Reflections of the sensory findings in the central nervous system in patients with neuropathic pain.

This study aimed to evaluate whether there was a difference in functional magnetic resonance imaging (fMRI) findings in patients who were found having hyperalgesia or hypoesthesia according to Quantitative Sensory Tests (QST). Forty participants were included in the study: 20 with neuropathic pain (NP) due to cervical disc pathology (NP group) and 20 healthy volunteers. After obtaining the socio-demographic and clinical data of the participants, the painDETECT questionnaire was administered, followed by QST analysis to show the presence of hypoesthesia and/or hyperalgesia, and fMRI examinations, which included sensory stimulation of both extremities. Sensory threshold tests were found to be higher in the NP group compared with the healthy volunteers, and the heat pain threshold was found to be lower in the tests showing pain thresholds in the intergroup analyses (p < 0.05). The changes described were found in both painful and non-painful limbs. In the hypoesthetic NP group, a lower somatosensory cortex activity was found in non-painful limbs compared with the healthy volunteers (p < 0.05). In the unilateral hyperalgesic NP group, a lower somatosensory cortex activity was found on the painful side, and if the hyperalgesia was widespread, lower blood oxygen-level-dependent activity was also found in the operculum and insular cortex (p < 0.05). The patients with different phenotypes of NP had different activities in the areas related to the processing of pain, and were more prominent in patients with widespread hyperalgesia. Studies with larger numbers of patients are required for a definite statement.

Effect of Inhalation Aromatherapy on Pain, Anxiety, Comfort, and Cortisol Levels During Trigger Point Injection.

The objective of this study was to examine the effects of inhaler aromatherapy on the level of pain, comfort, anxiety, and cortisol during trigger point injection in individuals with myofascial pain syndrome. Lavender oil inhalation was found to reduce pain and anxiety during trigger point injection and to improve patient comfort, but it did not affect the saliva cortisol level.

Validity and reliability study for the Turkish version of global pain scale.

INTRODUCTION: To investigate the validity and reliability of the "Global Pain Scale" for Turkish population . METHODS: The cross-sectional study was conducted at the Algology outpatient clinic of a university hospital in Izmir, Turkey, between March and December 2015, and comprised patients with chronic pain aged at least 18 years. Linguistic equivalence, content validity and construct validity were used for establishing the validity of the Global Pain Scale, while the Content Validity Index was used for the assessment of expert views. SPSS 16was used for data analysis. RESULTS: Of the 222 subjects, 142(64%) were females. Overall mean age of the sample was 54.22±13.79 years. Cronbach's alpha coefficient for the entire scale was 0.95. Total item correlation coefficients of the items in the scale ranged between 0.502 and 0.794, and no items were removed from the scale. CONCLUSIONS: The Global Pain Scale was found to have adequate validity and reliability indicators, and can be used with confidence in patients experiencing chronic pain.

Effects of Reflexology on Pain in Patients With Fibromyalgia.

The aim of this study was to investigate the effect of reflexology on pain intensity in patients with fibromyalgia, using an experimental repeated-measures design, and a convenience sample of 30 fibromyalgia inpatients. Thirty patients aged 18 to 70 years with fibromyalgia and hospitalized in the algology clinic were taken as a convenience sample. Patients received a total of 12 60-minute sessions of reflexology over a period of 6 consecutive weeks. Reflexology was carried out bilaterally on the hands and feet of patients at the reflex points relating to their pain at a suitable intensity and angle. Subjects had pain scores taken immediately before the intervention (0 minute), and at the 60th minute of the intervention. Data were collected over a 10-month period in 2012. The patients' mean pain intensity scores were reduced by reflexology, and this decrease improved progressively in the first and sixth weeks of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of reflexology in the routine care of patients with fibromyalgia could provide nurses with an effective practice for reducing pain intensity in these patients.

The effects of music therapy on pain in patients with neuropathic pain.

