Poster Sessions / European Journal of Pain 13 (2009) S55–S285 S141

measure the CAR, all participants provided 5 saliva samples (0, 15,

30, 45, and 60 minutes after awakening) on two days. FAR and ER

were assessed through questionnaires.

Results: The high pain group revealed higher scores in some of the

FAR variables and affective distress compared to the no/low pain

patients, however, there were no group differences in CAR and in

ER. In the whole sample, positive correlations with CAR were found

for the FAR variables fear-avoidance-beliefs, avoidance of social

activities, catastrophizing and help-/hopelessness. In contrast, ER

variables positive mood despite pain and task persistence behavior

revealed negative correlations with CAR.

Conclusions: The negative associations between ER and CAR may

indicate that these responses have a lowering effect on pain-

induced stress. In contrast to that, FAR may increase it.

472

EARLY IDENTIFICATION OF HIGH-RISK PATIENTS FOR CHRONIC

BACK PROBLEMS IN PRIMARY CARE

M. Van Leeuwen*, E. van Rijswijk, A. Wolff, W. Zentjens, A. Evers.

Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands

Aims: The aims were to investigate the predictive role of: (a) the

Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) and

(b) the general practitioner’s (GP’s) judgement to develop chronic

low back pain (LBP) in patients with (sub)acute LBP in primary

care.

Methods: A cohort of primary care patients with non-specific

(sub)acute LBP recruited from GP’s was prospectively followed.

At inception they completed the OMPSQ and their GP estimated

patient’s probability to develop chronic LBP. After 6 months,

patients completed validated questionnaires about accumulated

sick leave, functional disability and LBP.

Results: Analysis of 67 patients demonstrated that the mean

OMPSQ total scores at baseline predicted sick leave and functional

disability after 6 months in the non-recovered group. In addition,

the GP’s mean risk estimation also predicted functional disability

in the non-recovered group after 6 months. In logistic regression

analyses both the OMPSQ and GP’s prediction were significantly

associated with the outcome a half year later.

Conclusions: The OMPSQ is a useful tool in Dutch patients with

(sub)acute low back pain to predict poor prognosis with regard to

function and sick leave. The GP’s risk estimation can also be used

with respect to developing functional disability. The combined use

of both instruments might be relevant for use in primary care.

473

LUMBAR FACET JOINT ARTHROPATHY: A COMPARISON BETWEEN

HYALURONIC ACID AND METHYLPREDNISOLONE

H. Verschueren1,2 *. 1Center for Paintherapy, Schepdaal, Belgium;2Clinique du Louvre, Paris, France

Background and Aims: Lumbar facet joint arthropathy is a main

cause of chronic low back pain. We compared efficacy and safety

of facet joint injection with hyaluronic acid (HA – Suplasyn®

Grunenthal) and methylprednisolone (MP) for lumbar facet joint

arthropathy.

Methods: Patients were randomly assigned to receive under

radioscopic guidance either 20mg HA or 40mg MP per treated

facet joint on level L3-L4, L4-L5 and L5-S1. Pain was evaluated by

Numeric Rating Scale (NRS) after six weeks, three months and six

months. If needed a second injection was done after six weeks.

Results: We included 52 patients, 27 in HAgroup (69 y +12.23) and

25 in MPgroup (66.0 y +15.00). Baseline NRS in both groups was

comparable (HA 8.0+0.73 and MP 8.0+0.6). After 6 weeks the NRS

decreased to 4.3+0.99 in HAgroup and to 6.0+1.24 in MPgroup.

A second injection was needed in 16 patients in HAgroup and

22 in MPgroup. NRS at three months was 2.6+0.75 in HAgroup

and 5.1+1.20 in MPgroup. NRS at 6 months was comparable to

NRS 3 months (HA 2.1+0.62 and MP 4.5+1.19). No adverse events

were reported after administration of HA, however 5 MP patients

reported glucocorticoid related increase of weight.

Conclusion: Intra-articular administration of HA in low back pain

due to facet joint arthropathy resulted in a marked reduction in

pain with improved function and quality of life on long term.

Intra-articular injection of HA for facet joint arthropathy is a very

promising new treatment with no side effects.

474

DIFFERENTIATION OF OSTEOPOROTIC AND NEOPLASTIC

VERTEBRAL FRACTURES BY OPPOSED-PHASED IMAGING

(CHEMICAL SHIFT MR IMAGING)

Y. Ragab1, Y. Emad2 *, T. Gheita3, O. Moawayh4, A. Abou-Zeid5,

J.J. Rasker6. 1Department of Radiology, Cairo University, Cairo,

Egypt; 2Rheumatology and Rehabilitation Department Faculty of

Medicine Cairo University & Dr. Erfan and Bagedo General Hospital

Jeddah, KSA., Jeddah, Egypt; 3Rheumatology and Rehabilitation

Department; Faculty of Medicine Cairo University, Cairo, Egypt;4Radiology Department; Faculty of Medicine Cairo University, Cairo,

Egypt; 5Department of Public Health, Cairo University, Cairo, Egypt;6University Twente, Enschede, Netherlands

Background and Aim: Chemical shift MR imaging has proved

to be effective in facilitating distinction between malignant and

benign processes. The objective of this study was to establish

the cut-off value of the signal intensity drop on chemical shift

magnetic resonance imaging (MRI) with appropriate sensitivity and

specificity to differentiate osteoporotic from neoplastic wedging of

the spine.

Methods: All patients with wedging of vertebral bodies were

included consecutively between February 2006 and January 2007.

A chemical shift MRI was performed and signal intensity after

(in-phase and out-phase) images were obtained.

Results: A total of 40 patients were included, 20 with osteoporotic

wedging (group 1) and 20 neoplastic (group 2). They were 21 males

and 19 females. Acute vertebral collapse was observed in 15 patients

in group 1 and subacute collapse in another 5 patients, while in

group 2, 11 patients showed acute collapse and 9 patients (%)

showed subacute vertebral collapse. On the chemical shift MRI a

substantial reduction in signal intensity was found in all lesions in

both groups. The proportional changes observed in signal intensity

of bone marrow lesions on in-phase compared with out-of-phase

images showed significant differences in both groups (P < 0.05). At

a cut-off value of 35%, the observed sensitivity of out-of-phase

images was 95%, specificity was 100%, positive predictive value was

100% and negative predictive value was 95.2%.

Conclusion: A chemical shift MRI is useful in order to differentiate

patients with vertebral collapse due to underlying osteoporosis or

neoplastic process.

475

CANCER PATIENTS WITH MODERATE-TO-SEVERE PAIN ARE IN A

RISK OF UNDERTREATMENT DUE TO POOR PAIN ASSESSMENT

A. Novik1, T. Ionova2, S. Kalyadina1 *. 1Pirogov National Medical

Surgical Center, Moscow, Russia; 2Multinational Center of Quality of

Life Research, Saint-Petersburg, Russia

At present communication between physicians and patients about

symptoms continues to be hampered by attitudinal barriers among

physicians. To describe relation between poor pain assessment

and pain undertreatment we aimed to study discrepancies in

estimation of pain severity between a patient and a physician and

current pain treatment. 500 advanced cancer patients (male/female

ratio – 285/215, mean age 54.2) being treated in different 11

institutions were enrolled. Pain was assessed with M.D. Anderson

Symptom Inventory. Physicians were asked to assess their patients’

pain severity on 0–10 numeric rating scale. Generally, medical

professionals were correct in 64.2% of pain severity estimations.

Agreement for mild, moderate, and severe pain was 68%, 34%, and