• Journal of Oral Medicine and Pain
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• v.38 no.4
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• pp.313-318
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• 2013

The aim of this study was to the relationship between sleep disturbances and Burning mouth syndrome(BMS). BMS presents as a chronic burning sensation in the oral mucous membrane that is frequently associated with sleep disturbances. BMS is considered neuropathic pain condition with dysfunction of small diameter afferent sensory fiber. A review of the studies reveals, BMS suggested peripheral and cental nervous system changes. Sleep disruption or Rem sleep deprivation cause an inhibition of opioid protein synthesis and a reduced affinity of ${\mu}$ and ${\delta}$ opioid receptors. Let me say that sleep disturbances suggest a risk factor For BMS and support to evaluate as a part of BMS treatment. Further study will be required to ascertain the relationship between distruption of sleep continuity or Rem sleep deprivation and BMS and the evidence of altered neurochemical degeneration of BMS.

• Korean Journal of Psychosomatic Medicine
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• v.1 no.1
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• pp.52-58
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• 1993

Before studying the effectiveness of amitriptyline in alleviating the pain of diabetic neuropathy, this study was designed to compare the severity and nature of depressive symtoms of diabetic patients with neuropathy with those of diabetic patients without neuropathy and patients with somatoform disorder whose complaints were mainly somatic pain, respectively. The authors administered Beck Depression Inventory(BDI) to the three groups of patients. The mean total scores of BDI were relatively low in all groups and not significantly different among the three groups. The mean scores of four subscales of BDI were also not significantly different among the three groups. These results might suggest that the pain of diabetic neuropathy did not influence on the severity and the nature of depressive symptoms of preexisting diabetes.

• Korean Journal of Psychosomatic Medicine
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• v.15 no.1
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• pp.7-13
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• 2007

Antidepressants are used by substantial number of physicians as well as psychiatrists. Antidepressants are the mainstay of treatment of depression combined with physical illness, neuropathic pain, and various psychosomatic disorders. Antidepressants, especially TCA and SSRI, are superior to placebo in treating comorbid depression and pain of physical illness. Although it has been controversial whether the influence of depression on the risk and outcome of physical illness is true, antidepressants would provide more favorable prognosis and better quality of life for the patients with physical illness.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.8-15
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• 1999

Following peripheral nerve injury, rats will show a tactile allodynia and hyperalgesia. But the mechanism of allodynia is still obscure. The present studies, using rats rendered allodynia by loosely constrictive ligation of the common sciatic nerve (Bennett Model) and tight ligation of L5 & L6 spinal nerve (Chung Model), aimed to investigate the changes of metabotrophic glutamate receptor type 5 on the development of tactile allodynia. Male Sprague-Dawley rats (130~200 g) were anesthetized with halothane, the rats were randomly divided into one of these three groups, Group 1 (Sham operation), Group 2 (Bennett model) and Group 3 (Chung model). Seven days after surgical procedure, the animal was reanesthetized and decapitated. The spinal cord was quickly removed and stored at deep freezer for polymerase chain reaction (RT-PCR). In Group 2&3, rats showed that tactile allodynia checked by up-down method with calibrated 8 von Frey hair. The level of gene expression of mGluR5 mRNA was significantly increased in group 2 and 3. These increases was significantly different from sham operation, group 1. It was also showed that the increasing patterns of group 2 and 3 in the gene expression were similar correlation with the results of the threshold for tactile allodynia on von Frey hair test. Even though there were some differences between Bennett model and Chung model, these results suggested that mGluR5 had partly attributed to making a tactile allodynia from these models.

• Journal of Oral Medicine and Pain
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• v.44 no.3
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• pp.83-91
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• 2019

Purpose: Venlafaxine and duloxetine have been shown to be effective in the treatment of neuropathic pain disorders. However, knowledge about the efficacy of venlafaxine and duloxetine on burning mouth syndrome (BMS) is still insufficient. The purpose of this study was to investigate the efficacy of venlafaxine and duloxetine on refractory BMS patients. Methods: Twelve refractory BMS patients who were prescribed venlafaxine or duloxetine were included in this study. These patients did not respond to previous administration of clonazepam, alpha-lipoic acid, gabapentin, and nortriptyline. All participants were the primary type of BMS patients who had no local and systemic factors related to the oral burning sensation. The intensities of oral symptoms following venlafaxine or duloxetine administration were compared with those before administration and at baseline. Results: Venlafaxine and duloxetine were prescribed to four and nine patients, respectively. One patient was prescribed both medications in turn. Among them, only two patients showed improvement of oral symptoms without side effects. In the other ten patients, symptoms failed to improve. Six of them reported that the drug was ineffective, and four of them stopped taking the medications on their own due to intolerable side effects, such as insomnia, constipation, drowsiness, dizziness, and xerostomia. Conclusions: Venlafaxine and duloxetine may only relieve oral symptoms in a minority of refractory BMS patients. Further large-scale studies are needed to determine the potential clinical factors that could predict the efficacy of venlafaxine and duloxetine.

