• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.4
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• pp.337-344
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• 2021

Background: The primary indication for using long-acting anesthetics in dentistry is extensive dental procedures that require pulpal anesthesia beyond 90 min and management of postoperative pain. Ropivacaine is an amide local anesthetic that is available at various concentrations with inherent vasoconstrictive properties at low concentrations. Ropivacaine has a 75% greater margin of safety than bupivacaine. Ropivacaine can be a good alternative to bupivacaine as a local anesthetic in dental implant surgery as it provides a longer duration of both pulpal and soft tissue anesthesia after mandibular nerve block and lowers CNS and cardiovascular toxicity. This study aimed to evaluate and compare the clinical efficacy of ropivacaine and lignocaine for implant surgery anesthesia. Methods: Fifteen patients with bilateral edentulous sites indicated for implant placement were recruited for this study. Patients aged 20-60 years of both sexes were randomly recruited. Thirty implant placements were performed in the test and control groups using ropivacaine and lignocaine with adrenaline as local anesthetics, respectively. Results: The results were analyzed statistically. The duration of anesthesia was significantly higher in the test group than in the control group. Ropivacaine was found to be superior to lignocaine in terms of the quality of anesthesia. The comparison of mean visual analog scale scores showed ropivacaine to have better anesthetic and analgesic effects than the control group. Conclusion: Ropivacaine 0.75% provides a significantly longer duration of anesthesia than lignocaine 2% with adrenaline. Ropivacaine 0.75% decreased intraoperative and postoperative analgesia compared to lignocaine 2% with adrenaline. Hence, ropivacaine 0.75% can be used as an alternative to lignocaine in implant surgeries and other intraoral surgical procedures that require a longer duration of anesthesia and analgesia.

• Annals of Clinical Neurophysiology
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• v.23 no.2
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• pp.108-116
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• 2021

Background: Nitrous oxide (N₂O) is used in surgery and dentistry for its anesthetic and analgesic effects. However, neurological and psychiatric manifestations of N₂O abuse have been increasingly reported among Korean adults. The aim of this study was to demonstrate laboratory findings of N₂O abuse in Korean patients. Methods: Patients diagnosed with N₂O-induced neuropathy or myelopathy from August 2018 to December 2019 were enrolled. Their clinical presentations and laboratory and imaging findings were analyzed. Results: Sensory changes and limb weakness were present in nine of the enrolled patients. The laboratory findings revealed that seven patients had high homocysteine levels and five had high methylmalonic acid levels in their blood. Nerve conductions studies indicated that axonal neuropathy was present in four cases and longer F-wave and Hoffman's-reflex latencies were present in two cases. Signal changes in cervical spine imaging occurred in five patients, while two had normal results. Conclusions: Chronic N₂O abuse can cause neurological damage or psychiatric problems. Because N₂O is illegal for recreational use in Korea, patients tend to hide their history of use. Even though the spinal imaging results were normal, clinicians should consider the possibility of N₂O use, and further electrophysiological tests should be applied for precise evaluations.

• The Korea Journal of Herbology
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• v.33 no.2
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• pp.29-43
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• 2018

Objectives : Araliae Continentalis Radix(AC) is a medicinal herb belonging to the drug efficacy group treating musculoskeletal disorders(MSD) with anti-inflammatory, analgesic and antipyretic action. However, due to morphologic and onomastic similarity, adulterants(Angelicae Pubescentis Radix: AP, Gypsophilae Oldhamianae Radix: GO, Levistici Officinalis Radix: LO) have been included or replaced the standard. Methods : Multilateral methods were carried out on the identification of AC and its adulterants. Macroscopic and microscopic characteristics were observed by using stereoscope and microscope. For the comparison of chromatogram pattern, standard compounds were analyzed simultaneously using high performance liquid chromatography. Results : 1. The macroscopic identification of original plants was determined by the phyllotaxis type, the inflorescence type, the leaf margin and the color of flowers. The macroscopic identification of herbal materials was examined by oil spots, the cambium, heteromorphic vascular bundles, and the pholem. 2. For the microscopic identification, the fact whether its xylem ray is proliferated or not was first determined. Then medicinal herbs were secondly divided by cellular inclusions, fiber bundles, the distribution of secretary canals and the shape of cambium. 3. AC and its adulterants showed different chromatographic fingerprints. AC was containing continentalic acid and kaurenoic acid. AP was containing osthole and columbianadin. LO was containing osthole and falcarindiol. None of the compounds were found in GO. Conclusions : This recent identification keys of might be helpful to discriminate the pharmacopoeia standard and its adulterants for the right usage in clinics.

