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.

[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.

Efficacy of ultrasound-guided greater occipital nerve pulsed radiofrequency therapy in chronic refractory migraine.

OBJECTIVE: Ultrasound (US) guided pulsed radiofrequency (PRF) therapy can be used on the greater occipital nerve (GON) in patients with chronic migraine (CM) who are unresponsive to conservative treatments. We aimed to demonstrate the change in pain intensity, duration of migraine episodes, frequency of attacks, migraine disability, depression, and sleep disturbance scores before and after treatment in patients with CM who underwent US-guided GON PRF and the effectiveness of treatment. PATIENTS AND METHODS: According to the International Classification of Headache Disorders III beta version diagnostic criteria, 25 of 43 patients with CM whom treated with GON PRF were included in the study. The Migraine Disability Assessment Scale (MIDAS), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and a visual analog scale (VAS) were used on patients before GON PRF treatment and at post treatment months 1 and 3. RESULTS: The median duration and number of migraine episodes in the post-interventional 1st month and 3rd month were significantly shorter and fewer compared with the pre-intervention period (p < 0.001). In the comparison with the pre-intervention values, all of the scoring concepts, namely the MIDAS, VAS, BDI, and PSQI, revealed a significant drop in the postintervention 1st and 3rd month (p < 0.001). CONCLUSION: In this study, we observed that US-guided GON PRF therapy applied at the proximal (C2) level was a safe and effective treatment option. With GON PRF, we observed a decrease in pain intensity, pain frequency, and duration of episodes, and an improvement in depression symptoms, migraine disability, and sleep disorder scores accompanying chronic migraine.

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.

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.

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.

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.

The effects of preadministration of local anesthetic on pulsed radiofrequency

Background/aim: Pulsed radiofrequency (PRF) has been reported to be a safe and reliable method for the management of a variety of chronic pain syndromes. It is not known whether the preadministration of local anesthetic increases the size of the electrical field. We revealed the effects of administering local anesthetic on PRF and investigated whether they were related to local anesthetic or fluid effects. Materials and methods: Group 1 (n = 18) received PRF to the suprascapular nerve with 1 mL of bupivacaine, group 2 (n = 20) received PRF with 1 mL of physiological saline solution, and group 3 (n = 18) received PRF only. Results: There were significant improvements in visual analog scale (VAS) scores at 30 min, 1 month, and 3 months after treatment in group 1 (P < 0.05) and at 1 month and 3 months in groups 2 and 3 (P < 0.05). There was a significant improvement in VAS scores in group 1 compared with groups 2 and 3 at 30 min after treatment. Conclusion: PRF applied to the nerve along with local anesthetic may increase pain relief, especially in the early posttreatment period. The favorable effects may depend on the pharmacodynamic features of the local anesthetic .

Pulmonary embolism occurring in a patient treated with spinal cord stimulation.

Spinal cord stimulation (SCS) has been shown to be an effective method for treating many chronic pain syndromes. In addition, providing pain relief with SCS can reduce immobilization and complications related to immobilization. The present case describes pulmonary embolism (PE) that occurred in patient being treated with SCS for post-laminectomy syndrome. The possibility of PE must be kept in mind while treating patients with SCS.

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.

Is it necessary to strictly diagnose fibromyalgia syndrome in patients with chronic widespread pain?

The applicability of the American College of Rheumatology (ACR) 1990 and 2010 criteria for the diagnosis of fibromyalgia syndrome (FMS) was determined in 284 patients with chronic widespread pain (CWP) including those with regional and systemic painful disorders. On the basis of initial evaluation, patients were classified into three groups. Group 1, those without any comorbid disease (N = 105), group 2, those having regional non-inflammatory painful disorders (N = 104), and group 3, those with a diagnosis of an inflammatory rheumatic disease (N = 75). Overall, 65 % of the patients fulfilled the 1990 criteria, while 94 % of them fulfilled the 2010 criteria. Almost all of the patients (97 %) with CWP did meet at least one of the criteria set, regardless of whether they have accompanying painful disorders. Widespread pain index (WPI), symptom severity scale (SS), and fibromyalgia impact questionnaire (FIQ) scores were found to be significantly higher in the patients who satisfied the 1990 criteria than those who did not (P < 0.001). Tender point counts were found to be significantly correlated with WPI, SS, FIQ, and Beck depression inventory (BDI) scores (P < 0.001). The findings of the study support the suggestion that FMS is just a continuum of CWP, rather than a distinct diagnostic entity. As treatment of FMS is usually identical with that of CWP, strict diagnosis of FMS will provide little or no significance from the viewpoint of clinical practice. We suggest that future research should be directed toward classification of CWP to provide guidance to clinicians in selecting effective therapies.

