• The Journal of Korean Physical Therapy
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• 제22권3호
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• pp.79-85
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• 2010

Purpose: Many trials for new therapeutic approaches such as stem cell-based transplantation have been conducted to improve the repair and regeneration of injured cord tissue and to restore functions following spinal cord injury (SCI) in animals and humans. Adipose tissue-derived stromal cells (ATSCs) have multi-lineage potential to differentiate into cells with neuron-like morphology. Most studies of stem cell transplantation therapy after SCI are focused on cellular regeneration and restoration of motor function, but not on unwanted effects after transplantation such as neuropathic pain. This study was focused on whether transplantation of ATSCs could facilitate or attenuate hindpaw pain responses to heat, cold and mechanical stimulation, as well as on improvement of locomotor function in a rat with SCI. Methods: A spinal cord injury rat model was produced using an NYU impactor by dropping a 10 g rod from a height of 25 mm on to the T9 segment. Human ATSCs (hATSCs; approximately $5{\times}10^5$ cells) or DMEM were injected into the perilesional area 9 days after the SCI. After transplantation, hindpaw withdrawal responses to heat, cold and mechanical allodynia were measured over 7 weeks. Motor recovery on the Basso, Beattie, and Bresnahan (BBB) locomotor rating scale and on the inclined plane test were also evaluated. Results: The present study demonstrated that increased hindpaw withdrawal responses to cold allodynia was observed in both groups after transplantation, but the development of cold-induced allodynia in the hATSC transplantation group was significantly larger than in the control group. The difference between the two groups in locomotor functional improvement after SCI was also significant. Conclusion: Careful consideration not only of optimal functional benefits but also of unintended side effects such as neuropathic pain is necessary before stem cell transplantation therapy after SCI.

• 종양간호연구
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• 제9권2호
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• pp.145-154
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• 2009

Purpose: The purpose of this study was to obtain information about the experiences of sensations after breast cancer surgery characterized by prevalence, frequency, and severity, distresses, and disturbances in ADL using the BSAS (Breast Sensation Assessment Scale) and to develop the standardized Korean BSAS. Methods: Thirty two women from 3 to 100 days after breast cancer surgery (BCS) completed Roberta's BSAS. The 18 sensations of BSAS were translated using the references of Lee's Korean Pain Rating Scale and English-English, English-Korean dictionaries and the consultation from two native Americans, one bilingual permanent resident of the States, and one nursing professor. The Korean-translated BSAS has high reliability in test-retest. Likert type 4-point scale and 100 mm VAS were used for assessment. Results: Certain sensations remained prevalent (tender, pull, pain), frequent (numb, nag, throb), severe (throb, shoot, numb), causing distress (throb, penetrate, shoot), and influencing on ADL (throb, penetrate, nag). The most frequently experienced sensation other than BSAS was itching. There was little difference in the prevalence of symptom experiences between sentinel lymph node biopsy and axillary lymph node dissection. Conclusion: The women after BCS are suffering from neuropathic sensations. The Korean- translated BSAS could be used in effectively assessing breast sensations after BCS in Korean women.

• The Journal of Korean Physical Therapy
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• 제23권6호
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• pp.31-36
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• 2011

Purpose: This pilot case series study aimed to evaluate the efficacy of continuous radiofrequency (CRF) application on dorsal root ganglia (DRG) to reduce spasticity of spinal cord lesion (SCL) patients. Methods: We performed CRF procedures on DRG in 8 subjects (7 males; mean age 39 years, range 31-53 years) with intractable spasticity that impeded activities of daily living and caregiving, although they had maximal tolerable doses of anti-spastic medications and active rehabilitative treatment. All subjects underwent CRF (90 seconds at $90^{\circ}C$) at multiple lumbosacral and/or cervical DRG. Muscle tone of the extremities was measured by the modified Ashworth scale (MAS) before and one month after procedures. Functional goals were established at baseline, and subjects' satisfaction levels were categorized one month after procedures. Results: A total of 54 CRF treatments were performed in 8 patients. In all patients, we found some improvement in muscle tone measured by the MAS. Six patients reported themselves satisfied with their current status at one month's post-treatment, and 2 patients were fairly satisfied with their gait pattern. In 3 patients, neuropathic pain was present after CRF on DRG. In 1 lumbar case, the pain subsided after several days, and the other 2 cervical cases suffered from tolerable neuropathic pain treated with anti-convulsant medication. Conclusion: CRF on DRG might be a promising alternative treatment to reduce spasticity in SCL patients. Further well-designed clinical trials on the efficacy and safety of CRF application on DRG are needed.

