Can Eyigor

Intra-articular corticosteroid injections versus pulsed radiofrequency in painful shoulder: a prospective, randomized, single-blinded study.

ObjectiveChronic shoulder pain treatment is known to be a difficult and long process. The objective of this study is to compare the efficacy of intra-articular corticosteroid injection and pulse radiofrequency (PRF) applied to the suprascapular nerve in patients with shoulder pain. MethodsFifty patients with shoulder pain were included in the study. Patients were randomly allocated into group 1 (intra-articular injection of corticosteroid) and group 2 (PRF to the suprascapular nerve). Outcome measures included a pain scale (visual analog scale; VAS), range of motion, Shoulder Pain and Disability Index (SPADI), the Short Form-36, Beck Depression Scale questionnaires, and paracetamol consumption. ResultsIn both groups, significant improvement was observed in all weeks in VAS, range of motion (active-passive), and SPADI subscores (P<0.05). Improvement was detected in most of the Short Form-36 scores at the end of the treatment in both groups (P<0.05), whereas no significant change was observed in Beck Depression Inventory score (P>0.05). When the groups were compared, a significant difference was found between the groups in favor of group 1 in terms of VAS at night in weeks 1, 4, and 12; VAS at rest in weeks 1 and 4; and VAS during movement in week 1 (P<0.05). There was also a significant difference in favor of group 1 observed in weeks 1, 4, and 12 in SPADI pain and total subscores (P<0.05). Paracetamol consumption was observed to be lower in group 1 (P<0.05). ConclusionsIntra-articular injection of corticosteroid and PRF applied to the suprascapular nerve are effective in the treatment of painful shoulder. When 2 treatments are compared, it may be concluded that intra-articular steroid injection was more effective especially in the first weeks regarding pain than the PRF. Further studies are needed to confirm these results in the prospective treatment guidelines.

Assessment of pain, fatigue, sleep and quality of life (QoL) in elderly hospitalized cancer patients

As the proportion of older adults in the population continues to grow, the number of patients with cancer is expected to increase proportionally. In the previously conducted studies, data on elderly cancer patients were generally compared with the QoL scores of elderly patient group and with the data of non-cancer individuals. The purpose of this study was to examine differences in reported pain, fatigue, sleep problems and QoL between middle-aged and elderly hospitalized patients with cancer. We included 53 middle-aged (between 18 and 50 years) hospitalized cancer patients and 47 elderly (>60 years) hospitalized cancer patients in this study. Pain (visual analog scale=VAS, verbal pain rating), fatigue (brief fatigue inventory=BFI), sleep problems, QoL (Short Form 36=SF36), and European Organization for Research and Treatment of Cancer (EORTC)-QoL-C30 data were gathered using standardized measures. In the elderly group, no significant difference was detected in terms of VAS, verbal pain rating, fatigue, fatigue type, sleep problems and QoL scores (p>0.05). When the two age groups were compared, BFI scores were found to be significantly high among the elderly patients (p<0.05). A significant relationship was observed in both age groups between the scores of pain, fatigue and sleep problems, and QoL (p<0.05). Elderly hospitalized cancer patients did not demonstrate a distinctive difference in terms of pain, sleep and QoL compared to the younger group. The relationship between pain, fatigue, sleep and QoL should be definitely kept in mind in clinical practice.

Pulsed radiofrequency versus conventional transcutaneous electrical nerve stimulation in painful shoulder: a prospective, randomized study

Objective: To compare the efficacy of pulse radiofrequency applied to the suprascapular nerve with the efficacy of conventional transcutaneous electrical nerve stimulation treatment in patients with shoulder pain. Design: A randomized, controlled trial. Setting: An outpatient physical therapy and rehabilitation clinic. Subjects: Forty patients with shoulder pain lasting at least three months were included in the study. Subjects were randomly allocated into either a pulsed radiofrequency treatment or a conventional transcutaneous electrical nerve stimulation treatment. All patients received exercise therapy. Main measurements: Outcome measurements were performed using the visual analogue scale for pain and range of motion; the Shoulder Pain and Disability Index was used for disability; and the Short Form-36 was used to establish quality of life. All of the measurements were assessed at four points in time (before the intervention, and for 1, 4 and 12 weeks afterwards). Results: When the groups were compared, no significant difference was found between the groups in terms of visual analogue scale, range of motion, the Shoulder Pain and Disability Index (except for the Shoulder Pain and Disability Index total score), Short Form-36 subscores, and paracetamol consumption for all weeks (P >0.05). Conclusion: Our results showed that there is no difference in effect between transcutaneous electrical nerve stimulation and pulsed radiofrequency treatment for shoulder pain.

