Summary
The head and neck region is the most common site of the human body to be involved in a chronic pain condition. Neuropathic pain is one of those and refers to all pain initiated or caused by a primary lesion or dysfunction or transitory perturbation in the peripheral or central nervous system (CNS). Trigeminal neuralgia, atypical odontalgia (phantom tooth pain), burning mouth syndrome, traumatic neuropathies, postherpetic neuralgias and complex regional pain syndrome are the neuropathic pain conditions in orofacial region can be encountered in pain and dental clinics. Most of the time this problem misdiagnosed by the dentist causing unnecessary treatments including endodontic treatment and extraction of the tooth or teeth in the region. In this review, only post-traumatic peripheral painful neuropathies seen after dental treatments will be discussed.

Objectives: Our aim was to search addition of Tramadol to the treatment, when a dose increase is needed; before increasing transdermal fentanyl(TDF) dose in cancer patients using TDF would have any advantages.
Methods: Patients were divided in two groups as ControlGroup(GroupK) and TramadolGroup(GroupT).When patients were first came to polyclinic, demographic data,duration of pain and first VAS values were recorded.Following the first examination, all patients were given TDF containing 25µg/hfentanyl as initial treatment. During study period, TDF dose of patients in GroupK was increased in step of 25µg/h whenever needed. In GroupT, 200mgTramadol was added to treatment whitout increasing TDF dose when a dose increase is needed.In subsequent dose increase requirements in GroupT, TDF dose was sequentially increased 25µg/h when needed without stoping tramadol.Patients VAS score,advers effects were recorded in each polyclinic examination. Patients were asked to asses pain treatment with Treatment Assesment Scale(TAS).Each patient’s participation to the study and highest TDF dose reached were recorded.
Results: The TDS scores measured 1month and 2months after start of study were found similar.However, TAS scores measured at the end of 3rd and 4th months were found significantly higher in GroupT. Mean TDF dose reached at end of the study was found significantly higher in GroupK compared to GroupT.Itching was observed significantly more frequent among patients of GroupK.
Conclusion: We found out in our study, when TDF and Tramadol are use together,TDF need is reduced and pain managment protocol is beter tolerated by patients.Based on results of our study;we suggest concomitant use of strong and weak opioids.

Objective: Propofol causes considerable pain on injection, although different methods and propofol formulations have been used to decrease it. We aimed to investigate the effect of i.v esmolol pretreatment on the propofol injection pain.
Methods: Ninety ASA I-II patients undergoing elective surgery under general anesthesia were randomly assigned into three groups, tirthy each. A 20 G cannula was inserted into the dorsum of the nondependent hand. After venous occlusion for one minute, groups E, L and S were pretreated with 5 mg/cc (total 2cc) esmolol, 40 mg lidocaine and 2cc saline i.v respectively. After release of venous occlusion, one fourth of total propofol dose was administered at a rate of 0.5 ml/sec. During the injection of both pretreatment solution and propofol, patient pain was assessed by using 4 point scale. Heart rate and noninvasive arterial blood pressure values were recorded before induction, just after entubation and five minutes after entubation.
Results: Demographic values were similar among groups. Incidence of pain on injection of propofol in control, esmolol and lidocaine groups was 90%, 33.3%, 50% respectively.(p<0.05) Heart rate, systolic arterial pressure, diastolic arterial pressure values were not different between the groups.
Conclusions: Pretreatment with low dose esmolol i.v seems to be effective in attenuating pain during propofol injection.

OBJECTIVES: We aimed to compare the efficacies of patient controlled bolus administration and continuous infusion of low dose Fentanyl and Levobupivacaine combination by epidural catheter during vaginal labor on mother, baby and the duration of labor. METHODS: The 45 pregnants involved in the study were divided randomly into two groups, Group HKEB (patient controlled epidural bolus) and Group SEI (continuous epidural infusion). Hemodynamic parameters and VAS values of the pregnants, fetal heart rate, Apgar scores, duration of labor stages, types of delivery and side effects were recorded. Time to reach T10 dermatome was determined. Motor block was evaluated with modified Bromage scale. Additional analgesic needs were followed up and total drug consumptions were compared. RESULTS: Drug consumption was found to be significantly lower in HKEB admiistration(p<0,01). CONCLISION: Bolus administration of a basal dose that will keep analgesia level constant and additional drug administred upon patient requests both will prevent pregnants to experience a painful period and will give confidence and comfort to patient to ask for drug when she needs according to her pain character.

