(855) Improvements in functionality reduced pain differ onemotional status across diagnostic subgroups in mi-graine and orofacial pain

P. Davis, J. Reeves II, S. Graff-Radford; The Pain Center, Cedars Sinai MedicalCenter Department of Anesthesiology, Los Angeles, CAThe differential effects of emotions were compared across diagnoses ofneurovascular, myofacial and neuropathic types in a sample of 361 mi-graine and orofacial pain patients. Exploratory analysis revealed signif-icant differences between groups on outcome when higher and lowerlevels of depression and anxiety were assessed. For all groups, treatmentwas most successful in reducing pain and increasing functionality whenuncomplicated depression was present, even more than those patientswithout depression. Worst outcomes for all groups were seen in thosereporting both higher anxiety and depression. The disparity betweenbest outcomes for depressed patients and worst outcome for patientsboth anxious and depressed was greatest for the neuropathic patients.Subsequently, data was gathered for an additional 100 neuropathicpatients that confirmed the wider continuum of treatment response forthis group and greater sensitivity to emotional status as a determinantof treatment success.

(856) Pain and acute stress reaction in pediatric physical in-jury

J. Gold, M. Carson, A. Kant, M. Joseph, G. Mahour; Children’s Hospital LosAngeles, Los Angeles, CAChildren who experience physical injury requiring hospitalization havebeen shown to develop Acute Stress Disorder (ASD) and later Posttrau-matic Stress Disorder (PTSD). When a trauma requires medical interven-tion, the physical integrity of the child is threatened along with thechild’s psychological integrity. The injury, resulting medical proceduresand associated pain symptoms can each be a traumatic experience. Re-cent studies argue that chronic pain and PTSD can be a mutually main-taining condition and that effective pharmacological interventions forpain may actually decrease the incidence of ASD/PTSD symptoms. Thecurrent study is investigating children (8-18) and their caregivers follow-ing a traumatic event requiring hospitalization. The study is an ongoingprospective multi-rater quasi-experimental design to assess the immedi-ate, 1-month and 3-month impact of physical injury on the developmentof ASD and later PTSD. Instrumentation includes the Acute Stress Check-list-Kids, the UCLA PTSD Checklist and child/parental self-report ques-tionnaires (i.e., CBCL, Pain Inventory, PedsQL, KIDCOPE, PCL-C). Two casereports are discussed comparing acute stress symptoms, acute pain, andphysiological measures from initial paramedic intervention to the emer-gency department. Both children reported acute stress symptoms, sig-nificant pain levels, and increased physiological levels (heart rate andmean arterial blood pressure (MAP)). The data revealed that the childwho received early and dose/weight specific analgesia (.06mg/kg) hadfewer acute stress symptoms, faster pain relief, and decreased heart rateresponsivity. Whereas, the child who received a sub-therapeutic dose ofpain medication (.03mg/kg) continued to have an elevated heart rateand met criteria for ASD. While acute pain following an acute physicalinjury has not been an identified as a symptom or a trigger of ASD/PTSD,this data begins to suggest that untreated acute pain may exacerbate achild’s risk of developing ASD and that the assessment and treatment ofpain symptoms require closer investigation.

(857) Pediatric chronic pain, coping and health-related qualityof life

J. Gold, M. Carson, A. Griffin, A. Kant, M. Joseph; Children’s Hospital LosAngeles, Los Angeles, CAPrevious research has examined the debilitating effect of pediatricchronic pain on a child’s health-related quality of life (HRQOL): schoolattendance, physical and social activities, and psychological distress. Yet,prior studies have failed to investigate whether coping behaviors inthese patients can alleviate pain and therefore, enhance HRQOL. Thecurrent study is a cross-sectional sample exploring correlations betweencoping and HRQOL within the pediatric chronic pain population. Twen-ty-eight participants (21 girls, 7 boys) with a mean age of 13.4 wererecruited from pain management services at Children’s Hospital. HRQOLwas assessed with the Pediatric Quality of Life Inventory (PedsQLTM 4.0),which contains 23 self-report items that yield three summary scores(physical, psychosocial and total health) ranging from 0-100; higherscores indicated greater HRQOL. Pain and qualitative data were ob-tained with a clinic-developed pain questionnaire. Coping behaviorswere measured using the Response to Stress Questionnaire (RSQ) ChildSelf-Report, a 57-item inventory yielding four main strategies: primary/secondary control engagement coping, disengagement coping, involun-tary engagement, and involuntary disengagement. Children (8-12) re-ported poor HRQOL (M�59.8), physical (M�53.8) and psychosocial(M�63.0) functioning. Adolescents (13-18) also reported low HRQOL(M�55.8), physical (M�46.9), and psychosocial functioning (M�60.1).No associations were noted between primary or secondary control en-gagement coping and all measures of HRQOL. However associationswere detected between disengagement coping and total emotionalfunctioning (r��.41*). Correlations also existed between involuntarydisengagement and total HRQOL (r��.47**), physical (r��.39*), andpsychosocial (r��.48**) functioning. Similar relationships were de-tected between involuntary engagement and total HRQOL �(-.52**),physical (r��.46*), and psychosocial (r��.50**) functioning. These re-sults suggest that pediatric chronic pain patients may be incorporatingcoping skills that interfere with their daily life functioning, which isalready impaired. Interventions focused on building control engage-ment coping may facilitate improved HRQOL.

(858) Older and younger adults in pain management pro-grams in the United States: differences and similarities

H. Wittink, W. Rogers, A. Lipman, W. McCarberg, M. Ashburn, G. Oderda, D.Carr; New England Medical Center, Boston, MAChronic pain is a common problem in the United States for about 20% ofthe people over the age of 65 years. Their pain is due in part to theprogression of chronic disease and because the incidence of many pain-ful conditions, such as arthritis, increases with age. The high prevalenceof pain and its impact on older adults make this an increasingly impor-tant public health issue, yet to date it has received little attention. Al-though the American Geriatric Society chronic pain guideline recom-mends multidisciplinary management it has been reported that olderadults tend to be infrequently referred and treated in pain programs,while on the older adults that are treated in multidisciplinary pain pro-grams little information exists. It is, for instance, unclear whetherchronic pain has a similar impact on health related quality of life(HRQoL) in older adults as it has on younger adults. We used initialassessments of more than 6,000 patients from three pain managementprograms in different regions in the United States to investigate HRQoLof older (equal to and � 60 years) and younger adults (� 60 years) withchronic pain. We compared their HRQoL with existing normative dataon healthy adults and examined more fully differences in HRQoL be-tween younger and older adults with chronic pain. As an outcomesmeasure we used the Treatment Outcomes of Pain Survey, a diseasespecific instrument that includes the SF-36. We found that HRQoL isimpaired to a similar degree in both older and younger chronic painpatients as compared to healthy adults, but older adults with chronicpain differ in a number of important domains from younger adults withchronic pain.

S72 Abstracts