Diagnosis of epidural scarring and its possible coniribution to chronic loh back pain syndrome

S376 CIAGNOSIS

OF EPIOURAL

TO CHRONIC

LOW

BACK

SCARRING PAIN

ment

of Anesthesiology,

USA,

and Oepartment Aim

could cannot

was

IOU back

pain.

observe

changes

metal

Electric

stimulation

catheter

tip

repeated

injections

were and

made

at the

utilizing

the

compliance

mostly

desired

to more

be farmed

difficult

with

through

normal

resistance

L5-Sl the

a column

dermatomal

trigger

saline

and

existence site

and

radiculopathy,

space

and were

saline

III and since

it

of epidural with

chronic

of injection,

studied

the

then

muscle

local

space,

epidural

effect

catheters

appropriately

facilitated

by observing

epidural

localize

on patients the

space,

8.

laminectosies and

of the

block

epidural

G. U.lt.

Tyne,

follouing

determine

or 14-15

of normal

of the

Upon

area.

caudal

level

98195,

to diagnose

epidural

accurately

~ 554 Slide Wed 2~30

Depart-

WA

the possibility

of the

a possible

introduced

of first

to study

In t.his study

and

anesthetizing

were

could

is often

,

Charlton2 Seattle,

of Newcastle

diagnostic-therapeutic

In 69 patients tips

This

a method

in resistance and

Methods: with

during

We employed

J.L.

Washington,"

scarring

pain.

on an X-ray.

CONlHlBUlION

Barsal:

2 University

Epidural

to chronic

examined

of stimulating

J.E.

of Anesthetics,

be visualized

scarring

ITS POSSIBLE

1 University-of

of Investigation:

contribute

AND

SYNDROME.

the

localization

contraction.

anesthetic together

positioned.

in a volume

with

of the

Incremental

changes

of l--3 ml

in pain

level

activity. Results:

tance

In approximately

to injections

injection. injections fallowing

Pain

access

and

progressively anesthetic

to the

most

treatment

and

dysfunction. at St.

The site

and

* NW

were

local the

use

of the common

of epidural Joseph's

65%

decreased

levels

Conclusions: portantly,

and

of the patients, compliance

consistently decreased

raised

with

there

was

of the epidural to higher

local

evidence space

levels

anesthetics.

of increased

at the

particular

on repeated

Activity

resissite

of

incremental

levels

also

increased

injections. of electric

stimulation

injection. site

of scarring.

scarring

Hospital,

The

and Tampa,

identifies

caudal The

approach

above

its possible Florida

the

method

seems

contribution

33607,

epidural

is advantageous

space since

to be useful

to overall

pain

and more

im--

it provides in diagnosis problem

USA.

A MODEL FOR EVALUATING TREATMENT OUTCOMES IN LOW BACK PAIN. ~555 Slide M. BenDebba, W.S. Torgerson*, and D.M. Long, Departments of Wed 2:45 Psychology and Neurosurgery, The Johns Hopkins University, G. B. III 1 :-m-~-m 1 Baltimore, Maryland 21218, USA. Controlled clinical studies for evaluating treatment outcomes in low back pain are difficult due to the large number of physical, behavioral, A more psychological, social, and economic variables that require control. practical approach is one that is based on the accumulation of data, over long periods of time, on outcome of treatments applied to actual clinical cases. A program of research, based on this approach, is now underway. Each low back pain patient admitted to the Johns Hopkins Hospital is evaluated with respect to a host of physical, behavioral, cognitive, affective, social and economic variables. A locally developed questionnaire (LBPE) and a battery of psychological tests are used in the evaluation. Medical examination and diagnostic test data are also obtained for each patient. Treatment effects are assessed through a locally developed instrument (TOI) consisting of sets of perceptual, behavioral and psychosocial measures. Each patient is evaluated on the perceptual measures at time of discharge and all three measures at 6 months following discharge. One hundred and forty patients have participated in the study thus far. Preliminary analyses of their data show acceptable level of reliability for Significant individual differences do however exist both the LBPE and TOI. This variability has within and across prevalent diagnostic catergories. important implications for research on evaluation of treatment Outcomes. The major properties and scoring techniques of the LBPE and TOI will be Implications of the outlined, and data obtained to date will be presented. observed variability in the data on outcome studies will be discussed, and a data analytic model, which takes this variability into account in evaluating treatment outcomes, will be proposed.