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Poster 57 Subspecialization in physical medicine and rehabilitation: A survey of current trends 1993–1994
1052
ACADEMY ANNUAL ASSEMBLY ABSTRACTS
in the affected muscle. (4) Ligament sprains (sacroiliac joint, suprainter-spinous ligaments). (5) Bursitis, tendinitis, scars. (6) Sport injuries. In the acute stage, N&I allows early mobilization and speeds recovery. N&I is the most effective therapy in chronic stage. (7) Traumatic dystrophy with induration around injury or operations, fractures, sprains.
Poster 52 "Weight Alteration in Chronic Pain Patients." Raphael S. Orenstein, MD (Thomas Jefferson University Hospital, Philadelphia, PA); Mitchell K. Freedman, DO. Purpose of the study was to compare weight alteration of chronic pain patients with normals. We reviewed initial evaluations of 39 men and 38 women who presented to our chronic pain center. Their weight alteration was compared with 10-year weight alteration of subjects in the National Health and Nutrition Examination Surveys (NHANES). Men with chronic pain gained an average of 16 lbs in a 2.75-year interval from the onset of their pain. This compares with the maximum average weight gain in the NHANES male subjects of 14.04 lbs over 10 years. Women with chronic pain gained an average of 6.79 lbs in a 2.89-year interval from the onset of pain. This compares with the maximum average weight gain in the NHANES female subjects of 7.7 lbs over 10 years. A t test will compare the body mass index change of chronic pain patients to NHANES subjects. Other patterns of weight alteration that correlate with ethnicity, medications, depression, and substance abuse are presented. This is the first documentation that weight gain correlates with chronic pain. Morbidity of obesity, weight gain's role in perpetuation of chronic pain, and treatment options--including early intervention of weight control programs--are discussed.
Poster 53 "Transcutaneous Electrical Nerve Stimulation Treatment Outcome in Long-Term Users." David A. Fishbain, MD (University of Miami School of Medicine/University of Miami Pain Center, South Miami, FL); Charles Chabal, MD; Alice K. Abbott, MPH BSN, Lisa A. Wipperman-Heine, MSc; Robert B. Cutler, PhD. Previous reviews of Transcutaneous electrical nerve stimulation (TENS) outcome literature have concluded: (1) there are few long-term TENS follow-up studies, and (2) fewer studies have addressed the effect of long-term TENS use on other outcome variables besides pain (eg, function). From a random population of 2,003 chronic pain patients (CPPs) who acquired a TENS device for pain management, a randomly selected sample of 405 "long-term users" (TENS use > 6 months) were interviewed by telephone. Patients responded to a questionnaire designed to assess their perceptions regarding the effectiveness of TENS for a variety of treatment outcome variables. Paired t tests, correlated z-tests, SS Wilks and Chi-square tests demonstrated statistically significant change/ improvement (p < .05) attributed to TENS use in the following outcome variables: less pain interference with work, home, and social activities; increased activity and pain management; decreased use of other therapies (PT/OT, chiropractic); decreased use of narcotics, tranquilizers, muscle relaxants, NSAIDs, and steroids. Seventy-six percent of patients contacted as potential respondents reported using TENS in the prior 2 months. The results suggest TENS is associated with improvement on multiple outcome variables in addition to pain relief for CPPs who are long term users. Additionally, there is a group of CPPs who utilize TENS over a long time period.
