Kronik aðrý sendromu kompleks bir durum olup etyolojisinin net olmamasý ve deðiþik tedavilere iyi yanýt alýnamamasý ile hekimler tarafýndan büyük bir bilinmezlik olarak kabul görmektedir. Kronisite, beklenen iyileþme sürecinden sonra da aðrýnýn devam etmesi þeklinde yorumlanýr. Hastalarýn yaþamý üzerine kronik aðrýnýn etkisi hafif kýsýtlanmadan baðýmsýzlýðýn tümden kaybedilmesine kadar deðiþen bir yelpazede ortaya çýkar. Kronik aðrý sendromlarýnýn rehabilitasyonu multi-disipliner yaklaþým gerektirir ve fizyoterapi, uðraþý terapisi, manuel terapi, akuaterapi, biliþsel/davranýþsal terapi, biofeedback, psikoterapi ve diðer birçok yeni tedavi yöntemini içerir. Son yýllarda, kronik aðrý tedavisine bakýþ büyük oranda deðiþmiþ ve en iyi yaklaþýmýn multidisipliner olduðu, rehabilitatif sürecin tedaviye dahil edilmesi gerektiði anlaþýlmýþtýr. Tedavi protokolü bireysel olarak planlanmalý ve gerektiðinde modifiye edilmelidir. Birçok metodun kombine edilmesi söz konusu ise de özellikle yeni tedavi seçenekleri üzerinde uzun dönemde yapýlmýþ kanýta dayalý çalýþmalara ihtiyaç vardýr.

Chronic pain syndrome (CPS) is a complex condition that presents a major challenge to physicians because of its unknown etiology, and poor response to all kinds of therapies. It has been suggested that chronicity should be considered when pain persists longer than the acceptable healing time. The impact of chronic pain on patients' lives varies from minor limitations to complete loss of independence. The rehabilitation of chronic pain syndromes is multi- disciplinary and involves physical therapy, occupational therapy, manual therapy, aquatherapy, cognitive/behavioral therapy, biofeedback, psychotherapy and some new therapies. In recent years, point of view in chronic pain management changed substantially chronic pain syndrome is managed best with a multidisciplinary approach, including rehabilitative process. Treatment protocol should be planned and modified individually. Combination of several methods has been tried, but, long term evidence-based studies are needed for new treatment modalities.

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Amaç: Vertebra kompresyon kýrýklarýnda perkütan vertebroplasti (PVP) uygulamasýnýn etkinliðini ve komplikasyonlarýný araþtýrmak.
Gereç ve Yöntem: Çalýþmamýz Ekim 2006 ile Aralýk 2009 tarihleri arasýnda benign ya da malign nedenlere baðlý vertebral kompresyon kýrýðý olan hastalara uygulanmýþ olan PVP uygulamalarýnýn retrospektif olarak derlenmesi ile yürütülmüþtür. Hastalarýn aðrýlarý görsel analog skala (VAS) ile deðerlendirildi. Ayrýca enjekte edilen sement miktarý, korpus dýþýna sement kaçýþýnýn olup olmadýðý, operasyon esnasýnda veya sonra karþýlaþýlabilecek komplikasyonlar kayýt altýna alýndý. Hastalarýn yaþlarý, cinsiyetleri, aðrý süreleri, kýrýk vertebra sayýsý ve düzeyleri ile uygulama sonrasý takip süreleri de deðerlendirme için toplandý.
Bulgular: Toplam 15 hasta deðerlendirilmeye alýndý. Hastalarýn 13 tanesi kadýnlardan oluþurken, ortalama yaþ 69.5±8.5 yýl idi. 15 hastaya toplam 19 PVP uygulanmýþtýr. Baþlangýç VAS skorlarý 7.9±1.6 iken, ortalama 10.3±3.8 (aralýk: 4-18) aylýk takip sonunda 2.6±2.7 düþmüþtü. Aðrý skorunda baþlangýca göre en az %50 azalma bildiren hasta oraný %80 olarak hesaplanýrken, hastalarýn %86.7’si VAS skorlarýnda en az 2 puanlýk azalma bildirmiþlerdir. Üç hastada komþu intervertebral diske sement kaçaðý geliþti.
Sonuç: Medikal tedaviye yanýt vermeyen semptomatik vertebra kompresyon kýrýklarýnda perkütan vertebroplasti, oldukça düþük komplikasyon oraný ile baþarýyla uygulanabilmektedir.

