Cervical disc herniation is one of the most common causes of neck, shoulder and arm pain. There are many treatments for a cervical disc herniation, such as rest, physical therapy, medication, epidural steroid injection and surgery. However, conservative treatments sometimes have limited effectiveness, and a surgical discectomy is often associated with numerous complications. Nowadays, a percutaneous discectomy, using a Dekompressor(R) , has been used in herniated disc patients, but a posterolateral extruded disc is not an indication. Herein, our experience using a 19 G Dekompressor(R) , on a 52 year-old male patient with a left C6 7 posterolateral extruded disc, is reported. Decompression was successfully performed, and the pain and range of motion was immediately improved.
Arm ; Decompression ; Diskectomy* ; Diskectomy, Percutaneous ; Humans ; Intervertebral Disc Displacement ; Male ; Middle Aged ; Neck ; Range of Motion, Articular ; Shoulder

BACKGROUND: Prolotherapy is an effective treatment for pain due to ligament or tendon laxity. The purpose of this study was to determine the effects of prolotherapy on the relief of shoulder pain. METHODS: Twenty-nine patients who complained of shoulder pain were investigated using a pain score system. Prolotherapy was performed using 15% dextrose to regions according to Hemwall's pattern. We recorded numeric rating scale (NRS) pain scores just before prolotherapy and 1, 2, 4 and 8 weeks later. RESULTS: For the 29 patients, prolotherapy proved to be effective and satisfactory in 83% (NRS; 7.2 +/- 0.8 before, 2.0 +/- 1.3 after prolotherapy). CONCLUSIONS: Prolotherapy with 15% dextrose resulted in a clinically significant improvement of shoulder pain due to ligamentopathy.
Glucose ; Humans ; Ligaments ; Shoulder Pain* ; Shoulder* ; Tendons

No abstract available.
Low Back Pain

BACKGROUND: The presence of pain during interventional pain management such as prolotherapy and intramuscular stimulation is stressful to patients and can affect the treatment outcome. We studied the safety and efficacy of two drug regimens: midazolam alone and midazolam/alfentanil for sedation anesthesia during prolotherapy and intramuscular stimulation. METHODS: Fifty three patients received either midazolam 0.04-0.08 mg/kg (Group M) or midazolam 0.01-0.02 mg/kg with alfentanil 4-8microgram/kg (Group A) for prolotherapy or intramuscular stimulation. We recorded the pain response, sedation score and side effects during the procedure, as well as amnesia, satisfaction and time to discharge after the procedure. RESULTS: Both drug regimens had significant sedation scores, amnesia and overall provided patient satisfaction. The treatment of pain was superior in Group A. Respiratory depression of three patients occurred in Group A. The time to discharge was longer in Group M. CONCLUSIONS: Midazolam and midazolam/alfentanil used for sedation anesthesia during prolotherapy and intramuscular stimulation were both effective; however, midazolam alone was the safer approach.
Alfentanil ; Amnesia ; Anesthesia* ; Humans ; Midazolam* ; Pain Management ; Patient Satisfaction ; Respiratory Insufficiency ; Treatment Outcome

Pain-related impairment assessment by the fifth edition of the American Medical Association Guides had many ambiguous points, and therefore, it was not applicable directly in Korea. Several disputable pain disorders were excluded from the list of impairment evaluation, and complex regional pain syndrome was chosen as the first object of impairment evaluation. Scales such as Korean version of modified Barthel index for assessing the activity of daily livings and Beck Depression Inventory for assessing depression were added, and pain severity, pain treatment, pain behavior, etc. were scored. In order to objectify as much as possible and to remove the room for misuse, we develop a new rating system based on the concept of total score.
*Disability Evaluation ; Humans ; Korea ; *Pain Measurement ; Program Development ; Reflex Sympathetic Dystrophy/classification/physiopathology ; Sickness Impact Profile

Neuropathic pain is often refractory to intervention because of the complex etiology and an incomplete understanding of the mechanisms behind this type of pain. Glial cells, specifically microglia and astrocytes, are powerful modulators of pain and new targets of drug development for neuropathic pain. Glial activation could be the driving force behind chronic pain, maintaining the noxious signal transmission even after the original injury has healed. Glia express chemokine, purinergic, toll-like, glutaminergic and other receptors that enable them to respond to neural signals, and they can modulate neuronal synaptic function and neuronal excitability. Nerve injury upregulates multiple receptors in spinal microglia and astrocytes. Microglia influence neuronal communication by producing inflammatory products at the synapse, as do astrocytes because they completely encapsulate synapses and are in close contact with neuronal somas through gap junctions. Glia are the main source of inflammatory mediators in the central nervous system. New therapeutic strategies for neuropathic pain are emerging such as targeting the glial cells, novel pharmacologic approaches and gene therapy. Drugs targeting microglia and astrocytes, cytokine production, and neural structures including dorsal root ganglion are now under study, as is gene therapy. Isoform-specific inhibition will minimize the side effects produced by blocking all glia with a general inhibitor. Enhancing the anti-inflammatory cytokines could prove more beneficial than administering proinflammatory cytokine antagonists that block glial activation systemically. Research on therapeutic gene transfer to the central nervous system is underway, although obstacles prevent immediate clinical application.
Astrocytes ; Carisoprodol ; Central Nervous System ; Chronic Pain ; Cytokines ; Ganglia, Spinal ; Gap Junctions ; Genetic Therapy ; Microglia ; Neuralgia ; Neuroglia ; Neurons ; Synapses