- Email: [email protected]
Postherpetic neuralgia
44
Abstracts
C13 - Pain in Women
C14 - Postherpetic Neuralgia
(739) Tender point examination in women with vulvar vestibulitis syndrome: Evidence for generalized and heightened pain sensitivity to manual palpation
(741) Psychosocial predictors in the development of Post-Herpetic Neuralgia in a high-risk Acute Herpes Zoster population
C. Pukall, M. Baron, S. Khalife´ , Y. Binik; McGill University, Montreal, QC Vulvar vestibulitis syndrome (VVS) is a common cause of painful intercourse, affecting up to 12% of pre-menopausal women in the general population. In addition to recent evidence pointing to the importance of peripheral processes involved in the development and maintenance of VVS (e.g., increase in innervation), emerging data indicate that the central nervous system may also be involved: women with VVS report more pain-related complaints and have lower non-genital tactile, pain, and pressure thresholds than non-affected women. The primary goal of the present study was to examine whether women with VVS are more sensitive to pressure in non-genital areas of the body than control women. To date, 6 women with VVS and 12 control participants (mean age 25) underwent a standardized physical examination typically used for the diagnosis of fibromyalgia. An experienced, blinded rheumatologist manually palpated 9 non-genital body locations bilaterally (including left and right gluteal, low cervical, and supraspinatus regions). Pain intensity and unpleasantness ratings were recorded on a scale from 0 to 10. Intensity and unpleasantness ratings were not significantly different for the left and right sides of any given area; therefore, measures from left and right sides were averaged for each site. Analyses of variance (Bonferroni corrected for multiple comparisons) indicated that women with VVS rated both pain intensity and unpleasantness significantly higher than control women at every site examined (all p‘s ⬍ 0.05). The same pattern of results held when analyses were restricted to 6 VVScontrol pairs matched on age and oral contraceptive use. Women with VVS reported significantly higher pain intensity and unpleasantness ratings in response to palpation to various non-genital body regions than control participants. These results are consistent with the idea that women with VVS may suffer from a more generalized sensory abnormality than is currently believed.
H. Thyregod, M. Rowbotham, K. Petersen; University of California, San Francisco, Pain Clinical Research Center, San Francisco, CA Studies have suggested that measures of psychological stress and depression during acute herpes zoster (AHZ) are important risk factors for development of post-herpetic neuralgia (PHN). The aim of this longitudinal observational study was to evaluate stressful life-events, coping, quality of life, perceived social support, and ability to engage in daily activities as risk factors for development of PHN. These risk factors were compared to established risk factors such as pain severity and age. Subjects were assessed at 2-6 wks, 6-8 wks, 3 mos, and 6 mos after rash onset. Pain, allodynia, SF McGill Pain Questionnaire (SF-MPQ) and Multidimensional Pain Inventory (MPI) were measured at all visits. Stressful LifeEvents and Ways of Coping questionnaires were completed at Visit 1 and 4. Eighty-seven subjects have completed the study to date (34M, 53F, median age 69(46-89)). Forty subjects had PHN at 3 months (defined as average daily pain (VAS) ⬎ 20/100 or meeting 2 of the following 3 criteria: 1) any zoster-pain, 2) allodynia, 3) taking medication for zosterpain). There was no difference in age at AHZ onset between PHN and non-PHN patients. PHN patients had more pain at Visit 1. Mean scores on the SF-MPQ were higher in PHN patients at Visits 2 to 4. Coping-strategies and life-events were similar. Using the MPI-questionnaire, PHN patients rated higher on pain severity, interference with daily life, and affective distress at Visit 1 and 4. At Visit 4 there was a trend towards higher responses in the PHN group on life control and solicitous and distracting responses by significant other. In accordance with established risk factors, PHN patients reported more pain across all questionnaires. In addition, PHN patients reported interference with daily life and affective distress throughout the 6-month study period. There was no difference in coping strategies and concurrent life-events.
