Assessment of Factors Affecting the Preference of Pain Medicine Subspecialty Choices and Training Course in Turkey: A Cross-Sectional Survey Study.

Objective: The aim of this study is to assess the factors affecting the preference for the Pain Medicine subspecialty and the fellowship training programs by the pain specialists who have completed or continued the Pain Medicine fellowship training program from 2014 to 2021 in Turkey. Methods: The study was conducted in October 2020 and March 2021. By reaching out to the pain specialists who completed their fellowship or had been continuing their training by getting the right to receive a Pain Medicine fellowship. Via e-mail or WhatsApp application, an e-questionnaire link was sent to the participants, and data were collected on demographics, factors affecting the choice of Pain Medicine subspecialty, level of realization of the expectations during the training course and the level of proficiency in the field of pain specialization. Data analysis was performed using IBM SPSS Statistics 20.0 software, and tests were considered statistically significant if P < 0.05. Results: Participants reported that the factors that most affected their preferences were personal interest (55.1%), more comfortable working conditions (43.6%), and interest in an academic career (38.5%). Seventy-six participants answered the level of realization of expectations about performing interventional pain procedures using ultrasound imaging, and 31.6% reported that their expectations were not met, and 25% reported that their expectations were partially realised. Conclusion: We hope that our findings will lead to improving Pain Medicine subspecialty training programs, upgrading standards, and more comprehensive studies on these issues.

Effect of Cold Therapy on Managing Postoperative Pain Following Breast Conserving Surgery.

BACKGROUND: Cold therapy is an important non-pharmacologic method used for pain relief. AIM: In the present study, we aimed to evaluate the therapeutic effect of cold therapy on managing postoperative pain following breast-conserving surgery (BCS) and assess its effect on recovering quality. METHOD: The study was planned and implemented as a randomized controlled clinical study. Sixty patients with breast cancer were included in this study. All patients underwent BCS at Istanbul Faculty of Medicine. There were 30 patients in both the cold therapy and control groups. In the cold therapy group, a cold pack was placed around the incision line for 15 minutes every hour from the first hour after the operation until the 24th hour. To all the patients in both groups, pain levels were measured by visual analog scale (VAS) at the postoperative 1st, 6th, 12th, and 24th hours, respectively, and the quality of recovery was evaluated by a Quality of Recovery-40 questionnaire at the postoperative 24th hour. RESULTS: The patients' median age was 53 (range: 24-71). All patients were T1-2 clinically and had no lymph node metastasis. Interestingly, the mean of pain level in the cold therapy group was statistically significantly lower in the first 24 hours (1st, 6th, 12th, and 24th hours) of the postoperative period (p = .001). Notably, the cold therapy group had higher recovering quality than the control group. In the first 24 hours, only 4 (12.5%) patients in the cold therapy group received additional analgesics, whereas all patients (100%) in the control group received additional analgesics (p = .001). CONCLUSIONS: Cold therapy is an easy and effective non-pharmacologic method for pain relief after BCS in patients with breast cancer. Cold therapy reduces the acute pain of the breast and contributes to the quality of recovery of those patients.

The effect of cervical spinal cord stimulation on cervical spinal nerve root/brachial plexus injury.

Spinal cord stimulation (SCS) has been used for the treatment of chronic pain for almost 50 years. There have been several reports regarding to thoracic and lumbar SCS, while fewer publications have been documented for cervical SCS administration. In this article, we presented patient satisfaction after cervical SCS application in patients with chronic upper extremity pain. Three patients with cervical spinal nerve root or brachial plexus injury who reported no pain relief with the previous treatment modalities were identified. The patients were performed percutaneous cervical SCS. Cervical SCS implantation was successful in the first and the second patients, and with respect to decrease in VAS scores, analgesic drug requirements, and an increase in their quality of life, while the third patient had no pain relief. Cervical SCS may be an effective treatment option in upper extremity chronic pain syndromes as in the lower extremity pain syndromes treated with thoracolumbar SCS.

