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F204 EXPERIMENTAL EXTRA ARTICULAR PAIN OF THE SACROILIAC JOINT COMPLEX FACILITATES OUTCOME OF SACROILIAC JOINT PROVOCATION TESTS
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POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
gastrocnemius pain models, and these were reversed by the cannabinoid antagonists. Conclusions: Our results suggest that CB1 and CB2 peripheral cannabinoid receptors participate in pain induced by HS injection in the masseter and gastrocnemius. This study suggests that locally administered cannabinoids could be a future pharmacological option in the treatment of muscular pain, avoiding their psicoactive effects secondary to systemic administration. Supported by SAF2009–12422-CO2–01 Disclosure: None declared
F204 EXPERIMENTAL EXTRA ARTICULAR PAIN OF THE SACROILIAC JOINT COMPLEX FACILITATES OUTCOME OF SACROILIAC JOINT PROVOCATION TESTS T.S. Palsson *, T. Graven-Nielsen. Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark Background and Aims: Sacroiliac joint pain provocation tests are commonly used to diagnose pain originating within the sacroiliac joint. The aim of the present study was to evaluate whether experimental pain originating outside the joint could affect the outcome of these tests as well as inducing mechanical hyperalgesia. Methods: Hypertonic (1 ml, 6%) and isotonic saline was randomly injected into the long posterior sacroiliac ligament of healthy subjects (n = 30, 15 females). Before, immediately after and 10 min after the injection, pressure-pain thresholds at different sites proximal and distal to the injection site were assessed as well as assessment of five sacroiliac joint provocation tests. Pain intensity was recorded on an electronic visual analogue scale (VAS). A body chart was used to indicate pain areas. Results: The VAS peak were significantly higher after hypertonic compared with the isotonic saline (P < 0.05). Larger areas of pain referrals was indicated after hypertonic saline injection (P < 0.05) often extending to the thigh and lower back. The provocation tests added pain in 67% of subjects after hypertonic and in 17% of subjects after isotonic injections. Most participants in hypertonic group responded positively to 1–3 tests compared to a maximum of one in the isotonic group. No generalised decreased pressure pain thresholds were detected after experimental pain. Conclusion: Pain from extra articular structures of the sacroiliac joint can spread similarly as pain originating within the joint as described in clinical studies. Sacroiliac joint provocation tests might be useful to detect pain with extra articular origin. Disclosure: None declared
F205 THE EFFECTIVENESS OF USING EXTRACORPOREAL SHOCKWAVE THERAPY FOR THE TREATMENT OF LOWER BACK PAIN Z. Elchami *, M.B. Issa, R. Massoud, E.A. Diaz, R. Tannous. Pain and Headcahe Management COE, IMC, Jeddah, Saudi Arabia Background and Aims: A non-invasive procedure that is recognized as a treatment for musculoskeletal conditions inducing lower back pain, extracorporeal shockwave therapy (ESWT) uses shockwaves to stimulate healing and for its regenerative effect. This study aims to discuss the effectiveness of ESWT, by applying either 3 sessions or 6 sessions, for the treatment of low back pain (LBP). Methods: A trial was conducted for a period of 3 years, in International Medical Center, KSA. A total of 61 patients with LBP were evaluated after having either 3 sessions or 6 sessions of ESWT. 35 patients had 3 sessions while 37 had 6 sessions. ESWT was applied to the affected facets, paravertebral muscles and radiating triggered muscles, using focal hand piece (ESWT) settings: energy (mj/mm2 ): 0.15–0.25; pulses/session: 500–2000; depth focus (mm): 15–30; stand-off: II or I. Inclusive criteria: 31 females, 30 males; ages ranging 23–85, with mean of 54, for patients who had 3
sessions; while ages ranging 23–72, with mean of 47, for patients who had 6 sessions. Exclusive criteria: pediatric patients, anyone with pacemaker and has history of bleeding tendencies and as per other exclusive criteria of ESWT. Results: An average improvement up to 60% was appreciated in patients approaching 6 sessions of treatment. Conclusions: ESWT was proven to improve paravertebral muscle pain, facets pain and other trigger points and radiating pain, without the need for further medication or further Physical Therapy treatments. Disclosure: None declared