(740) Presenting characteristics of women referred to a multidisciplinary pain management centre for diverse chronic pain conditions
C30 - Other
L. Gordon, G. Pron; Wasser Pain Management Centre at Mount Sinai Hospital, Toronto, ON The objective was to assess the relationship between presenting characteristics and pain related disability in women referred to a multidisciplinary pain management centre. Common chronic pain conditions in women referred to the Wasser Pain Management Centre (WPMC), a hospital based outpatient multidisciplinary tertiary treatment centre, were determined from the database system. Charts of consecutive patients identified in the different pain groups were reviewed to confirm diagnosis and verify completeness of information. A convenience sample of 20 cases per group was chosen for initial chart audit. At entry to the WPMC patient‘s completed questionnaires including: McGill Pain Questionnaire (MPQ), Pain Disability Index (PDI), coping level (0-6), age of pain onset, drug addiction, abuse (sexual, physical and/or emotional). Drug addiction and disability coverage was determined from clinical records. Six common chronic pain conditions were identified from the WPMC database included: pelvic pain, pelvic pain with drug addiction, fibromyalgia, undiagnosed total body pain, facial pain and headache. Pain scores were moderate (20-35) for most groups, except for FM (42.4) and UTBP (41.7) groups, which were severe. A high percentage of patients in these two groups were receiving some form of disability compensation. Most cases did not have a drug addiction component except for the PP with drug addiction (100%) and UTBP (85%) groups. These groups were also the only groups that had a high percentage of abuse (75% for both). Disability scores were higher for patients reporting higher pain intensity. Most indicated disability in a variety of aspects whereas disability in the PP and FP groups was domain specific. Women with diverse chronic pain conditions attending a multidisciplinary CNCP reported similar levels of pain intensity but varying rates of drug abuse/ addiction, abuse and pain related disability. Further assessments are needed to understand how complex backgrounds of patients with complex chronic disease conditions relate to subsequent pain related disability and disability coverage.
(742) Chronicity of pain associated with spinal cord injury (SCI) Y. Cruz-Almeida, E. Widerstrom-Noga, A. Martinez-Arizala; University of Miami, School of Medicine, Miami, FL Further research is needed to determine the course and development of chronic pain associated with SCI. The present study was aimed to determine: (1) The chronicity of these pain syndromes and (2) The stability of specific patterns of pain characteristics over time. Persons with chronic pain and SCI (n⫽124) participated in two surveys 18 months apart (Survey 1 and Survey 2). Spearman correlations were used for pairwise comparisons of specific pain characteristics. Confirmatory factor analysis (CFA) was performed to examine three patterns of pain characteristics that emerged in a previous exploratory factor analysis (EFA) in Survey 1. The primary statistical goal of a CFA is to determine how well sample data fit a hypothesized model. Unlike EFA, in CFA, relationships among variables are defined a priori. Five individuals (4.0%) who experienced pain in Survey 1 did not report pain in Survey 2. In contrast, 9 individuals (7.3%) developed pain in the same time period. There were significant correlations between the two occasions with regards to specific pain characteristics (i.e., location of pain, r⫽0.626; p⬍0.001, pain descriptors, r⫽0.605; p⬍0.001, pain intensities, r⫽0.677; p⬍0.001, temporal aspects, r⫽0.574; p⬍0.001). The hypothesized model consisted of 3 factors: (1) Neuropathic pain below the level of injury, (2) Upper extremity pain in tetraplegia, and (3) Intense, persistent pain. The CFA resulted in a goodness-of-fit x2(31) of 53.1, and the following additional fit indices: NFI ⫽0.966, NNFI⫽0.940, CFI⫽0.985, RMSEA⫽0.076. The high correlations between Survey 1 and Survey 2 with respect to pain descriptors, pain intensities, and temporal aspects suggest that specific pain characteristics do not change considerably over time. Moreover, the pain relationships obtained in Survey 1 strongly correspond with the data obtained 18 months later, which confirms that certain clinical pain patterns remain stable in people with SCI.
