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Characteristics of chronic pain in persons with spinal cord injury: A differentiated approach
S76 (871) Characteristics of chronic pain in persons with spinal cord injury: A differentiated approach E. Felix, Y. Cruz-Almeida, E. Widerstrom-Noga; The Miami VA Center of Excellence in Spinal Cord Injury and the Miami Project to Cure Paralysis, University of Miami, Miami, FL Over 60% of persons with spinal cord injuries (SCI) develop chronic pain. Because the types of pain that develop after SCI are heterogeneous and frequently fail to respond to available treatments, it is important to evaluate these pains in a differentiated manner in order to move toward tailored treatment regimens. Using an interview-format questionnaire, 151 persons with SCI completed a battery of pain history questions detailing the locations, qualities, and factors that affect their different pains. Seventy-five percent of the sample reported that they had more than one area of pain with characteristics that were distinguishable from the other pains they experience. Pain located in the back area was most commonly reported across all participants (68.7%) and was significantly more likely than not to be labeled as the “most disturbing” of their pains (p⬍0.05). Across all pain locations, ratings of intensity and unpleasantness were significantly higher for pains labeled “most disturbing” compared to those areas where pain was not labeled most disturbing (p⬍0.05), and these “most disturbing” pains were more likely to be described as “sharp, “stabbing,” and “penetrating” (p⬍0.05) compared to other pains. Preliminary analyses suggest that the back area is most commonly reported as painful and most disturbing in those with SCI, and, therefore, this body site in particular, should be the object of further study and more targeted treatment strategies. In addition, pain areas that are considered most disturbing to those with SCI seem to possess specific descriptive characteristics which may help in understanding the mechanisms involved in the development and persistence of these pains.
Abstracts
G05 - Electrodiagnostic Approaches (873) Lamotrigine does not alter nerve conduction in patients with diabetic neuropathy: Results from two doubleblind trials D. Blum, V. Biton, M. Tuchman; GlaxoSmithKline, Durham, NC Painful diabetic neuropathy is occasionally treated with various medications including lamotrigine. The neurotoxicity of these treatments has not been established. Two replicate multi-center, randomized, doubleblind studies (NPP30004/30005) were conducted to evaluate the efficacy and safety of lamotrigine in painful diabetic neuropathy (PDN). Patients with PDN and a baseline pain score of ⱖ4 on a 0-10 scale were randomized 1:1:1:1 to receive lamotrigine 200, 300, 400mg/day or placebo. The study included a 7-week dose escalation phase and a 12-week fixed dose maintenance phase. Nerve conduction studies were performed at baseline and end of treatment in a subset of patients. After 19 weeks of treatment with lamotrigine, sural nerve latency (placebo N⫽30, lamotrigine N⫽88) and amplitude (placebo N⫽35, lamotrigine N⫽97), as well as peroneal nerve velocity (placebo N⫽48, lamotrigine N⫽127) and amplitude (placebo N⫽48, lamotrigine N⫽129), were not statistically different from baseline. Overall lamotrigine and placebo results were similar and no dose-related effect was identified. Lamotrigine does not alter nerve conduction in subjects with painful diabetic neuropathy.
(872) Psychometric characteristics of the Pain Treatment Satisfaction Scale
(874) Cardiac response of low back pain patients to clinical and experimental pain
R. Walker, M. Clark, R. Gironda; James A. Haley VA Hospital, Tampa, FL Treatment satisfaction is an important domain of pain treatment outcomes. The current study was designed to evaluate the psychometric characteristics of a previously developed patient treatment satisfaction measure using a large sample of individuals with chronic pain. Participants included patients enrolled in a nineteen-day inpatient interdisciplinary cognitive-behavioral pain management program. At program discharge patient satisfaction ratings were obtained, including ratings for overall program satisfaction, staff warmth, staff skill level, ease of scheduling appointments, and recommendation of the program to other patients. Reliability analyses indicated that individual item-total correlations were high and overall internal consistency was good. These items were then factor analyzed using a Principal-Components analysis with Varimax rotation. The analysis revealed a one-factor solution accounting for over 70% of the variance. Examination of concurrent outcome variables established a pattern of relationships that supported the construct validity of the Pain Treatment Satisfaction Scale. Implications for the use of treatment satisfaction as a measure of pain treatment outcomes are discussed.
Y. Tousignant-Laflamme, S. Marchand; University of Sherbrooke, Clinical Research Center, Sherbrooke, QC Rehabilitation clinicians are currently using heart rate (HR) in order to assess the sincerity of effort in certain types of evaluations. It has been shown that a relation exists between HR and experimental pain but no study has demonstrated the cardiac response of clinical pain and experimental pain in a patient population. The main goal was to determine the cardiac response of patients with sub-acute low back pain (LBP) to a mechanical stimulus (clinical pain) and to a thermal stimulus (experimental pain). Thirty LBP patients participated in this study (16 men, 14 women). Clinical pain was induced by an experimented physiotherapist applying two postero-anterior pressures (PA) over the spinous process of a painful lumbar segment for 15 and 30 seconds. The force applied was made in order to reproduce the patient’s typical LBP at a perceived intensity ranging 50-70/100. Experimental pain was induced by applying a thermal stimulus on the forearm at a temperature which reproduced the same pain intensity as the PA pressure. Within 30 seconds postclinical pain, a significant rise in HR% was observed ranging from 8.5% to 12.5%, with men showing a greater rise in HR% (p⫽0.11). The change in HR% was lower for the experimental pain (5%) and the peak response was delayed at 30 seconds post-pressure versus 5 seconds for the clinical pain. Galvanic skin response was significantly higher (p⬍0.001) during the experimental Vs clinical pain and women showed a greater response during the experimental pain (p⫽0.04). The results obtained using a brief mechanical stimulation in LBP patients are comparable to our previous findings in healthy subjects (Tousignant-Laflamme, J Pain, 2004). Theses results suggests that pain induced during a clinical evaluation will produce clinically significant HR augmentation, but gender differences observed in this study call for caution when interpreting the results.
