• Journal of Korean Neurosurgical Society
• /
• 제46권3호
• /
• pp.273-276
• /
• 2009

A 54-year-old man experienced injury to the second finger of his left hand due to damage from a paintball gun shot 8 years prior, and the metacarpo-phalangeal joint was amputated. He gradually developed mechanical allodynia and burning pain, and there were trophic changes of the thenar muscle and he reported coldness on his left hand and forearm. A neuroma was found on the left second common digital nerve and was removed, but his symptoms continued despite various conservative treatments including a morphine infusion pump on his left arm. We therefore attempted median nerve stimulation to treat the chronic pain. The procedure was performed in two stages. The first procedure involved exposure of the median nerve on the mid-humerus level and placing of the electrode. The trial stimulation lasted for 7 days and the patient's symptoms improved. The second procedure involved implantation of a pulse generator on the left subclavian area. The mechanical allodynia and pain relief score, based on the visual analogue scale, decreased from 9 before surgery to 4 after surgery. The patient's activity improved markedly, but trophic changes and vasomotor symptom recovered only moderately. In conclusion, median nerve stimulation can improve chronic pain from complex regional pain syndrome type II.

• 한방재활의학과학회지
• /
• 제18권4호
• /
• pp.39-61
• /
• 2008

목적 : 좌골신경 압좌손상으로 유발된 쥐의 모델을 이용하여 손상된 말초신경의 재생효과에 관한 침자극 효과를 세포분자학적, 조직학적 관점에서 연구하였다. 아울러 손상 좌골신경을 지배하는 척수신경근과 가까운 부위 경혈자극과 좌골신경이 지배하는 말초부위 경혈자극과의 침자극 효과를 비교 연구하였다. 방법 : 한쪽 좌골신경에 압좌손상을 유발 한 실험쥐들을 1주, 2주로 나눈 뒤 각각에 대해 격일로 1주군은 3회, 2주군은 6회의 침자극을 시행하였다. 손상 좌골신경의 재생효과를 비교실험하기 위해 정상군, 압좌손상만을 유발한 실험군, 침자극 군으로 나누었다. 침자극 군 중 한 군은 손상신경을 지배하는 척수신경근에 가장 가까운 2개의 화타협척혈(EX B2)에 자침(근위부 자극군)하였고, 다른 한 군은 말초부위에 위치한 족삼리혈(ST 36)과 위중혈(BL 40) 2곳에 자침(원위부 자극군)하였다. 실험 후 각각의 조직을 분리하여 Western blotting 혹은 Hoechst staining으로 Gap-43, Cdc2, Cdk2, Erk1/2 단백질을 분석 및 좌골신경의 각 세포수를 측정하였다. Retrograde tracing을 통해 L5의 DRG와 척수에서 말초신경 재생 효과를 관찰하였고, Immunofluorescence staining을 통해 신경돌기 가지의 신장 정도를 파악하였다. 결과 : 좌골신경 손상 7일된 실험쥐의 근위부와 원위부 침자극군에서 GAP-43와 Cdc2 단백질수준이 향상된 것으로 나타났다. Cdk2 단백질수준은 압좌손상 실험군에서 강하게 증가하였지만 침자극군과 비교해서 별다른 차이는 보이지 않았다. Phospho-Erk1/2 단백질수준은 침자극군에서 향상된 것으로 나타났다. 손상 7일과 14일 된 실험쥐의 손상 원위부에서 슈반세포 수가 증가하였으며 특히 근위부 침자극군에서 더욱 증가한 것으로 나타났다. Retrograde tracing을 이용한 검사 결과 침자극군에서 L5의 DRG와 척수의 염색 세포 수가 증가된 것으로 나타나 침자극이 축삭재생에 효과적인 것으로 나타났다. L5의 DRG 감각신경의 신경돌기 가지 신장정도 및 GAP-43 단백질의 발현 정도를 측정한 결과 근위부 침자극군에서 효과적으로 GAP-43 단백질의 발현 및 신경돌기 가지가 신장된 것으로 나타났다. 결론 : 본 실험결과 침치료가 손상 좌골신경의 재생에 효과적인 것으로 보여지며, 특히 손상된 좌골신경을 지배하는 척수신경근 주위 화타협척혈에 대한 침자극이 말초부위의 침자극에 비해 신경재생에 더욱 효과적인 것으로 나타났다.

