Neurogenic thoracic outlet syndrome (nTOS) is a condition caused by compression of the brachial plexus in the thoracic outlet, often leading to pain and paresthesia. In this article, we report a 34-year-old female patient with chronic nTOS symptoms refractory to prior management. Ultrasound-guided diagnostic blocks of the anterior scalene and pectoralis minor muscles provided significant temporary relief. Subsequent ultrasoundguided onabotulinum toxin A (BTX-A) injections into the scalene muscles resulted in near-complete symptom resolution lasting approximately six months. Over an 18-month follow-up, repeated injections at six-month intervals produced consistent clinical improvement without adverse effects. In conclusion, repeated ultrasound-guided BTX-A injections may be a safe and effective option within a multimodal treatment approach for nTOS.
BACKGROUND:This study aims to investigate the association between tobacco use and central sensitization (CS), as measured by the Central Sensitization Inventory (CSI), and to identify demographic and clinical factors associated with CS. PATIENTS AND METHODS:In this cross-sectional study, a total of 380 adults were included using a convenience sampling method between December 2024 and January 2025. Data collection was performed through an online survey platform to ensure accessibility and broad participation. The survey was distributed via digital platforms, social media networks, and email lists to reach a diverse adult population across Türkiye. Demographic characteristics, clinical variables, and tobacco product use status were recorded. Central sensitization was assessed using the CSI. Multiple linear and logistic regression analyses were performed to identify predictors of CSI scores. RESULTS:Of a total of 380 participants, 131 were male and 249 were female with a mean age of 41.21 ± 11.40 (range, 18 to 65) years. Tobacco users had significantly higher CSI total scores compared to non-users (p = 0.029). A higher proportion of individuals with a CSI score ≥ 40 was observed among tobacco users (p = 0.003). In the multiple linear regression model, age (β = -0.295), female sex (β = 6.255), chronic disease status (β = 4.524), chronic pain (β = 12.093), and tobacco use (β = 6.538) were independent predictors (p < 0.001). Logistic regression analysis indicated a significant association between tobacco use and the likelihood of having a CSI score ≥ 40 (odds ratio [OR] = 0.488, 95% confidence interval [CI]: 0.302-0.789). CONCLUSION:Tobacco use is positively associated with higher CS symptom severity. Given the cross-sectional design, these findings reflect a correlation rather than direct causality. Nevertheless, screening for smoking habits may provide valuable context during the clinical evaluation of chronic pain.
BACKGROUND:This study aims to assess the efficacy of erector spinae plane block (ESPB) for postoperative analgesia in patients undergoing total hip arthroplasty (THA) under spinal anesthesia. PATIENTS AND METHODS:In this randomized-controlled trial, a total of 30 patients (American Society of Anesthesiologists Class I-III, 20 to 65 years) who underwent elective unilateral THA under spinal anesthesia were included between January 2023 and December 2023. The patients were randomized either to Group E (n = 15) to receive ultrasound-guided lumbar ESPB with 40 mL of 0.25% bupivacaine in addition to spinal anesthesia (2.5 mL of 0.5% hyperbaric bupivacaine with 10 µg of fentanyl), or Group C (n = 15) who received spinal anesthesia alone. Primary outcomes were duration of analgesia and Visual Analog Scale (VAS) scores at 6 h. Secondary outcomes included VAS scores at 0, 0.5, 2, 4, 12, 24 h and total additional analgesic requirement in the first 24 h. RESULTS:Of a total of 30 patients included in the study, 22 were male and 8 were female with a mean age of 36.86 ± 13.24 (range, 18 to 65) years. The duration of analgesia was significantly longer in group E (10.76 ± 1.96 h vs. 4.18 ± 1.36 h; p < 0.01). The VAS scores were lower in group E at 0.5 h (p = 0.009), 2 h (p < 0.001), 4 h (p < 0.001), 6 h (p < 0.001), and 12 h (p = 0.02). Additional analgesic requirement during the first 24 h was higher in Group C. Surgeon and patient satisfaction scores significantly improved in Group E. No hemodynamic instability or motor weakness was observed. CONCLUSION:Lumbar ESPB with 40 mL of 0.25% bupivacaine significantly prolongs postoperative analgesia and reduces pain scores and analgesic consumption in patients undergoing THA under spinal anesthesia. Based on these findings, lumbar ESPB may provide effective and safe adjunctive analgesia in this patient population.
