• Journal of Hospice and Palliative Care
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• v.18 no.1
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• pp.1-8
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• 2015

Breakthrough cancer pain is a transient exacerbation of pain that occurs despite relatively well controlled background pain with around-the-clock analgesia. It is highly prevalent in patients with cancer pain, with an overall prevalence of 70~90%. Breakthrough cancer pain has several negative effects on quality of life, including a decrease in functional status and social relationship, and higher incidence of anxiety/depression. It also places a detrimental burden on their families, society, and the healthcare system. According to the pathogenic mechanism, breakthrough cancer pain is classified into two categories: idiopathic (or spontaneous) pain and incident pain. Episodes of breakthrough cancer pain have typical characteristics, including rapid onset (5~10 min), severe intensity, and short duration (30~60 min). However, there are some variations in timing and severity of pain among patients and episodes. Therefore, a thorough assessment of pain episodes is needed and management plan must be individualized to provide optimal treatment. Several immediate-release formulations such as oxycodone, morphine, and hydromorphone are widely used despite relatively slow onset of action. Recent studies have shown that transmucosal fentanyl preparations were effective for faster control of breakthrough pain. We hope to improve management of breakthrough cancer pain with more efficient analgesics in line with currently available evidence.

• Korean Journal of Psychosomatic Medicine
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• v.7 no.2
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• pp.256-262
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• 1999

Because chronic pain disorder may has multiple causes or contributing factors, including physical, psychological, and socio-environmental variables, the treatment of patients with the disorder requires biopsychosocial approaches in a multidisciplinary setting. In treating chronic pain, it is important to address functioning as well as pain, and treatment should be to increase functional capacity and manage the pain as opposed to curing it. Therefore treatment goal should be adaptation to pain or minimizing pain with corresponding greater functioning. Treatment begins with the initial assessment, which includes evaluation of psychophysiologic mechanisms, operant mechanisms, and overt psychiatric comorbidity. Psychiatric treatment of the patients requires adherence to sound pharmacologic and behavioral principles. There are four categories of drugs useful to psychiatrist in the management of chronic pain patients : 1) narcotic analgesics, 2) nonsteroidal antiinflammatory drugs, 3) psychotropic medications, and 4) anticonvulsants, but antidepressants are the most valuable drugs in pharmnacotherpy for them. Psychological treatments tend to emphasize behavioral and cognitive-behavioral modalities, which are divided into self-management techniques and operant techniques. Psychodynamic and insight-oriented therapies are indicated to some patients with long-standing interpersonal dysfunction or a history of childhood abuse.

• Journal of Oral Medicine and Pain
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• v.33 no.2
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• pp.205-218
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• 2008

Interaction between pain and sleep has long been proved through many researches, and various studies are being conducted to identify its mechanism. However, these studies have targeted on patients with systemic disease, such as rheumatic disease and fibromyalgia. There are few researches on patients with orofacial pain including temporomandibular disorder(TMD). In this study, we studied interaction between pain aspect and sleep quality in 229 patients with TMD, who visited the TMJ and Orofacial pain clinic. Pittsburgh Sleep Quality Index(PSQI), Epworth sleepiness scale(ESS) questionnaire were surveyed and sleep-screening device was operated. PSQI showed that sleep quality in TMD patients with pain was poorer than that in TMD patients without pain. The ratio of poor sleeper was higher in TMD patients with pain. Especially, TMD patients with chronic pain showed obviously poorer sleep quality than TMD patients with acute pain. The result of ESS showed that patients with painful TMD showed more daytime sleepiness than painless TMD patients. The ratio of TMD patients with chronic pain who had daytime sleepiness was higher than TMD patients with acute pain, and the amount of daytime sleepiness was higher in the group of chronic pain. In TMD patients with chronic pain, only the poor sleeper(PSQI>5) presented mean ESS>10(diagnostic criteria of daytime sleepiness). There was no correlation between pain intensity and sleep quality or daytime sleepiness. The result of ApnealinkTM for screening of sleep related breathing disorder showed that only 1 patient presented AHI>5 among 19 participants. TMD patients with chronic pain presented poor sleep quality and excessive daytime sleepiness similar to other chronic pain patients. Evaluation of sleep state by questionnaire might be useful for diagnosis and management of TMD, because sleep disturbance decreases pain threshold and pain disturbs sleep. In addition, sleep-screening device would be useful for screening sleep related breathing disorder in dental clinic.

