Lesioning using radiofrequency (RF) current has been increasingly used in clinical practice for the treatment of pain syndromes. Although formation of heat causing “thermocoagulation” of the nervous ...tissues is thought to be responsible of the clinical outcome, a more recent modality of RF application named pulsed radiofrequency (PRF) delivers the RF current without producing destructive levels of heat. In our study, we compared the effects of conventional RF (CRF) and PRF on rabbit dorsal root ganglion (DRG) morphology, including also control and sham operated groups. The setting of the experiment and the RF parameters used were similar to those used in current clinical practice. The specimens were analyzed both with light microscopy and electron microscopy, two weeks after the procedure. At the light microscopic level, all groups had preserved the normal DRG morphology and no differences were observed between them. In the electron microscopic analysis there were no pathological findings in the control and sham operated groups. But the ganglion cells in the RF groups had enlarged endoplasmic reticulum cisterns and increased number of cytoplasmic vacuoles which were more evident in the CRF group. Some of the ganglion cells in the CRF group had mitochondrial degeneration, nuclear membrane disorders or loss of nuclear membrane and neurolemma integrity. The myelinated and unmyelinated nerve fibers were of normal morphology in all groups. Our results suggest that PRF application is less destructive of cellular morphology than CRF at clinically used “doses”. Before making certain judgements, more experimental and clinical studies should be planned.
Classification of pain and identification of the specific pain mechanisms through utilization of clinical data are helpful to the physician in choosing the appropriate treatment model. For ...discrimination between different pain types, various tests could be used. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale is a scale based on the analysis of data obtained during bedside examination. The LANSS Pain Scale, as first used by Bennett, is a very useful tool that provides immediate information in the clinical setting and helps distinguish nociceptive pain from neuropathic pain. In this study we targeted validation of the LANSS Pain Scale in the Turkish population. A total of 104 patients who consulted the Algology Department of Istanbul Faculty of Medicine Outpatient Clinic were enrolled in our validation study. The sensitivity and specificity of the scale were found to be 89.9% and 94.2%, respectively. These results suggest a high validity level for the Turkish version of the LANSS Pain Scale. We believe that this scale is a useful tool for the differential diagnosis of neuropathic pain and can be used in future pharmacologic studies.
Any measures that aid in differentiating neuropathic pain from nociceptive pain would facilitate effective management of pain. In daily practice the simplicity of the classification method is important. The present study suggests that Turkish version of LANSS can be used for the discrimination between neuropathic and nociceptive types of pain.
The aim of this study was to determine the prevalence of diabetic peripheral neuropathy (DPN) and neuropathic pain in diabetic patients attending university outpatient clinics in Turkey. In this ...multicenter cross-sectional study, neurologic examinations and nerve conduction studies along with clinical diabetic neuropathy score, and Leeds Assessment of Neuropathic Symptoms and Signs pain scale were performed on 1,113 patients (46.2% male) from 14 centers. Prevalence of DPN determined only by clinical examination was 40.4% and increased to 62.2%, by combining nerve conduction studies with clinical examination. According to Leeds Assessment of Neuropathic Symptoms and Signs scores, neuropathic pain prevalence was 16.0% in those who reported pain. Poor glycemic control, retinopathy, microalbuminuria, hyperlipidemia, diabetic foot, and foot amputation were more commonly observed in patients with DPN. Clinical DPN affected 40.4% of diabetic patients, and neuropathic pain prevalence in diabetic patient population was 14.0%. Clinical examinations and nerve conduction studies are important components for early detection and accurate diagnosis of DPN and painful DPN.
In this study, we evaluated the efficacy and safety of prophylactic administration of intravenous caffeine sodium benzoate for postdural puncture headaches (PDPH) on patients administered spinal ...anesthesia.
Sixty ASA I and II patients undergoing lower abdominal or lower extremity surgery were included in this study. Patients were randomized by double-blind, placebo-controlled design to receive either 1,000 mL normal saline with 500 mg caffeine sodium benzoate (group C) or 1,000 mL normal saline (group S) during the first 90 minutes after spinal anesthesia administration. The patient's electrocardiogram, non-invasive blood pressure, and pulse oximetry were monitored and recorded. The patients' headaches were evaluated by using the visual analog scale (VAS). At the end of the fifth day, the severity of the headache was classified as follows: no headache = 0; mild headache = 1; moderate headache = 2; severe headache = 3. Analgesic requirements were recorded for 5 days.
