S171 S290
Conclusions:
Vertebral compression fracture can cause tension and
stretch to the dorsal ramus or rami, inducing LBP. The pain relief and
avoidance of surgical intervention in the patients with with thor-
acolumbar vertebral compression fracture can be achieved with spinal
dorsal rami injection and RF neurolysis combined with stander osteo-
porosis therapy.
Level of Evidence:
Level IV
Poster 113:
Association of Clinical Characteristics and Response
to Lumbar Epidural Steroid Injections in Subjects
with Axial Low Back Pain
Stephen Schaaf, MD (University of Pittsburgh Medical Center,
Pittsburgh, PA, United States), Gwendolyn A. Sowa, MD, PhD,
FAAPMR, Wan Huang, MD, PhD, Megan H. Cortazzo, MD,
Subashan Perera, PhD
Disclosures:
Stephen Schaaf: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
Despite the frequency of interventional procedures per-
formed for axial low back pain, selection criteria remain unclear and
suboptimal to predict those that will have an improved outcome. The
goal of the study was to examine the association of baseline clinical
characteristics and pain improvement following lumbar epidural ste-
roid injections (LESI) in individuals with axial low back pain.
Design:
Prospective Cohort Study
Setting:
Academic Medical Center.
Participants:
Subjects (n
¼
48) were eligible if they had primarily axial
low back pain without radiating symptoms.
Interventions:
Patients recruited had already consented for and then
underwent a LESI as part of their routine clinical care.
Main Outcome Measures:
Gender, age, body mass index, race, edu-
cation, employment status, smoking status, Oswestry Disability Index,
Roland Morris Disability, McGill Pain Questionnaire (MPQ), generalized
anxiety disorder, Patient Health Questionnaire (PHQ-9), 10m-walking
speed, fear avoidance beliefs questionnaire, catastrophizing, cumu-
lative illness rating scale, prior treatments and exercise, treatment
expectation, and medications were collected for baseline clinical
characteristics. Pain was scored on 0-10 numeric rating scale. Pain
score was taken at pre-injection and two-week follow-up. Responders
to injection were defined as those who had at least a 50% reduction in
their pain score at follow up.
Results:
At follow up, 17 subjects reported 50% or greater reduction in
their pain score. Responders had a significantly lower PHQ total score,
MPQ sensitive score, MPQ affective score, MPQ total score, more
frequent exercise, and were less unsure about expecting pain relief
following the LESI at baseline. No other significant associations were
observed.
Conclusions:
Certain baseline clinical characteristics represent a po-
tential opportunity to improve the clinical ability to predict response
to treatment for LESI. A larger sample size with randomized study
design to evaluate the ability of baseline clinical characteristics to
improve clinical decision making will be needed.
Level of Evidence:
Level II
Poster 114:
Efficacy and Safety of OnabotulinumtoxinA in an
Open-Label Study for the Prophylactic Treatment of
Chronic Migraine in Adult Patients: COMPEL
Andrew M. Blumenfeld (The Neurology Center, Carlsbad, CA, USA),
Richard J. Stark, MB BS FRACP, Aubrey Manack Adams, PhD,
Amelia Orejudos, MSc, Sheena K. Aurora, MD
Disclosures::
Andrew Blumenfeld: Consulting fees or other remuner-
ation (payment) - Allergan, Avanir, Teva, Pernix, Supernus, Depomed,
Dentex, Zosano Pharma, GLG, Guidepoint, Autodigest
Objective:
To evaluate longer-term efficacy and safety of onabotuli-
numtoxinA for the treatment of chronic migraine (CM).
Design:
Multicenter, open-label study.
Setting:
Multicenter, clinic setting.
Participants:
Patients with CM.
Interventions:
OnabotulinumtoxinA 155U every 12 weeks, using a
fixed-site, fixed-dose, injection paradigm.
Main Outcome Measures:
Primary measure: change in headache day
frequency from baseline at 108 weeks (9 treatments). Secondary/
exploratory measures: headache impact test (HIT-6), 30% responder
rate, Migraine Disability Assessment Questionnaire (MIDAS), and
Migraine Specific Quality of Life Questionnaire (MSQ).
Results:
Enrolled patients (N
¼
716) were 18
e
73 years old, primarily
female (n
¼
606, 84.8%), and Caucasian (n
¼
581, 81.3%). At baseline,
patients reported an average 22.0 (SD
¼
4.82) headache days per
month and 713 (99.6%) reported headaches with moderate/severe
pain, with pain primarily characterized as throbbing/pulsing (n
¼
507,
70.8%). By 108 weeks, a significant reduction in number of headache
days per month (-10.7 days, P
<
.0001; n
¼
715/716) was observed with
237 of 316 patients (75.0%) experiencing a 30% decrease in head-
ache days from baseline. Significant improvements (P
<
.0001) in HIT-6
scores (-7.1 point change) also were demonstrated at 108 weeks. In
addition, patients had significant improvements (P
<
.0001) from
baseline at 108 weeks in MIDAS (-34.8 point change; n
¼
489/715) and
MSQ domain scores (+15.2, +22.3, and +22.1 point change in role
function preventive [n
¼
489], role function restrictive [n
¼
489], and
emotional function [n
¼
487] subscales, respectively). 131 patients
(18.3%) reported 1 treatment-related adverse event (TRAE); most
frequently reported was neck pain (n
¼
29, 4.1%). One patient re-
ported a serious TRAE (rash). No treatment-related deaths were
reported.
Conclusions:
Progressive improvements in efficacy were observed
through 108 weeks with no new safety issues. Data support the efficacy
and safety of onabotulinumtoxinA for CM, up to 108 weeks (9 treat-
ment cycles).
Level of Evidence:
Level IV
Poster 115:
A Clinician’s Perspective on Vasoactive Intestinal
Peptide (VIP) as a Biomarker for the Complexity of
Chronic Pain due to Osteoarthritis
Vinicius Tieppo Francio, MD/PhD(c) (USAT College of Medicine MD/PhD
program, Oklahoma City, OK, United States)
Disclosures:
Vinicius Tieppo Francio: I Have No Relevant Financial
Relationships To Disclose
Objective:
Osteoarthritis is the most common musculoskeletal
problem causing chronic pain, which is the leading cause of disability
in the US. Vasoactive Intestinal Peptide (VIP) plays important roles in
many biological functions, such as anti-inflammatory and immune-
modulatory activity, and has been substantially connected as an
important biomarker for articular inflammation and pain. The goal of
this study is to briefly discuss the role of the neuroendocrine-immune
interconnections and VIP in the pathophysiology of article
inflammation.
Design:
This is a brief summary intended to inform clinicians in the
field of chronic pain and osteoarthritis regarding the pathophysiolog-
ical connections and biomarker role of VIP and articular inflammation
due to OA.
Setting:
Not applicable.
Participants:
Not applicable.
Interventions:
Not applicable.
Main Outcome Measures:
The specific role of VIP in the arthrogenic
inflammatory process related to osteoarthritis has been possibly
associated to a protective role in progression of joint degradation, in
synovial fluid and articular cartilage under joint degradation, and its
down regulation might contribute to the pathogenesis arthrogenic
S171
Abstracts / PM R 9 (2017) S131-S290