10th World Congress on Pain, List of topics

PAIN IN 70-YEAR-OLD MEN AND WOMEN. A SWEDISH POPULATION STUDY.
I. Bergh, B. Sjstrm, A. Odn, B. Steen Department of Geriatric Medicine, GÖTEBORG, Sweden , Department of Health Sciences, SKÖVDE, Sweden

AIM OF INVESTIGATION: To examine the prevalence of pain, frequency of episodes of pain, duration, number of location of pain and its relation to depressive symptoms in 70-year-old men and women.

METHODS: Data were collected within the gerontological and geriatric population studies in Gteborg, Sweden (H-70). A representative sample of 124 men and 117 women living in the community took part in the study. A questionnaire was applied which included four different aspects on pain experience: prevalence, frequency of episodes of pain, duration and number of locations. In close connection to this, an interview was conducted focusing on depressive symptoms using the Centre for Epidemiological Studies-Depression Scale.

RESULTS: The prevalence of pain within the last 14 days was significantly (p<0.001) higher in women (79%; n=91) than in men (53%; n=65). Women (68%; n=78) also reported pain that had lasted for >6 month to a greater extent (p<0.001), than men (38%; n=46) did. The frequency of episodes of pain was also higher (p<0001) among women, 64% (n=74) reported experiencing daily pain or pain several days within the past 14 days, 37% of the men (n=45) did so. Women (33%, n=38) also reported pain experience from 3 locations to a greater extent (p<0.001) than men (11%; n=13). Men showed an association between depressive symptoms (p<0.04) and the four aspects of pain experience. Among women the aspect number of location of pain showed a similar relation.

CONCLUSIONS: The results show that pain is common in 70-year-old people and especially in women. However, associations between depressive symptoms and the four aspects of pain experience were more pronounced among men than among women.

ACKNOWLEDGMENTS: The Lions Foundation.

AGE, ASIA GRADE AND GENDER INFLUENCE PAIN IN SPINAL CORD INJURED PATIENTS
C. Budh1< T. Ertzgaard, P. Levi, R. Werhagen, L. Hultling, C. Lund, I.>Spinalis SCI unit, Faculty of Public Health Sciences, Stockholm, Sweden

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Aim of investigation To describe pain and associated variables and to investigate whether gender differences regarding pain prevalence and perception exist in a prevalence group of persons with a sustained spinal cord injury (SCI).

Method 456 SCI patients were assessed in a yearly health control. Out of these, 130 patients suffering from pain were selected following matching, based on gender-, age-, ASIA grade and level of lesion in order to detect gender differences.

Results 291 out of 456 SCI patients (63.7%) suffered from pain and in 45.7% of these it was classified as being neurogenic. Aching pain was the most used descriptor (38.5%). Pain was most common in patients classified as ASIA D and there was a correlation between pain and higher mean age at injury and between pain and female gender. Pain was more frequent in females in the age group 50-59 years of age. In the matched group no differences between the sexes could be seen regarding pain and localisation, onset, distribution, factors affecting pain, number of painful body regions, pain descriptors, VAS ratings of pain intensities or in pain and quality of life. Still the use of analgesics was greater amongst women.

Conclusions In this study pain was more common in patients with incomplete lesions classified as ASIA D and in females, and there was a correlation between pain and higher mean age at injury.Despite that men and women described their pain similarly the use of opiates and NSAIDs was far more common in women.

Acknowledgements The study has been made possible with grants from The Swedish Association of Traffic and Polio Victims, The Association for Cancer and Traffic Victims and The Swedish Association for the Neurologically Disabled.

WIDOWHOOD AND OTHER DEMOGRAPHIC ASSOCIATIONS OF PAIN SEVERITY IN INDEPENDENT OLDER PEOPLE
M. Bradbeer, S. Scherer< S.J. Helme, R.D.>National Ageing Research Institute, Parkville, VIC, Australia

Aim of Investigation: To identify basic demographic factors associated with pain, particularly severe pain, in independent older people.

