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Burn Wound along the Guide Needle Trajectory as a Complication of Radiofrequency Neurotomy of the Lumbar Medial Branch: A case report.

Hong Jun YOUN ; Jae Chol SHIM

The Korean Journal of Pain.2006;19(2):257-260. doi:10.3344/kjp.2006.19.2.257

Radiofrequency neurotomy of the lumbar medial branch, via a caudal approach, is a representative interventional procedure for lumbar zygapophysial joint pain, which can be performed more accurately and easily using a guide needle technique. We experienced a case of burn wound formation along the guide needle trajectory, where heat conduction through the guide needle was suggested to have resulted in the burn wound.
Arthralgia ; Burns* ; Hot Temperature ; Needles* ; Wounds and Injuries*

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Percutaneous Cervical Discectomy using Dekompressor(R) to the Patient with Posterolateral Extrusion Disc: A case report.

Daehyun JO ; Sangjin KIM ; Myounghee KIM

The Korean Journal of Pain.2006;19(2):253-256. doi:10.3344/kjp.2006.19.2.253

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

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Clinical Experience of Pain Management for Postlaminectomy Syndrome due to Pseudomeningocele: A case report.

Hye Ran CHO ; Sang Ji HAN ; Sang Chul PARK ; Young Eun KWON ; Jun Hak LEE

The Korean Journal of Pain.2006;19(2):249-252. doi:10.3344/kjp.2006.19.2.249

Postlaminectomy syndrome is characterized by persistent low back pain and radiculopathy of the legs after surgery of the spine. Pseudomeningocele is an uncommon cause of postlaminectomy syndrome; it is characterized by an extradural collection of cerebrospinal fluid (CSF) without dural covering, resulting from unrecognized dural tears at the time of lumbar surgery. In most cases, surgery to repair a pseudomeningocele is recommended. However if surgical treatment does not yield symptomatic relief, then conservative treatment should be considered. We treated a patient with a pseudomeningocele after spine surgery in which selective transforaminal epidural block produced long-term relief of symptoms. Here we describe the management of this patient.
Cerebrospinal Fluid ; Humans ; Leg ; Low Back Pain ; Pain Management* ; Radiculopathy ; Spine

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Third Occipital Nerve Radiofrequency Neurotomy with Radiologic Open Mouth View: A case report.

Jung Ju PARK ; Mi Ae JUNG ; Jae Chol SHIM

The Korean Journal of Pain.2006;19(2):244-248. doi:10.3344/kjp.2006.19.2.244

Radiofrequency lesioning is a valuable tool for third occipital headache. Relative to most neural targets, a radiofrequency lesion is very small. Reliable pre-operative diagnosis of the nociceptive source is critical, as inappropriately placed lesions will not modulate pain. Knowledge of the anatomical courses of nerves and extremely precise electrode placement are required for accurate lesioning. This report describes our experience with RF lesioning in the treatment of chronic pain in two patients who suffered from third occipital headaches. In one patient, satisfactory improvement of the pain was observed after 10 months of follow up.
Chronic Pain ; Diagnosis ; Electrodes ; Follow-Up Studies ; Headache ; Humans ; Mouth*

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Improvement of Spinal Central Pain by Brachial Plexus Block: A case report.

Ok Sun KIM ; Woo Yong LEE ; Byung Hoon YOO ; Yun Hee LIM ; Seung Oh KIM

The Korean Journal of Pain.2006;19(2):241-243. doi:10.3344/kjp.2006.19.2.241

Central pain is defined as pain associated with lesions of the central nervous system, and is among the most intractable of chronic pain syndromes. A 47 year-old-female, who had right arm and shoulder pain, was diagnosed with syringomyelia of the Arnold Chiari malformation type I and received foramen magnum decompression and a syringo-subarachnoid shunt. After the operation, the evoked pain was improved, but she complained of a continuous burning pain, coupled with cold and tactile allodynia. This symptom failed to fully subside on administration of oral medicine; therefore, brachial plexus block was performed, which relieved her pain transiently. Through repeated trials, a gradual decrease in the pain intensity and frequency was found. However, the way in which brachial plexus block improves spinal central pain is not completely known.
Arm ; Arnold-Chiari Malformation ; Brachial Plexus* ; Burns ; Central Nervous System ; Chronic Pain ; Decompression ; Foramen Magnum ; Hyperalgesia ; Oral Medicine ; Shoulder Pain ; Syringomyelia

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Lumbar Sympathetic Block for Spinal Cord Infarction Patient: A case report.

Dong Hee KIM ; Sang Wook PARK ; Hyung Jee KIM

The Korean Journal of Pain.2006;19(2):237-240. doi:10.3344/kjp.2006.19.2.237

This report describes a case of spinal cord infarction after acupuncture. The patient was treated with lumbar sympathetic block with using C-arm fluoroscopy. A 66-year-old patient with chronic low back pain and radiating pain in the lower limb was treated with acupuncture and he suddenly had a loss of motor and sensory of both lower extremities. His clinical presentaion and neuroimaging studies were consistent with spinal cord infarction. He was treated with steroid megatherapy and he showed improved in motor function, but there was no pain relief despite the phamacological treatments that were combined with caudal blockade. He visited to our hospital and had lumbar sympathetic blockade performed. The pain was relieved without any related complication after 1 month (VAS 9/10 --> 2/10), and he has been content with the results of treatment.
Acupuncture ; Aged ; Fluoroscopy ; Humans ; Infarction* ; Low Back Pain ; Lower Extremity ; Neuroimaging ; Spinal Cord*

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The Trial of Continuous Intravenous Infusion of Ketamine in Patients with Phantom Limb Pain: A case report.

