More than 75% of patients undergoing surgery suffer from acute pain. Most of this pain transforms into chronic pain. Currently, treatment of postoperative pain is based mainly on opioids, but results are not quite satisfactory. Postoperative pain is defined as a condition of tissue injury together with muscle spasm after surgery. Recently, peripheral and central sensitization has been shown within the mechanisms of postoperative pain generation. Accordingly, anti-convulsive drugs have been used successfully for the treatment of postoperative pain. Therefore, the issue of whether postoperative pain is purely a nociceptive pain remains a topic of debate. Considering that every surgical intervention might result in a nerve injury, it is not surprising to find neuropathic pain features within the postoperative pain itself. In light of these findings, it would be more precise to define postoperative pain as a combination of inflammatory and neuropathic components instead of as pure pain. Thus, the appropriate postoperative treatment should be planned involving both of these components.

Objectives: We aimed to determine the hemodynamic effects and postoperative pain control quality of ropivacaine and ketamine addition to ropivacaine in children undergoing inguinal hernia repair with caudal anesthesia.
Methods: A total of 45 patients (1-4 years) scheduled to undergo inguinal hernia repair were studied. Anesthesia was induced with sevoflurane in O2/N2O and vecuronium was administered to facilitate endotracheal intubation. Anesthesia was maintained with sevoflurane in O2/N2O. Patients were randomly divided into three groups. Following endotracheal intubation, we administered 2 mg/kg 0.2% ropivacaine to Group R; 0.5 mg/kg ketamine to Group K; and 2 mg/kg 0.2% ropivacaine plus 0.5 mg/kg ketamine to Group R+K caudally. Pain levels were evaluated via modified CHEOPS, and sedation levels were assessed by the Wilson Sedation Scale.
Results: At the postoperative 45th minute (min), the CHEOPS score was significantly higher in Group R compared to Group K and Group R+K (p<0.05). This score was significantly higher in Group R than in Group R+K at the postoperative 60th min (p<0.05). The effective analgesic period was significantly higher in Group K (852±309 min) and Group R+K (1032±270 min) than in Group R (435.5±273 min) (p<0.05). The analgesic requirement in the first 24 hours postoperatively was lower in Group R+K than the other groups. Sedation scores were below 2 in all groups. There were no significant differences between groups regarding adverse events.
Conclusion: The results of the present study indicate that caudal ropivacaine, ketamine and ropivacaine plus ketamine provided effective postoperative analgesia. Additionally, ketamine combined with ropivacaine lengthened the duration of analgesia while lowering analgesic requirements.

Objectives: This study was conducted to compare the emotional status and physical activity level in women with chronic widespread pain (CWP) and fibromyalgia (FM).
Methods: Thirty-three women with CWP above the waist, including the upper extremities, and 68 women with FM were evaluated. To determine physical and emotional status, the Fibromyalgia Impact Questionnaire (FIQ), the Experience of Physical Activity Instrument, the Leisure Time Physical Activity Instrument, the Physical Activity at Home and Work Instrument, and the Hospital Anxiety and Depression Scale (HADS) were used.
Results: The CWP group had higher physical impairment scores than the FM group (p<0.05); however, the women with FM reported that they felt worse during the previous week than the other group before the interview. They also had higher scores for pain, morning tiredness and depression (FIQ 5, 7 and 10). Emotional symptoms were significantly elevated in FM patients versus the CWP patients. Conversely, no significant differences were found between the groups concerning the health status (FIQ-total) and physical activity (p>0.05). The results indicate that increased pain intensity and spread of pain have negative effects on both physical functioning and emotional status.
Conclusion: The women with FM reported much more severe clinical symptoms than those with CWP. Therefore, in addition to physical functioning, the emotional status of women with chronic pain should also be evaluated.

Objectives: In this study, we aimed to evaluate the websites directed at providing information about low back pain with respect to their content and quality.
Methods: The websites were detected by scanning the words ‘low back pain’ from the Turkish pages module of the Google search portal. One hundred and fifty websites introduced on the first 20 pages were evaluated; the 65 websites determined to fulfill the desired criteria were analyzed in detail.
Results: Twenty of the 65 websites were excluded due to low quality, extraction from another website, sales promotion-related books/products, or qualified as news. In the majority of websites, no site administrator was indicated. When an administrator was indicated, the common specialities were physical therapists (13%), neurosurgeons (8%) and anesthesiologists (4%). Ten of the websites (22%) provided a pain definition close to international standards, whereas pain classification was available on most of the websites (84%). There was no mention of methods of pain scoring on any of them. Treatment modalities for which information was given included mostly behavioral, physical and pharmacological therapies, respectively. Complementary techniques, in order, included acupuncture, yoga and bioenergy. On 10 websites, text was supported with medical photographs, and videos were available on two. None of the websites had a provision for selection of other languages.
Conclusion: Websites directed to low back pain should be enriched with respect to scientific content, thereby serving to increase the level of social education related to pain management.