Methods: This cross-sectional survey involved 1000 older people (65+) (Health Status of Older People study) randomly selected from residents living independently in Melbourne, Australia. Demographic characteristics, including age, gender, education, income, living alone, widowhood and absence of children, were analysed by logistic regression for their association with pain report of differing severity/impact combinations. Path analysis was used to confirm the association with pain severity and determine the role of mood disturbance in mediating this relationship.

Results: The prevalence of pain report for the preceding 12 months was 56.3% but more severe criteria in decreasing order of prevalence were: > moderate at worst (48.7%), > strong at worst (29.8%), activity-limiting (29.7%), > moderate current pain (4.1%) and > strong current pain (1.3%). After adjusting for type 1 error rate, living alone was associated with > moderate pain at worst and widowhood was associated with > moderate current pain. The latter association was characterized by more recent bereavement with an odds ratio greater than 3. Path analysis confirmed a significant relationship between the duration of spousal bereavement and pain severity, the latter being a latent variable constructed from three measures of pain severity. The model tested by path analysis suggested that the mood disturbance of spousal bereavement is sufficient to explain the increase in pain report.

Conclusion: Widowhood or living alone appear to be important environmental influences which promote pain severity by undermining psychological well-being in independent older people.

PAIN IN A DANISH POPULATION OF MS PATIENTS
K.B. Svendsen, K. Overvad3 H.J. Hansen2 N. Koch-Henriksen, F.W. Bach1, Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark , 2 Dept.of Neurology, Aarhus University Hospital, Aarhus, Denmark , 3 Dept.of Epidemiology and Social Medicine, Aarhus University, Aarhus, Denmark , 4 Dept.of Neurology, Aalborg Hospital, Aalborg, Denmark

Aim of investigation To assess pain prevalence,-intensity and -treatment in a population of multiple sclerosis (MS) patients and compare to a reference group drawn from background population.

Methods MS patients living in Aarhus County, Denmark, were identified through the Danish MS Registry. Questionnaires concerning pain in the month preceding assessment were mailed to 771 MS patients and to a gender and age-stratified reference group(n=769)identified through the Central Office of Civil Registration.

Results 81% of MS patients and 63% of controls returned the questionnaire. Gender and age were comparable. No difference in pain prevalence was found (79% vs. 75%, Prevalence Proportion Ratio,PPR 1.06 (95%CI 0.99-1.13)).

Among subjects with pain MS patients more often than controls reported pain in more than one site (81% vs. 70%,p<0.01). Patients reported higher VAS score (When the pain is at its least: 20(6-38) (median (25th-75th percentiles)) vs. 11(1-25) p<0.01). When the pain is at its worst: 68(46-85) vs. 55(35-75) p<0.01). A higher proportion of patients with pain than controls reported an intake of analgesic drugs 4 days in the past month (43% vs. 24%,PPR 1.8(1.5-2.2)).

Conclusion Pain prevalence in MS patients is not higher than in background population, but pain is more intense and analgesic treatment is more frequent.

Acknowledgements The study was supported by Danish Medical Research Council, The Danish Multiple Sclerosis Society, Warwara Larsen foundation, and grant from 'Direktr Ejnar Jonasson, kaldet Johnsen og hustrus mindelegat'.

EPIDEMIOLOGY OF NON-MALIGNANT CHRONIC PAIN IN DENMARK: A NATIONWIDE SURVEY
M.K. Jensengren, N. Rasmussen, J. Eriksen Rigshospitalet, Multidisciplinary Pain Center, Copenhagen, Denmark

Aim of investigation: To estimate the prevalence of chronic pain in Denmark, and to evaluate consequences of chronic pain.

