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PAIN, DISABILITY AND ANALGESIA IN PATIENTS WAITING FOR TOTAL HEMI-ARTHROPLASTY.
Dr M Human, Dr P D Collms The Pain Clinic Department, Taunton and Somerset Hospital Taunton Somerset, TA1 5 DA

Aim of investigation: many patients currently wait at least a year for total hip or knee arthroplasty in the UK It is the supposition of the authors that analgesia during this time is sub optimal

Method: over a penod of 4 months patients presenting for surgery were assessed for disability and pain using the Oxford Hip or Knee Score and the short form McGill questionnaire In addition all forms of analgesia prescnbed were recorded and the corresponding patient compliance

Results: preliminary analysis suggests that patients suffer a significant degree of pain prior to their surgery yet analgesia prescription is variable particularly with opiates

Conclusions: the results of this audit will be presented to the regional Primary Care Group together with recommendations from the pain clinic It is envisaged that this will provide positive educational information for the primary care workers who manage the majority of these pain patients

COMPARISON BETWEEN PHYSICAL FITNESS, PERCEIVED EXERTION, PAIN AND COGNITIVO-EMOTIONAL FACTORS IN LOW BACK PAIN AND FIBROMYALGIA WOMEN.
L. Barras. E. Masquelier and E. Ophoven, Pain Clinic, Climque St-Pien-e, 1340 Ottigmes, Belgium.

Aim of investigation : To correlate the relationschip between physical fitness, perceived exertion, pain and cogmtivo-emotional factors in a fybromyalgia syndrome (FS) and a low back pain (LBP) women population.

Methods : Nonrandomized french speaking females patients with FS (n=24, mean age=42.7 yrs) according to the ACR-critena and LBP in subacute stage (n=23, mean age=36.6 yrs) are include in this study. A submaximal exercice test is earned out on a cycle ergometer MONARK 818 E with an initial workload of 25 Watts followed by stepwise increments of 25 Watts every 2 minutes until exhaustion. During the test, the degree of perceived exertion is recorded to a 0-10 Modified Borg Scale. Heart rate is monitored with a Polar Sport Tester and the pain is scored on a Visual Analogue Scale (VAS). The fitness index for each patient is assessed using the Work Capacity Index (W65%/kg). Beck Depression Inventory, Spielberger, Survey Of Pain Attitude (SOPA) and Kmesiophobia questionnaires are carried out.

Results : The Work Capacity Index is better for FS than for LBP patients. But perceived exertion, pain, anxiety, depression, control, disability, solicitude and medical cure factors are significantly different for FS than for LBP patients. There is no correlation between Work Capacity Index and other factors.

Conclusion : Physical fitness in FS seems to be good like healthy women. But perceived exertion, pain and cognitivo-emotional factors are worse for FS that another painful population as LBP. In FS women, the cognitivo-emotional factors and pain are very important to assess to establish rehabilitation program.

ANXIETY, DEPRESSION AND CHRONIC PAIN
SilvaRMD: Correia D, MD; Freitas D, MD; Femandes LF, MD; Alves E,”MD; Bebiano G, MD. Terapeutica de Dor-Centro Hospitalar do Funchal - 9000 Funchal - Madeira Island-Portugal.

Aim of Investigation: The authors try to determine and evaluate the relationship between pain, anxiety, depression and functional incapacities in chronic pain patients in a first approach in the multidisciplinary pain facility at Madeira Hospital (Centro Hospitalar do Funchal).

Methods: In a universe of 500 patients we applied the Vaz Serra, test to evaluate depression and functional incapacity and made their relationship with pain, evaluated by a Visual Analogical Scale converted to a numeric scale (0 to 10).

Results: We analyse the studied variables and its correlation, and, as they were significant we calculated the predictive equation, being now in final conclusion, the statistic analyses.

Conclusion: In this study the authors documented the relationship between pain, anxiety, depression and its functional incapacities.

RECOLLECTION AND FAMILIARITY IN RECOGNITION MEMORY IN CHRONIC PAIN PATIENTS
Jacques Grisart. Consultation de la Douleur Chronique, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium.

