(866): Pain catastrophizing: Putting a new spin on the “fear factor” with chronic pain
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E30 - Other (864) Can nerve section and grafting relieve neuropathic pain? C Watson, J Rutka, C Forrest, S Mackinnon, J Stinson, C Hawkins; University of Toronto, Toronto, ON A case history is described of the relief of severe neuropathic pain by nerve section and grafting in a 14 year old male who was housebound and had intractable post-traumatic neuropathic pain after orbital frac- ture in the right infra-orbital nerve territory refractory to all analgesics over 3 years. Steady pain, jabs and allodynia were all rated at 10/10. He had missed three years of school. The infra-orbital nerve was sectioned and grafted into the buccal fat pad. Slowly over several months pain levels of steady, brief pain and allodynia abated from severe to mild to total relief and he has been able to return to school and has been pain-free for several months at two years follow-up. Generally with neuropathic pain the fear is that further deafferentation may cause a worsening of the pain. In this case there was dramatic resolution, which possibly is related to the use of a nerve graft. The relevant literature pertaining to this issue will be reviewed. F. Treatment Approaches (Psychosocial & Cognitive) F01 - Cognitive/Behavioral Approaches (865) Significant improvements in neurocognition observed in once-a-day Avinza (extended release morphine sul- fate) treated patients with chronic moderate to severe osteoarthritis (OA) pain M Rosenthal, S Bryant, T Iwan, C Spinweber, E Groves, L Schlosser, A Negro-Vilar; Ligand Pharmaceuticals, Inc., San Diego, CA Neurocognition was evaluated in 31 sustained-release-opioid-naı ¨ve patients reporting OA pain-related sleep disturbances. The morning following Polysomnography(PSG), Neuro- cognition, BPI-pain-on-average-VAS and Quality-of-Sleep-VAS testing were done at Day-6 (while receiving prior analgesics), at Day0 (after placebo 3-5 days), and at Day15 (after 14 days Avinza QAM,30mg or 60mg). At Day6, dosing continued at 30mg QAM 7 days further or increased to 60mg QAM,X14 days. Neurocognition: attention, concentration, motor- speed, coordination and memory was assessed via Letter-Number-Sequencing(LNS), Trail- Making-parts-a&b(TM), Digit-Symbol-Substitution(DSST), Finger-Tapping-Speed-right& left-hand (FTST), Rey-Auditory-Verbal-Learning (RAVLT1-5), Delayed-Trial-Number-Cor- rect (DTNC), Recognition-Number-of-Hits (RNH) and Recognition-Number-of-False- Alarms (RNFA). For all patients (n31) significant improvement from Day-6 was observed at Day15 for LNS, TM-part-a&b, DSST, RAVLT1-5, DTNC and RNH (1.1, 4.3, 11.3, 3.5, 2.1, 3.7, 1.2, respectively). Self-assessment BPI and Quality-of-Sleep and PSG scores for REM-Sleep-Latency, Sleep-Efficiency, Stage-2-Duration, Total-Sleep-Time, and Total- Wake-Time also significantly improved (2.0, 31.0, 45.4, 7.3, 34.6, 35.5, 35.9). Trend improvement or no change was observed for other measures. Similarly, there were improvement trends from Day0 at Day15 for RAVLT1-5 and TM-part-a (0.4, 3.8). BPI, Quality-of-Sleep and PSG-REM-sleep-latency also significantly improved (2.0, 23.4, 15.6). Trend improvement or no change was observed for other measures. Notably, less fragmented sleep (fewer awakenings), produced a strong trend toward improved perfor- mance on the DSST (sensitive to sleep and depressive drug effects) and deeper sleep (%-stage-1 decreases) produced a trend toward better performance on the LNS test. Additionally, patients who received either 30mg or 60mg X14 days (n22) showed signif- icant improvements and trends, relative to Day-6 or Day0, at Day15 for neurocognition, self-reported pain and sleep assessments, and PSG tests. OA pain patients treated with AVINZA® for their chronic, moderate-to-severe pain improved significantly compared to their former non-SRO-analgesics or placebo, in scores for pain, sleep quality, and neuro- cognition by Day15. No negative trends were observed in neurocognition scores. (866) Pain catastrophizing: Putting a new spin on the “fear factor” with chronic pain M Evans, C Townsend; Mayo Clinic, Rochester, MN Strong empirical support exists for the association between pain cata- strophizing, pain severity, perceived disability, occupational impair- ment, greater emotional distress and increased analgesic medication use (particularly opioids) in persons with chronic noncancer pain. How- ever, there is minimal research on effective interventions to decrease pain catastrophizing. The present study