OBJECTIVES: In a number of simulated night shift studies, timed exposure to bright light improves sleep quality and work performance. We evaluated the effect of bright light on adaptation to night shift work with a field study. METHODS: Five female nurses working shifts at Korea University Hospital were recruited for participation in this study. We investigated two series of six consecutive shift rotations comprising three day and three night shifts, using wrist Actigraphy, the Stanford Sleepiness Scale. Visual-analogue scales, STIM and tympanic membrane temperature for daytime sleep quality, alertness, subjective feeling, attention performance, and temperature rhythm. The subjects were exposed to bright light (2,500 lux) from 24:00 to 04:00 a.m. on three consecutive night shifts during the second series, whereas they worked under normal lightening (650 lux) conditions during the first series. RESULTS: Actigraphic assessment of daytime sleep showed no significant difference between the first and third night shift in both baseline and light exposure phase. The mean lowest temperature shifted earlier during baseline phase but not during the light exposure phase. Also, the score for subjective feelings of depression, anxiety, physical discomfort and sleepiness was significantly higher in the third night shift than the first during baseline phase but not during the light exposure phase. Attention and attention switching ability was significantly improved in the third night shift compared to the first night during the light exposure phase but there were no significant changes during the baseline phase. CONCLUSION: This result suggests that there were no significant differences between the two phase in measures of quality of daytime sleep, but subjective feelings, attention and alertness were enhanced during light exposure. Although some placebo effects and learning effects might influence this result, bright light exposure between midnight and 4:00 a.m. may improve adaptation to night shift. In future, further controlled studies with a larger sample size, including melatonin measurement, are needed for real shift workers.
Actigraphy ; Anxiety ; Depression ; Female ; Humans ; Korea ; Learning ; Melatonin ; Placebo Effect ; Sample Size ; Tympanic Membrane ; Weights and Measures ; Wrist

Postherpetic neuralgia is the most frequent complication of herpes zoster. Treatment of this neuropathic pain syndrome is difficult and often disappointing. Although postherpetic neuralgia is generally a self-limited condition, it can last indefinitely. Continuous epidural blockade for patients with acute zoster can shorten the duration of treatment. However, continuous epidural block has some complications such as infection, dural puncture, and total spinal and nerve damages. We report a case of myoclonus during continuous epidural block with ropivacaine, morphine, and ketamine in an acute zoster patient.
Amides ; Analgesia ; Herpes Zoster ; Humans ; Ketamine ; Morphine ; Myoclonus ; Neuralgia ; Neuralgia, Postherpetic ; Punctures

Herpes zoster most commonly occurs in elderly patients, and usually affects sensory neurons. Therefore, its characteristic symptoms are segmental pain, itching, and sensory changes in the affected areas. A 71-yr-old woman experienced painful herpetic rash on the right cervical 2-4 dermatomes for 16 days. Two days after the onset of the rash, she was diagnosed with herpes zoster, and prescribed 250 mg famciclovir three times a day for 7 days, pregabalin 150 mg twice a day, and tramadol 150 mg once a day for 14 days, by a dermatologist. Despite medication, her pain was rated at an intensity of 6/10 on the numeric rating scale. In addition, she complained of severe itching sensation on the affected dermatomes. Superficial cervical plexus block (SCPB) was performed at the right C4 level with 15 ml 0.5% lidocaine plus triamcinolone 30 mg. Five days after the procedure, pain and itching completely disappeared. SCPB may be an effective option for the treatment of acute pain and itching arising from herpes zoster, and for the prevention of postherpetic neuralgia.
Acute Pain ; Aged ; Cervical Plexus Block* ; Cervical Plexus* ; Exanthema ; Female ; Herpes Zoster* ; Humans ; Lidocaine ; Neuralgia, Postherpetic ; Pregabalin ; Pruritus ; Sensation ; Sensory Receptor Cells ; Tramadol ; Triamcinolone

Orofacial pain is a common complaint of patients that causes distress and compromises the quality of life. It has many etiologies including trauma, interventional procedures, nerve injury, varicella-zoster (shingles), tumor, and vascular and idiopathic factors. It has been demonstrated that the sympathetic nervous system is usually involved in various orofacial pain disorders such as postherpetic neuralgia, complex regional pain syndromes, and atypical facial pain. The stellate sympathetic ganglion innervates the head, neck, and upper extremity. In this review article, the effect of stellate ganglion block and its mechanism of action in orofacial pain disorders are discussed.
Complex Regional Pain Syndromes ; Facial Pain* ; Ganglia, Sympathetic ; Head ; Humans ; Neck ; Neuralgia, Postherpetic ; Quality of Life ; Stellate Ganglion* ; Sympathetic Nervous System ; Upper Extremity

