- Email: [email protected]
Poster 108
A24
ACADEMY ANNUAL ASSEMBLY ABSTRACTS
the addition of gabapentin. Setting: Clinic. Participants: Subjects with chronic low back and radicular pain in the lower extremity were evaluated for functional improvement after ESI. The addition of gabapentin use was factored into the assessment. Interventions: Fluoroscopic guidance of ESI done at the clinically suspected level in the lumbar region. Main Outcome Measures: Oswestry Disability Index (ODI) and verbal rating scale (VRS) for current pain severity. Results: 75 patients with a radiculopathy were evaluated for an ESI. 29 were on gabapentin and 46 were not. The mean gabapentin use ⫾ SD prior to injections was 1662⫾950mg. The patients were followed postinjection on average for 10.8⫾3.9 weeks. Posttreatment ODI score (61.9⫾16.2) was significantly improved (P⬍.001) in all cases compared with pretreatment ODI score (66.8⫾17.3). Pretreatment ODI and VRS scores did not differ significantly between groups showing positive (66.2⫾17.7, 7.2⫾1.9) and negative (67.1⫾17.2, 7.8⫾1.0) gabapentin use (P⬍.05). ODI improvement and VRS postinjection did not differ significantly for positive gabapentin use (6.6⫾10.8, 6.2⫾1.6) compared with negative use (3.7⫾15.3, 6.2⫾1.4) (P⬍.05). Conclusions: Subjects undergoing ESI for chronic radicular pain, who were using gabapentin prior to injection, did not show significant improvement in functional outcome as measured by the ODI or in current pain intensity as measured by the VRS. This study did not demonstrate that gabapentin use prior to spinal procedures has any benefit on the outcome of spinal injections in patients with chronic pain. The limitation of the study was the lack of patients on gabapentin and low functional improvement after ESI. The timing of gabapentin use and the dose of maximal therapeutic benefit were not evaluated by this study. Key Words: Epidural; Gabapentin; Radiculopathy; Rehabilitation. Poster 108 Coccygeal Pain Relief After Transsacrococcygeal Block of the Ganglion Impar Under Fluoroscopy: A Case Report. Mahesh R. Kuthuru, MD (University Hospitals of Cleveland/Case Western Reserve University, Cleveland, OH); Abdallah I. Kabbara, MD; Parke F. Oldenburg, MD; Mark V. Boswell, MD, PhD; Samuel K. Rosenberg, MD, e-mail: [email protected]. Disclosure: None. Setting: Tertiary care university hospital. Patient: A 48-year-old man with coccydynia. Case Description: The patient, who had multiple sclerosis, presented to our clinic with a 3-year history of coccygeal pain. Pain varied from 5 to 10 on a scale of 10 and was described as a sharp, knife-like, burning, stabbing, and achy pain. Walking, sitting, standing, and bending exacerbated pain. Alleviating factors included using topical capsaicin. The patient tried multiple medications without relief. Poor sleep parameters were noted. Strength was 2/5 on the left and 3/5 in the right lower extremity. Upper-extremity strength was normal. Assessment/Results: The patient was diagnosed with coccydynia. Fluoroscopically guided ganglion impar blocks were performed on February 4 and Feburary 8, 2002; the blocks resulted in 50% to 60% pain relief. A caudal epidural steroid injection, performed on March 4, 2002, under fluoroscopy, did not provide any relief. Pulsed radiofrequency denervation of the ganglion impar was performed under fluoroscopy on June 20, 2002, with good pain control noted. Discussion: Ganglion impar, also known as the ganglion of Walther, supplies some innervation for the pelvic and perineal regions, and it was initially blocked by Plancarte in 1990. To our knowledge, its effectiveness for coccydynia has not been published. We present 1 patient who experienced dramatic improvement in his coccygeal pain after blocking the ganglion impar under fluoroscopy. Successful pain control aids rehabilitation. The ganglion impar is the most caudal of the sympathetic prevertebral ganglion and supplies sympathetic fibers to the perineum. It is located anterior to the sacroccygeal junction. Blocking the ganglion impar has demonstrated considerable relief of intractable perineal and pelvic pain. Due to its location, bowel and bladder dysfunction are potential risks. Penetration of the rectum is a potential complication. Conclusions: Fluoroscopically guided ganglion impar block may offer a safe and effective way of improving coccygeal pain. Key Words: Fluoroscopy; Pain; Rehabilitation.
