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Volume: 36  Issue: 1   Year: 2023
  Ağrı: 16 (4)
Volume: 16  Issue: 4 - 2004
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1.Pain treatment in burn patients
Mehmet Emin Orhan, Atilla Şencan
Pages 9 - 16
Burn injuries can be causing the most intense and prolonged types of pain. Pain in such patients can also cause psychologic and functional difficulties, and is difficult to predict from wound depth. The fundamental problem of the burn pain treatment is insufficient analgesia. The pain management of the burn patient can be very difficult and necessitate enough experience because of individual differences of the patients and pain that involve different components. The psychological support and treatment is also as important as pharmacological treatment. The success rate of the pain treatment of the burn patient can be increased with the multidisciplinary approach based on the decision of the most appropriate pain treatment modalities for individual patient and the principles of the pain treatment.

2.Trigeminal autonomic cephalgias: Diagnosis, therapy, atypical forms and pathophysiology
Macit Selekler, Murat Alemdar
Pages 17 - 27
Trigeminal autonomic cephalgias; cluster headache, paroxysmal hemicrania, hemicrania continua and SUNCT (short-lasting unilateral neuralgiform headache attacks with conjuctival injection and tearing) syndrome are characterized by unilateral trigeminal distribution of pain and accompanying ipsilateral autonomic symptoms. Other than cluster headache, all of these syndromes have been described within last twenty years, and are found relatively less frequent and less known forms. Diagnosis of paroxysmal hemicrania and hemicrania continua, especially atypical forms, essentially depends on indomethacin responsiveness. For SUNCT syndrome, there is not such a drug which provides a practical approach to both diagnosis and therapy and its diagnosis depends on clinical features. So far, case reports from various countries helped us realize the existence of secondary forms of these syndromes and the necessity of imaging techniques, especially for recently described autonomic cephalgias.

3.Hypnic headache syndrome: Excessive periodic limb movements in polysomnography
Elif Kocasoy Orhan, Nalan Kayrak Ertas, Kadir Serkan Orhan, Mustafa Ertas
Pages 28 - 30
We report a patient with hypnic headache syndrome associated with excessive periodic limb movements in sleep, which is a unique finding for this syndrome recorded in polysomnography. She had had daily hypnic headache attacks history for 10 years. Her headache attacks ceased immediately after lithium carbonate therapy and she has been headache-free for 5 months.

4.Cancer pain management in children
Bilge Karslı
Pages 31 - 34
Pain is one of the most common and frightening symptoms of children with cancer and their families. If current pain management techniques are utilized, the majority of children can achieve adequate analgesia. It is the rare pediatric patients who develop intractable pain. The World Health Organization (WHO) has established principles of pain management for children with cancer.

5.Intrathecal melatonin increases the mechanical nociceptive threshold in the rat
Selami Ates Onal, Suheyla Inalkac, Selim Kutlu, Haluk Kelestimur
Pages 35 - 40
The aim of this investigation was to determine whether intrathecal (i.t.) administration of monodose melatonin provides an increase in mechanical nociceptive threshold in the rat. Twenty-four male Wistar rats were randomly assigned to four groups. Each animal was anesthetized, and a catheter was placed intrathecally via the cisterna magna. The study groups were: untreated controls (n=6); melatonin only (MEL, n=6); melatonin + luzindole (MEL+LZN, n=6); and melatonin + naloxone (MEL+NLX, n=6). Measurements of mechanical nociceptive threshold were made using an electronic algometer. Each animal was tested prior to injection and at 10, 20, 30 and 40 min after injection. In the MEL group, the mean nociceptive thresholds at all post-injection time points were significantly higher than the baseline value (p<0.05 for all). In the control and MEL+LZN groups, none of the four mean nociceptive thresholds recorded after i.t. injection was significantly different from the baseline value (p>0.05 for all). In the MEL+NLX group, the mean nociceptive thresholds at 20, 30 and 40 min post-injection were all significantly lower than the baseline value (p<0.05 for all). Comparison among the group nociceptive thresholds at baseline revealed no significant differences, and the same was true at 10 min after i.t. injection. At the 20, 30 and 40 min stages, the threshold in the MEL group was significantly higher than the threshold in the control group. The results indicate that i.t. injection of melatonin produces a time-dependent increase in mechanical nociceptive threshold in the rat and that the mechanism that underlies these effects involves both melatonin and opioid receptors.

