• The Korean Journal of Pain
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• v.20 no.2
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• pp.181-185
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• 2007

Background: The first pain clinic opened in korea in 1973 at Yonsei University Hospital, however, since then the number of pain clinics has gradually increased, as has the number of patients visiting them. This increase in patient has caused concerns about the way in which pain is managed, therefore, we conducted a retrospective review of data according to the sex, age and disease in an attept to aid us in planning for the future of our pain clinic. Methods: We analyzed 1,282 new patients who had visited our pain clinic and 828 inpatients who were admitted to our pain clinic between March 2006 and February 2007. Results: The most frequent age group was in the sixties in outpatient and in the seventies in inpatient. In addition, the incidence of disease in new patients and inpatients was as follows: in new patients, lumbar herniated intervertebral disc 16.5%, hyperhidrosis 12.3%, cervical disc disorder 10.5%, acute herpes zoster 8.2%, postherpetic neuralgia 7.9%, and trigeminal neuralgia 7.0%; in admitted patients, acute herpes zoster 17.6%, trigeminal neuralgia 15.6%, lumbar herniated intervertebral disc 13.0%, postherpetic neuralgia 11.2%, hyperhidrosis 9.8%, and complex regional pain syndrome 7.0%. Conclusions: The patients visiting our pain clinic have presented with a wide variety of diseases. This improved care reflects an effort to expand our fields not only to the management of outpatients but also inpatients, as well as to the treatment of new fields of disease. In the future, We need to manage various pain patients not only in outpatients but also in inpatients to expand our field even through pain clinic is rapidly growing in Korea.

• Journal of Korean Neurosurgical Society
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• v.45 no.5
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• pp.293-296
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• 2009

Objective : Pain has long been regarded as a subjective symptom. Recently, however, some regard a type of intractable chronic pain as a disease. Furthermore, chronic persistent pain becomes a cause of permanent impairment (PI) In 6th edition, the American Medical Association (AMA) Guides has rated the pain as a PI. In Korea, pain has been already been rated as a PI. Here, we examined the present status and the prospect of disability evaluation for the pain in Korea. Methods : Pain can be rated as a PI by the Workmen's Compensation Insurance Act (WCIA) and Patriots and Veterans Welfare Corporation Act (PVWCA) in Korea. We examined the definition, diagnostic criteria and grades of the pain related disability (PRD) in these two acts. We also examined legal judgments, which were made in 2005 for patients with severe pain. We also compared the acts and the judgments to the criteria of the 6th AMA Guides. Results : The PRD can berated as one of the 4 grades according to the WCIA. The provisions of the law do not limit the pain only for the complex regional pain syndrome (CRPS). The PRD can berated as one of the 3 grades by the PVWCA. If there were objective signs such as osteoporosis, joint contracture and muscle atrophy corresponding to the CRPS, the grade is rated as 6. When the pain always interferes with one's job except easy work,the grade is rated as high as 5. In Korea, judicial precedents dealt the pain a sa permanent disability in 2005. Conclusion : Although there were no objective criteria for evaluation of the PRD, pain has been already rated as a PI by the laws or judicial precedents, in Korea. Thus, we should regulate the Korean criteria of PRD like the AMA 6th edition. We also should develop the objective tools for evaluation of the PRD near in future.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.228-232
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• 2006

Complex regional pain syndrome (CRPS) type 1 is characterized by the presence of pain, which is severe, diffuse and associated with allodynia, and is also associated with autonomic and trophic changes. The sensitization phenomena of CRPS also cause allodynia and itching, as well as pain. These symptoms are the issues associated with the treatment of CRPS. Under normal conditions, an antagonistic interaction exists between the pain and itching, but the patterns of peripheral and central sensitization phenomena for the pain and itching are very similar. The chronic pain and chronic itch have similar characteristics in their developmental and therapeutical principles. Herein, our experience of 2 cases of CRPS, which showed improvement of these facial symptoms after sphenopalatine ganglion radiofrequency thermocoagulation, but were not controlled by spinal cord stimulation or other conservative treatments, is reported.

• Clinics in Shoulder and Elbow
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• v.18 no.1
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• pp.8-12
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• 2015

Background: The aim of this study was to assess demographics, clinical outcomes, and complications of classic floating elbow in adults. Methods: Six patients with ipsilateral diaphyseal fractures of the humerus, radius, and ulna were reviewed retrospectively. All patients were treated operatively and available for follow-up at a minimum of 1 year after surgery. The average age of the patients was 45.2 years (22-64 years) and the average follow-up period was 37.0 months (14-103 months). They were evaluated with postoperative outcome measures, including a visual analog scale (VAS) for pain, Mayo elbow performance score (MEPS), and American Shoulder and Elbow Surgeons (ASES) shoulder score. Residual complications were also evaluated. Results: Five patients (83.3%) had open fracture, and 4 patients (66.7%) presented with associated nerve injury. All fractures were united within postoperative 4 months, except 1 delayed union. The average VAS pain score, MEPS, and ASES shoulder score at the final follow-up examination was 2.5, 79.8, and 67.5 respectively. Three patients including 2 cases of joint stiffness with incomplete recovery from nerve injury and 1 case of complex regional pain syndrome had poor clinical outcome. Conclusions: Although the classic floating elbow is rare, these injuries potentially have associated problems such as open fracture or nerve injury. The presence of residual neurological symptoms predispose to poorer clinical outcomes.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.1
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• pp.44-51
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• 2008

