• The Korean Journal of Pain
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• v.22 no.1
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• pp.83-87
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• 2009

Case reports after accidental subdural injection during attempted epidural block have usually described extensive neuraxial blocks with a characteristic radiographic appearance on contrast injection. We experienced a case of cervical subdural injection with unusual clinical findings and radiographic appearance. A 51-year-old female patient with central herniated nucleus pulposus at cervical (C5/6) and lumbar level (L4/5, L5/S1) was referred to the pain clinic. During attempted cervical epidural block at the C6/7 interspace with fluoroscopy, injection of the 4 ml contrast showed posterior spread at cervical level. After cervical epidural steroid injection, the contrast was also confined to the posterior aspect of the spinal canal at lumbar level with fluoroscopy. In order to discriminate subdural space from epidural space, we performed transforaminal epidural injection of the 2 ml contrast at the L5/S1 interspace and we could confirm cervical epidural injection was made into the subdural space. We discuss the clinical characteristics of a subdural injection and the appearance of the cervical and lumbar subdurogram.

• Journal of Physiology & Pathology in Korean Medicine
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• v.16 no.1
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• pp.124-132
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• 2002

Daebangpung-tang(DBPT) is one of the prescriptions used for the treatment of rheumatoid arthritis(RA) in oriental medicine. The present study aimed to examine the analgesic effect of DBPT on a rat model of CFA-induced arthritis, which is not identical to human auto-immune arthritis although it does have many features in common with RA, and the relation between DBPT-induced analgesia and steroid hormones. CFA-induced arthritis rat model used to test the effect of DBPT was chronic pain model. After the induction of arthritis, rats subsequently showed a reduced stepping force of the affected limb for at least the next 18 days. The reduced stepping force of the limb was presumably due to a painful knee, since oral injection of indomethacin produced temporary improvement of weight bearing. DBPT dissolved in water was orally administrated. After the treatment, behavioral tests measuring stepping force were periodically conducted during the next 4 hours. DBPT produce significant improvement of stepping force of the hindlimb affected by the arthritis lasting at least 3 hours. The magnitude of this improvement was equivalent to that obtained after an oral injection of 3mg/kg of indomethacin and this improvement of stepping force was interpreted as an analgesic effect. The reduced stepping force was divided into three stages(10-30g, 30-50g, and 50-70g). All experiments was performed at 50-70g of stepping force, since both DBPT and indomethacin showed the most excellent analgesic effect at 50-70g of stepping force. DBPT produced the improvement of stepping force of the affected hindlimb in a dose-dependent manner and showed analgesic effect on neuropathic pain as well. DBPT-induced analgesic effect could not be blocked by systemic injection of steroid antagonist mifepristone. The present study suggest 1) that DBPT produces a potent analgesic effect on the chronic knee arthritis pain model in the rat and 2) that steroids system does not mediate DBPT-induced analgesia.

• The Korean Journal of Pain
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• v.29 no.2
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• pp.96-102
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• 2016

Background: It is widely accepted that cervical interlaminar steroid injection (CIESI) is more effective in treating radicular pain than axial neck pain, but without direct comparison. And the differences of effect after CIESI according to MRI findings are inconsistent. In this retrospective study, we evaluated the therapeutic response of CIESI according to pain sites, durations, MRI findings, and other predictive factors altogether, unlike previous studies, which evaluated them separately. Methods: The medical records of 128 patients who received fluoroscopy guided CIESI were analyzed. We evaluated the therapeutic response (more than a 50% reduction on the visual analog scale [VAS] by their second visit) after CIESI by (1) pain site; neck pain without radicular pain/radicular pain with or without neck pain, (2) pain duration; acute/chronic (more than 6 month), and (3) findings of MRI; herniated intervertebral disc (HIVD)/spinal stenosis, respectively and altogether. Results: Eighty-eight patients (68%) responded to CIESI, and there were no significant differences in demographic data, initial VAS score, or laboratory findings. And there were no significant differences in the response rate relating to pain site, pain duration, or MRI findings, respectively. In additional analysis, acute radicular pain with HIVD patients showed significantly better response than chronic neck pain with spinal stenosis (P = 0.04). Conclusions: We cannot find any sole predictive factor of therapeutic response to the CIESI. But the patients having acute radicular pain with HIVD showed the best response, and those having other chronic neck pain showed the worst response to CIESI.

• The Korean Journal of Pain
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• v.26 no.3
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• pp.265-269
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• 2013

Background: Transforaminal epidural steroid injections are known to reduce inflammation by inhibiting synthesis of various proinflammatory mediators and have been used increasingly. The anti-inflammatory properties of opioids are not as fully understood but apparently involve antagonism sensory neuron excitability and pro-inflammatory neuropeptide release. To date, no studies have addressed the efficacy of transforaminal epidural morphine in patients with radicular pain, and none have directly compared morphine with a tramadol for this indication. The aim of this study was to compare morphine and tramadol analgesia when administered via epidural injection to patients with lumbar radicular pain. Methods: A total of 59 patients were randomly allocated to 1 of 2 treatment groups and followed for 3 months after procedure. Each patient was subjected to C-arm guided transforaminal epidural injection (TFEI) of an affected nerve root. As assigned, patients received either morphine sulfate (2.5 mg/2.5 ml) or tramadol (25 mg/0.5 ml) in combination with 0.2% ropivacaine (1 ml). Using numeric rating scale was subsequently rates at 2 weeks and 3 months following injection for comparison with baseline. Results: Both groups had significantly lower mean pain scores at 2 weeks and at 3 months after treatment, but outcomes did not differ significantly between groups. Conclusions: TFEI of an opioid plus local anesthetic proved effective in treating radicular pain. Although morphine surpassed tramadol in pain relief scores, the difference was not statistically significant.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.75-80
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• 1999