(743) WITHDRAWN
Abstracts
C13 - Pain in Women
C14 - Postherpetic Neuralgia
(739) Tender point examination in women with vulvar vestibulitis syndrome: Evidence for generalized and heightened pain sensitivity to manual palpation
(741) Psychosocial predictors in the development of Post-Herpetic Neuralgia in a high-risk Acute Herpes Zoster population
C. Pukall, M. Baron, S. Khalife´ , Y. Binik; McGill University, Montreal, QC Vulvar vestibulitis syndrome (VVS) is a common cause of painful intercourse, affecting up to 12% of pre-menopausal women in the general population. In addition to recent evidence pointing to the importance of peripheral processes involved in the development and maintenance of VVS (e.g., increase in innervation), emerging data indicate that the central nervous system may also be involved: women with VVS report more pain-related complaints and have lower non-genital tactile, pain, and pressure thresholds than non-affected women. The primary goal of the present study was to examine whether women with VVS are more sensitive to pressure in non-genital areas of the body than control women. To date, 6 women with VVS and 12 control participants (mean age 25) underwent a standardized physical examination typically used for the diagnosis of fibromyalgia. An experienced, blinded rheumatologist manually palpated 9 non-genital body locations bilaterally (including left and right gluteal, low cervical, and supraspinatus regions). Pain intensity and unpleasantness ratings were recorded on a scale from 0 to 10. Intensity and unpleasantness ratings were not significantly different for the left and right sides of any given area; therefore, measures from left and right sides were averaged for each site. Analyses of variance (Bonferroni corrected for multiple comparisons) indicated that women with VVS rated both pain intensity and unpleasantness significantly higher than control women at every site examined (all p‘s ⬍ 0.05). The same pattern of results held when analyses were restricted to 6 VVScontrol pairs matched on age and oral contraceptive use. Women with VVS reported significantly higher pain intensity and unpleasantness ratings in response to palpation to various non-genital body regions than control participants. These results are consistent with the idea that women with VVS may suffer from a more generalized sensory abnormality than is currently believed.
H. Thyregod, M. Rowbotham, K. Petersen; University of California, San Francisco, Pain Clinical Research Center, San Francisco, CA Studies have suggested that measures of psychological stress and depression during acute herpes zoster (AHZ) are important risk factors for development of post-herpetic neuralgia (PHN). The aim of this longitudinal observational study was to evaluate stressful life-events, coping, quality of life, perceived social support, and ability to engage in daily activities as risk factors for development of PHN. These risk factors were compared to established risk factors such as pain severity and age. Subjects were assessed at 2-6 wks, 6-8 wks, 3 mos, and 6 mos after rash onset. Pain, allodynia, SF McGill Pain Questionnaire (SF-MPQ) and Multidimensional Pain Inventory (MPI) were measured at all visits. Stressful LifeEvents and Ways of Coping questionnaires were completed at Visit 1 and 4. Eighty-seven subjects have completed the study to date (34M, 53F, median age 69(46-89)). Forty subjects had PHN at 3 months (defined as average daily pain (VAS) ⬎ 20/100 or meeting 2 of the following 3 criteria: 1) any zoster-pain, 2) allodynia, 3) taking medication for zosterpain). There was no difference in age at AHZ onset between PHN and non-PHN patients. PHN patients had more pain at Visit 1. Mean scores on the SF-MPQ were higher in PHN patients at Visits 2 to 4. Coping-strategies and life-events were similar. Using the MPI-questionnaire, PHN patients rated higher on pain severity, interference with daily life, and affective distress at Visit 1 and 4. At Visit 4 there was a trend towards higher responses in the PHN group on life control and solicitous and distracting responses by significant other. In accordance with established risk factors, PHN patients reported more pain across all questionnaires. In addition, PHN patients reported interference with daily life and affective distress throughout the 6-month study period. There was no difference in coping strategies and concurrent life-events.
