Chronic pain is a multifactorial condition with both physical and psychological symptoms, and it affects around 20% of the population in the developed world. In spite of outstanding advances in pain management over the past decades, chronic pain remains a significant problem. This article provides a mechanism- and evidence-based approach to improve the outcome for pharmacologic management of chronic pain. The usual approach to treat mild to moderate pain is to start with a nonopioid analgesic. If this is inadequate, and if there is an element of sleep deprivation, then it is reasonable to add an antidepressant with analgesic qualities. If there is a component of neuropathic pain or fibromyalgia, then a trial with one of the gabapentinoids is appropriate. If these steps are inadequate, then an opioid analgesic may be added. For moderate to severe pain, one would initiate an earlier trial of a long term opioid. Skeletal muscle relaxants and topicals may also be appropriate as single agents or in combination. Meanwhile, the steps of pharmacologic treatments for neuropathic pain include (1) certain antidepressants (tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors), calcium channel alpha2-delta ligands (gabapentin and pregabalin) and topical lidocaine, (2) opioid analgesics and tramadol (for first-line use in selected clinical circumstances) and (3) certain other antidepressant and antiepileptic medications (topical capsaicin, mexiletine, and N-methyl-d-aspartate receptor antagonists). It is essential to have a thorough understanding about the different pain mechanisms of chronic pain and evidence-based multi-mechanistic treatment. It is also essential to increase the individualization of treatment.
Analgesics, Opioid ; Antidepressive Agents ; Calcium Channels ; Capsaicin ; Chronic Pain ; Fibromyalgia ; Lidocaine ; Ligands ; Mexiletine ; N-Methylaspartate ; Neuralgia ; Neuromuscular Agents ; Norepinephrine ; Pain Management ; Serotonin ; Sleep Deprivation ; Tramadol

There are numerous drug interactions related to many psychotropic and cardiovascular medications. Firstly, the principles in predicting drug interactions are discussed. Cytochrome P (CYP) 450 plays a significant role in the metabolism of these drugs that are substrates, inhibitors, or inducers of CYP450 enzymes. The two most significant enzymes are CYP2D6 and CYP3A4. The ability of psychotropic drugs to act as inhibitors for the enzymes may lead to altered efficacy or toxicity of co-administered cardiovascular agents as a substrate for the enzymes. The following is also a review of the known interactions between many commonly prescribed cardiovascular agents and psychotropic drugs. Most beta blockers are metabolized by CYP2D6, which may lead to drug toxicity when they use in combination with potent CYP2D6 inhibitors including bupropion, chlorpromazine, haloperidol, selective serotonin reuptake inhibitors, and quinidine. Concomitant administration of lithium with angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and diuretics may increase serum lithium concentrations and toxicity. Calcium channel blockers and cholesterol lowering agents are subject to interactions with potent inhibitors of CYP3A4, such as amiodarone, diltiazem, fluvoxamine, nefazodone, and verapamil. Prescribing antiarrhythmic drugs in conjunction with medications are known to prolong QT interval and/or inhibitors on a relevant CYP450 enzyme is generally not recommended, or needs watchful monitoring. Digoxin and warfarin also have warrant careful monitoring if co-administered with psychotropic drugs.
Amiodarone ; Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Anti-Arrhythmia Agents ; Bupropion ; Calcium Channel Blockers ; Cardiovascular Agents ; Chlorpromazine ; Cholesterol ; Cytochrome P-450 CYP2D6 ; Cytochrome P-450 Enzyme System ; Cytochromes ; Digoxin ; Diltiazem ; Diuretics ; Drug Interactions ; Drug Toxicity ; Fluvoxamine ; Haloperidol ; Lithium ; Psychotropic Drugs ; Quinidine ; Serotonin Uptake Inhibitors ; Triazoles ; Verapamil ; Warfarin

Medulloepithelioma(diktyoma) is a uncommon congenital tumor that is generally believed to arise from the embryonic neuroepithelium of the medullary tube. This tumor usually arises from the ciliary body epithelium. But medulloepitheliomas of the retina and optic nerve may also occur, although it is extremely rare, because the embryonal medullary epithelium that lines the optic vesicle is continuous with the epithelium lining the cavity of the optic nerve during the early embryonal period. The occurrence of medulloepithelioma of the optic nerve is exceptionally rare, with only a few cases have been previously reported. We report a first case of medulloep-ithelioma of the optic nerve head in Korea in a 5-year-old girl who presented with a poor vision and squint of the left eye.
Child, Preschool ; Ciliary Body ; Epithelium ; Female ; Humans ; Korea ; Neuroectodermal Tumors, Primitive* ; Optic Disk* ; Optic Nerve* ; Retina ; Strabismus

