Poster Sessions / European Journal of Pain 13 (2009) S55–S285 S263

increased after gum chewing. These results support the hypothesis

that activation of the ventral PFC during gum chewing evokes

augmented activity of 5-HT neurons in the dorsal raphe nucleus,

which in turn, suppresses nociceptive response.

928

NEW DEVICE IN PAINFUL VERTEBRAL METASTASES TREATMENT

A. Cesaroni*, G. Colini Baldeschi. UOSD Pain Therapy Ospedale

“S. Giovanni Addolorata”, Rome, Italy

The high incidence of spinal metastases and the high risk of

resulting VCFs imply that a significant proportion of cancer patients

ultimately will suffer from painful VCFs. Bipolar plasma radio

frequency ablation (Cavity ArthroCare Corporation, Sunnyvale, CA)

associated with vertebroplasty is a new option to remove the

tumoral tissue from the vertebral body and stabilized the spine

at the same time.

This proprietary technology involves the use of saline or Ringer’s

lactate solution around the bipolar electrode array, and the passage

of a distinctive RF current through the fluid to cause ions in solution

to energize into a focused ionic plasma cloud. The affect on the

target anatomy is that tissue touching the plasma is completely

dissolved via a process of molecular dissociation as ions break the

intramolecular bonds within cells.

In our first experience of 12 cases, we have used the Cavity device in

patients with vertebral metastases with excellent results in terms of

pain relief and spinal stabilization. The most important application

of this device is the possibility to treat patients with a disruption of

the posterior wall and an extension of the tumoral tissue inside the

spinal canal. The precision of the tumor debulking and the minimal

thermal injury at the margin permits a safety excision and a low

pressure injection of the cement inside the cavity.

Augmentation of VCFs has the potential to improve functionality

and mobility, reduce pain and improve quality of life in cancer

patients. It also may be performed without compromising the

effectiveness of continued oncologic treatments.

929

EXPLAINING THE SUCCESSES AND FAILURES OF A CHRONIC

PAIN MANAGEMENT COURSE

F. Toye*, K. Barker. Nuffield Orthopaedic Centre, Oxford, United

Kingdom

Background and Aim:We aimed to identify factors that explain the

success or failure of chronic pain management. No other qualitative

study has followed patients over time in order to identify these

factors.

Method: We interviewed a purposive sample of 20 patients

attending chronic pain management at 3 stages over one year.

We transcribed and analysed each interview before completing the

next, so that subsequent interviews could be shaped by evolving

theory. We used the methods of Grounded Theory to analyse the

data, and used NVivo a computerised programme, to assist.

Results: Those who attained a good result had found hope; they

had overcome specific fears; they perceived no loss of self and

used pacing and goal setting to minimise the impact of pain on self

identity; they accepted the psychological model, yet simultaneously

constructed a complementary mechanical model. In contrast to

this, those who were unsuccessful at one year had found no hope;

they did not describe specific fears; they experienced loss of self

and rejected pacing and goal setting; they continued to use the

biomedical model, rejecting the psychological model.

Conclusion: We conclude that hope is integral to successful

outcome. Although removal of fear explained success, it did not

fully explain the failure of treatment. For a successful outcome

patients needed to construct an acceptable explanatory model. We

refer to this as the mechanical model, whereby the body was

constructed as ‘out of order’ rather than ‘broken’. Finally, successful

patients no longer perceived loss of self.

This research was supported by a grant from Oxfordshire Health

Services Research Committee.

930

AUDIT OF INVOLVEMENT OF PHYSICAL THERAPISTS IN THE

MANAGEMENT OF BACK PAIN

S. Gummaraju*, S. Balasubramanian. University Hospitals of

Coventry & Warwickshire, Coventry, United Kingdom

Background: Pain is the second most common reason for claiming

incapacity benefits. [1]

Aims: To enhance awareness about the importance of physical

therapy (PT) in management of low back pain. Improve availability

of PT service.

Audit standards: Clinical advisory and services group recommends

that 100% of patients referred to pain clinic should have had PT

input and 100% of them should continue physical activity. [2]

Methods: 100 new referrals with predominant mechanical back

pain to the pain clinic were retrospectively audited.

Results: Sixty-nine percent were females, 60% were aged between

20–60 years. Fifty-five percent of referrals came from general

practioners (GPs). Overall 36% had previous physiotherapy, 26%

continued physical activity. Tertiary care referrals had more PT

inputs than GP referrals. Out of 60 patients in 20–60 years age

group, 46.6% were unemployed/on long sickness leave/claiming

disability benefits.

Conclusions: Inadequate physiotherapy input for patients with back

pain. Patients lacked motivation for PT. Re-audit by the end of the

year 2009. Actions initiated: Easier access to PT. Business case for

a Pain Management Programme.