• 생명과학회지
• /
• 제16권1호
• /
• pp.114-119
• /
• 2006

저출력 적외선 레이저가 손상된 말초신경의 재생에 미치는 영향을 알아보기 위하여 흰쥐의 양측 좌골신경에 압궤손상을 준 뒤, 레이저 조사 기간에 따라 1, 3, 5 및 7주군으로 나누어 손상된 좌골신경의 신경전도속도와 진폭을 측정하여 신경재생의 정도를 관찰한 결과는 다음과 같았다. 좌골신경전도속도 검사에서 압궤손상 유발후에 손상전보다 유의하게 전도속도가 지연되었으나, 레이저를 조사한 실험측은 치료후 3주에 현저하게 신경전도 속도가 증가하였다. 좌골신경 진폭 검사에서 압궤손상 유발후에 손상전보다 유의하게 진폭이 감소하였으나, 레이저를 조사한 실험측은 치료후 3주에 복합근 활동전위의 진폭이 유의하게 증가하였다. 이상의 결과로 보아, 저출력 레이저 조사는 손상된 좌골신경의 기능회복에 있어, 주로 손상 초기의 회복속도에 영향을 주는 것으로 생각되는 바, 향후 말초신경 손상의 재활치료에 고려해야 할 것으로 생각된다.

• The Korean journal of internal medicine
• /
• 제33권6호
• /
• pp.1058-1069
• /
• 2018

Neuropathic cancer pain (NCP) is caused by nerve damage attributable to the cancer per se, and/or treatments including chemotherapy, radiotherapy, and surgery; the prevalence is reported to be as high as 40%. The etiologies of NCP include direct nerve invasion or nerve compression by the cancer, neural toxicity, chemotherapy, and radiotherapy. NCP is subdivided into plexopathy, radiculopathy, and peripheral neuropathies, among several other categories. The clinical characteristics of NCP differ from those of nociceptive pain in terms of both the hypersensitivity symptoms (burning, tingling, and an electrical sensation) and the hyposensitivity symptoms (numbness and muscle weakness). Recovery requires several months to years, even after recovery from injury. Management is complex; NCP does not usually respond to opioids, although treatments may feature both opioids and adjuvant drugs including antidepressants, anticonvulsants, and anti-arrhythmic agents, all of which improve the quality-of-life. This review addresses the pathophysiology, clinical characteristics and management of NCP, and factors rendering pain control difficult.

• 동의생리병리학회지
• /
• 제22권4호
• /
• pp.896-902
• /
• 2008

Yukmijihwang-tang(YM) is used in Oriental medicine for treatments of diverse systemic symptoms including neurological dosorders. The present study was performed to examine potential effects of YM on growth-promoting activity of injured sciatic nerve axons. YM treatment in the injured sciatic nerve induced enhanced distal elongation of injured axons when measured 3 and 7 days after injury. Retrograde tracing of sciatic nerve axons showed YM-mediated increases in the number of DiI-labeled dorsal root ganglion (DRG) sensory neurons and spinal cord motor neurons at 3 days after injury. Hoechst nuclear staining showed that non-neuronal cell population was largely elevated by YM treatment in distal nerve area undergoing axonal regeneration. Furthermore, phospho-Erk1/2 protein levels were upregulated by YM treatment in the injured nerve area. These data suggest that YM may play a role in facilitated axonal regeneration in injured peripheral nerves. Further investigations of individual herbal components would be useful to explore effective molecular components and develop therapeutic strategies.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제35권1호
• /
• pp.25-30
• /
• 2013

Purpose: Many surgical procedures in oral and maxillofacial area can induce trauma to the peripheral nerve. The aim of the study is to evaluate the effects of short-term steroid therapy on nerve recovery after crush injury. Methods: Sixteen rats were randomly divided into two groups. The right sciatic nerves were exposed, crushed, and sutured. The control group was not given steroids. The test group was injected with dexamethasone disodium phosphate (2 mg/kg body weight/day) for 7 days. In all animals, compound muscle action potential (CMAP) was recorded before and at 1, 7, 14, 21, and 28 days after injury. Results: The amplitude of the CMAP before and at 1, 7, 14, 21, and 28 days after injury were $53.20{\pm}4.80$ mV, $20.12{\pm}5.38$ mV, $30.01{\pm}14.15$ mV, $31.14{\pm}13.56$ mV, $31.73{\pm}16.33$ mV, and $37.23{\pm}16.98$ mV in the control group, and $55.25{\pm}6.72$ mV, $18.62{\pm}6.26$ mV, $29.50{\pm}13.06$ mV, $32.90{\pm}13.226$ mV, $30.17{\pm}11.80$ mV, and $38.41{\pm}12.27$ mV in the test group, respectively. The nerve conduction velocity was $18.82{\pm}3.94$ m/s, $16.73{\pm}3.48$ m/s, $19.60{\pm}2.45$ m/s, $18.68{\pm}3.94$ m/s, $18.02{\pm}3.51$ m/s, and $19.25{\pm}3.88$ m/s in the control group, and $18.94{\pm}3.48$ m/s, $17.28{\pm}2.53$ m/s, $7.57{\pm}2.54$ m/s, $18.77{\pm}2.12$ m/s, $19.48{\pm}1.55$ m/s, and $19.22{\pm}2.97$ m/s in the test group, respectively. There was no significant difference between both groups (P>0.05). Conclusion: This study did not show any therapeutic effect of short-term administration of steroids on injured rat sciatic nerve. Further studies are needed.