Puerperium could have better intensive care outcomes with acute respiratory distress syndrome caused by COVID-19.

Acute respiratory distress syndrome (ARDS) with (COVID-19 often result in mortality. Treatment outcomes among puerperant, when compared with non-pregnant women (NPW) with the same syndrome. Physiological changes underwent within the gestation period have a considerable impact on the immune system, respiratory system, cardiovascular function, and coagulation. Through this research, it was aimed to compare intensive care unit (ICU) follow-up and treatment results of postpartum-period patients with those of non-pregnant ones. During the first week of ICU, 23 puerperant COVID-19 patients with ARDS and 34 non-pregnant COVID-19 patients took part in the study. Age, height, and predictive body weight (PBW) at admission to the ICU were compared with the clinical parameters of disease severity, such as FiO2 (fraction of inspired oxygen), PaO2 (arterial oxygen partial pressure), Horowitz index (PaO2/FiO2), procalcitonin (PCT), and C-reactive protein (CRP). Respiration parameters were recorded a meta-vision back server. Demographic data, FiO2, PaO2, Horowitz index, PCT, CRP and respiration parameters values were similar in both groups. The duration of non-mechanical ventilation and number of patients were seen to be significantly greater among the puerperant group than control group (P; .04 and .002, respectively). The duration of mechanical ventilation was similar in both groups (P; .07), while the mortality rate was lower in the puerperant group (P; .004). The postpartum women with COVID-19 induced ARDS were observed to have better ICU follow-up results and lower mortality. However, it is considered that the present results need to be supported greater number of participants.

The relationship between fibromyalgia and depression, anxiety, anxiety sensitivity, fear avoidance beliefs, and quality of life in female patients.

The study aims to determine whether there is a relationship between fibromyalgia (FM) disease and depression, anxiety, anxiety sensitivity, fear-avoidance beliefs, and quality of life in female patients with a diagnosis of fibromyalgia. 37 female patients followed up with FM diagnosis in pain medicine clinic and a control group consisting of 37 healthy women were included in the study. Sociodemographic and Clinical Characteristics Data Form, Quality of Life Form, fear-avoidance beliefs questionnaire, Anxiety Sensitivity Index-3, Beck Anxiety Inventory, Beck Depression Inventory, and Visual Analogue Scale was applied to the participants. When the patients in the FM group were compared to the control group; Statistically lower scores in all Quality of Life Form subscales except emotional role difficulty and social functionality scores; statistically higher scores in both physical and work activity subscales in fear-avoidance beliefs questionnaire; statistically higher scores in cognitive symptoms subscale in Anxiety Sensitivity Index-3, Beck Anxiety Inventory, Beck Depression Inventory, and Visual Analogue Scale scores were found. In FM patients, it has been determined that anxiety, depression and perceived pain severity reduce social functionality and quality of life in areas such as mental health, physical function, and emotional role difficulties. It was determined that the functionality and quality of life of patients diagnosed with FM decreased in daily life. An important contribution of the study to the literature is that it shows that the behavior of avoiding activity due to pain-induced fear exacerbates the pain and even contributes to its chronicity. These results, which show the effects of anxiety, depression, anxiety sensitivity, and fear-avoidance behavior on the prognosis of the disease in FM patients, indicate that psychiatric evaluation and treatment in FM patients is an important factor that determines the functionality and quality of life.

Does the application of pulse radiofrequency to the suprascapular nerve provide additional benefit in patients who have undergone glenohumeral intra-articular steroid injection and suprascapular nerve block?