The aim of this study was to investigate the effect of relaxing music on pain intensity in patients with neuropathic pain. A quasi-experimental study, repeated measures design was used. Thirty patients, aged 18-70 years, with neuropathic pain and hospitalized in an Algology clinic were identified as a convenience sample. Participants received 60 minutes of music therapy. Classical Turkish music was played to patients using a media player (MP3) and headphones. Participants had pain scores taken immediately before the intervention and at the 30th and 60th minutes of the intervention. Data were collected over a 6-month period in 2012. The patients' mean pain intensity scores were reduced by music, and that decrease was progressive over the 30th and 60th minutes of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of music therapy in the routine care of patients with neuropathic pain could provide nurses with an effective practice for reducing patients' pain intensity.

Gabapentinoids and lactation: Review of the literature.

Gabapentin and pregabalin, which belong to the gabapentinoid drug family, are widely used, especially in neuropathic pain treatment, due to their effectiveness in pain management. Although many of the comorbidities and symptoms that limit the use of gabapentinoids are clearly described in the literature, there is limited data on their use during lactation. A 33-year-old female patient was admitted to our clinic with neuropathic pain and muscle weakness in her left lower extremity following spinal anesthesia for a cesarean section. We aimed to present the gabapentin treatment of a breastfeeding patient with persistent neuropathic pain in light of a literature review.

Comparison of the efficacy of continuous radiofrequency thermocoagulation, pulsed radiofrequency denervation applications, and TENS therapies for lumbar facet syndrome: A single-blind randomized controlled trial.

OBJECTIVES: We aimed to compare the effectiveness of TENS, used in physical therapy departments, and continuous radiofrequency thermocoagulation (CRF) and pulsed radiofrequency denervation (PRF), used in algology departments, in patients with lumbar facet syndrome (LFS). METHODS: Subjects were selected from patients with LFS visiting outpatient clinics of physical therapy and algology departments at Ege University School of Medicine, whose pain was refractory to medical treatment for at least 3 months. Subjects were randomized into 3 groups. A total of 60 patients, with 20 in each group, were enrolled. The first group received CRF, the second group received TENS for 30 minutes a day for 15 days, and the third group received PRF. Patients were assessed at baseline, at the end of the first and sixth months, for a total of three times. RESULTS: Improvements at month 1 and month 6 were found to be statistically significant in all three treatment groups with respect to their pain scores, Oswestry Disability Indexes, hand-floor distance measurements, 20-meter walking times, 6-min walking distances, Beck Depression Inventory, and most of the SF-36 domain scores (p<0.05). A comparison of the treatment groups showed no superiority of any group over the others in any assessment parameters (p>0.05). CONCLUSION: We suggest that it might be more appropriate to use TENS, a non-invasive treatment, before trying more invasive procedures like CRF and PRF in these patients. However, it has been stated that further studies involving a larger patient sample are needed.

Examination of pain experiences of cancer patients in western Turkey: a phenomenological study.

This study aims to explore the individual experience of living with cancer pain. This qualitative study was performed by using a phenomenological research design. In-depth and open interviews with participants were conducted to collect the data and a qualitative Colaizzi method of analysis was performed. Following the analysis of the data, the expressions made by the cancer patients during the interviews were grouped under 5 themes. Consistent with the questionnaire format, 5 themes and 19 subthemes of responses were determined describing the pain of the cancer patients. The results of our study have demonstrated that cancer patients go through negative physical, psychological, and social experiences due to the pain they suffered.

[A rare cause of headache; case report of trigeminal neuralgia concomitant with idiopathic intracranial hypertension]. / Nadir bir bas agrisi nedeni; trigeminal nevralji ve idiyopatik intrakraniyal hipertansiyon birlikteligi: Olgu sunumu.

