Aðrý, mevcut veya potansiyel doku harabiyetine baðlý, nahoþ, duyusal ve emosyonel bir yaþantýdýr. Aðrý davranýþý ise aðrý, distres ve ýstrabýn davranýþsal görünümüdür. Aðrý davranýþý gösteren kiþilerin düþünce, his ve eylemleri aðrý durumlarý ile iliþkilidir. Objektif patoloji ile orantýsýz olan aðrý davranýþý ya adaptif yada patolojiktir. Kronik aðrýsý olan bir hastada aðrý davranýþýnýn bulunmasý halinde psikiyatrik bir bozukluðun aðrýyý alevlendirebileceði bildirilmiþtir. Aðrý davranýþýyla ile psikolojik faktörler arasýndaki iliþkiyi araþtýran pek çok çalýþma yapýlmýþtýr.

Pain is an unpleasent sensory and emotional experience associated with actual or potential tissue damage. Behavioral manifestation of pain, distress, and suffering have been characterized as pain behaviors. Pain behavior is the way individuals think, feel, and act in relation to their pain status. Pain behaviors are either adaptive or pathological, as when the pain behavior is disproportionate to the objective pathology. It’s reported that when pain behavior exists in patients with pain, a psychiatric disorder might to increase pain. The relation between psychological factors and pain behavior is investigated in several studies.

Abstract | Full Text PDF

Analjezik adjuvanlar, kullanýmlarý aðrý tedavisi dýþýnda olmasýna raðmen, bazý aðrýlý durumlarda analjezik etki gösteren ilaçlar olarak tanýmlanabilir. Çok deðiþlik gruplardan ilaçlarý bu sýnýflamaya alabiliriz. Kronik kanser-dýþý aðrý sendromlarýnda birinci tercih ilaçlar olarak kullanýlmaktadýr. Bazý adjuvanlar çeþitli aðrý tiplerinde etkinken bazýlarý da nöropatik ya da nosiseptif aðrý için spesifiktir. Antidepresanlar, antikonvülzanlar, nöroleptikler, antiaritmikler, antihistaminikler, NMDA reseptör antagonistleri, steroidler, kas gevþeticiler, bifosfonatlar ve radyofarmasötikler adjuvan ilaçlardýr. Bu derleme, ilaçlarýn medikal dozajlarý, yan etkileri ile ilaç etkileþimlerini vurgulamakta ve aðrý tedavisi için analjezik adjuvan kullanýmýný destekleyici kanýtlarý gözden geçirmektedir.

The term adjuvant analgesics describes any drug with a primary indication other than pain, but with analgesic properties in some painful conditions. Adjuvant analgesics often are administered as first-line drugs in the treatment of chronic non-malignant pain. The group includes numerous drugs in diverse classes. Some adjuvant analgesics possess analgesic properties in several types of pain, whereas others are specific for neuropathic pain, or nociceptive pain. Antidepressants, anticonvulsants, neuroleptics, antiarrythmics, antihistaminics, NMDA receptor-antagonists, steroids, muscle relaxants, bisphosphonates, and radiopharmaceuticals are adjuvant agents. This article reviews the evidence supporting the use of adjuvant analgesics for the treatment of pain and emphasizes medical dosages, side effects, and drug interactions.

Abstract | Full Text PDF

Migren deðiþik nörolojik, gastrointestinal ve otonomik deðiþikliklerin eþlik ettiði bir epizodik baþaðrýsý bozukluðudur. Migrenlilerin beþte birinde baþaðrýsýnýn geliþimi esnasýnda veya öncesinde migren aurasý adý verilen bir nörolojik bozukluk (vizüel, duyusal veya motor) ortaya çýkar. Kortikal yayýlan depresyon (CSD); bir odaktan baþlayýp ayný hemisfer boyunca yayýlan geçici nöronal depolarizasyon ve takiben geliþen uzun süreli baskýlanmýþ nöronal aktivitedir. Aura fazýnda gözlenen vizüel skotom ve geçici kortikal oligemi ile benzer bir hýzda yayýldýðýndan dolayý migren aurasýnýn temelinde CSD fenomeninin olduðu ileri sürülmüþtür. Migren patofizyolojisinin daha iyi aydýnlatýlmasýný saðlayan bu veri, migren tedavisi yanýnda, patofizyolojisinde kortikal yayýlan depresyonun yer aldýðý düþünülen, serebrovasküler hastalýklar, geçici global amnezi, travmatik beyin hasarý gibi nörolojik hastalýklarýn tedavisinde de yeni ufuklar açacaktýr

Migraine is an episodic headache disorder accompanied by various neurological, gastrointestinal and autonomic changes. In one fifth of the migraineurs, a neurological disturbance (visual, sensory or motor) appears during or before the development of the headache called migraine aura. Cortical spreading depression (CSD) is a transient neuronal depolarization that spreads across unilateral hemisphere from a focus and is followed by a long-lasting depression of neuronal activity. CSD was proposed to be the underlying phenomenon of the migraine aura as it propagates at a similar velocity with visual scotomata and the transient cortical oligemia seen in migraineurs during the aura phase. This data, enabling a better understanding of migraine pathophysiology, will result in new insights into the treatment of other neurological disorders such as cerebrovascular disorders, transient global amnesia, traumatic brain injury, in whose pathophysiology CSD is supposed to take part, beside the treatment of migraine itself.

