Characterization of head and neck pain symptoms of patients presenting to a tertiary care pain clinic.

OBJECTIVE: To characterize the presentation and symptomatology of individuals presenting with pain in head and neck regions. METHODS: A retrospective chart-review was performed on patients with pain in the HFN presenting to a tertiary pain center in Turkey between January 2016 and January 2017. Information regarding the characteristics of pain and medical and treatment history were extracted and reviewed. RESULTS: Among 197 subjects, 135 (68.5%) were females. The average duration of pain was 60.13 ± 92.32 months. The pain was continuous in presentation and severe in intensity in 43.1% and 51.8% of the subjects, respectively. The pain was associated with at least one somatosensory symptom in 12.1% of subjects. Common diagnoses were trigeminal neuralgia, persistent idiopathic facial pain, and migraine headaches. CONCLUSION: Painful disorders of the HFN are associated with varying and perplexing signs and symptoms. Such patients should undergo a comprehensive clinical assessment with a multidisciplinary team.

The efficacy of acupressure in managing opioid-induced constipation in patients with cancer: A single-blind randomized controlled trial.

PURPOSE: Opioid-induced constipation is one of the heath problems with a negative impact on the quality of life. This randomized-controlled trial aimed to investigate the effects of acupressure therapy on the management of opioid-induced constipation in patients with cancer. METHODS: The trial was conducted on 140 cancer patients, who were assigned to the acupressure (n = 70) and the control groups (n = 70). In addition to routine care, patients in the acupressure group received 8-min acupressure from the Zhongwan (CV12), Guanyuan (CV4), and Tianshu (ST25) acupoints once a day for 4 weeks. The outcomes included Defecation Diary (DD), Visual Analog Scale Questionnaire (VASQ), and Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL). RESULTS: We found a statistically significant difference between the acupressure and control groups in terms of stool consistency (2.22 ± 0.49 vs 1.80 ± 0.55) (p = 0.001), straining (1.98 ± 0.71 vs 2.91 ± 0.37) (p = 0.001), incomplete evacuation (0.37 ± 0.29 vs 0.61 ± 0.43) (p = 0.001), stool amount (0.93 ± 0.14 vs 0.95 ± 0.20) (p = 0.001), and the number of defecations (0.70 ± 0.22 vs 0.46 ± 0.29), (p = 0.001) measured at the fifth week. Besides, with the exception of stool amount, the DD scores obtained by the acupressure group significantly increased in the fifth week. Inter-group comparison of the pre-test and post-test scores showed that acupressure group obtained statistically significantly lower scores from the PAC-QOL (p = 0.0001). CONCLUSIONS: Findings of this trial suggested that a 4-week acupressure was an effective way to improve the quality of life and to reduce both the subjective and the objective constipation symptoms in patients with opioid-induced constipations. CLINICAL TRIAL NUMBER: NCT04876508.

Comparison of pulsed radiofrequency with conventional radiofrequency in the treatment of idiopathic trigeminal neuralgia.

The aim of this prospective, randomized, double-blinded study was to evaluate the effect of pulsed radiofrequency (PRF) in comparison with conventional radiofrequency (CRF) in the treatment of idiopathic trigeminal neuralgia. A total of 40 patients with idiopathic trigeminal neuralgia were included. The 20 patients in each group were randomly assigned to one of the two treatment groups. Each patient in the Group 1 was treated with CRF, whereas each patient in the Group 2 was treated by PRF. Evaluation parameters were: pain intensity using a Visual Analogue Scale (VAS), patient satisfaction using a Patient Satisfaction Scale (PSS), additional pharmacological treatment, side effects, and complications related to the technique. The VAS scores decreased significantly (p<0.001) and PSS improved significantly after the procedure in Group 1. The VAS score decreased in only 2 of 20 patients from the PRF group (Group 2) and pain recurrence occurred 3 months after the procedure. At the end of 3 months, we decided to perform CRF in Group 2, because all patients in this group still had intractable pain. After the CRF treatment, the median VAS score decreased (p<0.001) and PSS improved (p<0.001) significantly. In conclusion, the results of our study demonstrate that unlike CRF, PRF is not an effective method of pain treatment for idiopathic trigeminal neuralgia.

The efficacy and safety of venlafaxine in the prophylaxis of migraine.

OBJECTIVE: To evaluate the efficacy and safety of venlafaxine in the prophylaxis of migraine. BACKGROUND: The efficacy of venlafaxine, which is selectively effective on the serotonergic and noradrenergic mechanisms, on various headaches and chronic pain syndromes has been demonstrated. To our knowledge, this is the first placebo-controlled, double-blind, randomized study of two different doses of venlafaxine for migraine treatment. METHODS: In this prospective study, 60 migraine patients without aura were randomly assigned to venlafaxine XR 75 mg, venlafaxine XR 150 mg, or placebo. The frequency of headache attacks, the severity and the duration of attacks, and analgesic use were monitored every 2 weeks for 2 months. Adverse events and patient satisfaction were also evaluated during these visits. At the end of the 2 months, global efficacy and tolerance were investigated. RESULTS: A significant difference was observed between the venlafaxine 150 mg and placebo groups in the number of headache attacks (P= .006). According to patient satisfaction comparisons, the active drug groups were significantly different when compared with placebo (P= .001 at visit 2 and visit 6). When the global efficacy was considered, 80% of patients in the 75-mg group and 88.2% of the patients in the 150-mg group evaluated treatment benefits as either good or very good. CONCLUSIONS: Venlafaxine was more effective than placebo and is safe and well tolerated as migraine prophylaxis.

