• The Korean Journal of Pain
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• v.37 no.2
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• pp.119-131
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• 2024

There are growing concerns regarding the safety of long-term treatment with opioids of patients with chronic non-cancer pain. In 2017, the Korean Pain Society (KPS) developed guidelines for opioid prescriptions for chronic non-cancer pain to guide physicians to prescribe opioids effectively and safely. Since then, investigations have provided updated data regarding opioid therapy for chronic non-cancer pain and have focused on initial dosing schedules, reassessment follow-ups, recommended dosage thresholds considering the risk-benefit ratio, dose-reducing schedules for tapering and discontinuation, adverse effects, and inadvertent problems resulting from inappropriate application of the previous guidelines. Herein, we have updated the previous KPS guidelines based on a comprehensive literature review and consensus development following discussions among experts affiliated with the Committee on Hospice and Palliative Care in the KPS. These guidelines may assist physicians in prescribing opioids for chronic non-cancer pain in adult outpatient settings, but should not to be regarded as an inflexible standard. Clinical judgements by the attending physician and patient-centered decisions should always be prioritized.

• Journal of Oral Medicine and Pain
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• v.38 no.4
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• pp.313-318
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• 2013

The aim of this study was to the relationship between sleep disturbances and Burning mouth syndrome(BMS). BMS presents as a chronic burning sensation in the oral mucous membrane that is frequently associated with sleep disturbances. BMS is considered neuropathic pain condition with dysfunction of small diameter afferent sensory fiber. A review of the studies reveals, BMS suggested peripheral and cental nervous system changes. Sleep disruption or Rem sleep deprivation cause an inhibition of opioid protein synthesis and a reduced affinity of ${\mu}$ and ${\delta}$ opioid receptors. Let me say that sleep disturbances suggest a risk factor For BMS and support to evaluate as a part of BMS treatment. Further study will be required to ascertain the relationship between distruption of sleep continuity or Rem sleep deprivation and BMS and the evidence of altered neurochemical degeneration of BMS.

• Journal of Acupuncture Research
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• v.18 no.1
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• pp.76-87
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• 2001

Objective : Zusanli(ST36) and Hoku(Li4) are analgesic acupuncture points frequently used for acupuncture in Oriental medicine. The present study was conducted to see the antinociceptive effects produced by electroacupuncture combined two frequencies(Low, High) and two different acupuncture points(LI4, ST36) in the rat tail flick test. Method : In this study the Rats (Sprague-Dawley, 250-300g) were partially anesthetized with thiopental sodium(40mg/kg, i.p.). The basal reaction time for the tail-flick was 3${\pm}$0.5 sec. Low frequency(3Hz, 5V, biphasic) and high frequency(100Hz, 5V, biphasic) were applied to the inserted needle for the period of insertion(twenty minutes). Experimental groups are divied as follow; a) electroacupuncture stimulation groups at Hoku with or high frequency(L-EA, H-EA), b) electroacupuncture stimulation groups at Zusanli with low or high frequency(1-EA, h-EA), c) low frequency at Hoku and Zusanli(LIEA), d) low frequency at Hoku and high frequency at Zusanli(LhEA), e) high frequency at Hoku and low frequency at Zusanli(HIEA), f) high frequency at Hoku and Zusanli(HhEA) Results : The individual stimulation at either Hoku or Zusanli with low frequency has stronger and longer analgesic effect than high frequency stimulation. In addition, the combined stimulation at Hoku and Zusanli with low frequency has superior effect to individual stimulation with low frequency. LhEA and LIEA have superior effect to other stimulation groups among the combined groups. In order to determine the involvement of opioid system on the different antinociceptive effects, Naloxone, an opioid antagonist, was used in the combined groups. LIEA is the most sensitive when naloxone was administrated among study groups. HhEA is the least sensitive in the administration of naloxone. Conclusion : From results, this study confirmed that the opioid system is involved in analgesic effect of low frequency stimulation of acupuncture point, and we also can suggest the stronger analgesic effect of combining stimulation points is due to the theory of spatial summation in the nervous system.