• The Journal of Korean Physical Therapy
• /
• 제12권3호
• /
• pp.395-406
• /
• 2000

In general. it is known that central nervous system associated with nerve injury and regeneration in mature cann't regenerate, unlikely peripheral nervous system, due to various reasons. Although a lot of Patients arc suffered with central nervous system injury in the world, but there art a few resolution and researches and investigations. 'rho effect of central nervous system regeneration was partly revealed by many researchers. In this article, we describe about recovery (inclusive of axonal regeneration, remyelination, repair of spinal cord) and associated factors(inclusive of macrophage and autoimmune T-cell. neural stem cells. Nogo) after central nervous system injury.

• Journal of Oral Medicine and Pain
• /
• 제41권3호
• /
• pp.118-125
• /
• 2016

Purpose: The aims of this study were to evaluate the clinical characteristics of patients with altered sensation and/or pain, and to determine outcome predictors affecting persistent neuropathy. Methods: Patients who complained an altered sensation or pain following trigeminal nerve trauma were involved in this study. To determine outcome predictors affecting persistent neuropathy, the patients were divided into two groups; transient vs. persistent, and the clinical phenotypes are compared between groups. Data were analyzed with t-tests, chi-square, and multiple regression analyses with 95% confidence interval and p<0.05 significance level. Results: A total of 111 patients were included: 23 with transient and 88 persistent groups. The panoramic result and pin-prick test score were statistically different between the groups. Radiating symptoms after blunt and pinprick stimuli were also significantly different between groups. The results revealed that the presence of a neurologic lesion in the panoramic view result, reduced sensation in the pinprick test, and radiation in the pinprick test could affect the persistent group. Conclusions: The presence of a neurologic lesion in panoramic view result and reduced sensation and radiating symptoms in the pin prick test would be defining features of one of the main clinical features of persistent neuropathy. These features could serve as outcome predictors diagnosing the permanent nerve injury in trigeminal nerve.

• The Korean Journal of Pain
• /
• 제21권1호
• /
• pp.11-17
• /
• 2008

Background: Peripheral nerve injury induces up-regulation of the calcium channel alpha2delta (${\alpha}2{\delta}$) subunit and TRPM8 in the dorsal root ganglion (DRG) which might contribute to allodynia development. We investigated the expression of the ${\alpha}2{\delta}$ subunit and TRPM8 in the DRG of sympathetically maintained pain (SMP) and sympathetic independent pain (SIP) rat model. Methods: For the SMP model, the L5 and L6 spinal nerves were ligated tightly distal to the DRG. For the SIP model, the tibial and sural nerves were transected, while the common peroneal nerve was spared. After a 7 day postoperative period, tactile and cold allodynia were assessed using von Frey filaments and acetone drops, respectively. Expression of the ${\alpha}2{\delta}$ subunit and TRPM8 in the L5 and L6 DRG were subsequently examined by a Western blot. Results: There were no significant differences between the two models for the thresholds of tactile and cold allodynia. Expression of the ${\alpha}2{\delta}$ subunit in the ipsilateral DRG to the injury was increased as determined on a Western blot as compared to that in the contralateral or sham-operated DRG of the SMP model, but there was no difference in expression seen with the use of the SIP model. There was no difference in the expression of TRPM8 in the ipsilateral DRG to the injury and the contralateral or sham-operated DRG of either model. Conclusions: Up-regulation of the ${\alpha}2{\delta}$ subunit in injured DRG may play a role that contributes to tactile allodynia development in SMP, but not TRPM8 to cold allodynia after peripheral nerve injury.

• Journal of Korean Neurosurgical Society
• /
• 제47권6호
• /
• pp.420-423
• /
• 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.