• 제목/요약/키워드: Tension headache

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Current understanding of nociplastic pain

  • Yeong-Min Yoo;Kyung-Hoon Kim
    • The Korean Journal of Pain
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    • 제37권2호
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    • pp.107-118
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    • 2024
  • Nociplastic pain by the "International Association for the Study of Pain" is defined as pain that arises from altered nociception despite no clear evidence of nociceptive or neuropathic pain. Augmented central nervous system pain and sensory processing with altered pain modulation are suggested to be the mechanism of nociplastic pain. Clinical criteria for possible nociplastic pain affecting somatic structures include chronic regional pain and evoked pain hypersensitivity including allodynia with after-sensation. In addition to possible nociplastic pain, clinical criteria for probable nociplastic pain are pain hypersensitivity in the region of pain to non-noxious stimuli and presence of comorbidity such as generalized symptoms with sleep disturbance, fatigue, or cognitive problems with hypersensitivity of special senses. Criteria for definitive nociplastic pain is not determined yet. Eight specific disorders related to central sensitization are suggested to be restless leg syndrome, chronic fatigue syndrome, fibromyalgia, temporomandibular disorder, migraine or tension headache, irritable bowel syndrome, multiple chemical sensitivities, and whiplash injury; non-specific emotional disorders related to central sensitization include anxiety or panic attack and depression. These central sensitization pain syndromes are overlapped to previous functional pain syndromes which are unlike organic pain syndromes and have emotional components. Therefore, nociplastic pain can be understood as chronic altered nociception related to central sensitization including both sensory components with nociceptive and/or neuropathic pain and emotional components. Nociplastic pain may be developed to explain unexplained chronic pain beyond tissue damage or pathology regardless of its origin from nociceptive, neuropathic, emotional, or mixed pain components.

치과위생사의 직무 스트레스와 턱관절 장애 자각증상의 상관성 연구 (Relationship between job-stress and temporomandibular joint disorder in dental hygienists)

  • 정은영;김명래
    • 한국치위생학회지
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    • 제14권3호
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    • pp.381-390
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    • 2014
  • Objectives : The purpose of the study is to investigate the relationship between job-stress and temporomandibular joint(TMJ) disorder in dental hygienists. This study will provide the basic data to improve the working condition and the quality of life. Methods : The subjects were 229 dental hygienists at general hospitals in Seoul, Korea. A self-reported questionnaire was filled out from May 20 to June 20, 2013. The questionnaire consisted of 4 questions of demographic features, 11 questions for TMJ symptoms and 5 questions for job stress. The data were analyzed by frequency analysis, chi-square test, Mann-Whitney U test and multiple job-stress logistic regression analysis using SPSS version 21.0. Results : During the last six months, 53.3%(122 persons) of the dental hygienists had TMJ disorder symptoms including joint noise(40.6%, 93 persons), TMJ pain(31.4%, 71 persons) and limitation of TMJ(21.8%, 50 persons). Job-stress is divided into two ranges including high stress group(4.3-5.0 points) and low stress group(0.0-3.6 points) in TMJ pain and joint noise(p<0.05). TMJ pain was closely related to low back pain, pelvis pain and tension headache arising from the uncomfortable working posture. Conclusions : It is necessary to prevent the job stress in the dental hygienists by the improvement of working condition, emotional stability, and frequent postural change.

방사선 선량이 생체 내 조직에서 미량원소에 미치는 영향 (Impact of the Radiation Absorbed dose on the Microelements of Tissues in Living Bodies)

  • 지태정;곽병준
    • 한국콘텐츠학회논문지
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    • 제11권8호
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    • pp.204-210
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    • 2011
  • 방사선에너지가 생체에 미치는 영향 중 물질대사에 관여하는 미량원소의 함량을 알아보았다. 실험 방법은 mouse에 1Gy, 5Gy, 10Gy의 X선을 전신 조사한 후 간 조직에서 분석하였다. 그 결과, 일부 원소에서 대조군과 비교하여 함량 변화가 확인되었다. 선량에 따른 변화에서는 1Gy에서는 크게 차이를 보이지 않았으나 5Gy, 10Gy의 높은 선량에서는 Ca, Mn의 함량이 감소되었다. 그 중 Ca의 함량이 가장 많이 감소되었으며, 근육 긴장과 만성 두통 등의 증후군을 유발하는 것으로 판단된다. 함량 증가를 보인 원소는 Al으로 100% 증가된 것으로 조사되었다. 방사선 조사 후 기간 경과에 따른 함량 변화에서는 Fe, Ba 등에서 감소하는 경향을 보였다. 유해원소는 Cd 함량이 25% 증가 되었는데 이는 칼슘대사에 관여하는 것으로 알려졌다. 따라서 방사선에너지에 의한 세포 손상이 미량원소 함량 변화에 영향을 주는 것으로 판단되며, 전구증상을 유발하는데 일정부분 관련이 있는 것으로 사료된다.

