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892 A PROSPECTIVE CLINICAL STUDY ON PATIENTS, WITH PERSISTENT PAIN, AND THEIR RESPONSE TO TRANSCUTANEUS ELECTRIC NERVE STIMULATION (TENS) TREATMENT
Poster Sessions / European Journal of Pain 13 (2009) S55–S285
Results: Preliminary results show that in patients with gonarthrosis TENS therapy is effective in reducing the pain scores and need for medication. Conclusion: TENS therapy used in patients with gonarthrosis is effective and has few side effects. 890 SPINAL CORD STIMULATION COMBINING A SURGICAL PLATE AND A PERCUTANEOUS LEAD IN MANAGEMENT OF REFRACTORY ANGINA – A CASE STUDY H.K. Tsang *, D. Trenbath, A. Leach, M. Chester. National Refractory Angina Centre, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom Spinal cord stimulation has been utilized in the treatment of painful conditions and intractable angina. Studies have confirmed an improvement in the quality of life and reduced hospital admissions for these patients. [1,2,3] We report a case of a patient who experienced cross-talk between an implanted percutaneous lead and a surgical plate placed in parallel. Case report: A 64yr gentleman with a pacemaker was referred to the NRAC for management of his intractable angina. He progressed along our treatment algorithm to spinal cord stimulation with no interference to his pacemaker. Lead movement resulted in two lead revisions with short-lived improvements. He was referred to our local neurosurgical unit for a surgical plate. Stimulation remained in the right axilla with the target area central and left chest. He declined revision of the plate and a percutaneous lead was passed parallel to it. Stimulation persisted in the right axilla with the use of the lead only, plate only or lead and plate. This was overcome by passing a continuous ultra-low sub-threshold amplitude of 0.5 v in the surgical plate. Subsequent programming of the percutaneous lead provided stimulation in the target area and symptom control Discussion: Cross-talk between electrodes placed in parallel can be useful to increase the area of stimulation. The unexpected crosstalk between a surgical plate and percutaneous lead can lead to a programming challenge. Reference(s) DeJongste et al. J Am Coll Cardiol 1994;23:1592–7. DeJongste et al. Br Heart J 1994;71:413–8. Sanderson et al. Eur Heart J 1992;13:628–633.
891 BIO-PSYCHO-SOCIAL ASSESSMENT OF NEUROMODULATION TREATMENT OF PATIENTS WITH FAILED BACK SURGERY SYNDROME I. Vrba1 , J. Kozak ´ 2 *, P. Knotek3 , M. Koran4 , I. Stetkarova5 . 1 ICU Nemocnice Na Homolce, Institute of psychology MU LF Brno, Praha 5, Czech Republic; 2 Pain Centrum, Faculty Hospital Motol, Praha 5, Czech Republic; 3 Pain Centrum, Faculty Hospital Motol, Praha 5, Czech Republic; 4 Neurosurgery Dpt., Na Homolce Hospital, Praha 5, Czech Republic; 5 Neurology Dpt. Na Homolce Hospital, Praha 5, Czech Republic Aim: Failed back surgery syndrome (FBSS) refers to patients who continue to suffer from chronic back and leg pain following spinal surgery or surgeries. Patients experience mixed pain, disability, reduced functionality and quality of life. Various treatment methods are used with often poor results. Methods: We have used both neuromodulation analgetic methods for treatment in thirty six carefully selected FBSS patients. We evaluated pain relief changes, functional capacity, pain medication, quality of pain and other parameters through the administration of any bio-psycho-social instruments before and after implantation of neuromodulation system. We used VAS I-IV, SF-36 medical outcomes questionnaire, Beck depression inventory, Oswestry disability Index, Self-report symptom inventory and our assessment scale.
