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S501 PREVALENCE, CHARACTERISTICS AND FACTORS ASSOCIATED WITH CHRONIC PAIN WITH AND WITHOUT NEUROPATHIC CHARACTERISTICS IN BRAZIL
260
POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
randomized in two groups; with or without a follow-up intervention. The follow-up intervention included one face-toface interview and four weeks of written communication via a smartphone. Participants filled out three diaries daily to support self-monitoring of thoughts and feelings and planning and evaluation of daily activities. The registered diaries were immediately available to a therapist who submitted daily a tailored feedback on a secure website accessible on the phone. Both groups had access to a non-interactive web page with descriptions of selected ACT exercises and audio files with mindfulness exercises. Primary outcome variable was catastrophizing measured with Pain Catastrophizing Scale. Secondary outcomes included acceptance, values-based living and emotional distress. Data was gathered before and after the rehabilitation program and after the followup. Results: Preliminary results indicate that the follow-up intervention is effective in reducing catastrophizing and increasing activity engagement. Short-term effects on primary and secondary outcomes variables will be presented. Conclusions: Smartphone delivered follow-up intervention based on ACT seems to enhance the effect of inpatient rehabilitation and could be developed as part of standard care. Disclosure: None declared
S430 FIRST YEAR RESULTS OF EDUCATIONAL PROGRAM IN CHRONIC PAIN FOR FRENCH SPEAKING PATIENTS G. Vargas-Schaffer1 *, J. Cogan2 , M. Racine3 , C. Jeannotte1 , C. Haworth1 , J. Cayac1 , A. Busson1 , J. Cloutier1 , G. Besner1 . 1 Anaesthesiology, 2 Anaesthesiology Institut de Cardiologie, University of Montreal, 3 Centre de Recherche du CHUM, CRCHUM, Montreal, QC, Canada Background and Aims: There is a growing interest in providing educational programs for patients suffering from chronic diseases. Our aim was to create an Educational Program in Chronic Pain (EPCP) for patients, tailored to their needs and measure the levels of knowledge of patients in self-management of chronic pain. We present the results of the first year of this work. Methods: A survey was completed for patients at pain clinic at Hˆotel-Dieu du CHUM. A total of 25 patients completed an open ended questionnaire and specified what they wished to see in an EPCP. Once we had identified the topics in the survey, we have elaborated and prepared the EPCP with a multidisciplinary team. We elaborated 6 interactive sessions, and created educational materials. The knowledge’s patients were evaluated with 18 questionnaires. Data findings were analysed using a descriptive statistical method. Results: The first year our EPCP made 5 groups with a total of 63 patients and a variable number “significant others” accompanying them. Patients increased their knowledge of chronic pain from a 2.8% to 24%, according to their own assessment. The PMCA satisfaction was assessed at 5.33/7 scale Linkert. Conclusion: Our program helps patients and their families to gain and maintain the skills they need to best manage their lives by helping them understand both their illness and treatment. We also help them to work together and assume responsibility for their own care in order to help them maintain and improve their quality of life. Disclosure: None declared