Visual analog scale scores were significantly lower in group C than in group S. The incidence of moderate and severe headache was significantly higher in group S (11 patients) when compared with group C (3 patients). Analgesic demand was significantly lower in group C than in group S for 4 days.
Intravenous caffeine sodium benzoate administration during spinal anesthesia is a simple and safe way to minimize PDPH.
The purpose of this study was to retrospectively review the outcome and complications of totally implantable venous-access ports (TIVAPs) inserted via low internal jugular vein (IJV) approach under ...ultrasound guidance versus subclavian vein (SCV) approach.304 cancer patients who could be followed up to the time of catheter removal or to the end of the study period were enrolled in the study. 200patients had the placement of TIVAPs via IJV and 104 patients via SCV. Statistical analysis showed that there were no differences with regard to the patient characteristics and to the site of primary malignancy in two groups, while the large majority of the TIVAPs had been inserted in the right side. The average port dwelling time was higher in the IJV group compared to the SCV group, the difference was statistically significant (p<0.001). Complications were more frequent in the SCV than in the IJV approach (12 patients vs. 3 patients). Our analysis revealed that TIVAP is a safe and effective route for long-term administration of chemotherapy, and the placement of TIVAPs via the right IJV is associated with a low long-term complication rate.
Bu çalışmanın amacı, subklavyan ven (SCV) yaklaşımına karşı ultrason rehberliğinde düşük internal juguler ven (IJV) yaklaşımı ile yerleştirilen tamamen implante edilebilir venöz erişim portlarının (TIVAP'ler) sonuçlarını ve komplikasyonlarını geriye dönük olarak gözden geçirmektir. Kateter çıkarılıncaya veya çalışma süresinin sonuna kadar izlenebilen 304 kanser hastası çalışmaya alındı. 200 hastaya IJV yoluyla TIVAP ve 104 hastaya SCV yoluyla TIVAP yerleştirildi. İstatistiksel analizler hasta özellikleri ve primer malignite bölgesi açısından iki grupta fark olmadığını gösterdi, TIVAP'lerin büyük çoğunluğu sağ tarafa yerleştirilmişti. Ortalama port kalma süresi SCV grubuna kıyasla IJV grubunda daha yüksekti, bu fark istatistiksel olarak anlamlıydı (p<0.001). SCV'de komplikasyonlar IJV yaklaşımına göre daha sıktı (12 hastaya karşı 3 hasta). Çalışmamız, TIVAP'ın uzun süreli kemoterapi uygulaması için güvenli ve etkili bir yol olduğunu ve TIVAP'lerin doğru IJV yoluyla yerleştirilmesinin düşük uzun dönem komplikasyon oranı ile ilişkili olduğunu ortaya koydu.
In this study, we have performed hypogastric plexus block using a posterior transdiscal approach in 20 patients diagnosed with pelvic pain because of cancer.
The L(5)-S(1) interdiscal space was ...identified with fluoroscopy. A needle attached to a 5-mL syringe was introduced through the disc and advanced under lateral fluoroscopic control until resistance was lost. After verifying proper position, 5 mL of 10% aqueous phenol was administered through the needle. After drawing back the needle, cephazolin 50 mg in 1 mL was administered to the disc to prevent discitis. The visual analog scale (VAS) values, daily analgesic requirements, and patient satisfaction were evaluated before the procedure, at 24 hours and then every month for 3 months after the procedure.
Disc puncture was performed without difficulty in all patients, there were no complications associated with disc puncture such as discitis or disc rupture. Twelve patients had statistically significant pain relief immediately after the block (P <.05). Fifteen patients were satisfied after the block, and their daily analgesic requirement decreased significantly. No pain relief was observed in 5 patients.
Transdiscal approach to the hypogastric plexus appears to be a safe and effective procedure. However, prospective randomized controlled studies comparing different approaches are needed to increase our knowledge of hypogastric plexus block.
