S175 S290
Conclusions:
Studies and case reports have described the safety and
efficacy of injection of bone marrow aspirate concentrate with platelet
rich plasma in degenerative disease of peripheral joints and chondral
injuries, but there is a paucity of literature devoted to its application in
facet and sacroiliac joints. This case series describes a technique for the
injection of bone marrow aspirate concentrate with platelet-rich
plasma into painful degenerated facet and sacroiliac joints. No adverse
events have been reported. Our study synthesis includes ideas for hy-
potheses that may be tested in studies further examining safety and
efficacy of this treatment for painful degenerative disease.
Level of Evidence:
Level IV
Poster 125:
The Prevalence of Spinopelvic Misalignment in
Individuals with Refractory Low Back Pain and
Degenerative Disc Disease
Sibel Demir, MD, Professor (University of California, San Francisco,
San Francisco, California, United States), Hemra Cil,
Zachary McCormick, MD, Sigurd H. Berven, MD
Disclosures:
Sibel Demir: Research Grants - Pfizer, Nocimed
Objective:
Low back pain (LBP) is a common and challenging issue.
While many patients with LBP respond to treatments such as physical
therapy, oral analgesics, and spinal injections, others continue to
experience symptoms, yet those with degenerative disc disease (DDD)
in the absence of significant disc disruption or herniation, scoliosis,
stenosis, or spondylosis are poor surgical candidates. Recent investi-
gation has revealed spinopelvic misalignment (SPM) as a potential
etiology of chronic refractory LBP in individuals without surgical pa-
thology on lumbar magnetic resonance imaging (MRI).
Design:
Cross-sectional study.
Setting:
Spinopelvic curves were measured prospectively using
Surgimap on lateral spine standing X-rays in patients with DDD. SPM
was defined as PI-LL 10. Lumbar spine magnetic resonance images
(MRI) were reviewed.
Participants:
Patients with LBP and MRI findings of DDD but no surgical
or significant structural abnormality, who had failed to respond to
comprehensive non-operative treatment, were included. Eighty-two
patients were screened for possible study inclusion, of which, fifty-
three met criteria and were enrolled.
Interventions:
Not applicable.
Main Outcome Measures:
Age, gender, body mass index (BMI), lumbar
lordosis (LL), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT)
and MRI findings were reviewed. Spinopelvic misalignment (SPM) was
defined as PI-LL 10.
Results:
Nineteen patients (36%) out of 53 had SPM. LL was signifi-
cantly higher (51.1 9.7 vs 57.8 11.3, p
¼
.03) and PT was significantly
lower (15.5 6.1 vs 10.7 7.6, p
¼
.01) in patients with SPM. Age was
similar between groups. There were significantly fewer patients with
Modic changes in the group with SPM comparing to group without SPM
(p
¼
.041).
Conclusions:
The present study demonstrated SPM in 36% of partici-
pants. Further, Modic changes were less common on participants with
SPM, suggesting that the etiology of pain symptoms may be related to SPM
rather of primary discogenic origin. These results support previous study
that SPMmay be the root etiology of refractory LBP in a subset of patients.
Level of Evidence:
Level IV
Poster 126:
VA Hospital Opioid Safety Initiative: A Strategic
Hospital-Wide Approach to Reduce High Level Opioid
Use in Chronic Pain Patients
Adam S. Hintz (Loyola University School of Medicine PM&R, Riverside,
IL, USA), Monica L. Steiner, MD, Raj Uppal, MD, Latha Panicker, MSN,
APR-BC
Disclosures:
Adam Hintz: I Have No Relevant Financial Relationships
To Disclose
Objective:
To reduce opioid use in non-cancer, non-hospice chronic
pain patients who are prescribed over 200 morphine equivalents of
opioids daily in order to obtain better pain control and reduce harmful
side effects.
Design:
Quality Improvement.
Setting:
VA Hospital Outpatient.
Participants:
Non-cancer and non-hospice chronic pain patients who
are currently prescribed 200 morphine equivalents or higher of opioids
daily at Hines VA Hospital.
Interventions:
A coordinated, patient centered multi-disciplinary and
multi-modal approach to reduce patients’ daily opioid use to under
200 morphine equivalents by implementing pain contracts, drug
screening, non-opioid modalities, alternative medical strategies, psy-
chosocial interventions and education.
Main Outcome Measures:
Total daily opioid use standardized to
morphine equivalents, indication for opioid use, pain contract
compliance, urine drug screen and comorbidities (including psychiatric
disease, suicidality, substance abuse and other medical problems).
Results:
This is a currently ongoing quality improvement project and
results will be available at poster presentation.
Conclusions:
High opioid doses over 200 morphine equivalents daily
for non-cancer pain are thought in the pain community to not provide
additional pain relief and increase the likelihood of addiction and
harmful side effects. The VA has a particularly high risk population
with an increased incidence of post-traumatic stress disorder (PTSD),
major depressive disorder (MDD), alcohol use and suicide attempts
when compared to the general population. This quality improvement
project is evidence that using multiple different approaches including
pain contracts, drug screening, non-opioid modalities, alternative
medical strategies, psychosocial interventions and education, hospital-
wide opioid reduction in chronic pain patients using over 200 morphine
equivalents daily can be achieved.
Level of Evidence:
Level V
Poster 127:
Prevalence, Complications, and Pain Management of
Spinal Malignancies in an Acute IRF Setting
Kirill Alekseyev, MD, EMBA (Kingsbrook Jewish Med Cntr, Brooklyn,
NY, United States), Nikita Maniar, MD, Samuel P. Thampi, MD,
Malcolm Lakdawala, MD
Disclosures:
Kirill Alekseyev: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
In general, cancer pain treatment is far from being
optimal for many patients. Morphine is commonly used as a first-line
therapy, but other pure
m
agonists such as hydromorphone, fentanyl,
or oxycodone can be considered in addition. Therefore it is important
to evaluate the involvement of pain management in this patient
population in addition to identifying patterns of common spinal
involvement, interventions utilized, and any complications. We con-
ducted a retrospective, cross-sectional in which all patients with spi-
nal malignancies who attended acute IRF during the past three years.
Design:
Retrospective chart and Radiology Imaging Review.
Setting:
Acute IRF.
Participants:
We identified 68 consecutive adult patients with varying
severities of spinal metastasis. There were 30 men and 38 women with
an average age of 67 ( 16.89) years in the study group. 28 patients had
a direct spinal mass and 40 patients had metastasis to the spine. In-
clusion criteria for the review were illness compatible with vertebral
malignancy and / or evidence of spinal metastasis on x-ray or magnetic
resonance imaging (MRI).
Interventions:
FIM scores.
Main Outcome Measures:
Chart review.
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Abstracts / PM R 9 (2017) S131-S290