- Email: [email protected]
967 NUMERICAL INTERPRETATION OF MILD, MODERATE AND SEVERE CANCER PAIN BY PATIENTS IN SERBIA
S250
European Journal of Pain 2006, Vol 10 (suppl S1)
965 EPIDURAL STEROID INJECTION THERAPY: PROSPECTIVE ANALYSIS OF FACTORS INFLUENCING THE EFFICACY K. Saravanakumar1 ° , C. Plant2 , A. Kabeer3 . 1 Dept of Pain Medicine, Walton Centre for Neurology & Neurosurgery, Liverpool, 2 Dept of Physiotherapy, City Hospital, Birmingham, 3 Dept of Anaesthesia, City Hospital, Birmingham, UK Background: Though the efficacy of epidural steroid injections (ESI) has not been conclusively proven, they are reasonable alternative in selected patients. Patient selection, proper injection techniques and reasonable expectations hold the key for success. We audited our ESIs to find out prognostic factors. Method: Regional Ethics Committee was consulted regarding ethics approval. All the ESIs were performed by consultants, adhering to the standards recommended by the Royal College of Anaesthetists and British Pain society. We collected data prospectively on a purpose-designed audit form in 51 consecutive patients on the day of intervention and during their routine reviews over a period of 15 months. The collected data include demography, symptoms including pain scores & HADS, previous interventions, clinical reasoning, technical details, the drug, dose and volume of injectate, adjuvants used, pain relief including onset & duration and global impression of therapy. The collected data were entered into Microsoft Access database and analysed using Excel. Results: 49% of the patients benefited from the epidural. 31.37% had pain relief lasting for more than 6 weeks. Radicular symptoms (57.69%), less psychological distress (24% Vs 42%), pain of discal origin (64.70%) positively influences the outcome. Previous interventions, volume of injectate, and addition of hyalase did not seem to influence the pain relief. 20% of the patients got pain relief more than they expected. Conclusion: Lumbar ESI provides short term pain relief for patients with radiculopathy of proven discal origin without significant depression.
966 MYOFASCIAL PAIN SYNDROME DUE TO CERVICAL DISC HERNIATION ˙ H. Sari ° , U. Akarirmak, M. Uludag. Istanbul University Cerrahpasa ˙ Medical Faculty Physical Medicine and Rehabilitation, Istanbul, Turkey Background and Aim: Cervical root compression may frequently be the cause of radiculopathy symptoms like neck, arm, back and chest pain. In the course of the disease as the pain becomes chronic, together with neck pain, pain in muscles innervated by the involved nerve may continue. The objective of this study was to determine if there is an association between cervical radiculopathy and myofascial pain syndrome (MPS) in the neck and back muscles in cervical disc herniation (CDH) patients. Methods: Frequency of MPS were assessed in patients diagnosed as CDH clinically and by magnetic resonance findings. Two hundred forty four (244) patients diagnosed as CDH were enrolled in this study. Results: The patients comprised of 128 female (52.5%) and 116 male (47.5%) patients. Mean age was 44.58 (20−65). The level of herniation was C3−C4 in 24 patients (7%), C4−C5 in 65 patients (18%), C5−C6 in 163 (46%) patients and C6−C7 in 103 (29%) patients. CDH was diagnosed at one level in 108 (49%) patients, at two levels in 79 (36%), at 3 levels in 27 (12%) and at 4 levels in 8 (3%) patients. MPS were found in 125 (51.2%) of patients diagnosed as CDH especially in back muscles. Conclusions: Cervical radiculopathy caused by CDH was associated with increased myofascial trigger points in upper back muscles, especially in muscles innervated by the involved nerve root. Cervical root compressions may be the starting or maintaining factors of myofascial pain syndromes.
Abstracts, 5th EFIC Congress, Free Presentations
G30 OTHER 967 NUMERICAL INTERPRETATION OF MILD, MODERATE AND SEVERE CANCER PAIN BY PATIENTS IN SERBIA S.M. Bosnjak ° , D. Gavrilovic, S. Susnjar, I. Bozovic Spasojevic. Oncology Intensive Care Unit, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia, Serbia and Montenegro Background and Aims: The use of a verbal descriptor scale (VDS: mild, moderate, severe) and a 0−10 numerical scale (NS) is recommended to report pain severity. The aim of our study was to examine how patients in Serbia numerically interpret mild, moderate and severe cancer pain. Methods: The analysis included 190 patients who have never been introduced to the 0−10 NS before, and were not familiar with the ranges used for mild, moderate and severe pain. Patients reported average pain severity during the previous week using VDS and a 0−10 NS at baseline, and on days 7, 16 and 31 of their pain treatment. The strength of agreement between patient verbal grading of pain severity and 4 descriptive systems (S1-S4) determined with different pain severity cutpoints on a 0−10 NS scale was analyzed (S1, 1−4: mild, 5−7: moderate, 8−10: severe pain; S2, 1−4: mild, 5−6: moderate, 7−10: severe pain; S3, 1−3: mild, 4−7: moderate, 8−10: severe pain; S4, 1−3: mild, 4−6: moderate, 7−10: severe pain). Results: The highest strength of agreement was observed with S4 at baseline (k: 0.535, moderate agreement), with S2 on day 7 (k: 0.592, moderate agreement) and with S1 on day 16 (k: 0.592, moderate agreement) and day 31 (k: 0.648, good agreement). Conclusions: The highest agreement observed with S1 on day 16 and day 31 might indicate that our patients tend to use 4 as a cutpoint between mild and moderate pain, and 7 as a cutpoint between moderate and severe pain.
