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

Objectives: Patients suffer notable levels of pain after lumbar spine surgery. The primary objective of this randomized clinical trial is to investigate the efficacy of erector spinae plane block (ESPB) on 24-h post-operative pain score of patients undergoing lumbar spine surgery. Cumulative opioid consumption and intraoperative bleeding were assessed as well.

Methods: Adult patient candidates for elective lumbar spine surgery were randomly assigned to case (ESPB) and control (no ESPB) groups. The block was performed under ultrasound guidance in prone position after induction of general anesthesia. Both groups received the same anesthesia medication and technique. Post-operative pain score, number of patients requiring rescue analgesia (meperidine), total amount of post-operative rescue analgesic demand in the first 24 h, and intraoperative bleeding were recorded. To compare pain score variable in time span, the ANOVA repeated measure test was used. All the statistical tests were two tailed and p<0.05 considered as statistically significant.

Results: In all time intervals, pain score in case group was significantly lower than control group. In case group, eight patients demanded rescue analgesic (40%) which was significantly lower than that in control group (15 patients [75%]) (p=0.025). Total amount of meperidine consumption was 57.50±45.95 in control group and 22.50±32.34 in case group (p=0.01) which was higher in control group and statistically significant.

Conclusion: ESPB reduces post-operative pain score and opioid consumption, while it does not affect intraoperative bleeding in lumbar spine surgery.

High-energy chest wall traumas usually lead to multiple rib fractures associated with high morbidity and mortality. Pulmonary morbidity in patients with multiple rib fractures results from the impaired gas exchange from the pulmonary contusion areas and compromised breathing mechanics as a result of severe pain. Thus, analgesia plays a key role in the management of rib fractures. Erector spinae plane (ESP) block is a newly described technique and it has come into use in emergency departments for posterior rib fractures. ESP blocks can be administered in patients under anticoagulant therapy in the intensive care unit because the relevant area is located relatively superficial and far from the major vascular structures. In this report, anecdotal records of three patients with multiple rib fractures who had real benefits from ESP blocks are presented. This report highlights the bilateral extent of the sensory block after unilateral injection, the effect of ESP blocks on weaning from mechanical ventila-tion, and dramatic improvement in arterial blood gases analysis following ESP catheter insertion.

he autonomic nervous system (ANS) controls the heart rate, blood pressure, digestion, respiration, pupillary reactivity, sweating, urination, sexual arousal, and regulates the functions of internal organs. This system provides the homeostasis of the cells, tissues, and organs throughout the body and protects against the disturbances imposed by the external and internal stressors. The ANS has three main divisions: The sympathetic nervous system (SNS), the parasympathetic nervous system (PNS), and the enteric nervous system. In general, the SNS and PNS have opposing effects. Each region belonging to the 'pain matrix' interacts with ANS. The descending system regulates pain and creates a regulatory effect by the contribution of aminergic neurotransmitters. Hypothalamus, amygdala, and periaqueductal gray are the main structures of this regulatory system. Dysfunction of the ANS is frequently observed in pain patients. The SNS induce, facilitate, or potentiate chronic pain. Increased responsiveness of injured sensory nerves to catecholamines, increased expression of α-1 adrenoreceptors on the primary afferent nociceptors and hyperalgesic skin, central sensitization rendering Aβ mechanoreceptors, enhanced discharge and sympathetic sprouting in dorsal root ganglia, central sensitization, and dysfunction of the pain modulation is proposed mechanisms. In this review, the anatomical, physiological and pathological aspects of ANS and pain, and laboratory tests to evaluate autonomic functions will be discussed. Pathophysiological role of ANS in migraine, trigeminal autonomic cephalgias, trigeminal neuralgia, peripheral nerve injuries, small fiber neuropathies, myofascial pain syndrome, fibromyalgia, painful joint diseases, visceral pain, phantom limb pain, complex regional pain syndrome, and spinal cord injury will be discussed.

Platelet-rich plasma (PRP) has emerged as a viable therapeutic alternative for a number of clinical applications and has potential benefit for use in trigger finger. However, PRP use has not been previously reported for this condition. We report a 63-year-old woman sustaining a refractory trigger finger after a series of three PRP injections over a 2-week period. There was resolution of triggering, with no symptom recurrence at 3-month follow-up. On the basis of this report, we can assume that the treatment of trigger finger with PRP is a promising therapeutic option to be further explored with larger samples and high-quality studies.

Objectives: Myofascial pain syndrome (MPS) is a regional pain syndrome that causes pain due to hyperirritable trigger points in the musculoskeletal system. Trapezius is one of the most commonly affected muscles in MPS. We aimed to evaluate the efficacy of an ultrasound-guided interfascial block of the trapezius muscle in patients with MPS.