Abstracts
G05 - Electrodiagnostic Approaches (873) Lamotrigine does not alter nerve conduction in patients with diabetic neuropathy: Results from two doubleblind trials D. Blum, V. Biton, M. Tuchman; GlaxoSmithKline, Durham, NC Painful diabetic neuropathy is occasionally treated with various medications including lamotrigine. The neurotoxicity of these treatments has not been established. Two replicate multi-center, randomized, doubleblind studies (NPP30004/30005) were conducted to evaluate the efficacy and safety of lamotrigine in painful diabetic neuropathy (PDN). Patients with PDN and a baseline pain score of ⱖ4 on a 0-10 scale were randomized 1:1:1:1 to receive lamotrigine 200, 300, 400mg/day or placebo. The study included a 7-week dose escalation phase and a 12-week fixed dose maintenance phase. Nerve conduction studies were performed at baseline and end of treatment in a subset of patients. After 19 weeks of treatment with lamotrigine, sural nerve latency (placebo N⫽30, lamotrigine N⫽88) and amplitude (placebo N⫽35, lamotrigine N⫽97), as well as peroneal nerve velocity (placebo N⫽48, lamotrigine N⫽127) and amplitude (placebo N⫽48, lamotrigine N⫽129), were not statistically different from baseline. Overall lamotrigine and placebo results were similar and no dose-related effect was identified. Lamotrigine does not alter nerve conduction in subjects with painful diabetic neuropathy.
(872) Psychometric characteristics of the Pain Treatment Satisfaction Scale
(874) Cardiac response of low back pain patients to clinical and experimental pain
R. Walker, M. Clark, R. Gironda; James A. Haley VA Hospital, Tampa, FL Treatment satisfaction is an important domain of pain treatment outcomes. The current study was designed to evaluate the psychometric characteristics of a previously developed patient treatment satisfaction measure using a large sample of individuals with chronic pain. Participants included patients enrolled in a nineteen-day inpatient interdisciplinary cognitive-behavioral pain management program. At program discharge patient satisfaction ratings were obtained, including ratings for overall program satisfaction, staff warmth, staff skill level, ease of scheduling appointments, and recommendation of the program to other patients. Reliability analyses indicated that individual item-total correlations were high and overall internal consistency was good. These items were then factor analyzed using a Principal-Components analysis with Varimax rotation. The analysis revealed a one-factor solution accounting for over 70% of the variance. Examination of concurrent outcome variables established a pattern of relationships that supported the construct validity of the Pain Treatment Satisfaction Scale. Implications for the use of treatment satisfaction as a measure of pain treatment outcomes are discussed.
Y. Tousignant-Laflamme, S. Marchand; University of Sherbrooke, Clinical Research Center, Sherbrooke, QC Rehabilitation clinicians are currently using heart rate (HR) in order to assess the sincerity of effort in certain types of evaluations. It has been shown that a relation exists between HR and experimental pain but no study has demonstrated the cardiac response of clinical pain and experimental pain in a patient population. The main goal was to determine the cardiac response of patients with sub-acute low back pain (LBP) to a mechanical stimulus (clinical pain) and to a thermal stimulus (experimental pain). Thirty LBP patients participated in this study (16 men, 14 women). Clinical pain was induced by an experimented physiotherapist applying two postero-anterior pressures (PA) over the spinous process of a painful lumbar segment for 15 and 30 seconds. The force applied was made in order to reproduce the patient’s typical LBP at a perceived intensity ranging 50-70/100. Experimental pain was induced by applying a thermal stimulus on the forearm at a temperature which reproduced the same pain intensity as the PA pressure. Within 30 seconds postclinical pain, a significant rise in HR% was observed ranging from 8.5% to 12.5%, with men showing a greater rise in HR% (p⫽0.11). The change in HR% was lower for the experimental pain (5%) and the peak response was delayed at 30 seconds post-pressure versus 5 seconds for the clinical pain. Galvanic skin response was significantly higher (p⬍0.001) during the experimental Vs clinical pain and women showed a greater response during the experimental pain (p⫽0.04). The results obtained using a brief mechanical stimulation in LBP patients are comparable to our previous findings in healthy subjects (Tousignant-Laflamme, J Pain, 2004). Theses results suggests that pain induced during a clinical evaluation will produce clinically significant HR augmentation, but gender differences observed in this study call for caution when interpreting the results.