• The Korean Journal of Pain
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• 제34권4호
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• pp.487-500
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• 2021

Background: Although the erector spinae plane block has been used in various truncal surgical procedures, its clinical benefits in patients undergoing spinal surgery remain controversial. The aim of this meta-analysis was to evaluate the clinical benefits of erector spinae plane block in patients undergoing spinal surgery. Methods: We searched the Cochrane Library, PubMed, EMBASE, and China National Knowledge Infrastructure for randomized controlled trials comparing the erector spinae plane block with a nonblocked control for spinal surgery. Results: Twelve studies encompassing 696 subjects were included in our systematic review and meta-analysis. We found that the erector spinae plane block decreased postoperative pain scores and opioid consumption in the postoperative and intraoperative periods. Moreover, it prolonged the time to the first rescue analgesic, reduced the number of patients who required rescue analgesia, and lowered the incidence of postoperative nausea and vomiting. However, it did not exhibit efficacy in decreasing the incidence of urinary retention and itching or shortening the length of hospital stays, or the time to first ambulation. Conclusions: Erector spinae plane block improves analgesic efficacy among patients undergoing spinal surgery compared with nonblocked controls; however, there is insufficient evidence regarding the benefits of erector spinae plane block for rapid recovery.

• The Korean Journal of Pain
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• 제28권2호
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• pp.148-152
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• 2015

The goal of cancer treatment is generally pain reduction and function recovery. However, drug therapy does not treat pain adequately in approximately 43% of patients, and the latter may have to undergo a nerve block or neurolysis. In the case reported here, a 42-year-old female patient with lung cancer (adenocarcinoma) developed paraplegia after receiving T8-10 and $11^{th}$ intercostal nerve neurolysis and T9-10 interlaminar epidural steroid injections. An MRI results revealed extensive swelling of the spinal cord between the T4 spinal cord and conus medullaris, and T5, 7-11, and L1 bone metastasis. Although steroid therapy was administered, the paraplegia did not improve.

• The Korean Journal of Pain
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• 제24권4호
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• pp.179-184
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• 2011

Background: The analgesic mechanisms of cyclooxygenase (COX)-2 inhibitors have been explained mainly on the basis of the inhibition of prostaglandin biosynthesis. However, several lines of evidence suggest that their analgesic effects are mediated through serotonergic or adrenergic transmissions. We investigated the roles of these neurotransmitters in the antinociception of a selective COX-2 inhibitor at the spinal level. Methods: DUP-697, a selective COX-2 inhibitor, was delivered through an intrathecal catheter to male Sprague-Dawley rats to examine its effect on the flinching responses evoked by formalin injection into the hindpaw. Subsequently, the effects of intrathecal pretreatment with dihydroergocristine, prazosin, and yohimbine, which are serotonergic, ${\alpha}1$ adrenergic and ${\alpha}2$ adrenergic receptor antagonists, respectively, on the analgesia induced by DUP-697 were assessed. Results: Intrathecal DUP-697 reduced the flinching response evoked by formalin injection during phase 1 and 2. But, intrathecal dihydroergocristine, prazosin, and yohimbine had little effect on the antinociception of intrathecal DUP-697 during both phases of the formalin test. Conclusions: Intrathecal DUP-697, a selective COX-2 inhibitor, effectively relieved inflammatory pain in rats. Either the serotonergic or adrenergic transmissions might not be involved in the analgesic activity of COX-2 inhibitors at the spinal level.

• The Korean Journal of Pain
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• 제22권2호
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• pp.176-180
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• 2009

Cases of pyogenic spondylodiscitis are relatively rare diseases that concern 2-7% of total cases of osteomyelitis. Owing to the low frequency and initial nonspecific nature of signs and symptoms, diagnosis is often delayed up to 2-6 months. If the proper treatment is not established due to a diagnostic delay, there is a possibility of a serious neurologic deficit and spinal instability. We report two cases of infectious spondylodiscitis which were misdiagnosed as compression fracture and spinal stenosis respectively. They could be correctly diagnosed after MRI and laboratory test and under the recovery state after an antifungal and antibiotic medication. Special careful attention during the diagnostic procedure is a really important step considering the diagnostic delay and its resultant unsatisfactory outcome.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권2호
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• pp.77-82
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• 2019

It is well known that trigeminal nerve injury causes hyperexcitability in trigeminal ganglion neurons, which become sensitized. Long after trigeminal nerve damage, trigeminal spinal subnucleus caudalis and upper cervical spinal cord (C1/C2) nociceptive neurons become hyperactive and are sensitized, resulting in persistent orofacial pain. Communication between neurons and non-neuronal cells is believed to be involved in these mechanisms. In this article, the authors highlight several lines of evidence that neuron-glial cell and neuron macrophage communication have essential roles in persistent orofacial pain mechanisms associated with trigeminal nerve injury and/or orofacial inflammation.

