Intensive Pain Research Articles

HEMORRHOIDAL ENDOSCOPIC BAND LIGATION

Objective: To determine the management outcome of the endoscopic bandligation in the patients with internal haemorrhoids at isra university Hospital Hyderabad Sindh.Pakistan. Materials and methods: All the patients were under went sigmoidoscopy andcolonoscopy for the complete diagnosis and the patients were excluded, if polyps or evidenceof malignancy was found at colonoscopy. Haemorrhoids were sucked with the tip of endoscopefrom the anal canal and elastic bands were applied. After first treatment session, patients wereasked to complete a questionnaire to evaluate the subjective satisfaction, which was classifiedas poor, good and best. Patients who had with multiple haemorrhoids were recalled for theligation on remaining haemorrhoids after 2 weeks, if indicated. Results: Total 100 patients wereincluded in the study, In complications, intensive pain was found in the 55% of the cases whileother complications were seen in very few patients and many patients were seen without anycomplication. Hospital stay was only one day was noted in the very few patients and mostlypatients were discharged after few hours of the procedure. Outcome of the endoscopic bandligation was found excellent in 40% of the cases, good results found in the 45% of the cases andpoor results were seen only in the 15% of the cases. Re-endoscopic band ligation was donein the 20% of the cases and recurrence of hemorrhoids was noted in the 30% of the cases.Conclusions: We concluded that the endoscopic band ligation is very good management forhaemorrhoids without typical complications, with very short hospital stay and recurrences rate.

Psychological distress and stressful life events in pediatric complex regional pain syndrome.

There is little knowledge regarding the association between psychological factors and complex regional pain syndrome (CRPS) in children. Specifically, it is not known which factors precipitate CRPS and which result from the ongoing painful disease. To examine symptoms of depression and anxiety as well as the experience of stressful life events in children with CRPS compared with children with chronic primary headaches and functional abdominal pain. A retrospective chart study examined children with CRPS (n=37) who received intensive inpatient pain treatment between 2004 and 2010. They were compared with two control groups (chronic primary headaches and functional abdominal pain; each n=37), who also received intensive inpatient pain treatment. Control groups were matched with the CRPS group with regard to admission date, age and sex. Groups were compared on symptoms of depression and anxiety as well as stressful life events. Children with CRPS reported lower anxiety and depression scores compared with children with abdominal pain. A higher number of stressful life events before and after the onset of the pain condition was observed for children with CRPS. Children with CRPS are not particularly prone to symptoms of anxiety or depression. Importantly, children with CRPS experienced more stressful life events than children with chronic headaches or abdominal pain. Prospective long-term studies are needed to further explore the potential role of stressful life events in the etiology of CRPS.

Rapid treatment-induced brain changes in pediatric CRPS.

To date, brain structure and function changes in children with complex regional pain syndrome (CRPS) as a result of disease and treatment remain unknown. Here, we investigated (a) gray matter (GM) differences between patients with CRPS and healthy controls and (b) GM and functional connectivity (FC) changes in patients following intensive interdisciplinary psychophysical pain treatment. Twenty-three patients (13 females, 9 males; average age±SD=13.3±2.5years) and 21 healthy sex- and age-matched controls underwent magnetic resonance imaging. Compared to controls, patients had reduced GM in the primary motor cortex, premotor cortex, supplementary motor area, midcingulate cortex, orbitofrontal cortex, dorsolateral prefrontal cortex (dlPFC), posterior cingulate cortex, precuneus, basal ganglia, thalamus, and hippocampus. Following treatment, patients had increased GM in the dlPFC, thalamus, basal ganglia, amygdala, and hippocampus, and enhanced FC between the dlPFC and the periaqueductal gray, two regions involved in descending pain modulation. Accordingly, our results provide novel evidence for GM abnormalities in sensory, motor, emotional, cognitive, and pain modulatory regions in children with CRPS. Furthermore, this is the first study to demonstrate rapid treatment-induced GM and FC changes in areas implicated in sensation, emotion, cognition, and pain modulation.

