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S214 EFFECTS OF EXERCISE IN WATER (HYDROTHERAPY) ON PAIN RELIEF AND EXTENDED RANGE OF MOTION IN RHEUMATOID ARTHRITIS PATIENTS
POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
S214 EFFECTS OF EXERCISE IN WATER (HYDROTHERAPY) ON PAIN RELIEF AND EXTENDED RANGE OF MOTION IN RHEUMATOID ARTHRITIS PATIENTS S. Mahidashtizad1 *, S. Mohammadzadeh1 , F. Shojaie2 , H. Zeraati3 . 1 Nursing and Midwifery Faculty, 2 Islamic Azad University, Tehran Medical Unit, 3 Biostatistics, Tehran University, Tehran, Iran Background and Aims: Prior investigators have demonstrated the positive effects of exercise on pain relief and extended range of motion in rheumatoid arthritis (RA) patients. The present study was designed to determine and the effects of these exercises in water (hydrotherapy). Methods: In a clinical trial, a total of 32 adult females were equally assigned in experimental and control groups. At baseline, demographic data, patients’ pain and range of motion were determined. Then, the experimental group was advised associated hydrotherapy activities, finally, 6 weeks later, they were reassessed Results: The mean pain severity was reduced in both experimental and control groups (p < 0.0007, p < 0.03, respectively), however, pain severity reduction was more significant in hydrotherapy group. Range of motion was also significantly increased in hydrotherapy group, when compared with controls (p < 0.05). Conclusions: Hydrotherapy could effectively reduce pain severity and increase range of motion in RA patients. Disclosure: None declared
S215 ARTHROPATHY AND MUSCULOSKELETAL MANIFESTATIONS DUE TO UNDERLYING CONGENITAL INSENSITIVITY TO PAIN: WHY AND WHEN PAIN IS GOOD? Y. Ragab1 , Y. Emad2,3 *, N. El-Shaarawy4 . 1 Faculty of Medicine, Cairo University, 2 Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 3 Rheumatology and Rehabilitation Department, Dr. Erfan and Bagedo General Hospital, KSA, Jeddah, Saudi Arabia; 4 Rheumatology and Rehabilitation Department, Suez Canal University, Cairo, Egypt Background and Aims: ‘Painless whitlows’, ‘mal perforant du pied’ and ‘Morvan syndrome’ are some of the many names used to describe a wide range of conditions which grouped under hereditary sensory and autonomic neuropathy (HSAN). Common to all these conditions is insensitivity to pain, but in addition to their analgesia, proprioception, temperature sensitivity and vibratory sensation may also be affected and some have wider systemic problems. The aim of the current study is to describe the musculoskeletal manifestations and pattern of arthropathy in a cohort of children with proprioceptive sensory loss. Methods: The study comprised seven children with congenital insensitivity to pain and proprioceptive sensory loss. Plain radiographs were obtained in clinically affected joint. The spectrum of arthropathy and musculoskeletal manifestations in all patients were reviewed. Results: The most common features observed in our patients are fractures, self-mutilation, Charcot’s arthropathy, hip dislocation, and limb length discrepancy due to metaphyseal injury in the ankle joint and. All patients have an abnormality of interpretation of painful stimuli or lacks normal proprioceptive joint sense, leading to self-inflicted damage which pass unnoticed in spite of marked destructive changes obvious on plain radiographs. Conclusions: Patient/parent education is quite important to prevent inevitable complication of this rare syndrome. Early operative interference in case of metaphyseal injuries of the ankle joint is important to avoid unequal leg length and permanent deformity. Disclosure: None declared
227
S216 EFFICACY AND TOLERABILITY OF FLUPIRTINE IN MUSCULOSKELETAL PAIN – RESULTS OF A POOLED RE-ANALYSIS OF RANDOMIZED, DOUBLE-BLIND, CONTROLLED TRIALS 1 2 ¨ M.A. Uberall *, G.H.H. Muller-Schwefe ¨ , B. Terhaag3 . 1 Institut f¨ ur Qualit¨ atssicherung in Schmerztherapie und Palliativmedizin (IQUISP), N¨ urnberg, 2 Schmerz- und Palliativzentrum G¨ oppingen, G¨ oppingen, 3 AWD.pharma GmbH & Co. KG, Radebeul, Germany Background and Aims: Flupirtine is a selective neuronal potassium channel opener (SNEPCO), constitutes a unique class within the group of WHO-I analgesics and is one of the preferred analgesics for the treatment of musculoskeletal pain, particularly low back pain, in some European countries. Methods: Retrospective pooled analysis of the individual patient data of eight randomized controlled clinical trials in patients with sub-acute/chronic musculoskeletal pain comparing the efficacy and tolerability of flupirtine dosages of 100–400 mg/d with placebo and/or active comparators. Primary endpoint was the average change in pain intensity for the overall maintenance period. Results: A total of 1046 patients were evaluated for efficacy; 1095 