• The Korean Journal of Pain
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• v.19 no.2
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• pp.187-191
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• 2006

Background: Patient-controlled epidural analgesia (PCEA), using a local anesthetic-opioid mixture, has been effectively applied after total knee replacement (TKR) surgery, which is associated with intense postoperative pain that requires postoperative analgesia for both rehabilitation and the pain itself. However, adverse opioid-related effects, such as nausea, vomiting and pruritus, are commonly encountered. It was our hypothesis that the adverse opioid-related effects could be reduced by the addition of naloxone, an opioid antagonist, to a mixture of fentanyl-ropivacaine PCEA. Methods: In 120 patients undergoing elective TKR surgery, epidural or combined spinal-epidural (CSE) anesthesia was performed and PCEA applied. In the control group (n = 65), 0.16% ropivacaine and $3{\mu}g/ml$ fentanyl ($2.4{\mu}g/ml$ for those older than 65 yrs) were administered. In the naloxone group (n = 55), naloxone ($2{\mu}g/ml$) was coadministered with the above regimen. The incidence and severity of postoperative nausea and vomiting, and the frequency of pruritus, the visual analog score (VAS) and the PCEA volume used were assessed 6 and 24 hrs after surgery. Results: The incidence of nausea and vomiting during the early postoperative period, and those of pruritus during the late postoperative period were significantly lower in the naloxone group. The VAS pain scores, the PCEA volume used and amount of rescue IV meperidine were similar in the two groups. Conclusions: A small dose of naloxone mixed with an opioid significantly reduces the incidence and severity of adverse opioid-related effects in PCEA, without reducing the analgesic effect.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.4 no.2
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• pp.101-110
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• 2011

To describe the background, mechanism, clinical results and complications of prolotheapy based on the literature review. Prolotherapy is a minimally invasive injection-based treatment of chronic musculoskeletal pain, including ligament and joint laxity. The mechanism of this injection-based technique is to initiate a local inflammatory response with resultant tissue healing. The used proliferants are classified by bio-mechanism to act in three different ways as osmotic, irritants, and chemotatics. The most commonly used proliferant is hyperosmolar (10~25%) dextrose to act by osmotic rupture of cells. High resolution ultrasound imaging of musculoskeletal structure provide a more accurate diagnosis. Also ultrasound-guided intervention provides a more high efficacy and low rate of complications. The most common complication is local pain at the injected site, that is self-limited and good responsive to anti-inflammatory agents. Other complications are rare. It is reported that prolotherapy appears safe when performed by an experienced clinician. Prolotherapy has grown in popularity and has received significant recent attention. However there are limited evidence-based data supporting the indication and efficacy of prolotherapy in the treatment of chronic musculoskeletal pain or soft tissue injuries. Future studies are necessary to determine whether prolotherapy can play an independent and definitive role in a treatment for chronic musculoskeletal pain.

• Journal of Hospice and Palliative Care
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• v.9 no.1
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• pp.35-39
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• 2006

A 77-year-old female presented panperitonitis due to advanced gastric ranter during palliative care. In the case of panperitonitis following obstruction or perforation, surgical treatment is vital to avoid fatal sepsis and dehydration. However, the risk of surgery and the residual life of a patient must be carefully considered because of high mortality and complication rate in those patients with advanced disease due to the poor condition. The therapeutic value of aggressive hydration, nasogastric tube insertion, and the use of antibiotics is also questionable. Palliative surgery was not performed on this case, and she passed away peacefully in the presence of family after 4 days of palliative medical care. Here is the appropriate management for this kind of patients we would like to recommend through review of relevant references and long discussions. Firstly, we need to predict survival time using clinical variables. Secondly, considering patient status and risk of surgery, non surgical palliative care such as pain control, transient nasogastric tube insertion, and parenteral hydration is recommended. Minimal use of fluid is desirable to minimize complications such as edema and dyspnea if massive hydration in the beginning of treatment is not proved to be effective. Even though started earlier in the course of disease, discontinuation of antibiotics could be discussed with patients and their caregiver if patient status is not improved.

• Journal of Hospice and Palliative Care
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• v.19 no.4
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• pp.331-334
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• 2016

Purpose: Advanced cancer may accompany cold sweat as paraneoplastic symptom. Few studies have been performed on the efficacy of non-steroid anti-inflammatory drug (NSAID) in advanced cancer patients who sweated without fever. Methods: To select study participants, medical records were retrospectively reviewed for patients who satisfied the following criteria: 1) incurable, advanced solid cancer; 2) Cold sweating of 4 or higher on the numeric rating scale (NRS) 4; 3) No evidence of infection or hypoglycemia; 4) No newly started opioid or anti-hormonal agents within one month; 5) NSAID prescription for the management of cold sweating and 6) Documented NRS information before and after NSAID administration. Results: A total of 13 patients were selected after excluding four patients due to lack of NRS information or fever. The mean age was 59 years old (range: 50~71), and nine patients (69%) were male. Bile duct cancer was the most common primary tumor followed by pancreatic cancer, gastric cancer and prostate cancer. The mean NRS of cold sweating dropped from baseline 6.5 (min-max: 4~10) to 1.9 at the follow-up assessment (min-max: 0~5). The mean follow-up period was 9.1 days (range: 2~30 days) from NSAID treatment to assessment. Conclusion: NSAID was effective medication for management of sweating without fever in patients with advanced cancer.

