• The Journal of the Society of Stroke on Korean Medicine
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• v.18 no.1
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• pp.77-86
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• 2017

■ Objectives The purpose of this case study is to report the effect of Gami SSanghwa-tang on a patient with central post-stroke pain. ■ Methods The patient was treated with herbal medicine Gami SSanghwa-tang, acupuncture, pharmaco-acupuncture, and moxibustion. The treatment effect was evaluated by Numerical Rating Scale(NRS), Neuropathic Pain Symptom Inventory(NPSI), and 36-item Short-form Health Survey(SF-36). ■ Results After the treatment, the NRS score of pain intensity was reduced from moderate to mild degree. The total NPSI score and subscores also decreased, as the various features of the pain were relieved. The SF-36 score increased, as the patient's quality of life improved. ■ Conclusion This case study suggests that Gami SSanghwa-tang, could be effective in reducing pain and improving quality of life of patients suffering from central post-stroke pain.

• The Korean Journal of Pain
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• v.34 no.1
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• pp.35-46
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• 2021

Background: The present investigation explored the therapeutic actions of oleuropein along with the possible signaling pathway involved in attenuating neuropathic pain in chronic constriction injury (CCI) and vincristine-induced neuropathic pain in male rats. Methods: Four loose ligatures were placed around the sciatic nerve to induce CCI, and vincristine (50 ㎍/kg) was injected for 10 days to develop neuropathic pain. The development of cold allodynia, mechanical allodynia, and mechanical hyperalgesia was assessed using different pain-related behavioral tests. The levels of H2S, cystathionine-γ-lyase (CSE), cystathionine-β-synthase (CBS), orexin, and nuclear factor erythroid-2-related factor 2 (Nrf2) were measured in the sciatic nerve. Results: Treatment with oleuropein for 14 days led to significant amelioration of behavioral manifestations of neuropathic pain in two pain models. Moreover, oleuropein restored both CCI and vincristine-induced decreases in H2S, CSE, CBS, orexin, and Nrf2 levels. Co-administration of suvorexant, an orexin receptor antagonist, significantly counteracted the pain-attenuating actions of oleuropein and Nrf2 levels without modulating H2S, CSE and CBS. Conclusions: Oleuropein has therapeutic potential to attenuate the pain manifestations in CCI and vincristine-induced neuropathic pain, possibly by restoring the CSE, CBS, and H2S, which may subsequently increase the expression of orexin and Nrf2 to ameliorate behavioral manifestations of pain.

• Journal of Korea Entertainment Industry Association
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• v.14 no.8
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• pp.221-230
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• 2020

This study aimed to investigate the difference of sensory changes by central and peripheral stimulation for improving life care in chronic low back pain patients. Twelve chronic low back pain patients were randomly assigned to central stimulation (CS, n=6) and peripheral stimulation (PS, n=6). Quantitative sensory test (QST), pressure pain threshold (PPT) and Korean oswestry back pain disability index (KODI) were used to quantitatively measure and analyze. As a result, QST, PPT and KODI showed significant differences by period (p<.01) but did not showed any difference between the two groups (p>.05). Therefore, both stimulations had significant effects on increased sensory threshold and function improvement of the muscles that became sensitive due to pain. It is thought to be significant in improving life care for patients with chronic low back pain.

• 대한상한금궤의학회지
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• v.12 no.1
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• pp.127-135
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• 2020

Objective: In this case report, we aimed to determine the effect of Kyejigadahuang-tang on central post-stroke pain (CPSP). Methods: A 42-year-old woman presented with whole-body neuralgia due to CPSP. According to the diagnostic system based on Shanghanlun provisions (DPIDS), the patient was treated with Kyejigadahuang-tang. The results were evaluated using the Numeric Rating Scale (NRS) and Korean Neuropathic Pain Questionnaire (KNPQ). Results: After administration of Kyejigadahuang-tang for 30 days, the NRS score decreased from 8.5 to 3 and the KNPQ score decreased from 151 to 51. Conclusions: The patient completely recovered from CPSP following treatment with Kyejigadahuang-tang according to DPIDS.