examined 595 consecutive pa- tients admitted to the Mayo Comprehensive Pain Rehabilitation Center from August 2003 to January 2005. The patients completed the Pain Catastrophizing Scale (PCS) at admission and discharge from a 3-week intensive pain rehabilitation program incorporating opioid withdrawal. The staff developed a model describing a cognitive cycle of chronic pain for use in patient education groups. The model complemented previous models describing the behavioral and emotional stages of chronic pain and illustrated cognitions that mediate adaptive/maladaptive emotions and behaviors. Specific examples of pain catastrophizing and restructur- ing were examined. Analysis of variance of admission data revealed patients with PCS scores at clinically significant levels ( 75%ile) re- ported greater pain severity (p.001), depression on the CES-D (p.001), greater pain related anxiety (p.001) and were more likely to be using opioid medication for their pain (p.01). Repeated measures ANOVAs data revealed a significant decrease in pain catastrophizing (p.001) from admission (M 25.6; SD 12.6) to discharge (M 11.7; SD 10.4) representing a strong treatment effect size (Cohen’s d 1.2). While 41.2% of patients scored 30 (75%ile) at admission, only 6.0% continued to have significant levels of pain catastrophizing at discharge. These findings support the feasibility and effectiveness of a comprehen- sive rehabilitation program that incorporates a psychoeducational in- tervention to decrease pain catastrophizing and promote utilization of adaptive cognitive pain coping strategies. (867) Impact of the chronic angina self-management program on health-related quality of life for chronic stable an- gina patients: An Rct M McGillion, J Watt-Watson, B Stevens, S LeFort, P Coyte; University of To- ronto, Toronto, ON Chronic stable angina (CSA) is a cardinal symptom of coronary artery disease (CAD) and has a major negative impact on health-related quality of life (HRQOL) including general health status, and ability to self-man- age. Current secondary prevention approaches lack adequate scope to address CSA as a multidimensional persistent pain problem. This trial evaluated the impact of a low-cost 6-week angina psychoeducation pro- gram (CASMP) on HRQOL, self-efficacy and resourcefulness to self-man- age symptoms, and CSA-related costs. Patients (n130) were random- ized to the CASMP or 3-month wait-list control; 117 completed the study. Measures were taken at baseline and 3 months. The mean age of participants was 68, 80% were male. ANOVA of change scores yielded significant improvements in treatment group physical functioning [F 11.75(1,114), p0.008], general health [F10.94(1,114), p0.001], and physical component summary [F7.93(1,114), p 0.006] scores of the MOS SF-36. Angina frequency [F5.57(1,115), p0.02], angina stability [F 7.37(1,115), p0.008], and self-efficacy to manage disease [F8.45(1,115), p0.004] were also significantly improved at 3 months. The CASMP did not influence cost of illness. Societal costs of angina for 2004-5 were determined to be $19,000 per person. These data indicate that the CASMP was effective for improving physical functioning, per- ception of general health, symptom stability and frequency, and self- efficacy at 3 months, and provide basis for long-term evaluation of the CASMP. S67 Abstracts
Transcript of (866): Pain catastrophizing: Putting a new spin on the “fear factor” with chronic pain
E30 - Other(864) Can nerve section and grafting relieve neuropathic
pain?C Watson, J Rutka, C Forrest, S Mackinnon, J Stinson, C Hawkins; University ofToronto, Toronto, ONA case history is described of the relief of severe neuropathic pain bynerve section and grafting in a 14 year old male who was houseboundand had intractable post-traumatic neuropathic pain after orbital frac-ture in the right infra-orbital nerve territory refractory to all analgesicsover 3 years. Steady pain, jabs and allodynia were all rated at 10/10. Hehad missed three years of school. The infra-orbital nerve was sectionedand grafted into the buccal fat pad. Slowly over several months painlevels of steady, brief pain and allodynia abated from severe to mild tototal relief and he has been able to return to school and has beenpain-free for several months at two years follow-up. Generally withneuropathic pain the fear is that further deafferentation may cause aworsening of the pain. In this case there was dramatic resolution, whichpossibly is related to the use of a nerve graft. The relevant literaturepertaining to this issue will be reviewed.
