• The Korean Journal of Pain
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• 제20권1호
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• pp.60-65
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• 2007

Complex Regional Pain Syndromes (CRPS) type I and type II are neuropathic pain conditions that are being increasingly recognized in children and adolescents. The special distinctive features of pediatric CRPS are the milder course, the better response to treatment and the higher recurrence rate than that of adults and the lower extremity is commonly affected. We report here on a case of pediatric CRPS that was derived from ankle trauma and long term splint application at the left ankle. The final diagnoses were CRPS type I in the right upper limb, CRPS type II in the left lower limb and unclassified neuropathy in the head, neck and precordium. The results of various treatments such as medication, physical therapy and nerve blocks, including lumbar sympathetic ganglion blocks, were not effective, so implantation of a spinal cord stimulator was performed. In order to control the pain in his left lower limb, one electrode tip was located at the 7th thoracic vertebral level and two electrode tips were located at the 7th and 2nd cervical vertebral levels for pain control in right upper limb, head, neck and right precordium. After the permanent insertion of the stimulator, the patient's pain was significantly resolved and his disabilities were restored without recurrence. The patient's pain worsened irregularly, which might have been caused by psychological stress. But the patient has been treated with medicine at our pain clinic and he is being followed up by a psychiatrist. (Korean J Pain 2007; 20: 60-65)

• The Korean Journal of Pain
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• 제35권4호
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• pp.468-474
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• 2022

Background: The new type of corona virus has a wide range of symptoms. Some people who have COVID-19 can experience long-term effects from their infection, known as post-COVID conditions. The authors aimed to investigate prolonged musculoskeletal pain as a symptom of the post-COVID-19 condition. Methods: This is a descriptive study on the patients who were diagnosed with COVID-19 in a university hospital, between March 2020 and March 2021. Patient records and an extensive questionnaire were used to obtain relevant demographic and clinical characteristics, including hospitalization history, comorbidities, smoking history, duration of the pain, the area of pain, and the presence of accompanying neuropathic symptoms. Results: Of the diagnosed patients, 501 agreed to participate in the study. Among the participants, 318 had musculoskeletal pain during COVID-19 infection, and 69 of them reported prolonged pain symptoms as part of their a post-COVID condition which could not be attributed to any other cause. The mean duration of pain was 4.38 ± 1.73 months, and the mean pain level was 7.2 ± 4.3. Neuropathic pain symptoms such as burning sensation (n = 16, 23.2%), numbness (n = 15, 21.7%), tingling (n = 10, 14.5%), stinging (n = 4, 5.8%), freezing (n = 1, 1.4%) were accompanied in patients with prolonged musculoskeletal pain. Conclusions: Patients with COVID-19 may develop prolonged musculoskeletal pain. In some patients, neuropathic pain accompanies it. Awareness of prolonged post-COVID-19 pain is crucial for its early detection and management.

• The Korean Journal of Pain
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• 제19권2호
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• pp.159-163
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• 2006

Background: Despite the enormous amount of basic research on neuropathic pain, there is the lack of an objective diagnostic test for complex regional pain syndrome (CRPS). The aim of this study was to evaluate the usefulness of cold stress thermography in the diagnosis of CRPS. Methods: The study involved 12 patients with CRPS type 1, according to the IASP criteria, who were compared with 15 normal healthy volunteers. All subjects underwent thermographic examination under baseline conditions at $21^{\circ}C$. A cold stress test (CST; $10^{\circ}C$ water for 1 minute) was then applied to both hands below the wrists, immediate, and after 10 and 20 minutes. Results: The temperature asymmetry between the patients with CRPS and the volunteers showed significant discrimination at the baseline and after a 20 minute recovery period from the CST. Among the study subjects having temperature asymmetry of both hands of less than $1^{\circ}C$ (8 out of 12 CRPS patients and 14 out of 15 volunteer), 7 (87.5%) of the 8 CRPS patients and 3 (21%) of the 14 volunteers showed a temperature difference of more than $1^{\circ}C$ after the 20 minute recovery period. The actual temperature values during the four periods did not discriminate between the patients with CRPS and the volunteers. Conclusions: Thermography, under the CST, could be a more objective test for the diagnosis of CRPS. A temperature asymmetry greater than $1^{\circ}C$ during the 20 minute recovery period following CST provides strong diagnostic information about CRPS, with both high sensitivity and specificity.

