• 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.

• The Korean Journal of Pain
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• v.8 no.2
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• pp.347-349
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• 1995

A 43 year old man who suffered from right facial palsy was treated successfully with the application of both magnetic resonance diagnostic analyser(MRA) and drug therapy. Treatment of facial palsy is generally composed of stellate ganglion block(SGB), drug therapy and operative intervention. Short periods of exposure to appropriate magnetic resonance can beneficially modulate the balance of autonomic nervous system that are responsible for sympathetic overflow. It was concluded that recovery of facial palsy by application of both MRA and drug therapy was effective in patient who refused SGB.

• Journal of Korean Medicine Rehabilitation
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• v.19 no.4
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• pp.219-228
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• 2009

Objectives : This study was performed to report the effect of oriental medical treatment in the paraplegia and pain after epidural nerve block. Methods : A 39-year-old woman who underwent epidural nerve block at a local clinic was admitted with motor weakness of lower limbs, severe lower radiating pain and decreased sensation when voiding and defecating. We treated her by acupuncture, a herbal medicine, a bee venom injection, moxibustion and cupping treatment and physical theraphy from 11th July 2008 to 14th October 2008. Results : After treatment, most symptoms decreased, VAS(Visual Analog Scale) score changed from 9 to 2. and examinated muscle power changed from 2-3 to 4-5. Conclusions : Our study suggested that oriental medical treatments are significantly effective in the paralplegia and pain after epidural nerve block. And further studies will be aid to identify underlying mechanism of treatment.

• The Korean Journal of Pain
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• v.23 no.3
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• pp.198-201
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• 2010

Persistent and intractable hiccups (with respective durations of more than 48 hours and 1 month) can result in depression, fatigue, impaired sleep, dehydration, weight loss, malnutrition, and aspiration syndromes. The conventional treatments for hiccups are either non-pharmacological, pharmacological or a nerve block treatment. Pulsed radiofrequency lesioning (PRFL) has been proposed for the modulation of the excited nervous system pathway of pain as a safe and nondestructive treatment method. As placement of the electrode in close proximity to the targeted nerve is very important for the success of PRFL, ultrasound appears to be well suited for this technique. A 74-year-old man suffering from intractable hiccups that had developed after a coronary artery bypass graft and had continued for 7 years was referred to our pain clinic. He had not been treated with conventional methods or medications. We performed PRFL of the phrenic nerve guided by ultrasound and the hiccups disappeared.

• The Korean Journal of Pain
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• v.23 no.4
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• pp.242-246
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• 2010

Background: The first sacral nerve root block (S1NRB) is a common procedure in pain clinic for patients complaining of low back pain with radiating pain. It can be performed in the office based setting without C-arm. The previously suggested method of locating the needle entry point begins with identifying the posterior superior iliac spine (PSIS). Then a line is drawn between two points, one of which is 1.5 cm medical to the PSIS, and the other of which is 1.5 cm lateral and cephalad to the ipsilateral cornu. After that, one point on the line, which is 1.5 cm cephalad to the level of the PSIS, is considered as the needle entry point. The purpose of this study was to analyze the location of needle entry point and palpated PSIS in S1NRB. Methods: Fifty patients undergoing C-arm guided S1NRB in the prone position were examined. The surface anatomical relationships between the palpated PSIS and the needle entry point were assessed. Results: The analysis revealed that the transverse and vertical distance between the needle entry point and PSIS were $28.7{\pm}8.8mm$ medially and $3.5{\pm}14.0mm$ caudally, respectively. The transverse distance was $27.8{\pm}8.3mm$ medially for male and $29.5{\pm}9.3mm$ medially for female. The vertical distance was $1.0{\pm}14.1mm$ cranially for male and $8.1{\pm}12.7mm$ caudally for female. Conclusions: The needle entry point in S1NRB is located on the same line or in the caudal direction from the PSIS in a considerable number of cases. Therefore previous recommended methods cannot be applied to many cases.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.121-123
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• 1997

Stellate ganglion block(SGB) is frequently performed to relieve a patient from headache of various. We experienced a rare case of subarachnoid hemorrhage by aneurysmal rupture after SGB. A 46-year-old female patient diagnosed with tension headache, and normal MRI finding consulted our pain clinic. We performed right SGB in combination with greater occipital nerve block. The next day, we performed left SGB with 6 ml of 0.25% bupivacaine. She had no evidence of subarachnoid block or intravascular injection. 15 minutes after injection, she abruptly developed convulsion and loss of consciousness. She was given artificial respiration with oxygen. The diagnosis of ruptured left posterior communicating aneurysm was confirmed by 4-vessels angiography.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.218-221
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• 2005