Effects of intra-articular application of pulsed radiofrequency on pain, functioning and quality of life in patients with advanced knee osteoarthritis.

BACKGROUND AND OBJECTIVE: The number of studies and evidences is inadequate especially with regard to the efficacy of pulsed radiofrequency (PRF) application in non-spinal indications. The purpose of this study was to investigate the effect of PRF on pain, functioning and quality of life in patients with advanced knee OA. METHODS: The study included 21 patients with complaints of knee pain. Intra-articular PRF was applied for 10 minutes at 42◦C. Pain severity was assessed using the 10 cm standard visual analogue scale (VAS). Outcome measures also included a 20-meter walk test, a 6-minute walk test, WOMAC, Lequesne index, and the Short Form-36 (SF-36). All measurements were assessed before treatment and 4 and 12 weeks after the treatment. RESULTS: A statistically significant improvement was found in VAS scores at rest and after walking, subscores of SF36-pain and SF36-social functioning, and Lequesne score at week four (p < 0.05). This improvement was maintained for the scores of VAS-walking at week 12 (p < 0.05). CONCLUSION: It is possible to state that intra-articular PRF application is effective and safe for the pain treatment of patients with advanced knee OA. Therefore, we think that PRF application will be included in chronic pain treatment guidelines in the future with the increase in the number of future studies.

[Comparison of the effects of remifentanil and remifentanil plus lidocaine on intubation conditions in intellectually disabled patients]. / Comparação dos efeitos de remifentanil e remifentanil + lidocaína em intubação de pacientes intelectualmente deficientes.

BACKGROUND AND OBJECTIVES: This is a prospective, randomized, single-blind study. We aimed to compare the tracheal intubation conditions and hemodynamic responses either remifentanil or a combination of remifentanil and lidocaine with sevoflurane induction in the absence of neuromuscular blocking agents. METHODS: Fifty intellectually disabled, American Society of Anesthesiologists I-II patients who underwent tooth extraction under outpatient general anesthesia were included in this study. Patients were randomized to receive either 2µg/kg remifentanil (Group 1, n=25) or a combination of 2µg/kg remifentanil and 1mg/kg lidocaine (Group 2, n=25). To evaluate intubation conditions, Helbo-Hansen scoring system was used. In patients who scored 2 points or less in all scorings, intubation conditions were considered acceptable, however if any of the scores was greater than 2, intubation conditions were regarded unacceptable. Mean arterial pressure, heart rate and peripheral oxygen saturation (SpO2) were recorded at baseline, after opioid administration, before intubation, and at 1, 3, and 5 min after intubation. RESULTS: Acceptable intubation parameters were achieved in 24 patients in Group 1 (96%) and in 23 patients in Group 2 (92%). In intra-group comparisons, the heart rate and mean arterial pressure values at all-time points in both groups showed a significant decrease compared to baseline values (p=0.000) CONCLUSION: By the addition of 2µg/kg remifentanil during sevoflurane induction, successful tracheal intubation can be accomplished without using muscle relaxants in intellectually disabled patients who undergo outpatient dental extraction. Also worth noting, the addition of 1mg/kg lidocaine to 2µg/kg remifentanil does not provide any additional improvement in the intubation parameters.

Comparison of the effects of remifentanil and remifentanil plus lidocaine on intubation conditions in intellectually disabled patients.

