• The Korean Journal of Pain
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• v.4 no.1
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• pp.37-41
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• 1991

Celiac Plexus neurolysis (C. P. N) has been commonly used to treat malignant pain of the abdominal area that is intractable. It relieves the pain effectively instead of using massive systemic narcotic analgesics. C. P. N. with modified transaortic technique was performed under C-T guidance, in which a single needle was advanced from a left posterior paramedian approach through the aorta in order to inject anesthetic agents directly into the celiac plexus. There was marked pain relief without any hemorrhagic and neurological or other complications. We found this modified transaortic method of C. P. N. to be very effective, safe and easy to perform compared with the classic two needle technique.

• Journal of Korean Neurosurgical Society
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• v.41 no.1
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• pp.7-10
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• 2007

Objective : The aim of this study was to determine the efficacy of percutaneous radiofrequency neurotomy[RFN] of ramus communicans nerve in patients suffering from severe low back pain due to osteoporotic compression fracture. Methods : Twenty two patients with lumbar osteoporotic compression fracture who had intractable back pain for less than two weeks and were performed with RFN at L1-L4 from May 2004 to December 2005 were retrospectively analyzed. Clinical outcome using visual analogue scale[VAS] pain scores and modified MacNab's grade was tabulated. Complications related to the procedure were assessed. Results : Twenty-two female patients [age from 63 to 81 years old] were included in this study. The mean VAS score prior to RFN was 7.8, it improved to 2.6 within postoperative time of 48 hours, and the mean VAS score after 3 months was 2.8, which was significantly decreased. Eighteen of 22 patients were graded as excellent and good according to modified MacNab's criteria at final follow up. All patients recovered uneventfully, and the neurologic examination revealed no deficits. Two patients showing poor results worsened in symptom. Percutaneous was performed eventually resulting in symptom improvement. There were no significant complications related to the procedure such as sensory dysesthesia, numbness or permanent motor weakness. Conclusion : RFN is safe and effective in treating the painful osteoporotic compression fracture. in patients with intractable back pain due to lumbar osteoporotic compression fracture, RFN of gray ramus communicans nerve should be considered as a treatment option prior to vertebroplasty.

• The Korean Journal of Pain
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• v.7 no.1
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• pp.74-77
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• 1994

Since its introduction, low level lasers have been utilized in many varied clinical applications for the treatment of musculoskeletal and body surface lesions. Due to the laser beams specific characteristic-coherence, monochromaticity and unidirectionality, without adverse reaction with neighbouring tissue, physicians have used it with relative ease. We observed accelerating effects of healing process of some intractable skin wound, improvement of graft survival, as well as reduction of pain on ulcerating tissues, by treating twice weekly with low level Helium-Neon(He-Ne) and Infrared(IR) laser. The laser's energy density was set at $1\;J/cm^2$ and a fixed frequency of 600 Hz by continuous scanning. Irradiating time was calculated according to the cross diameter of the wound. Further clinical work will be required to evaluate the accelerated healing processes by biostimulating mechanisms of laser ray, especially for the intractable(diabetic) skin ulceration.

• Journal of Yeungnam Medical Science
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• v.26 no.1
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• pp.74-77
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• 2009

There are debates about whether peripherally induced movement disorders exist. We report a case of upper limb tremor induced by peripheral nerve injury. A 20-year-old male patient presented with pain and tremor of the left upper extremity, 2 days after a car accident. Magnetic resonance images of the brain and cervical spine were normal. His past medical history was unremarkable and there were no family members with symptoms of movement disorders. He suffered from an aggravating tremor for about 10 minutes, four to six times a day. We treated the patient with medication, epidural infusion, cervical nerve root block and trigger point injection of the trapezius muscle. The pain subsided 50% and the incidence of tremor attacks was reduced to once or twice a day. The role of peripheral trauma in the genesis of movement disorders has not been generally accepted. It is unclear whether peripheral trauma can induce dystonia and other movement disorders. It has been proposed that peripheral trauma can alter sensory input and induce cortical and subcortical reorganization that generates a movement disorder. Some studies provide evidence for central reorganization following peripheral injury.

• Journal of Korean Neurosurgical Society
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• v.43 no.2
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• pp.85-89
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• 2008

Objective: The purpose of this study is to identify the factors affecting the failure of trials (<50% pain reduction in pain for trial period) to improve success rate of spinal cord stimulation (SCS) trial. Methods: A retrospective review of the failed trials (44 patients, 36.1 %) among the patients (n=122) who underwent SCS trial between January 1990 and December 1998 was conducted. We reviewed the causes of failed trial stimulation, age, sex, etiology of pain, type of electrode, and third party support. Results: Of the 44 patients, 65.9% showed unacceptable pain relief in spite of sufficient paresthesia on the pain area with trial stimulation. Four of six patients felt insufficient paresthesia with stimulation had the lesions of the spinal cord. Seventy five percent of the patients experienced unpleasant or painful sensation during stimulation had allodynia dominant pain. Third-party involvement, sex, age and electrode type had no influence on the outcome. Conclusion: We conclude that SCS trial is less effective for patients with neuropathic pain of cord lesions, postherpetic neuropathy or post-amputation state. Further, patients with allodynia dominant pain can feel unpleasant or painful during trial stimulation.

