1.The pharmacological management of neuropathic pain.
Journal of the Korean Medical Association 2012;55(6):582-592
Neuropathic pain has recently been defined as "pain arising as a direct consequence of a lesion or disease affecting the somatosensory system". Neuropathic pain is a debilitating chronic condition that remains very difficult to treat and challenging to manage. Tricyclic antidepressants (amitryptiline, nortriptyline, imipramine), selective serotonin and norepinephrine reuptake inhibitors (duloxetine, venlafaxine), anticonvulsants (gabapentin, pregabalin), and 5% lidocaine patches have demonstrated efficacy in neuropathic pain and are recommended as first-line medications. In patients who fail to respond to these first-line medications alone and/or in combination, opioid analgesics or tramadol can be used as a second-line treatment alone or in combination with one of the first-line medications. Opioid analgesics and tramadol can also be considered for first-line use in selected clinical circumstances. Other pharmacological therapeutic options include selective serotonin reuptake inhibitors, antiepileptic drugs (levetiracetam, lacosamide, lamotrigine, valproic acid), cannabinoids, high concentration capsaicin patch, and botulinum toxin A. Medication selection should be individualized, with side effects taken into consideration as well as potential beneficial or deleterious effects on comorbidities, and whether or not prompt onset of pain relief is necessary.
Acetamides
;
Analgesics, Opioid
;
Anticonvulsants
;
Antidepressive Agents, Tricyclic
;
Botulinum Toxins
;
Cannabinoids
;
Capsaicin
;
Comorbidity
;
Humans
;
Lidocaine
;
Neuralgia
;
Norepinephrine
;
Nortriptyline
;
Serotonin
;
Serotonin Uptake Inhibitors
;
Tramadol
;
Triazines
2.Interventional therapy for chronic low back pain.
Journal of the Korean Medical Association 2012;55(6):562-570
Chronic low back pain has become a major public health problem in Korea. The lifetime prevalence of low back pain has been reported to be as high as 90%. The prevalences of discogenic pain, facet joint pain, and sacroiliac joint pain are 42%, 30%, and 18%, respectively. Increasing age is associated with a decreasing probability of discogenic pain but increasing probabilities of facet joint pain and sacroiliac joint pain as the source of low back pain. Physical examination of low back pain is limited and imaging may lack objective clues. Diagnostic interventions allow us to determine the etiology of back pain. Techniques include lumbar disc stimulation, facet joint block, medial branch block, and sacroilliac joint block. Initial therapy includes modification of activity, pharmacological analgesic therapy, and education of patients. In patients with chronic low back pain, a multimodal and interdisciplinary treatment approach is necessary. Use of interventional treatments for chronic low back pain are increasing but their utilization remains uncertain or controversial. Therefore, management of patients with chronic and disabling low back pain remains a clinical challenge.
Back Pain
;
Humans
;
Intervertebral Disc
;
Joints
;
Korea
;
Low Back Pain
;
Pain Management
;
Patient Education as Topic
;
Physical Examination
;
Prevalence
;
Public Health
;
Sacroiliac Joint
;
Zygapophyseal Joint
3.Treatment with Epidural Blood Patch for Iatrogenic Intracranial Hypotension after Spine Surgery.
Jaekook KIM ; Sunyeul LEE ; Youngkwon KO ; Wonhyung LEE
Journal of Korean Neurosurgical Society 2012;52(3):254-256
Intracranial hypotension syndrome typically occurs spontaneously or iatrogenically. It can be associated with headache, drowsy mentality and intracranial heamorrhage. Iatrogenic intracranial hypotension can occur due to dural pucture, trauma and spine surgery. Treatment may include conservative therapy and operation. We report a case of a 54-year-old man who was successfully treated with epidural blood patches for intracranial hypotension due to cerebrospinal fluid (CSF) leakage into the lumbosacral area after spine surgery.
Blood Patch, Epidural
;
Headache
;
Humans
;
Intracranial Hypotension
;
Middle Aged
;
Spine
4.Effect of Nalbuphine on Hemdynamic Values and Bispectral Indices during Total Intravenous Anesthesia (TIVA) with Propofol and Remifentanil.