S431 COMPASS: CHRONIC NON-CANCEROUS PAIN EDUCATION PROGRAMME, IMPACT ON ITALIAN GENERAL PHYSICIAN’S PRESCRIPTION G. Fanelli1 , C. Compagnone1 *, F. Tagliaferri1 , P. Loraprile2 , C. Bonazzi3 , G. Ventriglia2 , C. Cricelli4 . 1 Anesthesia, University of Parma, Parma, 2 General Practitioner, Societ` a Italiana di Medici Generali, Brescia, 3 Pain Therapy, Fondazione Salvatore Maugeri – Istituto Scientifico di Pavia, Pavia, 4 General Practitioner, Societ` a Italiana di Medici Generali, Firenze, Italy Background and Aims: The majority of patients with chronic pain are generally treated by general practitioners. Unfortunately, several studies had highlighted the frequent misinterpretation and the lack of adherence to the referral guidelines. The aim of the present study was to analyze the influence of noncancerous chronic pain management education program on general physician’s prescription. Methods: A sample of 200 general practitioners (GPs) was selected among those who regularly use the electronic-Problem Oriented Medical Record (e-POMR, Millewin® ) for daily activities (Health Care or Research). The selected GPs were members of the Italian Society of General Practice (SIMG) and worked in five Italian Regions (Piedmont, Lombardy, Friuli Venezia Giulia, Tuscany and Campania). GPs performed a 2 days course to learn a drug algorithm. A complex program (Genomedics® ) allowed to evaluate their performances analyzing 20 different indicators (coherence between diagnosis and treatment and percentage of patients with correct treatment) Results: We observed significative changes in drug prescription between the analyzed periods. Conclusions: Education program based on pathophysiological findings changed the prescription behaviors in our population sample. Further studies are needed to demonstrate an improvement in the outcome of patients with chronic non-cancerous pain. Disclosure: None declared
Epidemiology and Assessment S501 PREVALENCE, CHARACTERISTICS AND FACTORS ASSOCIATED WITH CHRONIC PAIN WITH AND WITHOUT NEUROPATHIC CHARACTERISTICS IN BRAZIL E.B.D.M. Vieira1 , J.B.S. Garcia2 *, A.A.M. Silva3 , R.L.T.M. Araujo ´ 4, R.C.S. Jansen4 . 1 Pain and Palliative Care/Academic Pain League, 2 Anesthesiology, Pain and Palliative Care, 3 Public Health and Epidemiology, 4 Academic Pain League, Federal University of Maranh˜ ao, S˜ ao Lu´ıs, Brazil Background and Aims: Chronic pain with and without neuropathic characteristics is a public health problem. This is the first population-based study in South America and the third study in the world to use the DN4 questionnaire in epidemiological studies. Our objectives were to estimate the prevalence and associated factors of chronic pain (CP) with and without neuropathic characteristics in Brazil. Methods: We surveyed 1,597 people, selected at random sampling. In addition to a questionnaire related to CP, we applied the DN4 questionnaire. We used Poisson regression to analyze the risk factors. Results: The prevalence of CP was 42%, and 10% had chronic pain with neuropathic characteristics (CPNC). The results showed that female sex and age ≥30 years were associated with an increased prevalence of CP, and education ≥12 years with a reduction in CP prevalence. The sensations reported most often were tingling (80.25%), pins and needles (87.90%) and numbness (80.25%). Cephalic region and limbs were the most frequently affected areas.
POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
Most respondents felt pain between 6 months and 4 years with daily frequency. Pain intensity, the impediments caused by pain and sadness were more prevalent in people who had CPNC. Health status was regular for most, 50.89% did not know the cause of their pain, 64.09% used drugs and only 6.95% had consulted with a pain specialist. Dissatisfaction with treatment was reported by 55.03%. Conclusions: CP with and without neuropathic characteristics is a public health problem in Brazil, with high prevalence and great influence on people’s daily lives. Disclosure: None declared
