• The Korean Journal of Pain
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• 제23권2호
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• pp.147-150
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• 2010

Background: Chronic low back pain can be a manifestation of lumbar degenerative disease, herniation of intervertebral discs, arthritis, or lumbar stenosis. When nerve roots are compromised, low back pain, with or without lower extremity involvement, may occur. Local inflammatory processes play an important role in patients with acute lumbosciatic pain. The purpose of this study was to assess the value of erythrocyte sedimentation rate (ESR) and high sensitivity C-reactive protein (hsCRP) measurements in patients with chronic low back pain or radiculopathy. Methods: ESR and hsCRP were measured in 273 blood samples from male and female subjects with low back pain and/or radiculopathy due to herniated lumbar disc, spinal stenosis, facet syndrome, and other diseases. The hsCRP and ESR were measured prior to lumbar epidural steroid injection. Results: The mean ESR was 18.8 mm/h and mean hsCRP was 1.1 mg/L. ESR had a correlation with age. Conclusions: A significant systemic inflammatory reaction did not appear to arise in patients with chronic low back pain.

• Annals of Clinical Neurophysiology
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• 제14권1호
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• pp.1-6
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• 2012

Low back pain is a common clinical condition with heterogeneous causes and challenges to manage. High prevalence and numerous assessments result in an enormous socioeconomic burden. Clinician must conduct efficient and stepwise evaluation process to rule out serious spinal pathology, neurologic involvement, and identify risk factors for chronicity. The process can be achieved through the focused history taking and physical examination. Certain factors related to serious spinal pathology include age (>50 years), trauma, unexplained fever, recent urinary or skin infection, unrelenting night or rest pain, unexplained weight loss, osteoporosis, immunosuppression, steroid use, and widespread neurological symptoms. In non-specific low back pain, diagnostic imaging and laboratory studies are often unnecessary and can disturb an appropriate management. For the management of acute low back pain, patient education and medication such as acetaminophen, non-steroidal anti-inflammatory drugs, and muscle relaxants are recommended. For chronic low back pain, behavior therapy, back exercise, and spinal manipulation are beneficial. The evidence based approach could improve success rate of management, result in prevention of acute low back pain from being chronic intractable pain.

• The Korean Journal of Pain
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• 제18권1호
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• pp.69-73
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• 2005

This report describes a case of spinal nerve root compression due to an acute inflammatory granuloma after lumbar surgery. A 39 year-old man with a history of increasing back pain with a 3-week duration was diagnosed with a herniated intervertebral disc (HIVD). The diagnosis of a HIVD was confirmed by magnetic resonance imaging (MRI) with indications for surgery. A discectomy and a partial laminectomy was performed and the symptoms were alleviated immediately after surgery for a five-day period. However, a slowly progressing pain was subsequently noted along a different dermatome. There was no pain relief despite the patient being given pharmacological treatments, combined with an epidural steroid injection. The follow up MRI images showed severe compression of the nerve roots by a epidural lesion. Another procedure was performed 17 days after the initial operation. The lesion responsible for the compression of the nerve roots was found to be an acute inflammatory granuloma. The pain was relieved after the second procedure and there were no other symptoms or neurological problems. This case is remarkable in that a granuloma formed relatively quickly and grew to such a size that it was able to severely compress the surrounding nerve roots.

• The Korean Journal of Pain
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• 제4권1호
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• pp.51-55
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• 1991

There is a variety of therapeutic modality for herniated nucleus pulposus. Recently the low level laser has come into use for treatment for it. We treated two patients suffered from herniated nucleus pulposus of the central type of $L_{3,4}$ level, with He-Ne, $CO_2$ and Ga Al As laser simultaneously daily under hospitalization. In order to determine the efficacy of treatment, we used the "visual analogue scale" and its improvement rate. The results were as follows; Case I complained of gait disturbance, and hypoesthesia on the lateral side of the left lower leg, as and as low back pain. At the 15th day after treatment, VAS improvement rate was 40%, and the gait disturbance and hypoesthesia were markedly improved. 35th days after tratement, VAS improvement rate was 80%. Case II complained only of low back pain. At the 15th day after treatment, the VAS improvement rate was 68%, and at 20 days after treatment it was 84%. We sugsest that, using the low level laser for treatment of herniated nucleus pulposus increased the cartilage entrophism, and inhibitory effects of the inflammatory materials such as acid glycosaminoglycan by its anti-inflammatory and analgesic effects.

