S52 Oral Presentations / European Journal of Pain 13 (2009) S1–S54

148

SUCCESS AND RETURN TO PLAY STATUS OF PROFESSIONAL

FOOTBALL PLAYERS AFTER EPIDURAL STEROID INJECTIONS

FOR HERNIATED NUCLEUS PULPOSUS

P. Birmingham, M. Drakos, D. Richman*, S. Waldman, S. Williams,

L. Weiss. The Hospital for Special Surgery, New York, United States

Background and Aims: There is minimal literature on the efficacy

of epidural steroid injections in the professional athlete population.

Literature regarding long term success of epidural steroid injections

is inconclusive, and does not support their use to improve long

term functionality or to avoid surgery. Moreover, in the short term,

a common criticism of epidural steroid injections is that they do

not improve average functional impairment. This study elucidates

the dramatic clinical efficacy of epidural steroid injections in the

professional athlete.

Methods: We performed a retroactive series of case studies

of eleven professional football players receiving epidural steroid

injections for incapacitating pain secondary to herniated nucleus

pulposus. Functional impairment was measured by an initial VAS

pain scale, and inability to play. Success was measured simply by

return to play status.

Results: Eleven players had 25 total injections. Only two did not

return to play. Nine did return to play, with 12 total games lost.

After 17 of the 25 injections, the player returned to play without

missing any games. No complications were reported.

Conclusions: In professional athletes with high baseline

functionality, results suggest epidural steroid injections are

extremely effective in treating symptomatic herniated nucleus

pulposus. They appear to be safe and well tolerated, with minimal

complications, thus enhancing compliance with physical therapy

while reducing the need for surgery.

Free Presentations 12: Best Selected Abstracts

149

5-HT3 RECEPTOR ANTAGONIST ONDANSETRON ATTENUATES

MORPHINE WITHDRAWAL INDUCED NEUROTOXICITY,

BBB DYSFUNCTION, GLIAL AND HEAT SHOCK PROTEIN

ACTIVATION IN RAT BRAIN

H.S. Sharma1 *, T. Gordh1, R. Patnaik2, S.F. Ali3. 1Uppsala University,

Anaesthesiology & Intensive Care Medicine, Dept. Surgical Sciences,

Uppsala, Sweden; 2School of Biomedical Engineering, Institute of

Technology, Banaras Hindu University, Varanasi-221005, India;3Neurochemistry Laboratory, Division of Neurotoxicology, HFT-132,

National Center for Toxicological Research/ US Food and Drug

Administration (FDA), 3900 NCTR Road, Jefferson, AR 72079–9502,

United States

Blockade of 5-HT3 receptors with ondansetron reduces morphine

dependence and withdrawal symptoms. However, effects of

ondansetron on morphine induced neurotoxicity is still unknown.

In this investigation, we examined the effects of ondansetron on

morphine neurotoxicity, glial activation and/or HSP response in our

rat model. Rats were administered ondansetron (1mg or 2mg/kg,

s.c) or saline once daily starting from 2 days before morphine

administration (10mg/kg, s.c., single injection for 10 days) and

continued up to 2 days after withdrawal. Abrupt cessation of

morphine administration in rats on day 11th results in withdrawal

symptoms from 24 h and onwards and continued up to 72 h

after cessation of morphine administration. Marked increase in

blood-brain barrier (BBB) permeability to Evans blue and [131]

Iodine was seen in the cerebral cortex, hippocampus, cerebellum,

thalamus, hypothalamus, brain stem and spinal cord on the 2nd

day of morphine withdrawal in saline treated animals. These brain

areas exhibited profound activation of glial fibrillary acidic protein

(GFAP), heat shock protein (HSP 72 kD) immunoreactivity and

neuronal damage. Pretreatment with ondansetron exhibited only

mild withdrawal symptoms on the day 2nd and 3rd. Breakdown

of the BBB, activation of GFAP and HSP expression and neuronal

damage were also considerably reduced in these animals treated

with high doses of ondansetron. These observations suggest that

blockade of 5-HT3 receptors with ondansetron attenuate morphine

withdrawal induced BBB dysfunction leading to reduction in

neurotoxicity, stress response and astrocytic activation, not reported

earlier.

150

A COMPARISON OF THE US-AMERICAN AND GERMAN GUIDELINE

WITH EULAR RECOMMENDATIONS FOR THE MANAGEMENT

OF FIBROMYALGIA

W. Hauser1,4, K. Thieme2 *, T. Denis3. 1Klinikum Saarbrucken,

Saarbrucken, Germany; 2Department of Clinical and Cognitive

Neuroscience, University of Heidelberg, Central Institute of Mental

Health, Mannheim, Germany; 3Department of Anesthesiology,

University of Washington, Seattle, United States; 4Interdisciplinary

center of pain therapy, Saarbrucken, Germany

Objective: To compare evidence-based guidelines for the

management of fibromyalgia syndrome (FMS).

Methods: Systematic searches up to April 2008 of the US-American

National Guideline Clearing House, the Scottish Intercollegiate

Guidelines Network, the Association of the Scientific Medical

Societies in Germany (AWMF) and Medline were conducted.

Three evidence-based guidelines for the management of FMS

published by professional organizations were identified: The

American Pain Society (APS) (2005), the European League

Against Rheumatism (EULAR) (2007), and the AWMF (2008). The

composition of panels, search strategies, categorization of evidence

and recommendations, methods for developing recommendations

and the recommendations of the 3 guidelines were compared and

contrasted.

Results: The steering committees and panels of APS and AWMF

were comprised of multiple disciplines engaged in the management

of FMS and included patients, whereas the task force of EULAR

only consisted of physicians, predominatly rheumatologists. APS

and AWMF ascribed the highest level of evidence to systematic

reviews and meta-analyses, whereas EULAR credited the highest

level of evidence to randomised controlled studies. Both APS

and AWMF assigned the highest level of recommendation to

aerobic exercise, cognitive-behavioral therapy, amitriptyline, and

multicomponent treatment. In contrast, EULAR assigned the highest

level of recommendation to a set of to pharmacological treatment.

Conclusion: The APS and AWMF guidelines assigned higher ratings

to CBT and multicomponent treatments. The inconsistencies across

guidelines are likely attributable to the criteria used for study

inclusion, weighting systems, and compositon of the panels.

W. Hauser received honoraria by Elli Lilly, Janssen-Cilag,

Mundipharma and Pfizer for educational lectures

151

ALTERED EXPRESSION OF ATF-3 IN PRIMARY AFFERENT

NEURONS DURING INFLAMMATORY PAIN

D. Nascimento1 *, D. Pozza1, J.M. Castro-Lopes1,2, F.L. Neto1.1Instituto de Histologia e Embriologia, Faculdade de Medicina do

Porto, Portugal, Oporto, Portugal; 2Instituto de Biologia Molecular e

Celular (IBMC), Universidade do Porto, Oporto, Portugal

Background and aims: ATF-3 is a member of the ATF/CREB

(activating transcription factor/cAMP responsive element binding

protein) transcriptional factors family and its expression has been

associated to cellular stress response, anti and pro- apoptosis

mechanisms, survival phenomenon and neuropathic pain. ATF-3

has been suggested as an “adaptive response”, as it can decide the

cell destiny, according to different stimulus and cellular context.

We aimed to study the disease progression and the associated

expression of ATF-3 in primary afferent neurons, over time, in a

well established model of chronic inflammatory pain.