• Journal of Korean Neurosurgical Society
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• v.41 no.4
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• pp.264-266
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• 2007

Atlantoaxial facet joint osteoarthritis is rare, often undiagnosed because it may be misdiagnosed as occipital neuralgia, or degenerative cervical spondylosis. Unilateral occipitocervical pain aggravated by head rotation is a specific symptom. Conservative treatment is usually effective. But when the patient complains of intractable neck pain localized to occipitocervical junction and unresponsive to medical therapy, surgical treatment should be considered. Though a few reports of surgically treated atlantoaxial osteoarthritis has been published, surgical outcome is favorable. A case of a surgically treated atlantoaxial osteoarthritis is presented with a review of the literatures.

• The Korean Journal of Pain
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• v.22 no.1
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• pp.74-77
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• 2009

Implantable intrathecal pump is one of the therapeutic options for intractable pain. A 24-year-old male with complex regional pain syndrome was suffering from right lower extremity pain. He had all modalities of treatment including spinal cord stimulator. However, his pain had been worse in the past 6 months. His visual analogue pain scale (VAS) was 8-10 and he could not sit or walk. Only opioid was thought to be effective. Then, intrathecal pump was considered. We estimated the minimal effective dose of spinal morphine before implantation. 0.3 mg of morphine was injected intrathecally as a starting dose. Dosage had been increased up to 0.8 mg in 10 days. His VAS score decreased from 8 to 5. He could sleep without pain and walk with crutch. Therefore, intrathecal pump was inserted. He could tolerate to pain. This case suggests that intrathecal morphine delivery can provide effective treatment for intractable non-malignant pain.

• The Korean Journal of Pain
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• v.20 no.2
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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.

• Journal of Hospice and Palliative Care
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• v.21 no.3
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• pp.104-107
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• 2018

While most benign hiccups can be controlled with empirical therapy, intractable hiccups lasting longer than one month tend to have significant adverse effects with obscure etiology. Treatment strategies for intractable hiccups have not been established. Only a few sporadic cases of bilateral phrenic nerve blockage have been reported. Here, we report a case of intractable hiccups that lasted five weeks in a 56-year-old male patient with a lung cancer above the right diaphragm. We hypothesized that his intractable hiccups were caused by irritation and mass effect caused by the lung cancer. We performed an ultrasound-guided right unilateral phrenic nerve pulsed radiofrequency treatment, and the patient's intractable hiccups were successfully managed without complication.

• The Korean Journal of Pain
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• v.12 no.2
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• pp.238-241
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• 1999

Intractable pain arising from disorders of the viscera and somatic structures within the pelvis and perineum often poses difficult problems for the pain pratitioner. The reason for this difficulty is that the region contains diverse anatomic structures with mixed somatic, visceral, and autonomic innervation affecting bladder and bowel control and sexual function. Clinically, sympathetic pain in the perineum has a distinctly vague, burning, and poorly localized quality and is frequently associated with the sensation of urgency. Although various approaches have been proposed for the management of intractable perineal pain, their efficacy and applications are limited. Historically, neurolytic blockade in this region has been focused mainly on somatic rather than sympathetic components. The efficacy of neurolytic ganglion impar block has been demonstrated in treating perineal pain without significant somatovisceral dysfunctions for patient with advanced cancer in 1990. The introduction of superior hypogastric plexus block in 1990 demonstrated its effectiveness in patients with cancer related pelvic pain. In our report, five patients had advanced cancer (rectal caner 3; cervix cancer 1; metastases to sacral portion of renal cell cancer 1). Localized perineal pain was present in all cases and was characterized as burning and urgent with 9~10/10 pain intensity. After neurolytic block of ganglion impar, patients experiened incomplete pain reduction (7~8/10), as determined by the VAS (visual analogue scale), and change in pain site. We then treated with superior hypogastric plexus block, which produced satisfactory pain relief (to less than 4/10), without complication.

• The Korean Journal of Pain
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• v.18 no.1
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• pp.19-22
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• 2005

Background: Most terminal cancer patients suffered from intractable pain. For the treatment of these patients, opioids, via various routes, are usually administered. Continuous epidural opioid, especially morphine, administration is a good method for the management of intractable cancer pain. Methods: We retrospectively analyzed 347 terminal cancer patients, who had been treated with continuous epidural morphine infusion, between 1999 and 2004. For the epidural infusion, an epidural catheter was inserted, tunneled subcutaneously and exited from the anterior chest or abdomen. Multiday $Infursor^{(R)}$ (Baxter, 0.5 ml/h) was used for the continuous infusion. Results: Of the 347 patients studied, there were 211 males and 136 females. The mean treatment time was 54.7 days, ranging from 5 to 481 days. The mean starting and termination doses of morphine were 32.4 (for 5 days) and 100.0 mg, respectively. The doubling time of the morphine dose was 26.3 days, corresponded to a 3.8 percent increase per day. Incidental catheter removal was the most common side effect, which occurred 130 times in 61 cases. Conclusions: The procedure of epidural catheterization, with subcutaneous tunneling, was simple and inexpensive. Despite the disadvantages, such as incidental catheter removal, it is a useful method for the control of terminal cancer pain.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.246-249
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• 1997