• The Korean Journal of Pain
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• 제21권3호
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• pp.197-201
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• 2008

Background: Kyphoplasty is a minimally invasive procedure that can stabilize osteoporotic and neoplastic vertebral fractures. We retrospectively evaluated the clinical outcomes of kyphoplasty for the treatment of vertebral compression fractures in cancer patients. Methods: We reviewed the clinical data of 27 cancer patients who were treated with kyphoplasty (55 vertebral bodies) between May 2003 and Feb 2008. The clinical parameters, using a visual analog 10 point scale (VAS) and the mobility scores, as well as consumption of analgesic, were evaluated preoperatively and at 1 week after kyphoplasty. Results: A total 55 cases of thoracic and lumbar kyphoplasties were performed without complications. The mean age of the patients was 66 years. All the patients experienced a significant improvement in their subjective pain and mobility immediately after the procedures. The pain scores (VAS), mobility scores and other functional evaluations using the Oswestry disability score and the SF-36 showed significant differences between the pre- and postoperational conditions. Conclusions: Kyphoplasty is an effective, minimally invasive procedure that can relieve the pain of patients with vertebral compression fractures and these fractures are the result of metastasis.

• The Korean Journal of Pain
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• 제30권1호
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• pp.51-58
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• 2017

Background: Recently symptoms-based screening questionnaires have gained attention for screening for a neuropathic pain component (NePC) in various chronic pain conditions. The present study assessed the usefulness of four commonly used NePC screening questionnaires including the Self-completed douleur neuropathique 4 (S-DN4), the ID Pain, the painDETECT questionnaire (PDQ), and the Self-completed Leeds Assessment of neuropathic Symptoms and Signs (S-LANSS) questionnaire in patients with chronic low back pain (CLBP) to assess the presence of NePC. Methods: This is a single-center cross-sectional study where patients with CLBP, with or without leg pain, were included. Participants were initially screened for NePC presence by a physician according to the regular practice, and later assessed using screening questionnaires. The diagnostic accuracy of these questionnaires was compared assuming the physician-made diagnosis as the gold standard. Results: A total of 215 patients with CLBP of which 164 (76.3%, 95% CI, 70.2-81.5) had a NePC were included. S-DN4, ID Pain, and PDQ have an area under the curve (AUC) > 0.8 indicating excellent discrimination. However, S-LANSS has an AUC of 0.69 (0.62-0.75), indicating low discrimination. S-DN4 has a significantly higher AUC as compared to ID Pain (d(AUC) = 0.063, P < 0.01) and S-LANSS (d(AUC) = 0.197, P < 0.01). But the AUC of S-DN4 does not significantly differ from that of PDQ (d(AUC) = 0.013, P = 0.62). Conclusions: S-DN4, ID Pain, and PDQ, but not S-LANSS, have good discriminant validity to screen for NePCs in patients with CLBP. Despite using all the tests, 20-30% of patients with an NePC were missed. Thus, these questionnaires can only be used as an initial clue in screening for NePCs, but do not replace clinical judgment.

• The Korean Journal of Pain
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• 제36권2호
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• pp.253-267
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• 2023

Background: Cancer-induced bone pain (CIBP) is considered to have both nociceptive and neuropathic components. However, the prevalence, risk factors, and impact of the neuropathic components are yet poorly understood. Methods: We estimate the prevalence of neuropathic pain (NP) features in patients with CIBP at a tertiary care pain clinic setting using the Douleur Neuropathique 4 questionnaire and evaluate their associated factors and their impact after 4 weeks of treatment using the Brief Pain Inventory questionnaire and the Edmonton Symptom Assessment System. Results: A total of 133 patients were recruited. The estimated prevalence of NP was 30.8% (95% confidence interval: 23.6%-39.1%). Initially, the patients with NP had significantly higher average pain scores (6.00 vs. 5.05, P = 0.006), higher total interference scores (5.84 vs. 4.89, P = 0.033), and symptom distress scores (35.88 vs. 26.52, P = 0.002). After 4 weeks of treatment, patients in both groups reported significantly decreased pain intensity and improved quality of life. However, the patients with NP still reported significantly higher average pain (4.61 vs. 3.58, P = 0.048), trending toward higher total interference scores (3.52 vs. 2.99, P = 0.426), and symptom distress scores (23.30 vs. 20.77, P = 0.524). From multivariate analysis, the independent risk factors for NP were younger age, pain in the extremities, and higher average pain scores. Conclusions: NP are common in patients with CIBP. These conditions negatively affect pain intensity and the patient's quality of life before and after treatment.