S502 EPIDEMIOLOGICAL ASPECTS OF NECK PAIN. ANALYZING COMMON AND RECURRENT BINARY OUTCOMES A. Grimby-Ekman *, E.M. Andersson, M. Hagberg. Public Health and Community Medicine, Medicine/Sahlgrenska Academy/Gothenburg University, Gothenburg, Sweden Background and Aims: Musculoskeletal pain is one common and recurrent outcome of importance when investigating health differences among women and men. Due to the high prevalence of musculoskeletal pain in many groups, the odds ratio (OR) will overestimate the risk ratio (RR). A third effect measure is the risk difference (RD), that is anabsolute measure sensitive to the level of risk. The choice between relative (RR and OR) and absolute (RD) effect measures are discussed and an empirical illustration is presented, where the impact of perceived stress and computer use pattern (break pattern) on neck pain is investigated. Methods: The sample consisted of 1,200 (627 women, 573 men) Swedish university students, aged 19–25, with 5 annual assessments. To handle the possible positive correlation between repeated measurements a random intercept logistic model was used. Results: For both women and men perceived stress and computer use pattern was associated with neck pain. Among women some cases of neck pain seems to be due to the simultaneous presence of both perceived stress and computer use pattern. 0.5 Lagged stress, Comp use without breaks 0.45
Stress, Comp use without breaks Comp use without breaks
Subject-specific (median) risk of neck pain
Lagged stress Stress
0.03
0.35
Unexplained 0.04 0.3 0.07 0.25 0.02
0.02
0.05
0.05
0.2
0.15 0.07
0.07
0.07
0.09
0.09
0.09
0.1
0.05
0.09
0.02 0 No stress
Stress
No stress
Stress
0.02
0.02
0.01 0.02
No stress
Stress
No stress
0.01 0.01 0.02 0.02 Stress
Computer use with breaks Computer use without breaks Computer use with breaks Computer use without breaks WOMEN
neck pain. Hence, the choice between absolute and relative effect measures should be ruled by the aim of the study. Disclosure: None declared
S503 CHRONIC NON-CANCER PAIN IN DENMARK: A NATION WIDE SURVEY G.P. Kurita1,2,3 , P. Sjøgren2 , K. Juel4 , J. Højsted1 *, O. Ekholm4 . 1 Multidisciplinary Pain Centre, 2 Section for Acute Pain Treatment and Palliative Medicine, Rigshospitalet, Copenhagen, Denmark; 3 School of Nursing, University of S˜ ao Paulo, S˜ ao Paulo, Brazil; 4 National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark Background and Aims: Studying chronic pain risk factors and consequences is a prerequisite for prevention and treatment. This survey aimed to estimate the current prevalence of chronic noncancer pain in the Danish adult population and to investigate the association between potential risk-factors and chronic pain. Methods: Data derives from the Danish Health Survey 2010. The survey was based on random sample of 25,000 individuals (16 years or older). Selected individuals were invited to fill in a mailed or online questionnaire. In all, 60.7% completed the questionnaire and 14,099 individuals with no cancer history were identified. The questionnaire included items on e.g. chronic pain (≥6 months), socio-demographic characteristics, health behavior, morbidity and health-related quality of life (SF-12). Results: In all, 26.1% (95% CI: 25.4–26.8) of the adult Danish population with no cancer history reported that they have chronic pain. Results from a multiple logistic regression analyze showed that female gender, old age, short education, being single (divorced, separated or widowed) and non-western ethnic background were associated with chronic pain. Most common pain locations were back (14.0%), shoulder/arms (13.2%) and legs (11.9%). Pain intensity increased according to increasing number of chronic pain locations (p < 0.0001). Individuals with chronic pain were more likely to report other health problems (e.g. hypertension, asthma, cardiovascular disease and diabetes) and worse healthrelated quality of life than individuals without chronic pain. Conclusions: High prevalence of chronic pain in Denmark was associated with demographics, ethnicity and comorbidity. Disclosure: None declared
S504 PREVALENCE OF PAIN EXPERIENCE AMONG YOUNG BREAST CANCER WOMEN FOUR YEARS AFTER DIAGNOSIS: DATA OF THE FRENCH COHORT ELIPPSE40 M.K. Bendiane *, D. Rey, A.-D. Bouhnik, P. Peretti-Watel. SE4S, ORS PACA – INSERM UMR 912, Marseille, France
Stress, Lagged stress
0.4
261
MEN
Figure: Estimated risk of neck pain.
