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inflammation; therefore been consider as a potential biomarker for
the process of osteoarthritis.
Results:
Recent studies demonstrated the role of VIP as a potent anti-
inflammatory and immune-modulator and a potential candidate for
treatment of inflammatory, autoimmune diseases and chronic
inflammation. Additional studies suggest a possible link between
the neuro-endocrine-immune response with the role of VIP down-
regulated in synovial fluid increasing the production of pro-
inflammatory cytokines that might contribute to the pathogenesis of
chronic inflammatory conditions.
Conclusions:
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 regula-
tion might contribute to the pathogenesis arthrogenic inflammation;
therefore been consider as a potential biomarker for the process of
osteoarthritis.
Level of Evidence:
Level IV
Poster 116:
Acupuncture for Veterans with Chronic Pain - A
Quality Improvement Initiative
Vishal Kamani, MD (Loyola University Medical Center, Maywood, IL,
United States), Peter Lapen, DO, Yvonne Lucero, MD, Vijaya Patil, MD,
Deborah Kim, MD, Sung Ahn, DO, Sami Chaudhuri, MD
Disclosures:
Vishal Kamani, MD: I Have No Relevant Financial Re-
lationships To Disclose
Objective:
The impact of acupuncture treatments for a Veteran
population with chronic pain was examined. Although there have
previously been numerous acupuncture studies performed; using these
studies to guide the provision of acupuncture in clinical practice at the
VA has been difficult due to heterogeneity in patient populations,
practitioner training, and acupuncture point protocols. Therefore,
currently there is limited precedent to guide the provision of
acupuncture into traditional medical centers. In this QI study, de-
mographic and treatment outcomes data were obtained for the first 50
patients treated by one physiatrist trained in medical acupuncture.
These data were evaluated for trends to guide future acupuncture
provision in our local VA.
Design:
Retrospective, Observational Study.
Setting:
Outpatient VA PM&R Clinic.
Participants:
50 Patients.
Interventions:
Acupuncture Treatments.
Main Outcome Measures:
Pain scales, pain locations(s), patient de-
mographics, pain medications, prior treatments.
Results:
24 patients were using opiate medications at the time of
initial consultation. 19 had previous surgery for musculoskeletal
pain. Verbal numeric rating scale from 0-10 was used to measure
pain prior to and after acupuncture treatments. Each patient had
an average of 5 treatment sessions, with a range from 1 to 15
treatments. 234 total acupuncture treatments were performed,
and pain scores from 152 of those treatments were available for
analysis. On average for all treatments, there was a 61%, 3.47-
point reduction in pain (p-value
<
.05) per treatment session. Spe-
cifically, for back pain, 126 treatments were performed and 84
were available for analysis. On average for back pain, there was a
61%, 3.39-point reduction in pain (p-value
<
.05) per treatment
session.
Conclusions:
Acupuncture performed by a physiatrist was clinically
beneficial for pain management in Veterans with chronic pain. Ob-
servations regarding strategies for provision of acupuncture, goals of
treatment, and managing patient expectations resulted from our
work. Future studies can be designed to evaluate optimal treatment
courses for durability of effect.
Level of Evidence:
Level IV
Poster 117:
Pain Assessment Survey (PAS) for Assessing Physical
Pain in Post-Cerebrovascular Accident (CVA) Patients
Post Intervention: Quality Improvement Project
Kirill Alekseyev, MD, EMBA (Kingsbrook Jewish Med Cntr, Brooklyn,
NY, United States), Nikhil Verma, Swathy Sreekumar, MD,
Amarin Suriyakhamhaengwongse, MD, Malcolm Lakdawala, MD,
Marc K. Ross, MD
Disclosures:
Kirill Alekseyev: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
Surveying post-stroke patients via a pain assessment sur-
vey (PAS) for physical pain after experiencing a CVA.
Design:
Retrospective and Prospective Study.
Setting:
Acute IRF.
Participants:
CVA IRF patients.
Interventions:
A PAS was designed and applied to survey patients with
ischemic and/or hemorrhagic strokes admitted to the IRF.
Main Outcome Measures:
Post-Admission Pain Assessment Survey
using Pain Ad Scale.
Results:
The project spanned over 13 months, during which six
months were for retrospective analysis, one-month transition period
for PAS implementation, and six months for prospective analysis. The
retrospective study included 82 post-CVA IRF patients, of which 71
patients had ischemic strokes and 11 patients had hemorrhagic
strokes. In the retrospective period 26% of our patients reported pain,
of which shoulder pain was the most prevalent at 43%. The prospective
study included 102 post-CVA IRF patients, of which 85 patients had
ischemic strokes and 17 patients had hemorrhagic strokes. Pain was
reported by 12% of the patients. Pain was most prevalent in patients
with ischemic stroke (83%). It was determined that two patients had
facial pain (17%), three patients had upper limb pain (25%), seven
patients had shoulder pain (58%), and two patients had lower limb pain
(17%). Averages of pain were ranked on a scale between 0-10, with
zero being no pain and ten being unbearable pain. Pre-intervention
pain average was 8.2 out of 10. 67% of the patients with pain had
improvement of at least 2 points by Day 1 of intervention and 75% of
the patients had complete pain resolution by Day 5 of intervention.
Conclusions:
Pain management has been involved in the care of pain
patients since discovering that 26% of our patient population exhibited
pain in the retrospective period and 12% of our patients exhibited pain
in the prospective period. Shoulder pain had the highest prevalence in
both retrospective and prospective period, 43% and 58% respectively.
Level of Evidence:
Level II
Poster 118:
Prevalence, Complications, and Pain Management of
Diskitis in an Acute IRF Setting
Kirill Alekseyev, MD, EMBA (Kingsbrook Jewish Med Cntr, Brooklyn,
NY, United States), Samuel P. Thampi, MD, Malcolm Lakdawala, MD
Disclosures:
Kirill Alekseyev: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
Evaluate acute rehab patients with diskitis and complica-
tions including FIM score analysis and pain management. To analyze
complications with diskitis and involvement of neurosurgical team
with cases that cannot be managed medically.
Design:
Retrospective cohort chart review of 100 patients between
2001-2016.
Setting:
Acute IRF.
Participants:
Inpatient rehab diskitis cases.
Interventions:
FIM scores.
Main Outcome Measures:
Chart Review and Radiological Imaging.
Results:
A total of 100 diskitis cases referred to our acute rehab unit
between 2001 and 2016 with an emphasis on treatment and compli-
cations during stay. Of the 100 patients that were included in the
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Abstracts / PM R 9 (2017) S131-S290