Prof. Dr. Serbülent Gökhan Beyaz


Can Pain Battery End All Pain?

I must say from the beginning that of course not. Pain is a complaint that forces the patient to see a doctor. If you don’t have pain, you don’t go to the doctor anyway, but if your pain is chronic, that is, if you have been suffering from it for a long time, you will even go to Fizana (place of exile, southwest of Libya) for treatment. Don’t worry, you don’t need to go there. We went abroad to learn about pacemaker treatments on your behalf, learned and have been successfully applying them to our patients for years. What is this Pain Battery? As the name suggests, the “pain pacemaker”, medically known as “spinal cord stimulator”, offers a treatment option for body pain based on certain diagnoses that cannot be treated with routine pain treatment methods. The device we call a pain pacemaker is a Spinal Cord Stimulator consisting of 3 separate structures: electrode, control-charger and battery. Two parts of it will be placed inside the body, while the control-charger will be in the patient. Just like mobile phones, which are very simple to use. Who is it applied to? Of course, pain pacemaker is not applied to every patient with pain. Because it is both an expensive treatment method (when applied in university, education and research hospitals and city hospitals, it is fully covered by the SSI) and requires a small operation and local anaesthesia to be applied to the body. Pain pacemakers are applied to patients with pain that does not go away after open surgeries for herniated disc, cervical hernia and spinal stenosis, known as Failed Back and Neck Surgery Syndrome, which is frequently applied in the world and in our country, and to patient groups with persistent and severe pain after spinal cord injury. Patients come to us when there is no surgical treatment method that can be surgically applied to patients with persistent pain, and we place this system on the operated area and try to completely stop the nerve impulses that cause pain from reaching the brain or reduce them as much as possible to increase the standard of living and bring the patient as close as possible to the daily functional activity in pain-free periods. In other words, we do not perform a new surgical intervention in the area where the surgery was performed. In addition to these diseases, pain pacemakers are also implanted to increase blood circulation and reduce pain in patients with foot and leg wounds due to decreased blood circulation or diabetes. We can say that another important feature of the pain pacemaker is to dilate the vessels. Which pain pacemaker should be implanted? What do you think about when you buy a new car? You think about the durability, fuel consumption, technical specifications, price, service network. For example, when you think of durability, German cars come to mind, while in the service network, two vehicle brands easily come to mind. Of course, pain batteries do not have as many options as cars. In pain battery treatment, when we choose the battery company, we choose it according to its service network, its compatibility with the MRI device since the patients to whom these batteries will be applied may need MRI at certain intervals, and its lifespan in the body. While the battery life used to last 3-5 years, it is now extending to 20 years. In addition, some battery companies’ devices do not work compatible with MRI. For example, when you are going to have an MRI for the knee or shoulder due to another health problem, you will either not have it done or you will have it done at the risk of battery failure because the battery is not compatible with MR. This situation puts both patients and physicians in a very difficult situation. For this reason, it would be wise to choose the product of a company that is MR compatible, has a long battery life and is easy to use. Are battery patients privileged? In our opinion, they are privileged because when you inform the company official when there is a problem with the use of the device, the company official works to solve the problem and, if necessary, provides contact with the physician who inserted the battery into the patient. Compared to the procedures in developed countries around the world, such treatments are performed by a small number of physicians in our country. One of the most important problems is that some distributor companies only import the pacemaker and do not interfere with the rest. Another important problem is that physicians cannot be reached due to reasons such as temporary duty, transfer, resignation or retirement of the public physician who installs this system in his/her patient. For this reason, companies that have actually expanded their service network and invested in this way should be preferred. In addition, these treatments should be allowed to be applied in designated centres in our country so that patients are provided with the right service. In addition, since it is a personalized treatment, that is, a treatment that needs to be adjusted according to the patient, it should be ensured that patients can benefit from this health service to the maximum extent. For this reason, as a physician who is involved in the system, I recommend the establishment of “Centres of Excellence” on this subject. The purpose of pain pacemaker application is to ensure that patients do not wake up with pain from sleep, as in all other pain treatments.

