• Journal of Hospice and Palliative Care
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• v.12 no.2
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• pp.88-94
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• 2009

Chest pain is a symptom observed commonly in outpatients and emergency room patients, and its causes are variable. Because treatment and prognosis of chest pain are different depending on its cause, it is more important than anything else to accurately diagnose the cause of chest pain. Most of patients complaining of chest pain undergo basic tests at a private local clinic or at the Internal medicine or chest surgery department of a general hospital and, they are referred to the pain clinic, with a note stating no particular finding. However, if they have sustained severe neuropathic pain in spite of nerve block, accurate diagnosis for chest pain is essential. We experienced rapidly developing spine breakdown and cord compression caused by metastatic spinal tumor in an inpatient who was being treated for chest pain, and thus, we report here in the case with literature review.

• Journal of Dental Rehabilitation and Applied Science
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• v.28 no.2
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• pp.171-178
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• 2012

Botulinum toxin type A (BoNT-A) has been applied successfully to treat chronic migraine, dystonia, spasticity and temporomandubular disorders(TMDs) as well as frontal wrinkle and glabella wrinkle. Recently it has been reported that BoNT-A, reversibly blocks presynaptic acetylcholine release, also inhibits the release of substance P, CGRP(calcitonin gene related peptide) and glutamate related to peripheral sensitization and neurogenic inflammation in sensory nerve, In this study we reviewed animal nerve injury model such as rat and rabbit and identify the analgesic effect and mechanism of nerve injury pain after dental treatment.

• Journal of Yeungnam Medical Science
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• v.35 no.2
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• pp.240-243
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• 2018

Negative myoclonus (NM) is a jerky, shock-like involuntary movement caused by a sudden, brief interruption of muscle contraction. An 80-year-old man presented with multifocal NM and confusion. Two days before the onset of NM, he commenced the intake of pregabalin at a dose of 150 mg/day for neuropathic pain. His NM resolved completely and mental status improved gradually after the administration of lorazepam intravenously and the discontinuation of pregabalin. Our study suggests that pregabalin can cause NM even in patients without a history of seizures.

• Journal of Oral Medicine and Pain
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• v.32 no.4
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• pp.455-460
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• 2007

Majority of toothache is caused by abnormality of pulpal or periodontal tissues. However, there are numerous nonodontogenic sources that may be responsible for pain felt in the tooth. Nonodontogenic toothache may result from muscle, maxillary sinus, neuropathic, neurovascular, even cardiac and psychogenic problems. Myofascial pain is one of the most common abnormality characterized by palpation of a hard band which acts as the trigger point that causes stiffness and fatigue of the muscle, referral pain in tooth, tension-type headache, and hyperalgesia. Masseter muscle particularly induce referral pain in maxillary and mandibular molars. This case reported the treatment of the pain in right mandibular molar originated from myofascial pain of the right masseter. The pain is improved by general and reversible treatments such as muscle exercise, physical therapy, and medication. Nonodontogenic toothache should undergo proper differential diagnosis in order to avoid unnecessary dental treatments, such as endodontic, periodontic treatment, and tooth extraction, which would fail to alleviate the symptom of the patient.

• The Korean Journal of Pain
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• v.22 no.1
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• pp.28-32
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• 2009

Background: Complex regional pain syndrome (CRPS) is characterized by severe neuropathic pain and disability, which can result in psychological and behavioral dysfunction. The goal of the present study was to evaluate neurocognitive disability, and to assess the relationship between clinical variables and neuropsychological features in CRPS patients. Methods: We investigated the neuropsychological features of 15 CRPS I patients. The neuropsychological tests that we made comprised of a full intelligence quotient, memory quotient, trail-making test A, trail-making test B (TMT-B), and MMPI (Minnesota multiphasic personality inventory). Results: The results showed severe disability in performance on TMT-B. There was no significant correlation between specific cognitive variables and MMPI scales. Conclusions: Decreased performance on TMT-B which shows mental flexibility in the prefrontal lobe exists independently from depressive disorders in CRPS patients.

• The Korean Journal of Pain
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• v.30 no.3
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• pp.214-219
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• 2017

Background: As herpes zoster progresses via postherpetic neuralgia (PHN) to well-established PHN, it presents its recalcitrant nature to the treatment. At this point, the well-established PHN is fixed as a non-treatable, but manageable chronic painful neuropathic disorder. This study evaluated the incidence of complete relief from PHN according to PHN duration at their first visit, and the other factors influencing it. Methods: A retrospective chart review was performed on patients with PHN at a university-based pain clinic over 7 years. The responders were defined as patients who had complete relief from pain after 1 year of active treatment. Age, sex, PHN duration at their first visit, dermatomal distribution, and underlying disorders were compared in the responder and non-responder groups. Responders were also compared according to these factors. Results: Among 117 PHN patients (M/F = 48/69), 35 patients (29.9%) had complete relief from PHN. Mean ages were $64.3{\pm}10.6$ and $66.9{\pm}10.7$ years, numbers of male to female patients were 11/24 and 37/45, and mean durations of PHN at their first visit were $8.5{\pm}6.3$ and $15.3{\pm}10.7$ months in the responder and non- responder groups, respectively. In addition, PHN patients who visited the clinic before 9 months showed a better result. Dermatomal distribution and underlying disorders did not show significant differences. Conclusions: Almost 30% of PHN patients received complete relief. Those who sought treatment in a pain clinic before 9 months received a better result.

