• The Korean Journal of Pain
• /
• v.31 no.3
• /
• pp.155-173
• /
• 2018

Chronic postsurgical pain (CPSP) is an unwanted adverse event in any operation. It leads to functional limitations and psychological trauma for patients, and leaves the operative team with feelings of failure and humiliation. Therefore, it is crucial that preventive strategies for CPSP are considered in high-risk operations. Various techniques have been implemented to reduce the risk with variable success. Identifying the risk factors for each patient and applying a timely preventive strategy may help patients avoid the distress of chronic pain. The preventive strategies include modification of the surgical technique, good pain control throughout the perioperative period, and preoperative psychological intervention focusing on the psychosocial and cognitive risk factors. Appropriate management of CPSP patients is also necessary to reduce their suffering. CPSP usually has a neuropathic pain component; therefore, the current recommendations are based on data on chronic neuropathic pain. Hence, voltage-dependent calcium channel antagonists, antidepressants, topical lidocaine and topical capsaicin are the main pharmacological treatments. Paracetamol, NSAIDs and weak opioids can be used according to symptom severity, but strong opioids should be used with great caution and are not recommended. Other drugs that may be helpful are ketamine, clonidine, and intravenous lidocaine infusion. For patients with failed pharmacological treatment, consideration should be given to pain interventions; examples include transcutaneous electrical nerve stimulation, botulinum toxin injections, pulsed radiofrequency, nerve blocks, nerve ablation, neuromodulation and surgical management. Physical therapy, cognitive behavioral therapy and lifestyle modifications are also useful for relieving the pain and distress experienced by CPSP patients.

• The Korean Journal of Physiology
• /
• v.21 no.1
• /
• pp.59-66
• /
• 1987

This study was aimed to investigate whether the conduction velocity of nerve impulses through the ventral afferent fibers is constant along their entire courses in dorsal as well as in ventral roots. Cats were anesthetized with ${\alpha}-chloralose$ (60 mg/kg, i.p.) and artificially ventilated. Laminectomies were done on L4-S1 spinal vertebrae to expose the lumbosacral spiral cord. Both ventral and dorsal roots of L7 or S1 spinal segments were isolated and cut near the spinal cord. Ventral roots were placed on 6-lead stimulating electrodes and stimulated with supra C-threshold intensity. Divided dorsal root fascicles were placed on bipolar recording electrodes and single fiber units activated by the stimulation of the ventral roots were identified. Followings are the results obtained: 1) A total of 27 VRA units were identified. 10 units of them conducted impulses slower than 2 m/sec. Conduction velocities of the remaining units were in the range of 3.11-20.91 m/sec. 2) In 12 Units conduction velocities Of the VRA units through dorsal$(CV_{DR})$ and venral root$(CV_{DR})$ were determined respectively. There was a tendency to conduct impulses faster through dorsal roots$(CV_{DR}=8.19{\pm}3.26\;m/sec)$ than ventral roots$(CV_{DR}=3.46{\pm}1.02\;m/sec)$. From the above results we confirmed that there exist nerve fibers in continuity between the spinal ventral and dorsal roots but we could not ascertain whether there is a change in conduction velocity through the entire course of ventral afferent unit.

• Journal of Veterinary Clinics
• /
• v.34 no.4
• /
• pp.287-290
• /
• 2017

A 6-month-old, 4.1 kg female Dachshund dog presented with intermittent non-weight bearing lameness of the right thoracic limb. Radiographs revealed caudolateral luxation of the right radial head and a shortened right ulna compared to the contralateral limb. Bone lengthening by distraction of the ulna using the Ilizarov technique was performed following ulnar osteotomy. The rate of distraction was 1.5 mm per day, adjusted a total of 3 times daily for a total distraction distance of 10 mm. The Ilizarov fixator was removed four weeks after surgery. The patient showed knuckling due to radial nerve injury that occurred during limb-lengthening. Corrective osteotomy was performed using a plate and pin for the luxation and deformity of the right radial head. The luxation of the radial head was successfully reduced following surgery. However, the knuckling persisted after surgery. Rehabilitation for radial nerve injury was performed using heat therapy, massage, a passive range of motion exercises, water treadmill exercises, neuromuscular electrical stimulation, leash-walking, and acupuncture. 15 months after surgery, the patient showed satisfactory weight-bearing ambulation without recurrence of lameness. The use of the Ilizarov technique is a good surgical option for the treatment of a patient with congenital elbow luxation.