BACKGROUND AND OBJECTIVES: This is a prospective, randomized, single-blind study. We aimed to compare the tracheal intubation conditions and hemodynamic responses either remifentanil or a combination of remifentanil and lidocaine with sevoflurane induction in the absence of neuromuscular blocking agents. METHODS: Fifty intellectually disabled, American Society of Anesthesiologists I-II patients who underwent tooth extraction under outpatient general anesthesia were included in this study. Patients were randomized to receive either 2 µg kg(-1) remifentanil (Group 1, n=25) or a combination of 2 µg kg(-1) remifentanil and 1 mg kg(-1) lidocaine (Group 2, n=25). To evaluate intubation conditions, Helbo-Hansen scoring system was used. In patients who scored 2 points or less in all scorings, intubation conditions were considered acceptable, however if any of the scores was greater than 2, intubation conditions were regarded unacceptable. Mean arterial pressure, heart rate and peripheral oxygen saturation (SpO2) were recorded at baseline, after opioid administration, before intubation, and at 1, 3, and 5 min after intubation. RESULTS: Acceptable intubation parameters were achieved in 24 patients in Group 1 (96%) and in 23 patients in Group 2 (92%). In intra-group comparisons, the heart rate and mean arterial pressure values at all-time points in both groups showed a significant decrease compared to baseline values (p=0.000) CONCLUSION: By the addition of 2 µg/kg remifentanil during sevoflurane induction, successful tracheal intubation can be accomplished without using muscle relaxants in intellectually disabled patients who undergo outpatient dental extraction. Also worth noting, the addition of 1mg/kg lidocaine to 2 µg/kg remifentanil does not provide any additional improvement in the intubation parameters.

Comparison of the effects of remifentanil and remifentanil plus lidocaine on intubation conditions in intellectually disabled patients / Comparação dos efeitos de remifentanil e remifentanil + lidocaína em intubação de pacientes intelectualmente deficientes / Comparación de los efectos del remifentanilo y el remifentanilo más lidocaína en intubación de pacientes intelectualmente discapacitados

BACKGROUND AND OBJECTIVES: This is a prospective, randomized, single-blind study. We aimed to compare the tracheal intubation conditions and hemodynamic responses either remifentanil or a combination of remifentanil and lidocaine with sevoflurane induction in the absence of neuromuscular blocking agents. METHODS: Fifty intellectually disabled, American Society of Anesthesiologists I-II patients who underwent tooth extraction under outpatient general anesthesia were included in this study. Patients were randomized to receive either 2 μg kg-1 remifentanil (Group 1, n = 25) or a combination of 2 μg kg-1 remifentanil and 1 mg kg-1 lidocaine (Group 2, n = 25). To evaluate intubation conditions, Helbo-Hansen scoring system was used. In patients who scored 2 points or less in all scorings, intubation conditions were considered acceptable, however if any of the scores was greater than 2, intubation conditions were regarded unacceptable. Mean arterial pressure, heart rate and peripheral oxygen saturation (SpO2) were recorded at baseline, after opioid administration, before intubation, and at 1, 3, and 5 min after intubation. RESULTS: Acceptable intubation parameters were achieved in 24 patients in Group 1 (96%) and in 23 patients in Group 2 (92%). In intra-group comparisons, the heart rate and mean arterial pressure values at all-time points in both groups showed a significant decrease compared to baseline values (p = 0.000) CONCLUSION: By the addition of 2 μg/kg remifentanil during sevoflurane induction, successful tracheal intubation can be accomplished without using muscle relaxants in intellectually disabled patients who undergo outpatient dental extraction. Also worth noting, the addition of 1 mg/kg lidocaine to 2 μg/kg remifentanil does not provide any additional improvement in the intubation parameters. .

JUSTIFICATIVA E OBJETIVOS: este é um estudo prospectivo, randômico e duplo-cego. Nosso objetivo foi comparar as condições de intubação endotraqueal e as respostas hemodinâmicas com o uso de remifentanil ou combinação de remifentanil e lidocaína em indução anestésica com sevoflurano sem agentes bloqueadores neuromusculares. MÉTODOS: cinquenta pacientes intelectualmente deficientes, estado físico ASA I-II, submetidos à extração dentária sob anestesia geral em ambulatório foram incluídos neste estudo. Os pacientes foram randomizados para receber 2 μg kg-1 de remifentanil (Grupo 1, n = 25) ou uma combinação de 2 μg kg-1 de remifentanil e 1 mg kg-1 de lidocaína (Grupo 2, n = 25). Para avaliar as condições de intubação, o sistema de pontuação de Helbo-Hansen foi usado. Em pacientes com 2 ou menos pontos em todas as pontuações, as condições de intubação foram consideradas aceitáveis, porém, se qualquer uma das pontuações fosse superior a 2, as condições de intubação seriam consideradas inaceitáveis. Pressão arterial média, frequência cardíaca e saturação periférica de oxigênio (SpO2) foram registradas no início do estudo, após a administração de opiáceos, antes da intubação e nos minutos 1, 3 e 5 após a intubação. RESULTADOS: parâmetros aceitáveis de intubação foram obtidos em 24 pacientes do Grupo 1 (96%) e em 23 pacientes do Grupo 2 (92%). Nas comparações intragrupo, os valores da frequência cardíaca e pressão arterial média em todos os momentod em ambos os grupos mostraram uma redução significativa em relação aos valores basais (p = 0.000). ...