Woosuk CHUNG ; Youngkwon KO ; Heesuk YOON ; Jungun LEE
Korean Journal of Anesthesiology 2007;53(6):S7-S11
BACKGROUND: Remifentanil requires a long acting agent for postoperative pain control, and Nalbuphine, a long acting agonist-antagonist, causes less respiratory depression than pure mu-agonists. However, Nalbuphine can also cause additional distress when used with a pure mu-agonist. Therefore, we evaluated the effects of nalbuphine during TIVA with remifentanil and propofol. METHODS: 56 ASA class I, II adult patients undergoing minor surgery were included in this study. After maintaining BIS values between 40-60 as well as a relatively similar blood pressure (BP) and heart rate (HR) for 20 minutes without changing the target concentrations of anesthesia during surgical procedures, the subjects received either 0.1 ml/kg of normal saline or nalbuphine intravenously. Hemodynamic and BIS variables were then recorded for 20 minutes, during which time the target concentrations were not modified. The BIS values, heart rate, and mean arterial pressure were then compared between groups using t-tests, with a P < 0.05 being considered statistically significant. RESULTS: The mean BIS and HR measured at each interval in the nalbuphine group were not significantly different from those of the control group. However, 10, 15 and 20 minutes after the administration of nalbuphine, the mean systolic BP and the mean arterial BP of the treatment and control groups were significantly different (P < 0.05). In addition, the mean diastolic BP was also significantly different 10 and 20 minutes after the treatment was administered (P < 0.05). Postoperative pain was well controlled and none of the patients reported intraoperative awareness. CONCLUSIONS: Although nalbuphine seems to cause distress, which appeared as an increase in BP, it may still be used in combination with propofol and remifentanil because it did not cause a significant increase in the HR and BIS values.
Adult
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Anesthesia
;
Anesthesia, Intravenous*
;
Arterial Pressure
;
Blood Pressure
;
Heart Rate
;
Hemodynamics
;
Humans
;
Intraoperative Awareness
;
Nalbuphine*
;
Pain, Postoperative
;
Propofol*
;
Respiratory Insufficiency
;
Surgical Procedures, Minor
5.Acute neck pain due to crowned dens syndrome: A case report.
Yeojung KIM ; Youngkwon KO ; Wonhyung LEE ; Yongsup SHIN ; Chan NOH ; Seounghun LEE ; Hyunwoo PARK
Anesthesia and Pain Medicine 2018;13(4):435-438
Crowned dens syndrome (CDS) is a cause of neck pain characterized by calcium deposition in the periodontoid tissues. Clinical features of the syndrome are acute onset of neck pain and headache with fever. Computed tomographic imaging is necessary for diagnosis. The prognosis of CDS is excellent. Symptoms disappear within several weeks and calcifications may be absorbed. We report a case of CDS with acute onset of severe neck pain, facial pain, and pharyngeal pain provoked by swallowing.
Calcium
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Crowns*
;
Deglutition
;
Diagnosis
;
Facial Pain
;
Fever
;
Headache
;
Neck Pain*
;
Neck*
;
Odontoid Process
;
Prognosis
6.Trigeminocardiac reflex: sudden severe bradycardia during open reduction for temporomandibular joint dislocation: A case report
Yeojung KIM ; Youngkwon KO ; Boohwi HONG ; Yongsup SHIN ; Chan NOH ; Seounghun LEE ; Seokhwan HONG
Anesthesia and Pain Medicine 2019;14(3):255-258
BACKGROUND: The trigeminocardiac reflex (TCR), which occurs after stimulation of the territory of the trigeminal nerve, is very rarely reported to be caused by stimulation of the mandibular branch. We report a case of TCR in open reduction for temporomandibular joint (TMJ) dislocation. CASE: A 74-year-old female presented for TMJ dislocation. During open reduction of TMJ under general anesthesia, severe bradycardia (15 beats/min) occurred. Immediately 0.5 mg atropine was administered intravenously, and the surgical manipulation was stopped. After 30 seconds, heart rate normalized. During surgery, severe bradycardia occurred one more time. It disappeared spontaneously as soon as surgical manipulation was stopped. The surgery was completed uneventfully. CONCLUSIONS: Because of the possibility of profound bradycardia, asystole, or even death when evoked, it is important to be aware of the trigeminocardiac reflex during manipulation of the mandibular divisions, especially during surgical stimulation of the TMJ.
