ISSN: 1300-0012 | E-ISSN: 2458-9446
Volume : 29 Issue : 3 Year : 2025
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Agri - Ağrı: 29 (3)
Volume: 29  Issue: 3 - 2017
REVIEW
1. Cortisol and migraine: A systematic literature review
Giuseppe Lippi, Camilla Mattiuzzi
PMID: 29039159  doi: 10.5505/agri.2017.25348  Pages 95 - 99
Migraine is a highly prevalent and disabling disorder. Because stress appears to be a prominent trigger of this condition and cortisol is a well-established stress hormone, we performed a search on Medline, Scopus, and Web of Science to identify clinical studies that assessed cortisol levels in migraineurs. Four cross-section studies, one observational study, and three both cross-sectional and observational studies were finally included in our analysis. The heterogeneity was modest for the sample size (49.8%) but was remarkably high for a sample matrix (66.0%), thus precluding the possibility to meta-analyze the data. In six of the seven cross-sectional studies, cortisol levels did not differ between the cases and controls. With regard to the four observational trials, both nitroglycerine and human corticotropin-releasing hormone but not m-chlorophenylpiperazine were effective in generating a more prominent cortisol release in migraineurs than in controls. In a fourth observation trial, salivary cortisol did not differ during the migraine attack and during the migraine free-period. In conclusion, even if altered corticotrope responsiveness exists in migraineurs, it appears to be irrelevant in the pathogenesis of migraine.

EXPERIMENTAL AND CLINICAL STUDIES
2. Mastalgia and associated factors: a cross-sectional study
Deniz Koçoğlu, Serife Kurşun, Belgin Akın, Kamile Altuntug
PMID: 29039149  doi: 10.5505/agri.2017.91069  Pages 100 - 108
Objectives: Mastalgia is a common and painful experience among women. This study aimed to determine the prevalence of breast pain, characteristics of the pain, and factors associated with breast pain, particularly those that can be changed.
Methods: This cross-sectional study comprised women aged from 18 to 65 years. In total, 752 women were included. Risk factors for breast pain were determined using logistic regression analysis with the entry model, and the risk factors for periodic and non-periodic breast pain were assessed using logistic regression analysis with the backward model.
Results: Results revealed that the following were significant risk factors: age between 35 and 50 years (OR, 1.614; CI, 1110–2347), university graduate (OR, 3.207; CI, 1.874–5.490), BMI of >30 (OR, 2.068; CI, 1.163–3.674), excessive use of salt (OR, 1,687; CI, 1.075–2.647), weight gain in the last 5 years (OR, 1.411; CI, 1018–1955), use of a small bra (OR, 3.260; CI, 2204–4821), and use of a large bra (OR, 1.896; CI, 1276–2817).
Conclusion: Weight control, restriction of salt intake, and selection of a suitable brassiere are important for preventing and managing mastalgia

3. Anxiety, depression and coping behaviors with pain in cancer patients who are aware or unaware of their cancer
Gülcan Güleç, Sacit Güleç, Dilek Ceyhan, Muhtelime Bahar, Soner Özdemir
PMID: 29039150  doi: 10.5505/agri.2017.56688  Pages 109 - 116
Objectives: This study aimed to investigate whether there are differences in depression, anxiety, pain and styles of coping with pain between cancer patients with and without awareness of their cancer diagnosis.
Methods: In this study, 30 cancer patients aware of their diagnosis and 30 cancer patients unaware of their diagnosis, all of whom visited a clinic for pain treatment, were enrolled in this study. A sociodemographic information form, a questionnaire comprising questions about pain severity and related variables, Hospital Anxiety Depression Scale, and the Pain Coping Questionnaire were administered to the patients.
Results: No significant association was observed between the patients with awareness or unawareness of cancer with respect to anxiety, depression, pain severity, or coping with pain. Pain intensity was significantly associated with depression in both the patient groups.
Conclusion: The study enrolled patients who were admitted for pain treatment, and the sampling group was small. However, this is the first study to investigate the effects of the awareness of cancer diagnosis on pain and its management.

4. Pain experience of nursing students and the methods used to cope with pain
Tuğba Uzunçakmak, Mahmut Kılıç
PMID: 29039151  doi: 10.5505/agri.2017.32650  Pages 117 - 121
Objectives: This study aimed to determine the pain experience of nursing students and the methods used to cope with it.
Methods: This descriptive study was conducted at the nursing department. Sampling was not used. The study was completed with 264 students. Data were collected using the questionnaire that was prepared by the researchers. Descriptive statistics and chi-square test were used for data analysis.
Results: Of all students, 76.1% (84.1%, females; 56.0%, males) who participated in this study had pain. The most experienced pain was headache (52.3%), stomachache (42.4%), and low back pain (33%); these were more prevalent in females than in males. The use of medication (42.9% in males and 47.8% in females) was higher than the other methods for pain treatment. Students who stayed in the dormitory were more likely to use drugs (58.5%), whereas those not staying in the dormitory were more likely to use non-drug methods (47.4%). Students who paid attention to feeding behavior used more medication (80%) than who did not pay attention (44.1%; p<0.05).
Conclusion: Students were mostly applied to health institutions owing to pain, they used drugs for headache, and the pain affected their daily life activities and resulted in them being absent on school days. In conclusion, considering the adverse effects of medications, it is recommended that students should be informed regarding reliable traditional nonpharmacological methods for coping with pain and should be encouraged to use such methods.

