Nöropatik ağrının tarihi Kısa bir bakış, 20(Özel ek sayı 3):4-9, 2008

Doç. Dr. Okan Bölükbaşı
Denizli Devlet Hastanesi Klinik Nörofizyoloji Laboratuvarı

A SHORT HISTORY OF NEUROPATHIC PAIN

Understanding of pain throughought the  ages, is the whole history of medicine also. Progressive achievements of surgery and basic physiology on nerve, brain and the “soul” has been paved the road to solve the complex nature of pain and the neuropathic pain in the mammalians. Galen discriminate the peripheral nerves, Ibni Sina explained their role in the transmission of “senses”, Descartes identified the thalamus as a final “center for pain”. We have to stress the influence of electricity and magnetism experiments by Galvani, Aldini, Duchenne, Du-Bois Raymond, Muller and Renshaw on the “modus operandi” of peripheral nerves and spinal cord and their relevance to pain. Despite the very  early mention of neuropathic pain as a document goes back to Hittite Empire era of Anatolia, Weir-Mitchel was clearly succeeded to wrote the clinical picture of neuropathic pain during the Civil War of the United States of America. Gate control theory for pain in 1965, “opened” the gates to molecular understanding and the story goes on at this particular  level.

Nöropatik ağrı: Semptomlar ve ölçek, 20(Özel ek sayı 3):10-11, 2008

Prof. Dr. Mustafa Ertaş
Anadolu Sağlık Merkezi Hastanesi, Nöroloji Bölümü

NEUROPATHIC PAIN: SYMPTOMS AND SCALES

Neuropathic pain is pain initiated or caused by a primary lesion or dysfunction in the nervous system at any level (peripheral, dorsal horn, central nervous system). Clinical sensory manifestations of nervous system damage are negative (loss in sersory modalities) and positive symptoms (pain, paresthesias, hyperalgesia, allodynia). Neuropathic pain has distintive features such as electric shock pain, burning pain. To measure the intensity of neuropathic pain, most used one-dimensional scales are visual analogue scale (VAS), verbal rating scale (VRS) and numerical rating scale (NRS). LANSS is a scale specific to neuropathic pain, to differentiate neuropathic pain from nociceptive pain

Nöropatik ağrı ve patofizyolojisi, 20(Özel ek sayı 3):12-16, 2008

PATHOPHYSIOLOGY OF NEUROPATHIC PAIN

International Association for the Study of Pain defines neuropathic pain as “pain initiated or caused by a primary lesion or dysfunction in the nervous system”. The pathophysiology of neuropathic pain still remains unclear. However, several animal and human studies on pathophyiology of neuropathic pain have been done to investigate the pathophysiology and to develop the treatment options. This review has focused on the known mechanisms involved in the pathophysiology of neuropathic pain

Nöropatik ağrı: Periferik nedenler, 20(Özel ek sayı 3):17-22, 2008

Prof. Dr. Nilgün Araç
Ege Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı

Chronic neuropathic pain, caused by lesions in the peripheral or central nervous system, comes in many forms.It is probable that, both peripheral and central nervous system mechanisms contribute to the persistence of most types of neuropathic pain.This review discusses peripheral causes of  neuropathic pain, according to a common used scheme for classifying neuropathic pain based on anatomy and aetiology.Most common locations are the peripheral nerves, the plexus, dorsal nerve roots. Mononeuropathies, multiple mononeuropathies, polyneuropathies with a etiological, sub-classification, etiologies ranging from travmatic to metabolic, from vascular to immunological will be discussed.

Santral nöropatik ağrı, 20(Özel ek sayı 3):23-29, 2008

Uzm. Dr. Kayıhan Uluç    Prof. Dr. Tülin Tanrıdağ
Marmara Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı

Santral nöropatik ağrının periferik kökenli ağrıdan önemli bir farklılığı, ağrının oluşma zamanıdır. Santral kökenli ağrılar, genellikle sinir sisteminde hasarlanma meydana getiren olaydan çok sonra, hatta hasta diğer nörolojik özürlülüklerinden kurtulma aşamasına geldiği zaman ortaya çıkabilmektedir. Diğer önemli farklılıklar, santral nöropatik ağrının daha az görülmesine rağmen, tedavisinde yaşanan güçlükler ve ağrının altında yatan nedenlerin çoğu zaman bilinememesidir

CENTRAL NEUROPATHIC PAIN

Neuropathic pain is caused by lesions in central nervous system as well as peripheral nervous system. Central neuropathic pain differs from peripheral neuropathic pain in that in the former, pain occurs much later than the time of damage in central nervous system. Another difference is that central neuropathic pain is more resistant to medical therapy than peripheral neuropathic pain. This review discusses the causes of central neuropathic pain and treatment options.

