• The Korean Journal of Pain
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• v.24 no.4
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• pp.185-190
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• 2011

Background: Spinal nerve ligation (SNL) injury in rats produces a pain syndrome that includes mechanical and thermal allodynia. Previous studies have indicated that proinflammatory cytokines such as tumor necrosis factor-${\alpha}$ (TNF-${\alpha}$) play an important role in peripheral mediation of neuropathic pain, and that altered dorsal root ganglion (DRG) function and degree of DRG neuronal apoptosis are associated with spinal nerve injury. The present study was conducted to evaluate the expression of TNF-${\alpha}$ and the extent of apoptosis in the dorsal root ganglion after SNL in rats. Methods: Sprague-Dawley rats were subjected to SNL of the left L5 and L6 spinal nerves distal to the DRG and proximal to the formation of the sciatic nerve. At postoperative day 8, TNF-${\alpha}$ protein levels in the L5.6 DRG were compared between SNL and naive groups using ELISA. In addition, we compared the percentage of neurons injured in the DRG using immunostaining for apoptosis and localization of activated caspase-3. Results: SNL injury produced significant mechanical and cold allodynia throughout the 7-day experimental period. TNF-${\alpha}$ protein levels were increased in the DRG in rats that had undergone SNL ($12.7{\pm}3.2$ pg/100 ${\mu}g$, P < 0.001) when compared with naive rats ($4.1{\pm}1.4$ pg/100 ${\mu}g$). The percentage of neurons or satellite cells co-localized with activated caspase-3 were also significantly higher in rats with SNL than in naive rats (P < 0.001, P < 0.05, respectively). Conclusions: SNL injury produces mechanical and cold allodynia, as well as TNF-${\alpha}$ elevation and apoptosis in the DRG.

• Archives of Hand and Microsurgery
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• v.23 no.4
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• pp.301-305
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• 2018

Hemangiomas are benign neoplasms of endothelial cells origin, rarely found in hand region. Authors report a 62-year-old female with capillary hemangioma of right index finger causing a neuropathic symptom via nerve compression. A space-occupying vascular lesion surrounding the radial digital nerve was revealed in magnetic resonance imaging (MRI), which was removed under microscopic assist. The digital nerve was decompressed consequently. The mass was firmly attached to both the digital nerve and digital artery, requiring a meticulous microscopic dissection to preserve the nerve and artery. Compression neuropathy caused by space-occupying lesions is rare and its diagnosis is often difficult. A microscopic surgical approach can be used to successfully relieve neuropathic pain after proper diagnosis established by diagnostic tools such as MRI as in this case.

• Asian Spine Journal
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• v.12 no.6
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• pp.1043-1052
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• 2018

Study Design: Level III retrospective cross-sectional study. Purpose: To define and characterize the presentation, symptom duration, and patient/surgical risk factors associated with 'post-decompressive neuropathy (PDN).' Overview of Literature: PDN is characterized by lower extremity radicular pain that is 'different' from pre-surgical radiculopathy or claudication pain. Although it is a common constellation of postoperative symptoms, PDN is incompletely characterized and poorly understood. We hypothesize that PDN is caused by an intraoperative neuropraxic event and may develop early (within 30 days following the procedure) or late (after 30 days following the procedure) within the postoperative period. Methods: Patients who consented to undergo lumbar laminectomy with or without an instrumented fusion for degenerative lumbar spine disease were followed up prospectively from July 2013 to December 2014. Relevant data were extracted from the charts of the eligible patients. Patient demographics and surgical factors were identified. Patients completed postoperative questionnaires 3 weeks, 3 months, 6 months, and 1 year postoperatively. Questions were designed to characterize the postoperative pain that differed from preoperative pain. A diagnosis of PDN was established if the patient exhibited the following characteristics: pain different from preoperative pain, leg pain worse than back pain, a non-dermatomal pain pattern, and nocturnal pain that often disrupted sleep. A Visual Analog Scale was used to monitor the pain, and patients documented the effectiveness of the prescribed pain management modalities. Patients for whom more than one follow-up survey was missed were excluded from analysis. Results: Of the 164 eligible patients, 118 (72.0%) completed at least one follow-up survey at each time interval. Of these eligible patients, 91 (77.1%) described symptoms consistent with PDN. Additionally, 75 patients (82.4%) described early-onset symptoms, whereas 16 reported symptoms consistent with late-onset PDN. Significantly more female patients reported PDN symptoms (87% vs. 69%, p=0.03). Patients with both early and late development of PDN described their leg pain as an intermittent, constant, burning, sharp/stabbing, or dull ache. Early PDN was categorized more commonly as a dull ache than late-onset PDN (60% vs. 31%, p=0.052); however, the difference did not reach statistical significance. Opioids were significantly more effective for patients with early-onset PDN than for those with late-onset PDN (85% vs. 44%, p=0.001). Gabapentin was most commonly prescribed to patients who cited no resolution of symptoms (70% vs. 31%, p=0.003). Time to symptom resolution ranged from within 1 month to 1 year. Patients' symptoms were considered unresolved if symptoms persisted for more than 1 year postoperatively. In total, 81% of the patients with early-onset PDN reported complete symptom resolution 1 year postoperatively compared with 63% of patients with late-onset PDN (p=0.11). Conclusions: PDN is a discrete postoperative pain phenomenon that occurred in 77% of the patients who underwent lumbar laminectomy with or without instrumented fusion. Attention must be paid to the constellation and natural history of symptoms unique to PDN to effectively manage a self-limiting postoperative issue.