• Clinical Pain
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• v.18 no.2
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• pp.130-132
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• 2019

Acupuncture is generally regarded as a safe procedure and as a popular treatment for patients with musculoskeletal disorders. We report a case of a 47-year-old male patient with late-onset tetraplegia, developed after acupuncture. He had no trauma, medical, and social history relevant to tetraplegia. Right after the acupuncture, he felt discomfort in his right arm. After 6 days, all 4 extremity weakness developed. Whole-spine magnetic resonance imaging revealed the presence of spinal subdural hematoma extending from the C5 vertebra to the coccyx level. Hand coordination dysfunction, neurogenic bladder, and neuropathic pain were other symptoms. After the management, he recovered muscle strength, but incomplete bladder control and neuralgia were sustained. It is important to be aware of the possibilities of severe complications after acupuncture.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.22-32
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• 2006

Background: This study was conducted to investigate the roles of the spinal and peripheral ${\gamma}$-aminobutyric acid (GABA)- ergic systems for the mechanical hypersensitivity produced by chronic compression of the dorsal root ganglion (CCD). Methods: CCD was performed at the left 5th lumbar dorsal root ganglion. The paw withdrawal threshold (PWT) to von Frey stimuli was measured. The mechanical responsiveness of the lumbar dorsal horn neurons was examined. GABAergic drugs were delivered with intrathecal (i.t.) or intraplantar (i.pl.) injection or by topical application onto the spinal cord. Results: CCD produced mechanical hypersensitivity, which was evidenced by the decrease of the PWT, and it lasting for 10 weeks. For the rats showing mechanical hypersensitivity, the mechanical responsiveness of the lumbar dorsal horn neurons was enhanced. A similar increase was observed with the normal lumbar dorsal horn neurons when the GABA-A receptor antagonist bicuculline was topically applied. An i.t. injection of GABA-A or GABA-B receptor agonist, muscimol or baclofen, alleviated the CCD-induced hypersensitivity. Topical application of same drugs attenuated the CCD-induced enhanced mechanical responsiveness of the lumbar dorsal horn neurons. CCD-induced hypersensitivity was also improved by low-dose muscimol applied (i.pl.) into the affected hind paw, whereas no effects could be observed with high-dose muscimol or baclofen. Conclusions: The results suggest that the neuropathic pain associated with compression of the dorsal root ganglion is caused by hyperexcitability of the dorsal horn neurons due to a loss of spinal GABAergic inhibition. Peripheral application of low-dose GABA-A receptor agonist can be useful to treat this pain.

• Journal of Korean Neurosurgical Society
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• v.63 no.6
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• pp.814-820
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• 2020

Objective : Trigeminal neuralgia (TN) is a severe neuropathic condition that affects several elderly patients. It is characterized by uncontrolled pain that significantly impacts the quality of life of patients. Therefore, the condition should be treated as an emergency. In the majority of patients, pain can be controlled with medication; however, other treatment modalities are being explored in those who become refractory to drug treatment. The use of the trigeminal nerve block with a local anesthetic serves as an excellent adjunct to drug treatment. This technique rapidly relieves the patient of pain while medications are being titrated to effective levels. We report the efficacy and safety of percutaneous trigeminal nerve block in elderly patients with TN at our outpatient clinic. Methods : Twenty-one patients older than 65 years with TN received percutaneous nerve block at our outpatient clinic. We used bupivacaine (1 mL/injection site) to block the supraorbital, infraorbital, superior alveolar, mental, and inferior alveolar nerves according to pain sites of patients. Results : All patients reported relief from pain, which decreased by approximately 78% after 2 weeks of nerve block. The effect lasted for more than 4 weeks in 12 patients and for 6 weeks in two patients. There were no complications. Conclusion : Percutaneous nerve block procedure performed at our outpatient clinic provided immediate relief from pain to elderly patients with TN. The procedure is simple, has no serious side effects, and is easy to apply.

• The Korean Journal of Pain
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• v.7 no.1
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• pp.113-115
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• 1994

Bacterial meningitis is a rare complication of epidural block. As epidural abscess, subarachnoid infection associated with epidural catheters are related to the treatment of pain in diabetic patient whose immune responses have been impaired. A 51-year-old male with non-insulin dependent diabetes came to the pain clinic with neuropathic gain on right thigh and amputated stump of right leg. Treatment consisted of continuous epidural block and subcutaneous tunnelling and epidural morphine with bupivacaine was given on an outpatient basis. Two months later, the patient noted a diffuse frontal headache, projectile vomiting and stiffness neck. These symptoms became more aggrevated over the following 24 h and temperature went up to $38.4^{\circ}C$. A diagnostic lumbar puncture revealed CSF total protein of 747 mg/dl, glucose of 43 mg/dl, and $4320\;WBC/mm^3$. Cultures of epidural catheter tip grew hemolytic staphylococcus epidermidis. A chest x-ray and brain CT scan were negative. Antibiotic therapy with penicillin G and chloramphenicol was given for 15 days. Recovery was uneventful.

• Journal of Oral Medicine and Pain
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• v.33 no.4
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• pp.401-407
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• 2008

The most common type of orofacial pain is toothache. However, many other types of pain which derived from nonodontogenic problems can mimic toothache. Nonodontogenic toothache is heterotopic pain that the site of pain is not in the same location of the source of pain. This differs from primary pain, in which the site of pain is the actual site which the pain originates. Heterotopic pain can be alleviated by direct treatment toward the source of pain. The common sources of nonodontogenic toothache include neuropathic pain, sinus pain, Myofascial pain, neurovascular pain and even cardiac pain and psychogenic pain. Thus, clinicians should have a thorough knowledge about causes of nonodontogenic toothache, and through pain history and examination of dental and nondental structures are needed. This case report is about some cases of nonodontogenic toothache, and it also emphasizes essential considerations for proper differential diagnosis and appropriate treatment.