Nöropatik ağrı değerlendirmesinde elektrofizyolojik yöntemler, 20(Özel ek sayı 3):30-37, 2008

Prof. Dr. Burhanettin Uludağ
Ege Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı

ELECTROPHYSIOLOGICAL METHODS IN ASSESSMENT OF NEUROPATHIC PAIN

Electromyography, late responses, somatosensorial evoked potentials, laser evoked potentials, microneurography and otonomic tests are used assesing of neuropathic pain.  These tests are performed to prove causes of neuropathic pain.

Periferik nöropatilerin tanısında sinir ve deri biyopsisinin yeri, 20(Özel ek sayı 3):38-42, 2008

Dr. Sevim Erdem-Özdamar
Hacettepe Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı ve Nöromusküler Hastalıklar Araştırma Laboratuvarı

THE ROLE OF PERIPHERAL NERVE AND SKIN BIOPSIES IN THE DIAGNOSIS OF PERIPHERAL NEUROPATHIES

Nerve biopsies and intraepidermal nerve fiber analysis in skin biopsies that is recently introduced to our clinical practice, have important roles in the diagnosis of peripheral neuropathies. An important point about nerve biopsies is that they are not screening tests to show the presence or absence of neuropathy. Diagnosis of neuropathy can be reached by history, neurological examination and electrophysiological tests. Being an invasive diagnostic tool and considering its limitations, nerve biopsies should be performed to answer specific questions. It is also important that nerve biopsy procedure shoud be performed by an experienced person and handled  in a  laboratory with all the necessary facilities. On the other hand, skin biopsies are  performed to show the existance of neuropathy but for the time being they do not contribute to the diagnosis of the etiology. Small fiber neuropathies which goes with normal routine electrophysiological studies can be diagnosed by analysis of intraepidermal nerve fibers in skin biopsies.

Diyabetik nöropatiler, 20(Özel ek sayı 3):43-46, 2008

Prof. Dr. Yeşim Gülşen-Parman
İstanbul Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı

DIYABETIC NEUROPATHIES

Diabetes is among the leading causes of neuropathy. In this review, the features of different types of neuropathy caused by diabetes and treatment options have been discussed.

İmmun kökenli nöropatiler, 20(Özel ek sayı 3):47-51, 2008

Prof. Dr. Yeşim Gülşen-Parman
İstanbul Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı

IMMUNE-MEDIATED NEUROPATHIES

Immune-mediated neuropathies include mainly Guillain Barre Syndrome, Chronic inflammatory demylinating polyneuropathies, and Dysglobulinemic neuropathies. In this review gives an update on immune-mediated neuropathies and treatment options.

Diyabetik nöropati, 20(Özel ek sayı 3):52-62, 2008

Uzm. Dr. A. Serap Yalın *    Prof. Dr. Zeynep Oşar-Sıva **
* Marmara Üniversitesi Tıp Fakültesi İç Hastalıkları Anabilim Dalı, ** İ. Ü. Cerrahpaşa Tıp Fakültesi İç Hastalıkları Anabilim Dalı, Endokrinoloji, Metabolizma, Diyabet Bilim Dalı

DIABETIC NEUROPTHY

This review discusses the diabetic neuropathy from the point of view of endocrinologist.

Nöropatik ağrı tedavisinde antiepileptikler, 20(Özel ek sayı 3):63-66, 2008

Dr. Ersin Tan
Hacettepe Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı

ANTIEPILEPTIC DRUGS IN THE TREATMENT OF NEUROPATHIC PAIN

Neuropathic pain is a form of chronic pain caused by injury to or disease of somatosensoriel system. Examples of neuropathic pain syndromes include postherpetic neuralgia, painful diabetic neuropayhy, the complex regional pain syndrome and the central poststroke pain syndrome. Neuropathic pain is typically severe, slow to resolve, and extremely distressing. Antiepileptic drugs are an effective treatment for all kinds of neuropathic pain. Multiple randomised controlled studies have shown the efficacy of gabapentin, pregabalin for postherpetic neuralgia and painful diabetic neuropathy. In the treatment of trigeminal neuralgia, carbamazepine and oxcarbazepine are accepted as the first line treatment agents. The effects of lamotrigine, valproat, levatiracetam, zonisamid, felbamate and fenitoin in the treatment of neuropathic pain are also discussed in the article.

Nöropatik ağrıda antidepresan tedavi, 20(Özel ek sayı 3):67-71, 2008

Doç. Dr. İsmet Melek
Mustafa Kemal Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı

ANTIDEPRESSANTS IN TREATMENT OF NEUROPATHIC PAIN

This review gives a detailed information about the current antidepressant treatment options in neuropathic pain

Nöropatik ağrıda girişimsel tedaviler, 20(Özel ek sayı 3):72-76, 2008

Prof. Dr. Ayşen Yücel
Anadolu Sağlık Merkezi, Algoloji Bölümü

INVASIVE TREATMENT OF NEUROPATHIC PAIN

It is hard to treat the pain with neuropathic origin. Medical treatment is still fist option in treatment of neuropathic pain. However, invasive treatment is an option in management of neuropathic pain. This article reviews the invasive techniques in management of pain with neuropathic origin.