EHMTI-0127. Three faces of pain-herpes zooster ophthalmicus

Background Herpes zoster ophthalmicus (HZO) occurs only the people who have been previously infected with varicella zooster virus (VZV). Primary infection is a chickenpox (95% VZV seropositivive in US adults). Reactivated forms its dormant status is the dorsal root, cranial nerve and other sensory ganglia may lay for years to decades. Reactivation of latens VZV localizated cutaneous rash erupting a single dermatome. It may travel along a sensory axon of the skin from vesicular lesions. Perineuritis causes intensive pain in the nerve distributionLifetime reactivation of VZV as shingles 50% incidence, HZO is rare (10-20%) of all VZV causes. HZO is a trigeminal manifestation of VZV. Reactivated VZV travels down V/1 and V/2 centripetal distribution. Contagious spread of the VZV may lead of the involvement of the other cranial nerves resulting optic neuropathy (II) isolated cranial nerve palsies (III. IV. especially IV.) neurogene motility disorders. Predisposing factors: immunecompromissed condition (decreased T-cell activity), acute herpes simplex virus infection and other reacting factors. Complications 50% of HZO patient is a postherpetic neuralgia (20% of a cases) involves the orbit (10-25% of a cases). Acute management: antiviral agent immediately-best prognosis started early-within 72 hours and general measures, ophthalmology consultation. Pain management: acute and postherpetic neuralgia. Our patient evaluated for left sided facial pain, unilateral “burning eye” and malaise that began two days ago. The neurological examination has been proven partially n. oculomotorius palsy of the left side and hyperaesthesia in dermatome V/1 unilateral side. Neuroimaging studies (cerebral and orbital CT and MRI) have shown normal status. Two days later on the face in the V/1 and V/2 dermatome we detected special characteristic skin symptom.

Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories

Even though nociceptive pathology has often long subsided, the brain of patients with chronic musculoskeletal pain has typically acquired a protective (movement-related) pain memory. Exercise therapy for patients with chronic musculoskeletal pain is often hampered by such pain memories. Here the authors explain how musculoskeletal therapists can alter pain memories in patients with chronic musculoskeletal pain, by integrating pain neuroscience education with exercise interventions. The latter includes applying graded exposure in vivo principles during exercise therapy, for targeting the brain circuitries orchestrated by the amygdala (the memory of fear centre in the brain).Before initiating exercise therapy, a preparatory phase of intensive pain neuroscience education is required. Next, exercise therapy can address movement-related pain memories by applying the ‘exposure without danger’ principle. By addressing patients' perceptions about exercises, therapists should try to decrease the anticipated danger (threat level) of the exercises by challenging the nature of, and reasoning behind their fears, assuring the safety of the exercises, and increasing confidence in a successful accomplishment of the exercise. This way, exercise therapy accounts for the current understanding of pain neuroscience, including the mechanisms of central sensitization.

Lumbosacral pain: Delivery of care to patients in the United Kingdom Podchufarova E.