OBJECTIVES: Shoulder pain is one of the most common musculoskeletal pain syndromes. Interventional treatments can be applied to patients who do not respond to conservative therapies. Intra-articular steroid injection and suprascapular nerve block are both short-acting and may sometimes be clinically inadequate. In this study, the answer to the question of whether pulse radiofrequency application to the suprascapular nerve provides additional benefit was investigated. METHODS: Patients who had shoulder pain and were injected between October 2016 and April 2018 were evaluated retrospectively. Totally 160 patients who underwent shoulder injections were included in the study. Patients were divided into two groups: 114 patients who underwent shoulder intra-articular steroid injection and suprascapular nerve block, as Group 1 and 46 patients who underwent pulse radiofrequency to the suprascapular nerve, in addition to shoulder intra-articular steroid injection and suprascapular nerve block, as Group 2. RESULTS: There was no statistical difference between the groups in pre-intervention numerical rating scale (NRS) scores. One month after the intervention, NRS scores of Group 2 were significantly lower than Group 1. In both groups, 1 month after the intervention NRS scores were significantly lower than pre-intervention. The duration of pain relief for Group 2 was longer than Group 1. The satisfaction percentages of patients for Group 2 were higher than Group 1. CONCLUSION: In addition to glenohumeral intra-articular steroid injection and suprascapular nerve block, pulse radiofrequency application to the suprascapular nerve provides additional benefits in terms of NRS scores, duration of pain relief, and patient satisfaction.

Comparison of the eficacy of epidural steroid injection applied in cervical and lumbar regions.

OBJECTIVES: Epidural injections have been used for many years in the treatment of chronic pain in patients with chronic backleg pain and chronic neck-arm pain. We aimed to compare the efficacy of lumbar and cervical epidural steroid injections on pain palliation, duration of pain relief and patient satisfaction. METHODS: This is a Retrospective, observational single-center study. A total of 159 patients (96 females, 63 males) who were performed epidural steroid injections in cervical and lumbar regions were included in the study. The patients were divided into two groups as lumbar epidural steroid injection 'Group 1' and cervical epidural steroid injection 'Group 2'. We retrospectively evaluated the patients for numerical rating scale (NRS) prior and after the injection, the duration of the pain relief, whether any complication occured related to injection and patient satisfaction. RESULTS: 130 patients in Group 1 and 29 patients in Group 2 were evaluated. Median NRS before the procedure: 8 in Group 1, 7 in Group 2 and median NRS after the procedure: 3 in Group 1, 4 in group 2. Patient satisfaction with the procedure 56.15% in Group 1 and 48.62% in Group 2. Mean duration of pain relief 7.23 months in Group 1 and 8.17 months in Group 2. There were no statistically significant difference in the evaluated parameters between the two groups. CONCLUSION: It was observed that the pain relief, duration of pain relief and patient satisfaction were similar for cervical and lumbar epidural steroid injections.

The effect of robotic surgery on intraocular pressure and optic nerve sheath diameter: a prospective study.

BACKGROUND AND OBJECTIVES: To investigate the effect of the steep Trendelenburg position (35° to 45°) and carbon dioxide (CO2) insufflation on optic nerve sheath diameter (ONSD), intraocular pressure (IOP), and hemodynamic parameters in patients undergoing robot-assisted laparoscopic prostatectomy (RALP), and to evaluate possible correlations between these parameters. METHODS: A total of 34 patients were included in this study. ONSD was measured using ultrasonography and IOP was measured using a tonometer at four time points: T1 (5minutes after intubation in the supine position); T2 (30minutes after CO2 insufflation); T3 (120minutes in steep Trendelenburg position); and T4 (in the supine position, after abdominal exsufflation). Systolic and diastolic arterial pressure, heart rate, and end-tidal CO2 (etCO2) were also evaluated. RESULTS: The mean IOP was 12.4mmHg at T1, 20mmHg at T2, 21.8mmHg at T3, and 15.6mmHg at T4. The mean ONSD was 4.87mm at T1, 5.21mm at T2, 5.30mm at T3, and 5.08 at T4. There was a statistically significant increase and decrease in IOP and ONSD between measurements at T1 and T4, respectively. However, no significant correlation was found between IOP and ONSD. A significant positive correlation was found only between ONSD and diastolic arterial pressure. Mean arterial pressure, heart rate, and etCO2 were not correlated with IOP or ONSD. CONCLUSIONS: A significant increase in IOP and ONSD were evident during RALP; however, there was no significant correlation between the two parameters.

