• Korean Journal of Psychosomatic Medicine
• /
• v.7 no.2
• /
• pp.256-262
• /
• 1999

Because chronic pain disorder may has multiple causes or contributing factors, including physical, psychological, and socio-environmental variables, the treatment of patients with the disorder requires biopsychosocial approaches in a multidisciplinary setting. In treating chronic pain, it is important to address functioning as well as pain, and treatment should be to increase functional capacity and manage the pain as opposed to curing it. Therefore treatment goal should be adaptation to pain or minimizing pain with corresponding greater functioning. Treatment begins with the initial assessment, which includes evaluation of psychophysiologic mechanisms, operant mechanisms, and overt psychiatric comorbidity. Psychiatric treatment of the patients requires adherence to sound pharmacologic and behavioral principles. There are four categories of drugs useful to psychiatrist in the management of chronic pain patients : 1) narcotic analgesics, 2) nonsteroidal antiinflammatory drugs, 3) psychotropic medications, and 4) anticonvulsants, but antidepressants are the most valuable drugs in pharmnacotherpy for them. Psychological treatments tend to emphasize behavioral and cognitive-behavioral modalities, which are divided into self-management techniques and operant techniques. Psychodynamic and insight-oriented therapies are indicated to some patients with long-standing interpersonal dysfunction or a history of childhood abuse.

• Journal of Hospice and Palliative Care
• /
• v.16 no.3
• /
• pp.145-154
• /
• 2013

This study was performed to evaluate the existing pain assessment methods including the tools developed for use with nonverbal older adults with dementia, and to suggest recommendations to clinicians based on the evaluations. Computerized literature searches published after year 2000 using databases - Google scholar, RISS, KoreaMed, Medline, ScienceDirect, CINAHL - were done. Searching keywords were 'pain', 'pain assessment', and 'cognitive impairment/dementia'. The pain assessments for non-communicative dementia patients who are unable to self-report their pains are often made using the assessment tools relying on the observation of behavioral indicators or alternatively the strategy of surrogate reporting. While several tools in English version and only one in Korean are suggested for the pain assessments based on the observation of behavioral indicators, none are commonly used. In this review, we selectively evaluated those tools known to show relatively higher degree of validity and reliability for nonverbal older adults with dementia, namely, CNPI, DOLOPLUS 2, PACSLAC, PAINAD, and DS-DAT. It is hoped that the present review of selected tools for assessing pain in those vulnerable population and the general recommendations given be useful for clinicians in their palliative care practice. And future studies should focus on enriching the validation of the useful tools used to observe the nonverbal patient's behavioral indicators for pain in Korean.

• Journal of Acupuncture Research
• /
• v.24 no.2
• /
• pp.39-49
• /
• 2007

목적 : 봉독으로 유발된 통각수용의 강도와 봉독으로 나타나는 항통각수용(통각억제성)의 강도를 쥐의 포르말린 테스트를 통해 상호관련됨을 확인하고 capsaicin과 bradykinin으로 통증 유발된 쥐의 자발적인 통증행동(핥기횟수측정; LN), 꼬리경타시험(TFL)과 열판시험(HPL)을 통해 봉독의 항통각수용(통각억제)작용을 재확인 하고자 하였다. 방법 : 쥐의 뒷다리에 통증유도 물질인 Capsaicin 또는 Bradykinin을 20${\mu}l$를 주사하여 동통을 유발하고 자발적 통증행동인 핥기횟수측정(LN), 꼬리경타기간(TFL)과 열판 위에서의 온도자극에 쥐가 반응하는 시간을 측정(HPL)하는 실험을 봉독을 주입하거나, 몰핀을 주입하거나, 아무것도 주입하지 않고 통증유발만 시킨 이후에 각각 시행하였다. 결과: 1. Capsaicin 또는 Bradykinin으로 동통유발 후 LN은 두드러증가를 보임, HPL은 감소를 TFL은 두드러진 감소를 나타내었다. 2. 봉독이나 몰핀 주입 30분 후에 Capsaicin으로 동통유발 이후 LN은 봉독과 몰핀에서 모두 현격한 감소를, HPL은 봉침은 현격한 증가를, 몰핀에서는 감소를, TFL은 봉침과 몰핀에서 모두 현격한 증가를 나타내었다. 3 봉독과 몰핀주입 30분후에 Bradykinin으로 동통유발 이후 LN은 봉독은 증가 몰핀은 현격한 감소를, HPL은 봉침은 증가 몰핀에서는 현격한 증가를, TFL은 봉침과 볼핀에서 모두 증가를 나타내었다. 결론 : 봉독은 Capsaicin 또는 Bradykinin으로 동통유발된 통각수용행동을 감소시키는 결과를 나타내었는데 이것은 기존의 연구결과들에서의 봉독의 항통각수용(통각억제성)의 효과를 입증하였고 봉약침은 염증의 개선이나 암과 관련된 동통에 유효한 방법임을 시사하는 것이다.

