Background & Aims
Background:
According to several large population-based surveys, an estimated one in five Canadians lives with
chronic pain. The three top sites of chronic pain are the low back pain, headaches, and neck pain. Most of the patients are referred to specialized pain clinics for some type of interventional treatment.
Anesthetic nerve blocks are one of the commonly performed interventions to manage chronic pain. The results are encouraging, however, a recent systemic review concluded that there is no clear evidence in the medical literature of either benefit or ineffectiveness of the nerve blocks.
Study Design:
One-Group Pre-test–Post-test design.
Setting:
A prospective study that is conducted at different sites of Pain Care Clinics (PCC) in Ontario, Canada.
Aim:
To evaluate the effectiveness of nerve blocks in improving pain and function among adults with chronic headaches, neck pain, and (low) back pain.
Methods
Methods:
A one-group pretest and post-test design to determine the analgesic and functional effects of 8-treatments of bupivacaine injection in patients with chronic low back pain, headaches, and chronic neck pain, hypothesizing that there will be a greater reduction in pain and improve function after bupivacaine injections in post-test group compared with the pretest group. A sample size of 747 subjects was calculated for the study.
Outcomes Assessment:
Primary outcomes were assessed utilizing the numeric pain rating scale (NRS) and disease-specific functional status questionnaires: Headache disability Index in chronic headache category, Oswestry Disability Index for low back pain category and Neck Disability Index in chronic neck pain category. Secondary outcome measures included: Functional assessment by Brief Pain Inventory (BPI), Pain Disability Index (PDI), Anxiety and Depression by Hospital Anxiety and Depression Scale [HADS], and Quality of life, using the Short Form 36
Results
Results:
To date, 622 patients were enrolled in the study, of whom 493 patients completed the study. Of those,
476 had back pain, 129 has neck pain and 17 has chronic headaches. 80% of the patients were females. The numeric pain rating scale (NRS) was 7.15 in the pretest while it was 2.15 in the post-test group. The disease-specific functional status scores also showed improvement in the scores. The analyses of secondary outcome also revealed functional status improvement. The Brief pain inventory (BPI) was 45.2 in the pretest while it was 25.9 in the post-test group. The Pain disability index (PDI) was 50.1 in the pretest while it was 24.0 in the post-test group. The Hospital Anxiety and Depression Scale (HADS) was 8.7/14.1 in the pretest while it was 5.8/10.6 in the post-test group.
Conclusions
Conclusion:
In this interim analyses, 8-treatments of bupivacaine injection in patients with chronic low back pain,
headaches and chronic neck pain provide a greater reduction in pain and improve function.
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Presenting Author
Rifat Rehmani
Poster Authors
Rifat Rehmani
MD; MSc
Pain Care Clinics, Canada
Lead Author
Topics
- Treatment/Management: Interventional Therapies – Injections/Blocks