S138 S290
Participants:
57 patients with cervical spondylosis and cervical
radicular pain who were deemed appropriate surgical candidates but
elected to undergo CESI first. 21/47 (37%) patients with depression
(defined as Zung Depression Scale 33) were included.
Interventions:
All patients received one or more cervical epidural
steroid injections.
Main Outcome Measures:
Patient reported outcomes including neck
disability index (NDI), Numeric Rating Scale (NRS) for arm pain (AP),
NRS for neck pain (NP), and EuroQol-5D (EQ-5D) were collected at
baseline and 3-month follow up. Minimal clinically important differ-
ence (MCID) were then calculated to provide dichotomous outcomes
measures of success.
Results:
Overall, 24 (42.1% 95%CI
12.8%) and 28 (49.1% 95%CI
13.0%) patients achieved at least 50% improvement in AP and NP
respectively. In terms of disability, 25/57 (43.9% 95%Ci
12.9%) pa-
tients achieved greater than 13.2-point improvement on NDI overall. In
patients with depression, 4/21 (19.0% 95%CI
16.8%) and 5/21(23.8%
95%CI 18.2%) achieved at least 50% improvement on NRS for AP and
NP respectively compared to 20 (55.5% 95%CI
16.2%) and 23 (63.9%
95%CI
15.7%) in patients without depression. This difference was
statistically significant for both pain measures (non-overlapping 95% CI
for both, p
<
.002 AP, p
<
.006 NP). Statistically fewer patients, 5/21
(24% 95%CI
18%) with depression achieved at least 13.2 point
improvement on NDI compared to 20/36 (55% 95%CI 16%) non-
depressed patients (95% CI overlapping, p
<
.01). There was no differ-
ence in outcomes between groups on EQ-5D.
Conclusions:
Patients with cervical spondylosis and co-morbid
depression who undergo CESI are less likely to achieve successful
outcomes in both pain and function compared to non-depressed pa-
tients at 3 months.
Level of Evidence:
Level II
Poster 104:
Development and Design of a Predictive Nomogram
for Missed Appointments at an Academic Pain
Treatment Center: A Prospective Year-Long
Longitudinal Study
Charles A. Odonkor, MD, MA (Johns Hopkins University School of Med,
Baltimore, MD, United States), Steven P. Cohen, MD
Disclosures:
Charles Odonkor: I Have No Relevant Financial Re-
lationships To Disclose
Objective:
Missed appointments cost the American healthcare system
more than $150 billion per year. In the setting of interventional pain
treatment centers, this poses major barriers to care with negative
implications for patient health outcomes. To address these challenges,
various specialty clinics have taken steps to identify and remedy
missed clinic appointments. To date, however, no prospective studies
have sought to delineate factors associated with pain clinic “no-
shows.” The objective of this study was to design a predictive nomo-
gram for missed pain clinic appointments.
Design:
A prospective longitudinal study was performed to assess
which factors among a comprehensive list of demographic, clinical and
environmental variables were predictive of no-shows to clinic. The
logistic regression model predicting no-shows was internally validated
with cross validation and bootstrapping methods. A predictive nomo-
gram was developed to display effect size of predictors for no-shows.
Setting:
Inner city academic pain clinic.
Participants:
5134 patients scheduled for pain clinic visits and pro-
cedures from January to December 2015.
Interventions:
Not applicable.
Main Outcome Measures:
Primary outcome measure was show vs. no-
show rate to scheduled appointments without canceling the day
before.
Results:
The overall no-show rate was 24.6%. Factors associated with
no shows included age
<
65 yrs, ethnicity, marital status (single),
health payer (Medicare/Medicaid), primary diagnosis of low back pain
or headaches, initial consult, rain or snow on day of appointment and
having at least 1 prior pain provider. Model discrimination (area under
curve) was 0.738, 99% CI: 0.70-0.85. A minimum threshold of 350
points on the nomogram predicted greater than 55% risk of no-shows.
Conclusions:
A high no-show rate was associated with predictable and
unpredictable (e.g. snow) factors. Pain clinic operation managers
could use a prediction nomogram as a risk stratification tool to maxi-
mize access to care. Accounting for patient-level risk of predictable
no-shows can potentially help to optimize clinic scheduling by stag-
gering low vs. high probability no-shows.
Level of Evidence:
Level I
Poster 105:
Reduction in Opioid Use for Injured Workers
Following Completion of a 4-Week Interdisciplinary
Pain/Functional Restoration Program
James W. Atchison, DO, FAAPMR (RIC Center for Pain Management,
Chicago, IL, United States), Avanti Badrinathan II, MS,
Christine M. Gagnon, PhD, Shana Margolis, MD, FAAPMR,
Randy L. Calisoff, MD
Disclosures:
James Atchison: Consulting fees or other remuneration
(payment) - Best Doctors, INSPE
Objective:
To assess changes in opioid use for pain by Injured Workers
(IW) at the completion of a 4-week Interdisciplinary (ID) pain program.
Design:
Retrospective cohort study.
Setting:
Academic Outpatient Pain Center.
Participants:
IW (N
¼
114) admitted to ID program between 1/1/2014
and 12/31/2015.
Interventions:
Daily treatment by PT, OT, Clinical Psychology, and
Biofeedback therapist for 7 hours/day, 5 days/week 4 weeks with
biweekly physician visits.
Main Outcome Measures:
Overall reduction in opioid use by mea-
surement of morphine milligram equivalents (MME). Stratify patients
by low-dose versus high-dose use at the start of the program and
compare their relative levels of opioid reduction.
Results:
The majority of the patients (80,70%) completed the 4-week
program. More than half the patients (52,65%) started the program on
opioids. Mean MME at the start of program was 75.59, and at
completion was 39.0 MME. This is a reduction of 48.4% for the entire
population. Ten of 52 (19.2%) discontinued all opioids. Further analysis
indicates that 33 (63.5%) of the 52 patients starting the program on
opioids were in the low-dose (50 MME) group with a mean starting dose
of 168.6 MME. In the low-dose group, 24.2% discontinued use and 42.4%
lowered opioid use by 50.9%. In the high-dose group, 10.5% dis-
continued use and 73.7% decreased opioid use by 89.9 MME (51.1%).
Conclusions:
This retrospective cohorts study demonstrates that
injured workers on opioid management admitted to a comprehensive,
interdisciplinary pain program for functional restoration can signifi-
cantly reduce their opioid use by completion of the 4-week program.
This reduction in opioid use occurred regardless of CDC Guideline
Classification, as similar proportions of the patients in the low-dose
and high-dose groups lowered their MME and patients in both groups
did so by approximately 50%.
Level of Evidence:
Level IV
Poster 106:
What Characteristics of Initial Pain Presentation Best
Predict Epidural Steroid Injection Response?
Vincent Y. Ma, MD (VA Greater LA Hlth Care Sys/UCLA, Los Angeles,
CA, United States), Ali Shakir, MD
Disclosures:
Vincent Ma: I Have No Relevant Financial Relationships
To Disclose
S138
Abstracts / PM R 9 (2017) S131-S290