Nöropatik aðrý periferal nosioseptörlerin uyarýmý olmaksýzýn santral veya çevresel sinir sisteminin yapýsal lezyonlarý ve fonksiyon bozukluðuna baðlý olarak geliþir. Nöropatik aðrýnýn hayat kalitesi üzerine büyük bir etkisi vardýr. Hastalarýn çoðu ýlýmlý ve ciddi kronik aðrý nedeniyle baðýmsýz hayatlarýný sürdüremezler ve sýklýkla depresyon hastalýðý aðýrlaþtýrýr. Ýnme, multipl sklerozis ve sirengomyeli gibi sýk rastlanan sebepler nöropatik aðrýya yol açabilmektedir. Nöropatik aðrý farklý moleküler yollarý içeren kompleks bir hastalýktýr. Son yýllarda yapýlan birçok deneysel ve klinik çalýþma bu taný ve tedavisi zor olan hastalýk grubuna yaklaþýmýmýzý kolaylaþtýrmasýna raðmen, nöropatik aðrý tedavisi halen zorluklar göstermektedir. Biz bu derlememizde nöropatik aðrý temelinde yatan mekanizma, taný ve farklý mekanizmalar üzerine kurulu tedavi yaklaþýmlarýný özetledik.

Neuropathic pain is caused by functional abnormalities of structural lesions or dysfunction in the peripheral or central nervous system, and occurs without peripheral nociceptor stimulation. Neuropathic pain has a great impact on the quality of life. Majority of the patients are unable to maintain an independent lifestyle due to their moderate to severe chronic pain and often depression contributes to the illness. Many common diseases, such as stroke, multiple sclerosis and syringomyelia may produce neuropathic pain. Neuropathic pain is a complex disease, involving several molecular pathways. Neuropathic pain treatment is stil extremely difficult despite our knowledge about this difficult to diagnose and treat pain condition has improved a lot with the aid of recent experimental and clinical studies. This review summarizes the underlying mechanisms, diagnosis and treatment approaches based on different mechanisms of effect.

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Radyocerrahi, kafa içindeki küçük hacimli hedeflerin tek dozda yüksek radyasyonla etkilenmesi iþlemidir. Aðrý tedavisinde Gamma Knife radyocerrahisi çok uzun yýllardýr kullanýlmaktadýr. Radyocerrahi tekniðinin ilk kullanýldýðý olgular trigeminal nevralji hastalarýdýr. 1968’de Gamma Knife cihazýnýn kullanýma girmesi ile öncelikle kansere baðlý aðrýsý olan hastalarda talamotomi uygulanmýþtýr. Ýlerleyen yýllarda baþka aðrýlý durumlarda da kullanýlýr olmuþtur. Günümüzde en çok trigeminal nevralji tedavisinde kullanýlmaktadýr.

Radiosurgery is to irradiate the small volume targets inside of the cranium with high dose radiation in a single session. Gamma knife radiosurgery has been in use for treatment of pain many years. The first cases which have been treated with radiosurgery technique were trigeminal neuralgia patients. After the first installment of gamma knife in 1968, it has been used for thalamotomy in cancer pain. Nowadays the main indication for gamma knife radiosurgery for pain is trigeminal neuralgia.