Abstract | Full Text PDF

Nöropatik aðrýya neden olan mekanizmalar tam olarak anlaþýlamamýþtýr. Bu klinik durum için çoðu tedavi modelleri yetersiz kalmaktadýr. Opioidlerin etkileri ve aðrý mekanizmalarýnýn daha iyi anlaþýlmasýndan sonra kanser dýþý kronik aðrýlarda ve nöropatik aðrýda opioidlerin kullanýlmasý yaygýnlaþmýþtýr. Bu çalýþmada, transdermal fentanil kullanan kronik non-malign nöropatik aðrýlý hasta, aðrý ve yan etki açýsýndan yaklaþýk ondört ay boyunca izlendi. Tedavi süresince hastanýn aðrýsý azaldý ve ciddi yan etki gözlenmedi. TDF kronik non-malign nöropatik aðrý tedavisinde etkin analjezi saðlamakta ve oldukça iyi tolere edilmektedir.

The mechanisms responsible for neuropathic pain are not fully understood. Most treatment modalities are ineffective or insufficient for this important clinical condition. Better understanding of pain mechanisms and opioid drug action has widened the indications for opioids in pain therapy of non-malignant pain including neurophatic pain. In this report of a case a female patient with chronic non-malignant neurophatic pain was followed–up for pain and side effects for approximately fourteen months with the use of transdermal fentanyl (TDF). Pain reduction was good throughout the study. Severe side effects did not occur. TDF was effective and tolerated in the treatment of chronic neuropathic pain of nonmalignant origin.

Abstract | Full Text PDF

Bu çalýþmanýn amacý, hemþirelerin, (N=235) aðrý ile ilgili bilgi, davranýþ ve klinik karar verme yeteneklerini incelemektir. Araþtýrmada veri toplama aracý olarak, Hemþire Tanýtým Formu, Aðrý ile Ýlgili Hemþire Bilgi ve Davranýþlarý Anketi, ve McCaffery ve Ferrell tarafýndan geliþtirilen ve Türk toplumuna uyarlanan Klinik Karar Verme Anketi olmak üzere toplam üç form kullanýlmýþtýr. Araþtýrmanýn sonucunda; hemþirelerin çoðunluðunun aðrý tanýlamasý ve yönetimi konusunda yeterli bilgiye sahip olmadýðý, %47.4’ünün aðrý yoðunluðunu tanýlamada hastanýn davranýþlarýný gözlemlemediði ve %74.5’inin ise hastanýn aðrýsýný ölçmek için aðrý tanýlama skalasý kullanmadýðý saptanmýþtýr.

The purpose of this study was to investigate the nurses’ ain related knowledge, attitude and clinical decision making skills. Three instruments were used in the study: (1) Nurses’ Introduction Form, (2) The Nurses' Knowledge and Attitudes Questionnaire and (3) Clinical Decision Making Survey Questionnaire developed by McCaffery and Ferrell was translated into Turkish and used with permission. The results showed that many nurses have inadequate knowledge about pain assessment and management, nurses’ (%47.4) did not observe patient’s behaviors to determine/assess the patient’s intensity of pain and %74.5 of nurses’ did not use pain assessment scales to measure the patient’s pain.

Abstract | Full Text PDF

Ortopedik cerrahi operasyonlarý içinde en aðrýlý prosedürlerden biri total diz protezi (TDP) operasyonlarýdýr. Calýþmamýzda, TDP operasyonlarýnda, 40 ml %0.375 ropivakain ile uygulanan preoperatif 3’e1 femoral sinir bloðunun (FSB), postoperatif hasta kontrollü analjezi (HKA) yöntemi ile uygulanan morfin tüketimine etkisini araþtýrmak amaçlanmýþtýr. Ayný zamanda, bloðun yan etki insidansýna etkisi de incelenmiþtir.Çalýþmaya 34 hasta dahil edilerek, grup R’ye (n=17), 40 ml, % 0.375 ropivakain ile preoperatif dönemde 3’e1 FSB uygulanmýþtýr. Grup S’ye (n=17), blok uygulanmayýp, operasyon bitiminden 30 dk önce 2 mg morfin yükleme dozu olarak verilmiþtir. Her iki gruba genel anestezi verilmiþ ve postoperatif dönemde HKA uygulanmýþtýr. Hastalarýn VAS skalalarý, total morfin tüketimi ve yan etkileri not edilmiþtir. Her gruptan 2 hasta çalýþma dýþý býrakýlmýþtýr. Çalýþmamýzda postoperatif 0,1,2,3,4,6,8 saatlerde takip edilen VAS skorlarý blok uygulanan grupta anlamlý olarak düþük bulunmuþtur (p<0.05). Grup R uyanma odasýnda ve postoperatif 8 saat boyunca hiç aðrý tanýmlamazken, grup S VAS≤3 düzeyine postoperatif 1. saatte ulaþabilmiþtir. Morfin ihtiyacý, grup R de 12., 18., 24., 48. postoperatif saatlerde anlamlý olarak düþük bulunmuþtur (p<0.001). Yan etki insidansý da grup R de daha düþük olarak tespit edilmiþtir.
TDP ameliyatý geçirecek olan yaþlý hastalarda, 40 ml %0.375 ropivakain ile uygulanan preoperatif 3’e1 FSB daha etkili analjezi, daha düþük morfin tüketimi ve daha az yan etkiye sebep olmuþtur.