• The Korea Journal of Herbology
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• v.35 no.2
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• pp.31-38
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• 2020

Objectives : Jakyakgamcho-tang has been used as analgesic and spasmolytic for muscle pain. It has reported to anti-diabetes, anti-inflammation, and neuro-protective effects. A clinical study of muscle fatigue and pain improvement effect of Jakyakgamcho-tang has been reported with increasing frequency of clinical use. However, the anti-fatigue effect of Jakyakgamcho-tang in animal model has not been studied. In this study, we compared anti-physical fatigue effects of water and 30% ethanol extract of Jakyakgamcho-tang. Methods : The amounts of components contained in water and 30% ethanol extract of Jakyakgamcho-tang were compared by ultra-performance liquid chromatography. Anti-physical fatigue effects were evaluated using weight-loaded forced swimming test. We also investigated the effects of Jakyakgamcho-tang on the change of fatigue parameters by blood biochemical analysis. Results : The relative amount of components of Jakyakgamcho-tang were about 19-53% higher in the 30% ethanol extract than in the water extract. In the swimming test, 30% ethanol extract showed a significantly greater anti-fatigue effects than conventional water extract of Jakyakgamcho-tang. The 30% ethanol extract of Jakyakgamcho-tang improved the exhausted swimming time (54%), and serum lactate dehydrogenase (48%) and lactic acid (60%) levels compared with water extract of Jakyakgamcho-tang. Conclusions : These results showed that differences in the amounts of components by different extraction were associated with differences of anti-fatigue effect of Jakyakgamcho-tang. Thus, the 30% ethanol extraction method could be applied to dose-reducing formulations of traditional herbal medicines.

• The Korea Journal of Herbology
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• v.37 no.5
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• pp.83-88
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• 2022

Objectives : Jakyakgamcho-tang (JGT) has been traditionally used to treat muscular convulsion and pain in South Korea. According to recent studies, JGT has been reported to have anti-depression, anti-inflammation, anti-oxidative, anti-diabetics, anti-spasm and analgesic effects, but studies on its anti-neuroinflammatory and neuroprotective effect have not been deeply conducted. Thus, we investigated the anti-neuroinflammatory activity of JGT on lipopolysaccharide (LPS)-stimulated mouse microglia cells. Methods : To investigate the anti-neuroinflammatory effects of JGT on BV2 microglial cells, we examined the production of nitric oxide (NO) using griess assay, and mRNA expressions of pro-inflammatory cytokines such as interleukin (IL)-1𝛽, IL-6, and tumor necrosis factor (TNF)-𝛼 using real time RT-PCR. Furthermore, to determine the regulating mechanisms of JGT, we investigated the heme oxygenase (HO)-1 by real time RT-PCR. Results : Pre-treatment of JGT effectively decreased NO production in LPS-stimulated BV2 cells at concentrations without cytotoxicity. Additionally, JGT significantly suppressed the production of IL-1𝛽, IL-6, and TNF-𝛼 in LPS-stimulated BV2 cells. Furthermore, JGT activated the HO-1 expression, which is one of the immunomodulatory signaling molecules. And the abolishment of HO-1 by tin protoporphyrin IX (SnPP, the HO-1 inhibitor) reversed the anti- inflammatory activity of JGT in LPS-stimulated BV2 cells. Conclusions : Our results suggest that the JGT has anti-neuroinflammatory effect through the activation of HO-1 in LPS-stimulated BV2 cells. Thereby, JGT could expected to be used for the prevention and treatment of neurodegenerative disease related to neuroinflammation.

