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Poster 154 Clinical Characteristics Associated with Cognitive Dysfunction in Fibromyalgia
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Abstracts / PM R 7 (2015) S83-S222
and, PI with STS (r¼.312; P¼.022), LR (r¼-.323; P¼.18), and FWF (r¼.267; P¼.51). Conclusion: Individuals with CSP tend to have a severe increase in participation restrictions, specifically severely poor PF, severe decrease in SSR, and high PI. The PROMIS tool adequately describes the PR of individuals with chronic cervical spine pain and correlates with functional performance scores. It would be valuable as an alternative to PBA in a busy clinical practice. Future research is needed to determine if there is an inter-relationship between body function, activity limitation, and participation restrictions in these individuals.
Poster 153 Physician Perspective of the Diagnostic Criteria of Myofascial Pain Syndrome Dinesh Kumbhare, MD, MSc, FRCP(C), DABPMR (University of Toronto, Toronto, Canada), Liza Grosman-Rimon, PhD, Hance Clarke, MD, PhD, FRCP(C), Patricia Branco-Mills, MD, FRCP(C), Aaron Chan, MD Disclosures: D. Kumbhare: I Have No Relevant Financial Relationships To Disclose. Objective: To characterize practicing clinicians’ perspectives of the current diagnostic criteria for myofascial pain syndrome. Design: Cross-sectional study. Setting: Pain clinic, Emergency Department, PMR office, Family Practice. Participants: The sample population (n¼119) consisted of 40% family physicians, 31% physical medicine and rehabilitation (PMR) specialists, 11% rheumatologists, 10% emergency room (ER) physicians, and 8% anesthesiologists specializing in chronic pain. Interventions: Questionnaire was administered to assess physician perspective of diagnostic criteria of myofascial pain syndrome. Results or Clinical Course: Anesthesiologists had a higher median score (6; IQR, 5-6) in response to “restricted range of motion” compared with the other clinician groups: family physicians (4; IQR 45), PMR specialists (4; IQR 2.5-5), rheumatologists (4; IQR, 2-4), ER physicians (3.5; IQR 3-4), (c2¼20.15, P<.000). Compared with other clinician groups, anesthesiologists had a higher trend of median scores for “referred pain” (6; IQR, 5.5-7 vs. 5; IQR, 4-6) and “pain reproduction” (6; IQR, 5-6 vs. 5; IQR, 4-6 ) criteria, but it did not reach significant levels. The median scores of the groups of practicing clinicians were 3 (IQR, 3-4) for “poor sleep”, 4 (IQR, 3-5) for “daytime fatigue” and 3 (IQR, 2-4) for “cognitive symptoms”. There were no significant differences between the median responses of the groups of practicing clinicians to “poor sleep” “daytime fatigue” and “cognitive symptoms”. Conclusion: In general, there was poor agreement amongst the physicians with regards to the diagnostic criteria. Further studies should examine clinician’s knowledge and understanding of the diagnostic criteria for MPS. These studies should also focus on their ability to accurately diagnose the syndrome.
Poster 154 Clinical Characteristics Associated with Cognitive Dysfunction in Fibromyalgia Lauren Burtz (Mayo Clinic, Rochester, MN, United States), Li Jiang, MD, Terry H. Oh, MD, Arya Mohabbat, MD, Ann Vincent, MD, Zhen Wang, PhD, Wenchun Qu, MD, PhD Disclosures: L. Burtz: I Have No Relevant Financial Relationships To Disclose. Objective: To examine the association between cognitive dysfunction and socio-demographic and clinical characteristics in patients with fibromyalgia (FM). Design: Cross-sectional study.
Setting: Interdisciplinary fibromyalgia treatment program (FTP) at a tertiary care hospital. Participants: 668 subjects with FM who completed the FTP between May 2012 and November 2013. Interventions: Not applicable. Main Outcome Measures: Multiple Ability Self-report Questionnaire (MASQ) assessing cognitive function in 5 domains, tender point count (TPC), Widespread Pain Index (WPI), Bodily Pain Score (BPS), Physical Function Scale (PFS), Medical Outcomes Sleep Scale-II (MOS-II), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Multidimensional Fatigue Inventory (MFI-20). Results or Clinical Course: Age negatively correlated with MASQ scores in all cognitive domains except visual-perceptual ability. Education, sex, and TPC had no correlation with MASQ scores. All other outcome measures had statistically significant correlations with all 5 domains of MASQ. Worse cognitive functions were associated with higher WPI scores (more areas of pain), lower BPS scores (more severe/limiting pain), lower PFS scores (decreased physical functioning), higher MOS-II scores (more sleep problems), higher GAD-7 scores (greater anxiety), higher PHQ-9 scores (greater severity of depression), and higher MFI-20 scores (greater fatigue). Multiple regression modeling showed that mental fatigue (M-F) subset scores of the MFI-20 had the strongest correlation with MASQ scores in the 5 cognitive domains (language, visual-perceptual ability, verbal memory, visual-spatial memory, and attention-concentration) (R2 ¼ 0.38, 0.18, 0.33, 0.22, and 0.50 respectively; P<.0001) followed by PHQ-9 scores (R2 ¼ 0.19, 0.11, 0.15, 0.13, and 0.24 respectively; P<.0001). Conclusion: Cognitive dysfunction in individuals with FM is correlated with a variety of clinical characteristics, and cognitive dysfunction in specific domains shows different strengths of correlation with different clinical characteristics.