• Journal of Korean Academy of Nursing
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• v.31 no.2
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• pp.206-220
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• 2001

The purpose of this study was to investigate the impact of depression, discomfort, spirituality, physical care, and opioid use on pain with terminally ill cancer patients residing in hospice units. The convenient sample of this study consisted of 41 terminally ill cancer patients at three hospice units in university affiliated hospitals. Patients were interviewed with structured questionnaires three times at predetermined intervals: admission to the hospice unit (Time 1), one week later (Time 2), and two weeks later (Time 3). The data was collected from January 1998 to January 1999 and was analyzed using ANOVA, Pearson correlation coefficient, and multivariate multiple regression. 1. The mean age of the participants was approximately 55 years old. In terms of diagnosis, lung cancer showed the highest frequency (19.5%), followed by stomach cancer and rectal cancer (17.1%). The motive of seeking hospice unit admission was control (72. 2%), followed by spiritual care (50%), and symptom relief (38.9%). 2. Regarding the type of pain felt, the highest pain frequency the participants experienced was deep pain (55%), followed by multiple pain (25%), intestinal pain (10%), then superficial (5%) and neurogenic pain (5%). For the level of pain measured by VAS, there was no significant difference among the three time points; Time 1 (5.04$\pm$2.21), Time 2 (4.82$\pm$2.58) and Time 3(4.73$\pm$2.51). 3. There was significant change seen in spirituality and physical care in each time interval. Namely, the longer the length of admission at the hospice unit, the higher the importance of spirituality (p=0.0001) and the more the physical care the participants received (p=0.01). The opioid use at the three time points showed the following frequencies : Time 1 (75.6%), Time 2 (85.4%) and Time 3 (75.6%). 4. Regarding factors influencing pain, the pain level was significantly affected by the depression level (p〈0.01) and the opioid use (p〈0.1). These results were the most significant at the two time points (Time 1 and Time 2). At Time 3 (two weeks later), the pain level was significantly affected by the depression level (p〈0.05) and the amount of physical care the participants received (p〈0.1). In conclusion, the terminally ill cancer patients had moderate pain, were generally depressed, and were treated with opioid analgesics. As approaching death, the patients received more physical care due to increased physical symptoms experienced and they had a higher perception of the importance of spirituality. Thus, health care professionals need to provide continuous care for each of them to die comfortably physically, psycho- logically, and spiritually.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.75-82
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• 1996

Background: Nerve blocks, including epidural analgesia, can be risky for terminal cancer pain patients in generally poor conditions. We performed this study to evaluate the efficacy of intravenous patient-controlled analgesia(PCA) to treat severe pain of terminally ill cancer patients during the last days of life. Methods: We explained the patient's poor general condition to relatives and received a written consent to administer PCA. The starting dose of opioid for PCA in cancer pain management was based on previous 24-hour dose. Previous 24-hour opioid dose was converted to intramuscular morphine equivalent. The concentration of opioid mixed into Basal Bolus $Infusor^{(R)}$ was controlled to allow for one half of the previous 24-hour equianalgesic dose to infuse continuously. Patients controlled their pain by pushing the PCA module themselves. Patients were observed by pain service team. Some discharged patients were treated at home until death. Results: Forty eight patients received PCA for last two years. The most common reason receiving a PCA was the patient's poor general condition(52.0%). The mean starting dose of PCA was $20.6{\pm}16.2$ mg of morphine. Over eighty percents of the patients were in good or tolerable state of analgesia. Half of the patients expired within one week. The mean duration of PCA was $8.7{\pm}7.0$ days. The problems during PCA were: difficulty in maintaining intravenous routes, early loss of mentality after starting PCA, hypotension and nausea. Conclusion: We concluded that PCA, if correctly, is an effective, relatively safe and readily controllable method of pain management in terminally ill cancer patients during the last days of life. For future considerations, terminal patients may expire at the comfort of their own homes after the resolution of legal problems regarding using opioid in home care.

• Journal of the korean academy of Pediatric Dentistry
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• v.25 no.2
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• pp.467-475
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• 1998