Aged
;
Anesthesia, General
;
Atropine
;
Bradycardia
;
Dislocations
;
Female
;
Heart Arrest
;
Heart Rate
;
Humans
;
Reflex, Trigeminocardiac
;
Temporomandibular Joint
;
Trigeminal Nerve
7.Bone regeneration with umbilical cord blood mesenchymal stem cells in femoral defects of ovariectomized rats
Boohwi HONG ; Sunyeul LEE ; Nara SHIN ; Youngkwon KO ; DongWoon KIM ; Jun LEE ; Wonhyung LEE
Osteoporosis and Sarcopenia 2018;4(3):99-105
OBJECTIVES: Current treatments for osteoporosis were prevention of progression, yet it has been questionable in the stimulation of bone growth. The mesenchymal stem cells (MSCs) treatment for osteoporosis aims to induce differentiation of bone progenitor cells into bone-forming osteoblasts. We investigate whether human umbilical cord blood (hUCB)-MSCs transplantation may induce bone regeneration for osteoporotic rat model induced by ovariectomy. METHODS: The ovariectomized (OVX) group (n = 10) and OVX-MSCs group (n = 10) underwent bilateral ovariectomy to induce osteoporosis, while the Sham group (n = 10) underwent sham operation at aged 12 weeks. After a femoral defect was made at 9 months, Sham group and OVX group were injected with Hartmann solution, while the OVX-MSCs group was injected with Hartmann solution containing 1 × 107 hUCB-MSCs. The volume of regenerated bone was evaluated using micro-computed tomography at 4 and 8 weeks postoperation. RESULTS: At 4- and 8-week postoperation, the OVX group (5.0% ± 1.5%; 6.1% ± 0.7%) had a significantly lower regenerated bone volume than the Sham group (8.6% ± 1.3%; 12.0% ± 1.8%, P < 0.01), respectively. However, there was no significant difference between the OVX-MSCs and Sham groups. The OVX-MSCs group resulted in about 53% and 65% significantly higher new bone formation than the OVX group (7.7% ± 1.9%; 10.0% ± 2.9%, P < 0.05). CONCLUSIONS: hUCB-MSCs in bone defects may enhance bone regeneration in osteoporotic rat model similar to nonosteoporotic bone regeneration. hUCB-MSCs may be a promising alternative stem cell therapy for osteoporosis.
Animals
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Bone Development
;
Bone Regeneration
;
Female
;
Fetal Blood
;
Humans
;
Mesenchymal Stem Cell Transplantation
;
Mesenchymal Stromal Cells
;
Models, Animal
;
Osteoblasts
;
Osteogenesis
;
Osteoporosis
;
Ovariectomy
;
Rats
;
Stem Cells
;
Umbilical Cord
8.TWIK-Related Spinal Cord K+ Channel Expression Is Increased in the Spinal Dorsal Horn after Spinal Nerve Ligation.
Hee Youn HWANG ; Enji ZHANG ; Sangil PARK ; Woosuk CHUNG ; Sunyeul LEE ; Dong Woon KIM ; Youngkwon KO ; Wonhyung LEE
Yonsei Medical Journal 2015;56(5):1307-1315
PURPOSE: The TWIK-related spinal cord K+ channel (TRESK) has recently been discovered and plays an important role in nociceptor excitability in the pain pathway. Because there have been no reports on the TRESK expression or its function in the dorsal horn of the spinal cord in neuropathic pain, we analyzed TRESK expression in the spinal dorsal horn in a spinal nerve ligation (SNL) model. MATERIALS AND METHODS: We established a SNL mouse model by using the L5-6 spinal nerves ligation. We used real-time polymerase chain reaction and immunohistochemistry to investigate TRESK expression in the dorsal horn and L5 dorsal rot ganglion (DRG). RESULTS: The SNL group showed significantly higher expression of TRESK in the ipsilateral dorsal horn under pain, but low expression in L5 DRG. Double immunofluorescence staining revealed that immunoreactivity of TRESK was mostly restricted in neuronal cells, and that synapse markers GAD67 and VGlut2 appeared to be associated with TRESK expression. We were unable to find a significant association between TRESK and calcineurin by double immunofluorescence. CONCLUSION: TRESK in spinal cord neurons may contribute to the development of neuropathic pain following injury.