Chronic perineal pain is an often encountered problem, which produces a great degree of functional impairment and frustration to the patient and a challenge to the treating physician. The reason for this problem is that the region contains diverse anatomic structures with mixed somatic, visceral and autonomic innervations affecting bladder and bowel control and sexual function. A blockade of nociceptive and sympathetic supply to the perineal region, supplied through the ganglion impar has been shown to benefit patients with chronic perineal pain. Several options to this block have been described that chemical neurolysis, radiofrequency ablation etc. Although the analgesic effect of Botulinum toxin type A (BoNT-A) has long been considered secondary to its action for muscle relaxation, BoNT-A also affects the release of the neurotransmitters that are involved in pain perception. We describe a patient who was successfully given ganglion impar block with BoNT-A.
Botulinum Toxins ; Botulinum Toxins, Type A ; Frustration ; Ganglion Cysts ; Humans ; Muscle Relaxation ; Nerve Block ; Neurotransmitter Agents ; Pain Perception ; Urinary Bladder

A pair of eyes of a 18 year-old girl with advanced congenital glaucoma was examined by light and electron microscopy. Results were as follows: 1. Trabecular meshwork and iris root showed fibrosis. 2. Schlemm's canal was absent. 3. Endothelium of the trabecular meshwork was degenerated. 4. Ciliary body was atrophied. 5. Inner layer of retina showed degeneration with the loss of nerve fiber layer and ganglion cell layer, which was replaced by Mueller cells. 6. Optic nerve showed atrophy from a loss of nerve fibers and there was proli feration of collagen tissue.
Adolescent ; Atrophy ; Ciliary Body ; Collagen ; Endothelium ; Female ; Fibrosis ; Ganglion Cysts ; Glaucoma* ; Humans ; Iris ; Microscopy, Electron ; Nerve Fibers ; Optic Nerve ; Retina ; Trabecular Meshwork

Each year many people are exposed to life-threatening disaster and traumatic events that put them at risk for trauma- and stressor-related disorders such as posttraumatic stress disorder. This report reviews research on the psychosocial interventions currently employed for the prevention and treatment of trauma- and stressor-related disorders. Cognitive behavioral therapy, including cognitive therapy and prolonged exposure, has been shown to improve several outcomes. Considerable progress has also been made in the use of eye movement desensitization and reprocessing. Trauma- and stressor-related disorders are associated with complex outcomes and multiple comorbid emotional, social, and physical health difficulties. Further advances are required in the intervention for populations with complex and chronic forms and in the development of integrated and well-related systems of care.
Adult* ; Cognitive Therapy ; Disasters ; Eye Movements ; Humans ; Stress Disorders, Post-Traumatic

PURPOSE: This study identifies research trends and provides fundamental data related to curative power of aromatherapy to relieve pain in Korea. METHODS: The study analyzed 44 experimental studies on humans that were published in Korea before the end of December, 2009. The key words used for searching were: aroma, aromatherapy, hyang-yobeob, hyanggi-yobeob, hyanggichilyo, aromatherapy and pain, headache, scapulodynia, omodynia, feeling uncomfortable in the perineal region, sense of pain, labor pains, arm pain, menstrual pain, aches, and dysmenorrheal. Those words were found on websites, including those for Korea Education & Research Information Service, the National Assembly Library, KISS, KoreaMed, and NDSL. Collected data were analyzed using descriptive statistics. RESULTS: The results showed that most of essential oils to relieve pain is composed of three to four kinds of oils, including Lavender, Roman chamomile, Rosemary, and Clarysage. Aromatherapy is applied usually by means of massage (50%), inhalation (13.6%), or a combination of the above two (13.6%). Measuring instruments as a dependent variable include VAS, questionnaire, GRS, blood pressure, pulse, and Algometer. Aromatherapy plays an important role in soothing headaches and arthralgia. However, when it comes to labor and menstrual pain, it doesn't seem to be effective. CONCLUSION: The study found that different kinds of oil, frequencies, and periods of time are used for the same symptoms. Further research should employ standardized oil blending, application, duration, and measuring instruments, and more systematically analyze the effects of aromatherapy to establish the effects on relieving pain.
Arm ; Aromatherapy ; Arthralgia ; Blood Pressure ; Chamaemelum ; Dysmenorrhea ; Female ; Headache ; Humans ; Information Services ; Inhalation ; Korea ; Labor Pain ; Lavandula ; Massage ; Oils ; Oils, Volatile ; Pregnancy ; Surveys and Questionnaires