Objective: To test for an effect of a novel, simple device used outside the body and employing special materials to recover infrared (IR) heat lost through clothes, warming the lumbar area constantly and continuously. Design: 2 randomized double-blind placebo-controlled pilot trials; one was a crossover with a washout period (trial 1) and the other, a parallel group trial (trial 2). Setting: Outpatient pain clinic of 2 separate university hospitals. Participants: Patients with chronic mechanical low back pain (age, 1– 40y). Trial 1: 30 patients; trial 2: 23 patients. Interventions: Lightweight soft belt device with special materials that reflect infrared heat lost through clothes, warming the low back constantly and continuously, to higher temperatures than those achieved with other materials. The placebo was a look-alike device without IR reflective materials. Minimum device use was 8h/d in trial 1; for trial 2, use was the same plus overnight use. The follow-up period was 1 month in trial 1 and 1 to 3 months in trial 2. Main Outcome Measures: Pain 100-mm visual analog scale (VAS), disability index (trial 1: Roland-Morris Disability Questionnaire [RMDQ], trial 2: Oswestry Disability Index [ODI]). Results: Both trials showed encouraging responses versus placebo. The crossover trial showed a VAS rating reduction for chronic pain of “limited” duration (⬍5y) without history of surgery (10 –14mm VAS, 21%–29%; P⬍.05). The RMDQ response was small but followed that of the VAS. The parallel group trial, for chronic pain patients who had not had surgery, with reasonably matched groups, showed a marked reduction in both VAS rating (40%) and ODI score (25%), but the sample size was too small for statistical analysis. Conclusion: The simple IR reflective technique, which provided constant and continuous low-level heat to the low back, appears to be promising for chronic back pain treatment and warrants further investigations. Key Words: Back pain; Heat; Randomized controlled trial; Rehabilitation. Poster 111 Treatment of Chronic Pain in a 17-Year-Old With Klippel-Trenaunay-Weber Syndrome: A Case Report. Sarah L. Schuler, MD (JFK Johnson Rehabilitation Institute/JFK Medical Center, Edison, NJ); Iqbal Jafri, MD; Sara Cuccurrullo, MD; Thomas Strax, MD, e-mail: [email protected]. Disclosure: None. Setting: Outpatient pain management program. Patient: A 17-year-old girl with history of Klippel-Trenaunay-Weber syndrome (KTWS). Case Description: The patient was diagnosed at birth with KTWS, which affected her right leg and resulted in a propensity for bleeding due to cutaneous capillary malformations and severe edema due to deeper venous malformations. At age 3, she underwent amputation of 2 toes and a skin graft in an attempt to arrest bleeding. At presentation, she described constant burning pain of intensity 8 on a 0 to 10 pain scale and allodynia of the lateral ankle and medial thigh, which interfered with sleep, concentration, and gait. A 5% lidocaine transdermal patch to the ankle was added to her existing regimen of 300mg of gabapentin 3 times daily, 200mg of celecoxib every day, and weekly aquatic therapy. Because her pain remained unchanged at the 6-week follow-up, 2 lidocaine patches were placed on her ankle, gabapentin was increased to 300mg 4 times daily, and therapy was increased to twice a week. At 12 weeks, the pain intensity was still rated at 8, and the only change made to the regimen was the addition of a 50g/h fentanyl transdermal patch. Fentanyl was not tolerated and was stopped by the patient at week 13. Assessment/Results: At 18-week follow-up, her pain had decreased to an intensity of 4 and her functional status and sleep were significantly improved. Discussion: A literature search has revealed no other examples of pain or treatment of pain caused by KTWS. From our experience with this case, gabapentin and lidocaine patch can decrease pain and, consequently, in conjunction with aquatic therapy, can increase the patient’s functional status. Conclusion: The sequence of medication choices and dosages in addition to the exercise modality provided effective treatment in this case of KTWS. Key Words: Klippel-Trenaunay-Weber syndrome; Pain; Rehabilitation.