Coronavirus and Probiotics

The Covid-19 disease, caused by the coronavirus, first emerged in Wuhan, China in December 2019 and then spread around the world within months, causing the World Health Organization to declare a “pandemic”, that is, a worldwide epidemic, in March 2020. Today, the disease has infected more than 71 million people worldwide, 49 million of whom have fully recovered and about 1.6 million have died. In our country, while the first Covid-19 case was announced by the Ministry of Health on 11 March 2020, more than 1.8 million cases have been detected so far and nearly 16 thousand people have lost their lives. Of course, as with any disease, a person’s recovery is not only about being discharged from the hospital or the markers of that disease. The main goal is for a person to regain full physical and psychological functioning after recovery from the disease. Coronavirus and Covid-19 disease, a new enemy the world has just met, mainly attacks the lungs and respiratory tract, but it also frequently affects the gastrointestinal system. Apart from this, it damages many organs and system functions in the body and causes complaints about these organs in people. Although some drugs have been routinely used in the world and in our country for treatment, there is no drug that has been found to definitively treat this disease, and even the side effects of the drugs used are emerging. Due to the lack of a definitive therapeutic method, treatment methods called conservative treatment, which will support the body according to the current complaints of the person suffering from the disease and the severity of these complaints, come to the fore, while sometimes our people take the way of herbalists. For example, patients who are detected to have Covid-19 disease but do not have serious complaints and feel relatively well are treated with medication under quarantine in their own homes, while patients who have a very severe disease and have serious respiratory distress are hospitalized in intensive care and treated by being supported with a respirator when necessary. The fact that there is no medication that we are sure is curative in our fight against the disease, of course, brings to mind methods to support the body’s immune system and resistance. As well as bacteria that cause disease, there are also bacteria that get along well with the body and even help the body. These bacteria can be taken from the outside with supportive foods or drug formulations, as well as bacteria that have been in our bodies since the day we were born, and even bacteria that we get sick when their number decreases in our body. In the intestine of an adult human, there are bacteria called intestinal flora, which are estimated to number 100 trillion and weigh more than 2 kilograms. The benefit of these bacteria to the body is to synthesize some micro substances that play a role in body balance, especially vitamins B and K. Unlike bacteria whose presence in the body causes diseases, when the number of these bacteria decreases, disease occurs in the body. When the intestinal function is impaired due to a cause such as diarrhoea, the functions and numbers of these bacteria decrease. While the coronavirus infection itself can cause gastrointestinal complaints such as diarrhoea, nausea and vomiting, antibiotics and other medications used to treat the infection can also cause side effects, including the same complaints, and can disrupt the balance of this flora in the intestines, causing different problems in addition to the disease. The function of the digestive system is not only to digest food. After the brain and spinal cord, the body’s largest and most complex neural network is located in the digestive tract and is often referred to as the “second brain”. Therefore, a dysfunction or complaint in the intestines can affect the whole body, not just one part of it. So what can we do to prevent all these negative conditions from developing or worsening? Supplemental probiotics come to mind. Probiotics are live bacteria that have been scientifically proven to be beneficial to humans when taken in sufficient amounts according to the World Health Organization. When the intestinal flora is negatively affected, it becomes very important to support the body with probiotics. Since coronavirus infection has serious harmful effects on the digestive system, scientific studies investigating the effect of probiotic use, especially in critically ill patients, have been conducted worldwide during the pandemic process, and some studies have found positive contributions of probiotics to the treatment process. The conclusions and interpretations drawn from these studies are not medically valid recommendations for the moment, but it is a known fact that the use of probiotics has positive effects on the body and is accepted by the World Health Organization. And also the following

Is There a New Pain Treatment for Carpal Tunel Syndrome?

