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F288 CHARACTERIZATION OF CHRONIC POST-SURGICAL PAIN IN A PORTUGUESE PAIN DEPARTMENT – A RETROSPECTIVE STUDY
POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
considered pain intensity mild (45.5%) or moderate (33.1%). The most common treatment group: analgesics / antipyretics (64.1%), opioids (23.8%) and NSAIDs (21.5%). 41.5% of patients used nonpharmacological treatments. In patients with cognitive impairment the lower the MMSE score, pain intensity was greater. Functional Dependence: directly related to the pain intensity, the greater the functional dependence pain intensity was higher punctuated. Regarding non analgesic treatment, patients received a median of 6 drugs (n = 584). Conclusions: There is no significant difference in pain intensity between patients with or without cognitive impairment. In patients with mild to moderate dementia, pain intensity, seems to be higher as it increases the degree of cognitive impairment. Disclosure: None declared
F286 PATTERN OF MUSCULOSKELETAL PAIN AMONG ELDERLY IN PHYSIOTHERAPY DEPARTMENT, OBAFEMI AWOLOWO UNIVERSITY TEACHING HOSPITALS COMPLEX, ILE IFE, NIGERIA A.O. Ojoawo *. Medical Rehabilitation, Obafemi Awolowo University, Ile Ife, Nigeria Background and Aims: Elderly patients often suffer from both acute and chronic painful conditions and ineffective pain management can have a significant impact on the quality of life of older adults, leading to depression, social isolation, and a loss of function. There is paucity of data on pattern of musculoskeletal pain in elderly patients in Nigeria. Methods: The case notes of patients that were 60 years old and above who reported musculoskeletal pain in the physiotherapy department of OAUTHC, Ile Ife, from June 2002 to May 2007 were examined. Among things assessed were age, sex, site of pain, and causes of pain. Results: Results indicated that there were 132 patients in all, consisting of 68 (51.51%) male and 64 (48.48%) female. Forty six (34.84%) patients had knee pain, comprises of 15 men and 31 women, 43 (32.57%) cases of low back pain (LBP) and 29 (21.96%) cases of cervical pain. Osteoarthritis was found to be responsible for the cause of pain in 89.39% of the patients. Conclusions: It can be concluded that the leading cause of musculoskeletal pain from this study is osteoarthritis and knee pain in the commonest site of pain while the number of women that complain about knee pain doubled that of men. Disclosure: None declared
F287 DRUG THERAPY FOR PAIN ASSOCIATED WITH OSTEOPOROTIC FRACTURES AND SUBSEQUENT CONDITIONS N. Muller ¨ *. Orthop¨ adische Gemeinschaftspraxis, Zirndorf, Germany Background and Aims: Patients suffering from pain caused by osteoporotic fracture most want pain reduction and the ability to live independently. Drug therapy in elderly patients has to be safe and effective even in severe pain conditions. Methods: Relevant factors for planning and applying drug therapy for pain reduction are identified by literature review with special attention to the osteoporosis guide lines in correlation with clinical experience. Results: There are multiple national and supernational guidelines addressing the treatment of osteoporosis per se. Within these guidelines, however, there are only few recommendations on how to specifically deal with the concomitant pain in acute phase or chronic phase. A synopsis of the relevant drugs in use with respect to the demands “elderly” – “severe pain” – “safety” is outlined. The key results are: Drug therapy in this group of patients has to be performed and monitored carefully. Age, comorbidity and co-medication are individual factors which can interfere with drug therapy. Pitfalls are numerous and complex. Highly effective drug
149
therapy of pain may interfere with the risk of falling and of subsequent injuries. Low effect pain therapy enhances further bone loss by immobilization. Strategies for risk reduction are outlined and clarified by examples. Conclusions: Good and safe pain reduction in elderly patients suffering from osteoporotic fractures and subsequent conditions usually depends on a clear-cut individual regime in a transdisciplinary approach. Effective pain therapy from the beginning is the most important factor to prevent further damage by immobilization and more bone loss. Disclosure: The author previously received funding for research and/ or travel expenses by several organizations including drug companies. There is no conflict of interests in this topic.
