• 대한족부족관절학회지
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• 제12권2호
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• pp.230-233
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• 2008

The avulsion fracture of the calcaneal tuberosity is rare injury. Usually, it occurs from indirect trauma in old patients with osteoporosis or in patients with diabetic neuropathy. Especially, the bone and joint damage occurred in active patient with severe sensory loss or arthropathy related to nerve damage regardless of the cause is referred to neuropathic arthropathy. Generally, a patient with nondisplacement or minimally displacement is treated by conservative therapy and a patient with severe displacement is treated by open reduction and internal fixation. We experienced a 33 years-old woman with diabetes mellitus who had the displaced avulsion fracture of the calcaneal tuberosity without significant trauma and did not treat. We report upon this case at the 2 years follow-up.

• Molecules and Cells
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• 제25권2호
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• pp.242-246
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• 2008

To assess the role of $\alpha_{1G}$ T-type $Ca^{2+}$ channels in neuropathic pain after L5 spinal nerve ligation, we examined behavioral pain susceptibility in mice lacking $Ca_{V}3.1$ (${\alpha}_{1G}{^{-/-}}$), the gene encoding the pore-forming units of these channels. Reduced spontaneous pain responses and an increased threshold for paw withdrawal in response to mechanical stimulation were observed in these mice. The ${{\alpha}_{1G}}^{-/-}$ mice also showed attenuated thermal hyperalgesia in response to both low-(IR30) and high-intensity (IR60) infrared stimulation. Our results reveal the importance of ${\alpha}_{1G}$ T-type $Ca^{2+}$ channels in the development of neuropathic pain, and suggest that selective modulation of ${\alpha}_{1G}$ subtype channels may provide a novel approach to the treatment of allodynia and hyperalgesia.

• 한국전문물리치료학회지
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• 제6권3호
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• pp.1-10
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• 1999

The purpose of this study was to determine whether high voltage pulsed current stimulation (HVPCS) would enhance wound healing in neuropathic rabbits. Ten rabbits were assigned to either an experimental or a control group. The wounded part around the peripheral neuropathy of the experimental rabbits was stimulated for two hours twice a day for six days under the following conditions: pulse frequency 80 pps, pulse duration $100{\mu}s$, and stimulation intensity 30~40 V. The results indicated that there was no difference in the wound closure between the experimental and control groups. The two groups showed similar aspects in collagen and reticulum, which were observed by colored Masson's trichome. While the rabbits in the control group had more or less thick fibers, the rabbits in the experimental group had thin and branched-shape fibers. The rabbits in the experimental group showed both strong responses in the shaping of elastic fibers and the increased aspects in fibroblast when compared with the control group.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권1호
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• pp.1-8
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• 2016

Most dental pain is caused by an organic problem such as dental caries, periodontitis, pulpitis, or trauma. Diagnosis and treatment of these symptoms are relatively straightforward. However, patients often also complain of abnormal dental pain that has a non-dental origin, whose diagnosis is challenging. Such abnormal dental pain can be categorized on the basis of its cause as referred pain, neuromodulatory pain, and neuropathic pain. When it is difficult to diagnose a patient's dental pain, these potential alternate causes should be considered. In this clinical review, we have presented a case of referred pain from the digastric muscle (Patient 1), of pulpectomized (Patient 2), and of pulpectomized pain (Patient 3) to illustrate referred, neuromodulatory, and neuropathic pain, respectively. The Patient 1 was advised muscle stretching and gentle massage of the trigger points, as well as pain relief using a nonsteroidal anti-inflammatory and the tricyclic antidepressant amitriptyline. The pain in Patient 2 was relieved completely by the tricyclic antidepressant amitriptyline. In Patient 3, the pain was controlled using either a continuous drip infusion of adenosine triphosphate or intravenous Mg2+ and lidocaine administered every 2 weeks. In each case of abnormal dental pain, the patient's diagnostic chart was used (Fig.2 and 3). Pain was satisfactorily relieved in all cases.

• Hip & pelvis
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• 제30권4호
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• pp.226-232
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• 2018

Purpose: Pain caused by osteoarthritis is primarily nociceptive pain; however, it is considered that a component of this pain is due to neuropathic pain (NP). We investigated the effects of total hip arthroplasty (THA) in patients with NP diagnosed by the PainDETECT questionnaire. Materials and Methods: One hundred sixty-three hips (161 patients) were evaluated. All patients were asked to complete the PainDETECT questionnaire based on their experience with NP, and clinical scores were evaluated using the Japanese Orthopaedic Association (JOA) Hip Score before and after THA. Results: The patients of 24.5% reported NP before THA; 5.5% reported NP 2 months after THA. Prior to THA, there was no significant correlation between the PainDETECT score and the radiographic severity; however, there was a significant correlation between the PainDETECT score and JOA score. NP at 2 months after THA was not significantly correlated with pain scores at 1 week after THA; however, a significant correlation was observed between the preoperative pain score and NP at 2 months after THA. Conclusion: THA was useful for relieving nociceptive pain and for relieving NP in patients with hip osteoarthritis. Preoperative pain was a risk factor for NP after THA. Controlling preoperative pain may be effective for reducing postoperative NP.