• Journal of Digital Convergence
• /
• v.18 no.8
• /
• pp.505-509
• /
• 2020

A migraine was a headache disorder characterized by recurrent moderate to severe headaches. The diagnosis was based on clinical signs and symptoms. Medication, physical therapy, nerve block, and nerve stimulation could be applied for treatment. This report described a case of severe migraine without aura that lasted several weeks periodically in a 59-year-old woman. Periodic headache had lasted for more than 14 years, and although she took medicines and nerve blocks, severe pain (VAS 7) was persisted. We recommended her to use the thermo-spinal massage device (CGM MB-1401, CERAGEM Inc., Cheonan, South Korea) continuously three times a week applying in semi-automatic mode around the neck for 40 minutes. There was no change in the pain scale in the automatic mode for the first 4 weeks. Subsequently, the semi-automatic mode of the cervical area was treated for 2 weeks to relieve the pain scale, and it was confirmed that the relieved state maintained for 2 months. This case highlighted the importance in considering thermo-spinal massage devices for managing migraine without aura.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
• /
• v.11 no.2
• /
• pp.1-12
• /
• 2005

The purpose of this study is compare the effects of two therapeutic processes-i) conservative Myofacial Release Technique along and ii) Transcutaneous Electrical Nerve stimuliation alone - on the increase in the range of motion(ROM) and on the decrease in patient's pain with chronic Neck pain. The subjects of the study were student with choronic neck pain in Daegu health university. Half of them (10) took conservative Myofacial Release Technique along and the others (10) took Transcutaneous Electrical Nerve stimuliation alone. I used 3D Motion analysis. The range of motion (ROM) in six areas-flexion, extension, left lateral flexion, right lateral flexion, left rotation, right rotation-to check the effectiveness of the two combinations of methods, measured pain with visual analogue scale (VAS) to see the effect on pain reduce. Assement was conducted to the groups before the treatment began and affer the four weeks treatment ended. This study shows that both groups demonstrated significant improvement in ROM increase and pain reduction. Flexion ROM increases were significant in MFR and TENS after treatment 2 weeks and 4 weeks. Extension ROM increases were significant in MFR and TENS after treatment 2 weeks. Right rotation ROM was no significant differences were found in MFR and TENS after treatment all weeks. Right lateral flexion ROM increases were significant in MFR and TENS after treatment 3 weeks. Left lateral flexion ROM increases were significant in MFR and TENS after treatment 1 weeks. But the others no significant differences were in MFR group and TENS group during 4 weeks.

• The Korean Journal of Physiology
• /
• v.24 no.2
• /
• pp.389-402
• /
• 1990

The physiological characteristics of the neurons receiving the ventral root afferent inputs were investigated in the cat. A total of 70 cells were identified in the lumbosacral spinal cord. All these cells responded only to the C-strength stimulation of the distal stump of cut ventral root and the estimated conduction velocities of the VRA fibers were not faster than 4 m/sec. The majority of them were silent in resting state. For 49 cells, their peripheral receptive fields were characterized. Among them, 25 cells were exclusively excited by VRA inputs, 8 were inhibited and the remaining cells recevied both excitatory and inhibitory VRA inputs. According to the response pattern to the mechanical stimuli applied to their receptive fields, only a fourth of them were typical high threshold cell, a sixth, wide dynamic range cells, while remainings were a rather complex cells. Most of the cells receiving VRA inputs, received only the A ${\delta}-peripheral$ nerve inputs. Intravenous injection of morphine decreased the response of spinal cells to the VRA activation. The responses were abolished completely by counter irritation to the common peroneal nerve with C-strength-low frequency stimuli. These physiological properties of the spinal neurons receiving the VRA inputs are differ in some aspect from the spinal neurons receiving nociceptive inputs from the periphery, but still were consistent with the contention that VRA system might carry nociceptive informations arising from the spinal cord and/or neraby surrounding tissues.

