- Email: [email protected]
Pain and disability
S498
A METHOD FOR AlTAiNlNG RAPID AND SUSTAINED PAIN RELIEF AND DISCRIMINATINQ NOCICEPTWE FROM NEUROPATWC PAIN IN CANCER PATlENTS c. stratto n Hill, Jr., Deborah M. Thorpe, Linda McCrory*, Pain Son&e, Unlver8ity of Texas hf. D. Anderson Cancer Center, Houston, Texas, 77030, USA
965
Slide
Fri
3:00
ACC Hall
D
I------
i AIM OF INVESTIQATION: To review our experience using an Intravenous rapid Injection test) In cancer patients wtth paln to determine: 1) its -uabaakfor optlmum oral doee of opiate, obviating the Incrementai dose lncreaee techntque whkh dekys optimum pain reilef, and 2) its usefulness In descrimlnatlng opiate responsive from opiate non or partlaily re+oneive pain. METHODS: Recorda of 102 consecutive patients referred to the Pain Servka of the UT. M.D. AnCancer Center evaluated by thk morphlna test were revlewed. Foilowlng a detaffed pain hktory and physkal examkatlon morphine sulfate was admlnktered either as a single dose or In seque&l doaea u&f pain wan relieved, or lt WIU evldent that pain was non or partlaliy reeponslve. Patients rated their pain Menatty prior to the lnhkl and subsequent do8w. lnltal dose determination was based on the examker’a cllnkal aeaeesreent of pein and patlent’s previous drug exposure, and ranged from 5 to 15mg. SubaequeM incrementai d&we8 were ako In this range. Response to te8t was rated as poositlvewith 75% relief, partlal with Scm, and negative with leas than 50%. Patlents In the first category were Judged to have predominently nockepttve pain, the &econd mixed nocicepthrdneuropathlc pain, and the latter predomlnently neuropathk, or other opiate unreeponelve pain. RESULTS: 102 subjeck received 108 morphlne tests. The total teat dose of morphine ranged between 8 and 400mg with a medlan of 20 mg. 83 subjects were Judged posltlve responders, 13 negative, and 11 were partial responders, and one wa8 unevalwble. Of 94 poshive and partial resondem, 81 were piaced on morphine. Of these, 4S were placed on controlled releaee morphine, and 30 on Immediate relaaae morphine. An orel morphine dose wa8 calculated baaed on the Intravenous doee requlred to relieve subject’8 pain. lnltki 24 hour oral doses ranged from 60mg to 528Omg with a medlan of 270 mg. The goal of Immediate and austalned pain relief was achieved In 52,14 required elther a drug or route of admlnktratlon change, and 15 were lost to folfow-up. CONCLUSlON: We conclude the morphlne test Is a safe and valuable cllnkal tool to achieve Immediate and sustained paln control with oral opiates In cancer patients, obvlatlng the period of unneceaary paln endured with the usual method of oral dose titration. Further, we conclude thlr test k useful In determinlng varying degrees of responalveness of pain to opiates, and help8 dlscrlmlnate noclceptive from newopethk Pain.
Low Back Pain PAIN AND DISABILITY. G. Wad&$, M. Newton, W.I. Henderson* (SPON: Prof. M.R. Bond) Orthopaedic Dept., Western Infirmary, Glasgow, Gil 6NT, Scotland, UK. .
.
