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Volume: 36  Issue: 2   Year: 2024
  Ağrı: 17 (1)
Volume: 17  Issue: 1 - 2005
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Serdar Erdine, Ayşen Yücel
Page 4
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2.Neuropathic pain: Mechanisms, diagnosis and treatment
Ayşen Yücel, Ali Çimen
PMID: 15791494  Pages 5 - 13
Neuropathic pain, resulting from the disturbances of central or peripheral nervous system with mechanisms that we cannot explain yet exactly, is really a troublesome situation both for the patient and the physician. 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, common conditions, diagnosis and treatment of neuropathic pain.

3.Celiac Ganglion Block
Serdar Erdine
PMID: 15791495  Pages 14 - 22
The percutaneus blockade of the celiac plexus is being performed nearly for a century. The aim of performing celiac plexus and splancnic nerve blocks was surgical anesthesia at the beginning. But because of the technical demands and variable results of celiac plexus and splanchnic nerve blocks as a surgical anesthetic, over time, these techniques were supplanted by spinal anesthesia and segmental blockade of the somatic paravertebral nerves. As celiac plexus and splanchnic nerve blocks were falling into disuse for surgical anesthesia, the clinical utility of these techniques was becoming apparent in the new specialty of pain management. Celiac plexus and splancnic nerve blocks are effective in relieving chronic abdominal pain, especially originating from the malignancies of the pancreas, liver, gallbladder, omentum, mesentery, and alimentary tract from the stomach to the transverse portion of the large colon. The relevant anatomy, indications, cotraindications, different application techniques and results of celiac blockade is reviewed in this paper.

4.Epidural steroid injections and low back pain
Atilla Ergin
PMID: 15791496  Pages 23 - 27
Low-back pain nearly affects all the people in the population; male or female, at any period of their lives and continues with spontaneous regressive attacks. In 10% of the patients, the pain persists despite conservative treatments and causes significant decrements of life quality. For this reason, the patients with chronic low back-pain are applying to pain specialists and treated with different invasive pain therapies. Epidural steroid injections are the most common invasive procedures in the treatment of low-back pain. However, the effects and outcomes are contradictory. Epidural steroid injections should be performed absolutely under fluoroscopic guidance. Pain selection should be made carefully and algorithms should be performed fastidiously.

5.Challenges in the treatment of pain in children with cancer and tunneling of epidural catheter for long term infusion
Pervin Bozkurt, Mefkür Bakan, Leyla Türkoğlu Kılınç
PMID: 15791497  Pages 28 - 32
The main differences of cancer pain in children from adults are predominance of tumor related pain, difficulties in pain assessment and rare use of regional blocks. A 2.5 years old girl with severe pain due to pelvic/sacro-cocygeal mass will be presented here. Pain assessment depended on the observations of other patients’ parents in the ward, because the child’s family was uncooperative. An epidural catheter was placed at T12-L1 level when the conventional methods were unsuccessful and tunneled 5 cm away from the insertion site. Infusion of bupivacain 0.2 mg/kg/hr + fentanyl 0.4 mg/kg/hr from the catheter provided pain relief. Another epidural catheter placed when intravenous morphine infusion (0.02 mg/kg/hr) became inefficient following accidental removal of the initial one. The patient was transferred to another hospital for chemotherapy on the 2nd week. The good interactions between the anesthesiologists accomplished the continuity of pain therapy. Tunneling epidural catheter is an invaluable technique in children who are resistant to conventional pain therapies.

6.Effect of tramadol on regeneration after experimental sciatic nerve injury
Yasemin Güneş, Tufan Mert, Y. Kenan Dağlıoğlu, Hayri Özbek, İsmail Günay, Dilek Özcengiz, Geylan Işık
PMID: 15791498  Pages 33 - 38
Abnormal impulses in peripheral nerves play a critical role in neuropathic pain syndromes. The voltage-gated Na+ channels that underlie the action potential are main targets for clinically useful drugs in the pain therapy. Systemic tramadol has been shown to have clinical efficacy against some forms of neuropathic pain. Therefore, we investigated the mechanisms of action of tramadol by an in vitro model by sucrose-gap technique. Tramadol produced concentration-dependent and frequency-dependent decrements in CAP amplitude. Also, injured nerves were more sensitive to tramadol. Tramadol decreased the amplitude of the delayed depolarization and the hyperpolarizing afterpotentials. In conclusion, blocking potencies of small concentration tramadol on the delayed depolarization and hyperpolarizing afterpotential in regeneration period may be contributed for understanding of the action mechanisms of tramadol on neuropathic pain therapy.

