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Early-stage breast cancer patients with and without insomnia: Differences in pain and the relationship between sleep and pain
S32 (693) Patterns of occurrence of sickle cell pain and illness episodes over time for infants and young children with sickle cell disease C. Dampier, B. Ely, D. Brodecki, P. O’Neal, C. Coleman; St. Christopher’s Hospital for Children, Philadelphia, PA Using a longitudinal, prospective study design we are collecting occurrence of illness symptoms, hospitalizations, sickle pain, and steady state laboratory data from young children with SCD. Hospitalizations were obtained from the Center’s clinical database, and caregiver reports of pain or illness at home were obtained from monthly telephone or daily electronic pager reports. Data reported here were collected from 3/2001 to 12/2003 for a total of 60 children (ages 3– 60 months), male (n⫽37), and 157 patient-years (pt-yrs) of observation. An initial descriptive analysis was done by grouping occurrence data by patient age in years and by hemoglobinopathy: SCD-SS and Saˆ0Thal (Group 1, 79 pt-yrs, n⫽38) and SCD-SC and Saˆ⫹Thal (Group 2, 78 pt-yrs, n⫽22). The cumulative prevalence of hospitalizations, home pain episodes and home illness episodes over the 6 year period for group 1 were 85%, 73%, and 57% of patients, and for group 2 were 82%, 46%, and 67% (p⬍0.036 for pain episodes). While the average yearly prevalence of pain was higher for group 1 than group 2 (55% vs 27%), average illness episode occurrences were similar for both groups (38% vs 28%), and were relatively consistent across the six age ranges. In contrast, hospitalizations were more prevalent in the 0-4 year age range for group 2 (66%) than in the 4-6 yr age range (5%), while they were similar for both age ranges in group 1 (60% vs 57%). While there was a similar wide range of pain episode occurrence in both groups (group 1, 0-18 per pt; group 2, 0-21 per pt), in group 1 three patients accounted for 32% of episodes versus group 2 where 3 patients accounted for over 68% of episodes. This study is providing a rich dataset describing illness and pain occurrences in the first 6 years of life of children with SCD.
Abstracts (695) Risk factors for chronic pain after elective cesarean section in healthy women S. Genot, P. Lavand’homme, F. Roelants, H. Waterloos; St Luc Hospital - Universite´ Catholique de Louvain, Brussels, Belgium Chronic pain remains one potential adverse outcome of surgery (1). Although cesarean section (CS) represents common procedure in young healthy women, incidence and risk factors to develop chronic pain are still under-evaluated (2). After informed consent, 100 healthy patients undergoing elective CS were studied. Surgery was performed under spinal anesthesia, with Pfannenstiel incision and peritoneal layers closure in all patients. Patient Controlled Analgesia delivering morphine was available with NSAIDs for postoperative analgesia. Residual pain after 6 months was questioned by mail. Medical history and analysis of 48h postoperative data (VAS:0-100, morphine use, mapping area of wound hyperalgesia) were recorded. Statistical analysis used one way ANOVA and X2. Six months after CS, 14.8 % patients reported residual pain and discomfort located around the scar, associated to visceral component for 2% and to regular analgesics intake in 4%. Respectively in pain and no residual pain (⫽control) group: age 35⫾5 vs 32⫾5 yrs, average pregnancies number 2.4 (1-7) vs 2.6 (1-8), nulliparas % (50 % vs 32.8%) were similar. Medical history did not differ respectively in pain patients and control group for previous: CS (31%vs41%),abdominal surgery (25%vs34%),endometriosis (6.2%vs2.8%) or obstetric procedures (37.5%vs21.4%). More women with pain reported previous genitourinary infections (56%vs17%;p⫽0.003). Chronic pain group displayed higher 24h VAS pain scores at rest (30⫾21vs17⫾16;p⫽0.04) and movement (72⫾18vs46⫾22;p⫽0.003) but no difference for total morphine consumption (25⫾12mg vs24⫾18 mg). Wound hyperalgesia area was similar whilst at 24h and 48h, 69% and 56% chronic pain patients presented hyperalgesia for only 24%(p⫽0.002) and 14%(p⫽0.001) in control group. In conclusion, chronic pain after elective CS should not be ignored. Our results match those already published (12.3% at 10 months(2)). Previous infectious conditions of genitourinary tract seem to represent striking risk factor as well as higher postoperative pain and presence of wound hyperalgesia. (1. Perkins, Anesthesiology, 2000; 2. Nikolajsen, Acta Anaesthesiol Scand, 2004)