• Journal of Hospice and Palliative Care
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• v.7 no.2
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• pp.238-247
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• 2004

Purpose: Pain management is often needlessly suboptimal. Health care professionals are seldom trained in pain management, may not realize the importance of pain management or recognize that a patient is in pain, and may fear prescribing opioid medications. Noting that one of the problems related to health care professionals is poor assessment of pain, we studied a trend of pain severity and satisfaction with pain controls after using TTS-fentanyl in order to determine whether a regular pain assessment was effective for controlling cancer pain. Methods: We assessed the pain as a $5^{th}$ vital sign after using TTS-fentanyl in 471 hospitalized cancer patients during 4 days. The data were collected from September, 2003 to December, 2003. Pain severity was assessed by using a numeric pain intensity scale($0{\sim}10$) by ongoing pain assessment. Results: Pain assessment as a $5^{th}$ vital sign had led to reduce patient's pain scores. High degrees of satisfaction scores in both patients and doctors with TTS-fentanyl were observed. They were also negatively correlated with the pain severity. Conclusion: Regular pain assessment was effective in the management of cancer pain.

• Physical Therapy Korea
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• v.9 no.4
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• pp.69-76
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• 2002

본 연구에서는 상부 승모근의 근막통증(myofascial pain syndrome; MPS)를 대상으로 이완상태에서 근 활성도를 측정해보고, 통증을 감소시키는 데 주로 이용되는 경피신경자극 치료 후 근 활성도에 어떠한 영향을 미치는지 알아보기 위해 실시하였다. 본 연구의 대상자는 근막 통증으로 진단을 받은 총 10명을 대상으로 실시하였다. 주관적 시각 척도(visual analogue scale; VAS)와 압통 역치 측정계(pressure threshold meter)를 이용하여 경피신경자극 전, 후 통증의 정도를 평가하였고, 표면 근전도를 이용하여 이완시 근 활성도를 측정하였다. 치료 기구는 경피신경자극기(TENS: HAT-2000)를 이용하였다. 치료 전과 비교하여 VAS는 통증이 심한 쪽과 약한 쪽 모두에서 유의하게 감소하였으며(p<.05), 압통 역치는 통증이 심한 쪽과 약한 쪽 모두에서 유의한 차이가 없었고(p>.05), 근 활성도는 통증이 심한 쪽에서 유의하게 감소하였다(p<.05).

• The Journal of the Korea Contents Association
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• v.17 no.1
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• pp.402-411
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• 2017

To develop a more efficient computer-based empathy program that enables medical students to increase their empathy levels, and to test its applicability to medical students. We developed PACP (the Pain Assessment Computer Program) for measurement of medical students' levels of recognition of another's pain. An empathy questionnaire was administered to 145 medical students before and after the PACP. In the high empathy group, the scores for cognitive empathy increased significantly after completion of the PACP, while affective empathy scores showed no significant change. In contrast, in the low empathy group, both cognitive and affective empathy scores increased significantly after the PACP. The PACP effectively increased cognitive empathy for the high empathy group, and increased both cognitive and affective empathy, particularly for the low empathy group. Given the fact that existing empathy education programs are time-consuming and costly, and the demand for more efficient empathy education is high, the PACP as a useful tool can be applicable to medical students, particularly those with low empathy in order to enhance their empathic abilities within a short period of time.

• The Journal of the Korea institute of electronic communication sciences
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• v.12 no.4
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• pp.679-690
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• 2017

The purpose of this study was to investigate the relationship between neck posture and range of motion and neck disability index(NDI) in young adults with reduced cervical lordosis. This study selected 34 young adults with cervical lordosis reduced (Cobb's angle less than 35 degrees). The assessor measured neck flexion, extension, left lateral flexion, right lateral flexion, left rotation, right rotation and forward displacements of all subjects using cervical of range motion instrument, Then, the NDI was evaluated. After all assessments, degree for cervical lordosis was divided into two groups: bottom group(severe cervical lordosis) and top group(mild cervical lordosis). The bottom group was significantly higher in Cobb's angle, extension, left lateral flexion, right lateral flexion, left rotation, right rotation and forward displacement compared to the top group (p<.05). There was no significant difference between the two groups in flexion, NDI(p >.05). In comparison of subscale of NDI, top group was significantly higher in pain, lifting, and headache than bottom group (p <.05). In correlation analysis, Cobb's angle showed significant positive correlation with flexion, extension, left lateral flexion, right lateral flexion, left rotation and right rotation(p<.05), and showed significant negative correlation with forward displacement, NDI(p<.05). Cobb's angle showed a significant negative correlation with pain, lifting, and headache of subscale of NDI(p<.05). The findings of this study potentially suggest that neck posture may affect the cervical range of motion and pain.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.7 no.1
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• pp.21-25
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• 2012

