• The Korean Journal of Pain
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• v.23 no.4
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• pp.230-235
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• 2010

Background: Bone cancer pain has a disruptive effect on the cancer patient's quality of life. Although ginsenosides have been used as traditional medicine in Eastern Medicine, the effect on bone cancer pain has not been throughly studied. The aim of this study was to determine whether ginsenosides may alter the bone cancer pain at the spinal level. Methods: NCTC 2472 tumor cells ($2.5{\times}10^5$) were injected into the femur of adult male C3H/HeJ mice to evoke bone tumor and bone cancer pain. To develop bone tumor, radiologic pictures were obtained. To assess pain, the withdrawal thereshold was measured by applying a von Frey filament to the tumor cells inoculation site. The effect of intrathecal ginsenosides was investigated. Effect of ginsenosides (150, 500, $1,000{\mu}g$) was examined at 15, 30, 60, 90, 120 min after intrathecal delivery. Results: The intrafemoral injection of NCTC 2472 tumor cells induced a radiological bone tumor. The withdrawal threshold with tumor development was significantly decreased compared to the sham animals. Intrathecal ginsenosides effectively increased the withdrawal threshold in the bone cancer site. Conclusions: NCTC 2472 tumor cells injection into the mice femur caused bone tumor and bone cancer pain. Intrathecal ginsenosides attenuated the bone cancer-related pain behavior. Therefore, spinal ginsenosides may be an alternative analgesic for treating bone cancer pain.

• The Journal of the Korean bone and joint tumor society
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• v.2 no.1
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• pp.72-77
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• 1996

Metastaic bone tumors are usually accompanied with severe pain. The treatment modalities for this pain are so variable that patients are sometimes afraid of using them. Salmon calcitonin has a function to increase beta-endorphines followed by increasing the blood level of prostaglandin and thromboxan A2, which results in analgesic effect. This drug also has been known to decrease bone resorption. There were a few reports that parenteral use of salmon calcitonin decrease the pain from metastatic bone tumor. We wanted to know the effectiveness and tolerability of nasal spray of salmon calcitonin in relieving bone pain with metastatic tumor. We analyzed the effectiveness in the aspects of pain, sleep, performance status, mobility, supplementary analgesic use. The biologic effect of salmon calcitonin was analysed with CBC, Ca/P, BUN/Cr, uric acid. Simple radiography, alkaline phosphatase, osteocalcin, pyrilink-K were used as parameters for bone change. Eighteen cases of metastatic bone tumors took nasal spray of salmon calcitonin($Miacalcic^{(R)}$, 200IU/day) for 4 weeks, to relieve bone pain. With Wilcoxon Matched-Pairs Signed Ranks Test, we could find pain decreased significantly at 3 week and mobility become improved at 4 week of salmon calcitonin use. Other parameters didn't show any significant changes. We think the analgesic effect is mainly due to effect not on the local bone lesion but on the central nervous system, and that increased dose of salmon calcitonin can induce earlier and stronger analgesic effect.

• The Korean Journal of Pain
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• v.30 no.3
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• pp.165-175
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• 2017

Nuclear medicine imaging is widely used in pain medicine. Low back pain is commonly encountered by physicians, with its prevalence from 49% to 70%. Computed tomography (CT) or magnetic resonance imaging (MRI) are usually used to evaluate the cause of low back pain, however, these findings from these scans could also be observed in asymptomatic patients. Bone scintigraphy has an additional value in patients with low back pain. Complex regional pain syndrome (CRPS) is defined as a painful disorder of the extremities, which is characterized by sensory, autonomic, vasomotor, and trophic disturbances. To assist the diagnosis of CRPS, three-phase bone scintigraphy is thought to be superior compared to other modalities, and could be used to rule out CRPS due to its high specificity. Studies regarding the effect of bone scintigraphy in patients with extremity pain have not been widely conducted. Ultrasound, CT and MRI are widely used imaging modalities for evaluating extremity pain. However, SPECT/CT has an additional role in assessing pain in the extremities.

• Nuclear Medicine and Molecular Imaging
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• v.40 no.2
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• pp.82-89
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• 2006