Aim of investigation: Chronic pain partly consumes the limited attentional resources. Consequently, pain may interfere with the attention-demanding processes underlying cognitive activities. This may account for the frequent memory complaints in chronic pain patients (CPP). The present study investigates the state of awareness associated with recognition memory in CPP. For Tulving (1985), recognition occurs on the basis of two states of awareness:
either recollection (referring to the conscious awareness of a past event) or familiarity (the feeling of having seen the item). Contrary to familiarity, recollection requires an elaborative processing at encoding and is moderated by a concurrent demand of attention. Consequently, as pain demands attention, recognition in CPP is expected to be less accurate and, moreover, less reliant on recollection but more on familiarity.

Methods: After a study phase, fifteen CPP and 15 healthy controls underwent a recognition task with neutral words. For each correctly recognized word, the subjects specified that the response was made on the basis of recollection or of familiarity.

Results: Between-groups comparisons show that the exactitude of recognition is poorer in CPP (p = 0.007). In CPP, recollection is less common (p < 0.0001) but familiarity is a more frequent basis for recognition (p < 0.0001). Within-group analyses show that recognition is mainly sustained by recollection in Controls (p < 0.0001), and is supported in CPP by an equal ratio of recollection to familiarity (p = 0.31).

Conclusions: Being in a chronic pain state affects the attention-demanding aspects of the encoding procedure (recollection), favouring less effortful procedures (familiarity), which weakens the overall recognition performance. This provides additional evidence of the attentional cost of pain that selectively disturbs processes underlying memory functioning.

THE McGILL PAIN QUESTIONNAIRE: A PRACTITIONER PERSPECTIVE AND CURRENT RESEARCH IN THE COMMUNITY
(1) Jane Latham. Visiting Lecturer, City University, St. Bartholomew School of Nursing and Midwifery, London El EA, England
(2) Professor Bryn Davis, Nursing Consultant, Cardiff, Wales

Aim of investigation: To examine life-style disability, resource usage and pain profiles of chronic pain patients and other patients in the community.

Methods: Development and utilisation of the McGill Pain Questionnaire will be reviewed from a practitioner perspective. The current study pre-identified criteria for one chronic pain and two "non pain" groups (n = 120) selected at random from general practices in the U.K. At interview, an additional cohort of unrecognised chronic pain patients were subsequently identified from the two "non-pain" groups (n = 16). The interview schedule included the McGill Pain Questionnaire, the Sickness Impact Profile and a Resources Questionnaire.

Results: With reference to the McGill Pain Questionnaire, Group 1 with previously identified chronic pain have consistently higher scores across all dimensions and the overall profile score when compared to those in Group 4 with previously unidentified chronic pain. Sickness Impact Profile data also reflects such findings, with both pain groups scoring higher disability profile scores than other "non-pain" diagnostic groups in the community.

Conclusions: Whilst this is a small exploratory study, findings indicate the need for further more large-scale studies. In view of legislative changes in the UK, which affect the primary and secondary health/social care interface, priority should be placed on addressing education and training needs of health care professionals in relation to screening and treatment programmes for long-term chronic pain management in the community.

MULTIDIMENSIONAL AND MULTIPROFESSIONAL ASSESSMENT OF FUNCTIONING AND DISABILITY IN PATIENTS WITH CHRONIC PAIN
Seija Talo. Ph.D, SII, Research and Development Centre, Peltolant. 3, 20720 Turku-FIN, Finland* Ulla Rytokoski, M.D., Folkhalsan, Mannerheimint. 97,00280 Helsinki-FIN, Finland. Anneli Hamalainen, M.A.*

Aim of investigation: To assure universally fair treatment of patients with chronic pain unified procedures of diagnosing and assessing functioning and disability are needed. This paper presents the three-dimensional (dimensions of Body functions and structure. Activities and Participation determined by WHO) and bio-psycho-social BPSDC-model to assess the physical, psychological and social prerequisites for functioning.