Poster 155 Back Pain in the Gut: A Case Report Leigh F. Hanke, MD (New York Presbyterian Hospital, University Hospital of Columbia and Cornell, New York, NY, United States), David J. Cormier, DO, George Christolias, MD Disclosures: L. F. Hanke: I Have No Relevant Financial Relationships To Disclose. Case Description: A 59-year-old man presented with chronic, severe and stabbing right flank and right lower quadrant (RLQ) abdominal. Pain was exacerbated with maneuvers that increased intra-abdominal pressure and alleviated with extension and walking. Physical examination was notable for mild pain with lumbar ROM, mild right costovertebral, and RLQ tenderness without rebound or guarding. Neurologic examinations was intact. Thoracic, lumbar, and pelvic musculoskeletal examination with provocative testing of these regions were unremarkable. MRI of the lumbar spine was notable for facet arthrosis and L5-S1 degenerative disc disease. Prior conservative treatment with medications and physical therapy had limited relief. Patient had seen multiple gastroenterologists, and had extensive workup including ultrasound, computed tomography of the abdomen and pelvis, and significant laboratory evaluation. Abdominal and pelvic etiologies could not be identified to explain his abdominal pain. Setting: Academic medical center. Results or Clinical Course: Thoracic spine MRI demonstrated evidence of a large right side foraminal T11-12 disc extrusion encroaching upon exiting T11 nerve root. Consideration was given to a right T11 neuritis with an atypical presentation as the source of his abdominal pain. A right T11 thoracic transforaminal epidural steroid injection (TTFESI) was pursued and resulted in a 90% pain reduction, complete functional restoration, and was diagnostic of the disc extrusion at this level as the source of pain.
Abstracts / PM R 7 (2015) S83-S222
and, PI with STS (r¼.312; P¼.022), LR (r¼-.323; P¼.18), and FWF (r¼.267; P¼.51). Conclusion: Individuals with CSP tend to have a severe increase in participation restrictions, specifically severely poor PF, severe decrease in SSR, and high PI. The PROMIS tool adequately describes the PR of individuals with chronic cervical spine pain and correlates with functional performance scores. It would be valuable as an alternative to PBA in a busy clinical practice. Future research is needed to determine if there is an inter-relationship between body function, activity limitation, and participation restrictions in these individuals.
Poster 153 Physician Perspective of the Diagnostic Criteria of Myofascial Pain Syndrome Dinesh Kumbhare, MD, MSc, FRCP(C), DABPMR (University of Toronto, Toronto, Canada), Liza Grosman-Rimon, PhD, Hance Clarke, MD, PhD, FRCP(C), Patricia Branco-Mills, MD, FRCP(C), Aaron Chan, MD Disclosures: D. Kumbhare: I Have No Relevant Financial Relationships To Disclose. Objective: To characterize practicing clinicians’ perspectives of the current diagnostic criteria for myofascial pain syndrome. Design: Cross-sectional study. Setting: Pain clinic, Emergency Department, PMR office, Family Practice. Participants: The sample population (n¼119) consisted of 40% family physicians, 31% physical medicine and rehabilitation (PMR) specialists, 11% rheumatologists, 10% emergency room (ER) physicians, and 8% anesthesiologists specializing in chronic pain. Interventions: Questionnaire was administered to assess physician perspective of diagnostic criteria of myofascial pain syndrome. Results or Clinical Course: Anesthesiologists had a higher median score (6; IQR, 5-6) in response to “restricted range of motion” compared with the other clinician groups: family physicians (4; IQR 45), PMR specialists (4; IQR 2.5-5), rheumatologists (4; IQR, 2-4), ER physicians (3.5; IQR 3-4), (c2¼20.15, P<.000). Compared with other clinician groups, anesthesiologists had a higher trend of median scores for “referred pain” (6; IQR, 5.5-7 vs. 5; IQR, 4-6) and “pain reproduction” (6; IQR, 5-6 vs. 5; IQR, 4-6 ) criteria, but it did not reach significant levels. The median scores of the groups of practicing clinicians were 3 (IQR, 3-4) for “poor sleep”, 4 (IQR, 3-5) for “daytime fatigue” and 3 (IQR, 2-4) for “cognitive symptoms”. There were no significant differences between the median responses of the groups of practicing clinicians to “poor sleep” “daytime fatigue” and “cognitive symptoms”. Conclusion: In general, there was poor agreement amongst the physicians with regards to the diagnostic criteria. Further studies should examine clinician’s knowledge and understanding of the diagnostic criteria for MPS. These studies should also focus on their ability to accurately diagnose the syndrome.