In this study, we have evaluated clinical results of the discTRODE system, in 15 patients with discogenic pain. All procedures were performed under sterile conditions with fluoroscopic guidance. ...After identifying the disc space under fluoroscopy, the introducer of the discTRODE was introduced using a tunneled vision. After inserting the introducer; navigable, semi-rigid discTRODE catheter was advanced through the introducer and directed medially and contralaterally along the posterior nuclear-annular interface. The SMK Thermocouple Electrode was placed in the outer-annulus on the contralateral side so as to monitor local tissue temperature. The treatment temperature was manually increased in a step-wise progression from 50 degrees C to 65 degrees C. Patient outcomes were evaluated during follow-up visits at 1, 3, 6 and 12th months post-procedure. Before the procedure and at each visit during the follow-up period, patients completed Visual Analogue Pain Scale (VAS) and Short Form-36 Health Status Questionnaire (SF-36). Annuloplasty was performed without difficulty in all patients, there were no complications associated with disc puncture such as discitis or disc rupture. Symptoms improved in 10 of 15 (66.6 %) of the patients on the SF-36 Physical Function subscale, in 9 of 15 (60 %) on the SF-36 Bodily Pain subscale and in 9 of 15 (60 %) on the VAS scores. 5 of 15 of the patients did not show improvement on any scale. This technique seems to be a reliable method for patients complaining of discogenic pain. However, prospective randomized controlled studies comparing different approaches are needed.
The aim of the present study was to investigate the effect of the rate of temperature increase on the intensity of the evoked pain before and after hyperalgesia induced by topical capsaicin. Further, ...hyperalgesia to suprathreshold heat stimuli was investigated. Thirteen healthy volunteers were included in the experiment. All stimuli were applied in randomised order within the volar surface of both forearms using a computer-controlled contact stimulator. In one of the forearms, the effect of the rate of temperature change was investigated for 1.0, 5.0, and 8.0
°C/s reaching a peak temperature of 30.0, 33.0, 36.0, 39.0, and 42.0
°C in the primary hyperalgesic area and reaching a peak temperature of 33.0, 36.0, 39.0, 42.0, 45.0, 47.0, and 49.0
°C in the secondary hyperalgesic area before and after the induction of hyperalgesia. In the other forearm, the same procedure was repeated without capsaicin application as a control measurement. After the induction of hyperalgesia, the pain ratings were significantly higher in the arm treated with capsaicin compared with baseline for 36, 39, and 42
°C heating rates in the primary hyperalgesic area. The pain ratings were significantly higher with 1
°C/s heating rate compared with 5 and 8
°C/s for 36, 39, and 42
°C in the primary hyperalgesic area. Heat hyperalgesia was also observed within the secondary hyperalgesic area to pin-prick for stimulus temperatures of 45, 47, and 49
°C compared with the baseline measurements. Increased ratings were found for all three heating rates in the secondary hyperalgesic area. There were no heat hyperalgesia in the control arm. In conclusion, hyperalgesia to suprathreshold heat stimuli was observed in the secondary hyperalgesic area and C-fibres play an important role in the primary hyperalgesia to heat.
Diverging observations on secondary hyperalgesia to heat stimuli have been reported in the literature. No studies have investigated the importance of heat stimulus intensity and duration for the ...assessment of secondary heat hyperalgesia. The present study was designed to investigate systematically (1) if pain sensitivity to radiant heat stimuli (focused Xenon light) is altered in the area of secondary punctuate hyperalgesia induced by intradermal injection of capsaicin and (2) if heat stimulus duration and intensity had an influence on the ability to detect secondary heat hyperalgesia.
Pain ratings to radiant heat stimuli from a focused xenon lamp were assessed within the area of secondary punctuate hyperalgesia in fifteen volunteers before and after intradermal injection of capsaicin. The stimulus conditions were systematically varied between three intensity levels (0.8, 1.0 and 1.2 × heat pain threshold (PT)) and four duration steps (200, 350, 500 and 750 ms). The present study shows that long duration (350-750 ms) and low intensity (0.8 and 1.0 × PT) radiant heat stimuli were adequate to detect secondary heat hyperalgesia.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Neuropathic pain, resulting from the disturbances of central or peripheral nervous system with mechanisms that we cannot explain yet exactly, is really a troublesome situation both for the patient ...and the physician. Our knowledge about this difficult to diagnose and treat pain condition has improved a lot with the aid of recent experimental and clinical studies. This review summarizes the underlying mechanisms, common conditions, diagnosis and treatment of neuropathic pain.
