The Occipital Nerves Applied Strain Test to Support Occipital Neuralgia Diagnosis

Introduction: Occipital neuralgia (ON) is a disabling cephalalgia form with demanding diagnostic workflow. We report the description and reliability analyses of the occipital nerves applied strain (ONAS) test for occipital neuralgia (ON) early-stage diagnosis in cephalalgia patients. Methods: In a retrospective and observational study, we evaluated, among n = 163 consecutive cephalalgia patients, the sensitivity, specificity, and prior probability [positive (PPV) and negative (NPV) predictive values] of the ONAS test against two reference tests (occipital nerve anesthetic block and the painDETECT questionnaire). Multinomial logistic regression (MLR) and v2 analyses verified the ONAS test outcome’s dependence upon independent variables (gender, age, pain site, block test, and painDETECT outcomes). We assessed inter-rater agreement with Cohen’s kappa statistic. Results: ONAS test showed sensitivity and specificity of 81 and 18%, respectively, against the painDETECT and of 94 and 46%, respectively, against the block test. PPV was >70% against both tests, while NPV was 81% against the block test and 26% against the painDETECT. Interrater agreement Cohen’s kappa was excellent. Significant association (X2 analyses) and relationship (MLR) were found only between ONAS test and pain site but not with the other independent predictors. Conclusions: The ONAS test showed satisfactory reliability among cephalalgia patients; thus, it might be considered a valuable early stage tool for ON diagnosis in these patients.PLAIN LANGUAGE SUMMARY We report the description and reliability features of an occipital neuralgia diagnostic tool. The latter is based on the assertion that applying a strain on putatively compromised occipital nerves prompts abnormal nerve discharges and subjective pain reactions and thus may reveal occipital neuralgia. Among 163 cephalalgia patients, the test showed sensitivity and specificity of 81 and 18%, respectively, against the painDETECT questionnaire and 94 and 46%, respectively, against the occipital nerves’ block test. Interrater agreement was excellent, and significant associations and relationships were found only between the tool and congruent pain site but not with the other independent predictors. This tool may help clinicians’ early detection of occipital neuralgia in cephalalgia patients

Corticocortical connections between frontal periarcuate regions and visual areas of the superior temporal sulcus and the adjoining inferior parietal lobule in the macaque monkey

In macaque monkeys, corticocortical connections between distinct parietotemporal visual areas (areas MST-FST, DP, and 7a) and frontal periarcuate areas are studied using tritiated aminoacids and WGA-HRP. While labeling within the banks of the principal sulcus, the dorsal part of the arcuate concavity, and the banks of the upper arcuate limb were present in both 7a and MST-FST injected animals; in the latter cases, additional projections were found towards frontal regions including the dorsomedial frontal cortex and the posterior bank of the arcuate ventral limb. Our results point to widespread frontal connections of the MST-FST complex, involving both prefrontal and premotor cortical regions

SCORING SYSTEM FOR BREAKTHROUGH-PAIN LIKELIHOOD IN CANCER PATIENTS: AN IMPACT STUDY

Session type Topic Cancer and Palliative Care Abstract title SCORING SYSTEM FOR BREAKTHROUGH-PAIN LIKELIHOOD IN CANCER PATIENTS: AN IMPACT STUDY Objectives: Breakthrough Cancer pain (BTcP) shows variable prevalence and challenging management. We report the preliminary results of an impact multicenter study with a novel Scoring System (SS) based on a validated diagnostic/prognostic tool, the IQ-BTP1,2, for BTcP recognition and likelihood (High, Intermediate, Low).\ua0 Methods: The IQ-BTP SS was administered at 3 consecutive visits to n=100 patients. Other studied variables were: demographics, disease related information, pain therapy, Brief Pain Inventory and, physician concordance with and appreciation of the SS. We planned to establish among patients with potential BTcP the proportions of its High, Intermediate and Low likelihood and the feasibility/reliability of the SS. Results: The majority of the patients were correctly classified as potentially having (or not having) BTcP. In Visit #1, 2 and 3, respectively, \u2018potential BTcP\u2019 was found in 40, 43 and 24% of the patients with, respectively, high (48, 33 and 46%), intermediate (38, 51 and 50%) and low (15, 16 and 8%) likelihood. Over 90% of physicians reported that the SS was feasible and very helpful in diagnosing and managing BTcP. Conclusions: The IQ-BTP with its SS and with adequate feasibility enables the detection of potential-BTP and its likelihood. The latter has significant relevance to BTcP epidemiology and management.\ua0 Bibliography\ua0 1. Samolsky Dekel BG et al. Development, validation and psychometric properties of a diagnostic/prognostic tool for breakthrough pain in mixed chronic-pain patients.Clin Neurol Neurosurg. 2016 Feb;141:23-9.\ua0 2. Samolsky Dekel BG et al. Development and performance of a diagnostic/prognostic scoring system for breakthrough pain. J Pain Res. 2017 May;31;10:1327-1335.\ua0 Keywords Breakthrough pain\u2028scoring system\u2028likelihood\u2028cancer pain\u2028BTcP\u2028IQ-BTP\u2028Brief Pain Inventor

