• Title/Summary/Keyword: Persistent Pain

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Comparison of sevoflurane and propofol anesthesia on the incidence of hyperglycemia in patients with type 2 diabetes undergoing lung surgery

  • Kim, Hyuckgoo;Han, Jisoo;Jung, Sung Mee;Park, Sang-Jin;Kwon, Nyeong Keon
    • Journal of Yeungnam Medical Science
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    • v.35 no.1
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    • pp.54-62
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    • 2018
  • Background: The type and regimen of anesthesia may affect perioperative hyperglycemia following major surgical stress. This study compared the effects of sevoflurane and propofol on the incidence of hyperglycemia and clinical outcomes in diabetic patients undergoing lung surgery. Methods: This retrospective study included 176 patients with type 2 diabetes mellitus who had undergone lung surgery. Blood glucose levels and clinical outcomes from the preoperative period to the first 2 postoperative days (PODs) were retrospectively examined in patients who received sevoflurane (group S, n= 87) and propofol (group P, n=89) for maintenance of general anesthesia. The primary endpoint was the incidence of persistent hyperglycemia (2 consecutive blood glucose levels >180 mg/dL [10.0 mmol/L]) during the perioperative period. The secondary composite endpoint was the incidence of major postoperative complications and 30-day mortality rate after surgery. Results: Blood glucose levels similarly increased from the preoperative period to the second POD in both groups (p=0.857). Although blood glucose levels at 2 hours after surgery were significantly lower in group P than in group S (p=0.022; 95% confidence interval for mean difference, -27.154 to -2.090), there was no difference in the incidence of persistent hyperglycemia during the perioperative period (group S, 70%; group P, 69%; p=0.816). The composite of major postoperative complications and all-cause in-hospital and 30-day mortality rates were also comparable between the two groups. Conclusion: Sevoflurane and propofol were associated with a comparable incidence of perioperative hyperglycemia and clinical outcomes in diabetic patients undergoing lung surgery.

Clinical Experiences of Transforaminal Balloon Decompression for Patients with Spinal Stenosis

  • Kim, Sung-Hoon;Koh, Won-Uk;Park, Soo-Jin;Choi, Woo-Jong;Suh, Jeong-Hun;Leem, Jeong-Gil;Park, Pyung-Hwan;Shin, Jin-Woo
    • The Korean Journal of Pain
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    • v.25 no.1
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    • pp.55-59
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    • 2012
  • Lumbar spinal stenosis is a commonly treated with epidural injections of local anesthetics and corticosteroids, however, these therapies may relieve leg pain for weeks to months but do not influence functional status. Furthermore, the majority of patients report no substantial symptom change over the repeated treatment. Utilizing balloon catheters, we successfully treated with three patients who complained persistent symptoms despite repeated conventional steroid injections. Our results suggest that transforaminal decompression using a balloon catheter may have potential in the nonsurgical treatment of spinal stenosis by modifying the underlying pathophysiology.

Residual Pain after Operative Treatment for Chronic Ankle Instability (만성 발목 불안정증 수술 후의 지속적인 발목 통증)

  • Cho, Byung-Ki;Ahn, Byung-Hyun
    • Journal of Korean Foot and Ankle Society
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    • v.25 no.1
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    • pp.32-37
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    • 2021
  • Patients with chronic lateral ankle instability often experience a range of associated injuries. The well-known comorbidities include intra-articular pathologies (osteochondral lesion, soft tissue or bony impingement, and loose body), peroneal tendon pathologies, neural injuries, and other extra-articular pathologies. Surgeons should have a high index of suspicion for these associated pathologies before operative intervention, correlate the clinical findings, and plan the treatment. Despite the restoration of ankle stability following ligament repair or reconstruction surgery, a high prevalence (13%~35%) of postoperative residual pain has been reported. This pain can negatively affect the clinical outcomes and patient satisfaction. This study examined the causes of persistent pain after surgical treatments for chronic ankle instability.

Neuromodulation for Trigeminal Neuralgia

  • Chung, Moonyoung;Huh, Ryoong
    • Journal of Korean Neurosurgical Society
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    • v.65 no.5
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    • pp.640-651
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    • 2022
  • Clinical studies on neuromodulation intervention for trigeminal neuralgia have not yet shown promising results. This might be due to the fact that the pathophysiology of chronic trigeminal neuropathy is not yet fully understood. Chronic trigeminal neuropathy includes trigeminal autonomic neuropathy, painful trigeminal neuropathy, and persistent idiopathic facial pain. This disorder is caused by complex abnormalities in the pain processing system, which is comprised of the affective, emotional, and sensory components, rather than mere abnormal sensation. Therefore, integrative understanding of the pain system is necessary for appropriate neuromodulation of chronic trigeminal neuropathy. The possible neuromodulation targets that participate in complex pain processing are as follows : the ventral posterior medial nucleus, periaqueductal gray, motor cortex, nucleus accumbens, subthalamic nucleus, globus pallidus internus, anterior cingulate cortex, hypothalamus, sphenopalatine ganglion, and occipital nerve. In conclusion, neuromodulation interventions for trigeminal neuralgia is yet to be elucidated; future advancements in this area are required.

