Amaç: Kendi kendine bildirilen bel aðrýsý ve alt ekstremite özürlülüðü arasýndaki iliþkinin yaný sýra boyun aðrýsý ve üst ekstremite özürlülüðü arasýndaki iliþkinin incelenmesi.
Gereç ve Yöntem: 126 saðlýk çalýþaný bu kesitsel çalýþmaya dahil edildi. Boyun ve bel aðrýsý varlýðý Ýskandinav Kas Ýskelet Sistemi Anketi kullanýlarak belirlendi. Boyun ve bel aðrýsý/özürlülüðü sýrasýyla Boyun Aðrýsý ve Özürlülük Ölçeði (BAÖÖ) ve Oswestry Dizabilite Ýndeksi (ODÝ) ile deðerlendirildi. Üst ve alt ekstremite özürlülüðü sýrasýyla Hýzlý - Kol, Omuz ve El Sorunlar Anketi (Quick-DASH) ve Western Ontario ve McMaster Osteoartrit Ýndeksi (WOMAC) ile deðerlendirildi.
Bulgular: Bel aðrýsý olduðunu bildiriren katýlýmcýlarýn alt ekstremitelerdeki kas iskelet sistemi þikayetleri daha fazlaydý (p<0.001) ve boyun aðrýsý olduðunu bildiren katýlýmcýlarda da benzer þekilde üst ekstremitelerde daha fazla kas iskelet sistemi þikayetleri bildirildi (p<0.001). Son 12 ay boyunca ve son 7 gün içinde bel aðrýsý olduðunu bildiren katýlýmcýlarýn ODI ve WOMAC skorlarý arasýnda anlamlý bir korelasyon vardý (sýrasýyla, ρ=0.674, p<0.001 ve ρ=0.510, p<0.001). Son 12 ay boyunca ve son 7 gün içinde boyun aðrýsý olduðunu bildirin katýlýmcýlarda BAÖÖ ve Quick-DASH arasýnda anlamlý bir korelasyon bulundu (sýrasýyla, ρ=0.659, p<0.001 ve ρ=0.734, p<0.001).
Sonuç: Daha þiddetli bel aðrýsý bildiren bireylerde alt ekstremite özürlülüðü de daha yüksek düzeyde bildirdirilmekteydi. Bu iliþki ayný zamanda boyun aðrýsý ve üst ekstremite özürlülüðü arasýnda da bulunmaktaydý.

Objectives: To investigate the association between self-reported low back pain (LBP) and lower limb disability as well as the association between neck pain and upper limb disability.
Methods: A hundred twenty-six participants registered as a healthcare staff member were included in this cross-sectional study. The presence of neck and LBP were determined using the Nordic Musculoskeletal Questionnaire. Neck and LBP/disability were measured with the Neck Pain and Disability Scale (NPDS) and Oswestry Disability Index (ODI), respectively. Upper and lower limb disability were measured with the Quick Disabilities of Arm, Shoulder, and Hand (Quick-DASH) and Western Ontario and McMaster Osteoarthritis Index (WOMAC), respectively.
Results: Participants reporting LBP had more musculoskeletal complaints in the lower limbs (p<0.001) and similarly participants reporting neck pain also reported more musculoskeletal complaints in the upper limbs (p<0.001). There was a correlation between the ODI and WOMAC in the participant reporting LBP during the 12 months (ρ=0.510, p<0.001) and during the last 7 days (ρ=0.674, p<0.001). The NPAD was correlated with the Quick-DASH in the participants reporting neck pain during the last 12 months (ρ=0.659, p<0.001) and the last 7 days (ρ=0.734, p<0.001).
Conclusion: People reporting more severe LBP also reported high levels of lower limb disability. This association was also existing between the neck pain and upper limb disability.