Objectives: To investigate the effectiveness and complications of the percutaneous vertebroplasty (PVP) applications in vertebral compression fractures.
Methods: Our study was carried out as a retrospective study in which PVP conducted on patients with vertebral compression fractures due to benign or malign reasons between October 2006 and December 2009. The patients’ pains were evaluated on the visual analog scale (VAS). In addition, the amounts of cement injected, whether any leakage out of the vertebrae corpus were seen or not, as well as any complications resulting from the application during or after the operation were recorded. The age and gender of the patients, the duration of pain, number and location of fractured vertebrae, and the length of follow-up time were also collected for evaluation.
Results: A total of 15 patients were included in the assessment. Of the patients, 13 were women, while the mean age was 69.5±8.5 years. A total of 19 PVP were applied out on the 15 patients. While initial VAS scores were 7.9±1.6, at the end of an average 10.3±3.8 (range: 4-18) months of follow up, they had fallen to 2.6±2.7. 80% of the patients reported at least a 50% reduction in pain scores compared to initial pain scores, and 86.7% of them reported at least a 2 points decrease in VAS scores. In three patients, a leakage of cement into the intervertebral disc occurred.
Conclusion: Percutaneous vertebroplasty in symptomatic vertebral compression fractures not responding to medical treatment may successfully be used at low rate of complications.

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Amaç: Transdermal fentanil (TDF) günümüzde kronik kanser aðrýsýnýn tedavisinde sýklýkla tercih edilen bir ajandýr. Biz, çalýþmamýzda TDF’in analjezik etkinliðini, yan etki sýklýðýný ve hasta memnuniyetini; eriþkin ve geriatrik hasta grubunda karþýlaþtýrmayý hedefledik.
Gereç ve Yöntem: Aðrý polikliniðimizde takip edilen hastalar içerisinden kriterlere uyan 181 hastanýn verileri (TDF kullanýmý ile baþlayan 4 aylýk dönem) retrospektif taranarak çalýþmaya alýndý. Hastalar yaþlarýna göre Grup E ( Grup Eriþkin; 18 ile 65 yaþ arasý, n= 95 ) ve Grup G ( Grup Geriatrik; 65 yaþ üstü, n= 86 ) olarak iki gruba ayrýldý. Hastalarýn demografik özellikleri, kanser türleri, kanser aðrýsý çekme süreleri, visüel analog skala ( VAS ) skorlarý, tedavi deðerlendirme skalasý ( TDS ) skorlarý, kullandýklarý TDF dozu, belirttikleri yan etkiler ve TDF tedavisi sonlandýrýlan hasta sayýsý kaydedildi.
Bulgular: Her iki grupta da TDF kullanýmý sonrasý aðrý þiddetinde azalma saptandý (p<0.001). Tedavi deðerlendirme skalasý skoru 1. ay sonunda gruplar arasýnda benzer fakat izleyen diðer zamanlarda Grup G’de daha düþük saptandý (p<0.05). Grup G’de konstipasyon, aðýz kuruluðu, somnolans, dispne daha sýk görüldü ve yan etkiler nedeniyle TDF tedavisi sonlandýrýlan hasta sayýsý daha fazlaydý (p<0.05).
Sonuç: TDF, eriþkin hasta grubunda olduðu gibi geriatrik hasta grubunda da kanser aðrýsý tedavisinde uygun bir seçenektir. Fakat geriatrik hastalarda yan etki insidansýnýn daha fazla olduðu unutulmamalý ve bu hasta grubu daha yakýndan takip edilmelidir.