• Journal of Korean Neurosurgical Society
• /
• v.29 no.7
• /
• pp.954-958
• /
• 2000

In the removal of small subcortical lesion in the eloquent area like sensory-motor cortex, the prevention of neurologic deficit is important. We present our technique of identification of M-1, S-1 cortex in a case of subcortical granuloma located in sensorymotor cortex. To accurately localize mass, stereotactic craniotomy was planned. At the beginning of procedure, functional MRI of motor cortex was done with stereotactic headframe in place. Next, the stereotactic craniotomy about 4 cm was done under propofol anesthesia for cortical mapping. After reflection of dura, central sulcus was identified with phase-reversal response of intraoperative SEP(somatosensory evoked potential) of contralateral median nerve. Then the patient was awakened, and direct cortical stimulation was done. We observed the muscle contractions of elbow, hand and fingers and the paresthesia over forearm, hand, fingers on the M-1 and S-1 cortex. Through cortical mapping and stereotactic guidance, we concluded that the mass lie immediately posterior to central sulcus, then the mass was carefully removed through small transsulcal approach, opening about 1 cm of rolandic sulcus.

• The Korean Journal of Pain
• /
• v.18 no.2
• /
• pp.156-160
• /
• 2005

Background: Frozen shoulder is not an uncommon disease, which is associated with chronic pain and joint movement limitation. However, there are numerous devices to assist in the treatment of shoulder pain, but their efficacy has not been proven and their use remains immensely controversial. Therefore, a randomized clinical study was conducted to determine the effectiveness of a low-frequency stimulator for the treatment of frozen shoulder. Methods: A randomized clinical trial was carried out on 40 patients with frozen shoulder, with 40 patients assigned to two groups; a control treatment group (group C, n = 20) and a low frequency stimulator application group (group T, n = 20). Both groups were given a routine treatment modality, such as trigger point injection, intramuscular stimulation or suprascapular nerve block etc. The level of the shoulder pain was evaluated using a 100mm VAS (visual analog scale) at each visit, with the limitation in the range of motion simultaneously evaluated. Results: All the subjects improved after treatment, with the VAS scores after termination of treatment showed a statistically significant reduction (P < 0.05). However, there was no significant difference between the two groups. One month after termination of 5 cycles of treatment, group T maintained their improved state, whereas the pain in some of those in group C reemerged, which also showed a statistically significant difference (P < 0.05). The limitation in the range of motion improved, with most subjects able to resume daily activity. Conclusions: Although the low frequency stimulation provided no more pain relief than routine treatment, the effect was significantly prolonged. From this result, low frequency stimulation can be considered to aide the therapeutic effect of classical frozen shoulder therapy.

• The Korean Journal of Pain
• /
• v.18 no.2
• /
• pp.240-245
• /
• 2005

Herein is described the successful treatment of complex regional pain syndrome type II with the combination treatment of spinal cord stimulation and radiofrequency thermocoagulation of the lumbar sympathetic ganglion. A 62 years old male patient, suffering from CRPS type II in his left lower extremity, visited our pain clinic. Medication and nerve blockade produced only slight improvement in his symptoms and signs. Therefore, a linear type spinal cord simulator was inserted into the thoracic epidural space, using a non-surgical percutaneous approach, with the cephalad lead located at the T11 level. Two months later, the repositioning of the electrode to the T12 level for more effective pain control, with radiofrequency thermocoagulation of lumbar sympathetic ganglion also performed at the left L2 and 3 levels for the control of trophic change. These resulted in significant pain relief and decreased trophic change, with no complications, after which the patient was able to resume a normal life.

• Journal of Biomedical Engineering Research
• /
• v.23 no.5
• /
• pp.405-412
• /
• 2002

The principle of Acupuncture effect on meridians is what physical stimulation does on general physiology so that is gets into new equilibrium from the fallen function state of human body. However, in western medicine, it is generally accepted that the action passageway of various kinds stimulation has been regarded as nerve-endocrine-immune system. Acupuncture effect has been regarded any action for all meridians as a respones by the stimulation. Western medicine doesn's accept treatment for transmission of the bio-energy. In this paper, we compared change of electric potential when an acupuncturist's bio-energy is passed on and when is not. As a result of clinics, the acupuncture effect is different as acupuncture method, when an acupuncturist's bio-energy is passed on the meridian and it isn's. It implies that acupuncture effect can complicately respond by simple acupuncture stimulus and transmission of bio-energy, on same meridian. We could confirm the relationship between an acupuncturist's energy transmission and acupuncture effect. Therefore, we could diagnosis the state of meridian using change of electric potential on the same meridian.