Methods: The records of patients who underwent an ultrasound-guided interfascial block of the trapezius between November 2019 and October 2020 were retrospectively examined. The pain levels of the patients were evaluated with the numeric rating scale (NRS). Patients with a reduction in pain ≥50% after the procedure were considered to have benefited from the procedure.

Results: A total of 54 patients (41 women and 13 men) were evaluated. The mean NRS values of the patients were 7.16 (5-9) before the procedure, 3.31 (0-8) 10 min after the procedure, and 3.37 (0-8) 1 week after the procedure. The number of patients who benefited from the procedure was 40 (74.07%) 10 min after the procedure. The number of patients who benefited from the procedure for up to 1 week, 1-2 weeks, 2 weeks-1 month, 1-3 months, and more than 3 months after the procedure was 38 (70.37%), 36 (66.66%), 31 (57.40%), 26 (48.14%), and 17 (31.48%), respectively.

Conclusion: Pain relief lasting for months was achieved in most of the patients. We believe that ultrasound-guided interfascial block of the trapezius is effective for the treatment of MPS.

Objectives: This study aims to determine the treatment preferences of physicians interested in fibromyalgia treatment and to investigate their hesitations about prescribing pregabalin.

Methods: Our survey study was conducted between February 5 and 20, 2021. The survey forms were sent to the known email addresses and phone numbers of 1569 physical medicine and rehabilitation (PMR), algology, and rheumatology physicians. The replies to the surveys were checked for possible resubmissions. The pooled data were evaluated with the SPSS 22.0 statistical package program. Frequency distributions were calculated and presented as n, %.

Results: Four hundred and six PMR, rheumatology, and algology specialists fulfilled the study forms. About 59.0% of physicians stated that they prefer duloxetine as the first-line agent of fibromyalgia syndrome (FMS) treatment. Pregabalin was only 6.0% of the physicians' first choice for FMS. About 35.0% of the participating physicians stated that the PMR department should follow up FMS patients. About 44.3% of the participants noted that they refer FMS patients to other departments which interested in FMS treatment and do not want to follow-up FMS patients. About 81% agreed that pregabalin causes addiction. About 36.7% stated that at least 20% of the patients could abuse pregabalin and 97.8% of physicians stated that they were prejudiced about prescribing pregabalin to prisoners. Approximately two of the three physicians experienced an act of violence in their hospital regarding pregabalin prescribing.

Conclusion: These data showed that the 'Pregabalinophobia' should be accepted. This condition is associated with life safety concerns of the physician not only from unreliability of the drug. It seems that the doctors have valid reasons to develop this prejudice.

Objectives: Chronic pain is a cause that negatively affects quality of life and functional capacity. Spinal cord stimulation is used for various painful indications such as failed back surgery syndrome, complex regional pain syndrome (CRPS), and peripheral vascular disease (PVD). Our aim is to retrospectively investigate the effectiveness of cervical spinal cord stimulator therapy in nine patients.

Methods: Nine patients with chronic pain in the upper extremity who did not benefit from medical (pharmacological, physical therapy, etc.) and algological interventional procedures (such as nerve blocks) were included in the study. Cervical spinal cord stimulator was applied to these patients in our pain clinic between January 1, 2016, and January 1, 2019. The pain levels and analgesic and antiepileptic drug doses of the patients before and after the procedure were analyzed.

Results: The mean age of patients was 51.8±14.6% (29-76), 44.4% (4) were female and 55.6% (5) were male. Indications for cervical spinal cord stimulator insertion were CRPS type 1 (five patients), CRPS type 2 (two patients), previous neck surgery (one patient), and pain syndrome due to PVD (one patient). After the procedure, we saw a statistical decrease in the pain levels and drug doses of the study patients. SPSS 22.0 statistics package program was used to evaluate the data. NPar and Friedman tests were used for comparisons. Continuous variables are given as mean±standard deviation. p<0.05 was considered statistically significant.

Conclusion: Cervical spinal cord stimulator is an effective method in the treatment of neck and upper extremity chronic pain.

In this article, we report a patient with migraine who was hospitalized with a prediagnosis of pseudotumor cerebri and diagnosed as neurobrucellosis with isolated intracranial hypertension presentation. A 22-year-old woman was admitted to emergency department with a complaint of headache. Her anamnesis indicated that she had migraine for 7 years. Neurological examination revealed bilateral papilledema. Cranial magnetic resonance imaging was normal. Cerebrospinal fluid (CSF) examination revealed 80 lymphocytes per mm3 with 178 mg/dL protein. Opening pressure was 260 mmH2O. Brucella tube agglutination and Rose Bengal tests were positive in blood and CSF. She was diagnosed as neurobrucellosis. If the systemic findings are insignificant and neurological findings are atypical such as isolated papillary edema, neurobrucellosis may not be considered and its diagnosis may be delayed. We believe that brucella serology should be included in the diagnostic protocols in endemic areas. Thus, early diagnosis and appropriate treatment can prevent complications of neurobrucellosis.