968 MEDICATION USE IN PATIENTS WITH CHRONIC NON-MALIGNANT PAIN: DO THEY ADHERE TO THE PRESCRIPTION OF THE PAIN CENTRE? S. Broekmans1−2 ° , E. Geyssens1 , A. Mottart1 , B. Morlion2 , K. Milisen1 , S. Vanderschueren2 . 1 Centre for Health Services and Nursing Research, Catholic University Leuven, 2 The Leuven Centre for Algology, University Hospitals Leuven, Belgium Background: Chronic non-malignant pain has a complex pathophysiology and important psychosocial consequences. Pharmacological treatment plays an important role in the multimodal and multidisciplinary approach of chronic pain. The efficacy of treatment depends on the accuracy of medication use. Aim: The aim of this study was to investigate the prevalence of medication non-adherence and self medication in a Belgian multidisciplinary pain centre (MPC). Methods: Medication adherence was measured by patients self report. We invited 359 patients for the study. Non response was 22%. Finally 281 patients were included. The mean age of the study population was 51 years, 60% was female. The most common pain diagnoses were low back pain (32%), neuropathic pain (21%) and fibromyalgia (15%). Result: Six out of 10 patients did not follow the prescription of the MPC correctly. Almost one third of the study population took less medication than prescribed, a quarter used self medication, 17% increased the dose or frequency of prescribed medication. The most important reasons for under-medication were the occurrence of or fear for side-effects. Patients took more medication if they were still in pain. Conclusion: Medication non-adherence among patients of a MPC is a frequent problem. More research is needed 1) to determine the factors influencing non-adherence, 2) to delineate a risk profile of non adherent patients and 3) to promote adherence.
European Journal of Pain 2006, Vol 10 (suppl S1)
965 EPIDURAL STEROID INJECTION THERAPY: PROSPECTIVE ANALYSIS OF FACTORS INFLUENCING THE EFFICACY K. Saravanakumar1 ° , C. Plant2 , A. Kabeer3 . 1 Dept of Pain Medicine, Walton Centre for Neurology & Neurosurgery, Liverpool, 2 Dept of Physiotherapy, City Hospital, Birmingham, 3 Dept of Anaesthesia, City Hospital, Birmingham, UK Background: Though the efficacy of epidural steroid injections (ESI) has not been conclusively proven, they are reasonable alternative in selected patients. Patient selection, proper injection techniques and reasonable expectations hold the key for success. We audited our ESIs to find out prognostic factors. Method: Regional Ethics Committee was consulted regarding ethics approval. All the ESIs were performed by consultants, adhering to the standards recommended by the Royal College of Anaesthetists and British Pain society. We collected data prospectively on a purpose-designed audit form in 51 consecutive patients on the day of intervention and during their routine reviews over a period of 15 months. The collected data include demography, symptoms including pain scores & HADS, previous interventions, clinical reasoning, technical details, the drug, dose and volume of injectate, adjuvants used, pain relief including onset & duration and global impression of therapy. The collected data were entered into Microsoft Access database and analysed using Excel. Results: 49% of the patients benefited from the epidural. 31.37% had pain relief lasting for more than 6 weeks. Radicular symptoms (57.69%), less psychological distress (24% Vs 42%), pain of discal origin (64.70%) positively influences the outcome. Previous interventions, volume of injectate, and addition of hyalase did not seem to influence the pain relief. 20% of the patients got pain relief more than they expected. Conclusion: Lumbar ESI provides short term pain relief for patients with radiculopathy of proven discal origin without significant depression.