Abstract | Full Text PDF

Amaç: Çalýþmanýn amacý iki farklý kuru iðneleme yönteminin (derin kuru iðneleme ve peppering) miyofasial aðrý sendromunda (MAS) karþýlaþtýrýlmasý.
Gereç ve Yöntem: Hastanemize baþvuran MAS tanýsý alan 72 hasta, rasgele derin kuru iðneleme ve peppering olmak üzere iki gruba ayrýldý. Tüm hastalar 4 kez deðerlendirildi; tedaviden önce ve tedavide uygulamasýndan sonraki 1.–5. ve 12. haftalarda. Her deðerlendirmede hastalara Vizüel Analog Skala, Nottingham Geniþletilmiþ Günlük Yaþam Aktiviteleri Skalasý ve Beck Depresyon Ölçeði uygulandý. Ek olarak hastalar prosedür boyunca aðrý hissi ve yan etki profili açýsýndan takip edildi.
Bulgular: Takip sürecini 26 derin kuru iðneleme ve 28 peppering hastasý tamamladý. Baþlangýca göre bakýldýðýnda her iki grupta da 1.–5. ve 12. hafta kontrollerinde aðrýnýn azaltýlmasý, depresif semptomlarý ve fonksiyonelliðin artýrlmasý açýsýndan fayda saðlandý. Öte yandan gruplararasý analizlerde her iki grup arasýnda anlamlý fark saptanmadý. Her iki grup arasýndaki tek anlamlý farklýlýk uygulama sýrasýnda derin kuru iðneleme grubunda aðrýnýn daha az olmasýydý.
Sonuç: Derin kuru iðneleme de peppering de MAS tedavisinde etkili ve bu etki 12 haftaya kadar devam etmektedir. Ayrýca her iki tekniðin de yan etki profili benzer saptandý. Öte taraftan, derin kuru iðnelemenin daha aðrýsýz bir prosedür olduðu görüldü.

Objectives: To compare the efficacy of two different dry needling (DN) techniques (deep dry needling & peppering) in myofascial pain syndrome (MPS).
Methods: Seventy-two patients, who were diagnosed as MPS at our outpatient clinic were randomly assigned into two groups as deep dry needling (DDN) and peppering. All patients were evaluated four times as: before the treatment and 1–5–12 weeks after the completion of treatment protocol. In each evaluation, Visual analogue scale (VAS), Nottingham extended activities of daily living scale (NEADLS), Beck depression inventory (BDI) scores were recorded. Additionally, all patients were evaluated for the pain felt during the procedure and side effect profile.
Results: Twenty-six patients from DDN group and twenty-eight patients from peppering group accomplished the follow-up period. Both DDN and peppering seem to be effective for relieving pain and depressive symptoms and improving functionality compared to baseline when evaluated on the 1st, 5th and 12th weeks. On the other hand the intergroup analyses showed no significant differences between DDN and peppering groups. The only significant difference between the groups is the lesser pain felt during the procedure in the DDN group.
Conclusion: Both DDN and peppering are effective in MPS and the effects last up to 12 weeks. Also the adverse event profiles of the two techniques are similar. On the other hand, DDN is a painless procedure.

Abstract | Full Text PDF

Amaç: Migren hastalarýnda Revize Hastalýk Algýsý Ölçeðinin (IPQ) geçerliðini araþtýrmak ve deprem gibi aðýr bir yaþam olayýnýn hastalýk algýsý üzerine etkisini araþtýrmak amaçlandý.
Gereç ve Yöntem: Çalýþmaya deprem sýrasýnda Erciþ’te bulunan (n=33) ve deprem tecrübesi hiç yaþamamýþ (n=29) toplam 62 migren tanýlý hasta alýndý. Hastalara görüþme formu, IPQ ve Beck Depresyon Ölçeði (BDÖ) uygulandý. Çalýþmaya alýnan hastalarýn yaþ ortalamasý 31 ve ortalama 7.8 yýldýr migren tanýlarý vardý. Deprem tecrübesi olan (Grup 1) ve olmayan (Grup 2) grup arasýnda yaþ, cinsiyet, medeni durum, eðitim süresi, taný süresi ve atak sýklýðý açýsýndan fark yoktu (p>0.05).
Bulgular: IPQ hastalýk belirtileri, hastalýk hakkýnda görüþler ve olasý nedenler olmak üzere 3 kýsýmdan oluþur. Hastalýk belirtileri kýsmýnda migren hastalarýnda en sýk yaþanan belirtilerin aðrý, baþ aðrýsý ve yorgunluk olduðu görüldü. Hastalýk hakkýnda görüþler ve olasý nedenler için güvenirlik analizinde testin güvenilir olduðu saptandý. Hastalýk hakkýnda görüþler bölümünde incelenen hastalýðý anlayabilme ve süre (döngüsel) alt boyutlarý skorlarý Grup 1’de daha yüksekti (p<0.05). Diðer alt boyutlarý açýsýndan gruplar arasýnda anlamlý farklýlýk saptanmadý (p>0.05). Grup 1’de BDÖ skoru daha yüksekti (z: -2,006, p<0.05). Deprem gibi aðýr bir yaþam olayý depresyon skorunda artýþa sebep olmasýna raðmen IPQ skorlarýnda çok fazla deðiþikliðe neden olmamýþtýr. Grup 1 hastalýðý daha büyük oranda anlamakta ve hastalýðýn döngüsel yapýsýný daha iyi kavramaktadýr. Hastalýðýn süresi, hasta ve ailesine etkisi, hastanýn hastalýk üzerine kontrolü, hastalýða tedavinin etkisi ve emosyonel etki ile ilgili algýlarý her iki grupta aynýydý.
Sonuç: Hastalýk algýsý deprem gibi aðýr bir yaþam olayýndan çok fazla etkilenmemiþtir. IPQ Türk migren hastalarýnda da güvenle kullanýlabilir.