Reference(s)

[1] Pain in Europe. A 2003 report. Research project by NFO world group

funded by an education grant from Mundipharma International Ltd,

Cambridge, England.

[2] The Epidemiology and Cost of Back Pain. Clinical Standards Advisory

Group. 1994 ISBN 0–11–321889–3.)

931

LATERALITY TRAINING WITHIN A GRADED MOTOR IMAGERY

(GMI) CLINICAL PATHWAY FOR COMPLEX REGIONAL PAIN

SYNDROME (CRPS): A PROSPECTIVE AUDIT

S. Johnson*, A. Goebel, M. Draper, S. Barnett, G. Derbeyshire,

L. Hogan, C. Rooney, A. Williams, H. Cameron, D. Dennery. C/o

The Walton Centre For Neurosurgery and Neuroscience NHS Trust,

Liverpool, United Kingdom

Background: GMI has demonstrated good evidence for pain

reduction in longstanding CRPS within a single centre research

setting (Moseley 2004; Moseley 2006). We conducted a prospective

audit to assess GMI outcomes in a clinical setting. Here we report

outcomes from the first stage, laterality training.

Methods: Upon confirmation of diagnosis (Bruehl criteria)

patients with longstanding CRPS (>6 months) were referred for

physiotherapy/occupational therapy (PT/OT) plus GMI. Outcomes

included Numeric Rating Scale (NRS) pain intensity, and function

(Task Specific Scale (TSS)). Results: 33/53 referred patients entered

the pathway, of which 20 completed the first stage. Reasons

for not completing the first stage included failure to attend,

declined treatment, ongoing treatment elsewhere and computer

problems. Recognition times improved in both limbs (average:

0.91 sec affected versus 1.22 secs unaffected). Average 24h pain

intensity improved from 6.6 to 6.36 on a NRS. There was no

correlation between improvement in recognition times and pain.

TSS (completed by n=8) values improved in all patients (average:

1.73 points). Average duration of laterality training was 6 weeks

rather than the projected 4 weeks because patients were unable to

attend earlier follow up. 18/20 patients progressed to the second

stage of GMI whilst 2 discontinued due to increased pain.

S264 Poster Sessions / European Journal of Pain 13 (2009) S55–S285

Conclusion: We found that a combination of GMI laterality training

and standard PT/OT, when applied in longstanding CRPS in a

clinical setting, only minimally improved patients’ pain intensity,

and recognition time. This raises questions about the translatability

of GMI to clinical practice and its mechanism of action.

932

PHYSIOTHERAPY STUDENTS’ BELIEFS ABOUT HARMFULNESS

OF PHYSICAL ACTIVITIES IN BACK PAIN PATIENTS

M.A. Laekeman1 *, H. Sitter2, R.A.B. Oostendorp3. 1University of

Applied Sciences, Muenster, Germany; 2Institute of Theoretical Surgery

Philipps-University Marburg, Marburg, Germany; 3Radboud University

Nijmegen Medical Centre, Nijmegen, Netherlands

Aims: To evaluate kinesiophobic beliefs of physiotherapy students

(PTs) and to explore their harmfulness ratings of physical activities

regarding low back pain patients (LBP).

Methods: PTs (n =61) received (a) the Tampa Scale Kinesiophobia

consisting of 17 items adapted for physiotherapists (TSK-PT) (17–68;

1 = strongly disagree, 4 = strongly agree), (b) the PHOtograph

series of Daily Activities (PHODA) consisting of 26 photographs

with different daily activities, and (c) a Visual Analogue Scale

(0–100mm) asking for PTs’ perceived pain related fear regarding

physical activities in LBP patients (VAS-rf). Descriptive and

inferential analyses of the data were carried out using SPSS.

Results: Internal consistency of the TSK-PT was a =0.80 (Cronbach’s

alpha). The median split TSK-PT score (35) divides the sample into

high scorers (>35; n =31) and low scorers (<35; n =30). Correlations

between TSK-PT and PHODA were 0.49 and between VAS-rf and

PHODA 0.27. Regression analysis with TSK-PT as dependent variable

showed a significant influence of PHODA. PTs with a high TSK score

had significantly less experience in treating LBP Patients (p< 0.05).

Conclusions: The reliability of TSK-PT is good. The results

underscore the validity of the TSK-PT. The high TSK scores most

probably are a consequence of low experience in LBP management.

933

ARE THE ACTUAL AND PERCEIVED LEVEL OF PHYSICAL ACTIVITY

IN CHRONIC LOW BACK PAIN PATIENTS ASSOCIATED?

