Pain in Post-Polio Pain in Post-Polio PatientsPatients

Anne C. Gawne MDAnne C. Gawne MD

Director Post-Polio ClinicDirector Post-Polio Clinic

Roosevelt Warm Springs Roosevelt Warm Springs IntsituteIntsitute

Post-Polio Syndrome (PPS)Post-Polio Syndrome (PPS)

New Weakness New Weakness Pain in Muscles and JointsPain in Muscles and Joints FatigueFatigue Shortness of BreathShortness of Breath

Pain in Polio SurvivorsPain in Polio Survivors

Most Prevalent Complaint in Many Most Prevalent Complaint in Many StudiesStudies

80% of all Polio Survivors Complain 80% of all Polio Survivors Complain of Painof Pain

Types of Pain in PPSTypes of Pain in PPS

Post-polio Muscle Post-polio Muscle PainPain

Overuse PainOveruse Pain Biomechanical Biomechanical

PainPain FibromyalgiaFibromyalgia

Post-Polio Muscle PainPost-Polio Muscle Pain

Occurs in muscles affected by polioOccurs in muscles affected by polio Deep aching pain, with cramps and Deep aching pain, with cramps and

fasciculationsfasciculations Occurs in the evening or at nightOccurs in the evening or at night Exacerbated by physical activity, Exacerbated by physical activity,

cold and stresscold and stress

Overuse PainOveruse Pain

Occurs in muscles, tendons bursa Occurs in muscles, tendons bursa and ligamentsand ligaments

Common in the shoulder) rotater Common in the shoulder) rotater cuff Tendonitis), back (Myofascial cuff Tendonitis), back (Myofascial pain)pain)

Worse with overuse, poor body Worse with overuse, poor body mechanicsmechanics

Biomechanical PainBiomechanical Pain

DJD DJD Low Back PainLow Back Pain Nerve Nerve

Compression Compression SyndromesSyndromes

Caused by poor Caused by poor BiamechanicsBiamechanics

FibromyalgiaFibromyalgia

8/11 Tender points8/11 Tender points Widespread pain in 4 quadrants X Widespread pain in 4 quadrants X

3 mo3 mo FatigueFatigue Sleep disorderSleep disorder Numbness and tinglingNumbness and tingling HeadachesHeadaches

Fibromyalgia Less Fibromyalgia Less CommonCommon

Jaw Pain/TMJJaw Pain/TMJ Irritable Bowel SyndromeIrritable Bowel Syndrome HeadachesHeadaches Cognitive or Memory ImpairmentCognitive or Memory Impairment Dizziness or Impaired CoordinationDizziness or Impaired Coordination PMSPMS

Treatment for PPMPTreatment for PPMP

RestRest Heat Heat StretchingStretching Medication (elavil, Medication (elavil,

Trazadone,Ultram)Trazadone,Ultram)

Treatment for Overuse Treatment for Overuse PainPain

Modalities (Ice Heat, US)Modalities (Ice Heat, US) TENSTENS NSAIDS, Celebrex, VioxxNSAIDS, Celebrex, Vioxx Injections (trigger point, ,joint, Injections (trigger point, ,joint,

bursa)bursa) RestRest

Treatment for Biomechanical Treatment for Biomechanical PainPain

RestRest Change in PostureChange in Posture Assistive Device (cane, crutch, Assistive Device (cane, crutch,

wheelchair)wheelchair) NSAIDs, Vioxx, CelebrexNSAIDs, Vioxx, Celebrex InjectionInjection

Treatment for Treatment for FibromyalgiaFibromyalgia

Rest?/ Heat /Stretch/RelaxationRest?/ Heat /Stretch/Relaxation Medications to Improve SleepMedications to Improve Sleep SSRIs (Paxil, Effexor, Zoloft)SSRIs (Paxil, Effexor, Zoloft) Muscle Relaxants***Muscle Relaxants*** NSAIDSNSAIDS Long Lasting NarcoticsLong Lasting Narcotics

Purpose of This StudyPurpose of This Study

To Clearly Define PPMPTo Clearly Define PPMP To Differentiate PPMP from Non-To Differentiate PPMP from Non-

