5th World Congress
World Institute of Pain-WIP
i \ , 1 t ' l l t o d s : U s i r g \ l l { l r r r t l p r o r o c r t i r r t l i s c o g r i r p h r t o c s t r r l r l i s h i r ) t c r n x l c l i s e t l i s r L r p r i o n , j 0 c o n s c e u t i r c p i t t i e n r s \ \ i r l t l L r r r b i r r c l i s c o g c n i c p i t i n ( 2 ( r n r o n t h s ) l c r c i t l c n t i f i c r l , u r r c l c r -w c n t l l ) l - . l t r c i t t n t c n t r n c l h r l l o -w c t l i 0 r l . l n t o r r r h s l i r c l p r r r r s c r c r i r r ( I I p o i n t r u n c r i c s c i r l c ) iu t ( l i u r r c t i o n ( ( ) s u . c s r r r r l i s r b i l i r r i n c l c r l O l ) l l ) u c r e c r i r l r r r t r c c l p r c r r c i l t r n c D t r n t l r r l l r n r l 1 4 r r r r r r r h s ( . l i n i c r l s t r c c c s s r r r s c l e f i n c c l ir s lr c l . o f f o l l o u -u p s -u r i l c r \ n r r h c i r f l - c c r r r l l c r c l . ) 2 - p O i n t p r i r t r n t l ) 1 . 5 - p O i n r ( ) l ) l i n r p r o r c n r c r t r , l i c , - s r r / l - ç : \ l c r n I ) l i u s e ( ) r c s r l c c r c r s c c l f r o n r 7 ( r I I . I p r c -t r c l ' l -t n r c r r r r o 2 + 1 I i i r t l - 1 n t o n t l t s . r c p t c s c n t i n g r l n l t \ c r i 1 i 3 c 6 l i ( ' o r n r p r o \ c n t c n t ( 1 ' < 0 . 0 0 ( ) l ) . \ l c r r r O l ) l c l c c r c r r s c t l h o n t 5 9 0 " , , : l I ( r " , , r O l 0 1 " , , + I l . l ' l i , ( 6 ( , " , , . / , < 0 ( X ) 0 1 ) l ) u c r o p c r s i s t c D t s \ D r p r o r l s , c ) Prtiertrs lrlrcl sLrrgicrtl t l c l f n t c r t r ( . + t u s i o r t . j c l i s c r e p l r r c c r t r e n t ) ( ) n c p r t i e n r c l i c l n o t r c h i e r c 2 2 p o i r t p r i n i n t p r o r c r r c n t . i l t r l o r r c p l t i c l t t ( l i ( l t ) o t t c l t i e \ c ) I 5 - p o i r t r O l ) l i n r p r o r c r r c n t I h u s , r h e c l i n i c r l s u c c c \ \ r i l t c t e s 7 1 i " , , ( 1 9 o f 5 0 ) ( . l i r r i c e l s u e e c s s r v r s r e l r r c c l t o t l e g r c c o f t l i s c o g r i r p h i e c ( ) n e ( ) r ( l i r l e c ( / ' < 0 ( X ) 0 1 ) , l l l 7 . l l ' = 0 0 0 1 ) . I ' f i r r r t t r n r t g , r r t l e ( / ) - 0 0 ( X ) l ) . i r n r l p c r c c n t r n n L r l r r s e o r c r r r s e ( / ) < 0 0 0 0 I ) .
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PBe6 PATTL.NT-REPORTI-]) OUTCOMF.S ( pl{O) IN RL,FIIACTORY I'AIN ASSOCIATI--I) TO T-OW I I A C I ( I ' A l N : A N A N A I . Y S I S O F T H L . E F F E C T O I -P R F - G A I J A I - I N I N A I 2 - W E E I ( N A T U R A I - I S T I C S T U I ) Y l r ( l c b c r i o l i r l c l . r , \ l I - k i r c z ( i r r c i r r r . ( . i \ l o r c r e l ) . ' l r i l , t r r ( / . \ \ l . l \ f i l n r i ' n . ( ) | r t i r t . . I l { r . i , r , r l { c h . r b i l i t r t i o n U n i t . I I o s p i t r l r l c L l r b r r r r r i n , I ) r n r p l o n r r , N r r r r r r n . S p i r i r , r l { c h e b r l i r i t tr o r l L I n it , l - o u r r c l r r i o n l i o s p i r r l , \ l e o r e o r . , \ l c o r c o n , \ l r t i r i t l . S p r i n , r ' I r i t u n r r r t o l o g r r n c l ( ) r t h o p r r c r l i c S u r g , c r r L l n i t . I I o s p i t r r l N I r r r L r r d c I c r r r r s i r . l i r r c c l o r r r , S p r i n . ' l ) c p r r r n t c r r r o l l i i o n t e t r i c s , l : u r o p c r r r l i i o r r c t r i c s I n s r i r u r c , I J i l r e c l o r r r , S p r r n , ' ( ) t r r c o n t c s l ( c s