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Importance of sleep quality in chronic pain
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
ISPR8-1021
The inherent role of the multidisciplinary palliative care team on pain management: A critical review I. Amorim 1,∗ , S. Rego 2 , G. Pires 1 , S. Proec¸a 1 , F. Correia 1 CMRA, Servic¸o de Reabilitac¸ão de Adultos, Lisboa, Portugal 2 Centro Hospitalar Universitário do Algarve, Servic¸o de Medicina Física e de Reabilitac¸ão, Faro, Portugal ∗ Corresponding author. E-mail address: [email protected] (I. Amorim) 1
Introduction/Background Cancer pain and palliative care (PC) are recognized as significant international health issues. Treatment of pain and rehabilitation programs in PC are challenging. Rehabilitation is the process that helps a person to reach physical, psychologic, social and educational potential with physiologic, anatomic impairment, desires and life ambitions. Rehabilitation improves patients physical function, independence and pain management to improve quality of life and patients’ dignity. Material and method Update on the role of rehabilitation in PC by detailed view of rehabilitation treatment methods and their evidence for application into PC conditions. Databases of Cochrane Library, Google Scholar and Pubmed were search from January 2005–December 2016. Results There is few evidence that rehabilitation can impact function and pain management in PC. However, experience suggests that physical modalities should be applied early to minimize the generalized deconditioning and aid in the pain management, decreasing the need for pain medications. Physical modalities can be applied by health care providers. Passive, active, and activeassisted motion exercises and gentle strengthening exercises can aid in the maintenance of strength and joint range of motion. The prescription of assistive devices, and the teaching of compensatory techniques for mobility can aid in ambulation. There is also evidence that immune function may be improved by moderate exercise. Conclusion A rehabilitation team has the ability to integrate physical aspects of treatment in a biopsychosocial model of pain into a comprehensive rehabilitation program for cancer patients. More research should focus on the role of rehabilitation and defining appropriate interventions. Keywords Palliative care; Pain; Rehabilitation Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.254 ISPR8-1655
Importance of sleep quality in chronic pain M. Parada Marcilla FLENI, Neurology, Buenos Aires, Argentina E-mail address: [email protected] Introduction/Background Poor sleep is a risk factor of a range of several adverse outcomes including disabling pain conditions. The aim of this study is to analyze the interdisciplinary outpatient pain rehabilitation program (IOPRP) treatment outcomes of chronic back and neck pain (spinal pain) with comorbidity sleep disorders. Material and method We included 513 patients, between 1/8/14 and 28/2/16, in our IOPRP. A battery of self-reported questionnaires was completed at the beginning and end of a 16-session program; follow-up visits were scheduled three months and one year after discharge. The presence of chronic spinal pain and sleep disturbances were recorded. All subjects were separated into two groups, chronic spinal pain with sleep disturbances group 11.30% (n = 58), and chronic spinal pain without sleep disturbances group 88.7% (n = 455). Visual Analogue Scale (VAS) was used to evaluate pain, Insomnia Severity Index (ISI) to evaluate sleep quality, those with
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ISI > 8 underwent polysomniography to confirm sleep disturbances, and Short-Form Survey (SF-36) to evaluate the quality of life. Both groups were treated with the IOPRP, working under international standards (Carf accreditation). Treatment included pain medication, physical and occupational therapy, cognitive and behavioral techniques for pain, sleep and stress management. Results Mean age was 55.76A ± 0.44 years; 68.9% were females; IOPRP at baseline showed: Visual Analogue Scale (VAS) 5.66A ± 0.07, poor quality of life (SF36) 41.9(A ± 0.54), subclinical insomnia Insomnia Severity Index (ISI) 11.31A ± 0.26. At the end of the program, statistically significant improvement (P < 0.05) was observed on VAS, SF-36 (8 domains), and ISI. Conclusion The IOPRP, working under international standards, shows improvement in sleep associated with better physical functioning and pain reduction. Interventions in the interaction between pain and sleep could potentially reduce pain and increase quality of life for patients suffering chronic pain. More studies are needed for a better understanding of this relation, pain-sleep disorders. Disclosure of interest The author declares that he has no competing interest. https://doi.org/10.1016/j.rehab.2018.05.255 ISPR8-1792
