• Journal of Korean Neurosurgical Society
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• v.47 no.6
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• pp.420-423
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• 2010

Objective : Peripheral nerve injury often leads to neuropathic pain, which is characterized by burning pain, allodynia, and hyperalgesia. The role of the sympathetic nervous system in neuropathic pain is a complex and controversial issue. It is generally accepted that the alpha adrenoreceptor (AR) in sympathetic nerve system plays a significant role in the maintenance of pain. Among alpha adrenoreceptor, alpha-1 receptors play a major role in the sympathetic mediated pain. The primary goal of this study is to test the hypothesis that sympathetically maintained pain involves peripheral alpha-2 receptors in human. Methods : The study was a randomized, prospective, double-blinded, crossover study involving twenty patients. The treatments were : Yohimbine (30 mg mixed in 500 mL normal saline), and Phentolamine (1 mg/kg in 500 mL normal saline) in 500 mL normal saline at 70 mL/hr initially then titrated. The patients underwent infusions on three different appointments, at least one month apart. Thus, all patients received all 2 treatments. Pain measurement was by visual analogue scale, neuropathic pain questionnaire, and McGill pain questionnaire. Results : There were significant decreases in the visual analogue scale, neuropathic score, McGill pain score of yohimnine, and phentolamine. Conclusion : We conclude that alpha-2 adrenoreceptor, along with alpha-2 adrenoreceptor, may be play role in sympathetically maintained pain in human.

• Journal of Dental Anesthesia and Pain Medicine
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• v.16 no.4
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• pp.237-244
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• 2016

Topical anesthetics act on the peripheral nerves and reduce the sensation of pain at the site of application. In dentistry, they are used to control local pain caused by needling, placement of orthodontic bands, the vomiting reflex, oral mucositis, and rubber-dam clamp placement. Traditional topical anesthetics contain lidocaine or benzocaine as active ingredients and are used in the form of solutions, creams, gels, and sprays. Eutectic mixtures of local anesthesia cream, a mixture of various topical anesthetics, has been reported to be more potent than other anesthetics. Recently, new products with modified ingredients and application methods have been introduced into the market. These products may be used for mild pain during periodontal treatment, such as scaling. Dentists should be aware that topical anesthetics, although rare, might induce allergic reactions or side effects as a result of an overdose. Topical anesthetics are useful aids during dental treatment, as they reduce dental phobia, especially in children, by mitigating discomfort and pain.

• The Korean Journal of Physiology and Pharmacology
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• v.2 no.3
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• pp.307-312
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• 1998

This study was performed to investigate the mechanism of central analgesic effects of antidepressants. Thirty four male rats were anesthetized with pentobarbital sodium (40 mg/kg, ip). A stainless steel guide cannula and a PE tube (PE10) were implanted into the lateral ventricle and cisterna magna area. Stimulating and recording electrodes were implanted into the incisor pulp and anterior digastric muscle. Electrodes were led subcutaneously to the miniature cranial connector sealed on the top of the skull with acrylic resin. The jaw opening reflex was used in freely moving rats, and antidepressants were administered intracisternally in order to eliminate the effects of anesthetic agents on the pain assessment and evaluate the importance of the central action site of antidepressants. After 48 hours of recovery from surgery, digastric electromyogram (dEMG) of freely moving rats was recorded. Electrical shocks (200 ${\mu}sec$ duration, 0.5-2 mA intensity) were delivered at 0.5 Hz to the dental pulp every 2 minute. Intracisternal administration of $15\;{\mu}g$ imipramine suppressed dEMG elicited by noxious electrical stimulation in the tooth pulp to $76{\pm}6%$ control. Intracisternal administration of $30\;{\mu}g$ desipramine, nortriptyline, or imipramine suppressed dEMG remarkably to $48{\pm}2,\;27{\pm}8,\;or\;25{\pm}5%$ of the control, respectively. Naloxone, methysergide, and phentolamine blocked the suppression of dEMG produced by intracisternal antidepressants from $23{\pm}2\;to\;69{\pm}4%,\;from\;32{\pm}5\;to\;80{\pm}9%,\;and\;from\;24{\pm}6\;to\;77{\pm}5%$ of the control, respectively. These results indicate that antidepressants produce antinociception through central mechanisms in the orofacial area. Antinociception of intracisternal antidepressants seems to be mediated by an augmentation of descending pain inhibitory influences on nociceptive pathways.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.143-145
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• 1998

There are reports on cervical epidural anesthesia for surgery of neck, chest and upper limb. However, there are limited published data on the specific problems with this procedure, including dural puncture, epidural abscess, and vasovagal syncopes. We experienced two cases of vasovagal syncope during cervical epidural anesthesia in the sitting position. These syncopes consisted of sudden hypotention and bradycardia, associated with nausea, dizzness and sweating. The patients were resuscitated successfully and recovered without any adverse effects. Current literature is being reviewed and the possible mechanisms of cardiac arrest under cervical epidural anesthesia in the sitting position are being discussed.

