Pain Inventory Questionnaire Research Articles

A burden of illness study for neuropathic pain in Europe.

PurposeNeuropathic pain (NP) is often severe and represents a major humanistic and economic burden. This study aimed at providing insight on this burden across France, Germany, Italy, Spain, and the UK, considering direct and indirect costs, productivity loss, and humanistic impact on patients and their families.MethodsPhysician questionnaires provided data on patients presenting with NP covering demographics, sick leave and retirement, number of consultations, drug treatments, and surgical procedures. Patients provided further demographic and disease-related data and completed the Work Productivity and Activity Impairment (WPAI), the EuroQol 5-Dimension (EQ-5D), and the Brief Pain Inventory (BPI) questionnaires. All health-related direct unitary costs were collected from relevant country-specific sources and adjusted to 2012 prices (€) where necessary. A subgroup analysis of costs based on diabetic peripheral neuropathy (n=894), fibromyalgia (n=300), and low back pain (n=963) was performed.FindingsAbout 413 physicians completed a total of 3,956 patient records forms. Total annual direct health-care costs per patient ranged from €1,939 (Italy) to €3,131 (Spain). Annual professional caregiver costs ranged from €393 (France) to €1,242 (UK), but this only represented a small proportion of total care because much care is provided by family or friends. Sick leave costs ranged from €5,492 (UK) to €7,098 (France), with 10%–32% patients prevented from working at some point by NP. Total cost (including direct and indirect costs) of NP per patient was €10,313 in France (69% of the total cost), €14,446 in Germany (78%), €9,305 in Italy (69%), €10,597 in Spain (67%), and €9,685 in the UK (57%). Indirect costs (ie, sick leave) constituted the majority of costs in all five countries: €7,098 in France, €11,232 in Germany, €6,382 in Italy, €7,066 in Spain, and €5,492 in the UK. In the subgroup analysis, total annual direct costs per patient were highest for neuropathic back pain and radiculopathy, and lowest for fibromyalgia. Mean WPAI score range was 34.4–56.1; BPI interference was 4.1–4.8; and EQ-5D was 0.57–0.74. The results suggest that a significant proportion of the patient’s work time in the previous week was affected by NP, and these are relatively high compared with other diseases such as diabetes, respiratory conditions, and arthritis.ImplicationsDespite differences in practice between countries, these findings suggest a high opportunity cost for society in terms of lost work and productivity due to NP. The wider costs appear significantly higher to patients, carers/families, and society as a whole than to the health system alone.

Qualificação da dor em trabalhadoras de uma malharia no sul do Brasil

Objective: To analyze and qualify pain in women workers of a textile factory in the south of Brazil. Methods: Cross-sectional descriptive study, with quantitative approach, in which 15 women workers were interviewed on a single day in May 2012. The assessments for pain qualification and analysis were performed by means of three instruments: multidimensional adapted questionnaire, Wisconsin Pain inventory (pain analysis) and McGill Pain questionnaire (qualification). For data analysis, descriptive statistics was employed, by calculating the average, standard deviation, percentage and absolute numbers. Results: The participants’ mean age was 33.4 (± 14.9) and they worked 9 hours a day. As for the painful posture in the workplace, the major complaint regarded abducted shoulders and flexed elbows (n=7, 46.6%). The most commonly painful anatomic sites were shoulders (n=8, 22.2%), cervical spine (n=7, 19.4%) and elbows (n=7, 19.4%). Pain analysis through the Wisconsin inventory, classified by the Visual Analogue Pain Scale (VAS), demonstrated moderate interference with work, sleep, mood, enjoyment of life and general activity. According to McGill questionnaire, the sensory level stood out, with highest frequencies to throbbing pain (n=10, 50%), needled (n=4, 20%) and tingling pain (n=4, 20%). Conclusion: The sample showed high frequency of pain in shoulders, elbows and cervical spine, in addition to painful symptomatology regarded moderate in most of the evaluated items, which might lead to significant interference with the labor activities and daily life.