• The Korean Journal of Pain
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• v.35 no.4
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• pp.391-402
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• 2022

Background: The mechanism of peripheral axon transport in neuropathic pain is still unclear. Chemokine ligand 13 (CXCL13) and its receptor (C-X-C chemokine receptor type 5, CXCR5) as well as GABA transporter 1 (GAT-1) play an important role in the development of pain. The aim of this study was to explore the axonal transport of CXCL13/CXCR5 and GAT-1 with the aid of the analgesic effect of botulinum toxin type A (BTX-A) in rats. Methods: Chronic constriction injury (CCI) rat models were established. BTX-A was administered to rats through subcutaneous injection in the hind paw. The pain behaviors in CCI rats were measured by paw withdrawal threshold and paw withdrawal latencies. The levels of CXCL13/CXCR5 and GAT-1 were measured by western blots. Results: The subcutaneous injection of BTX-A relieved the mechanical allodynia and heat hyperalgesia induced by CCI surgery and reversed the overexpression of CXCL13/CXCR5 and GAT-1 in the spinal cord, dorsal root ganglia (DRG), sciatic nerve, and plantar skin in CCI rats. After 10 mmol/L colchicine blocked the axon transport of sciatic nerve, the inhibitory effect of BTX-A disappeared, and the levels of CXCL13/CXCR5 and GAT-1 in the spinal cord and DRG were reduced in CCI rats. Conclusions: BTX-A regulated the levels of CXCL13/CXCR5 and GAT-1 in the spine and DRG through axonal transport. Chemokines (such as CXCL13) may be transported from the injury site to the spine or DRG through axonal transport. Axon molecular transport may be a target to enhance pain management in neuropathic pain.

• Journal of Acupuncture Research
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• v.39 no.3
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• pp.159-169
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• 2022

Failed back surgery syndrome (FBSS) is a term that applies to symptoms such as persistent or recurring low back pain, paresthesia, sciatica, or numbness after spine surgery. Electroacupuncture (EA) has been reported to have excellent analgesic effects although there have been no systematic reviews on the effects of EA on FBSS. Therefore, a systematic review and meta-analysis of the effectiveness of EA on FBSS was conducted. Eight databases were searched for studies that used EA for FBSS and 7 randomized controlled trials (RCTs) were included. RCTs of EA as combination therapy for FBSS compared with conventional treatment demonstrated improvement in the level of pain, lumbar functional scale scores, and quality of life. However, meta-analysis showed that reduction in pain was not statistically significant, while evaluation of lumbar function significantly improved, although the quality of evidence in the RCTs was generally low. RCTs comparing EA alone with conventional treatment demonstrated an improved level of pain, lumbar function, and effective rate of treatment. Meta-analysis showed that pain was significantly decreased in the EA alone group compared with the control group, although the quality of evidence was low. To improve the quality of evidence, high-quality RCTs are required in the future.

• Biomolecules & Therapeutics
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• v.31 no.2
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• pp.168-175
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• 2023