Multilevel evaluation of motion and posture patterns in lower extremity and spine using dynamic ultrasound R. Bubnov a,∗ , L. Kalika b,1 Clinical Hospital “Feofaniya”, Ultasound, Kyiv, Ukraine b New York Dynamic Neuromuscular Rehabilitation & Physical Therapy, New York, USA ∗ Corresponding author. E-mail address: [email protected] (R. Bubnov) a
Introduction/Background Evaluation of intrinsic/extrinsic muscles posture is a crucial task for physical therapy and pain treatment. Integrative assessment of pain case in order restoring postural imbalance has not been developed. The aim was to evaluate feasibility of motion posture analysis using M-mode ultrasound in foot, ankle, gluteus region, pelvis and spine. Material and method We included 33 patients (both sexes, aged 17–52 y.o.) with clinically diagnosed leg, back pain with reduced motility in spine, pelvis and lower extremity levels. Another 20 patients (aged 18–53 y.o.) without pain and related complains on MSK disorders were controls. We conducted precise physical tests, extensive neuromuscular ultrasound using M-mode to evaluate muscle thickness, CSA and motion in intervetrebral spaces, pelvis, intrinsic/extrinsic muscles in pelvis, gluteus region, foot and ankle. Results We obtained sufficient quality panoramic scans on leg using convex 5–8 MHz probe in 2 approaches to evaluate structure and motion of extrinsic/intrinsic muscles during one session. Thickness measurements of peroneal portion, plantar intrinsic foot muscles on the plantar surface in two transverse positions and one longitudinal using linear probe; contractility using M-mode tested in walking were most representative data. We evaluated different patterns of decreasing motility, contractility (muscle contracted/rested thickness) on M-mode during functional tests and walking at all levels in group 1 (P < 0.05). We preliminary observed correlation of changes (muscle hypertrophy) in contralateral extrinsics/intrinsics muscles at same levels, due to biomechanical instability; trigger points detection corresponded to areas of hypomobility in 95% cases. Conclusion Extensive evaluation of motion posture in foot, ankle, and gluteus region, pelvis and spine is feasible and informative protocol. Further research needed for development US patterns, conducting comparative RCT using US, CAREN, static & dynamic balance tests, pressure analysis, etc.; and to develop educational programs.
ISPR8-1021
The inherent role of the multidisciplinary palliative care team on pain management: A critical review I. Amorim 1,∗ , S. Rego 2 , G. Pires 1 , S. Proec¸a 1 , F. Correia 1 CMRA, Servic¸o de Reabilitac¸ão de Adultos, Lisboa, Portugal 2 Centro Hospitalar Universitário do Algarve, Servic¸o de Medicina Física e de Reabilitac¸ão, Faro, Portugal ∗ Corresponding author. E-mail address: [email protected] (I. Amorim) 1
Introduction/Background Cancer pain and palliative care (PC) are recognized as significant international health issues. Treatment of pain and rehabilitation programs in PC are challenging. Rehabilitation is the process that helps a person to reach physical, psychologic, social and educational potential with physiologic, anatomic impairment, desires and life ambitions. Rehabilitation improves patients physical function, independence and pain management to improve quality of life and patients’ dignity. Material and method Update on the role of rehabilitation in PC by detailed view of rehabilitation treatment methods and their evidence for application into PC conditions. Databases of Cochrane Library, Google Scholar and Pubmed were search from January 2005–December 2016. Results There is few evidence that rehabilitation can impact function and pain management in PC. However, experience suggests that physical modalities should be applied early to minimize the generalized deconditioning and aid in the pain management, decreasing the need for pain medications. Physical modalities can be applied by health care providers. Passive, active, and activeassisted motion exercises and gentle strengthening exercises can aid in the maintenance of strength and joint range of motion. The prescription of assistive devices, and the teaching of compensatory techniques for mobility can aid in ambulation. There is also evidence that immune function may be improved by moderate exercise. Conclusion A rehabilitation team has the ability to integrate physical aspects of treatment in a biopsychosocial model of pain into a comprehensive rehabilitation program for cancer patients. More research should focus on the role of rehabilitation and defining appropriate interventions. Keywords Palliative care; Pain; Rehabilitation Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.254 ISPR8-1655
