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Poster 116: Acupuncture for Veterans with Chronic Pain - A Quality Improvement Initiative
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Abstracts / PM R 9 (2017) S131-S290
inflammation; therefore been consider as a potential biomarker for the process of osteoarthritis. Results: Recent studies demonstrated the role of VIP as a potent antiinflammatory and immune-modulator and a potential candidate for treatment of inflammatory, autoimmune diseases and chronic inflammation. Additional studies suggest a possible link between the neuro-endocrine-immune response with the role of VIP downregulated in synovial fluid increasing the production of proinflammatory cytokines that might contribute to the pathogenesis of chronic inflammatory conditions. Conclusions: The specific role of VIP in the arthrogenic inflammatory process related to osteoarthritis has been possibly associated to a protective role in progression of joint degradation, in synovial fluid and articular cartilage under joint degradation, and its down regulation might contribute to the pathogenesis arthrogenic inflammation; therefore been consider as a potential biomarker for the process of osteoarthritis. Level of Evidence: Level IV
Poster 116: Acupuncture for Veterans with Chronic Pain - A Quality Improvement Initiative Vishal Kamani, MD (Loyola University Medical Center, Maywood, IL, United States), Peter Lapen, DO, Yvonne Lucero, MD, Vijaya Patil, MD, Deborah Kim, MD, Sung Ahn, DO, Sami Chaudhuri, MD Disclosures: Vishal Kamani, MD: I Have No Relevant Financial Relationships To Disclose Objective: The impact of acupuncture treatments for a Veteran population with chronic pain was examined. Although there have previously been numerous acupuncture studies performed; using these studies to guide the provision of acupuncture in clinical practice at the VA has been difficult due to heterogeneity in patient populations, practitioner training, and acupuncture point protocols. Therefore, currently there is limited precedent to guide the provision of acupuncture into traditional medical centers. In this QI study, demographic and treatment outcomes data were obtained for the first 50 patients treated by one physiatrist trained in medical acupuncture. These data were evaluated for trends to guide future acupuncture provision in our local VA. Design: Retrospective, Observational Study. Setting: Outpatient VA PM&R Clinic. Participants: 50 Patients. Interventions: Acupuncture Treatments. Main Outcome Measures: Pain scales, pain locations(s), patient demographics, pain medications, prior treatments. Results: 24 patients were using opiate medications at the time of initial consultation. 19 had previous surgery for musculoskeletal pain. Verbal numeric rating scale from 0-10 was used to measure pain prior to and after acupuncture treatments. Each patient had an average of 5 treatment sessions, with a range from 1 to 15 treatments. 234 total acupuncture treatments were performed, and pain scores from 152 of those treatments were available for analysis. On average for all treatments, there was a 61%, 3.47point reduction in pain (p-value<.05) per treatment session. Specifically, for back pain, 126 treatments were performed and 84 were available for analysis. On average for back pain, there was a 61%, 3.39-point reduction in pain (p-value<.05) per treatment session. Conclusions: Acupuncture performed by a physiatrist was clinically beneficial for pain management in Veterans with chronic pain. Observations regarding strategies for provision of acupuncture, goals of treatment, and managing patient expectations resulted from our work. Future studies can be designed to evaluate optimal treatment courses for durability of effect. Level of Evidence: Level IV
Poster 117: Pain Assessment Survey (PAS) for Assessing Physical Pain in Post-Cerebrovascular Accident (CVA) Patients Post Intervention: Quality Improvement Project Kirill Alekseyev, MD, EMBA (Kingsbrook Jewish Med Cntr, Brooklyn, NY, United States), Nikhil Verma, Swathy Sreekumar, MD, Amarin Suriyakhamhaengwongse, MD, Malcolm Lakdawala, MD, Marc K. Ross, MD Disclosures: Kirill Alekseyev: I Have No Relevant Financial Relationships To Disclose Objective: Surveying post-stroke patients via a pain assessment survey (PAS) for physical pain after experiencing a CVA. Design: Retrospective and Prospective Study. Setting: Acute IRF. Participants: CVA IRF patients. Interventions: A PAS was designed and applied to survey patients with ischemic and/or hemorrhagic strokes admitted to the IRF. Main Outcome Measures: Post-Admission Pain Assessment Survey using Pain Ad Scale. Results: The project spanned over 13 months, during which six months were for retrospective