Methods: The multiprofessional team cooperated to find the most useful conceptual model and the associated assessment instruments of functioning. Conceptual discussions about physical, psychological and social prerequisites of functioning preceded clinical and scientific experimentation of many kinds of prevailing and/or developed instruments assumed to be recommendable for functional assessment.

Results: Based on the philosophical understanding of human functioning as the bio-psycho-social whole, the model prefers describing functioning as physical, psychological and social prerequisites instead of talking about physical, psychological or social functioning. The litterature review discovered a lot of procedures to assess physical and psychological - but only rare procedures to assess social prerequisites of functioning. The most useful and economical instruments of functional assessment were collected and listed by multiprofessional effort.

Conclusions: To assess functioning and disability in patients with chronic pain the multidimensional and the biopsychosocial approach should be adopted. It is important to link the treatment and rehabilitation of patient functioning to his/her resources and defects shown by the 9-point profile of the functional prerequisites determined by universally accepted reliable assessment instruments.

PAIN AND QUALITY OF LIFE AFTER MITRAL SURGERY
Correia D, MD; Silva R, MD; Rodrigues JM, MD. Terapeutica de Dor-Centro Hospitalar do Funchal -9000 Funchal - Madeira Island-Portugal

Aim of Investigation: To determine, in a prospective study, the relationship between pain and life quality, in patients submitted to Mitral Surgery.

Methods: In 25 patients, pre-surgically, and then 30, 90 and 180 days after surgery, we evaluated the pain in terms of a numeric scale (0 to 10) and we applied the NHP (Nottingham Health Profile) and EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire), and determined the Pemax (maximal expiratory pressure) and Pimax (maximal inspiratory pressure) and the NYHA (New York Heart Association) classification.

We analysed the studied variables and its correlation with the algic symptomatology and its evolution during this period.

Results and Conclusions: The authors concluded that during all the period in study, pain is a major symptom in these patients, which has significative influence in life quality and functional capacity.

PAIN AND QUALITY OF LIFE AFTER MITRAL SURGERY AND A NORMAL POPULATION
Rodrigues JM, MD Correia D,MD; SilvaR, MD ; Ferreira T, MD. Terapeutica de Dor-Centro Hospitalar do Funchal -9000 Funchal - Madeira Island-Portugal

Aim of Investigation: To determine, in a prospective study on patients submitted to Mitral Surgery, the relationship between pain and life quality and a "normal" population.

Methods: In 25 patients, pre-surgically, and on 30, 90 and 180 days after surgery, we evaluated the pain by a numeric scale (0 to 10) and we applied the NHP (Nottingham Health Profile) and EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire).

We analysed the obtained results comparatively with the NHP by Hunti (in Chronic pain), by Chocron2,3 (in patients undergoing Cardiac surgery) and the EORTC QLQ-C30 by Klee4 (in a normal population).

Results and Conclusions: The authors concluded that the results obtained on Third and fourth observations (90 and 180 days) are near to the Hunt's in the elder with chronic disease. On the first and second observations and correlating with the study of Klee, the values are under the average, being on the rest near to the normal levels. Chronic pain is a significative symptom in the studied samples.

Bibliography: Hunt SM McEwen, J.Mckena SP. Measuring health status : a new tool for clinicians and epidemiologists. J.R. Coil. Gen. Pract. 1985; 35(273):185-188

Chocron S, Rude N, Dussaucy A, Leplege A, Clement F, Alwan K, Viel JF, Etievent JP. Quality of life after open heart surgery in patients of 75 years old. Rev. Age and aging 1996; 25:8-11

Chocron S, Etievent JP, Viel JF, Dussaucy A, Clement F, Alwan K, Neidhardt M.Schipman. Prospective study of quality of life before and after open heart operations. Ann Thorac.Surg,1996; 61:153-157

Klee M.,Groenvold M, Machin D, Quality of Life of Danish women: population-based norms for the EORTC QLQ-C30. Quality of life Research, vol.6, 27-34, 1997

Pain in Europe III. EFIC 2000, Nice, France, September 26-29, 2000. Abstracts book, p. 250, 256, 347, 349, 350, 351, 357, 358.

   

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