• The Korean Journal of Pain
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• v.20 no.2
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• pp.92-99
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• 2007

Background: A correlation between a T-type voltage activated calcium channel (VACC) and pain mechanism has not yet been established. The purpose of this study is to find out the effect of ethosuximide and mibefradil, representative selective T-type VACC blockers on postoperative pain using an incisional pain model of rats. Methods: After performing a plantar incision, rats were stabilized on plastic mesh for 2 hours. Then, the rats were injected with ethosuximide or mibefradil, intraperitoneally and intrathecally. The level of withdrawal threshold to the von Frey filament near the incision site was determined and the dose response curves were obtained. Results: After an intraperitoneal ethosuximide or mibefradil injection, the dose-response curve showed a dose-dependent increase of the threshold in a withdrawal reaction. After an intrathecal injection of ethosuximide, the threshold of a withdrawal reaction to mechanical stimulation increased and the increase was dose-dependent. After an intrathecal injection of mibefradil, no change occurred in either the threshold of a withdrawal reaction to mechanical stimulation or a dose-response curve. Conclusions: The T-type VACC blockers in a rat model of postoperative pain showed the antihyperalgesic effect. This effect might be due to blockade of T-type VACC, which was distributed in the peripheral nociceptors or at the supraspinal level. Further studies of the effect of T-type VACC on a pain transmission mechanism at the spinal cord level would be needed.

• The Korean Journal of Pain
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• v.27 no.2
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• pp.168-173
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• 2014

Background: Recently, there have been several case reports and retrospective studies about the incidence of intradiscal (ID) injection during transforaminal epidural steroid injection (TFESI). Inadvertent ID injection is not a rare complication, and it carries the risk of developing diskitis, although there has been no report of diskitis after TFESI. We prospectively evaluated the incidence of inadvertent ID injection during lumbar TFESI and analyzed the contributing factors. Methods: Ten patients received 2-level TFESI, and the remaining 229 patients received 1-level TFESI. When successful TFESI was performed, 2 ml of contrast dye was injected under real-time fluoroscopy to check for any inadvertent ID spread. A musculoskeletal radiologist analyzed all magnetic resonance images (MRIs) of patients who demonstrated inadvertent ID injection. When reviewing MRIs, the intervertebral foramen level where ID injection occurred was carefully examined, and any anatomical structure which narrowing the foramen was identified. Results: Among the 249 TFESI, we identified 6 ID injections; thus, there was an incidence of 2.4%. Four patients had isthmic spondylolisthesis, and the level of spondylolisthesis coincided with the level of ID injection. We further examined the right or left foramen of the spondylolisthesis level and identified the upward migrated disc material that was narrowing the foramen. Conclusions: Inadvertent ID injection during TFESI is not infrequent, and pain physicians must pay close attention to the type and location of disc herniation.

• The Journal of Korean Physical Therapy
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• v.9 no.1
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• pp.103-115
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• 1997

The purpose of this study was to examine the amount of $\beta-endorphin$ and pain threshold according to time sequences in applying experimented TENS and MENS(pre treatment, posttreatment, 25 minutes after the treatment). This test was to aim at showing the effects of the experimental $\beta-endorphin$ and pain threshold applied to the randomly selected twenty healthy men in their twenties. The subjects were divided into two group(ten for TENS and the other ten MENS). The results obtained are as follows : 1. There was no significant difference in the $\beta-endorphin$ between TENS and HENS(p>0.05). There was no difference in the pain threshold at pretreatment and posttreatment(p>0.05), but there was some difference at 25 minutes after the treatment(p<0.05). 2. The group of TENS in the experimental $\beta-endorphin$ had the highest level of $14.40{\pm}3.098$ at posttreatment, but the level decreased a little according to time passed. And in the experimental pain threshold, the level went to the highest plateau of $2.92{\pm}0.483$ at 25 minutes after the treatment. 3. The group of MENS in the experimental $\beta-endorphin$ had the highest plateau of $14.20{\pm}3.967$ at posttreatment, but the level decreased a bit according to time passed also. And in the experimental pain threshold, the level went to the highest plateau of $2.49{\pm}0.617$ posttreatment. 4. There were some differences of the experimental $\beta-endorphin$ in TENS group at pretreatment and posttreatment(p<0.05). There were some differences in the experimental pain threshold between pretreatment and posttreatment as well as between pretreatment and 25 minutes after the treatment(p<0.05) MENS did not influence the experimental $\beta-endorphin$ and pain threshold. This experiment showed that TENS increased the levels of the experimental $\beta-endorphin$ at posttreatment and increased the levels of the experimental pain threshold untill 25 minutes after the treatment. Therefore, the time of sustaining pain in TENS group was longer than that of MENS group. Also, MENS showed that it increased each level of the experimental $\beta-endorphin$ and pain threshold, but these levels were not statistically meaningful.