6.Percutaneous annuloplasty in the treatment of discogenic pain: Retrospective evaluation of one year follow-up
Serdar Erdine, Aysen Yucel, Mehmet Celik
Pages 41 - 47
In this study, we have evaluated clinical results of the discTRODE TM system, in 15 patients with discogenic pain. All procedures were performed under sterile conditions with fluoroscopic guidance. After identifying the disc space under fluoroscopy, the introducer of the discTRODE TM was introduced using a tunneled vision. After inserting the introducer; navigable, semi-rigid discTRODE TM catheter was advanced through the introducer and directed medially and contralaterally along the posterior nuclear-annular interface. The SMK Thermocouple Electrode was placed in the outer-annulus on the contralateral side so as to monitor local tissue temperature. The treatment temperature was manually increased in a step-wise progression from 50 °C to 65 °C. Patient outcomes were evaluated during follow-up visits at 1, 3, 6 and 12th months post-procedure. Before the procedure and at each visit during the follow-up period, patients completed Visual Analogue Pain Scale (VAS) and Short Form-36 Health Status Questionnaire (SF-36). Annuloplasty was performed without difficulty in all patients, there were no complications associated with disc puncture such as discitis or disc rupture. Symptoms improved in 10 of 15 (66.6 %) of the patients on the SF-36 Physical Function subscale, in 9 of 15 (60 %) on the SF-36 Bodily Pain subscale and in 9 of 15 (60 %) on the VAS scores. 5 of 15 of the patients did not show improvement on any scale. This technique seems to be a reliable method for patients complaining of discogenic pain. However, prospective randomized controlled studies comparing different approaches are needed.

7.Blockade of ganglion impar through sacrococcygeal junction for cancer-related pelvic pain
Elif Başağan Moğol, Gürkan Türker, Nermin Kelebek Girgin, Nesimi Uçkunkaya, Şükran Şahin
Pages 48 - 53
Impar ganglion block provides pain relief in patients who suffer from sympathetically mediated pain arising from disorders of viscera and somatic structures within the pelvis and perineum. We performed impar ganglion blockade through sacrococcygeal junction instead of anococcygeal ligament in 9 patients who had localized perineal pain of visceral origin. All the blocks which were performed through sacrococcygeal junction without bending the needle under fluoroscopic guidance were easy to perform without any complication. Pain intensity by Visual Analogue Scale, daily opioid requirements, and complications related to opioids were evaluated before the procedure, and for 2 months after the procedure. The intensity of pain, daily opioid requirement and the complication related to the opoioids were significantly decreased in 8 patients. We suggest that impar ganglion block through sacrococcygeal junction appears to be safe and effective procedure in the management of perineal pain related to malignancy.

8.Beneficial effects of single dose multimodal epidural analgesia on relief of postoperative microdiscectomy pain
Alper Kararmaz, Sedat Kaya, Haktan Karaman, Selim Turhanoğlu, Ali Özyılmaz
Pages 54 - 58
We aimed to assess the efficacy of multimodal epidural analgesia in decreasing postoperative pain after microdiscectomy. Fourty patients, ASA physical status I or II, undergoing microsurgical lumbar discectomy were enrolled in this prospective, randomised, controlled, double-blinded study. 10 ml study solution consisting of 2 mg of morphine, 15 mg of bupivacaine, 80 mg of methylprednisolone, and 0.05 mg of adrenaline was prepared for epidural administration. At the end of the procedure but prior to wound closure, the surgeon inserted an 18-gauge epidural catheter into the epidural space. After closure of incision, patients were assigned to receive either study solution (Group E) or saline (Group C). The epidural catheter was then removed. Patient controlled analgesia with morphine was used for postoperative analgesia. Visual Anologue Scale (VAS) pain scores and morphine consumptions were lower in Group E. Time to first ambulation was shorter in Group E. Patients in Group E were more satisfied with their analgesic regimen. Single dose multimodal epidural analgesia administered after wound closure provided better postoperative analgesia after lumbar microdiscectomy.

9.Comment on: Isın Unal Cevik: Postherpetic neuralgia
Ali Çimen
Page 64

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