Methods: Basis for the study was the Danish National Health and Morbidity Survey of 2000. A group reporting chronic pain (> 6 months) (PG) and a control group (CG) were identified. Chronic pain prevalence was estimated in general and in relation to socio-demographic variables and concurrent health characteristics as self-rated health and self-reported long-standing disease. The consequences of chronic pain were evaluated.

Results: 10093 persons participated in the survey. The prevalence of chronic pain was 18%. Chronic pain increased by age. The prevalence of chronic pain 29% in the group having less than 10 years of education compared to 14% among those having 13 years or more. Quitting of job for health reasons was five times higher in the PG (25%) compared to CG (4%). The three most frequently used opioids in the PG were tramadole (5%), codeine (4%) and ketobemidone (2%). Antidepressants and anxiolytics were used almost three times as frequent in the PG compared to the CG.

Conclusions: With a prevalence of 18% in the general population this study established chronic pain as a severe health care problem. We found that chronic pain was unevenly distributed in the population with prevalences higher among women, less educated and with pain increasing by age. The study reported, in detail, the differences in consumption of opioids, antidepressants and anxiolytics between the PG and CG.

Acknowledgements: Supported by the Danish Center for Evaluation and Health Technology Assessment and the Danish National Institute of Public Health.

EPIDEMIOLOGY OF LONG LASTING NON-MALIGNANT PAIN IN DENMARK: THE DEVELOPMENT FROM 1994 TO 2000
J. Eriksen, M.K. Jensen1gren, N.K. Rasmussen Multidisciplinary Pain Center, Rigshospitalet, Copenhagen, Denmark

Aim of investigation: To describe the secular development of long lasting non-malignant pain over a period of six years using two comparable, cross sectional surveys.

Methods: The Danish National Health and Morbidity Surveys of 1994 and 2000 provided the background for the study. In both surveys, the same questions regarding pain assessment, sociodemography, concurrent health characteristics and consequences of pain as activity restrictions; quitting job for health reasons; and use of health care services were used. Both surveys included the short form 36 (SF-36), through which the pain group (PG) and the group without pain, named control group (CG), were identified. Pain prevalence and the prevalence of pain in relation to sociodemography and concurrent health characteristics were compared for 1994 and 2000. Changes in self-reported consequences of pain for PG and CG were also investigated.

Results: The prevalence of long lasting pain increased from 14% in 1994 to 15% in year 2000. In both surveys, the prevalence of pain was, higher among women and less educated (< 10 years) compared to men and those having 13 years or more of education, respectively. Both, in 1994 and 2000, activity restriction was reported by 24% of the PG. However quitting job for health reasons had increased in the PG from 20% in 1994 to 26% in 2000. In the same period it was unchanged for the CG.

Conclusions: The distribution in the population of long lasting pain had not changed much from 1994 to 2000, but the study may indicate a change in the self-reported consequences of long lasting pain.

Acknowledgements: Supported by the Danish Center for Evaluation and Health Technology Assessment and the Danish National Institute of Public Health.

SIX-YEARS FOLLOW-UP STUDY OF LONG LASTING NON-MALIGNANT PAIN IN DENMARK
P. Sjgren, M.K. Jensen1< J. Rasmussen, N.K.> Multidisciplinary Pain Center, Rigshospitalet, Copenhagen, Denmark

Aim of investigations: To investigate the age related development of long lasting pain over a period of six years including estimation of incidence of pain and potential risk factors.

Methods: The Danish National Health and Morbidity Surveys of 1994 and 2000 were used. The participants in the survey of 1994 were asked to take part in year 2000. Both surveys included the short form 36 (SF-36), through which the pain group (PG) and the group without pain, control group (CG), were identified for both years. Among those without pain in 1994 it was possible to calculate the 6-year incidence rate and relate it to sociodemographic variables and health characteristics.

Results: 2649 persons were followed for six years. 2292 persons were classified as CG at baseline. The incidence of long lasting pain among women was 13% compared to 9% among men. The incidence increased with age. Incidence rate of long lasting pain was 13% among those having < 10 years of education compared to 9% among those having 13 years or more. For those reporting poor self-rated health incidence rate was 25% compared to 9% among those reporting a good self-rated health.