Dolor y trabajo. Influencia de variables sociodemográficas en la respuesta terapéutica y la productividad laboral

IntroductionPain is a major cause of medical consultation. The complexity of managing it is due to its long duration and intensity, and it sometimes requires a combination of multiple drugs. The objective of this study is to assess the use of drugs for pain in workers, the clinical response obtained, its influence on estimating work productivity, its relationship to sociodemographic variables, and the type of drug used. Material and methodsA cross-sectional study on 1,080 workers, aged 18-65 years, during periodic surveys to monitor their health in companies in the service sector in Spain. Treatments used, clinical efficacy, influence on work productivity and sociodemographic variables (age, gender) are evaluated. The Brief Pain Inventory questionnaire, validated for Spain, was used to assess pain, and the SPSS® 20.0 package for the statistical analysis. ResultsNSAIDs and simple analgesics have higher percentages of improvement in pain (P=.032 and P<.0001, respectively). Men respond better to NSAIDs, and women to simple analgesics. Improved productivity is higher in men than in women (P=.042). No significant differences were observed for age, pain improvement or productivity, except in those over 55 years. ConclusionsThe analgesic prescription pain conditions must consider the age and gender of the patient, as well as the type of drug. The choice of drug should be based on the aetiology and aspects unrelated to the clinical variables, such as sociodemographic, work or psychosocial.

Pain and Its Clinical Associations in Individuals With COPD: A Systematic Review

Pain is emerging as a clinical complication in COPD, but the clinical impact of this comorbidity and the measurement properties of instruments used to assess pain require evaluation. Electronic searches of five databases were performed up to September 2014 for the two phases of this review. To be included in phase 1, studies reported the clinical associations of pain and prevalence in individuals with COPD. To be included in phase 2, studies reported measurement properties of an instrument assessing pain in COPD. Two independent reviewers rated the quality of quantitative and qualitative evidence (phase 1) and the measurement properties using the four-point Consensus-Based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist (phase 2). Of the 358 studies identified in the literature, nine met the inclusion criteria for phase 1 and five for phase 2. The mean (SD) quality score (of 16) for the quantitative studies was 13.1 (1.7). The pooled prevalence of pain in moderate to very severe COPD was 66% (95% CI, 44%-85%). Higher pain intensity was associated with increased dyspnea, fatigue, poorer quality of life, and a greater quantity of specific comorbidities. Of the two identified instruments (Brief Pain Inventory and McGill Pain Questionnaire), the measurement properties analyzed were construct validity, internal consistency, and criterion-predictive validity, with variable findings based on "fair" or "poor" quality studies. In people with COPD, pain has negative clinical associations with symptoms and quality-of-life measures. Further research exploring the measurement properties of instruments assessing pain is required.

Abstract P5-15-03: Baseline joint pain predicts severity of subsequent joint symptoms in women initiating aromatase inhibitors for early stage breast cancer

