Description: The patient was admitted to our department with severe neck pain and headache which had been lasting for 4 weeks. Brain CT was normal and cervical x-ray showed cervical spondylosis. Cervical MRI revealed spinal stenosis at C5-C6 intervertebral disc level. Neurologic exam was normal. 15 sessions of electrotherapy and exercises were applied but her complaints did not resolve. As we questioned the patient carefully, persis- tent pain and stiffness affecting both shoulder and pelvic girdles were detected. Morning stiffness was lasting more than an hour. Erythrocyte sedimentation rate (ESR) was 60 mm/hr. Based on these findings, PMR diagnosis was given. Low-dose prednisolone (10 mg/day) was begun. Prednisolone led to significant clinical improvement after the 4th day of the treatment. ESR was 25 mm/hr at the 10th day of the treatment. The patient had continued prednisolone treatment for 6 months. Discussion: In this case report we aimed to present an elderly patient who had diagnostic challenge for PMR. We wanted to emphasize that the pathological finding on MRI can not always be the cause of the patient’s pain. Clinical exami- nation can sometimes be more valuable than diagnostic images. Con- clusion: Clinicians should keep in mind PMR diagnosis in old patients with cervical pain and headache who do not respond to conservative treatments. Patients should be asked whether they have shoulder/pelvic girdle pain and morning stiffness. Reprinted with permission. No. 221 Lumbar Disc Herniation in a Gymnast: A Case Report. Koray Aydemir; Yasin Demir; Umut Guzelkucuk; Evren Yasar. Setting: 200-bed rehabilitation center. Patient: A 22-year-old man with low back pain. Case Description: He was admitted to our hospital with low back pain. He claimed that he had been enrolled in intense gymnastic lessons for the last two years. Visual analog score (VAS) of low back pain was 80 mm. On physical examination the movement of the lumbosacral spine was painful and 1/4 restricted. He reported reproduction of pain at 30 degrees for right while straight leg raising test. In the manual muscle testing of both upper and lower extremities, sensation examination and deep tendon reflexes were normal. Assessment/Results: Laboratory tests were normal. Magnetic resonance imaging (MRI) showed a large extrusion of the L5-S1 disc accompanied compression of right L5 nerve root. We adminis- tered a treatment consisting of electrotherapy and physical therapy. VAS of pain was decreased to 30 mm after the treatment. Discussion: It should always be kept in mind that sports or positions which are challenging lumbar spine like gymnastics may cause intervertebral disc overloading and may trigger lumbar disc diseases. No. 222 Assessment of Quality of Life, Sleep, and Mood After Step Increase in Analgesic: Prospective Study. Idoya Barca Fernandez; Ana Rodriguez Gonzalez; Rocio Martinez Arribas; Rocio Vacas Mata. Objective: Evaluate how it affects the improvement in pain intensity on quality of life, sleep, and mood. Design: Prospective study. Variation in the quality of life, sleep quality, and mood and their correlation with improved pain control is studied (considering as such the decrease of at least 2 points on the numerical scale of pain intensity) after three months. Location: Primare Care University Hospital, Madrid, Spain. Partici- pants: 15 patients who come to consult with chronic pain (> 6 months) uncontrolled (ENID > 5) with the usual medication .âäV 80%.65 Æ 12.3 years old. 47 % back pain, knee pain 33%, 20% painful shoulder .3 Æ 2.6 years of evolution. Prior analgesic treatment: first analgesic step, 53.3%; patient’s second analgesic step, 46.7 patients. Assessment: Optimizing pharmacologic treatment by raising the patient’s prior analgesic step. Main Outcome Measures: Linear correlation (p < 0.05), changes in the level of pain and quality of life and sleep. Study variables: sex, age, cause of pain, duration of prior analgesic treatment, prescribed treatment score on the numerical scale of pain intensity (ENID) questionnaire on the quality of life (EUROQ 5D), the sleep quality (MOS scale), and mood (Rank Beck). Evidence level: 2. Results: ENID: initial: 8 (1.7) at 3 months: 5.4 (2.7) p < 0.001. EUROQ 