• Physical Therapy Korea
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• v.22 no.3
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• pp.1-11
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• 2015

The purpose of this study was to investigate the effect of lumbar stabilization training and additional thoracic mobilization on pain, proprioception and static balance in patients with chronic low back pain. The subjects of this study were 48 chronic low back pain patients who were randomly allocated to an experimental group 1 ($n_1=16$, lumbar stabilization and thoracic mobilization, thoracic hypomobility), experimental group 2 ($n_2=16$, lumbar stabilization and thoracic mobilization, thoracic normal mobility), and a control group ($n_3=16$, lumbar stabilization, thoracic hypomobility) after a thoracic mobility test. Both experimental groups underwent lumbar stabilization training and additional thoracic mobilization. The control group underwent only lumbar stabilization training. The intervention was performed 3 times per week, 30 minutes each time, for a total of 6 weeks. Thoraco-lumbar joint reposition error was measured using an electrogoniometer and static balance ability was measured using the Tetrax posture analysis system. Subjects' pain level was measured using a 100 mm visual analogue scale. Statistical analyses were performed using a one-way analysis of variance and a paired t-test. Post-hoc testing was carried out with a Bonferroni test. The pain level was significantly lower in both experimental groups compared to the control group. Both experimental groups showed significant reductions in joint reposition error angle (flexion, extension, and side bending) compared to the control group. The static balance level was significantly lower in both experimental groups than in the control group. In summary, lumbar stabilization exercises and additional thoracic mobilization significantly improved the pain level, proprioception, and static balance in patients with chronic low back pain.

• The Korean Journal of Pain
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• v.20 no.1
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• pp.46-49
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• 2007

Background: Cervical epidural injection, performed via the interlaminar approach, represents a useful interventional pain management procedure indicated in patients with a cervical herniated disk. Due to thedecreased epidural space in the cervical region, cervical epidural injections may result in potentially serious complications, especially during a large volume injection. Methods: Thirty-four patients with neck pain due to a cervical herniated disk that were referred to the pain clinic for cervical epidural steroid injection were randomized into two groups. One group received a cervical epidural injection of 4 ml drug and the other group received 2 ml drug. The injected mixture included triamcinolon, ropivacaine and omnipaque. Spread levels of the drug after injection were estimated with the use of C-arm fluoroscopy. Results: Spread levels to the cephalad for patients in the two groups were $4.88{\pm}0.78segments$ and $4.53{\pm}0.49segments$, respectively. Spread levels to the caudad for patients in the two groups were $4.59{\pm}0.93segments$ and $4.47{\pm}0.51segments$, respectively. The results showed no significant difference in the spread level between the two groups. Conclusions: Use of a small volume of drug (2 ml) can provide a sufficient spread level of the injected drug that is desirable for patients with a cervical herniated disk.

• The Korean Journal of Pain
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• v.28 no.2
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• pp.75-87
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• 2015

Background: Lumbar discogenic pain without pain mediated by a disc herniation, facet joints, or the sacroiliac joints, is common and often results in chronic, persistent pain and disability. After conservative treatment failure, injection therapy, such as an epidural injection, is frequently the next step considered in managing discogenic pain. The objective of this systematic review is to determine the efficacy of lumbar epidural injections in managing discogenic pain without radiculopathy, and compare this approach to lumbar fusion or disc arthroplasty surgery. Methods: A systematic review of randomized trials published from 1966 through October 2014 of all types of epidural injections and lumbar fusion or disc arthroplasty in managing lumbar discogenic pain was performed with methodological quality assessment and grading of evidence. The level of evidence was based on the grading of evidence criteria which, was conducted using 5 levels of evidence ranging from levels I to V. Results: Based on a qualitative assessment of the evidence for both approaches, there is Level II evidence for epidural injections, either caudal or lumbar interlaminar. Conclusions: The available evidence suggests fluoroscopically directed epidural injections provide long-term improvement in back and lower extremity pain for patients with lumbar discogenic pain. There is also limited evidence showing the potential effectiveness of surgical interventions compared to nonsurgical treatments.