PURPOSE: Neuroendocrine differentiation and expression of drug resistance may affect the response to chemotherapy and the prognosis of advanced non-small cell lung cancer. We conducted retrospective study to evaluate the possibilities of neuroendocrine differentiation and drug resistance markers being used as prognostic factors in patients with non-small cell lung cancer. MATERIAL AND METHOD: Immunohistochemical staining of NSE, PgP and GST-pai with polyclonal antibodies in pathologic specimens of 47 patients with non-small cell lung cancer were done. The relationship between the expression of the markers and the response to cisplatin-based chemotherapy and the overall survival were assessed. RESULTS: NSE staining was positive in 17% and there was no difference between adenocarcinoma and squamous cell carcinoma. NSE positive patients showed increased response rate (63% vs 26%, p=0.049) and prolonged response duration (15.8mo vs 4.5mo, p=0.0007). But there was no difference in overall survival between NSE positive and negative groups. The PgP positive rate was 17% and GST-pai positive rate was 47%. No correlations were found among the expression of drug resistance, the sensitivity to chemotherapy and overall survival. CONCLUSION: Patients with non-small cell lung cancer with positive NSE showed increased response rate to chemotherapy and prolonged response duration but overall survival was not related to NSE expression. Expression of PgP and GST- were not important in predicting the prognosis in non-small cell lung cancer.
Adenocarcinoma ; Antibodies ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Drug Resistance ; Drug Therapy ; Drug Therapy, Combination* ; Glutathione Transferase* ; Glutathione* ; Humans ; Neurons* ; P-Glycoprotein* ; Phosphopyruvate Hydratase* ; Prognosis ; Retrospective Studies

Abdomianl pregnancy is rare, occurring 9.2 cases per 1,000 ectopic pregnancies and encountered in 1 in 10,000-25,000 births. Omental pregnancy is extremely rare form of abdominal pregnancy that may cause life-threatening massive hemorrhage in case of rupture. The clinical characteristics is variable and physical examination by itself may be insufficient for diagnosis. Early and accurate diagnosis is necessary to decrease fetal and maternal mortality and morbidity, serious complications. We report a case of ruptured early omental pregnancy with a review of literature.
Diagnosis ; Female ; Hemorrhage ; Maternal Mortality ; Parturition ; Physical Examination ; Pregnancy* ; Pregnancy, Abdominal ; Pregnancy, Ectopic ; Rupture

BACKGROUND: Since heightened microglial activation was shown to play a role in the pathogenesis of many brain disorders, understanding the molecular mechanisms of microglial activation may lead to new treatment strategies. The microarray system permitted screening of large numbers of genes in biological or pathological processes. Therefore, we evaluated the gene expression pattern during microglial activation using microarray analysis. METHODS: Primary microglial cultures were prepared from postnatal Swiss Webster mice. The cells were activated by lipopolysaccharide (LPS, 10 microgram/ml) for 5 hours prior to cell harvesting. From the cultured cells, we isolated mRNA, synthesized cDNA, converted to biotinylated cRNA and then reacted with GeneChips (Affymetrix MU74A-v2). The data were normalized and analyzed. RESULTS: After microglial activation with LPS, we found >4 fold increases in the expression of 139 genes and >4 fold decreases of 16 genes expression compared with control. Most of the induced or suppressed genes were known to regulate inflammation, immune reactions, injury responses, cell death or survival related mechanisms. CONCLUSIONS: These results suggest that microarray analysis of gene expression may be useful for screening novel molecular mediators of microglial activation and making profound understanding of the cellular mechanisms as a whole. Such screening techniques should provide insights into the molecular basis of brain disorders and help to identify potential targets for therapy.
Animals ; Brain Diseases ; Cell Death ; Cells, Cultured ; DNA, Complementary ; Gene Expression* ; Inflammation ; Mass Screening ; Mice ; Microarray Analysis ; Microglia* ; Pathologic Processes ; RNA, Complementary ; RNA, Messenger