Objectives: To determine the lifetime and point prevalences of neck, upper back and low back pain of the people living in the central Malatya with the influencing factors.
Methods: This research is a cross-sectional interview survey. Thirty health house spots tied to the health clinics in the city center were chosen as thirty sets with the method of sampling and 600 people by taking 20 people from each set were included in the research. The data were collected between the 1st of June and the 1 st of September. Association between pain prevalences and socio-demographic, health and behavior related characteristics were evaluated. Chi-square and backward stepwise logistic regression tests were used in the analyses.
Results: Of the participants, 56.2% were women, 46.8% were men, and the mean age was 38.5±0.5 years. The lifetime neck, upper back and low back prevalences were 79.3%, 59.5% and 86.3%, respectively. The point prevalences of neck, upper back and low back were, 12.0%, 3.0% and 18.3%, in order. Gender, age, and psychological problems were determined to be the main predictors of life time pain prevalences. For point pain prevalences, the main predictors were gender, psychological problems and body mass index.
Conclusion: Both lifetime and point pain prevalences showed that musculoskeletal disorders symptoms were common in the central Malatya. In-service training of health personnel on the subject, and assessment, notification and prevention methods should be developed.

Background and aims: Hyperhidrosis is thought to result from functional impairment of sympathic nervous system. In this study, percutaneous T4 sympathic radiofrequency (RF) thermocoagulation was used to treat palmar hyperhidrosis which do not respond to conservative treatment and the results were evaluated in terms of safety, efficiency and patient satisfaction.
Methods: In this study, 15 patients aged 16-48 regularly performed retrospectively on data obtained from records kept. Patient satisfaction scores (very satisfied, satisfied, not satisfied), after treatment of the hand condition (dry, mild dry, no improvement), and whether the most common complication and most patients expressed by the compensatory hyperhidrosis (CH) degree (none, mild, moderate, severe) were analyzed.
Results: No complications were observed except a coughing crisis lasting in 2 hours in one patient, transient bradycardia in 1 patient and transient injection site pain in all cases. Two patients 1 per week and three patients 1, 2 and 6 months developed recurrence.
Conclusions: Sympathic T4 ablation with RF thermocoagulation was found to have a long term (6 months) patient satisfaction (80 %). It was also effective in reducing the sweating of hand (80 % dry or mild dry). The CH rate was 27 %. According to our results, sympathic T4 ablation with RF thermocoagulation is a safe and effective treatment with high patient satisfaction.

If migraine does not manifest itself in the form of headache but in some other atypical symptoms with a headache, it is labelled a Migraine Variant. Many migraine variants have been redefined and included in the International Classification of Headache Disorders 2004 classification. These include hemiplegic migraine, basilar-type migraine, childhood periodic syndromes, retinal migraine, complicated migraine, ophthalmoplegic migraine and vertiginous migraine. In this study, we report two patients in different age group who resemble basilar-type migraine with symptoms of prolonged atypical aura. Migraine Variants are important to recognise in clinical practice. Most variants respond well to treatment with antimigraine prophylaxis. If diagnosed correctly, treatment response is always satisfying.

Chronic headache is known to be aggravated by fasting and fasting even triggers headache among those not suffering from chronic headache. Headache is also aggravated during Ramadan in which The Moslem do not eat and drink anything or smoke from dawn to sunset for about a month in a year. But it mainly increases in people who are prone to headaches like migraine sufferrers. As far as we know there are no reports in specific headache syndromes pointing to precipitating factor of fasting. In this report, we present a 32 years-old man diagnosed as spontaneous intracranial hypotension, treated by conservative means and relapsed after fasting during Ramadan and we aim to discuss the possible underlying mechanisms of precipitation of orthostatic headache during fasting.