[Pharmachologic treatment of acute postoperative pain: A clinical practice guideline of The Turkish Society of Algology]. / Akut postoperatif agrinin farmakolojik tedavisi: Türk Algoloji-Agri Dernegi klinik uygulama kilavuzu.

Satisfactory pain relief is a fundamental right of every patient suffering from pain. Despite the developments on pharmachologic treatment modalities and interventions for pain control, inadequacy of postoperative pain management is still a major problem. After surgical intervention, 66% of patients experience moderate to severe pain during discharge, 9% after two weeks. Untreated postoperative pain may lead to prolonged hospital stay, increased intensive care needs, development of chronic pain, and reduced the patients quality of life. In the following guideline all aspects of postoperative pain briefly evaluated. The clinical practice of postoperative analgesia, recommendations, the diagnosis, assessment and pharmachologic treatment of acute postoperative pain with the current available agents in Turkey are discussed in this article. Our aim is to promote awareness of effective, and safe postoperative pain management strategies to meet the needs of the patients; minor patient groups, such as paediatric population, pregnant patients, elderly, patient with high body mass index and covid 19 diesease. Despite all the recommendations, any guidelines special cases where standard modalities fail to treat postoperative pain management as in patients with chronic pain who previously used opioids, drug addicts, the patient should be consulted with an pain specialist.

Multidisciplinary approach in the treatment of osteoid osteoma with radiofrequency ablation.

OBJECTIVES: This study aims to present the importance of a multidisciplinary approach to radiofrequency ablation (RFA) treatment in osteoid osteoma (OO) patients by a team of experts in their field in preventing recurrence and complications. PATIENTS AND METHODS: For this retrospective study, a team of two orthopedists, two interventional radiologists, and one anesthesiologist was established in January 2013 to manage the diagnosis, follow-up, and treatment process of patients with OO at Bakirköy Dr. Sadi Konuk Training and Research Hospital. A total of 27 patients (15 males, 12 females; mean age 22.9 years; range, 9 to 54 years) were treated by this team between February 2013 and September 2016. The anatomic localization included iliac crest in four patients, the femur in 12 patients, fibula in two patients, humerus in three patients, radius in one patient, tibia in three patients, talus in one patient, and metacarpal in one patient. The procedures were carried out by the same interventional radiologists, same orthopedic surgeons, and same anesthesiologist in the computed tomography (CT) unit under aseptic conditions. After appropriate anesthesia for the localization of OO, the patient was positioned on the CT bed and the localization of the lesion was confirmed with a CT scan mapping. Then, a bone penetration cannula was advanced and bone cortex was penetrated with a charged motor and Kirschner (K)-wire. When the cannula reached the nidus, it was replaced with RFA probe. Ablation of the nidus was performed for five minutes at 90°C. RESULTS: The mean follow-up period was 46 months (range, 25 to 66 months). Patients were evaluated with visual analog scale (VAS) scores preoperatively and at postoperative 15th day, sixth month, and first year. In the last evaluation of the study data, the patients were called by telephone and questioned whether there were any changes in their final status. The mean preoperative VAS score was 7.2. The mean postoperative VAS scores of the 15th day, sixth month, and first year were 1.3, 0.6, and 0, respectively. In the last follow-up, the OO-related pain completely disappeared and none of the patients had any recurrence. There was a significant difference between preoperative and postoperative 15th day and sixth month VAS score measurements. CONCLUSION: Radiofrequency ablation treatment of OOs is a minimally invasive, safe, low-cost, and efficient method. We believe that with experienced teams and appropriate planning, RFA will take part in practice as the standard treatment of OO.

Childhood and adult attention deficit hyperactivity disorder symptoms in fibromyalgia: associations with depression, anxiety and disease impact.

