The ultimate goal of advanced human experimental pain research is to obtain a better understanding of mechanisms involved in pain transduction, transmission and perception under normal and pathophysiological conditions. Hopefully, this can provide better characterization, prevention and management of pain. As pain is a multi-dimensional perception it is obvious that the reaction to a single standardized stimulus of a given modality can only represent a very limited fraction of the entire pain experience. Evidently, the experimental possibilities available for studying cutaneous pain are much more advanced than the possibilities available for studying pain from deep tissue. Different techniques are available to induce repeated stimulation of skin and to assess the responses. Repeated stimulations can be used to assess centrall summation, which is a general and important mechanism for the human nervous system. Various stimulus modalities are available for induction of controlled experimental cutaneous pain, such as electrical (Trans-cutaneous, Intra-cutaneous), thermal (Heat, Cold), mechanical (Pin prick, Pressure, Impact stimuli) and chemical (Capsaicin, Mustard oil). The assessment methods for cutaneous pain are based on psychophysical, electrophysiological and imaging techniques. Experimental techniques can be used to study basic mechanisms in healthy volunteers or to characterize sensory dysfunction in patients. The experimental possibilities available for studying cutaneous pain are far from equal. There is a need for more experimental and clinical studies to provide new knowledge for this clinically revelant area.

PCA-IV is applied to children older than 5 years with two different doses of morphine and the results are evaluated. Twenty-eight patients ages ranging from 5 to 15 years undergoing major surgical procedures were included in this study. Following standard anaesthesia technique 0.1 mg/kg morphine was given intravenously. In group A (low dose group) patients weighing 0-20 kg. received bolus 0.5 mg, 20-30 kg patients received 1 mg and 30-40 kg patients received 1.5 kg and patients weighing more than 40 kg received 2 mg bolus dose of morphine in the PCA regimen. Group B (high dose) was administered 1 mg, 1.5 mg 2.0 mg and 2.5 mg bolus doses of morphine respectively. Four hour maximum limit doses was set to 400 mcg/kg. Patients were observed for 24 hours for the frequent complications (nausea, vomiting, itching, urinary retention, bowel motility), SpO2, respiratory rate, heart rate, systolic blood pressure, sedation and pain scores were recorded every hour. Faces Pain Scale average for 24 hours was 2.15±0.47 in group A and 1.67±0.5 in group B. The average sedation score was 0.79±0.23 and 0.87±0.3 in group A and B respectively. Group A delivered total of 19.5±12.2 mg (29 mcg/kg/hour) morphine and group B delivered total of 39.5±17.6 mg (50 mcg/kg/hour) morphine. High dose morphine bolus regimen achieved better analgesia and sufficient sedation. Morphine usage in high dose group (group B) was more frequent in the first 12 hours. Frequency of drug delivery and demand did not decrease in group A. The relation between demand and delivery let us to conclude that high dose bolus morphine is more suitable.

The goal of this study was to examine the onset and duration of analgesia after adding ketamine to two different local anesthetics in spinal block. ASA I-II group 100 patients were included into our study in 4 groups. Group 1 recieved heavy bupivacaine 4 cc (20 mg) + 1 cc saline, group 2 recieved heavy bupivacaine 4 cc (20 mg) + 1 cc (50 mg) ketamine, group 3 recieved heavy articaine 2 cc (100 mg) + 1 cc saline and group 4 recieved heavy articaine 2 cc (100mg) + 1 cc (50 mg) ketamine. Onset times for sensorial and motor block were recorded. The complete regression times of the motor and sensorial block, sedation scores were also recorded. As a result, addition of ketamine 50 mg to local anesthetics fasten the onset time of spinal block, lenghten the duration of analgesia and provide sedation intraoperatively.

In this study, fluvoxamine, a relatively new selected serotonin reuptake inhibitor, was compared with amitriptyline in a double-blind, crossover study in 15 hospital outpatients suffering from fibromyalgia syndrome. The study was approved by the Ethics Committee of Ege University Hospital and informed consent was obtained from each patient. Exclusion criteria for the investigation were presence of psychiatric diagnosis, rheumatic disease and other systemic co-existing disease. Flowing a 2 week wash-out period for analgesic and/or adjuvan drugs, patients randomly received 25 mg amitriptyline or 50 mg fluvoxamine for a period of 4-weeks. After a 2-week wash-out period, patients were re-evaluated before receiving the second drug for another 4 weeks. Assesment of efficacy was made on entry and at 2 week intervals for each drug using visual analog scale (VAS) scores, number of tender points, presence and degree of minor criteria symptoms. Analysis of variance and Wilcoxon matched pairs were used for the statistical comparison of the data. At the end of the trial, there was a significant reduction in VAS scores, number of tender points as well as the severity of the minor criteria symptoms. Overall there were no significant differences in terms of efficacy between the two drugs except anxiety. Anxiety scores in fluvoxamine group were significantly lower than the amitriptyline group. It was concluded that fluvoxamine in an effective, well-tolerated alternative to amitriptyline in the treatment of fibromyalgia syndrome.

In this study the efficacy and complications of epidural lysis (corticosteroid and hypertonic saline administration) were evaluated retrospectively in 48 patients (19 males, 29 females, ages 34-63) suffering from cervical pain due to various reasons. After performing physical examination, radiodiagnostic and elecrophysiologic evaluation; conservative treatment modalities were tried. The patients who did not respond to these treatment modalities were hospitalized for epidural lysis application. The procedures were performed in the operating room, under surgical conditions with fluoroscopic guidance. 16 G R-K needle was inserted either trough the C7-T1 or T1-T2 vertebral interspace, through which a Racz catheter was placed after performing epidurography. Epidural lysis was performed for three consecutive days. The patients were followed up monthly for 6 months. The quality of pain relief (as excellent, good, moderate, poor), and opioid consumptions were evaluated. Phyisical activities, opioid consumptions and VAS values were compared before and after the procedure. Complications were recorded. VAS values were decreased significantly after the procedures. Most of the patients had significant pain relief. On complications basis 1 patient had infection on the insertion site, 1 patient had dural puncture and 2 patients had parestesis on upper extremities. We concluded that cervical epidural lysis is an effective and safe method particularly in the patients who have not had any benefit from the other conventional therapies.

In this study, for postoperative pain management of 40 patients who were operated for lumbal scoliosis, spondylolystesis and spondylolysis, a catheter was placed into the epidural space,during intraoperative period. By this way bupivacaine+morphine or bupivacaine+clonidine were administered and compared for analgesic, haemodynamic and side effects. In all patients premedication, induction and maintenence of anesthesia were similar. After awakening and neurologic examination, in group I, patients received bupivacaine % 0.125+morphine 2 mg; in group II; bupivacaine % 0.125+1 mcg/kg clonidine; in 10 ml volume of % 0.9 NaCl, via the catheter. Pain (NRS), haemodynamic, respiratory and side effects were noted at: the begining of the postoperative period (0. min.), 30. min. and 1., 2., 6., 12. and 24. hours respectively. 2 mg of morphine was applied from the catheter when needed and total morphine requirements were noted. Data were evaluated statistically; while NRS and haemodynamic results were lower in group II, respiratory values were equal. Analgesia time and side effects were higher in group I. In conclusion, as both combinations were effective and safe in postoperative pain management via an epidural catheter, bupivacaine+clonidine may be an alternative to morphine+bupivacaine