Ilknur Albayrak

Axis I and Axis II psychiatric disorders in patients with fibromyalgia

OBJECTIVE To determine the current prevalence of Axis I and Axis II psychiatric disorders in patients with fibromyalgia. METHOD The study sample includes 103 patients with fibromyalgia and 83 control subjects. Axis I and Axis II disorders were determined by structured clinical interviews. RESULTS The rate of any Axis I psychiatric disorder (47.6% vs. 15.7%), major depression (14.6% vs. 4.8%), specific phobia (13.6% vs. 4.8%), any Axis II disorder (31.1% vs. 13.3%), obsessive-compulsive (23.3% vs. 3.6%) and avoidant (10.7% vs. 2.4%) personality disorders were significantly more common in the patient group compared to the control group. CONCLUSION Our results suggest that a considerable proportion of patients with fibromyalgia also present with Axis I and Axis II psychopathologies.

Effectiveness of back school for treatment of pain and functional disability in patients with chronic low back pain: a randomized controlled trial.

OBJECTIVE To evaluate the effectiveness of the addition of back school to exercise and physical treatment modalities in relieving pain and improving the functional status of patients with chronic low back pain. DESIGN A randomized controlled trial. PATIENTS A total of 146 patients with chronic low back pain were enrolled in the study. METHODS Subjects were divided into 2 groups: the back school group received exercise, physical treatment modalities and a back school programme; and the control group received exercise and physical treatment modalities. Treatment efficacy was evaluated at the end of treatment and 3 months post-treatment, in terms of pain, measured with the Visual Analogue Scale, and functional status, measured with the Oswestry Low Back Pain Disability Questionnaire. RESULTS In both groups, Visual Analogue Scale and Oswestry Low Back Pain Disability Questionnaire were significantly reduced after therapy (p < 0.01), but the difference between the scores at the end of treatment and 3 months post-treatment was not significant. There was a significant improvement in Visual Analogue Scale and Oswestry Low Back Pain Disability Questionnaire in the back school group compared with the control group at the end of therapy and 3 months post-treatment (p < 0.05). CONCLUSION The addition of back school was more effective than exercise and physical treatment modalities alone in the treatment of patients with chronic low back pain.

The efficacy of electrical stimulation in reducing the post-stroke spasticity: a randomized controlled study

Purpose: The purpose of this study is to evaluate the efficacy of surface electrical stimulation on the spasticity occurring in the wrist flexor muscles after a cerebrovascular event. Method: Hemiplegic patients with stage 2–3 spasticity in the wrist muscles based on the Ashworth scale were divided into two groups. Both groups were applied stretching. One group was additionally administered neuromuscular electrical stimulation (NMES) to the wrist extensors, in the form of pulsed current, 100 Hz, with a pulse duration of 0.1 msec, and a resting duration of 9 seconds, for 15 minutes to provide the maximum muscular contraction. The efficacy of the treatment was evaluated using the following: modified Ashworth scale (MAS), Fmax/Mmax ratio, Hmax/Mmax ratio, wrist extension range of motion (ROM). The daily activities were assessed by Functional Independence Measurement (FIM) and the motor recovery was evaluated by Brunnstrom motor staging. Results: Both groups revealed a significant recovery after the treatment based on the MAS, the electrophysiological evaluation results, wrist ROM, FIM and Brunnstrom motor staging. The group receiving the combined treatment showed a better recovery in terms of MAS, wrist ROM, FIM and Brunnstrom motor staging compared to the group doing the stretching alone. Conclusions: The results of this study showed that NMES given together with stretching of the wrist extensor muscles was more effective than stretching of the wrist extensor muscles alone in reducing spasticity. Implications for Rehabilitation There is a wide range of treatment options for spasticity, from conservative treatments (medications, splint, physical treatment modalities, and exercise) to surgery. The efficacy of electrical stimulation in spasticity is still controversial. Electrical stimulation treatment applied together with wrist extensor muscles passive stretching exercise is effective in reducing spasticity.