Poster 154 Clinical Characteristics Associated with Cognitive Dysfunction in Fibromyalgia Lauren Burtz (Mayo Clinic, Rochester, MN, United States), Li Jiang, MD, Terry H. Oh, MD, Arya Mohabbat, MD, Ann Vincent, MD, Zhen Wang, PhD, Wenchun Qu, MD, PhD Disclosures: L. Burtz: I Have No Relevant Financial Relationships To Disclose. Objective: To examine the association between cognitive dysfunction and socio-demographic and clinical characteristics in patients with fibromyalgia (FM). Design: Cross-sectional study.
Setting: Interdisciplinary fibromyalgia treatment program (FTP) at a tertiary care hospital. Participants: 668 subjects with FM who completed the FTP between May 2012 and November 2013. Interventions: Not applicable. Main Outcome Measures: Multiple Ability Self-report Questionnaire (MASQ) assessing cognitive function in 5 domains, tender point count (TPC), Widespread Pain Index (WPI), Bodily Pain Score (BPS), Physical Function Scale (PFS), Medical Outcomes Sleep Scale-II (MOS-II), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Multidimensional Fatigue Inventory (MFI-20). Results or Clinical Course: Age negatively correlated with MASQ scores in all cognitive domains except visual-perceptual ability. Education, sex, and TPC had no correlation with MASQ scores. All other outcome measures had statistically significant correlations with all 5 domains of MASQ. Worse cognitive functions were associated with higher WPI scores (more areas of pain), lower BPS scores (more severe/limiting pain), lower PFS scores (decreased physical functioning), higher MOS-II scores (more sleep problems), higher GAD-7 scores (greater anxiety), higher PHQ-9 scores (greater severity of depression), and higher MFI-20 scores (greater fatigue). Multiple regression modeling showed that mental fatigue (M-F) subset scores of the MFI-20 had the strongest correlation with MASQ scores in the 5 cognitive domains (language, visual-perceptual ability, verbal memory, visual-spatial memory, and attention-concentration) (R2 ¼ 0.38, 0.18, 0.33, 0.22, and 0.50 respectively; P<.0001) followed by PHQ-9 scores (R2 ¼ 0.19, 0.11, 0.15, 0.13, and 0.24 respectively; P<.0001). Conclusion: Cognitive dysfunction in individuals with FM is correlated with a variety of clinical characteristics, and cognitive dysfunction in specific domains shows different strengths of correlation with different clinical characteristics.
Poster 155 Back Pain in the Gut: A Case Report Leigh F. Hanke, MD (New York Presbyterian Hospital, University Hospital of Columbia and Cornell, New York, NY, United States), David J. Cormier, DO, George Christolias, MD Disclosures: L. F. Hanke: I Have No Relevant Financial Relationships To Disclose. Case Description: A 59-year-old man presented with chronic, severe and stabbing right flank and right lower quadrant (RLQ) abdominal. Pain was exacerbated with maneuvers that increased intra-abdominal pressure and alleviated with extension and walking. Physical examination was notable for mild pain with lumbar ROM, mild right costovertebral, and RLQ tenderness without rebound or guarding. Neurologic examinations was intact. Thoracic, lumbar, and pelvic musculoskeletal examination with provocative testing of these regions were unremarkable. MRI of the lumbar spine was notable for facet arthrosis and L5-S1 degenerative disc disease. Prior conservative treatment with medications and physical therapy had limited relief. Patient had seen multiple gastroenterologists, and had extensive workup including ultrasound, computed tomography of the abdomen and pelvis, and significant laboratory evaluation. Abdominal and pelvic etiologies could not be identified to explain his abdominal pain. Setting: Academic medical center. Results or Clinical Course: Thoracic spine MRI demonstrated evidence of a large right side foraminal T11-12 disc extrusion encroaching upon exiting T11 nerve root. Consideration was given to a right T11 neuritis with an atypical presentation as the source of his abdominal pain. A right T11 thoracic transforaminal epidural steroid injection (TTFESI) was pursued and resulted in a 90% pain reduction, complete functional restoration, and was diagnostic of the disc extrusion at this level as the source of pain.