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.

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.

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.

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.

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.

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.

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.

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.

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.