Importance of sleep quality in chronic pain M. Parada Marcilla FLENI, Neurology, Buenos Aires, Argentina E-mail address: [email protected] Introduction/Background Poor sleep is a risk factor of a range of several adverse outcomes including disabling pain conditions. The aim of this study is to analyze the interdisciplinary outpatient pain rehabilitation program (IOPRP) treatment outcomes of chronic back and neck pain (spinal pain) with comorbidity sleep disorders. Material and method We included 513 patients, between 1/8/14 and 28/2/16, in our IOPRP. A battery of self-reported questionnaires was completed at the beginning and end of a 16-session program; follow-up visits were scheduled three months and one year after discharge. The presence of chronic spinal pain and sleep disturbances were recorded. All subjects were separated into two groups, chronic spinal pain with sleep disturbances group 11.30% (n = 58), and chronic spinal pain without sleep disturbances group 88.7% (n = 455). Visual Analogue Scale (VAS) was used to evaluate pain, Insomnia Severity Index (ISI) to evaluate sleep quality, those with
e117
ISI > 8 underwent polysomniography to confirm sleep disturbances, and Short-Form Survey (SF-36) to evaluate the quality of life. Both groups were treated with the IOPRP, working under international standards (Carf accreditation). Treatment included pain medication, physical and occupational therapy, cognitive and behavioral techniques for pain, sleep and stress management. Results Mean age was 55.76A ± 0.44 years; 68.9% were females; IOPRP at baseline showed: Visual Analogue Scale (VAS) 5.66A ± 0.07, poor quality of life (SF36) 41.9(A ± 0.54), subclinical insomnia Insomnia Severity Index (ISI) 11.31A ± 0.26. At the end of the program, statistically significant improvement (P < 0.05) was observed on VAS, SF-36 (8 domains), and ISI. Conclusion The IOPRP, working under international standards, shows improvement in sleep associated with better physical functioning and pain reduction. Interventions in the interaction between pain and sleep could potentially reduce pain and increase quality of life for patients suffering chronic pain. More studies are needed for a better understanding of this relation, pain-sleep disorders. Disclosure of interest The author declares that he has no competing interest. https://doi.org/10.1016/j.rehab.2018.05.255 ISPR8-1792
Multilevel evaluation of motion and posture patterns in lower extremity and spine using dynamic ultrasound R. Bubnov a,∗ , L. Kalika b,1 Clinical Hospital “Feofaniya”, Ultasound, Kyiv, Ukraine b New York Dynamic Neuromuscular Rehabilitation & Physical Therapy, New York, USA ∗ Corresponding author. E-mail address: [email protected] (R. Bubnov) a
Introduction/Background Evaluation of intrinsic/extrinsic muscles posture is a crucial task for physical therapy and pain treatment. Integrative assessment of pain case in order restoring postural imbalance has not been developed. The aim was to evaluate feasibility of motion posture analysis using M-mode ultrasound in foot, ankle, gluteus region, pelvis and spine. Material and method We included 33 patients (both sexes, aged 17–52 y.o.) with clinically diagnosed leg, back pain with reduced motility in spine, pelvis and lower extremity levels. Another 20 patients (aged 18–53 y.o.) without pain and related complains on MSK disorders were controls. We conducted precise physical tests, extensive neuromuscular ultrasound using M-mode to evaluate muscle thickness, CSA and motion in intervetrebral spaces, pelvis, intrinsic/extrinsic muscles in pelvis, gluteus region, foot and ankle. Results We obtained sufficient quality panoramic scans on leg using convex 5–8 MHz probe in 2 approaches to evaluate structure and motion of extrinsic/intrinsic muscles during one session. Thickness measurements of peroneal portion, plantar intrinsic foot muscles on the plantar surface in two transverse positions and one longitudinal using linear probe; contractility using M-mode tested in walking were most representative data. We evaluated different patterns of decreasing motility, contractility (muscle contracted/rested thickness) on M-mode during functional tests and walking at all levels in group 1 (P < 0.05). We preliminary observed correlation of changes (muscle hypertrophy) in contralateral extrinsics/intrinsics muscles at same levels, due to biomechanical instability; trigger points detection corresponded to areas of hypomobility in 95% cases. Conclusion Extensive evaluation of motion posture in foot, ankle, and gluteus region, pelvis and spine is feasible and informative protocol. Further research needed for development US patterns, conducting comparative RCT using US, CAREN, static & dynamic balance tests, pressure analysis, etc.; and to develop educational programs.