Tramadol is an opioid analog used to treat chronic and acute pain. Intradermal injections of tramadol at hundreds of millimoles have been shown to produce a local anesthetic effect. We used the whole-cell patch-clamp technique in this study to investigate whether tramadol blocks the sodium current in HEK293 cells, which stably express the pain threshold sodium channel Na_v1.7 or the cardiac sodium channel Na_v1.5. The half-maximal inhibitory concentration of tramadol was 0.73 mM for Na_v1.7 and 0.43 mM for Na_v1.5 at a holding potential of -100 mV. The blocking effects of tramadol were completely reversible. Tramadol shifted the steady-state inactivation curves of Na_v1.7 and Na_v1.5 toward hyperpolarization. Tramadol also slowed the recovery rate from the inactivation of Na_v1.7 and Na_v1.5 and induced stronger use-dependent inhibition. Because the mean plasma concentration of tramadol upon oral administration is lower than its mean blocking concentration of sodium channels in this study, it is unlikely that tramadol in plasma will have an analgesic effect by blocking Na_v1.7 or show cardiotoxicity by blocking Na_v1.5. However, tramadol could act as a local anesthetic when used at a concentration of several hundred millimoles by intradermal injection and as an antiarrhythmic when injected intravenously at a similar dose, as does lidocaine.

• Korean Journal of Acupuncture
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• v.39 no.4
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• pp.132-141
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• 2022

Objectives : Some acupoints are commonly utilized to treat a variety of diseases. The acupoints appear to have a wide range of effects caused by several mechanisms. The purpose of this study is to investigate into the potential role of microRNAs (miRNAs) in the multipotent effects of individual acupoint stimulation. Methods : We examined the miRNA expressions in the dorsal root ganglia (DRG) of neuropathic or inflammatory pain rats following ST36 and GB34 electroacupuncture (EA) stimulation. Neuropathic pain was induced by L5 spinal nerve ligation. Inflammatory pain was induced by knee joint injection of Complete Freund's adjuvant (CFA). EA was given under gaseous anesthesia with the same parameters (1mA, 2Hz, 30 min) in 5 consecutive days. Pain behaviors and miRNA expressions were analyzed. Results : In rats with neuropathic and inflammatory pain, EA treatments significantly enhanced the paw withdrawal threshold and weight-bearing force. After nerve injury, 36 miRNAs were upregulated in the DRG of neuropathic rats, while EA downregulated 10 of them. Furthermore, 14 miRNAs were downregulated following nerve damage, while one was increased by EA. 15 miRNAs were increased in the DRG of inflammatory rats following CFA injection, while 5 were downregulated by EA. Furthermore, 17 miRNAs were downregulated following CFA injection, while 7 were increased by EA. The miRNAs rno-miR-335, rno-miR-381-5p, rno-miR-1306-3p, and rno-miR-1839-3p were regulated by EA in both models. Conclusions : In two pain models, EA applied to ST36 and GB34 regulated miRNA expression differently. There appeared to be both acupoint-specific and non-specific miRNAs, and miRNA regulation of differential protein expression may modulate a variety of EA mechanisms.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.6
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• pp.356-362
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• 2022

Objectives: A single-blinded randomized controlled trial was designed to compare and evaluate the effectiveness of the periotome and piezotome as aids for atraumatic extraction and its sequalae. Materials and Methods: The study sample comprised 48 teeth, equally allotted to the piezotome or periotome groups by random allocation, in participants aged 19-62 years. All samples in both groups had either complete tooth structure or intact roots without crowns and had mobility ≤grade II. Clinical parameters of operative duration, presence or absence of gingival laceration, reported operative and postoperative pain, and intake of analgesics following extraction were recorded. IBM SPSS software package version 22 was used for data entry and analysis. Results: The mean operation time was significantly (P≤0.05) longer in the piezotome group than in the periotome group. However, fewer gingival lacerations were observed with use of a piezotome than with a periotome, although no significant difference was observed. The piezotome group reported significantly (P≤0.05) higher visual analog scale (VAS) pain scores during the procedure and non-significantly higher scores thereafter until the third postoperative day. In the piezotome group, the dosage of analgesic was higher, although the periotome group had a higher percentage of participants who used analgesics postoperatively; however, these differences were not statistically significant. Conclusion: The present clinical trial favors the use of periotome over piezotome for atraumatic extraction due to shorter operating time, lower postoperative VAS pain scores, and lower dosage of analgesics despite the superior ability of the piezotome to prevent gingival laceration.