• The Korean Journal of Pain
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• v.14 no.1
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• pp.104-109
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• 2001

We describe the accidental injection of local anesthetics containing steroid into the subdural space during an attempted lumbar epidural injection for intractable radiculopathy in a patient with failed back surgery syndrome. A 24-year-old man complained of severe radiating pain to left lower extremity and showed a walking disturbance and severe lumbar scoliosis. The MRI finding was a left paramedian recurred disc herniation on L4-5 in a laminectomy state. Several therapeutic modalities such as epidural steroid injection, transforaminal injection, L2 root block, medication, and exercise therapy, etc failed. Initially, during epidural block at L4-5 under fluoroscopic guidance, a railroad track appearance appeared on epidurogram suggesting the presence of a subdural space. A second epidural block was tried at L5-S1. Following confirmation of epidural space upon epidurogram, 6 ml of 0.5% lidocaine including triamcinolone 40 mg was injected. The patient showed signs of the subdural injection including an unexpectedly high sensory block (T2) and a motor weakness of both lower extremities. Following this event, the severe radiculopathy and lumbar scoliosis were improved. Therefore, we conclude that subdural injection of steroid could be helpful in intractable radiculopathy, especially in the failed back surgery syndrome. However, it must be used cautiously with careful patient selection.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.261-265
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• 2006

A vertebral compression fracture can cause chronic back pain, and may also result in progressive kyphosis. The traditional treatments of a vertebral compression fracture include bed rest, analgesics and bracing. Balloon kyphoplasty can restore the vertebral height and allow safe bone cement injection into the cavity made by the balloon, which significantly reduces the risk of cement leakage compared to vertebroplasty. An 82-year-old female patient suffered from severe low back pain. Due to the intractable pain and immobility, which could not be relieved by conventional care, as well as the empty vertebral body associated with communicated fractures of the vertebral surfaces, balloon kyphoplasty, with a thicker bone cement injection than usual with balloon kyphoplasty, was chosen. The preoperative intractable pain and immobility were dramatically relieved soon after the procedure, without any complications.

• The Korean Journal of Pain
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• v.12 no.1
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• pp.87-94
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• 1999

Backgroud: We have performed the CT-guided celiac plexus block (CPB) using anterior approach to evaluate the safety and efficacy of the procedure and to determine the role of CT. Methods: CPB were done in 10 patients (5 men and 5 women: mean age, 58.1 years) with intractable upper abdominal pain due to terminal malignancy of the stomach (n=3), pancreas (n=4), gallbladder (n=2), and liver (n=1). To permit an anterior approach, patients lay supine on the CT scan table during the procedure. One 21-guage Chiba needle was placed just anterior to the diaphragmatic crus between the celiac and superior mesenteric arteries and 10~12 ml of dehydrated alcohol was injected. Degree of pain relief following the procedure was assessed and pain was graded on a numeric rating scale (NRS) from 0 to 10. Results: The results suggest a direct relation between the degree of celiac invasion and the response to the CPB. With CT guidance, it is possible for us to direct the needle into more accurate region, allowing alcohol to be deposited in specific ganglion area. Conclusions: CT-guided CPB using an anterior approach was an easy and effective way of reducing intractable upper abdominal pain due to terminal malignancies. CT-guidance allowed precise needle placement and safe procedure. Careful classification of cases is important to predict the degree of pain relief using the grading system based on the degree of involvement of the celiac plexus.

• The Korean Journal of Pain
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• v.1 no.1
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• pp.9-15
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• 1988

Postherpetic neuralgia, the most feared complication of acute herpes zoster, may agonize the pain clinician because the appropriate management of intractable pain can fail inspite of various and prolonged therapeutic techniques. Of all patients with herpes zoster, approximately 5~10% will develop postherpetic neuralgia. Postherpetic neuralgia is very rare in young patient but very common in patients over 60. In other words, the older, the higher incidence. In our pain clinics, 13 postherpetic neuralgic patients were treated with sympathetic blocks, local infiltration with local anesthetics and steroids, TENS, Laser and various drugs including antiderpressant. The results of management of pain in 13 patents were as follows. 1. Excellent pain control :4(30.8%) 2. Good pain control :3(23.0%) 3. Fair pain control :2(15.4%) 4. No effect :4(30.8%).

• Clinical Pain
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• v.18 no.2
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• pp.138-141
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• 2019

Lateral epicondylopathy represents pain in the lateral (radial aspect) of the elbow caused by degeneration in the common extensor tendon. Calcium deposit frequently developes in lateral epicondylopathy, with the prevalence up to 46%. There are considerable debates on its treatment protocols for lateral epicondylopathy so far, likewise, the effective treatment method for calcific lateral epicondylopathy has not been established. We report here a case of chronic intractable calcific lateral epicondylopathy treated with ultrasound-guided barbotage and focused type extracorporeal shock wave therapy (ESWT). To our knowledge, this is the first report of calcific lateral epicondylopathy treated by ultrasound-guided barbotage combined with ESWT.

• Journal of International Society for Simulation Surgery
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• v.3 no.2
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• pp.77-79
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• 2016

Osteoma is one of the benign tumor that occurs on the bones all over the body. Mostly the simple excision is known to be enough. However, sometimes we encounter the troublesome situation where the osteoma is located in very challenging area, which results in the recurrence. 26 year female presented with the intractable intracranial osteoma. Given the disease entity of the osteoma, the simple excision would be enough or conservative management. But this osteoma turned out to be huge and recurrent in spite of the endoscopic resections, which causes the facial disappearance accompanied by the orbital vertical dystopia. Moreover, the patient's main concern was the pain. We performed the intracranial resection of the whole lesion and reconstructed the skull base and frontal bone as well as the part of the orbital wall. In order to restore the original bony anatomy, the 3D printing model was used based on the titanium mesh. I report this unusual case of the intractable intracranial huge osteoma. This report may be helpful for the other surgeons to make a decision on their similar cases in the future.