patients for safety. Treatment with flupirtine or active comparators resulted in significant reduction in pain intensity in comparison to placebo from day four until the end of the trials as well as for the overall maintenance period (all p < 0.001). Flupirtine proved to be non-inferior to active comparators, however, showed a superior tolerability profile with both significantly less patients reporting adverse events from the treatment as well as a significantly lower percentage of patients who prematurely discontinued study medication due to these adverse events. Conclusions: Flupirtine proved to be superior to placebo in terms of analgesic effectiveness across its effective and approved dosing range, provided at least a non-inferior efficacy to different active comparators, and showed a superior tolerability profile as well as a significantly lower treatment discontinuation rate in comparison to all active comparators. Disclosure: Speaker fee
S217 EFFECTIVENESS OF PERCUTANEOUS CERVICAL EPIDURAL NEUROPLASTY FOR CERVICAL DISC HERNIATION E.J. Park *, D.Y. Koh. Godoil Spine and Pain Hospital, Seoul, Republic of Korea Background and Aims: Percutaneous cervical epidural neuroplasty (PCEN) has been applied as an treatment option for cervical disc herniation. The objective of our study was to evaluate the effectiveness of PCEN depending on the type of herniated disc. Methods: One hundred fifty one patients received PCEN between Aug 2009 and Dec 2010. All of them had cervical disc herniations in the MRI. Outcomes incluing the numerical rating scale (NRS), change in functional status, symptom improvement rate and complications were assessed at the pretreatment, 1-day, 1-week, 1, 3, 6, 12 months post-treatment. After treatment when patients showed VAS of 50 or greater, we performed cervical epidural blocks up to 3 times. The Prepocedural baseline data were collected from the medical records, and postprocedural follow-up data were obtained using telephone interview. Results: The NRS scores demonstrated stastically significant improvement at the 1-day, 1-week, 1, 3, 6, 12-month follow-up when compared to preprocedural values (p < 0.01). And the NDI score reduced significantly at 1-month and 12-month follow-up (p < 0.01). There was no significant difference in pain scores and functional status between protruded disc and extruded disc. There were no serious complications. Conclusions: PCEN is a safe and effective procedure for treatment of cervical disc disorder. Extruded type of disc has also good clinical
S214 EFFECTS OF EXERCISE IN WATER (HYDROTHERAPY) ON PAIN RELIEF AND EXTENDED RANGE OF MOTION IN RHEUMATOID ARTHRITIS PATIENTS S. Mahidashtizad1 *, S. Mohammadzadeh1 , F. Shojaie2 , H. Zeraati3 . 1 Nursing and Midwifery Faculty, 2 Islamic Azad University, Tehran Medical Unit, 3 Biostatistics, Tehran University, Tehran, Iran Background and Aims: Prior investigators have demonstrated the positive effects of exercise on pain relief and extended range of motion in rheumatoid arthritis (RA) patients. The present study was designed to determine and the effects of these exercises in water (hydrotherapy). Methods: In a clinical trial, a total of 32 adult females were equally assigned in experimental and control groups. At baseline, demographic data, patients’ pain and range of motion were determined. Then, the experimental group was advised associated hydrotherapy activities, finally, 6 weeks later, they were reassessed Results: The mean pain severity was reduced in both experimental and control groups (p < 0.0007, p < 0.03, respectively), however, pain severity reduction was more significant in hydrotherapy group. Range of motion was also significantly increased in hydrotherapy group, when compared with controls (p < 0.05). Conclusions: Hydrotherapy could effectively reduce pain severity and increase range of motion in RA patients. Disclosure: None declared
S215 ARTHROPATHY AND MUSCULOSKELETAL MANIFESTATIONS DUE TO UNDERLYING CONGENITAL INSENSITIVITY TO PAIN: WHY AND WHEN PAIN IS GOOD? Y. Ragab1 , Y. Emad2,3 *, N. El-Shaarawy4 . 1 Faculty of Medicine, Cairo University, 2 Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt; 3 Rheumatology and Rehabilitation Department, Dr. Erfan and Bagedo General Hospital, KSA, Jeddah, Saudi Arabia; 4 Rheumatology and Rehabilitation Department, Suez Canal University, Cairo, Egypt Background and Aims: ‘Painless whitlows’, ‘mal perforant du pied’ and ‘Morvan syndrome’ are some of the many names used to describe a wide range of conditions which grouped under hereditary sensory and autonomic neuropathy (HSAN). Common to all these conditions is insensitivity to pain, but in addition to their analgesia, proprioception, temperature sensitivity and vibratory sensation may also be affected and some have wider systemic problems. The aim of the current