• Journal of Yeungnam Medical Science
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• 제19권1호
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• pp.49-54
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• 2002

척수손상 환자에게 동반되는 통증은 흔하지만 치료에 잘 반응하지 않고 환자들의 일상생활에 더욱 장애를 줄 수 있는 합병증의 하나로 알려져 있다. 3년 전 외상성 척수손상으로 인하여 불완전 하지 마비 소견을 보였던 52세 된 남자 환자로 손상 직후부터 발생된 양측 T10위치의 분절통과 손상 1개월 후부터 발생된 양하지 통증이 있어 약물요법, 물리치료, 및 운동치료 등의 여러 가지 치료를 시행하였으나 치료에 잘 반응하지 않아 DREZ(Dorsal Root Entry Zone)otomy 수술을 시행한 후 분전통이 호전된 증례가 있어 이를 보고하고자 하였다. 보존적 치료에 잘 반응하지 않는 척수손상 후 통증의 경우 DREZotomy 수술도 도움이 될 것으로 사료된다.

• 대한한의학회지
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• 제26권3호
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• pp.239-248
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• 2005

Objectives : Electroacupuncture (EA)-induced analgesia has been known to be mediated through the activation of opioid, noradrenergic and serotonergic receptors. However, little study on serotonergic mechanism has been performed in an animal model of chronic pain. The present study was designed to elucidate the type of serotonergic receptors responsible for EA analgesia in the chronic pain model. Methods : In rats with complete Freund's: adjuvant-induced inflammation and spinal nerve injury, spinal wide dynamic range (WDR) cell responses to graded electrical stimulation of afferent C fiber were recorded before and after spinal application of selective 5-hydroxytryptamine (5-HT) receptor antagonists. EA stimulation (2Hz, 0.5msec, 3mA) was applied to the contralateral Zusanli point for 30 min. Results : In both models of chronic pain, WDR cell responses were greatly inhibited after EA stimulation. EA-induced inhibition of WDR celt responses was significantly attenuated by spinal application of non-selective 5-HT receptor antagonist, dihydroergocristine Of 5-HT receptor antagonists tested, 5-HT1A (WAY 100635) and 5-HT2 (LY53857) receptor antagonists strongly reduced an ability of EA stimulation to inhibit WDR cell responses. However, 5-HT1B (GR55562) and 5-HT3 (LY278584) receptor antagonists also had weak but significant blocking action on EA-induced inhibitory effect on chronic pain. Conclusions : Dorsal hem cell responses, afferent C fiber stimulation, chronic pain, electroacupuncture, serotonergic receptors.

• Journal of Acupuncture Research
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• 제27권2호
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• pp.43-49
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• 2010

Objectives : Among young generation, the prevalence of spinal disorders is known to be increasing. This study aimed to analyze the clinical data of spinal disorder in young ages in Korea. Methods : Number of patient, kinds of disorder, and medical cost were analyzed for patients(7~18 years) underwent spinal disorders using computerized database of Health Insurance Review and Assessment Service(HIRAS) from 2004 to 2008. We included dorsopathies as spinal disorder according to Korean Classification of Diseases(KCD) and excluded spinal disorder caused by trauma. We compared the data of traditional Korean medicine treatment with that of western medical care. Results : 4.8% of the children and adolescents had medical treatment with spinal disorder in 2008. The claim number and medical cost for both traditional Korean medicine and western medicine treatment are increasing 1.8 and 1.3 times respectively over 5 years. Total medical spent of western clinic was 2.1 times than those of traditional Korean clinic. The most common spinal disorder was dorsalgia(31.8%) and scoliosis(13.5%) in western clinics while back pain(29.0%) and neck pain(10.8%) in oriental clinic. Conclusions : We first reported the clinical tendency of spinal disorder in Korean children adolescents from 2004 to 2008. This study will support the development of a strategy for traditional Korean medicine-based prevention or treatment of spinal disorders in young generation.

• The Korean Journal of Pain
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• 제13권2호
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• pp.247-250
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• 2000

Recently, some authors reported that discogenic low back pain should be regarded as a referred pain in respect of neural pathway. The afferent pathways of discogenic low back pain is transmitted mainly by sympathetic afferent fibres from the sinuvertebral nerves in the second lumbar nerve root. This pain arises from the lumbar intervertebral discs, and it had been transmitted mainly through the sympathetic afferent fibres contained in the second lumbar spinal nerve root. Second lumbar dermatome corresponds to the low back area. We experienced a case of low back pain which could not be controlled by conventional therapy and progressed wax and wane. The CT finding showed bulging disc between $L_4$ and $L_5$ and spinal stenosis in $L_4$ area. And epiduroscopic feature showed severe adhesion in $L_4$, $L_5$ and $S_1$. After we blocked $L_2$ root, pain score decreased 10 to 2. Therefore, the $L_2$ root block may be a useful diagnostic procedure as well as provide therapeutic value.

• The Korean Journal of Pain
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• 제23권4호
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• pp.266-269
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• 2010

Spinal cord stimulation (SCS) is used to manage chronic pain syndromes and it is accepted a cost-effective therapy. Child-bearing women who had SCS become or choose to become pregnant despite these policies pregnancy is a relative contraindication. A 32-year-old woman had SCS as a treatment for the CRPS I of the left lower extremity, During various check up tests, we happen to find out that her serum beta-hCG was positive and confirmed pregnancy. SCS is not recommended in pregnancy because the effects of SCS on pregnancy and nursing mothers had not been confirmed. However, many female patients suffering from chronic pain may expect future pregnancy and we think that they must be informed about the possibility of pregnancy and the effects of SCS device implantation in the course of pregnancy. First of all, a good outcome requires a multidisciplinary team approach, including obstetrics, neonatology, pain medicine and anesthesia, as was used from an early pregnancy. Unfortunately, she had a misabortrion after 6 weeks.