• Journal of Korean Neurosurgical Society
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• 제67권2호
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• pp.202-208
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• 2024

Objective : Failed back surgery syndrome (FBSS) is a common long-term complication following spine surgeries characterized by chronic persistent pain; different strategies of management were employed to deal with it. This clinical trial aims to compare the efficacy of Pregabalin and Gabapentin in the management of this condition. Methods : A double-blind, randomized, comparative study (clinical trial registry NCT05324761 on 11th April 2022) with two parallel arms with Pregabalin and Gabapentin were used in arms one and two, respectively. Visual analog scale was used for basal and endpoint assessment of pain. T-test and analysis of covariance were used to deal with different variables. A pairwise test was used to compare pairs of means. Results : Of 66 patients referred to the trial, 64 were eligible, with 60 patients completing the 30 days trial. Both pregabalin and gabapentin effectively reduce pain, with significant p-values of 0.001 for each group. However, the pregabalin group was superior to gabapentin in pain reduction (p=0.001). Gender was an insignificant factor (p=0.574 and p=0.445 for the pregabalin and gabapentin groups, respectively, with a non-significant reduction (p=0.393) for both groups in total. Location of stenosis before surgery and type of surgery performed show non-significant effect on pain reduction for both groups. Conclusion : Both pregabalin and gabapentin effectively and safely relieve neuropathic pain associated with FBSS; pregabalin was significantly more effective irrespective of the patients' gender.

• The Korean Journal of Pain
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• 제37권2호
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• pp.107-118
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• 2024

Nociplastic pain by the "International Association for the Study of Pain" is defined as pain that arises from altered nociception despite no clear evidence of nociceptive or neuropathic pain. Augmented central nervous system pain and sensory processing with altered pain modulation are suggested to be the mechanism of nociplastic pain. Clinical criteria for possible nociplastic pain affecting somatic structures include chronic regional pain and evoked pain hypersensitivity including allodynia with after-sensation. In addition to possible nociplastic pain, clinical criteria for probable nociplastic pain are pain hypersensitivity in the region of pain to non-noxious stimuli and presence of comorbidity such as generalized symptoms with sleep disturbance, fatigue, or cognitive problems with hypersensitivity of special senses. Criteria for definitive nociplastic pain is not determined yet. Eight specific disorders related to central sensitization are suggested to be restless leg syndrome, chronic fatigue syndrome, fibromyalgia, temporomandibular disorder, migraine or tension headache, irritable bowel syndrome, multiple chemical sensitivities, and whiplash injury; non-specific emotional disorders related to central sensitization include anxiety or panic attack and depression. These central sensitization pain syndromes are overlapped to previous functional pain syndromes which are unlike organic pain syndromes and have emotional components. Therefore, nociplastic pain can be understood as chronic altered nociception related to central sensitization including both sensory components with nociceptive and/or neuropathic pain and emotional components. Nociplastic pain may be developed to explain unexplained chronic pain beyond tissue damage or pathology regardless of its origin from nociceptive, neuropathic, emotional, or mixed pain components.

• Korean Journal of Acupuncture
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• 제37권2호
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• pp.104-121
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• 2020

