International Conference and Exhibition on Pain Medicine June 08-10, 2015 Chicago, USA

Migraine is a neurovascular disorder characterized by recurrent unilateral headaches accompanied by nausea, vomiting, photophobia and phonophobia. Migraine headache is associated with trigeminal nerve activation and calcitonin gene -related peptide (CGRP) release from the trigeminovascular system. Various factors have been identified as being migraine triggers, including foods, stress, hormones, sensory stimuli, and so on. Individuals with migraine are often aware of the things that serve as triggers for them, since part of migraine management is avoidance of triggers. One of factors on the onset of migraine is olfactory sensory. This is review article to examine the relationship between headaches and smell disturbance. And the psychological effects of odors are in this group. Most common causes of smell disturbance are nasal and sinus disease, upper respiratory infection and head trauma. Smell or taste dysfunction can have a significant impact on quality of life. In general, the olfactory system regenerates poorly after a head injury. Most patients who recover smell function subsequent to head trauma do so within 12 weeks of injury. Olfactory dysfunction in some people as loss of smell sense, and in some one thernpsychological impact of an increased sense of smell, which affect their quality of life.

Overview: The present study deal with the analgesic effect of magnesium sulfate (MS) on the inflammatory somatic pain after systemic and local administration in rats.
Introduction: N-methyl-D-aspartate (NMDA) receptors are ligand-gated receptor complexes that have been associated with learning and memory, pain transmission, depression, schizophrenia and neurodegenerative disorders. Magnesium, noncompetitive NMDA receptor antagonists, has been demonstrated analgesic efficacy against neuropathic pain, but results in inflammatory pain are controversial. This study aimed at evaluating the systemic and local effects of magnesium sulfate in carrageenan-induced mechanical hyperalgesia using von Frey anesthesiometer test.
Materials and Methods: In male Wistar rats hyperalgesia was induced by the 0.5% carrageenan (0.1 ml) into the paw. MS was given subcutaneously 5 min before the injection of carrageenan or co-injected with carrageenan. Hind paw withdrawal threshold to mechanical stimuli was measured at 0, 0.25, 0.5, 1, 2, 3, 4, 5 and 6 h after intraplantar injection of carrageenan.
Results: Subcutaneous magnesium sulfate at doses of 0.5, 5, 15 and 30 mg/kg, reduced the hyperalgesia by 44.4±8.8, 68± 8.4, 24.6±6.9 and 45.3±6.7% respectively. MS at doses of 0.05, 0.1 and 0.5 mg/paw, co-injected with carrageenan had no influence on hyperalgesia.
Conclusion: The present study revealed that magnesium sulfate is effective against inflammatory pain after systemic, but not after local peripheral administration. The findings suggest that low doses of systemic MS may be useful analgesic in the therapy of somatic inflammatory pain.

Panagiotis Zogopoulos is a resident of Neurosurgery at the General Hospital of Nikaia-Piraeus “Agios Panteleimon”, Athens, Greece. He has received a 6-month advanced clinical training (clinical fellow) at the Neurosurgery Department of Osaka University Hospital in Japan. Several of his papers have been published in reputed peer-review journals and he has presented various researches in international conferences.

Migraine is a complex and multifactorial painful condition in which patients suffer from recurrent episodes of disabling headache, often leading to severe psychological distress. It affects approximately 18% of women and 5% of men in the United States and annual healthcare costs associated with school and work absence due to migraine attacks are several billion dollars. Although there are various treament modalities for migraine, they are not always effective and none of them is curative. World Health Organization lists migraine as one of the several conditions treated effectively by acupuncture and numerous researches have proved that acupuncture may be an effective and safe adjuvant or alternative migraine treatment. It has been commonly used both for preventing migraine attacks and relieving pain during a migraine. Neuroimaging examinations [such as resting-state functional magnetic resonance imaging (fMRI) on migraine patients have shown that long-term acupuncture treatment can elicit an extensive and remarkable cerebral response, particularly at the regions involved in pain processing. It may positively influence cerebral autoregulation during the interictal phase (by lowering the levels of serum NO). Acupuncture has been found to significantly decrease migraine frequency and pain intensity, for a period extending even more than 12 weeks after the last acupuncture session. Acupuncture is a better treatment option than the conventional drug therapy in not only relieving the pain of migraine but also in improving the psychological profile of patients. It is safe, long lasting, cost-effective and has cumulative effects. Therefore its use should be encouraged as an alternative or adjunct treatment for migraine.