Poster 109 Phantom Rectum Pain: An Intractable Pain Syndrome: A Case Report. Leonard B. Kamen, DO (MossRehab Hospital, Philadelphia, PA), e-mail: [email protected]. Disclosure: Kamen, Jannsen Pharmaceuticals Speakers bureau, Research grant from Allergan. Setting: Outpatient physical medicine clinic. Patient: A 74-year-old woman with ulcerative colitis. Case Description: The patient underwent a total colectomy with an ileostomy 6 years before presentation. 4 years later, after initiating a stationary bicycle exercise program, she developed intractable pain in the sacrococcygeal, perianal surgical area. Imaging studies of the rectal area failed to identify an anatomic derangement or source of pain. Failed trials of multiple analgesic medications included nonsteroidals, antidepressants (3), muscle relaxants (3), opioids (5), and antiepileptic drugs (4). Anesthetic interventions, including perianal lidocaine with steroid injections, lumbar epidural steroid injections, and phenol to the sacral nerves, provided no relief. Intrathecal morphine pump and implanted spinal stimulation trials failed to provide any benefit and were discontinued. Assessment/Results: Intractable sacrococcygeal perianal pain in the absence of a rectum with no response to intense medical and peripheral treatment supported a central or phantom pain syndrome mandating a different conceptual pain rehabilitation approach. Discussion: On referral to our rehabilitation clinic, coordinated physical and psychologic therapy combined with use of high-dose opioids (300g of transdermal fentanyl; 80mg of methadone), adjunctive medications, and botulinum toxin type A injections to pubococcygeus and pelvic floor muscle pain generators offered a modicum of pain relief. Conclusions: Phantom pain presenting in unusual nonlimb areas has been reported in descriptions of anatomic loss. Phantom rectum pain syndrome was defined by the location, character of pain, and nonresponse to peripheral treatment. Conceptual categorization of intractable nonlimb pain as phantom pain allows for an enhanced biopsychosocial approach to pain resource utilization. Key Words: Pain, intractable; Rectum; Rehabilitation.
Poster 112 The Influence of a Combination of Infrared Light With Transcutaneous Electric Nerve Stimulation in Patients With Cervical Symptoms of Ankylosing Spondylitis. Gordana Devecerski, MD, PhD (School of Medicine, Novi Sad, Yugoslavia); Djordje Letic, MD; Mirko Teofilovski, MD, PhD; Gordana Teofilovski-Parapid, MD, PhD; Biljana Parapid, MD, e-mail: [email protected]. Disclosure: None. Objective: To study the advantages of a home treatment combination of infrared (IR) light with transcutaneous electric nerve stimulation (TENS) over the classic approach of nonsteriodal antiinflammatory drugs (NSAIDs) in treating ankylosing spondylitis (AS). Design: Prospective randomized follow-up study. Setting: Academic medical center. Participants: Patients were randomized into 2 groups (20 each). All were men, ages 30 to 40 years old, with cervical symptoms of AS. Interventions: Range of motion of the cervical spine and presence of pain in the neck were evaluated in each group. Patients in both groups underwent kinesitherapy during 2 weeks. Also, group 1 took NSAIDs (7.5mg of meloxicam twice a day), while group 2 had TENS (30min) applied with IR lamp 300W (20min) over the cervical region every morning. Main Outcome Measures: Pain decrease and movement increase. Results: After 2 weeks, in group 1, 60% of the patients experienced a reduction in pain, while 25% experienced an increased amplitude of neck movements. In group 2, 40% experienced a reduction in pain and 75% had a significant increase in neck movements. Conclusions: Application of TENS with an IR lamp is useful and practical in home treatment of patients with cervical symptoms of AS. Also, we must not forget kinesitherapy and NSAIDs, which are a necessary part of treatment. Key Words: Infrared rays; Rehabilitation; Spondylitis, ankylosing; Transcutaneous electric nerve stimulation.
Poster 110 Infrared Reflective Thermal Device for Chronic Low Back Pain: Results From 2 Pilot Randomized Controlled Trials. Satham Petty-Saphon, PhD (Spine-issimus Ltd, Saffron Walden, UK); Rajesh R. Munglani, MD; Tim P. Nash, MD, e-mail: spettysaphon@spine-issimus. com. Disclosure: Petty-Saphon, Spine-Issimus employee; Munglani, Research grant from Spine-Issimus; Nash, None.
Poster 113 Sensory-Gating Deficits in Patients With Chronic Low Back Pain: A P50 Midlatency Auditory Evoked Potential Study. Alice V. Fann, MD (Central Arkansas Veterans Healthcare System; UAMS, North Little Rock, AR); Michael A. Preston, BS; Robert D. Skinner, PhD; Edgar Garcia-Rill, PhD, e-mail: [email protected]. Disclosure: Fann, Research grant from the Veterans Affairs Rehabilitation Research and Development; Other authors: None.