JUSTIFICACIÓN Y OBJETIVOS: este es un estudio prospectivo, aleatorizado y doble ciego. Nuestro objetivo fue comparar las condiciones de intubación endotraqueal y las respuestas hemodinámicas con el uso de remifentanilo o la combinación de remifentanilo y lidocaína en inducción anestésica con sevoflurano sin agentes bloqueantes neuromusculares. MÉTODOS: cincuenta pacientes intelectualmente discapacitados, estado físico ASA I-II, sometidos a la extracción dental bajo anestesia general en ambulatorio fueron incluidos en este estudio. Los pacientes fueron aleatorizados para recibir 2 μg/kg-1 de remifentanilo (grupo 1, n = 25) o una combinación de 2 μg/kg-1 de remifentanilo y 1 mg/kg-1 de lidocaína (grupo 2, n = 25). Para evaluar las condiciones de intubación se usó el sistema de puntuación de Helbo-Hansen. En pacientes con 2 o menos puntos en todas las puntuaciones, las condiciones de intubación fueron consideradas aceptables, sin embargo, si cualquiera de las puntuaciones fuese superior a 2 las condiciones de intubación serían consideradas inaceptables. La presión arterial media, frecuencia cardíaca y la saturación periférica de oxígeno, fueron registradas al inicio del estudio, después de la administración de opiáceos, antes de la intubación y en los minutos 1, 3 y 5 después de la intubación. RESULTADOS: se obtuvieron parámetros aceptables de intubación en 24 pacientes del grupo 1 (96%) y en 23 pacientes del grupo 2 (92%).En las comparaciones intragrupo, los valores de la frecuencia cardíaca y la presión arterial media en todos los momentos en ambos grupos arrojaron una reducción significativa con relación a los valores basales (p = 0,000). CONCLUSIÓN: con la adición de 2 μg/kg de remifentanilo durante la inducción con sevoflurano ...

[Case management based multidisciplinary care protocol in the palliative care of cancer patients]. / Kanser hastasinin palyatif bakiminda vaka yönetimine dayali multidispliner bakim protokolü.

Today, multifaceted approach is needed for the palliative care of advanced stage cancer patients. The main objective for these patients, elimination of pain and other symptoms, psychosocial and spiritual needs are met and to increase the quality of life. We are also faced with the challenge of meeting the physical and psychosocial needs of family members. The purpose of a holistic approach to patient and family who provide effective and quality care, care coordination and case management of a multidisciplinary team approach is based on cooperation. Care protocols specified patient care activities to be carried by the related disciplines to achieve results on a timeline that shows a certain, a multidisciplinary clinical management tool. A lot of care guidelines and protocols developed by a team of experts to contribute to the palliative care activities, and this is thought to be a guiding team members, working with patients.

Preemptive analgesic efficacy of dexketoprofen trometamol on impacted third molar surgery.

OBJECTIVE: The aim of this study was to compare the pre-emptive analgesic efficacy of intravenous (IV) dexketoprofen trometamol (DT) and placebo, following impacted mandibular third molar surgery. METHODS: Twenty patients over 18 year old who needed bilateral lower third molar extractions were included in this prospective, randomized and placebo-controlled clinical trial. Patients whom had taken DT 50 mg of before their one extraction, took placebo before their other extraction which had been performed on the opposite side. A total of 40 observations were made. Pain scores were evaluated with a Verbal Rating Scale (VRS) after surgery. Moreover; the time to first analgesic requirement use, additional analgesic need of patients, patient and doctor satisfaction, side effects were also determined. RESULTS: During the first 12 hours, the VRS values in DT group were significantly lower than those of placebo group patients (p<0.05). In placebo group, the time to first analgesic requirement use was significantly earlier than that of patients in DT group (p<0.05). Additional analgesic need of placebo group were significantly greater, when compared with the analgesic need of DT group patients (p<0.05). Among the DT group patients, patient and physician satisfaction was greater, which was statistically significant (p<0.05). CONCLUSION: Preemptive use of IV DT is more effective than placebo for using as preemptive analgesia for acute postoperative pain control in patients underwent removal of an impacted mandibular third molar surgery.

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.