• The Korean Journal of Pain
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• v.34 no.1
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• pp.58-65
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• 2021

Background: Supraspinal delivery of neurotensin (NTS), which may contribute to the effect of a systemically administered agonist, has been reported to be either pronociceptive or antinociceptive. Here, we evaluated the effects of systemically administered NTSR1 agonist in a rat model of neuropathic pain and elucidated the underlying supraspinal mechanism. Methods: Neuropathic pain was induced by L5 and L6 spinal nerve ligation in male Sprague-Dawley rats. The effects of intraperitoneally administered NTSR1 agonist PD 149163 was assessed using von Frey filaments. To examine the role of 5-HT neurotransmission, a serotonin (5-HT) receptor antagonist dihydroergocristine was pretreated intrathecally, and spinal microdialysis studies were performed to measure the change in extracellular level of 5-HT in response to PD 149163 administration. To investigate the supraspinal mechanism, NTSR1 antagonist 48692 was microinjected into the rostral ventromedial medulla (RVM) prior to systemic PD 149163. Additionally, the effect of intrathecal DHE on intra-RVM PD 149163 was assessed. Results: Intraperitoneally administered PD 149163 exhibited a dose-dependent attenuation of mechanical allodynia. This effect was partially reversed by intrathecal pretreatment with dihydroergocristine and was accompanied by an increased extracellular level of 5-HT in the spinal cord. The PD 149163-produced antinociception was also blocked by intra-RVM SB 48692. Direct injection of PD 149163 into the RVM mimicked the maximum effect of the same drug delivered intraperitoneally, which was reversed by intrathecal dihydroergocristine. Conclusions: These observations indicate that systemically administered NTSR1 agonist produces antinociception through the NTSR1 in the RVM, activating descending serotonergic projection to release 5-HT into the spinal dorsal horn.

• The Journal of the Korean dental association
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• v.48 no.9
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• pp.688-695
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• 2010

Burning mouth disorders (sometimes referred to as burning mouth syndrome) are characterized by a burning sensation in the tongue or other oral sites, usually in the absence of clinical and laboratory findings. Affected patients often present with multiple oral complaints, including burning, dryness and taste alterations. Burning mouth complaints are reported more often in women, especially after menopause. Typically, patients awaken without pain, but report increasing symptoms through the day and into the evening. Conditions that have been reported in association with burning mouth syndrome include chronic anxiety or depression, various nutritional deficiencies, diabetes and changes in salivary function. However, these conditions have not been consistently linked with the syndrome, and their treatment has had little impact on burning mouth symptoms. Recent studies have pointed to dysfunction of several cranial nerves associated with taste sensation as a possible cause of burning mouth disorders. The most common central mechanism that likely explains burning mouth disorders is a centrally mediated continuous neuropathic pain. Given in low dosages, benzodiazepine, tricyclic antidepressants or anticonvulsants may be effective in patients with burning mouth disorders.