F206 THE EFFECTIVENESS OF RADIAL SHOCKWAVE THERAPY IN THE MANAGEMENT OF CERVICOGENIC HEADACHE Z. Elchami *, O. Asali, A. Mirambel, E.A. Diaz, D. Magayano. Pain and Headache Management COE, IMC, Jeddah, Saudi Arabia Background & Aims: Since cervicogenic headache is commonly known as head pain that is referred from the bony structures or soft tissues of the neck, for this, treatment must be aimed at the problem in the neck. The aim of this study is to evaluate the effectiveness of Radial Shockwave therapy (RSWT) in the management of cervicogenic headache. Methods: A trial was conducted over a 3-year period in International Medical Center, KSA. A total of 111 patients were evaluated according to the IHS Classification of Secondary Headaches, and given RSWT of various sessions, applied to the cervical muscle region, with settings: (1) pain points, radial hand piece: energy (mj/mm2): 1.8–3.0; pulses/session: 400; frequency: 10–15 Hz; shock transmitter: 15–20 mm; (2) muscles: energy (mj/mm2): 1.6–3.0; pulses/session: 2000–3000; frequency: 15–21 Hz; shock transmitter: 20–35 mm. 29 patients received 3 sessions, while 82 patients received 6 sessions. Inclusive criteria: 32 males, 79 females; ages ranging from 17–82, with mean of 38. Exclusive criteria: pregnant, children, anyone with pacemaker, and anyone who has history of bleeding tendencies. Sample showed that cervicogenic headache was two times more prevalent in females. Results: An average improvement of 67% and 71% were seen in patients who were treated with RSWT 3 and 6 sessions, respectively. Conclusion: Significant improvement was appreciated in patients who received RSWT for cervicogenic headache management. Disclosure: None declared
F207 THE EFFECTIVENESS OF BOTOX® INJECTION AND RADIAL SHOCKWAVE THERAPY IN THE MANAGEMENT OF CERVICOGENIC HEADACHE Z. Elchami *, M.B. Issa, M. Dusaran, D. Magayano. Pain and Headcahe Management COE, IMC, Jeddah, Saudi Arabia Background and Aims: In cervicogenic headache, neck muscles are involved in pain generation. This study aims is to evaluate the effectiveness of Botox® injection and Radial Shockwave therapy (RSWT) in the management of cervicogenic headache. Methods: Trial was conducted over a 3-year period in International Medical Center, KSA. 49 patients with cervicogenic headache were evaluated, randomly given either Botox® injection, or Botox® injection with RSWT. Standard dose of Botox® : 100 units, injected to the suboccipital, upper, mid and lower trapezius muscles. RSWT, applied to the cervical region, with settings: 1) pain points, radial hand piece: energy (mj/mm2): 1.8–3.0; pulses/session: 400; frequency: 10–15 Hz; shock transmitter: 15–20 mm; 2) muscles: energy (mj/mm2): 1.6–3.0; pulses/session: 2000–3000; frequency: 15–21 Hz; shock transmitter: 20–35 mm. Patients received single treatment of either Botox® , or Botox® plus RSWT 3 and 6 sessions, respectively. Inclusive criteria: 11 males, 38 females; ages from 21–78, with mean of 45. Exclusive criteria: patients who have
POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
gastrocnemius pain models, and these were reversed by the cannabinoid antagonists. Conclusions: Our results suggest that CB1 and CB2 peripheral cannabinoid receptors participate in pain induced by HS injection in the masseter and gastrocnemius. This study suggests that locally administered cannabinoids could be a future pharmacological option in the treatment of muscular pain, avoiding their psicoactive effects secondary to systemic administration. Supported by SAF2009–12422-CO2–01 Disclosure: None declared
F204 EXPERIMENTAL EXTRA ARTICULAR PAIN OF THE SACROILIAC JOINT COMPLEX FACILITATES OUTCOME OF SACROILIAC JOINT PROVOCATION TESTS T.S. Palsson *, T. Graven-Nielsen. Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark Background and Aims: Sacroiliac joint pain provocation tests are commonly used to diagnose pain originating within the sacroiliac joint. The aim of the present study was to evaluate whether experimental pain originating outside the joint could affect the outcome of these tests as well as inducing mechanical hyperalgesia. Methods: Hypertonic (1 ml, 6%) and isotonic saline was randomly injected into the long posterior sacroiliac ligament of healthy subjects (n = 30, 15 females). Before, immediately after and 10 min after the injection, pressure-pain thresholds at different sites proximal and distal to the injection site were assessed as well as assessment of five sacroiliac joint provocation tests. Pain intensity was recorded on an electronic visual analogue scale (VAS). A body chart was used to indicate pain areas. Results: The VAS peak were significantly higher after hypertonic compared with the isotonic saline (P < 0.05). Larger areas of pain referrals was indicated after hypertonic saline injection (P < 0.05) often extending to the thigh and lower back. The provocation tests added pain in 67% of subjects after hypertonic and in 17% of subjects after isotonic injections. Most participants in hypertonic group responded positively to 1–3 tests compared to a maximum of one in the isotonic group. No generalised decreased pressure pain thresholds were detected after experimental pain. Conclusion: Pain from extra articular structures of the sacroiliac joint can spread similarly as pain originating within the joint as described in clinical studies. Sacroiliac joint provocation tests might be useful to detect pain with extra articular origin. Disclosure: None declared
