic effect among them. 825 20 YEARS OF DEPARTMENT OF ALGESIOLOGY IN F.D. ROOSEVELT UNIV. HOSP, BANSKA BYSTRICA, SLOVAKIA I. Martuliak *. Dpt. of Algesiology F.D. Roosevelt Univ. Hosp., Banska Bystrica, Slovakia Introduction: 20 years of continual Pain treatment is a good reason to look back. We want to illustrate the work of 10 physicians, nurses and staff at the leading Pain Center in Slovakia on the field of diagnostics and treating of chronic pain as well as educational, research and scientific activities. The dpt. of Algesiology in our Hosp. started working in Jan.11, 1989 as an Out-pts. clinic (1st Pain Clinic based in 1984 in Martin), since 1995 as a Pain Center with its own ward with 10 beds in this time. There is an out-pts. clinic, in-pts. ward, interventional room, consilliary service and Acute Pain Service. The personnel consists of the Head of the Dpt., 4 physicians, 4 nurses and 1 secretary. In a period of 20 years, we have treated over 8,100 pts, that means over as 72,000 examinations (avg. 18% Cancer pain). We have hospitalized more as 1,700 pt. in Algesiol. ward with performing appx. 6,200 Epidural (Intrath.) bl., thousands of muscule TPs, Joints, Nerve and Scar infiltrations, hundreds of Bier’s bl., Plexal bl. and some of Drug-pump implantations. We have cooperation with the regional Hospic. Our Algeziol. Dpt. is also the Teaching base for Algesiolog. graduation in Slovakia, our staff generates many publications, lectures, pre- and post-gradual teaching. Conclusion: 20 years of continual Pain treatment in the City of Banska Bystrica (and 25 years of consistent Pain Treatment in Slovakia) means tens of thousands of patients, examinations, diagnostic and treating procedures. But it also means less human pain and suffering. 826 AN EVALUATION OF THE IMPLEMENTATION OF A MULTIDISCIPLINARY SERVICE FOR PERSISTENT PAIN IN A LONDON BOROUGH D. Carnes1 *, J. Gallagher4 , S. Leake2 , J. Wardell2 , D. York2 , M. Underwood3 . 1 Barts and the London School of Medicine and Dentistry, London, United Kingdom; 2 Tower Hamlets PCT, London, United Kingdom; 3 Warwick Medical School, Warwick, United Kingdom; 4 Barts and the London NHS Trust, London, United Kingdom Background: A multidisciplinary persistent pain service in the London Borough of Tower Hamlets was established in January 2008. All patients are referred into the service via their GP. We aimed evaluated the implementation of the service, over the first nine months. Method: We collected data using patient questionnaires, monthly activity reports from clinicians and the service administrator, and patient and staff interviews. Results: The activity data showed a steady increase in referrals to the service to full capacity after 9 months. 82% of Tower Hamlets GPs referred patients to the service, the referrals were appropriate.5% had been discharged at 9 months and a further 9% failed to attend or declined. The majority of patients were female (64%), between 41 and 60 years old, 79% were unemployed, 28% were registered disabled, 27% had their pain for more than 10 years and 37% of patients were not fluent in English. Generally the patients had high levels of distress, low self efficacy and high levels of pain and disability. The estimated cost per patient entering the PPS was ~£610.00, using recurrent cost data, and ~£440.00 per patient, using estimated notional costs. The patient and practitioner interviews highlighted the need for efficient administration, good communication with patients,