• The Korean Journal of Pain
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• 제29권4호
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• pp.239-248
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• 2016

Background: The present study was undertaken to evaluate the incidence of chronic persistent post-surgical pain (CPPP) and the role of signal transduction genes in patients undergoing staging laparotomy for carcinoma ovary. Methods: The present observational study was undertaken following institutional ethical committee approval and informed consent from all the participants. A total 21 patients of ASA grade I to III with age 20-70 years, scheduled for elective staging laparotomy for carcinoma ovary were included. Patients were excluded if had other causes of pain, cognitive dysfunction or chronic neurological disorders. Statistical analysis of pool data was done using SPSS version-17. For various scales like GPE, PDQ, NPSI, the visual analogue scale (VAS), global perceived effect (GPE), the pain DETECT questionnaire (PDQ), and neuropathic pain symptoms inventory (NPSI), one factor repaeted measure ANOVA applied with simple contrast with baseline as on post-operative day 1 (considered as reference and compared with subsequent time-interval), and the P values were adjusted according to "Bonferroni adjustments". In patients with CPPP, the ${\Delta}ct$ values of mRNA expressions of genes at the end of postoperative day 90 were compared with the baseline control values by one factor repeated ANOVA. P value < 0.005 significant. Results: The present study demonstrates 38.1% (8 out of 21 patients) incidence of CPPP. The functional status and quality of life as were observed to be significantly diminished in all patients with chronic pain. An up-regulation in the mRNA expression of signal transduction and a positive correlation was noted between the mRNA expression of signal transduction genes and VAS score in all patients with CPPP at the end of postoperative day 90. Conclusions: The reported incidence of CPPP in patients with carcinoma ovary was 38.1%. An up-regulation and positive correlation between mRNA expression of signal transduction genes and VAS score depicts its potential role in the pathogenesis of CPPP.

• Journal of Oral Medicine and Pain
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• 제34권2호
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• pp.217-225
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• 2009

통증은 포괄적이고 생리적, 심리적, 사회적 복합현상이기 때문에 통증을 보다 잘 이해하고 더 나은 치료를 위해서는 환자의 삶의 질과 심리적 상태에 대한 평가가 필요하다. 본 연구는 비치성 구강안면통증 환자들이 느끼는 통증의 정도와 통증으로 인한 일상생활의 제한(pain interference)을 평가하고 심리적 요인과의 관련성을 평가하고자 하였다. 또한 성별 및 연령, 통증의 지속기간과 진단에 따른 차이를 함께 평가하고자 하였다. 연구대상은 3개월간 단국대학교 부속 치과병원 구강내과구강안면통증클리닉에 내원한 초진환자들 중에서 간이동통목록(Brief Pain Inventory, BPI)과 병원불안우울척도(Hospital Anxiety and Depression Scale, HADS)의 두 가지 설문지에 답하고, 비치성 구강안면통증으로 진단받은 환자들을 대상으로 하였다. 환자들은 의사와의 첫 면담 전 대기실에서 설문지를 작성하도록 하였고, 작성 후에는 진료실에서 임상검사와 면담을 통해 진단을 내렸다. 총 163명의 환자들이 연구에 포함되었는데, 남녀비 1:1.5, 평균 연령 34.6세, 평균 통증지속기간 13.3개월이었다. 진단에 따라 삼차신경통군(Trigeminal Neuralgia group; TN), 신경병성동통군(Neuropathic Pain group; NeP), 만성안면통증군(Persistent Idiopathic Facial Pain; PIFP), 턱관절장애군(TMD)으로 나누고 TMD는 저작근장애군(TMD-m), 관절장애군(TMD-j) 및 근육-관절 복합군(TMD-c)으로 세분하였다. 비치성 구강안면통증 환자들은 중등도의 통증과 중등도의 일상생활 제한을 보였다. 3개월 이상의 만성통증을 가진 환자들은 급성군에 비해 높은 수준의 불안과 우울척도를 보였다(p<0.05). TMD 환자들보다 삼차신경통, 만성안면통증 및 신경병성통증 환자들의 통증이 심하고 pain interference가 컸으며 불안과 우울척도도 높았다 (p<0.05). Pain interference는 통증의 강도과 강한 상관관계를 보였고 우울 및 불안척도와 중등도의 상관관계를 보였다 (p=0.000). 우울 및 불안척도는 통증의 강도와 약한 상관관계를 보였다 (p<0.05). 결론적으로 구강안면통증의 성공적인 치료를 위해서는 통증 자체의 조절뿐 아니라 통증으로 인한 심리적, 사회적 영향에 대한 평가와 심리사회적 측면에서의 지원(psychosocial support)가 필요함을 알 수 있다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제18권6호
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• pp.361-365
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• 2018

