• The Korean Journal of Pain
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• 제23권1호
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• pp.78-81
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• 2010

Spinal cord stimulation (SCS) has become an established clinical option for treatment of refractory chronic pain. Current hardware and implantation techniques for SCS are already highly developed and continuously improving; however, equipment failures over the course of long-term treatment are still encountered in a relatively high proportion of the cases treated with it. Percutaneous SCS leads seem to be particularly prone to dislocation and insulation failures. We describe our experience of lead breakage in the inserted spinal cord stimulator to a complex regional pain syndrome patient who obtained satisfactory pain relief after the revision of SCS.

• The Korean Journal of Pain
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• 제23권2호
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• pp.109-115
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• 2010

Background: The pathophysiological and neurochemical changes following spinal injury are not yet elucidated. This study was designed to evaluate the morphological changes of the dorsal horn of the spinal cord and profiles of pain behaviors following intraspinal injection of NMDA in rats. Methods: Rats were randomized into three groups: a sham-operated control group and groups where the rats received 10 mM or 100 mM N-methyl-D-aspatate (NMDA) injected into their spinal dorsal horn. Following injection, hypersensitivity to cold and mechanical stimuli and excessive grooming behaviors were assessed serially for four weeks. Morphological changes of the spinal cord were evaluated four weeks after intraspinal injection. Results: Few animals in the NMDA groups developed hypersensitivity to cold and mechanical stimuli. The number of groomers and the severity of excessive grooming were significantly higher in the 100 mM NMDA group than those values of the control and 10 mM NMDA groups. The size of the neck region (lamina III-IV) was significantly smaller in the 100 mM NMDA group than in the control and 10 mM NMDA groups. Conclusions: In conclusion, intraspinal injection of NMDA in rats leads to the pathological sequela in the spinal cord and to excessive grooming behavior. These results support the use of NMDA and excessive grooming behavior after excitotoxic SCI as a model to study chronic pain after SCI.

• The Korean Journal of Pain
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• 제21권1호
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• pp.74-79
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• 2008

The progression of spinal tuberculosis is usually slow and insidious, and its main symptom, backache, is nonspecific. Considerable delay in diagnosis may occur before an infectious process is considered. Even when a diagnosis of spinal tuberculosis is considered, it may be difficult to confirm. Radiological findings indicative of tuberculosis are involvement of the vertebral bodies on either side of the disc, subligamentous spread, abscess formation and collection and expansion of granulation tissue adjacent to the vertebral body, relative sparing of the disc space and calcification within a paravertebral abscess. We report two patients with spinal tuberculosis who had nonspecific backache and received a delayed diagnosis for several months or years.

• The Korean Journal of Pain
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• 제25권2호
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• pp.121-125
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• 2012

Refractory angina pectoris is defined as angina refractory to optimal medical treatment and standard coronary revascularization procedures. Despite recent therapeutic advances, patients with refractory angina pectoris are not adequately treated. Spinal cord stimulation is a minimally invasive and reversible technique which utilizes electrical neuromodulation by means of an electrode implanted in the epidural space. It has been reported to be an effective and safe treatment for refractory angina pectoris. We report a case of spinal cord stimulation which has effectively relieved chest pain due to coronary artery disease in a 40-year-old man. This is the first report of spinal cord stimulation for treatment of refractory angina pectoris in South Korea.

• The Korean Journal of Pain
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• 제22권3호
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• pp.249-252
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• 2009

Spinal epidural lipomatosis (SEL) is a rare condition of pathological overgrowth of fat tissue in the vertebral canal. SEL leads to back pain, radiculopathy or paraparesis. Glucocorticoids seem to play a major role in the development of SEL. SEL is best diagnosed by magnetic resonance imaging. The treatment of SEL is directed at reducing the body weight and decreasing the excess glucocorticoid. In severe cases, decompressive laminectomy with removal of the excess epidural fat might become necessary to alleviate the neurological symptoms caused by spinal cord compression.

