• Journal of Hospice and Palliative Care
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• v.1 no.1
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• pp.47-55
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• 1998

Background : It is almost important therapy modality to control pain for the terminal cancer patients for the last 24 hours because those terminally illed patient deserved to have pain free and peaceful time before death. Physician who is deal with terminal cancer patients for their last 24 hours does not need to worry about drug addiction or other untoward side reactions of pain medications. The purpose of this study was to evaluate if terminally illed cancer patient was given pain medication properly and sufficiently and if there was any different behavior to control pain of terminal cancer patients between medical physicians and surgeons in terms of type, amount and administration route and frequency. Methods : A retrospective chart audit of analgesic type, amount and administration route was performed on the medical recorders of 160 hospitalized terminal cancer patients who had died in the Korea University Medical Center Anam Hospital during the period of July 1, 1994 to June 30, 1995. Patients were classified into 103 patients were cared for by medical physicians and 57 patients were cared for by surgeons. After then, we analysed the difference of pain control pattern between them. Different types and amount of analgesics were converted to a common standard, an oral morphine equivalents(OME) relative to 1mg of oral morphine. Results : 1) The total number of patients was 160, male 102 cases(63.8%), and the female was 58 cases(36.2%) respectively. 2) The mean age was 56.4(${\pm}14.62$) years old and mean admission period was 27.8 days(${\pm}34.85$). 3) The frequent cancer site was stomach 42 cases(26.315), lung and liver 29 cases(18.1%) each, pancreas 10 cases(6.2%) in order 4) 125 out of 160 subjects (78.13%) complained pain, and 66 out of 103(64.08%) and 31 out of 57(54.39%) were treated with analgesics to relieve pain. 50 out of 97(51.55%) were able to continue on oral medication. 5) 86 cases(53.75%) were well oriented 24 hours prior to death. 6) The frequent analgesics for regular basis were long acting form of oral morphine 34 cases(Medical phsicians 24, Surgeons 10), intravenous morphine 26 cases(Medical physicians 20, Surgeons 6) in order, and the most common p.r.n.(pro re nata) analgesics used was intravenous morphine. 7) The mean amount of analgesics on regular basis was 115.41 OME by medical physicians and 52.7 OME by surseons(P<0.05). The mean amount of p.r.n. analgesics was significantly larger in patients are for by surgeons(66.64 OME) than medical physicians 23.49 OME(P<0.01). 8) The mean frequency of administrated number of p.r.n. analgesics was 0.62 times/day on medical part and 1.88 times/day on surgical part (P<0.001). Conclusion : Of the 97 patients with advanced cancer, 51.55% were able to take oral medications in the last day of life. The parenteral analgesics were more frequently used in the patients cared for by surgeons than medical physicians. Over the half of terminal cancer patients were well oriented in the last day of life. Doctor's knowledge and attitude towards pain is very important to mange the pain, effectively.

• Journal of Ginseng Research
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• v.24 no.3
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• pp.143-147
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• 2000