Intrathecal morphine and bupivacaine for phantom limb pain: a case report.

Besides the causes and prevention issues, chronic nonmalignant pain must be considered as a combination of multidimensional disorder of neurophysiology, behavior, culture, social, economic aspects.

Efficacy of coeliac plexus and splanchnic nerve blockades in body and tail located pancreatic cancer pain.

Palliative treatment, pain therapy and quality of life (QOL) are very important in pancreatic cancer patients. We evaluated the pain relieving efficacy, side effects and effects on QOL of neurolytic coeliac plexus blockade (NCPB) and splanchnic nerves neurolytic blockade (SNB) in body and tail located pancreatic cancer. The study protocol was approved by the local ethics committee. Patients were randomly divided into two groups. Coeliac group; GC, N = 19 were treated with coeliac plexus blockade, whereas the patients in splanchnic group; GS, N = 20 were treated with bilateral splanchnic nerve blockade. The VAS values, opioid consumption and QOL (Patient satisfaction scale=PSS, performance status scale=PS) were evaluated prior to the procedure and at 2 weeks intervals after the procedure with the survival rates. The demographic features were found to be similar. The VAS differences (difference of every control's value with baseline value) in GS were significantly higher than the VAS differences in GC on every control meaning that VAS values in GS decreased more than the VAS values in GC. GS patients were found to decrease the opioid consumption significantly more than GC till the 6th control. GS patients had significant improvement in PS values at the first control. The mean survival rate was found to be significantly lower in GC. Two patients had severe pain during injection in GC and 5 patients had intractable diarrhoea in GC. Comparing the ease, pain relieving efficacy, QOL-effects of the methods, splanchnic nerve blocks may be an alternative to coeliac plexus blockade in patients with advanced body and tail located pancreatic cancer.

[Sacral nerve stimulation in fecal incontinence; efficacy and safety]. / Fekal inkontinans olgularinda sakral sinir stimülasyonu; etkinligi, güvenilirligi.

Fecal incontinence is common due to various reasons. Conservative therapy of fecal incontinence may sometimes be effective in improving function, but usually many patients require surgery. Sacral nerve stimulation is another treatment modality which gained interest, and appears to be an alternative method that is successful with low morbidity. With the approval of the local ethical committee a total of 14 patients with rectal incontinence had undergone trial stimulation of sacral neuromodulation after failure of conservative treatment modalities. The implantations were performed under surgical sterile conditions with fluoroscopic guidance through the S3 foramen. After correct placement 0.5-2 V, 15 /min, pulse width 210 micro s stimulus was given. The patients had trial period longer than 6 weeks; 9 of 14 patients responded positively to the trial period. Of these 1 had permanent implantation, 3 were booked for permanent implantation, and 2 of the patients had complete incontinence relief from the trial period. Evaluating the data and the results of our study we may conclude that sacral nerve stimulation is an emerging surgical technique to produce a clinically beneficial physiological effect on the lower bowel, pelvic floor and anal canal.

The effects of three different analgesia techniques on long-term postthoracotomy pain.

UNLABELLED: In this clinical, randomized, prospective study, we compared the effects of three different analgesia techniques (thoracic epidural analgesia [TEA] with and without preoperative initiation and IV patient-controlled analgesia [IV-PCA]) on postthoracotomy pain in 69 patients. In two groups, a thoracic epidural catheter was inserted preoperatively. Group Pre-TEA had bupivacaine and morphine solution preoperatively and intraoperatively. Postoperative analgesia was maintained with epidural PCA with a similar solution. Group Post-TEA, with no intraoperative medication, had the same postoperative analgesia as Group Pre-TEA plus the bolus dose. Group IV-PCA received only IV-PCA with morphine for postoperative analgesia. Pain was evaluated every 4 h during the first 48 h at rest, cough, and movement. Pre-TEA was associated with decreased pain compared with the other groups. Six months later, the patients were asked about their pain. The incidence and the intensity of pain were most frequent in Group IV-PCA (78%) and were the least in Group Pre-TEA (45%) (Group Pre-TEA versus Group IV-PCA, P = 0.0233; Group Pre-TEA versus Group IV-PCA, P = 0.014). Patients having pain on the second postoperative day had 83% chronic pain. TEA with preoperative initiation is a preferable method in preventing acute and long-term thoracotomy pain. IMPLICATIONS: Preoperatively initiated thoracic epidural analgesia has the most satisfying results in controlling postthoracotomy pain in the acute and long-term period, and it is associated with a decreased incidence (and intensity) of chronic pain compared with postoperative (epidural or IV) analgesia. Chronic pain has an incidence of 62%.