Musculoskeletal pain syndromes are one of the most common causes of disability and referral to a medical specialist. Seven million consultations for lumbosacral pain are annually carried out in the United Kingdom. Examination of patients with back pain. Three levels of health care delivered to patients with back pain in the United Kingdom may be arbitrarily identified. Level 1 is outpatient: a general practitioner jointly with a manipulative therapist, a physiotherapist, a rehabilitation specialist, and mid-level health workers render care to patients with insignificant and mild pain syndrome; Level 2 is also outpatient, which involves the participation of a hospital or multidisciplinary team consultant, for example, in a musculoskeletal pain service or a specialized pain center; Level 3 is to deliver care at neurosurgical or orthopedic hospital, by applying invasive interventions. Acute back pain is a benign condition in the vast majority of cases; there is no need for additional instrumental and laboratory studies; but spinal X-ray study, computed tomography (СT scan), or magnetic resonance imaging (MRI), general blood and urine tests are required when marked neurological and somatic disorders are present. Management of patients with acute lumbosacral pain is to inform a patient about the benign nature of the disease; to exclude bed rest; to explain the need to maintain normal activity; to train how to correctly lift weights and to maintain normal posture; to refer for manual and exercise therapy in order to return to normal motor activity; to use proven effective medication. In most cases, acute back pain goes away spontaneously for a short period of time; an active treatment approach is considered to be optimal. Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are used for analgesia if required. Patients who show no improvement after 4 weeks of treatment need rescreening for markers of potentially dangerous spinal diseases, as well as determination of the signs of psychosocial ill-being and correction of therapy with consideration for identified disorders. Management of patients with subacute and chronic pain (persisting for >6 weeks, but <1 year) involves the regular reconsideration of whether the diagnosis of nonspecific back pain is correct in order to rule out possible specific causes. MRI is indicated when a patient is decided to be referred for surgical treatment or there is presumptive evidence for spinal tumors, infectious, inflammatory, or traumatic injury, or cauda equina syndrome. It is optimal to start treatment with a program of therapeutic exercises, manual therapy, or acupuncture. Drug therapy encompasses NSAIDs, acetaminophen, and opioids to treat intensive pain syndrome.

FRI0097 Factors Associated with Major Depressive Disorder in Rheumatoid Arthritis Patients

BackgroundPsychiatric disorders occur in rheumatoid arthritis (RA) patients very often. It is considered that major depressive disorder (MDD) in RA is stress-related and associated with disease activity and chronic pain.Objectivesto...

Editorial introductions

Editorial introductions

AB0791 Investigation of OA Progressing Factors in Prospective 5-Years Observation

BackgroundPrediction of osteoarthritis (OA) course presents certain difficulties, as early diagnostics of the disease is practically absent, the data on risk factors of progressing are controversial till now.ObjectivesTo single out...

OP0091 A Retrospective Look at the Recurrence of Digital Ulcers in Patients with Scleroderma after Discontinuation of Oral Treprostinil

BackgroundIschemic digital ulcers (DU) are a frequent complication in systemic sclerosis, estimated to occur in over 40% of patients. Treprostinil diethanolamine, a newer prostacyclin analog that has been developed for...

The responsive amygdala: Treatment-induced alterations in functional connectivity in pediatric complex regional pain syndrome

The amygdala is a key brain region with efferent and afferent neural connections that involve complex behaviors such as pain, reward, fear, and anxiety. This study evaluated resting state functional connectivity of the amygdala with cortical and subcortical regions in a group of chronic pain patients (pediatric complex regional pain syndrome) with age-sex matched control subjects before and after intensive physical-biobehavioral pain treatment. Our main findings include (1) enhanced functional connectivity from the amygdala to multiple cortical, subcortical, and cerebellar regions in patients compared with control subjects, with differences predominantly in the left amygdala in the pretreated condition (disease state); (2) dampened hyperconnectivity from the left amygdala to the motor cortex, parietal lobe, and cingulate cortex after intensive pain rehabilitation treatment within patients with nominal differences observed among healthy control subjects from time 1 to time 2 (treatment effects); (3) functional connectivity to several regions key to fear circuitry (prefrontal cortex, bilateral middle temporal lobe, bilateral cingulate, hippocampus) correlated with higher pain-related fear scores; and (4) decreases in pain-related fear associated with decreased connectivity between the amygdala and the motor and somatosensory cortex, cingulate, and frontal areas. Our data suggest that there are rapid changes in amygdala connectivity after an aggressive treatment program in children with chronic pain and intrinsic amygdala functional connectivity activity serving as a potential indicator of treatment response.