c r r c l l I ) h z c r S p r i r , A l e o b c n t l r r s \l r c l r i c l . S p r i n l l t t l i g t r t t r t u l t t i l , \ i n t s : T o r n r r l r z c r h c c f i e c t o f r t l t l i n g l ) r c -S . t b r t l i n ( l ) ( i l : i ) o r r I ) l t O r n c i t s r r r c n l c n t s in t h c t f c i t t n t c n f ( , i r c f r l c t ( ) r \ I o r r I ' i r t c l i l' r i n ( l l J l ' ) t r n t l c T r o u r i n c n r c r l i c r l p r a . r i c c c o n c l i n o r t s i \ l t , t l t o J s : I ) o s r h o c i l 1 1 a l \ s i s o f r r t l u l t p r r r i c r t s rv i t h r c i r r c t o r r c h r o n r c I l i l ) i n e l L r c l c r ] i r r r p r o s p c e r i r c . rr r t u r r l i s r i c . l l - r v c c l i s t u d r I h i s r r r r l r s i s c o n t p r r c c l p r t i c r r t s r c c c i \ i n ! 1 , I ) ( i l l r s r n r c l c l - o n t h c r r p r ( l ) ( ' l l r c l i l - o n ) r s s u b j c c r s r c c e i \ i n ! l rr t r o t l t c r r r i r l g c s i c p i l t r c r n r r ( ) r i r c l L r r l i n l - l l ) ( i l i ( n o n l ) ( i l i ) l ) l { ( ) n t c r -s u r c n r c n t \ i n e l L r r l c t l c \ r l l L l i l r i ( ) r 1 o f s c r c r ir r l r n c l in t c r f c r c n c r o f p r i n ( l i r i c l I ) r i n l r t r c n t o r r ) , l r r t r i c t r r n t l r l c p r e s s i o n s \ n t p t o r ) l s ( H ' \ l ) s c . r l c ) . i t n t l r l L r r l i t r o f l r t e ( S F - 1 2 ) 1 i r - < r r i 1 - < : S i r h u n c l r c t l a r r r l c i q h t r r h r c c p r t i e n t s r v c r c r n . r l r z c t l : l i l ( - " , , r c c c i r c c l l ) ( i l J i r t l t l - o n e n r l l 7 - 1 " 1 , n o n - l ) ( , l ' i l ) ( i l i r t r l r l o r r r r r r s r s s o c i r r t c r l ri t h l r i s h c r r c t l r r c t i o n i l p r i n s c r c r i i l t h r r i r t r r o n - l ) ( i l i ; - i . + ( l ( ) ) p t s , ( r I ( r " , , r c s p o n c l c r s ( 2 5 ( ) . , , l r r s c l i n c p r i r r r t c l u c t i o n ) r s . ] . 0 ( l | ) . l l . l ' l i , r c s p o n t l c r s ; 1 ' < 0 ( X ) 0 1 . r c \ p c e r i \ c l \ l ' r t i n i n r c r f e r c n c c u i r s r l s o r c c l u c c c l n r o r c l i r h I ) ( i l i r r l t l o n : - l I ( l I ) p t s \ s - l 0 ( - l 3 ) . r c s p c e t i r c l r : 1 ) < 0 ( ) ( X ) 1 , r n t l s h o l c t l g r c i r t c r r c t l r r c t i o n r l c l c p r e r -s i o u ( - 1 0 1 . 1 l i p r s v s l . I l l l l ; 1 ' < 0 0 0 0 1 ) r n r l r r r r x i c r r ( - 1 , l . l 6 l p t s \ s - l 9 l l . ( ) l i / ) < 0 0 0 0 1 ) s r n r p r o n r s s c o r c s . r i c l t l i n g r o r s i g , n i f i c r t n t i n r p r o r c n t c r r t i n t ; u r l i r r o l l i f c : n t c n t r l r n c l p l r r s i c r l c o n r p o n c n t s c l r l n s c r r e r e h i e h c r i n l ) ( i l i r c l c l - o l t h r r r P r q r o u P : + . I ( l 0 ( r ) r s + 2 0 ( 7 - { ) ; / ' < ( ) ( ) ( X ) 1 . r n t l + 9 ; ( 9 . 6 ) \ 5 + i l l { 8 l ) i / ' < ( ) 0 0 ( ) 1 . rc s p c c r i r c l r ( t t t r L - l t t s i r t r t : ( . o n r p . r r c c l r i i t h r t l r l i n g ( ) t h c r r n \ t l r u g , r c l t l i t i o r r O f l ' ( ; l l r r t l r c t r c r t n t c n r o l r c f r r e r o r r I l i l ) s c e n r s t o b c i r s \ o e i i r t c ( l r r i r h l r i g h c r i r r p r o t c n t c n r l r I ) l { ( ) r n c r s u r c n t c r t r s , i n c l r r i l i r g r c r l r r c t i o n o l p i r i n s c r c r i t r r r r r l i r r r c r f c r c n c c r n c l i r t t p r o r c n r c r r r o l c l L r r l i