Conclusions: The estimated effect of the risk factors percieved stress and computer use pattern differed depending on the choice of effect measure. For men the absolute effect of stress was small, but the relative effect indicated that stress doubled the risk of
Background and Aims: Pain is one of the most important effects of cancer treatment that dramatically affects quality of life of survivors. However studies had documented that physicians tend to underestimate pain experience, especially for women patients. We attempted to measure the prevalence of pain experience four years after diagnosis among young women with breast cancer. Methods: Since July 2005, all consecutive women included in the File of the French National Health Insurance Fund for a diagnosis of primary non-metastatic breast cancer, aged 18–40 years and living in South Eastern France have been asked to participate in ELIPPSE40 follow-up. Women who agree to participate answer questionnaire in the month after diagnosis and 10, 16, 36 and 48 months later. At each point of patient’s follow-up, pain experience is assessed by detailed questions. Results: From July 2005 to March 2007, 217 women agreed to participate, 11 died and 173 women were followed (4-years attrition rate: 17%). We studied pain experience of 160 survivors (excluding 13 women with cancer recurrence or second cancer). Among them 51% reported recent in breast area pain (including arm
POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
randomized in two groups; with or without a follow-up intervention. The follow-up intervention included one face-toface interview and four weeks of written communication via a smartphone. Participants filled out three diaries daily to support self-monitoring of thoughts and feelings and planning and evaluation of daily activities. The registered diaries were immediately available to a therapist who submitted daily a tailored feedback on a secure website accessible on the phone. Both groups had access to a non-interactive web page with descriptions of selected ACT exercises and audio files with mindfulness exercises. Primary outcome variable was catastrophizing measured with Pain Catastrophizing Scale. Secondary outcomes included acceptance, values-based living and emotional distress. Data was gathered before and after the rehabilitation program and after the followup. Results: Preliminary results indicate that the follow-up intervention is effective in reducing catastrophizing and increasing activity engagement. Short-term effects on primary and secondary outcomes variables will be presented. Conclusions: Smartphone delivered follow-up intervention based on ACT seems to enhance the effect of inpatient rehabilitation and could be developed as part of standard care. Disclosure: None declared
S430 FIRST YEAR RESULTS OF EDUCATIONAL PROGRAM IN CHRONIC PAIN FOR FRENCH SPEAKING PATIENTS G. Vargas-Schaffer1 *, J. Cogan2 , M. Racine3 , C. Jeannotte1 , C. Haworth1 , J. Cayac1 , A. Busson1 , J. Cloutier1 , G. Besner1 . 1 Anaesthesiology, 2 Anaesthesiology Institut de Cardiologie, University of Montreal, 3 Centre de Recherche du CHUM, CRCHUM, Montreal, QC, Canada Background and Aims: There is a growing interest in providing educational programs for patients suffering from chronic diseases. Our aim was to create an Educational Program in Chronic Pain (EPCP) for patients, tailored to their needs and measure the levels of knowledge of patients in self-management of chronic pain. We present the results of the first year of this work. Methods: A survey was completed for patients at pain clinic at Hˆotel-Dieu du CHUM. A total of 25 patients completed an open ended questionnaire and specified what they wished to see in an EPCP. Once we had identified the topics in the survey, we have elaborated and prepared the EPCP with a multidisciplinary team. We elaborated 6 interactive sessions, and created educational materials. The knowledge’s patients were evaluated with 18 questionnaires. Data findings were analysed using a descriptive statistical method. Results: The first year our EPCP made 5 groups with a total of 63 patients and a variable number “significant others” accompanying them. Patients increased their knowledge of chronic pain from a 2.8% to 24%, according to their own assessment. The PMCA satisfaction was assessed at 5.33/7 scale Linkert. Conclusion: Our program helps patients and their families to gain and maintain the skills they need to best manage their lives by helping them understand both their illness and treatment. We also help them to work together and assume responsibility for their own care in order to help them maintain and improve their quality of life. Disclosure: None declared