Bilateral Complex Regional Pain Syndrome Associated with Cervical Disc Herniation: A Case Report

AbstractObjectives: To report a previously undescribed sudden onset of bilateral complex regional pain syndrome [CRPS] associated with cervical disc herniation [CDH].Findings: A patient with sudden onset of intensive pain in both hands was diagnosed as bilateral CRPS. The etiologic factor was found to be CDH, spinal cord, and C6 nerve root compression. The diagnosis was confirmed by three-phase scintigraphy. The patient was treated with pregabalin.Conclusions: This case allows clinicians to suggest CDH in the etiology of CPRS, even if the patient does not have any symptoms and complaints resulting from CDH. The mechanism is not clear, but suggests nerve damage.

Impact of the newly implemented human feedback in contrast to Q-CPR® feedback and standard BLS on the “Effective Compression Ratio” outcome

Tanja Muschnig1,∗, Christoph Schriefl1, Matthias Muller1, Christoph Dibiasi1, Erich Pawelka1, Dominik Stumpf2, Franz Josef Nierscher3, Robert Greif4, Henrik Fischer5 1 Medical University Vienna, Vienna, Austria 2 Hospital of the Sisters of Charity Linz, Linz, Austria 3 Department of Anaesthesia, General Intensive Care and Pain Medicine, Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Medical University Vienna, Vienna, Austria 4 Department of Anaesthesiology and Pain Medicine, University Hospital Bern and University of Bern, Bern, Switzerland 5 Federal Ministry of the Interior, Vienna, Austria

(541) Guiding parent responses to their child’s pain during intensive interdisciplinary pediatric pain rehabilitation

Parental responses to their child's pain, particularly protective responses, are associated with the young person’s pain-related impairment, pain complaints, mood, and engagement in social activities. Research suggests these responses may be affected by the parent’s feelings of distress and helplessness, parent catastrophizing, and parent attributions about the cause of symptoms. However, few studies have investigated the effect of pediatric pain rehabilitation on parental responses or directly targeted these potential contributors to parent responses. While their adolescent children (ages 11-18) participated in a 3-6 week intensive interdisciplinary pediatric pain rehabilitation program, all 22 parents (primarily mothers) consistently attended two 60-90 minute parent groups per week led by a psychologist or social worker. Groups maintained a supportive and educational format, and parents were encouraged to share challenges of parenting a teen with pain, while also being prompted to interact with a specific topic each session (e.g. coping with own emotions, responding to teen pain, promoting appropriate teen independence, behavior management, and education about chronic pain). One parent from each family completed measures at baseline, the end of each week of treatment, and one-month follow-up, including the Adult Responses to Children’s Symptoms (ARCS) and the parent Functional Disability Inventory (FDI-parent). Teens reported their pain on a 100mm visual analog scale. Results indicate, on average, both parent protective and monitoring responses declined throughout the program (t=5.37; p<.001; t=6.18; p<.001, respectively) and these effects were maintained at follow-up. FDI-parent was somewhat associated with protective and monitoring parent responses at baseline (p’s<.05), but only with protective responses at program end (p<.05). Child pain was not associated with parent responses. In conclusion, parent groups during intensive interdisciplinary pediatric pain rehabilitation may be an effective format to target parent responses to their child’s pain, and these effects are not solely explained by improvements in child disability or pain. Parental responses to their child's pain, particularly protective responses, are associated with the young person’s pain-related impairment, pain complaints, mood, and engagement in social activities. Research suggests these responses may be affected by the parent’s feelings of distress and helplessness, parent catastrophizing, and parent attributions about the cause of symptoms. However, few studies have investigated the effect of pediatric pain rehabilitation on parental responses or directly targeted these potential contributors to parent responses. While their adolescent children (ages 11-18) participated in a 3-6 week intensive interdisciplinary pediatric pain rehabilitation program, all 22 parents (primarily mothers) consistently attended two 60-90 minute parent groups per week led by a psychologist or social worker. Groups maintained a supportive and educational format, and parents were encouraged to share challenges of parenting a teen with pain, while also being prompted to interact with a specific topic each session (e.g. coping with own emotions, responding to teen pain, promoting appropriate teen independence, behavior management, and education about chronic pain). One parent from each family completed measures at baseline, the end of each week of treatment, and one-month follow-up, including the Adult Responses to Children’s Symptoms (ARCS) and the parent Functional Disability Inventory (FDI-parent). Teens reported their pain on a 100mm visual analog scale. Results indicate, on average, both parent protective and monitoring responses declined throughout the program (t=5.37; p<.001; t=6.18; p<.001, respectively) and these effects were maintained at follow-up. FDI-parent was somewhat associated with protective and monitoring parent responses at baseline (p’s<.05), but only with protective responses at program end (p<.05). Child pain was not associated with parent responses. In conclusion, parent groups during intensive interdisciplinary pediatric pain rehabilitation may be an effective format to target parent responses to their child’s pain, and these effects are not solely explained by improvements in child disability or pain.