966 MYOFASCIAL PAIN SYNDROME DUE TO CERVICAL DISC HERNIATION ˙ H. Sari ° , U. Akarirmak, M. Uludag. Istanbul University Cerrahpasa ˙ Medical Faculty Physical Medicine and Rehabilitation, Istanbul, Turkey Background and Aim: Cervical root compression may frequently be the cause of radiculopathy symptoms like neck, arm, back and chest pain. In the course of the disease as the pain becomes chronic, together with neck pain, pain in muscles innervated by the involved nerve may continue. The objective of this study was to determine if there is an association between cervical radiculopathy and myofascial pain syndrome (MPS) in the neck and back muscles in cervical disc herniation (CDH) patients. Methods: Frequency of MPS were assessed in patients diagnosed as CDH clinically and by magnetic resonance findings. Two hundred forty four (244) patients diagnosed as CDH were enrolled in this study. Results: The patients comprised of 128 female (52.5%) and 116 male (47.5%) patients. Mean age was 44.58 (20−65). The level of herniation was C3−C4 in 24 patients (7%), C4−C5 in 65 patients (18%), C5−C6 in 163 (46%) patients and C6−C7 in 103 (29%) patients. CDH was diagnosed at one level in 108 (49%) patients, at two levels in 79 (36%), at 3 levels in 27 (12%) and at 4 levels in 8 (3%) patients. MPS were found in 125 (51.2%) of patients diagnosed as CDH especially in back muscles. Conclusions: Cervical radiculopathy caused by CDH was associated with increased myofascial trigger points in upper back muscles, especially in muscles innervated by the involved nerve root. Cervical root compressions may be the starting or maintaining factors of myofascial pain syndromes.
Abstracts, 5th EFIC Congress, Free Presentations
G30 OTHER 967 NUMERICAL INTERPRETATION OF MILD, MODERATE AND SEVERE CANCER PAIN BY PATIENTS IN SERBIA S.M. Bosnjak ° , D. Gavrilovic, S. Susnjar, I. Bozovic Spasojevic. Oncology Intensive Care Unit, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia, Serbia and Montenegro Background and Aims: The use of a verbal descriptor scale (VDS: mild, moderate, severe) and a 0−10 numerical scale (NS) is recommended to report pain severity. The aim of our study was to examine how patients in Serbia numerically interpret mild, moderate and severe cancer pain. Methods: The analysis included 190 patients who have never been introduced to the 0−10 NS before, and were not familiar with the ranges used for mild, moderate and severe pain. Patients reported average pain severity during the previous week using VDS and a 0−10 NS at baseline, and on days 7, 16 and 31 of their pain treatment. The strength of agreement between patient verbal grading of pain severity and 4 descriptive systems (S1-S4) determined with different pain severity cutpoints on a 0−10 NS scale was analyzed (S1, 1−4: mild, 5−7: moderate, 8−10: severe pain; S2, 1−4: mild, 5−6: moderate, 7−10: severe pain; S3, 1−3: mild, 4−7: moderate, 8−10: severe pain; S4, 1−3: mild, 4−6: moderate, 7−10: severe pain). Results: The highest strength of agreement was observed with S4 at baseline (k: 0.535, moderate agreement), with S2 on day 7 (k: 0.592, moderate agreement) and with S1 on day 16 (k: 0.592, moderate agreement) and day 31 (k: 0.648, good agreement). Conclusions: The highest agreement observed with S1 on day 16 and day 31 might indicate that our patients tend to use 4 as a cutpoint between mild and moderate pain, and 7 as a cutpoint between moderate and severe pain.
968 MEDICATION USE IN PATIENTS WITH CHRONIC NON-MALIGNANT PAIN: DO THEY ADHERE TO THE PRESCRIPTION OF THE PAIN CENTRE? S. Broekmans1−2 ° , E. Geyssens1 , A. Mottart1 , B. Morlion2 , K. Milisen1 , S. Vanderschueren2 . 1 Centre for Health Services and Nursing Research, Catholic University Leuven, 2 The Leuven Centre for Algology, University Hospitals Leuven, Belgium Background: Chronic non-malignant pain has a complex pathophysiology and important psychosocial consequences. Pharmacological treatment plays an important role in the multimodal and multidisciplinary approach of chronic pain. The efficacy of treatment depends on the accuracy of medication use. Aim: The aim of this study was to investigate the prevalence of medication non-adherence and self medication in a Belgian multidisciplinary pain centre (MPC). Methods: Medication adherence was measured by patients self report. We invited 359 patients for the study. Non response was 22%. Finally 281 patients were included. The mean age of the study population was 51 years, 60% was female. The most common pain diagnoses were low back pain (32%), neuropathic pain (21%) and fibromyalgia (15%). Result: Six out of 10 patients did not follow the prescription of the MPC correctly. Almost one third of the study population took less medication than prescribed, a quarter used self medication, 17% increased the dose or frequency of prescribed medication. The most important reasons for under-medication were the occurrence of or fear for side-effects. Patients took more medication if they were still in pain. Conclusion: Medication non-adherence among patients of a MPC is a frequent problem. More research is needed 1) to determine the factors influencing non-adherence, 2) to delineate a risk profile of non adherent patients and 3) to promote adherence.