analysis, one-month transition period for PAS implementation, and six months for prospective analysis. The retrospective study included 82 post-CVA IRF patients, of which 71 patients had ischemic strokes and 11 patients had hemorrhagic strokes. In the retrospective period 26% of our patients reported pain, of which shoulder pain was the most prevalent at 43%. The prospective study included 102 post-CVA IRF patients, of which 85 patients had ischemic strokes and 17 patients had hemorrhagic strokes. Pain was reported by 12% of the patients. Pain was most prevalent in patients with ischemic stroke (83%). It was determined that two patients had facial pain (17%), three patients had upper limb pain (25%), seven patients had shoulder pain (58%), and two patients had lower limb pain (17%). Averages of pain were ranked on a scale between 0-10, with zero being no pain and ten being unbearable pain. Pre-intervention pain average was 8.2 out of 10. 67% of the patients with pain had improvement of at least 2 points by Day 1 of intervention and 75% of the patients had complete pain resolution by Day 5 of intervention. Conclusions: Pain management has been involved in the care of pain patients since discovering that 26% of our patient population exhibited pain in the retrospective period and 12% of our patients exhibited pain in the prospective period. Shoulder pain had the highest prevalence in both retrospective and prospective period, 43% and 58% respectively. Level of Evidence: Level II Poster 118: Prevalence, Complications, and Pain Management of Diskitis in an Acute IRF Setting Kirill Alekseyev, MD, EMBA (Kingsbrook Jewish Med Cntr, Brooklyn, NY, United States), Samuel P. Thampi, MD, Malcolm Lakdawala, MD Disclosures: Kirill Alekseyev: I Have No Relevant Financial Relationships To Disclose Objective: Evaluate acute rehab patients with diskitis and complications including FIM score analysis and pain management. To analyze complications with diskitis and involvement of neurosurgical team with cases that cannot be managed medically. Design: Retrospective cohort chart review of 100 patients between 2001-2016. Setting: Acute IRF. Participants: Inpatient rehab diskitis cases. Interventions: FIM scores. Main Outcome Measures: Chart Review and Radiological Imaging. Results: A total of 100 diskitis cases referred to our acute rehab unit between 2001 and 2016 with an emphasis on treatment and complications during stay. Of the 100 patients that were included in the
Abstracts / PM R 9 (2017) S131-S290
inflammation; therefore been consider as a potential biomarker for the process of osteoarthritis. Results: Recent studies demonstrated the role of VIP as a potent antiinflammatory and immune-modulator and a potential candidate for treatment of inflammatory, autoimmune diseases and chronic inflammation. Additional studies suggest a possible link between the neuro-endocrine-immune response with the role of VIP downregulated in synovial fluid increasing the production of proinflammatory cytokines that might contribute to the pathogenesis of chronic inflammatory conditions. Conclusions: The specific role of VIP in the arthrogenic inflammatory process related to osteoarthritis has been possibly associated to a protective role in progression of joint degradation, in synovial fluid and articular cartilage under joint degradation, and its down regulation might contribute to the pathogenesis arthrogenic inflammation; therefore been consider as a potential biomarker for the process of osteoarthritis. Level of Evidence: Level IV
Poster 116: Acupuncture for Veterans with Chronic Pain - A Quality Improvement Initiative Vishal Kamani, MD (Loyola University Medical Center, Maywood, IL, United States), Peter Lapen, DO, Yvonne Lucero, MD, Vijaya Patil, MD, Deborah Kim, MD, Sung Ahn, DO, Sami Chaudhuri, MD Disclosures: Vishal Kamani, MD: I Have No Relevant Financial Relationships To Disclose Objective: The impact of acupuncture treatments for a Veteran population with chronic pain was examined. Although there have previously been numerous acupuncture studies performed; using these studies to guide the provision of acupuncture in clinical practice at the VA has been difficult due to heterogeneity in patient populations, practitioner training, and acupuncture point protocols. Therefore, currently there is limited precedent to guide the provision of acupuncture into traditional medical centers. In this QI study, demographic and treatment outcomes data were obtained for the first 50 patients treated by one physiatrist trained in medical acupuncture. These data were evaluated for trends to guide future acupuncture provision in our local VA. Design: Retrospective, Observational Study. Setting: Outpatient VA PM&R Clinic. Participants: 50 Patients. Interventions: Acupuncture Treatments. Main Outcome Measures: Pain scales, pain locations(s), patient demographics, pain medications, prior treatments. Results: 24 patients were using opiate medications at the time of initial consultation. 