(546) Treatment of pediatric chronic pain associated with joint hypermobility in an interdisciplinary pain management program

Chronic pain is common in individuals with joint hypermobility syndromes, but effective treatment options are poorly described. Intensive interdisciplinary pain management programs, incorporating medication management, pain psychology, biofeedback, physical and occupational therapy are effective for the treatment of multiple chronic pain conditions. We aimed to determine if such a program can improve pain and function in pediatric patients with chronic pain related to joint hypermobility. This retrospective cohort study included patients less than 18 years of age diagnosed with a joint hypermobility syndrome and chronic pain, who were treated in an intensive 6-week program at an interdisciplinary pain management center. Outcomes measured included Numeric Rating Scale (NRS) pain scores, Bath Adolescent Pain Questionnaire (BAPQ), Child Functional Disability Index (C-FDI) and Parent Functional Disability Index (P-FDI). Changes from admission to discharge were compared by Wilcoxon rank-sum test and assessed for clinical significance according to Cochrane Review criteria for treatment of chronic pain. Eleven female patients, mean age of 14.6, standard deviation (SD) 2.2 years (ranging 9-17), were included. From admission to discharge, average NRS scores significantly decreased for typical pain (p = 0.08) and greatest daily pain (p = 0.03). Patients showed significant improvement in the daily functioning as measured by the BAPQ (p = 0.04). The mean magnitude of change was 2.6 (SD 2.2), 2.5 (SD 3.0), and 4.5 (SD 6.6) for the decrease in typical pain, decrease in greatest pain, and improvement in daily functioning, respectively, representing clinically improvement for each of these outcome measures. Improvements on the C-FDI, P-FDI, and the emotion domain of the BAP-Q were nonsignificant (p’s >.05). Our findings suggest that an intensive interdisciplinary pain management program results in improvements in pain and functional scores that are both statistically and clinically significant. Chronic pain is common in individuals with joint hypermobility syndromes, but effective treatment options are poorly described. Intensive interdisciplinary pain management programs, incorporating medication management, pain psychology, biofeedback, physical and occupational therapy are effective for the treatment of multiple chronic pain conditions. We aimed to determine if such a program can improve pain and function in pediatric patients with chronic pain related to joint hypermobility. This retrospective cohort study included patients less than 18 years of age diagnosed with a joint hypermobility syndrome and chronic pain, who were treated in an intensive 6-week program at an interdisciplinary pain management center. Outcomes measured included Numeric Rating Scale (NRS) pain scores, Bath Adolescent Pain Questionnaire (BAPQ), Child Functional Disability Index (C-FDI) and Parent Functional Disability Index (P-FDI). Changes from admission to discharge were compared by Wilcoxon rank-sum test and assessed for clinical significance according to Cochrane Review criteria for treatment of chronic pain. Eleven female patients, mean age of 14.6, standard deviation (SD) 2.2 years (ranging 9-17), were included. From admission to discharge, average NRS scores significantly decreased for typical pain (p = 0.08) and greatest daily pain (p = 0.03). Patients showed significant improvement in the daily functioning as measured by the BAPQ (p = 0.04). The mean magnitude of change was 2.6 (SD 2.2), 2.5 (SD 3.0), and 4.5 (SD 6.6) for the decrease in typical pain, decrease in greatest pain, and improvement in daily functioning, respectively, representing clinically improvement for each of these outcome measures. Improvements on the C-FDI, P-FDI, and the emotion domain of the BAP-Q were nonsignificant (p’s >.05). Our findings suggest that an intensive interdisciplinary pain management program results in improvements in pain and functional scores that are both statistically and clinically significant.