Arch Phys Med Rehabil Vol 84, September 2003
ACADEMY ANNUAL ASSEMBLY ABSTRACTS
the addition of gabapentin. Setting: Clinic. Participants: Subjects with chronic low back and radicular pain in the lower extremity were evaluated for functional improvement after ESI. The addition of gabapentin use was factored into the assessment. Interventions: Fluoroscopic guidance of ESI done at the clinically suspected level in the lumbar region. Main Outcome Measures: Oswestry Disability Index (ODI) and verbal rating scale (VRS) for current pain severity. Results: 75 patients with a radiculopathy were evaluated for an ESI. 29 were on gabapentin and 46 were not. The mean gabapentin use ⫾ SD prior to injections was 1662⫾950mg. The patients were followed postinjection on average for 10.8⫾3.9 weeks. Posttreatment ODI score (61.9⫾16.2) was significantly improved (P⬍.001) in all cases compared with pretreatment ODI score (66.8⫾17.3). Pretreatment ODI and VRS scores did not differ significantly between groups showing positive (66.2⫾17.7, 7.2⫾1.9) and negative (67.1⫾17.2, 7.8⫾1.0) gabapentin use (P⬍.05). ODI improvement and VRS postinjection did not differ significantly for positive gabapentin use (6.6⫾10.8, 6.2⫾1.6) compared with negative use (3.7⫾15.3, 6.2⫾1.4) (P⬍.05). Conclusions: Subjects undergoing ESI for chronic radicular pain, who were using gabapentin prior to injection, did not show significant improvement in functional outcome as measured by the ODI or in current pain intensity as measured by the VRS. This study did not demonstrate that gabapentin use prior to spinal procedures has any benefit on the outcome of spinal injections in patients with chronic pain. The limitation of the study was the lack of patients on gabapentin and low functional improvement after ESI. The timing of gabapentin use and the dose of maximal therapeutic benefit were not evaluated by this study. Key Words: Epidural; Gabapentin; Radiculopathy; Rehabilitation. Poster 108 Coccygeal Pain Relief After Transsacrococcygeal Block of the Ganglion Impar Under Fluoroscopy: A Case Report. Mahesh R. Kuthuru, MD (University Hospitals of Cleveland/Case Western Reserve University, Cleveland, OH); Abdallah I. Kabbara, MD; Parke F. Oldenburg, MD; Mark V. Boswell, MD, PhD; Samuel K. Rosenberg, MD, e-mail: [email protected]. Disclosure: None. Setting: Tertiary care university hospital. Patient: A 48-year-old man with coccydynia. Case Description: The patient, who had multiple sclerosis, presented to our clinic with a 3-year history of coccygeal pain. Pain varied from 5 to 10 on a scale of 10 and was described as a sharp, knife-like, burning, stabbing, and achy pain. Walking, sitting, standing, and bending exacerbated pain. Alleviating factors included using topical capsaicin. The patient tried multiple medications without relief. Poor sleep parameters were noted. Strength was 2/5 on the left and 3/5 in the right lower extremity. Upper-extremity strength was normal. Assessment/Results: The patient was diagnosed with coccydynia. Fluoroscopically guided ganglion impar blocks were performed on February 4 and Feburary 8, 2002; the blocks resulted in 50% to 60% pain relief. A caudal epidural steroid injection, performed on March 4, 2002, under fluoroscopy, did not provide any relief. Pulsed radiofrequency denervation of the ganglion impar was performed under fluoroscopy on June 20, 2002, with good pain control noted. Discussion: Ganglion impar, also known as the ganglion of Walther, supplies some innervation for the pelvic and perineal regions, and it was initially blocked by Plancarte in 1990. To our knowledge, its effectiveness for coccydynia has not been published. We present 1 patient who experienced dramatic improvement in his coccygeal pain after blocking the ganglion impar under fluoroscopy. Successful pain control aids rehabilitation. The ganglion impar is the most caudal of the sympathetic prevertebral ganglion and supplies sympathetic fibers to the perineum. It is located anterior to the sacroccygeal junction. Blocking the ganglion impar has demonstrated considerable relief of intractable perineal and pelvic pain. Due to its location, bowel and bladder dysfunction are potential risks. Penetration of the rectum is a potential complication. Conclusions: Fluoroscopically guided ganglion impar block may offer a safe and effective way of improving coccygeal pain. Key Words: Fluoroscopy; Pain; Rehabilitation.
