• The Korean Journal of Pain
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• v.25 no.1
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• pp.7-15
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• 2012

Background: Neuropathic pain is a chronic pain due to disorder in the peripheral or central nervous system with different pathophysiological mechanisms. Current treatments are not effective. Analgesic drugs combined can reduce pain intensity and side effects. Here, we studied the analgesic effect of nimesulide, nefopam, and morphine with different mechanisms of action alone and in combination with other drugs in chronic constriction injury (CCI) model of neuropathic pain. Methods: Male Wistar rats (n = 8) weighing 150-200 g were divided into 3 different groups: 1- Saline-treated CCI group, 2- Saline-treated sham group, and 3- Drug-treated CCI groups. Nimesulide (1.25, 2.5, and 5 mg/kg), nefopam (10, 20, and 30 mg/kg), and morphine (1, 3, and 5 mg/kg) were injected 30 minutes before surgery and continued daily to day 14 post-ligation. In the combination strategy, a nonanalgesic dose of drugs was used in combination such as nefopam + morphine, nefopam + nimesulide, and nimesulide + morphine. Von Frey filaments for mechanical allodynia and acetone test for cold allodynia were, respectively, used as pain behavioral tests. Experiments were performed on day 0 (before surgery) and days 1, 3, 5, 7,10, and 14 post injury. Results: Nefopam (30 mg/kg) and nimesulide (5 mg/kg) blocked mechanical and thermal allodynia; the analgesic effects of morphine (5 mg/kg) lasted for 7 days. Allodynia was completely inhibited in combination with nonanalgesic doses of nefopam (10 mg/kg), nimesulide (1.25 mg/kg), and morphine (3 mg/kg). Conclusions: It seems that analgesic drugs used in combination, could effectively reduce pain behavior with reduced adverse effects.

• The Korean Journal of Pain
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• v.22 no.1
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• pp.107-111
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• 2009

Neuroablation should be performed cautiously because neuropathic pain can occur following denervation of a somatic nerve. A 34-year-old man presented with severe penile pain and allodynia following a selective neurectomy of the sensory nerve that innervated the glans penis for treatment of his premature ejaculation. He was treated with various nerve blocks, including continuous epidural infusion, lumbar sympathetic block and sacral selective transforaminal epidural blocks, as well as intravenous ketamine therapy. However, all of the treatments had little effect on the relief of his pain. We performed spinal cord stimulation as the next therapy. After this therapy, the patient has currently been satisfied for 3 months.

• Clinics in Shoulder and Elbow
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• v.6 no.2
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• pp.115-126
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• 2003

Although painful conditions of varying degrees of severity involving the soft tissues (i .e., muscles, tendons, ligaments, periosteum and peripheral nerves) occur frequently, their underlying pathogenesis is poorly understood. The term peripheral neuropathic pain has recently been suggested to embrace the combination of positive and negative symptoms in patients whose pain is due to pathological changes or dysfunction in peripheral nerves or nerve root. The spinal nerve root, because of its vulnerable position, is very easily prone to injury from pressure, stretch, angulation, and friction. Therefore, not a few of musculoskeletal chronic pains are result of nerve root dysfunction. Neuropathic changes due to nerve root dysfunction are primarily in soft tissue especially muscle, tendon and joint. It shows tenderness over muscle motor points and palpable muscle contracture bands and restricted Joint range. Careful palpation and physical examination is the important tool that, be abne to detect all of these phenomena.

• Journal of Korean Medicine Rehabilitation
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• v.23 no.2
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• pp.175-184
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• 2013

This study is to observe the effect of Korean medicine treatment combined with electro-acupuncture and chuna manual treatment on tarsal tunnel syndrome inpatient. The patient, diagnosed as tarsal tunnel syndrome, was treated by Korean medicine treatment in combination with electro-acupuncture and chuna manual treatment. We measured visual analogue scale(VAS). Neuropathic pain scale(NPS) was adopted as a method of measuring the treatment results of pain & hypoesthesia. Rt. sole numbness & pain decreased from VAS 10 to VAS 4. Rt. foot paresthesia decreased from VAS 10 to VAS 4 and Rt. ankle pain was disappeared. NPS score decreased from 80 to 62. Korean medicine treatment in combination with electro-acupuncture and chuna manual treatment is proved to be helpful to improve the symptoms of the tarsal tunnel syndrome patient.

