(528) The influence of fear of pain on activity-induced exacerba- tion of delayed ... Visual Feedback (MVF) for phantom limb pain: a random- ized clinical trial.
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The Journal of Pain
(528) The influence of fear of pain on activity-induced exacerbation of delayed onset muscle pain K Naugle, S Chang, J Parr, and K Naugle; University of Florida, Gainesville ,FL Little is known regarding the influence of fear of pain on acute exacerbations of pain during activity, which is reported in several chronic pain conditions. Thus, the purpose of this study was to investigate the influence of fear of pain on pain perception during activity and at rest after induced delayed onset muscle pain (DOMP) of the bicep. Forty-two young healthy adults completed 2 consecutive days of testing. On Day 1, subjects completed the State-Trait Anxiety Inventory –Trait version (STAI-T), the Pain Catastrophizing Scale (PCS), and the Fear of Pain Questionnaire (FPQ-III). Then, subjects performed an eccentric exercise protocol of the non-dominant elbow flexors to induce DOMP. At baseline and 24 hours after the eccentric exercise protocol, bicep pain was assessed at rest and during elbow flexion, and extension. Subjects were then randomly assigned to perform 20 minutes of either standardized activity of the painful muscles (elbow flexion/extension with a 1lb dumbbell), non-standardized activity of the painful muscles (elbow flexion/ extension while playing Nintendo Wii Boxing), or quiet rest. Subjects rated their worst pain during the activity/rest. Step-wise regression models considered baseline pain measures and scores on the STAI-T, PCS, and FPQ-III as predictors of DOMP at rest and elbow flexion/extension 24 hours later. Bivariate correlations examined the relationship between fear of pain and worst pain during 20 minutes of activity or rest. FPQ-III scores significantly predicted DOMP at rest (b=.481) and pain during elbow extension (b=.445), and were significantly related to worst pain during 20 minutes of rest (r=.853) and standardized elbow flexion/extension activity (r=.733). These results confirm the influence of fear of pain on DOMP while at rest and provide novel evidence showing that greater fear of pain is also associated with greater activityinduced exacerbations of DOMP, with the exception of pain reported while playing Wii Boxing.
(529) Integrated Cognitive-Behavioral Therapy (CBT) and Mirror Visual Feedback (MVF) for phantom limb pain: a randomized clinical trial J McQuaid, D Peterzell, T Rutledge, R Cone, P Nance, D Velez, R Coeshott, J Ortega, M Van Duyn, P Otilingam, and J Atkinson; San Francisco VA Medical Center, San Francisco, CA Phantom limb pain (PLP), the perception of pain located in a missing limb, is a prevalent, treatment-resistant and impairing symptom following amputation. Phantom limb sensations have been attributed to cortical reorganization, and anecdotal reports suggest mirror visual feedback of the contralateral intact limb may alleviate phantom pain. In a 2-arm, 8-week, randomized clinical trial we compared the combination of CBT and MVF with an active control condition (Supportive Psychotherapy Care, SC), for the management of PLP. We hypothesized that CBT+MVF would lead to significantly greater improvement on functioning and mood. Participants (N = 59) were primarily white (71%) men (91%) in their mid-50s with chronic PLP (duration 8.9 years) following amputation (lower limb, 91%), who were randomized to either CBT+VF (N = 26) or SC (N = 33). Most (77%) completed at least 5 weeks of treatment. Outcomes were functioning (SF-12), adjustment to amputation and prothesis (Trinity Amputation and Prothesis Scale) and anxiety (measured with the GAD-7) were assessed. The hypothesis was tested with both completer and intent-to-treat analyses using a 2 x 2 repeated measures with outcomes assessed at baseline and end of treatment. Initial results indicate that while patients overall had significant reductions in anxiety symptoms (F[1,37] = 22.22, p < .001), groups did not significantly differ on anxiety at the end of treatment (F[1,37] = .027, n.s.). Additional analyses will be presented on functioning. However, the findings suggest that combined CBT+MVF does not have robust effects above those of general psychotherapeutic interventions.
Abstracts
(530) Suboxone decreases the odds of opioid resumption in patients with opioid addiction following treatment in a chronic pain rehabilitation program including opioid weaning K Huffman, M Mathews, G Sweis, E Shella, V Taton, W Umberger, and J Scheman; Cleveland Clinic, Cleveland, OH Patients weaned from opioid within an interdisciplinary chronic pain rehabilitation program (CPRP) show improvements in improve pain and function. Patients with chronic non-cancer pain (CNCP) and comorbid opioid addiction also face potential relapse. Suboxone has been demonstrated to decrease the odds of opioid relapse; however, little research has examined it’s use in a CPRP. This retrospective study compared 12 month treatment outcomes of patients with opioid addiction discharged on Suboxone for with patients with opioid addiction who were opioid weaned. 30 patients were discharged on Suboxone between 2007-2012. Cases were matched in age and gender, resulting in a total n of 60. Participants were predominately married (56.7%, n=34) males (n=39, 65.0%) with a mean age of 42.55 (612.49). Both groups were equally likely to have a lifetime history of a substance use disorder (63.3%, n=38, c2=.86, 1, ns) and there was no difference between the two in mean morphine equivalence dosage at admission (M=280.286300.42). Pain and function ratings were collected at admission, discharge and 12 months post-treatment and opioid resumption at 12 months. Repeated measures MANOVA indicated participants reported improvements in pain (p
