• Journal of The Korean Dental Society of Anesthesiology
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• v.14 no.2
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• pp.89-94
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• 2014

Local anesthesia known as the safe and essential procedure to control pain in dentistry may cause sensory changes such as paresthesia or altered taste at the affected sites after even successful local anesthesia. Although the prognosis of the nerve injuries after local anesthesia is favorable, it might cause prolonged problems such as dysesthesia. The lingual nerve is a single fascicle at the level of the lingual among 1/3 of patients and more movable during regeneration compared to the inferior alveolar nerve after the injury. As a result, the lingual nerve is more vulnerable and has poorer outcomes. More vigilant clinical considerations are required to the lingual nerve injury after local anesthesia. Generally, more than 80% of cases are spontaneously resolved within 2 weeks after the local anesthesia even without any specific treatment. However, the patient having long lasting abnormal sensations more than 2 weeks needs specialists' care for further assessment. In case of dysesthesia which is a symptom of neuropathic pain, immediate referral to specialists is mandatory. The exact mechanism, how to prevent its occurrence, or specific treatments of the nerve injury related to the local anesthesia have not been elucidated. To prepare clinical or medicolegal problems, many cautious considerations are given to the patients who complain sensory changes after local anesthesia.

• Journal of Oral Medicine and Pain
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• v.49 no.1
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• pp.18-21
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• 2024

Orofacial pain has various causes, making it challenging to differentiate from dental-related diseases based solely on symptoms. Toothache, usually attributed to pathological changes in the pulp and periodontal tissue, is the most common cause of orofacial pain and relatively easy to diagnose. However, distinguishing orofacial pain and nonodontogenic toothache due to myofascial, neuropathic, neurovascular, paranasal sinus and cardiac originating, and psychogenic pain presents diagnostic challenges that may result in incorrect treatment. Therefore, dentists must recognize that orofacial pain can arise from not only dental issues but also other causes. This case report explores the necessary considerations in diagnosing orofacial pain and nonodontogenic toothache by examining the diagnoses of patients presenting at the dental hospital with orofacial pain and nonodontogenic toothache of cardiac origin.

• Journal of Acupuncture Research
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• v.21 no.3
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• pp.133-144
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• 2004

Background and Objective : Twirling is one of the needling methods, which is frequently used for acupuncture in oriental medicine. Some thesis about needle manipulation has been reported that needle manipulation is more effective than plain acupuncture. So we have developed the auto-controlled twirling needle(ACTN) system which is most simple style of needle manipulation. The present study was conducted to see if ACTN can enhance the antinociceptive effect of acupuncture. Methods : To investigate the analgesic effect of acupuncture we used two pain model. One is acute pain model using tail flick latency(TFL), the other is neuropathic pain model using mechanical allodynia. For TFL test, rats were lightly anesthetized with pentobarbital sodium(40 mg/kg, i.p). To produce mechanical allodynia in the rat tail, the right superior caudal trunk was resected between the S1 and S2 spinal nerves. For plain acupuncture(PA), a needle was inserted into a Zusanli(ST36) for 15min. In combining ACTN with PA, twirling needle was performed once in a second. We measured the difference of analgesic effect of only PA and ACTN on two different kinds of pain. Results and conclusion : ACTN increased TFL more than PA. (15min P<0.001, 25min P<0.01). And ACTN also reduced neuropathic pain (15min P<0.01, 25min<0.05). But PA alone can't reduce the neuropathic pain. These results indicate that ACRN had more analgesic effect than PA. The mechanism that play a key role, and the condition which produce best analgesic effect of ACTN are to be studied further.

• Journal of Yeungnam Medical Science
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• v.35 no.1
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• pp.104-108
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• 2018

Syncope is defined as a transient loss of consciousness and postural tone, characterized by rapid onset, short duration, and spontaneous recovery. Stellate ganglion block (SGB) is a nerve block method that is used for treatment of neuropathic pain in the head, neck and upper extremities, especially trigeminal neuralgia, postherpetic neuralgia and complex regional pain syndrome. SGB can modulate and stabilize the sympathetic nervous system, which prevents it from overexcitation and improves symptoms of syncope. The authors report a patient who was treated for pain and edema of both upper extremities with SGB, then showed improvement in recurrent syncope followed by chest pain and overall quality of life.