Objectives: The transdermal fentanyl ( TDF ) patch has become widely used in the treatment of cancer pain. We aimed to compare analgesic efficiency, side effects and patient satisfaction of TDF in the adult and geriatric patients.

Methods: Data of the 181 patients whom we observed in our pain clinic have been included in this retrospective study. There were 95 patients in the adult group ( Group A ) and 86 patients in the geriatric group ( Group G ). Demographic data, cancer type, duration of pain, side effects, visual analog scale ( VAS ) score, treatment assessment scale ( TAS ) score, TDF dosage and the number of patients in whom therapy has beeen terminated.

Results: After the usage of TDF reducement in pain score have been observed in the both groups ( p < 0.001 ). TAS score was similar between the groups at the end of the first mounth, but it was fewer in Group G, in the following months. Constipation, dry mouth, somnolance and dyspnea were seen more frequently in group G. Because of these side effects, the number of patients in whom therapy was terminated were more in group G.

Conclusion: TDF patch is a good choice for cancer pain treatment for both adults and geriatric patients. We have seen that incidence of side effects are more in the geriatric patients. Because of that, geriatric patients needed to be treated more carefully.

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Amaç: Migren ile serotonin düzeyleri arasýndaki iliþki net deðildir. Daha önceki çalýþmalarda migrenlilerde plazma serotonin düzeyleri araþtýrýlmýþtýr. Ancak güncel literatürde santral sinir sistemindeki düzeyi yansýtmasý açýsýndan trombositlerdeki serotonin düzeyinin daha güvenilir sonuçlar vereceði belirtilmektedir.
Gereç ve Yöntem: Çalýþma Uluslararasý Baþaðrýsý Derneði’nin ölçütlerine göre taný almýþ 30 aurasýz migrenli kadýn hasta ile yaþ ve cinsiyet olarak uyumlu 20 saðlýklý kontrolle gerçekleþtirildi. Tüm hasta ve kontrollere Hamilton Depresyon Ölçeði (HAM-D) uygulandý ve 10 puanýn üzerinde alanlar çalýþmaya alýnmadý. Olgulardan sabah açlýk venöz kan örnekleri alýndý. Trombositten zengin ve fakir plazma hazýrlanarak yüksek performanslý sývý kromatografisi cihazýnda deðerlendirildi ve trombosit serotonin konsantrasyonu hesaplandý.
Bulgular: Çalýþmamýzda migrenlilerin trombosit serotonin konsantrasyonunu kontrol gurubuna göre istatistiksel olarak anlamlý düzeyde düþük olduðu saptandý. Hasta grubunda ailede migren görülme oraný kontrol grubundan belirgin oranda yüksek bulundu. Migrenlilerin HAM-D puanlarý kontrol grubundan belirgin düzeyde yüksek bulundu. Atak sayýsý ve süresi ile düþük serotonin düzeyleri arasýnda zayýf bir korelasyon görülse de istatiksel olarak anlamlý bir iliþki saptanmadý.
Sonuç: Sonuçlarýmýz migren patojenezinde düþük serotonin düzeylerine ve migrende kalýtýmýn rolüne iþaret etmektedir. Çalýþmaya alýnan tüm olgular klinik depresyon puanýnýn altýnda seçilmiþ olmalarýna raðmen, migrenlilerde kontrollere göre HAM-D puanlarý daha yüksek bulunmuþtur. Bu durum migrenlilerde düþük serotonin düzeyi ile iliþkili subklinik depresyonun varlýðýna iþaret edebilir. Hem aðrýlý hem de aðrýsýz dönemleri içeren ve serotonin dýþýnda da belirteçleri kapsayan geniþ ölçekli çalýþmalara ihtiyaç vardýr.