Alexander Mulik is a Doctorate of Biology, and a Professor. He is the director of the Institute of Natural Sciences, head of Research and Education Center of Homeostasis Physiology of Volgograd State University, Russia. He is the chairman of the Volgograd Regional Branch of the Physiological Society named IP Pavlov, the Russian Academy of Sciences, the member of Central Council of the Physiological Society named IP Pavlov, the Russian Academy of Sciences,the head of the Scientific Section of the Volgograd Regional Association of Psychotherapists \"Salus\". His Academic degrees and titles include, Candidate of Biological Sciences, specialty Allergology and Immunology, July 08, 1992 (All-Russian Research Antiplague Institute \"Microbe\"); Senior Researcher, specialty Allergology and Immunology, April 24, 1997 (Volgograd Scientific Research Antiplague Institute); Doctor of Biological Sciences, specialty Normal Physiology, July 10, 1998 (Kuban State Medical University); and Professor at the Department of Social Work and Biomedical Adaptation, October 10, 2006 (Volgograd State University).

Undertaken theoretical and experimental researches have proved the universality and consistency of functional features in manifestation of the organism is painful sensitivity in humans and various species of laboratory animals. As a result of the biometric analysis of manifestations of nociceptive sensitivity was revealed general biological nature of intra-specific distribution of pain threshold in humans and traditional laboratory animals. Defined species boundaries varying values of the pain are threshold. It is statistically proven that intra-specific distribution of pain threshold in humans and animals corresponds to the normal distribution. There were significant differences between the distributions of the pain threshold in different populations of a single species of animals and humans. As a result a number of experimental researches were identifying the mechanisms of the central and vegetative organization and personalization of nociceptive reactivity of the organism. Revealed morpho-functional features of the nuclei of the anterior hypothalamus, limbic, parietal and frontal cortex of the brain related to the level of painful sensitivity of the organism of experimental animals. As a result of electroencephalographic researches were identified by specific issues of bioelectrical activity basic rhythms organization of the cerebral cortex in individuals with different levels of nociceptive sensitivity of the organism. At the analysis of cardio intervalography, it was revealed that people with high painful sensitivity observed a large liability of standard indicators activity of the cardiovascular system, mainly in the form of relative predominance of the sympathetic nervous system in the organization of vegetative homeostasis. In addition, depending on the individual pain threshold are differentiated manifestations of somatotype and morphological characteristics of the organism, circadian biorhythms, typology of higher nervous activity, psychological symptoms, and level of stress resistance of the organism. By results of researches there were developed methods of individual prognosis of human adaptation to environmental impacts, based on analysis of a combination of nociceptive reactivity, circadian chronotype and separate elements of the functional status of the organism.

Overview: Pain has always been defined as the most unpleasant experience of an individual than any other life experience. Pain is always a subjective phenomenon experienced by an individual. Although pain is now recognized as being more of an experience than a sensation that recognizes the nature of initiating stimulus including its quality, intensity, location and duration. The degree of pain & suffering, that a patient experiences is not related to the amount of tissue injury. With the changing concepts of pain represented in body, mind & person, diagnosis and management of such problems require the broad understanding of people on the part of attending clinician. Oro-facial pain, though multi-factorial, is one of the most common causes for repeated visits of the patients to doctor.
Introduction: Chronic orofacial pain is collective term used for a number of complex orofacial pain and dysfunction disorders including TMJ disorders, neuropathic pain, non odontogenic pain, musculoskeletal pain, neurovascular pain, Neuralgias, referred pain, headache, oromotor dysfunction, cancer related pain and mandibular behavioral disorders, resulting in symptoms of chronic head neck and orofacial pain. Diagnosis is by far the most difficult aspect of managing a patient’s orofacial pain.
Methodology: Enumeration of the various types of orofacial pain presentations and literary and pictorial review of the different treatment methodologies are available. A multi-disciplinary approach towards the treatment of chronic oro-facial pain can be deemed as the call of the hour. Pain medicine in itself is proving to be a paradigm shift towards the pragmatic approach in treatment of chronic oro-facial pain. Pain relief may be achieved by a variety of means and the treatment must be customized to the individual with drug treatment, image guided interventions (like nerve or ganglion blocks and other neurolytic or ablative procedures), physiological and behavioural approaches geared to the patient’s needs. Prevention, assessment, diagnosis, treatment, and rehabilitation of orofacial pain disorders should be offered to the patient as a complete package. Aggressive treatments like Gasserian ganglion block, Glossopharyngeal block, Sphenoplatine block etc are the keys for sustain relief of chronic orofacial pain.
Conclusion: Many pain problems require interdisciplinary management and a good working relationship among various specialists. Good treatment begins with an attitude of caring and concern for the person more than for his or her body. Human beings are more than patients that have to be treated. Eliciting the proper etiology and diagnosing oro-facial pain is the more difficult aspect of managing the patient’s pain problem. A combined approach from the oral physician and pain practitioners might open new doors for those suffering from chronic oro-facial pain.

