• The Korean Journal of Pain
• /
• v.5 no.2
• /
• pp.273-278
• /
• 1992

With the medical progress that has given spinal cord injured(SCI) individuals greater longevity and better overall health, chronic pain is emerged as major challenge in treating this population. According to past reports, estimates of prevalance of severe/disabling chronic pain in SCI patients have ranged from 18% to 63%. In etiologies of chronic pain in SCI patients, psychic or psychogenic pain categories should be included and more recent data have demonstrated that the persistant pain is directly related to higher levels of psychosocial distress and impairment. Recently, neurophysiological classification of the SCI pain syndrome into three etiologic groups(a; mechanical pain, b; radicular pain, c; deafferentation pain) is more frequently adopted for the classification of chronic SCI pain syndrome. The deafferentation pain is most common of the pain syndromes associated with SCI. After cervical epidural anesthesia for the surgical intervention of decubitus ulcer on the hip of two SCI patients, there were much reduction of existing chronic deafferentation character pain.

• The Korean Journal of Pain
• /
• v.10 no.1
• /
• pp.28-33
• /
• 1997

Background : Analgesic effect of intra-articular morphine or ketoronac treatment alone, or a combination of both drugs, on postoperative pain were evaluated in 40 healthy male patients undergoing arthroscopic knee surgery. Method : Upon completion of surgery under spinal anesthesia, each patients knee joint was injected with 30 ml of 0.25% bupivacaine. Then, via parenteral or intra-articular route, one study group received morphine and other group received ketorolac. Results : Groups who received either intra-articular ketorolac, or morphine, experienced decreased postoperative pain reducing need for additional analgesics. The combination treatment of intra-articular morphine and ketorolac did not improved results. Conclusions : Singular use of either intra-articular morphine, or ketorolac, improves postoperative analgesia in patients undergoing arthroscopic sugery: Combination of these drugs offered no further advantage over its single prescription.

• Journal of Korean Neurosurgical Society
• /
• v.58 no.2
• /
• pp.144-146
• /
• 2015

Postdural punctural headache (PDPH) following spinal anesthesia is due to intracranial hypotension caused by cerebrospinal fluid (CSF) leakage, and it is occasionally accompanied by an intracranial hematoma. To the best of our knowledge, an intracranial chronic subdural hematoma (CSDH) presenting with an intractable headache after a cervical epidural steroid injection (ESI) has not been reported. A 39-year-old woman without any history of trauma underwent a cervical ESI for a herniated nucleus pulposus at the C5-6 level. One month later, she presented with a severe headache that was not relieved by analgesic medication, which changed in character from being positional to non-positional during the preceding month. Brain magnetic resonance imaging revealed a CSDH along the left convexity. Emergency burr-hole drainage was performed and the headache abated. This report indicates that an intracranial CSDH should be considered a possible complication after ESI. In addition, the event of an intractable and changing PDPH after ESI suggests further evaluation for diagnosis of an intracranial hematoma.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.18 no.3
• /
• pp.183-187
• /
• 2018

Complex cervical spine fractures are a serious complications of maxillofacial trauma and associated with high mortality and neurological morbidity. Strict vigilance in preventing further insult to the cervical spine is a crucial step in managing patients who are at risk for neurologic compromise. We report a rare case of a right transverse process of atlas fracture with right-sided vertebral artery injury that was associated with a comminuted fracture of the body and angle of the mandible, which restricted mouth opening. Airway management was performed by an awake fiber-optic nasotracheal intubation, where neck movement was avoided with a cervical collar. Vertebral artery injuries may have disastrous consequences, such as basilar territory infarction and death, and should be suspected in patients with head and neck trauma. After mandibular plating, the patient was on cervical collar immobilization for 12 weeks and anti-coagulant therapy.

• The Korean Journal of Pain
• /
• v.20 no.1
• /
• pp.74-77
• /
• 2007

The trigger point injection technique is widely used in pain clinics for the treatment of acute and chronic pain. Yet it has a variety of complications such asvasovagal syncope, total spinal anesthesia, paralysis, root block, pneumothorax, needle breakage, skin infection, and hematoma formation. Among them, the simultaneous occurrence of psoas and epidural abscesses is extremely rare. We report here on a patient who was diagnosed with epidural and psoas abscesses after paravertebral trigger point injection.

• Journal of Medicine and Life Science
• /
• v.19 no.2
• /
• pp.70-73
• /
• 2022

Here, we report a case of ultrasound-assisted subarachnoid block in a patient with severe kyphosis. A 69-year-old man was scheduled for metal removal from hip screws. He had a previous experience with subarachnoid block using the landmark-guided technique, but it was very difficult due to severe kyphosis. However, we could easily determine the correct needle insertion point using ultrasound imaging and performed a successful dural puncture on the first attempt. This case demonstrates the clinical usefulness of ultrasound imaging for subarachnoid blocks in patients with severe kyphosis.