5. Evaluation of the neuropathic pain in the smokers
Sercan Bulut Çelik, Hüseyin Can, Melih Kaan Sözmen, Tijen Şengezer, Yusuf Cem Kaplan, Gökçenur Utlu, Alp Şener, Arzu Aybek Yılmaz, Olgu Aygün
PMID: 29039152  doi: 10.5505/agri.2017.68815  Pages 122 - 126
Objectives: Nicotine addiction is one of the most important causes of the general failure of treatment and keeping the habit of smoking. Peripheral neuropathy is a leading factor of smoking. This study aimed to analyze the association of neuropathic pain and addiction levels of individuals.
Methods: The study was performed on the day on which the smokers visited the hospital for any reason. The Douleur Neuropathique 4 (DN-4) Scale and Fagerström Addiction Survey were administered to the individuals after obtaining their consent.
Results: In total, 444 individuals were included in the study, and 57.2% of them were males (n = 254). The age average of the individuals with neuropathic pain (46.4±12.3 years) was significantly higher than that of those without pain. The individuals with pain smoked approximately 31.8±18.3 packet/year cigarettes, whereas those without pain smoked approximately 22.4 ± 15.5 packet/year cigarettes; the difference was significant statistically (p<0.05). According to multivariate logistic regression analysis with the backward elimination method, the existence of pain was found to be PR = 2.22 (95% GA, 1.26–3.91) in terms of sex, DM existence was found to be PR = 1.97 (95% GA, 1.02–3.81), and for each standard deviation increase (2.7) in Fagerström scale, PR was 1.29 (95% GA, 1.14–1.46).
Conclusion: Smoking is a risk factor for neuropathic pain. In our study, the possibility of neuropathic pain increases as the duration of smoking and addiction level increase, and with diabetes, this rate increases even more. It is extremely important that the smokers should be informed regarding these facts and possibilities.

6. Postoperative analgesia after arthroscopic shoulder surgery: A comparison between single-shot interscalene block and single-shot supraclavicular block
Ahmet Kemalettin Koltka, Mehmet Büget, Emre Sertaç Bingül, Ali Erşen, Süleyman Küçükay, Ata Can Atalar, Mert Şentürk
PMID: 29039153  doi: 10.5505/agri.2017.67984  Pages 127 - 131
Objectives: In arthroscopic rotator cuff surgery for postoperative analgesia opioids, nonsteroid analgesics, and local anesthetics can be used. This study aimed to compare the effectiveness, additional analgesic requirements, patients satisfaction, and complications of single-shot interscalene and supraclavicular blocks.
Methods: After obtaining the ethics committee’s approval and informed consent, 50 ASA I-II patients were randomized to either the interscalene (GISB) or supraclavicular (GSCB) group. Preoperatively, patients received an ultrasonography-guided block using 30 ml of 0.5% bupivacaine. In the postoperative period, morphine patient-controlled analgesia was administered as a 0.3-mg/h basal dose and 1-mg bolus dose, with a 20-min lockout time. Postoperative visual analog scale (VAS; 0–10 cm) scores of the patients were evaluated at 4, 8, 12, and 24 h postoperatively; additional analgesic requirements, adverse effects, and complications were recorded. Patient satisfaction (PS) scores were evaluated after 24 h.
Results: VAS scores at 4 h were lower in the GSCB group than in the GISB group, and the VAS scores at 8, 12, and 24 h were lower in the GISB group than in the GSCB group, with no statistical significance. Additional analgesic requirements was 28% in the GISB group and 68% in the GSCB group (p < 0.05). Total morphine consumption was lower in the GISB group than in the GSCB group (18.95±9.2 mg vs. 30.6 ± 9.6 mg; p < 0.001). PS scores were higher in the GISB group than in the GSCB group (7.0±1.0 vs. 6.1±0.9; p < 0.01). Adverse effects and complication rates were similar in both the groups. In GISB group, seven patients (28%) had nausea/vomiting, whereas in the GSCB group, 12 patients (48%) had nausea/vomiting. This difference was statistically insignificant.
Conclusion: Supraclavicular block can be considered as an alternative to interscalene block for arthroscopic shoulder surgery.