F288 CHARACTERIZATION OF CHRONIC POST-SURGICAL PAIN IN A PORTUGUESE PAIN DEPARTMENT – A RETROSPECTIVE STUDY S.M. Santos *, M. Quesada, A. Pedro, G. Coucelo. Hospital Prof. Dr. Fernando Fonseca EPE, Amadora, Portugal Background and Aims: In the past ten years there has been recognition that chronic post-surgical pain (CPSP) is a significant problem. CPSP is a clinical picture persisting for at least three months following a surgical intervention, where additional particular neuropathic symptoms are observed. This study aimed to analyse the cases of CPSP followed at our institution. Methods: We retrospectively analysed the cases of patients followed in our pain unit for CPSP, evaluating the following factors: gender, age, type of surgery, median time to development of complaints and degree of pain before and after treatment. Statistical analysis: SPSS version 13.0 (SPSS Inc., Chicago, IL). Results: We reviewed 105 cases and excluded 4 due to missing data. The average age of our patients was 62 years, predominantly female (66%). Most frequent cases were for orthopedic, gynecological and general surgery, with special focus on inguinal hernia repair (12%) and breast surgery (7.9%). The average time to complaints after surgery was 16.1 months (max 108 months; min 1 day); the vast majority (>90%) is still being followed. Types of pain were distributed as follows: neuropathic (67.3%), nociceptive (6.9%) and mixed (25.8%). The vast majority received pharmacological treatment with 33.6% of cases subjected to more invasive techniques: peripheral nerve block, ozone therapy and TENS. Pain intensity before treatment was 7.6/10 (sd+/1.97) and after treatment 4.01/10 (sd+/1.97). Conclusions: CPSP following surgery is a common entity. Our results show a major fall of pain scores after treatment, reinforcing the importance that CPSP patients be evaluated at a pain unit. Disclosure: None declared
F289 POSTOPERATIVE ANALGESIA EVALUATION AFTER TOTAL KNEE ARTHROPLASTY E. Marquez-Martinez *, E. Cano-Peral, L. Silva-Gil, C. Ordonez˜ Naufal, A. Mesas-Idanez, ˜ M.V. Ribera-Canudas, M. Panos-Gozalo. ˜ Anesthesia, Hospital Universitario Vall d’Hebron, Barcelona, Spain Background and Aims: Our primary objective was to assess the analgesic quality we offer our patients undergoing total knee arthroplasty (TKA), adverse effects and complications associated with differents analgesic techniques. Methods: A prospective trial including sixty-five patients subjected to TKA with anaesthesia intradural alone or associated with peridural catheter. We collected demographic variables, medical history, type of postoperative analgesia, acumulative mophine consumption, adverse effects and complications. We evaluated
considered pain intensity mild (45.5%) or moderate (33.1%). The most common treatment group: analgesics / antipyretics (64.1%), opioids (23.8%) and NSAIDs (21.5%). 41.5% of patients used nonpharmacological treatments. In patients with cognitive impairment the lower the MMSE score, pain intensity was greater. Functional Dependence: directly related to the pain intensity, the greater the functional dependence pain intensity was higher punctuated. Regarding non analgesic treatment, patients received a median of 6 drugs (n = 584). Conclusions: There is no significant difference in pain intensity between patients with or without cognitive impairment. In patients with mild to moderate dementia, pain intensity, seems to be higher as it increases the degree of cognitive impairment. Disclosure: None declared
F286 PATTERN OF MUSCULOSKELETAL PAIN AMONG ELDERLY IN PHYSIOTHERAPY DEPARTMENT, OBAFEMI AWOLOWO UNIVERSITY TEACHING HOSPITALS COMPLEX, ILE IFE, NIGERIA A.O. Ojoawo *. Medical Rehabilitation, Obafemi Awolowo University, Ile Ife, Nigeria Background and Aims: Elderly patients often suffer from both acute and chronic painful conditions and ineffective pain management can have a significant impact on the quality of life of older adults, leading to depression, social isolation, and a loss of function. There is paucity of data on pattern of musculoskeletal pain in elderly patients in Nigeria. Methods: The case notes of patients that were 60 years old and above who reported musculoskeletal pain in the physiotherapy department of OAUTHC, Ile Ife, from June 2002 to May 2007 were examined. Among things assessed were age, sex, site of pain, and causes of pain. Results: Results indicated that there were 132 patients in all, consisting of 68 (51.51%) male and 64 (48.48%) female. Forty six (34.84%) patients had knee pain, comprises of 15 men and 31 women, 43 (32.57%) cases of low back pain (LBP) and 29 (21.96%) cases of cervical pain. Osteoarthritis was found to be responsible for the cause of pain in 89.39% of the patients. Conclusions: It can be concluded that the leading cause of musculoskeletal pain from this study is osteoarthritis and knee pain in the commonest site of pain while the number of women that complain about knee pain doubled that of men. Disclosure: None declared