• Journal of Korean Physical Therapy Science
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• v.1 no.2
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• pp.345-353
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• 1994

Shoulder pain is probably the most frequent complication of hemiplegia. Many of the factors contributing to the occurrence of shoulder pain in hemiplegia have shown that the lesions of the rotator cuff tendon or the tendon of the long head of the biceps brachii, the reflex sympathetic dystrophy syndrome, shoulder-hand syndrome, subluxation and rupture of the rotator cuff. Subluxation has been measured by finger breadths, X-Ray, Radiological measure and jig device. The propose of this study decribes the sourse of shoulder pain with hemiplegia, method for subluxation measure and treatment of. hemiplegic shoulder pain.

• Annals of Clinical Neurophysiology
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• v.24 no.2
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• pp.35-45
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• 2022

Complex regional pain syndrome (CRPS) is a chronic regional pain disorder that most frequently affects the limbs. It is characterized by hyperalgesia, allodynia, edema, motor disturbance, and vasomotor instability, and typically occurs following surgery or trauma. In type-I CRPS there is no confirmed nerve injury, while peripheral nerve injury is present in type-II CRPS. The multifactorial pathophysiological etiology of CRPS includes inflammation, autoimmune responses, abnormal cytokine production, autonomic dysfunction, altered blood flow, psychological factors, and central cortical reorganization. There are no specific laboratory diagnostic tools for CRPS, and so it is diagnosed clinically. The Budapest criteria are currently the most-accepted diagnostic criteria.

• The Journal of Korean Medicine
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• v.20 no.3 s.39
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• pp.36-44
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• 1999

Objectives: It has been well known that electroacupuncture(EA) has an analgesic effect and there is a pain control system in the central nervous system(CNS). The pain control system is composed of three major nuclei, which are periaqueductal gray(PAG), raphe nuclei, and the pain inhibitory complex located in the spinal cord. It has been suggested that the analgesic effect of EA might be the result of activation of the pain control system in the CNS. However, there may be a possibility that other nuclei are also involved in this pain modulation. Thus, we investigated whether the posterior intralaminar thalamic nuclei (PTIN) are involved in the pain modulation. Methods: To measure the level of pain, the jaw opening reflex (JOR) was used as a pain index. The magnitude of JOR is estimated by averaging the area of 10 successive responses. JOR was evoked by tooth-pulp stimulation with bipolar electrode carrying stimulus with the following parameters: intensity ranging from 420uA to 680ulA, 0.3ms duration of square pulse, and 0.5 Hz. Hapkog($LI_4$) and Taechung ($LR_3$) were the chosen acupoints. The Hapkog point was stimulated ipsilaterally at 5V, 3 Hz, for 15min in total, and the Taechung was stimulated at 2-3 V, 3 Hz, and for a total of 15 or 30 minutes. Different intensities of stimulation were given the PITN; one was given at $300{\mu}A$ and the other was at 500uA. The position stimulated in these nuclei by Paxinos Atlas was AP; from bregma $-4.0{\sim}-4.3mm,\;L; 0.5{\sim}1.8mm,\;D;\;4.8{\sim}6.3mm$. Results: The Hapkog point had a significant analgesic effect (P<0.05). However, the Taechung point had no effect. Both types of stimulation in the PITN did not reveal any analgesic effects. Conclusions: From these results, it was suggested that the posterior intralaminar thalamic nuclei are not involved in the modulation of pain.