Pain Management in Peripheral Arterial Obstructive Disease: Oral Slow-Release Oxycodone Versus Epidural L-Bupivacaine

Objectives: To compare the effectiveness of oral slow-release oxycodone (group OX, n=18) with that of epidural L-bupivacaine (group LRA, n=13) for the control of moderate/severe pain of advanced-stage peripheral arterial obstructive disease (PAOD) patients. Design: Observational and retrospective analysis of advanced stage and hospitalised PAOD patients treated for pain management for at least 7 days prior to surgery or discharged from the hospital without surgery. Methods: The outcome measures were pain intensity using the visual analogue scale under static, (VASs) and dynamic (VASd) conditions; vital signs, treatment side effects and patient satisfaction. Results: In both groups, pain control was satisfactory and VAS scores median were VASs< 3 and VASd < 4; under dynamic conditions, pain control was better in the LRA group (p< 0.01). Against fewandtransient sideeffects,mostpatients (n=30) foundbothpaintreatments good orexcellent. Results should be confirmed by studies with larger samples. Conclusions: In the perioperative setting, the epidural infusion of local anaesthetics, such as L-bupivacaine, is an effective technique for pain control in PAOD patients; for patients with contraindication for this technique or for non-surgical or outpatients, slow-release oxycodone is suggested as a possible alternative for the control of severe pain in these patients

CONTROLLO DEL DOLORE POST-OPERATORIO NELLA CHTRURGIA DELLA MALATTIA DI CROHN

Obiettivo. Scopo dello studio era il confronto delle principali metodiche antalgiche impiegate nel controllo del dolore postoperatorio, in pazienti con MC. Materiali e metodi. Lo studio, osservazionale e retrospettivo, \ue8 stato condotto su 133 pazienti affetti da Malattia di Crohn che, nel periodo compreso tra settembre 2011 e aprile 2012, sono stati trattati chirurgicamente presso i Reparti di Chirurgia Generale dei Professori G. Poggioli e M. Taffurelli e sono stati seguiti, nel decorso post-operatorio, dal Servizio di Terapia del Dolore acuto Peri-Operatorio dell\u2019Unit\ue0 Operativa di Anestesiologia e Terapia Intensiva (Direttore Prof. G.F. Di Nino). La valutazione del dolore \ue8 stata effettuata mediante l\u2019utilizzo della NRS, esaminando i pazienti tre volte al giorno in condizioni statiche e dinamiche. Le variabili indagate, oltre all\u2019intensit\ue0 del dolore, comprendevano anche il Protocollo di terapia antalgica applicata. Risultati. Tra gli N=133 pazienti inseriti nello studio, il 48,1% (n=64) era di sesso maschile e il 51,9% (n=69) di sesso femminile; l\u2019et\ue0 media era 38,2 ( \ub1 13,8). La maggioranza del campione (n=60) \ue8 stata trattata nelle prime 48h post-operatorie mediante somministrazione di analgesico endovenoso tramite pompa PCA (Protocollo C), oltre un terzo \ue8 stato trattato con analgesia endovenosa continua mediante elastomero (n=48, Protocollo B), n=20 pazienti sono stati trattati con analgesia peridurale (Protocollo D) e n=5 con analgesici endovenosi ad orari fissi (Protocollo A). Analizzando l\u2019andamento del dolore in condizioni statiche, la mediana dell\u2019NRSs era superiore in tutte le rilevazioni per i pazienti trattati con Protocollo D. Alla 16a e 40a ora post-operatoria l\u2019analgesia con Protocollo D era meno efficace sia rispetto al Protocollo B (p=0,04) sia al Protocollo C (p=0,011 e p=0,03); alla 24a ora l\u2019analgesia peridurale era meno efficace rispetto alla PCA (p=0,03) ma non rispetto all\u2019elastomero (p=0,07). Infine all\u20198a ora post-operatoria il trattamento con PCA era superiore rispetto ad entrambe le metodiche. L\u2019andamento della mediana dell\u2019NRSd risultava essere superiore in tutte le rilevazioni nei pazienti trattati con Protocollo D. Alla 8a, 24a, 32a e 40a ora, il trattamento con Protocollo D era meno efficace rispetto alla PCA (p<0,02); alla 16a e 48a ora l\u2019analgesia peridurale era meno efficace sia rispetto alla PCA che rispetto all\u2019elastomero endovenoso. Discussione e conclusioni. Il dolore post-operatorio nei pazienti con MC pu\uf2 essere complesso e di difficile gestione1. Nel nostro studio l\u2019analgesia con PCA era la metodica pi\uf9 efficace nel controllo del dolore post-operatorio, permettendo un\u2019analgesia di base mediante l\u2019infusione continua del farmaco e consentendo al paziente di autosomministrarsi un bolo aggiuntivo in caso di persistenza del dolore. Forniva inoltre al paziente un controllo sulla propria malattia, rafforzando il suo \u201cinternal pain locus of control\u201d. L\u2019analgesia endovenosa continua mediante elastomero era sovrapponibile alla PCA nel controllo del dolore post-operatorio. L\u2019analgesia peridurale era meno efficace rispetto alle precedenti metodiche analizzate. \uc8 plausibile che la limitata efficacia antalgica sia legata all\u2019estensione del taglio chirurgico, non compatibile con l\u2019analgesia locoregionale. Bibliografia 1. Cameron CA, Sawatzky JA. Postoperative pain management: the challenges of the patient with Crohn\u2019s disease. Medsurg Nurs 2008;17:85-91