CASE REPORTS
7. Severe headache following ozone therapy: Pneumocephalus
Hüseyin Toman, Uğur Özdemir, Hasan Ali Kiraz, Nurettin Lüleci
PMID: 29039154  doi: 10.5505/agri.2016.36024  Pages 132 - 136
Pneumocephalus is defined as air in the cranial cavity. Pneumocephalus can result from inadvertent dural puncture during lumbar epidural anesthesia or epidural steroid injection. Presently described is case of 41-year-old woman who had undergone lumbar disc hernia operation but due to ongoing complaints, was diagnosed as having failed back surgery syndrome. Percutaneous epidural neuroplasty was performed. In the operating room, under sterile conditions and under sedoanalgesia, Racz catheter was inserted in caudal area and guided to epidural area with scope. In accordance with Madrid Declaration, 20 ug/mL concentration and 5 mL volume oxygen–ozone mixture was injected. After waiting 5 minutes, 0.25% bupivacaine + 80 mg triamcinolone + 1500 units hyaluronidase was administered through the catheter. After epidural neuroplasty procedure, when patient was taken to gurney, she complained of severe headache and nausea. Computed tomography scans of head were done immediately, and consistent with pneumocephalus, air was observed in right lateral ventricle frontal horn, interhemispheric fissure, and superior cerebellar cistern. Patient was placed in Trendelenburg position and intravenous fluid was replaced. Analgesics and bed rest were recommended as treatment. Patient was discharged from hospital on the second day. Within a week, headache pain and other complaints had resolved. In this article, the case of a failed back surgery patient who was postoperatively treated with medical ozone and experienced complication of pneumocephalus is discussed in context of literature data.

8. Successful anesthetic management in axillo-axillary bypass surgery
Dilek Altun, Özlem Çınar, Emre Özker, Ayda Türköz
PMID: 29039155  doi: 10.5505/agri.2015.94840  Pages 137 - 140
Axillo-axillary bypass grafting is considered the operation of choice for patients with subclavian steal syndrome. Anesthetic management of high-risk patients with coronary-subclavian steal syndrome presents safety and technical challenges. Presently described is case of chronic obstructive lung disease and coronary artery disease in a 52-year-old man who required axillo-axillary bypass surgery to treat stenosis at the origin of left subclavian artery. Successful anesthetic management was achieved for patient undergoing axillary-axillary bypass surgery using a cervical epidural technique.

9. Vertebrobasilar artery dolichoectesia and pain; coincidence or etiology?
Murat Alemdar
PMID: 29039156  doi: 10.5505/agri.2016.29200  Pages 141 - 146
Dolichoectesia is described as elongation, widening, and tortuosity of an artery. Most commonly involved vessels are the intracranial vertebral and basilar arteries. Vertebrobasilar artery dolichoectesia is usually asymptomatic. Cerebral ischemia, hemorrhage, or compression findings due to mass effect can be seen in symptomatic patients. Although there are case reports of trigeminal neuralgia due to fifth cranial nerve compression in the literature, to the best of our knowledge, neither hemicranial nor continuous facial pain secondary to vertebrobasilar artery dolichoectesia has been reported previously. Presently described is case of a 42-year-old male with vertebrobasilar dolichoectesia who had complaint of continuous right-sided hemicranial pain, and his 19-year-old niece, who presented with continuous right-sided facial pain.

LETTER TO THE EDITOR
10. The anatomical variation to be considered in upper extremity blocks: double axillary vein
Ali İhsan Uysal, Eylem Tarakçı, Başak Altıparmak, Semra Demirbilek, Metin Özcan
PMID: 29039157  doi: 10.5505/agri.2016.19870  Pages 147 - 148
Upper limb nerve blocks are often implemented as a method for the treatment of chronic pain and surgery. The anatomical variatons of block area should be noted. The possibility of complication like intravascular enjection increases in patients with anatomical variation of double axillary vein. It would be beter to apply upper extremity blocks with ultrasound for identifying possible double axillary vein and avoiding intravascular injection. Hydrolocalization can be useful for removing artery from vein when faced with a variation of double axillary vein.

11. Total spinal block, bupivacaine toxicity or else under epidural anaesthesia?
Ömer Karaca, Hüseyin Ulaş Pınar, Rafi Doğan
PMID: 29039158  doi: 10.5505/agri.2016.05924  Pages 149 - 150
Epidural anesthesia of which effectiveness has proved on the protection of organs, is preferred particularly in high-risk patients. However this anesthesia technique has life-threatening complications. The symptoms occurring for any reason during epidural anesthesia resemble the symptoms of such complications for which reason the diagnosis of anaphylaxis can be easily missed.