t r o l l i i e P B 9 7 C A N T H E I ] O I I G S C A I - E , T . O R P E I { C E I V E I ) T , X E I T T I O N I ] E U S I , I ) I N P A T I E N T S W I T H C H I T O N I C L O W I ] A C K P A I N ? ( . l ) c n r o L r l i n , l. V c r b L r n t r . ,\ K n o r t n c r t r s ' . I{ S r r c c t s l r l ) c p i r r t r r c n t o l \ l o t r i c i t r S c i c n c c s r n c l l ) c p . t r r n r c r r r o f l ) h r s i c r l \ l c c l i c i n c a r r t l l { c l r r b r l i r r r i o n / N l i r i r s r r i c h r L j r r r r c r s i r r . I i c g c t h r i v c r s i n r n t l ( . 1 IL l o l I i c g c / l \ l a r s t r i c l t r t i r r i r c r s i n . I i c g c , l l c l g i u r r r . r l{ c h r [ r i l it r t i o n I - ( ) u l ] ( l r l t r ( ) n I i l r b t r r g / S c h o o j o i l ) u b l i c I I c r r l r h r n r l l ) r i n r r r r ( - r r c I { e s c r r e l r N l r e s r r i c l r r I J r r i r c r s i t r , \ l r r s t r i c h r , I l r c N c r h c r l r n t l s , ' S c h o o l o i l ) r r b l i e I I c r l r h i t n d I ) r i n r r r r ( . r r r c I { c s e i r r c h , \ l r r s t r i c h t [ ] r r i r c r s i r r , \ l r r s t r i c h r , I h c N c t l r c r l r n r l s I l t t l : g t r t t t r t d t r r t l , - l l z - s r . \ c c o r r l i n s r o s r \ c r i l l s t t r r l i c s . t h c l i o r g ( r - 1 0 s c r l c i s r r c p r o t l u c i b l c too] ro nrcrrsurc rrrings oi per-e c i r c t l c x c r r i o r r (l { l ) F . ) H o u c r c r , n r o s r o i r h c r r per-e r l c L r l r t c t l t h e e o t T t l r r r i o n e o c l f i c i c r r t o r t l r c i r r t r re l r s s c r t r r c l r t i o n c o e f H c i e n r r l r i c h c l o n o t r c t l c c t i l s r c c n r e r r r t l r o L r g h i t r s p r e i e r r b l c i , , r ' c r i r l t t r r t i o n p u r p o s c \ , l - t r r t h c r n t o r c , n o s n r c l r h r s i r r r c s t i g r t c t l i t s r c p r o c l u e i b i l i t r in p r r i c n r s u i t h c h r o r r i c l o r r b , r c l i p r r i r r ( ( , I I J P ) I l r c r c k r r c , r h c p u r p o s c o l t h i s s n r d r \ \ i r s t ( ) i l s s c s s r h e l i r r g \ c r l c i n s u c h p r r t i c n t s l i r h r c c o n r n r c r r t l c t l it g l c c l l t e n t p l l r i l l -c t -c r s ( S t l r r t r l l r r t l c r r r l r o l ' n t c i t s r r r e n t c n t (S f . N I t e n d l - i n t r t s , r f . \ g r e e n r r n t ( l ( ) A ) I l t ' l l : r d s : I t i i t r - c i g h t frticnt5 ( l-{ ntcn. l'1 \\()nrcn; rlljc rilngc: l 0 ( r l r c r r s ) \ \ ' i r h ( . 1 l l l ' j ( r r r c i t r r I { l ) Q s c o r o s rc r c h i n i l I I c / : t i . 7 ) p a r t i c i p r r c c l l l r p r o q r i r r o f r r c r o b i c r r r i n i r l i l o r r r h i c r c l c ( 2 0 n r i r u r c s p c r i o r n r i n u rt ( r 5 ' l i , r o S 0 " i , o f t h c n t i r r i n t r l l t c r r t i t t c ) , . 1 s c s s i 0 n s p c r \ c c l i \ \ ' c r c c o r t l c c l h e r r t r i r t e ( i n l ) c r t t s p c r n r i n u r c ) r r n t l r r r t i D g s O l p c r c c i r c t l l c r c l o i e x c r r i O n iort r ( ' 2 0 l i o r g s e r l r ' ) t l L r r i n u r l r c t i r s r I s c s s i o n s rl u r i n g u l t i c h r v o r l i l o . r r l r r ' . t s it l c n t i e r l 1 i r , - ç l r i l - s : I r b l c I p r c s c n t s n r c r r n s . r l i i l c r c n c c s o f r r r r r n s r r n r l i r s r c c D r c r r r P i l r - r l n r c t c r s ( S l : \ l = I 0 f r r i t l t i n s u l ) j c c r \ t r i l l t c c r n