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The occurrence of headache pain among polytrauma patients with and without traumatic brain injury
S74 (398) Sleep duration is associated with distraction analgesia C Campbell, L Buenaver, A Carteret, K Witmer, R Edwards, M Smith, J Haythornthwaite; Johns Hopkins, Baltimore, MD Behavioral analgesic techniques such as distraction have been shown to reduce pain in clinical samples and in the context of experimentally-administered noxious stimuli. This powerful technique is presumed to operate in-part through activation of descending inhibitory pathways initiated by release of endogenous opioids. However, individuals differ in the magnitude of distraction analgesia, and additional study is needed to identify factors that influence distraction’s effectiveness. Sleep quality/ quantity is increasingly recognized as an important factor impacting pain. Interestingly, sleep deprivation has been shown to alter opioid function. In this study, we sought to evaluate the impact of sleep on the magnitude of distraction analgesia. Thirty-two healthy participants completed three sessions in a randomized order. In one session, pain was induced by a 60-minute topical application of a 10% capsaicin cream to the non-dominant hand. Verbal ratings of capsaicin pain were obtained at regular intervals on a 0-100 numeric rating scale. In another session, identical capsaicin application procedures were followed, but during the experience of capsaicin pain, subjects played a series of video games. Again, verbal pain ratings of capsaicin pain were obtained at regular intervals while engaged in the distracting video game tasks. The third session involved assessing performance on the video games in isolation (no capsaicin was applied). Participants completed a questionnaire pertaining to their sleep over the past several weeks. Twenty-nine percent of the sample slept <6.5hour/night, a cut-off prior work by our group has shown to be associated with enhanced next-day pain frequency in the general population. Individuals who sleep less than 6.5 hours/night in the month prior to the study experienced significantly less behavioral analgesia (p = 0.042), despite controlling for the degree of pain elicited by capsaicin This suggests that poor sleepers may derive less analgesic benefit from distraction and further indicates altered inhibitory regulation.
Abstracts (400) Hypothalamic-pituitary-adrenocortical activity in older adults with low back pain J Garofalo, R Robinson, R Gatchel, T Whitfill; University of Texas at Arlington, Arlington, TX Estimates indicate that nearly 2/3 of older adults living in the US experience chronic pain. In light of the growing number of older adults, there is a strong need to understand the biobehavioral factors that contribute to the onset and maintenance of pain in this population. Our laboratory has examined the role of the hypothalamic-pituitary-adrenocortical (HPA) axis in pain and has found that the quality of cortisol release, rather than the quantity, is a more telling biobehavioral variable in chronic pain. Specifically, we found that the greater the variability of cortisol secretion, the greater the dysregulation of the HPA axis. The present study sought to determine whether age influences ‘‘HPA dysregulation’’ by comparing 20 young adults (<54 years of age) to 20 older adults (55>), all of whom had LBP for less than six months. Pain severity assessment was measured by using a 10-point visual analogue scale. Cortisol procedures involved collecting saliva samples in order to analyze free cortisol levels upon awakening and 20 minutes later. Younger LBP patients exhibited greater mean cortisol levels (M = .3779, SD = .2182) compared to older LBP patients (M = .3545, SD = .2489, p<.02). However, in terms of cortisol release variability, no differences were observed between the two groups. For pain severity, older patients greater pain severity (Mean = 2.91, SD = 2.15) than younger LBP patients (Mean = 2.57, SD = 2.22; p<.05). In spite of no differences in cortisol secretion variability, we postulate that the lower cortisol levels observed in older LBP patients suggest HPA dysregulation. These data coincide with research demonstrating HPA changes in older adults, which may be more pronounced in the presence of a medical condition. Greater pain ratings from older adults, coupled with differences in cortisol levels, suggest that dysfunction of the neuroendocrine system in pain patients may be magnified by endocrine changes that accompany aging.
