• The Korean Journal of Pain
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• 제35권3호
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• pp.240-249
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• 2022

Background: Widespread pain partially depends upon sensitization of central pain mechanisms. However, mechanisms controlling pain distribution are not completely known. The present study sought to assess skin temperature variations in the area of experimentally-induced pain and potential sex differences. Methods: Pressure-pain thresholds (PPTs) were measured on the right infraspinatus muscle. At the end of Day 0, all participants performed an eccentric exercise of the shoulder external rotators to induce muscle soreness 24 hours after. On Day 1, participants indicated on a body chart the area of pain induced by 60 seconds of suprathreshold pressure stimulation (STPS; PPT + 20%) on the right infraspinatus muscle. Skin temperature variations in the area of referred pain were recorded with an infrared thermography camera, immediately before and after the STPS. Results: Twenty healthy, pain-free individuals (10 females) participated. On Day 0, the pre-STPS temperature was higher than the post-STPS temperature on the arm (P = 0.001) and forearm (P = 0.003). On Day 1, the pre-STPS temperature was higher than the post-STPS temperature on the shoulder (P = 0.015), arm (P = 0.001), and forearm (P = 0.010). On Day 0, the temperature decrease after STPS in females was greater than in males on the forearm (P = 0.039). On Day 1, a greater temperature decrease was found amongst females compared with males at the shoulder (P = 0.018), arm (P = 0.046), and forearm (P = 0.005). Conclusions: These findings indicate that sympathetic vasomotor responses contribute to expand pressure-induced referred pain, especially among females.

• The Korean Journal of Pain
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• 제37권1호
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• pp.3-12
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• 2024

One of the most common sources of spinal pain syndromes is the facet joints. Cervical, thoracic, and lumbar facet joint pain syndromes comprise 55%, 42%, and 31% of chronic spinal pain syndromes, respectively. Common facet joint disorders are degenerative disorders, such as osteoarthritis, hypertrophied superior articular process, and facet joint cysts; septic arthritis; systemic and metabolic disorders, such as ankylosing spondylitis or gout; and traumatic dislocations. The facet pain syndrome from osteoarthritis is suspected from a patient's history (referred pain pattern) and physical examination (tenderness). Other facet joint disorders may cause radicular pain if mass effect from a facet joint cyst, hypertrophied superior articular process, or tumors compress the dorsal root ganglion. However, a high degree of morphological change does not always provoke pain. The superiority of innervating nerve block or direct joint injection for diagnosis and treatment is still a controversy. Treatment includes facet joint injection in facet joint osteoarthritis or whiplash injury provoking referred pain or decompression in mass effect in cases of hypertrophied superior articular process or facet joint cyst eliciting radicular pain. In addition, septic arthritis is treated using a proper antibiotic, based on infected tissue or blood culture. This review describes the diagnosis and treatment of common facet joint disorders.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제21권1호
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• pp.48-53
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• 1999

Purpose: The aim of this study was to investigate the improvement of referred symptoms of TMJ internal derangement after open surgery of TMJ. Materials and Methods: The present study focused referred symptoms such as headache, neck pain, shoulder pain and evaluated the incidences and changes in their improvement at 1, 3, 6, 12 months after surgery in 118 patients who had TMJ internal derangement and received meniscoplasty(or meniscorrhaphy) and eminectomy at TMJ clinic of Yonsei University, Yongdong Severance Hospital, between 1992 and 1997. Results: One hundred eighteen patients(102 females, 16 males) with mean age of 29.6 years(range, 14 to 74) were included in this study and the mean follow-up period was 19.5 months(range, 12 to 60). The incidences of headache, neck pain, shoulder pain among the surgically treated TMJ internal derangement patients were 66.9%, 28.8%, 28.0% before surgery. Thirty-two preoperative severe(+++) headache patients were all improved their headache at 1, 3, 6 months after surgery, but slight relapse(9.4%) was found at 12 months after surgery. The clearance rate of preoperative neck and shoulder pain were 91.2% and 90.9% at 1 month after surgery and all of these groups had no pain at 12 months after surgery. Conclusions: Referred symptoms of TMJ internal derangement such as headache, neck pain, shoulder pain were dramatically improved after surgical treatment of TMJ.

• 대한물리치료과학회지
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• 제4권1호
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• pp.351-359
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• 1997

The joint dysfunction is the major cause of pain in trunk and extremities according to J. McM. Mennell who mentioned that there were no pathological changes that was found in the painful joint. The referred pain due to joint dysfunction has to be differentiated from other painful conditions, particularly of the neuromusculoskeletal system. Most of the pain in the lower extremities is due to the sacroiliac joint dysfunction according to Setsuo Hakata who had developed arthrokinematic approach(AKA) for sacroiliac joint in 1989. AKA for sacroiliac dysfunction is made up of distraction & gliding technics that are no violent to recover the disturbed intra-articular movement and result in immediate relief of pain.

