BACKGROUND: Coccygodynia is a clinical condition characterized by pain and tenderness around the coccygeal region. Trauma is the most common etiologic factor. We aimed to investigate the effectiveness of pulsed radiofrequency (PRF) treatment in patients with coccygodynia that could not be relieved by classic treatment protocols and presenting our long-term results of caudal epidural PRF.
METHODS: Study included 21 patients that were treated for coccygodynia by caudal epidural PRF in our Pain Clinic. Sixteen patients (76%) had a history of trauma; three patients (14%) had previous surgery whereas two patients (10%) had idiopathic coccygodynia with no identifiable cause. All patients had been previously treated by conservative methods, but none had pain relief. Pain level of the patients was assessed by visual analog scale (VAS) score. A questionnaire to evaluate subjective patient satisfaction was also used at third week and at sixth month follow-ups.
RESULTS: Median VAS score was 8 at the beginning, decreased to 2 by the third week and measured as 2 at the sixth month. VAS at 3 week and 6 m were significantly lower compared to baseline (p<0.001). At sixth month twelve patients (57%) had excellent result, 5 patients (24%) had good results and only 4 (19%) patients had poor results regarding subjective patient satisfaction questionnaire.
CONCLUSIONS: Caudal epidural PRF may be an alternative to surgery for coccygodynia patients that are unresponsive to classic treatment methods.

Introduction: Arthroscopic rotator cuff surgery can result in severe postoperative pain. We compared a continuous subacromial infusion to a continuous interscalene block with levobupivacaine for patients undergoing arthroscopic rotator cuff surgery.
Methods: Sixty patients were randomized to two groups: 1) interscalene block with 0.5% levobupivacaine (30 mL) followed by a postoperative subacromial infusion: 0.125% levobupivacaine 5 mL/h basal infusion, 5mL bolus dose and a 20 min lockout time or; 2) interscalene block with 0.5% levobupivacaine (30 mL) followed by a postoperative interscalene infusion: 0.125% levobupivacaine 5 mL/h basal infusion, 5mL bolus dose and a 20 min lockout time. Infusions were maintained for 48 hours.
Results: The VAS scores in the postanesthesia care unit and at 4 h were not different. The VAS scores at 8, 12, 24, 36 and 48 h were lower than 4 in both groups; but they were significantly lower in the interscalene group. Additional analgesic requirements were lower in the interscalene group (16.6% vs 53.3%, p<0.05). Patients’ satisfaction was higher in the interscalene group (9,4 ± 0,8 vs 8 ± 1,2, p<0,01). One patient had a toxicity related to interscalene block but; there was no complication related to subacromial catheters.
Conclusions: This study demonstrates that subacromial infusions, although provided good postoperative analgesia, are not as effective as interscalene infusions and additional analgesics should be prescribed when subacromial infusions are started. Subacromial infusions could be considered as an alternative in case of any contraindication to interscalene block.

Objectives: The objective of this study was to retrospectively analyze the incidence of the concurrent existence of temporomandibular disorders (TMD) and headaches.
Methods: Forty patients (36 female, 4 male, mean age: 29.9±9.6 years) clinically diagnosed with TMD were screened. Patient records were analyzed regarding: range of mouth opening, temporomandibular joint (TMJ) noises, pain on palpation of the TMJ and masticatory muscles and neck and upper back muscles, and magnetic resonance imaging of the TMJ.
Results: According to patient records, a total of 40 (66.6%) patients were diagnosed with TMD among 60 patients with headache. Thirty-two (53%) patients had TMJ internal derangement (ID), 8 (13%) patients had only myofascial pain dysfunction (MPD) and 25 (41.6%) patients had concurrent TMJ ID/MPD. There were statistically significant relationships between the number of tender masseter muscles and MPD patients (p=0.04) and between the number of tender medial pterygoid muscles and patients with reducing disc displacement (RDD) (p=0.03).
Conclusion: The TMJ and associated orofacial structures should be considered as possible triggering or perpetuating factors for headaches, especially tension-type. There might be a significant connection between TMD and headache. However, most medical and dental practitioners are unaware of this relationship. Therefore, a careful evaluation of the TMJ and associated orofacial structures is required for a correct interpretation of the craniofacial pain in headache patients, and these patients should be managed with a multidisciplinary approach.

Objective: In this study the efficacy of preemtively dexketoprofen usage on postoperative pain relief and tramadol consumption were evaluated.
Methods: Fifty ASA-I or ASA-II patient undergoing plastic surgery were randomized into two groups. Group-1 received dexketoprofen 25 mgr. and group-2 received placebo tablets 1h before surgery. All patients received a standard anesthetic protocol. At the end of the surgery all patients received tramadol iv. with Patient Controlled Analgesia (PCA) device. Pain scores was evaluated with Visual Analogic Scale (VAS) during postoperative 1., 8. and 24h. Tramadol consumption, adverse effects and patient satisfaction were recorded.
Results: The pain scores and tramadol consumption were significantly lower in group 1 (p<0.05) While nausea and vomiting was observed in group 2 more than group-1, patient satisfaction was better in group 1 (p<0.05).
Conclusion: Preemtive use of dexketoprofen was reduced postoperative tramadol consumption and insidance.of adverse events.