C13 - Pain in Women
C14 - Postherpetic Neuralgia
(694) Early-stage breast cancer patients with and without insomnia: Differences in pain and the relationship between sleep and pain
(696) Pain relief with pregabalin in postherpetic neuralgia (PHN) is not influenced by concomitant medications
M. Rumble, F. Keefe, J. Edinger, L. Porter, P. Marcom; Duke University, Durham, NC Insomnia is a common and distressing symptom reported by breast cancer patients. However, few studies have examined whether insomnia is associated with other cancer symptoms such as pain. The purpose of this preliminary study was to examine differences in pain between breast cancer patients with and without insomnia and the relationship between sleep and pain in each of these groups. Participants were 38 women with early-stage breast cancer (mean age 50.59; 87% Caucasian). 20 women met criteria for insomnia and 18 did not meet criteria for insomnia, as determined by a structured diagnostic interview. All participants completed daily logs measuring sleep efficiency, sleep quality, restfulness, and pain for 7 days, and these daily measures were averaged for all analyses. Results indicated that breast cancer patients with insomnia rated their average daily pain significantly higher than breast cancer patients without insomnia. In patients with insomnia, however, averaged daily sleep measures were not related to pain. In patients without insomnia, significant relationships between sleep and pain were detected. Patients who reported lower sleep efficiencies and less restfulness upon awakening also rated their pain higher. Interestingly, these cross-sectional results indicate that breast cancer patients meeting criteria for insomnia had significantly higher levels of pain, but averaged daily sleep measures were not related to pain, whereas breast cancer patients not meeting criteria for insomnia had significantly lower pain, but averaged daily sleep measures were related to pain. Possible explanations for these findings include pain not being a factor contributing to insomnia in breast cancer patients or floor and ceiling effects. Future studies should investigate the relationship between sleep and pain as well as other symptoms in breast cancer patients with insomnia using daily diary methods and more sophisticated analyses (e.g., within day and lagged analyses) to gain a further understanding of these relationships.
R. Dworkin, U. Sharma, J. Young, L. LaMoreaux; University of Rochester School of Medicine, Rochester, NY Pregabalin is an alpha-2-ligand demonstrated to be efficacious treatment for pain associated with diabetic peripheral neuropathy (DPN), postherpetic neuralgia (PHN), and fibromyalgia syndrome (FMS). In clinical trials investigating the use of pregabalin for the treatment of PHN, patients have been allowed to remain on stable background medications, such as opioids or antidepressants, as long as they still had moderate-to-severe pain at baseline. In 4 completed double-blind placebocontrolled studies of 1034 PHN patients, approximately 50%-65% of participants were receiving concomitant medications. Data from these studies were analyzed to provide treatment-effect estimates after adjusting for concomitant medication use, and to determine whether treatment effect differences existed between patients who were taking background medications and those who were not. The trials lasted 5-13 weeks and used 75-600 mg/day of pregabalin. Individual and across-trial (pooled) data sets were analyzed using ANCOVA models that included factors for co-medication class. The co-medications investigated were: a) tricyclic and non-tricyclic antidepressants, b) anticonvulsants; c) opioids; and d) other analgesics. In each individual study, estimates of treatmenteffect magnitude changed very little when adjusting for stable co-medication. Furthermore, no evidence was found that indicated differences in treatment effect between patients who took a co-medication and those who did not. Comparable findings were obtained when data from the four trials were pooled. The lack of a significant interaction (p⫽0.7446) between treatment effect and co-medication use demonstrates that pregabalin can be used effectively to treat PHN even when patients are taking other pain medications. Findings from these studies demonstrate that pregabalin is an efficacious treatment for PHN that can be administered concurrently with other pain medications and whose effect does not vary depending on whether or not patients use other pain concomitant medications.