r l [ ( ) ' \ - I 9 ( r x t ] t c l n S l ) o i i l i i f c r c n c c s ) h r r l : i o r g s c o r c s il n ( l H I { n = 5 8 D if f e r e n c e s S e s s i o n l s e s s i o n 2 5 1 - 5 2 M e a n s ( S D ) M e a n s ( 5 D ) M e a n s ( 5 D ) s E M L O A B o r g S c o r e 1 3 3 1 ( 1 7 ) H R ( b p m ) 1 3 1 9 ( 1 3 2 ) 1 3 2 8 ( 1 7 ) 0 0 3 ( 1 2 ) 1 3 2 3 ( 1 3 2 ) 0 4 ( 8 8 ) 2 3 1 7 2 ( t t r t c l t r s i o t t s : ( ) u r s r u c l r r c r c r t l c r l s i t r i s f t c r ( ) r \ i r l l r c c n t c n t p r u i l n r c t c r \ k r r l i o r g r i t l L r c s ii l p r t i c D t s r i r h ( . 1 l i l ) . P I ] 9 8 I I E , S P O N S I V E N E S S A N D I N T E R P I { E T A I ] I I - I T Y O F T H r ' . QUEBEC IIACK pArN I)ISABILITY SCtAr_E ( . [ ) c n r o u l i n r , l{ ( ) s r c l o r . ,\ . 1 h r o r t n c r L r s t . l{ S r r c c t s ' r l i e q e L l r r i r c r s i r r r n L l ( . 1 ll . l o f I i ù ; i c / \ l r r s r r i c h t I J r r i r c r s i t r . I i c g c . l i c l g i u r n . 'l : N I ( ; O l n s t i t r r t c / l ) c p r r r n t c n t o f H c r r l t l t S c i c n e c s , \ I L J L J n i r c r s i r r , A n t s t c r c l r n r , T h c N c t h c r l r n c l s . ' s c h o o l o l I ' L r L r l i c I I c r l r h r n r l l ) r i r r i r r r ( . r r r c l { c s c r r r c h . \ l i r r s r r i c h r L J n i r c r s i t r . i \ l i r r s r r i c h r , I h c N c r h e rl r n d s , ' S c h o o l o f I ) u b l i c H c r l t h r r n r l I) r i r r r r r r r ( . r r c l { c s c r r c l r , i \ I i r r r s r r i e h t ll n ir c r s i r r /l l e h r r b i l i r r r i o n l - o L r n c l r r r r o r r I i n t b u r s , N l r r r s f n c h t , I h e N c t h c r lr n t l s I l t t l : , 1 t o t r r t d t r n l , \ i t r t s : T l t c p u r p o s c s o f t h i s s t u r l r r r c r c t o i n \ r s t i g i r r c rc s P O n s i r c n c s s i r r t r l in t c r p r c r r b i l i r r O f r h c Q u c l r . . l j i r c k I ) r i n l ) i s r b i l i r r S c L r l c i Q I i l ) l ) S ) b r r n e r r r s o i r c c o n t -n r c -n r l c c l n r c r h o d s iS n r r l l c s r l) e r c c r r b l e ( . l r r n g c 1 S t ) ( . ) l { ( ) ( i p r l r l r r c t c r s ) r r n t l I O e s r i r r r r r r c r h c \ l i n i n r r l I n t p O r t r r t r (i h i r u r u ( \ l t ( . ) N I t ' t l t r d s : In t o t . r l , ll 2 p r r r t i c i p r n r s l i r h c h r o n i e n o n s p c c i f i c I o r v b n e l i p i r i n p r r t i c r p r r e ( l in r l t c s t L l ( l \ Q l l l ) l ) S r r r r s . r c l r t i n -i s t c r c t l n v -i c c t o l r l l p . t t -i c D t s ( p r c r t n . l lrosf-tte-ittllcnt-i Tl rlld f 2 ) n h r r l s o c o n r p l e t c c l r ( i c n c r r r l l ) c r c e i r c c l I - . i f c c t s c r l c ( ( i l ' l - . ) r t T l , \ n r r l r s c s u c r c b r s c r l o r r t h c ( ' l ) l : s c o r c r r n c l o r r s c ( ) r c c l r i l r e c s b c t \ c c D I I i r n i l T l t l L r r i n u r r l r i c h s L r [ r j c c r s r c c c i r c r l o r c o i t h c n n r l o n r i z c r l r r c l r r n r e n t s r l r h r r t l r o r r r r r t i o r t f e t i l n c l l I 0 8 4
