Arthritis

36 (707) The effects of stellate ganglion block on rats Z. Yang, S. Abdi; Department of Anesthesiology and Perioperative Medicine and Pain Management, University of Miami, School of Medicine, Miami, FL The purpose of this study is to evaluate Stellate Ganglion Block (SGB) on ptosis and heart rate changes on rats under general or local anesthesia. In the first part of the study, we used Sprague-Dawley rats (N⫽9; 280g to 380g), to evaluate the degree of ptosis. In the second part of our study, twenty-six Sprague-Dowley rats (310-400g) were divided into 3 groups. Gr. I (N⫽5) underwent left SGB, while Gr. II (N⫽4) right SGB and Gr. III (N⫽5) bilateral SGB respectively. SGB was performed under general anesthesia with isoflurane using 0.2 ml of 0.25% bupivacaine HCI. Once the SGB was done, the animals were awakened for the evaluation to ptosis and kept under light general anesthesia for the evaluation of EKG changes. EKG data from rats were recorded and analyzed by animal EKG system. All the animals were awake within 3 min. after discontinuation of anesthesia. There was a significant ptosis observed in the ipsilateral side of the SGB in all the animals. This effect lasted up to 30 min. Furthermore, there was no statistically significant EKG or heart rate changes after unilateral SGB. However, there was a significant decrease in heart rate after bilateral SGB. This effect lasted for up to 45 min. We conclude from our study that unilateral SGB on healthy animals seems to be a relatively safe procedure which might not affect heart rhythm or rate, but we caution a bilateral SGB. Further studies are needed to evaluate SGB effects on animals with myocardial insufficiency and/or existing arrhythmia.

Abstracts

C02 - Arthritis (709) Methotrexate use and symptoms of pain and sleep disturbance in postmenopausal women with Rheumatoid Arthritis C. Bourguignon, D. Taibi; University of Virginia, Charlottesville, VA The aim of this study was to investigate whether postmenopausal women with rheumatoid arthritis (RA) taking MTX differed in the symptoms of pain and sleep disturbance from those not taking MTX. Nineteen postmenopausal women with RA participated in this pilot study. Three were excluded due to missing data. Mean age was 61.5 ⫾ 9.0 (46-78). Seven participants (43.8%) were taking MTX. Self-rated RArelated disability did not depend on MTX use (␹2⫽.085, p⫽.386). Symptoms of pain (0-10 NRS), sleep disturbance (daily logs and wrist actigraphy), and inflammatory responses (RADAR, morning stiffness) were measured for three days. Women taking MTX rated their sleep quality significantly better than those not taking MTX (t⫽-2.64, p⫽.02). Objective sleep measures (awakenings, time in bed, sleep latency, and sleep efficiency) revealed significantly worse sleep disturbance in those taking MTX (t-tests, p⬍.05). Women taking MTX had an average sleep efficiency of 80.9%, which was 10% lower than those not taking MTX. There were no significant differences between the MTX groups in pain, morning stiffness, or RADAR joint tenderness (t-tests, p⬎.05). Pain was not correlated with sleep disturbance in either group. Caffeine (an adenosine agonist that might counteract the effects of MTX) was not significantly related to any of the symptoms. Pain and joint counts did not differ between groups. In addition, women on MTX experienced worse sleep disturbance. From this pilot study, it is impossible to determine whether MTX contributed to the sleep disturbance or whether a greater severity of RA warranting the use of MTX contributed to sleep disturbance through disruption of the HPA axis and cytokine pathways. Clearly, the relationship between MTX and sleep disturbance should be further explored and practitioners should address this symptom. Study supported by the University of Virginia School of Nursing and grant T32 AT00052-01 funded by NCCAM, NIH.

C. DISEASE ENTITIES (Human)

C04 - Headache

C01 - Amputation Pain

(710) Occipital neuralgia: Misdiagnosis as migraine headache

(708) Impact of Surgical and Psychological Factors in Women with Postmastectomy Pain I. Kudel, R. Edwards, J. Haythornthwaite, S. Raja, L. Heinberg; Johns Hopkins University School of Medicine, Baltimore, MD Approximately one-third of breast cancer survivors experience postmastectomy pain, however long-term follow-up studies are relatively rare and little attention has been paid to psychosocial outcomes in this population. Accordingly, we assessed the impact of surgical and psychosocial factors on pain-related disability in women who were between one and four years postmastectomy. Five-hundred and four questionnaires were mailed to women with breast cancer who underwent mastectomy surgery at JHH between May ‘96 and April ‘99. The questionnaire consisted of demographic data, surgery-related questions, measures of postmastectomy pain, and psychosocial measures assessing depressive symptoms and pain-related disability. Two-hundred and seventy-nine women (56%) returned the questionnaire, the majority being Caucasian (81.2%) or African-American (13.4%), having an average age of 57.7 (SD⫽13.3). A majority of participants had their lymph nodes removed (81.2%), and reported experiencing mastectomy-related pain (57%), and 47.3% opted for cosmetic surgery. Surgical procedures (removal of lymph nodes; reconstructive surgery) were not related to the degree of pain-related disability. Hierarchical regression analyses indicated that pain related to surgery (phantom breast pain, pain from surgical scar, other pain as a result of the mastectomy) and nonpainful symptoms related to mastectomy (numbness, muscle weakness, arm stiffness/swelling) accounted for 23.5% of the variance (p⬍.001) and depressive symptoms accounted for 14.2% of the variance (p⬍.001) in painrelated disability. In subjects who reported phantom breast pain (32%), hierarchical regression analyses indicated that VAS ratings of phantom breast pain severity and presence of other pain related to surgery (pain from surgical scar, other body pains) accounted for 20.8% of the variance (p⬍.001), and depressive symptoms accounted for an additional 28.0% of the variance (p⬍.001) in pain-related disability. These findings demonstrate that pain, non-painful post-mastectomy symptoms, and depressive symptoms are important determinants of pain-related disability postmastectomy.

X. Yi, A. Cook, R. Hamill-Ruth, J. Rowlingson; University of Virginia Health System, Charlottesville, VA Differential diagnosis of headache is often challenging, with significant consequences of misdiagnosis for clinical outcome, quality of life, and socioeconomic impact. Considerable attention has been given to the differential diagnosis of migraines. Misdiagnoses have been reported, most commonly involving organic brain disorders. Occipital neuralgia misdiagnosed as migraine has received little attention in the literature. Four female patients, ages 26 to 69, were evaluated and treated by the pain management service at an academic medical center for complaint of chronic, severe headaches with standing diagnoses of migraine. Three were treated as outpatients, and one during a headache-related hospitalization. All had obtained minimal relief from migraine therapies. On physical examination, all had occipital nerve tenderness or positive Tinel‘s sign. All responded very well to occipital nerve blocks with local anesthetic, with complete or substantial pain relief lasting up to 2 months. Pain severity ratings on an 11-point numerical rating scale were reduced by 67% to 100%. Accurate diagnosis of occipital neuralgia can lead to substantial headache relief through occipital nerve blocks in patients misdiagnosed with migraines. Clinical challenges and recommendations are discussed.