Objectives: The relation between migraine and serotonin levels is not clear. Plasma serotonin levels in migraineurs were studied in previous studies. However, in the current literature, it is stated that measuring serotonin level in platelets will give more reliable results.
Methods: Thirty female migraine without aura patients who have been diagnosed according to criteria of International Headache Society and 20 healthy controls were enrolled in the study. The Hamilton depression scale (HAM-D) was applied to all subjects and the ones who have 10 and above were not considered. Fasting venous blood samples were taken from subjects in the morning. Platelet rich and poor plasma were prepared. The samples measured with high performance liquid chromatography and platelet serotonin concentration was calculated.
Results: Our results suggest that migraineurs have significantly low platelet serotonin concentration than the controls. The ratio of family history of migraine in patient group is clearly higher than controls. HAM-D scores in migraineurs were significantly higher in control group. Although, there was a weak correlation between low serotonin levels and attack duration and number, there was no statistical significance.
Conclusion: Our results suggest that the role of heredity and low serotonin levels in migraine pathogenesis. Despite, all subjects enrolled in the study had scores under depression level, HAM-D scores were higher in migraineurs than controls. It may indicate the presence of subclinical depression associated with low serotonin levels in migraineurs. Extensive studies including both serotonin and other markers during pain and pain free periods are needed.

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Amaç: Bu araþtýrma aðrý yaþayan bireylerin Tamamlayýcý ve Alternatif Tedavi’ye (TAT) iliþkin bilgi, tutum ve davranýþlarýný deðerlendirmek amacýyla tanýmlayýcý olarak yapýlmýþtýr.
Gereç ve Yöntem: Araþtýrma 5 Eylül -30 Kasým 2010 tarihlerinde Erzurum il merkezindeki bir aile saðlýðý merkezine gelen, 535 aðrý yaþayan yetiþkin birey üzerinde yapýlmýþtýr. Veriler anket formu ile toplanmýþtýr, ve bilgisayar ortamýnda deðerlendirilmiþtir.
Bulgular: Bireylerin %42.4’ü yaþadýklarý aðrýyý gidermek için TAT kullandýðýný, %83.7’si kullandýklarý yöntemin aðrýlarýný geçirdiðini ve %39.6’sý ise tavsiye üzerine TAT’ý kullandýðýný belirtmiþlerdir. Katýlýmcýlarýn %95.5’i pozitif düþünmenin küçük hastalýklarý yenmemize yardýmcý olabileceðine, %91.6’sý TAT’ýn daha fazla bilimsel testlere tabi tutulmasý gerektiðine, %65.6’sý TAT’ýn insanlarýn tam bir tedavi almasýný önleyerek tehlikeli olabileceðine, %68.4’ü TAT’ýn yalnýzca geleneksel týbbýn hiçbir çözüm sunamadýðý zaman son çare olarak kullanýlabileceðine, %93.6’sý insanlarýn bir dizi stresli olay yaþamasý durumunda muhtemelen hasta olabileceðine, %61.9’u doktora gitmeden önce TAT’ýn denemeye deðer olmadýðýna, %68.2’si TAT’ýn yalnýzca küçük rahatsýzlýklarda kullanýlmasýna daha ciddi hastalýklarýn tedavisinde kullanýlmamasý gerektiðine, %76.3’ü ise TAT’ýn vücudun kendi savunmasýný güçlendirerek kalýcý tedaviye yardým etmekte olduðuna inandýklarý görülmüþtür.
Sonuç: Sonuç olarak aðrý yaþayan bireylerin öncelikle modern týbba baþvurduklarý ve TAT’a karþý olumlu bir tutum içinde olduklarý belirlenmiþtir.