I. Huijnen1 *, J. Verbunt2, M. Peters3, P. Delespaul4, H. Kindermans3,

J. Roelofs3, M. Goossens3, H. Seelen2. 1Department of Rehabilitation

Medicine, Maastricht University, Maastricht, Netherlands;2Rehabilitation Foundation Limburg, Hoensbroek, Netherlands;3Department of Clinical Psychological Science, Maastricht University,

Maastricht, Netherlands; 4Department of Mental Health Services

Research & Development, Maastricht University, Maastricht,

Netherlands

Background and Aim: Earlier research postulated that chronic

pain patients may have difficulties estimating their own level

of physical functioning. Their perception of physical load seems

influenced by their pain-related disability level. In the current

study, the relationship between subjective and objective measures

of activity in daily life in Chronic Low Back Pain (CLBP) patients

was investigated, relative to disability levels found.

Methods: 100 CLBP patients were included in a cross-sectional

study. Physical activity level in daily life was measured:

1. Subjectively, based on an electronic diary featuring random daily

timing cues (beeps) during two weeks. The first item (“What

was your effort between this and the previous beep?”) reflects

the subjective physical activity level in daily life between two

timing cues (Subjectiveactivity). The second item (“This activity

is strenuous for me.”) reflects the intensity of the activity

(Subjectiveintensity).

2. Objectively, based on accelerometry during the same period

(Objectiveactivity).

The Roland Disability Questionnaire (RDQ) measured the

patient’s disability level. The association between Subjectiveactivity,

Subjectiveintensity, Objectiveactivity, and the RDQ was tested (Pearson

Correlation coefficient).

Results: A significant association was found between RDQ

and Subjectiveactivity (r = −0.33, p < 0.05), RDQ and Subjectiveintensity

(r = 0.40, p < 0.01), but not for the subjective measures and

Objectiveactivity, nor for Objectiveactivity and RDQ.

Conclusions: The subjective reported intensity of an activity is an

even more disabling factor in CLBP patients than the perceived

activity level, but the actual functioning seems not associated.

Acknowledgments: Sponsored by ZON-MW (14350042) and EFIC

Grunenthal Grant.

934

THE VIBRATION TRAINING AS A LOW BACK PAIN TREATMENT

METHOD

U. Lukashevich*, S. Likhachev. The Republic Research Centre of

Neurology and Neurosurgery, Minsk, Belarus

Introduction: The pain syndrome in the loin, or LBP (Low Back

Pain), conditional on osteochondrosis, has for a long time remained

a major reason for a temporary incapacity for work among the

persons of working age.

Materials: The main group was made up of 12 LBP patients (7

females and 5 males). Among them, 8 had been diagnosed with

the lumbodynia syndrome, 3 with lumbar ischialgia and 1 had

been treated for radicular syndrome. A motion video analysis of

the functionally complicated ‘Step’ walking movement, with a

subsequent singling-out of the both feet video analytical profile,

conducted under the authors’ method, revealed reactive postural

control distortions in 5 persons (41.7%), whereas the value of the

interangular differential between the homolateral angles of the

upper and lower limb girdle made 19.16+4.65º. The control group

consisted of 10 persons – 22.75+6.75º. All the main group patients

had a vibration training applied for 15 to 20 sessions. After the

vibration training was over, a clinical improvement was recorded

in 100% of the patients. The thermovision diagnostics has revealed

in all the patients a thermal radiation optimization within the limits

and values of the physiological figures. The value of the interangular

differential between the homolateral angles of the upper and lower

limb girdle has made 21.06+6.05º. After the vibration training was

over, no reactive postural control function distortions have been

recorded among the main group patients.

Conclusions: The research conducted has demonstrated a high

efficacy of applying the vibration training for LBP.

935

PAIN AND DYSFUNCTION IN POST-TRAUMATIC DISORDERS

S.A. Nica*, A.M. Meila. University of Medicine and Pharmacy “Carol

Davila”, Bucharest, Romania

Backround and Aims: In post-traumatic pathology acute and

especially chronic pain has a deep echo and very important

consequences in functional and psycho-behavioral fields.

Methods: Our study is on a number of 390 post-traumatic patients

hospitalized in the National Institute of Physical Medicine and

Rehabilitation Bucharest, Romania, between July 2008 and January

2009. Our patients were between 47 and 70 years old. After

a complete clinical and functional examination correlated with

lab tests, we established a diagnostic, and initiated a Medical

Rehabilitation program. For our patients’ pain control we used

pharmacological (analgesics) and physical therapy. Physical therapy

consisted of: analgesic electrotherapy, thermography (criotherapy

in acute affections, heat in chronic disorders), sedative massage.

We used visual analogical scale (VAS), ADL (Activity of Daily Living)

and Quality of Life Questionnaire at the beginning of the treatment

and after 6 months of treatment.

Results: For 81% of the patients, pain treatment consisted of

pharmacological and nonpharmacological treatment, for 10% only

of physical methods, and for 9% only of pharmacological treatment.

For each group we noticed the correlation between pain decrease

and functional and somatic improvement, but for the first group