Gülçin Gazioğlu Türkyılmaz

Ultrasound-guided suprascapular nerve block (SSNB) and subacromial injection (SI) are commonly used for chronic subacromial impingement syndrome (SIS), but the additional benefit of combining these interventions remains uncertain. This study evaluated whether adding ultrasound-guided SI to SSNB improves clinical outcomes in patients with chronic MRI-confirmed SIS who had failed conservative treatment. This retrospective cohort study included consecutive patients with chronic SIS treated between December 2021 and January 2025. Patients underwent ultrasound-guided SSNB alone or combined SSNB with SI according to routine clinical practice. SIS was classified by MRI as grade 1 (tendinopathy), grade 2 (partial-thickness rotator cuff tear), or grade 3 (full-thickness rotator cuff tear). The primary outcome was treatment success, defined as a ≥50% reduction in Numerical Rating Scale (NRS) score at 3 months. Secondary outcomes included pain intensity, patient satisfaction, and treatment outcomes according to MRI grade. Sixty-one patients were included (30 SSNB and 31 SSNB + SI). Both treatment groups demonstrated substantial pain reduction during follow-up. Treatment success rates were similar between the SSNB and SSNB + SI groups (86.7% vs 87.1%, P = .999), as were patient satisfaction rates (86.7% vs 87.1%, P  = .946). No significant between-group differences were observed in NRS scores at 1 or 3 months. Treatment success was significantly higher in patients with grade 1 SIS than in those with grade 2 SIS (97.4% vs 80.0%, P = .044). All 3 patients with grade 3 SIS experienced treatment failure. Ultrasound-guided SSNB was associated with favorable short-term outcomes in patients with chronic SIS who had failed conservative treatment. Adding ultrasound-guided SI did not provide additional improvement in pain, treatment success, or patient satisfaction over 3 months. Higher treatment success was observed in patients with grade 1 SIS than in those with more advanced disease. Larger prospective randomized studies are needed to confirm these findings.

Background/Objectives: Recurrent lumbar disc herniation (RLDH) refers to a lumbar disc herniation (LDH) that recurs at the same level, location, and side following surgical repair. This study aimed to evaluate the efficacy of transforaminal epidural steroid injection (TESI) and dorsal root ganglion pulsed radiofrequency (DRG PRF) therapy with and without caudal epidural steroid injection (CESI) for the treatment of lumbar radicular pain (LRP) associated with RLDH. Methods: This retrospective cohort study included 57 patients treated for RLDH in a hospital pain clinic between September 2022 and February 2024. A total of 27 patients received TESI and DRG PRF therapy (Group 1) and 30 patients received TESI, DRG PRF, and CESI therapy (Group 2). We evaluated patient age, sex, symptom duration, pain medication use, number of prior LDH operations, presence of stabilization on magnetic resonance imaging (MRI), intervention received, lumbar level and side of the intervention, and Numeric Rating Scale (NRS) pain scores before and at 1, 3, and 6 months post-procedure. Treatment success was defined as an NRS score at least 50% or 4 points lower than the pre-procedure score at post-procedure 6 months. Results: There was no significant difference in NRS scores between the groups during the 6-month follow-up period. Moreover, NRS scores did not differ based on the presence of stabilization on MRI or the use of pain medication (p > 0.05). Conclusions: TESI and DRG PRF therapy were effective in the treatment of LRP associated with RLDH over a 6-month follow-up period, and adding CESI did not increase treatment success.

Chronic lumbar facet pain is commonly treated with fluoroscopy-guided facet medial branch blocks (FMBBs). However, the associated radiation exposure of both patients and clinicians is a growing concern. This study aimed to compare radiation doses and fluoroscopy times between two techniques, i.e., oblique and posterior–anterior (PA) fluoroscopic approaches, while also examining the impact of physician experience on these metrics. A retrospective analysis was conducted on 180 patients treated at Mersin University Hospital Pain Clinic between January and July 2024. Patients were divided into two groups: 90 received the oblique technique (Group O) and 90 received the AP technique (Group A). Radiation dose and fluoroscopy time data were collected for each patient. The AP technique was associated with significantly lower radiation doses (mean 66 mGy) and shorter fluoroscopy times (mean 28 s) compared to the oblique technique (mean radiation dose of 109 mGy and fluoroscopy time of 46 s) (p < 0.001). Physician experience also influenced these outcomes, with more experienced physicians consistently using less radiation. The AP technique should be considered for FMBBs, as it reduces radiation exposure while maintaining procedural efficiency, highlighting the importance of experience in optimizing outcomes.