S431 COMPASS: CHRONIC NON-CANCEROUS PAIN EDUCATION PROGRAMME, IMPACT ON ITALIAN GENERAL PHYSICIAN’S PRESCRIPTION G. Fanelli1 , C. Compagnone1 *, F. Tagliaferri1 , P. Loraprile2 , C. Bonazzi3 , G. Ventriglia2 , C. Cricelli4 . 1 Anesthesia, University of Parma, Parma, 2 General Practitioner, Societ` a Italiana di Medici Generali, Brescia, 3 Pain Therapy, Fondazione Salvatore Maugeri – Istituto Scientifico di Pavia, Pavia, 4 General Practitioner, Societ` a Italiana di Medici Generali, Firenze, Italy Background and Aims: The majority of patients with chronic pain are generally treated by general practitioners. Unfortunately, several studies had highlighted the frequent misinterpretation and the lack of adherence to the referral guidelines. The aim of the present study was to analyze the influence of noncancerous chronic pain management education program on general physician’s prescription. Methods: A sample of 200 general practitioners (GPs) was selected among those who regularly use the electronic-Problem Oriented Medical Record (e-POMR, Millewin® ) for daily activities (Health Care or Research). The selected GPs were members of the Italian Society of General Practice (SIMG) and worked in five Italian Regions (Piedmont, Lombardy, Friuli Venezia Giulia, Tuscany and Campania). GPs performed a 2 days course to learn a drug algorithm. A complex program (Genomedics® ) allowed to evaluate their performances analyzing 20 different indicators (coherence between diagnosis and treatment and percentage of patients with correct treatment) Results: We observed significative changes in drug prescription between the analyzed periods. Conclusions: Education program based on pathophysiological findings changed the prescription behaviors in our population sample. Further studies are needed to demonstrate an improvement in the outcome of patients with chronic non-cancerous pain. Disclosure: None declared
Epidemiology and Assessment S501 PREVALENCE, CHARACTERISTICS AND FACTORS ASSOCIATED WITH CHRONIC PAIN WITH AND WITHOUT NEUROPATHIC CHARACTERISTICS IN BRAZIL E.B.D.M. Vieira1 , J.B.S. Garcia2 *, A.A.M. Silva3 , R.L.T.M. Araujo ´ 4, R.C.S. Jansen4 . 1 Pain and Palliative Care/Academic Pain League, 2 Anesthesiology, Pain and Palliative Care, 3 Public Health and Epidemiology, 4 Academic Pain League, Federal University of Maranh˜ ao, S˜ ao Lu´ıs, Brazil Background and Aims: Chronic pain with and without neuropathic characteristics is a public health problem. This is the first population-based study in South America and the third study in the world to use the DN4 questionnaire in epidemiological studies. Our objectives were to estimate the prevalence and associated factors of chronic pain (CP) with and without neuropathic characteristics in Brazil. Methods: We surveyed 1,597 people, selected at random sampling. In addition to a questionnaire related to CP, we applied the DN4 questionnaire. We used Poisson regression to analyze the risk factors. Results: The prevalence of CP was 42%, and 10% had chronic pain with neuropathic characteristics (CPNC). The results showed that female sex and age ≥30 years were associated with an increased prevalence of CP, and education ≥12 years with a reduction in CP prevalence. The sensations reported most often were tingling (80.25%), pins and needles (87.90%) and numbness (80.25%). Cephalic region and limbs were the most frequently affected areas.
POSTER SESSIONS / European Journal of Pain Supplements 5 (2011) 15–295
Most respondents felt pain between 6 months and 4 years with daily frequency. Pain intensity, the impediments caused by pain and sadness were more prevalent in people who had CPNC. Health status was regular for most, 50.89% did not know the cause of their pain, 64.09% used drugs and only 6.95% had consulted with a pain specialist. Dissatisfaction with treatment was reported by 55.03%. Conclusions: CP with and without neuropathic characteristics is a public health problem in Brazil, with high prevalence and great influence on people’s daily lives. Disclosure: None declared
S502 EPIDEMIOLOGICAL ASPECTS OF NECK PAIN. ANALYZING COMMON AND RECURRENT BINARY OUTCOMES A. Grimby-Ekman *, E.M. Andersson, M. Hagberg. Public Health and Community Medicine, Medicine/Sahlgrenska Academy/Gothenburg University, Gothenburg, Sweden Background and Aims: Musculoskeletal pain is one common and recurrent outcome of importance when investigating health differences among women and men. Due to the high prevalence of musculoskeletal pain in many groups, the odds ratio (OR) will overestimate the risk ratio (RR). A third effect measure is the risk difference (RD), that is anabsolute measure sensitive to the level of risk. The choice between relative (RR and OR) and absolute (RD) effect measures are discussed and an empirical illustration is presented, where the impact of perceived stress and computer use pattern (break pattern) on neck pain is investigated. Methods: The sample consisted of 1,200 (627 women, 573 men) Swedish university students, aged 19–25, with 5 annual assessments. To handle the possible positive correlation between repeated measurements a random intercept logistic model was used. Results: For both women and men perceived stress and computer use pattern was associated with neck pain. Among women some cases of neck pain seems to be due to the simultaneous presence of both perceived stress and computer use pattern. 0.5 Lagged stress, Comp use without breaks 0.45