Objectives: The aim of this study was to investigate the reliability of the Revised Illness Perception Questionnaire (IPQ) and to determine the effects of earthquake experience on the perception in migraine patients.
Methods: The sample was composed of 62 outpatients, consisting of with migraine diagnosis who were in Erciþ during earthquake (n=33) and who had never had any earthquake experience (n=29).The interview form, IPQ-R and Beck Depression Scale (BDS) were applied. The study was carried out on migraine patients whose mean age was 31 and who had been diagnosed since 7.8 years. Comparison of groups with earthquake experience (group1) and without experience (group 2) there were no difference in point of demographic findings and disease severity (p>0.05).
Results: In the part concerning the manifestations of the disease, the most frequently manifestations were found pain, headache and fatige. The test was determined to be reliable. Illness coherence and timeline (cyclic) subscale scores (p<0.05) and BDS score (z: -2.006, p<0.05)were significantly higher in group 1. Although an earthquake caused an increase in depression scores did not cause much change in the IPQ-R scores. Group1 understand disease better and realize of the cyclical nature of the disease. Other perception parameters of the disease were same in both groups.
Conclusion: A severe life event such as an earthquake did not much change IPQ-R scores in migraine patients. The results of this study demonstrated that IPQ could be used reliably in the Turkish migraine patients.

Abstract | Full Text PDF

Amaç: Spinal kord stimülasyonu (SKS), baþarýsýz bel cerrahisi sendromu (BBCS), dejeneratif disk hastalýðý, periferal kozalji, nöropatik aðrý, kompleks rejyonel aðrý sendromu (KRAS), periferik vasküler hastalýk, iskemik kalp hastalýðý ve kanser aðrýsý gibi endikasyonlarda kullanýlabilen bir nöromodülasyon yöntemidir.
Gereç ve Yöntem: Bu çalýþma, retrospektif tanýmlayýcý bir araþtýrmadýr. Çalýþmada, Akdeniz Üniversitesi Týp Fakültesi Algoloji Bilim Dalý kliniðinde Þubat 2011–Ocak 2015 tarihleri arasýnda spinal kord stimülasyonu (SKS) uygulanan 62 hastanýn iþlem öncesi ve sonrasýndaki aðrý düzeyleri, analjezik ilaç kullanýmlarý, uyku düzenleri deðerlendirildi, iþlem memnuniyetleri, günlük aktivite deðiþiklikleri ve iþe dönüþ süreleri sorgulandý.
Bulgular: Yapýlan çalýþmada SKS prosedürü uygulanan hastalarýn aðrý seviyelerinin azaldýðýný, buna baðlý uyku düzenleri ve günlük aktivitelerinin iyileþtiði sonucu bulundu.
Sonuç: Sonuç olarak, yapýlan diðer çalýþmalar ve bizim çalýþmamýzýn gösterdikleri doðrultusunda SKS‘nin kronik aðrý palyasyonunda etkili ve güvenilir bir tedavi yöntemi olduðu düþüncesindeyiz.

Objectives: Spinal cord stimulation (SCS) is used for various indications such as Failed Back Surgey Syndrome, peripheral causalgia, neuropathic pain, complex regional pain syndrome, reflex sympathetic dystrophy, peripheral vascular disease, ischemic heart disease and cancer pain.
Methods: This is a retrospective study. 62 patients applied SCS were included in retrospective study from february 2011-january 2015 in Akdeniz University medicine faculty algology department. We asked about patients’ VAS values before and after procedure, analgesic medicine usings, sleep disorders, pleasure after procedure, daily activity improvement and time of going back to work.
Results: We found that decrease on the patients’ pain severity and improvement on quality of sleep and daily activities.
Conclusion: As a result; our study and the other studies show that SCS is reliable and effective procedure on chronic pain management.