Abstract Background: Aromatase inhibitors (AIs) are the standard adjuvant treatment of hormone-sensitive breast cancer (BC) in postmenopausal women. However, these therapies are associated with musculoskeletal complaints which may lead to non-adherence and early discontinuation. The aim of this study was to characterize the natural history of the AI-induced arthralgia. Methods: Postmenopausal women with stage I-III BC were prospectively enrolled at the onset of adjuvant AI therapy. Subjects completed the Brief Pain Inventory (BPI) questionnaire at baseline, 3, 6, 9, and 12 months. BPI worst pain scores were categorized as 0-3, 4-6 and 7-8. Multiple logistic regression analysis was used to evaluate the association between baseline factors and having a 2-point worsening in BPI worst pain score. A Cox-proportional hazards model was used to evaluate factors that influenced the time to first 2-point worsening in pain score. Clinically significant change was defined as ≥2-point increase from baseline. Those with a baseline BPI worst pain score of ≥9 were removed from analysis. Results: Among 180 consented subjects, 1 was found to be ineligible due to being perimenopausal, 42 subjects were lost to follow up, 17 subjects came off their AI and 8 subjects dropped out. Mean age was 61; 60% were white, 32% Black, 10%, Asian and 31% were Hispanic; 86% started on anastrazole; 24% had a change in AI. At baseline, 76 women had a BPI worst pain score between 0-3; 28 between 4-6; and 18 had 7+. Seventy subjects (64%) experienced at least a 2-point worsening of BPI from baseline and women who developed a 2-point worsening had a lower mean baseline BPI (2.57 vs. 3.75) compared to those who did not. Those experiencing an initial worsening in the first 6 months of therapy improved over time; while the patients experiencing BPI worsening at 9 months, continued to have progressive increase in BPI. In a multiple logistic regression model adjusting for AI switching, BMI, age, baseline score, prior chemotherapy, osteoarthritis, and prior hormone replacement therapy, those who had a baseline worst pain score between 4-6 (p=0.04) or 7+ (p=0.005) were less likely to develop a 2-point worsening in BPI at 12 months from baseline. Similarly, those with a baseline worst pain categorization of 7+ had a hazard ratio of 0.34 for time to 2-point worsening. Conclusions: Women with low baseline BPI score are more likely to develop worsening BPI score over time. Women who develop symptoms later in the course of their therapy are at greatest risk for persistent symptoms. This has implications for studies evaluating interventions for prevention of AI arthralgias. BPI mean scorePatients with &amp;gt;2 point increase in BPI at any timePatients with &amp;gt;2 point increase in BPI at 3 monthsPatients with &amp;gt;2 point increase in BPI at 6 monthsPatients with &amp;gt;2 point increase in BPI at 9 monthsPatients with &amp;gt;2 point increase in BPI at 12 monthsBaseline score3.752.57*2.592.302.11*1.85*Three month score4.254.526.08*4.684.133.87Six month score4.504.83*5.32*6.37*5.074.22Nine month score4.005.105.115.135.75*5.04Twelve month score4.255.37*5.484.865.666.21**p value &amp;lt;0.05 compared to baseline Citation Format: Lea Baer, Katherine D Crew, Danielle Awad, Kevin Kalinsky, Matt Maurer, Dawn L Hershman. Baseline joint pain predicts severity of subsequent joint symptoms in women initiating aromatase inhibitors for early stage breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-15-03.

Metastatic Bone Pain Palliation using (177)Lu-Ethylenediaminetetramethylene Phosphonic Acid.

177Lu-ethylenediaminetetramethylene phosphonic acid (EDTMP) is presently suggested as an excellent bone seeking radionuclide for developing metastatic bone pain (MBP) palliation agent owing to its suitable nuclear decay characteristics. To find the exact dosage and its efficiency, this clinical study was performed on the human being, using 177Lu-EDTMP for MBP palliation. 177Lu-EDTMP was prepared by Iran, atomic energy organization. Thirty consecutive patients with determined tumors, incontrollable MBP, and positive bone scan at 4 weeks before the beginning of the study participated in this study in the nuclear medicine ward. 177Lu-EDTMP in the form of sterile slow IV injection was administered with a dose of 29.6 MBq/kg. Short form of brief pain inventory questionnaire was used to evaluate the efficiency of the intervention. Questionnaires were filled out by an expert nuclear physician every 2 weeks while the cell blood count was also checked every 2 weeks up to 12 weeks for evaluation of bone marrow suppression and hematological toxicity. Furthermore, whole body scan was done at days 1, 3, and 7. Twenty-five patients showed a significant pain relief since 2 weeks after the injection, and continued until the end of the follow up period (12 weeks). There were no significant early complications such as bone marrow suppression, hematological toxicity, and no systemic adverse effects. No complication was observed in renal function. Twenty one patients showed flare phenomenon that was started after the 12.2 ± 1.78 h lasting for 38.4 ± 23.08. Sixteen patients (53%) were completely treated; nine patients (30%) showed a partial response, and five patients (17%) had no response to treatment. Total response to treatment was achieved in 25 patients (83%). At the end of the evaluation, no bone marrow suppression or hematologic toxicity was observed. 177Lu-EDTMP has shown suitable physical and biological properties with good results in long term bone pain relief for patients with bone metastasis.

Effect of radium-223 dichloride (Ra-223) on pain from US EAP.

