Transcript Pain in Post-Polio Patients

Pain in Post-Polio Patients
Anne C. Gawne MD
Director Post-Polio Clinic
Roosevelt Warm Springs Intsitute
Post-Polio Syndrome (PPS)
 New Weakness
 Pain in Muscles and Joints
 Fatigue
 Shortness of Breath
Pain in Polio Survivors
 Most Prevalent Complaint in Many Studies
 80% of all Polio Survivors Complain of Pain
Types of Pain in PPS
Post-polio Muscle
Pain
 Overuse Pain
 Biomechanical Pain
 Fibromyalgia

Post-Polio Muscle Pain
 Occurs in muscles affected by polio
 Deep aching pain, with cramps and
fasciculations
 Occurs in the evening or at night
 Exacerbated by physical activity, cold and
stress
Overuse Pain
 Occurs in muscles, tendons bursa and
ligaments
 Common in the shoulder) rotater cuff
Tendonitis), back (Myofascial pain)
 Worse with overuse, poor body mechanics
Biomechanical Pain
DJD
 Low Back Pain
 Nerve Compression
Syndromes
 Caused by poor
Biamechanics

Fibromyalgia
 8/11 Tender points
 Widespread pain in 4 quadrants X 3 mo
 Fatigue
 Sleep disorder
 Numbness and tingling
 Headaches
Fibromyalgia Less Common
 Jaw Pain/TMJ
 Irritable Bowel Syndrome
 Headaches
 Cognitive or Memory Impairment
 Dizziness or Impaired Coordination
 PMS
Treatment for PPMP
 Rest
 Heat
 Stretching
 Medication (elavil, Trazadone,Ultram)
Treatment for Overuse Pain
 Modalities (Ice Heat, US)
 TENS
 NSAIDS, Celebrex, Vioxx
 Injections (trigger point, ,joint,
 Rest
bursa)
Treatment for Biomechanical Pain
 Rest
 Change in Posture
 Assistive Device (cane, crutch, wheelchair)
 NSAIDs, Vioxx, Celebrex
 Injection
Treatment for Fibromyalgia
 Rest?/ Heat /Stretch/Relaxation
 Medications to Improve Sleep
 SSRIs (Paxil, Effexor, Zoloft)
 Muscle Relaxants***
 NSAIDS
 Long Lasting Narcotics
Purpose of This Study
 To Clearly Define PPMP
 To Differentiate PPMP from Non-PPMP in
Polio Survivors
 To Develop Tools to Diagnose and
Treat PPMP
Hypothesis
 There is a unique group of patients who will
meet the following criteria for PPMP:
Cramping, aching, fasciculating pain in
their extremities
 Their pain profile will be distinct from
patients without PPMP and from non polio
patients
Subjects
 175 Polio Survivors from RWSIR
 94 Fibromyalgia Patients from UM
 114 Rheumatoid Arthritis
Patients from UM
Methods
 Post-Polio Pain Questionnaire
 McGill Pain Questionnaire
 MANOVA Analysis
Results
 Age
 Sex
 Relieving Factors
 Exacerbating Factors
 McGill Pain MANOVA Analysis
Age
Group
N
Mean
Max
Min
No Pain
31
54.1
82
44
PPMP
64
56.2
78
33
No PPMP 80
58.7
85
40
FM
RA
46.1
57.8
76
83
33
25
94
114
Sex
Group
Male
No Pain 16
PPMP
23
No PPMP 36
RA
61
FM
10**
nificant
% Female
52%
15
36%
41
45%
44
54%
53
11%
84
%
48%
64%
55%
46%
89%
Relieving Factors
Group
Massage Brace Sleep Heat
Ice
Weight Stretch Rest
loss
Exercise Injection
PPMP
47%
23%
47% 78% 1%
33%
36%
90%
1%
1%
No
PPMP
50%
16%
34% 58% 6%
16%*
27%
84%
6%
11%*
*significant p<.001
Exacerbating Factors
Group
Cold
Rest
Exercise
Weight Gain
68%
3%
61%
56%
10%
51%
PPMP
NO PPMP
Stress
Activity
39%
53%
78%
32%
46%
78%
Results
 80% Of Polio Survivors Had Pain Complaints
 44%
Met Criteria for PPMP
 Polio Survivors were Similar to Patients
with Fibromyalgia on McGill Pain
Questionnaire
 Polio Survivors were Different than Patients
with Rheumatoid Arthritis
Results
 No significant differences between polio
groups with respect to age, sex relieving
and exacerbating factors
 There were significantly more woman with
fibromyalgia
Conclusion
 Post-Polio Muscle Pain is Common in Polio
Survivors
 Many Polio Survivors May also Have
Fibromyalgia
 There is a need for Further Study of
Fibromyalgia in Polio Survivors
Acknowledgements
 Scott Richards, PhD
 Greg Petrosky, MS
 Research Enrichment Program for
Physiatrists
 NIDDR
 University of Missouri