966 Slide Fri
3:15
ACC Hall
0
of InTo analyse the relationship between pain and disability in UK patients with low back disorders. Stodv 1 (160 patients) Severity of pain (VAS) and self-reported disability in activities of daily living are related r = 0.44. Regression analysis showed that 22.8% of the variance of disability was explained by -pain characteristics + 14.8% by psychological distress + 15.8% by clinical measures of abnormal illness behaviour (AIB). &I&Z (140 patients) Severity of pain only explained 10.3% of time off work. Social and work-related factors were much more important. AIB.explained 33.9% of time off work. &t&Q (120 patients) Coping strategies explained 43.0% of depressive symptoms and an additional 11.3% of disability even after allowing for pain and depressive symptoms. w (150 patients) The main study included detailed assessment of pain, disability, physical impairment, isokinetic measures, cognitive factors, psychological distress and AIB. Cognitive factors and AlB were more important influences on disability than either pain or physical abnormality. . m: These results are combined into a model of pain and disability which suggests that assessment and management should emphasize disability and rehabilitation as much as pain and treatment. copmg strategies
>
PSYCHOLOGICAL
DISTRESS
A METHOD FOR AlTAiNlNG RAPID AND SUSTAINED PAIN RELIEF AND DISCRIMINATINQ NOCICEPTWE FROM NEUROPATWC PAIN IN CANCER PATlENTS c. stratto n Hill, Jr., Deborah M. Thorpe, Linda McCrory*, Pain Son&e, Unlver8ity of Texas hf. D. Anderson Cancer Center, Houston, Texas, 77030, USA
965
Slide
Fri
3:00
ACC Hall
D
I------
i AIM OF INVESTIQATION: To review our experience using an Intravenous rapid Injection test) In cancer patients wtth paln to determine: 1) its -uabaakfor optlmum oral doee of opiate, obviating the Incrementai dose lncreaee techntque whkh dekys optimum pain reilef, and 2) its usefulness In descrimlnatlng opiate responsive from opiate non or partlaily re+oneive pain. METHODS: Recorda of 102 consecutive patients referred to the Pain Servka of the UT. M.D. AnCancer Center evaluated by thk morphlna test were revlewed. Foilowlng a detaffed pain hktory and physkal examkatlon morphine sulfate was admlnktered either as a single dose or In seque&l doaea u&f pain wan relieved, or lt WIU evldent that pain was non or partlaliy reeponslve. Patients rated their pain Menatty prior to the lnhkl and subsequent do8w. lnltal dose determination was based on the examker’a cllnkal aeaeesreent of pein and patlent’s previous drug exposure, and ranged from 5 to 15mg. SubaequeM incrementai d&we8 were ako In this range. Response to te8t was rated as poositlvewith 75% relief, partlal with Scm, and negative with leas than 50%. Patlents In the first category were Judged to have predominently nockepttve pain, the &econd mixed nocicepthrdneuropathlc pain, and the latter predomlnently neuropathk, or other opiate unreeponelve pain. RESULTS: 102 subjeck received 108 morphlne tests. The total teat dose of morphine ranged between 8 and 400mg with a medlan of 20 mg. 83 subjects were Judged posltlve responders, 13 negative, and 11 were partial responders, and one wa8 unevalwble. Of 94 poshive and partial resondem, 81 were piaced on morphine. Of these, 4S were placed on controlled releaee morphine, and 30 on Immediate relaaae morphine. An orel morphine dose wa8 calculated baaed on the Intravenous doee requlred to relieve subject’8 pain. lnltki 24 hour oral doses ranged from 60mg to 528Omg with a medlan of 270 mg. The goal of Immediate and austalned pain relief was achieved In 52,14 required elther a drug or route of admlnktratlon change, and 15 were lost to folfow-up. CONCLUSlON: We conclude the morphlne test Is a safe and valuable cllnkal tool to achieve Immediate and sustained paln control with oral opiates In cancer patients, obvlatlng the period of unneceaary paln endured with the usual method of oral dose titration. Further, we conclude thlr test k useful In determinlng varying degrees of responalveness of pain to opiates, and help8 dlscrlmlnate noclceptive from newopethk Pain.
Low Back Pain PAIN AND DISABILITY. G. Wad&$, M. Newton, W.I. Henderson* (SPON: Prof. M.R. Bond) Orthopaedic Dept., Western Infirmary, Glasgow, Gil 6NT, Scotland, UK. .
.
966 Slide Fri
3:15
ACC Hall
0
of InTo analyse the relationship between pain and disability in UK patients with low back disorders. Stodv 1 (160 patients) Severity of pain (VAS) and self-reported disability in activities of daily living are related r = 0.44. Regression analysis showed that 22.8% of the variance of disability was explained by -pain characteristics + 14.8% by psychological distress + 15.8% by clinical measures of abnormal illness behaviour (AIB). &I&Z (140 patients) Severity of pain only explained 10.3% of time off work. Social and work-related factors were much more important. AIB.explained 33.9% of time off work. &t&Q (120 patients) Coping strategies explained 43.0% of depressive symptoms and an additional 11.3% of disability even after allowing for pain and depressive symptoms. w (150 patients) The main study included detailed assessment of pain, disability, physical impairment, isokinetic measures, cognitive factors, psychological distress and AIB. Cognitive factors and AlB were more important influences on disability than either pain or physical abnormality. . m: These results are combined into a model of pain and disability which suggests that assessment and management should emphasize disability and rehabilitation as much as pain and treatment. copmg strategies
>
PSYCHOLOGICAL
DISTRESS