(740) Presenting characteristics of women referred to a multidisciplinary pain management centre for diverse chronic pain conditions
C30 - Other
L. Gordon, G. Pron; Wasser Pain Management Centre at Mount Sinai Hospital, Toronto, ON The objective was to assess the relationship between presenting characteristics and pain related disability in women referred to a multidisciplinary pain management centre. Common chronic pain conditions in women referred to the Wasser Pain Management Centre (WPMC), a hospital based outpatient multidisciplinary tertiary treatment centre, were determined from the database system. Charts of consecutive patients identified in the different pain groups were reviewed to confirm diagnosis and verify completeness of information. A convenience sample of 20 cases per group was chosen for initial chart audit. At entry to the WPMC patient‘s completed questionnaires including: McGill Pain Questionnaire (MPQ), Pain Disability Index (PDI), coping level (0-6), age of pain onset, drug addiction, abuse (sexual, physical and/or emotional). Drug addiction and disability coverage was determined from clinical records. Six common chronic pain conditions were identified from the WPMC database included: pelvic pain, pelvic pain with drug addiction, fibromyalgia, undiagnosed total body pain, facial pain and headache. Pain scores were moderate (20-35) for most groups, except for FM (42.4) and UTBP (41.7) groups, which were severe. A high percentage of patients in these two groups were receiving some form of disability compensation. Most cases did not have a drug addiction component except for the PP with drug addiction (100%) and UTBP (85%) groups. These groups were also the only groups that had a high percentage of abuse (75% for both). Disability scores were higher for patients reporting higher pain intensity. Most indicated disability in a variety of aspects whereas disability in the PP and FP groups was domain specific. Women with diverse chronic pain conditions attending a multidisciplinary CNCP reported similar levels of pain intensity but varying rates of drug abuse/ addiction, abuse and pain related disability. Further assessments are needed to understand how complex backgrounds of patients with complex chronic disease conditions relate to subsequent pain related disability and disability coverage.
(742) Chronicity of pain associated with spinal cord injury (SCI) Y. Cruz-Almeida, E. Widerstrom-Noga, A. Martinez-Arizala; University of Miami, School of Medicine, Miami, FL Further research is needed to determine the course and development of chronic pain associated with SCI. The present study was aimed to determine: (1) The chronicity of these pain syndromes and (2) The stability of specific patterns of pain characteristics over time. Persons with chronic pain and SCI (n⫽124) participated in two surveys 18 months apart (Survey 1 and Survey 2). Spearman correlations were used for pairwise comparisons of specific pain characteristics. Confirmatory factor analysis (CFA) was performed to examine three patterns of pain characteristics that emerged in a previous exploratory factor analysis (EFA) in Survey 1. The primary statistical goal of a CFA is to determine how well sample data fit a hypothesized model. Unlike EFA, in CFA, relationships among variables are defined a priori. Five individuals (4.0%) who experienced pain in Survey 1 did not report pain in Survey 2. In contrast, 9 individuals (7.3%) developed pain in the same time period. There were significant correlations between the two occasions with regards to specific pain characteristics (i.e., location of pain, r⫽0.626; p⬍0.001, pain descriptors, r⫽0.605; p⬍0.001, pain intensities, r⫽0.677; p⬍0.001, temporal aspects, r⫽0.574; p⬍0.001). The hypothesized model consisted of 3 factors: (1) Neuropathic pain below the level of injury, (2) Upper extremity pain in tetraplegia, and (3) Intense, persistent pain. The CFA resulted in a goodness-of-fit x2(31) of 53.1, and the following additional fit indices: NFI ⫽0.966, NNFI⫽0.940, CFI⫽0.985, RMSEA⫽0.076. The high correlations between Survey 1 and Survey 2 with respect to pain descriptors, pain intensities, and temporal aspects suggest that specific pain characteristics do not change considerably over time. Moreover, the pain relationships obtained in Survey 1 strongly correspond with the data obtained 18 months later, which confirms that certain clinical pain patterns remain stable in people with SCI.
(743) WITHDRAWN