S253
Results: To compare the patients before and after implantation, we recognized lower use of pain killers, mainly strong opioids. Significant positive changes were found in pain relief reduction, functional capacity and quality of life. We detected improvement in seven items of patient satisfaction. We recognised some complications. Conclusions: We showed that both neuromodulation treatments provide pain relief, reduce consumption of pain killers and improve functional capacity and quality of pain in selected FBSS patients. Psychological and social assessment of FBSS patients with use of suitable instruments before neuromodulation is an important part of good patient selection. The FBSS is the worldwide most common indication for neuromodulation treatment. Supported by Internal Grant Agency of the Czech Ministry of Health (IGA NF-8232/3), and the Czech Ministry of Education and Sports (RG 0021620816/2005–2011) 892 A PROSPECTIVE CLINICAL STUDY ON PATIENTS, WITH PERSISTENT PAIN, AND THEIR RESPONSE TO TRANSCUTANEUS ELECTRIC NERVE STIMULATION (TENS) TREATMENT H. Westergren, P. Scho¨ on, ¨ I.B. Andersson *. Section for Specialized Pain Rehabilitation, Dept of Rehabmedicine, University Hospital, Lund, Sweden Background and Aims: Although widely used world-over clinical treatment with TENS is very sparsely studied. We have investigated if any group of patients with persistent pain is more liable to respond to TENS treatment than others. Methods: The patients investigated all suffered from different kinds of persistent pain and were referred from a primary pain assessment, either by a team or a single physician, to a nurseled semi-structured “TENS-program”. The patients were assessed individually for electrode placement and type of TENS program(s), using Cefar-Compex, PrimoPro® . The patients brought the TENS device home for 2–6 weeks and after that they decided if they wanted to rent the TENS device at a cost of 300 SEK (ca. 30 Euro) per year. We have recorded demographic data, type of pain and pain history as well as social and psychological profiles. The endpoint of the study was “if the patient decided to rent the TENS device or not”. Results: In total 94 patients went through the testing protocol during one year. All were assessed regarding demographic data, type of pain and pain history, 53 were additionally assessed with psychological profiles (MPI). In the end 65 patients (69%) chose to rent the TENS device. We present a description of recorded data from the two groups i.e. responders versus non-responders. The study was partly supported by the Cefar-Compex company 893 PULSED RADIOFREQUENCY (PRF) FOR THE TREATMENT OF OCCIPITAL NEURALGIA: 6 MONTHS FOLLOW UP K. Aerts *, P. Vanelderen, P. De Vooght, M. Puylaert, R. Heylen, J. Van Zundert. Ziekenhuis Oost Limburg, Genk, Belgium Aim of Investigation: The International Headache Society describes occipital neuralgia as non-throbbing neck pain spreading ipsilaterally to the occipito-temporo-frontal area, relieved by injection of local anesthetics at the greater and/or lesser occipital nerve. There is no gold standard for treatment. We performed a 6-month follow-up after treatment with PRF and measured VAS (Visual Analog Scale), GPE (General perceived effect) and MQS (Medication Quantification Scale). Methods: 19 patients had PRF (45 Volt, 42º C) for 4 minutes after positive diagnostic block of the occipital nerves (>50% VAS reduction). External landmarks described by Vital and Becser ¸ identified target nerves. Needle position was controlled with electrical stimulation at 50 Hz (threshold <0.5 V). Follow-up at 1, 2 and 6 months.
Results: Preliminary results show that in patients with gonarthrosis TENS therapy is effective in reducing the pain scores and need for medication. Conclusion: TENS therapy used in patients with gonarthrosis is effective and has few side effects. 890 SPINAL CORD STIMULATION COMBINING A SURGICAL PLATE AND A PERCUTANEOUS LEAD IN MANAGEMENT OF REFRACTORY ANGINA – A CASE STUDY H.K. Tsang *, D. Trenbath, A. Leach, M. Chester. National Refractory Angina Centre, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom Spinal cord stimulation has been utilized in the treatment of painful conditions and intractable angina. Studies have confirmed an improvement in the quality of life and reduced hospital admissions for these patients. [1,2,3] We report a case of a patient who experienced cross-talk between an implanted percutaneous lead and a surgical plate placed in parallel. Case report: A 64yr gentleman with a pacemaker was referred to the NRAC for management of his intractable angina. He progressed along our treatment algorithm to spinal cord stimulation with no interference to his pacemaker. Lead movement resulted in two lead revisions with short-lived improvements. He was referred to our local neurosurgical unit for a surgical plate. Stimulation remained in the right axilla with the target area central and left chest. He declined revision of the plate and a percutaneous lead was passed parallel to it. Stimulation persisted in the right axilla with the use of the lead only, plate only or lead and plate. This was overcome by passing a continuous ultra-low sub-threshold amplitude of 0.5 v in the surgical plate. Subsequent programming of the percutaneous lead provided stimulation in the target area and symptom control Discussion: Cross-talk between electrodes placed in parallel can be useful to increase the area of stimulation. The unexpected crosstalk between a surgical plate and percutaneous lead can lead to a programming challenge. Reference(s) DeJongste et al. J Am Coll Cardiol 1994;23:1592–7. DeJongste et al. Br Heart J 1994;71:413–8. Sanderson et al. Eur Heart J 1992;13:628–633.
