Delespaul, P.A.E.G.

Lousberg, R.

Mes, C.A.J.

Turk, D.C.

Zilvold, G.

English

Background and Aims: The match-mismatch (MM) model of pain, mainly investigated in laboratory situations, states that people with pain make predictions of pain by evaluating previous (painful) events. Aim of study was to examine whether the MM model could be generalized to daily life of chronic pain patients, and what the influence is of cognitive behavioral rehabilitation on the MM mechanism.Methods: Before as well as after treatment, 100 chronic pain patients were randomly prompted 10 times a day during 7 days to complete a questionnaire concerning pain experience, pain expectation and contextual aspects (Experience Sampling). Multi-level regression techniques and path analysis were used for data-analysis.Results: Effects of (mis)matches were in the hypothesized direction: underpredictions were followed by significant increases in predicted and experienced pain; overpredictions by significant decreases in predicted pain and matches mainly by ‘no changes’ in pain. Additionally, chronic pain patients were more likely to underpredict than overpredict pain (respectively 41.2% and 19.2% of total number of (mis)matches. The more pain control (b = −0.265; t = −2.135) or fear-avoidance (b = −0.465; t = −1.937) patients showed, the smaller the difference between the number of underpredictions and overpredictions. After treatment, the number, size and effect of mismatches decreased, particularly in case of underpredictions.Conclusion: The MM mechanism could be applied in daily life of chronic pain patients. The results provided an indication of the importance of underpredictions in daily life of chronic pain patients, which may be influenced by fear-avoidance and pain control