The Italian Questionnaire for Cancer Breakthrough Pain Diagnosis, a Multicenter Validation Study

none9noIntroduction: The literature lacks formally validated and reliable tools for the diagnosis of breakthrough cancer pain (BTcP). The Italian Questionnaire for BTcP diagnosis (IQ-BTP) is an 11-item questionnaire aimed at detecting potential-BTP and classifying it into three likelihood classes: high, intermediate, and low. Methods: A multicenter, prospective, and observational study was designed to validate the IQ-BTP. In three consecutive visits with each cancer patient, the demographic and clinical details of the patient, the Brief Pain Inventory (BPI) scores, IQ-BTP outcomes, and clinicians' autonomous BTcP diagnosis (gold standard) and the agreement of this diagnosis with IQ-BTP outcomes were recorded. The assessed domains for IQ-BTP validation were: Validity, including content and face validity, construct validity (hypothesis testing, and cross‐cultural validitymeasurement invariance), and criterion validity; Reliability (internal consistency, reliability, and measurement error); Interpretability, and Responsiveness. Results: Seven palliative and pain management facilities in Italy recruited 280 patients, yielding 753 evaluations. Using the IQ-BTP, the rate of potential-BTcP was 27.2%, of which its likely presence was high in 52.7% of patients, intermediate in 38.5, and low in 8.8%. The BPI item scores differed significantly between the two IQ-BTP classes (no-BTcP and potential-BTcP classes). The correlation of the latter class with BPI items was significant but low. The IQ-BTcP showed two principal components, accounting for 66.6% of the variance. Cronbach’s α was 0.71. The agreement rate between the gold standard and IQ-BTP outcomes was 82%. Cohen's κ was 0.535. The IQ-BTP showed sensitivity and specificity of 69 and 86%, respectively. Conclusions: The IQ-BTP extensive formal validation showed satisfactory psychometric and validity properties. Its content, face, construct, and criterion validities and its reliability, interpretability, and responsiveness were shown. Its use enabled potential-BTcP to be identified and differentiated into three likelihood classes with direct therapeutic and epidemiological implications. The latter may be confirmed in future studies.openSamolsky Dekel B.G.; Gori A.; Gunnellini M.; Gioia A.; Di Marco M.; Casale G.; Bevilacqua M.; Bersani P.; Melotti R.M.Samolsky Dekel B.G.; Gori A.; Gunnellini M.; Gioia A.; Di Marco M.; Casale G.; Bevilacqua M.; Bersani P.; Melotti R.M

Lasting Prolonged-Release Tapentadol for Moderate/Severe Non-Cancer Musculoskeletal Chronic Pain

INTRODUCTION: Despite opioids’ recognized role in the treatment of moderate/severe musculoskeletal chronic pain, their long-term benefits need investigation. We explored the lasting analgesic efficacy, tolerability, influence on life quality, and chronicity stage of the novel prolonged release (PR) opioid, tapentadol, in 30 outpatients. METHODS: We evaluated patients’ pain intensity and relief (Numerical Rating Scale; NRS), adverse effects, sleep quality, treatment satisfaction, health status (12-questions Health-Survey; SF-12), chronicity stage (Italian Mainz Pain-Staging System; I-MPSS) at 10, 30, 60, and 90 days after tapentadol prescription. RESULTS: At follow-ups, the investigated outcomes showed an overall statistically significant (Wilcoxon signed-rank test) improvement and remained stable over time, as did the health status and chronicity stage. Adverse effects were limited, transitory, and tolerable. CONCLUSIONS: Twelve weeks of PR tapentadol in outpatients with moderate/severe chronic musculoskeletal pain showed satisfactory analgesic efficacy and tolerability, and had a positive influence on life quality and chronicity stage. The results are robust enough to warrant a subsequent study with a larger sample and a longer observation period