• The Korean Journal of Pain
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• 제4권1호
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• pp.8-19
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• 1991

• Journal of Korean Medical Science
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• 제33권52호
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• pp.339.1-339.11
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• 2018

Background: Hip pain is a common musculoskeletal complaint in general practice. Although comprehensive diagnostic approach on hip pain is mandatory for adequate treatment, un- or mis-diagnosis is not rare in primary care. The aim of this study was to analyze descriptively un- or mis-diagnosed hip pain cases referred from primary care to a tertiary hospital, especially in young adults ${\leq}50years\;old$. Methods: We retrospectively analyzed a consecutive cohort of 150 patients (${\leq}50years\;old$) with chronic hip pain (${\geq}6weeks$), which was not diagnosed or misdiagnosed based on the information provided on the referral form. Results: Overall an average 32 cases/month were referred due to hip pain without a diagnosis or with an incorrect diagnosis. Among them, 150 patients were enrolled in this study and 146 (97.3%) could be allocated to a specific disease by using data from routine clinical practice. Four common final diagnoses were femoroacetabular impingement (FAI) syndrome (55.3%), hip dysplasia (HD, 13.3%), referred pain from the lumbar spine (9.3%), and spondyloarthritis (SpA, 7.3%). In patients with FAI syndrome, 37 (44.0%) had pincer-type FAI and 33 (39.8%) had combined-type. Although the pain site or gender was not tightly clustered, the distribution of final diagnosis was significantly different according to hip pain location or gender. Especially, SpA or HD was not observed in younger women subgroup or elder men subgroup, respectively, when stratified by the mean age of participants. Conclusion: Most (> 80%) young patients with hip pain, a difficult issue to diagnosis for many primary physicians, had FAI syndrome, HD, spine lesions, and SpA. This study could give a chance to feedback information about cases with un- or mis-diagnosed hip pain, and it suggests that primary physicians need to be familiar with the diagnostic approach for these 4 diseases.

• The Korean Journal of Pain
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• 제19권1호
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• pp.119-122
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• 2006

Upper thoracic back pain can be musculoskeletal in origin or it could be visceral referred pain, which may be indicative of a serious medical condition. We experienced a case of a 55-years-old female patient who complained of upper thoracic back pain for 1 month, which started 10 days after a traffic accident. She described the pain as being a dull, constant nagging sensation with an intensity of 4/10 on the visual analogue scale. Her pain did not subside after trigger point injection of the rhomboid and trapezius muscles. She reported intermittent palpitation, which indicated that the cardiovascular or pulmonary systems were involved. She was diagnosed with pulmonary thromboembolism by the imaging studies. Refractory upper thoracic back pain should be investigated to rule out this treatable, but potentially fatal condition.

• Journal of Oral Medicine and Pain
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• 제41권2호
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• pp.80-84
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• 2016

Non-odontogenic toothaches are frequently present and can be challenge to the dental clinician. A 41-year-old male patient with sharp and spontaneous pain on the right maxillary posterior dentition, which developed as like localized toothache 3 months ago, was finally treated with endoscope assisted sinus surgery on right maxillary sinus. Although the initial clinical characteristics are similar to odontogenic toothache in this patient, previous several treatment with the affected teeth did not alleviate the pain. Sinusitis around the facial structure is one of the common causes to make referred pain to maximally teeth and the sinus toothache resembles the pulpal or the periodontal toothache. The clinician should be well aware of various causes of the non-odontogenic toothache and be able to differentiate them.

• International Journal of Oral Biology
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• 제35권3호
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• pp.83-89
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• 2010

We investigated the role of the central MAPK pathways in extra-territorial (referred) pain resulting from inflammation of the temporomandibular joint (TMJ). Experiments were carried out on male Sprague-Dawley rats weighing 220-280 g. Under anesthesia, these animals were injected with $50\;{\mu}L$ of complete Freund's adjuvant (CFA) into the TMJ using a Hamilton syringe. In the control group, saline was injected into the TMJ. To identify the extent of inflammation of the TMJ, Evans blue dye (0.1%, 5 mg/kg) was injected intravenously at 1, 3, 6, 9, 12 and 15 days after CFA injection. The concentration of Evans blue dye in the extracted TMJ tissue was found to be significantly higher in the CFA-treated animals than in the saline-treated group. Air-puff thresholds in the vibrissa pad area were evaluated 3 days before and at 3, 6, 9, 12, 15 and 18 days after CFA injection into the TMJ. Referred mechanical allodynia was established at 3 days, remained until 12 days, and recovered to preoperative levels at 18 days after CFA injection. This referred mechanical allodynia was observed in contralateral side area. To investigate the role of central MAPK pathways, MAPK inhibitors ($10\;{\mu}g$) were administrated intracisternally 9 days after CFA injection. SB203580, a p38 MAPK inhibitor, significantly attenuated referred mechanical allodynia, as compared with the vehicle group. PD98059, a MEK inhibitor, also reduced CFA-induced referred mechanical allodynia. These results suggest that TMJ inflammation produces extra-territorial mechanical allodynia, and that this is mediated by central MAPK pathways.

• Journal of Oral Medicine and Pain
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• 제47권1호
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• pp.72-73
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• 2022