• The Korean Journal of Pain
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• 제31권3호
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• pp.155-173
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• 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.

• Asian Pacific Journal of Cancer Prevention
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• 제14권2호
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• pp.739-742
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• 2013

Background: This study was to evaluate the survival of patients with pleural and intraperitoneal malignant mesothelioma and to investigate the efficacy of chemotherapy (CT) as well as radiotherapy (RTH) and surgery compared to best supportive care (BSC). Materials and Methods: Forty patients with malignant mesothelioma (38 with pleural and 2 with intraperitoneal) were enrolled. Twenty seven patients underwent (CT) chemotherapy of which 2 also received (RTH) and surgery was only for biopsy in 15/40. Combination chemotherapy included cisplatin-gemcitabine, cisplatin-navelbine and cisplatin (or carboplatin) with premetrexed. Thirteen patients received only best supportive care. Results: A total of 12 (30%) patients were male, and 28 (70%) female. Median age was 54.0 years and the male/female ratio was 1/2.33 (P=0.210). Residential exposure played a major role in two regions, Helwan and Shoubra, in 20% and 15%, respectively. Overall mean survival time was $13.9{\pm}2.29$ months. That for patients who had received best supportive care was $7.57{\pm}1.85$ months, for chemotherapy was $16.5{\pm}3.20$ months, and multimodality treatment regimen $27{\pm}21.0$ months (P=0.028). Kaplan-Meier survival did not significantly vary for sex, residence and the pathological types epithelial, mixed and sarcomatous. The median survival for performance status and treatment modalities was significant (P=0.001 and 0.028). Best supportive care using opioids with a mean dose of 147.1 mg (range 0-1680) of morphine sulphate produced good subjective response and reasonable quality of life but did not affect survival. Conclusions: We conclude that CT prolongs survival compared to BSC in patients with malignant mesothelioma. Moreover, using escalating doses of opioids provides good pain relief and subjective responses.

• Asian Pacific Journal of Cancer Prevention
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• 제14권2호
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• pp.713-716
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• 2013

Social and behavioral scientists have proposed that a person's belief system crucially influences his or her behaviour, and therefore may affect outcomes of pain management. The purpose of this study was to explore the relationship between analgesic beliefs, analgesic adherence and pain experience amongst Taiwanese cancer outpatients. The cross-sectional study included 92 oncology outpatients in two teaching hospitals in the Taipei area of Taiwan. The research instruments included the Pain Opioid Analgesic Beliefs Scale-Cancer (POABS-CA), opioid adherence, and the Brief Pain Inventory-Chinese (BPI-Chinese). Beliefs about pain and opioids demonstrated a significant relationship with patients' opioid adherence (r = -0.30, p < 0.01). The more negative beliefs regarding opioids and pain the patient had, the worse their adherence to around the clock (ATC) analgesic regimen. However, there was no significant correlation between opioid belief and pain experience. As well, there were no significant relationships between adherence to opioid regimen and any of the measures of pain experience. The study highlights the potential importance of a patient's pain and opioid beliefs in adherence to pain medication.

• The Korean Journal of Physiology and Pharmacology
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• 제22권4호
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• pp.419-425
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• 2018

The superficial dorsal horn of the spinal cord plays an important role in pain transmission and opioid activity. Several studies have demonstrated that opioids modulate pain transmission, and the activation of ${\mu}$-opioid receptors (MORs) by opioids contributes to analgesic effects in the spinal cord. However, the effect of the activation of MORs on GABAergic interneurons and the contribution to the analgesic effect are much less clear. In this study, using transgenic mice, which allow the identification of GABAergic interneurons, we investigated how the activation of MORs affects the excitability of GABAergic interneurons and synaptic transmission between primary nociceptive afferent and GABAergic interneurons. We found that a selective ${\mu}$-opioid agonist, [$D-Ala^2$, $NMe-Phe^4$, Gly-ol]-enkephanlin (DAMGO), induced an outward current mediated by $K^+$ channels in GABAergic interneurons. In addition, DAMGO reduced the amplitude of evoked excitatory postsynaptic currents (EPSCs) of GABAergic interneurons which receive monosynaptic inputs from primary nociceptive C fibers. Taken together, we found that DAMGO reduced the excitability of GABAergic interneurons and synaptic transmission between primary nociceptive C fibers and GABAergic interneurons. These results suggest one possibility that suppression of GABAergic interneurons by DMAGO may reduce the inhibition on secondary GABAergic interneurons, which increase the inhibition of the secondary GABAergic interneurons to excitatory neurons in the spinal dorsal horn. In this circumstance, the sum of excitation of the entire spinal network will control the pain transmission.

• Tuberculosis and Respiratory Diseases
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• 제62권2호
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• pp.140-143
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• 2007

심한 암통증을 호소하는 폐암 환자에서 고용량 펜타닐 첩포($600{\mu}g/hr$)를 이용하여 통증의 완화를 경험하였기에 이를 문헌고찰과 함께 보고하는 바이다.

• 대한약침학회지
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• 제12권2호
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• pp.67-75
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• 2009

Objectives : This study was performed to developing orally administered analgesics and locally injected pharmacopuncture analgesics like opioids. Methods : Literary investigation on the origin of poppy (Papaver somniferum L) and other narcotics was conducted to examine the potential of developing orally administered analgesics and locally injected pharmacopuncture analgesics. Opium is a gum-like mass derived from air-dried white fluid of immature fruit of the poppy. Opium contains approximately 20 types of alkaloids including morphine, codeine, thebaine, papaverine and others. Natural opioids and synthetic alkaloid derivatives are the constituents of opioid analgesics and their effects and side-effects depend on the peculiarities of receptors. An extreme caution is required in the selection of proper dosage, proper analgesic types, and indications for successful pain management. Results and Discussion : With the enactment of "Narcotic control protocol", herbs such as cannibis and poppy are no longer available for use by Korean medicine doctors, and these doctors are faced with difficulty in managing severe pain in the clinical environment. A systematic consideration is inevitable for overcoming the limitation on these analgesics.