160 Background: Ra-223, a first-in-class alpha-emitting radiopharmaceutical, has shown pain palliation in phase 2 trials (Parker 2013; Nilsson 2012). Here we present the results of Ra-223 effect on pain from US EAP. Methods: Pain was assessed at baseline, during treatment (trt) , and follow up (up to 6 mos after last trt visit) using the Brief Pain Inventory (BPI-SF) Questionnaire. The pain severity assessment was based on the worst pain item from the BPI-SF. The analysis was restricted to those not on opioids at baseline due to missing data for those on opioids. Hypotheses tests were based on changes from baseline. A meaningful change in score was defined as &gt;2 points from baseline (Atkinson 2010). Results: Of 177 treated patients (pts) with baseline pain scores, 109 were not on opioids at baseline (6% had a score of 0 [no pain], 46% had 1-4 [mild pain], 34% had 5-7 [moderate pain], 14% had 8-10 [severe pain]). A significant decrease in mean pain severity from baseline (P&lt;0.05) was observed at all trt visits. Among 97 pts who could have pain improvement (baseline score ≥2), 57 (59%) experienced a reduction in pain during at least one on-trt visit. Among all pts not on opioids at baseline and had baseline pain assessment, 46/109 (42%) had improved pain without worsening (decrease of ≥2 points), 20/109 (18%) had stable pain (no change of ≥2 points), 30/109 (28%) had worsening of pain (increase of ≥2 points or initiation of opioids) at some point and never had improvement, 11/109 (10%) had improvement and worsening at different times during trt, and 2/109 (2%) had no post baseline data. (Table presents data at each trt visit). Conclusions: Radium-223 was associated with meaningful pain relief in 42% of pts, whereas 28% had worse pain and 18% no change. The confounding effect of change in opioids after initiation prevents adequate interpretation of this finding for pts on opioids at baseline. Clinical trial information: NCT01516762. [Table: see text]

The efficacy of cold-gel packing for relieving episiotomy pain – a quasi-randomised control trial

Purposes: This study evaluated the effectiveness of cold-gel packing on episiotomy pain among postpartum women who had normal spontaneous deliveries.Methods: A quasi-randomised control trial was conducted in a maternity ward of a regional teaching hospital in northern Taiwan. Seventy postpartum women were recruited, choosing to be in either the experimental or control group (35 women per group). Subjects in the experimental group received at least six interventions of cold-gel packing applied to the perineal wound and were provided oral analgesics routinely. The subjects in the control group received oral analgesics routinely.Findings: Pain intensity, pain interference on daily activities and satisfaction levels with pain management were assessed using Brief Pain Inventory (BPI) and pain management questionnaire, respectively. The results showed that women in the experimental group reported significantly lower mean pain intensity score, pain interference on daily activities scores at 48 hours post-delivery, and higher level of satisfaction with pain management at 24 and 48 hours post-delivery than the control group after adjusting for demographic and obstetric data.Conclusions: Cold-gel packing on the perineum is a cost-effective, convenient, easy-to-deploy and non-pharmacologic approach to pain reduction, with an overall positive impact on postpartum recovery for parturients.

Impact of pregabalin on the occurrence of postthoracotomy pain syndrome: a randomized trial.

Postthoracotomy pain syndrome (PTPS) is a frequent cause of chronic postoperative pain. Pregabalin might reduce the incidence of chronic postoperative pain. The goal of this study was to evaluate the impact of perioperative pregabalin on the occurrence of PTPS, defined as any surgical site pain 3 months after surgery. We conducted a randomized, placebo-controlled, double-blind trial in patients undergoing elective thoracotomy. Patients received either pregabalin 150 mg orally twice a day initiated 1 hour before thoracotomy and continued until 4 days after thoracotomy (10 doses total) or a placebo using the same protocol. All patients received preincision thoracic epidural analgesia. Postthoracotomy pain syndrome was evaluated using the Brief Pain Inventory questionnaire through a telephone interview. Secondary outcomes included evaluation of neuropathic characteristics through the Leeds Assessment of Neuropathic Symptoms and Signs questionnaire, analgesic use 3 months after surgery, and evaluation of acute postoperative pain and opioid consumption. One hundred fourteen patients were randomized, and 99 patients completed the study (placebo, n = 49; pregabalin, n = 50). Postthoracotomy pain syndrome occurred in 49 (49.5%) of 99 patients and more frequently in the pregabalin group (31/50 [62%] vs 18/49 [37%] in the placebo group, P = 0.01). However, among patients with PTPS, those in the pregabalin group required significantly less analgesics, reported less moderate to severe average pain, and presented significantly less neuropathic characteristics than patients in the placebo group 3 months after surgery. Pregabalin did not reduce the incidence of PTPS in this study. Future research on PTPS should focus on the impact of regional analgesia on central sensitization.