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S c n s i r i r r t ) = , f i " , , , r r r r l S P c e i f i c i n = , 1 " , , ) \ c o n r p l c r r r c n t r r r - r I l ( ) ( . r n r l r s i s b r r s c t l o r r r h c Q l i l ' l ) S s c o r c c h r r n g c c r p r c s s e r l i n " , , r c r c i r l e r l ( ) ( . 1 ) o i l 8 l ' 1 , , (r i r h A t l ( . = ( ) l i i r r , S c r s i r i r i r \ - - r " , , , r r c l S P e c i f i c i r r - l i ) " , , ) Q I ' i l ' l ) S h r s e l i r c s e o r r ' s r r c i r h c r r r r r l t c l r r s t l i n e s c o t c s r t r c u s c r l t o c l u r t e r p r t i c r r r s ir f l u e r r e c e l T t ' t p o r ) r i r c n e s r i t n t l i r r r c r l r r c t r b i l i r r i r c l i c r t o r s ( ) t t r t l t t s i , t t s : I h i s s r r r r l r p r ( ) p ( ) \ c \ \ l l ( . r r l r r e s l r r p r t i t r r r s r r i r l r ( . 1 l j l ' r c f e r r c d l ' ( ) r r r r u l r i c l i s e i p l i r r r r r r r c r r t n l c n t I h e b r s c -l i n e s c o r c s r n t l t h c r r r r t o c l r r s r e r p r t i c n t \ \ \ i r h r c g r r t l t o t l r c i r s e o r r ' s h r l r c t < l b c t r k t ' r i r t t o r r c c o r r r t t l h i l c i r t c r p r e r i r t g th e \ c ( ) f ( ' e l l i l n g , e \ rl t r c f t r c x n l l c r l r P B e e E P I t ) U R A I _ S T I - . R O I t ) l N . l [ . C T I ( ) N A S A M I N T M A L I N \ A S I V F - A P P I { O A ( ] H F O I T C H I T O N I C S ( ] I A T I ( ] P A I N \ l | | l - . b r r h i n r z r L l c h . \ l l . l ) c i r r n r l i r , I S h c v l i h i r n ' ' ( ) r r l r o p c . l i . S L r r g , c r r , ( , h . r e n r I l o s p i r r l \ l r s l r r r h r l l l n i r c r s i r r o i \ l e d i c r l S c i e r r c c , \ l r s h h r r t l , I r r n . r ( ) r r h o g r c c l i c S L r r g c r r , \ l r s h e h r l U r t i r e t s i r r o l \ l c t l i e e l S . i e n . t . \ l r s h h r t l . ' \ l r s h r h t l I l n i r c r s i t r o l - r \ l c t l i c r l S e i c n c c , \ l r s l r h r L l . I r r n I ) t t k . g o t r t r L l : l { e g . r r c l i r r g r o r h c p r c r r l c r c e o f l o \ \ l . r e k p r r i n i n t h e c o n r n r u n i t \ . \\ c c i l n r e to c r r t l u r t t c c p i c l L r r r l s t c r o i c l i r j e c -t i ( ) n .l \ r l n r i n i n l . l ] l \ ir -t r , r s i r c r r r r r i r p r t i t r r r s l i t h r e r r t c r r c l i e L r -l a r t I J I ) . , \ l t , t l : t i l t t t J , \ 1 , / 1 . , 1 . r / - i i l - o r t r p r r i c n r s r r e r c s r u r l i c r l p r o s P c c r i r c l r c i u r i r t q ( ) r ) c \c i r r r r h o r t r e i . r r c c l r o o r r h o p r c t l i c c l i r r i e s o f l r n r r l r t l i l l o s p i t r l \ \ i r h r e u r c r r c l i c L r l r r I l l l ) . l ) r t i c n r s r r i t h r l i s e r r l l r c r n i r t i o n \ \ h i c l r \ \ ( r c r l i r r g n o s c r l i n ( r r r c c k s o i i n i t i . r t i o n ( ) i i r e u t c p r i r r u i t h o r r t r l n \ r ( ' \ p o n \ ( r o n r c r l i e r l r h c r r p r . c n r c r e r l rh i s s r r r r l r . \ l l { l r r s r l o n e I r r r l l p r t i e n t s l ) i l i l c n t \ \ \ c r c s e o r e c l t l r o L r g l r I ' I { ( ) l ( ) l s s c s s i r r r l s r s r c n r I ' l t i e r r r s r r r ' r e i r j t c r e c l - { 0 r r g o f t r i r r n r c i n o l o r c in c o r r b i n i r t i o r r r v i t l r I i t l o e r i r r J " , , c p i t l r r r r l l r c \ e r \ o t l t ( r t l l r r f 0 r I t r n t e s l ) l t t i c r t r s \ \ c r c c \ l t l u i t t e ( l [) ( l - ( ) r c , j u s r r f r c r I n r o r r r h s i r ( l 6 n l ( ) n r h \ ] i t c r / i r ' - s r r / / - r ; \ n r o r S r l l p r r i c n r s ( r l i " , , l c r c n r r l c r n t l . l - 5 , , \ c r c i c n r . t l c . - 1 0 " , , 0 i p l t t r c r r r s c o n r l ) l . l i n e ( l O i P l t r c s t l t c s t l t l t n