• Journal of Korean Neurosurgical Society
• /
• v.41 no.5
• /
• pp.295-300
• /
• 2007

Objective : Unilateral facet dislocation of the cervical spine occurs by flexion and rotation injuries and cannot be easily reduced by axial traction. We analyzed 14 consecutive patients with unilateral facet dislocation of the cervical spine to increase knowledge about anatomical reduction of locked facet and factors for successful reduction. Methods : Fourteen patients [10 men and 4 women] with unilateral facet dislocation of the cervical spine were retrospectively analyzed. Plain X-ray, computerized tomography scan, and magnetic resonance imaging were performed. All patients underwent manual reduction and surgery with anterior interbody fusion and plate fixation. The manual reduction was performed by neck flexion and rotation to the opposite side of dislocation, followed by rotation and flexion of the head toward the side of dislocation and extension with relaxation of traction. Mean follow-up period was 17 months. The level of spine, amount of subluxation, combined facet fracture, and time from injury to initial reduction were analyzed using the data obtained from medical records. Results : Thirteen [93%] patients were reduced successfully. Immediate reduction was achieved in 7 patients but failed in 7 patients. Seven patients underwent delayed closed reduction under general anesthesia, and successful reduction was achieved in 6 patients. Only one patient with bone chips between articular facets failed to achieve anatomical reduction. Conclusion : In order to reduce the locked facet more easily and safely, we recommend manipulative traction with anterior interbody fusion and plate fixation under general anesthesia after being aware of spinal cord injury with magnetic resonance imaging.

• International Journal of Oral Biology
• /
• v.32 no.2
• /
• pp.59-65
• /
• 2007

It has been well known that excitatory amino acids, primarily glutamate, are involved in the transmission of nociception in pathological and physiological conditions in the spinal and brainstem level. Recently, peripheral glutamate also play a critical role in the peripheral nociceptive transmissions. The present study investigated the role of N-methyl-D-aspartic acid (NMDA) or non-NMDA ionotropic glutamate receptors in formalin-induced TMJ pain. Experiments were carried out on male Sprague-Dawley rats weighing 220-280 g. Intra-articular injection was performed under halothane anesthesia. Under anesthesia, AP-7 (10, $100\;{\mu}M$, $1\;mM/20\;{\mu}L$), a NMDA receptor antagonist, or CNQX disodium salt (0.5, 5, 50, $500\;{\mu}M/20\;{\mu}L$), a non-NMDA receptor antagonist, were administered intra-articularly 10 min prior to the application of 5% formalin. For each animal, the number of behavioral responses, such as rubbing and/or scratching the TMJ region, was recorded for nine successive 5-min intervals. Intra-articular pretreatment with 1 mM of AP-7 or $50\;{\mu}M$ CNQX significantly decreased the formalin-induced scratching behavioral responses during the second phase. Intra-articular pretreatment with $500\;{\mu}M$ of CNQX significantly decreased the formalin-induced scratching behavior during both the first and the second phase. These results indicate that the intra-articular administration of NMDA or non-NMDA receptor antagonists inhibit formalin-induced TMJ nociception, and peripheral ionotropic glutamate receptors may play an important role in the TMJ nociception.

• The Korean Journal of Pain
• /
• v.2 no.1
• /
• pp.89-93
• /
• 1989

We performed the autologous epidural blood patch (AEBP) for the relief of headache and other related symptoms following dural punctures of the lumbar region during 8 years from 1981 to 1988. The total of 37 patients with the patching consisted of 9 cases in 3007 of spinal anesthesia, 12 accidental dural punctures in 4283 cases of lumbar epidural anesthesia, 12 cases in 4747 of epidural analgesia for back pain control, 3 cases of myelography and a case of diagnostic lumbar puncture. The headaches were relieved completely in 35 cases following the first AEBP and the remaining two were also relieved following the second AEBP. We think that the AEBP for postdural-puncture headache is the treatment of choice.

• The Korean Journal of Pain
• /
• v.34 no.1
• /
• pp.4-18
• /
• 2021

Except for carbamazepine for trigeminal neuralgia, gabapentinoid anticonvulsants have been the standard for the treatment of neuropathic pain. Pregabalin, which followed gabapentin, was developed with the benefit of rapid peak blood concentration and better bioavailability. Mirogabalin besylate (DS-5565, Tarlige®) shows greater sustained analgesia due to a high affinity to, and slow dissociation from, the α2δ-1 subunits in the dorsal root ganglion (DRG). Additionally, it produces a lower level of central nervous system-specific adverse drug reactions (ADRs), due to a low affinity to, and rapid dissociation from, the α2δ-2 subunits in the cerebellum. Maximum plasma concentration is achieved in less than 1 hour, compared to 1 hour for pregabalin and 3 hours for gabapentin. The plasma protein binding is relatively low, at less than 25%. As with all gabapentinoids, it is also largely excreted via the kidneys in an unchanged form, and so the administration dose should also be adjusted according to renal function. The equianalgesic daily dose for 30 mg of mirogabalin is 600 mg of pregabalin and over 1,200 mg of gabapentin. The initial adult dose starts at 5 mg, given orally twice a day, and is gradually increased by 5 mg at an interval of at least a week, to 15 mg. In conclusion, mirogabalin is anticipated to be a novel, safe gabapentinoid anticonvulsant with a greater therapeutic effect for neuropathic pain in the DRG and lower ADRs in the cerebellum.