5D: initial: 5.5 (2.2) at 3 months: 3.8 (2.9) p < 0.001. MOS: initial: 11.5 (4.2) at 3 months: 9 (4.8) p < 0.001. Beck: initial 10.5 (5.6) at 3 months: 8.4 (6) p < 0.001. Conclusions: There is a clear association between improvement in pain intensity and quality of life and sleep and mood. In the third step analgesic better control of the quality of life and mood were observed. No. 223 Case Report of Woman With Severe Refractory Thoracolumbar Pain: Evaluation and Treatment. Idoya Barca; Concepcion Cuenca; Adriel Cuevas; Miguel Archanco. Setting: Clínico San Carlos Hospital Rehabilitation Service. Patient: 76- year-old patient with a history of type II diabetes mellitus and hypertension. Osteoporosis diagnosed in 2007 after trauma resulting in right Colles fracture and a domiciliary falling resulting in D10 vertebral compression fractures. Baseline condition: BADL. Risk of a 3 point fracture and a chance of hip and vertebral fracture in the next ten years of 16.4% and 24.7%, respectively. Case Description: Patient comes due to severe thor- acolumbar pain, difficulty walking, inability to perform activities of daily living and personal care. Pre densitometry to: lumbar T-score: -2.7 hip -1.4. Frax index: 8.8%. RX: Acute fracture D9. Assessment: Postural advice and nutritional tips are provided, light aerobic exercise, and resistance exercises. Second step analgesia and PTH regimen. Basic analytic control and bone markers in blood and urine quarterly. Post-treatment densitom- etry: lumbar T-score: -2.4 hip -1.2. Discussion: After treatment states a decrease in pain (VAS of four points) and an improvement in quality of life. Markers of bone remodeling remained increased compared with base- line after 18 months and significantly improved densitometry. Con- clusion: Early diagnosis of osteoporotic vertebral fracture is very important in postmenopausal women because it is associated with increased risk of new fractures, increased morbidity, increased mortality, and impaired quality of life. Markers of bone remodeling help us identify women with risk of fracture and provide additional information to the DMO. No. 224 Vertebral Affectation for Osteoid Osteoma Lumbar Pain With Gait Disturbance. Idoya Barca Fernadez; Concepcion Cuenca Gonzalez; Ana Maria; Herranz Torrubiano; Maria Fernanda Berzal Cantalejo. Location: Hospital Clinic, San Carlos, Madrid, España. Dis- closure: None. Setting: Regional hospital and national reference. First level hospital. Patient: 11-year-old male patient with scoliosis and gait disturbance. Case Description: Patient derived from orthopedic surgery department due to lumbar pain radiates to right iliac crest and left lumbar scoliosis. Case studied in neuropediatrics unit because presyncope and gait disturbance. Physical examination: asthenic habit. Pain in apophysis of L4- L5 vertebrae with tenderness at the right paravertebral muscles and increase volume of right square muscle. Slope shoulder and right scapula (>left) asymmetry, waist (left>right) pelvic imbalanced due to flexed left knee. Adams test: left lumbar hump (irreducible with slight bending test) and slight rib hump. Significant gait disturbance with clockwise rotational component of the pelvis and left leg in flexion and internal rotation. Upper limb hypermobility, femoropopliteal angle about 130 degress bilateral. Finger-ground distance 30 cm. Teleradiography column: deviation right thoracic angle of 27 o Cobb (T1-T6), deviation left lumbar angle of 30 o Cobb (L1-L5). Risser 0. Results: Thoracolumbar TC presented an 8 mm lytic lesion in right pars interarticularis of L4 vertebra with sclerosis around the same suggestive with osteoid osteoma. Discussion: After clinical session with the orthopedic surgery department treatment with per- cutaneous electrocoagulation radiofrequency was undertaken to complete destruction of the nidus and orthotic treatment with Boston brace. Conclusions: Scoliosis is asymptomatic in children and adolescents. If the pain is present in spine, there is a significant gait disturbance, rigidity, and low reducibility of the deviation of spinal curves in the exploration we should carry out complementary diagnostic test to search secondary causes. PM&R Vol. 6, Iss. 8S2, 2014 S137