• Physical Therapy Korea
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• v.9 no.1
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• pp.69-79
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• 2002

Many pregnant women have experienced low back pain (LBP) during pregnancy and after delivery, and it has been an important component in women health. This study was designed to investigate the characteristics and management of the LBP in postpartum women. Eighty-five postpartum women were participated in this survey. Mean age of 85 women was 28.1 years. Of 85 postpartum women, 55.3% (n=47) had LBP after pregnancy. Thirty of 47 women had pain on lumbar region, 17 postpartum women had pain on sacroilium region. Of 85 postpartum women, 74% (n=54) had LBP before pregnancy and 71.8% (n=61) had LBP during pregnancy. Of 47 postpartum women who had LBP, 83% (n=39) had not received medical management for LBP, 12.8% (n=6) took medication, and 4.3% (n=2) performed self-exercise. None of postpartum women had received physical therapy during pregnancy and after delivery for treatment low back pain. The pain in SI region was more severe than in lumbar region after pregnancy according to VAS (visual analog scale) (p<.05). However, there was no significant difference in VAS scores between SI pain and lumbar pain before and during pregnancy (p>.05). Pain region after delivery was related to pain region of pre-pregnancy and during pregnancy (p<.01). Pain level after delivery was related to the pain and night pain level during pregnancy (p<.01).

• Research in Community and Public Health Nursing
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• v.20 no.3
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• pp.381-389
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• 2009

Purpose: The study was to explore the level of low back pain and characteristic factors influencing low back pain (LBP) and mental health during pregnancy. Methods: The subjects were a total of 383 healthy pregnant women in S City and K-Do. Data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson's correlation. Results: 82.5% of the pregnant women answered the existence of LBP and 19.7% of them had high LBP. The preferred method of controlling LBP was 'Just endure'(42.3%). There were significant differences in pregnancy level (p<.05) and discomfort condition related to pregnancy (p<.01) according to low back pain. There were significant differences in pain intensity according to mental health. The correlation between pain level and pregnancy weeks (p<.001) and BMI in previous pregnancy (p<.001) was significant. The correlation between mental health and age was significant (p<.001). Conclusion: The majority of the pregnant women experienced LBP during pregnancy. However, they were not offered the best method of controlling the pain. Thus, for preventing LBP during pregnancy, we recommend regular exercises and BMI control.

• Physical Therapy Rehabilitation Science
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• v.12 no.3
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• pp.355-364
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• 2023

Objective: The aim of this study is to test the effects of elastic band exercise accompanied by Swiss ball exercise on lower limb muscle strength, balance and pain in middle-aged women with osteoarthritis. Design: A randomized controlled trial. Methods: Thirty-five participants were randomly assigned to the experimental group (n=18), which performed elastic band exercise combined with Swiss ball exercise, and the control group (n=17), which performed elastic band exercise only. Both groups did a 30-minute session of exercise three times a week for eight weeks and were assessed for lower extremity muscle strength, static and dynamic balance, and pain levels before the first therapy session. All participating patients underwent outcome assessment after eight weeks of therapy without any additional treatment. Results: The experimental group made a significant increase in muscle strength of the lower extremities, static and dynamic balance ability, and pain level (p<0.05). The control group made a significant improvement in lower limb muscle strength, dynamic balance ability and pain level (p<0.05) with no such improvement in static balance ability. The exercise group made a significant increase in static and dynamic balance ability and pain level compared to the control group (p<0.05). Conclusions: These results demonstrated that both Swiss ball exercise and elastic band exercise were effective for middle-aged women with osteoarthritis and found that elastic band exercise combined with Swiss ball exercise produced more significant effects on their balance and pain.

• Physical Therapy Korea
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• v.22 no.3
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• pp.50-60
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• 2015

The purpose of this study was to apply the joint mobilization technique to the level of segments with pain and to the level of segments with hypomobility respectively and compare the immediate effects of the joint mobilization technique on the pain, the active cervical range of motion (ROM), and treatment satisfaction of patients with acute mechanical neck pain. After the baseline assessment, forty-two patients were randomized into two groups: a painful group ($n_1=21$) that received joint mobilization at the most painful cervical spine level and a hypomobile group ($n_2=21$) that received joint mobilization at the most hypomobile cervical level. The patients received an intervention that applied unilateral posterior-anterior gliding for 5 minutes and two repetitions of 10 times of active extension motion with distraction. In the Wilcoxon signed-rank test, the painful group and the hypomobile group were improved significantly in all pain variables (p<.001), while the painful group was improved significantly in the active cervical flexion (p<.001), extension (p<.001), left side-bending (p<.01), right side-bending (p=.001), left rotation (p<.001), and right rotation (p<.001). The hypomobile group was significantly improved in active cervical flexion (p=.001), extension (p<.001), left side-bending (p<.05), right side-bending (p=.001), left rotation (p=.001), and right rotation (p<.01) after intervention. In the Mann-Whitney U test, there was no significant difference in any of the dependent variables after the intervention between the two groups, but the painful group was slightly superior to the hypomobile group in all variables except for the right lateral flexion ROM and treatment satisfaction. These outcomes suggest that the cervical joint mobilization may be applied to either the level of painful segments or the hypomobile segments for the treatment of patients with acute mechanical neck pain.