목적: 이 증례 보고는 성인 특발성 측만증 환자에 있어서 등의 통증과 척추 만곡에 대한 침 치료의 효과를 보고하기 위한 것이다. 방법: 증례의 환자는 25세 여자 환자로 9년 동안 우측 흉추 측만증과 등과 허리의 통증이 있었다. 1주일에 3번, 3주간 침 치료를 시행했고, 치료 전후로 Whole spine x-ray를 촬영하였으며, 환자의 통증 정도를 Visual Analog Scale(VAS)로 평가하였다. 내원시 Cobb angle은 $22^{\circ}$였고, 관상면 균형은 -3.0cm, 쇄골각은 $-3.5^{\circ}$였다. VAS 8의 통증을 호소하였다. 결과: Cobb angle은 $5^{\circ}$ 감소하였고, 관상면 균형은 1.4cm, 쇄골각은 $1.7^{\circ}$ 회복되었다. 등과 허리의 통증은 VAS 8에서 VAS 3으로 감소하였다. 결론: 침 치료는 특발성 척추 측만증 환자에 있어서 등과 허리의 통증뿐만 아니라 척추 측만을 개선시키고 관상면 균형 회복에도 효과적이다.

• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.1
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• pp.9-15
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• 2011

배경: 술 후 통증은 술 후 합병증의 발생가능성을 증가시키며 생체기능의 회복을 방해한다. 술 후 통증을 효과적으로 조절하기 위해선 통증의 정도를 객관적으로 평가하는 것이 필요하다. 술 후 통증은 수술의 침습도와 관련이 높을 가능성이 많다. 본 연구에서는 수술 침습도의 정도와 술 후 통증의 정도 사이의 상관관계를 확인하고자 한다. 방법: 총 153명의 환자를 수술의 침습도에 따라 4개의 그룹으로 나누었다(그룹 1: 악성종양 수술 (malignancy surgery), 그룹 2: 양악수술(bimaxillary surgery), 그룹 3: 양성 종양수술(benign cancer surgery) 그룹 4: 임플란트 & 골절 수술(implant & frature)) 수술이 끝나갈 무렵 fentanyl 700 ${\mu}g$, ketorolac 1,500 mg (총 용적 120 ml)가 포함된 자가통증조절장치를 정맥로에 연결하였다. 술 후 통증의 정도는 시각통증등급(visual analogue scale)을 이용하여 측정하였고 자가통증조절장치의 총 사용시간, 투여된 진통제의 양, bolus 투여 총 횟수를 측정하였다. 결과: 술 후 시각통증등급은 술 후 1일부터 3일까지 그룹 1, 2 군에서 유의하게 높았다. 또한 시각통증등급 3점 이상의 통증을 호소하는 환자의 비율 역시 그룹 1, 2 군에서 유의하게 높았다. 진통제 총 투여용량 및 자가로 주입한 진통제의 양 역시 그룹 1, 2군에서 3, 4 군에 비해 유의하게 높은 것을 확인하였다. 결론: 본 연구결과 외과적 수술의 침습도가 술 후 통증의 정도를 결정하는데 있어 중요한 요소임 을 확인하였다.

• Journal of the Korean Society of Physical Medicine
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• v.3 no.4
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• pp.301-307
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• 2008

목적 : 노년층의 대부분이 가지고 있는 골관절염이라고도 알려진 퇴행성 관절 질환은 척추에 영향을 끼친다. 그리고 이 질환은 통증과 일상생활에서의 활동 제한을 초래한다. 본 연구는 퇴행성 관절질환 환자의 물리치료 빈도에 따른 효과를 검증하는 데 있다. 방법 : 퇴행성 관절 질환을 가진 30명의 환자가 이 연구에 참여하였고 이들에 취해진 물리치료의 빈도에 따른 효과를 평가하여 그 결과를 물리치료 임상 지침서와 비교분석하였다. 본 연구에 참여한 환자들은 시각적 사상척도(Visual Analog Scale, VAS), 멕길 통증 설문지, 일반적인 설문지에 응했으며 물리치료 전과 후를 물리치료 빈도에 중점을 두어 평가받았다. 결과 : 본 연구에 참여한 환자들은 제시된 치료 빈도와 평가에 근거하여 볼 때 놀랄만한 호전을 보였다. 치료 초기와 물리치료를 시작하기 전의 평가 자료를 비교하여 보았을 때 설문지로 평가된 점수에서 큰 향상을 보였다. 결론 : 본 연구는 물리치료가 퇴행성 관절 질환 환자들에게 효과가 있음을 보여주었다. 또한 물리치료 임상지침서는 따라야 할 좋은 자료가 될 수 있지만 물리치료 처방에는 정해진 기준은 없다는 것을 보여주었다.