t l . r l l r r r c n t i o n e c l r r l r c r n l i t t e n t I l i l ' . S l l t t e s r r i i f l c r c t l \ t r l t i s t i e . r u \ b c f o r e f i r s t r n r l r f t c r t h e t h i r r l i n j c c t i o n ( / ' < 0 0 5 ) l ' r i r r r e l i c i i r r r t s P 0 D t ( r O t g r i J L r r r l i n j t ' e r i 0 n rr r c l r r s r r r e \ u l t ( l ( ' e r e r r \ ( ' i I r n r l i l c \ i e r l r L r g i r r r i t l e * l s o b r r o u s r n t l s t r t r s t t e r l l r rt t c r r t r n g i u l i n s c e o n t l rn c l t h i r c l f o l l o u r r P { / ' < 0 ( ) ) ) . h u t i r r r . r s n o t t h e s r r r r r e i r r h r n e r i o r r r n c l e l - i c c r i r e n c s s ( / r > 0 ( ) i 1 l n u r ' n c r r l r l r c r i r t j t e t i o n l - i " , , o f p i t r c n t \ \ \ ( r ( l r r l l r s r t i s f i t r l r n r l ( ' l i r r c r c r c l . r t i r c l r s , t t i s f i e t l ( t t t t t ' l t t s i o t t : S e i r r i c g r r i n i s n r o r t p r t r r l t ' n t r r n r o n g r r r r r l e f l r r r e r r r s l i r t l e i r l p r o r c n r t r r r i n c f f e c r i \ c l r t ' t t ,r r , l p h r r i c r l e o r r t l i t i o n o l p r r i c r t s r f r c f \ t c r ( ) i ( l in j c e r i o r t l ) i r i r r r e l i c f h r r l r p c r e c l c l r r i c k l r . t r t t l c l r . t n t . t t r c . t l l r . t f r e r in j c c r i o n r n r l i n p . t r r l l e l . l n . l l S , c s i c . l r u g r p p l i e r t i o n r l c c r c r s c t l o h r i o r r s l r P B l 0 0 I - ( ) N G - T F . R M E F I I I C T S ( ) F A C O M B I N I - . 1 ) L , X I - I { C I S I - A N I ) N I O T I \ A T I O N P R O G R A N 4 I N P A T I E N T S W I ' | H C H I { O N I C I O W I ] A C K I ' A I N : A F t v E - \ ' f . A I t F O t . l . O \ \ ' - U P \ 1 . l i r i c c l r i c h r . ( i ( i r t t l c r l l ) e p , r r t r r r c r r t h r r ( ) r h o p r r e t l i c P r i n \ l r r r r g c n r c n t . ( ) r r l r o p r c t l i c I l o s p i t r l S p c i s i n g , V i e n r r r , , \ r r s r r i r . [ ) r ' p r r t r r r c n t o f I ) s r c h o l o g r . t l r t i r t ' r s i r r o f Y i c r t r t . t , \' i e r t n . t , À L l s t r r i l B t r k . g , , r t r t J J t r t l , \ i u t s : l l r e r e i s . r p p r c e i r r b l e c r r t l c n c c o f a t r i l r s i ( ' D t P O s i t i r c e f f c c t o i c x c r c i s c r l r c r r p r i r t t l r c f r c r l r n r c l r t o l c l r r o n i e l o u l r r c k P r i n l r r r \ t u ( l \ o r ) r h c r ' f i e c t s o f i r e o n r -b i r t ' c l c x c r e i s e lr t c l n r o t i r , t r i o n p r ( ) g r r l n r o n c o r t t p l i r r t e e r r r r l r h e l c r c l o l r l i s r h i l i n i n l . r t i t r r r s u i t h e h r o r i c l o r r h r c k p r i n . p o s i t i r c t l f c e t s r r r r e s t i l l l ) r c s c r t o n c \ c r r . l i r c r t e r r n i r t . t r i o n o f s t r p c r r i t e c l c o n r l . i n c t l t r c r l r n r c l l r I h c . \ i r r r ( ) l t l l \ \ t u ( l \ \ \ r s t o i r r r c s t i g , . r t c r l t c 5 r c . t r e f f e c t s o f t l l c I l o g r r n r, \ l e l / : o , 1 - ç r ( ) l t h e 9 I e h r o n i c l o r r l - r r e k Iirir l)rticrrrs rirrtlorrlr r s s i g r e . l r o e i t l r e r rt s r . t n c l . t r . l c \ e r f i s e p r ( ) g l i l r ) t r l r . t e o n r b l r c t l e r c r e i s e i t r r t l n r o r i \ i t t i o n p r ( ) g r i ' t n l . ) 6 I r i t i c r r r \ \ \ e r r' r \ l i l r l ) l c i r l r i - r e i t r f 0 l l r l r r t r l t I i