Conclusions: This study enlighted a neglected and poorly understood subject: the development of pain over time. The results of this study indicated that socio-demographic factors were strongly associated with development of pain.

Acknowledgements: Supported by the Danish Centre for Evaluation and Health Technology Assessment and the Danish National Institute of Public Health.

THE QUEBEC POP-MAN STUDY - DETERMINANTS OF ACUTE PAIN ONE WEEK AFTER SURGERY: RESULTS OF A PROSPECTIVE COHORT STUDY
A. Velly, M. Choinire, S. Shapiro, C. Bellera1, T. Ducruet1, F. Carli, C. Roy, G. Blaise, J. Collet Epidemiology, McGill Un, Mtl, PQ, Canada ,2 Anesthesiology, McGill Un, Mtl, PQ, Canada , Anesthesiology, CHUM, Mtl, PQ, Canada

Aim of investigation: To assess factors related to persistence of acute pain one week after surgery.

Methods: Prospective follow-up. Patients were recruited from 11 hospitals and underwent surgery for: total knee replacement (n=88), knee arthroscopy (n=94), total hip replacement (n= 88), abdominal hysterectomy (n=92), laparoscopic cholecystectomy (n=99) and inguinal hernia repair (n=83). Data were collected preoperatively and during a 3-month period to assess pain intensity (0-10 scale), anxiety (STAI) and depression (Beck Inventory) These measures along with socio-demographic factors were entered into a logistic regression model.

Results: Overall, patients complaining of moderate to severe pain (score>3) in the recovery room had a two fold risk of acute pain at day seven (OR=2.0; 95%CI: 1.00-4.13) than patients presenting no or mild pain. Having important pain on the first day was associated with an OR of 3.20 (95%CI: 1.37-7.48) of having pain one week later. Additionally, pain before surgery was related to more intense pain on day seven (OR= 2.60, 95%CI: 1.26-5.35). Moderate or severe pain was less likely in men than in women (OR= 0.36; 95%CI: 0.16-0.80). Anxiety, depression and age were not associated with the severity of pain one week after surgery.

Conclusion: A high pain score immediately after surgery is associated with a greater level of pain at day seven irrespective of the pain reported before surgery or the type of surgery. Sex differences were also found.

Acknowledgements: Supported by Pfizer Inc, Pharmacia Corporation and the Canadian Institute of Health Research (CIHR).

THE QUEBEC POP-MAN STUDY-PAIN BEFORE SURGERY AS A PREDICTOR OF CHRONIC PAIN THREE MONTHS AFTER SURGERY
S. Shapiro, J. Cogan, A. Velly1, C. Bellera G. Blaise3, M. Choinire3, S. Blumenstein, F. Carli1, T. Ducruet1, J. Collet Epidemiology, McGill Un, Mtl, PQ, Canada , Anesthesiology, McGill Un, Mtl, PQ, Canada , Anesthesiology, CHUM, Mtl, PQ, Canada

Aim of investigation: To assess factors related to the presence of pain 3 months after surgery.

Methods: Prospective study to assess factors related to pain 3 months after surgery. Recruited from 11 hospitals and surgery for: total knee replacement (n=88), knee arthroscopy (n=94), total hip replacement (n= 88), abdominal hysterectomy (n=92), laparoscopic cholecystectomy (n=99) and inguinal hernia repair (n=83). Data was collected preoperatively and during a 3 month follow-up period to assess severity of pain (0-10 scale), anxiety (STAI), depression (Beck Inventory). These measures along with socio-demographic factors were entered into a logistic model.