• Journal of Physiology & Pathology in Korean Medicine
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• v.28 no.6
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• pp.689-694
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• 2014

We report a female small cell lung cancer patient in the extensive stage(T3N3Mx). After 6 cycles of chemotherapy combined radiation therapy, she received inpatient Korean medical care including herbal medicine, acupuncture therapy and concurrent western oral medications of opioid analgesics and anti-anxiety agent. The chief complaint was right side thoracic wall pain which had started after chemotherapy and was not effectively controlled by analgesics. For this condition, we treated her with 2Hz of constant electrical stimulation on Jiaji (Ex-B2) points T5-T7 laterally (right) using three needles for 20 minutes once a day for 9 days. With every session of electrical acupuncture treatment, thoracic pain decreased acutely. Korean medicine treatments including Jiaji (Ex-B2) point stimulation might be tried for lung cancer patients with uncontrolled thoracic pain at least for the acute analgesic effect.

• Journal of The Korean Dental Society of Anesthesiology
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• v.4 no.2 s.7
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• pp.84-89
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• 2004

Background: Many studies on efficacy of preemptive analgesia have been processed in different ways. But the value of preemptive analgesia is still controversial. The goal of this study was to compare analgesic effect of an NSAID according to three different administration times for oral surgical pain. Patients and Methods: Using a randomized, parallel-group, single-center, and active-controlled test design, this study was conducted to healthy 80 patients undergoing a surgical removal of an impacted mandibular third molar requiring bone removal. The oral NSAID was first administered 1 hour preoperatively, or 1 hour postoperatively, or no scheduled administration in pre or postsurgery. Whenever patients felt at least moderate pain (score ${\ge}$ 5 on a 10-point scale) after surgery, they were instructed to take the same drug. Pain intensities and times to the first and second onset of postoperative pain from end of surgery were assessed for 24 hours. Results: Of the enrolled eighty subjects in this study, 25 patients were assigned to preemptive, 26 to post-treatment and 29 to no treatment group. The demographic distribution and duration of surgery in the three groups were statistically similar. The mean time to first onset of postoperative pain was significantly prolonged in post-treatment group (277.2 minutes, p < 0.05) compared to preemptive (158.4 minutes) and no treatment group (196.5 minutes). The mean time to second onset of postoperative pain was not significantly different among the three groups. No significant statistical difference was found among the mean pain intensities at the first and second onset of postoperative pain in the three groups. Conclusions: In this small selected group of subjects and limited study design, the analgesic effects of NSAID administered preoperatively were no longer effective for postoperative pain. The results in this population imply that scheduled postoperative analgesics before pain development are adequate for postoperative analgesia without preoperative administration.

• Korean Journal of Acupuncture
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• v.31 no.1
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• pp.33-39
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• 2014

Objectives : This study was designed to evaluate the feasibility of further acupuncture research as an effective and safe treatment for reducing cancer-related upper abdominal pain in patients treated with Neurolytic celiac plexus block(NCPB). Methods : This study is a randomized controlled pilot clinical trial of 3-week duration. Fourteen patients will be recruited and randomly allocated to 2 groups: an acupuncture plus NCPB group(experimental group) and a NCPB group(control group). All patients will undergo one session of NCPB, but only the experimental group will receive three acupuncture sessions a week for 2 weeks(6 in total). The primary outcome will be measured using the visual analogue scale, and the secondary outcome will be measured using the Painvision system and the consumption of additional analgesics. Assessments will be made at baseline and at 1, 2, and 3 weeks thereafter(that is, the 3-week assessment will be made 1 week after treatment cessation). Conclusions : This clinical trial will inform the design of a full-scale trial. The outcomes will provide information to facilitate the incorporation of acupuncture into existing pain management methods such as NCPB in the treatment of cancer-related upper abdominal pain patients.