• The Journal of Korean Physical Therapy
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• 제16권2호
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• pp.169-180
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• 2004

The aim of this study was to investigate the effect of TENS on muscle pain induced by carrageenan. Muscle pain was induced in male Sprague-Dowley rats by intra-muscular injection of gastrocnemius with $3\%$ carrageenan. nNOS was measured to assess the effect of TENS on muscle pain induced by Carrageenan. The lumbar enlargement of the spinal cord was removed in different groups of animals 24 h after induction of muscle pain. The level of nNOS mRNA was measured in the lumbar section of the spinal cord using RT-PCT. The expression of nNOS was analyzed in the dorsal horn of the lumbar spinal cord by immunohistochemistry. TENS decreased nNOS immunoreactivity in the dorsal horn of the lumbar spinal cord when compared with controls(p<.05). In RT-PCR, TENS decreased nNOS mRNA level of lumbar spinal cord when compared with controls(p<.05). These results suggested that application of TENS attributed to decrease muscle pain.

• The Korean Journal of Pain
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• 제19권2호
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• pp.131-136
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• 2006

Background: The aim of this study was to clarify the role of spinal groups II and III metabotropic glutamate receptors (mGluRs) with respect to postoperative pain at the spinal level. In addition, the nature of the pharmacological interaction between groups II and III mGluRs agonists and morphine was determined. Methods: Catheters were inserted into the intrathecal space of male SD rats. To induce postoperative pain, an incision was made in the plantar surface of the hind paw. A pharmacological characteristic for the interaction between groups II and III mGluRs agonists and morphine was evaluated using a fixed-dose analysis. Results: None of intrathecal group II and III mGluRs agonists modified the withdrawal threshold of the incisional pain. The administration of intrathecal morphine resulted in an increase of a dose dependent withdrawal threshold. A fixed-dose analysis revealed that the group III mGluRs agonist, ACPT-III, increased the antinociceptive action of morphine, while the group II mGluRs agonist, APDC, had no effect the antinociception of morphine. Conclusions: These results suggest that group II and III mGluRs may not play a direct modulatory role in the processing of postoperative pain at the spinal level. However, agonizing group III mGluRs may indirectly contributable to the potentiation of morphines antinociception in the spinal cord. Thus, the combination of morphine and a group III mGluRs agonist may be useful in the management of spinal postoperative pain.

• Journal of Korean Neurosurgical Society
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• 제48권3호
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• pp.281-284
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• 2010

Spinal epidural hematoma is a rare complication associated with pain control procedures such as facet block, acupuncture, epidural injection, etc. Although it is an uncommon cause of acute myelopathy, and it may require surgical evacuation. We report four patients with epidural hematoma developed after pain control procedures. Two procedures were facet joint blocks and the others were epidural blocks. Pain was the predominant initial symptom in these patients while two patients presented with post-procedural neurological deficits. Surgical evacuation of the hematoma was performed in two patients while in remaining two patients, surgery was initially recommended but not performed since symptoms were progressively improved. Three patients showed near complete recovery except for one patient who recovered with residual deficits. Although, spinal epidural hematoma is a rare condition, it can lead to serious complications like spinal cord compression. Therefore, it is important to be cautious while performing spinal pain control procedure to avoid such complications. Surgical treatment is an effective option to resolve the spinal epidural hematoma.

• Journal of Korean Neurosurgical Society
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• 제47권2호
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• pp.151-154
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• 2010

The efficacy of spinal cord stimulation (SCS) for treatment of various chronic painful conditions is well established. Very few reports have documented the use of SCS for treatment of chronic pain after spinal cord injury. We present a case showing a good outcome after such treatment, and suggest that high cervical stimulation may be efficacious. A 53-year-old male underwent SCS on the C1-3 level for treatment of intractable neuropathic pain below the T3 level, and in the upper extremities, arising from spinal cord injury resulting from transverse myelitis caused by schistosomiasis. High cervical SCS significantly improved the pain in the upper extremities and at the T3-T10 dermatome level. The patient continues to report excellent pain relief 9 months later. The present case suggests that high cervical stimulation may improve chronic pain in the upper extremities and the T3-T10 dermatome level arising from spinal cord injury.

• The Korean Journal of Pain
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• 제25권3호
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• pp.143-150
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• 2012

Spinal cord stimulation has become a widely used and efficient alternative for the management of refractory chronic pain that is unresponsive to conservative therapies. Technological improvements have been considerable and the current neuromodulation devices are both extremely sophisticated and reliable in obtaining good results for various clinical situations of chronic pain, such as failed back surgery syndrome, complex regional pain syndrome, ischemic and coronary artery disease. This technique is likely to possess a savings in costs compared with alternative therapy strategies despite its high initial cost. Spinal cord stimulation continues to be a valuable tool in the treatment of chronic disabling pain.