In previous studies we have demonstrated that several individual ginsenosides such as Rc, Rd, Re and Ri relieves formalin-induced pain following systemic treatment. But it is unknown where these single ginsenosides induce antinociception. We investigated the antinoiceptive effect of four individual ginsenosides on formalin-induced pain after intrathecal (i.t.), intracereventricular (i.c.v.), or subcutaneous (s.c.) administration using mice. We found that ginsenoside Rc, Rd, and Re except Rf attenuated both acute and tonic phase of pain. Ginsenoside Rf attenuated only tonic phase of pain after i.t. administration. The ED$\_$50/ was 1.0 (0.55∼l.75 mg/kg) for Rc, 1.15 (0.6∼2.25 mg/kg) for Rd, and 8.9 (3.9∼20.5 mg/kg) for Re in acute phase of pain. The ED$\_$50/ was 0.3 (0.1∼0.85 mg/kg) for Rc, 0.6 (0.35∼l.1 mg/kg) for Rd, 2.45 (1.25∼4.65 mg/kg) for Re, and 1.9 (1.5∼4.25 mg/kg) for Rf in tonic phase of pain. We also found that ginsenoside Rc, Rd, Re, and Rf after i.c.v. administration attenuated both acute and tonic phase of pain. The ED5o for acute phase of pain was 0.9 (0.55∼l.4mg/kg) for Rc, 0.9 (0.45∼1.7 mg/kg) for Rd, 0.93 (0.5∼l .75 mg/kg) for Re, and 1.85 (0.95∼3.5 mg/kg) for Rf. The ED$\_$50/ for tonic phase of pain was 0.7 (0.45∼1.05 mg/kg) for Rc,1.25 (0.7∼2.2 mg/kg) for Rd, 0.85 (0.45∼1.6 mg/kg) for Re, and 0.8 (0.4∼1.45 mg/kg) for Rf. Thus, the order of the analgesic potency was Rc$\geq$Rd>Re>Rf in both i.t. and i.c.v. administration routes. However, s.c. pretreatment of four ginsenosides did not reduce formalin-induced pain. These results suggest that analgesic effect of ginsenosides is achieved through spinal or supraspinal site(s) in formalin test.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.5 no.1
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• pp.1-8
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• 2012

Purpose: The purpose of this study is to report the preliminarily result of the radiologic disappearance of the calcific material, regardless of the size, type or location, on one-time ultrasonographic (US) assisted needling for calcific tendinitis of the shoulder. Materials and Methods: From March to August 2011, 46 patients (47 shoulders) with symptomatic calcific tendinitis were treated by one-time US assisted needling. Initially, a diagnostic US was performed with patient to determine the locations, numbers and sizes of calcific deposits. After 1% lidocaine local anesthesia, the calcific material was punctured with an 18-gauge needle under US monitoring. If no calcific material was aspirated after 2 or 3 additional attempts, the deposits was performed multiple puncture to achieve decompression. And then all patients were performed subacromial corticosteroid injection. All patients were followed up 4 weeks after procedure. To assess the radiologic disappearance after one-time US assisted needling, simple radiographs of the treated shoulder were performed and size, dense, and morphology of the calcific deposits were compared with those in baseline radiographs. For clinical evaluations, visual analogue scale for pain and function (PVAS and FVAS), and American Shoulder and Elbow Surgeons (ASES) score were assessed. Results: There were 11 male and 35 female patients with the mean age of 53.8 years (28-71). The morphology of the calcific deposits were 31 type A and 16 type B by French Arthroscopic Society classification and mean size was $2.9{\pm}6.7$ mm before the procedure. At 4 weeks after the index procedure, the radiographic unchanged group was included in 10 cases and changed group was 37 cases. No intergroup difference for the clinical results after the procedure was evident, but group FAS classification before the procedure was significantly different (p=0.011). Conclusion: At 4 weeks after one-time US assisted needling for calcific tendinitis of the shoulder, the radiographic size- or dense-changed cases were showed in 79%, regardless of the size, type or location of the calcific material. But the radiographic nearly or complete disappearance were showed in only 21%.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.12
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• pp.352-358
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• 2017

Frontotemporal dementia, the second most common cause of early onset dementia, is a neurodegenerative clinical syndrome characterized by progressive deficits in behavior, executive function and language. Although motor symptoms in frontotemporal dementia are represented by motor neuron disease, parkinsonism and progressive supranuclear palsy syndrome, there have been no reports of motor weakness caused by the direct involvement of central motor nervous systems in frontotemporal dementia. Moreover, no association between clinical dementia groups and complex regional pain syndrome has been reported. We diagnosed a rare case with motor weakness and complex regional pain syndrome of lower limbs due to central nervous system lesion in a patient with frontotemporal dementia by magnetic resonance imaging, electrodiagnostic study and three phase bone scan. Following steroid therapy for complex regional pain syndrome, pain was improved. Functional improvement was noted after rehabilitation therapy, including functional electrical stimulation, muscle strengthening exercise and gait training during hospitalization. This case report suggests that rehabilitation therapy for motor weakness in frontotemporal dementia could be effective for improving overall function.

