• The Korean Journal of Pain
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• v.8 no.1
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• pp.127-130
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• 1995

A 34 year old male patient visited to our neuro-pain clinic with symtoms of a left frontal headache, eyeball throbbing and occipital pain. Two days after the first visit to our clinic. pain was aggrevated and the skin eruption appeared on the left forehead. He was diagnosed as raving Herpes Zoster Opthalmicus(HZO). We performed stellate ganglion block(SGB), but pain did not subsid. So a continuous cervical epidural block was perfomed(CCEB) and it could relieve the pain promptly. In this case, VAS(visual analogue scale) was diminished from 10 to 3 and the skin eruption was healed 24 days after the treatment with CCEB and SGB. We experienced that CCEB is more effective rather than intermittent SGB in intractable HZO. CCEB should be considered to the treatment of choice in patients with HZO.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.220-225
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• 1998

Background: The patients of facial hyperhidrosis have been known that they had much difficulties in interpersonal relationships and social activities due to excessive hidrosis when they were in stress, hot weather, or having meals. Previous drug therapy and stellate ganglion block have only temporary effects. The surgical method, $T_1$ sympathetomy has the risk of Hornor's syndrome. For that reasons, the sympathicotomy of proximal and distal portions of $T_2$ sympathetic ganglion with electroresectoscope used in transurethral resection seemed to be appropriate procedure, and we would like to report the results of our procedure. Method: Under the general anesthesia with semi-sitting position, and the portal was made through the small incision along the upper border of the 4th rib at the crossing point of mid-axillary line. After the partial collapse of lung by insufflation of 300 to 500 ml of $CO_2$, $T_2$ sympathetic ganglion was identified and resected proximally and distally with electro-cauterization. Finally the lung was expanded by limiting flow until the airway pressure reached 30 to 40 cm$H_2O$, and the wound was closed after removal of electroresectoscope. Result: There was no postoperative complication requiring surgical interventions. The facial sweating was stopped immediately after the operation and all the patients appeared to be satisfied. Conclusion: $T_2$ sympathicotomy with TUR electroresectoscope is thought be the minimal invasive and highly successful method in the treatment of facial hyperhidrosis. But longer terms follow-up will be needed to prove this result.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.283-287
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• 1998

Background: Recently, pain clinic is attracting attention and interest of both physicians and laymen. It is the purpose of this article to analyze our 10 years' experience to seek and improve better protocol of treating pain. Methods & Materials: We analyzed retrospectively 11,235 patients who visited the clinic during 10 years from 1986 to 1996. Total number of hospital visits was 51,908. Male to female ratio was 35：65(3910：7325). Treatment modalities employed were SGB(stellate ganglion block), TPI(trigger point injection), etc. Results: Yearly distribution showed a gradual upward curve until 1992 and remains in a horizontal pattern thereafter. Of age distribution, 6th decades occupied the largest proportion(27.29%). As of disease entities, Low back pain & lower extremities pain comprised of the majority(34.01%) and the epidural block was most frequently given as a treatment. Conclusion: Pain clinic is improving rapidly as an important part of medical science in Korea and outpatients of clinic are on an increasing trend. So, anesthesiologists should be make every efforts to research for treatment of good quality.

• The Korean Journal of Pain
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• v.3 no.1
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• pp.34-39
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• 1990

Fifty-one cases of acute herpes zoster infection were analyzed to search for the most effective management strategy of the disease, including pain relief and decreasing the incidence of postherpetic neuralgia. Anti-viral treatment was not included. Analgesics and nerve blocks, such as stellate ganglion block or epidural block, were helpful. Corticosteroid was administered in most of the cases either systemically or epidurally or both. Epidural administration of local anesthetic in combination with corticosteroid seemed to have certain advantages of excellent pain relief as a result of sympathetic blockade and regional plus systemic anti-inflammatory effects of the steroid, although this was not proved by definite statistical evidence.

• The Korean Journal of Pain
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• v.34 no.4
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• pp.509-533
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• 2021

Background: Postherpetic neuralgia (PHN) is a refractory complication of herpes zoster (HZ). To prevent PHN, various strategies have been aggressively adopted. However, the efficacy of these strategies remains controversial. Therefore, we aimed to estimate the relative efficacy of various strategies used in clinical practice for preventing PHN using a network meta-analysis (NMA). Methods: We performed a systematic and comprehensive search to identify all randomized controlled trials. The primary outcome was the incidence of PHN at 3 months after acute HZ. We performed both frequentist and Bayesian NMA and used the surface under the cumulative ranking curve (SUCRA) values to rank the interventions evaluated. Results: In total, 39 studies were included in the systematic review and NMA. According to the SUCRA value, the incidence of PHN was lower in the order of continuous epidural block with local anesthetics and steroids (EPI-LSE), antiviral agents with subcutaneous injection of local anesthetics and steroids (AV + sLS), antiviral agents with intracutaenous injection of local anesthetics and steroids (AV + iLS) at 3 months after acute HZ. EPI-LSE, AV + sLS and AV + iLS were also effective in preventing PHN at 1 month after acute HZ. And paravertebral block combined with antiviral and antiepileptic agents was effective in preventing PHN at 1, 3, and 6 months. Conclusions: The continuous epidural block with local anesthetics and steroid, antiviral agents with intracutaneous or subcutaneous injection of local anesthetics and a steroid, and paravertebral block combined with antiviral and antiepileptic agents are effective in preventing PHN.