• 대한수의학회지
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• 제39권4호
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• pp.715-723
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• 1999

Bee venom (BV) has been traditionally applied to relieve pain and to cure inflammatory diseases such as rheumatoid arthritis (RA) and neuritis. While several investigators have evaluated the anti-inflammatory effect of BV treatment, the anti-nociceptive effect of BV treatment on inflammatory pain is not reported. Therefore, we decided to evaluate the analgesic effect of BV treatment using Freund's adjuvant induced chronic arthritis model. Freund's adjuvant-induced arthritis has been used as an experimental animal model for RA in humans to assess the efficacy of the anti-inflammatory/analgesic drugs. In this study, subcutaneous BV treatment (1mg/kg/day) produced significantly reductions of symptoms related to arthritic pain (i.e. mechanical hyperalgesia and thermal hyperalgesia). The anti-nociceptive effect of BV was observed from at least 12 days after BV treatment. Furthermore, BV treatment significantly suppressed adjuvant induced Fos expression in lumbar spinal cord. We also found that local injection of BV into near the inflammatory site (especially Zusanli-acupoint) showed more potent analgesic effect on arthritic pain rather than distant injection of BV from inflammatory site (arbitrary side of back). The present study demonstrates that BV treatment has anti-nociceptive effect on arthritis induced inflammatory pain. The analgesic effect of BV on RA is probably mediated by the effect of BV itself or possible other mechanism such as counter-irritation. Furthermore, it is possible that BV acupuncture is one of the promising candidates for long-term therapy of RA.

• The Korean Journal of Pain
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• 제33권4호
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• pp.294-304
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• 2020

The sacroiliac joints connect the base of the sacrum to the ilium. When inflamed, they are suspected to cause low back pain. Inflammation of the sacroiliac joints is called sacroiliitis. The severity of the pain varies and depends on the degree of inflammation. Sacroiliitis is a hallmark of seronegative spondyloarthropathies. The presence or absence of chronic sacroiliitis is an important clue in the diagnosis of low back pain. This article aims to provide a concise overview of the anatomy, physiology, and molecular biology of sacroiliitis to aid clinicians in the assessment and management of sacroiliitis. For this narrative review, we evaluated articles in English published before August 2019 in PubMed. Then, we selected articles related to the painful manifestations of the sacroiliac joint. From the retrieved articles, we found that chronic sacroiliitis may be caused by various forms of spondyloarthritis, such as ankylosing spondyloarthritis. Sacroiliitis can also be associated with inflammatory bowel disease, Crohn's disease, gout, tuberculosis, brucellosis, and osteoarthritis, indicating common underlying etiological factors. The pathophysiology of sacroiliitis is complex and may involve internal, environmental, immunological, and genetic factors. Finally, genetic factors may also play a central role in progression of the disease. Knowing the genetic pre-disposition for sacroiliitis can be useful for diagnosis and for formulating treatment regimens, and may lead to a substantial reduction in disease severity and duration and to improved patient performance.

• The Korean Journal of Pain
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• 제37권4호
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• pp.288-298
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• 2024

Nerve growth factor (NGF) is a neurotrophic protein that has crucial roles in survival, growth and differentiation. It is expressed in neuronal and non-neuronal tissues. NGF exerts its effects via two types of receptors including the high affinity receptor, tropomyosin receptor kinase A and the low affinity receptor p75 neurotrophin receptor highlighting the complex signaling pathways that underlie the roles of NGF. In pain perception and transmission, multiple studies shed light on the effects of NGF on different types of pain including inflammatory, neuropathic, cancer and visceral pain. Also, the binding of NGF to its receptors increases the availability of many nociceptive receptors such as transient receptor potential vanilloid 1, transient receptor potential ankyrin 1, N-methyl-D-aspartic acid, and P2X purinoceptor 3 as well as nociceptive transmitters such as substance P and calcitonin gene-related peptide. The role of NGF in pain has been documented in pre-clinical and clinical studies. This review aims to shed light on the role of NGF and its signaling in different types of pain.