근막동통으로 인한 하악 구치부 연관통의 임상증례 (A Case Report of Referral Pain on Mandibular Toothache Originated from Myofascial Pain)

  • 강진규
    • Journal of Oral Medicine and Pain
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    • 제32권4호
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    • pp.455-460
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    • 2007
  • 치아의 통증을 호소하는 환자 중 임상검사 및 방사선학적 검사소견에서 특기할 병적 소견이 관찰되지 않는 경우 비치성 치통을 의심해보아야 하며, 근육질환, 상악동염, 신경병성 통증, 신경혈관 질환 등의 원인으로 치통이 유발될 수 있다. 이러한 비치성 치통의 경우 진성 치통과 구별하기 위하여 철저한 병력 조사 및 전반적인 임상검사가 시행되어야 하며, 진단용 국소마취를 통하여 보다 정확한 진단을 확립할 수 있다. 이러한 비치성 치통의 가장 흔한 원인 중의 하나인 근막동통은 근육조직을 촉진 시 단단한 띠가 만져지는 것이 특징적이며 이것이 발통점으로 작용하여 근육이 뻣뻣한 느낌과 피로감, 연관통, 치아에 전이되는 통증, 근긴장성 두통, 통각과민 등의 증상을 유발할 수 있으며, 특히 교근은 상악 구치부 및 하악 구치부의 통증을 유발한다. 본 증례는 우측 교근부의 근막동통에 기인한 하악 우측 구치부의 치통 양상을 운동요법, 물리치료, 약물치료 등의 통상적이고 가역적인 근육질환의 치료법을 통해 증상의 호전을 보인 증례이다. 비치성 치통은 정확하게 진단되지 않을 경우 근관치료, 치주치료, 발치 등의 불필요한 치과치료가 시행될 수 있으며, 이러한 치료를 통하여도 환자의 통증은 경감되지 않기 때문에 치과치료가 시행되기 전에 반드시 정확한 감별진단이 필요하리라 사료된다.

개흉술후 지속적 경막외마취가 통증감소에 미치는 영향 (The Effect of Ipidural Pain Block After Thoracotomy)

  • 최덕영;원경준
    • Journal of Chest Surgery
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    • 제30권8호
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    • pp.809-814
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    • 1997
  • 마약성 진통제와 국소마취제에 의한 지속적 경막외마취는 개흉술후 통증감소를 위한 방법으로 널리 사용되고 있다. 본 연구에서는 지난 1994년 1월부터 1995년 7월까지 본원 흉부외과에서 츠방 혹은 후측방 개흉술을 받은 환자 38명을 대상으로 19명씩 실험군과 대조군으로 구분하여 실험군에 경막외마취를 시행하여 그 효과를 조사하였다. 먼저 lidocaine과 norphine을 섞어 경막서 지속적 외도관을 통해 주사하고 그후 bupivacaine과 morphine을 섞어 술후 5∼6일간 지속투여를 하였다. 대조군에 비해 실험군에서 환자의 통증수치와 상지거상능력과 호흡수는 주사추 30분부터 통계적으로 의미 있게 변화되어 술후 통증이 경감되고 있음을 알 수 있었고, 말초동맥혈 이산화탄소분압은 2시간 후부터 통계적으로 의미 있게 줄어들어 환자가 효과적인 호흡을 하고 있음을 알 수 있었다. 술후 재원기간도 의미 있게 줄어들었다. 경막외마취의 주요한 합병증으로는 뇨정체가 있었으나 심각하지는 않았다. 이상의 결과로 우리는 개흉술후 경막외마취가 우수한 통증완화 효과가 있어 술후 폐합병증을 예방하고 술후 빠른 회복에도 좋은 영향을 미치는 것으로 생각한다.