• Journal of Oral Medicine and Pain
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• v.31 no.1
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• pp.69-77
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• 2006

Botulinum toxin injection has been used in the masticatory muscle area as an effective treatment method of various movement disorders and facial contouring, but its effects on jaw function have not been evaluated. The aims of this study were to evaluate the effects of botulinum toxin type A injection into the masseter muscle on the EMG activities of masseter and anterior temporal muscles, and the limitation of jaw function. Fourteen healthy subjects were recruited. Five subjects were injected with 80 units of botulinum toxin type A(Dysport, Ipsen, Wrexham, UK) into each side of masseter muscle, and nine subjects were injected with saline into the same site as the botulinum toxin group. The surface EMG activities at maximum voluntary contraction of masseter and anterior temporal muscles were recorded before, 1 week, 2 weeks, and 3 weeks after injection. Presence of jaw functional limitations in each subject was investigated using Korean version of Jaw Functional Limitation Scale(JFLS) questionnaire. The masseter muscle EMG was gradually decreased in the botulinum toxin group comparing with that of the control group(p<0.001), but the anterior temporal muscle EMG did not show significant changes. There was significant increases in the mastication (p<0.01), and global jaw limitation(p<0.05) subscales of JFLS at 1 week after injection, but no significant changes in the other subscales including opening, and verbal and emotional expression during the recording periods. Our results suggest that botulinum toxin injection into masseter muscle can affect modest limitation in mastication function at 1 week after injection but recovered to the baseline until 3 weeks after injection. The EMG activity of masseter muscle had been gradually decreased until 3 weeks after botulinum toxin injection but the anterior temporal muscle did not show any significant changes.

• Journal of Yeungnam Medical Science
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• v.11 no.2
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• pp.270-276
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• 1994

To evaluate the effect of a new topical anesthetic cream (EMLA: Eutectic mixture of local anesthetics) on reducing pain associated with DPT vaccination, we conducted a clinical observation on eighty infants who were brought to well baby clinic of Yeungnam University Hospital for DPT vaccination. 80 Infants, who were between 2 months and 8 months in age, were divided into two groups. EMLA treated group and control group. Male to femle sex ratio was 1.4 to 1. EMLA cream was applied 60 minutes before DPT vaccination, the effect of reducing pain was assessed by using McGrath's face scale, Oucher pain scale and modified behavioral pain scale (MBPS) and also evaluated by measuring the duration and time of crying (the time of the first crying after injection, duration of the first crying, total duration of crying). The scores of those scales were lower in EMLA treated group than in control group significantly (P(0.01 in McGrath's face scale, MBPS and p<0.05 in Oucher pain scale). There was no difference in the time of the first crying after vaccination in both groups. The duration of the first crying was shorter in EMLA treated group than control group of crying was also shorter in EMLA treated group (EMLA treated group $9.0{\pm}6.0$ sec, control group $21.9{\pm}12.5$ sec, p<0.05). Transient skin erythema was noted in 5 infants after EMLA application, but no other adverse effects were observed. We conclude that the application of EMLA cream before vaccination seems to be an effective and safe way to reduce the pain from vaccination, but it takes usually 60 minutes to get the anesthetic effect of EMLA and it is expensive, so EMLA cream can not be recommended in routine vaccination in infants now.

• Clinics in Shoulder and Elbow
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• v.6 no.2
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• pp.108-114
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• 2003

The shoulder is a complex area which makes it vulnerable to painful pathologic processes. Chronic shoulder pain has become more common recently due to increased use of computers and a ,generally more sedentary life style among most people . Trigger point injection and neural blockade are useful for the management of chronic shoulder pain which has not improved with conservative treatment. Published articles concerning trigger point injection or neural blockade for chronic shoulder pain were reviewed to evaluate promising methods. If we are careful to remain aware of the details and complications in addition to adhering to effective treatments, these should be good armamentarium for doctors enthusiastic about the management of chronic shoulder pain.