891 BIO-PSYCHO-SOCIAL ASSESSMENT OF NEUROMODULATION TREATMENT OF PATIENTS WITH FAILED BACK SURGERY SYNDROME I. Vrba1 , J. Kozak ´ 2 *, P. Knotek3 , M. Koran4 , I. Stetkarova5 . 1 ICU Nemocnice Na Homolce, Institute of psychology MU LF Brno, Praha 5, Czech Republic; 2 Pain Centrum, Faculty Hospital Motol, Praha 5, Czech Republic; 3 Pain Centrum, Faculty Hospital Motol, Praha 5, Czech Republic; 4 Neurosurgery Dpt., Na Homolce Hospital, Praha 5, Czech Republic; 5 Neurology Dpt. Na Homolce Hospital, Praha 5, Czech Republic Aim: Failed back surgery syndrome (FBSS) refers to patients who continue to suffer from chronic back and leg pain following spinal surgery or surgeries. Patients experience mixed pain, disability, reduced functionality and quality of life. Various treatment methods are used with often poor results. Methods: We have used both neuromodulation analgetic methods for treatment in thirty six carefully selected FBSS patients. We evaluated pain relief changes, functional capacity, pain medication, quality of pain and other parameters through the administration of any bio-psycho-social instruments before and after implantation of neuromodulation system. We used VAS I-IV, SF-36 medical outcomes questionnaire, Beck depression inventory, Oswestry disability Index, Self-report symptom inventory and our assessment scale.
S253
Results: To compare the patients before and after implantation, we recognized lower use of pain killers, mainly strong opioids. Significant positive changes were found in pain relief reduction, functional capacity and quality of life. We detected improvement in seven items of patient satisfaction. We recognised some complications. Conclusions: We showed that both neuromodulation treatments provide pain relief, reduce consumption of pain killers and improve functional capacity and quality of pain in selected FBSS patients. Psychological and social assessment of FBSS patients with use of suitable instruments before neuromodulation is an important part of good patient selection. The FBSS is the worldwide most common indication for neuromodulation treatment. Supported by Internal Grant Agency of the Czech Ministry of Health (IGA NF-8232/3), and the Czech Ministry of Education and Sports (RG 0021620816/2005–2011) 892 A PROSPECTIVE CLINICAL STUDY ON PATIENTS, WITH PERSISTENT PAIN, AND THEIR RESPONSE TO TRANSCUTANEUS ELECTRIC NERVE STIMULATION (TENS) TREATMENT H. Westergren, P. Scho¨ on, ¨ I.B. Andersson *. Section for Specialized Pain Rehabilitation, Dept of Rehabmedicine, University Hospital, Lund, Sweden Background and Aims: Although widely used world-over clinical treatment with TENS is very sparsely studied. We have investigated if any group of patients with persistent pain is more liable to respond to TENS treatment than others. Methods: The patients investigated all suffered from different kinds of persistent pain and were referred from a primary pain assessment, either by a team or a single physician, to a nurseled semi-structured “TENS-program”. The patients were assessed individually for electrode placement and type of TENS program(s), using Cefar-Compex, PrimoPro® . The patients brought the TENS device home for 2–6 weeks and after that they decided if they wanted to rent the TENS device at a cost of 300 SEK (ca. 30 Euro) per year. We have recorded demographic data, type of pain and pain history as well as social and psychological profiles. The endpoint of the study was “if the patient decided to rent the TENS device or not”. Results: In total 94 patients went through the testing protocol during one year. All were assessed regarding demographic data, type of pain and pain history, 53 were additionally assessed with psychological profiles (MPI). In the end 65 patients (69%) chose to rent the TENS device. We present a description of recorded data from the two groups i.e. responders versus non-responders. The study was partly supported by the Cefar-Compex company 893 PULSED RADIOFREQUENCY (PRF) FOR THE TREATMENT OF OCCIPITAL NEURALGIA: 6 MONTHS FOLLOW UP K. Aerts *, P. Vanelderen, P. De Vooght, M. Puylaert, R. Heylen, J. Van Zundert. Ziekenhuis Oost Limburg, Genk, Belgium Aim of Investigation: The International Headache Society describes occipital neuralgia as non-throbbing neck pain spreading ipsilaterally to the occipito-temporo-frontal area, relieved by injection of local anesthetics at the greater and/or lesser occipital nerve. There is no gold standard for treatment. We performed a 6-month follow-up after treatment with PRF and measured VAS (Visual Analog Scale), GPE (General perceived effect) and MQS (Medication Quantification Scale). Methods: 19 patients had PRF (45 Volt, 42º C) for 4 minutes after positive diagnostic block of the occipital nerves (>50% VAS reduction). External landmarks described by Vital and Becser ¸ identified target nerves. Needle position was controlled with electrical stimulation at 50 Hz (threshold <0.5 V). Follow-up at 1, 2 and 6 months.