악안면 영역에 동통이 가하여지면 회피반사의 일종인 개구반사가 유발되며, 개구반사의 크기는 뇌간의 중추에 전달된 동통의 크기에 비례한다. 따라서 동통의 정도를 악이복근의 근전도를 이용하여 정량화 할 수 있고 동통의 지표로 이용할 수 있다. 본 실험은 악안면동통에 의하여 유발된 개구반사의 크기가 침점(족삼리) 전기자극으로 감소되는지와 이러한 전기침의 효과가 나타나는데 opioid 물질이 관여하는지에 대하여 연구하고자 하였다. 8주 이상, 150g이상의 Sprague-Dawley계 쥐 34 마리를 암수 구별없이 이용하여 실험하였다. 복강 내 Urethane용액(1.5g/kg)을 주입 전신마취하고 악이복근을 노출시켜 근전도 기록을 위한 한쌍의 선전극을 삽입하였다. 동통유발을 위하여 구강내 하악 이공주변에 0.1mm의 선전극을 한쌍 삽입하고 전기자극기에 연결하였다. 유해자극 조건은 duration $100{\mu}sec$, interval 5sec의 pulse로 정하고 자극의 크기는 개구반사를 일으키는 역치의 2배 크기로 하며 매 측정시마다 동일 자극을 10회식 가하여 평균하였다. 침점의 전기자극을 위하여 침점의 하나인 족삼리(Zusanli)에 표면전극(넓이 $0.4cm^2$ 정도)을 부착하고 자극부위가 약한 근수축을 일으키는 강도인 $100{\mu}sec$, 5V, 2Hz의 자극을 20분간 가하였다. 악이복근의 근전도는 교류증폭기 (Dam80, WPI, USA) 에서 1000배 증폭하여 유해자극이 가해진 순간 oscilloscope 에서 관찰하여 그 크기를 측정하였다. 침점의 전기자극으로 나타나는 진통효과가 opioid의 분비와 관련있는지 알아보기 위하여 opioid 의 길항제인 naloxone(0.2mg/kg)을 복강 내로 투여하였다. 실험군을 4군(group I - IV)으로 분류하였고 각 군에서 근전도를 측정한 단계는 다음과 같다. group I : control 침점에 전기자극 20 분간 가한후(EA), 20분후(EA20) group II : control 침점에 전기자극 20분간 가한후(EA), naloxone 투여 20분후(NX) group III : control naloxone 투여 5분후 침점에 전기자극 20분 가한후(NxEA20) group IV : control naloxone 투여 20분후(NX20) 구강내에 가해진 유해자극에 의하여 발생하는 악이복근 근전도는 족삼리 침점의 전기자극으로 그 크기가 감소하였고 이러한 침점자극의 효과는 naloxone의 투여로 인하여 억제되었다. 이와 같은 결과는 침점자극으로 진통작용이 나타나는데에 opioid 물질이 관여하고 있음을 시사한다.

• 한국약용작물학회:학술대회논문집
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• 2007.11a
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• pp.281.1-281.1
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• 2007

• Proceedings of the PSK Conference
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• 2002.04a
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• pp.110.1-110.1
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• 2002

• Proceedings of the Ginseng society Conference
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• 1990.06a
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• pp.36-44
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• 1990

The analgesic effect of morphine was antagonized and the development of tolerance was suppressed by the modification of the neurologic function in the animals treated with ginseng saponins. The activation of the spinal descending inhibitory systems as well as the supraspinal structures by the administration of morphine was inhibited in the animals treated with ginseng saponins intracerebrally or intrathecally The development of morphine tolerance and dependence, and the abrupt expression of naloxone induced abstinence syndrome were also inhibited by ginsenoside Kbl , Rba, Rgl and Re. These results suggest that ginsenoside Kbl, Rba, Rgl and Re are the bioactive components of panax ginseng on the inhibition of the development of morphine tolerance and dependence, and the inhibition of abrupt abstinence syndrome. In addition, further research on the minor components of Panax ginseng should be investigated. A single or daily treatment with ginseng saponins did not induce any appreciable changes in the brain level of monoamines at the various time intervals and at the various day intervals, respectively The inhibitory or facilitated effects of ginseng saponins on electrically evoked contractions in guinea pig ileum (U-receptor) and mouse was definers (5·receptor) were not mediated through opioid receptors. The antagonism of a x receptor agonist, U-, iO.488H was also not mediated through opioid receptors in the animals treated with ginseng saponins, bolt mediated through serotonergic mechanisms. Ginseng saponins inhibited morphine S-dehydrogenase that catalyzed the production of morphine from morphine, and increased hepatic glutathione contents for the detoxification of morphine. This result suggests that the dual action of the above plays an important role in the inhibition of the development of morphine tolerance and dependence.

• Journal of Dairy Science and Biotechnology
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• v.26 no.1
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• pp.11-19
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• 2008

Milk from dairy cows has long provided a high quality source of protein and selected micronutrients as calcuim to most populations. Recently, a relationship between disease risk and consumption of specific bovine ${\beta}$-casein fraction either A1 or A2 genetic variants has identified. Populations, which consume milk contain high containing high levels of ${\beta}$-casein A2 variants, have a lower incidence of cardiovascular disease and type 1 diabetes. Furthermore, consumption of milk with the A2 variants may be associated with less severe symptoms of autism and schizophrenia. The mechanism of action focuses on ${\beta}$-casein A1 and related forms preferentially that are able to produce a bioactive opioid peptide, ${\beta}$-casomorphin-7(${\beta}$-CM-7) during digestion. Infants may absorb ${\beta}$-CM-7 due to an immature gastrointestinal tract. Adult, on the other hand, appear to reap the biological activity locally on the intestinal brush boarder. ${\beta}$-CM-7 can potentially affect numerous opioid receptors in the nervous, endocrine, and immune system. Whether there is a definite health benefit to milk containing the A2 genetic variant is unknown and requires further investigation.