Diabetic neuropathy (DN) is the most common complication of diabetes mellitus. It causes microvascular and macrovascular damages and diagnosis can easily be overlooked by most physicians. Generally; the diagnosis of DN can be omitted by physicians dealing with diabetes treatment since it starts with non-specific findings, shows slow progression and can be confused with complaints in many diseases. It is estimated that there will be 578 million people diagnosed with DN in the world in 2030. Chronic hyperglycemia, microvascular insufficiency, oxidative and nitrosative stress, impaired neurotropism and autoimmunity are some of the factors that cause nerve destruction. Paresthesias such as tingling, burning, electrical shock-like sensations, numbness, throbbing, compression, pinpricks to the skin, complaints are the most common symptoms. There is no treatment for pathogenetic mechanisms in diabetic neuropathy that completely eliminates neuronal damage. The purposes of treatment is slowing down the progression of the disease, controlling the pain, preventing complications, quick and adequate treatment of occurred complications, maintaining the functional capacity of the patient. In this review, we aimed to comprehensively address the general approach to diabetic neuropathy, diagnosis and treatment.

Psoriatic arthritis (PsA) is a chronic inflammatory multisystemic disease. Limitations due to skin and joint involvement of the patients; can lead to negativie suffix in emotional state, social and physical activities. The aim of this study is to investigate the effects of parameters such as skin joint involvement and disease severity on factors such as fatigue, quality of life, depression, etc. in psoriasis and PsA patients. Thirty-four psoriasis and 48 PsA patients matched with each other in terms of age, sex, and other factors were included in the study. Disease severity was measured by Psoriasis Area Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI), Disease Activity in Psoriatic Arthritis (DAPSA) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores. In order to determine the depression status, quality of life and fatigue levels of the patients, respectively; Beck Depression Inventory (BDI), Health Assessment Questionnaire (HAQ) and Functional Assessment of Chronic Illness Therapy - fatigue scale (FACIT) scores were used. SPSS 17 for statistical evaluation (SPSS Inc. Released 2007. SPSS for Windows, Version 17.0. Chicago, SPSS Inc.) software package was used for analyses. Written informed consent was obtained from all patients who were enrolled to the study. PsA patients were found to have worse quality of life scores than psoriasis patients who were similar in terms of age, gender and other demographic characteristics. (0.22±0.36-0-0.48±0.52 p=0.017 respectively). There was a strong correlation between DAPSA scores and HAQ scores of the cases in the PsA group (r:0 ,615 p<0.05). Likewise, disease activity measured by DAPSA was found to have moderate correlation with FACIT score, and weak but statistically significant correlation with BDI score. (r: -0.578 p<0.05 and r:0.346 p<0.001, respectively). No correlation was found between NAPSI-PASI scores and HAQ, BDI - FACIT scores in both the psoriasis and PsA groups. Both psoriasis and PsA affect the quality of life, and our findings suggest that this effect is more pronounced in PsA patients. Our study supports that; the disease severity in PsA patients is related to depression, bad quality of life and fatigue level.

Objectives: Lumbar facet radiofrequency ablation (LFRA) is a painful procedure. Sedation may be applied to improve patient comfort during the procedure; however, deep sedation should be avoided to maintain the patient cooperation. The purpose of this study was to compare dexmedetomidine and midazolam in sedoanalgesia for LFRA. Methods: Patients planning to undergo LFRA were included in this cross-sectional, observational study. After a bolus dose, intravenous infusion of dexmedetomidine was administered in group D, whereas intravenous midazolam was given in group M. Intraoperative vital signs, procedural pain severity (Numerical Rating Scale—NRS), Patient Satisfaction Score (PSS), Operator Satisfaction Score (OSS), and complications were recorded. Results: A total of 96 patients were included in the study. Group D consisted of 47 and group M of 49 patients. Procedural NRS, PSS, and OSS were significantly in favor of group D. Mean procedural NRS of group D was 2.91±2.03, and 4.14±2.17 in group M (P=0.005). The rate of unsatisfactory PSS was 1 (2.1%) in group D and 7 (20%) in group M (P=0.03). The rate of unsatisfactory OSS results was 2 (4.2%) in group D and 16 (32.6%) in group M (P<0.001). Although over-sedation and low oxygen saturation were significantly more frequent in group M, hypotension was higher in group D. Discussion: In sedoanalgesia for LFRA, dexmedetomidine is superior to midazolam with lower procedural pain, higher satisfaction scores, and improved patient cooperation. The results of this study can be considered for sedoanalgesia in other interventional pain procedures.