Trigeminal neuralgia (TN) is the condition of sudden, usually unilateral, very short-lasting, stinging, and recurrent pain in the distribution area of one or more branches of the trigeminal nerve. Idiopathic intracranial hypertension (IIH) is an increase in intracranial pressure associated with normal cerebrospinal fluid composition that is not due to a secondary cause. Although not frequent, the association of IIH and TN has also been reported. We aimed to present a rare case report in which TN is concomitant with IIH. A 56-year-old female patient was admitted to our clinic with the complaint of jabbing pain that may feel like an electrical shock on the right side of her face. In the patient's history, she was diagnosed with TN 8 years ago. She had a lightning-flashing pain in the area corresponding to the right mandibular nerve dermatome. Her pain attacks lasted 1-2 min, and recurring 15-20 times during the day. In the CISS sequence cranial MRI, bilateral perioptic CSF distance showed mild prominence, prominence in Meckel caves, and empty sella appearance features. These findings were found to be compatible with intracranial hypertension. As a result,based on these findings, the patient was diagnosed with TN or trigeminal neuropathy accompanying IIH. While patients diagnosed with TN may be associated with IIH, also trigeminal nerve may be affected, although not as much as other cranial nerves in patients with a diagnosis of IIH. The use of cranial MRI may prevent an additional pathology to be missed.

Our clinical experiences in the earthquake victims who came to our university after the 2020 Aegean Sea earthquake during the COVID-19 pandemic.

BACKGROUND: Earthquakes are natural disasters that threaten human life and cause loss of life and property in a very short time. In our study, we aim to carry out the medical analysis of the earthquake victims who came to our hospital after the Earthquake in the Aegean Sea and to share our clinical experiences. METHODS: We retrospectively analyzed patients the medical data records of earthquake victims brought to our hospital or the injured who applied due to the Aegean Sea earthquake. Patients demographic data, their complaints and diagnoses, hour of admission, their clinical courses, hospital arrangements (admission, discharge, and transfer), time spent until the operation, anesthesia methods, surgical intervantions, intensive care needs, crush syndrome, presence of acute renal failure, number of dialysis, mortality, and mor-bidity were reviewed. RESULTS: A total of 152 patients were brought to our hospital due to the earthquake. The most intense period of admission to the emergency department was the 1st 24-36 h. Mortality rate was found to be higher depending on the increase of age. While the most common cause of admission for the mortal earthquake survivors was to be trapped in the wreckage, the survivors applied for other reasons as well such as falling down. The most common type of fracture observed in survivors was the lower extremity fractures. CONCLUSION: Epidemiological studies can make an important contribution to the management and organization of the future earthquake-related injuries by healthcare institutions.

Evaluation of disease burden, patient journey, unmet diagnosis and treatment needs of patients with HIP and knee osteoarthritis in Turkey: A study through Delphi Methodology.

Objective: To get information-driven insights from expert physicians regarding multiple aspects of the patient journey in knee and hip OA and establish a consensus for future studies and decision tree models in Turkey. Design: 157 questions were asked in total during this three-round modified Delphi-method panel to 10 physical medicine and rehabilitation specialists (2 have rheumatology and 3 have algology subspeciality), one orthopaedic surgeon and one algology specialist from anaesthesia specialty background. A consensus was achieved when 80% of the panel members agreed with an item. Contradictions between different disciplines were accepted as a non-consensus factor. Results: Panellists agreed that American College of Rheumatology classification criteria is mostly sufficient to provide an OA diagnosis in clinical practice, OA patients with ≥5 Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain or physical function score can be defined as moderate-to-severe OA if they have an additional ≥2 Kellgren-Lawrence (KL) score, a minimum improvement of 30% from baseline in WOMAC pain or function subscales or in PGA score can be accepted as moderate treatment response where ≥50% improvement from baseline in those scores as substantial response. Panellists stated that arthroplasty procedures need to be delayed as long as possible, but this delay should not jeopardize a beneficial and successful operation. Conclusions: These findings show that there is a significant disease burden, unmet treatment needs for patients with moderate-to-severe OA in Turkey from experts' perspective. Therefore, an updated systematic approach and decision tree models are needed to be implemented.

Quantitative sensory test findings in cervical radicular pain and their relationship with the symptoms.