• The Korean Journal of Pain
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• v.22 no.1
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• pp.1-15
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• 2009

Neuropathic pain is often refractory to intervention because of the complex etiology and an incomplete understanding of the mechanisms behind this type of pain. Glial cells, specifically microglia and astrocytes, are powerful modulators of pain and new targets of drug development for neuropathic pain. Glial activation could be the driving force behind chronic pain, maintaining the noxious signal transmission even after the original injury has healed. Glia express chemokine, purinergic, toll-like, glutaminergic and other receptors that enable them to respond to neural signals, and they can modulate neuronal synaptic function and neuronal excitability. Nerve injury upregulates multiple receptors in spinal microglia and astrocytes. Microglia influence neuronal communication by producing inflammatory products at the synapse, as do astrocytes because they completely encapsulate synapses and are in close contact with neuronal somas through gap junctions. Glia are the main source of inflammatory mediators in the central nervous system. New therapeutic strategies for neuropathic pain are emerging such as targeting the glial cells, novel pharmacologic approaches and gene therapy. Drugs targeting microglia and astrocytes, cytokine production, and neural structures including dorsal root ganglion are now under study, as is gene therapy. Isoform-specific inhibition will minimize the side effects produced by blocking all glia with a general inhibitor. Enhancing the anti-inflammatory cytokines could prove more beneficial than administering proinflammatory cytokine antagonists that block glial activation systemically. Research on therapeutic gene transfer to the central nervous system is underway, although obstacles prevent immediate clinical application.

• Journal of the Korean Society of Physical Medicine
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• v.12 no.2
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• pp.83-90
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• 2017

PURPOSE: Central post-stroke pain (CPSP), a chronic pain condition of stroke patients, can impair activities of daily living and worsen the quality of life (QOL), thereby negatively influencing the rehabilitation process. However, CPSP remains an underestimated complication of stroke. This study aimed to describe the prevalence and types of new-onset chronic pain and to identify the relation between pain and QOL in stroke patients. METHODS: All patients hospitalized because of a diagnosis of stroke were included. Questionnaire was used. Pain intensity was measured using Numerical rating scale (NRS), and pain characteristics were assessed using DN4. QOL was measured using SF-36. Descriptive statistics were used to analyze the characteristics and pain data, and chi-square test was used to compare QOL categorical data between the nociceptive and neurological pain groups. RESULTS: CPSP development was reported by 34% of the post-stroke pain patients. Perceived QOL was low in both groups, especially with respect to the physical functioning, bodily pain, physical-role functioning, emotional-role functioning, and mental health domains. However, no significant difference was observed in QOL between the nociceptive and neurological pain groups (p<.05). CONCLUSION: Our results indicated that CPSP is a common and disabling complication that is difficult to treat, often decreases QOL, and may negatively affect rehabilitation treatment.

• The Korean Journal of Pain
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• v.36 no.4
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• pp.408-424
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• 2023

Central post-stroke pain (CPSP) is an incapacitating disorder that impacts a substantial proportion of stroke survivors and can diminish their quality of life. Conventional therapies for CPSP, including tricyclic antidepressants, anticonvulsants, and opioids, are frequently ineffective, necessitating the investigation of alternative therapeutic strategies. Repetitive transcranial magnetic stimulation (rTMS) is now recognized as a promising noninvasive pain management method for CPSP. rTMS modulates neural activity through the administration of magnetic pulses to specific cortical regions. Trials analyzing the effects of rTMS on CPSP have generated various outcomes, but the evidence suggests possible analgesic benefits. In CPSP and other neuropathic pain conditions, high-frequency rTMS targeting the primary motor cortex (M1) with figure-eight coils has demonstrated significant pain alleviation. Due to its associaton with analgesic benefits, M1 is the most frequently targeted area. The duration and frequency of rTMS sessions, as well as the stimulation intensity, have been studied in an effort to optimize treatment outcomes. The short-term pain relief effects of rTMS have been observed, but the long-term effects (> 3 months) require further investigation. Aspects such as stimulation frequency, location, and treatment period can influence the efficacy of rTMS and ought to be considered while planning the procedure. Standardized guidelines for using rTMS in CPSP would optimize therapy protocols and improve patient outcomes. This review article provides an up-to-date overview of the incidence, clinical characteristics, outcome of rTMS in CPSP patients, and future perspective in the field.