(399) The occurrence of headache pain among polytrauma patients with and without traumatic brain injury
(401) Treatment of chronic pain using an interdisciplinary approach: coping and affective outcomes
E Andrews, M Clark; James A Haley VA Medical Center, Tampa, FL Traumatic Brain Injury (TBI) and pain are two of the most important clinical issues facing active duty U.S. soldiers and veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). Returning military personnel with injuries to multiple organ systems are treated in VA system through the Polytrauma System of Care, and one of the most pervasive problems seen in this population is headache pain. The current study was designed to explore the prevalence and nature of headache pain among polytrauma patients. This retrospective study involved the review of medical records of active duty soldiers and veterans who have incurred polytrauma injuries in the OIF/OEF conflicts (n = 189). Medical records for patients who were treated at a Polytrauma Rehabilitation Center (PRC) between 2003 and 2006 were reviewed for this study. Medical records reviews focused on patients’ injury pattern and circumstances, self-reported or inferred pain, pain-related disabilities, and pain management interventions utilized during their rehabilitation. Initial data analyses demonstrated that TBI (79%) and headache pain (33%) were common problems in this sample of PRC patients. Further analysis suggested that polytrauma patients with TBI as a result of a penetrating head injury were more likely to experience headache pain, whereas polytrauma patients with TBI as a result of a closed head injury were less likely to experience headache pain. Additionally, headaches were more common among polytrauma patients experiencing blast injuries regardless of whether or not a diagnosis of TBI was present. The implications of these findings for polytrauma pain treatment will be discussed.
S Barrett, C Gagnon, S Stanos, P Joseph, L Rader, N Harden; Rehabilitation Institute of Chicago, Center for Pain Management, Chicago, IL The efficacy of our interdisciplinary treatment approach was assessed in 69 patients with chronic pain. Treatment took place within a US-based tertiary care setting. Patients participated in either an intensive (5 days per week) or a modified (1-2 half days per week) outpatient program. Treatment included individual and/or group appointments with pain psychology, physical and occupational therapy, relaxation training, and medical management. Patients also participated in group nursing lectures, vocational lectures, and movement-based classes including Feldenkrais. Outcome measures included the total scores on the Center for Epidemiologic Studies Depression scale, the Pain Anxiety Symptoms Scale, and the Chronic Pain Acceptance Questionnaire, and all subscales (Distraction, Catastophizing, Ignoring, Distancing, Cognitive Coping, Praying) from the Coping Strategies Questionnaire-Revised (CSQ-R). Paired-samples t-tests showed significant reductions in depression [t67 = 6.525, p < .000] and pain-related anxiety [t68 = 3.266, p = .002], as well as significant increases in acceptance of pain [t66 = 6.495, p < .000]. Analysis of the CSQ-R revealed a significant decrease in painrelated catastrophizing [t67 = 4.147, p < .000] as well as increases in the use of distraction [t67 = 4.9887, p < .000], cognitive coping [t66 = 5.501, p < .000], distancing [t67 = 4.257, p < .000], and ignoring pain [t67 = 5.182, p < .000]. There was no pre-post change in the use of prayer to cope with pain. Overall, the data suggest that participation in our interdisciplinary programs results in higher levels of pain acceptance, improved emotional functioning, and an improved ability to cope with pain at discharge. Results regarding the effects of treatment on pain levels are currently being tabulated and will also be presented.
Abstracts (400) Hypothalamic-pituitary-adrenocortical activity in older adults with low back pain J Garofalo, R Robinson, R Gatchel, T Whitfill; University of Texas at Arlington, Arlington, TX Estimates indicate that nearly 2/3 of older adults living in the US experience chronic pain. In light of the growing number of older adults, there is a strong need to understand the biobehavioral factors that contribute to the onset and maintenance of pain in this population. Our laboratory has examined the role of the hypothalamic-pituitary-adrenocortical (HPA) axis in pain and has found that the quality of cortisol release, rather than the quantity, is a more telling biobehavioral variable in chronic pain. Specifically, we found that the greater the variability of cortisol secretion, the greater the dysregulation of the HPA axis. The present study sought to determine whether age influences ‘‘HPA dysregulation’’ by comparing 20 young adults (<54 years of age) to 20 older adults (55>), all of whom had LBP for less than six months. Pain severity assessment was measured by using a 10-point visual analogue scale. Cortisol procedures involved collecting saliva samples in order to analyze free cortisol levels upon awakening and 20 minutes later. Younger LBP patients exhibited greater mean cortisol levels (M = .3779, SD = .2182) compared to older LBP patients (M = .3545, SD = .2489, p<.02). However, in terms of cortisol release variability, no differences were observed between the two groups. For pain severity, older patients greater pain severity (Mean = 2.91, SD = 2.15) than younger LBP patients (Mean = 2.57, SD = 2.22; p<.05). In spite of no differences in cortisol secretion variability, we postulate that the lower cortisol levels observed in older LBP patients suggest HPA dysregulation. These data coincide with research demonstrating HPA changes in older adults, which may be more pronounced in the presence of a medical condition. Greater pain ratings from older adults, coupled with differences in cortisol levels, suggest that dysfunction of the neuroendocrine system in pain patients may be magnified by endocrine changes that accompany aging.
