REVIEW | |
1. | Fibromyalgia Syndrome from the Perspective of Neuropathic Pain Sibel Eyigör, Yesim Kirazli PMID: 18338273 Pages 8 - 12 Fibromyalgia Syndrome from the Perspective of Neuropathic Pain Fibromyalgia syndrome (FMS) is one of the several chronic pain syndromes and have been proposed to reflect some primary abnormality of the nervous system. Patients with FMS display common clinical features with neuropathic pain. The responsible mechanisms for symptoms and signs are still unknown. Mounting evidence was shown for central pain processing abnormalities in almost all FMS patients. These anomalies including hyperalgesia, allodynia, abnormal activation of pain-related brain regions and abnormal temporal summation of second pain in FMS patients strongly indicate a neuropathic pain syndrome. This new information led to the proposal that FMS may be a neuropathic pain syndrome maintained by central nervous system sensitization and sympathetic hyperactivity. This different perspective on FMS opens new avenues for research and treatment. In this review, a synthesis of the information about how FMS is related to neuropathic pain syndromes is provided. |
EXPERIMENTAL AND CLINICAL STUDIES | |
2. | Pain Severity and Analgesia Approaches in Adult Trauma Patients Fatma Eti Aslan, Dilek Sarıyıldız, Aysel Gürkan, Dilek Aygin PMID: 18338274 Pages 13 - 18 This study was carried out descriptive for determine trauma patient’s pain severity and pain relief approaches. This scope of the research covered 418 patients who were between 18-65 years and applied to emergency unit of two training hospitals because of the trauma in Istanbul. The data of the research were collected by using individual characteristics form and forth section of Mc Gill Pain Questionnaire form. It was determined that all patients had pain after trauma. Moreover, 14.6 % (n=61) of the patients defined the pain “severe”, 51.7 % (n=216) that they defined the pain “much severe” and 33.7 %(n=141) that they defined the pain “unbearable”. Nonsteroid Antiinflamatuar Drugs (NSAID) were given only 85.9 % (n=359) that they had pain. Besides, being extra to NSAID opioid was given to14.1% (n=59) of the patients by 95.5% (n=416) intramuscular approach and 62.9 % (n=293) of the patients, whose pains were not over in spite of the pain treatment Based on these results, trauma patients’ pains still haven’t been handled as a serious problem. Also, it can be said that there is hot any effective pain relief approach at emergency units yet. |
3. | The preoperative analgesic effect of 3-in-1 block on postoperative pain and tramadol consumption in total hip arthroplasty Süleyman Köroğlu, Suna Akın Takmaz, Çetin Kaymak, Altuğ Narlı, Kubilay Karalezli, Bayazit Dikmen PMID: 18338275 Pages 19 - 25 We studied the effect of preoperative 3-in-1 block for total hip replacement surgery on postoperative pain and tramadol consumption during patient-controlled analgesia. Thirty ASA I-II patients undergoing elective total hip arthroplasty (THA) were included in the study. Patients were randomly divided into 2 groups; Group I: Patients who received 3-in-1 block with 40 ml of 0.25% bupivacaine 30-minutes before surgery and later received general anesthesia, Group II: Patients who received only a simple needle puncture at the operation site 30-minutes before surgery and later received general anesthesia. All patients received intravenous tramadol at the end of surgery via a PCA device. Pain was evaluated at 0,1/2,1,4,8,12,24 and 48h at rest and on movement of the hip, using a 10cm VAS. The average intraoperative fentanyl consumption was lower in Group I than in Group II. VAS scores were significantly lower in group I, both at rest and during movement at all timepoints over in the first postoperative 12h and also during movement 24h postoperatively. However differences in VAS scores weren’t clinically significant after 4 hours. In the recovery room, Group I VAS scores were only a third of Group II, both at rest and movement (p=0.0001). Total tramadol consumption was lower in GroupI (633.0±119.3 mg) than in GroupII (991.1±41.0 mg). Patient satisfaction scores were higher in GroupI than in GroupII. We concluded that preoperative 3-in-1 block with 40 ml-0,25% bupivacaine provides effective postoperative pain relief for elective THA, reducing intra-and postoperative analgesic consumption without increase in side effects. |
4. | Effect of Lornoxicam on Postoperative Analgesia After Myomectomy İpek Erdoğan, Türkay Çakan, Ayşe Özcan, Esra Türkyılmaz, Bülent Baltacı, Bayazit Dikmen PMID: 18338276 Pages 26 - 31 BACKGROUND: In this prospective, randomized study, we evaluate the postoperative analgesic effect of lornoxicam after myomectomy operations. MATERIAL-METHOD: Forty ASA I-II patients scheduled for myomectomy operation were enrolled to this study. Patients were randomly divided into two groups and epidural block was performed with 0,75 % ropivacaine. After the operation, morphine Patient Controlled Epidural Analgesia (PCEA) combined with placebo (saline 2 ml iv) and morphine PCEA combined with lornoxicam 8 mg iv were administered to patients in Group I and Group II, respectively. Pain was assessed at the 0,1st, 2nd, 4th, 6th, 8th, 12th and 24th hours postoperatively. Chi-square and student’s t tests were used for statistical analysis. RESULTS: VAS( Visual Analog Scale) scores were higher in Group I than Group II at 2nd, 4th, 6th and 24th hours. Total morphine consumption was 10.45± 4.03 in Group I and 4.25 ± 1.74 in Group II. CONCLUSION: Single dose iv lornoxicam is a safe and an effective treatment option of post-myomectomy pain as it produces effective analgesia, reduces morphine consumption and does not increase the side effects. |
