317 Chronic pain after open repair of inguinal hernia

317 Chronic pain after open repair of inguinal hernia

S140 Poster Presentations / Clinical – Case Studies / European Journal of Pain 11(S1) (2007) S59–S207 d Prince of Wales Medical Research Institute ...

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S140

Poster Presentations / Clinical – Case Studies / European Journal of Pain 11(S1) (2007) S59–S207

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Prince of Wales Medical Research Institute and the University of New South Wales, Sydney, NSW, Australia Background and aims. Over the past decade, there has been growing interest in the role of the motor system in pain processing. The aim of this investigation was to determine the effects of movement imagery on the level of on-going pain in spinal cord injury (SCI) patients with neuropathic pain. Methods. We compared the effects of imagined right ankle plantarflexion and dorsiflexion on perceived pain intensity in SCI subjects with clinically complete (ASIA A) thoracic injuries (T2–T10), with (n = 7) and without (n = 7) neuropathic pain below the level of their injury. A recorded engine sound was used to assist in the timing of movements. Imagined movements were rehearsed for one week prior to assessment. Results. In every SCI subject with neuropathic pain, ankle movement imagery resulted in a significant increase in pain intensity. In no SCI subject did either attention directed towards the right ankle or movement imagery involving the right wrist evoke any change in pain or non-painful intensity or distribution. In each SCI subject without neuropathic pain, but with phantom sensations, ankle movement imagery did not evoke pain, but instead evoked a significant increase in the intensity of perceived phantom sensation. One patient reported new unpleasant phantom sensation during imagery. Conclusions. In contrast to studies employing motor cortex stimulation which typically reduces pain, movement imagery significantly increases neuropathic pain and phantom sensations in patients with SCI. Furthermore, movement imagery can evoke unpleasant phantom sensations in SCI patients without on-going phantom sensation and/or pain. doi:10.1016/j.ejpain.2007.03.330

316 INFLUENCE OF AGE ON CENTRAL POSTSTROKE PAIN M. Zaletel *, B. Zvan, J. Kobal University Medical Centre, Department of Neurology, Ljubljana, Slovenia Introduction. Central post-stroke pain (CPSP) is a syndrome characterized by sensory disturbances and neuropathic pain. Functional disturbances such as depression, anxiety and sleep disturbances may significantly have an influence on neuropathic pain expression. The contribution of age in CSPS is not clear. Methods. We randomly investigated 297 patients (mean age 72 ± 5.4 years) with first-time stroke over a

1-year period. Patients were evaluated 6 months and 12 months following stroke onset. Pain was assessed using a visual analogue scale ranging from zero mm (no pain) to 100 mm. Using the scale, zero was defined as no pain, 10–30 as mild pain, and 40–100 as moderate to severe pain. Depression was evaluated on a depression scale. Logistic regression was used to analyse the associations. Results. Twenty-seven (9.2%) patients developed CPSP. Factors significantly associated with an increased likelihood of having moderate to severe pain included younger age and higher scores on a depression scale (p < 0.01). Pain was reported as constantly present in 37% patients, and it disturbed sleep in 67% patients. Conclusions. We concluded that CPSP was associated with younger age stroke patients. Depression is an important factor in CPSP. doi:10.1016/j.ejpain.2007.03.331

Poster Session 2: Clinical – Case Studies 317 CHRONIC PAIN AFTER OPEN REPAIR OF INGUINAL HERNIA M. Kokolaki, A. Bairaktari *, P. Kamperi, M. Vafiadou Department of Anesthesia and Pain Clinic, ‘‘Sismanoglion’’ General Hospital, Athens, Greece We present the management of four patients that suffered from severe chronic pain after open repair of inguinal hernia. Material. Four male patients, aged 55–70 years old complained of severe paroxysmal pain (VAS: 7–10) one month after open repair of inguinal hernia. The pain was described as ‘‘sharp’’, ‘‘stabbing’’ and ‘‘electric shock-like’’ along the line of the incision. There was not any hyperalgesia or allodynia. Surgical examination excluded any surgically correctable pathology such as hernia recurrence. Two of the patients received gabapentin (1200 mg/day) for two months. The pain was relieved and never reappeared. The third patient was reoperated in an attempt to identify the cause of the pain at surgery and correct the problem. Pain continued to exist after reoperation and the patient received gabapentin (1200 mg/day) and amitriptyline (50 mg/day) for three months. The fourth patient although he received many kinds of treatment (gabapentin, amitriptylline, venlafaxine, ketamine, patch lidoderm, NSAID, infiltrations with local anesthetics along the incision line) was partially relieved (VAS: 5).

Poster Presentations / Clinical – Case Studies / European Journal of Pain 11(S1) (2007) S59–S207

Conclusion. Principles of treatment of chronic pain after inguinal hernia repair have not been defined. Physical therapy, surgical treatment and NSAIDS have been proposed. However, gabapentin and amitriptylline seems to be effective when the pain has characteristics of neuropathic pain.

References Bozuk, M. et al. (2003). Disability and chronic pain after open mesh and laparoscopic inguinal hernia repair. Am Surgeon, 69(10), 839–841. Bay-Nielsen, M. et al. (2004). Chronic pain after open mesh and sutured repair of indirect inguinal hernia in young males. Br J Surg, 91(10), 1372–1376. doi:10.1016/j.ejpain.2007.03.332

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was performed. Patient remained free of pain and resumed all his professional activities with a five years follow-up. The second case concerns a 19 years-old woman presenting with a two-years lasting supra-orbitary neuralgia associated to a chronic otitis. Neurological examination remained normal. CT-scan revealed a huge enlargement of the ovale foramen; MRI, a trigeminal neuroma extending from the gasserian ganglia to the inferior dental canal. Surgery permitted a quit complete removal assuming pain relief, audition improvement without any complications at three years. These two cases illustrate the importance of clinical screening when an ’’essential’’ neuralgia is diagnosed, especially by a young patient, of imaging investigations and of neurosurgical etiology-oriented procedures for pain relief.

318 THE TRIGEMINAL NEURALGIA: WHEN ESSENTIAL CRITERIA MEET COMPRESSIVE ETIOLOGY E. Blondet e, T. Briche *,c, D. Vandershooten d, V. Prudon b, M. Sindou a a

Department Lyon, France b Department France c Department France d Department France e Department France

of Neurosurgery, Hopital P. Wertheimer, of Medical Imagery, HIA Percy, Clamart, of ENT Surgery, HIA Percy, Clamart, of Psychiatry, HIA Percy, Clamart, of Neurosurgery, HIA Percy, Clamart,

Facial pain must recover specific clinical criteria to be assumed as essential: periodical evolution of paroxysmal neuropathic pain, indolent intercritic phase, improvement under carbamazepine, normal neurological examination, dermatomal distribution,. . .. Intracranial lesions may be however identified on MRI as clinical course losses its essential criteria. We report two cases of ‘‘essential’’ trigeminal neuralgia but relating to an intracranial lesion. A 18 years-old boy presented with a 3 years history of typical trigeminal neuralgia. During his formation as fireman, he was referred for a persistent facial pain. Neurological examination remained normal. Enhancement of medical treatment remained partially successful. Cerebral imaging revealed a developmental venous anomaly draining the homolateral ponto-cerebello-mesencephalic structures, running along the trigeminal tract. Partial rhizotomy

doi:10.1016/j.ejpain.2007.03.333

319 NEUROMODULATION IN THE MANAGEMENT OF PAIN FROM BRACHIAL PLEXUS AVULSION S. Brill *, I. Goor-Aryeh