Results: Overall, 19% of patients experienced pain (score >0) 3 months after surgery, mostly after orthopedic surgeries. Patients complaining of pain before surgery had 3.5 times the risk of chronic pain (OR= 3.53, 95%CI: 1.07-11.67) in comparison to patients presenting no pain. Pain in the recovery room (OR= 0.96; 0.40-2.32), and pain on the first day after surgery (OR=1.20, 0.44-3.24) were not related to chronic pain. Men seemed protected from chronic pain (OR= 0.48; 0.205-1.12) while anxiety, depression and age were not associated.

Conclusion: These results suggest that pain before surgery is a contributing factor to chronic pain pain (model adjuted for pain after surgery and peronnal characteristics). Initial severity of the condition, chronic neuropathic pain before surgery or personal sensitivity to pain are possible explanations.

Acknowledgements: Supported by Pfizer Inc, Pharmacia Corporation and the Canadian Institute of Health Research (CIHR).

QUEBEC POPMAN STUDY: EPIDEMIOLOGY OF PAIN AFTER DIFFERENT TYPES OF SURGERY
J. Cogan1, M. Choinire, C. Roy, A. Robinson, T. Ducrue, B. Blaise, J. Collet Anesthesiology, McGill Un, Mtl, PQ, Canada , 2 Epidemiology, McGill Un, Mtl, PQ, Canada , 3 Anesthesiology, CHUM, Mtl, PQ, Canada

Aim of investigation: To document pain intensity and duration after surgery as well as patients' expectations and beliefs concerning pain.

Methods: Prospective follow-up study. Recruitment from 11 hospitals. Surgery for: total knee replacement (n=88), knee arthroscopy (n=94), total hip replacement (n= 88), abdominal hysterectomy (n=92), laparoscopic cholecystectomy (n=99) and inguinal hernia repair (n=83). Data was collected preoperatively and during a 3-month period. Numerical pain intensity scales (0-10) were used. Satisfaction with treatment was also assessed along with patients' barriers regarding pain management.

Results: 544 patients: 307 women and 237 men. At baseline, 89% of patients expected to have moderate to severe pain (score>3)and only 36% believed that medications could control pain. 64% of the patients experienced pain (score >0) in the recovery room, 95% on day one, 76% on day seven, and 19% at three months. For pain of moderate to severe intensity (score>3), figures were 45%, 66%, 27% and 3%, respectively. The percent of patients with pain scores>3 on day 1, day 7 and at 3 months post-surgery were, respectively: for knee replacement 81%, 53%, and 8%; knee arthroscopy 53%, 18%, and 4%; hip replacement 64%, 41%, and 4%; hysterectomy 67%, 29%, and 5% and cholecystectomy 65%, 7%, and 0%. Despite these results, 95% of patients were satisfied with their treatment.

Conclusion: This study shows that post-surgical pain remains a problem and that patients anticipate poor pain relief, suggesting that patient education may have beneficial effects.

Acknowledgements: Supported by Pfizer Inc, Pharmacia Corporation and the Canadian Institute of Health Research (CIHR).

THE PREVALENCE OF SYMPTOMS CLUSTERS AND COMORBIDITIES IN ONCOLOGY OUTPATIENTS
C. West1< K. Paul, S. Dodd, M. Miaskowski, C.> School of Nursing, University of California, San Francisco, CA

Aim of Investigation: The purposes of this cross-sectional study, in a sample of oncology outpatients, were: 1) to determine the prevalence of pain, fatigue, and/or sleep disturbances and 2) to determine the prevalence of a number of comorbid conditions.