A Study for Musculoskeletal Disorders of Assembly Line Workers

  • Kim, Dae-Sig
    • Journal of Industrial Convergence
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    • v.3 no.2
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    • pp.73-84
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    • 2005
  • Musculoskeletal Disorders are usually caused or aggravated by poor work processes and unsuitable working conditions - that involve repetitive or forceful movements or the maintenance of constrained or awkward postures. The condition is characterized by discomfort and persistent pain. Case and Demographic Characteristics for Work-related Injuries and Illnesses Involving Days Away From Work, 2003. U.S" was examined. Causes of musculoskeletal disorders for assembly line workers were carpal tunnel syndrome(CTS), tendonitis, low back pain, and occupational stress. Recommendations of improvement for productivity are redesign of working conditions, exercise, prevent of musculoskeletal disorders and avoiding stress.

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An Investigation on the Risk Factors of Musculoskeletal Disorders in the Assembly Line for industrial Pump (산업용 펌프 조립공정에서의 근골격계 질환 유해요인 조사)

  • Kim, Dae-Sig
    • Journal of Industrial Convergence
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    • v.6 no.1
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    • pp.3-16
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    • 2008
  • Musculoskeletal Disorders are usually caused or aggravated by poor work processes and unsuitable working conditions - that involve repetitive or forceful movements or the maintenance of constrained or awkward postures. The condition is characterized by discomfort and persistent pain. An investigation on the risk factors of musculoskeletal should have done one time per three years. Cause of musculoskeletal disorders for assembly line worker was a low back pain(LBP). Recommendations of improvement for productivity are redesign of working conditions, exercise, prevent of musculoskeletal disorders and avoiding stress.

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Repeat Vertebroplasty for the Subsequent Refracture of Procedured Vertebra

  • Choi, Sang Sik;Hur, Won Seok;Lee, Jae Jin;Oh, Seok Kyeong;Lee, Mi Kyoung
    • The Korean Journal of Pain
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    • v.26 no.1
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    • pp.94-97
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    • 2013
  • Vertebroplasty (VP) can effectively treat pain and immobility caused by vertebral compression fracture. Because of complications such as extravasation of bone cement (polymethylmethacrylate, PMMA) and adjacent vertebral fractures, some practitioners prefer to inject a small volume of PMMA. In that case, however, insufficient augmentation or a subsequent refracture of the treated vertebrae can occur. A 65-year-old woman visited our clinic complaining of unrelieved severe low back and bilateral flank pain even after she had undergone VP on the $1^{st}$ and $4^{th}$ (L1 and L4) lumbar vertebrae a month earlier. Radiologic findings showed the refracture of L1. We successfully performed the repeat VP by filling the vertebra with a sufficient volume of PMMA, and no complications occurred. The patient's pain and immobility resolved completely three days after the procedure and she remained symptom-free a month later. In conclusion, VP with small volume cement impaction may fail to relieve fracture-induced symptoms, and the refracture of an augmented vertebral body may occur. In this case, repeat VP can effectively resolve both the persistent symptoms and problems of new onset resulting from refracture of the augmented vertebral body due to insufficient volume of bone cement.

Ultrasound-guided Pulsed Radiofrequency Lesioning of the Phrenic Nerve in a Patient with Intractable Hiccup

  • Kang, Keum-Nae;Park, In-Kyung;Suh, Jeong-Hun;Leem, Jeong-Gill;Shin, Jin-Woo
    • 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.

Autologous Fat Grafting as a Last Resort for Unsustainable Pain in a Woman with Multiple Osteochondromas

  • Negenborn, Vera Lidwina;Moerman, Esther;Ham, Simon Johannes
    • Archives of Plastic Surgery
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    • v.44 no.2
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    • pp.162-165
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    • 2017
  • Multiple osteochondromas (MO) is characterized by the formation of osteochondromas throughout the entire body. Although the evidence regarding its pathogenesis is well understood, no curative treatment for the disorder is available. Patients can be treated symptomatically by surgical removal of painful osteochondromas. Unfortunately, some patients still suffer from severe pain, even after surgery. We report on a case concerning a 48-year-old woman with a history of MO who presented with persistent pain after surgical removal of a symptomatic osteochondroma of the left scapula and multiple symptomatic osteochondromas of the left foot and trochanteric region. Several interventions to reduce the pain did not have any lasting effect. Subsequently, she was treated with autologous fat grafting (AFG). After each session she was pain-free for at least one year and reported only partial recurrence of the pain. This is the first case report describing AFG for the treatment of pain after both surgical removal of an osteochondroma and symptomatic osteochondromas in a patient suffering MO with promising results. The treatment is more effective and clearly continues to remain active longer than injection therapy or pain medication. Future studies are necessary to confirm our results.

Clinical Experience of Pain Management for Postlaminectomy Syndrome due to Pseudomeningocele -A case report- (가성수막류에 의한 척추수술 후 증후군 환자의 통증치료경험 -증례보고-)

  • Cho, Hye Ran;Han, Sang Ji;Park, Sang Chul;Kwon, Young Eun;Lee, Jun Hak
    • The Korean Journal of Pain
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    • v.19 no.2
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    • pp.249-252
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    • 2006
  • Postlaminectomy syndrome is characterized by persistent low back pain and radiculopathy of the legs after surgery of the spine. Pseudomeningocele is an uncommon cause of postlaminectomy syndrome; it is characterized by an extradural collection of cerebrospinal fluid (CSF) without dural covering, resulting from unrecognized dural tears at the time of lumbar surgery. In most cases, surgery to repair a pseudomeningocele is recommended. However if surgical treatment does not yield symptomatic relief, then conservative treatment should be considered. We treated a patient with a pseudomeningocele after spine surgery in which selective transforaminal epidural block produced long-term relief of symptoms. Here we describe the management of this patient.