1. Pain in Post-Polio Patients Anne C. Gawne MD Director Post-Polio Clinic Roosevelt Warm Springs Intsitute

2. Post-Polio Syndrome (PPS) b New Weakness b Pain in Muscles and Joints b Fatigue b Shortness of Breath

3. Pain in Polio Survivors b Most Prevalent Complaint in Many Studies b 80% of all Polio Survivors Complain of Pain

4. Types of Pain in PPS b Post-polio Muscle Pain b Overuse Pain b Biomechanical Pain b Fibromyalgia

5. Post-Polio Muscle Pain b Occurs in muscles affected by polio b Deep aching pain, with cramps and fasciculations b Occurs in the evening or at night b Exacerbated by physical activity, cold and stress

6. Overuse Pain b Occurs in muscles, tendons bursa and ligaments b Common in the shoulder) rotater cuff Tendonitis), back (Myofascial pain) b Worse with overuse, poor body mechanics

7. Biomechanical Pain b DJD b Low Back Pain b Nerve Compression Syndromes b Caused by poor Biamechanics

8. Fibromyalgia b 8/11 Tender points b Widespread pain in 4 quadrants X 3 mo b Fatigue b Sleep disorder b Numbness and tingling b Headaches

9. Fibromyalgia Less Common b Jaw Pain/TMJ b Irritable Bowel Syndrome b Headaches b Cognitive or Memory Impairment b Dizziness or Impaired Coordination b PMS

10. Treatment for PPMP b Rest b Heat b Stretching b Medication (elavil, Trazadone,Ultram)

11. Treatment for Overuse Pain b Modalities (Ice Heat, US) b TENS b NSAIDS, Celebrex, Vioxx b Injections (trigger point,,joint, bursa) b Rest

12. Treatment for Biomechanical Pain b Rest b Change in Posture b Assistive Device (cane, crutch, wheelchair) b NSAIDs, Vioxx, Celebrex b Injection

13. Treatment for Fibromyalgia b Rest?/ Heat /Stretch/Relaxation b Medications to Improve Sleep b SSRIs (Paxil, Effexor, Zoloft) b Muscle Relaxants*** b NSAIDS b Long Lasting Narcotics

14. Purpose of This Study b To Clearly Define PPMP b To Differentiate PPMP from Non-PPMP in Polio Survivors b To Develop Tools to Diagnose and Treat PPMP

15. Hypothesis b There is a unique group of patients who will meet the following criteria for PPMP: Cramping, aching, fasciculating pain in their extremities b Their pain profile will be distinct from patients without PPMP and from non polio patients

16. Subjects b 175 Polio Survivors from RWSIR b 94 Fibromyalgia Patients from UM b 114 Rheumatoid Arthritis Patients from UM Patients from UM

17. Methods b Post-Polio Pain Questionnaire b McGill Pain Questionnaire b MANOVA Analysis

18. Results b Age b Sex b Relieving Factors b Exacerbating Factors b McGill Pain MANOVA Analysis

19. Age GroupNMeanMaxMin No Pain 3154.18244 PPMP6456.27833 No PPMP 8058.78540 FM9446.17633 RA11457.88325

20. Sex Group Male % Female % No Pain16 52%1548% PPMP23 36%4164% PPMP23 36%4164% No PPMP36 45%4455% RA 61 54%5346% FM 10** 11%8489% nificant

21. Relieving Factors

22. Exacerbating Factors GroupColdRest Exercise Weight Gain StressActivity PPMP 68% 3%61%39%53%78% NO PPMP56%10%51%32%46%78%

24. Results b 80% Of Polio Survivors Had Pain Complaints b 44% Met Criteria for PPMP b Polio Survivors were Similar to Patients with Fibromyalgia on McGill Pain Questionnaire b Polio Survivors were Different than Patients with Rheumatoid Arthritis

25. Results b No significant differences between polio groups with respect to age, sex relieving and exacerbating factors b There were significantly more woman with fibromyalgia

26. Conclusion b Post-Polio Muscle Pain is Common in Polio Survivors b Many Polio Survivors May also Have Fibromyalgia b There is a need for Further Study of Fibromyalgia in Polio Survivors

27. Acknowledgements b Scott Richards, PhD b Greg Petrosky, MS b Research Enrichment Program for Physiatrists b NIDDR b University of Missouri