19 had previous surgery for musculoskeletal pain. Verbal numeric rating scale from 0-10 was used to measure pain prior to and after acupuncture treatments. Each patient had an average of 5 treatment sessions, with a range from 1 to 15 treatments. 234 total acupuncture treatments were performed, and pain scores from 152 of those treatments were available for analysis. On average for all treatments, there was a 61%, 3.47point reduction in pain (p-value<.05) per treatment session. Specifically, for back pain, 126 treatments were performed and 84 were available for analysis. On average for back pain, there was a 61%, 3.39-point reduction in pain (p-value<.05) per treatment session. Conclusions: Acupuncture performed by a physiatrist was clinically beneficial for pain management in Veterans with chronic pain. Observations regarding strategies for provision of acupuncture, goals of treatment, and managing patient expectations resulted from our work. Future studies can be designed to evaluate optimal treatment courses for durability of effect. Level of Evidence: Level IV
Poster 117: Pain Assessment Survey (PAS) for Assessing Physical Pain in Post-Cerebrovascular Accident (CVA) Patients Post Intervention: Quality Improvement Project Kirill Alekseyev, MD, EMBA (Kingsbrook Jewish Med Cntr, Brooklyn, NY, United States), Nikhil Verma, Swathy Sreekumar, MD, Amarin Suriyakhamhaengwongse, MD, Malcolm Lakdawala, MD, Marc K. Ross, MD Disclosures: Kirill Alekseyev: I Have No Relevant Financial Relationships To Disclose Objective: Surveying post-stroke patients via a pain assessment survey (PAS) for physical pain after experiencing a CVA. Design: Retrospective and Prospective Study. Setting: Acute IRF. Participants: CVA IRF patients. Interventions: A PAS was designed and applied to survey patients with ischemic and/or hemorrhagic strokes admitted to the IRF. Main Outcome Measures: Post-Admission Pain Assessment Survey using Pain Ad Scale. Results: The project spanned over 13 months, during which six months were for retrospective analysis, one-month transition period for PAS implementation, and six months for prospective analysis. The retrospective study included 82 post-CVA IRF patients, of which 71 patients had ischemic strokes and 11 patients had hemorrhagic strokes. In the retrospective period 26% of our patients reported pain, of which shoulder pain was the most prevalent at 43%. The prospective study included 102 post-CVA IRF patients, of which 85 patients had ischemic strokes and 17 patients had hemorrhagic strokes. Pain was reported by 12% of the patients. Pain was most prevalent in patients with ischemic stroke (83%). It was determined that two patients had facial pain (17%), three patients had upper limb pain (25%), seven patients had shoulder pain (58%), and two patients had lower limb pain (17%). Averages of pain were ranked on a scale between 0-10, with zero being no pain and ten being unbearable pain. Pre-intervention pain average was 8.2 out of 10. 67% of the patients with pain had improvement of at least 2 points by Day 1 of intervention and 75% of the patients had complete pain resolution by Day 5 of intervention. Conclusions: Pain management has been involved in the care of pain patients since discovering that 26% of our patient population exhibited pain in the retrospective period and 12% of our patients exhibited pain in the prospective period. Shoulder pain had the highest prevalence in both retrospective and prospective period, 43% and 58% respectively. Level of Evidence: Level II Poster 118: Prevalence, Complications, and Pain Management of Diskitis in an Acute IRF Setting Kirill Alekseyev, MD, EMBA (Kingsbrook Jewish Med Cntr, Brooklyn, NY, United States), Samuel P. Thampi, MD, Malcolm Lakdawala, MD Disclosures: Kirill Alekseyev: I Have No Relevant Financial Relationships To Disclose Objective: Evaluate acute rehab patients with diskitis and complications including FIM score analysis and pain management. To analyze complications with diskitis and involvement of neurosurgical team with cases that cannot be managed medically. Design: Retrospective cohort chart review of 100 patients between 2001-2016. Setting: Acute IRF. Participants: Inpatient rehab diskitis cases. Interventions: FIM scores. Main Outcome Measures: Chart Review and Radiological Imaging. Results: A total of 100 diskitis cases referred to our acute rehab unit between 2001 and 2016 with an emphasis on treatment and complications during stay. Of the 100 patients that were included in the