Poster 54 "Mastigatory Myofascial Pain Syndrome: Longterm Follow-up." Marta Imamura, MD (Hospital das Clinicas/Sao Paulo University, Sat Paulo, Brazil); Silvia Adler, MD. Our objective was to evaluate the long-term follow-up of the therapeutic effects of a multidisciplinary approach to temporomandibular joint (TMJ) dysfunction. Forty patientes, 32 women and 8 men 18 to 40 years old (mean = 32) were referred from the maxilofacial surgery division with preauricular pain. They had failed to respond to previous conservative and orthodontic treatment. Mean duration of pain was 38.7 months. A daily program of therapeutic exercises were performed for 45 days, including stretching exercises, reeducation of mastigatory, cervical spine, and scapular thoracic girdle muscles for 10 repetitions, 3 times a day. Correction of predisposing factors, postural reeducation, and conscientization of habits that lead to masticator muscles overuse were indicated. No occlusion intervention and psychological approach was
Arch Phys Med Rehabil Vol 76, November 1995
performed. Measurement of pain intensity was by visual analysis scale before, 30, 45 days after, and 3 years after treatment. Significant supression of pain with linear regression in pain intensity was observed. After 3 years, 20 patients returned for follow-up evaluation. Significant reduction in pain intensity was observed in 80% of the patients. A multidisciplinary approach was shown effective in the treatment of TMJ disorders of myofascial origin in a long-term follow-up period.
Poster 55 "Longterm Outcome in Chronic Low Back Pain Patients Given Back School Training." Lutfiye Muslumanoglu, MD (Istanbul University Medical School, Istanbul, Turkey,); Emel Yildiz, MD; Mustafa Filiz, MD; Esra Arikan, MD; Ender Berker, MD. The aim of this study was to evaluate outcome in patients with chronic low back pain who were given back school training for 2 years. Thirty patients admitted to our back school were evaluated before admission and after 2 years by the following parameters: intensity of pain (VAS), lumbar schober, finger tip-floor distance. Functional disability was assessed by the Revised Oswestry Pain Questionnaire. For statistical analysis, student's t test was used. Pain (p < .001), lumbar schober (p < .01), finger tip-floor distance (p < .05), and functional disability (p < .001) showed statistically significant improvement after 2 years. We conclude that back school is an effective adjunctive procedure in obtaining positive outcome and in alleviating subjective and objective symptoms in chronic low back pain patients. We believe that larger controlled studies will offer more convincing evidence about prolonged beneficial effects of back schools.
Poster 56 "Giant Cell Tumor: A Case of Chronic Leg Pain." Alyce F. Jackson, MD (Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL); Barbara Parke, MD. We present a 33-year-old man who complained of left leg pain of 5 to 6 years' duration. The worknp revealed a cell tumor 13cm in length by 9cm in width by 5cm in diameter in the left proximal tibia. The patient underwent a wide en bloc resection of the left proximal tibia, reconstruction with modular tumor knee prosthesis with transfer of the medial head of the gastrocnemius to the quadriceps muscle. In rehabilitation, he was placed on restrictions of touch down weight-bearing with a Bledsoe brace for ambulating, locked extension and flexion limited to 0 ° to 40 ° to be slowly advanced to 50 ° over 2 months. During the stay he continued to improve in ambulation, balance, and pain management. Four months later he was ambulating without the Bledsoe brace, but used a straight cane. Follow-up studies for recurrence or metastases were negative. The rehabilitation goal for the patient is to ambulate without the straight cane. The diagnosis, pathology, and rehabilitation of this type of tumor is discussed.
Practice Management Poster 57 "Subspecialization in Physical Medicine and Rehabilitation: A Survey of Current Trends 1993-1994." Andrew Mazur, MD (Medical College of Wisconsin, Milwaukee, WI); Farrukh Hamid, MD. The purpose of this study was to initiate a data base documenting current subspecialization choices in physical medicine and rehabilitation (PM& R) and the factors that influence those decisions. Surveys were mailed to all PM&R residency programs in the United States with 71 graduating seniors responding in 1993 and 102 in 1994. Main results indicate a majority of residents (approximately 60%) consider further training, although only a minority actually pursue a fellowship (7% in 1993, 17% in 1994). Fellowship mentor and reputation were the most important factors determining choice of fellowship. The most common reason for not pursing a fellowship was "extra training time." Musculoskeletalsports medicine fellowships were overwhelmingly the most popular with electrodiagnostic medicine a distant second. More PM&R residents pursued private practice positions (49% and 42%) than academic positions (32% and 37%) in 1993 and 1994. These results showed a possible trend in PM&R towards academia. There was a 15% increase in academic verses private practice positions and a 243% increase in percentage of respondents pursuing fellowship training from 1993 to 1994. These trends will be more accurately assessed as this initial data base expands in future years.