F. Treatment Approaches (Psychosocial & Cognitive)F01 - Cognitive/Behavioral Approaches(865) Significant improvements in neurocognition observed
in once-a-day Avinza (extended release morphine sul-fate) treated patients with chronic moderate to severeosteoarthritis (OA) pain
M Rosenthal, S Bryant, T Iwan, C Spinweber, E Groves, L Schlosser,A Negro-Vilar; Ligand Pharmaceuticals, Inc., San Diego, CANeurocognitionwasevaluated in31sustained-release-opioid-naı̈vepatients reportingOApain-related sleep disturbances. The morning following Polysomnography(PSG), Neuro-cognition, BPI-pain-on-average-VAS and Quality-of-Sleep-VAS testing were done at Day-6(while receiving prior analgesics), at Day0 (after placebo 3-5 days), and at Day15 (after 14daysAvinzaQAM,30mgor60mg).AtDay6,dosingcontinuedat30mgQAM7daysfurtheror increased to 60mg QAM,X14 days. Neurocognition: attention, concentration, motor-speed, coordination and memory was assessed via Letter-Number-Sequencing(LNS), Trail-Making-parts-a&b(TM), Digit-Symbol-Substitution(DSST), Finger-Tapping-Speed-right&left-hand (FTST), Rey-Auditory-Verbal-Learning (RAVLT1-5), Delayed-Trial-Number-Cor-rect (DTNC), Recognition-Number-of-Hits (RNH) and Recognition-Number-of-False-Alarms (RNFA). For all patients (n�31) significant improvement from Day-6 was observedatDay15forLNS,TM-part-a&b,DSST,RAVLT1-5,DTNCandRNH(1.1�,�4.3�,�11.3�, 3.5�,2.1�, 3.7�, 1.2�, respectively). Self-assessment BPI and Quality-of-Sleep and PSG scores forREM-Sleep-Latency, Sleep-Efficiency, Stage-2-Duration, Total-Sleep-Time, and Total-Wake-Time also significantly improved (�2.0�, 31.0�, �45.4�, 7.3�, 34.6�, 35.5�, �35.9�).Trend improvement or no change was observed for other measures. Similarly, there wereimprovement trends from Day0 at Day15 for RAVLT1-5 and TM-part-a (0.4, �3.8). BPI,Quality-of-Sleep and PSG-REM-sleep-latency also significantly improved (�2.0�, 23.4�,�15.6�). Trend improvement or no change was observed for other measures. Notably, lessfragmented sleep (fewer awakenings), produced a strong trend toward improved perfor-mance on the DSST (sensitive to sleep and depressive drug effects) and deeper sleep(%-stage-1 decreases) produced a trend toward better performance on the LNS test.Additionally, patients who received either 30mg or 60mg X14 days (n�22) showed signif-icant improvements and trends, relative to Day-6 or Day0, at Day15 for neurocognition,self-reported pain and sleep assessments, and PSG tests. OA pain patients treated withAVINZA® for their chronic, moderate-to-severe pain improved significantly compared totheir former non-SRO-analgesics or placebo, in scores for pain, sleep quality, and neuro-cognition by Day15. No negative trends were observed in neurocognition scores.
