Palliative care is the active, total care of patients whose disease is not responsive to curative treatments. The term “palliative care” refers to those aspects of medical care concerned with the physical, psychosocial and spiritual issues faced by persons with cancer, their families, their communities, and their healthcare providers. At its core, palliative care is concerned with providing the maximum quality of life to the patient/family unit. This growing area of medicine is often practiced in inpatients units, with a transitional approach that involves sending some patients home with home hospice care. This is a very patient-centered, multidisciplinary method of caring for dying patient.

Spinal pain is a very common disorder in the clinical practice and an important cause of man-power loss. Radiological investigations are commonly used to identify the underlying pathology of spinal pain. Along with the technological advancements, the radiological techniques have improved a lot during the last few decades. This review explains the use, advantages and restrictions of direct roentgenogram, myelograpy applications, computed tomography, magnetic resonance imaging, discography and spinal angiography which are commonly used radiological techniques in the diagnosis and follow-up of spinal pain conditions. Better understanding of the indications, advantages and disadvantages of such radiological techniques by the clinicians will improve the clinical output while optimizing the problems such as x-ray exposure and economical burden.

Trigeminal neuralgia is a painful condition of the face characterized by paroxysmal lancinating, shock-like pain confined to the somatosensory distribution of the trigeminal nerve. The etiology of most cases of tigeminal neuralgia has been suggested to be vascular compression of the central axons of the trigeminal nevre at the level of pontocerebellar region, so called hyperactive disfunctional syndrome. Trigeminal neuralgia is the one of the most known pain syndromes. Several neurosurgical procedures have been developed for the treatment of idiopathic trigeminal neuralgia and in this review, idiopathic trigeminal neuralgia was discussed in aspect of different surgical modalities.

Interlaminary epidural steroid injections have been used in pain management for many years. However, either incomplete clinical recoveries or increase of anatomical knowledge and experience lead to investigation of different techniques. Transforaminal approach has lead to rather favourable results, but it has also the risk of severe complications especially when used in the cervical area. So, investigators have started to search for how to decrease these complications and even started to investigate for more safe techniques. In this review, transforaminal epidural steroid injection techniques and their complications are examined.

Epidural fibrosis and adhesions can have many causes. Postsurgical bleeding and the healing process frequently produce scarring. The associated irritation or inducement of epidural venous engorgement may contribute to pain production. Lysis of epidural adhesions could be performed after rest, drug therapies such as NSAID and muscle relaxants, physical therapy with activity programs and epidural steroid injections.

Pain treatment of patients with opioid addiction and tolerance may be challenging due to their unexpectedly higher pain sensitivities and opioid requirements. It has been reported that the N-methyl-D-aspartate receptor is involved in mechanisms of tolerance to opioid analgesics. Recently enhancement of morphine induced analgesia by low dose ketamine addition to the treatment regimen has been reported. We report a cancer patient with meperidine tolerance and psychological dependency to the agent who was afterwards successfully treated with morphine-ketamine combination.

Suprascapular nerve blockade can be performed in chronic shoulder pain secondary to rotator cuff lesions, shoulder joint osteoarthritis, and adhesive capsulitis. Local anesthetics and steroids are commonly combined for the blockade. In this report, we present pulsed mode radiofrequency lesioning of suprascapular nerve for persistent shoulder pain in 8 patients. 8 patients with no response to six weeks physical or medical treatment were hospitalized in our Algology Clinic for suprascapular nerve pulsed mode radiofrequency lesioning. All blocks were performed in sitting position with a 22-Gauge, 100 mm “SMK” needle with 5 mm active tip and “Radionics” radiofrequency generator. Sensory stimulation at 50 Hz, 0.2 millisecond pulse width was performed and paresthesias in the shoulder joint occurred at 0.3 V. Motor stimulation at 2 Hz, 0.2 millisecond pulse width showed the contractions of the infraspinatus and supraspinatus muscles occurred at 0.4-0.5 V. Pulsed mode radiofrequency lesioning was then carried out two times for 120 seconds at 2 Hz frequency and pulse width of 20 milliseconds at 42 °C. Patients were evaluated for pain scores and shoulder joint movements at 1, 2, 4, 8, and 12 weeks after the procedure. Pulsed mode radiofrequency lesioning of suprascapular nerve block provided pain control for at least twelve weeks and improved shoulder joint movements.

Lumbar puncture or identification of the epidural space is technically more difficult in children. Prior obtained information regarding the distance from skin to the dura mater may be useful as leading to an increase in success. We studied the anatomy of the posterior lumbar spine at the L4-5 intervertebral space in 137 children, using ultrasonography. Children aged between 7 and 12 years in whom weight and height are in 3-97 percentiles (recommended for healthy Turkish boys and girls) were investigated. The measured distance from skin to dura mater was found significantly higher in girls (2.59 ± 0.44 cm) than boys (2.43 ± 0.46 cm) (p<0.05). Prediction of the posterior dural depth at L4-5 level was obtained using single linear regression equation. All demographic variables correlated significantly with the dural depth in both sexes. In girls the skin-duramater distance achieved highest correlation ranks with weight and body surface area (BSA): ‘dural depth’ (cm) = 1.094 + [0.048 x weight (kg)], r = 0.79, p<0.01 and ‘dural depth’ (cm) = 0.337 + [2.119 x BSA (m2)], r = 0.76, p<0.01). We concluded that the distance between the skin and the dura mater at the level of L4-5 interspace could be predicted using a statistical model based on the age, weight, height or BSA of children aged between 7-12 years old.