This report describes a case of dizziness in a patient with trigeminal neuralgia that was caused by a vestibular schwannoma. A 60-year-old man with a history of pain on his left cheek, chin, molar and tongue for 5 months was diagnosed as suffering with trigeminal neuralgia of the left mandibular nerve, and this was caused by a left vestibular schwannoma. The diagnosis of the tumor was confirmed with magnetic resonance imaging (MRI), and so gamma knife surgery was performed 1 month later. At that time, the patient had been referred to the pain clinic due to allodynia on the tongue and gingival, and hypesthesia was also present on the left half of the face. Trigeminal nerve block with dehydrogenated alcohol and stellate ganglion block with 1% mepivacaine were performed and oral medication with diphenylhydantoin was started. The symptoms were alleviated after nerve block and oral medication. Dizziness, blurred vision and ataxia then developed from the 13th hospital day. We considered the symptoms as a side effect of diphenylhydantoin and we reduced the dose of diphenylhydantoin. However, the symptoms grew worse. Another brain MRI showed a slight increase of the tumor size and a mass effect with displacement of the adjacent organs, and hydrocephalus was also noted. This case shows the importance of considering the secondary symptoms that are due to brain tumor while treating trigeminal neuralgia. The changes of the brain tumors should also be considered along with the presence of new side effects.

• The Korean Journal of Pain
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• v.26 no.2
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• pp.177-180
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• 2013

Trigeminal neuralgia (TN) is characterized by recurrent paroxysms of unilateral facial pain that typically is severe, lancinating, and activated with cutaneous stimulation. There are two types of TN, classical TN and atypical TN. The pain nature of classical TN are the same as those described above, whereas atypical TN is characterized by constant, burning pain. We describe the case of a 49-year-old male presenting with right-sided facial pain. The patient was diagnosed with temporomandibular joint disorder at a dental clinic and was on medical treatment, but his symptoms worsened gradually. He was referred to our pain clinic for further evaluation. Radiologic evaluation, including MRI, showed a parapharyngeal tumor. For the relief of TN, a right mandibular nerve (V3) root block was performed at our pain clinic, and then he was scheduled for radiation and chemotherapy.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.97-100
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• 1997

We treated a 56 year old male ailing of painful herpetic eruption on his 2nd, 3rd and 4th left cervical spinal segment. On the 18th day, patient also suffered an abrupt left facial palsy, accompanied with ongoing postherpetic neuralgia even though the skin eruption had been cured. This patient visited our pain clinic on his 46th day of illness and was teated with continuous cervical epidural block for 9 days, and stellate ganglion block plus oral analgesics and antidepressant for 12 days. The combination of treatments resulted in marked improvement of facial palsy and postherpetic neuralgia. A possible explanation of facial palsy accompanied with herpes zoster on cervical spinal segment could be related to Hunt's hypothesis that geniculate ganglion forms a chain connecting the high cervical ganglion below. Another possibility may be related to a compression injury of the facial nerve by long-term severe edema on the soft tissue of the face, the periauricular area and parotid gland around the facial nerve, and edema on the facial nerve itself emerging out from the cranium.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.8
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• pp.317-323
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• 2017

This study was conducted to investigate the differences in magnetic resonance imaging (MRI) findings after lumbar epidural nerve block using the transforaminal approach and the interlaminar approach in patients with low back pain. This study was an observational analysis study of abnormal findings of MRI after epidural nerve block. This study included 78 patients who underwent MRI at approximately 24 h after lumbar epidural nerve block at a pain clinic of a university hospital between January 2007 and December 2016. Among patients who received epidural nerve block, 36 used the interlaminar approach and 42 used the transforaminal approach. The incidence of patients with abnormal changes in MRI findings was higher among patients using the interlaminar approach (53%) than those using the transforaminal approach (7%). Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes, with epidural air being the most frequent abnormal finding (72%). We recommend use of the transforaminal approach to reduce the possibility of misreading or difficulty in interpretation of images of patients who underwent MRI at approximately 24 h after lumbar epidural nerve block. Practitioners should consider the possibility of abnormal findings such as epidural air on MRI in cases of epidural nerve block using the interlaminar approach.