• The Journal of Internal Korean Medicine
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• v.42 no.5
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• pp.931-938
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• 2021

Objective: This study addressed a case of central post-stroke pain described as right arm painful with coldness and left lateral medullary infarction. Methods: A patient, 71 years old female with medullary infarction, was treated with a Korean herbal medication (BackJun-pill). The improvement of symptoms was evaluated using the Numeral Rating Scale and reports of coldness and pain in the affected areas. We also measured the body temperature difference between the left and right arms using digital infrared thermographic imaging (DITI). Results: After six weeks of treatment with Korean medicine, the patient's pain and sensation of coldness decreased. Conclusions: This clinical case study suggests that BackJun-pill may be effective for alleviating pain and coldness due to central post-stroke pain.

• The Korean Journal of Pain
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• v.23 no.1
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• pp.1-10
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• 2010

Background: Recent studies indicate that reactive oxygen species (ROS) are involved in persistent pain, including neuropathic and inflammatory pain. Since the data suggest that ROS are involved in central sensitization, the present study examines the levels of activated N-methyl-D-aspartate (NMDA) receptors in the dorsal horn after an exogenous supply of three antioxidants in rats with chronic post-ischemia pain (CPIP). This serves as an animal model of complex regional pain syndrome type-I induced by hindpaw ischemia/reperfusion injury. Methods: The application of tight-fitting O-rings for a period of three hours produced CPIP in male Sprague-Dawley rats. Allopurinol 4 mg/kg, allopurinol 40 mg/kg, superoxide dismutase (SOD) 4,000 U/kg, N-nitro-L-arginine methyl ester (L-NAME) 10 mg/kg and SOD 4,000 U/kg plus L-NAME 10 mg/kg were administered intraperitoneally just after O-ring application and on the first and second days after reperfusion. Mechanical allodynia was measured, and activation of the NMDA receptor subunit 1 (pNR1) of the lumbar spinal cord (L4-L6) was analyzed by the Western blot three days after reperfusion. Results: Allopurinol reduced mechanical allodynia and attenuated the enhancement of spinal pNR1 expression in CPIP rats. SOD and L-NAME also blocked spinal pNR1 in accordance with the reduced mechanical allodynia in rats with CPIP. Conclusions: The present data suggest the contribution of superoxide, produced via xanthine oxidase, and the participation of superoxide and nitric oxide as a precursor of peroxynitrite in NMDA mediated central sensitization. Finally, the findings support a therapeutic potential for the manipulation of superoxide and nitric oxide in ischemia/reperfusion related pain conditions.

• The Journal of Internal Korean Medicine
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• v.38 no.6
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• pp.1060-1067
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• 2017

Objectives: This case study examined the effects of treatment with traditional Korean medicine on a central post-stroke pain patient, who had impingement syndrome of the right shoulder. Methods: The patient received traditional Korean medical treatments, including acupuncture, warm-needling, moxibustion, and cupping, throughout the treatment period, and extracorporeal shock-wave therapy and physical therapy for part of the treatment period. The effects of treatments were measured with a manual muscle test (MMT), numerical rating scale (NRS), range of motion (ROM), and gait staging index (self-invented). Results: The clinical symptoms of the patient were improved considerably after the complete treatment. Conclusions: Traditional Korean medicine may be effective for treatment of central post-stroke pain in patients with impingement syndrome.