Objective: The first aim of this study was to determine the prevalence of childhood and current attention deficit hyperactivity disorder (ADHD) symptoms in patients with fibromyalgia. The second aim is to assess the role of depression and anxiety on the relationship between childhood and adult ADHD symptoms with disease impact in this population.Methods: Sixty-four patients with fibromyalgia were compared to matched 58 healthy controls. All participants completed the Wender Utah Rating Scale (WURS), Adult ADHD Self-Report Scale (ASRS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Fibromyalgia Impact Questionnaire (FIQ).Results: Patients with fibromyalgia had significantly higher mean scores of depression (BDI), anxiety (BAI), childhood ADHD symptoms (WURS) and adult ADHD symptoms (ASRS total, ASRS hyperactivity/impulsivity subscale and ASRS attention deficit subscale) than the control group. Fibromyalgia impact (FIQ) was significantly correlated with depression (BDI; r = 0.57, p < .001), anxiety (BAI; r = 0.56, p < .001) and childhood ADHD symptoms (WURS; r = 0.41, p < .001) in fibromyalgia group. There was no significant correlation between fibromyalgia impact (FIQ) and adult ADHD symptoms (ASRS total or sub-scale scores). Hierarchical multiple regression indicated that childhood ADHD symptoms (WURS), anxiety (BAI) and depression (BDI) predicted fibromyalgia impact. Both anxiety (BAI) and depression (BDI) mediated the relationship between childhood ADHD symptoms (WURS) and fibromyalgia impact (FIQ).Conclusion: Childhood ADHD symptoms may be a contributory factor to poorer functioning in the patients with fibromyalgia. The relationship was more pronounced in the presence of depression and anxiety symptoms. Evaluation of childhood and adult ADHD symptoms in patients with fibromyalgia is important for recognition and treatment of ADHD comorbidity and also for attenuating the severity of the disease.

Comparison of epidural and intravenous route for acute and chronic postoperative pain control in patients with gynecological malignancy.

OBJECTIVES: This study compared the effects of patient-controlled epidural and intravenous analgesia on acute and chronic postoperative pain in patients who were operated on for gynecological malignancy. METHODS: Postoperatively, patient-controlled analgesia was administered via epidural route to Group 1 and the intravenous route to Group 2. Pain was evaluated using the Visual Analog Scale (VAS) in the acute phase at postoperative 24 hours and at 6 months in the chronic phase. RESULTS: The VAS scores at 24 hours were lower in Group 1 than in Group 2 (3.29 vs 3.93; p<0.05). The VAS scores at 6 months were 2.03 in Group 1 and 2.53 in Group 2, indicating no statistically significant difference (p>0.05). There was no significant difference in the Leeds Assessment of Neuropathic Symptoms and Signs pain scale scores at 6 months (p>0.05). CONCLUSION: The results showed that epidural and intravenous analgesia had a similar effect regarding the chronicity of pain but better outcomes were achieved with epidural analgesia in the acute stage.

DNA damage effects of inhalation anesthetics in human bronchoalveolar cells.

BACKGROUND: The main objective was to evaluate and compare the local genotoxicity of sevoflurane and desflurane in bronchoalveolar cells, while the secondary outcome was to detect systemic oxidative DNA damage. To our knowledge, our study is the first one to evaluate the local effects of inhalation anesthetics in human bronchoalveolar cells in patients. METHODS: American Society of Anesthesiologists group I-II patients scheduled for lumbar discectomy surgery were enrolled in this randomized prospective study. Patients were randomized to sevoflurane or desflurane for anesthesia maintenance. Bronchoalveolar lavage samples and peripheral blood samples were taken at 2-time points: the first point (baseline, T1); and the second point (postexposure, T2). Final number of 48 samples were the sevoflurane (n = 22) and desflurane (n = 26) groups. Comet assay was applied to examine genotoxic properties. Oxidative DNA damage in plasma was measured with 8-hydroxy-2'-deoxyguanosine (8-OHdG). RESULTS: T2 values were higher than baseline values in both the desflurane group (tail-length: 66 ±â€Š24, %DNA in tail: 72 ±â€Š60, tail moment: 47.52 ±â€Š14.4; P = .001, P = .005, P = .001, respectively) and the sevoflurane group (tail-length: 58 ±â€Š33, %DNA in tail: 88 ±â€Š80, tail moment: 51.04 ±â€Š26.4; P = .001, P = .012, P = .001, respectively). T2 plasma 8-OHdG levels were also higher than baseline levels in the desflurane group (3.91 ±â€Š0.19 ng/ml vs 1.32 ±â€Š0.20 ng/ml, P = .001) and sevoflurane group (3.98 ±â€Š0.18 ng/ml vs 1.31 ±â€Š0.11 ng/ml, P = .001). There were no differences between the 2 groups in comet parameters and 8-OHdG levels. CONCLUSION: Our results indicate that both inhalation agents cause DNA damage in the bronchoalveolar cells. Also, we detected increases in plasma 8-OHdG concentrations. Local genotoxicity and systemic oxidized DNA damage were similar in both groups.