Methods: One hundred oncology outpatients were recruited from three outpatient settings. Patients were over 18 years of age and were receiving active treatment for their disease. Patients were asked to complete the Wisconsin Brief Pain Inventory (BPI), the Lee Fatigue Scale (LFS), the General Sleep Disturbance Scale (GSDS), and a checklist of common medical conditions. Patients were categorized into one of eight symptom clusters using the following cutoffs: a worst pain score of >3, a LFS score of >5, and a GSDS score of >60. Descriptive statistics and frequency distributions were generated. Results: The average patient was 59.4 years of age, female (76.8%), and had a Karnofsky score of 77.2. The prevalence of the eight symptom groupings was as follows: no symptoms, 42.3%; only pain, 10.3%; only fatigue, 6.2%; only sleep disturbance, 8.2%; pain & fatigue, 4.1%, pain & sleep disturbance, 9.3%; fatigue & sleep disturbance, 6.2%; and pain, fatigue, & sleep disturbance, 13.4%. The most frequently reported comorbid conditions by these patients were: back problems, 65.2%; allergies, 58.5%; headaches, 50.5%; hemorrhoids, 46.3%; arthritis, 33.3%; and hypertension, 30.4%.

Conclusion: These findings suggest that oncology outpatients do experience multiple symptoms simultaneously and are living with a number of comorbid conditions in addition to their cancer.

Acknowledgements: Supported by a grant from the National Cancer Institute.

EPIDEMIOLOGY OF PAIN: A HIDDEN PROBLEM ?
G.M. Cavallotti1< S. Zavisic,> Research & Development, AstraZeneca, Sweden Giuse Cavallotti, Stojan Zavisic, Sven Undeland (SPON. Robert R Allen), AstraZeneca R&D Sdertlje Sweden

Aim of Investigation: To understand the epidemiology of pain by comparing definitions and prevalences of predefined pain conditions.

Methods: We carried out a systematic literature search on epidemiological data in fifty pain conditions. The search included; MEDLINE, EMBASE and Current Contents/Science Edition (until June 2001). Keywords: Pain (by predefined definitions), Nociceptive, Neuropathic, Musculoskeletal, Visceral pain, Epidemiology, Incidence, Prevalence; limited to humans. Prevalence and incidence data were classified and analyzed according to the underlying pain mechanism.

Results: The prevalences on all fifty pain conditions will be presented, according to the used mechanistic classification:

Neuropathic pain 1-1.5%

Nociceptive pain (musculoskeletal) 13-29%

Visceral pain 4-15%

Migraine 8-10%

We identified a number of possible explanations to the wide variations within each category. The definitions used in the literature ranged a lot across the studies. Measures of severity, duration and significance of chronic pain were poorly validated. Additionally it was found that the studies were done in many different clinical settings (GPs, hospital settings, pain clinics).

Conclusions: To better understand the size of the clinical problem of pain, future epidemiological studies would benefit from the clarification and harmonization across pain definitions. It is also necessary to further study the co-morbidities across pain conditions.

Acknowledgements: Supported by AstraZeneca R&D Sdertlje, Sweden.

SELF-MANAGEMENT STRATEGIES AND PAIN DISABILITY: RESULTS FROM A POPULATION-BASED STUDT
F.M. Blyth, M.K. Nicholas, M.J. Cousins Pain Management & Research Centre, University of Sydney, Sydney, NSW, Australia , 2 Rheumatology, University of Sydney, Sydney, NSW, Australia

Aim of Investigation: To test whether the self-management strategies which reduce chronic pain disability and health service use in clinical populations are associated with lower disability in those in chronic pain in the general population.

Methods: 474 chronic pain subjects were identified in a random digit dialling telephone study. Data were collected on strategies used by subjects to manage pain and pain-related disability (Von Korffs Chronic Pain Grade).

Results: Passive behavioural strategies (e.g. rest) were most commonly reported (53.6%). Conventional medical strategies (e.g. drugs) were used by 49.8%. 35.1% used active behavioural strategies (e.g. exercise), and 20.8% used complementary treatments. Cognitive strategies (e.g. distraction) were used by 11.8%. Subjects using helpful strategies (i.e. active behavioural and/or cognitive strategies) tended to be younger and were better educated, but were similar in terms of distress and self-rated health. There were significantly fewer in this group with pain-related disability (CPG III or IV). In multiple logistic regression modelling with pain-related disability as the dependent variable, use of active behavioural strategies was protective, compared with use of conventional medical strategies (adjusted odds ratios=0.51 [p=0.002] & 2.36 [p=0.002] respectively).