Purpose: The aim of this study was to evaluate the effectiveness of a pain identification and treatment training program for medical students based on the “good medical practice” framework. Methods: A questionnaire was used to collect data from a total of 732 students who received the 3-day pain identification and treatment training held by the algology department between 2014 and 2021. The questionnaire included 8 questions about the definition of pain, types of pain, assessing pain, treatment methods and analgesic drugs. The students completed the questionnaire in person before training and 3 months after the training. A total of 732 pre-training and 230 post-training questionnaires were included in the analysis. Results: Correct response rates before and after the training, respectively, were 11.3%(n=83) and 77.4%(n=178) for knowing which nerve fibers conduct pain; 22.3%(n=163) and 74.8%(n=172) for knowing what “VAS” stands for; 76%(n=556) 90.4%(n=208) for giving correct examples of chronic pain; 6.3%(n=46) and 63.5%(n=146) for knowing what the World Health Organization’s analgesic ladder is; and 24.8%(n=178) and 87.7%(n=202) for giving correct examples of strong opioid analgesics (p<0.001 for all). Conclusion: It is known that pain is one of the main reasons for presenting to primary health care services. Therefore, we believe it is important for medical students to learn the diagnosis and treatment of pain in programs that use different teaching methods and encourage active participation of the student in order to ensure the permanence of knowledge, increase physician competence and confidence, and prevent the mismanagement of pain.

Background/aim: The aim of the study is to identify predictors of treatment success with combined transforaminal epidural steroid injection (TFESI) and dorsal root ganglion pulsed radiofrequency (DRG-PRF) in patients with lumbar radicular pain (LRP) associated with lumbar disc herniation. Materials and methods: The study included 48 patients with herniation-related LRP who underwent TFESI and DRG-PRF treatment between November 1, 2020 and April 30, 2021. Patient age, sex, symptom duration, history of lumbar surgery, and numeric rating scale (NRS) pain scores before and at 10 days, 1 month, and 3 months after treatment were evaluated retrospectively. Treatment success was defined as ≥50% improvement or a 4-point decrease in NRS score at 3 months. Results: Twenty-nine female and 19 male patients with a mean age of 51.54 ± 13.31 years were analyzed. The median symptom duration was 6 (interquartile range: 8.50) months. Symptom duration did not affect treatment success (p = 0.105). History of spinal surgery was more common among patients with failed treatment but was not statistically associated with treatment success. A 1-unit increase in pre-treatment NRS score was associated with 72% lower odds of treatment success (p = 0.022), while a 1-unit increase in NRS score on post-treatment day 10 compared to the pre-treatment value was associated with 95% lower odds of treatment success (p = 0.008). Conclusion: Symptom duration and history of spinal surgery were not predictive of treatment success with combined TFESI and DRGPRF for herniation-related LRP. However, the 3-month prognosis was significantly better for patients with a marked reduction in NRS score at 10 days.

Context . No specific treatment exists for fibromyalgia syndrome (FMS), and usually patients continue to experience pain indefinitely and their quality of life decreases. Major ozone autohemotherapy (MAH) is a complementary treatment for FMS that stimulates the body's antioxidant system. Objective . This study aims to prospectively evaluate the effects of MAH on pain, quality of life, and general health status in FMS. Design . The research team designed a prospective crosssectional study. Setting . The study took place at the algology clinic at Mersin University in Yenisehir, Mersin, Turkey. Participants . Participants were 40 patients with FMS, aged 18 to 65, who were admitted to the clinic between February 15 and August 15, 2019. Intervention . Participants completed 13 sessions of major ozone autohemotherapy (MAH), two sessions per week in the first five weeks and one session per month for the remaining three months. In the following three months, the last administered dose was repeated. Outcome Measures . Patients completed the Fibromyalgia Impact Questionnaire (FIQ) and the Quality of Life-short form (SF-36), at baseline (PRE), at five weeks after 10 sessions of MAH (PT), at 9 weeks after 11 sessions (PT1), and postintervention at 17 weeks after 13 sessions (PT3). Results . Significant improvement in FIQ and SF-36 scores was observed in all periods compared to the previous period (P < .05). Between two consecutive measurements the most prominent improvements in both FIQ scores (P < .001) and SF-36 scores was observed between baseline and the PT period (P < .001). Significant improvement also occurred in all SF36 subscale scores between PT and PT3 (P <= .02). Conclusions . The study was the first to demonstrate the efficacy of MAH for fibromyalgia patients as found using FIQ and SF-36 questionnaires repeated at certain intervals. The study found that MAH provided improvements in quality of life and general health status for FMS patients.