Objective: To test for an effect of a novel, simple device used outside the body and employing special materials to recover infrared (IR) heat lost through clothes, warming the lumbar area constantly and continuously. Design: 2 randomized double-blind placebo-controlled pilot trials; one was a crossover with a washout period (trial 1) and the other, a parallel group trial (trial 2). Setting: Outpatient pain clinic of 2 separate university hospitals. Participants: Patients with chronic mechanical low back pain (age, 1– 40y). Trial 1: 30 patients; trial 2: 23 patients. Interventions: Lightweight soft belt device with special materials that reflect infrared heat lost through clothes, warming the low back constantly and continuously, to higher temperatures than those achieved with other materials. The placebo was a look-alike device without IR reflective materials. Minimum device use was 8h/d in trial 1; for trial 2, use was the same plus overnight use. The follow-up period was 1 month in trial 1 and 1 to 3 months in trial 2. Main Outcome Measures: Pain 100-mm visual analog scale (VAS), disability index (trial 1: Roland-Morris Disability Questionnaire [RMDQ], trial 2: Oswestry Disability Index [ODI]). Results: Both trials showed encouraging responses versus placebo. The crossover trial showed a VAS rating reduction for chronic pain of “limited” duration (⬍5y) without history of surgery (10 –14mm VAS, 21%–29%; P⬍.05). The RMDQ response was small but followed that of the VAS. The parallel group trial, for chronic pain patients who had not had surgery, with reasonably matched groups, showed a marked reduction in both VAS rating (40%) and ODI score (25%), but the sample size was too small for statistical analysis. Conclusion: The simple IR reflective technique, which provided constant and continuous low-level heat to the low back, appears to be promising for chronic back pain treatment and warrants further investigations. Key Words: Back pain; Heat; Randomized controlled trial; Rehabilitation. Poster 111 Treatment of Chronic Pain in a 17-Year-Old With Klippel-Trenaunay-Weber Syndrome: A Case Report. Sarah L. Schuler, MD (JFK Johnson Rehabilitation Institute/JFK Medical Center, Edison, NJ); Iqbal Jafri, MD; Sara Cuccurrullo, MD; Thomas Strax, MD, e-mail: [email protected]. Disclosure: None. Setting: Outpatient pain management program. Patient: A 17-year-old girl with history of Klippel-Trenaunay-Weber syndrome (KTWS). Case Description: The patient was diagnosed at birth with KTWS, which affected her right leg and resulted in a propensity for bleeding due to cutaneous capillary malformations and severe edema due to deeper venous malformations. At age 3, she underwent amputation of 2 toes and a skin graft in an attempt to arrest bleeding. At presentation, she described constant burning pain of intensity 8 on a 0 to 10 pain scale and allodynia of the lateral ankle and medial thigh, which interfered with sleep, concentration, and gait. A 5% lidocaine transdermal patch to the ankle was added to her existing regimen of 300mg of gabapentin 3 times daily, 200mg of celecoxib every day, and weekly aquatic therapy. Because her pain remained unchanged at the 6-week follow-up, 2 lidocaine patches were placed on her ankle, gabapentin was increased to 300mg 4 times daily, and therapy was increased to twice a week. At 12 weeks, the pain intensity was still rated at 8, and the only change made to the regimen was the addition of a 50g/h fentanyl transdermal patch. Fentanyl was not tolerated and was stopped by the patient at week 13. Assessment/Results: At 18-week follow-up, her pain had decreased to an intensity of 4 and her functional status and sleep were significantly improved. Discussion: A literature search has revealed no other examples of pain or treatment of pain caused by KTWS. From our experience with this case, gabapentin and lidocaine patch can decrease pain and, consequently, in conjunction with aquatic therapy, can increase the patient’s functional status. Conclusion: The sequence of medication choices and dosages in addition to the exercise modality provided effective treatment in this case of KTWS. Key Words: Klippel-Trenaunay-Weber syndrome; Pain; Rehabilitation.