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Araþtýrma, çocuk kliniklerinde çalýþan hekim ve hemþirelerin yenidoðanlarda aðrýyý fark edebilme, deðerlendirebilme ve tedavi etmede uygun nonfarmakolojik giriþimleri kullanma durumlarýný belirlemek amacýyla tanýmlayýcý olarak yapýldý.
Çalýþma Mart-Mayýs 2005 tarihleri arasýnda uygulandý. Çalýþmadaki toplam 198 örneklemin 31’ini Sivas 1. Ýzzettin Keykavus Devlet hastanesi, 76’sýný Akdeniz Üniversitesi Týp Fakültesi hastanesi, 45’ini Mersin Üniversitesi Týp Fakültesi Araþtýrma hastanesi, Mersin Devlet ve Toros Devlet Hastanesi ve 46’sýný Ege Üniversitesi Týp Fakültesi hastanesinde çalýþan çocuk hekim ve hemþireleri oluþturdu. Veriler, 16 sorudan oluþan anket formu aracýlýðýyla toplandý. Anket formundaki sorularýn 5’i hekim ve hemþirelerin sosyodemoðrafik özelliklerini, 11’i ise hekim ve hemþirelerin yenidoðanlarda aðrý konusundaki bilgilerini içermektedir. Araþtýrma sonucunda, hekim ve hemþirelerin yenidoðanlarda aðrý konusunda bilgili olduklarý saptanmýþtýr. Çocuk hemþirelerinin yenidoðanlarda invaziv iþlemler sýrasýnda nonfarmakolojik yöntemleri kullandýðý, hekimlerin ise kullanmadýðý belirlenmiþtir.
Sonuç olarak, yenidoðanlarda aðrýnýn multidisipliner ekip yaklaþýmlarýyla kontrol altýna alýnmasý için hekim ve hemþirelerin yenidoðanlarda uygulayacaklarý invazif iþlemler sýrasýnda nonfarmakolojik yöntemleri kullanmalarýný teþvik etmek amacýyla hastanelerde hizmet içi eðitim proðramlarýnda bu konuya daha fazla deðinilmesi önerilmektedir.

This research was conducted as a descriptive study for the purpose of determining the status of pediatricians and nurses who work on pediatric wards about their recognizing, evaluating, and using appropriate nonpharmacologic interventions to treat pain in newborn infants.
The study was conducted between March and May 2005. A total of 198 nurses and physicians were included in the sample, 31 of whom were from Sivas 1st Ýzzettin Keykavus State Hospital, 76 from Akdeniz University Medical Faculty Hospital, 45 from Mersin University Medical Faculty Research, Mersin State and Taurus State Hospitals and 46 from Ege University Medical Faculty Hospital. The data were collected using a 16-question survey form. Five of the survey questions were regarding the nurses' and physicians' sociodemographic characteristics and 11 contained questions directed at obtaining physicians and nurses' information about pain in newborns. The results of the research showed that the physicians and nurses were knowledgeable about newborn pain. It was determined that the pediatric nurses used nonpharmacologic methods during invasive procedures in the newborns but the physicians did not.
In conclusion it is recommended that this issue receive more discussion in continuing education programs at hospitals for the purpose of encouraging nurses and physicians to use nonpharmacologic methods during invasive procedures that are done in newborns to facilitate a multidisciplinary team approach for pain management in newborn infants.

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Genel anesteziden sonra baþlanan magnezyum sülfat infüzyonu analjezik gereksinimini azaltmaktadýr. Bu çalýþmada, brakiyal pleksus blokajýndan sonra postoperatif ilk 24 saat uygulanan magnezyum sülfat infüzyonunun blok süresi, sedasyon ve postoperatif analjezik tüketimine etkilerinin araþtýrýlmasý amaçlandý. Yerel Etik Kurul onayý alýnarak ASA I ve II sýnýfý 70 hasta çift kör, randomize çalýþmaya alýndý. Brakiyal pleksus blokajý aksiller yaklaþýmla lidokainin 40 ml %1.25 1/200000 adrenalinli solüsyonu kullanýlarak gerçekleþtirildi. Hastalara 24 saat sürede eþit volümde 5 mg.kg–1 bolus ve 500 mg.saat–1 magnezyum sülfat veya serum uygulandý. Ýlk 24 saatlik sürede gruplarýn ilk aðrý duyumu, motor bloðun kalkma süresi ve analjezik gereksinimi yanýnda 4 saatte bir alýnan sedasyon ve vizüel analog skorlarý deðerlendirildi. Ýlk aðrý duyumu ve ilk analjezik kullanýmý belirgin oranda artmakla birlikte magnezyum infüzyon grubunda toplam analjezik tüketiminde belirgin düzeyde azalma saptandý (Dolantin: K: 36.3 ± 42.6 mg, Mg: 11.7 ± 12.2 mg, p: 0.001). Ayný zamanda vizüel analog skorlarýn tüm peryotlarda azaldýðý gözlendi. Motor blok gerileme ve sedasyon skorlarý arasýnda fark bulunamadý. Magnezyum sülfat infüzyonunun, brakiyal pleksus blokajý uygulanan hastalar için analjezik tüketimini ve olasý yan etkilerini günlük aktiviteleri etkilemeksizin azaltmada güvenli bir ilaç olduðu kanýsýna varýldý.