• The Korean Journal of Pain
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• v.8 no.2
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• pp.293-297
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• 1995

Despite applying recent advances in research and technology and taking into acount proper histories and performing thorough physical examinations, a high percentage of patients with low back pain have no identifiable pathology. Problems especially of the sacroiliac joint are commonly missed. The purpose of this article is to describe the effects of sacroiliac injection of local anesthetics and corticosteroids on patients with acute sacroiliac sprain. The sacroiliac joints are essentially nonweight-bearing joints that allows a small amount of anteroposterior rotatory movement around transverse axis usually about 5 to 10 cm below the promontory of the sacrum vertically. The ligamentous portion of sacroiliac joint is vulnerable to rotatory movement particularly when the individual is in an awkward position. Injections of 3 ml of 2% lidocaine and 10 mg of methylprednisolone were given twice at two day intervals to 26 patients with acute sacroiliac sprain. Most of those patients obtained excellent results without any adverse effects.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.2 no.2
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• pp.79-84
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• 2009

Purpose: Medial or Lateral epicondylitis is one of the most common causes of elbow pain and recently ESWT (Extracorporeal Shockwave Therapy) is welcomed as a new treatment modality and has been performed in many clinics. The purpose of this study is to report the clinical result after the ESWT treatment for the lateral or medial epicondylitis of the elbow. Materials and Methods: From Nov. 2005 to Jan. 2009, seventy four cases of seventy two (11 male, 61 female) patients diagnosed as medial or lateral epicondylitis of the elbow are included in this study. The average age was 52.4 years old. Authors used visual analogue scale (VAS) to assess the degree of pain at rest and during work, comparing the score before the ESWT treatment with that of $6^{th}$, $12^{th}$ and $24^{th}$ week after the treatment. Authors also checked the number of awakeness during sleep due to pain and compared them before and after the ESWT treatment. Results: Average resting pain score improved from 4.60 before the treatment to 2.01 at $6^{th}$ week, 0.43 at $12^{th}$ week and 0.16 at $24^{th}$ week. Average pain score during working also showed quite an improvement with time from 7.20 before the treatment to 4.05 at $6^{th}$ week, 2.01 at $12^{th}$ week and finally 0.36 at $24^{th}$ week. We checked the frequency of sleep arousal during a week, and also found similar significant treatment efficacy as the average frequency decreased from 9.64 per week before the treatment to 1.21, 0.08 and 0.09 per week at $6^{th}$ week, $12^{th}$ week and $24^{th}$ week, respectively. Conclusion: ESWT for medial or lateral epicondylitis is thought to be one of the effective treatment modalities for those patient group not quite responsive to other conservative treatment.

• Clinics in Shoulder and Elbow
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• v.10 no.2
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• pp.167-174
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• 2007

Purpose: We evaluated calcium resolution and clinical improvement of calcific tendinitis after conservative and arthroscopic treatment. Materials and Methods: We reviewed 126 patients of calcific tendinitis treated from January, 2002 to April, 2005. Average age was 53 and female dominant in 77% of the cases. Calcium deposits were involved in supraspinatus tendon in 84% of the cases. We compared clinical changes for 64 cases treated with injection, and 12 cases treated by arthroscopic decompression with 6 month follow-up. Results: 77%(49/64) of the cases with steroid injection showed symptom improvement. Even though complete resolution of calcific deposit occurred in 36%(23/64), incomplete resolution in 17%(11/64) and no change in 47%(30/64), Pain was relieved in 87%(20/23), 82%(9/11) and 67%(20/30), respectively. With arthroscopic treatment, calcium deposit completely resolved in 83%(10/12), and all cases showed pain free motion after 6 months. Conclusion: Conservative treatment with steroid injection was effective for acute pain in resorptive phase. In cases of arthroscopic treatment, there was no need for complete removal of calcium deposit during the procedure, but clinical symptoms improved with resolution of the deposit.