• The Korean Journal of Pain
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• v.4 no.2
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• pp.122-126
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• 1991

Continuous epidural analgesia with intermittent morphine injection is a good technique for the management of intractabie cancer pain. Since epidural tunnelling was introduced for the first time to our institution in 1988, it has been widely used for the cancer pain management. Recently epidural tunnelling was introduced for the keeping an inserted catheter for a long period of time. Twenty-five patients with terminal cancer had been used an epidural tunnelling at the pain clinic of Dongsan Medical Center during the period of 3 months in 1991. Among the 25 patients, 14 were male and 11 were female, and most of them were at the ages of 6th decade. The causes of pain were from stomach cancer in 12, CBD cancer in 3, hepatoma in 2, pancreatic cancer in 2, uterine cervical cancer in 2, and miscellaneous cancer in 4 cases respectively. The outcome of treatment were excellent results in 14(56%), good in 9(36%), and moderate in 2.patients(8%). Accordingly satisfactory pain relief was achieved in 92% of the patients. It is suggested that this long-term management of intractable cancer pain by epidural bupivacaine and morphine with epidural tunnelling is satisfactory and reliable.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.89-92
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• 1997

Neurolytic splanchnic nerve block is effective for treatment of intractable upper abdominal cancer pain. Conventional approach for splanchnic nerve block is conducted in the prone position to ensure proper orientation and to allow insertion of needles on each side of the vertebral body. However, the prone position has some technical disadvantages as this position is frequently poorly tolerated by a majority of patients with advanced cancer due to severe abdominal pain, ascites and so on. Male patient, 53-year old with transverse colon cancer, carcinomatosis peritonei and $L_1,\;L_2$ vertebral body metastasis, was admitted for treatment of severe right upper quadrant and right iliac crest pain. We performed neurolytic splanchnic nerve block with transdiscal technique in the lateral decubitus position under fluoroscopic guidance, and well noted the usefulness and the advantage of this technique. The benefits of this technique are safe, simple and effective because the lateral position is better tolerated by patients and makes bony landmarks more accessible during fluoroscopy.

• The Korean Journal of Pain
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• v.10 no.1
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• pp.82-85
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• 1997

Destruction of the gasserian ganglion can be carried out by creating a radiofrequency lesion under biplanar fluoroscopic guidance. This procedure is reserved for patients who have failed various interventions for intractable trigeminal neuralgia including retro-gasserian injection of glycerol and whose physical status otherwise precludes more invasive neuro-surgical treatments such as microvascular decompression. Radiofrequency thermocoagulation of the gasserian ganglion provides a safe method of achieving long-standing relief from trigeminal neuralgia with low risk. This technique is currently emerging worldwide as the surgical treatment of choice for trigeminal neuralgia. Recently we performed a successful radiofrequency gasserian ganglionotomy, without any complication, under fluoroscopic guidance. The procedure was successful and complete pain relief was achieved for a patient who already had treatments of various interventions including microvascular decompression but never experienced pain relief.

• Journal of Korean Neurosurgical Society
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• v.50 no.2
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• pp.130-133
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• 2011

Spinal epidural lipomatosis (SEL) is an overgrowth of the normally encapsulated adipose tissue in the epidural space around the spinal cord in the thoracic and lumbar spine causing compression of the neural components. Idiopathic SEL in non-obese patients is exceptional. Idiopathic SEL can result in thoracic myelopathy and lumbar radiculopathy. A thoracic radiculopathy due to idiopathic SEL has not been reported yet. We report a case of idiopathic SEL with intractable chest pain and paresthesia. We suggest that idiopathic SEL should be considered as a cause of chest pain.

• The Korean Journal of Pain
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• v.12 no.2
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• pp.268-271
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• 1999

Intrathecal phenol-glycerin block is a potent tool in stepwise approach to intractable perineal pain. At outpatient clinic, intrathecal phenol-glycerin block have been frequently used to control the cancer pain, as this procedure does not require special equipment. However, undesirable effects may occur with any given intrathecal injection. Although most side effects do not last long, they deserve well to prevent. Recently, we have been controlled the perineal and perianal cancer pain with intrathecal phenol-glycerin block without any specific complications. However, one patient we managed experienced that one patient, with this procedure for chronic non-malignant perineal pain control experience gait disturbance and one-week of voiding and defication difficulties. This research reports these practices, including the review of literature.