Carpal Tunnel Syndrome is most commonly diagnosed after nerve compression in the arms. Patients present with a wide range of complaints and may see doctors from many different branches for treatment. The diagnosis and treatment methods of this disease are also evolving and changing. What is Carpal Tunel Syndrome and who has it? Carpal Tunel Syndrome is a disease that appears as pain or altered sensation in the hand, wrist and forearm and is frequently mentioned by patients. According to scientific sources, it is stated that this disease can affect approximately 5% of the society. In other words, 4-5 million people in our country face this disease. I can say that women are a bit unlucky in this regard because this disease is 3-4 times more common in women than in men. It is less common in children. The pathology that causes this disease is the compression of the nerve called “Median Nerve” in the wrist in the area called “Carpal Tunnel”. The cause of the majority of cases is idiopathic, that is, it is not known how the disease develops. Traumas in the hand and wrist such as falls, bumps or excessive and heavy activities with the hand and wrist, pregnancy, obesity, hypothyroidism, i.e. underactive thyroid glands, kidney failure, diabetes, osteoarthritis, i.e. calcifications and some rheumatic diseases trigger the emergence of this disease. How is it diagnosed? Carpal Tunnel Syndrome is diagnosed with some special tests that increase nerve compression and electrophysiological studies such as Electromyography (EMG). In addition, symptoms such as pain, tingling and numbness in the thumb, index finger and middle finger give us clues for this diagnosis. Sometimes muscle weakness in the hand muscles, which we call atrophy, may also be noticeable. There may also be a decrease in the person’s apparent abilities, such as difficulty making a fist, feeling weak when holding a cup or glass, or even dropping it. Sometimes patients do not think that these complaints are caused by a disorder and begin to describe themselves as clumsy. How is it treated? Wrist splint: It is applied to the wrist in a straight position. It can relieve the symptoms of Carpal Tunnel Syndrome. Steroid injection: It is a highly accepted and safe treatment method. It can be safely applied in mild-moderate-advanced cases. Physical therapy: Includes programs such as rest, modification of activities, physiotherapy, tendon and nerve shifting regimens and wrist strengthening. Surgery: Although the results of surgical treatment are good, it is ultimately an open interventional procedure. There is always the possibility of complications in surgery, that is, unwanted but unavoidable outcomes. The most common complication is a deep pain on the side of the thumb and tenderness at the site of the surgical incision. The aim of surgery is to remove the compression on the median nerve. Are there new treatment methods? Carpal tunnel syndrome is a very common disease and there is a search for ways to treat it effectively without open surgery. One of the recently preferred methods is the hydrodissection method. Thanks to ultrasonography, the nerve, tendon and bone structures of the wrist can be easily distinguished. In the hydrodissection method, drugs such as saline or steroids, ozone gas and hyaluronic acid are injected around the median nerve with the help of ultrasonography and the pressure around the nerve is removed. Finally, one of the new treatment approaches is prolotherapy. Its effectiveness is high when applied by experienced physicians. In order to prevent carpal tunnel syndrome, first of all, it may be a solution to avoid jobs that strain the hands and wrists, and if we cannot avoid these jobs, it may be a solution to do these jobs with intervals. Nowadays, medical secretaries, who are mostly near us, are at high risk because they use their hands and wrists intensively while working with computers. For this reason, it is important not to keep the wrist constantly bent while using the computer, to use a silicone-supported mousepad, and to be careful not to strain the hand and wrist while doing heavy housework, such as wringing laundry, to avoid Carpal Tunnel Syndrome. Let us repeat our last word: As a result, we continue to fight against all pains that disrupt the social order…

Pain in Dementia Patients

In the 20th century, life expectancy in the world population has increased dramatically. Declining mortality rates in the first years of life may be one of the reasons for this increase. Previously, people over the age of 60 were referred to as old people and had lower mortality rates. Nowadays, these older people are getting older (80 years and older), leading to an increase in the population we call the very old. Of course, as a result of these age-related changes, some diseases such as dementia and Alzheimer’s disease are becoming more common. Chronic pain increases with aging and accompanies such diseases. Arthritis, especially arthritis due to arthritis, is one of the most common conditions suffered by the elderly population. Dementia, in other words dementia, is a disease that can lead to forgetfulness, difficulty in finding words, repetition of questions or sentences, memory loss, personality changes, inability to recognise relatives and friends, mental complaints and sometimes physical self-sufficiency, and can only perform daily tasks with a caregiver or helper and can lead to changes in consciousness. There are many subtypes. The most common subtype is Alzheimer’s Disease. It is important to keep in mind that there are more than 50 million people with dementia in the world and 10 million new patients are diagnosed every year. More than half of patients with dementia in communities experience pain every day. In particular, nurses report that 60-80% of patients with dementia experience pain every day. There are many different causes of this pain. These include musculoskeletal, gastrointestinal and cardiac diseases as well as urinary tract infections and pressure sores. Not all patients with dementia who have pain may have prolonged or persistent pain, but this rate is higher in those who experience faster memory loss during the dementia process. It should also be noted that as the degree of dementia progresses, the pain suffered by patients similarly progressively increases. How do we recognise pain in patients with dementia? Patients with dementia who are conscious and in the early stages may be able to express their pain in some way by showing or telling you about it. However, in patients with advanced dementia, behaviours such as verbal abuse, idle wandering, agitation and aggression may be signs of pain. How do we assess the pain of patients with dementia and their response to treatment? There are many pain measurement and assessment tests abroad to assess this. We adapt one of them into Turkish and apply it to our patients. What is applied in pain treatment? We divide the treatments into two. The first one includes treatments such as exercise, music therapy, behavioural therapy, reflexology, reiki, person-centred bath, rocking chair therapy, which we call non-drug treatments. Your pain physician should decide which of these should be applied at which stage. The second is medication. These can range from the simplest painkillers to the most powerful pain patches. If the pain persists despite these, we can apply interventional pain treatments to our patients. Dementia is not a natural consequence of ageing. It is a disease. Let us not forget that patients with dementia can also experience pain and suffering. As a result, we continue to fight against all pain that disrupts the social order…