Background: Despite tension type headache is popular, the exact mechanism and method of treatment are not certain yet. So, we supposed the basic mechanism of tension type headache is myogenic, and did Tienchu acupoint block, occipital nerve block, and trigger point injection in tension type headache patients. Methods: Fifty-seven tension type headache patients were treated with local anesthetics and small dose of steroid. The intensity of pain and effect of every treatment was evaluated as Verbal Rating Score (VRS; 0~10) before and after every treatment. Evaluation of treatment was based on the time of treatment (1,2 times, 3 times, 4,5 times). Goal of treatment was VRS reaching below two point and it was considered as treated state. Results: Symptom improvement rates of each treatment were 90% (1, 2 times), 91% (3 times), 70% (4, 5 times) respectively. VRS reduction more than 50% rates were 60%, 64%, 60% respectively. Treated state (VRS<2) rates were 33%, 27%, 30% respectively. Conclusion: Tienchu acupoint block, occipital nerve block, trigger point injection were sorts of most effective and simply applicable modalities of treatment in tension type headache.

• The Korean Journal of Pain
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• v.6 no.1
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• pp.117-121
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• 1993

The pyriformis syndrome is an entrapment neuropathy in which the sciatic nerve is compromised by the pyriformis muscle. Using local anesthetics and steroid injection through a needle guided by an electric nerve stimulator, we satisfactorily treated a case of pyriformis syndrome.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.1 no.1
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• pp.6-9
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• 2008

Purpose: To investigate the effectiveness of injection therapy in the treatment of subacromial bursitis. Materials and Methods: A total of 38 patients with sonographic confirmation of subacromial bursitis were recruited into this study. The shoulder abduction range of motion and visual analog scale (VAS) were compared before injections and 3 wks after the completion of injections. Results: The shoulder range of abduction before injection was $77.89{\pm}14.17$ degrees and improved to $148.68{\pm}13.39$ degrees 3 wks after the injection treatments (P<0.05). VAS before injection was $6.8{\pm}1.4$ and improved to $1.4{\pm}0.8$ 3 wks after the injection treatments (P<0.05). Conclusions: Ultrasound may be used as an adjuvant tool in guiding the needle accurately into the inflamed subacromial bursa. The ultrasound-guided injection technique can result in significant improvement in shoulder abduction range of motion in treating patients with subacromial bursitis.

• The Korean Journal of Pain
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• v.26 no.4
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• pp.387-391
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• 2013

A 64-year-old woman visited our pain clinic with the pain of right lateral side of thigh for one year. Her pain always started from knee and was radiated to buttock area when symptom was severe. She showed significant tenderness at knee lateral side and local tightness at lateral thigh. Magnetic resonance image of the knee was performed and we could identify high signal intensity of iliotibial band through coronal and axial view. In spite of medication and physical stretching exercise of iliotibial band for one month, she did not show any improvement of pain. To alleviate her symptom, ultrasound guided local corticosteroid injection targeting beneath the iliotibial band was performed. After the procedure, the reduction of pain was significant and there was no need for further management.

• Journal of Korean Neurosurgical Society
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• v.58 no.5
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• pp.483-486
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• 2015

Cervical epidural steroid injection is frequently used in the conservative management of neck pain and cervical radiculopathy. Epidural cervical transforaminal injections are usually well-tolerated with mild side effects such as transient decreased sensory and motor function, or headache due to dural puncture. Although there are a few case reports about adverse effects of cervical epidural injection in the literature, it can cause severe complications such as large hematoma, infarction by spinal vascular injury. Subdural hematoma has been occurred much less common rather than epidural hematoma in the spinal cord. We report a rare catastrophic case of cervical spinal subdural hematoma with quadriparesis after cervical transforaminal epidural block.

• 대한핵의학회:학술대회논문집
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• 1999.05a
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• pp.200-204
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• 1999

Rheumatoid arthritis (RA) is o chronic inflammatory disease of joints with proliferation of synovial epithelial tissue. Therapeutic approach of the RA consists of pharmacological and surgical interventions. Synovectomy is indicated in patients with progressive inflammatory signs and symptoms intractable to medical treatment including local intracavitary steroid injection. Recently, local injection of radionuclides which emit high energy beta rays are labeled with chemical compounds such as $^{90}Y,\;^{165}Dy-ferric$ hydroxide macroaggregate and have been introduced as an alternative therapeutic modality to surgical synovectomy. Holmium-166 is one of beta emitter and Ho-166-chitosan complex was developed for radiation synovectomy. Preclinical trial is on-going at our hospital using Ho-166-chitosan. The procedure and methods of preclinical trial are discussed.