(399) The occurrence of headache pain among polytrauma patients with and without traumatic brain injury
(401) Treatment of chronic pain using an interdisciplinary approach: coping and affective outcomes
E Andrews, M Clark; James A Haley VA Medical Center, Tampa, FL Traumatic Brain Injury (TBI) and pain are two of the most important clinical issues facing active duty U.S. soldiers and veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). Returning military personnel with injuries to multiple organ systems are treated in VA system through the Polytrauma System of Care, and one of the most pervasive problems seen in this population is headache pain. The current study was designed to explore the prevalence and nature of headache pain among polytrauma patients. This retrospective study involved the review of medical records of active duty soldiers and veterans who have incurred polytrauma injuries in the OIF/OEF conflicts (n = 189). Medical records for patients who were treated at a Polytrauma Rehabilitation Center (PRC) between 2003 and 2006 were reviewed for this study. Medical records reviews focused on patients’ injury pattern and circumstances, self-reported or inferred pain, pain-related disabilities, and pain management interventions utilized during their rehabilitation. Initial data analyses demonstrated that TBI (79%) and headache pain (33%) were common problems in this sample of PRC patients. Further analysis suggested that polytrauma patients with TBI as a result of a penetrating head injury were more likely to experience headache pain, whereas polytrauma patients with TBI as a result of a closed head injury were less likely to experience headache pain. Additionally, headaches were more common among polytrauma patients experiencing blast injuries regardless of whether or not a diagnosis of TBI was present. The implications of these findings for polytrauma pain treatment will be discussed.
S Barrett, C Gagnon, S Stanos, P Joseph, L Rader, N Harden; Rehabilitation Institute of Chicago, Center for Pain Management, Chicago, IL The efficacy of our interdisciplinary treatment approach was assessed in 69 patients with chronic pain. Treatment took place within a US-based tertiary care setting. Patients participated in either an intensive (5 days per week) or a modified (1-2 half days per week) outpatient program. Treatment included individual and/or group appointments with pain psychology, physical and occupational therapy, relaxation training, and medical management. Patients also participated in group nursing lectures, vocational lectures, and movement-based classes including Feldenkrais. Outcome measures included the total scores on the Center for Epidemiologic Studies Depression scale, the Pain Anxiety Symptoms Scale, and the Chronic Pain Acceptance Questionnaire, and all subscales (Distraction, Catastophizing, Ignoring, Distancing, Cognitive Coping, Praying) from the Coping Strategies Questionnaire-Revised (CSQ-R). Paired-samples t-tests showed significant reductions in depression [t67 = 6.525, p < .000] and pain-related anxiety [t68 = 3.266, p = .002], as well as significant increases in acceptance of pain [t66 = 6.495, p < .000]. Analysis of the CSQ-R revealed a significant decrease in painrelated catastrophizing [t67 = 4.147, p < .000] as well as increases in the use of distraction [t67 = 4.9887, p < .000], cognitive coping [t66 = 5.501, p < .000], distancing [t67 = 4.257, p < .000], and ignoring pain [t67 = 5.182, p < .000]. There was no pre-post change in the use of prayer to cope with pain. Overall, the data suggest that participation in our interdisciplinary programs results in higher levels of pain acceptance, improved emotional functioning, and an improved ability to cope with pain at discharge. Results regarding the effects of treatment on pain levels are currently being tabulated and will also be presented.