BACKGROUND:This study aims to compare clinical outcomes, procedural efficiency, and safety of pulsed radiofrequency (PRF) of the cervical medial branches performed under ultrasound (US) versus fluoroscopy (FL) guidance. PATIENTS AND METHODS:This single-center, retrospective cohort study included a total of 177 patients between January 2023 and June 2025. The patients were allocated to FL- (n = 75) or US-guided groups (n = 102). The Numeric Rating Scale (NRS), Neck Disability Index (NDI), and monthly analgesic use were assessed at baseline, at six weeks (primary endpoint), and at three and six months. The primary outcome inter-group NRS at six weeks was analyzed using analysis of covariance adjusted for baseline NRS, age, sex, bilaterality, and number of treated levels. Secondary outcomes included NDI, analgesic use, and procedural metrics. Six-week analyses included all patients; three- and six-month analyses used available-case data (up to n = 141). Last-observation-carried-forward (LOCF) sensitivity analyses were performed. RESULTS:Of the 177 patients included in the study, 60 were male and 117 were female with a mean age of 53.47 ± 5.46 (range, 39 to 66) years. Compared to FL, US-guided PRF was associated with shorter procedure times (8.64 ± 0.93 vs. 14.41 ± 2.24 min), fewer needle redirections (1.36 ± 0.50 vs. 3.56 ± 1.02), and fewer minor complications (11.8% vs. 30.7%) (p ≤ 0.003 for all). At six weeks, adjusted mean NRS was 4.46 in US group versus 4.56 in FL group, with no significant inter-group difference (adjusted difference 0.10; 95% confidence interval [CI]: -0.53 to 0.34). No significant differences were observed for NDI or analgesic use at any time point. Responder, longitudinal mixed-effects, and LOCF sensitivity analyses yielded concordant results. CONCLUSION:Our study results suggest that US- and FL-guided cervical medial branch PRF can yield similar clinical outcomes. However, US guidance provides procedural and safety advantages without compromising effectiveness.
BACKGROUND:This study aimed to translate the Clinically Aligned Pain Assessment (CAPA) Scale into Turkish, perform its cultural adaptation, and evaluate its validity and reliability in Turkish patients. PATIENTS AND METHODS:This single-center, cross-sectional study included a total of 105 patients with pain lasting at least one week between March 2026 and June 2026. The translation process followed standardized forward-backward procedures. Reliability was assessed using internal consistency and test-retest analysis (n = 68, 48-72 h). Construct validity was evaluated with exploratory factor analysis, and convergent validity was examined using Numeric Rating Scale (NRS). RESULTS:Of a total of 105 participants, 37 were male and 68 were female with a mean age of 46.90 ± 11.974 (range, 23 to 71) years. In the study, the CAPA-TR showed good internal consistency (Cronbach's alpha = 0.859) and excellent test-retest reliability (intraclass correlation coefficient = 0.959). Item-total correlations were above 0.30 for all items. Floor and ceiling effects were below acceptable thresholds. Exploratory factor analysis revealed a single-factor structure explaining 66.2% of the total variance. No significant correlation was found between CAPA-TR scores and NRS. CONCLUSION:Our study results suggest that CAPA-TR is a valid and reliable multidimensional tool for pain assessment in Turkish-speaking patients. It provides a practical and patient-centered approach that may support more comprehensive evaluation of pain in clinical practice.
While post-thoracotomy pain syndrome is a known phenomenon in thoracic surgery, its occurrence after pleural shunt placement has not been described in the literature. A 41-year-old female with a history of Chiari I decompression surgery was admitted with a complaint of paresthesia, neuropathic pain affecting all extremities, and gait difficulty. Cervical magnetic resonance imaging revealed a C2-7 syringomyelia, and a syringopleural shunt was placed. The patient improved both clinically and radiologically, but after four months of follow-up, she complained of pain near the thoracic incision and in the dermatome relevant to the intercostal nerve root. The wound was surgically explored, and reactive changes to the shunt catheter were found near the intercostal nerve root. The shunt was subsequently removed, and a syringoarachnoidal shunt was placed instead. The patient improved postoperatively and was discharged without any complications. In conclusion, careful consideration of the location and course of the intercostal nerves is essential when placing pleural shunt systems.