In the traditional medical field, the patient was a person to receive protection from the doctor because there are vertical relationship between the patient and the doctor. But in modern medical field, patients change their role to health-care consumer to be guaranteed their rights more actively. This study compare patient's rights in doctor's vocational ethics and patient's rights in law, consumer rights. This study analyzes what is type of law-relationship between patients and doctor and how can they act health-care as health-care consumer.
Ethics ; Humans ; Jurisprudence ; Patient Rights*

The management of chronic pain, particularly neuropathic pain, still has significant unmet needs. In addition to inadequate symptomatic relief, there are concerns about adverse effects and addiction associated with treatments. The transplantation of cells that secrete neuroactive substances with analgesic properties into the central nervous system has only become of practical interest in more recent years, but provides a novel strategy to challenge current approaches in treating chronic pain. This review covers pre-clinical and clinical studies from both allogeneic and xenogeneic sources for management of chronic refractory pain.
Central Nervous System ; Chronic Pain ; Genetic Therapy ; Neuralgia ; Pain, Intractable ; Tissue Therapy ; Transplants

Spinal cord stimulation (SCS) is one of the most effective modalities for management of refractory neuropathic pain unresponsive to conservative therapies. The SCS has been successful in providing analgesia, improving function, and enhancing quality of life for patients suffering from chronic pain conditions such as failed back surgery syndrome, complex regional pain syndrome, ischaemic and phantom limb pain, and coronary artery disease. This technique has proven to be cost effective in the long term despite its high initial cost. In this review article, we discuss the history of SCS development, mechanism of action, and indications for SCS.
Cost-Benefit Analysis ; Electric Stimulation Therapy ; adverse effects ; economics ; methods ; Failed Back Surgery Syndrome ; therapy ; Humans ; Treatment Outcome

Recent studies for the diabetic polyneuropathy have quantified as well as compared the clinical and the electrophysiological findings. Thirty-one diabetic patients were examined with a conventional nerve conduction study, a late response, a somatosensory evoked potential (SEP), a sympathetic skin response (SSR), a R-R interval, and a needle electromyography (EMG) after the clinical examination. The purposes of this study were to evaluate the correlation of clinical features and electrophysiological findings and to provide reliable criteria for the diagnosis of diabetic polyneuropathy. Diabetic polyneuropathy was diagnosed when a nerve conduction study revealed abnormal findings in two or more peripheral nerves. The following parameters were highly correlated with a diabetic polyneuropathy; ankle jerks (Spearman's r=0.92), H reflexes (Spearman's r=0.92), F waves by the tibial nerve stimulation (Spearman's r=0.88), F waves by the peroneal nerve stimulations (Spearman's r=0.84), and amplitudes of a sensory nerve action potential (SNAP) in the sural nerve (Spearman's r=0.79), SEPs by the tibial nerve stimulation (Spearman's r=0.79). Motor nerve conduction of the upper limbs, R-R interval ratios, and blood pressure changes had no significant correlations with a diabetic polyneuropathy. We concluded that these clinical and electrophysiological findings with significantly high correlation values would be good parameters for the diagnosis of diabetic polyneuropathy.
Action Potentials ; Ankle ; Blood Pressure ; Diabetic Neuropathies* ; Diagnosis ; Electromyography ; Evoked Potentials, Somatosensory ; H-Reflex ; Humans ; Needles ; Neural Conduction ; Peripheral Nerves ; Peroneal Nerve ; Polyneuropathies ; Skin ; Sural Nerve ; Tibial Nerve ; Upper Extremity

Myringotomy and ventilation tube insertion are widely performed in pediatric patients with chronic otitis media. This procedure is performed under general anesthesia or sedation with local anesthesia infiltration in pediatric patients. In this case report, we report a case of transient facial paralysis in a pediatric patient who underwent myringotomy and ventilation tube insertion using sevoflurane inhalation and four-quadrant blocks with lidocaine.

Fibromyalgia is a syndrome characterized by chronic pain in the skeletal system accompanied by stiffness, sleep disturbance, fatigue, and psychiatric problems, such as anxiety and depression. Fibromyalgia commonly affects orofacial health, presenting with a variety of oral manifestations, including temporomandibular disorder, xerostomia, glossodynia, and dysgeusia. Therefore, oral healthcare providers need to be aware of this clinical entity to effectively manage oral symptoms and provide proper oral self-care modification and education on the nature of fibromyalgia.This review focuses on the epidemiology, pathophysiology, clinical manifestation, diagnosis, orofacial concerns, and treatment of fibromyalgia.