Percutaneous CT-guided cryoablation for the treatment of refractory pudendal neuralgia.

To evaluate the safety and efficacy of percutaneous CT-guided cryoablation of the pudendal nerve for the treatment of refractory pudendal neuralgia. Eleven patients were selected to undergo percutaneous CT-guided cryoablation of the pudendal nerve based on established diagnostic criteria. Brief Pain Inventory questionnaires were administered prior to the procedure, during the immediate 24h post procedure, and 45days and 6months following the procedure. Prior to treatment, the average level of pain on a scale from 0 (no pain) to 10 (worst pain imaginable) was 7.6, with pain described as "burning" (80%), "pulling" (37.5%), "crushing" (50%), "pressure" (84.5%), "throbbing" (50%), "knife-life" (52%), and "other" (60%). At 24h, 45days, and 6months post-treatment, pain intensity dropped to 2.6, 3.5, and 3.1, respectively (p < 0.005). There were no procedure-related complications. CT-guided percutaneous cryoablation may represent a safe and efficacious option for selected patients with refractory pudendal neuralgia.

Factors Associated With Pain Reduction After Transforaminal Epidural Steroid Injection for Lumbosacral Radicular Pain

ObjectiveTo identify demographic and clinical factors associated with pain improvement after a lumbosacral transforaminal epidural steroid injection (TFESI) for the treatment of radicular pain. DesignRetrospective cohort study. SettingOutpatient center. ParticipantsAdults (N=188) who underwent a fluoroscopically guided TFESI for lumbosacral radicular pain. InterventionsNot applicable. Main Outcome MeasuresPain reduction from preinjection to 2-week follow-up was measured by visual analog scale (VAS). Patients were grouped by those who experienced no pain relief or worsened pain (≤0%), pain relief but <50% relief (>0%–<50%), or significant pain relief (≥50%) on the VAS. ResultsThe mean duration of pain prior to injection was 45.8±81 weeks. The mean time to follow-up after TFESI was 20±14.2 days. Significantly more patients who experienced ≥50% pain relief at follow-up reported higher preinjection pain on the VAS (P=.0001) and McGill Pain Inventory Questionnaire (P=.0358), reported no worsening of their pain with walking (P=.0161), or had a positive femoral stretch test (P=.0477). No significant differences were found between VAS pain reduction and all other demographic and clinical factors, including a radiologic diagnosis of disk herniation versus stenosis or other neural tension signs on physical examination. ConclusionsGreater baseline pain on the VAS and McGill Pain Inventory, a history of a lack of worsening pain with walking, and a positive femoral stretch test predict a greater likelihood of pain reduction after TFESI for lumbosacral radicular pain at short-term follow-up. Greater baseline pain on the McGill Pain Inventory and a lack of worsening pain with walking predict a magnitude of >50% pain reduction.

AB1143-HPR A Pilot Study of A Standardized Educational Programme for the Improvement of Chronic Pain and Fatigue in Systemic Lupus Erythematosus (SLE)

ObjectivesTo evaluate the effectiveness of a standardized educational intervention to improve pain, fatigue, sleep and health-related quality of life (HRQoL) in patients with systemic lupus erythematosus.MethodsDesign: Open, uncontrolled intervention. Patients:...

