Agri-The Journal of the Turkish Society of Algology最新文献

Objectives: Lumbosacral radicular pain (LRP) is one of the most common causes of neuropathic pain. This pain often arises from inflammation in the dorsal root ganglia (DRG) or spinal nerves. Despite various treatment modalities, success rates are not very high in chronic LRP cases. Pulsed radiofrequency (PRF) therapy, frequently applied to the DRG, is widely used, but its effectiveness is often questioned in various studies. The primary aim of our study is to evaluate the effectiveness of PRF treatment in 154 patients.

Methods: Patients with LRP for longer than 3 months, treated with PRF, were included in this study. To assess the efficacy of PRF treatment, numerical rating scale (NRS) scores were evaluated at the 4th-week and 6th-month follow-ups.

Results: The NRS scores were significantly lower at the 4th-week and 6th-month follow-ups compared to pre-treatment levels (p<0.001). However, there was no significant difference between the mean NRS scores at the 4th week and 6th month.

Conclusion: Success in interventional pain procedures is often considered as at least a 50% reduction in pain scores. The success rate for PRF treatment for LRP in the literature varies between 30% and 60%, which is similar to our findings at the 4th week and 6th month. PRF treatment is widely used due to its low side-effect profile and cost-effectiveness in the long term. There is no fully standardized practice regarding procedural aspects, such as the duration of the application, and prospective studies with larger participation are needed.

Lumbar facet joint synovial cysts are benign degenerative abnormalities of the lumbar spine and can cause lower extremity ra-diculopathy, spinal stenosis, and low back pain. Herein, we report a case with a synovial cyst treated by percutaneous fluoros-copic aspiration via the facet joint. A 46-year-old woman presented to the neurosurgery clinic complaining of a 2-month history of low back pain with left-sided radicular symptoms. Her physical examination was consistent with a left L5 radiculopathy, and MRI confirmed a left L5-S1 facet joint synovial cyst compressing the nerve root. Percutaneous fluoroscopic cyst aspiration via the facet joint was planned. The cyst was aspirated, and a total of 0.2-0.3 cc of fluid was removed. During the aspiration, the patient reported pain relief. Thus, the procedure was completed. An MRI taken after 3 weeks showed that the cyst had become smaller than before, with no evidence of nerve root compression. For 1 year, the patient has had no pain or neurological symptoms. Patients who undergo a fluoroscopic percutaneous rupture by filling of the facet joint cyst typically have successful outcomes. We conclude that aspiration of the facet joint cyst without rupture can also result in the same successful outcome.

Objectives: To reduce the drug side effects and facilitate the emergence from anesthesia after complex spine surgery, various methods have been proposed. One of these methods is ESPB, which has been less studied. Hence, we conducted this study to evaluate the effectiveness of ESPB on the use of anesthetic drugs in lumbar spine surgery.

Methods: In this study, 70 patients undergoing lumbar spine fusion surgery were studied. Patients were randomly divided into two groups: the case group (n=35), in which bilateral ESPB was done, and the control group (n=35). After standard anesthesia protocols, anesthesia was maintained with isoflurane in both groups. Intraoperative isoflurane and perioperative opioid consumption were recorded. Statistical analysis was performed using SPSS software version 21.

Results: Intraoperative use of fentanyl in the case group was significantly lower than the control group (14.29±21.5 vs. 65.96±73.33 µg, p<0.001). Furthermore, isoflurane consumption in the intervention group compared to the controls was significantly lower (20.71±5.02 versus 28.83±8.68 mL, p<0.001). Moreover, the emergence time was significantly shorter in the case group than in the control group (8.49±4.30 minutes versus 15.00±4.94, p<0.001). In the post-anesthesia care unit 1 h after surgery, the pain scores in the case group were significantly lower than the controls (p<0.001).

Conclusion: ESPB under ultrasound guidance is an effective method of regional anesthesia/analgesia for lumbar spine surgery (fusion) by decreasing the consumption of anesthetics during and following the surgery.

Post-herpetic neuralgia (PHN) is the most common chronic complication of herpes zoster and the most common pain syndrome associated with infections. There are medical and interventional treatment options in PHN, and some patients may be resistant to the preferred medical treatments. This situation negatively affects the quality of life of the patient. Interventional treatments come to the fore, especially in patients in whom medical treatments are not sufficient, and systemic side effects such as hepatotoxicity and nephrotoxicity occur. Erector spinal plane block (ESPB) is a recently described ultrasound-guided regional anesthesia technique. It is especially used to prevent post-operative pain due to trunk surgeries. In this study, ESPB was administered with methylprednisolone and bupivacaine in five patients who developed PHN after thoracic herpes zoster and did not have an expected response to three-month medical treatments. Pain severity was assessed using the Numerical Pain Rating Scale. We want to emphasize that ESPB, which is applied with steroids and anesthetics, is a speedy and longacting treatment option that increases the quality of life of the patient, has low side effects, and is a cost-effective treatment option.