ACADEMY ANNUAL ASSEMBLY ABSTRACTS
in the affected muscle. (4) Ligament sprains (sacroiliac joint, suprainter-spinous ligaments). (5) Bursitis, tendinitis, scars. (6) Sport injuries. In the acute stage, N&I allows early mobilization and speeds recovery. N&I is the most effective therapy in chronic stage. (7) Traumatic dystrophy with induration around injury or operations, fractures, sprains.
Poster 52 "Weight Alteration in Chronic Pain Patients." Raphael S. Orenstein, MD (Thomas Jefferson University Hospital, Philadelphia, PA); Mitchell K. Freedman, DO. Purpose of the study was to compare weight alteration of chronic pain patients with normals. We reviewed initial evaluations of 39 men and 38 women who presented to our chronic pain center. Their weight alteration was compared with 10-year weight alteration of subjects in the National Health and Nutrition Examination Surveys (NHANES). Men with chronic pain gained an average of 16 lbs in a 2.75-year interval from the onset of their pain. This compares with the maximum average weight gain in the NHANES male subjects of 14.04 lbs over 10 years. Women with chronic pain gained an average of 6.79 lbs in a 2.89-year interval from the onset of pain. This compares with the maximum average weight gain in the NHANES female subjects of 7.7 lbs over 10 years. A t test will compare the body mass index change of chronic pain patients to NHANES subjects. Other patterns of weight alteration that correlate with ethnicity, medications, depression, and substance abuse are presented. This is the first documentation that weight gain correlates with chronic pain. Morbidity of obesity, weight gain's role in perpetuation of chronic pain, and treatment options--including early intervention of weight control programs--are discussed.
Poster 53 "Transcutaneous Electrical Nerve Stimulation Treatment Outcome in Long-Term Users." David A. Fishbain, MD (University of Miami School of Medicine/University of Miami Pain Center, South Miami, FL); Charles Chabal, MD; Alice K. Abbott, MPH BSN, Lisa A. Wipperman-Heine, MSc; Robert B. Cutler, PhD. Previous reviews of Transcutaneous electrical nerve stimulation (TENS) outcome literature have concluded: (1) there are few long-term TENS follow-up studies, and (2) fewer studies have addressed the effect of long-term TENS use on other outcome variables besides pain (eg, function). From a random population of 2,003 chronic pain patients (CPPs) who acquired a TENS device for pain management, a randomly selected sample of 405 "long-term users" (TENS use > 6 months) were interviewed by telephone. Patients responded to a questionnaire designed to assess their perceptions regarding the effectiveness of TENS for a variety of treatment outcome variables. Paired t tests, correlated z-tests, SS Wilks and Chi-square tests demonstrated statistically significant change/ improvement (p < .05) attributed to TENS use in the following outcome variables: less pain interference with work, home, and social activities; increased activity and pain management; decreased use of other therapies (PT/OT, chiropractic); decreased use of narcotics, tranquilizers, muscle relaxants, NSAIDs, and steroids. Seventy-six percent of patients contacted as potential respondents reported using TENS in the prior 2 months. The results suggest TENS is associated with improvement on multiple outcome variables in addition to pain relief for CPPs who are long term users. Additionally, there is a group of CPPs who utilize TENS over a long time period.
Poster 54 "Mastigatory Myofascial Pain Syndrome: Longterm Follow-up." Marta Imamura, MD (Hospital das Clinicas/Sao Paulo University, Sat Paulo, Brazil); Silvia Adler, MD. Our objective was to evaluate the long-term follow-up of the therapeutic effects of a multidisciplinary approach to temporomandibular joint (TMJ) dysfunction. Forty patientes, 32 women and 8 men 18 to 40 years old (mean = 32) were referred from the maxilofacial surgery division with preauricular pain. They had failed to respond to previous conservative and orthodontic treatment. Mean duration of pain was 38.7 months. A daily program of therapeutic exercises were performed for 45 days, including stretching exercises, reeducation of mastigatory, cervical spine, and scapular thoracic girdle muscles for 10 repetitions, 3 times a day. Correction of predisposing factors, postural reeducation, and conscientization of habits that lead to masticator muscles overuse were indicated. No occlusion intervention and psychological approach was
Arch Phys Med Rehabil Vol 76, November 1995
performed. Measurement of pain intensity was by visual analysis scale before, 30, 45 days after, and 3 years after treatment. Significant supression of pain with linear regression in pain intensity was observed. After 3 years, 20 patients returned for follow-up evaluation. Significant reduction in pain intensity was observed in 80% of the patients. A multidisciplinary approach was shown effective in the treatment of TMJ disorders of myofascial origin in a long-term follow-up period.