Background/Objectives: This study aimed to evaluate the effect of sacral epidural laser discectomy (SELD) on clinical parameters in patients with chronic low back and/or leg pain (CLBLP) resistant to conservative treatment. Methods: A total of 75 patients with CLBLP who received SELD treatment were retrospectively included in this study. Patients were assessed for pain (numeric rating scale—NRS) and disability (Oswestry Disability Index—ODI). NRS and ODI scores were recorded before the operation and 1, 6, and 12 months after the operation. Results: Of the 75 patients, with a mean age of 52 ± 11 years (range: 30–78 years), 45 (60.0%) were female and 35 (40.0%) were male. The baseline pain intensity (7.43 ± 0.774) and pain intensities obtained at three time points following the surgeries (1 month [3.93 ± 1.571], 6 months [4.36 ± 1.591], 12 months [5.00 ± 1.716]) showed statistically significant differences (p < 0.001). The baseline pain-related disability (2.92 ± 0.539) and the data obtained at three subsequent time points (1 month [1.76 ± 0.883], 6 months [1.85 ± 0.896], and 12 months [2.01 ± 0.923]) showed a statistically significant difference in pain-related disability (p < 0.001). The most common complications were headache (five patients) and incisional pain (five patients). Conclusions: As a result of this study, we found that SELD reduces pain and disability in patients with conservative-treatment-resistant CLBLP. Although serious complications may rarely occur, the procedure is generally associated with an acceptable and low complication rate.

Amaç: Bu çalışmadaki amacımız, hastanemiz ağrı polikliniğine 45 aylık sürede ağrı şikayeti ile başvuran hastaların demografik özellikleri, ağrı tipleri ve tedavilerini geriye dönük olarak değerlendirmektir. Gereç ve Yöntemler: Çalışmamızda Temmuz 2015-Mart 2019 tarihleri arasında Sağlık Bilimleri Üniversitesi Samsun Eğitim ve Araştırma Hastanesi ağrı polikliniğine kronik ağrı şikayeti ile başvuran hastaların dosyaları incelendi. Hastaların demografik özellikleri, ağrı tipleri ve uygulanan tedaviler geriye dönük, kesitsel çalışma olarak değerlendirildi. Bulgular: 45 aylık sürede polikliniğimize 25288 kronik ağrılı hastanın başvurduğu görüldü. Hastaların 16046’sı kadın (%63,5), 9242’si erkek (%36,5) olarak tespit edildi. En sık kanser dışı ağrı nedenleri (KDA); bel ağrısı, miyofasial ağrı ve nöropatik ağrı idi. Kanser ağrısı (KA) nedeni ile başvuran hasta sayısı 674 (%2,7) idi. Hastaların tamamına medikal tedavi ve 3635 (%14,4) hastaya ek olarak girişimsel ağrı tedavisi uygulandığı tespit edildi. En sık yapılan girişimsel ağrı tedavi yöntemleri; tetik nokta enjeksiyonu, eklem içi enjeksiyon uygulaması, transforaminal epidural enjeksiyon ve faset median sinir bloğu uygulaması olarak saptandı. Sonuçlar: 45 aylık sürede algoloji kliniğimize yoğun bir hasta başvurusu olduğu ve hastaların %14,4’lük kısmına girişimsel ağrı tedavisi uygulandığı görülmüştür. Merkezimizin bu sonuçlarının kronik ağrı çalışmaları için önemli bir veri kaynağı olacağını düşünmekteyiz.