t c n t . t r D ( ) u t e ( ) n 1 e I I ( . t \ u l ( \ r t c r . r l i s -l r b i -l i t r ( -l o r b r r e -l i p r r i n ( ) L l r c ( ) n r e s e o r c ) , p r r i n i r t c n s i r r . p h r r i -e r l i r l P i r i r r r c r t { f i n g c r - r i p - r o - f l o ( ) r - ( i i s t . r n c c . t r t t l . t l r r i o r t t i r t r l n r u s c l c s t r c r t g r l r ; , r r o r k i n t r b i i i r r , e n r l e t t t t t p l i r r r t e t r \ I r ) c i l -s u r c t l b r r -s t r l o n Pltticrt rcPor r-s oi rhc rtLrmbcr ol- r e .tr-s tlrer e o l r r i n r r c t l c \ c r c i s i n g , r ( g u l r r l \ r f t e r r h c r c r n r i n r t i O r o l s r r P e r r i s e r l t r e , r t r t t c r t t / i c , - ç r r 1 l , s ; l r i r c \ e r r \ r l i t e r \ t u ( l \ r r ) t r \ , t l t e r t r r l s r r i g r t i f i e r n t t l i l f c r c n c c i n h r o r o f t h r ' r r o t i r i r t i o r u r o t r p l i t h r e g r r 1 1 r o r l t c r l i s r b i l i n s e o r e (/ ' - 0 ( X ) l ) , [ r . l i r ] r ) t c n \ i t \ ( 1 ' = 0 0 ( ) l ) . r n t l u o r l i i r g L l l ) i l i t \ ( / ' = 0 0 l l ) N ( ) s r q n i f i l r n r r l i i f c r c n c c s n c r c f o u r r d i r r t h c i r r p r i r n r t r r r Irrlrrlnr(tcr\ \\ ith rr'grrcl to eonrl)li r n c e , r s i i l n i f i c i r n t c l i f f c r c r r c c in f r r o r o i r h c c o r r r r r l g , r o u p \ \ r t s s c c r r ( / ' - ( ) 0 l l ) ( . r l t t l t t s i o t t s : N l o r c t l r r n i r t r r s r l ' t c r e ( ) n c ] u \ i ( ) n o l th e c o r r r -b i r t c c l c x e r e i s e r r t c l r t t o t i r . r t r , r r t p r ( ) g r l n r . r h e p o s i t i t c e t l e c r s o n r l i s r b i l i t r , p r i r r i n r e n s i r r . r n t l u ' o r l i r b i l i r r r i c r e s r i l l P r e s e n f P B I 0 I C H I T O N I C I . I I P I N A I ) T - \ ' E I - o P I N C ; C O L J N T I { \ . AT AN UNDF,I{ ITESOUII(]I-,I) STAT}, HOSPITAI - IS T H F . I { E A C A S I ' . F O I t F I I { S T L I N E I N T E R V h N T I O N A I P A I N M A N A C ; I - - M E N T ? l r I " r o h l i e l r . l ) . l ) t r l ) l t s s i s , \ r r r c s r l r c s i o l o g r . \ \ i n r r t c r s r r n t l [ ] n ir c r ti t r . l o h r r r n t s i r r r r g . 5 o u r l t . \ t r i e r B t L k g r u r t n l J t r t l t \ u 1 t s : ( . h r o n i e l o r r l r r c k l ) i l i r p ( ) \ ( ' \ r r \ i . l r t i f i c r n t s o e i . t l r r r c l c c o r o r t t i c r r u r t r e n I h c l i t c f i r t u r c is r r e o r r r r r c r r l i r r g r n r u l r i r l i s c i p l i r r r r r . r p p r o r e l r i r r r o l r in g p h r r n r r c o l o g r . e o t l r i t i r c b c h . t r i o r ^ t l r h e r l l ] \ , ( ) e e u P t t i o r i l l t l t c r i t p r , P h r s r o t h e r l n r . t s O I n o r r r L r n r t r r e r p p l r . l e o n s c r \ i l t i \ c n r L r l t i c l i s e i p l i r r r r r r p p r o r c l r , h o u t ' r e r s h o r r r g e s o i r l l i e c l r h e r r r p r s r r i f . p r r i e r t s f i r r i r r r c i r l e i r e r r n r s t l n e c s r r t l t h e c r r r t i c r r r i l r l r i l i r r o f p r i n r r r r . t r t t l s e e o r t . l . t r r r n . l l g c \ i e s r r c f r u s t r . r t i n g i u r ( l ( l i \ ! ( ) t t r r g i r g i r ) r p l r t i c r r r s ri l ( l r n c c l i c r r l s t r i f , \ l c l l o t l - ç : ,\ r c t r o s p e c r i r e r r . r l r s i s o f . l . r t . r c o l l e c r e . l f r o n r o u r r c c o r tl s u l r s c o r t r l u c r e c l I ) l t