study is to describe the musculoskeletal manifestations and pattern of arthropathy in a cohort of children with proprioceptive sensory loss. Methods: The study comprised seven children with congenital insensitivity to pain and proprioceptive sensory loss. Plain radiographs were obtained in clinically affected joint. The spectrum of arthropathy and musculoskeletal manifestations in all patients were reviewed. Results: The most common features observed in our patients are fractures, self-mutilation, Charcot’s arthropathy, hip dislocation, and limb length discrepancy due to metaphyseal injury in the ankle joint and. All patients have an abnormality of interpretation of painful stimuli or lacks normal proprioceptive joint sense, leading to self-inflicted damage which pass unnoticed in spite of marked destructive changes obvious on plain radiographs. Conclusions: Patient/parent education is quite important to prevent inevitable complication of this rare syndrome. Early operative interference in case of metaphyseal injuries of the ankle joint is important to avoid unequal leg length and permanent deformity. Disclosure: None declared
227
S216 EFFICACY AND TOLERABILITY OF FLUPIRTINE IN MUSCULOSKELETAL PAIN – RESULTS OF A POOLED RE-ANALYSIS OF RANDOMIZED, DOUBLE-BLIND, CONTROLLED TRIALS 1 2 ¨ M.A. Uberall *, G.H.H. Muller-Schwefe ¨ , B. Terhaag3 . 1 Institut f¨ ur Qualit¨ atssicherung in Schmerztherapie und Palliativmedizin (IQUISP), N¨ urnberg, 2 Schmerz- und Palliativzentrum G¨ oppingen, G¨ oppingen, 3 AWD.pharma GmbH & Co. KG, Radebeul, Germany Background and Aims: Flupirtine is a selective neuronal potassium channel opener (SNEPCO), constitutes a unique class within the group of WHO-I analgesics and is one of the preferred analgesics for the treatment of musculoskeletal pain, particularly low back pain, in some European countries. Methods: Retrospective pooled analysis of the individual patient data of eight randomized controlled clinical trials in patients with sub-acute/chronic musculoskeletal pain comparing the efficacy and tolerability of flupirtine dosages of 100–400 mg/d with placebo and/or active comparators. Primary endpoint was the average change in pain intensity for the overall maintenance period. Results: A total of 1046 patients were evaluated for efficacy; 1095 patients for safety. Treatment with flupirtine or active comparators resulted in significant reduction in pain intensity in comparison to placebo from day four until the end of the trials as well as for the overall maintenance period (all p < 0.001). Flupirtine proved to be non-inferior to active comparators, however, showed a superior tolerability profile with both significantly less patients reporting adverse events from the treatment as well as a significantly lower percentage of patients who prematurely discontinued study medication due to these adverse events. Conclusions: Flupirtine proved to be superior to placebo in terms of analgesic effectiveness across its effective and approved dosing range, provided at least a non-inferior efficacy to different active comparators, and showed a superior tolerability profile as well as a significantly lower treatment discontinuation rate in comparison to all active comparators. Disclosure: Speaker fee
S217 EFFECTIVENESS OF PERCUTANEOUS CERVICAL EPIDURAL NEUROPLASTY FOR CERVICAL DISC HERNIATION E.J. Park *, D.Y. Koh. Godoil Spine and Pain Hospital, Seoul, Republic of Korea Background and Aims: Percutaneous cervical epidural neuroplasty (PCEN) has been applied as an treatment option for cervical disc herniation. The objective of our study was to evaluate the effectiveness of PCEN depending on the type of herniated disc. Methods: One hundred fifty one patients received PCEN between Aug 2009 and Dec 2010. All of them had cervical disc herniations in the MRI. Outcomes incluing the numerical rating scale (NRS), change in functional status, symptom improvement rate and complications were assessed at the pretreatment, 1-day, 1-week, 1, 3, 6, 12 months post-treatment. After treatment when patients showed VAS of 50 or greater, we performed cervical epidural blocks up to 3 times. The Prepocedural baseline data were collected from the medical records, and postprocedural follow-up data were obtained using telephone interview. Results: The NRS scores demonstrated stastically significant improvement at the 1-day, 1-week, 1, 3, 6, 12-month follow-up when compared to preprocedural values (p < 0.01). And the NDI score reduced significantly at 1-month and 12-month follow-up (p < 0.01). There was no significant difference in pain scores and functional status between protruded disc and extruded disc. There were no serious complications. Conclusions: PCEN is a safe and effective procedure for treatment of cervical disc disorder. Extruded type of disc has also good clinical