Objectives: This study aimed to determine the physical activity (PA) level of individuals with migraine and examine its effects on pain intensity (PI), disability, and quality of life (QoL).

Methods: Individuals diagnosed with migraine between the ages of 18 and 55 were included in the study. PA levels are assessed by the International PA Questionnaire Short Form (IPAQ-SF), PI with the McGill Melzack Pain Questionnaire, disability with the Migraine Disability Assessment Scale (MIDAS), and QoL with the World Health Organization QoL Scale Short Form (WHOQOL-BREF).

Results: A total of 88 individuals, with a mean age of 34.11±10.51 years, were included in the study; 53.41% were low active (LA), 30.68% were moderate active (MA), and 15.91% were high active (HA). The physical health of LAs (p=0.047) was lower than that of MAs. General (p<0.001), physical (p<0.001), and psychological (p=0.003) health scores were lower than HAs. LAs had a higher disability (p=0.042) and PI (p=0.001) than HAs. There was a weak negative correlation between PA and PI (p=0.001) and disability (p=0.005), and a weak positive correlation between PA levels and social (p=0.007) and environmental (p=0.013) scores, and moderate positive correlations with physical (p=0.000), general (p=0.000), and psychological (p=0.000) scores.

Conclusion: It was observed that as PA levels increased, PI decreased, and functionality and QoL increased in patients with migraine. Ensuring exercise continuity seems to be effective for improving the negative effects of migraine.

Objectives: The aim is to determine the pain beliefs and related factors of cancer patients.

Methods: The study was designed as a descriptive and analytical type. It was completed between January and June 2019 with 100 individuals who were 18 years of age or older, who were receiving chemotherapy, and who agreed to participate in the study. Data were collected using a patient information form, a pain assessment form, and the Pain Beliefs Scale.

Results: In the results of the regression analysis, the psychological belief scores of those who acted nervously were statistically 0.408 points higher than those who acted calmly. Organic beliefs scores were statistically 0.814 points and 0.599 points higher in basically literate and primary school graduates, respectively, compared to university graduates. They were 0.372 points higher for those whose income was less than their expenditure compared to those whose income was balanced with their expenditure, 0.414 points higher in those who had experienced pain in the last 6 months compared to those who had not, and 0.561 points higher in those who did not use non-pharmacological methods in pain control compared to those who did. Those who expressed pain verbally were found to have points that were 0.447 higher than those who did not say they had pain.

Conclusion: Based on the results obtained, it is recommended that cancer patients be given training that will improve self-management and self-efficacy with cognitive-behavioral methods, taking into account their pain beliefs and affecting factors, in order for them to be successful in pain management.

Objectives: The aim of this study was to evaluate the efficacy of consecutive facet medial branch (FMB) radiofrequency denervation (RFD) and dorsal root ganglion pulse radiofrequency (DRG PRF) therapy in patients with chronic lumbar facet joint pain.

Methods: The study included 27 patients with chronic lumbar pain who had ≥50% pain reduction after FMB block for suspected lumbar facet syndrome and subsequently underwent FMB RFD together with PRF to the adjacent DRG. The patients were retrospectively analyzed in terms of age, gender, pre-procedure symptom duration, history of previous back surgery, FMB RFD and DRG PRF level and side, and numerical rating scale scores immediately before and at 1, 3, and 6 months after the procedure, and subjective pain reduction at 6 months post-treatment. Treatment success was defined as ≥50% subjective pain reduction at 6 months.

Results: A total of 19 women and 8 men with a mean age of 57.7±12.4 years were analyzed. Twenty patients (74.1%) had no prior history of low back surgery. The success rate of the procedure in terms of subjective pain reduction at 6 months was 82.5% (n=25). The subjective percentage of pain reduction at post-procedure 6 months was significantly lower in patients with a pre-procedure symptom duration of 12 months or longer compared to those whose pre-procedure symptom duration was <12 months (p=0.04).

Conclusion: Our study results show that the analgesic efficiency of DRG PRF added to FMD RFD treatment can be increased in patients with short symptom durations.