Objectives: Pain is a subjective experience. Besides, sensory, affective and behavioral responses, and autonomic response are part of pain response to noxious stimuli. Evaluation of pupil diameter by pupillometry has been used as an alternative method for pain assessment. In algologic procedures like interventional headache management have not been addressed in the literature. Herein, we investigated changes in pupil diameter during interventional headache management as an objective method for pain assessment.
Methods: Demographic data of the patients were collected before the bilateral major occipital nerve blockage (MONB) procedure. Numeric rating score (NRS) and pupil diameter measurements by pupillometer were recorded before MONB. Standard MONB procedure was applied to all patients. Pain assessment and pupillary diameter measurements were obtained after nerve blockage.
Results: Twenty-eight patients were included in this study. Mean age was 41.03+-12.63 years. There is no difference between the hemodynamic parameters before and after the procedure. Post-procedure NRS and pupil diameter values were significantly lower than pre-procedure values. There was a positive correlation between changes in NRS scores and changes in the right and left pupil diameters.
Conclusion: There was a significant correlation between NRS score and pupil diameter in patients who underwent MONB. Monitoring of pupil diameter can be used for pain assessment during headache treatment. Evaluation of pupil diameter is a new approach in pain palliation. Future research is needed to study the effect of other parameters, that is, gender, age, origin of pain, acute, and chronic pain on pupil diameter and to evaluate its application in different algological procedures.
Objectives: The aim of the study was to investigate and compare the low-back pain, depression, and burnout levels among formal caregivers of elderly individuals and children with disability.
Methods: This descriptive and cross-sectional study included 29 caregivers of children with disabilities (Group 1) and 26 caregivers of elderly individuals (Group 2). The sociodemographic characteristics of the participants were questioned. The part of low back pain in the Standardized Nordic Musculoskeletal Questionnaire was used to estimate of low back pain. Beck Depression Inventory and Maslach Burnout Inventory were used to evaluate the levels of depression and burnout, respectively. In analysis, percentage values, mean, standard deviation, frequency, and t-test for comparative statistics and Chi-square and Fisher Exact test for categorical variables were used.
Results: There was a significant difference between the two groups only for the frequency of pain (p=0.039). There was a significant difference in depression levels between the groups (p=0.001) and no difference in the burnout level of the among groups (emotional exhaustion p=0.21; depersonalization p=0.95; and personal achievement p=0.066).
Conclusion: It was observed that the disabled and elderly care personnel included in this study similarly experienced moderate burnout, and they also had similar complaints in terms of low back pain, except for the frequency of pain. It was found that the depression levels of the disabled child caregivers were higher than the elderly caregivers. As a result, it has been seen that care work can cause both physical and psychosocial problems in both groups.
Ischemic pain is the main symptom of a group of diseases that result in inadequate blood flow to the extremities and ischemia. In this symptomatology, two major diseases are distinguished: Critical vascular disease and Raynaud's phenomenon. Critical vascular disease background of atherosclerosis caused by diabetes mellitus or hypertension. Raynaud phenomenon is divided into primary and secondary form. The primary form is due to vasospasm and there is no underlying cause. Secondary form is associated with underlying connective tissue or rheumatic diseases, peripheral vascular diseases such as thromboangitis obliterans (Burger's disease). Clinical findings in Raynaud's disease are vasomotor changes with cold exposure such as bruising, coldness, painful paresthesias, and ulcers due to chronic ischemia. Clinic presentation in critical ischemic disease is intermittent claudication for earlier stage and resting pain, gangrene, necrosis, and trophic changes were added in advanced stages. The treatment of the Raynaud 's disease in early stage is medical and conservative. In case of advanced stage ischemic vascular disease, medical treatment resistant pain, insufficient response to endovascular treatment, and inoperabl cases, interventions such as sympathectomy and spinal cord stimulation (SCS) can be applicable. SCS reduces vascular resistance through vasodilator mediators and increases blood flow. SCS also suppresses sympathetic vasoconstriction, increases tissue vascularity, reduces tissue damage, provides ulcer healing and pain reduction. In this report, we demonstrated that persistent Raynaud's disease and advanced stage Burger's disease were successfully treated with SCS.
Objectives: The aim of this study was to evaluate the frequency of pain and related factors in musculoskeletal system in children.
Methods: A total of 313 primary school students were analyzed in this cross-sectional study conducted in the Famagusta city center and surrounding villages. The physical activity musculoskeletal pain (MSP) level, health-related quality of life weight, height, and school bag weights of the students were measured by a blinded researcher.
Results: The study group consisted of 164 (52.40%) boys and 149 (47.6%) girls with a mean age of 9.53±0.82 years. In the present study, MSP frequency was found to be 39.0%. There was no relationship between MSP and the following parameters: Age, sex, body mass index, hours of weekly gym lesson, regular participation in sports, weekly time spent with sports, school bag type, and school bag weight. There was also no relationship between these parameters and region of pain.
