Onder Murat Ozerbil

Gabapentin Is a First Line Drug for the Treatment of Neuropathic Pain in Spinal Cord Injury

Study Design. Prospective, randomized, double blind, placebo-controlled, crossover clinical trial. Objectives. To determine the efficacy of gabapentin in the treatment of neuropathic pain related to spinal cord injury. Summary of Background Data. Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system. Neuropathic pain associated with spinal cord injury is quite refractory, and current treatments are not effective. Gabapentin, an anticonvulsant, has become the first choice in the treatment of neuropathic pain. The place of gabapentin in the treatment of spinal cord injury-related neuropathic pain was questioned in only a few recent reports; however, they are retrospectively designed, nonstandardized, and uncontrolled studies, or involve a very small series of patients using less than optimum doses. Methods. A total of 18-week study period included a 4-week medication/placebo titration period. This was followed by a 4-week stable dosing period when the patients continued to receive maximum tolerated doses, a 2-week washout period, then a crossover of 4 weeks of medication/placebo titration, and another 4 weeks of stable dosing period. Twenty paraplegic patients (female/male: 7/13) with complete spinal cord injury at the thoracic and lumbar level, aged between 20 and 65 years, with neuropathic pain for more than 6 months were recruited for the study. Results. All patients completed the study. Gabapentin reduced the intensity as well as the frequency of pain, relieved all neuropathic pain descriptors except the itchy, sensitive, dull, and cold types, and improved the quality of life (P < 0.05). Conclusions. Gabapentin can be added to the list of first-line medications for the treatment of chronic neuropathic pain in spinal cord injury patients. It is a promising new agent and offers advantages over currently available treatments.

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.

The effect of isokinetic exercise on symptoms, functional status and EMG activation onset time of the vastus medialis oblique and vastus lateralis in female patients with patellofemoral pain syndrome

The aim of this study was to evaluate VMO and VL EMG activation onset times (AOT) during isometric contractions at various degrees of knee flexion and to explore the effects of a 6-w isokinetic exercises program on pain, quality of life, muscle strength and, if observed, on the difference in AOT, in patients with patellofemoral pain syndrome (PFPS). Twenty two female patients suffering from anterior knee pain and diagnosed with PFPS were recruited. The main outcome measures consisted of AOT and maximal isometric contraction of VMO and VL muscle and Medical Outcomes Study (SF36) and VAS scores. Compared to control knees, pre-exercise measurements revealed significant delay only in VMO at knee flexion angles of 15°, 30°, 45°. Post-exercise measurements showed improvement in the delay at 15°, 30°, 45° and also in the other pain, health quality and muscle strength measurements. In conclusion; VMO is activated later than VL in PFPS patients while exercise results in improvements in both symptoms and delay in VMO.

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.

Trigeminocervical Reflex in Fibromyalgia Patients

OBJECTIVE To describe the properties of trigeminocervical reflex in normal subjects and in patients with primary fibromyalgia syndrome (PFS) having neck pain. DESIGN Prospective testing of trigeminocervical reflex. SETTING University hospital electromyography laboratory in Turkey. PARTICIPANTS Patients with PFS (n=16) and healthy volunteers (n=20). INTERVENTIONS Trigeminocervical reflex is a brainstem reflex that is evoked by stimulating the sensory branches of the trigeminal nerve and can be recorded from the neck muscles. Electric stimulation of the supraorbital nerve evokes a reflex response (C3) and early reflex response (C1). The mean latencies of C1 and C3 of patients with PFS were compared with normal values. MAIN OUTCOME MEASURE The C1 and C3 latencies of trigeminocervical reflex. RESULTS In healthy volunteers, C3 latency +/- standard deviation was 54.17+/-6.00ms ipsilaterally and 51.25+/-9.26ms contralaterally. The difference was not significant (P=.26). The C1 latency was 17.46+/-4.89ms. In patients with PFS, C1 latency was 13.83+/-4.48ms and the C3 latency was 62.70+/-18.22ms. The difference was not significant between the patients (P=.08) and healthy volunteers (P=.17). CONCLUSION In patients with PFS having neck pain, trigeminocervical connections were not influenced and some other mechanisms may be responsible for pain in these patients.