Oasis, The Online Abstract Submission System

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Control/Tracking Number: 14-A-1503-IASP Activity: Poster Abstract Submission Current Date/Time: 2/11/2014 1:59:29 PM A CASE STUDY OF AN INDIVIDUAL WITH CHRONIC HIP PAIN RECEIVING INTERDISCIPLINARY GRADED EXPOSURE IN VIVO AND D-CYCLOSERINE THERAPY

Author Block: N. V. Karayannis, S. M. Gritzner, H. King, T. M. Searle, S. Mackey, Dept. of Anesthesiology, Perioperative and Pain Med., Stanford Univ. Sch. of Med., Palo Alto, CA, USA Abstract: Aim of Investigation: For certain individuals with pain, fear of movement, reinjury and activity avoidance plays an important role in the maintenance of pain, physical deconditioning, affective distress and disability. Graded Exposure (GE) is a specific treatment for reducing fear-avoidance beliefs and behaviors. Pharmacology manipulation using D-cycloserine (D-C) holds promise in promoting fear reduction in individuals with anxiety disorders. We hypothesized that coupling GE therapy in vivo with D-C would be effective in modulating pain-related fear of movement and activity avoidance for an individual with a regional pain syndrome. Methods: Case study of a 39-year old female with chronic left hip pain after a motor vehicle collision 5 years prior. Orthopaedic diagnosis (and treatment) consisted of left hip chondral lesion (15 mo. post-operative hip arthroscopic repair, previous left hip piriformis and adductor muscle bupivacaine-trigger point injections, and prior physical therapy aimed at addressing the hip movement impairment/restoring hip motor control). No present sign of femoroacetabular impingement, but mild left hip abduction and external rotation weakness remained. A psychology diagnosis was made of adjustment disorder, mild depression and pain-related anxiety. Pharmacologic management consisted of topiramate, naproxen and lidocaine patch. Past medical history of right knee staphylococcus infection and sympathetic mediated pain (status post cortisone injection) and anorexia nervosa (outpatient treatment). The GE therapy was based on the Vlaeyen et al. model and administered within an interdisciplinary setting between a pain psychologist and physical therapist. The patient received 40 mg of D-C 2 hours prior to administration of GE over the course of 8-weekly supervised sessions and home practice. The Photograph Series of Daily Activities (PHODA-SeV) was used to determine the fear hierarchy and activity exposure. The Tampa Scale of Kinesiophobia (TSK), Fear Avoidance-Beliefs

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Questionnaire-Physical Activity subscale (FABQ-PA), Pain Catastrophizing Scale (PCS) and PROMIS® questionnaires were administered pre- and post- therapy. Results: At the beginning of therapy, the patient reported that she perceived running as the most harmful activity to her hip (PHODA-SeV score=100/100). At the end of therapy, she was running on an inclined treadmill (PHODA-SeV score=10/100). From a functional perspective the patient had not ridden a bicycle for 3 years for fear of further damaging her hip, by the end of therapy she was bicycle commuting, performing yoga poses, hiking and ice-skating. Pain-related fear of movement scores reduced post-therapy (TSK 10 points, FABQ-PA 3 points) and catastrophizing was reduced post-therapy (PCS 9 points). No improvements were evident with PROMIS® measures related to depression, anxiety, physical function or pain interference. Medication use was mildly reduced (100mg Topiramate). A limitation of the study was reduced compliance with administration of D-C during some home exposure of fear related movements. Conclusions: GE+D-C therapy shows preliminary promise in modulating pain-related fear of movement, reducing sinister beliefs and catastrophizing thoughts, enhancing coping skills and improving activities and participation. Further efficacy trials are needed to gain a better understanding of the optimal behavioural and pharmacological parameters. :

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Additional Information (Complete): ACKNOWLEDGEMENTS / DISCLOSURES : Redlich Pain Research Endowment

Topic (Complete): : +Interdisciplinary Approaches

Keyword (Complete): Graded exposure in vivo ; D-cycloserine ; Fear of movement ; Activity avoidance Status: Complete International Association for the Study of Pain 1510 H Street NW, Suite 600 Washington, DC 20005-1020 USA Phone: +1-202-524-5300 Email: IASP Secretariat TECHNICAL SUPPORT: +1-217-398-1792 (Monday through Friday 9:00 am-5:00 pm Central Standard Time) or OASIS Helpdesk

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