• The Korean Journal of Pain
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• v.7 no.2
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• pp.242-248
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• 1994

Postherpetic neuralgia is frequently painful, incapacitating, mood depressing, and sometimes lifelong. We investigated the influence of duration from eruption to nerve blocks in conjunction with patients age on analgesic and preventive effect for postherpetic neuralgia. We retrospectively evaluated 50 outpatient medical records for the above T4 dermatome. Patients had been referred to pain clinic and were treated over 2weeks from Jan. 1988 to Dec. 1993. Fifty patients were divided into 4 groups as follows: Group I (a): less than 4weeks from eruption to nerve block and younger than 65 years old. Group I (b): less than 4weeks from eruption to nerve block and older than 65 years old. Group II (a): more than 4weeks from eruption to nerve block and younger than 65 years old. Group II(b): more than 4weeks from eruption to nerve block and older than 65 years old. Mean number of stellate ganglion blocks were 29.7. Tramadol, amitriptyline, nicardipine were most commonly prescribed. Group I (a): had the most improvement rate(77.8%) as compared with other group(46.6, 52.7, 56.0%). Number of patients who complained of severe pain (VAS > 5) were 0, 3(39%), 2(15.4%), 5(30%) in I (a), I (b), II (a), II (b) group respectively. In conclusion, analgesic effect was best in cases of patients younger than 65 years old whose treatment were started within 4 weeks of eruption. Patients older than 65 yrs, analgesic effect did not vary on the timing of treatment.

• The Korean Journal of Pain
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• v.13 no.1
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• pp.97-100
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• 2000

Thoracic outlet syndrome (TOS) is a combination of signs and symptoms caused by the compression of the vital neurovascular structure at the thoracic outlet region. It may stem from a number of abnormalities, including degenerative or bony disorders, trauma to cervical spine, fibromuscular bands, vascular abnormalities and spasm of the anterior scalene muscle. CPT (current perception threshold) is defined as the minimum amount of current applied transcutaneously that an individual consciously perceives. It enables quantification of the hyperesthesia that precedes progressive nerve impairment, as well as hypoesthetic conditions. We experienced a case of thoracic outlet syndrome caused by fibrosis of anterior scalene muscle. The patient was a 30 years old woman with a 3 years history of numbness on the ulnar side, progressive weakness and coldness of both hand, tiredness in the left arm, nocturnal pain in the left forearm, and pain in the left elbow, shoulder and neck. Conservative treatment, stellate ganglion block, cervical epidural block, anterior scalene block and previous operation, including both carpal tunnel release, provided no remarkable relief to the patient. A left scalenectomy and first rib resection were performed by transaxillary approach and left cervical root neurolysis was done. After surgery, we measured CPT using neurometer and found conditions worsening in the opposite arm. We performed the same procedure on right side, and followed by CPT measurement. This case suggests that CPT is a useful measurement of recovery and progression of TOS.

• 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.3 no.2
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• pp.131-138
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• 1990

Postherpetic neuralgia (PHN) causes intractable pain which disturbs sleep and daily life. Numerous drugs and treatment strategies have been introduced for the management of PHN. However, no single regimen has proved to be effective. I analysed 38 patients with PHN. Amitriptyline, a tricyclic antidepressant and chlorpromazine were most commonly prescribed. Stellate ganglion blocks for the head and neck pain and epidural blocks for the rest part of the body were most frequently given. Triamcinolone acetate was administered epidurally in most of the cases or by iontophoresis on the affected skin area in two cases. Complications were related to the technique of the nerve block and the side effects of drugs administered. Repeated nerve blocks with tricyclic antidepressant and steroid therapy were thought to be the most effective for the treatment of postherpetic pain.

• The Korean Journal of Pain
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• v.26 no.4
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• pp.401-405
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• 2013

Complex regional pain syndrome secondary to brachial plexus injury is often severe, debilitating and difficult to manage. Percuteneous radiofrequency sympathectomy is a relatively new technique, which has shown promising results in various chronic pain disorders. We present four consecutive patients with complex regional pain syndrome secondary to brachial plexus injury for more than 6 months duration, who had undergone percutaneous T2 and T3 radiofrequency sympathectomy after a diagnostic block. All four patients experienced minimal pain relief with conservative treatment and stellate ganglion blockade. An acceptable 6 month pain relief was achieved in all 4 patients where pain score remained less than 50% than that of initial score and all oral analgesics were able to be tapered down. There were no complications attributed to this procedure were reported. From this case series, percutaneous T2 and T3 radiofrequency sympathectomy might play a significant role in multi-modal approach of CRPS management.