• The Korean Journal of Pain
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• v.21 no.3
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• pp.173-178
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• 2008

Background: The intrathecal (IT) $GABA_A$ receptor antagonist, bicuculline (BIC), results in tactile allodynia (TA) through disinhibition in the spinal cord. Such disinhibition is considered to be an important mechanism for neuropathic pain. Agmatine, an endogenous polyamine, has a neuro-protective effect in the central nervous system. We investigated the analgesic effects and mechanisms of agmatine action on BIC-induced TA. Methods: Male Sprague-Dawley rats, weighting 250-300 g, were subjected to implantations of PE-10 into the lumbar subarachnoid space for IT drug injection. Five days after surgery, either $10{\mu}l$ of normal saline (NS) or agmatine ($30{\mu}g$ or $10{\mu}g$) in $10{\mu}l$ NS were injected 10 min prior to BIC ($10{\mu}g$) or NMDA ($5{\mu}g$). We assessed the degree of TA (graded 0: no response, 1: mild response, 2: moderate response, 3: strong response) every 5 min for 30 min. Areas under curves and degree of TA were expressed as mean ${\pm}$ SEM. Results were analyzed using one-way ANOVA followed by a Tukey test for multiple comparisons. P < 0.05 was considered significant. Results: IT BIC-induced strong TA reached its peak and plateaued between 10 to 15 min. IT NS-NMDA induced mild transient TA for up to 15 min. Preemptive IT AG attenuated IT BIC-induced TA dose dependently and preemptive IT AG10 completely abolished the IT NMDA-induced TA. Conclusions: Preemptive IT AG attenuated the IT BIC-induced TA through inhibitory actions on postsynaptic NMDA receptor activation. AG might be a viable therapeutic option in the treatment of neuropathic pain.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.26-38
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• 1996

In a normal state, sympathetic efferent activity does not elicit discharges of sensory neurons, whereas it becomes associated with and excites sensory neurons in a pathophysiological state such as injury to a peripheral nerve. Although this sympathetic-sensory interaction is reportedly adrenergic, involved subtypes of adrenoreceptors are not yet clearly revealed. The purpose of this study was to determine which adrenorceptor subtypes were involved in sympathetic-sensory interaction that was developed in rats with an experimental peripheral neuropathy. Using rats that received a tight ligation of one or two of L4-L6 spinal nerves 10~15 days previously, a recording was made from afferent fibers in microfilaments teased from the dorsal root that was in continuity with the ligated spinal nerve. Electrical stimulation of sympathetic preganglionic fibers in T13 or L1 ventral root (50 Hz, 2-5 mA. 0.5 ms pulse duration, 10 sec) was made to see if the activity of recorded afferents was modulated. About half of afferents showing spontaneous discharges responded to sympathetic stimulation, and had the conduction velocities in the A-fiber range. Most of the sympathetically induced afferent responses were excitation. This sympathetically induced excitation occurred in the dorsal root ganglion (DRG), and was blocked by yohimbine (${\alpha}_2$ blocker), neither by propranolol ($\beta$ blocker) not by prazosine (${\alpha}_1$ blocker). The results suggest that after spinal nerve ligation, sympathetic efferents interact with sensory neurons having A-fiber axons in DRG where adrenaline released from sympathetic nerve endings excites the activity of sensory neurons by acting on 2-adrenoreceptors. This 2-adrenoreceptor mediated excitation of sensory neurons may account for sympathetic involvement in neuropathic pain.

• Journal of Medicine and Life Science
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• v.20 no.1
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• pp.1-7
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• 2023

Transient receptor potential ankyrin 1 (TRPA1) receptors are major polymodal nociceptors that generate primary pain responses in the peripheral nerve endings of the dorsal root ganglion neurons. Recently, we reported that the activation of TRPA1 receptors by reactive oxygen species (ROS) signaling, which is triggered by Ca²⁺ influx through T-type Ca²⁺ channels, contributes to prolonged pain responses induced by jellyfish toxin. In this review, we focus on the characteristics of the TRPA1 receptor involved in intracellular signaling as a secondary pain modulator. Unlike other transient receptor potential receptors, TRPA1 receptors can induce membrane depolarization by ROS without exogenous stimuli in peripheral and central sensory neurons. Therefore, it is important to identify the functional characteristics of TRPA1 receptors to understand pain modulation under several pathogenic conditions such as neuropathic pain syndromes and autoimmune diseases, which are mediated by oxidative signaling to cause chronic pain in the sensory system.