Objectives : Since neuropathic pain shows a variety of symptoms via various mechanisms, there are many difficulties in treatment and various treatments have been tried. This study was conducted to investigate the effects of Araliae Continentalis Radix pharmacopuncture (ACR) on neuropathic pain. Methods : After dividing the white rats into six groups, the sciatic nerves of five groups except the normal group were excised to induce neuropathic pain. Except normal and control group, the other four groups were given: saline (Saline group), ACR 1.100 mg/kg (ACR 1 group), ACR 2.743 mg/kg (ACR 2 group), and ACR 5.486 mg/kg (ACR 3 group) at GB30, twice a week for a total of six times in three weeks. Withdrawal response react time and force intensity, c-Fos, TNF-α, IL-6, and IFN-γ were observed to investigate the efficacy of ACR in each group. Body weight, WBC, RBC, HGB, PLT, AST, ALT, BUN, and Cr changes were observed to check the safety of ACR. Results : Both withdrawal response react time & force intensity were significantly increased in the ACR2 and ACR3 groups at 3 weeks. C-Fos tended to decrease in all ACR groups and significantly decreased in ACR3 group. In blood serum, TNF-α showed a tendency to decrease in all ACR groups and a significant decrease in ACR3 group. But IL-6 and IFN-γ did not change significantly in all experimental groups. In the spinal cord, IFN-γ was significantly decreased in the ACR3 group. But TNF-α and IL-6 were not significantly changed in all experimental groups. Body weight was not changed significantly in all experimental groups. RBC increased significantly in ACR2 group, HGB increased in ACR3 group, and PLT increased significantly in all experimental groups. ALT significantly decreased in ACR1 group, and there were no significant changes in AST, BUN, and Cr in all experimental groups. Conclusions : At high concentrations, ACR pharmacopuncture reduced c-Fos, and TNF-α in the blood serum and IFN-γ in the spinal cord thereby suppressed allodynia. More in-depth studies about pharmacopuncture concentration or mechanism are needed.

• 전자공학회논문지SC
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• 제43권3호
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• pp.60-66
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• 2006

본 논문은 photoplethysmography(PPG)와 Laser doppler(LD)를 이용하여 당뇨병 환자의 신경병증을 조기 진단하기 위한 시스템을 구성하여 손가락과 발가락의 혈류량을 측정하고 그 비율을 이용하는 방법을 제안하였다. 당뇨병 환자의 신경병증 진단을 위해 임상에서는 신경전도검사(NCV)가 사용되고 있으나 이 검사는 피부에 전기자극을 가하므로 환자에게 스트레스와 고통을 준다. 이에 본 논문에서는 고통이 전혀 없으며, 비관혈적이고 측정방법이 간단한 PPG와 LD를 이용하여 신경병증 진단법을 제안하였다. PPG가 LD에 비해 손가락 및 발가락의 혈류량 및 온도와의 상관관계, 민감도 및 특이도에서 더 우수하였다. 분석결과 50명의 신경병성 당뇨환자의 혈류비($0.96{\pm}0.20$)가 64명의 정상인의 혈류비($0.46{\pm}0.15$)에 비해 유의하게 높았다(p<0.000). 또한 신경병성 당뇨환자의 발가락 온도($30.5{\pm}1.4^{\circ}C$)가 정상인의 발가락 온도($29.3{\pm}2.0^{\circ}C$)에 비해 유의하게 높았다(p<0.000). 본 연구로부터 도출된 최적 혈류비(0.678)에 대한 측정 방법의 높은 민감도(95.3%)와 특이도(95.3%)를 확인하였다. 마지막으로 신경병성 당뇨환자 그룹의 경우 모두 손가락과 발가락의 온도차가 $4.5^{\circ}C$ 미만이었다.

• The Korean Journal of Pain
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• 제21권3호
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• pp.179-186
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• 2008

Background: The adrenergic nervous system in the spinal cord contributes to the development of neuropathic pain after nerve injury. Brain derived neurotrophic factor may facilitate the sympathetic change in the spinal cord and influence the state of neuropathic pain. We probed the effect of chronic repetitive administration of systemic 4-methylcatechol, which is known to be a neurotrophic factor inducer, in a spinal nerve ligation model. Methods: We made the rat neuropathic pain model by the ligation of the L5 spinal nerve. Intraperitoneal 4-methylcatechol ($10{\mu}g/kg$) or the same volume of saline wasadministrated twice daily just after the operation for 7 days. The tactile allodynia was measured by using von Frey filaments and its change was followed up from 3 days after SNL. The lumbosacral enlargement of the spinal cord was taken out and the mRNA contents of the ${\alpha}_2-adrenoceptor$ subtypes were measured by real time polymerase chain reaction and this was then compared with the control groups. The antiallodynic effect of intrathecal clonidine (3, 10, $30{\mu}g$) was evaluated and compared in the 4-methylcatechol treated rats and the control rats. Results: The expression of the ${\alpha}_{2A}$ and ${\alpha}_{2C}$ adrenoceptor subtypes did not change after 4-methylcatechol treatment. Intrathecal clonidine showed an earlier and better effect at the highest dose ($30{\mu}g$ intrathecal), but not with any other doses. Conclusions: Chronic intraperitoneal administration of 4-methylcatechol may improve the effect of intrathecal clonidine, but we could not prove the increase of ${\alpha}_{2A}$ and ${\alpha}_{2C}$ adrenoceptors in the spinal cord of 4-methylcatechol treated rats.