Is pain the only symptom in patients with benign joint hypermobility syndrome

The aims of this study were to evaluate pain, depression level, fatigue, sleep, and quality of life (QoL) among patients with benign joint hypermobility syndrome (BJHS) and to compare their results with those of healthy controls. The study involved 115 patients and 114 healthy volunteers. Pain level was rated using visual analogue scale (VAS) for all patients. Depression level, fatigue, sleep quality, and QoL of all the participants were evaluated by the Beck Depression Inventory (BDI), the Checklist Individual Strength (CIS), the Pittsburgh Sleep Quality Index (PSQI), and the Short Form-36 (SF-36), respectively. VAS value was 6.29 ± 0.94 in the patient group. Comparison of two groups showed that there were statistically significant differences between the patient group and the control group with respect to BDI, total CIS, PSQI scores, SF-36 subscales (physical function, role physical, bodily pain, general health, role emotional, and mental health), and mental component summary (p < 0.001). While pain is the predominant symptom among BJHS patients, depression, fatigue, impaired sleep, and QoL also commonly occur. Thus, all of these components should be taken into account when assessing patients with BJHS.

The association between bone mineral density, quality of life, quality of sleep and fatigue

Objectives:: This study was undertaken to examine quality of life (QoL), the quality of sleep and fatigue level in postmenopausal women with osteoporosis (OP) but without fractures, to assess the associations between these parameters and to compare the results with those for subjects who have osteopenia or normal bone mineral density (BMD). Methods:: In this study, 113 postmenopausal osteoporosis (PMO) subjects without fractures, 172 subjects with osteopenia and 102 subjects with normal BMD were included. The severity of pain, QoL, quality of sleep and fatigue were assessed using the visual analogue scale (VAS), the QoL Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41), the Pittsburgh Sleep Quality Index (PSQI) and the Checklist of Individual Strength (CIS) questionnaire. Results:: No statistically significant differences between the three groups were found in terms of VAS and QUALEFFO-41 total scores (p > 0.05). On the other hand, PSQI and CIS total scores were significantly different in the PMO and osteopenia groups (P = 0.015 and 0.007, respectively) compared to the group with normal BMD. Conclusions:: During the follow-up and treatment of women with PMO or osteopenia, QoL, quality of sleep and fatigue should be assessed and incorporated into treatment decisions, even in the absence of fractures.

A rare cause of dysphagia: compression of the esophagus by an anterior cervical osteophyte due to ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatological disease affecting the axial skeleton with various extra-articular complications. Dysphagia due to a giant anterior osteophyte of the cervical spine in AS is extremely rare. We present a 48-year-old male with AS suffering from progressive dysphagia to soft foods and liquids. Esophagography showed an anterior osteophyte at C5-C6 resulting in esophageal compression. The patient refused surgical resection of the osteophyte and received conservative therapy. However, after 6 months there was no improvement in dysphagia. This case illustrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS and should be included in the diagnostic workup in early stages of the disease.

Effect of Different Transcutaneous Electrical Stimulation Modalities on Cervical Myofascial Pain Syndrome

Objectives The aim of this study is to compare the efficacies of different therapeutic transcutaneous electrical nerve stimulation [TENS] types and placebo TENS on pain syndrome in cervical myofascial pain syndrome [MPS] and to determine the superior method. Methods Patients recruited in the study were randomized into four groups. Group 1 was treated with a conventional TENS with a frequency of 100 Hz, 40 µs duration, low amplitude; Group 2 with an acupuncture-like TENS with a frequency of 4 Hz, 250 µs duration, high amplitude; Group 3 with burst TENS with high [100 Hz] and low [2 Hz] frequency, 40 µs and high amplitude. Group 4 was treated with an electrical stimulation until the patient felt it. Then the electrical current was interrupted, but the patient was told the current was proceeding and he/she did not feel it any more since he/she had gotten used to it. All groups were treated with a total of 10 therapies with 30-minute sessions three times a week. Patients were assessed with a visual analog scale and the bodily pain subscale of the Short Form Health Survey-36 scale before and after treatment. Results Eighty patients participated in the study. Before and after treatment, intra-groups and inter-groups evaluations of all groups showed that there was no significant progression in both scales [P > 0.05]. Conclusions In conclusion, it was observed that none of the TENS types was superior to another or placebo. As a result of this outcome, it was thought that TENS alone has no role in cervical MPS therapy.

Efficacy of Pulsed Radiofrequency Therapy to Dorsal Root Ganglion Adding to TENS and Exercise for Persistent Pain after Total Knee Arthroplasty.