• The Korean Journal of Pain
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• v.13 no.1
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• pp.105-110
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• 2000

Central neuropathic pain may occur in 10~20% of the patients after spinal cord injury. The central pain syndrome include spontaneous continuing and intermittent pain as well as evoked pain. The pain is evoked by non-noxious stimulation of the region (allodynia) and repeated stimulation (wind-up phenomenon). Four patients were referred suffering from severe pain, allodynia and hyperaesthesia after spinal cord injury. They had received conventional treatment with non-steroidal anti-inflammatory drugs, steroid, anticonvulsant, antidepressant and rehabilitation which failed to provide pain relief. We administered combination of low doses of morphine and ketamine (10 mg) through the epidural catheter with other conventional therapy. Satisfactory pain relief was achieved in each patient. The reduction of pain was not associated with severe side effects. The most bothersome side effect of ketamine was dizziness in one patient, only caused by bolus injection (ketamine 10 mg with normal saline 10 ml). This suggests synergy from this combination that provides an alternative treatment for central pain.

• Journal of Pharmacopuncture
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• v.6 no.2
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• pp.159-164
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• 2003

Results : 1. The most important concept of IMS is chronic pain illness that may develop into hypersensitivity of the nerves, i.e., neuropathy. 2. Muscle shortening may be triggered by stress, including emotional, physical, external, and internal factors. 3. Muscle shortening increases mechanical tension on the muscles as well as inducing abrasion of the tissues by stretching ligament, tendon, cartilage, bone, and etc. 4. Pain from neuropathy is normally manifested on musculoskeletal system and spasm or shortening play as the central axis of this pain. 5. Neuropathy often appears at the nerve root level and the most important decisive factor of radiculopathy is muscle shortening. 6. Spondylosis is the most common cause of radiculopathy. 7. The most significant treatment principle of IMS is to relieve muscle shortening and remove stimulating determinant from the vertebrae. 8. Dry needling is quite effective for treating various pain caused by muscle shortening.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.229-231
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• 2005

The most common and cumbersome complication of herpes zoster is postherpetic neuralgia, which typically presents as neuropathic pain. However, the painful symptoms of the postherpetic period might be associated with other causes, such as skin lesions of the herpes zoster. We report a case of a hypertrophic scar that developed in the lesion of an acute herpes zoster patient and was accompanied by pain.

• The Korean Journal of Pain
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• v.21 no.3
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• pp.224-228
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• 2008

Ulnar nerve compression in the cubital tunnel is a common entrapment syndrome of the upper limb. Pulsed radiofrequency lesioning (PRFL) has been reported as a treatment method for relieving neuropathic pain. Since the placement of the electrode in close proximity to a targeted nerve is very important for the success of PRFL, ultrasound seems to be well suited for this technique. A 36-year-old woman presented with complaints of numbness and pain on the medial aspect of the elbow and the pain radiated down to the $4^{th}$ and $5^{th}$ fingers for 10 years after she suffered an elbow contusion, we then scheduled this woman for the ultrasound guided PRFL of the ulanr nerve. The initial ultrasound examination demonstrated a swollen nerve, loss of the fascicular pattern and an increased cross sectional area of the ulnar nerve. After confirmation of the most swollen site of the nerve via ultrasound, two sessions of PRFL were performed. The postprocedural 10 cm visual analog scale score decreased from 8 to 1 after the two sessions of PRFL.

• Asian Oncology Nursing
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• v.9 no.2
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• pp.145-154
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• 2009

Purpose: The purpose of this study was to obtain information about the experiences of sensations after breast cancer surgery characterized by prevalence, frequency, and severity, distresses, and disturbances in ADL using the BSAS (Breast Sensation Assessment Scale) and to develop the standardized Korean BSAS. Methods: Thirty two women from 3 to 100 days after breast cancer surgery (BCS) completed Roberta's BSAS. The 18 sensations of BSAS were translated using the references of Lee's Korean Pain Rating Scale and English-English, English-Korean dictionaries and the consultation from two native Americans, one bilingual permanent resident of the States, and one nursing professor. The Korean-translated BSAS has high reliability in test-retest. Likert type 4-point scale and 100 mm VAS were used for assessment. Results: Certain sensations remained prevalent (tender, pull, pain), frequent (numb, nag, throb), severe (throb, shoot, numb), causing distress (throb, penetrate, shoot), and influencing on ADL (throb, penetrate, nag). The most frequently experienced sensation other than BSAS was itching. There was little difference in the prevalence of symptom experiences between sentinel lymph node biopsy and axillary lymph node dissection. Conclusion: The women after BCS are suffering from neuropathic sensations. The Korean- translated BSAS could be used in effectively assessing breast sensations after BCS in Korean women.