(548) Trajectories of child pain and function in intensive interdisciplinary pediatric pain rehabilitation

s The Journal of Pain S113 (548) Trajectories of child pain and function in intensive interdisciplinary pediatric pain rehabilitation C Hoffart, R Anderson, D Feltrop, M Wilson, B Dorton, A Chapman, and D Wallace; Children’s Mercy Hospital, Kansas City, MO Given the prevalence of pediatric chronic pain, degree of disability, and compromise in quality of life, there is a critical need to identify the natural history of pain anddisability. Few studies investigate the effect of interdisciplinary treatment on pain and functional trajectories in children with chronic musculoskeletal pain. We hypothesized function would improve prior to decrease in pain. 22 patients (18 female) aged 11-18 with chronic musculoskeletal pain completed the modified Bruce Treadmill Test, Functional Disability Inventory (FDI-patient), and reported pain using a 100mm Visual Analog Scale (VAS 0-100) at program start, the end of each week, and 19 completed one-month follow-up. One parent from each family completed FDI-parent, a measure of parent perception of pain-related functional limitations. Mean treatment program duration was 3.64 weeks (6 0.9). Patients’ pain worsens before it improves approximately halfway through the program. Pain increased from 61.7 at baseline to 72.1 and 67.5 at the end of weeks 1 (P=0.03) and 2 (P=0.22), respectively, with subsequent significant decrease in pain to 31.9 through post-treatment follow-up (P=0.001). Baseline patient and parent FDI scores correlated (27.6 and 25.5, respectively, r=.861; P< .0001) and demonstrated steady declines at week one and throughout treatment, indicating improved function prior to pain decrease. Patient FDI improved to 13.9 by program end (P<.0001) and continues to improve following treatment to 7.6 (P=.002). Bruce treadmill endurance increased steadily from baseline of 7.11 minutes with continued improvement through program end to 10.4 minutes (P<.0001). Concurrent trajectories of patient outcomes suggest that function improves before pain. Whereas pain gets worse during the first weeks of treatment, patient function increases within the first week. These trajectories may aid in determining the projected course for patients requiring intensive interdisciplinary pain rehabilitation. (549) Relationships among fear of pain and movement, strength test performance, and indicators of hypothalamic pituitary adrenal axis (HPA axis) activity E Dannecker and P Hinton; University of Missouri, Columbia, MO Two studies were located that tested associations between fear of pain and movement and performance during strength testing. They reported mixed results. In this study, we advance the literature by incorporating measures of Hypothalamic Pituitary Adrenal (HPA) axis activity – cortisol and blood pressure, whichwe collected directly before upper extremity strength tests. During a single session, healthy, upper-body untrained participants (N = 32, 46.9%women, 78% Caucasian, 24 yrs old (SD = 5.18)) completed measures of fear of pain and movement and pain catastrophizing before two consecutive strength tests using the non-dominant elbow flexors. Immediately before the strength tests, we collected blood pressure readings and saliva via an oral swab for cortisol. We also recorded perceived exertion, pain intensity, pain unpleasantness, and force output during the strength tests. Contrary to our hypotheses, we detected no significant associations among fear of pain and movement and cortisol, blood pressure, perceived effort, pain, or force output. However, systolic and diastolic blood pressure and perceived effort positively correlated with force output (r’s = .49 .61, p < .01; r’s = .57 .60, p < .01; r’s = .35 .42, p < .05). In addition, the total score of the Pain Catastrophizing Scale (PCS) and rumination subscale of the PCS inversely correlated with force output (r’s = -.37 -.40, p < .04; r’s = -.42 .46, p < .02). These results support that pain catastrophizing is more strongly related to force output than fear of pain and movement, but none of the psychological constructs were significantly associated with indicators of HPA axis activity. Future studies should test relationships among these variables in samples with clinical pain, conduct alternative types of strength and function tests, and administer otherHPAmeasures such as the corticotropin-releasing hormone challenge test. (550) Functional disability through initial and follow-up evaluations in a multidisciplinary pediatric headache clinic A Caruso, E Mahoney, L Lazdowsky, and A LeBel; Boston Children’s Hospital,