Background: Recently, we examined the effects of 2% lidocaine gel on the tactile sensory and pain thresholds of the face, tongue and hands of symptom-free individuals using quantitative sensory testing (QST); its effect was less on the skin of the face and hands than on the tongue. Consequently, instead of 2% lidocaine gel, we examined the effect of 8% lidocaine spray on the tactile sensory and pain thresholds of the skin of the face and hands of healthy volunteers. Methods: Using Semmes-Weinstein monofilaments, QST of the skin of the cheek and palm (thenar skin) was performed in 20 healthy volunteers. In each participant, two topical sprays were applied. On one side, 0.2 mL of 8% lidocaine pump spray was applied, and on the other side, 0.2 mL of saline pump spray was applied as control. In each participant, QST was performed before and 15 min after each application. Pain intensity was measured using a numeric rating scale (NRS). Results: Both the tactile detection threshold and filament-prick pain detection threshold of the cheek and thenar skin increased significantly after lidocaine application. A significant difference between the effect of lidocaine and saline applications was found on the filament-prick pain detection threshold only. NRS of the cheek skin and thenar skin decreased after application of lidocaine, and not after application of saline. Conclusion: The significant effect of applying an 8% lidocaine spray on the sensory and pain thresholds of the skin of the face and hands can be objectively scored using QST.

• 대한족부족관절학회지
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• 제26권4호
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• pp.177-182
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• 2022

Purpose: The efficacy and safety of low-dose pregabalin and alpha lipoic acid in diabetic neuropathy were evaluated and analyzed. Materials and Methods: This study designed a retrospective study that included patients with diabetic neuropathic pain. From 2009 to 2022, 100 patients who suffered from diabetic neuropathic pain were included in this study. The patients were divided into group I (pregabalin 150 mg/day with alpha lipoic acid 600 mg/day) and group II (pregabalin 300 mg/day with alpha lipoic acid 600 mg/day). The visual analogue scale (VAS), medication side effects, and neurometer results were compared. Results: The mean follow-up period of the above patients was 120.23 weeks in group I and 149.05 weeks in group II. The average VAS score in group I decreased by 3.23 points, and the average VAS score in group II decreased by 2.86 points. Approximately 24.3% of group I had side effects, such as dizziness, sleepiness, and gastrointestinal trouble, while 76.7% of patients in group II had side effects. Sixtyseven patients had a neurometer examination before and after the medication, and there is no statistical difference between the two groups. Conclusion: The combination of low-dose pregabalin (pregabalin 150 mg/day) and alpha lipoic acid in diabetic neuropathy had a similar clinical effect and less frequent medication side effects than regular dose pregabalin (pregabalin 300 mg/day) and alpha lipoic acid. Therefore, low-dose pregabalin (pregabalin 150 mg/day) and alpha lipoic acid should be considered in treating diabetic neuropathy.

• Journal of Oral Medicine and Pain
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• 제44권3호
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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.

• 생물정신의학
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• 제18권3호
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• pp.163-167
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• 2011

Complex regional pain syndrome (CRPS) is a disease that causes chronic spontaneous pain and hyperesthesia of one or more parts of legs and arms, which is accompanied with problems of the automatic nervous system or the motor nervous system. However, up to date, it is unclear what causes the syndrome and how to diagnose and treat it. Although several treatments including medication and sympathetic nerve block are performed against CRPS, the therapeutic effect of the treatments is limited. The electroconvulsive thera-py (ECT), of which the mechanism is not clarified, is a treatment used for treatment-resistant depression. ECT is also reported to be effective against pain. Therefore, we performed the ECT for a 24-year-old female patient who has been diagnosed as CRPS. Her pain had not been much improved by medications and interventional procedures. At admission to a psychiatric ward for ECT, she com-plained of over 8 points of pain on visual analogue scale and the constrained movement around the painful part. Eight ECTs-three times a week-were performed for three weeks in hospital and then the ECT once a week was performed after her leaving the hospital. During the ECTs, pain had been reduced and the range of movement in the constrained parts had increased. Further systematic re-search is needed to confirm the effect of electroconvulsive therapy against CRPS.

• The Korean Journal of Pain
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• 제12권2호
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• pp.188-190
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• 1999

Background: The goal of this study was to evaluate the effects of gabapentin on postherpetic neuralgia. Gabapentin is a known anti-seizure medication, whose cellular mechanism of action is not well understood. Unlike other anticonvulsant, gabapentin has the advantage of a low toxicity and favorable side effect profile. If has been recently recommended for use in treatment of neuropathic pain. Methods: Twelve patients with a diagnosis of postherpetic neuralgia were prescribed gabapentin after failure of routine therapeutic regimens. The dose of gabapentin ranged 300~1800 mg per day, in three divided doses. If initial dose was ineffective and no side effects were noted, the dosages was increased by 300 mg a day in divided doses, to the maximum level for 2 weeks. Patients were evaluated for analgesia using visual analogue scale (VAS) pain score (0; no pain, 10; worst possible pain) and possible side effects. Results: A significant decrease in pain scores with gabapentin were noted. There were several mild side effects such as dizziness, somnolence, dry mouth, constipation and facial edema, without need of special treatment. Conclusions: Gabapentin may be a useful adjunct for treating intractable postherpetic neuralgia with a minimal side effects.