low back pain for evaluation and treatment. She had alsobeen evaluated by her internist, neuro-ophthalmologist, oto-laryngologist and another pain physician. Previous work-upincluded computed tomography (CT) of the chest done inDecember 2007 and magnetic resonance imaging (MRI) ofher brain in May 2008, which were both negative. She wasdiagnosed with trigeminal neuralgia and optic migraines andwas started on gabapentin. On presentation to the rehabili-tation clinic in December 2008, she complained of ongoingright facial pain and headache in addition to non-radiatinglow back pain. A thorough history and examination revealednormal reflexes, strength and hip range of motion. Straightleg raising test was negative and lumbar tenderness was notassessed per the patient’s request. There was right-sidedptosis, tenderness over the right temporal artery and fullnessof the right eyelid with eye erythema, facial flushing, but nomiosis. Blood work, MRI of the lumbo-sacral (L-S) spine anda CT scan of the chest were ordered.Setting: Outpatient rehabilitation clinic.Results: Blood work was normal. MRI of the L-S spineshowed a lesion in the left sacrum suspicious for metastasis inaddition to severe stenosis. CT of the chest revealed a newright hilar mass suspicious for metastasis and several noncal-cified nodular densities in the lungs bilaterally.Discussion: We propose that this patient had a Pancoasttumor on the right that was compressing the sympatheticchain thus causing her symptomatology. She was referredback to her internist and oncologist for further work-up.Conclusions: The most common factor producing thepreganglionic Horner’s syndrome is malignant tumors. It isimportant to keep this diagnosis in mind when evaluating apatient with a history of cancer who presents with headachesand facial pain.Keywords: Rehabilitation, Horner’s syndrome, Pancoasttumor, Trigeminal neuralgia.

Poster 21

Challenges in Rehabilitation of PathologicFractures Secondary to Multiple Myeloma: ACase Series.David Cheng, MD (New York Presbyterian Hospi-tal: The University Hospital of Columbia and Cor-nell, New York, NY); Michael W. O'Dell, MD.

Disclosures: D. Cheng, None.Patients or Programs: Patient A: 45-year-old woman,Patient B: 61-year-old man, Patient C: 61-year-old man; withnewly-diagnosed multiple myeloma and pathologic frac-tures.Program Description: Patient A is a 45-year-old womanwith myelomatous disease in axial and appendicular skeletonwho developed hip flexor weakness and pathologic fractureof the right humeral head status post humeral nailing. Painsecondary to disease in clavicles and scapula was controlledwith lidocaine patch, local radiation, and oxycodone. PatientB is a 61-year-old man who presented with renal failure andpathologic left femoral neck fracture status post hip arthro-

plasty. Progress was limited by lethargy that improved afterhemodialysis. He developed nausea with chemotherapy,which was relieved with intravenous ondansetron. Patient Cis a 61-year-old man who presented with confusion fromhypercalcemia and L2-L3 compression fractures for which hedeclined kyphoplasty. His back pain and fatigue impeded fullparticipation in therapy despite lidocaine and fentanylpatches, oral opioids, and intravenous hydromorphone. Herequired scheduled ondansetron for nausea.Setting: Tertiary care hospital.Results: Patient A was hospitalized for 9 days with a Func-tional Independence Measure score (FIM) gain from 100 to106 and discharged to home alone with nursing, home healthaide (HHA), and therapies. Patient B was hospitalized for 28days (FIM score 61 -� 84) and discharged to orthopedicservice for incisional drainage before going home with ser-vices. Patient C was hospitalized for 15 days (FIM score 78-� 95) and discharged home with family with nursing, HHA,and therapies.Discussion: These 3 cases demonstrate the impact of MMcomplications and comorbidities on functional recovery.Conclusions: Pain, nausea, and fatigue are potential bar-riers to rehabilitation in multiple myeloma-associated frac-tures. Addressing these impairments early and effectivelymay improve outcome.Keywords: Rehabilitation, Fracture, Multiple myeloma.

Poster 22

Fentanyl Buccal Soluble Film (FBSF)Demonstrates Dose-Proportional FentanylExposure and Favorable Efficacy andTolerability in the Management ofBreakthrough Pain in Opioid Tolerant CancerPatients.Neal Slatkin, MD (City of Hope-Beckman Re-search Center, Arcadia, CA); Andrew Finn,PharmD; Larry Gever, PharmD; Niraj Vasisht, PhD.

Disclosures: N. Slatkin, MEDA, Consulting fees or otherremuneration; Cephalon, Speakers bureauObjective: To evaluate the pharmacokinetics for fentanylacross a range of fentanyl buccal soluble film (FBSF) doses(FEN-110) and to evaluate the efficacy and safety of FBSF inthe management of cancer breakthrough pain (BTP) (FEN-201).Design: Open-label, 3-period crossover study (FEN-110)and a phase 3 double-blind, multiple crossover study (FEN-201)Setting: FEN-110 was conducted in a phase I unit. FEN-201 was conducted at various institutions on an outpatientbasis.Participants: FEN-110 enrolled 12 healthy volunteers.Participants in FEN-201 were patients with cancer on stableopioid doses who achieved adequate control of BTP withFBSF (200 1200 �g) in an open label titration phase.Interventions: In FEN-110, participants received singledoses of FBSF (200, 600, 1200 �g) 72 hours apart. In

S112 POSTER PRESENTATIONS