(555) Psychological functioning improves during intensive interdisciplinary pediatric pain rehabilitation

Intensive interdisciplinary pediatric pain rehabilitation programs seek to return children and adolescents who are disabled by pain to normal physical, social, and academic functioning. Psychological outcomes represent an important domain of functioning for these teens as they tend to show high levels of catastrophizing, have increased depressive symptoms, and tend to make avoidance of pain a priority over the pursuit of other goals and values. However, no study has specifically investigated the longitudinal pattern of change in these variables over the course of intensive treatment. Adolescents in our interdisciplinary pediatric pain rehabilitation program engage in physical therapy and occupational therapy, and each week also participate in 4.5 hours of yoga, 1 hour of self-regulation training, 2-3 hours of individual and 2-3 hours of group behavioral health intervention, and one hour each of group-based music and art therapy. Parents also attend 2-3 hours per week of group behavioral health intervention and occasional individual family sessions. For this investigation of initial outcomes, 22 participants completed measures (PROMIS anxiety and depression, PRCQ-catastrophizing, Pain Acceptance Questionnaire for Adolescents, and VAS pain ratings) at program baseline, the end of each week, and 19 completed one-month follow-up. Statistically-significant improvements in depression, anxiety, catastrophizing, and pain acceptance (all p’s<.01), but not pain, were observed during the program. Self-reported pain improved significantly between the end of the program and follow-up (t=3.14, p<.01), and pain acceptance showed further improvement between program-end and follow-up (t=3.17, p=.001). Heirarchical linear modeling analysis supports consistent improvement in psychological variables across the program and follow-up (all p’s<.001). Data also suggest that psychological variables change prior to changes in pain. These results suggest that interdisciplinary pediatric pain rehabilitation leads to steady improvements in psychological factors relevant to adolescents’ return to normal activities, and that changes in psychological functioning precede changes in self-reported pain. Intensive interdisciplinary pediatric pain rehabilitation programs seek to return children and adolescents who are disabled by pain to normal physical, social, and academic functioning. Psychological outcomes represent an important domain of functioning for these teens as they tend to show high levels of catastrophizing, have increased depressive symptoms, and tend to make avoidance of pain a priority over the pursuit of other goals and values. However, no study has specifically investigated the longitudinal pattern of change in these variables over the course of intensive treatment. Adolescents in our interdisciplinary pediatric pain rehabilitation program engage in physical therapy and occupational therapy, and each week also participate in 4.5 hours of yoga, 1 hour of self-regulation training, 2-3 hours of individual and 2-3 hours of group behavioral health intervention, and one hour each of group-based music and art therapy. Parents also attend 2-3 hours per week of group behavioral health intervention and occasional individual family sessions. For this investigation of initial outcomes, 22 participants completed measures (PROMIS anxiety and depression, PRCQ-catastrophizing, Pain Acceptance Questionnaire for Adolescents, and VAS pain ratings) at program baseline, the end of each week, and 19 completed one-month follow-up. Statistically-significant improvements in depression, anxiety, catastrophizing, and pain acceptance (all p’s<.01), but not pain, were observed during the program. Self-reported pain improved significantly between the end of the program and follow-up (t=3.14, p<.01), and pain acceptance showed further improvement between program-end and follow-up (t=3.17, p=.001). Heirarchical linear modeling analysis supports consistent improvement in psychological variables across the program and follow-up (all p’s<.001). Data also suggest that psychological variables change prior to changes in pain. These results suggest that interdisciplinary pediatric pain rehabilitation leads to steady improvements in psychological factors relevant to adolescents’ return to normal activities, and that changes in psychological functioning precede changes in self-reported pain.