Abstract | Full Text PDF

Amaç: Bu çalýþma, migren hastalarýnýn tedavisinde büyük oksipital sinir bloðu (GON) etkinliðini deðerlendirmek amacý ile yapýldý.
Gereç ve Yöntem: Bu çalýþmaya 2014–2015 yýllarý arasýnda migren tanýsý almýþ 28 hasta dahil edildi. GON bloðu iþlemi eksternal oksipital protuberans 2 cm laterali ve 2 cm inferiyoruna 1.5 ml %2 lidokain uygulanarak yapýldý. GON bloðu iþlemi bilateral olarak 1 hafta ara ile 3 kez uygulandý. Hastanýn VAS deðerleri, atak sýklýðý, atak süresi ve analjezik kullaným ihtiyacý iþlem öncesinde deðerlendirildi. Ýþlemden sonra 1. hafta, 1. ay, 3. ayda tekrar bu parametreler deðerlendirildi.
Bulgular: Hastalarýn yaþ ortalamasý 42.21±10.13. VAS skoru iþlem öncesi 9.28±0.72 iken, iþlemden sonra 1. haftada 2.96±2.16, 1. ayda 2.60±1.96, 3. ayda 1.75±1.37 idi. Atak sýklýðýný iþlem öncesi 9.42±4.51 iken, 1. ay 5.42±3.30, 3. ay da 3.57±3.14 olarak deðerlendirdik.
Sonuç: Migren baþaðrýsýnda GON bloðu 1.5 ml %2 lidokain ile güvenilir, basit ve efektif bir tedavi yöntemidir.

Objectives: The aim of this study was to evaluate the efficacy of greater occipital nerve (GON) block in the treatment of migraine patients.
Methods: This study included 28 patients diagnosed with migraine between 2014 and 2015. The GON block procedure was applied by administering 1.5 ml of 2% lidocaine 2 cm lateral and 2 cm inferior to the external occipital protuberance. The patients were evaluated in respect of VAS scores, attack frequency, attack duration and the need for analgesia before the procedure. These parameters were evaluated again at 1 week, 1 month and 3 months after the procedure.
Results: The mean age of the patients was 42.21±10.13 years. The mean VAS score was 9.28±0.72 before the procedure and 2.96±2.16 at 1 week, 2.60±1.96 at 1 month and 1.75±1.37 at 3 months. The frequency of attacks was 9.42±4.51 before the procedure and, 5.42±3.30 at 1 month and 3.57±3.14 at 3 months.
Conclusion: GON block with 1.5 ml of 2% lidocaine is a safe, simple and effective treatment method for migraine headache.

Abstract | Full Text PDF

Leriche sendromu aortada, sýklýkla renal arterlerin distalinde trombotik oklüzyonla karakterize bir hastalýktýr. Bu sendromun klasik semptomlarý; alt ekstremitede egzersizle ortaya çýkan aðrý (klodikasyon), femoral nabýzlarýn palpe edilememesi ve erkek hastalarda impotanstýr. Dolaþým yetersizliðine baðlý klodikasyon ile nörojen kaynaklý klodikasyonun ayýrýcý tanýsý zordur. Ayýrýcý taný yapýlmasýnda anamnez, fizik muayene ve görüntüleme yöntemleri önemli yer tutar. Fizik muayenede bilateral femoral nabýzlarýn palpe edilememesi leriche sendromunu akla getirmelidir. Leriche sendromlu olgularda renkli Doppler ultrasonografi ile, her iki iliyak arterde de akým olmadýðý gösterilebilir. Bu hastalarda bilgisayarlý tomografi anjiyografi ile aortadaki trombotik týkanýklýk doðrulanmalýdýr. Sunduðumuz bu vaka klodikasyon þikayetiyle hastaneye baþvurmuþ ve lomber disk hernisi tanýsý konulmuþ bir Leriche sendorumu vakasýdýr. Ayýrýcý tanýda vasküler patolojiler düþünülmemesi nedeniyle tedavisinde geçikilmiþ ve mortaliteyle sonuçlanmýþ olmasý nedeniyle önem taþýmaktadýr. Bacak aðrýsý þikayetiyle hastaneye baþvuran hastalarda vasküler patolojiler ayýrýcý tanýda düþünülmeli ve klinisyenler tanýya giden yolda öncelikle detaylý anemnez ve kapsamlý bir fizik muayeneye güvenmelidirler.

Leriche syndrome is a disease that is characterized by a thrombotic occlusion in the aorta, frequently in the renal artery distal. The classical symptoms of this syndrome include pain in the lower extremities emerging during activity ( claudication ), impalpability of the femoral pulses and impotency in male patients. The definitive diagnosis of claudication, due to insufficient circulation as well as neurogenic-caused claudication, is hard. Medical history, physical examination and monitoring methods are important for definitive diagnosis. Impalpability of bilateral femoral pulses in physical examination may be a sign of leriche syndrome. With colored doppler ultrasonography, it can be demonstrated in cases having Leriche syndrome that there is no circulation in both iliac arteries. In these patients, thrombotic occlusion of the aorta shall be confirmed by computed tomography angiography. This case that we present is a case of Leriche syndrome in which the patient came to the hospital with the complaint of claudication and was diagnosed with lumbar disc herniation. Since vascular pathologies were not considered in definitive diagnosis, the treatment was delayed and it resulted in mortality; for this reason it is important. In the case of patients coming to hospital with complaints of leg pain, the vascular pathologies shall be thought of in the definitive diagnosis and the clinicians, and in that way leading to the diagnosis, shall depend on detailed patient history and comprehensive physical examination.