Purpose: This study was carried out as descriptively in order to evaluate the knowledge, attitude and behaviors of individuals who suffer from pain towards Complementary and Alternative Medicines (CAM).
Material and Method: The research was applied to 535 adult individuals suffer from pain who visited a family health centre in Erzurum between September 5th and November 30th in 2010. The data were collected by questionnaire form, and computer environment are evaluated.
Results: 42.4% of the individuals mentioned that they use CAM in order to eliminate pain, 83.7% of them mentioned that the method they applied eliminated their pain and 39.6% of them used CAM by the recommendation. It was observed that 95.5% of the participants believe in that positive thinking helps the patients recover from their minor diseases, 91.6% of them believe in that it is necessary to perform much more scientific tests on CAM, 65.6% of them believe in that CAM may be dangerous, 68.4% of them believe in that CAM may be used as a last resort, 93.6% of people believe in that they are likely to be ill by range of stressful events, 61.9% believe in that it is worthless to try CAM before seeing the doctor, 68.2% believe in that CAM should not be used for serious diseases, 76.3% believe in that CAM helps the lasting treatment.
Conclusion: It was founded out that people who suffer from the pain apply for the modern medicine and have positive attitudes towards CAM.

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Servikal radikülopati toplumda yaygýn olup, tedavisinde kullanýlan yöntemler konservatif tedaviden cerrahi tedaviye kadar geniþ bir aralýkta yer almaktadýr. Optimal radiküler aðrý tedavisinde invaziv yaklaþýmlar açýsýndan henüz tam bir fikir birliði bulunmamaktadýr. Servikal diskopati semptomlarý gösteren hastalarda servikal epidural steroid injeksiyonu (SESÝ) bu tedavi yaklaþýmlarýndan birisidir. 1 yýllýk dönem içerisinde semptomatik servikal radikülopati tanýsý almýþ 58 hastaya uyguladýðýmýz SESÝ tedavisinin 6 aylýk dönemdeki sonuçlarý retrospektif olarak incelenmiþtir. Hastalar oturur ve baþ fleksiyon pozisyonda iken standart sterilizasyon sonrasý C7-T1 aralýðýndan median yaklaþým ve asýlý damla tekniði kullanýlarak epidural aralýða girildi ve daha önceden hazýrlanmýþ olan, içerisinde 80 mg triamsinolon ile 10 mg levobupivakainin bulunduðu 6 ml’lik solüsyon enjekte edildi. SESÝ uygulamasý sonrasý hastalarýn VAS deðerlerinin tedavi öncesi deðerlere göre anlamlý olarak daha düþük bulundu. SESÝ tedavisinde baþarý oranlarý 1. ayda %93, 3. ayda %86 ve 6.ayda %72 idi. SESÝ uygulamasý servikal radikülopati tedavisinde etkili bir yöntemdir ve hastalarýn cerrahiye ihtiyaç duyma oranlarýný düþürmektedir.

Cervical radiculopathy is widespread in society, the methods used in the treatment of a wide range of conservative treatment, surgical treatment is located. Invasive approaches are optimal for the treatment of radicular pain there is no consensus yet. However, cervical epidural steroid injection (CESI) has been used for the patients with symptoms of cervical discopathy. The 6-month period of treatment results of 58 patients, diagnosed as symptomatic cervical radiculopathy and applied CESI within one year period, were evaluated retrospectively. While the patients were in a sitting position and the head flexed after sterilization, the C7-T1 epidural space was entered using the median approach and the hanging drop technique and the 6 ml solution, consisted of triamsinolon 80 mg with 10 mg levobupivacaine, was injected prepared previously. Following the CESI application, the posttreatment VAS values of the patients were significantly lower than pretreatment VAS values. The treatment success rates for CESI application were 93% in first month, 86% in 3th months, 72% in 6th months respectively. The CESI application is an effective method in the treatment of cervical radiculopathy and reduces the rate of patients needing surgery.