(558) Child pain, function, and psychological outcomes in association with treatment duration in intensive interdisciplinary pediatric pain rehabilitation

We examined the functional, psychological, and pain-related outcomes among children with chronic pain completing an intensive interdisciplinary pediatric pain rehabilitation program. We hypothesized that baseline psychological measures would predict a longer treatment course while baseline pain severity would not correlate with program duration. This outpatient program provides 5-6 hours of daily intensive physical therapy and occupational therapy in addition to yoga, self-regulation training, individual and group behavioral health intervention, group-based music and art therapy, and parent group intervention.

(556) Chronic pain rehabilitation and alcohol use disorder: promising outcomes in an interdisciplinary treatment program

(556) Chronic pain rehabilitation and alcohol use disorder: promising outcomes in an interdisciplinary treatment program

A155: Development of an Intensive Interdisciplinary Pediatric Pain Rehabilitation Program: Improving Pain, Functioning, and Psychological Outcomes

Background/Purpose:We examined functional, psychological, and pain‐related outcomes among children with amplified pain syndromes completing an intensive interdisciplinary pediatric pain rehabilitation program. We hypothesized that baseline psychological measures and disability would predict a longer treatment course.Methods:This outpatient program provides 5–6 hours of daily intensive physical and occupational therapy in addition to yoga, self‐regulation, and behavioral health intervention. All pain medications are discontinued, and no invasive therapeutic procedures are utilized. 30 patients (26 female) aged 11–18 with chronic musculoskeletal pain completed Functional Disability Inventory, 100mm Visual Analog Scale, PROMIS Anxiety, Depression, and PRCQ‐catastrophizing at baseline and the end of each week; 22 have completed a one‐month follow‐up, and 6 completed six‐month follow‐up. The mean program duration was 3.7 (SD 0.91) weeks, determined by achievement of functional goals. Analyses were conducted with SPSS and supplemented with hierarchical linear modeling (HLM7) for time‐series analyses of pain and functioning.Results:There is linear improvement in parent‐reported FDI (25.2 to 7.3, P &lt; .001) and patient‐reported FDI (27.5 to 13.9, P &lt; .001) between baseline and program end. Patient‐reported function showed additional significant gains at 1 and 6‐month follow‐up with FDI of 7.2 and 2.8, respectively (P &lt; .001). Patient‐reported pain did not consistently change during the program (P = .975); however, longitudinal patterns demonstrated significant decrease in pain between program end and follow‐up (P &lt; .001). Pain is significantly affected by conversion symptoms, which are associated with higher levels of pain (P = .005) but did not affect the pattern of pain resolution. Patient reported anxiety and depression decline significantly (P = 0.004 and P = 0.001, respectively) as does patient catastrophizing following treatment (P = .001). Duration of treatment correlated with baseline functional disability (FDI r = .664; P = .001), and presence of conversion symptoms (r = .548; P = .008). imageConclusion:Children with amplified pain syndromes successfully restore and maintain function and improve pain without pharmacotherapy. Baseline functional disability and psychological factors correlate with treatment program duration. Prospective studies are warranted to determine long‐term efficacy and effectiveness of this interdisciplinary program.