• The Korean Journal of Pain
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• v.18 no.2
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• pp.107-112
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• 2005

Background: Nerve ligation injury may produce mechanical allodynia, but this can be reversed after an intrathecal administration of adenosine analogues. In many animal and human studies, ATP-sensitive potassium channel blockers have been known to reverse the antinociceptive effect of various drugs. This study was performed to evaluate the mechanical antiallodynic effects of spinal R-PIA (Adenosine A1 receptor agonist) and the reversal of these effects due to pretreatment with glibenclamide (ATP-sensitive potassium channel blocker). Thus, the relationship between the antiallodynic effects of R-PIA and ATP-sensitive potassium channel were investigated in a neuropathic model. Methods: Male Sprague Dawley rats were prepared by tightly ligating the left lumbar 5th and 6th spinal nerves and implantation of a chronic lumbar intrathecal catheter for drug administration. The mechanical allodynia was measured by applying von Frey filaments ipsilateral to the lesioned hind paw. And the thresholds for paw withdrawal assessed. In study 1, either R-PIA (0.5, 1 and $2{\mu}g$) or saline were administered intrathecally for the examination of the antiallodynic effect of R-PIA. In study 2, glibenclamide (2, 5, 10 and 20 nM) was administered intrathecally 5 min prior to an R-PIA injection for investigation of the reversal of the antiallodynic effects of R-PIA. Results: The antiallodynic effect of R-PIA was produced in a dose dependent manner. In study 1, the paw withdrawal threshold was significantly increased with $2{\mu}g$ R-PIA (P < 0.05). In study 2, the paw withdrawal threshold with $2{\mu}g$ R-PIA was significantly decreased almost dose dependently by intrathecal pretreatment of 5, 10 and 20 nM glibenclamide (P < 0.05). Conclusions: These results demonstrated that an intrathecal injection of ATP-sensitive potassium channel blockers prior to an intrathecal injection of adenosine A1 receptors agonist had an antagonistic effect on R-PIA induced antiallodynia. The results suggest that the mechanism of mechanical antiallodynia, as induced by an intrathecal injection of R-PIA, may involve the ATP-sensitive potassium channel at both the spinal and supraspinal level in a rat nerve ligation injury model.

• Korean Journal of Acupuncture
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• v.30 no.4
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• pp.289-297
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• 2013

Objectives : Diabetic peripheral neuropathy(DPN), generally considered to be the most symptomatically distressing complication of diabetes, affects more than 50% of people with diabetes. However, no consistently effective treatment for DPN is available and patients are forced to struggle with medications that provide only partial relief. In this pilot study, we evaluated the clinical effects of Saam acupuncture for the treatment of painful DPN. Methods : A total of 10 patients with painful DPN were included in the study; 6 subjects with Saam acupuncture treatment and 4 subjects without it. Subjects were defined as having painful DPN if they had at least 2 points using total symptom score(TSS). Treatments were delivered three times a week for 4 weeks. Vitamin $B_{12}$ was orally administrated in the all subjects. At initial(0 week) and follow-up after 4 weeks and 8 weeks, all subjects underwent TSS, Michigan Neuropathy Screening Instrument(MNSI), and nerve conduction test. Results : After initial(0 week) and follow-up(8 weeks), TSS and MNSI were not significantly different between the two groups(p=0.400 and p=0.830, respectively). However, in both two groups, according to time, there was a significant difference in TSS as well as MNSI(p=0.001 and p=0.004, respectively). Conclusions : Saam acupuncture may be considered as the effective treatment for the patients of DPN although the changes of the symptoms were of limited significance in this study. Further investigations are required to elucidate the role of Saam acupuncture for the pain control of DPN.