Conclusions: These results suggest that there is a gap between current thinking on best practices for management of chronic pain and widespread adoption of these practices within the general Australian community.

Acknowledgements: This study was supported financially by the NHMRC, the NSAHS and CAPMR.

PAIN AFTER MINOR BURNS
M. Choinire, C. Johnston, P. Desaulniers, D. McGillivray4, P. Gaudreault Burn Centre, CHUM, Montreal, PQ, Canada , Faculty of Nursing, McGill University, Montreal, PQ, Canada , Emerg Dept, CHUM, Montreal, PQ, Canada , Emerg Dept, Montreal Children's Hospital, Montreal, PQ, Canada , Emerg Depart, Ste-Justine Hospital, Montreal, PQ, Canada

Aim if the investigation: To assess the pain experience in patients with minor burns when initially treated in the emergency department (ED).

Methods: Prospective of 111 children and 113 burn adults recruited from EDs of 5 university hospitals. Structured interview protocols were used to assess pain severity and various aspects of pain management. Numerical scales (0-10) were used to measure pain intensity during treatment in the ED (e.g., wound cleansing, removal of dressings) and upon discharge from the ED.

Results: Maximal pain intensity during treatment in the ED reached values 7/10 in 44% of the children and in 55% of the adults. Regression logistic analysis revealed that moderate to severe pain (4/10) was less likely in children with smaller burns (< 1% VS between 1 and 5% or 5% of the body)(p=.0005). Such a relationship did not emerge in the adult group. No pain medication was offered to 47% of the patients during their ED stay. At times of discharge from ED, moderate to severe pain was still reported in 33% of the children and 62% of the adults. Less than half of the participants (46%) were provided with instructions for pain management at home. Despite these results, the majority of the parents were satisfied with pain treatment.

Conclusion: These findings suggest that pain resulting from minor burns is not adequately treated in the ED. Patients experienced substantial pain during their ED stay, and many of them were discharged home with significant pain.

Acknowledgements: Supported by the Fonds de la recherche en sant du Qubec and the Quebec Firemen Foundation

CHRONIC PAIN AFTER SURGERY
M.H. Gehling1< M.> Dept. of Anesthesiology, Intensive Care Medicine and Pain Therapy, Klinikum Kassel, Kassel, Germany

Aim of Investigation: Recently Perkins et al. have described a surprisingly high prevalence of persistent pain complaints in patients serveral months after elective surgery (Perkins et al. 2000). To determine whether surgical procedures result in chronic pain, we reviewed our data from a specialized chronic pain center for patients who suffered from chronic pain after surgery or trauma.

Methods: We included in our analysis all patients that were documented by IASP-classification from Jan 1th 1999 through Sept 31th 2001. Based on the IASP-classification, we identified patients with prior surgery or trauma as supposed aetiology of chronic pain. We calculated the frequency of ICD-10 diagnoses and aetiology.

Results: 1747 patients with chronic pain were admitted to our pain clinic. Trauma or surgery preceeded the development of chronic pain in 299 patients (17%). The most frequent diagnoses were neuropathy (17%), phantom limb pain (12%), radiculopathy/ postlaminectomy syndrome (9%), low back pain (9%), and others (53%). The underlying pathology was attributed to the nervous system (61%), musculosceletal system (30%)and others (9%). Severity and duration of pain were classified as severe, more than 6 months (31%), severe 1 to 6 months (10%), severe less than one month (16%), medium, more than 6 months (21%)and others (22%).

Conclusions: Among patients who require a special pain management, chronic pain after surgery or trauma was strongly associated with neuropathies. We suppose, that chronic pain may develop especially in those patients with lesions of the peripheral or central nervous system.