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2000년부터 독일에서 수행된 대규모 침 임상연구들에 대한 고찰: ASH, ART, ARC, GERAC (Review of the Large-Scale Clinical Researches on Acupuncture in Germany: ASH, ART, ARC, and GERAC)

  • 윤주연;한국인;정진수;이승호;장인수
    • Korean Journal of Acupuncture
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    • 제30권1호
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    • pp.21-26
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    • 2013
  • Objectives : The purpose is to introduce the recent large-scale clinical researches for safety, efficacy and effectiveness of acupuncture in Germany. Results : In 2000, the German Federal Committee of Physicians and Health insurer proposed that large research initiatives on acupuncture, Acupuncture Model Projects(Modellvorhaben Akupunktur), could be conducted by health insurance companies for several pain that acupuncture is syndromes to justify the insurance-based reimbursement. Accordingly, 4 clinical researches were carried out; the Acupuncture Safety and Health economics studies(ASH), the Acupuncture Randomised Trial(ART), the Acupuncture in Routine Care studies(ARC), and the German Acupuncture trial(GERAC). Meanwhile, ASH is a prospective observational study for safety and costs. ART and GERAC are composed of RCTs for efficacy. ARC includes 6 pragmatic RCTs with additional non-randomized cohort study for effectiveness. We investigated the papers related to them and discussed about the outcomes. The researches showed that acupuncture is effective in practice for several chronic conditions such as migraine, tension-type headache, chronic low back pain, osteoarthritis of knee, dysmenorrhea, and allergic rhinitis. Based in part on them, the German health authorities decided that acupuncture would be included into routine reimbursement by social health insurance funds for chronic low back pain and chronic osteoarthritis of the knee in 2006. Conclusions : The German clinical researches may suggest the clues for establishing the evidence of acupuncture treatment.

애구(艾灸)가 고혈압(高血壓) 환자(患者)의 혈압강하(血壓降下)에 미치는 영향(影響) (The Effects of Decreasement of Blood Pressure on Hypertension Patients by Moxibustion)

  • 이병훈;김철홍;서정철;윤현민;장경전;송춘호;안창범
    • Journal of Acupuncture Research
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    • 제18권5호
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    • pp.70-76
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    • 2001
  • Objective : In order to study effects of decreasement of blood pressure on hypertension patients by moxibustion a clinical study was performed. Methods : Moxibustion at Quchi(LI11), Guanyan(CV4) 10 times on 25 hyper tension patients who were treated via opd on Dong-Eui Oriental Medical Hospital. Results : 1. After 10 times moxibustion at Quchi(LI11), Guanyan(CV4),the systolic blood pressure were decreased 16.5% degree. 2. After 10 times moxibustion at Quchi(LI11), Guanyan(CV4),the diastolic blood pressure were decresed 26.6% degree. 3. Subjective symptoms(i.e. headache, dizziness, heat in the upper part of the body, dyspnea etc) were decresed after 10 times moxibustion at Quchi(LI11), Guanyan(CV4). Conclusion : Continous Moxibustion at Quchi(LI11), Guanyan(CV4) implies decreasement of blood pressure and improvement of subjective symptoms.

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거짓침을 대조군으로 사용한 국내 침 임상시험에 대한 체계적 고찰과 메타분석 (A Systematic Review and Meta-analysis of Acupuncture Trials in Republic of Korea that Used Sham Acupuncture as a Control Group)

  • 김정은;강경원;김태훈;이승훈;김주희;백승민;최선미
    • Journal of Acupuncture Research
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    • 제28권6호
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    • pp.1-17
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    • 2011
  • Objectives : This study aimed to review randomized controlled trials of acupuncture performed in South Korea that used sham acupuncture as a control group. Methods : The following databases were searched through the end of September 2011: Koreanstudies information service system (KISS), Korean medical database (KMbase), national discovery OR science leaders (NDSL), oriental medicine advance searching integrated system (OASIS), and research information service system (RISS). The following search terms were used: acupuncture AND (sham or placebo). The reference lists of searched articles and Korea institute of oriental medicine (KIOM) reports(2005~2009) were identified. The following data were extracted: year/first author, disease, number of participants, blinding, intervention, outcome, and result. Where appropriate, we performed meta-analysis. The methodological quality was assessed according to the Jadad scale and 'risk of bias' by Cochrane Handbook procedure. Results : Twenty-nine studies were included in this review. In eighteen studies, penetrating sham controls were used as the control intervention, whereas the remaining eleven studies adopted non-penetrating sham controls such as the Park Sham Device or blunt auricular acupuncture. Nine studies showed statistically significant difference in outcomes. Twelve studies concerning insomnia after stroke, chronic tension-type headache, idiopathic Parkinson's disease, Hwa-Byung, and smoking cessation were included in meta-analysis. A meta-analysis of insomnia after stroke only found significant difference(MD -4.31, 95% Cl -6.19 to -2.42, $p$<0.00001). In general, all of the studies showed low methodological quality(Jadad score: mean 2.1). Risk of bias by Cochrane Handbook procedure varied. Conclusions : The results of this study could not suggest conclusive evidence that acupuncture is more effective than sham acupuncture in several diseases. In the future, more studies with rigorous acupuncture trials using sham controls should be conducted.