OBJECTIVES: This study aims to define and compare sensory phenotypes in cervical radiculopathy patients exhibiting neuropathic pain (NP) components with healthy volunteers using clinical examination and quantitative sensory test (QST) findings. Another aim of the study is to show whether symptomatic components of the pain detect questionnaire (PDQ) are correlated with the QST findings, which may help clinicians indicate patients with sensory abnormalities without the use of specialized tests. METHODS: Fifty-seven participants were included in the study, including patients with NP (n=20) and healthy volunteers (n=37). After obtaining the sociodemographic and clinical data of the participants, the PDQ was performed in patients with pain followed by QST analysis in all participants. RESULTS: Analyses between painful and non-painful extremities yielded no differences in all groups for QST (p>0.05). Sensory thresholds were found to be higher in the NP group compared to healthy volunteers, and the pain threshold test was found to be lower (p<0.05) in the intergroup analyses. The changes described were found in both painful and non-painful limbs. Pain with slight pressure was found to be correlated with the lower heat pain threshold values (R=-0.602, p=0.005). CONCLUSION: Patients with NP were found to have lower thresholds for pain and higher sensory thresholds when compared to healthy volunteers. Moreover, pain with pressure component in PDQ was found to be associated with hyperalgesia in QST.

An analysis of nursing and medical students' attitudes towards and knowledge of complementary and alternative medicine (CAM).

AIMS AND OBJECTIVES: This study aims to evaluate and compare nursing and medical students' attitudes and knowledge about complementary and alternative medicine (CAM). BACKGROUND: Despite increased popularity of the use of complementary and alternative medicine, it is not included in nursing and medicine schools' curricula in many countries. DESIGN: A cross-sectional design was used. METHOD: This study's research population included 972 students who were educated at a school of nursing and a faculty of medicine during the academic year 2006-2007. The study used a questionnaire the researchers prepared as data collection form. Pearson chi-square test was used to observe the differences between nursing and medical students. A p-value <0.05 was accepted statistically significant. RESULTS: The population was 49.1% nursing students and 50.9% medical students. Of the nursing students, 57.8% agreed with the statements that complementary and alternative medicine modalities should be integrated into clinical practice, 61.3% agreed for curriculum. Of the medical school students, 32.6% agreed for clinical practice and 37.9% for curriculum. The nursing students had sufficient knowledge of mostly massage and imagery; and medical students had sufficient knowledge of mostly diet therapy, vitamins and prayer. CONCLUSIONS: The results of current study reveal that nursing students adopt more positive attitudes than medical students towards complementary and alternative medicine therapies and that both student groups have limited knowledge of complementary and alternative medicine modalities. RELEVANCE TO CLINICAL PRACTICE: Physicians and nurses play important roles in helping patients use complementary and alternative medicine safely and accurately. Therefore, as future nurses and physicians, nursing and medical students should have sufficient knowledge of and education on complementary and alternative medicine modalities. In this context, handling complementary and alternative medicine on a scientific scale and including it in nursing and medical students' educational programmes should be among the goals and plans in Turkey.

Percutaneous Spinal Cord Stimulation for Failed Back Surgery Syndrome: A Retrospective Study.

AIM: To evaluate the outcomes of percutaneous spinal cord stimulation (PSCS) in patients with failed back surgery syndrome (FBSS) in an academic tertiary care center. MATERIAL AND METHODS: The hospital records of patients with FBSS who had undergone PSCS were retrospectively reviewed. A total of 19 patients with FBSS matched the search criteria, and among them, 16 were included in the study, in whom permanent implantable pulse generators (IPGs) were implanted. Demographic, clinical and surgical outcomes were evaluated. RESULTS: Twelve (75%) women and 4 (25%) men with a median age of 50 years (range, 35-80 years) were analysed. The average number of surgeries before PSCS was 1.6 ± 1.2 (range, 1-4). Pain was localised in the back and leg in 81.25% of the patients. The mean duration of symptoms was 6.3 ± 3.1 years (range, 2-10 years). The mean length of trial period was 16.3 ± 6.8 days (range, 7?29 days). In this study, the permanent implantation rate was 84.2% (16/19). The mean follow-up time was 18.3 ± 3.9 months (range, 14-26 months). Postoperative back/leg numerical pain rating scale (NPRS) score was significantly lower than preoperative back/ leg NPRS score (p < 0.001). The postoperative Oswestry Disability Index (ODI) score was significantly lower than the preoperative ODI score (p < 0.001). CONCLUSION: PSCS is a safe and effective treatment method for patients with FBSS. In this study, the high rate of improvement in the outcome scores may be attributed to the small sample size and early PSCS implantation.

