S218 European Journal of Pain 2006, Vol 10 (suppl S1) Abstracts, 5th EFIC Congress, Free Presentations

838TENS AS ADDITIONAL TREATMENT OPTION FOR NAUSEAAND VOMITING IN PALLIATIVE CARE – A CASE REPORT

G. Bollig °. Department of Palliative Care, Bergen Red Cross Nursinghome, Bergen, Norway

Background: Several studies have shown that acupuncture point stim-ulation is an effective treatment for nausea and vomiting in pregnancy,the postoperative period, cancer and chemotherapy-induced nausea andvomiting. The acupuncture point P6 can be activated by acupuncture,TENS (transcutaneous electrical nerve stimulation) and other methods. Arecent review has questioned the effect of non-invasive electrostimualtionwhen state-of-the-art pharmacologic antiemetic therapy is provided.Method: A case report of a patient resistant to pharmacologic treatmentof nausea and vomiting is presented.Results: The case of a 79-year old female patient who had breast canceron the right side with metastases to the spine and head is presented. Hermajor complaint was nausea and vomiting that could not be treated bystate-of-the-art pharmacological antiemetic therapy. On admission to ourpalliative care unit she scored 9/10 for nausea on the ESAS-scale.After starting cyclizine 50mg 3 times daily and additional TENS-stimulation of the acupuncture point P6 with 2 Hertz for 30 minutes twicea day the nausea vanished (0/10). On one occasion the patient failed toplace the electrode correctly over the point P6. On that day she complainedagain about nausea (4/10). After instruction of the patient and properacupuncture point location nausea symptoms vanished after 20 minuteswith TENS-stimulation on P6.Conclusion: This case reports shows that TENS has a place in the treat-ment of nausea and vomiting in palliative care. It showed to be effectivein a patient who could not be treated effectively by pharmacologicalantiemetic therapy alone.

839EFFICIENCY OF TENS TREATMENTS IN HEMIPLEGICSHOULDER PAIN: A PLACEBO CONTROLLED STUDY

A. Ekim°, O. Armagan, C. Oner. Department of Physical Therapy andRehabilitation, Osmangazi University Faculty of Medicine, Eskisehir,Turkey

Objective: The aim of the present study was to evaluate the efficacytranscutaneous electrical nerve stimulation (TENS) treatment on shoulderpain in hemiplegic patients.Material and Methods: We studied a total of 19 hemiplegic patientswith painful shoulder. The patients were randomly assigned into Group 1(n = 10, TENS) and Group 2 (n = 9, placebo TENS). In Group 1, patientswere given high-intensity TENS for 10 sessions. In Group 2, placeboTENS was given for the same period. All patients received conventionalrehabilitation based on the Brunnstrom concept. Clinical assessments wereperformed at baseline, at the end of the treatment in all patients.The shoulder passive range of motion (PROM), and the visual analogscale (VAS), the Modified Rankin Scale and Functional IndependenceMeasure, and Ashworth scale were performed to evaluate the Clinicaland neurophysiological parameters.Results: Clinical and neurophysiological parameters were similar at base-line in both groups. In both groups significant improvements were observedin VAS after treatment (p< 0.001, p< 0.05 respectively). PROM forabduction and external rotation significant improvements were observed inhemiplegic shoulder in only group 1 after treatment (p< 0.001, p< 0.001respectively). A comparison between the groups showed significant im-provements in only VAS and PROMs in favor of group 1 after therapy(p< 0.05, p< 0.05 respectively).Conclusions: Our study results indicated that TENS seem to be effectivein pain and shoulder PROMs in hemiplegic patients. We, therefore, suggestthat TENS could be used as a good alternative therapy method on shoulderpain in hemiplegic patients.

840TENS IN CHRONIC PAIN: JUST PAIN REDUCTION AS ANOUTCOME?

A.J. Koke1,2 °, J.W. Vlaeyen3, R. Perez4, M. van Kleef1, J. Patijn1.1Pain Management and Research Center, University Hospital Maastricht,Maastricht, 2Rehabilitation Foundation Limburg, Hoensbroek,3Department of Medical, Clinical and Experimental Psychology,University of Maastricht, Maastricht, 4Department of Anesthesiology, VUUniversity medical center, Amsterdam, The Netherlands

Background and Aim: Studies on the effectiveness of TranscutaneousElectrical Nerve Stimulation (TENS) mainly focus on pain reduction asprimary outcome. Reports of secondary effects of TENS such as; reductionof medication intake, increase in level of activity, and improved workcapacity, are sparse. Long-term use of TENS might not solely due to painreduction. The aim of our study is to investigate effectiveness of TENSbeyond the domain of pain reduction.Method: In a prospective cohort the effectiveness of TENS in chronic painwas evaluated. After 6 months two subgroups were distinguished: ‘users’(patients continuing TENS) and ‘nonusers’ (patients stopped using TENS).Besides pain reduction (Visual Analogue Scale; VAS), we evaluated:physical functioning (Short Form-36), work status, health care utilization,self-efficacy beliefs (Chronic Pain Self Efficacy Questionnaire; CPSEQ)and pain coping (Pain Coping and Cognition List; PCCL).Results: Of the 180 patients included, 149 returned for follow-up mea-surements at 6 months. 75 patients were in the users-group compared to74 in nonusers-group. The users-group had statistically significant betterimprovements compared to nonusers-group:• pain reduction (VAS): 28% vs 0%• higher physical functioning (SF-36): 33% vs 11%• less health care utilization:– stop pain medication: 44% vs 25%– non current treatment: 50% vs 22%

• higher self efficacy beliefs (CPSEQ: 22% vs 3%)• less catasthrophizing (PCCL): 11% vs 2%Conclusion: Besides pain reduction TENS is effective in increasing phys-ical functioning, self-efficacy beliefs and decreasing health care utilizationand catasthrophizing thoughts.

841REPETITIVE TRANSCRANIAL MAGNETIC STIMULATIONAND PAIN RELIEF: THETA BURST STIMULATION

A. Oliviero °, M. Rubio-Esteban, A. Vari, J. De Andres, J.L. Diaz,J.M. Gomez-Arguelles, F. Sebastian de la Cruz, Y. Perez-Borrego.Hospital Nacional de Paraplejicos, Toledo, Spain

The present study investigated whether five consecutive days of rTMSwould lead to lasting pain relief in chronic intractable neuropathic pain.Eighteen patients with therapy resistant chronic pain syndromes partici-pated. They received 40 seconds real rTMS over the hand area of motorcortex bilaterally (cTBS, 2×20 s trains, intensity 80% of motor threshold)every day for five consecutive days. Patients received, in a different sessionof 5 days, sham stimulation. Pain was assessed using a visual analoguescale (VAS). Real and sham rTMS had different effects on the VAS. Real-rTMS led to a greater improvement in scales than sham-rTMS, evidenteven two weeks after the end of the treatment. No patient experiencedsevere adverse effects. These results confirm that five daily sessions ofrTMS over motor cortex can produce longlasting pain relief in patientswith neuropathic pain.