PPMP in Polio SurvivorsPPMP in Polio Survivors To Develop Tools to Diagnose and To Develop Tools to Diagnose and

Treat PPMPTreat PPMP

HypothesisHypothesis

There is a unique group of patients There is a unique group of patients who will meet the following criteria who will meet the following criteria for PPMP: Cramping, aching, for PPMP: Cramping, aching, fasciculating pain in their fasciculating pain in their extremitiesextremities

Their pain profile will be distinct Their pain profile will be distinct from patients without PPMP and from patients without PPMP and from non polio patientsfrom non polio patients

SubjectsSubjects

175 Polio Survivors from RWSIR175 Polio Survivors from RWSIR 94 Fibromyalgia Patients from UM94 Fibromyalgia Patients from UM 114 Rheumatoid Arthritis 114 Rheumatoid Arthritis

Patients from UMPatients from UM

MethodsMethods

Post-Polio Pain Questionnaire Post-Polio Pain Questionnaire McGill Pain QuestionnaireMcGill Pain Questionnaire MANOVA AnalysisMANOVA Analysis

ResultsResults

AgeAge SexSex Relieving FactorsRelieving Factors Exacerbating FactorsExacerbating Factors McGill Pain MANOVA AnalysisMcGill Pain MANOVA Analysis

AgeAge

GroupGroup NN MeanMean MaxMax MinMin

No No PainPain

3131 54.154.1 8282 4444

PPMPPPMP 6464 56.256.2 7878 3333

No No PPMPPPMP

8080 58.758.7 8585 4040

FMFM 9494 46.146.1 7676 3333

RARA 114114 57.857.8 8383 2525

SexSex

GroupGroup Male % Female Male % Female % %

No PainNo Pain 1616 52% 52% 1515 48%48%

PPMPPPMP2323 36% 36% 4141 64%64%

No PPMPNo PPMP 3636 45% 45% 4444 55%55%

RARA 61 61 54% 54% 5353 46%46%

FMFM 10** 11% 10** 11% 848489%89%

nificantnificant

Relieving FactorsRelieving Factors

Group Massage Brace Sleep Heat Ice Weightloss

Stretch Rest Exercise Injection

PPMP 47% 23% 47% 78% 1% 33% 36% 90% 1% 1%

NoPPMP

50% 16% 34% 58% 6% 16%* 27% 84% 6% 11%*

*significant p<.001

Exacerbating FactorsExacerbating Factors

Group Cold Rest Exercise

Weight Gain Stress Activity

PPMP68% 3% 61% 39% 53% 78%

NO PPMP 56% 10% 51% 32% 46% 78%

ResultsResults

80% Of Polio Survivors Had Pain 80% Of Polio Survivors Had Pain ComplaintsComplaints

44% Met Criteria for PPMP44% Met Criteria for PPMP Polio Survivors were Similar to Polio Survivors were Similar to

Patients with Fibromyalgia on McGill Patients with Fibromyalgia on McGill Pain QuestionnairePain Questionnaire

Polio Survivors were Different than Polio Survivors were Different than Patients with Rheumatoid ArthritisPatients with Rheumatoid Arthritis

ResultsResults

No significant differences between No significant differences between polio groups with respect to age, polio groups with respect to age, sex relieving and exacerbating sex relieving and exacerbating factorsfactors

There were significantly more There were significantly more woman with fibromyalgiawoman with fibromyalgia

ConclusionConclusion

Post-Polio Muscle Pain is Common Post-Polio Muscle Pain is Common in Polio Survivorsin Polio Survivors

Many Polio Survivors May also Many Polio Survivors May also Have FibromyalgiaHave Fibromyalgia

There is a need for Further Study There is a need for Further Study of Fibromyalgia in Polio Survivorsof Fibromyalgia in Polio Survivors

AcknowledgementsAcknowledgements

Scott Richards, PhDScott Richards, PhD Greg Petrosky, MSGreg Petrosky, MS Research Enrichment Program for Research Enrichment Program for

PhysiatristsPhysiatrists NIDDRNIDDR University of MissouriUniversity of Missouri