Conclusion: Excessive walking and sitting were associated with increased MSP. Contrary to popular opinion, it was found that school bag weight and school bag type were not effective on MSP. Our results show that the quality of life of children can be improved by reducing MSP.
Objectives: The purpose of this study was to evaluate the incidence of primary headache and potential biomarkers in patients diagnosed with Hashimoto thyroiditis.
Methods: Patients with Hashimoto thyroiditis referred to the outpatient endocrinology clinic were included in the study. The demographic data, thyroid function test results, and autoantibody titers were recorded. The headache's clinical characteristics were also determined. The same researcher used the visual analog scale for headache severity rating in all patients.
Results: 155 patients with Hashimoto thyroiditis were included the study. There were 95 (61.3%) cases diagnosed with headache consisting of 20 (21.1%) migraine cases, 17 (17.9%) tension type headaches (TTHs), and 20 (21.1%) new daily persistent headaches (NDPHs). 38 of 155 (24.5%) had hypothyroidism related headaches (HRHs). There was no statistically significant relationship between the headache type and a high blood antibody level anti thyroid peroxidase antibody (p=0.135), while a positive correlation was found with thyroid stimulating hormone (TSH) (p<0.001). Hashimoto patients with migraine (n=14, 70.0%) were found to have higher blood antibody levels, while these ratios were found as 86.8% (n=33) in HRH-patients, 76.5% (n=13) in TTH-patients, and 60.0% (n=12) in NDPH-patients. 86 of 155 (55.5%) patients reported new onset headaches after a Hashimoto's thyroiditis diagnosis, and the headaches persisted without hormone therapy in 48 (84.2%) of these patients. These patients diagnosed with primary headache and this was interpreted as demonstrating comorbidity between Hashimoto's disease and primary headaches.
Conclusion: Detection of only the relationship between TSH level and headache suggested that different mechanisms play a role in the pathophysiology. In the diagnosis of primary headache, it is important to look into secondary reasons.
Objectives: The aim of this study is to investigate the effect of vitamin D on pain threshold in rats. In addition, to examine, whether EB1089, which is a vitamin D receptor agonist, can contribute to this mechanism by increasing the effects of the receptor.
Methods: In the study, 24 male Wistar Albino rats of 3 months, an average of 240-260 g, were used. The animals were randomly divided into three groups, eight animals in each group. Groups; control, vitamin D (10 µg/kg), and EB1089 (10 µg/kg). Tail flick and hot plate tests were used to evaluate the antinociceptive effect. Measurements were taken at 0 min before drug administration and at 30, 60, and 90 min after drug administration and times were recorded in seconds. Serotonin levels were also analyzed by ELISA method in plasma obtained from intracardiac blood samples taken at the end of the experiment.
Results: Vitamin D and EB1089 significantly increased the time to endure pain in the tail flick test compared to the control group (p<0.05). In the hot plate test, EB1089 group significantly extended the pain threshold compared to the control group (p<0.05), while the vitamin D group did not create a significant difference, although it had a higher latency than the control group (p>0.05). There was no significant difference between the groups in terms of serotonin levels (p>0.05).
Conclusion: As a result of our study, the administration of vitamin D and EB1089 increased the pain threshold in animals and increased pain resistance.
Objectives: The aim of this study was to investigate the effectiveness duration of the peripheral blocks applied with high concentration local anesthetic and steroid in trigeminal neuralgia.
Methods: The data of 48 patients (nine patients received medical treatment and 39 patients underwent interventional procedure for peripheral block and Gasser ganglion radiofrequency thermocoagulation [RFT]) were analyzed retrospectively. The medications used by patients, pre-operative and post-operative visual analog scale scores who underwent interventional procedures, and duration for effectiveness of the procedure were evaluated with 36 months follow-up.
Results: Forty-eight patients (32 females and 16 males) who were treated with primary and secondary etiologies were evaluated. Three patients V1, 12 patients V2, 25 patients V3, and eight patients V2+V3 trigeminal nerve branches described appropriate clinical symptoms. Only peripheral block was applied to 31 patients and Gasser ganglion RFT was applied to eight patients after peripheral block. In 24 patients who underwent peripheral block, pain severity reduction was ≥50%, mean effectiveness duration of peripheral block was 7.5 months. The eight patients undergoing Gasser ganglion RFT had ≥50% pain intensity reduction, mean effectiveness duration of Gasser ganglion RFT was 22.7 months (p=0.002). While one patient had hypoesthesia in the palate after RFT, no serious side effects were recorded.
Conclusion: The duration of pain control for peripheral branch blocks in trigeminal neuralgia is not as long as RFT, but it is a relatively less invasive and less complicated interventional technique with good efficacy duration due to neurotoxicity of the used high concentrated local anesthetic.
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.
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