• The Journal of Dong Guk Oriental Medicine
• /
• v.8 no.2
• /
• pp.25-46
• /
• 2000

Pain can be evaluated by experimental methods and clinical methods, but due to subjective characteristics of pain, clinical methods are generally used. The clinical pain measurement tools are divided into unidimensional and multidimensional assessment tools. The former include Visual Analogue Scale, Verbal Rating Scale, Numerical Rating Scale, Pain Faces Scale, and Poker Chip Tool and the latter include McGill Pain Questionnaire, MMPI, Pain Behavior Scale, Pain disability index, and Pain Rating Scale. Unidimensional pain scales mainly measure the intensity of pain on the basis of the patient's self report and their simple construction and ease of use enable the invesgator to assess acute pain. Multidimensional pain scales are used to evaluate subjective, psychological and behavioral aspects of pain and because of its comprehensive and confidential properties they are applied to chronic pain. Patient's linguistic and cognitive abilities are major factors to restrain accurate assessment of pain. Although behavioral patterns and vital sign are inferior to self-report in the measurement of pain, they can be useful indexes in those situations. When deciding on a pain-assessment tool, the investigator must determine which aspect of pain he or she wishes to evaluate on the characteristics of the group of patients, their backgrounds, and their communication skills. Making the proper choice will facilitate the acquisition of meaningful data and the formulation of valid conclusions.

• Journal of Ginseng Research
• /
• v.23 no.1 s.53
• /
• pp.38-43
• /
• 1999

Ginseng total saponins (ginsenosides) are biologically active main ingredients of Panax ginseng. In present study, we have investigated whether pretreatment of ginsenosides inhibited capsaicin-induced pain at the spinal level, in the view that capsaicin causes substance P (SP) release from primary afferents. Ginsenosides relieved capsaicin-induced pain in a dose-dependent manner. The $ED_{50}$ of the effect was 43 (20-93, $95\%$ C.I.) ${\mu}g/mouse$. We investigated excitatory amino acids-induced nociceptive responses in mice, because these agents are also involved in nociceptive transmission in the spinal cord. Coadministration of ginsenosides with N-methyl-D-aspartate (NMDA) or kainate via i.t. inhibited NMDA- but not kainate-induced pain behaviors. The $ED_{50}$ for the inhibition of NMDA-induced pain by ginsenosides was 37 (21-66, $95\%$ C.I.) ${\mu}g/mouse$. These results suggest that the ginsenosides-induced antinociception results from blocking of pain transmitter-induced nociceptive information at the spinal level.

• Journal of Veterinary Clinics
• /
• v.22 no.1
• /
• pp.6-15
• /
• 2005

This study was performed to investigate non-invasive behavioral pain assessment of dogs after surgery, and the analgesic effects of butorphanol after intestinal anastomosis in dogs. In this study, five dogs in the Control Group were anesthetized, but did not undergo surgery. Five dogs in the Analgesic Group were undergone intestinal anastomosis and treated with butorphanol. Five dogs in the Non-analgesic Group were also undergone intestinal anastomosis without analgesic treatment. The dogs in the Analgesic Group received butorphanol (0.4 mg/kg, IM) before and immediately after operation, while dogs in Control and Non-analgesic Groups received isovolumetric doses of sterile saline. The behavior of dogs were videotaped for 400 mins after anesthesia, during which time a researcher interacted with the dog once per each 80 mins. At each interaction, the researcher recorded behavioral pain score, using University of Melbourne Pain Scale. Interactive and non-interactive behaviors were observed and quantitated by a single observer using focal continuous sampling method. Vocalizations were obtained during 400 mins after anesthesia, and duration of call, intensity, pitch, 1-4 Formant were analyzed. Surgery affected an increasing of pain score. During interactions with researcher, greeting behaviors were decreased after surgery. Differences between Analgesic group given analgesic or that given a placebo drug were readily understood using quantitative behavioral measurements and vocalization. Significant difference between Analgesic group given butorphanol or that the given placebo drug was apparent(p< 0.05).