Poster 109 Phantom Rectum Pain: An Intractable Pain Syndrome: A Case Report. Leonard B. Kamen, DO (MossRehab Hospital, Philadelphia, PA), e-mail: [email protected]. Disclosure: Kamen, Jannsen Pharmaceuticals Speakers bureau, Research grant from Allergan. Setting: Outpatient physical medicine clinic. Patient: A 74-year-old woman with ulcerative colitis. Case Description: The patient underwent a total colectomy with an ileostomy 6 years before presentation. 4 years later, after initiating a stationary bicycle exercise program, she developed intractable pain in the sacrococcygeal, perianal surgical area. Imaging studies of the rectal area failed to identify an anatomic derangement or source of pain. Failed trials of multiple analgesic medications included nonsteroidals, antidepressants (3), muscle relaxants (3), opioids (5), and antiepileptic drugs (4). Anesthetic interventions, including perianal lidocaine with steroid injections, lumbar epidural steroid injections, and phenol to the sacral nerves, provided no relief. Intrathecal morphine pump and implanted spinal stimulation trials failed to provide any benefit and were discontinued. Assessment/Results: Intractable sacrococcygeal perianal pain in the absence of a rectum with no response to intense medical and peripheral treatment supported a central or phantom pain syndrome mandating a different conceptual pain rehabilitation approach. Discussion: On referral to our rehabilitation clinic, coordinated physical and psychologic therapy combined with use of high-dose opioids (300g of transdermal fentanyl; 80mg of methadone), adjunctive medications, and botulinum toxin type A injections to pubococcygeus and pelvic floor muscle pain generators offered a modicum of pain relief. Conclusions: Phantom pain presenting in unusual nonlimb areas has been reported in descriptions of anatomic loss. Phantom rectum pain syndrome was defined by the location, character of pain, and nonresponse to peripheral treatment. Conceptual categorization of intractable nonlimb pain as phantom pain allows for an enhanced biopsychosocial approach to pain resource utilization. Key Words: Pain, intractable; Rectum; Rehabilitation.
Poster 112 The Influence of a Combination of Infrared Light With Transcutaneous Electric Nerve Stimulation in Patients With Cervical Symptoms of Ankylosing Spondylitis. Gordana Devecerski, MD, PhD (School of Medicine, Novi Sad, Yugoslavia); Djordje Letic, MD; Mirko Teofilovski, MD, PhD; Gordana Teofilovski-Parapid, MD, PhD; Biljana Parapid, MD, e-mail: [email protected]. Disclosure: None. Objective: To study the advantages of a home treatment combination of infrared (IR) light with transcutaneous electric nerve stimulation (TENS) over the classic approach of nonsteriodal antiinflammatory drugs (NSAIDs) in treating ankylosing spondylitis (AS). Design: Prospective randomized follow-up study. Setting: Academic medical center. Participants: Patients were randomized into 2 groups (20 each). All were men, ages 30 to 40 years old, with cervical symptoms of AS. Interventions: Range of motion of the cervical spine and presence of pain in the neck were evaluated in each group. Patients in both groups underwent kinesitherapy during 2 weeks. Also, group 1 took NSAIDs (7.5mg of meloxicam twice a day), while group 2 had TENS (30min) applied with IR lamp 300W (20min) over the cervical region every morning. Main Outcome Measures: Pain decrease and movement increase. Results: After 2 weeks, in group 1, 60% of the patients experienced a reduction in pain, while 25% experienced an increased amplitude of neck movements. In group 2, 40% experienced a reduction in pain and 75% had a significant increase in neck movements. Conclusions: Application of TENS with an IR lamp is useful and practical in home treatment of patients with cervical symptoms of AS. Also, we must not forget kinesitherapy and NSAIDs, which are a necessary part of treatment. Key Words: Infrared rays; Rehabilitation; Spondylitis, ankylosing; Transcutaneous electric nerve stimulation.
Poster 110 Infrared Reflective Thermal Device for Chronic Low Back Pain: Results From 2 Pilot Randomized Controlled Trials. Satham Petty-Saphon, PhD (Spine-issimus Ltd, Saffron Walden, UK); Rajesh R. Munglani, MD; Tim P. Nash, MD, e-mail: spettysaphon@spine-issimus. com. Disclosure: Petty-Saphon, Spine-Issimus employee; Munglani, Research grant from Spine-Issimus; Nash, None.
Poster 113 Sensory-Gating Deficits in Patients With Chronic Low Back Pain: A P50 Midlatency Auditory Evoked Potential Study. Alice V. Fann, MD (Central Arkansas Veterans Healthcare System; UAMS, North Little Rock, AR); Michael A. Preston, BS; Robert D. Skinner, PhD; Edgar Garcia-Rill, PhD, e-mail: [email protected]. Disclosure: Fann, Research grant from the Veterans Affairs Rehabilitation Research and Development; Other authors: None.
Arch Phys Med Rehabil Vol 84, September 2003