Aǧrı : Ağrı (Algoloji) Derneği'nin Yayın organıdır = The journal of the Turkish Society of Algology
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The perception and interpretation of pain is the end point of an interaction of cognitive, cultural, and environmental factors and this complex interaction effects the pain response and quality of life of each person which shows that pain perception and the verbal and behavioral response shows variations and is specific for each patient. Chronic pain can be due to Fibromyalgia Syndrome (FMS) and Neuropathic Pain (NP) where the underlying pathophysiologic mechanisms are being revealed or it can be chronic low back pain (CLBP) where pain persists in spite of healing of tissue and no underlying pathologic mechanism can be defected. Central sensitization, inhibition of descending pain inhibitory systems, functional changes in autonomic nervous system amd neurotransmitter as well as changes in stress response system are factors contributing to the initiation and maintenance of pain and cognitive, behavioral factors are also important contributors in chronic pain. ⋯ The targets of activity should be physical, functional and social. Psychologic based programs as cognitive-behavioral techniques and operant conditioning are also valid procedures in rehabilitation of chronic pain patients. Rehabilitation should be multidisciplinary and of long-term targeted to valid out-come for success.
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The percutaneus blockade of the celiac plexus is being performed nearly for a century. The aim of performing celiac plexus and splancnic nerve blocks was surgical anesthesia at the beginning. ⋯ Celiac plexus and splancnic nerve blocks are effective in relieving chronic abdominal pain, especially originating from the malignancies of the pancreas, liver, gallbladder, omentum, mesentery, and alimentary tract from the stomach to the transverse portion of the large colon. The relevant anatomy, indications, cotraindications, different application techniques and results of celiac blockade is reviewed in this paper.
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Low-back pain nearly affects all the people in the population; male or female, at any period of their lives and continues with spontaneous regressive attacks. In 10% of the patients, the pain persists despite conservative treatments and causes significant decrements of life quality. For this reason, the patients with chronic low back-pain are applying to pain specialists and treated with different invasive pain therapies. ⋯ However, the effects and outcomes are contradictory. Epidural steroid injections should be performed absolutely under fluoroscopic guidance. Pain selection should be made carefully and algorithms should be performed fastidiously.
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Regional anesthesia techniques are used in pain treatment for more than a century. Although its use for acute pain conditions, such as intraoperative, postoperative and traumatic pain, is very well accepted, its use for the chronic pain syndromes is still lacking a consensus among the practitioners. The interventional techniques, which are mostly originated from the regional anesthetic techniques, have gained an increasing interest for the treatment of chronic pain syndromes during the last few decades. In this review, the development and clinical aspects of epidural injections, epiduroscopy, facet denervaion, intradiscal applications, vertebroplasty, sympathetic neurolysis, and central and peripheral continuous infusion techniques are discussed.
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Management of acute postoperative pain remains suboptimal; nearly 80 % of the patients report moderate to extreme pain following surgery. Nonselective nonsteroidal antiinflammatory drugs (NSAIDs) have a role in postoperative pain management, but conventional NSAIDs can cause gastrointestinal ulceration, renal injury, and disruption of platelet function and hemostasis. ⋯ These drugs have demonstrated analgesic efficacy and opioid sparing effect after variety of surgical procedures. This article will review the role and outcome of COX-2 inhibitors for postoperative pain management.