• Journal of Hospice and Palliative Care
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• v.20 no.3
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• pp.159-166
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• 2017

According to the advance of antiretroviral regimen and the early treatment strategy, people living with human immunodeficiency virus (PLWH) are achieving the goal of virologic suppression and immune restoration. Most of them no more die of acquired immunodeficiency syndrome (AIDS) defining illnesses, and become older with chronic comorbidities such as cardiovascular, metabolic, hepatic, renal and neurological diseases. However some PLWH still visit hospitals as late presenters with very low CD4+ T cell counts, so that they suffer AIDS defining illnesses to die or experience severe neurological complications resulting in disabilities. Early palliative interventions are needed on the various symptoms of PLWH. Thus far chronic pains such as distal symmetric sensory polyneuropathies have been underevaluated. Active pain-relieving interventions are important to them. Recently we define end of life condition of human immunodeficiency virus (HIV) or eligibility to hospice care after adjusting current status of HIV treatment. Hospice teams should pay attention to the specific medical conditions, psychological needs, and social circumstances of PLWH. With just standard precautions as common infection control measures, general hospice cares can be provided to them like to other hospices subjects. For giving PLWH opportunities to have the end of life with value and dignity, hospice multidisciplinary team should intervene them early and aggressively. Now we need more clinical experiences and institutional improvements.

• The Journal of Internal Korean Medicine
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• v.44 no.2
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• pp.231-243
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• 2023

Background: Diabetic polyneuropathy is the most common complication in diabetics, occurring in 50% of all cases. About 10-20% of all diabetics are accompanied by neurological pain, showing a tendency to increase with age. Clinical aspects are very diverse, from mild abnormalities on nerve conduction tests to severe abnormalities in all sensory, motor, and autonomic nerves; however, sensory symptoms usually precede motor symptoms. Patients typically express sensory symptoms, such as positive and negative symptoms, which decrease the quality of life and have marked clinical implications, such as increased morbidity and mortality. Although Western medical drugs, such as tricyclic antidepressants, anticonvulsants, and narcotic analgesics, are used for diabetic polyneuropathy, a standard treatment has not been established. Case report: A 65-year-old male with paresthesia and pain due to diabetic polyneuropathy was treated with Uchashinki-hwan, acupuncture, electroacupuncture, moxibustion, and Jungsongouhyul pharmacopuncture for 10 days. We used the Toronto Clinical Neuropathy Scoring System, EuroQol-5 Dimension, and Visual Analog Scale to evaluate symptoms. Subsequently, the Neuropathy Scoring System, EuroQol-5 Dimension, and subjective discomfort improved. Conclusion: The present case report suggests that combined Korean medicine treatment might be an effective treatment for paresthesia and pain with diabetic polyneuropathy. Several follow-up studies should be conducted to clarify the effectiveness of the treatment.

• Journal of Acupuncture Research
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• v.32 no.4
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• pp.17-27
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• 2015

Objectives : The purpose of this study is to evaluate the correlation between HbA1c and pain intensity in diabetic peripheral neuropathy patients, and to compare the difference between two groups divided by the risk of complications. Methods : The participants were 46 men and women suffering from neuropathic pain diagnosed with diabetes mellitus who visited the Hospital of Traditional Korean Medicine, Semyung University from June, 2014 to August, 2015. Age, duration of diabetes mellitus, numeric rating scale(NRS), and Michigan neuropathy screening instrument(MNSI) were used as evaluation tools. Results : 1. In all 46 cases, there were no significant correlations between HbA1c and age, duration of diabetes mellitus, NRS, MNSIQ, or MNSIE. 2. Among 23 cases with a high risk of complications (more than 7.0 % of HbA1c, group A), there were no significant correlations between HbA1c and age, duration of diabetes mellitus, NRS, MNSIQ, or MNSIE. 3. Among 23 cases with a low risk of complications(less than 7.0 % of HbA1c, group B), there were no significant correlations between HbA1c and age, duration of diabetes mellitus, NRS, MNSIQ, or MNSIE. 4. Means of duration of diabetes mellitus, NRS, MNSIQ, and MNSIE were higher in group A than group B, but there were no significant correlations in statistics. Conclusions : This study could not find statistically significant correlations between pain intensity and HbA1c in diabetic peripheral neuropathy patients, so more studies are required in the future.