The frequency of fibromyalgia syndrome and quality of life in hospitalized cancer patients.

To explore the frequency of fibromyalgia syndrome (FMS) among hospitalized cancer patients and address the relationships between pain, fatigue and quality of life with regard to the extent of pain, a cross-sectional and descriptive study was carried out in the Oncology Supportive Care Unit on 122 hospitalized cancer patients. Pain, sleep, disease impact (Fibromyalgia Impact Questionnaire), fatigue (Brief Fatigue Inventory), quality of life (Short Form 36 and European Organization for Research on Treatment of Cancer questionnaires Quality of Life-C30) were gathered using standardized measures. Thirteen of the hospitalized cancer patients (10.7%) included in the study were diagnosed with FMS. There were no statistically significant differences among three pain groups with respect to demographic characteristics (P > 0.05). There were significant differences among groups with regard to the presence of metastasis, fatigue, sleep disorder, pain, Brief Fatigue Inventory, Fibromyalgia Impact Questionnaire, most of subscores of Short Form 36 and European Organization for Research on Treatment of Cancer questionnaires Quality of Life-C30 scores (P < 0.05). In the present study, we have calculated the frequency of FMS among patients admitted to the oncology hospital in addition to establishing the relationships between pain, fatigue and quality of life with regard to the extent of pain. We believe that the descriptive data presented in this study would be helpful in future studies and therapeutic approaches.

Effects of intra-articular application of pulsed radiofrequency on pain, functioning and quality of life in patients with advanced knee osteoarthritis

BACKGROUND AND OBJECTIVE The number of studies and evidences is inadequate especially with regard to the efficacy of pulsed radiofrequency (PRF) application in non-spinal indications. The purpose of this study was to investigate the effect of PRF on pain, functioning and quality of life in patients with advanced knee OA. METHODS The study included 21 patients with complaints of knee pain. Intra-articular PRF was applied for 10 minutes at 42◦C. Pain severity was assessed using the 10 cm standard visual analogue scale (VAS). Outcome measures also included a 20-meter walk test, a 6-minute walk test, WOMAC, Lequesne index, and the Short Form-36 (SF-36). All measurements were assessed before treatment and 4 and 12 weeks after the treatment. RESULTS A statistically significant improvement was found in VAS scores at rest and after walking, subscores of SF36-pain and SF36-social functioning, and Lequesne score at week four (p < 0.05). This improvement was maintained for the scores of VAS-walking at week 12 (p < 0.05). CONCLUSION It is possible to state that intra-articular PRF application is effective and safe for the pain treatment of patients with advanced knee OA. Therefore, we think that PRF application will be included in chronic pain treatment guidelines in the future with the increase in the number of future studies.

Preemptive analgesic efficacy of dexketoprofen trometamol on impacted third molar surgery.

OBJECTIVE The aim of this study was to compare the pre-emptive analgesic efficacy of intravenous (IV) dexketoprofen trometamol (DT) and placebo, following impacted mandibular third molar surgery. METHODS Twenty patients over 18 year old who needed bilateral lower third molar extractions were included in this prospective, randomized and placebo-controlled clinical trial. Patients whom had taken DT 50 mg of before their one extraction, took placebo before their other extraction which had been performed on the opposite side. A total of 40 observations were made. Pain scores were evaluated with a Verbal Rating Scale (VRS) after surgery. Moreover; the time to first analgesic requirement use, additional analgesic need of patients, patient and doctor satisfaction, side effects were also determined. RESULTS During the first 12 hours, the VRS values in DT group were significantly lower than those of placebo group patients (p<0.05). In placebo group, the time to first analgesic requirement use was significantly earlier than that of patients in DT group (p<0.05). Additional analgesic need of placebo group were significantly greater, when compared with the analgesic need of DT group patients (p<0.05). Among the DT group patients, patient and physician satisfaction was greater, which was statistically significant (p<0.05). CONCLUSION Preemptive use of IV DT is more effective than placebo for using as preemptive analgesia for acute postoperative pain control in patients underwent removal of an impacted mandibular third molar surgery.

Examination of pain experiences of cancer patients in western Turkey: a phenomenological study.

