(775) Fluoroscopy radiation safety in interventional pain procedures
(777) Comparative efficacy and safety of different analgesics for neuropathic pain
Y. Zhou, N. Singh, S. Abdi, J. Wu, J. Crawford, P. Barach; University of Miami School of Medicine, Miami, FL Use of fluoroscopy in pain management procedures may result in radiation exposure with risks posed to the patients, physicians, and other personnel. The literature is scant in evaluating the radiation exposure in university pain practices. The objective of this study is to evaluate safety and duration of radiation exposure for interventional pain procedures in university pain clinics. We retrospectively collected data from March 2004 to April 2004 in two university pain clinics. Total fluoroscopy time (FT) for each procedure and frequency of pulsed fluoroscope usage were analyzed. A total of 149 cases of spine injection procedures were collected. The mean fluoroscopy time and standard errors for lumbar epidural steroid injection, facet joint block, sympathetic nerve block, and sacroiliac joint injection were 46.6 ⫹ 4.2, 81 ⫹ 12.8, 64.4 ⫹11, and 146.8 ⫹ 25.1 seconds respectively. These results are different from those of Manchikanti, who reported a mean fluoroscopy time and standard errors of 11.7 ⫹ 1.41; 11.7 ⫹ 0.57, 10; and 15.0 ⫹ 4.89 seconds for epidural steroid injection, facet joint block, sympathetic nerve block, and sacroiliac joint injection respectively. Among the 149 cases, pulsed fluoroscopy was used in 16 cases (9.6%). Even though neither the physicians nor the patients reported any adverse reactions to the radiation exposure during this period, the mean fluoroscopy time from the two university pain clinics are more than four times longer than that in private practice. Prolonged radiation exposure could cause possible long-term threat to the health of the interventional pain physicians and other operating room personnel. It is unclear whether prolonged fluoroscopy exposure is a common phenomenon among the university pain clinics across the nation. It remains a challenge for university pain clinics to review their radiation safety protocol, reduce the fluoroscopy time while maintaining the quality of resident and fellow training.
C. Watson, M. Chipman; University of Toronto, Toronto, ON The scientifically proven drug treatment of neuropathic pain may involve antidepressants, anticonvulsants, opioids and topical agents. Much ado has been made of the superiority of newer analgesics and approaches such as gabapentin, pregabalin and the lidocaine patch for these conditions. The aim of this poster is to examine the scientific basis for this. In a systematic review of randomized controlled trials of antidepressants in chronic pain, 22 out of 69 were comparative trials, most of these comparing one antidepressant with another. Only 7 out of 69 were of different analgesics classes with 5 being studies of neuropathic pain conditions. These comparative studies are the preferred way of making drug comparisons. Another source of comparative data are number needed to treat and number needed to harm figures available from a variety of sources. These data need however to be interpreted with caution because of differing study designs, numbers of patients and data analyses. Data from RCTs may not be generalizable because of restrictive inclusion criteria. Data from these limited sources do not support the superiority in analgesic efficacy and safety of newer drugs and there is some indication from unpublished reports that some of the older analgesics, such as the antidepressants, are more effective and as safe. More comparative trials are sorely needed, particularly those independent of industry funding.
(776) Treatment satisfaction for pain medication: Development and pilot testing of a patient questionnaire
(778) Fentanyl extraction / recovery experiments: Simulation of fentanyl diversion
S. Mathias, R. Sneeringer, M. Strauss, S. Kim; Ovation Research Group, San Francisco, CA There has been recent interest in the development of measures assessing treatment satisfaction. Typically these measures are developed with the goal of differentiating one product versus another to provide a competitive marketing edge. Many of the questionnaires that are currently being used contain only single items (e.g., How satisfied are you with your method of pain relief?). We developed a brief, yet fairly comprehensive generic measure of satisfaction suitable for use in patients receiving pain medication, including oral medications or a transdermal patch. Two primary care sites in the United States were recruited and were asked to enroll patients for a pilot test of the questionnaire. These patients (n⫽17) had used or were currently using an oral or transdermal patch medication to manage pain of the low back or osteoarthritis of the hip or knee within the past 3 months. Patients were asked to complete the questionnaire and were then interviewed to ensure that its content was understandable, appropriate, and comprehensive. We also wanted to determine that respondents could discern one medication for pain from another when answering the questions. Overall, patients found the questionnaire very easy or extremely easy to understand (94%) and appropriate in length (88%). A few specific recommendations were provided to help differentiate long acting pain medication from medications used for pain flare-ups. The final questionnaire contains 7 items assessing aspects such as convenience, effectiveness, and willingness for continued usage. Its factor structure will be examined and validation analyses will be undertaken in the near future. This questionnaire should prove to be a useful tool for researchers and clinicians to assess satisfaction to help patients differentiate amongst the myriad of treatment options.
R. Bianchi, K. Ballard, C. Harte, G. Vorsanger; Janssen Medical Affairs, Fairfax, VA Fentanyl is a potent opioid medication used in the management of moderate to severe chronic pain. This study involves the conduct of a series of fentanyl extraction/recovery experiments to determine the relative ease of obtaining fentanyl in an abusable form from the Duragesic” reservoir patch and a prototypical fentanyl matrix patch. The experiments were designed to evaluate fentanyl recovery using readily available solvents in a manner consistent with drug abuser capability. The Duragesic® and matrix patches were readied for extraction by removing the adhesive covering and placing them in the selected solvent. The patches were subjected to extraction techniques including soaking and percolation at various times and temperatures. Extraction efficiency was evaluated by liquid chromatography/tandem mass spectrometry (LC-MS/MS) at various time points. Experiments involving minimal time and effort yielded significant amounts of fentanyl in the free base form from the matrix patch system. For example, soaking for 15 minutes at room temperature in three readily available solvents yielded 61%, 75%, and 97%, respectively, for the matrix patch, and at 3 hours yielded 89%, 93%, and 100%, respectively. Yields for the Duragesic patch did not exceed 10% at any time point in any of the solvents tested. More complex extraction processes like percolating for 3 hours or boiling in various solvents were required to obtain significant yields from the Duragesic® reservoir patches. Overall, these extraction techniques resulted in a greater quantity of fentanyl being extracted in a shorter time period with less complex techniques from the matrix patch versus the Duragesic reservoir patch.