Magnesium sulphate infusion decreases analgesic requirements after general anaesthesia. Aim of this study was to assess the effects of postoperative magnesium infusion for 24 hours on duration of the block, sedation and postoperative analgesic consumption after brachial plexus block. After obtaining approval from local ethic committee, 70 ASA class I and II patients were included to the randomised double blind study. Brachial plexus block was performed using axillary approach with lignocaine 1.25 % adrenaline 1/200 000 40 ml. Groups received 5 mg.kg –1 bolus and 500 mg.h–1 magnesium sulphate infusion or saline controls at the same volume during 24 hour. Analgesia and sedation were assessed while determining time to first pain and rescue analgesic, time to regain motor capability, visual analogue scale and sedation scores for every 4 hour during postoperative 24 h. period. While time to first pain and rescue analgesic was increased, total analgesic consumption was reduced significantly on magnesium infusion group (Meperidine: C: 36.3 ± 42.6 mg, Mg: 11.7 ± 12.2 mg, p: 0.001). Visual analogue scales were also observed to be lower in all periods. Time to motor block resolution, and sedation scores were similar. Magnesium sulphate infusion is thought as a safe and suitable adjunct for reducing analgesic consumption and possible complications without interfering daily activity in patients undergoing brachial plexus block.

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Bu çalýþmada, elektif açýk kolesistektomi cerrahisinde, preoperatif tek doz 900 ve 1200 mg gabapentin dozunun, postoperatif aðrý ve tramadol tüketimi üzerine olan etkisi araþtýrýlmýþtýr. Elektif açýk kolesistektomi yapýlacak ASA I-II grubundan 45 hasta rastgele 3 gruba ayrýldý. I.gruptaki hastalar kontrol grubu kabul edilirken II ve III.gruptaki hastalara operasyondan 1 saat önce sýrasýyla 900mg veya 1200mg gabapentin verildi. Ameliyatýn sonunda tüm hastalara hasta kontrollü analjezi (HKA) cihazý ile iv-tramadol verildi. Postoperatif aðrý uyanma odasýnda (0),1,2,3,4,6,8,12 ve 24. saatlerde VAS skalasý ile istirahatte ve harekette deðerlendirildi. Total tramadol tüketimi, ilave meperidin ihtiyacý, yan etkiler ve hasta memnuniyeti kaydedildi. III.gruptaki hastalarýn uyanma odasý VAS istirahat skorlarýnda I ve II.gruba göre 3 kat (1,4±0.6’ya karþýn 4,9±1.0 ve 4.4±1.1), VAS hareket skorlarýnda ise 2 kat (3.4±1.0’e karþýn 6.8±1.8 ve 6.1±1.6) azalma tesbit edildi. Ortalama yükleme dozu III.grupta (28.3 ±8.7) I. (66.6±20.4) ve II. (61.6±20.8) gruba göre belirgin olarak azdý. VAS istirahat skorlarý ilk 6 saat, VAS hareket skorlarý ise ilk 8 saat III.grupta, I. ve II.gruba göre belirgin olarak düþüktü. Total tramadol tüketimi III.grupta (240.4±31.0), I. (456.0±35.5) ve II. (438.7±35.0) gruba göre daha düþüktü. III.grupta hiçbir hastada ilave meperidin ihtiyacý olmazken, I ve II.gruptan 2’þer hastada gerekli oldu. III.grupta daha yüksek hasta memnuniyet skorlarý elde edildi. Yan etki sýklýðý I ve II.grupta III. gruba göre daha fazlaydý. Sonuç olarak, açýk kolesistektomi sonrasý analjezi kalitesini arttýrmak üzere kullanýlacak preoperatif tek doz oral gabapentinin en az 1200 mg dozunda kullanýlmasý gerektiði kanaatine varýldý.

