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Poster 141 Assessing Self-Efficacy of Muscle Spasms Control and Its Impact on Intensity of Pain-Tension- Spasm-Pain Cycle within an Interdisciplinary Pain Management Program
S138
Abstracts / PM R 7 (2015) S83-S222
recommend a program of CNT prior to considering surgery for patients with SS.
Poster 141 Assessing Self-Efficacy of Muscle Spasms Control and Its Impact on Intensity of Pain-Tension- Spasm-Pain Cycle within an Interdisciplinary Pain Management Program Felix Laevsky, MS, Christine M. Gagnon, PhD, James W. Atchison, DO (Rehabilitation Institute of Chicago, Chicago, IL, United States) Disclosures: J. W. Atchison: Research Grants - Paraxel/Pfizer, INC/ Grunenthal. Objective: Patients with chronic pain participating in our interdisciplinary treatment program frequently report experiencing muscle spasms. Most of these patients are unaware that muscle spasms are a part of the vicious cycle of pain and muscle tension and lack the skills for controlling spasms. We seek to assess how relaxation and biofeedback training may help patients to reduce muscle spasm, improve their confidence to control them, and to determine whether this reduction in muscle spasm leads to a reduction in intensity of vicious cycle components. Design: Retrospective Setting: Urban academic pain management clinic. Participants: 102 chronic pain patients. Interventions: Biofeedback and relaxation training. Main Outcome Measures: Measures included; 1) a modified version of the Chronic Pain Self-Efficacy Scale (CPSS) with an additional question about the patient’s certainty to control spasms; 2) the patients reports on changes in muscle spasms; and 3) numeric rating scales (0 “no pain or tension” to 10 “worst imaginable”) to assess pain and tension preand post-treatment. Results or Clinical Course: The majority of patients (68%) reported that their spasms improved at the end of treatment (19% same and 4% worse; 10% not assessed). Patients indicated improved control over their spasms and pain, a reduction in severe pain, and reduced levels of average pain and muscle tension, (all P’s < .01). Moreover, the improvements were similar regardless of antispasmodic medication usage (all P’s > .79). Improved confidence to manage muscle spasms was significantly associated with reductions in average pain and tension and increased efficacy to control pain (all P’s < .05, r’s 0.21 e 0.34). Conclusion: Examination of patient reports and data shows that patients receiving training in relaxation and biofeedback as part of an interdisciplinary pain program demonstrated improved muscle spasms symptoms and increased confidence in their ability to control them. Overall it appears that improved control of muscle spasms helped to narrow pain-tension- spasm-pain cycle.
Poster 142 Regenerative Medicine to Treat an Unresponsive Painful Shoulder of Multiple Etiologies: A Case Report Ali Mirdamadi, MD (Medstar Georgetown University Hospital/National Rehabilitation Hospital, Washington, DC, United States) Disclosures: A. Mirdamadi: I Have No Relevant Financial Relationships To Disclose. Case Description: A 52-year-old woman presented with complaints of right arm pain with paresthesias radiating down to her right elbow following increased training at the gym. Her imaging showed OA at the AC joint as well as partial thickness tear of the supraspinatus tendon. Patient had failed conservative treatments with therapy and medication. Now presenting with increased intensity of paresthesias in her right arm radiating into her hand. Patient had previous cervical fusion; follow-up imaging was unremarkable. She also had no relief from cervical epidural steroid injections. Patient failed conservative measures with therapy and anti-inflammatories.