Objectives: In this study, the effects of administration of subfacial levobupivacaine infusion with the ON-Q pain pump system were investigated in elective cesarean operations for postoperative pain control and tramadol-sparing effect.
Methods: Fifty ASA I-II patients scheduled for cesarean operation were enrolled into this study. Patients were randomly divided into two groups: Group I served as a control group, without the ON-Q pain pump system, whereas Group II received the ON-Q pain pump system with subfacial 0.25% levobupivacaine infusion for 24 hours at 4 ml/hour. All patients received a standard anesthetic protocol. At the end of the surgery, all patients received tramadol i.v. via a PCA (Patient Controlled Analgesia) device. Pain scores were assessed at 2, 6, 12 and 24 hours postoperatively. Tramadol consumption and adverse effects were noted in the first 24 hours following surgery.
Results: The pain scores were significantly lower in the levobupivacaine group when compared with the control group (p<0.05). The cumulative tramadol consumption was lower in the levobupivacaine group than in the control group (p<0.05). Group II used less antiemetic and had less postoperative nausea and vomiting, and the difference was statistically significant (p<0.05).
Conclusion: No complication occurred as a result of the ON-Q pain pump system. Subfacial levobupivacaine infusion with the ON-Q pain pump system diminished postoperative pain and the need for tramadol use following cesarean operations.

Objectives: Anesthesiology and Algology healthcare workers work under difficult conditions a majority of the time, and their physical and mental status must be determined in order to improve working conditions. In this study, the main goal was to evaluate the burnout level of Anesthesiology and Algology healthcare workers in the Middle Anatolian region of Turkey.
Methods: A questionnaire was sent to Anesthesiology and Algology healthcare workers of hospitals with an Algology clinic in the Middle Anatolian region and were returned by e-mail in March and April 2008. In the questionnaire, descriptive features and the Turkish validated Maslach burnout inventory (MBI) were evaluated. The MBI has 3 aspects: emotional exhaustion (EE), depersonalization (D) and personal accomplishment (PA). All questionnaires were evaluated by SPSS 11.5 program.
Results: 113 people were enrolled, of whom 18.8% (21) were specialist doctors and 41.1% (46) were residents. Among the doctors, the mean daily and weekly working periods were 10.3±2.3 and 61.3±19 hours, respectively. The period spent by doctors in Algology was 100% in 9.6%, 75% in 9.7% and 25% in 61.5%. Working conditions were evaluated, and 20.9% of healthcare workers were unsatisfied with the physical conditions, 19.3% with the working period and 52.5% with wages. MBIs in doctors were calculated as EE 14.7±5, D 5.7±3.5, and PA 21.6±4.2.
Conclusion: This study revealed similar high burnout scores among healthcare workers, which reflect a serious burnout in the Anesthesiology and Algology group in Turkey. Burnout may be affected by dissatisfaction with working conditions. Improvement in physical conditions and reorganization to achieve psychological support might be helpful towards improving the health of healthcare workers.

Post-thoracotomy pain syndrome is a chronic pain syndrome and is seen in approximately 5-65% of patients after thoracotomy. Post-thoracotomy pain syndrome is generally considered to be neuropathic pain due to intercostal nerve injury. A 21- year-old male patient experienced pain radiating along the incision after the thoracotomy operation. Allodynia and hyperalgesia were determined in the upper part of the incision; visual analogue scale (VAS) score was 10. Gabapentin and amitriptyline were started as medical treatment. Three months later, the patient complained of concentration difficulty at work and in daily life. Medical therapy was planned again. In view of the persisting complaints, epidural pulse radio frequency with Pasha-Cath was scheduled. After 3 weeks and also at 3 months, the VAS was 2. After 6 months, VAS remained at 2. As a result, we concluded that epidural pulse radio frequency with Pasha-Cath is an alternative and effective choice of treatment in post-thoracotomy pain syndrome when the medical treatment alone is not sufficient.