아토피 피부염 환자의 생활사건 스트레스와 대처방식 (Life Event Stress and Coping Strategy in Patient with Atopic Dermatitis)

  • 한덕현;최한규;기백석;남범우;서성준
    • 정신신체의학
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    • 제7권2호
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    • pp.226-232
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    • 1999
  • 연구목적 : 본 연구에서는 사회적, 심리적 관점에서 아토피 피부염에서 보이는 스트레스의 양을 측정 하고 스트레스에 대한 대처 방식의 특정을 알아보고자 하였다. 방법 : 1997년 9월부터 1998년 5월까지 중앙대학교 의과대학 부속병원 피부과에 내원한 20세 이상의 아토피 피부염 환자를 분석 대상으로 생활사건 척도(Scale of Life Event)와 다차원적척도(Multimensional Coping Scale)를 이용하여 스트레스 정도와 대처방식의 차이를 알아보고자 하였다. 결과 : 생활 사건에 대한 스트레스의 양은 아토피 피부염 환자군이 $386.52{\pm}257.93$이었고, 대조군은 $255.98{\pm}161.93$으로 통계적으로 유의한 차이를 보였고 대처 방식에 있어서는 아토피 피부염 환자군에서 적극적 망각 척도, 정서적 진정 척도, 긍정적 비교 척도에서 각각 $7.30{\pm}3.56$(t=2.55. df=53, p=0.013), $8.0{\pm}2.05$(t=2.42. df=58, p=0.019), $6.00{\pm}4.97$(t=2.48, df=58, p=0.16)으로 대조군에 비해 통계적으로 유의하게 높았다. 결론 : 스트레스는 아토피 피부염의 발생 및 악화에 영향을 미칠 것으로 추정되며, 적극적 망각과 같은 정서중심적, 비효과적 대처방식을 문제 중심적 대처로 변환시키고 자신보다 못한 상태에 있는 타인을 비교함 자신의 상태를 유지하려하는 인지적 측면과 스트레스 상황에서 발생한 정서적 혼란을 가라앉히려는 정서적 측면에 대해 지지적 치료가 이루어지면 아토피 피부염을 비롯한 정신 신체 질환의 치료에 도움이 될 것으로 생각된다.

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암 환아 부모의 경험에 대한 질적 연구 (The Experience of Parents Whose Child is Dying with Cancer)

  • 조영숙;김수지
    • 대한간호학회지
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    • 제22권4호
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    • pp.491-505
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    • 1992
  • The purpose of this research was to understand the structure of the lived experience of parents of a child terminally ill with cancer The research question was “What is the structure of the experience of parents of a child terminally ill with cancer\ulcorner” The sample consisted of 17 parents of children admitted to the cancer units of two university hospitals in Seoul. The unstructured interviews were carried out from October 10, 1991 through January 10, 1992. They were audio-recorded and analysed using Van Kaam's method. Parents ascribed the cause of the cancer to the mother's emotional imbalance during pregnancy, the mother's stress, failure to observe religious rites, food, the parent's sin, misfortune and pollution. The theme clusters were tension, fear and depression experienced during pregnancy, stress that children suffer from abusive parents, failure to observe religious activites, bad luck, and sins committed during a previous life. When the child suffered a recurrence of cancer, the parents experienced negative emotions, nervousness, sorrow. depression and death. The theme clusters were feelings of despair, helplessness, regret, guilt, insecurity, emptyness and apathy. The long struggle with cancer resulted in the loss of economic security, loss of psychological and physical well being, and social withdrawal. The theme clusters were the economic burden of medical cost, giving up treatment, debt, limited medical insurance coverage and blood transfusion. The loss of psychological well being included stress, lack of support systems, inability to carry out responsibilities, lack of trust of the medical ten family breakdown, inappropriate expression of emotion and not disclosing the diagnosis to the child. Physically the parents suffered fatigue, insomnia, loss of appetite, loss of weight, dizzness, headache, psychosomatic symptoms, and increased consumption of liquor and cigarettes. Social withdrawal was manifested by taking time off from work to look after the child, decrease of outside social activities and feelings of isolation. Influences on family life were spousal conflicts, negative response of siblings, separation of the family members and economic hardship. The theme clusters were blaming a spouse for the cause of the illness and disagreements, maladjustment, lonliness, hostility and depression of siblings. The high price of medical care over the long period was a major factor influencing the life of the family. Positive experiences during the child's long illness were the strengthening of support systems and religious beliefs and financial help from social organizations. The support of one's spouse primarily helped to overcome the stress of the long illness. In addition, support was received from parents of other children with cancer and from nurses and religious leaders. The nurse, by providing empathetic support, should be a person with whom parents can express their feelings and share their experiences.

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