Abstract | Full Text PDF

Topuk aðrýsý ayak aðrýlarýnýn %15’ini oluþturur. Aðrý, plantar fasiit, kalkaneal kýrýk, kalkaneal apofizit, topuk yastýðýnýn atrofisi, enflamatuar hastalýklar gibi nedenlere baðlý olabildiði gibi sinir kökenli de olabilir. Tibial, plantar ve/veya medial kalkaneal sinir sýkýþmasý aðrýnýn nöral nedenlerindendir. Medial kalkaneal sinir topuktaki yumuþak dokularýn çoðunun duysal innervasyonunu saðlar. Topuk aðrýsýnýn nöral kaynaklý olduðunu teþhis etmek için öykü ve dikkatli bir fizik muayene gerekir. Topuk aðrýsýnýn diðer nedenleri dýþlanmadan önce cerrahi giriþim için acele edilmemeli, konservatif tedavi sonrasýnda taný yeniden gözden geçirilmelidir.

Pain heel constitutes 15% of foot pain. Pain may be caused by plantar fasciitis, calcaneal fractures, calcaneal apophysitis, heel pad atrophy, inflammatory diseases or related with nerve involvement. Tibial, plantar and/or medial nerve entrapment are the neural causes of pain. Most of the heel soft tissue sensation is provided by medial calcaneal nerve. Diagnosis of heel pain due to neural causes depends on history and a careful examination. Surgery should not be undertaken before excluding other causes of heel pain. Diagnosis should be reconsidered following conservative therapy.

Abstract | Full Text PDF

Uçak yolculuðu ile iliþkili baþaðrýsý, son yýllarda olgu sunumlarýyla önem kazanmýþ ve 2013 yýlýnda baþaðrýsý sýnýflamasýnda yerini almýþtýr. Bu nadir durum primer baþaðrýlarýndan farklý özel karakteristik özelliklere sahiptir ve patofizyolojisi henüz net deðildir. Bu olguda, 27 yaþýndaki bir kadýn hastaya anamnez, muayene ve görüntüleme yöntemleriyle uçak yolculuðu ile iliþkili baþaðrýsý tanýsý konuldu. Literatür eþliðinde muhtemel patofizyolojisi ve tedavisi tartýþýldý.

Recently, headache associated with airplane travel has gained importance with case reports and took its place in the classification of headache in 2013. This rare condition has different spesific characteristic from the primary headaches and its pathophysiology is not clear yet. In this case report, a 27-years-old female patient was diagnosed with the headache associated with airplane travel by history, examination and imaging findings. The possible pathophysiology and treatment were discussed.

Abstract | Full Text PDF

Lakozamid (LCM) parsyel epilepsinin ekleme tedavisinde kullanýlan, güvenli yeni bir antiepileptiktir. En sýk yan etkileri sersemlik, baþ aðrýsý, çift görme, bulantý ve kusmadýr. 32 yaþýnda 2 yýldýr epilepsi tanýsýyla izlenen hasta nöbet geçirme yakýnmasýyla hastaneye baþvurdu. LCM tedavisi hastaneye baþvurudan 20 gün önce nöbet kontrolü için tedaviye eklendi. LCM dozu baþ aðrýsý nedeniyle azaltýldý ve baþ aðrýsý þiddeti azaldý. Sað oksipital bölgeye büyük oksipital sinir blokajý (bupivakain 2 mg) uygulandý. GON blokajý LCM iliþkili baþ aðrýsýnda etkili bulundu.

Lacosamide (LCM) is a newer antiepileptic drug with a favorable safety profile used in partial epilepsy as add-on therapy. The most common side effects include dizziness, headache, diplopia, nausea, and vomiting. A 32-year-old female with a 2-year history of epilepsy was admitted to our hospital because of seizure. LCM was added for further seizure control 20 days before the current presentation. LCM dosage was reduced because of headache and headache violence to reduce. Great Occipital Nerve (GON) blockade, with bupivacaine (2 mg), were performed in the right occipital region. GON blockade was find effective in LCM induced headache.

Abstract | Full Text PDF