• The Korean Journal of Pain
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• v.36 no.4
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• pp.408-424
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• 2023

Central post-stroke pain (CPSP) is an incapacitating disorder that impacts a substantial proportion of stroke survivors and can diminish their quality of life. Conventional therapies for CPSP, including tricyclic antidepressants, anticonvulsants, and opioids, are frequently ineffective, necessitating the investigation of alternative therapeutic strategies. Repetitive transcranial magnetic stimulation (rTMS) is now recognized as a promising noninvasive pain management method for CPSP. rTMS modulates neural activity through the administration of magnetic pulses to specific cortical regions. Trials analyzing the effects of rTMS on CPSP have generated various outcomes, but the evidence suggests possible analgesic benefits. In CPSP and other neuropathic pain conditions, high-frequency rTMS targeting the primary motor cortex (M1) with figure-eight coils has demonstrated significant pain alleviation. Due to its associaton with analgesic benefits, M1 is the most frequently targeted area. The duration and frequency of rTMS sessions, as well as the stimulation intensity, have been studied in an effort to optimize treatment outcomes. The short-term pain relief effects of rTMS have been observed, but the long-term effects (> 3 months) require further investigation. Aspects such as stimulation frequency, location, and treatment period can influence the efficacy of rTMS and ought to be considered while planning the procedure. Standardized guidelines for using rTMS in CPSP would optimize therapy protocols and improve patient outcomes. This review article provides an up-to-date overview of the incidence, clinical characteristics, outcome of rTMS in CPSP patients, and future perspective in the field.

• Journal of the Institute of Electronics Engineers of Korea SC
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• v.43 no.3 s.309
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• pp.60-66
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• 2006

The purpose of this study was to suggest a new detection method for early diagnosing diabetic neuropathic foot by obtaining a ratio of toe to finger blood flow using photoplethysmography(PPG) and Laser Doppler(LD). Nerve conduction velocity (NCV) has been routinely used for diagnosing neuropathic foot, but it applies strong electric stimulus to peripheries resulting in stress and pain. The blood flow ratio of 50 neuropathic diabetes($0.96{\pm}0.20$) was significantly higher than that of 64 normal person($0.46{\pm}0.15$)(p<0.000). It also showed that toe temperature of neuropathic diabetes($30.5{\pm}1.4^{\circ}C$) was significantly higher than that of normal group($29.3{\pm}2.0^{\circ}C$)(p<0.000). The optimal boundary value of the blood flow ratio was found to be 0.678 and the sensitivity and specificity of this proposed method resulted in 95.3% and 95.3% respectively. Lastly, there were no neuropathic diabetes whose temperature difference between finger and toe was higher than $4.5\;^{\circ}C$.

• The Korean Journal of Physiology and Pharmacology
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• v.1 no.3
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• pp.251-262
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• 1997

Peripheral nerve injury sometimes leads to neuropathic pain and depletion of calcitonin gene related-peptide (CGRP) and substance P (SP) in the spinal cord. However, the pathophysiological mechanisms for depletion of CGRP and SP following the neurorathic injury are still unknown. This study was performed to see whether the distribution of immunoreactivity for CGRP and SP in the superficial dorsal horn and dorsal root ganglia(DRG) was related to the distance between the DRG and injury site. To this aim, we compared two groups of rats; one group was subjected to unilateral inferior and superior caudal trunk transections at the level between the S3 and S4 spinal nerves (S34 group) and the other group at the levels between the S1 and S2, between S2 and S3 and between S3 and S4 spinal nerve (S123 group). The transections in both groups equally eliminated the inputs from the tail to the S1-3 DRG, but the distance from the S1/S2 DRG to the injury site was different between the two groups. Immunostaining with SP and CGRP antibody was done in the S1-S3 spinal cord and DRG of the two groups 1 and 12 weeks after the injury. The results obtained are as follows: 1. The immunoreactivity for CGRP and SP in the ipsilateral superficial dorsal horn and DRG decreased 1 and 12 weeks after neuropathic nerve injury. 2. The immunoreactive area of SP and CGRP in the S1 dorsal horn was smaller in the S123 group than in the S34 group, whereas that in the S3 dorsal horn was not significantly different between the two groups. The number of SP-immunoreactive DRG cells decreased on the neuropathic side as compared to the sham group's in all DRGs of experimental groups except the S1 DRG of the S34 group. These results suggest that the amounts of SP and CGRP in the dorsal horn and DRG following neuropathic injury inversely decrease according to the distance between the DRG and injury site.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.86-88
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• 1997

Regional sympathetic blockade is the most effective treatment for reflex sympathetic dystrophy (RSD). Radiofrequency thermocoagulation provides longer duration of pain relief than local anesthetics and less complication than chemical neurolytic agents for lumbar sympathectomy. Spinal cord stimulation (SCS) is thought to be an effective modality yieding good results in treating intractable neuropathic pain. Therefore RSD might be a good indication for SCS. We treated a patient with RSD who responded well to lumbar sympathetic blockade (LSB) with radiofrequency thermocoagulation and SCS. The patient had a left ankle sprain requiring a case for the lower leg for 2 weeks. The patient suffered increasing pain and swelling on the lower part of that leg. We thought to block the lumbar sympathetic chain utillzing radiofrequency thermocoagulation 2 days after LSB with local anesthetics. The results provided accepatable pain relief (VAS $8{\rightarrow}15$) but the patient still could not walk due to remaining pain which was further aggravated by walking. After SCS, pain relief improved (VAS $5{\rightarrow}13$) and patient could walk without assistance.