• The Korean Journal of Physiology
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• v.19 no.2
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• pp.227-232
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• 1985

Previously, we had reported that the electrical stimulation of peripheral nerve with stimlatory parameters of 20 V strength and 2 Hz frequency for 60 min resulted in reducing the pain reaction. The present study was performed to evaluate if the pain reaction was affected by the peripheral nerve stimulation with different stimulatory parameters in the decerebrated cat. The flexion reflex was used as an index of the pain reaction. The reflex was elicited by stimulating the sural nerve (stimulus strength of 20 $V\;\times\;0.5$msec) and recorded as a compound action potential from the motor nerve innervated to the posterior biceps femoris muscle. The common perneal nerve was selected as a peripheral nerve on which the electrical stimulation of various intensities and frequencies was applied. The results are summarized as follows : 1) The peripheral nerve stimulation with 100 mV strength, regardless of frequencies, did not affect the pain reaction induced by the sural nerve stimulation. 2) When the stimulus of 1V intensity and slow frequency (2 Hz) was applied to the peripheral nerve for 30 min or 60 min, the pain reaction was significantly reduced comparing to the control. However, this reduced pain reaction by the peripheral nerve stimulation was not reversed by the injection of naloxone (0.02 mg/kg) 3) High frequency stimulus (60 Hz) of 1V intensity for 30 or 60 min did not show any effects of affecting the pain reaction. These results suggest that the stimulus of relatively high intensity (at least 1V) and low frequency (2 Hz) is needed to elicite the analgesic effect by the peripheral nerve stimulation. By the 1V stimulus, $A\delta$ nerve fiber is activated. Therefore, an $A\delta$ or smaller nerve fibers must be activated for showing analgesia by the peripheral nerve stimulation. However, the mechanism of analgesia by the $A\delta$ nerve activation alone was not related to the endogeneous morphine system since the reduced pain reaction by the $A\delta$ fiber activation alone was not reversed by the treatment of naloxone.

• The Journal of Korean Medicine
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• v.20 no.1 s.37
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• pp.106-112
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• 1999

The purpose of this study is to investigate the effects of Bee Venom Herb-Acupuncture on the jaw opening reflex evoked by tooth pulp stimulation. Rats were anesthetized with thiopental sodium given intraperitoneally in an initial dose of 80mg/kg. Maintenance doses of 5mg/kg thiopental sodium were given through a cannular in the femoral vein as required to maintain light anesthesia. To apply noxious stimuli, a pair of enameled wires were inserted into the tooth pulp of the lower incisor. The effects of conditioning stimuli were estimated as an indicator of the degree of suppression of the digastric muscle electromyogram(dEMG) in the jaw opening reflex. Bee Venom Herb- Acupuncture(0.2% solution 0.1ml/rat) was injected to Hapgok(LI4) loci. In addition, Normal Saline (0.1ml/rat) was injected to Hapgok loci so as to compare the degree of suppression elicited from Bee-Venom. By administration of Bee Venom Herb-Acupuncture, the amplitude of dEMG was maximally suppressed to $67.5{\pm}3.38%$ ipsilaterally, 73.33{\pm}8.00%$ contralaterally. Generally, the dEMG activities caused by electrical stimulation were gradually suppressed during the stimulation and maximal suppressive effect showed at 15min after its onset. However the dEMG activities by Be Venom Herb-Acupuncture were immediately suppressed after its onset and the suppressive effect continued for a long time compared to electrical stimulation. In conclusion, Bee Venom Herb-Acupuncture may have a different mechanism of analgesia from that of electro-acupuncture and contribute to the modulation of pain analgesia.

• Korean Journal of Acupuncture
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• v.27 no.3
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• pp.97-108
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• 2010

Background : The location of acupoints on rat, which may differ from that of human body due to anatomical structure, is defined variously among researchers, which may cause the problem of low repeatability and objectivity. Design : The measurement of hind limb consist of measuring the distance between knee joint and tibia tubercle in order to set the knee joint as common criteria. Based on it, the three mostly referred location of ST36 were represented with the knee joint as a datum point and compared. The electroacupuncture stimulation was administrated after the abdominal pain was induced by acetic acid. And the analgesic activity of each ST36 acupoint was evaluated by measuring the number of writhing reflex, in order to observe the differences of treatment effect in accordance with the location of ST36 acupoints. Results : The result of measurement confirmed the differences in the acupoint location of ST36 among researchers. The writhing reflex test using the acetic acid-induced abdominal pain stimulated with electroacupuncture of 100Hz showed that there were statistically significant differences in the analgesic effect between control group and three ST36 groups (P<0.05). However there were no differences observed among three mostly referred location of ST36 acupoints (P>0.05). Conclusions : We recommend "the point located 6.5 mm below the knee joint at the anterior tibial muscle" as a standard ST36 acupoint location qualified by the WHO Standard Acupuncture Point Locations in 2008.