Purpose: We performed this study to evaluate reliability on interpretation of three phase bone scintigraphy (TPBS) in patients with post-traumatic complex regional pain syndrome (PT-CRPS). Methods: Based on International Association for the Study of Pain guideline in 1994, 34 patients with PT-CRPS were selected for this study. Two nuclear medicine physicians evaluated identical TPBS according to the uptake pattern, extent and intensity of the lesion, and their agreements (kappa values) were analysed. The final diagnosis based on arbitrary criteria of each physician were compared with those obtained by the criteria for PT-CRPS established in this study, which are hyperactivity on all phases (criteria 1), hyperactivity of whole joints on delayed phase (criteria 2), and hyperactivity of either whole or FDGal joints on delayed phase (criteria 3). Results: Intra-observer agreements were good for uptake pattern, intensity, and extent on TPBS. Inter-observer agreements were also good, except extent on blood pool phase (0.55). The inter-observer agreements on final diagnosis improved when criteria 1-3 were applied (0.77-0.88), compared to when physician's own criteria were used (0.63). Those also improved from 0.29 to 0.47-0.82 for acute stage, and from 0.37 to 1.0 for chronic stage. The sensitivities of chronic stage were relatively lower to those of acute stage. Conclusions: Inter-observer's variations in diagnosis of the patients with PT-CRPS using TPBS were observed. These results were attributed to different criteria set by observers. In order to improve agreement on interpretation of TPBS, common positive criteria should be established, especially considering uptake pattern and clinical stages.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.199-206
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• 2001

Background: The lumbar sympathetic ganglia are variable in both position and numbers. The aim of this study was to detect the appropriate lumbar vertebral level where the lumbar sympathetic ganglia primarily aggregate. Methods: Forty patients comprising of hyperhidrosis (26 cases), complex regional pain syndrome (10 cases), peripheral artery occlusion disease (3 cases) and postherpetic neuralgia (1 case) underwent lumbar sympathetic block. We randomly selected one of two (L2 or L3) levels and the L4 level. The position of the needle tip and distribution of dye was verified by injection of a mixture of radio-opaque dye (1.5 ml) and 4% lidocaine (1.5 ml) and subsequently confirmed by L-spine anteroposterior and a lateral view X-ray. We considered the response positive when the skin temperature increased more than $1^{\circ}C$ in 5 min. Results: In general, the positive response ratio was greater when the needle tip located at the L2 or L4 level vice L3 and when the drug was distributed on the lower half of the L4 body and in the L4/5 intervertebral disc space. In a right side block, the positive response ratio was greater when the drug was distributed on the lower half of the L4 body and in the L4/5 intervertebral disc space, although in a left side block there was no significant difference seen between the levels. The complications of the neurolytic block were alcohol neuritis (7.5%) and hypoesthesia (5%) on the L1 or L2 dermatome. Conclusions: The best effect with least chance of complication may be induced by spreading the drug on the lower half of the L4 body and/or into the L4/5 intervertebral disc space by placing the needle tip on the L4 body.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.1
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• pp.47-56
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• 2024

Background: Among the various pain-related diseases that can be encountered at the clinic, there is a neuropathic pain that is difficult to treat. Numerous methods have been proposed to treat neuropathic pain, such as taking medication, nerve block with lidocaine, or neurolysis with alcohol or phenol. Recently, a method of perineural injection using dextrose instead of lidocaine was proposed. This study was designed to compare the effects of perineural injection therapy (PIT) with buffered 5% dextrose or 0.5% lidocaine on neuropathic pain. Methods: The data were collected from the database of pain clinic from August 1st, 2019 to December 31st, 2022 without any personal information. The inclusion criteria were patients diagnosed with postherpetic neuralgia (PHN), trigeminal neuralgia (TN), complex regional pain syndrome (CRPS), or peripheral neuropathy (PN), and patients who had undergone PIT with buffered 5% dextrose (Dextrose group) or 0.5% lidocaine (Lidocaine group) for pain control. The data of patients, namely sex, age, and pain score (numerical rating scale, NRS) were collected before PIT. The data of NRS, side effects, and satisfaction grade (excellent, good, fair, or poor) were collected one week after each of the four PIT, and two weeks after the last PIT. Results: Overall, 112 subjects were enrolled. The Dextrose group included 89 and Lidocaine group included 23 patients. Because the number of patients in the Lidocaine group was too small to allow statistical analysis, the trend in Lidocaine group was just observed in each disease. There were no significant side effects except for a few bruise cases on the site of injection in all groups. The NRS in most Dextrose groups except CRPS were reduced significantly; however, the Lidocaine group showed a trend of pain reduction only in PHN. The Dextrose group except CRPS showed increased satisfaction two weeks after the final PIT. Conclusion: From the results, it is suggested that PIT with buffered 5% dextrose may have a good effect for neuropathic pain without any side effect except for patients with CRPS. This may offer a window into a new tool that practitioners can employ in their quest to help patients with neuropathic pain.