Abstracts (695) Risk factors for chronic pain after elective cesarean section in healthy women S. Genot, P. Lavand’homme, F. Roelants, H. Waterloos; St Luc Hospital - Universite´ Catholique de Louvain, Brussels, Belgium Chronic pain remains one potential adverse outcome of surgery (1). Although cesarean section (CS) represents common procedure in young healthy women, incidence and risk factors to develop chronic pain are still under-evaluated (2). After informed consent, 100 healthy patients undergoing elective CS were studied. Surgery was performed under spinal anesthesia, with Pfannenstiel incision and peritoneal layers closure in all patients. Patient Controlled Analgesia delivering morphine was available with NSAIDs for postoperative analgesia. Residual pain after 6 months was questioned by mail. Medical history and analysis of 48h postoperative data (VAS:0-100, morphine use, mapping area of wound hyperalgesia) were recorded. Statistical analysis used one way ANOVA and X2. Six months after CS, 14.8 % patients reported residual pain and discomfort located around the scar, associated to visceral component for 2% and to regular analgesics intake in 4%. Respectively in pain and no residual pain (⫽control) group: age 35⫾5 vs 32⫾5 yrs, average pregnancies number 2.4 (1-7) vs 2.6 (1-8), nulliparas % (50 % vs 32.8%) were similar. Medical history did not differ respectively in pain patients and control group for previous: CS (31%vs41%),abdominal surgery (25%vs34%),endometriosis (6.2%vs2.8%) or obstetric procedures (37.5%vs21.4%). More women with pain reported previous genitourinary infections (56%vs17%;p⫽0.003). Chronic pain group displayed higher 24h VAS pain scores at rest (30⫾21vs17⫾16;p⫽0.04) and movement (72⫾18vs46⫾22;p⫽0.003) but no difference for total morphine consumption (25⫾12mg vs24⫾18 mg). Wound hyperalgesia area was similar whilst at 24h and 48h, 69% and 56% chronic pain patients presented hyperalgesia for only 24%(p⫽0.002) and 14%(p⫽0.001) in control group. In conclusion, chronic pain after elective CS should not be ignored. Our results match those already published (12.3% at 10 months(2)). Previous infectious conditions of genitourinary tract seem to represent striking risk factor as well as higher postoperative pain and presence of wound hyperalgesia. (1. Perkins, Anesthesiology, 2000; 2. Nikolajsen, Acta Anaesthesiol Scand, 2004)
C13 - Pain in Women
C14 - Postherpetic Neuralgia
(694) Early-stage breast cancer patients with and without insomnia: Differences in pain and the relationship between sleep and pain
(696) Pain relief with pregabalin in postherpetic neuralgia (PHN) is not influenced by concomitant medications
M. Rumble, F. Keefe, J. Edinger, L. Porter, P. Marcom; Duke University, Durham, NC Insomnia is a common and distressing symptom reported by breast cancer patients. However, few studies have examined whether insomnia is associated with other cancer symptoms such as pain. The purpose of this preliminary study was to examine differences in pain between breast cancer patients with and without insomnia and the relationship between sleep and pain in each of these groups. Participants were 38 women with early-stage breast cancer (mean age 50.59; 87% Caucasian). 20 women met criteria for insomnia and 18 did not meet criteria for insomnia, as determined by a structured diagnostic interview. All participants completed daily logs measuring sleep efficiency, sleep quality, restfulness, and pain for 7 days, and these daily measures were averaged for all analyses. Results indicated that breast cancer patients with insomnia rated their average daily pain significantly higher than breast cancer patients without insomnia. In patients with insomnia, however, averaged daily sleep measures were not related to pain. In patients without insomnia, significant relationships between sleep and pain were detected. Patients who reported lower sleep efficiencies and less restfulness upon awakening also rated their pain higher. Interestingly, these cross-sectional results indicate that breast cancer patients meeting criteria for insomnia had significantly higher levels of pain, but averaged daily sleep measures were not related to pain, whereas breast cancer patients not meeting criteria for insomnia had significantly lower pain, but averaged daily sleep measures were related to pain. Possible explanations for these findings include pain not being a factor contributing to insomnia in breast cancer patients or floor and ceiling effects. Future studies should investigate the relationship between sleep and pain as well as other symptoms in breast cancer patients with insomnia using daily diary methods and more sophisticated analyses (e.g., within day and lagged analyses) to gain a further understanding of these relationships.
R. Dworkin, U. Sharma, J. Young, L. LaMoreaux; University of Rochester School of Medicine, Rochester, NY Pregabalin is an alpha-2-ligand demonstrated to be efficacious treatment for pain associated with diabetic peripheral neuropathy (DPN), postherpetic neuralgia (PHN), and fibromyalgia syndrome (FMS). In clinical trials investigating the use of pregabalin for the treatment of PHN, patients have been allowed to remain on stable background medications, such as opioids or antidepressants, as long as they still had moderate-to-severe pain at baseline. In 4 completed double-blind placebocontrolled studies of 1034 PHN patients, approximately 50%-65% of participants were receiving concomitant medications. Data from these studies were analyzed to provide treatment-effect estimates after adjusting for concomitant medication use, and to determine whether treatment effect differences existed between patients who were taking background medications and those who were not. The trials lasted 5-13 weeks and used 75-600 mg/day of pregabalin. Individual and across-trial (pooled) data sets were analyzed using ANCOVA models that included factors for co-medication class. The co-medications investigated were: a) tricyclic and non-tricyclic antidepressants, b) anticonvulsants; c) opioids; and d) other analgesics. In each individual study, estimates of treatmenteffect magnitude changed very little when adjusting for stable co-medication. Furthermore, no evidence was found that indicated differences in treatment effect between patients who took a co-medication and those who did not. Comparable findings were obtained when data from the four trials were pooled. The lack of a significant interaction (p⫽0.7446) between treatment effect and co-medication use demonstrates that pregabalin can be used effectively to treat PHN even when patients are taking other pain medications. Findings from these studies demonstrate that pregabalin is an efficacious treatment for PHN that can be administered concurrently with other pain medications and whose effect does not vary depending on whether or not patients use other pain concomitant medications.