F287 DRUG THERAPY FOR PAIN ASSOCIATED WITH OSTEOPOROTIC FRACTURES AND SUBSEQUENT CONDITIONS N. Muller ¨ *. Orthop¨ adische Gemeinschaftspraxis, Zirndorf, Germany Background and Aims: Patients suffering from pain caused by osteoporotic fracture most want pain reduction and the ability to live independently. Drug therapy in elderly patients has to be safe and effective even in severe pain conditions. Methods: Relevant factors for planning and applying drug therapy for pain reduction are identified by literature review with special attention to the osteoporosis guide lines in correlation with clinical experience. Results: There are multiple national and supernational guidelines addressing the treatment of osteoporosis per se. Within these guidelines, however, there are only few recommendations on how to specifically deal with the concomitant pain in acute phase or chronic phase. A synopsis of the relevant drugs in use with respect to the demands “elderly” – “severe pain” – “safety” is outlined. The key results are: Drug therapy in this group of patients has to be performed and monitored carefully. Age, comorbidity and co-medication are individual factors which can interfere with drug therapy. Pitfalls are numerous and complex. Highly effective drug
149
therapy of pain may interfere with the risk of falling and of subsequent injuries. Low effect pain therapy enhances further bone loss by immobilization. Strategies for risk reduction are outlined and clarified by examples. Conclusions: Good and safe pain reduction in elderly patients suffering from osteoporotic fractures and subsequent conditions usually depends on a clear-cut individual regime in a transdisciplinary approach. Effective pain therapy from the beginning is the most important factor to prevent further damage by immobilization and more bone loss. Disclosure: The author previously received funding for research and/ or travel expenses by several organizations including drug companies. There is no conflict of interests in this topic.
F288 CHARACTERIZATION OF CHRONIC POST-SURGICAL PAIN IN A PORTUGUESE PAIN DEPARTMENT – A RETROSPECTIVE STUDY S.M. Santos *, M. Quesada, A. Pedro, G. Coucelo. Hospital Prof. Dr. Fernando Fonseca EPE, Amadora, Portugal Background and Aims: In the past ten years there has been recognition that chronic post-surgical pain (CPSP) is a significant problem. CPSP is a clinical picture persisting for at least three months following a surgical intervention, where additional particular neuropathic symptoms are observed. This study aimed to analyse the cases of CPSP followed at our institution. Methods: We retrospectively analysed the cases of patients followed in our pain unit for CPSP, evaluating the following factors: gender, age, type of surgery, median time to development of complaints and degree of pain before and after treatment. Statistical analysis: SPSS version 13.0 (SPSS Inc., Chicago, IL). Results: We reviewed 105 cases and excluded 4 due to missing data. The average age of our patients was 62 years, predominantly female (66%). Most frequent cases were for orthopedic, gynecological and general surgery, with special focus on inguinal hernia repair (12%) and breast surgery (7.9%). The average time to complaints after surgery was 16.1 months (max 108 months; min 1 day); the vast majority (>90%) is still being followed. Types of pain were distributed as follows: neuropathic (67.3%), nociceptive (6.9%) and mixed (25.8%). The vast majority received pharmacological treatment with 33.6% of cases subjected to more invasive techniques: peripheral nerve block, ozone therapy and TENS. Pain intensity before treatment was 7.6/10 (sd+/1.97) and after treatment 4.01/10 (sd+/1.97). Conclusions: CPSP following surgery is a common entity. Our results show a major fall of pain scores after treatment, reinforcing the importance that CPSP patients be evaluated at a pain unit. Disclosure: None declared
F289 POSTOPERATIVE ANALGESIA EVALUATION AFTER TOTAL KNEE ARTHROPLASTY E. Marquez-Martinez *, E. Cano-Peral, L. Silva-Gil, C. Ordonez˜ Naufal, A. Mesas-Idanez, ˜ M.V. Ribera-Canudas, M. Panos-Gozalo. ˜ Anesthesia, Hospital Universitario Vall d’Hebron, Barcelona, Spain Background and Aims: Our primary objective was to assess the analgesic quality we offer our patients undergoing total knee arthroplasty (TKA), adverse effects and complications associated with differents analgesic techniques. Methods: A prospective trial including sixty-five patients subjected to TKA with anaesthesia intradural alone or associated with peridural catheter. We collected demographic variables, medical history, type of postoperative analgesia, acumulative mophine consumption, adverse effects and complications. We evaluated