Influence of pain severity on the quality of life in patients with head and neck cancer before antineoplastic therapy

BackgroundThe aim of this study was to assess the severity of pain and its impact on the quality of life (QoL) in untreated patients with head and neck squamous cell carcinoma (HNSCC).MethodsA study group of 127 patients with HNSCC were interviewed before antineoplastic treatment. The severity of pain was measured using the Brief Pain Inventory (BPI) questionnaire, and the QoL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) and the head and neck module (QLQ-H&N35).ResultsThe mean age of the patients was 57.9 years, and there was a predominance of men (87.4%). The most frequent site of the primary tumor was the oral cavity (70.6%), and the majority of the patients had advanced cancers (stages III and IV). QoL in early stage of cancer obtained better scores. Conversely, the patients with advanced stage cancer scored significantly higher on the symptom scales regarding fatigue, pain, appetite loss and financial difficulties, indicating greater difficulties. Regard to the severity of pain, patients with moderate-severe pain revealed a significantly worse score than patients without pain.ConclusionsThe severity of pain is statistically related to the advanced stages of cancer and directly affects the QoL. An assessment of the quality of life and symptoms before therapy can direct attention to the most important symptoms, and appropriate interventions can then be directed toward improving QoL outcomes and the response to treatment.

Coenzyme Q10 supplementation decreases statin-related mild-to-moderate muscle symptoms: a randomized clinical study.

BackgroundStatin use is frequently associated with muscle-related symptoms. Coenzyme Q10 supplementation has yielded conflicting results in decreasing statin myopathy. Herein, we tested whether coenzyme Q10 supplementation could decrease statin-associated muscular pain in a specific group of patients with mild-to-moderate muscle symptoms.Material/MethodsFifty patients treated with statins and reporting muscle pain were recruited. The Q10 group (n=25) received coenzyme Q10 supplementation over a period of 30 days (50 mg twice daily), and the control group (n=25) received placebo. The Brief Pain Inventory (BPI) questionnaire was used and blood testing was performed at inclusion in the study and after 30 days of supplementation.ResultsThe intensity of muscle pain, measured as the Pain Severity Score (PSS), in the Q10 group was reduced from 3.9±0.4 to 2.9±0.4 (P<0.001). The Pain Interference Score (PIS) after Q10 supplementation was reduced from 4.0±0.4 to 2.6±0.4 (P<0.001). In the placebo group, PSS and PIS did not change. Coenzyme Q10 supplementation decreased statin-related muscle symptoms in 75% of patients. The relative values of PSS and PIS significantly decreased (−33.1% and −40.3%, respectively) in the Q10 group compared to placebo group (both P<0.05). From baseline, no differences in liver and muscle enzymes or cholesterol values were found.ConclusionsThe present results show that coenzyme Q10 supplementation (50 mg twice daily) effectively reduced statin-related mild-to-moderate muscular symptoms, causing lower interference of statin-related muscular symptoms with daily activities.

Pain Trajectories Identify Patients at Risk of Persistent Pain After Knee Arthroplasty: An Observational Study

Persistent postsurgical pain is a major source of dissatisfaction after knee arthroplasty. Postoperative pain trajectories allow a dynamic view of pain resolution after surgery and might help to identify patients at risk for persistent pain. In this prospective observational study, we examined the relationship between postoperative pain trajectories and persistent pain, specifically neuropathic pain, at 3months after knee arthroplasty. Over a 1-year period, all patients undergoing elective unilateral knee arthroplasty for osteoarthritis by one surgeon were invited to participate in the study, provided they had not had prior knee surgery and their American Society of Anesthesiologists grade was 3 or lower; 128 patients fulfilled these criteria. Patients filled in a diary questioning postoperative pain at rest and during mobilization and maximal pain from Day 1 until Day 8 after surgery. At 3months, the patients were questioned concerning the presence of persistent pain and its nature and intensity using the Douleur Neuropathique 4 [Neuropathic Pain 4] and Brief Pain Inventory questionnaires. At 3months, 112 of the 128 patients (87%) were successfully contacted. At 3months, 47 of the 112 (42%) patients were totally pain free and 65 (58%) reported persistent pain at the surgical site. Among the latter, 12 patients (11%) presented with a neuropathic component and more severe persistent pain. Pain trajectories highlighted higher acute pain scores for maximal pain (from Day 1 until Day 8) and for pain at mobilization (from Day 3 until Day 8) in patients with neuropathic persistent pain (p<0.05 at all time points compared with the no persistent pain group). Postoperative pain trajectories constructed from patient's pain diary suggest that a subgroup of patients who will present with higher pain at 3months after knee arthroplasty might be identified early in the postoperative period and might benefit from preventative treatment. Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