Given her continued neuropathic pain complaints, she was started on a tricyclic antidepressant pain medication. EMG/NCS revealed an upper trunk plexopathy. Given the chronicity of injury (> 1year) patient was advised to stop NSAIDs and undergo treatment with regenerative medicine. Setting: Outpatient physiatry clinic. Results or Clinical Course: Patient responded well to initial prolotherapy of the right supraspinatus tendon under ultrasound guidance with continued relief, eventually electing to undergo injection of platelet-rich plasma (PRP) into the tendon for more definitive relief. Patient was noted afterwards to have relief of pain and improvement in function. Discussion: The use of regenerative medicine, more specifically, prolotherapy and platelet-rich plasma (PRP) under ultrasound guidance, can be used to treat shoulder pain as a result of a supraspinatus partial tear due to osteophytes at acromioclavicular joint as well as upper trunk brachial plexopathy of unknown origin unresponsive to a more conservative approach. Conclusion: Regenerative medicine in conjunction with a wellrounded approach involving physical therapy, appropriate neuropathic/anti-inflammatory pain medications, and structured return to activity can be effective when used together in treating difficult shoulder pain of multiple etiologies. Poster 143 Genicular Neurotomy as an Alternative Option for Chronic Knee Pain after Total Knee Arthroplasty: A Case Report Ali Mirdamadi, MD (Medstar Georgetown University Hospital/National Rehabilitation Hospital, Washington, DC, United States), Christopher S. Karam Disclosures: A. Mirdamadi: I Have No Relevant Financial Relationships To Disclose. Case Description: A 56-year-old man presented with complaints of chronic right knee pain 2 years post right knee replacement.The procedure was followed by two subsequent staph infections along with persistent knee pain. Patient failed conservative treatment with focused therapy, oral pain medications, and steroid injection. He was then referred to an interventional pain management physician to explore an alternative treatment plan. Setting: Outpatient Interventional Spine and Pain management clinic. Results or Clinical Course: After failing conservative management, other pain generators were explored, and a genicular nerve block was discussed in detail with the patient. After agreeing with the plan, an initial diagnostic genicular nerve block was performed under direct fluoroscopic guidance. Patient was followed up 10 days after the initial diagnostic block and his pain improved by more than 50% as per his pain diary. After the successful diagnostic block, a genicular nerve radiofrequency ablation was performed under fluoroscopic guidance. Patient was followed up 10 days after the ablation and he reported 80-100% pain relief and improvement in function. Discussion: Despite the general efficacy of knee replacements, there are those with pain that persists after surgery. Traditionally in these unfortunate cases, patients have few options if any that does not involve additional surgery, which is rarely successful. Radiofrequency ablation of the genicular nerves with a wellrounded approach involving physical therapy, appropriate pain medications, and structured return to activity are effective when used together, thus alleviating pain to the knee and restoring function. Conclusion: It is important to note that while surgery is considered to be the accepted treatment option for patients with advanced joint disease, many individuals have comorbidities that may prevent them from being an appropriate surgical candidate. Others may simply want to avoid surgery due to personal reasons such as being unable to take off the necessary time from work for the procedure
Abstracts / PM R 7 (2015) S83-S222
recommend a program of CNT prior to considering surgery for patients with SS.
Poster 141 Assessing Self-Efficacy of Muscle Spasms Control and Its Impact on Intensity of Pain-Tension- Spasm-Pain Cycle within an Interdisciplinary Pain Management Program Felix Laevsky, MS, Christine M. Gagnon, PhD, James W. Atchison, DO (Rehabilitation Institute of Chicago, Chicago, IL, United States) Disclosures: J. W. Atchison: Research Grants - Paraxel/Pfizer, INC/ Grunenthal. Objective: Patients with chronic pain participating in our interdisciplinary treatment program frequently report experiencing muscle spasms. Most of these patients are unaware that muscle spasms are a part of the vicious cycle of pain and muscle tension and lack the skills for controlling spasms. We seek to assess how relaxation and biofeedback training may help patients to reduce muscle spasm, improve their confidence to control them, and to determine whether this reduction in muscle spasm leads to a reduction in intensity of vicious cycle components. Design: Retrospective Setting: Urban academic pain management clinic. Participants: 102 chronic pain patients. Interventions: Biofeedback and relaxation training. Main Outcome Measures: Measures included; 1) a modified version of the Chronic Pain Self-Efficacy Scale (CPSS) with an additional question about the patient’s certainty to control spasms; 2) the patients reports on changes in muscle spasms; and 3) numeric rating scales (0 “no pain or tension” to 10 “worst imaginable”) to assess pain and tension preand post-treatment. Results or Clinical Course: The majority of patients (68%) reported that their spasms improved at the end of treatment (19% same and 4% worse; 10% not assessed). Patients indicated improved control over their spasms and pain, a reduction in severe pain, and reduced levels of average pain and muscle tension, (all P’s < .01). Moreover, the improvements were similar regardless of antispasmodic medication usage (all P’s > .79). Improved confidence to manage muscle spasms was significantly associated with reductions in average pain and tension and increased efficacy to control pain (all P’s < .05, r’s 0.21 e 0.34). Conclusion: Examination of patient reports and data shows that patients receiving training in relaxation and biofeedback as part of an interdisciplinary pain program demonstrated improved muscle spasms symptoms and increased confidence in their ability to control them. Overall it appears that improved control of muscle spasms helped to narrow pain-tension- spasm-pain cycle.