• Korean Journal of Psychosomatic Medicine
• /
• v.10 no.2
• /
• pp.110-119
• /
• 2002

Objectives : Numbers of patients who have chronic pain seem to be increasing in the psychiatric practice. Many investigators have used models of stress and coping to help explain the differences in adjustment found among persons who experience chronic pain. Coping strategies appear to be associated with adjustment in chronic pain patients. The objectives of this study were to develop a self-report questionnaire which is the most widely used measures of pain coping strategies, Coping Strategies Questionnaire (CSQ) into Korean version and to study the different coping strategies with which chronic pain patients frequently use when their pain reaches a moderate or greater level of intensity. Methods : One hundred twenty-eight individuals with chronic pain conditions and two hundred fifty-two normal controls were administered the Korean version-Coping Strategies Questionnaire(KCSQ) to assess the frequency of use and perceived effectiveness of a variety of cognitive and behavioral pain coping strategies. We also obtained their clinical features in chronic pain patients. Reliability of the questionnaire were analyzed and evaluated differences of coping strategies between two groups. Results : Data analysis revealed that the questionnaire was internally reliable. Chronic pain patients reported frequent use of a variety of pain coping strategies, such as coping self-statements, praying and hoping, catastrophizing, and increase behavior scales which were higher compared to the normal controls. Conclusion: K-CSQ revealed to be a reliable self-report questionnaire which is useful for the assessment of coping strategies in clinical setting on chronic pain. And analysis of pain coping strategies may be helpful in understanding pain for chronic pain patients. The individual K-CSQ may have greater utility in terms of examining coping, appraisals, and pain adjustment. A consideration of pain coping strategies may allow one to design pain coping skills training interventions so as to fit the individual chronic pain patient. Further research is needed to determine whether cognitive-behavioral intervention designed to decrease maladaptive coping strategies can reduce pain and improve the physical and psycho-social functioning of chronic patients.

• Journal of Yeungnam Medical Science
• /
• v.26 no.1
• /
• pp.74-77
• /
• 2009

There are debates about whether peripherally induced movement disorders exist. We report a case of upper limb tremor induced by peripheral nerve injury. A 20-year-old male patient presented with pain and tremor of the left upper extremity, 2 days after a car accident. Magnetic resonance images of the brain and cervical spine were normal. His past medical history was unremarkable and there were no family members with symptoms of movement disorders. He suffered from an aggravating tremor for about 10 minutes, four to six times a day. We treated the patient with medication, epidural infusion, cervical nerve root block and trigger point injection of the trapezius muscle. The pain subsided 50% and the incidence of tremor attacks was reduced to once or twice a day. The role of peripheral trauma in the genesis of movement disorders has not been generally accepted. It is unclear whether peripheral trauma can induce dystonia and other movement disorders. It has been proposed that peripheral trauma can alter sensory input and induce cortical and subcortical reorganization that generates a movement disorder. Some studies provide evidence for central reorganization following peripheral injury.

• The Journal of the Korean dental association
• /
• v.39 no.4 s.383
• /
• pp.279-284
• /
• 2001

• Korean Journal of Psychosomatic Medicine
• /
• v.7 no.2
• /
• pp.252-255
• /
• 1999

Numbers of patients who have chronic pain seem to be increasing even in the psychiatric practice. One report in Korea showed more than 40% of psychiatric patients who visited out-patient clinic were suffered from chronic pain and one third of those patients were needed treatment for the on-going pain. For evaluating and treating those patients the charateristics of illness behavior should be understood. Abnormal Illness behavior was found as one of the most influential factors which led symptoms complicated and chronified. This symposium was planned to illustrate how to manage the patients whose pain are associated with arthropathy and connective tissue diseases, neuropathic pain and headache more effectively and efficiently. So, It is hoped to get fruitful knowledges for the management of chronic pain in the scope of consultation-liaison psychiatry.