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Intravenous orphenadrine: Objective and subjective measurement of effect in the chronic pain patient
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CHRONIC LUMBOSCIATICA AND THE DIAGNOSTIC EPIDURAL OPIOID BLOCKADE. L. Plaqhki, J.L. Scholtes J.M. Godfraind and J.M -ml Vanmarsenille. Faculte de Mbdecine, Universite Catholique de Louvain - 1200 B. Brussels - BELGIUM Aim of investigation : The usefulness of the Diagnostic Epidural Opioid Blockade (DEOB) is examined on 45 cases of chronic lumbosciatica well documented by detailed physical, psychological (MMPI), and laboratory (Xray, Thermography, CT-Scan) assessments. Indeed, Cherry et al. have proposed the DEOB to differentiate between pain of mainly physical or emotional origin (Pain, 21 (1985) 143-152 ) : they showed pain of physical basis to be little affected by saline (except for some placebo effect), decreased by Fentanyl and increased by Naloxone. Methods : Pain rates are estimated with a VAS, 20 min before and 20 min after sequential injections of : epidural saline (2 times), epidural Fentanyl, IV Naloxone; procedure and dosage are similar to those of Cherry et al.. Patients responses are classified in three groups according to amplitude and direction of changes in pain ratings : 1) group NR (= no response) if ratings changes are non significant i.e < 5 units on the VAS (O-100 units), 2) group ER (= expected response) if significant changes occur in the expected direction, and 3) group RR (= reversed response) for changes in the non-expected direction. Results and conclusions : No significant correlate appears between the response profiles on the DEOB and physical, psychological or laboratory results. Group frequencies (NR, ER, RR) with Fentanyl and Naloxone, classified in a 3x3 contingency table, show complete independance of the two variables (Chi2 = 1.34; n.s.). Unexpectedly, data from Fentanyl and saline submitted to the same statistical test revealed a significant link (Chi2 = 13.77; P < 0.01). In this population of patients, the DEOB appears to have a rather poor diagnostic and prognostic performance. oRPl-ENAcRINE: oBJl3cTIVE AN) SUBJECTIVE INTRAW F] WAWWIRWCF EFFBCT IN TIE CI-@XXWCPAIN PATIBNI-. T. Newkirk+, A. Flood*, K. Bender*, R. Collins*, B. Kern* (SKN: M. Drake), Center for Occupational Health, J. Fleckles*, Kentfield Medical Hospital, Kentfield, CA 94904, U.S.A. -OF A series of double blind studies to assess the effect of intravenous orphenadrine in facilitating recovery of truncal range of motion in chronic pain patients. Sixteen patients were monitored with surface FMG MEZQJX: Electronmgraph electrodes applied to both painful and non-painful trunk nuscles. Either saline or orphenadrine was administered intravenously and baseline vs. 30 min post dose done EMG rates compared. Next, detailed range of nmtion measurements were performed as baseline and after intravenous saline or orphenadrine administration. These measurements were ,used as a subjective measure of the effect of orphenadrine versus saline. In all studies 6Omg orphenadrine was diluted with saline to a final value of ZOml in order’& avoid symptomatic venous irritation. Measurements used included I&XI, Visual Analog Scale (VAS) and Flexion/Extension Range of Motion. m: No consistent improvement in surface HvKI electrode readings was detected in the sixteen patients measured by this method even though pain levels (VAS) declined and Range of Motion improved. Surface E% electrode measurement is not a reliable CINcLusIcN: indicator of the effectiveness of orphenadrine in chronic back pain patients. Range of Motion studies are a mDre appropriate tool to assess the effect of orphenadrine used intravenously.
CHRONIC LUMBOSCIATICA AND THE DIAGNOSTIC EPIDURAL OPIOID BLOCKADE. L. Plaqhki, J.L. Scholtes J.M. Godfraind and J.M -ml Vanmarsenille. Faculte de Mbdecine, Universite Catholique de Louvain - 1200 B. Brussels - BELGIUM Aim of investigation : The usefulness of the Diagnostic Epidural Opioid Blockade (DEOB) is examined on 45 cases of chronic lumbosciatica well documented by detailed physical, psychological (MMPI), and laboratory (Xray, Thermography, CT-Scan) assessments. Indeed, Cherry et al. have proposed the DEOB to differentiate between pain of mainly physical or emotional origin (Pain, 21 (1985) 143-152 ) : they showed pain of physical basis to be little affected by saline (except for some placebo effect), decreased by Fentanyl and increased by Naloxone. Methods : Pain rates are estimated with a VAS, 20 min before and 20 min after sequential injections of : epidural saline (2 times), epidural Fentanyl, IV Naloxone; procedure and dosage are similar to those of Cherry et al.. Patients responses are classified in three groups according to amplitude and direction of changes in pain ratings : 1) group NR (= no response) if ratings changes are non significant i.e < 5 units on the VAS (O-100 units), 2) group ER (= expected response) if significant changes occur in the expected direction, and 3) group RR (= reversed response) for changes in the non-expected direction. Results and conclusions : No significant correlate appears between the response profiles on the DEOB and physical, psychological or laboratory results. Group frequencies (NR, ER, RR) with Fentanyl and Naloxone, classified in a 3x3 contingency table, show complete independance of the two variables (Chi2 = 1.34; n.s.). Unexpectedly, data from Fentanyl and saline submitted to the same statistical test revealed a significant link (Chi2 = 13.77; P < 0.01). In this population of patients, the DEOB appears to have a rather poor diagnostic and prognostic performance. oRPl-ENAcRINE: oBJl3cTIVE AN) SUBJECTIVE INTRAW F] WAWWIRWCF EFFBCT IN TIE CI-@XXWCPAIN PATIBNI-. T. Newkirk+, A. Flood*, K. Bender*, R. Collins*, B. Kern* (SKN: M. Drake), Center for Occupational Health, J. Fleckles*, Kentfield Medical Hospital, Kentfield, CA 94904, U.S.A. -OF A series of double blind studies to assess the effect of intravenous orphenadrine in facilitating recovery of truncal range of motion in chronic pain patients. Sixteen patients were monitored with surface FMG MEZQJX: Electronmgraph electrodes applied to both painful and non-painful trunk nuscles. Either saline or orphenadrine was administered intravenously and baseline vs. 30 min post dose done EMG rates compared. Next, detailed range of nmtion measurements were performed as baseline and after intravenous saline or orphenadrine administration. These measurements were ,used as a subjective measure of the effect of orphenadrine versus saline. In all studies 6Omg orphenadrine was diluted with saline to a final value of ZOml in order’& avoid symptomatic venous irritation. Measurements used included I&XI, Visual Analog Scale (VAS) and Flexion/Extension Range of Motion. m: No consistent improvement in surface HvKI electrode readings was detected in the sixteen patients measured by this method even though pain levels (VAS) declined and Range of Motion improved. Surface E% electrode measurement is not a reliable CINcLusIcN: indicator of the effectiveness of orphenadrine in chronic back pain patients. Range of Motion studies are a mDre appropriate tool to assess the effect of orphenadrine used intravenously.