• Journal of Acupuncture Research
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• 제19권3호
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• pp.216-229
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• 2002

Objective : To compare the effect of Carthmi- Flos herbal acupuncture theraphy and acupucture treatment to Low back pain patient. Methods : 70 patients with Low back pain are evaluated by being divided Carthmi- Flos herbal acupuncture theraphy Group(HAG, 30 peples) and non- Carthmi- Flos herbal acupuncture theraphy Group(NHAG, 40 peoples) at Ik-San Oriental medical hospital in wonkwang university from the first November 2000yr to 31th December 2001yr. Results : 1. In the cause of Low back pain, the most of HAG is acute sprain(9cases, 30%) and NHAG is non-inducement(13 cases, 22.5%). 2. In the analysis of the radiation result, HIVD and Degenerative change respectively were 22 cases(50%) in HAG and 29 cases(52.8 %) in NHAG. 3. The effect of treatment by Duration as follows :Two groups were the most improved highly in acute stage and they were improved lowly in chronic stage(6 month). 4. The effect of treatment by condition of patients was follows: After treatment, Grade IV & III were decreased 69.5% in HAG and 60% in NHAG. 5. In the distribution of treatment progression : 28 cases(93.3%) were recoverd in HAG but 30 cases(90%) in NHAG. Conclusion : These results shows that the effect of treatment by Carthmi- Flos herbal acupuncture treatmen is exellent by relaxing contracted muscles, strengthening weakened ligaments and improving inflammatory parts.

• The Korean Journal of Pain
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• 제8권1호
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• pp.149-151
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• 1995

Piriformis syndrome is a syndrome of low back and leg radiating pain thought to be due to a chronic contracture of the piriformis muscle that causes irritation of the sciatic nerve. The piriformis muscle is a flat pyramidal muscle, an external rotator and abductor of the hip, originating from the front of the sacrum and inner aspect of the sacroiliac joint, then passes laterally out of the sciatic notch to attach posteriorly to the greater trochanter of the femur, the sciatic nerve passes between the two bellies of the muscle. Mechanical irritation of the sciatic nerve by an inflammatory reaction of the piriformis muscle and its fascia at this pelvic level causes pain to radiate in the dermatomal regions of the nerve roots similar to that disk entrapment. diagnosis of piriformis syndrome is made primary on the basis of history and clinical examination. The incidence is considerably higher in women, with the reported ratio of women to men of 6:1. These patients frequently present with associated symptoms of pelvic pain and/or dyspareunia. Symptoms are usually unilateral but occasionally be bilateral. We had a 42 year-old woman patient with low back and left leg radiating pain and dyspareunia treated by caudal steroid and local anesthetic.

• 대한정형외과학회지
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• 제56권4호
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• pp.283-293
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• 2021

퇴행성 추간판 질환은 전통적으로 수핵과 섬유륜의 변화에 따른 요통으로 생각되어 왔으나, 최근 연구들에서 추간판을 이루고 있는 상·하 종판의 변화가 추간판의 퇴행을 유발하고, 그 결과로 기계적 압박과 염증 반응에 의해 요통이 유발된다고 한다. 또한 최근에는 추체 골수-종판-수핵과 섬유륜을 하나의 단위로 생각하고, 그 연관성을 설명하고 있다. 종판이 손상되면 결국 추체, 수핵과 섬유륜의 퇴행성 변화를 가중시킨다. 이 과정에서 섬유륜에 가해지는 압박력이 증가하고, 염증성 매개 물질들에 의한 염증 반응이 일어나서, 동척추 신경(sinuvertebral nerve)과 기저추 신경(basivertebral nerve)이 자극을 받으면서 요통을 발생시킨다. 이런 변화가 만성화되면, 추체 내 골수에도 Modic 변화 같은 퇴행성 변화가 발생하게 된다. 결국, 퇴행성 추간판 질환은 추체 골수-종판-수핵과 섬유륜을 하나의 단위로 연관지어서 생각해야 할 필요가 있다. 그러므로 만성 요통 환자 진료 시에는 수핵과 섬유륜의 변화 소견뿐 아니라, 종판의 병변에 관심을 가질 필요가 있다고 생각된다.