Poster 56: Outcomes of Spinal Injections for Low Back Pain: Results of a Cohort Study

on pain reduction was not only maintained (upper bound �-0.45) during the extension phase but a further significantpain reduction (within-group) was observed. Significantwithin-group improvements in QOL, RDQ, CGI-S, and BPIseverity and interference ratings were also observed for pa-tients entering the extension phase. Duloxetine was welltolerated with safety findings being similar to those fromearlier duloxetine trials.Conclusions: In this study, the analgesic effect of duloxetinein patients with CLBP was maintained for at least 41 weeks.Keywords: Low back pain, Duloxetine.

Poster 56

Outcomes of Spinal Injections for Low BackPain: Results of a Cohort Study.Amitabh Goel, MD, FRCS (Wichita Clinic, Wichita,KS);

Disclosures: A. Goel, None.Objective: The primary purpose was to determine the effec-tiveness of spinal injections in treatment of low back pain.Design: An observational cohort study of prospectivelycollected outcomes.Setting: An interventional pain clinic affiliated with an ac-ademic center.Participants: Patients with low back pain referred to thepain clinic over a given period of time; who were offeredspinal injections. All participants had failed a trial of medica-tions and exercise therapy.Interventions: Spinal injections for treatment of low backpain.Main Outcome Measures: Pain relief using the VisualAnalog Scale and Functional Asessment using the RolandMorris Scale.Results: The study enrolled patients over 16 months. Therewere 112 participants in the study. Median length of timebetween initial visit and follow up after the spinal injectionswas 12 weeks. 64(57.1%) patients had improvement in bothpain and function, 16(14.3%) had improvement in pain and17(15.2%) had improvement in function only, 15(13.4%)had no improvement in pain or function. 11(9.8%) patientselected to have surgery.Discussion: There is considerable controversy in the liter-ature regarding the benefits of spinal injections for back pain.Most recent studies have looked at outcomes of surgery incomparison with medications or therapy; not spinal injec-tions. The few studies on spinal injections have focused on aspecific diagnosis or procedure rather than the utility ofspinal injections in a broader framework. This study assessedthe results of spinal injections for low back pain in general,with or without radicular symptoms, in terms of pain reliefand functional improvement over a period of time to assesswhether spinal injections are a viable intervention for lowback pain.Conclusions: Spinal injections for low back pain help toimprove pain and function. They should be considered be-fore surgery as part of the conservative treatment protocol.

Keywords: Rehabilitation, Back pain, Spinal injections,Outcome research.

Poster 57

Patient Registry of Outcomes in Spasticity(PROS) Care.Albert Esquenazi, MD (MossRehab, Elkins Park,PA); Stella Kim, MPA; Nathaniel H. Mayer, MD.

Disclosures: A. Esquenazi, Allergan, Research grants.Objective: To compile data characterizing clinical andpatient-reported outcomes associated with the diagnosis andtreatment of spasticity with chemodenervation in stroke andtraumatic brain injury (TBI) patients.Design: Prospective, multicenter, observational study.Setting: Multicenter.Participants: 363 patients to date.Interventions: Botulinum toxin Type A (BoNT-A) andphenol injections.Main Outcome Measures: Demographics, patient his-tory, pain score (VAS 0-10), patient goals, Ashworth, treat-ment, satisfaction (from -2 for “very dissatisfied” to 2 for “verysatisfied”), goal attainment (from -2 for “lost a lot of groundtowards goal” to 2 for “complete achievement of goal”).Results: Data analysis is based on 246 patients. Data com-prised of 74.0% stroke and 26.8% TBI patients. The flexedelbow was the most frequently presenting problem (26.2%)for the upper limb and the equinovarus foot (62.5%) for thelower limb. The most frequently injected muscle for theflexed elbow was the biceps (42.2%) and the medial/lateralgastrocnemius (23.6%) for the equinovarus foot. Averagedose of BoNT-A injections for the upper limb (n � 941) was61.4 � 37.3 units per muscle (range, 5.0 - 250.0 units) andfor the lower limb (n � 364) was 100.5 � 63.3 units permuscle (range, 10.0 - 400.0 units). Average phenol treatmentfor the upper limb (n � 8) was 3.7 � 0.7cc of 7% and theaverage for the lower limb (n � 15) was 4.0 � 1.3 cc of 6%and 7%. Mean Ashworth score (n � 96) improved -1.1 �1.0. On average, the foot (n � 12) presented the largestreduction in pain score -4.4 � 2.9. Patients reported “verysatisfied” (33.1%) and “somewhat satisfied” (45.5%) withtheir treatment. No related adverse effects were reported.Conclusions: This is the first, multicenter, descriptive,observational study providing insight into spasticity manage-ment relating to etiology, degree of spasticity, interventiontypes, muscle selection, delivery methods, patient goals andadverse effects.Keywords: Rehabilitation, Botulinum toxin type A, Musclespasticity.

Poster 58

Patient with Angioedema with PersistentMacroglossia: A Case Report.Catherine I. Dalton, MD (Sinai Hospital of Balti-more, Baltimore, MD).

Disclosures: C. I. Dalton, None.

S128 POSTER PRESENTATIONS