• Annals of Clinical Neurophysiology
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• v.14 no.1
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• pp.1-6
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• 2012

Low back pain is a common clinical condition with heterogeneous causes and challenges to manage. High prevalence and numerous assessments result in an enormous socioeconomic burden. Clinician must conduct efficient and stepwise evaluation process to rule out serious spinal pathology, neurologic involvement, and identify risk factors for chronicity. The process can be achieved through the focused history taking and physical examination. Certain factors related to serious spinal pathology include age (>50 years), trauma, unexplained fever, recent urinary or skin infection, unrelenting night or rest pain, unexplained weight loss, osteoporosis, immunosuppression, steroid use, and widespread neurological symptoms. In non-specific low back pain, diagnostic imaging and laboratory studies are often unnecessary and can disturb an appropriate management. For the management of acute low back pain, patient education and medication such as acetaminophen, non-steroidal anti-inflammatory drugs, and muscle relaxants are recommended. For chronic low back pain, behavior therapy, back exercise, and spinal manipulation are beneficial. The evidence based approach could improve success rate of management, result in prevention of acute low back pain from being chronic intractable pain.

• The Korean Journal of Pain
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• v.35 no.4
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• pp.475-487
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• 2022

Background: Use of opioids for chronic intractable pain is increasing globally, and their proper use can improve patients' quality of life. In contrast, opioid use disorders, such as abuse or addiction, caused by prescribing opioids, are a worldwide issue. This study aimed to understand current opioid prescribing patterns and pain physicians' experiences with opioid use in South Korea. Methods: Pain physicians in 42 university hospitals in South Korea were asked to complete anonymous questionnaires regarding opioid prescriptions. Results: A total of 69 surveys were completed. Most pain physicians started prescribing opioids at a pain score of 7/10 and aimed to reduce pain by 50%. Most physicians (73.1%) actively explained the prescribed medications and possible side effects, and 61.2% of physicians preferred the prescription interval of 4 weeks. Immediate-release opioids were the most popular treatment for breakthrough pain (92.6%). The most common side effect encountered by physicians was constipation (43.3%), followed by nausea/vomiting (34.3%). Of the physicians, 56.5% replied that addiction and misuse prevalences were less than 5%. However, the most concerning side effect was addiction (33.0%). Conclusions: The survey results showed that the prescribing patterns of pain physicians generally followed Korean guidelines. Physicians were most interested in the safety and effectiveness of opioid prescriptions. They were most concerned about respiratory depression and abuse or addiction. A significant number of physicians agreed that the NHIS regulations needed improvement for patient convenience and safe and effective treatment, though there were pros and cons of the NHIS restrictions on prescription conditions.

• The Korean Journal of Pain
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• v.34 no.2
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• pp.210-216
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• 2021

Background: Postherpetic neuralgia (PHN) is the most common complication of acute herpes zoster. The treatment of PHN remains a challenge for clinical pain management. Despite the effectiveness of anticonvulsants, antidepressants, and lidocaine patches in reducing PHN, many patients still face intractable pain disorders. In this randomized controlled study, we evaluated whether hydromorphone through intravenous patient-controlled analgesia (IV PCA) was effective in relieving PHN. Methods: Patients with PHN were randomly divided into two groups, one group received oral pregabalin with IV normal saline, another group received oral pregabalin with additional IV PCA hydromorphone for two weeks. Efficacy was evaluated at 1, 4, and 12 weeks after the end of the treatments. Results: Two hundred and one patients were followed up for 12 weeks. After treatment, numerical rating scale (NRS) score of patients in the hydromorphone group was significantly lower than that of the control group, and the difference of NRS scores between the two groups was statistically significant at 4 and 12 weeks after treatment. The frequency of breakthrough pain in the hydromorphone group was significantly lower than that in the control group 1 and 4 weeks after treatment. After treatment, the quality of sleep in the hydromorphone group was significantly improved compared with the control group. The most common adverse reactions in the hydromorphone group were dizziness and nausea, with no significant respiratory depression. Conclusions: IV PCA hydromorphone combined with oral pregabalin provides superior pain relief in patients with PHN, which is worthy of clinical application and promotion.

• The Korean Journal of Pain
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• v.14 no.1
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• pp.110-113
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• 2001

In controlling chronic intractable pains, the current therapeutic methods used are exercise, over the counter medication, cognitive-behavioral therapy, opioid medication, neural blockade, operation, etc., spinal cord stimulation being the last resort. Spinal cord stimulation was initiated when Shearly and others clinically tested the Gate control theory of Melzack and Wall. This had triggered the advancement of theoretic research on the mechanism and hardware necessary and has resulted in an accumulation of clinical experiences. This is known to be effective for treating sympathetic pain, arachnoiditis, failed back pain syndrome, radiculopathy, peripheral vascular disease, phantom limb syndrome, post-herpetic neuralgia, peripheral neuropathy, and angina pectoris. This report describes our experience in experimental spinal cord stimulation in patients with simultaneous post-herpetic neuralgia and herniated intervertebral disc. There wasn't any improvement in the post-herpetic neuralgia but the symptoms of a herniated intervertebral disc was much ameliorated. This was quite an unexpected result. The patient's back pain returned when the stimulation stopped.