Comparision of pregabalin and gabapentin efficiency on patients with neuropatic pain related spinal cord injury

Spinal kord yaralanmalı (SKY) hastaların ortalama %40'ında nöropatik ağrı gözlenmektedir ve önemli bir morbitide sebebidir. Nöropatik ağrının tedavisinde birçok farmakolojik ve non farmakolojik tedavi modalitesi kullanılmaktadır. Gabapentin ve pregabalin SKY'na bağlı nöropatik ağrıda daha önce yapılmış birçok çalışmada etkinliği gösterilmiş iki antikonvülzan ajandır. Benzer etki mekanizmaları olmasına karşın son zamanlarda yapılmış bazı çalışmalarda pregabalinin gabapentine dirençli bazı vakalarda da etkin olduğu yönünde çeşitli bulgular mevcuttur. Ancak halen literatürde pregabalin ile gabapentinin bire bir karşılaştırıldığı bir çalışma yoktur. Bu çalışmada SKY'na bağlı nöropatik ağrıda pregabalin ve gabapentinin etkinliği ve yan etkileri karşılaştırıldı.Bu amaçla spinal kord yaralanmasına bağlı nöropatik ağrı tarifleyen ve çalışma kriterlerine uyan 28 katılımcı çalışmaya alındı. Çalışma crossover olarak dizayn edildi. Hastalar 4 hafta titrasyon ve 4 hafta stabil dozda olmak üzere her iki ilacı da 8 hafta boyunca kullandı. Çalışmayı her iki tedaviyide etkin dozda kullanabilen 19 hasta tamamladı. Takiplerde VAS ağrı skoru, nöropatik ağrı skalası, lattinen testi, beck depresyon skalası, ağrı günlüğü ve tedavi memnuniyet skalası kullanıldı. Olguların çalışma başlangıcında, 4. ve 8. haftalarda kontrol değerlendirilmeleri yapıldı.Çalışmanın sonucunda vizüel analog skala ile ağrı değerlendirilmesinde hem gabapentinin hemde pregabalinin başlangıca göre anlamlı düzelme yaptığı saptandı (p0.05).Nöropatik ağrı skalası ile değerlendirlen farklı ağrı tipleri, lattinen testi ve tedavi memnuniyetinin grup içi değerlendirilmesinde her iki ilaç tedavisininde anlamlı düzelmeye sebep olduğu saptandı (p0.05).Beck depresyon ölçütü ile değerlendirilen emosyonel durum açısından her iki tedavi grubundada başlangıca göre anlamlı düzelme gözlenmedi (p>0.05).Yan etki sıklıkları ve yan etkiden dolayı çalışmayı terk sıklığı da benzer şekilde pregabalin grubunda daha yüksekti ancak iki grup arasında istatistiki olarak anlamlı fark yoktu (p>0.05).Sonuç olarak daha önce birçok klinik çalışmada SKY'na bağlı nöropatik ağrıda etkin olduğu gösterilmiş olan gabapentin ve pregabalin tedavilerinin her ikisininde hem ortalama VAS ağrı skorunda hemde nöropatik ağrının farklı tiplerinde (yanıcı, batıcı vb. gibi) belirgin olarak düzelme yaptığını saptadık. VAS ağrı ortalamasındaki düzelme ilk 4 haftada pregabalin lehine istatistiksel olarak anlamlılık göstermekte iken 8. haftanın sonunda iki grup arasında anlamlı farklılık saptanmadı. Tedavi maliyetleri, tolerabiliteleri ve 8. haftadaki etkinlikleri açısından anlamlı fark olmadığı göz önünde bulundurulduğunda, spinal kord yaralanmasına bağlı nöropatik ağrı tedavisinde iki ilacın da oldukça etkin ve güvenilir olduğu ve birbirlerine bir üstünlüklerinin olmadığı sonucuna varıldı. Ancak bu konuda daha geniş bir populasyonda ve plasebo kontrollü çalışmaların yapılmasının daha sağlıklı verilerin elde edilmesi için gerekli olduğunu düşünmekteyiz.Neuropathic pain is seen in approximately 40% of patients with spinal cord injury (SCI) and is also an important cause of morbidity. In the management of neuropathic pain numerous pharmacological and non-pharmacological treatment modalities are used. Gabapentin and pregabalin are two anticonvulsive agents which are shown to be effective for the treatment of neuropathic pain in SCI. Despite having similar mechanisms of action some recent studies show cases resistant to gabapentin can be effectively treated with pregabalin. In the present literature there is not any study comparing gabapentin and pregabalin effectiveness. In this study we compared the effectiveness and side effects of gabapentin and pregabalin for the treatment of neuropathic pain in SCI.In this study, 28 patients having a history of neuropathic pain due to SCI and eligible for the study protocol were included. The study was designed as a crossover study. Both drugs were titrated during the first 4 weeks and stable dose was continued for another 4 weeks to be completed in 8 weeks. Nineteen patients were able to complete both treatments with effective doses. In the follow up we used VAS (Visual analog scale) pain score, neuropathic pain scale, lattinen test, beck depression scale, pain diary and treatment pleasantness scale we assessed cases at 4th and 8th weeks.At the end of the study there was significant improvement in VAS both with gabapentin and pregabalin (p0.05).Significant improvement was detected with both drugs in different pain types as assessed by neuropathic pain scale, lattinen test and treatment pleasantness scale (p0.05).In both groups no significant improvement was seen in emotional status as assessed with Beck depression scale(p>0.05).Frequency of side effects and exclusion from the study due to side effects were higher for the pregabalin group but it was not significant between the groups (p>0.05).As a result, we found improvement in VAS pain scores in different types of neuropathic pain (burning, pricking etc?) with both gabapentin and pregabalin treatment which was previously shown to be effective for neuropathic pain in SCI. In the first 4 weeks we found statically significant difference in favor of pregabalin but at the end of the 8 weeks there was no significant difference between the two groups. Taking into consideration cost effectiveness, tolerability and no difference in terms of effectiveness after 8 weeks of treatment, it is concluded that both drugs are effective and safe for the treatment of neuropathic pain due to SCI but no difference exist between the two drugs. We are in the opinion that large studies that include more patients and placebo control should be carried out for more accurate data about this topic