BACKGROUND:This study aims to investigate whether moderate sedation (MOAA/S 3-4) affects procedural efficiency, radiation exposure, patient-physician satisfaction, and clinical outcomes during lumbar transforaminal epidural steroid injections (L-TFESI). PATIENTS AND METHODS:Between January 2021 and January 2024, a total of 201 patients with unilateral, single-root compression who underwent L-TFESI either with (Group S, n = 99) or without sedation (Group NS, n = 102) were retrospectively analyzed. In the sedation group, midazolam and fentanyl were titrated to a target Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score of 3-4. The primary outcomes were cumulative radiation dose (mGy), fluoroscopy time, and procedural complications. Additional outcomes included Numeric Rating Scale-11 (NRS-11) scores (baseline, Day 4, Week 4) and Likert satisfaction scales. RESULTS:Of a total of 201 patients, 143 were male and 58 were female with a mean age of 47.22 ± 10.03 (range, 22 to 65) years. Both groups were comparable in terms of baseline demographics and pain scores. The sedation group had significantly lower cumulative radiation exposure (3.92 ± 0.30 mGy vs. 4.31 ± 0.40 mGy) and shorter fluoroscopy times (28.13 ± 2.79 sec vs. 33.13 ± 3.95 sec). Minor procedural complications (commonly vasovagal reactions and hypertension) were more frequent in the non-sedated group (21.6% vs. 2.0%). Group S reported lower pain scores on Day 4 (1.11 ± 1.29 vs. 1.88 ± 1.25), although outcomes were similar at Week 4. Patient and physician satisfaction were higher in the sedation group. CONCLUSION:Moderate sedation (MOAA/S 3-4) during L-TFESI is associated with lower radiation exposure, shorter procedure times and fewer minor complications, while improving both patient satisfaction and procedural conditions. These findings suggest that sedation is a potentially useful adjunct in selected patients that may contribute to improved procedural quality in interventional pain management.
Background: This study aimed to evaluate whether the magnesium depletion score (MDS), an indicator of magnesium deficiency, is associated with the development of complex regional pain syndrome type 1 (CRPS-1) in patients with traumatic extremity injuries. Patients and Methods: Between November 2024 and May 2025, a total of 117 patients who suffered from traumatic extremity injuries were included. Demographic and clinical data of the patients were collected and recorded, and the MDS was calculated. Age, sex, body mass index (BMI), smoking status, alcohol consumption, diabetes, hypertension, duration of immobilization, MDS, and injury-related characteristics were evaluated as potential risk factors for CRPS-1 development. Results: Of the patients, 40 were male and 77 were female with a mean age of 51.9 ± 15.01 (range, 20 to 91 years). In a total of 42.7% of patients with traumatic extremity injuries, CRPS-1 developed. The female-to-male ratio was higher among patients with CRPS-1 than among those without. The MDS, hypertension, diabetes, smoking, and alcohol consumption were not found to be independent risk factors. However, prolonged immobilization (more than one month) was found to be an independent risk factor for the development of CRPS-1. Conclusion: Our study results suggest that the MDS score is not a risk factor for developing CRPS-1, but immobilization for more than one month significantly increases the risk. Taken together, these findings indicate that the duration of immobilization following injury may be a more decisive factor in the development of CRPS-1 than demographic and clinical characteristics.