Management of Painful Pelvic Bone Metastasis of Renal Cell Carcinoma Using Embolization, Radio-frequency Ablation, and Cementoplasty: A Prospective Evaluation of Efficacy and Safety

To measure the impact on pain relief and patient quality of life using embolization radio-frequency ablation and cementoplasty (ERC) for local combination therapeutic management of painful pelvic bone metastasis of renal cell carcinoma (RCC). This prospective monocentric registry was approved by our Local Institutional Review Board. Between January 2008 and January 2013, all consecutive patients who fully met the inclusion criteria were enrolled in the ERC-procedure prospective registry. They were assigned to follow-up at discharge and again at 1 and 6 months. Efficacy was evaluated using a pain visual analog scale (VAS), and narcotic consumption and quality of life were assessed using the Brief Pain Inventory questionnaire. Fifty-two patients were enrolled, among whom 58 lesions were treated. Technical success was obtained in all procedures. The median VAS score decreased from 7 ± 1.4 (ranges 5-10) at baseline to 3 ± 1.5 (ranges 0-6) at discharge, 2 ± 1.5 (ranges 0-5) at 1 month (p < 0.0001), and 2 ± 1.6 (ranges 0-5) at 6 months. In 28 patients (54 %), narcotic consumption was halved at discharge and halved in 40 (77 %) patients at 1 and 6 months compared with baseline. Five patients had complete pain relief at 1 month. A major improvement in quality of life, especially regarding mood and motion, was observed in all patients. This specific approach to painful bone metastasis is efficient and safe and yields sustained results. The ERC procedure could be suggested for patients with RCC bone metastasis.

Corneal nerve quantification predicts the severity of symptoms in sarcoidosis patients with painful neuropathy

Small fiber neuropathy (SFN) is a debilitating condition characterized by chronic pain as well as sensory and autonomic dysfunction. SFN is an increasingly recognized component of a large number of diseases, including sarcoidosis. Although affecting an estimated 2–3% of the adult population in the United States, it often remains undiagnosed. Skin biopsy for evaluating intra-epidermal nerve fiber density (IENFD) and more recently corneal confocal microscopy (CCM) have been used to identify small fiber damage in patients with neuropathy. We demonstrate a significant reduction in IENFD, corneal nerve fiber number and length, with no change in the number of branches in patients with painful sarcoid neuropathy. Moreover, unlike IENFD, corneal nerve fiber number and length inversely correlate with the degree to which pain interferes with activities of daily living as assessed by the Brief Pain Inventory questionnaire. CCM thus constitutes an accurate, non-invasive assessment technique to aid in the diagnosis of SFN, as well as an objective marker of symptoms in patients with painful sarcoid neuropathy.

High-Dose Daily Opioid Administration and Poor Functional Status Intensify Local Anesthetic Injection Pain in Cancer Patients

Background: Evidence for opioid-induced hyperalgesia (OIH) has been shown in animal and human studies, but the clinical implications of this phenomenon remain unclear. Objectives: We examined whether cancer patients taking opioids differ in their sensitivity to a clinical pain stimulus using a local anesthetic injection compared to those not taking opioids. We also evaluated the effect of the opioid dose, duration of opioid therapy, and patients’ pain severity and functional status on this clinical pain stimulus. Study Design: Prospective observational study. Setting: University outpatient department for interventional pain management, Republic of Korea. Methods: Eighty-two cancer patients including 20 patients not taking opioids (non-opioid group) and 62 taking opioids (opioid group) who were scheduled for an interventional procedure were enrolled in this study. Patients received a standardized subcutaneous injection of lidocaine prior to a full dose of local anesthetic (LA). Before the injection, patients completed the Brief Pain Inventory (BPI) questionnaire and were asked to rate their current pain using numeric rating scales. Immediately following the injection, LA injection-specific pain was evaluated using pain intensity, unpleasantness, and behavior pain scores. Results: LA injection-specific pain intensity, unpleasantness, and behavior pain score were significantly higher in the opioid group compared with the non-opioid group (P &lt; 0.001). In the opioid group, these post-injection pain scores were higher in patients taking high-dose opioids than those taking low doses (P &lt; 0.05). In addition, we observed a strong correlation between the baseline BPI pain interference score and the LA injection-specific pain score (r = 0.695, P &lt; 0.001). Limitations: This study is limited by its sample size and observational design. Various opioid medications, which were not standardized, may have inadvertently biased our results. Finally, the pain assessed by a brief stimulus does not fully reflect disturbances in endogenous pain inhibitory processes. Conclusion: The results of this study suggest that opioid medication is an important contributing factor to pain perception accompanying LA injection, and cancer patients using high-dose opioids may be highly susceptible to hyperalgesic responses to this clinical stimulus. We also suggest that the possible presence of OIH may be intensified among cancer patients with poor physical and psychosocial functional status. Key words: Adverse effects; analgesics, opioid; anesthetics, local; cancer; hyperalgesia; injections, subcutaneous; nociceptive pain; pain measurement; pain perception; quality of life