INTRODUCTIONrnrnPostmastectomy pain syndrome (PMPS) is defined as chronic (continuing for three or more months) neuropathic pain affecting the axilla, medial arm, breast, and chest wall after breast cancer surgery. The prevalence of PMPS has been reported to range from 20% to 68%. In this study, we aimed to determine the prevalence of PMPS among mastectomy patients, the severity of neuropathic pain in these patients, risk factors that contribute to pain becoming chronic and the effect of PMPS on life quality.
MATERIALS AND METHODS
This prospective cross-sectional study was approved by the Sakarya University Medical Faculty Ethical Council and included 146 patients ranging in age from 18 to 85 years who visited the pain clinic, general surgery clinic, and oncology clinic and had breast surgery between 2012 and 2014. Patients were divided into two groups according to whether they met PMPS criteria: pain of the at axilla, arm, shoulder, chest wall, scar tissue or breast at least 3 months after breast surgery. All patients gave informed consent prior to entry into the study. Patient medical records were collected and pain and quality of life were evaluated by the visual analog scale (VAS) for pain, short form of the McGill Pain Questionnaire (SF-MPQ), Douleur Neuropathique 4 (DN-4) and short form-36 (SF-36).rnrnRESULTSrnPatient mean age was 55.22 ± 11.83 (33-83). PMPS prevalence was 36%. Mean scores on the VAS, SF-MPQ and DN-4 in PMPS patients were 1.76 ± 2.38 (0-10), 1.73± 1.54 (0-5), 1.64 ± 2.31 (0-8) respectively. Of these patients, 31 (23.7%) had neuropathic pain characteristics, and 12 (9.2%) had phantom pain according to the DN-4 survey. Patients who had modified radical mastectomy were significantly more likely to develop PMPS than patients who had breast protective surgery (p = 0.028; Table 1). Only two (2.4%) of PMPS patients had received proper treatment (anticonvulsants or opioids).
CONCLUSIONSrnPMPS seriously impacts patients emotional situation, daily activities, and social relationships and at is a major economic burden for health systems. We conclude that the rate of PMPS among patients receiving breast cancer surgery in Turkey is 64.1%, and that challenges to proper treatment of these patients deserve further investigation.

Spinal cord stimulation (SCS) is an effective therapy for persistent back and leg pain and has demonstrated success in a variety of chronic intractable conditions. SCS consists of stimulating electrodes implanted in the epidural space and an electrical pulse generator. Many troubles can be observed while electrode placement in the epidural space. In this case, we present a patient with persistent tinnitus symptom after SCS replacement.

Failed back surgery syndrome (FBSS) may be defined as persisting or relapsing back and or leg pain due to several conditions after back surgery. FBSS incidence is estimated between 5-50 % range after lumbar spine or vertebrae surgery (1). In the USA 7 million new low back pain sufferer appear each year and 200.000 of them are applied Lomber spinal surgery. 20% of them are re-operated by reason of lasting pain (2). So approximately 40.000 new FBSS cases occur in USA every year and relief of back and radicular pain symptoms of these patients becomes necessary. In our study ; we aimed to evaluate the efficacy of epiduroscopy procedure for patients that had been diagnosed as failed back surgery syndrome with persisting back and leg pain.

Glossopharyngeal nerve (GPN) blocking is an interventional technique that has occasionally been used for the palliative treatment of pain due to head-neck malignancies and glossopharyngeal neuralgia (1). In clinical practice, GPN blocking was first used as an aid for awake endotracheal intubation in the late 1950s (2). In 1910, Wisenburg (2) identified pain in the distribution of the glossopharyngeal nerve in a patient with a cerebellopontine angle tumor. In 1921, Harris (2) reported the first idiopathic case and coined the term glossopharyngeal neuralgia. However, there are very few articles and case presentations on GPN blocking. Therefore, we present a patient with cancer of the tongue base who underwent bilateral GPN neurolysis using alcohol.

Cervical disc hernia is a pathological condition which usually causes pain on the neck, shoulders and arms (1), while radiculopathy and myelopathy caused by compression of spinal cord are rare. In this study, we aimed to retrospectively investigate the clinical effects of Discogel® Radiopaque Gelified Ethanol application in the patients with cervical disc hernia who had chronic pain and weakness on the neck, shoulders and arms.