(866) Pain catastrophizing: Putting a new spin on the “fearfactor” with chronic pain
M Evans, C Townsend; Mayo Clinic, Rochester, MNStrong empirical support exists for the association between pain cata-strophizing, pain severity, perceived disability, occupational impair-ment, greater emotional distress and increased analgesic medicationuse (particularly opioids) in persons with chronic noncancer pain. How-ever, there is minimal research on effective interventions to decreasepain catastrophizing. The present study examined 595 consecutive pa-tients admitted to the Mayo Comprehensive Pain Rehabilitation Centerfrom August 2003 to January 2005. The patients completed the PainCatastrophizing Scale (PCS) at admission and discharge from a 3-weekintensive pain rehabilitation program incorporating opioid withdrawal.The staff developed a model describing a cognitive cycle of chronic painfor use in patient education groups. The model complemented previousmodels describing the behavioral and emotional stages of chronic painand illustrated cognitions that mediate adaptive/maladaptive emotionsand behaviors. Specific examples of pain catastrophizing and restructur-ing were examined. Analysis of variance of admission data revealedpatients with PCS scores at clinically significant levels ( 75%ile) re-ported greater pain severity (p�.001), depression on the CES-D(p�.001), greater pain related anxiety (p�.001) and were more likely tobe using opioid medication for their pain (p�.01). Repeated measuresANOVAs data revealed a significant decrease in pain catastrophizing(p�.001) from admission (M � 25.6; SD � 12.6) to discharge (M � 11.7;SD � 10.4) representing a strong treatment effect size (Cohen’s d � 1.2).While 41.2% of patients scored 30 (75%ile) at admission, only 6.0%continued to have significant levels of pain catastrophizing at discharge.These findings support the feasibility and effectiveness of a comprehen-sive rehabilitation program that incorporates a psychoeducational in-tervention to decrease pain catastrophizing and promote utilization ofadaptive cognitive pain coping strategies.
(867) Impact of the chronic angina self-management programon health-related quality of life for chronic stable an-gina patients: An Rct
M McGillion, J Watt-Watson, B Stevens, S LeFort, P Coyte; University of To-ronto, Toronto, ONChronic stable angina (CSA) is a cardinal symptom of coronary arterydisease (CAD) and has a major negative impact on health-related qualityof life (HRQOL) including general health status, and ability to self-man-age. Current secondary prevention approaches lack adequate scope toaddress CSA as a multidimensional persistent pain problem. This trialevaluated the impact of a low-cost 6-week angina psychoeducation pro-gram (CASMP) on HRQOL, self-efficacy and resourcefulness to self-man-age symptoms, and CSA-related costs. Patients (n�130) were random-ized to the CASMP or 3-month wait-list control; 117 completed thestudy. Measures were taken at baseline and 3 months. The mean age ofparticipants was 68, 80% were male. ANOVA of change scores yieldedsignificant improvements in treatment group physical functioning [F�11.75(1,114), p�0.008], general health [F�10.94(1,114), p�0.001], andphysical component summary [F�7.93(1,114), p� 0.006] scores of theMOS SF-36. Angina frequency [F�5.57(1,115), p�0.02], angina stability[F� 7.37(1,115), p�0.008], and self-efficacy to manage disease[F�8.45(1,115), p�0.004] were also significantly improved at 3 months.The CASMP did not influence cost of illness. Societal costs of angina for2004-5 were determined to be $19,000 per person. These data indicatethat the CASMP was effective for improving physical functioning, per-ception of general health, symptom stability and frequency, and self-efficacy at 3 months, and provide basis for long-term evaluation of theCASMP.
S67Abstracts