Yong Kwan CHEONG ; Cheol LEE ; Yong SON ; Yoon Kang SONG ; Tai Yo KIM ; Seung Woo LEE

The Korean Journal of Pain.2006;19(2):233-236. doi:10.3344/kjp.2006.19.2.233

Phantom limb pain is a painful sensation from an absent limb. The onset of pain is generally early, with 75% of patients developing pain within the first few days after amputation. The frequency and duration of attacks tend to be reduced with time, although the prevalence and intensity remain constant. We report here a case of a 38-year-old man who exhibited the signs and symptoms of phantom limb pain due to the above-knee amputations of both legs. He was not responded to opioid therapy and a continuous intravenous infusion of ketamine, an N-methyl-D-aspatate receptor antagonist, reduced his severe pain.
Adult ; Amputation ; Extremities ; Humans ; Infusions, Intravenous* ; Ketamine* ; Leg ; Phantom Limb* ; Prevalence ; Sensation

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The Sphenopalatine Ganglion Radiofrequency Thermocoagulation on a Patient of CRPS with Facial Pain and Pruritus:A report of 2 cases.

Seung Jae PARK ; Dong Eon MOON ; Won Young KIM ; Jung Ju PARK ; Eun Jeong CHO ; Suk Woo YANG

The Korean Journal of Pain.2006;19(2):228-232. doi:10.3344/kjp.2006.19.2.228

Complex regional pain syndrome (CRPS) type 1 is characterized by the presence of pain, which is severe, diffuse and associated with allodynia, and is also associated with autonomic and trophic changes. The sensitization phenomena of CRPS also cause allodynia and itching, as well as pain. These symptoms are the issues associated with the treatment of CRPS. Under normal conditions, an antagonistic interaction exists between the pain and itching, but the patterns of peripheral and central sensitization phenomena for the pain and itching are very similar. The chronic pain and chronic itch have similar characteristics in their developmental and therapeutical principles. Herein, our experience of 2 cases of CRPS, which showed improvement of these facial symptoms after sphenopalatine ganglion radiofrequency thermocoagulation, but were not controlled by spinal cord stimulation or other conservative treatments, is reported.
Central Nervous System Sensitization ; Chronic Pain ; Electrocoagulation* ; Facial Pain* ; Ganglion Cysts* ; Humans ; Hyperalgesia ; Pruritus ; Spinal Cord Stimulation

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Is Early Spinal Cord Stimulation in Patients with Complex Regional Pain Syndrome Necessary?: A case report.

Hyoung Ki MIN ; Kyung Ream HAN ; Sang Eun LEE ; Kyoung Tae KIM ; Chan KIM

The Korean Journal of Pain.2006;19(2):223-227. doi:10.3344/kjp.2006.19.2.223

Complex regional pain syndrome (CRPS) is clinically characterized by pain, abnormal regulation of blood flow and sweating, edema of skin and subcutaneous tissues, sensory and motor disturbances, and trophic changes of the skin. A 21-year-old man was suffering from pain and swelling in his right hand and forearm. His arm had been in splints for 3 weeks following an extension injury of the right fingers and wrist, with the pain having developed 2 weeks after the splinting. He was treated with various nerve blocks including continuous epidural infusion, thoracic sympathetic block and peripheral nerve blocks, and squeezing his edematous region under general anesthesia as well as intravenous lidocaine and ketamine infusions. However, all of the performed treatments had no effect on the patient's pain or hand swelling. As a next line therapy, spinal cord stimulation should be considered because of intractable severe pain and swelling to almost all other modalities of therapy. We therefore performed an early intervention of spinal cord stimulation for the patient with refractory CRPS type I 5 months after the onset of pain and have got an excellent result.
Anesthesia, General ; Arm ; Early Intervention (Education) ; Edema ; Fingers ; Forearm ; Hand ; Humans ; Ketamine ; Lidocaine ; Nerve Block ; Peripheral Nerves ; Skin ; Spinal Cord Stimulation* ; Spinal Cord* ; Splints ; Subcutaneous Tissue ; Sweat ; Sweating ; Wrist ; Young Adult

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Perioperative Pain Management in the Patient with Complex Regional Pain Syndrome: A case report.

Ji Yon JO ; Mi Geum LEE ; Hyo Min LEE ; Yun Suk CHOI ; Hey Jeong YUN ; Chul Joong LEE ; Sang Chul LEE ; Yong Chul KIM

The Korean Journal of Pain.2006;19(2):218-222. doi:10.3344/kjp.2006.19.2.218

Complex regional pain syndrome (CRPS) is a syndrome of pain and sudomotor or vasomotor instabilities. The perioperative pain management in CRPS patients is very important, as surgery can aggravate preexisting symptoms, especially when performed around the lesion site. Despite the increasing interest in CRPS research, little is known about the optimal perioperative treatment strategy for CRPS patients. Herein, the case of a female CRPS patient, who underwent elective surgery at the lesion site, is reported. As a preemptive analgesia, the patient was satisfactorily managed with two weeks of patient-controlled epidural analgesia, initiated 2 days prior to surgery. The techniques for the prevention of perioperative pain, including preemptive analgesia, as well as its importance, are discussed.
Analgesia ; Analgesia, Epidural ; Female ; Humans ; Pain Management*

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