Amaç: Mezuniyet sonrası pratisyen hekimler; ağrılı hastanın değerlendirmesinde ve birinci basamak ağrı tedavisinin düzenlenmesinden sorumludurlar. Bu çalışma ile Mersin Üniversitesi Tıp Fakültesi 5. Sınıf öğrencilerinin Anesteziyoloji ve Reanimasyon AD stajı öncesi ağrı ve tedavisi hakkındaki bilgilerinin “Hazır Bulunuşluk Testi” ile değerlendirilmesi amaçlandı. Yöntem: Anesteziyoloji ve Reanimasyon stajına 01/09/2012-01/01/2020 tarihleri arasında gelen Mersin Üniversitesi Tıp Fakültesi 5. Sınıf öğrencilerine staj öncesinde uygulanan Hazır Bulunuşluk Testlerinden, eksiksiz olarak doldurulduğu saptanan 848 testin sonuçları retrospektif olarak değerlendirildi. Test içeriğinde ağrının değerlendirilmesi, ağrıya ait tedavi yöntemleri, kullanılan ilaçlar ve ağrı tipleri konuları bulunmakta idi. Veriler tanımlayıcı istatistik analizleri ile değerlendirildi. Bulgular: Öğrencilerin sadece 85’i (%10.0) ağrı duyusunu taşıyan lifleri doğru olarak tanımlamıştı. Öğrencilerden sadece 57’sinin (%6.7) Dünya Sağlık Örgütü tarafından önerilmiş ‘Ağrıda Basamak Tedavisi’ hakkında bilgisinin olduğu saptandı. Opioidlerin hastaya uygulama yollarını doğru olarak işaretleyen 13 (%1.5) öğrenci mevcuttu. Hastanın ağrısını değerlendirmede kullanılan Vizuel Analog Skala’yı doğru olarak tanımlayan 200 (%23.6) öğrenci vardı. Ağrı tedavisinde kullanılan ilaçlardan, yeşil reçeteye yazılanlara öğrencilerin 61’nin (%7.2), kırmızı reçeteye yazılanlara ise 209’unun (%24.6) doğru analjezik örneği verdiği bulundu. Anketlerin 59’unda (%6.9) parasetamol ve NSAI ilaçların yeşil ve/veya kırmızı reçeteye örnek olarak yazıldığı saptandı. Sonuç: Anketi yanıtlayanların ¼ kadarının doğru bilgi sahibi olduğu saptandı. Tıp fakültelerinde klinik öncesi ağrı ile ilgili bilgi aktarımının, klinik korelasyonla gerçekleştirilmesinin daha kalıcı bilgi oluşturacağı düşüncesindeyiz. Ayrıca eğitim öncesinde ve tamamlandıktan sonra yapılacak değerlendirmeler ile bilgi içeriğinin yapılandırılması gerektiği kanısındayız.

Introduction: This study aims to evaluate the effect of intra-articular ozone treatment on pain and physical functionality by measuring Numerical Pain Rating Scale (NRS), WOMAC Osteoarthritis Index (WOMAC-OI), and Active Joint Range of Motion (AROM) in patients diagnosed with osteoarthritis. Material and methods: A total of 30 patients diagnosed with stage 2-3 osteoarthritis according to the Kellgren-Lawrence Classification System (K-L) were included in the study. Ozone gas was administered (10 ml of 10 mcg/ml per session) twice weekly for a total of four sessions. AROM examination was performed at pre-treatment baseline (BL), post-treatment (PT), and two weeks after treatment (PT2). During these periods, NRS was assessed and WOMAC-OI questionnaire was administered. Results: Significant improvement in NRS and WOMAC-OI total index scores were observed at PT and PT2 periods compared to BL (6.9±1.2; 2.1±1.3; 3.3±1.1; WOMAC-OI total index: 48.1±10.1; 25.5±10.4; 29.1±11.1 respectively; p˂0.001 for all). However, in both of these evaluation methods, the recovery at PT2 had decreased compared to the PT period (NRS p˂0.001; WOMAC-OI p˂0.05). Significant improvement was observed in the AROM values measured during the PT and PT2 periods, compared to baseline (105.6 ± 10.4°; 118.8 ± 8.1°; 117.5 ± 9.2°, respectively) (p˂0.001). There was no difference between the PT and PT2 periods in terms of AROM measurements (p˃0.05). Conclusion: Our study demonstrates that intra-articular ozone injection treatment provides improvement in pain and physical functionality in osteoarthritis patients. In our two-month follow-up assessment, although evaluation methods indicated that there was regression in recovery, AROM measurements showed that there was no regression in function. Therefore, we believe that future studies may include AROM as an objective measurement among evaluation methods.