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Paget hastalýðý kemik aðrýsý, deformitesi, patolojik kýrýklar, nörolojik semptomlarla (baþaðrýsý, iþitme kaybý, tinnitus vb.) karakterize kronik, fokal bir iskelet hastalýðýdýr.
Ýleri yaþ grubunda sýk görülür. Etyolojisinde viral ve genetik faktörler rol oynar. Hastalarýn çoðu asemptomatiktir. Taný sýklýkla radyografi çekilirken rastlantýsal bir bulgu olarak veya beklenmeyen serum alkalen fosfataz yüksekliði ile konur. Geliþebilecek kemik deformiteleri ve nörolojik komplikasyonlar nedeniyle yaþam kalitesi olumsuz etkilenir. Bu nedenle erken taný ve tedavi önem taþýr. Tedavide en sýk kullanýlan ilaçlar bifosfanatlardýr.
Burada baþaðrýsý yakýnmasý ile baþvuran ve Paget hastalýðý tanýsý alan bir olgu sunulmuþtur. Paget hastalýðýnýn taný ve tedavisi, nörolojik komplikasyonlarý literatür ýþýðýnda gözden geçirilmiþtir.

Paget’s disease of bone is a chronic, focal skeletal disease which is characterized with bone pain and deformity, pathological fractures and neurological symptoms such as headache, hearing loss and tinnitus, etc. The frequency of the the disease increases in further ages. Viral and genetical factors play role in the etiology.. In the majority of cases are asymptomatic. It is often diagnosed with an incidental finding on radiography or an unexpected high serum alkaline phosphatase level. Bone fractures or neurological complications can negatively affect the quality of life. Early diagnosis and treatment is very because of these reasons. Bisphosphonates are the most frequently used medication in the treatment.
We present a case, who seeked medical help because of headache and diagnosed as Paget’s disease. Neurological complications, the diagnosis and treatment of Paget’s disease were reviewed in the literature.

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Abdominal kutanöz sinir tuzak sendromu ( AKSES ) klinisyenler tarafýndan nadir görülen bir hastalýk gibi görülmesine karþýn, klinik belirtiler ile karýn aðrýsýnýn açýklanamadýðý zamanlarda olaðan tanýlar içinde en üst sýralarda olmasý gereken bir sendromdur.
Karýn aðrýsý çoðu zaman biz hekimler tarafýndan intraabdominal sebeplere dayandýrýlmaktadýr. Sonuç olarak hasta için gereksiz konsültasyonlar ve testler istenmekte hatta hasta gereksiz abdominal cerrahiye maruz kalabilmektedir. Bu tip aðrýsý olan hastalar birçok kliniðe gitmekte çoðu zaman da asýl tanýlarý konulamadýðý için psikiatrik hasta olarak deðerlendirilmektedirler. Aslýnda, abdominal duvar aðrýsýnýn sýk görülen nedenlerinden biri de rektus abdominis kasýnýn lateral kenarýndaki sinir tuzaklanmasýdýr.
Bu yazýmýzda kronik karýn aðrýsý ile gelmiþ fakat bize gelene kadar kendisinden birçok konsültasyon, tetkik istenen farklý klinikler tarafýndan tedaviye alýnan ve en son olarak abdominal cerrahiye karar verilen hastanýn teþhisi ve tedavisi ile ilgili bilgileri paylaþmak istiyoruz.

Although abdominal cutaneous nerve entrapment syndrome (ACNES) is accepted as a rare condition, it is a syndrome that should be more common diagnosis when the clinical signs can not explain the cause of abdominal pain.
Abdominal pain is commonly based on intra-abdominal causes by physicians. Consequently redundant tests and consultations are asked for the patients, and unnecessary surgical procedures may be applied. The patients with these types of pain are counsulted by many clinics, and because their definitive diagnoses can not be done they are assessed as psychiatric patients. Actually a common cause of abdominal wall pain is the nerve entrapment on the lateral edge of rectus abdominis muscle.
In this paper we would like to share information about diagnosis and treatment of a patient who until come to us has applied to different clinics for chronic abdominal pain and many tests and consultations were asked, and eventually abdominal surgery have decided.

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Ultrasound guidance during peripheral nerve block is a revolutionary approach in clinical practice. For a successful block, local anesthetics(LA) should surround the nerve circumferentially. Circumferential distrubution of local anesthetic is discribed as ''coin sign'' view which may predict block success of sciatic nerve.

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