Can we use magnesium for sedation in the intensive care unit for critically ill patients: Is it as effective as other sedatives?

OBJECTIVES: The aim of this prospective, randomized study was to investigate the effect of magnesium added to midazolam on the hemodynamics, transition time to a T-piece, mechanical ventilation duration, additional sedative-analgesic requirement using bispectral index (BIS) monitorization and sedation scales. METHODS: Fifty critically ill patients receiving mechanical ventilation support in the intensive care unit were randomly assigned to 2 groups. Group I received a 0.03-0.3 mg/kg bolus loading dose+0.03-02 mg/kg/hour midazolam infusion; Group II received a 2 g bolus at 30 minutes, 16 mg/24-hour magnesium infusion+0.03-02 mg/kg/hour midazolam infusion. BIS levels and sedation levels were continuously monitored. RESULTS: The duration of mechanical ventilation in Group I was longer than that of Group II (31+-12 hours, 19+-11 hours, respectively; p<0.01). The length of time to start spontaneous breathing trials with a T-piece was greater in Group I than in Group II (27+-11 hours, 16+-11 hours, respectively; p<0.01). The 48-hour insulin requirement of Group I was greater than that of Group II (p<0.05). CONCLUSION: Adding intravenous magnesium to the traditional sedation protocols in the intensive care unit decreased midazolam use as well as the additional analgesic requirement and mechanical ventilatory support duration without any side effects.

Risk factors for mortality in geriatric hip fractures: a compressional study of different surgical procedures in 785 consecutive patients.

BACKGROUND: Only a little is known about whether type of surgical intervention has an effect on mortality of these patients. Our primary objective was to assess whether different type of surgical procedures has an effect on mortality among elderly patients with hip fracture. A secondary objective was to examine factors that are related to mortality in our patient population. Our hypothesis is that type of surgical procedure, especially external fixation, should have an influence on mortality outcomes. METHODS: We included 785 patients age 65 years or older, with hip fractures. Operative treatment consisted of external fixation, internal fixation, total hip arthroplasty and hip hemiarthroplasty. Age, gender, type of fracture, type of surgery performed, American Society of Anesthesiology (ASA) grade, clinical comorbidities, anesthesia type, blood transfusion requirement, time to surgery, intensive care unit requirement, operation length and length of hospital stay and number of comorbidities were documented. RESULTS: During the study period, 785 patients (262 male, 523 female) were included to study, Overall mortality rate was 37.2 % (292/785). Their age ranged between 65 and 100 years (mean 81). Surgery type Kaplan-Meier cumulative mortality curves suggested no significant difference between four different types of surgery groups (p = 0.064). Transfusion requirement was significantly lower in external fixation group comparing to other groups (p = 0.014). Cox regression analysis showed the number of comorbidities 2 and ≥ 3 (p = 0.0027, p = 0.015), transfusion requirement (p = 0.0001), ASA 4 (p = 0.016) to be significant predictors of mortality. CONCLUSIONS: Transfusion requirement, ASA grade 4 and having more than two comorbidities are risk factors for mortality in geriatric hip fractures. Type of surgical intervention and fracture type had similar mortality rates in our patient population.