Bone metastasis is a common sequelae of solid malignant tumors such as prostate, breast, lung, and renal cancers, which can lead to various complications, including fractures, hypercalcemia, and bone pain, as well as reduced performance status and quality of life it occurs as a result of a complex pathophysiologic process between host and tumor cells leading to cellular invasion, migration adhesion, and stimulation of osteoclastic and osteoblastic activity. Several sequelae occur as a result of osseous metastases and resulting bone pain can lead to significant debilitation. A multidisciplinary approach is usually required not only to address the etiology of the pain and its complicating factors but also to treat the patient appropriately. Pharmaceutical therapy of bone pain, includes non-steroidal analgesics, opiates, steroids, hormones, bisphosphonates, and chemotherapy. While external beam radiation therapy remains the mainstay of pain palliation of a solitary lesions, bone seeking radiopharmaceuticals have entered the therapeutic armamentarium for the treatment of multiple painful osseous lesions. $^{32}P,\;^{89}SrCl,\;^{153}Sm-EDTMP,\;^{188}Re/^{186}Re-HEDP,\;and\;^{177}Lu-EDTMP$ can be used to treat painful osseous metastases. These various radiopharmaceuticals have shown good efficacy in relieving bone pain secondary to bone metastasis. This systemic form of metabolic radiotherapy is simple to administer and complements other treatment options. This has been associated with improved mobility in many patients, reduced dependence on narcotic and non-narcotic analgesics, improved performance status and quality of life, and, in some studios, improved survival. All of these agents, although comprising different physical and chemical characteristics, offer certain advantages in that they are simple to administer, are well tolerated by the patient if used appropriately, and can be used alone or in combination with the other forms of treatment. This article illustrates the salient features of these radiopharmaceuticals, including the usual therapuetic dose, method of administration, and indications for use and also describe about the pre-management checklists, and jndication/contraindication and follow-up protocol.

• Clinical and Experimental Pediatrics
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• v.51 no.8
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• pp.792-796
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• 2008

Bone pain in a child could be associated with cancer as an initial manifestation of the disease. The childhood malignancies that frequently present bone pain are leukemia, neuroblastoma, and primary bone tumors such as osteosarcoma and Ewing sarcoma. Persistent bone or joint pain associated with swelling, mass, or limitation of motion implies underlying serious causes. Systemic manifestations such as lymphadenopathy, hepatosplenomegaly, fever, fatigue, night sweat, and laboratory abnormalities are also suggestive of malignancy. The index of suspicion tends to be low since less than 1% of children who complain of bone pain are diagnosed as cancer. Nonetheless, pediatricians should be alert to the possibilities of cancer since early detection and prompt treatment might reduce mortality.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.6
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• pp.349-359
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• 2018

Background: Propofol is an intravenous anesthetic which has antioxidant effects due to its similarity in molecular structure to ${\alpha}$-tocopherol. It has been reported that ${\alpha}$-tocopherol increases osteoclast fusion and bone resorption. Here, we investigated the effects of propofol on signaling pathways of osteoclastogenic gene expression, as well as osteoclastogenesis and bone resorption using bone marrow-derived macrophages (BMMs). Methods: BMMs were cultured with macrophage colony-stimulating factor (M-CSF) alone or M-CSF plus receptor activator of nuclear factor kappa B ligand (RANKL) in the presence of propofol ($0-50{\mu}M$) for 4 days. Mature osteoclasts were stained for tartrate-resistant acid phosphatase (TRAP) and the numbers of TRAP-positive multinucleated osteoclasts were counted. To examine the resorption activities of osteoclasts, a bone resorption assay was performed. To identify the mechanism of action of propofol on the formation of multinucleated osteoclasts, we focused on dendritic cell-specific transmembrane protein (DC-STAMP), a protein essential for pre-osteoclastic cell fusion. Results: Propofol increased the formation of TRAP-positive multinucleated osteoclasts. In addition, the bone resorption assay revealed that propofol increased the bone resorption area on dentin discs. The mRNA expression of DC-STAMP was upregulated most strongly in the presence of both RANKL and propofol. However, SB203580, a p38 inhibitor, significantly suppressed the propofol/RANKL-induced increase in mRNA expression of DC-STAMP. Conclusion: We have demonstrated that propofol enhances osteoclast differentiation and maturation, and subsequently increases bone resorption. Additionally, we identified the regulatory pathway underlying osteoclast cell-cell fusion, which was enhanced by propofol through p38-mediated DC-STAMP expression.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.4
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• pp.1503-1510
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• 2014

Breast cancer bone metastasis causing severe morbidity is commonly encountered in daily clinical practice. It causes pain, pathologic fractures, spinal cord and other nerve compression syndromes and life threatening hypercalcemia. Breast cancer metastasizes to bone through complicated steps in which numerous molecules play roles. Metastatic cells disrupt normal bone turnover and create a vicious cycle to which treatment efforts should be directed. Bisphosphonates have been used safely for more than two decades. As a group they delay time to first skeletal related event and reduce pain, but do not prevent development of bone metastasis in patients with no bone metastasis, and also do not prolong survival. The receptor activator for nuclear factor ${\kappa}B$ ligand inhibitor denosumab delays time to first skeletal related event and reduces the skeletal morbidity rate. Radionuclides are another treatment option for bone pain. New targeted therapies and radionuclides are still under investigation. In this review we will focus on mechanisms of bone metastasis and its medical treatment in breast cancer patients.