Animals
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Disease Models, Animal
;
Hyperalgesia
;
Ligation
;
Male
;
Neuralgia/*metabolism/physiopathology
;
Neurons/metabolism
;
Nociceptors
;
Pain/metabolism/*physiopathology
;
Potassium Channels/*metabolism
;
Rats
;
Rats, Sprague-Dawley
;
Real-Time Polymerase Chain Reaction
;
Spinal Cord Dorsal Horn/*metabolism
;
Spinal Nerves/*injuries
9.Ultrasound-guided placement of a permanent peripheral nerve stimulator in a patient with complex regional pain syndrome: A case report.
Woosuk CHUNG ; Yohan KIM ; Jiyong LEE ; Sunyul LEE ; Yoonhee KIM ; Yongsup SHIN ; Wonhyung LEE ; Youngkwon KO
Anesthesia and Pain Medicine 2016;11(3):295-298
A 56-year-old man complained of continuous pain in the right foot that began 6 months after undergoing surgery on the right calcaneus bone. The patient was diagnosed with complex regional pain syndrome (CRPS) type I and was treated with medication, lumbar sympathetic ganglion blocks, epidural nerve blocks, and spinal cord stimulation. However, all treatments were halted because they were ineffective or complications developed. Peripheral nerve stimulation (PNS) was planned after confirming the analgesic effects of a sciatic nerve block, and the patient received PNS via minimally invasive ultrasound-guided electrode placement. PNS reduced the pain intensity and the incidence of paroxysmal pain. Other than discomfort at the battery insertion site (resolved with re-implantation), the patient developed no complications. These results suggest that ultrasound-guided minimally invasive PNS is a safe and effective treatment for patients with CRPS in the lower extremities.
Calcaneus
;
Complex Regional Pain Syndromes
;
Electrodes
;
Foot
;
Ganglia, Sympathetic
;
Humans
;
Implantable Neurostimulators
;
Incidence
;
Lower Extremity
;
Middle Aged
;
Nerve Block
;
Neuralgia
;
Pain Management
;
Peripheral Nerves*
;
Sciatic Nerve
;
Spinal Cord Stimulation
;
Ultrasonography
10.A retrospective comparison for prediction of optimal length of right subclavian vein catheterization in infants: landmark-based estimation vs. linear regression model
Chahyun OH ; Boohwi HONG ; Yumin JO ; Woosuk CHUNG ; Hoseop KIM ; Suyeon SHIN ; Ah Young CHOI ; Chaeseong LIM ; Youngkwon KO ; Yoon-Hee KIM ; Sun Yeul LEE
Anesthesia and Pain Medicine 2021;16(3):258-265
Background:
The optimal insertion length for right subclavian vein catheterization in infants has not been determined. This study retrospectively compared landmark-based and linear regression model-based estimation of optimal insertion length for right subclavian vein catheterization in pediatric patients of corrected age < 1 year.
Methods:
Fifty catheterizations of the right subclavian vein were analyzed. The landmark related distances were: from the needle insertion point (I) to the tip of the sternal head of the right clavicle (A) and from A to the midpoint (B) of the perpendicular line drawn from the sternal head of the right clavicle to the line connecting the nipples. The optimal length of insertion was retrospectively determined by reviewing post-procedural chest radiographs. Estimates using a landmark-based equation (IA + AB – intercept) and a linear regression model were compared with the optimal length of insertion.
Results:
A landmark-based equation was determined as IA + AB – 5. The mean difference between the landmark-based estimate and the optimal insertion length was 1.0 mm (95% limits of agreement –18.2 to 20.3 mm). The mean difference between the linear regression model (26.681 – 4.014 × weight + 0.576 × IA + 0.537 × AB – 0.482 × postmenstrual age) and the optimal insertion length was 0 mm (95% limits of agreement –16.7 to 16.7 mm). The difference between the estimates using these two methods was not significant.
Conclusion
A simple landmark-based equation may be useful for estimating optimal insertion length in pediatric patients of corrected age < 1 year undergoing right subclavian vein catheterization.