• Journal of Korean Medicine Rehabilitation
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• v.19 no.3
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• pp.15-32
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• 2009

Objectives : The purpose of this Study was to identify the effect of Dokhwalgisaeng-tang(Duhuoqisheng-tang) and Jungsongouhyul pharmacopuncture on pain control and nerve regeneration after crush injury in rat sciatic nerve. Methods : Neuropathic pain was induced by crush-induced model of right sciatic nerve. Animal groups were divided as follows; Group I: no treatment control group, Group II : experimental group treated with Dokhwalgisaeng-tang(Duhuoqisheng-tang), Group III : experimental group treated with Jungsongouhyul pharmacopuncture, and Group IV : experimental group treated with Dokhwalgisaeng-tang(Duhuoqisheng-tang) and Jungsongouhyul pharmacopuncture. To evaluate pain intensity, each group was observed paw withdrawal threshold and immunoreactivity on the c-fos before and after respective treatments in five hours, first, third, and fifth day. To evaluate nerve regeneration, those were observed SFI(Sciatic Functional Index) and GAP-43(Growth Associated Protein 43) after each treatment in seventh and thirteenth day. Results : 1. Paw withdrawal threshold to the mechanical stimuli made the significant difference between group IV and the control group after five days of the experiment. 2. Paw withdrawal threshold to the thermal stimuli made the significant difference between group I and III, I and IV, II and IV. 3. In immunohistochemical response of c-fos, as time passes, the immunoreactivity of all groups was decreased gradually. Especially, group IV was observed the lowest after three days. 4. The differences of sciatic function indexes in each group were significantly between group I and III, I and IV, II and IV after 14 days, and between group I and III, I and IV, II and IV, III and IV after 21 days. 5. In immunohistochemical response of GAP-43, all groups had higher GAP-43 immunoreactivity at the 14 days from post-injury and group IV showed highest immunoreactivity. Conclusions : Based on above the results, it is proposed that Dokhwalgisaeng-tang(Duhuoqisheng-tang) and Jungsongouhyul pharmacopuncture may be helpful as a treatment in neuropathic pain and nerve regeneration in rat model.

• Korean Journal of Acupuncture
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• v.22 no.2
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• pp.9-24
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• 2005

Objective: We have studied the effects of acupuncture and low level He-Ne laser therapy(LLLT) at $SI_3$, $BL_{40}$ on the tibial, sural nerve injury due to sports-damage or traffic accident and L5 spinal nerve ligature model like general herniation of nucleus pulposus(HNP) in a rat of neuopathic pain. Methods: A model of neuropathic pain was made by injuring tibial nerve and sural nerve while common peroneal nerve was maintained. Also, it was made by isolating left 5th lumbar spinal nerve. Three weeks after the neuropathic surgery, acupuncture and LLLT was injected at $SI_3$,$BL_{40}$ one time a day for one week. LLLT was divided three groups, that is LLLT-1(5mW), LLLT-2(10mW) and LLLT-3(30mW). After that, we examined the withdrawal response of neuropathic rats' legs by Von frey filament and acetone stimulation. And also we examined c-Fos, Nocieptin and KOR-3 in the midbrain central gray of neuropathic rats. Results: As we have observed the effect of mechanical allodynia, LLLT-3 group were diminished on 4 day, 5 day, 6 day and 7 day in the resection model compared with control model, LLLT-1 group were diminished on 5 day, LLLT-2 group were diminished on 3 day and 6 day, LLLT-3 group were diminished on 3 day, 4 day, 5 day, 6 day and 7 day in connected model compared with control group. As we have observed the effect of cold allodynia, LLLT-3 group were diminished on 7 day in the resection model compared with control model, LLLT-1 group were diminished on 6 day, 7 day, LLLT-3 group were diminished on 7 day in connected model compared with control group. As we have observed the effect of activity of c-Fos in the central gray part, LLLT-3 were diminished in resection model compared with control group, LLLT-1 group were diminished in connected model compared with control group. As we have observed the effect of activity of Nociceptin in the central gray part, resection model were not increased compared with control group, LLLT-1 group and LLLT-3 group were increased in connected model compared with control model. As we have observed the effect of activity of KOR-3 in the central gray part, resection model were not increased compared with control group, LLLT-3 group were increased in connected model compared with control model. Conclusions: We have noticed that LLLT-1 and LLLT-3 group have more controllable effect than acupuncture group. This study can be used in clinical therapy for neuropathic pain. But it is not reliability that Nociceptin and KOR-3 have effectively to control pain. Therefore We have to follow up about that.

• Journal of Acupuncture Research
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• v.29 no.4
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• pp.93-97
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• 2012

Complex regional pain syndrome type 1(CRPS 1) is a neuropathic pain disorder that accompanies severe pain and motor deficit as well as changes in the skin in the extremities. The pathophysiology of CRPS 1 is still not exactly elucidated. However, the general consensus of involvement of inflammatory mediators in the development of CRPS 1 is amply made. On the basis that placental extract successfully inhibited the production of inflammatory cytokines and mediators in several experimental models, we have tried a long-term weekly injection of placental extract into acupuncture points to a CRPS 1 patient suffering pain and immobilization of shoulder joint. The results say that placental extract effectively resolved pain, restored skin color and improved immobilization of shoulder joint in the CRPS 1 patient.