BACKGROUND:This study aims to compare the analgesic efficacy and procedural efficiency of pectoral (PECS II) blocks performed using artificial intelligence (AI)-integrated ultrasonography (USG) versus conventional USG in patients undergoing modified radical mastectomy (MRM). PATIENTS AND METHODS:Between November 2021 and March 2023, a total of 70 female patients scheduled for unilateral MRM under general anesthesia were included in this randomized study. The patients were randomly allocated into two groups: USG group (n = 35) and AI-USG group (n = 35). A fourth-year anesthesiology resident performed the PECS II blocks under the supervision of a senior anesthesiologist. The primary outcome was the postoperative pain score as assessed by Visual Analog Scale (VAS) at 12 hours. Secondary outcomes included pain scores at other postoperative time points, total opioid consumption, time first to rescue analgesia request within 24 hours, and the resident's skill development at the end of the study. RESULTS:The mean age was 55.3±11.4 (range, 35 to 75) years. Intraoperative remifentanil consumption was higher in USG group than in AI-USG group; however, the difference was not statistically significant (p > 0.05). The durations of anesthesia and surgery were shorter in AI-USG group (p = 0.005 and p = 0.008, respectively). A comparison of local anesthetic injection times between the first 35 and the last 35 patients revealed a statistically significant decrease in the USG group (4.0 min vs. 3.0 min, p = 0.014). The VAS pain scores in the post-anesthesia care unit were initially higher in the AI-USG group (p = 0.05); however, at 12 and 24 postoperative hours, VAS scores were significantly lower than those in the USG group (p = 0.005 and p < 0.001, respectively). There was no significant difference in total tramadol consumption via PCA during the first 24 hours postoperatively (p > 0.05). Surgeon satisfaction scores were lower in the AI-USG group (p = 0.037). CONCLUSION:Our study results suggest that AI-enhanced USG guidance is associated with improved analgesic outcomes and may offer clinical and educational advantages in the performance of PECS II blocks, particularly for residents in training. The integration of AI into routine USG-guided regional anesthesia practice holds promise for improving procedural consistency and supporting novice practitioners.
Serratus anterior plane block (SAPB) is an effective regional anesthesia technique for chest wall analgesia. In this article, we report three cases of critically ill patients with chest trauma in whom a single-shot SAPB combined with low-dose dexmedetomidine (DEX) was used as part of a multimodal analgesia strategy. In all cases, SAPB with DEX provided effective and prolonged analgesia, with pain relief lasting up to 72 hours. The technique also contributed to improved respiratory function and facilitated clinical decision-making during the weaning process in one patient by helping to distinguish pain-related respiratory limitation from diaphragmatic dysfunction. In conclusion, SAPB with low-dose DEX may be a safe and effective option for chest wall analgesia at T3-T8 levels, even in polytrauma patients.
BACKGROUND:This study aims to determine the effect of position changes on pain in stroke patients who are unable to communicate verbally in the intensive care unit (ICU). PATIENTS AND METHODS:Between August 2021 and February 2022, a total of 129 stroke patients who were unable to communicate verbally in the ICU were included in this cross-sectional study. Data were collected using the Personal Information Form, Critical Care Observation Tool (CPOT), Behavioral Pain Scale (BPS), Motor Activity Assessment Scale (MAAS). RESULTS:Of a total of 129 patients included in the study, 56 were male and 73 were female with a mean age of 73.5±11.2 (range, 45 to 92) years. There was a significant difference in conditions such as heart rate, blood pressure, oxygen saturation value, changes in pupils, sweating, nausea-vomiting, and pallor-redness on the skin before, during, and after the position change (p < 0.05). In the multiple comparisons, the values before and after the intervention were lower than the values during the position change. There was a significant relationship between CPOT, BPS and MAAS in the study (p < 0.05). CONCLUSION:Stroke patients in the ICU who are unable to communicate verbally experience pain associated with position changes, as evidenced by both behavioral responses and physiological alterations. In-service training programs should be organized for intensive care nurses to enhance their ability to recognize and evaluate pain-related behaviors.
BACKGROUND:This study aims to evaluate the validity of the Visual Analog Scale-Tension (VAS-T). PATIENTS AND METHODS:This cross-sectional study included a total of 100 patients with chronic pain and 100 individuals without pain complaints between April 2021 and April 2022. All participants completed a sociodemographic information form, the Visual Analog Scale for Tension (VAS-T), the Depression Anxiety Stress Scale (DASS-42), and the Toronto Alexithymia Scale (TAS-20). Additionally, patients with chronic pain completed the Visual Analog Scale for Pain (VAS-P) and algometer assessments. The discriminant, concurrent, and convergent validity of the VAS-T was evaluated. RESULTS:Concerning discriminant validity, analyses revealed that individuals in the pain group exhibited significantly higher VAS-T scores compared to the control group (p < 0.001). There was a significant correlation between VAS-T scores, muscle tension algometer scores, and anxiety, stress, and alexithymia levels (p < 0.01). Participants reporting low tension on the VAS-T differed significantly from those reporting high tension regarding these variables (p < 0.05). CONCLUSION:The self-reported VAS-T is a rapid, practical and valid self-reported tool for assessing muscle tension.