Total knee replacement (TKR) is one of the most painful orthopedic surgical procedures. This study was aimed to investigate the effect of a single-shot preoperative 3-in-1 femoral nerve block on postoperative pain by using 0.375% ropivacaine, and on the consumption of morphine by using PCA following the TKR surgery. Side effects were also evaluated in this setting. 34 patients were included in this study. Group R (n=17) received a 3-in-1 femoral nerve block (FNB) with 40 ml of ropivacaine %0.375. Group S (n=17) received only a 2 mg loading dose of morphine 30 minutes before the end of surgery, and no block was performed. Both groups received general anesthesia and postoperatively had a PCA pump programmed to deliver morphine.VAS scores at rest, morphine consumption and adverse effects were recorded. Two patients were excluded from each group. Pain scores at 0,1,2,3,4,6,8 postoperative hours were significantly lower in group R in resting position (p<0.05). Group R experienced no pain at the recovery room and this state lasted 8 hours after the surgery while group S reached the acceptable score (VAS ≤ 3) one hour after leaving the recovery room. The morphine requirement was significantly lower in Group R at 12, 18, 24, 48 hr after TKR (p<0.001). Side effects were also lower in this group. Preoperative single-shot 3-in-1 FNB with 40 cc of ropivacaine %0.375 provides better VAS scores, less morphine consumption and fewer side effects in elderly patients when compared to the group with no block.

Abstract | Full Text PDF

Manisa’da kýrsal bir alanda yürütülen bu kesitsel araþtýrmada kadýnlarýnda bel aðrýsý sýklýðý ve ev iþleri arasýndaki iliþkiyi deðerlendirmek amaçlanmýþtýr. Araþtýrma grubu 302 kiþiden oluþmuþ ve mahalle nüfuslarýna orantýlý küme örnekleme yöntemi kullanýlmýþtýr. Araþtýrmanýn katýlým oraný %89.1’dir. Ýstatistiksel analizde t testi, %95 güven aralýðýnda tek deðiþkenli ve çok deðiþkenli risk analizi uygulanmýþtýr. Araþtýrma grubunda yeti yitimi düzeyleri Kýsa Yeti Yitimi Anketi ile deðerlendirilmiþtir. Araþtýrma grubunda bel aðrýsýnýn nokta ve yaþam boyu prevalansý %34.9 ve %79.2’dir. Ev iþlerinden ütü yapma sýrasýnda hatalý vücut postüründe çalýþmanýn [2.2 (1.1-4.5)], yeti yitimi varlýðýnýn [9.2 (4.3-19.7)], aðýr yük taþýmanýn [4.5 (2.1-9.2)], ve kilolu/obez olan kadýnlarýn [3.8(1.7-8.3)], bel aðrýsý açýsýndan risk taþýdýklarý saptanmýþtýr. Koruyucu saðlýk hizmetleri açýsýndan ev kadýnlarýnda ayný zamanda çalýþma ortamý olan ev iþlerinin yapýlmasýnda uygun duruþ alýþkanlýklarýnýn kazandýrýlmasý ve ergonomik çalýþma koþullarýnýn yaþama geçirilmesi gereklidir.
Anahtar kelimeler: bel aðrýsý, prevalans, ev iþleri, ergonomi

The aims of this cross-sectional study were to determine the prevalence of low back pain and to evaluate the effects of household jobs on low back pain in women living in a rural setting in Manisa. Study population is consisted of 302 women and cluster sampling is performed according to percentage of health center district populations. Participation ratio of this study was 89.1%. Univariete and multivariete risk approach in 95% confidence interval and t test were performed in data analysis. Brief Disability Questionnaire was applied to the study group. Life time and point prevalence of low back pain were determined 79.2% and 34.9% of the study group. Low back pain risk in 95%CI was higher in wrong posture during ironing, heavy load lifting, overweight/obesity and disability 2.2(1.1-4.5), 4.5 (2.1-9.2), 3.8 (1.7-8.3) and 9.2 (4.3-19.7) times respectively.For preventive health measures it is necessary to apply ergonomic working conditions and to give appropriate postural habits to women.

Abstract | Full Text PDF