The aim of this study was to determine prevalence of pain(p) in adults and their preference for pain treatment, by using questionnaire. First 7 questions of “Brief Pain Inventory-Short Form” and “Cornell Musculoskeletal Dıscomfort Questionnaire” were applied to 250 participants in face to face interview. A hundred eighty of the individuals were women (38.3±14.0years old) and 70 were men (36.6±13.2years old). Data analysis were performed using SPSS,version10. Eighteen individuals (7.2%) had no pain and 232 (92.8%)of them had pain in different parts of the body. A hundred fourty five individuals had lowback p, 116 neck p, 101 dorsal p, 152 shoulder p, 69 upperarm p, 66 forearm p, 75 wrist p, 59 hip p, 69 upper leg p, 98 knee p, 81 crus pain. Their mean pain score was 3.6±1.8,mean pain score at its worst in the last 24 hours was 4.4±2.6. Thirty three % of individuals had used non-steroidal anti-inflammatory and/or analgesic drugs to relieve pain, 22.7% had physical therapy, 4.1% had other pain-relief methods, 1.2% had surgery, and 38% had nothing. Our results showed that 92.8% adults had pain. Although shoulder has highest pain prevalance, severe pain was mostly described in lowback area. Knee pain was largely interfered work ability. An important percent of persons experiencing pain has recieved no treatment and first preference for treatment was drug. Inspite of high pain prevalence in our study, slightly uncomfortable pain severity and no need for treatment can be explain a result of individual differences in pain perception.

Objectives: To investigate the differences and similarities of the sociodemographic properties and pain conditions of patients, from that of other studies conducted all around the world.
Material and Methods: In our policlinic, all the patients are asked the questions in the “Pain Assessment Form” before the diagnosis and answers are recorded. Their demographic characteristics such as age, gender, occupation, marital status, education and economical status are written on the forms. For the detailed pain anamnesis, following factors are questioned and recorded in the pain assessment form: The location, quantity and starting time of pain, its period, the factors that increase and decrease the pain, duration of pain, prior medication.
Results: Our study includes the results of 772 patients who applied to our policlinic between January 1st, 2006 and December 31st, 2007. The most frequent complaints were the region of low back, shoulder and head. The most frequent three diagnoses were low back pain, musculoskeletal pain and headache. VAS value was found to be 7.3.. Seventy three percent of patients had been suffering from chronic pain. Pain was mostly accompanied by weakness, muscle weakness, insomnia, nausea and vomiting. The most frequent treatments were medical treatments along with invasive pain therapy.
Conclusion: Knowing sociodemographic properties and close investigation of patients’ answers to the treatments are important. When medical treatment is insufficient, invasive pain treatment should be realized by experienced pain therapy practitioner. Informing patients and their relatives about applied treatment may increase the success of treatment.

In this case, we present a 86 years-old patient with severe chronic obstructive pulmonary disease undergoing modified radical mastectomy with axillary dissection by thoracic paravertebral block (PVB). Use of thoracic PVB provided hemodynamic and respiratory stability, excellent unilateral anesthesia and high patient satisfaction.

Ocular pain is often difficult to treat and may be caused by many eye diseases. First step in pain management is medical therapy combined with analgesics, however severe and resistant cases may require neurolytic eye blocks or definitive surgery. The retrobulbar block with neurolytic agents such as alcohol may be preferred, if the eye is cosmetically normal or the patient is medically or psychologically unsuitable for enucleation or evisceration. Here, we present successful and efficient pain management with retrobulbar alcohol injection in 4 patients with painful blind eyes. The patients with neovascular glaucoma presenting with painful blind eyes were accepted to our clinic for pain management. The patients had continuous pain with an increasing severity in the last months. We planned to perform retrobulbar alcohol injection as the pain of the patients were resistant to medical therapy and we noted measurement of verbal analogue scale for pain (VAS) before the block (7, 9, 9 and 10, respectively), after retrobulbar lidocaine and alcohol injection, at postoperative 1st day, 1st,2nd 3rd and 4th week, 3rd, 4th, 5th, 6th and 12th months. We also noted the early and late complications. On the first day after injection, no patient required additive analgesic therapy and their VAS scores were 0, 0, 0 3, respectively.Except a patient who underwent enucleation because of a bacterial infection, others’ VAS scores were 1, 0 and 1 at 12th months’ assessment. We suggest that neurolytic retrobulbar block is an efficient pain management strategy in blind painful eyes.