In this study, the effects of preoperative 900 and 1200mg single dose of gabapentin on postoperative pain relief and tramadol consumption in elective open cholecystectomies were investigated. Fourtyfive ASAI-II patients were randomly divided into three groups. GroupI was control group and patients in groupII and III received 900mg or 1200mg gabapentin 1 hour before the operations respectively. All patients received intravenous tramadol at the end of surgery via a PCA device. Pain scores were evaluated at the recovery room(0),1,2,3,4,6,8,12 and 24h postoperatively at rest and movement, using a 10cm VAS. In the recovery room, VAS scores at rest were three times less (1,4±0.6 versus 4,9±1.0 and 4.4±1.1), and VAS scores at movement were two times less (3.4±1.0 versus 6.8±1.8 ve 6.1±1.6) in groupIII when compared to groupI and II respectively. Mean loading doses were significantly lower in groupIII (28.3±8.7) than groupI (66.6±20.4) and II (61.6±20.8). VAS scores at rest during the postoperative first 6h and at movement during the postoperative first 8h were significantly lower in groupIII than groupI and II. Total tramadol consumption was lower in groupIII (240.4±31.0), than groupI (456.0±35.5) and groupII (438.7±35.0). Additional meperidine was necessary for two patients both in groupsI and II, although none of the patients needed in groupIII. Higher patient satisfaction scores were obtained in group III. Adverse effect incidences were higher in groupI and II than in groupIII. As a result, we believe that to improve analgesic quality after open cholecystectomy, preoperative single dose of gabapentin should at least be 1200 mg.

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Topikal anestezi altýnda katarakt cerrahisi sýrasýnda intravenöz hasta-kontrollü analjezide remifentanil ve fentanilin kullanýmý
Amaç; topikal anestezi altýnda fakoemülsifikasyon yöntemi ile gerçekleþtirilen katarakt cerrahisi sýrasýnda fentanil veya remifentanilin hasta kontrollü sedoanaljezideki etkinliðini araþtýrmaktý.
Prospektif, randomize, çift kör çalýþma için etik komite izni alýndý. Katarakt cerrahi geçirecek ASA I-III 120 olgu randomize 3 gruba ayrýldý. Fentanil 0.7 μg/kg yükleme dozu sonrasý, 10 μg bolus dozda 5 dakika kilitli kalma süresi, remifentanil 0,3 μg/kg yükleme, 20 μg bolus ve 3 dakika kilitli kalma süresi ayarlanarak hasta kontrollü analjezi (HKA) cihazý ile verildi. Kontrol grubunda serum fizyolojik herhangi bir ilaç katýlmadan verildi. Kardiyorespiratuvar sistem bulgularý, sözel aðrý skoru ve sedasyon skorlarý preoperatif, intraoperatif 5., 10., 15., 20. ve 30. dakikalarda kaydedildi. Cerrahi sýrasýndaki rahatsýzlýk, HKA cihazýna basma ve komplikasyonlar kaydedildi.
Ýlaç verilen gruplarda sözel aðrý skala sonuçlarý, 15. dakikada kontrol grubundakinden daha düþüktü. Sedasyon skoru; remifentanil grubunda 5. dakikada (p=0.019), fentanil grubunda ise 10. dakikada (p=0.007) kontrol grubundan anlamlý olarak daha yüksekti. Hasta kontrollü analjezi cihazýna basan hasta sayýsý kontrol grubunda, ilaç verilen gruplardan anlamlý fazla idi (p<0.05). Hasta konforu ve cerrah memnuniyeti ilaç verilen gruplarda daha yüksekti (p<0.05)
Topikal anesteziye eklenen ÝV hasta kontollü sedo/analjezinin hasta konforu, cerrah memnuniyeti ve sedoanaljezi için avantaj saðladýðý sonucuna varýldý. Hasta kontrollü analjezi özellikle operasyonun baþlangýcýnda anksiyetenin varlýðýnda, healon/lens yerleþtirilmesi sýrasýnda uygun ve emniyetli bir yöntemdir.

