Pain in the masticatory muscles and temporomandibular joint is the main symptom of temporomandibular disorders. The etiology of temporomandibular disorder pain is multifactorial. Several studies have reported that there are predisposing, initiating and aggravating factors contributing this disorder. Although factors such as trauma, occlusal discrepancies, stress, parafunctions, hypermobility, age, gender and heredity has been implicated in the maintenance of temporomandibular disorder pain, there are still controversies for the actualy etiology. This review will summarize the past and current concepts that is related to the etiology of arthrogenic and myogenic originated temporomandibular pain.

Objectives: Myofascial pain syndrome is a disorder characterized by hypersensitive sites called trigger points at one or more muscles and/or connective tissue, leading to pain, muscle spasm, sensitivity, rigor, limitation of movement, weakness, and rarely, autonomic dysfunction. Various treatment methods have been used in the treatment of myofascial pain syndrome. Among these, stretch and spray technique, trigger point injection, dry needling, pharmacological agents, and physical therapy modalities have been proven effective.
Methods: Sixty-five patients with acute myofascial pain syndrome were recruited into the study. Patients were randomized into three groups. The first group received thiocolchicoside ointment onto the trigger points, the second group received 8 mg thiocolchicoside intramuscular injection to the trigger points, and the third group received both treatments. Treatment was applied for 5 consecutive days. Algometric and goniometric measurements and pain severity assessments with visual analog scale (VAS) were repeated on the first, third, and fifth days of the treatment.
Results: Pain severity measured with VAS significantly improved after the first day in the mono-therapy groups and after the third day in all groups. While significant improvement was observed in all three groups in right lateral flexion measurements, no significant changes were observed in the combined treatment group in left lateral flexion measurements.
Conclusion: Thiocolchicoside can be used in the treatment of myofascial pain syndrome. The ointment form may be a good alternative, particularly in patients who cannot receive injections.

The efficiency of non-invasive techniques including transcutaneous electrical nerve stimulation (TENS) and laser treatments and invasive techniques including lidocaine and botulinum toxin-A injection, in the patients with myofascial pain syndrome (MPS) were compared in this study.
Hundred patients who admitted to Firat University Hospital Pain Department and who were diagnosed as MPS were included in the study. Patients were randomized into four groups and each group consisted of 25 patients. 60 sessions of TENS and 20 sessions of laser treatments were performed to the first and second groups, respectively. Lidocaine and botulinum toxin-A were injected to the third and fourth groups, respectively. 2ml (20 mg) %1 lidocaine was injected to each patient twice a week for one month in Group I. 25 U (0.5 ml) of botulinum toxin-A was injected to each patient only once in Group II. Pain was evaluated with visual analogue scale (VAS), palpable muscle spasm scoring (PMSS) and anesthesiometer at baseline, 15, 30 and 45 days.
There was no statistically significant difference between the groups with respect to age, sex and education level. Pain control was statistically better in Group III compared with the other groups with respect to VAS, PMSS and anesthesiometer scores.
In conclusion, botulinum toxin-A injection provided better pain control when compared to trigger point injection with lidocaine and non-invasive techniques including TENS and laser treatments.

Objectives: This study assessed the efficacy and adverse effects of preoperatively administered lornoxicam versus tramadol in adults, for post-tonsillectomy pain.
Methods: This prospective, double blind, randomized, clinical research was performed in the Ear, Nose and Throat Surgery Room in the Department of Anesthesia and Reanimation, Gazi University Faculty of Medicine. Forty American Society of Anesthesiologists (ASA) status I-II patients of both gender, aged 18-55 years, were included.
Results: Tonsillectomy patients were divided into two groups: Those in Group L received 8 mg lornoxicam and in Group T received 50 mg tramadol intravenously just before induction of general anesthesia. Induction and maintenance of anesthesia (propofol, atracurium, nitrous oxide and sevoflurane) were standardized. Heart rate and systolic and diastolic arterial pressure data were monitored during the anesthesia. Intra-operative bleeding was scored by the same operator using a 5-point scale at the end of the surgery. Postoperative pain on swallowing was scored by a blinded anesthesiologist using Verbal Rating Scale (VRS) on arrival in the Post Anesthesia Care Unit (T0), at 30 min (T1), 1h (T2), 2h (T3), 3h (T4), 4h (T5), 5h (T6), and 6h (T7) thereafter. During the first postoperative 6 hours, when VRS ≥2, 1mg.kg-1 im meperidine was used as a rescue analgesic. Adverse effects in the postoperative 6h period were noted. T1 and T2 pain scores in Group T were higher than in Group L (p=0.049, p=0.007, respectively). The number of patients requiring rescue analgesics during the first 6 hours in Group L was lower than in Group T. Nausea-vomiting, bleeding and postoperative hemorrhage values were similar between Group L and Group T.
Conclusion: Preoperative 8 mg lornoxicam was more effective than 50 mg tramadol with respect to early postoperative tonsillectomy pain in adult patients, and side effects were similar.

Spondylodiscitis is a serious and important clinical problem that can occur after iatrogenic interventions and should be kept in mind. Spondylodiscitis after transrectal ultrasonography (TRUS)-guided prostate biopsy is an extremely rare complication. A 70-year-old patient who presented with severe back pain, intermittent high fever, loss of appetite, and fatigue following TRUS-guided prostate biopsy was diagnosed with thoracic spondylodiscitis (T6-7) after clinical, laboratory and radiological assessments and he was treated surgically. We present this case to remind medical professionals to keep spondylodiscitis in mind in the presence of sudden onset back and low-back pain, since TRUS-guided prostate biopsy is a frequently used procedure.

The use of ultrasound provides clinicians the ability of doing nerve blocks that would not be feasible with the aid of nerve stimulator alone. It is helpful when motor response to nerve stimulation is difficult or even impossible to evaluate in cases like arthrodesis, total absence of a joint or already blocked extremity during ongoing surgery. A 28 years old ASA I female patient presented for right forearm surgery for nerve and tendon injury due to trauma. She had an ultrasound guided lateral sagittal infraclavicular block (LSIB) using a relatively low dose local anesthetic mixture (10 ml of lidocaine 2% and 10 ml of 0.75% levobupivacaine). Twenty minutes after block pain free surgery started. Two hours after the start of surgery patient had some pain on surgical site. Instead of converting to general anesthesia we decided to supplement the block with the guidance of ultrasound. Using LSIB technique 10 ml of lidocaine 2% was administered directly posterior to axillary artery. Patient was pain free within a few minutes and surgery was completed uneventfully within 45 minutes. Although incomplete blocks before surgery starts can be supplemented by different means, intraoperative pain perception often results in conversation to general anesthesia. We believe that with the aid of ultrasound guidance intraoperative block supplementation is possible thus the need to convert to general anesthesia during prolonged surgery or incomplete blocks can be avoided during hand surgery.