This study aims to explore the individual experience of living with cancer pain. This qualitative study was performed by using a phenomenological research design. In-depth and open interviews with participants were conducted to collect the data and a qualitative Colaizzi method of analysis was performed. Following the analysis of the data, the expressions made by the cancer patients during the interviews were grouped under 5 themes. Consistent with the questionnaire format, 5 themes and 19 subthemes of responses were determined describing the pain of the cancer patients. The results of our study have demonstrated that cancer patients go through negative physical, psychological, and social experiences due to the pain they suffered.

Tracheal intubation in intellectually disabled patients: Clinical usefulness of remifentanil and sevoflurane without a muscle relaxant:

Objective To compare two remifentanil doses (1 µg/kg and 2 µg/kg) in order to determine the preferred dose in intellectually disabled patients undergoing day care dental surgery under sevoflurane-induced general anaesthesia. Methods Patients were randomly assigned to receive either 1 µg/kg (group 1) or 2 µg/kg (group 2) remifentanil; both groups received 8% sevoflurane anaesthesia induction. All other conditions were identical in both groups. Heart rate (HR), mean arterial pressure (MAP) and intubation conditions were assessed. Results A total of 27/30 (90.0%) patients in group 1 and 29/30 patients (96.7%) in group 2 had acceptable intubation conditions. Remifentanil administration resulted in significant reductions in HR compared with baseline levels, in both groups. There were no significant between-group differences in HR at any timepoint. MAP decreased significantly compared with baseline in group 2 only. Conclusion Successful tracheal intubation in intellectually disabled patients can be accomplished with a combination of 1 µg/kg or 2 µg/kg remifentanil and 8% sevoflurane anaesthesia induction, without the requirement for neuromuscular blocking drugs.

Combination therapy in treatment of peripheral diabetic neuropathy with severe pain in an adolescent patient

The concept of surgical treatment of cervical myelomeningocele to remove the cystic mass for cosmetic reasons and untether the cervical spinal cord prophylactically is absolutely different from the one of lumbar meningocele to prevent infection and protect spinal cord from mechanical injury (2,4). Therefore, it is reasonable to say that anesthetic concerns for cervical myelomeningocele in the perioperative period are to preserve ‘normal’ neurological functions and perform surgery in the elective conditions. However, no anesthetic information about this disease has been available although possible difficulties could encounter anesthetic management, especially anesthetic induction and positioning. Cervical flexion, which is one of important factors for direct laryngoscopy, per se does not seem to impair spinal cord; however, neck movement including cervical flexion in the supine position might result in injuring the posterior cervical sac or increase in the intrathecal-cranial pressure. Therefore, it is safest to avoid placing the patient in the supine position on the hard table anytime, even during the induction period. It has been reported that it is relatively easy to perform direct laryngoscopy and endotracheal intubation in the prone position (5). This is one of the choices for that purpose; however, the prone position is not the standard position for airway instrumentation with direct laryngoscopy and endotracheal intubation under general anesthesia. As we presented in this report, head tilted method with hugging the patients could be recommended because patients with cervical myelomeningocele are small infants. In regard to patient’s positioning during the operation for the co-existing disease prior to the radical operation, we need to pay a great attention to the cervical sac. In our case, he needed to undergo VPS in the supine position. Some devices like cushion pads used in this case are very useful (Figure 2). With some modification, these devices could be used for direct laryngoscopy and tracheal intubation in the supine position just in case. In conclusion, cervical myelomeningocele differs structurally and clinically from myelomeningocele in distal area. Therefore, anesthetic consideration for this disease is also different. Some difficulties might encounter anesthetic management because of the large posterior cervical lesion; however, these possible problems can be solved with some devices. Aki Okamoto Satoki Inoue Yuki Terada Masahiko Kawaguchi Hitoshi Furuya Department of Anesthesiology and Neurosurgery, Nara Medical University, Shijo-cho Kashihara Nara, Japan (email: seninoue@naramed-u.ac.jp)

Superficial venous thrombophlebitis caused by rocuronium

Pain is one of the major disadvantages of rocuronium, which is used during induction of anesthesia. Even at subparalyzing doses, 50–100% of patients complain of intense pain. Sudden flexion and withdrawal movement in the wrist or arm have been reported following rocuronium use in many papers. No information about risk factors leading to this withdrawal movement or pain on injection is available and whether this reaction leads to erythema or to venous sequelae (i.e. thrombosis and thrombophlebitis) has not been systematically investigated. However, in both of our cases, visible reactions occurred and both patients were diagnosed with venous superficial thrombophlebitis. Therefore, we believe that rocuronium-related pain may, in part, be because of direct venous injury.