7.The use of transdermal fentanyl in chronic non-malignant pain
Taylan Akkaya, Murat Sayın, Haluk Gümüş
PMID: 15791499  Pages 39 - 44
Twelve non-malignant pain patients were followed-up for pain, improvement in the quality of life, satisfaction for pain therapy and side effects for a mean of 95.25 days with the use of transdermal fentanyl (TDF). During this period a mean of 32.04 mg/gr TDF was used. While the score of pain at rest was decreased by 52.6%, mean pain score on movement was decreased by 45.2% (p= 0.002). Quality of sleep improved and impairment of daily living by pain was decreased significantly (p= 0.002). Satisfaction by the pain therapy was 83.3% and the most common side effect was nausea (16.8%). TDF may be a good alternative in the therapy of chronic non-malignant pain if patients were selected carefully.

8.The relationship of stabbing headaches with migraine attacks
Hamit Macit Selekler, Sezer Şener Komşuoğlu
PMID: 15791500  Pages 45 - 48
Temporal and spatial relationships between idiopathic stabbing headache and migraine headache have so far been reported. We aimed to obtain some clues about the stabbing headache pathophysiology by comparing the two types of headache in regard to temporal and spatial relationships as well as precipitating and relieving factors of stabbing headache during migraine attacks. 43 patients who reported temporal relationship between migraine headache and stabs were studied. Localizations of migraine and stabbing headaches overlapped in 38 (88%) of the patients. 34 (79%) had stabs during migraine attacks, while 9 (21%) had stabs with a very close temporal relationship to migraine attacks. During the attacks, while head movements caused stabs in 10 patients (23%); applying pressure to the temples (n=3) and sleeping (n=2) alleviated or abolished stabs. We thought that stabs probably occur during a period in which central pain control mechanisms are weakened.

9.The effects of clodronate for the pain treatment of bone metastasis due to prostate cancer
Emine Özyuvacı, Aysel Altan, Cumhur Demir
PMID: 15791501  Pages 49 - 53
Hormone refractory prostate cancer is dominated by osseous metastases. Bisphosphonates are able to reduce bone resorption. Sixteen hormone refractory prostate cancer patients with related bone metastases were included in the study. Group A consisted of patients who were not treated with bisphosphonates (n=9) and group B consisted of patients who had received bisphosphonates treatment previously, but not receiving currently (n=7). All patients were treated with the same analgesic medications. Clodronate 400 mg; 1200 mg/day (p.o.) was added to the treatment of the patients in group A. Visual Analogue Scale (VAS) scores, consumptions and side effects of analgesics were recorded by two week intervals. Alkaline phosphatase, creatinine and serum Ca++ levels were controlled by 4 week intervals. At the end of the 12th week, the study was ended. In Group A, VAS decreased at the end of the 2nd week but in Group B VAS decreased in the 4th week. VAS decreased 75% in group A and 65.7% in group B and the difference was considered statistically significant (p<0.0001). Clodronate treatment was stopped in 2 patients because of nausea, 7 patients are still being treated with clodronate. We conclude that bisphosphonates treatment of painful osseous metastasis due to hormone refractory prostate cancer results in significant pain decrease.

10.Low doses of prazosin potantiates the antinociceptive / analgesic effect of amitriptyline
Murat Büyükşekerci, Hülya Gültekin
PMID: 15791502  Pages 54 - 56
In this study, we aimed to reveal the interaction between the tricyclic antidepressant amitriptyline and a1-adrenoceptor antagonist prazosin in mice by using an analgesiometric device hot-plate. Amitriptyline (10 mg/kg) has analgesic effect as expected. Neither of the prazosin doses (0.1, 0.2, 0.5, 1 mg/kg) displayed analgesic effect alone. The combination of lower doses of prazosin (0.1, 0.2, 0.5 mg/kg) with amitriptyline (10 mg/kg) potentiated the antinociceptive effect of this drug. However, the relatively higher dose of prazosin (1 mg/kg) did not effect amitriptyline analgesia. Thus we conclude that the antinociceptive effect of amitriptyline is potentiated by low doses of prazosin.

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