5. | Does transcutaneous electrical nerve stimulation or therapeutic ultrasound increase the effectiveness of exercise for knee osteoarthritis: a randomized controlled study Sibel Eyigör, Hale Karapolat, Ugur Ibisoglu, Berrin Durmaz PMID: 18338277 Pages 32 - 40 OBJECTIVE: The aim of this study was to determine if transcutaneous electrical nerve stimulation (TENS) or therapeutic ultrasound (US) increase the effectiveness of exercise on pain, function, musle strength and quality of life for knee osteoarthritis(OA). METHODS: Forty-five patients with primary knee OA diagnosis according to ACR criteria were divided into 3 random groups. The patients in group 1 received TENS (with superficial heat and exercise), group 2 received US (with superficial heat and exercise), and group 3 acted as controls (superficial heat and exercise). Outcome measures were included as visual analog scale (VAS), 20-meter walking, Lequesne index, WOMAC scores, isokinetic muscle testing, and the Short Form 36 (SF 36). All of the patients were subjected to six weeks of exercise program. RESULTS: All of the treatment groups had significant improvement on activity VAS, 20 meter walking, Lequesne, WOMAC scores, and most of the subscores of SF36 when compared with their initial status (p<0.05). All of the treatment groups, a significant musle strength gain in most of the angular velocity in knee extensor PT values after the treatment (p<0.05). However there was no statistically significant difference after the treatment between the all treatment groups (p>0,05). CONCLUSION: All of the treatment groups were effective on pain, function, musle strength and quality of life in patients with knee OA. Statistically significant differences could not be found between the treatment groups. The exercise program, as it is cheaper, more easily performed and efficient, may be preferable for the treatment of knee OA. |
6. | Efficiency Of TENS Treatment In Hemiplegic Shoulder Pain: A Placebo Controlled Study Ayşe Ekim, Onur Armağan, Cengiz Öner PMID: 18338278 Pages 41 - 46 OBJECTIVE: To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) therapy on shoulder pain and upper extremity functions in hemiplegic patients. MATERIAL-METHODS: Total of 19 hemiplegic patients with shoulder pain were as consecutive randomly assigned into two groups. TENS was applied in group 1 (n = 10) for 20 minutes and group 2 (n = 9) received placebo stimulation. Conventional rehabilitation program were applied total 15 sessions during a period of 3 week in both groups.The visual analog scale (VAS) to evaluate shoulder pain, Barthel Index (BI) for daily-life activities (DLA) were used. The shoulder passive range of motions (PROMs) and Brunnstrom stage of motor recovery were measured. RESULTS: Clinical parameters were similar at baseline. In both groups, significant improvements were observed in VAS and BI (group 1: p<0.001; group 2: p<0.05). In VAS (p<0.001), and BI (p<0.05) were showed significant improvements in favor of group 1, when compared with the groups. In PROMs of abduction and external rotation of shoulder significant improvements were observed in only group 1 (p<0.001, p<0.001 respectively). There was not any significant improvement on Brunnstrom stage of motor recovery in both groups (p>0.05). CONCLUSION: In conlusion that TENS therapy together with conventional rehabilitation could be used as a good alternative therapy in patients with hemiplegic shoulder pain. |
CLINICAL CONCEPTS AND COMMENTARY | |
7. | Greater occipital nevre block in migraine headache: Preliminary results of 10 patients Suna Akın Takmaz, Nurten İnan, Serap Üçler, Mehmet Akif Yazar, Levent İnan, Hülya Başar PMID: 18338279 Pages 47 - 50 Despite a favorable clinical experience, there are little evidence existing about the effects of greater occipital nerve (GON) block in migraine treatment. In an open, preliminary trial we evaluated the use of GON block with 0,5 % bupivacaine, in prevention of migraine attacks.Ten women suffering from migraine diagnosed according to International Headache Society criteria were evaluated in a six-month study. During the treatment and entire follow-up period, the patients avoided prophylactic therapy. Patients were given 3 times GON blocks with 0,5 % bupivacaine one week intervally. Afterwards blocks were repeated for a maximum 5 sessions depending on the clinical response. Clinical evaluation was assessed using a monthly Total Pain Index (TPI), and recording of the number of migraine attacks and analgesic consumption per month. At the end of the first month, TPI reduced from 308,3±55,2 to 114,1±4,7 (p=0,005). When compared to the values before treatment, it was seen that during the first month mean number of migraine attacks reduced from 12,6±4,8 to 4,9±1,8, mean analgesic consumption reduced from 11,0±3,4 to 4,9±1,1, and these reductions lasted up to six months. During the treatment no severe advers effect was seen in all cases. Although preliminary and obtained on a limited number of patients, our results show that the GON block with 1,5 ml of 0,5% bupivacaine does not have any severe advers effect and is effective in the prevention of migraine attacks. |
ABSTRACTS | |
8. | Abstracts Pages 51 - 54 Abstract | |
BOOK REVIEW | |
9. | Book Review: Interventional Spine an Algorithmic Approach Gül Köknel Talu Pages 55 - 56 Abstract | |