&NA; The majority of patients achieve substantial pain relief and improved function after total knee arthroplasty (TKA), but a proportion continues to experience life‐disturbing persistent postsurgical pain (PPSP) in the months and years after surgery. This study aimed to assess the efficacy of transcutaneous electrical nerve stimulation (TENS), exercise, and pulsed radiofrequency (PRF) treatment on pain severity, neuropathic pain, knee flexion range of motion (ROM), functional status, and patient satisfaction in patients with PPSP after TKA. This is a retrospective study of prospectively collected data. Patients who were identified retrospectively from hospital charts were divided into two groups: group 1 (n = 17) received TENS and exercise treatment and group 2 (n = 22) received TENS, exercise, and PRF application to the dorsal root ganglion (DRG). The following procedure‐related parameters were collected from the special registry form: visual analog scale (VAS), Douleur Neuropathique 4 (DN4) questionnaire, knee flexion ROM, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and patient satisfaction scale scores. The mean follow‐up was 253.8 ± 109 days. When the two groups were compared, a significant difference of at least 50% improvement in the VAS (activity) and a significant reduction in the DN4 scores following the last control examination were found in group 2. There was a significant reduction in total WOMAC scores in group 1 compared with group 2 for the four study periods. Higher scores for the patient satisfaction scale were found in group 1 compared with group 2 following the last control examination. Adding PRF to TENS and exercise therapy is useful in reducing the degree of pain and the neuropathic component of PPSP in patients with PPSP.

Pulsed radiofrequency applied to the dorsal root ganglia for treatment of post-stroke complex regional pain syndrome: A case series

STUDY OBJECTIVE Complex regional pain syndrome is a painful and disabling syndrome where the patient presents with neuropathic pain, edema, or vasomotor or pseudomotor abnormalities that are often refractory to treatment. Complex regional pain syndrome type 1 may occurs in stroke patients. Radiofrequency is a therapeutic modality that has been used for years for diseases associated with neuropathic pain. DESIGN Case series report. SETTING Selcuk University Hospital. PATIENTS A 69-year-old woman and a 48-year-old women who suffered post-stroke complex regional pain syndrome type 1. INTERVENTIONS Pulsed radiofrequency current application to the cervical dorsal root ganglia. MEASUREMENTS Pain reduction. MAIN RESULTS The patients had complete resolution of their symptoms, which was maintained at 10 and 5 months of follow-up. CONCLUSIONS These cases illustrates that pulsed radiofrequency applied to cervical dorsal root ganglia might play a significant role in multi-modal approach of complex regional pain syndrome type 1 management after stroke. Further randomized, controlled studies are needed to support this argument.

Rheumatoid pannus compressing the medulla oblongata.

A 47-year-old woman with a 33-year history of rheumatoid arthritis (RA) visited our outpatient clinic complaining of numbness in her hands and progressive weakness in all four extremities. She had urinary incontinence for 1 month. On physical examination, she had joint deformities due to RA in all four extremities. The deep tendon reflexes were hyperactive and she was quadriparetic. Cervical spine magnetic resonance imaging revealed periodontoid pannus formation that had destroyed the C1 and C2 vertebrae bodies and compressed the medulla oblongata (Fig. 1). Figure 1 A T2-weighted magnetic resonance imaging of the sagittal cervical spine shows compression of the medulla oblongata by periodontoid pannus (shown by the arrow). We administered three infusions of 1,000 mg of methylprednisolone intravenously to relieve her symptoms. However, the response to the steroid pulses was poor. A neurosurgeon recommended surgery, but the patient refused. Antitumor necrosis factor (anti-TNF) therapy was contraindicated because the patient had active pulmonary and urinary infections. At follow-up, her neurological symptoms were unchanged. Typically, RA affects synovial joints. Spinal involvement generally presents in the cervical spine. Myelomalacia can develop with compression of the cervical spinal cord by periodontoid pannus. Recently, the treatment of RA has become more effective and the development of periodontoid pannus has become very rare. When patients with RA present with difficulty walking, progressive weakness of all four extremities, spasticity, and neurogenic bladder symptoms, the clinician should consider periodontoid pannus compression. The literature includes cases of periodontoid pannus treated successfully with surgery. In addition, two cases were treated successfully with infliximab. Therefore, anti-TNF therapy in the early stages of rheumatoid myelopathy might obviate the need for surgery.