(904) Pain and emotional problems in military personnel re-turning from Iraq and Afghanistan

K Clements, M Clark, J Murphy, R Gironda, R Walker; James A. Haley VAMC,Tampa, FLPreliminary research has indicated that chronic pain may be more com-mon in military personnel returning from Operation Iraqi Freedom (OIF)and Operation Enduring Freedom (OEF) than those involved in the GulfWar. For example, an examination of the medical records of over 550OIF/OEF veterans indicated that approximately 50% reported a chronicpain condition. However, little is known about the nature, life interfer-ence, or emotional concomitants of pain experienced in these individu-als. To address this knowledge gap, we conducted detailed, in-personpain assessments in a sample of over 125 OIF/OEF military personnelregistering for medical care at a large southeastern tertiary care Veter-ans Affairs medical center. To accomplish this we first reviewed themedical records of a random selection of OIF/OEF medical care regis-trants and identified those with pain scores 1. Next, we contactedthese individuals by phone to invite them for an in-person evaluation oftheir pain complaints. More than 80% agreed to participate and com-pleted a structured clinical interview and limited psychological testing.Data collected included complete pain and military deployment histo-ries; information concerning combat exposure, pain-related impair-ments, and daily functioning; emotional adjustment data (includingPTSD symptoms); and indicators of possible substance abuse. Resultsindicated, as expected, that the prevalence of pain problems in thiscohort exceeded rates observed among Gulf War veterans and ranks asone of the most frequent complaints among OIF/OEF returnees. Addi-tionally, data revealed significant pain-related impairment, high ratesof emotional adjustment difficulties, and numerous barriers to tradi-tional VA medical care approaches. Implications of these data for VAand community pain care approaches for OIF/OEF returnees and forfuture research will be discussed.

(905) Prevalence and characteristics of pre-operative pain inbreast cancer patients and its association with post-operative pain intensity and baseline symptom experi-ences

B Aouizerat, C Miaskowski, M Dodd, S Paul, K Lee, C West; University ofCalifornia San Francisco, San Francisco, CAAs part of a large prospective, longitudinal study that is evaluating bothneuropathic pain and sensory changes in the breast and ipsilateral arm ofwomen undergoing breast cancer surgery, we sought to determine the prev-alence of preoperative pain; to examine the impact of preoperative pain onexperiences with the symptoms of fatigue, sleep disturbance, and depression;to explore whether patients reporting pain differed on selected demo-graphic, disease, and treatment characteristics; to determine if preoperativepain was associated with postoperative pain; and to determine whether pa-tients reporting pain differed on functional status and quality of life (QOL).This descriptive, correlational study enrolled 100 women prior to breast can-cer surgery from five sites in northern California. Patients completed a demo-graphic questionnaire, Karnofsky Performance Status scale, Lee Fatigue Scale,General Sleep Disturbance Scale, Center for Epidemiological Studies Depres-sion Scale, Multidimensional Quality-of-Life Scale Cancer, and a numeric rat-ing scale of worst pain intensity. Medical records were reviewed for diseaseand treatment information. Differences in demographic, disease, and treat-ment characteristics as well as in outcomes were evaluated using analysis ofvariance and chi square analysis. The main research variables were pain/no-pain group membership, fatigue, sleep disturbance, depression, pain, func-tional status, and QOL. Women reporting preoperative pain (34%) in theaffected breast were younger (p�0.017), reported more sleep disturbance(p�0.048), had lower functional status (p�0.03), and were depressed(p�0.007). Importantly, this group also experienced more severe postopera-tive pain (p�0.004). This study is the first to report the occurrence and prev-alence of preoperative pain in women prior to surgery; to establish the co-occurrence of clinically relevant symptoms and impaired function; and toestablish the negative impact of preoperative pain on post-operative painintensity. Findings from this study suggest a new and significant preoperativepain problem that warrants further investigation to improve the quality ofpostoperative pain management.

(906) Breakthrough pain in a racially diverse cancer popula-tion

L Montague, T Hart-Johnson, C Green; University of Michigan, Ann Arbor, MIBreakthrough pain (pain flares that interrupt well controlled baselinepain) is a common problem among cancer patients. Its prevalence, char-acteristics, and impact on health-related quality of life have been de-scribed, but it has not been studied in a racially diverse population. Thiscomparative study of cancer patients examines racial differences inbreakthrough pain characteristics and impact on quality of life. Datawere collected from patients with stage III or IV breast, prostate, colo-rectal, or lung cancer, or stage II, III, or IV multiple myeloma presentingwith breakthrough pain. Patients completed an initial assessment andfollow-up surveys at 3 and 6 months. The surveys assessed consistent andbreakthrough pain severity, depressed affect, active coping ability, andhealth-related quality of life. Ninety-six patients were surveyed (75%white, 66% female, mean age � 56.310.3 years). Overall, patientsexperienced significant psychological distress as measured by the Centerfor Epidemiological Studies Depression Scale, but there were not racialdifferences in depression prevalence. Non-white Americans (minorities)reported significantly greater severity for consistent pain at its worst(p�.009), least (p�.001), on average (p�.004), and at initial assessment(p�.04). Minorities also reported significantly greater severity for break-through pain at its worst (p�.03), least (p�.02), and at initial assessment(p�.008). There were not significant racial differences in the duration,quality, or location of pain flares, although minorities reported agreater number of flare types (3.0 versus 1.8, p�.001). Minorities re-ported consistently, though not significantly, poorer outcomes on eachhealth-related quality of life subscale (physical, role, emotional, cogni-tive and social functioning) measured and poorer quality of life symp-tom control at trend level (p�.08) including lower dyspnea control(p�.002). This study provides new information on health care disparitiesthat will be useful in informing health policy and clinical practice.

(907) Pain and opiate abuse in a population of substanceabuse patients

J Brevard, S Butler; Inflexxion, Inc., Newton, MAPrescription opiates are one of the most effective treatments for chronicpain. However, opiate abuse has been increasing in the U.S. population,causing concern that patients taking opiates for pain may become ad-dicted. This study examines pain and opiate abuse in a population ofclients in treatment for substance abuse. Data from the ASI-MV Connect,a substance abuse assessment tool, developed for the National Addic-tions Vigilance Intervention and Prevention Program (NAVIPPRO), wereexamined for this study. Clients from several substance abuse treatmentcenters (N�1,554) were surveyed at intake. Forty seven percent of clientsresponding reported having a pain problem (N�640; 218 did not an-swer). Of those with a pain problem, 48% had taken an opiate (N�307).Of those who had taken an opiate, 61% (N�189) admitted to usingopiates illicitly (in a way other than prescribed by their doctor) in thepast month. Therefore, within the entire population of clients, 12%reported having a pain problem and taking prescription opiates illicitly.Among those clients with pain who are taking opioids, those reportingopioid abuse tended to have: (1) fewer days in the past month experi-encing medical problems (p�.01), (2) shorter history of pain problems(trend; p�.10), and (3) rate themselves as being less troubled by theirmedical problems in the past month (p�.01) than those clients with apain problem who are not misusing opioids. Illicit opiate users with apain problem had greater scores on measures of drug and family prob-lems (p�.05) than those who were not misusing opiates. These findingssuggest that: 1) a significant proportion of clients entering substanceabuse treatment report having a pain problem, 2) not all clients, eventhose in substance abuse treatment programs, who take opiates abusethem, and 3) those with more severe medical problems may be less likelyto abuse opiates.

S77Abstracts