• The Korean Journal of Pain
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• v.24 no.4
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• pp.226-230
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• 2011

Surgical excision was performed on a 30-years old woman with a painful mass on her left thigh. The pathologic findings on the mass indicated fibromatosis. After the operation, she complained of allodynia and spontaneous pain at the operation site and ipsilateral lower leg. We treated her based on postoperative femoral neuropathy, but symptom was aggravated. We found a large liposarcoma in her left iliopsoas muscle which compressed the lumbar plexus. In conclusion, the cause of pain was lumbar plexopathy related to a mass in the left iliopsoas muscle. Prompt diagnosis of acute neuropathic pain after an operation is important and management must be based on exact causes.

• Journal of Acupuncture Research
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• v.31 no.2
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• pp.119-134
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• 2014

Objectives : The purpose of this study was to investigate the analgesic effects of filiform acupuncture and laser acupuncture at the points of $TE_3{\cdot}GB_{41}$ in neuropathic pain induced rats. Methods : Neuropathic pain in rats was induced by partial resection of the tibial and sural nerves. Three weeks after the neuropathic surgery, each of the experimental groups(AT, LAT, AT + LAT and LAT + AT) was injected at the $TE_3{\cdot}GB_{41}$ twice per week for three weeks. Results : 1. All of the experimental groups(AT, LAT, AT + LAT and LAT + AT) showed a significant decrease in the plantar withdrawal response of allodynia and the thermal allodynia as compared with the control group. During the early phase, the AT and AT + LAT groups have been marked as more significant than the LAT + AT and LAT groups. 2. The expression of c-Fos significantly decreased in the LAT and LAT + AT groups as compared with the control group. 3. The LAT + AT group showed a significant decrease in Bax as compared with the control group. In each experimental groups(AT, LAT, AT + LAT and LAT + AT), Bcl-2 increased and Bax/Bcl-2 ratio decreased as compared with the control group. 4. The LAT, AT + LAT and LAT + AT groups showed a significant increase in mGluR5 as compared with the control group. Conclusions : These results represented that the filiform acupuncture and laser acupuncture at the $TE_3{\cdot}GB_{41}$ exerted anti-apoptotic and neuroprotective effects on the model of neuropathic pain, thereby suggesting that they should be available for decreasing mechanical allodynia.

• Journal of Acupuncture Research
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• v.21 no.1
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• pp.240-251
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• 2004

Objective: We have studied to know effects of acupuncture at SI3, BL40, SI3 BL40 on mechnical allodynia, cold allodynia and c-fos protein expression in a model of neuropathic pain of rat. Methods: A model of neuropathic pain was made by injuring tibial nerve and sural nerve while common peroneal nerve was maintained. after 2 weeks, we performed behavioral tests for 7 days to try out mechnical allodynia using von frey filament and cold allodynia using acetone, which are calculated by counting withdrawal response on foot. Rat brains removed and sliced on 8th days. Serial sections were immunohistochemically reacted with polyclonal c-fos antibody. The numbers of c-Fos protein immunoreactive neurons in the central gray were examined using scion image program. Results: Mechanical allodynia in the SI3, BL40, SI3 BL40 groups were diminished compared with the control group. Cold allodynia in the SI3, BL40, SI3 BL40 groups were diminished compared with the control group. c-Fos protein expression on the central gray in the SI3 group were lower than that of the control group. Conclusions: We have noticed that acupuncture at SI3, BL40, SI3 BL40 diminished mechanical allodynia and cold allodynia in a model of neuropathic pain compared with the control group. c- Fos protein expression in the central gray of that group was also decreased compared with the control group. pain control using acupunture was accumulated as time goes by. This study can be used as a basic resource on a study and a treatment of pain.