Reference Perkins FM, Kehlet H Chronic pain as an outcome of surgery Anesthesiology 2000; 93: 1123-33.

CHRONIC PAIN IN CANADA - A PATIENT SURVEY
D.E. Moulin, M. Speechley, P.K. Morley-Forster U.W.O. Interdisciplinary Pain Program, University of Western Ontario, London, ON, Canada , 2 Pain Management Unit, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada

Aim of Investigation: To assess the prevalence, treatment and impact of chronic pain in Canada.

Methods: A stratified random sample of 2,012 adult Canadians were surveyed by telephone in 2001 for the prevalence of chronic pain defined as continuous or intermittent pain for at least six months. A representative sample of 340 chronic pain sufferers who were taking prescription medication for their pain were studied in detail to determine current therapeutic approaches and to assess the social and economic impact of chronic pain.

Results: Chronic non-cancer pain was reported by 29% of respondents, with increased frequency in females and older age groups. The average duration of pain was 10.7 years and the average intensity was 6.3 (scale 1-10) with 68% reporting moderate or severe pain. Anti-inflammatory agents were prescribed for 43% and opioid analgesics for 22% (2/3 codeine). Almost 70% were worried about addiction potential and 1/3 felt that strong analgesics should be reserved for terminal illnesses. Almost half were unable to attend social and family events and 41% were unable to work due to pain for one or more days in the past year.

Conclusions: Chronic non-cancer pain is common in adult Canadians and has a significant social and economic impact. Despite growing evidence of the efficacy and safety of major opioid analgesics for chronic non-cancer pain, less than 10% of chronic pain patients on prescription medication were treated with a major opioid. Chronic pain is undertreated in Canada and major opioid analgesics are probably underutilized.

Acknowledgements: Supported by an unrestricted grant from Janssen-Ortho Inc., Toronto, Ontario, Canada.

PREVALENCE AND CHARACTERISTICS OF NEUROPATHIC PAIN AND CONSEQUENCES OF THE SENSORY LOSS IN 303 PATIENTS WITH LEPROSY
P. Stump1,, L. Marciano1, J. Lauris, S. Ura1, M. Teixeira2, M. Virmond1 1 Trainning & Research, ILSL, Bauru, Brazil , Medical School, USP, São Paulo, Brazil , 3 Dentistry School, USP, Bauru, Brazil

Aim of investigation: This study aims to contribute to the knowledge of prevalence and characteristics of neuropathic pain in leprosy.

Methods: A total of 303 leprosy patients were evaluated (58.7% lepromatous, 25.7% borderline, 13.9% tuberculoid and 1.7% indeterminate). All patients underwent neurological examination with special focus on the occurrence of pain, its localization, duration, installation, intensity (verbal scale) and quality (McGill Pain Questionnaire).

Results: The disease led to protective sensory loss and/or motor deficits resulting in deformities in 251 (82.8%) patients. Neuropathic pain was present in 174 (57.4%), before (73.0%) or at the moment of evaluation (27.0%). Pain lasted more than six months in 138 (79.4%) and installed as bursts in 84 (48.3%) cases out of the 174 cases. It affected one or more peripheral nerve territories totalizing 291 territories, mainly ulnar nerve in 101 (58.0%). Pain was present at the moment of evaluation in 47 (27.0%) patients. It was moderate or severe in 41 (87.2%), constant in 30 (63.8%) and remitted in only 9 (19.1%).

Conclusions: Leprosy is a frequent peripheral neurological disease. It affects the peripheral nerves and very often results in severe neuropathic pain. Leprosy patients may also present disabilities due to lack of pain sensation. Both conditions associated with the social exclusion due to myths about leprosy are some of the reasons for investments in research about prevention and treatment of the disease and its consequences.

10th World Congress on Pain, List of topics

10th World Congress on Pain. International Association for the Study of Pain, San Diego, California, USA August 17-22, 2002