• Journal of Korean Medicine Rehabilitation
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• v.25 no.1
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• pp.27-44
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• 2015

Objectives This study was carried out to find the effects of Gami-cheongyulsaseub-tang (hereinafter referred to GCST) on the inhibition of zymosan-induced pain in rats and collagen II-induced arthritis (CIA) in DBA/1J mouse. Methods As an acute inflammatory pain model, peripheral inflammation was induced by intraplantar injection of zymosan into the right hind paw in rats and then the hyperalgesia and pain regulating factors in spinal cord were analyzed. As a chronic inflammation model, the mixture of collagen II and complete Freund's adjuvant was treated into mice to establish rheumatoid arthritis and then body weight, thickness of hind paw, pathological change of spleen, immunological rheumatoid factor (IgG1, IgG2a, IgG2b, IgM and anti-collagen II), pro-inflammatory cytokines, and bone injury were analyzed. Results In the acute inflammatory pain model, GCST significantly inhibited the thermal and mechanical hyperalgesia and the pain regulating factors, including Fos, CD11b, PKA and PKC, in the spinal cord with a dose-dependent manner. In the chronic rheumatoid arthritis model, GCST administration decreased arthritic index and paw edema as compared with CIA control group. In particular, GCST reduced significantly the serum levels of total IgG2a, IgG2b, IgM, and specific anti-collagen II, but not total IgG1. GCST also resulted in the attenuation of bone injury and spleen enlargement/adhesion in CIA mice. Moreover, the secretion of pro-inflammatory cytokines TNF-${\alpha}$ and IL-$1{\beta}$ in CIA mice was significantly reduced by GCST in a dose-dependent manner. Conclusions Comparison of the results in this study showed that GCST had anti-nociceptive and immunomodulatory effects. These data imply that GCST can be used as an effective drug for not only rheumatoid arthritic pain but also other auto-immune diseases.

• The Korean Journal of Pharmacology
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• v.20 no.2
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• pp.23-34
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• 1984

To investigate diurnal variations of opiate receptor binding and its modification by experimental condition or treatment of various centrally-acting drugs, the amount of maximum $^3H-morphine$ binding in rat midbrain homogenates was measured at 4 hour intervals for 24 hours. Animals were conditioned under the controlled L : D, 12 : 12 cycle or D: D, 12 : 12 cycle, for 3 weeks and treated with 0.5 ml of physiological saline or drugs for 2 weeks. A highly significant diurnal rhythm with peak at 22 hour of early dark phase with an amplitude$(0.68{\pm}0.06\;pmole/mg\;protein)$ of +51.1% and nadir $(0.33{\pm}0.03\;mole/mg\;prtein)$ at 18 hour of late light phase with an amplitude of -26.6% was found in control group. 24 tour mean of $^3H-morphine$ binding was $0.45{\pm}0.03\;pmole/mg$ protein respectively. Constant dark adaptation or treatment of reserpine, pargyline, imipramine, amphetamine and chlorpromazine modified the diurnal rhythm in the time of peak and nadir binding shape, phase, amplitude of the diurnal curve and 24 hour mean of $^3H-morphine$ binding. However, Kd values were not changed in all experimental groups : Statistical analysis at times of least and great binding indicates that the differences in $^3H-morphine$ binding were due to changes not in the affinity, but in the number of binding sites. The results are interpreted with regard to the diurnal rhythm of opiate receptor finding. The modes of action of psychoactive drugs are closely related to postulated changes of receptor sensitivity in neuropharmacological aspects.

• Journal of Physiology & Pathology in Korean Medicine
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• v.25 no.2
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• pp.195-201
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• 2011

Nardostachys chinensis;Anti-proliferation;Cell cycle arrest;Differentiation;U937 cells; This study was conducted to determine the analgesic effect of Sokyungwhalhyul-tang(SKWHT) using the model of peripheral neuropathic pain model. A model of neuropathic pain was made by ligating left 5th lumbar spinal nerve of rats. After 1 days, the extract of SKWHT was orally administered daily. Rats were divided into four groups; (1) Control group(n=6), (2) Experimental group I(SKWHT-OA1, 100 mg/kg, n=6), (3) Experimental group II(SKWHT-OA2, 300 mg/kg, n=6), (4) Experimental group III(SKWHT-OA3, 500 mg/kg, n=6). After that, we examined the withdrawl response of neuropathic rats legs by von Frey filament and Hot plate at pre, $1^{th}$, $4^{th}$, $7^{th}$, $14^{th}$, $21^{th}$ days after the induction of neuropathic pain. And also we examined c-fos, GOT, GPT and histological study of Liver at 21th days. von Frey filament and Hot plate were increase in experimental group I, II, III than Con. especially group III was most significantly analgesic effect than the other groups at $14^{th}$, $21^{th}$ days. In c-fos protein expression on spinal cord, group III was most significantly reduction immunoreactivity at $21^{th}$ days and in blood serum GOT & GPT levels and histologic finding of Liver in all experimental groups were no significant difference with Con at $21^{th}$ days. According to the above results, SKWHT(500 mg/kg) may have a significant analgesic effect on the neuropathic pain.