• Journal of Korean Foot and Ankle Society
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• v.17 no.3
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• pp.203-208
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• 2013

Purpose: We analyzed retrospectively the effect of pyridoxine in the treatment of peripheral nerve related foot pain because we have seen favorable clinical results from it as a monotherapy. Materials and Methods: We analyzed the clinical results of 200 cases of peripheral nerve related foot pain, treated with pyridoxine from March 2009 to February 2012. We devided them into three groups, peripheral neuritis, Morton's neuroma and posttraumatic neuralgia and recorded percentage of improvement of pain, compared to initial pain level at 2 weeks and 6 weeks. Results: There were 127 peripheral neuritis cases, 22 Morton's neuroma and 51 posttraumatic neuralgia. At 2 weeks after treatment, 135 cases(67.5%) showed pain relief. At 6 weeks, 36 cases(21%) showed complete improvement of pain, 81 cases(47%) showed more than 50 % of improvement, 22 cases(13%) showed less than 50% of improvement and 33 cases(19%) showed no improvement. There are 4 cases of gastrointestinal discomfort and 2 cases of aggravation of nervy pain. Conclusion: Pyridoxine was effective drug in the treatment of peripheral neuropathic pain in terms of pain relief, safety and cost effectiveness. So it can be an available first line drug before adding other drugs.

• The Korean Journal of Pain
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• v.14 no.1
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• pp.26-31
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• 2001

Background: Sympathetic blocks with local anesthetics are used to differentiate sympathetically- maintained pain (SMP) from sympathetically-independent pain (SIP). However, systemic lidocaine is also used in the management of neuropathic pain. Therefore, there may be possibility of a false positive response in relieving their pain by systemic absorption of lidocaine following a diagnostic sympathetic block in patients with SIP. In this study, we measured the plasma lidocaine concentrations after a stellate ganglion block (SGB) using three volumes of 1% lidocaine. Methods: This prospective, crossover study was performed in 3 patients who experience sudden hearing loss and in 4 volunteers. Each person received SGB three times using three different volumes (6 ml, 12 ml and 16 ml) of 1% lidocaine at one week intervals. SGB was performed using a 23 G butterfly needle via a paratracheal approach by two persons. Two ml of venous blood was obtained from a prepared contra-lateral sided venous route at 1, 3, 5, 7, 10, 20 and 60 min after SGB. Plasma lidocaine level was analyzed by immunoassay. Results: Mean plasma lidocaine concentrations correlated well with the volumes of 1% lidocaine used in SGB; larger volumes showed higher concentrations (P < 0.01). Mean peak plasma concentrations were $1.08{\pm}0.18$ in 6 ml, $1.90{\pm}0.47$ in the 12 ml and $2.74{\pm}0.67{\mu}g/ml$ in the 16 ml groups (P < 0.01). The mean time to reach peak plasma concentration was not significantly different between the three groups. Conclusions: The peak plasma lidocaine concentrations in SGB using large volume were found to be similar to that of IV lidocaine infusion in the management of neuropathic pain. These data suggest that diagnostic sympathetic block may result in many false positive responses for SMP. Part of its effect may be related to systemic local anesthetic absorption and not to a sympathetic block. Therefore, physicians may be required to use optimal volumes and minimal concentration of local anesthetic in diagnostic sympathetic block procedures and also make a careful assessment of the performance of a permanent sympathetic block.

• Journal of Korean Neurosurgical Society
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• v.50 no.5
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• pp.420-425
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• 2011

Objective : Excitatory amino acids play important roles in the development of secondary pathology following spinal cord injury (SCI). This study was designed to evaluate morphological changes in the dorsal horn of the spinal cord and assess profiles of pain behaviors following intraspinal injection of N-methyl-D-aspartate (NMDA) or quisqualate (QUIS) in rats. Methods : Forty male Sprague-Dawley rats were randomized into three groups : a sham, and two experimental groups receiving injections of 125 mM NMDA or QUIS into their spinal dorsal horn. Following injection, hypersensitivity to cold and mechanical stimuli, and excessive grooming behaviors were assessed serially for four weeks. At the end of survival periods, morphological changes in the spinal cord were evaluated. Results : Cold allodynia was developed in both the NMDA and QUIS groups, which was significantly higher in the QUIS group than in the NMDA group. The mechanical threshold for the ipsilateral hind paw in both QUIS and NMDA groups was significantly lower than that in the control group. The number of groomers was significantly higher in the NMDA group than in the QUIS group. The size of the neck region of the spinal dorsal horn, but not the superficial layer, was significantly smaller in the NMDA and QUIS groups than in the control group. Conclusion : Intraspinal injection of NMDA or QUIS can be used as an excitotoxic model of SCI for further research on spinal neuropathic pain.