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Volume: 32  Issue: 3  Year: 2020

Attention: These articles have been accepted for publication; however, this list does not indicate the order in which articles will be published. As new articles are accepted, the order displayed here will change.

Ağrı: 16 (2)
Volume: 16  Issue: 2 - 2004
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1.Pain and immun system
I. Aydınlı, K. Keskinbora
PMID: 15152529  Pages 7 - 16
Recently, it is suggested that peripheric and central immune activation play primary role in hyperalgesia and allodynia. Non-neuronal cells that are immune cells in the periphery and glia (microglia, astrocyte) within the brain and spinal cord can drive hyperalgesic and allodynic states. Microglia and astrocytes, activated in response to noxious stimuli in the body tissues, in the peripheral nerves and also in the spinal cord, produce and release proteins called proinflammatory cytokines (PIC). Release of PIC from activated glia cause excessive release of excitatory neurotransmitters from synaptic terminals of primary afferent neuron and then spinal cord dorsal horn pain transmission neurons to become so hyperexcitable. However, in addition to this effect, PIC appears to interfere with the functions of the hippocampus that are involved in cognition, memory and mood. So PIC are important mediators of enhanced pain both in the periphery and in the central nervous system. As a new approach, it is important that this sight indicates alteration of targets in pain management.

2.Gender and pain
Ş Şahin
PMID: 15152530  Pages 17 - 25
Epidemiological, psychophysical and prevalence studies reveal that women have greater and more variable pain than men. Gender differences in pain are brought by genetic, physiological, anatomical, neural, hormonal, lifestyle and cultural factors. While women are more vulnerable to pain than men, they have more ways to deal with it. The clinical applicability of findings from the studies on gender differences in pain may lead to improve not only diagnosis but also treatment with various drugs and techniques.

3.Minimal invazive treatment modalities for geriatric pain management
N S Özyalçın
PMID: 15152531  Pages 26 - 36
Geriatric pain is a significant problem in health care, because of multiple disease processes in this aged population their population will increase. Treatment options for the geriatric pain patient include pharmacotherapy, interventional pain management, physical rehabilitation, and/or psychological modalities. The most commonly employed modality for geriatric pain control is pharmacotherapy. However in older patients nonsteroidal anti-inflammatory drugs (NSAIDs) have significant side effects and are the most common cause of adverse drug reactions. In that reason NSAIDs should be used with caution. Opioid analgesic drugs are effective for relieving moderate to severe pain. If weak opioids were found to be ineffective in attenuating pain intensity, then therapeutic nerve blocks or low risk neuroablative pain procedures should be employed prior to recommending strong opioids. A combination of invasive procedures and systemic medications has the distinct advantage of reducing medication intake and its side effects. Currently there is very scant evidence that this is the best treatment option while others have thought that the multidisciplinary approach to geriatric pain may be the most effective.

S Erdine
PMID: 15152532  Pages 37 - 40
Vertebroplasty is the polymethylmetacrilate (PMMA) injection into a vertebral body. It may be used for patients with compression fractures due to osteoporosis, metastatic tumors, or benign tumors. Vertebroplasty is performed to provide pain relief or to produce bone strengthening. The contraindications of the intervention are lack of patient consent, coagulopathy, infection, radiculopathy and extensive vertebral destruction. Vertebroplasty may be performed with transpedicular or extrapedicular approaches. The main complications are lamina pedicle or rib fractures, pneumothorax, and cement leakage into vessels, epidural space or disc.

5.The role of pain in operative strategy
A Keskin
PMID: 15152533  Pages 41 - 43
As minimally invasive surgical procedures have become widespread, postoperative patient comfort has also gained importance for surgeons. Unfortunately, the issue of pain has not received the attention it deserves. Laparoscopic operations are not the only means of decreasing postoperative pain, as different techniques for open procedures have proven to result in different degrees of pain. The degree of postoperative pain should take place in the selection criteria for surgical techniques for many diseases, as well mortality, morbidity and recurrence rates.

6.Referred shoulder pain
N. İnan, S. A. Takmaz, A. O. Özcan, B. Dikmen
PMID: 15152534  Pages 44 - 46
Referred pain; feeling pain at a site different than the source of pain; is also included in cancer pain. Mechanisms and treatment of referred pain has been evaluated because of a case with shoulder pain rising from diaphragmatic irritation.

7.The effects of application of rectal naproxen on postoperative analgesia, sedation and morfin consumption in heart surgery operations
T. Kayacan, F. Güzelmeriç, H. Oğuş, R. Yaltırık, Ö. Barutçuoğlu, V. Erentuğ, T. Koçak
PMID: 15152535  Pages 47 - 55
In this study, effects and side effects of application of rectal naproxen, combined with patient controlled intravenous morphine analgesia, were investigated in the elective coronary bypass operations for postoperative pain control, sedation and opioid use. Following the ethical committee approval and individual patient self consent, 40 patients, who underwent coronary artery bypass surgery were included in the study. A double blind study was performed by administering rectal naproxen to group N (n=20) and placebo to group P (n=20), at the end of the operation. Doses were repeated at the 12 th hour postoperatively.Patient controlled intravenous morphine analgesia was performed to all patients for postoperative 24 hours. Postoperative pain and sedation levels were assessed, the side effects were noted. There was no difference between two groups with respect to their demographic features duration of surgery, extubation time and side effects ( p>0.05). With respect to group P, decrease in opioid use, better sedation and decrease in pain scores during both resting and coughing was seen in group N (p<0.05). In conclusion, analgesia applied by addition of rectal naproxen to opioids achieved better pain management in selected patients after cardiac surgery.

8.The effects of sufentanil and remifentanil in the isolated perfused rat kidney
S. Tuncer, H. Barışkaner, A. Yosunkaya, M. Kılıç, N. Doğan, Ş. Otelcioğlu
PMID: 15152536  Pages 56 - 61
In this study, the effects of indomethacin (prostaglandin synthase inhibitor), propranolol (beta adrenergic receptors blocker), tetraethylammonium (TEA) (calcium-dependent potassium channel blocker) and glibenclamide (ATP-sensitive potassium channel blocker), NG nitro-L-arginine (NO synthetase inhibitor) and naloxane (nonselective opioid receptor antagonists) on the responses induced by sufentanil and remifentanil were investigated in the isolated perfused rat kidney. Renal arter was cannulated. Then the kidney was perfused continueously with warmed (37 °C) and aerated (95 % O2 and 5 % CO2). Krebs Henselieit solution by using a peristaltic pump delivering a constat flow (8-10 ml/min). Vascular responses were detected as changes in perfussion pressure, which was monitored continuously with a pressure transuder and recorded on polygraph. After phenilephrine (PE)-induced vasoconstriction had reached a platoe, sufentanil or remifentanil were given. Vasodilatation was recorded. Antagonists or inhibitors were added and responses were recorded. At the end of each experiment; papaverine was used to obtain the maximum dilatation. None of the used antagonists or inhibitors were not effected the submaximum PE construction. The used opioids were not alter in basal perfusion pressure. Antagonists or inhibitors had no effect on papaverine-induced dilatation. Bolus addition of sufentanil and remifentanil produced concentration dependent vasodilation. Indomethacine L-NAME, propranolol, naloxone and glibenclamide did not significantly alter responses of both of the opioids (p>0.05). But, sufentanil and remifentanil induced dilatation were significantly affected by TEA (p<0.05). The present results demonstrated that sufentanil and remifentanil decrease perfusion pressure in the isolated rat kidney and such mechanism may involve the calcium actived K+ channels activation.

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