• The Korean Journal of Pain
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• 제20권2호
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• pp.240-245
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• 2007

It is important to treat cancer-related pain in cancer patients to ensure the life quality of the patient, as well as to improve their life span. It has been estimated that at least 5% of cancer patients have pain refractory to medical treatment. Therefore, the need for epidural or intrathecal analgesia with opioids and local anesthetics is indicated if systemic treatment has failed. Intrathecal catheter placement and implantation of the injection port for administration of opioids and local anesthetics may improve pain relief in patients who are unresponsive to epidural routes. Although intrathecal implantation has several complications, similar infection rates have been reported between intrathecal and epidural administration. In addition, intrathecal administration showed better outcomes, including improved pain control, lowered daily doses, and an improvement in the level of drowsiness experienced when compared to epidural administration. We report here a case in which a terminal cancer patient was treated using an intrathecal catheter and subcutaneous port. The patient had cancer-related pain that could not be controlled by epidural opioid administration. Based on the results presented here, we suggest that intrathecal implantation is a feasible long term pain management method for intractable cancer pain patients.

• Korean Journal of Acupuncture
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• 제26권2호
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• pp.75-89
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• 2009

Objectives: Warm needling combines simultaneously the effects of acupuncture and moxibustion. This study was to investigate whether warm needling could relieve acute knee arthritis induced by carrageenan in rats. Methods: To illuminate the underlying mechanisms of the warm needling-induced antinociception, weight bearing force (WBF) was observed on the acute knee arthritic rat model. Under general anesthesia, ST36, SP9, Hakjung extra point, LI4 were punctured and stimulated with 30 mg moxa ball combustion on top of the needle (${\emptyset}0.18{\times}8mm$). Results: In behavioral test, rats subsequently showed a reduced stepping force of the affected limb 3 hours after the induction of arthritis. Warm needling on the contralateral or ipsilateral ST36 failed to show antinociceptive effect on the acute knee arthritis. Warm needling on the contralateral SP9 or LI4 increased WBF values to normal level in the acute stage of the arthritis. Warm needling on the Hakjung extra-point resulted in the significant antinociceptive effects through acute stage. These effects of warm needling were suppressed by opioids receptor antagonist naltrexone (10 mg/kg, i.p.) and alpha adrenoceptor antagonist phentolamine (5 mg/kg, i.p.). Conclusion: The data suggest that warm needling-induced antinociception is differently mediated by acupoints and accomplished by activating the descending inhibitory systems including endogenous opioids and $\alpha$-adrenoceptors.

• The Korean Journal of Pain
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• 제32권4호
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• pp.286-291
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• 2019

Background: Breast cancer is complicated by a high incidence of chronic postoperative pain (25%-60%). Regional anesthesia might play an important role in lowering the incidence of chronic pain; however it is not known if the pectoral nerve block (PECS block), which is commonly used for breast surgery, is able to prevent this complication. Our main objective was therefore to detect any association between the PECS block and chronic pain at 3, 6, 9, and 12 months in patients undergoing breast surgery. Methods: We conducted a prospective, monocentric, observational study. We enrolled 140 consecutive patients undergoing breast surgery and divided them in patients receiving a PECS block and general anesthesia (PECS group) and patients receiving only general anesthesia (GA group). Then we considered both intraoperative variables (intravenous opioids administration), postoperative data (pain suffered by the patients during the first 24 postoperative hours and the need for additional analgesic administration) and development and persistence of chronic pain (at 3, 6, 9, and 12 mo). Results: The PECS group had a lower incidence of chronic pain at 3 months (14.9% vs. 31.8%, P = 0.039), needed less intraoperative opioids (fentanyl $1.61{\mu}g/kg/hr$ vs. $3.3{\mu}g/kg/hr$, P < 0.001) and had less postoperative pain (3 vs. 4, P = 0.017). Conclusions: The PECS block might play an important role in lowering incidence of chronic pain, but further studies are needed.

• 한국임상수의학회지
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• 제39권5호
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• pp.226-234
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• 2022

To evaluate butorphanol and tramadol as adjuvants to lidocaine in dogs undergoing mandibular nerve block. Fifteen beagles were allocated to groups based on the following treatments: lidocaine alone (L group), lidocaine + butorphanol (LB group), or lidocaine + tramadol (LT group). After mandibular nerve block with opioids as an adjunct to local anesthetics, the onset time, duration of action, and depth of anesthesia were evaluated using a quantitative method through neuromuscular blockades (NMBs) monitoring. The onset time of nerve block was 4.60 ± 2.06 min, 2.00 ± 0.00 min, and 2.60 ± 1.62 min in the L, LB, and LT groups, respectively; however, there was no statistically significant difference. The duration of nerve block was 111.88 ± 34.78 min, 302.00 ± 76.72 min, and 260.40 ± 49.88 min in the L, LB, and LT groups, respectively, with a significant difference between L and LB groups. The LB group demonstrated a more profound depth of anesthesia compared to the L and LT groups. In this study, using a quantitative method through NMBs monitoring, it was demonstrated that lidocaine and butorphanol in combination can increase the duration of nerve block and more profound the depth of anesthesia rather than lidocaine alone. Additionally, the combined use of lidocaine and opioids presented an objective indicator that could provide a more clinically stable nerve block.