F205 THE EFFECTIVENESS OF USING EXTRACORPOREAL SHOCKWAVE THERAPY FOR THE TREATMENT OF LOWER BACK PAIN Z. Elchami *, M.B. Issa, R. Massoud, E.A. Diaz, R. Tannous. Pain and Headcahe Management COE, IMC, Jeddah, Saudi Arabia Background and Aims: A non-invasive procedure that is recognized as a treatment for musculoskeletal conditions inducing lower back pain, extracorporeal shockwave therapy (ESWT) uses shockwaves to stimulate healing and for its regenerative effect. This study aims to discuss the effectiveness of ESWT, by applying either 3 sessions or 6 sessions, for the treatment of low back pain (LBP). Methods: A trial was conducted for a period of 3 years, in International Medical Center, KSA. A total of 61 patients with LBP were evaluated after having either 3 sessions or 6 sessions of ESWT. 35 patients had 3 sessions while 37 had 6 sessions. ESWT was applied to the affected facets, paravertebral muscles and radiating triggered muscles, using focal hand piece (ESWT) settings: energy (mj/mm2 ): 0.15–0.25; pulses/session: 500–2000; depth focus (mm): 15–30; stand-off: II or I. Inclusive criteria: 31 females, 30 males; ages ranging 23–85, with mean of 54, for patients who had 3
sessions; while ages ranging 23–72, with mean of 47, for patients who had 6 sessions. Exclusive criteria: pediatric patients, anyone with pacemaker and has history of bleeding tendencies and as per other exclusive criteria of ESWT. Results: An average improvement up to 60% was appreciated in patients approaching 6 sessions of treatment. Conclusions: ESWT was proven to improve paravertebral muscle pain, facets pain and other trigger points and radiating pain, without the need for further medication or further Physical Therapy treatments. Disclosure: None declared
F206 THE EFFECTIVENESS OF RADIAL SHOCKWAVE THERAPY IN THE MANAGEMENT OF CERVICOGENIC HEADACHE Z. Elchami *, O. Asali, A. Mirambel, E.A. Diaz, D. Magayano. Pain and Headache Management COE, IMC, Jeddah, Saudi Arabia Background & Aims: Since cervicogenic headache is commonly known as head pain that is referred from the bony structures or soft tissues of the neck, for this, treatment must be aimed at the problem in the neck. The aim of this study is to evaluate the effectiveness of Radial Shockwave therapy (RSWT) in the management of cervicogenic headache. Methods: A trial was conducted over a 3-year period in International Medical Center, KSA. A total of 111 patients were evaluated according to the IHS Classification of Secondary Headaches, and given RSWT of various sessions, applied to the cervical muscle region, with settings: (1) pain points, radial hand piece: energy (mj/mm2): 1.8–3.0; pulses/session: 400; frequency: 10–15 Hz; shock transmitter: 15–20 mm; (2) muscles: energy (mj/mm2): 1.6–3.0; pulses/session: 2000–3000; frequency: 15–21 Hz; shock transmitter: 20–35 mm. 29 patients received 3 sessions, while 82 patients received 6 sessions. Inclusive criteria: 32 males, 79 females; ages ranging from 17–82, with mean of 38. Exclusive criteria: pregnant, children, anyone with pacemaker, and anyone who has history of bleeding tendencies. Sample showed that cervicogenic headache was two times more prevalent in females. Results: An average improvement of 67% and 71% were seen in patients who were treated with RSWT 3 and 6 sessions, respectively. Conclusion: Significant improvement was appreciated in patients who received RSWT for cervicogenic headache management. Disclosure: None declared
F207 THE EFFECTIVENESS OF BOTOX® INJECTION AND RADIAL SHOCKWAVE THERAPY IN THE MANAGEMENT OF CERVICOGENIC HEADACHE Z. Elchami *, M.B. Issa, M. Dusaran, D. Magayano. Pain and Headcahe Management COE, IMC, Jeddah, Saudi Arabia Background and Aims: In cervicogenic headache, neck muscles are involved in pain generation. This study aims is to evaluate the effectiveness of Botox® injection and Radial Shockwave therapy (RSWT) in the management of cervicogenic headache. Methods: Trial was conducted over a 3-year period in International Medical Center, KSA. 49 patients with cervicogenic headache were evaluated, randomly given either Botox® injection, or Botox® injection with RSWT. Standard dose of Botox® : 100 units, injected to the suboccipital, upper, mid and lower trapezius muscles. RSWT, applied to the cervical region, with settings: 1) pain points, radial hand piece: energy (mj/mm2): 1.8–3.0; pulses/session: 400; frequency: 10–15 Hz; shock transmitter: 15–20 mm; 2) muscles: energy (mj/mm2): 1.6–3.0; pulses/session: 2000–3000; frequency: 15–21 Hz; shock transmitter: 20–35 mm. Patients received single treatment of either Botox® , or Botox® plus RSWT 3 and 6 sessions, respectively. Inclusive criteria: 11 males, 38 females; ages from 21–78, with mean of 45. Exclusive criteria: patients who have