• The Korean Journal of Pain
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• v.34 no.4
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• pp.375-393
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• 2021

Percutaneous osteoplasty (POP) is defined as the injection of bone cement into various painful bony lesions, refractory to conventional therapy, as an extended technique of percutaneous vertebroplasty (PVP). POP can be applied to benign osteochondral lesions and malignant metastatic lesions throughout the whole skeleton, whereas PVP is restricted to the vertebral body. Common spinal metastases occur in the thoracic (70%), lumbosacral (20%), and cervical (10%) vertebrae, in order of frequency. Extraspinal metastases into the ribs, scapulae, sternum, and humeral head commonly originate from lung and breast cancers; extraspinal metastases into the pelvis and femoral head come from prostate, urinary bladder, colon, and uterine cervical cancers. Pain is aggravated in the dependent (or weight bearing) position, or during movement (or respiration). The tenderness and imaging diagnosis should match. The supposed mechanism of pain relief in POP is the augmentation of damaged bones, thermal and chemical ablation of the nociceptive nerves, and local inhibition of tumor invasion. Adjacent (facet) joint injections may be needed prior to POP (PVP). The length and thickness of the applied needle should be chosen according to the targeted bone. Bone cement is also selected by its osteoconduction, osteoinduction, and osteogenesis. Needle route should be chosen as a shortcut to reach the target bony lesions, without damage to the nerves and vessels. POP is a promising minimally invasive procedure for immediate pain relief. This review provides a technical survey for POPs in painful bony lesions.

• Journal of Korean Foot and Ankle Society
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• v.23 no.4
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• pp.183-188
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• 2019

Purpose: Bone contusion is usually treated with conservative therapy for 3 months. Bone contusion around knee and hip joints has been extensively reported on, but there are scant reports on this condition in foot and ankle joints. This study evaluated the nature, characteristics and location of bone contusion around foot and ankle joints to enlighten clinicians on how to better treat this disease entity. Materials and Methods: We classified bone contusion of the 76 patients into three types (102 sites; 47 ankle sprains, 18 traffic accidents, 11 falls) according to the Costa-Paz system with employing magnetic resonance imaging (MRI), and the study then analyzed the common sites and areas of occurrence according to the mechanism of injury and duration of pain after first conducting conservative therapy. Results: Of the 76 patients (102 sites) on the MRI, 43 case (42.2%) for talus, 19 cases for distal tibia, and 12 cases for calcaneus were involved. The classification, according to the Costa-Paz system, was Type I, 51 cases; Type II, 32 cases; and Type III, 19 cases. The duration of pain after conservative treatment was 12.15±2.17 weeks for Type I, 14.5±2.15 weeks for Type II, and 21.0±3.8 weeks for Type III. Conclusion: The most common location of post-traumatic bone contusion around both the foot and ankle is the talus, distal tibia, and calcaneus. The most common type of injury noted on MRI is a diffuse signal with change of the medullary component (Type I), In cases of bone contusion extending to a subjacent articular surface or disruption or depression of the normal contour of the cortical surface (Types II, III), the patients' pain appears to last longer. Thus, it is necessary to consider a longer period of conservative treatment in cases of Types II and III bone contusion because the patients' pain may last longer than 3 months.

• Physical Therapy Korea
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• v.27 no.1
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• pp.70-77
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• 2020

Background: Neck pain can be caused by any structure in the neck, such as intervertebral discs, ligaments, muscles, facet joints, dura mater, and nerve roots. The hyoid bone is a structure that is also related to head and neck posture, neck movement and pain, but there are no studies on hyoid deviation, neck pain, and range of motion (ROM). Objects: The purpose of this study was to investigate the effect of fascia relaxation and mobilization of the hyoid bone on the ROM, pain, and lateral deviation of the hyoid bone. Methods: Twenty-five patients with neck pain identified by the lateral motion test (10 males [35.13 ± 7.67 years, 172.69 ± 3.90 cm, 78.77 ± 6.96 kg] and 15 females [35.13 ± 10.05 years, 161.11 ± 4.09 cm, 52.59 ± 2.98 kg]) was chosen randomly. Baseline values for pain, neck ROM, and lateral deviation in the hyoid bone were recorded using a visual analogue scale (VAS), goniometer, and tape measure. Then, each patient was treated with hyoid fascia relaxation and mobilization, and all results were recorded after intervention. Comparison of the results before and after intervention was analyzed using paird t-test (p < 0.05). Results: Right rotation, extension, VAS, and rotational asymmetry statistically significant differences (p < 0.05). Right rotation and extension increased ROM, rotational asymmetry ratio and VAS decreased. However, there was no significant difference in flexion, left rotation, center point (p > 0.05). Conclusion: Fascia relaxation and hyoid mobilization could improve the ROM of cervical extension, asymmetry of the cervical rotation and neck pain.