University of Twente Research Information

Topic G: DIAGNOSIS, ASSESSMENT AND REVIEWS S251969CAN THE PAIN CATASTROPHIZING SCALE AND THE TAMPASCALE OF KINESIOPHOBIA BE USED FOR CLINICALDECISION MAKING IN CHRONIC PAIN?I.E. Lame1 °, M.L. Peters2, A.H. Kessels3, M. van Kleef1, J. Patijn1.1University Hospital Maastricht, Pain Management and Research Centre,Maastricht, 2University Maastricht, Dept. of Medical, Clinical andExperimental Psychology, Maastricht, 3University Hospital Maastricht,Dept. of Clinical Epidemiology and Medical Technology Assessment,Maastricht, The NetherlandsBackground and Aims: Psychological screening measures are increas-ingly used in clinical settings either to match subgroups of patients withsimilar characteristics or as means in therapeutic decision making. Anyscreening measure with diagnostic consequences needs to be stable insimilar time. In this study the stability of two frequently used screeningmeasures in chronic pain, the Pain Catastrophizing Scale (PCS) and theTampa Scale of Kinesiophobia (TSK), was investigated over a relativelylong interval of time. In addition, stability of the TSK and PCS subscaleswas examined.Methods: A test-retest study of the PCS and TSK was conducted in 50consecutive non-malignant chronic pain patients of an Outpatient Clinicfor Pain and Pain Management. All patients completed the PCS and TSKas part of the standard intake procedure. The second administration wascompleted on the day of their first appointment with the physician.Results: The interval period between the first and the second administra-tion varied from 14 to 135 days. Both the PCS and TSK were found to bestable. Stability of the TSK further improved after omitting the reversedkey items. The two subscales of the TSK and the subscale Magnificationof the PCS were sufficiently stable, but the helplessness and ruminationsubscales of the PCS had lower stability.Conclusions: Both the PCS and TSK can be recommended for use asscreening tool in clinical settings. It is advised to use the TSK without thereversed key items.970PAIN FOLLOWING BONE MARROW ASPIRATION IN ADULTSY. Lidén1 °, E. Johansson2, O. Landgren2, S. Arnér1. 1Dept ofAnaesthesia and Intensive Medicine, Karolinska University HospitalSolna, Stockholm, 2Dept of Hematology, Karolinska University HospitalSolna, Stockholm, SwedenBackground and Aims: Bone marrow aspiration/biopsy (BMA) is a com-mon procedure in patients with hematological disorders. BMA is regardedas a painful procedure. The aim of this study was to identify frequency,intensity and determinants of pain among adult patients undergoing BMA.Methods: We included 236 patients (m/f = 126–110). Before BMA, pa-tients answered questions concerning daily pain and anxiety. A localanaesthetic was used as pain relief during BMA. 15 minutes after theBMA, 235 patients answered questions about BMA-associated pain,discomfort, satisfaction with pain relief. One week later, 213 patientsanswered questions concerning pain after BMA. The intensity of pain,discomfort and anxiety was measured with VAS, ranging from 0−100mm.Anxiety was also assessed with the State Trait Anxiety Scale (STAI-S andSTAI-T).Results:75% of the patients reported pain during BMA, (median VASscore 37/100), among these 5% scored VAS 100mm. After 15 minutes,17% of the patients experienced pain and 12% reported pain after oneweek. Discomfort during BMA was experienced in 89% of the participants.Pain in daily life (p = 0.02), pain before BMA (p = 0.006), the presence ofanxiety before BMA (p = 0.0001), a higher score on STAI-S (p = 0.0005) orSTAI-T (p = 0.004, younger age (p = 0.04) and lack of written informationabout the procedure (p = 0.03) were factors significantly associated with ahigher frequency and/or intensity of pain during BMA.Conclusions: The majority of the patients experienced BMA-associatedpain and discomfort. The presence of pain in daily life and anxiety beforeBMA were associated with higher risk of pain during BMA.971APPLICATION OF THE MATCH-MISMATCH MODEL INCHRONIC PAIN TREATMENT: AN EXPERIENCE SAMPLINGSTUDYC.A.J. Mes1 °, R. Lousberg1,2, G. Zilvold1,3, P.A.E.G. Delespaul4,D.C. Turk5. 1Roessingh Research & Development, Enschede, 2UniversityHospital Maastricht, Department of Psychiatry & Neuropsychology,Maastricht, 3University of Twente, Biomedical Technology Institute,Enschede, 4Maastricht University, Department of Psychiatry andNeuropsychology, South Limburg Mental Health Research and TeachingNetwork, EURON, Maastricht, The Netherlands, 5University ofWashington School of Medicine, Department of Anesthesiology, Seattle,WA, USABackground and Aims: The match-mismatch (MM) model of pain,mainly investigated in laboratory situations, states that people with painmake predictions of pain by evaluating previous (painful) events. Aim ofstudy was to examine whether the MM model could be generalized todaily life of chronic pain patients, and what the influence is of cognitive-behavioral rehabilitation on the MM mechanism.Methods: Before as well as after treatment, 100 chronic pain patientswere randomly prompted 10 times a day during 7 days to complete aquestionnaire concerning pain experience, pain expectation and contextualaspects (Experience Sampling). Multi-level regression techniques and pathanalysis were used for data-analysis.Results: Effects of (mis)matches were in the hypothesized direction:underpredictions were followed by significant increases in predicted andexperienced pain; overpredictions by significant decreases in predicted painand matches mainly by ‘no changes’ in pain. Additionally, chronic pain pa-tients were more likely to underpredict than overpredict pain (respectively41.2% and 19.2% of total number of (mis)matches. The more pain control(b =−0.265; t = −2.135) or fear-avoidance (b =−0.465; t = −1.937) patientsshowed, the smaller the difference between the number of underpredictionsand overpredictions. After treatment, the number, size and effect ofmismatches decreased, particularly in case of underpredictions.Conclusion: The MM mechanism could be applied in daily life of chronicpain patients. The results provided an indication of the importance ofunderpredictions in daily life of chronic pain patients, which may beinfluenced by fear-avoidance and pain control.972TWELFTH NERVE PALSY AFTER POSTDURAL PUNCTUREL. Pirbudak Çöçelli1 °, G. Serin1, I. Erkutlu2, M.G. Ugur3, M. Neyal4,N. Tahtaci1. 1Anesthesia, 2Neurosurgery, 3Obstetric and Gynecology,4Neurology, Gaziantep Univ, Medical School, Gaziantep, TurkeyIntroduction: Cranial nerve dysfunction after dural puncture is seen rarely.We discussed a case with prolonged postspinal puncture headache and 12.cranial nerve dysfunction.Case: A 36 year-old female patient has been admitted to pain center havingheadache and atrophy on the left half side of her tongue. She had a historyof cesarean delivery with spinal anesthesia in 2000. On the postoperativefirst day her headache had begun and had lasted seven days; it had occurredagain at interval of 3−4 months without any response to the analgesicdrugs. On 2003, she had had difficulty in speaking and on 2004, she hadrecognized a change in shape of on the left side of her tongue and shehad been admitted to the department of neurology. MR myelography hadbeen performed. Cerebrospinal fluid leakage was determined. In 2005 sheapplied to our department with the complaint of headache and a changein shape of her tongue.Discussion: It has been reported that the most common effected nerveafter spinal anesthesia is the nervus abducens because of its long course.However the nerve palsy had developed 2−5 days after dural puncture. Inour case twelfth nerve palsy had developed 4 years later intelligently. Inour opinion, the hypoglossus nerve palsy after post spinal puncture mayoccur by the distorsion of the nerve fibers due to the traction of the brainstem downwardly and in the patients having spinal anesthesia when thecomplications appear at long term this probability should not be forgotten.

Application of the match-mismatch model in chronic pain treatment:An experience sampling study

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Application of the match-mismatch model in chronic pain treatment:An experience sampling study

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