Hiccup is defined as an abrupt involuntary contraction of the diaphragm and intercostal muscles with sudden closure of the glottis 35 msec after onset. The term "intractable" is given to those hiccups with a duration ranging from 24 hours to more than 25 years. Short hiccup bouts are mostly associated with gastric distention or alcohol intake, resolved spontaneously or with simple remedies. In contrast, intractable hiccup is a rare but disabling condition which can induce depression, weight loss and sleep deprivation. Although the pathophysiologic mechanisms of hiccup are still poorly understood, wide variety of pathological conditions such as: brain tumor, abdominal tumor, myocardial infarction, renal failure, abdominal surgery etc., can cause intractable hiccup. A 58-year-old male who had suffered from hepatocellular cancer was consulted from medical department due to intractable hiccup. Initial treatment modalities with administrations of metoclopramide and chlorpromazine and nerve block including phrenic nerve block, cervical epidural block and glossopharyngeal nerve block were not effective. Administration of midazolam and baclofen however achieved desirable effect.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.1
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• pp.67-70
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• 2022

Persistent idiopathic facial pain is a rare and difficult condition to treat. Several pharmacological, nonpharmacological, and invasive treatment options have been used, with varying results. We report the case of a patient with intractable persistent idiopathic facial pain who responded favorably to a combination of botulinum toxin injections and pulsed radiofrequency treatment of the infraorbital nerve.

• The Korean Journal of Pain
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• v.32 no.4
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• pp.245-255
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• 2019

Stem cells are attracting attention as a key element in future medicine, satisfying the desire to live a healthier life with the possibility that they can regenerate tissue damaged or degenerated by disease or aging. Stem cells are defined as undifferentiated cells that have the ability to replicate and differentiate themselves into various tissues cells. Stem cells, commonly encountered in clinical or preclinical stages, are largely classified into embryonic, adult, and induced pluripotent stem cells. Recently, stem cell transplantation has been frequently applied to the treatment of pain as an alternative or promising approach for the treatment of severe osteoarthritis, neuropathic pain, and intractable musculoskeletal pain which do not respond to conventional medicine. The main idea of applying stem cells to neuropathic pain is based on the ability of stem cells to release neurotrophic factors, along with providing a cellular source for replacing the injured neural cells, making them ideal candidates for modulating and possibly reversing intractable neuropathic pain. Even though various differentiation capacities of stem cells are reported, there is not enough knowledge and technique to control the differentiation into desired tissues in vivo. Even though the use of stem cells is still in the very early stages of clinical use and raises complicated ethical problems, the future of stem cells therapies is very bright with the help of accumulating evidence and technology.

• Journal of Korean Neurosurgical Society
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• v.54 no.6
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• pp.507-510
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• 2013

Objective : The aim of this study was to evaluate effect of pulsed radiofrequency (PRF) neuromodulation of suprascpaular nerve (SSN) in patients with chronic shoulder pain due to adhesive capsulitis and/or rotator cuff tear. Methods : The study included 11 patients suffering from chronic shoulder pain for at least 6 months who were diagnosed with adhesive capsulitis (n=4), rotator cuff tear (n=5), or adhesive capsulitis+rotator cuff tear (n=2) using shoulder magnetic resonance imaging or extremity ultrasonography. After a favorable response to a diagnostic suprascapular nerve block twice a week (pain improvement >50%), PRF neuromodulation was performed. Shoulder pain and quality of life were assessed using a Visual Analogue Scale (VAS) and the Oxford Shoulder Score (OSS) before the diagnostic block and every month after PRF neuromodulation over a 9-month period. Results : The mean VAS score of 11 patients before PRF was $6.4{\pm}1.49$, and the scores at 6-month and 9 month follow-up were $1.0{\pm}0.73$ and $1.5{\pm}1.23$, respectively. A significant pain reduction (p<0.001) was observed. The mean OSS score of 11 patients before PRF was $22.7{\pm}8.1$, and the scores at 6-month and 9 month follow-up were $41.5{\pm}6.65$ and $41.0{\pm}6.67$, respectively. A significant OSS improvement (p<0.001) was observed. Conclusion : PRF neuromodulation of the suprascapular nerve is an effective treatment for chronic shoulder pain, and the effect was sustained over a relatively long period in patients with medically intractable shoulder pain.