• The Korean Journal of Pain
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• 제29권2호
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• pp.136-140
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• 2016

Myofascial pain syndrome (MPS) is one of the common musculoskeletal conditions of the shoulder which may develop sensory-motor and autonomic dysfunctions at the various level of the neuromuscular system. The pain and dysfunction caused by MPS were primarily treated with physical therapy and pharmacological agents in order to achieve painfree movements. However, in recent years intramuscular electrical stimulation (IMES) with conventional electrode placement was used by researchers to maximise therapeutic values. But, in this study an inverse electrode placement was used to deliver electrical impulses intramuscularly to achieve neuro-modulation at the various level of the nervous system. Nine patients with MPS were treated with intramuscular electrode stimulation using inversely placed electrodes for a period of three weeks. All nine subjects recovered from their shoulder pain and disability within the few weeks of intervention. So, this inverse electrode placement may be more appropriate for chronic pain management.

• Journal of Acupuncture Research
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• 제39권4호
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• pp.317-322
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• 2022

Gold thread therapy (GTT) continuously stimulates acupoints and is used to treat chronic conditions/diseases such as chronic lumbar pain. During the procedure gold thread is embedded into the skin and although gold thread is medically pure, GTT is an irreversible treatment where there is limited evidence on its safety. Here, we report a case of a 79-year-old woman being treated for low back pain who developed side effects following moving cupping therapy at a site of GTT (performed in the 1970s). Adverse reactions causing radiating pain persisted more than at least 9 days following moving cupping therapy. The symptoms of pain were evaluated using the numerical rating scale, and changes in tenderness and the state of bruising was recorded. Low back pain improved but the radiating low leg pain did not improve. This case highlights the need for caution when performing moving cupping therapy where GTT has been previously performed.

• Journal of Oral Medicine and Pain
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• 제42권3호
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• pp.53-61
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• 2017

Myogenous temporomandibular disorder is a collective term for pathologic conditions of the masticatory muscles, mainly characterized by pain and dysfunction associated with various pathophysiological processes. Among the subtypes of myogenous temporomandibular disorder, myofascial pain is one of the most common muscle disorders, characterized by the presence of trigger points (TrPs). Various modalities, such as ultrasound, manipulative therapy, spray-and-stretch technique, transcutaneous electrical nerve stimulation, injection/dry needling, and low-level laser therapy are used to inactivate TrPs. Needling/injection on the TrPs is one of the most common treatments for myofascial pain. Despite the evidence, there is continued controversy over defining the biological and clinical characteristics of TrPs and the efficacy of injection/dry needling. This review discusses the current concept of injection/needling to relieve TrPs.

• Clinics in Shoulder and Elbow
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• 제6권2호
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• pp.115-126
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• 2003

Although painful conditions of varying degrees of severity involving the soft tissues (i .e., muscles, tendons, ligaments, periosteum and peripheral nerves) occur frequently, their underlying pathogenesis is poorly understood. The term peripheral neuropathic pain has recently been suggested to embrace the combination of positive and negative symptoms in patients whose pain is due to pathological changes or dysfunction in peripheral nerves or nerve root. The spinal nerve root, because of its vulnerable position, is very easily prone to injury from pressure, stretch, angulation, and friction. Therefore, not a few of musculoskeletal chronic pains are result of nerve root dysfunction. Neuropathic changes due to nerve root dysfunction are primarily in soft tissue especially muscle, tendon and joint. It shows tenderness over muscle motor points and palpable muscle contracture bands and restricted Joint range. Careful palpation and physical examination is the important tool that, be abne to detect all of these phenomena.