PP008: The relationships among pain, symptoms, and analgesics in head and neck cancer patients

Purpose The pain is a common symptom in patients with cancer, including those with head and neck cancer (HNC). This pain can affect physical functions, emotional states, and patients’ quality of life (QoL). The aim of this study was to evaluate the QoL and pain of HNC patients. Material and methods Ninety-one untreated patients diagnosed with head and neck squamous cells carcinoma were interviewed. The QoL was assessed by the EORTC QLQ-C30 questionnaire and QLQ-H&N35 module. The pain was measured using the item of ‘average pain’ during the last 24 h in the Brief Pain Inventory (BPI) questionnaire and smoking/alcohol habits, gender, age, TNM-stage, and tumor site were determined. Results We found predominance of men (86.8%), smokers/drinkers habits (53.8%) and mean age 56.5 ± 13.3. The primary site of tumor was usually lip and oral cavity (61.5%), followed by the oropharynx (23%), larynx (10.9%) and hypopharynx (4.6%). Most cases (63.7%) were in advanced stage (stages III/IV) and pain was associated with advanced TNM stage. The EORTC QLQ-C30 questionnaire demonstrated lower scores in the domains of QoL (49.4%), insomnia (36%), emotional functioning (40%), and appetite loss (39.5%) whereas the EORTC QLQ-H&N35 module identified that the domains with lower scores were sticky saliva (54.9%), swallowing (45%), and weight loss (32%). The nonsteroidal anti-inflammatory and nonopioid drugs were the most used among patients with pain and in the preceding 24 h the average pain relief experienced was 76%. Conclusions The pain was statistically related to the advanced stages and directly affects the QoL. The QoL questionnaire may help us to better understand the physical, psychological, and social problems of our patients, and this information, in turn, can help improve quality of care, regulate medications and therefore assist the physician and patient in the treatment decision. Financial support: CAPES, INCT-IF/REBRAFVIME and FAPES.

Randomized, Controlled Clinical Trial Evaluating the Efficacy of Pulsed Signal Therapy in Dogs with Osteoarthritis

To evaluate the efficacy of pulsed signal therapy (PST) in reducing pain and increasing function in dogs with osteoarthritis (OA) using a randomized, blinded, controlled clinical trial. Randomized, controlled, blinded clinical trial. Adult dogs (n = 60) with moderate-to-severe clinical signs of OA. Dogs were randomized by age into 2 groups: dogs ≥ 9 years and dogs < 9-years old. The control group received 1 hour of rest in hospital for 9 consecutive days and dogs in the treatment group received PST for 1 hour on 9 consecutive days. Goniometry and gait analysis were performed, and the Canine Brief Pain Inventory (CBPI) questionnaire was given to the owners to fill out without supervision. Outcome measures were repeated at the end of treatment (Day 11) and 6 weeks after beginning treatment (Day 42). The PST group performed significantly better than the control group as measured by the CBPI Severity and Interference scores (P < .01). Extension (P = .04) and peak vertical force (PVF) (P = .03) were not statistically significant after adjusting for multiple comparisons. The group receiving PST performed better than the treatment group according to owner assessment.