Effects of pain education program on pain intensity, pain treatment satisfaction, and barriers in Turkish cancer patients.

The purpose of this randomized controlled study was to investigate the effect of a pain education program (PEP) on pain intensity, patients' satisfaction with pain treatment, and patient-related barriers to pain management among Turkish patients with cancer. The study was conducted in a sample of 40 patients who were hospitalized for cancer and experiencing pain. The patients were equally randomized to either a PEP or a control group. The data were collected by means of the McGill Pain Questionnaire, the Numeric Rating Scale, and the Barrier Questionnaire-Revised. After the completion of the questionnaires at the first interview, patients in the PEP group received pain education using a pain educational booklet and an explanatory slide program that discussed the booklet's content with the patients. Patients in the control group received routine clinical care. The questionnaires were reapplied to the patients in both groups after 2, 4, and 8 weeks. Participation in a PEP was associated with decreased pain intensity scores for "present" and "least pain" during weeks 2, 4, and 8 (p < .05). Similarly, there were significant differences between the groups with respect to weeks 2, 4, and 8 satisfaction with pain treatment (p < .05). At the end of second week, the total BQ-r score decreased significantly in the PEP group from 2.12 to 1.29 compared with 2.30 to 2.28 in the control group (p < .001). The findings suggest that the PEP decreases pain intensity, improves satisfaction with treatment, and decreases barriers about cancer pain management in cancer patients. Incorparation of PEP into the standard of care for cancer patients with pain may improve the quality of pain management.

Effects of intraperitoneal levobupivacaine on pain after laparoscopic cholecystectomy: a prospective, randomized, double-blinded study.

OBJECTIVES: We aimed to determine the effects of intraperitoneal administration of levobupivacaine on pain after laparoscopic cholecystectomy in a prospective, randomized, double-blinded, placebo-controlled trial. METHODS: In all patients, infiltration of levobupivacaine 0.25% (15 mL) was used prior to skin incisions for trocar insertion. After pneumoperitoneum was achieved, patients were allocated randomly to receive intraperitoneally either 40 mL of 0.25% levobupivacaine (LB group, n=20) or normal saline (NS group, n=20) under direct vision into the hepatodiaphragmatic lodge and above the gallbladder. Data of intraoperative variables, postoperative pain relief, rescue analgesic consumption, side effects, and patient satisfaction were followed in both groups. RESULTS: The postoperative pain scores were significantly lower in the first half-hour period in the LB group than in the NS group (p<0.05). However, the incidence of right shoulder pain was not significantly different between the LB group (10%) and NS group (15%). The mean dose of meperidine consumption and the number of patients needing rescue meperidine were significantly lower in the LB group than in the NS group (p<0.05). Significantly lower vomiting incidence and increased patient satisfaction were determined in the LB group compared to the NS group (p<0.05). CONCLUSION: Intraperitoneal administration of 40 mL levobupivacaine 0.25% given immediately after pneumoperitoneum into the hepatodiaphragmatic lodge and above the gallbladder demonstrated useful effects on postoperative pain relief after laparoscopic cholecystectomy, especially in the early postoperative period, and reduced postoperative rescue analgesic requirement, with excellent patient satisfaction. There were no LB-related complications or side effects.

Transforaminal epidural steroid injection and infraneural approach.