Stress, Comp use without breaks Comp use without breaks
Subject-specific (median) risk of neck pain
Lagged stress Stress
0.03
0.35
Unexplained 0.04 0.3 0.07 0.25 0.02
0.02
0.05
0.05
0.2
0.15 0.07
0.07
0.07
0.09
0.09
0.09
0.1
0.05
0.09
0.02 0 No stress
Stress
No stress
Stress
0.02
0.02
0.01 0.02
No stress
Stress
No stress
0.01 0.01 0.02 0.02 Stress
Computer use with breaks Computer use without breaks Computer use with breaks Computer use without breaks WOMEN
neck pain. Hence, the choice between absolute and relative effect measures should be ruled by the aim of the study. Disclosure: None declared
S503 CHRONIC NON-CANCER PAIN IN DENMARK: A NATION WIDE SURVEY G.P. Kurita1,2,3 , P. Sjøgren2 , K. Juel4 , J. Højsted1 *, O. Ekholm4 . 1 Multidisciplinary Pain Centre, 2 Section for Acute Pain Treatment and Palliative Medicine, Rigshospitalet, Copenhagen, Denmark; 3 School of Nursing, University of S˜ ao Paulo, S˜ ao Paulo, Brazil; 4 National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark Background and Aims: Studying chronic pain risk factors and consequences is a prerequisite for prevention and treatment. This survey aimed to estimate the current prevalence of chronic noncancer pain in the Danish adult population and to investigate the association between potential risk-factors and chronic pain. Methods: Data derives from the Danish Health Survey 2010. The survey was based on random sample of 25,000 individuals (16 years or older). Selected individuals were invited to fill in a mailed or online questionnaire. In all, 60.7% completed the questionnaire and 14,099 individuals with no cancer history were identified. The questionnaire included items on e.g. chronic pain (≥6 months), socio-demographic characteristics, health behavior, morbidity and health-related quality of life (SF-12). Results: In all, 26.1% (95% CI: 25.4–26.8) of the adult Danish population with no cancer history reported that they have chronic pain. Results from a multiple logistic regression analyze showed that female gender, old age, short education, being single (divorced, separated or widowed) and non-western ethnic background were associated with chronic pain. Most common pain locations were back (14.0%), shoulder/arms (13.2%) and legs (11.9%). Pain intensity increased according to increasing number of chronic pain locations (p < 0.0001). Individuals with chronic pain were more likely to report other health problems (e.g. hypertension, asthma, cardiovascular disease and diabetes) and worse healthrelated quality of life than individuals without chronic pain. Conclusions: High prevalence of chronic pain in Denmark was associated with demographics, ethnicity and comorbidity. Disclosure: None declared
S504 PREVALENCE OF PAIN EXPERIENCE AMONG YOUNG BREAST CANCER WOMEN FOUR YEARS AFTER DIAGNOSIS: DATA OF THE FRENCH COHORT ELIPPSE40 M.K. Bendiane *, D. Rey, A.-D. Bouhnik, P. Peretti-Watel. SE4S, ORS PACA – INSERM UMR 912, Marseille, France
Stress, Lagged stress
0.4
261
MEN
Figure: Estimated risk of neck pain.
Conclusions: The estimated effect of the risk factors percieved stress and computer use pattern differed depending on the choice of effect measure. For men the absolute effect of stress was small, but the relative effect indicated that stress doubled the risk of
Background and Aims: Pain is one of the most important effects of cancer treatment that dramatically affects quality of life of survivors. However studies had documented that physicians tend to underestimate pain experience, especially for women patients. We attempted to measure the prevalence of pain experience four years after diagnosis among young women with breast cancer. Methods: Since July 2005, all consecutive women included in the File of the French National Health Insurance Fund for a diagnosis of primary non-metastatic breast cancer, aged 18–40 years and living in South Eastern France have been asked to participate in ELIPPSE40 follow-up. Women who agree to participate answer questionnaire in the month after diagnosis and 10, 16, 36 and 48 months later. At each point of patient’s follow-up, pain experience is assessed by detailed questions. Results: From July 2005 to March 2007, 217 women agreed to participate, 11 died and 173 women were followed (4-years attrition rate: 17%). We studied pain experience of 160 survivors (excluding 13 women with cancer recurrence or second cancer). Among them 51% reported recent in breast area pain (including arm