n n r c t c r s lu l i r l \ z c ( l \ \ c r c t h c c ( ) n r p l i-r n c e i-r i-r i t l i-r i-r i-r u l i-r i t l i s c i p l i i-r i-r i-r i-r i-r r r o c l r l i t i c s . .r r rr i l r h i l i r r o l c l r t r g s . V r \ 5 , r c r i r i t r l c r t ' 1 , n r o o r l , in ( l s r r i s f i l . t r ( ) n u i t l t t h e r . t p r I h c i r r r e n c n t i o r r i t l n r o r l . t l i t i e s t l r r l t \\ e r e e n r p l ( ) \ e ( l i n O r r r tt n i t r r t r e r r r r l \ r e d s e p r r r r t e l r / i r ' - r 1 1 1 - c : \ \ ' c h r r e r c r i e l c . l l ( r + e ( ) n s c e u t i \ ( rt e t t r t l s l ) l r l r r r -c t -c r s r r r r l r z e -c l r r e r e t l L r r l i t r o l - li f r ' , r -c t i r i t r , n r o o r l , r n r l \ , \ S I h c e o s t o l n r t r l r i t l i s e i p l i r r r r in t e r r e r t t i o r r r r l s c o r t p , t r e t l t r r t l l . l t ( , 1 I r r r ( r \ ( r t t , ' r . t l r r r , ' t l . t l i t i . '
( t t r t t lttsirtr: \\1r' postul.ttc tlrrt in tlrc ersh strrl.pctl cn\ ir()n-n r e r t t o i i t i l c r e l o p i ir()n-n g e ( ) L l r t r \ , t h r ' p o p t r l r t i t t r s u t f c r i n g i r o r t c h r o n i c l - o r r l i r c l i p r i n c r r n r r r t b t r r l c t l t r r r e l r n c . l t e ( l i ( ) l l ( ) \ \ i n g r s t r i c t n r L r l t i ( l i \ c i p l i r r r r \ p r o s r r n l W c s t r g , g c s t r l r r t e r i r l e n e e h l t s c r l i r t r t r r c n r i o r t r r l l . r o c c t l t t r c s e o u l t l b e b r o u g , h r t o r r r r r c l o n t ] r e t r c i l t n r e r r r l r c l c l e r . r l l o r r i r t g c r r r c i L r l l r s c l c c t c t l i n t c r r c n t i ( ) n s t ( ) L r c c o r r r c r f i r s t l i n c r r c r t -r -r c -r t -r i n ( ) L l f ll i l -r i c -r ) t I ) ( ) l l r r l t t r ( ) n W c l r r p o r h e s i z c r h r r t r h e l i r c l i o f e o r t t i n r r i t r o l - s c r r i c e b r r l l r c r l p r r c t i t i ( ) n ( r s . l i n r i r c c l c h o i e t ' s o i r r r i t l g c s i c s . s h o r r r t g e s . t r t c l r r n p l r r r n c t l r v i r h t l ri t n i t l o l r t e c l t c r tr o r t . r r t r l p r t i c n t ' t i i r r r n c i r r l i n r b i l i n t 0 c o n l n l \ \ \ i t l r n r r r l t i r l i s c i P l i n r r r t r c i l r r ( n t . r r r l k r r r c l t s c io r c r r r I r r r r c r \ c n t i o l r i r l t l r c r r P t \ \ ' c r r r r l r z c r h e o u t e ( ) n r e r n t l f i n r n . i r l i r r r p l i e r t i o n s o f r h i s r p p r o . r e h I ' I ] I 0 ] A T T A C - - H M } - N T A N I ) P A I N N l ( i i u l r n i O r t h o p r i d i s e h c U n i r e r r i t r i r s k li n i k I I c i t l t l t r c r g , . l l c i t l t l L r c r e . ( , C r t l l l l t l t l ' l t i r t . .r n t r r l r i t l r n r e n s i ( ) n r l l ) l r c n o n r c n o r . i s i t t f l t t c r c r ' c l h r p s r -e h o s o c i r l r r t l b i o l o q i -e r l r r r i r b l t s I l r ' s c r r c l r in . t r r . t c l t r t t c r t r t l l c ( ) r \ s t r r t s l r o n r t l r t i r s \ u r r r p t i o r r r] r , r t r \ p e \ o f r t r l c l i l i l e D t r n c l t h c e o r r c s p o r r l i r t i g n r c r r r i l l r r ( ) ( l e l s o f r l t c s t l l . o f o t h c r s r n t l o f t h c \ ( ) c r i 1 l e n \ r T ( ) n n r e r r r i r ( ( l c t c r r i r r c i l L r r c r r r l r i t t t . , -P c r s o n r r l ( \ l ) c r i ( n e e I h c s c t \ [ ) e \ e r r t p r o r i . i e a r u a i . l l c l L r c \ t( )