Sağlıklı Gebelerde Kas İskelet Sistemi Ağrıları; Lokalizasyon, Şiddet ve Karakter Değerlendirilmesi: Kesitsel Çalışma

Giriş ve amaç: Bu kesitsel çalışmada gebelikte görülen özgül olmayan kas iskelet sistemi ağrılarının lokalizasyonunu ve yayılımını, şiddetini ve karakterini ortaya koymak amaçlanmıştır.Gereç ve yöntemler: Çalışmaya yaş aralığı 18-35 yaş arası olan ve çalışmaya katılmaya gönüllü olan gebeler dahil edildi. Gebelerden fiziyatrist eşliğinde, ayaklı 40x55 cm’ lik laminat yazı tahtası üzerine çizilmiş insan ön ve arka yüzü figürü üzerinde ağrının yerini hissettiği bölgelerde olduğu gibi boyaması istendi. Boyama esnasında ağrının şiddetini belirlemek üzere 5 farklı (siyah: çok şiddetli, kırmızı: şiddetli-orta düzeyde, mavi: orta düzeyde, yeşil: orta- hafif düzeyde, sarı: oldukça hafif düzeyde) renk kullanması istendi. Boyama işleminden sonra hastanın ağrılı bölgeler üzerinde ağrının karakterini künt / zonklayıcı / yanıcı / dondurucu / karıncalanma / elektriklenme veya elektrik çarpması gibi / batma veya iğnelenme gibi /gerilme kelimelerini kullanarak tanımlaması istendi.Bulgular: Çalışmaya katılan 250 gebenin ortalama yaşı 26.44.1 idi. Gebelerden %25,6(64)’ sı birinci, %32,8 (82)’ ikinci ve %41,6 (104)’ sı üçüncü trimesterda idi. En sık ağrı uyulan bölgeler sırasıyla bel, kalça ve sırt bölgesi olarak belirtilirken, ağrı şiddeti en yüksek olan bölgeler ise sırasıyla el-el bileği, kalça kuşağı & uyluk ve bel bölgesi olarak belirtildi. Nöropatik karakterde ağrıların en sık el bileği ve ellerde, ayak bilekleri ve ayaklarda ve sırt bölgesinde görüldüğü izlendi.Sonuç: Sağlıklı gebelerde sıklıkla kendini sınırlayıcı kas iskelet sistemi ağrılarının iyi tanımlanması ilerleyici ve sekel bırakıcı durumların ayırt edilebilmesi açısından önemlidir

Common mistakes in the dual-energy x-ray absorptiometry (dxa) in turkey. A retrospective descriptive multicenter study