• The Korean Journal of Pain
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• v.23 no.1
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• pp.1-10
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• 2010

Background: Recent studies indicate that reactive oxygen species (ROS) are involved in persistent pain, including neuropathic and inflammatory pain. Since the data suggest that ROS are involved in central sensitization, the present study examines the levels of activated N-methyl-D-aspartate (NMDA) receptors in the dorsal horn after an exogenous supply of three antioxidants in rats with chronic post-ischemia pain (CPIP). This serves as an animal model of complex regional pain syndrome type-I induced by hindpaw ischemia/reperfusion injury. Methods: The application of tight-fitting O-rings for a period of three hours produced CPIP in male Sprague-Dawley rats. Allopurinol 4 mg/kg, allopurinol 40 mg/kg, superoxide dismutase (SOD) 4,000 U/kg, N-nitro-L-arginine methyl ester (L-NAME) 10 mg/kg and SOD 4,000 U/kg plus L-NAME 10 mg/kg were administered intraperitoneally just after O-ring application and on the first and second days after reperfusion. Mechanical allodynia was measured, and activation of the NMDA receptor subunit 1 (pNR1) of the lumbar spinal cord (L4-L6) was analyzed by the Western blot three days after reperfusion. Results: Allopurinol reduced mechanical allodynia and attenuated the enhancement of spinal pNR1 expression in CPIP rats. SOD and L-NAME also blocked spinal pNR1 in accordance with the reduced mechanical allodynia in rats with CPIP. Conclusions: The present data suggest the contribution of superoxide, produced via xanthine oxidase, and the participation of superoxide and nitric oxide as a precursor of peroxynitrite in NMDA mediated central sensitization. Finally, the findings support a therapeutic potential for the manipulation of superoxide and nitric oxide in ischemia/reperfusion related pain conditions.

• The Korean Journal of Pain
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• v.33 no.2
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• pp.99-107
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• 2020

Chronic severe pain results in a detrimental effect on the patient's quality of life. Such patients have to take a large number of medications, including opioids, often without satisfactory effect, sometimes leading to medication abuse and the pain worsening. Spinal cord stimulation (SCS) is one of the most effective technologies that, unlike other interventional pain treatment methods, achieves long-term results in patients suffering from chronic neuropathic pain. The first described mode of SCS was a conventional tonic stimulation, but now the novel modalities (high-frequency and burst), techniques (dorsal root ganglia stimulations), and technical development (wireless and implantable pulse generator-free systems) of SCS are becoming more popular. The improvement of SCS systems, their miniaturization, and the appearance of new mechanisms for anchoring electrodes results in a significant reduction in the rate of complications and revision surgeries, and the appearance of new waves of stimulation allows not only to avoid the phenomenon of addiction, but also to improve the long-term results of chronic SCS. The purpose of this review is to describe the current condition of SCS and up-to-date technical advances.

• Journal of Korean Foot and Ankle Society
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• v.8 no.2
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• pp.149-152
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• 2004

Purpose: We assessed the clinical results of modified Brostrom procedure as a revision method after failure of a primary reconstruction. Materials and Methods: This is a retrospective study of seven patients treated with Modified Brostrom procedure after failed lateral ankle ligament reconstruction between 1996 and 2002. Instability symptom developed average 4.7 month after the initial reconstruction surgery at other clinics. All patients had significant functional impairment before surgery and not responded to conservative protocols. Modified Brostrom procedure was applied to all patients. Results: The average follow up was 51 months (18 to 84). Seven of eight patients had clinical stability following revision reconstruction, six patients (75%) returned to their previous functional level. American Orthopaedic Foot and Ankle Society ankle-hindfoot scores averaged 87.5. There is no difference in active or passive range of motion of plantar flexion or dorsiflexion when compared to the contralateral ankle. However, three patients were noted to have lost some degree of inversion when compated to contralateral ankle. Two patients had osteochondral lesion and multiple spurs and had pain around the ankle that prevented their full recovery. One patient complained of persistent pain which was considered complex regional pain syndrome. Conclusion: Though the outcome of the Modified Brostrom procedure as a method of revision surgery was less satisfactory compared to the results of primary ankle reconstruction, it would be an appropriate option when concomitant abnormalities were not accompanying.