Transforaminal epidural steroid injections are a common intervention in the treatment of radicular pain. Complications are rare, but can be catastrophic. One of the potentially devastating complications is occlusion of the artery of Adamkiewicz (AKA). This report is a description of an approach to avoid the complication of injury to the AKA related to transforaminal epidural injection. A 71-year-old male patient presented at the clinic with radiculopathy secondary to lumbar disc hernia. A transforaminal epidural steroid injection was planned. After a radiocontrast injection, vascular filling was detected. The needle was repositioned and an inferior entrance to the epidural space was used. No vascularity was seen and dexamethasone was administered to the patient. A transforaminal epidural steroid injection is an effective interventional treatment for radicular pain, but it requires careful attention due to the possible complications. The AKA was located in the upper half of the foramen. Keeping the wide variation in the anatomy of the AKA in mind is very important in order to prevent spinal cord ischemia.

Validity and reliability of Turkish version of the Brief Pain Inventory-Short Form for patients with chronic nonmalignant pain.

OBJECTIVES: The aim of this study was to evaluate the validity and reliability of the Turkish version of the Brief Pain Inventory-Short Form for patients with chronic nonmalignant pain. METHODS: An analytical design was used. A total of 192 patients were included in the study. A demographic questionnaire and the Brief Pain Inventory-Short Form were used to collect data. Content validity was assessed by experts and construct validity was tested using exploratory factor analysis. Reliability analyses estimated the internal consistency and test-retest reliability. Cronbach's alpha and the item-total correlations were calculated for the subscales to examine internal consistency. RESULTS: Exploratory factor analysis yielded 2 factors: pain severity and pain interference, which accounted for 68.81% of the total variance. The coefficient alpha of both subscales demonstrated good internal consistency. The item-total correlations of the scale ranged between 0.56 and 0.87. The test-retest reliability was r=0.774 for pain severity and r=0.808 for pain interference (p=0.001). CONCLUSION: The Turkish version of the Brief Pain Inventory-Short Form is a valid and reliable instrument to assess chronic nonmalignant pain.

Knowledge and attitudes of Turkish oncology nurses about cancer pain management.

Effective pain management requires accurate knowledge, attitudes, and assessment skills. The purpose of the present study was to examine information about the knowledge and attitudes of Turkish oncology nurses regarding cancer pain management. The sample consisted of 68 oncology nurses employed in oncology and hematology units in two university hospitals located in Izmir, Turkey. The Nurses' Knowledge and Attitudes Survey Regarding Pain was used to measure the nurses' pain management knowledge and attitudes. Data were analyzed by using descriptive statistics, t test, Kruskal-Wallis analysis, and Pearson correlation test. Of the nurses that participated in the study, 57.4% were between the ages of 21 and 30 years, 58.8% were unmarried, and 55.9% had an associate degree. The average correct response rate was 35.41%, with rates ranging from 5.13% to 56.41% for each survey question. Among the 39 pain knowledge questions assessed, the mean number of correctly answered questions was 13.81 +/- 5.02, with a range of 2 to 22 items correctly answered. When the knowledge scores were further analyzed by nurses' background characteristics, the nurses' pain knowledge was only positively correlated to length of working experience in oncology units (r = 0.263; p < .05). The findings support the concern of inadequate knowledge and attitudes in relation to cancer pain management. We believe that basic and continuing education programs may improve knowledge level of nursing about pain management.

[Non-opioid and opioid medication in neuropathic pain]. / Nöropatik agri tedavisinde non-opioid ve opioid ajan kullanimi.

Treatment of neuropathic pain is difficult despite new treatments and there is no single treatment that Works for all conditions and their underlying mechanisms. Given the increasing evidence for effective treatments of neuropathic pain, it is important for the clinician to know which drugs are most effective neuropathic pain relieving pain and associated with the fewest adverse effects and there is a need for an evidence-based algorithm to treat neuropathic pain conditions. Ideally, the evidence for the non-opioids and opioids choices in such an algorithm would be based on direct comparisons of one drug with another, for both efficacy and side effects. There are very few such direct comparisons available.