Background: Osteoporosis is a widespread metabolic bone disease representing a global public health problem currently affecting more than two hundred million people worldwide. The World Health Organization states that dual-energy X-ray absorptiometry (DXA) is the best densitometric technique for assessing bone mineral density (BMD). DXA provides an accurate diagnosis of osteoporosis, a good estimation of fracture risk, and is a useful tool for monitoring patients undergoing treatment. Common mistakes in BMD testing can be divided into four principal categories: 1) indication errors, 2) lack of quality control and calibration, 3) analysis and interpretation errors, and 4) inappropriate acquisition techniques. The aim of this retrospective multicenter descriptive study is to identify the common errors in the application of the DXA technique in Turkey. Methods: All DXA scans performed during the observation period were included in the study if the measurements of both, the lumbar spine and proximal femur were recorded. Forearm measurement, total body measurements, and measurements performed on children were excluded. Each examination was surveyed by 30 consultants from 20 different centers each informed and trained in the principles of and the standards for DXA scanning before the study. Results: A total of 3,212 DXA scan results from 20 different centers in 15 different Turkish cities were collected. The percentage of the discovered erroneous measurements varied from 10.5% to 65.5% in the lumbar spine and from 21.3% to 74.2% in the proximal femur. The overall error rate was found to be 31.8% (n = 1021) for the lumbar spine and 49.0% (n = 1576) for the proximal femur. Conclusion: In Turkey, DXA measurements of BMD have been in use for over 20 years, and examination processes continue to improve. There is no educational standard for operator training, and a lack of knowledge can lead to significant errors in the acquisition, analysis, and interpretation

Common Mistakes in the Dual-Energy X-ray Absorptiometry (DXA) in Turkey. A Retrospective Descriptive Multicenter Study

Background: Osteoporosis is a widespread metabolic bone disease representing a global public health problem currently affecting more than two hundred million people worldwide. The World Health Organization states that dual-energy X-ray absorptiometry (DXA) is the best densitometric technique for assessing bone mineral density (BMD). DXA provides an accurate diagnosis of osteoporosis, a good estimation of fracture risk, and is a useful tool for monitoring patients undergoing treatment. Common mistakes in BMD testing can be divided into four principal categories: 1) indication errors, 2) lack of quality control and calibration, 3) analysis and interpretation errors, and 4) inappropriate acquisition techniques. The aim of this retrospective multicenter descriptive study is to identify the common errors in the application of the DXA technique in Turkey. Methods: All DXA scans performed during the observation period were included in the study if the measurements of both, the lumbar spine and proximal femur were recorded. Forearm measurement, total body measurements, and measurements performed on children were excluded. Each examination was surveyed by 30 consultants from 20 different centers each informed and trained in the principles of and the standards for DXA scanning before the study. Results: A total of 3,212 DXA scan results from 20 different centers in 15 different Turkish cities were collected. The percentage of the discovered erroneous measurements varied from 10.5% to 65.5% in the lumbar spine and from 21.3% to 74.2% in the proximal femur. The overall error rate was found to be 31.8% (n = 1021) for the lumbar spine and 49.0% (n = 1576) for the proximal femur. Conclusion: In Turkey, DXA measurements of BMD have been in use for over 20 years, and examination processes continue to improve. There is no educational standard for operator training, and a lack of knowledge can lead to significant errors in the acquisition, analysis, and interpretation

Assessment of the Relationship Between Vitamin D Level and Non-specific Musculoskeletal System Pain: A Multicenter Retrospective Study (Stroke Study Group)

Objective: In this study, it was aimed to evaluate the relationship between vitamin D level and pain severity, localization and duration in patients with non-specific musculoskeletal pain

Assessment of the Relationship Between Vitamin D Level and Non-specific Musculoskeletal System Pain: A Multicenter Retrospective Study (Stroke Study Group)

Objective: In this study, it was aimed to evaluate the relationship between vitamin D level and pain severity, localization and duration in patients with non-specific musculoskeletal pain. Materials and Methods: Patients who applied to physical medicine and rehabilitation outpatient clinics due to non-specific muscle pain in 19 centers in Turkey were retrospectively screened. Three thousand four hundred fourpatients were included in the study, whose pain level was determined by visual analog scale (VAS) and the painful region, duration of pain and vitamin D level were reached. D group was found to be D deficient (group 1) when 25 (OH)D level was 20 ng/mL or less and group D 2 (vitamin D deficiency) was higher than 30 ng/mL (group 3). The groups were compared in terms of pain duration, localization and severity. In addition, the correlations of pain localization, severity and duration with vitamin D levels were examined. Results: D vitamin deficiency was detected in 2202 (70.9%) of 3 thousand four hundred and four registered patients, and it was found that vitamin D deficiency in 516 (16.6%) and normal vitamin D in 386 (12.4%). The groups were similar in terms of age, body mass index, income level, duration of complaint, education level, family type and working status (p>0.05). There was no statistically significant difference between groups in terms of VAS, pain localization and duration scores (p>0.05). Conclusion: Our study shows that vitamin D deficiency in patients with nonspecific musculoskeletal pain is not associated with the severity and duration of pain