Aim was to investigate the effects of patient-controlled sedo/analgesia with fentanyl or remifentanil during cataract surgery with phacoemulsification method under topical anaesthesia.
The Ethical committee has approved the prospective, randomized, double-blind study. ASA I-III, 120 patients underwent cataract surgery were randomly allocated to 3 groups. Fentanyl was administered in 0.7 μg/kg loading, 10 μg bolus dose with 5 minutes lockout time, remifentanil was administered 0,3 μg/kg loading, 20 μg bolus dose with 3 minutes lockout time by PCA equipment. In the control group, saline solution was given without any analgesic drug. Cardiorespiratory system findings, verbal pain scale and sedation scores were recorded preoperatively and intraoperatively at the 5th, 10th, 15th, 20th and 30th minutes. Discomfort during surgery, pressing the PCA button, and complications were observed.
The Verbal pain scale score was significantly lower in the drug groups than the control group at the 15th minute. The sedation score was significantly higher in the remifentanil group at the 5th minute (p=0,019) and in the fentanyl group at the 10th minute (p=0,007) than the control group. The number of patients pressing the PCA button was much higher in the control group than the drug groups (p<0.05). Patient comfort and surgeon satisfaction were higher in the drug groups (p<0,05).
Patient-CA is a convenient and safe method, especially at the beginning of the operation when anxiety is intense, and during healon/lens implantation. Intravenous-PC sedo/analgesia addition to topical anaesthesia provides an advantage in sedo/analgesia, patient comfort, and surgeon satisfaction.

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EEGbiyofeedback (Nörofeedback-NFB), kiþilerin beyin dalgalarýný deðiþtirebilmelerini saðlayan bir öðrenme stratejisidir. Bu olgu sunumunda, Fibromyalji Sendromu (FMS) bulunan üç hastaya NFB protokolü uyguladýk. Vizüel Analog Skala ile aðrý deðerlendirmesi, yorgunluk, Hamilton Depresyon ve Anksiyete Çizelgesi Ölçeði, Back Depresyon ve Anksiyete Çizelgesi Ölçeði ve SF-36 kayýtlarý, NFB uygulamasý öncesinde ve sonrasýnda deðerlendirildi. On seans sonunda semptomlarýn çoðu azaldý. Ölçeklerin tümünde tedavi sonrasý ilerleme kaydedildi. Bu çalýþmanýn sonuçlarý, NFB uygulamasýna FMS tedavisinde yeni bir metot olabileceðini düþündürmektedir.

EEG Biofeedback (Neurofeedback-NFB) is a learning strategy that enables people to alter their brainwaves. In the present case study, we applied a NFB protocol on three patients with Fibromyalgia Syndrome (FMS). The existing symptoms and clinical conditions of the patients attributed to FMS, Visual Analog Scale for pain and fatigue, Hamilton Depression and Anxiety Inventory Scales, Beck Depression and Anxiety Inventory Scales, and SF-36 were recorded before and after NFB training. Most of the symptoms were decreased after ten sessions. There was also improvement in all of the scales after the treatment. The results of the present study may suggest NFB training as a novel treatment method in FMS.

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Siringomyeli yavaþ progresyon ile karakterizedir; en sýk etkilenen eklemler omuz ve dirseklerdir. Elde nöropatik artropati oldukça nadirdir. Bu yazýda siringomyeliye sekonder nöropatik artropatisi (NA) bulunan bir olguyu sunmaktayýz. Bu vakanýn atipik özellikleri, ayný üst ekstremitede omuz, dirsek ve metakarpofalengeal eklemlerde NA
varlýðýdýr. Bu atipik özellikler omuz subluksasyonu ve elektrofizyolojik çalýþma ile ortaya konan brakiyal pleksopatinin üzerine eklenmiþtir. Bizim bilgimize göre bu çalýþma, yukarýda belirtilen semptomlarýn hepsine sahip bir hastayý sunan ilk çalýþmadýr.

Syringomyelia is characterized by slow progression; the joints involved most frequently are the shoulders and elbows. Neuropathic arthropathy of the hand is quite rare. Herewith, we present a case of neuropathic arthropathy (NA) of the joints in the upper limb secondary to Syringomyelia. Atypical features of the case included NA of the shoulder, elbow and metacarpophalengeal joint in the same upper limb. These atypical features superimposed shoulder subluxation and brachial plexopathy which diagnosed by electrophysiologic studies. To the best of our knowledge, our study is the first of its kind that reports a patient who had all the abovementioned symptoms in the same upper limb.

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