Poster 55 "Longterm Outcome in Chronic Low Back Pain Patients Given Back School Training." Lutfiye Muslumanoglu, MD (Istanbul University Medical School, Istanbul, Turkey,); Emel Yildiz, MD; Mustafa Filiz, MD; Esra Arikan, MD; Ender Berker, MD. The aim of this study was to evaluate outcome in patients with chronic low back pain who were given back school training for 2 years. Thirty patients admitted to our back school were evaluated before admission and after 2 years by the following parameters: intensity of pain (VAS), lumbar schober, finger tip-floor distance. Functional disability was assessed by the Revised Oswestry Pain Questionnaire. For statistical analysis, student's t test was used. Pain (p < .001), lumbar schober (p < .01), finger tip-floor distance (p < .05), and functional disability (p < .001) showed statistically significant improvement after 2 years. We conclude that back school is an effective adjunctive procedure in obtaining positive outcome and in alleviating subjective and objective symptoms in chronic low back pain patients. We believe that larger controlled studies will offer more convincing evidence about prolonged beneficial effects of back schools.
Poster 56 "Giant Cell Tumor: A Case of Chronic Leg Pain." Alyce F. Jackson, MD (Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL); Barbara Parke, MD. We present a 33-year-old man who complained of left leg pain of 5 to 6 years' duration. The worknp revealed a cell tumor 13cm in length by 9cm in width by 5cm in diameter in the left proximal tibia. The patient underwent a wide en bloc resection of the left proximal tibia, reconstruction with modular tumor knee prosthesis with transfer of the medial head of the gastrocnemius to the quadriceps muscle. In rehabilitation, he was placed on restrictions of touch down weight-bearing with a Bledsoe brace for ambulating, locked extension and flexion limited to 0 ° to 40 ° to be slowly advanced to 50 ° over 2 months. During the stay he continued to improve in ambulation, balance, and pain management. Four months later he was ambulating without the Bledsoe brace, but used a straight cane. Follow-up studies for recurrence or metastases were negative. The rehabilitation goal for the patient is to ambulate without the straight cane. The diagnosis, pathology, and rehabilitation of this type of tumor is discussed.
Practice Management Poster 57 "Subspecialization in Physical Medicine and Rehabilitation: A Survey of Current Trends 1993-1994." Andrew Mazur, MD (Medical College of Wisconsin, Milwaukee, WI); Farrukh Hamid, MD. The purpose of this study was to initiate a data base documenting current subspecialization choices in physical medicine and rehabilitation (PM& R) and the factors that influence those decisions. Surveys were mailed to all PM&R residency programs in the United States with 71 graduating seniors responding in 1993 and 102 in 1994. Main results indicate a majority of residents (approximately 60%) consider further training, although only a minority actually pursue a fellowship (7% in 1993, 17% in 1994). Fellowship mentor and reputation were the most important factors determining choice of fellowship. The most common reason for not pursing a fellowship was "extra training time." Musculoskeletalsports medicine fellowships were overwhelmingly the most popular with electrodiagnostic medicine a distant second. More PM&R residents pursued private practice positions (49% and 42%) than academic positions (32% and 37%) in 1993 and 1994. These results showed a possible trend in PM&R towards academia. There was a 15% increase in academic verses private practice positions and a 243% increase in percentage of respondents pursuing fellowship training from 1993 to 1994. These trends will be more accurately assessed as this initial data base expands in future years.