BACKGROUND:This study aims to investigate the prevalence of neuropathic pain in shoulder pain, its relationship with nociplastic pain, and the effects of both pain types on functional outcomes. MATERIALS AND METHODS:Between May 2024 and December 2024, a total of 73 patients with non-traumatic shoulder pain persisting for more than three months were included in this multi-center, prospective, cross-sectional study. Participants were classified according to diagnoses of rotator cuff disorders, subacromial impingement, adhesive capsulitis, osteoarthritis, or calcific tendinitis. Assessments were performed using the Visual Analog Scale (VAS), the Short Form of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS-SF), the Central Sensitization Inventory (CSI), and the Shoulder Pain and Disability Index (SPADI). RESULTS:Of the patients, 28 were male and 45 were female with a mean age of 54.89±10.24 (range, 32 to 70) years. Neuropathic pain was present in 26% of patients, while 28.8% exhibited central sensitization (CS), indicating nociplastic pain. Patients with both neuropathic and nociplastic pain had significantly higher SPADI scores (p < 0.05), indicating greater functional impairment. However, nociplastic pain alone was not significantly associated with disability. Patients with CS had higher VAS scores and longer symptom duration (p < 0.05), indicating its role in pain chronicity. CONCLUSION:In non-traumatic shoulder disorders, neuropathic and nociplastic pain mechanisms overlap; however, their clinical impacts differ. Nociplastic pain increases pain perception, whereas neuropathic pain is more strongly associated with functional impairment. These findings highlight the importance of multidisciplinary treatment strategies that target both pain components rather than focusing solely on CS.
Sacrococcygeal dislocation commonly occurs after trauma and may cause coccydynia. Although most cases of coccydynia after sacrococcygeal dislocation resolve with conservative and medical treatment, surgery is also an option with refractory pain. Sacral erector spinae plane block (SESPB) is a novel approach for sacrococcygeal procedures and may be effective in the postoperative pain of this region. In this article, we present a case of a successful median approach SESPB for postoperative pain management following coccyx removal in a patient with sacrococcygeal dislocation. In conclusion, SESPB seems to be a promising regional anesthesia technique for pain originating from the coccyx.
BACKGROUND:This study aims to compare the clinical effectiveness and safety of intra-articular corticosteroid (IAC) injections versus radiofrequency ablation (RFA) of the femoral and obturator articular branches in patients with advanced hip osteoarthritis (OA). PATIENTS AND METHODS:This single-center, retrospective cohort study included a total of 93 patients including 62 who received IAC and 31 who received RFA between January 2022 and May 2025. Pain severity (Numeric Rating Scale, NRS), clinical improvement (Global Perceived Effect, GPE), and analgesic use were evaluated at baseline, one month, and six months. Longitudinal changes were analyzed using the Generalized Estimating Equations (GEE) adjusted for age, sex, body mass index (BMI), and opioid use. RESULTS:Of a total of 93 patients included in the study, 17 were male and 76 were female with a mean age of 66.8±12.3 (range, 27 to 89). Both groups exhibited significant reductions in NRS scores at one and six months compared to baseline (p < 0.001). No significant inter-group differences were observed in absolute NRS scores or the proportion of patients achieving a good clinical response (GPE ≥ 6). At six months, the RFA group demonstrated numerically greater improvement; however, differences in absolute (median 2.0 vs. 0.0; p = 0.052) and percentage change (median 25.0% vs. 0.0%; p = 0.054) did not reach statistical significance. Longitudinal analyses using GEE confirmed a significant main effect of time, with no treatment group effect or group-by-time interaction after adjusting for age, sex, BMI, and baseline opioid use. CONCLUSION:Both IAC and RFA provide meaningful and comparable pain relief in patients with refractory hip OA. While the analgesic effect of IAC injections appears to diminish by the sixth month, RFA may offer a safe alternative with a potentially more sustained clinical trajectory.