Poster 142 Regenerative Medicine to Treat an Unresponsive Painful Shoulder of Multiple Etiologies: A Case Report Ali Mirdamadi, MD (Medstar Georgetown University Hospital/National Rehabilitation Hospital, Washington, DC, United States) Disclosures: A. Mirdamadi: I Have No Relevant Financial Relationships To Disclose. Case Description: A 52-year-old woman presented with complaints of right arm pain with paresthesias radiating down to her right elbow following increased training at the gym. Her imaging showed OA at the AC joint as well as partial thickness tear of the supraspinatus tendon. Patient had failed conservative treatments with therapy and medication. Now presenting with increased intensity of paresthesias in her right arm radiating into her hand. Patient had previous cervical fusion; follow-up imaging was unremarkable. She also had no relief from cervical epidural steroid injections. Patient failed conservative measures with therapy and anti-inflammatories.
Given her continued neuropathic pain complaints, she was started on a tricyclic antidepressant pain medication. EMG/NCS revealed an upper trunk plexopathy. Given the chronicity of injury (> 1year) patient was advised to stop NSAIDs and undergo treatment with regenerative medicine. Setting: Outpatient physiatry clinic. Results or Clinical Course: Patient responded well to initial prolotherapy of the right supraspinatus tendon under ultrasound guidance with continued relief, eventually electing to undergo injection of platelet-rich plasma (PRP) into the tendon for more definitive relief. Patient was noted afterwards to have relief of pain and improvement in function. Discussion: The use of regenerative medicine, more specifically, prolotherapy and platelet-rich plasma (PRP) under ultrasound guidance, can be used to treat shoulder pain as a result of a supraspinatus partial tear due to osteophytes at acromioclavicular joint as well as upper trunk brachial plexopathy of unknown origin unresponsive to a more conservative approach. Conclusion: Regenerative medicine in conjunction with a wellrounded approach involving physical therapy, appropriate neuropathic/anti-inflammatory pain medications, and structured return to activity can be effective when used together in treating difficult shoulder pain of multiple etiologies. Poster 143 Genicular Neurotomy as an Alternative Option for Chronic Knee Pain after Total Knee Arthroplasty: A Case Report Ali Mirdamadi, MD (Medstar Georgetown University Hospital/National Rehabilitation Hospital, Washington, DC, United States), Christopher S. Karam Disclosures: A. Mirdamadi: I Have No Relevant Financial Relationships To Disclose. Case Description: A 56-year-old man presented with complaints of chronic right knee pain 2 years post right knee replacement.The procedure was followed by two subsequent staph infections along with persistent knee pain. Patient failed conservative treatment with focused therapy, oral pain medications, and steroid injection. He was then referred to an interventional pain management physician to explore an alternative treatment plan. Setting: Outpatient Interventional Spine and Pain management clinic. Results or Clinical Course: After failing conservative management, other pain generators were explored, and a genicular nerve block was discussed in detail with the patient. After agreeing with the plan, an initial diagnostic genicular nerve block was performed under direct fluoroscopic guidance. Patient was followed up 10 days after the initial diagnostic block and his pain improved by more than 50% as per his pain diary. After the successful diagnostic block, a genicular nerve radiofrequency ablation was performed under fluoroscopic guidance. Patient was followed up 10 days after the ablation and he reported 80-100% pain relief and improvement in function. Discussion: Despite the general efficacy of knee replacements, there are those with pain that persists after surgery. Traditionally in these unfortunate cases, patients have few options if any that does not involve additional surgery, which is rarely successful. Radiofrequency ablation of the genicular nerves with a wellrounded approach involving physical therapy, appropriate pain medications, and structured return to activity are effective when used together, thus alleviating pain to the knee and restoring function. Conclusion: It is important to note that while surgery is considered to be the accepted treatment option for patients with advanced joint disease, many individuals have comorbidities that may prevent them from being an appropriate surgical candidate. Others may simply want to avoid surgery due to personal reasons such as being unable to take off the necessary time from work for the procedure