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A Case of Occipital Neuralgia in the Greater and Lesser Occipital Nerves Treated with Neurectomy by Using Transcranial Doppler Sonography: Technical Aspects.

Sang Jin JUNG ; Seong Keun MOON ; Tae Young KIM ; Ki Seong EOM

The Korean Journal of Pain.2011;24(1):48-52. doi:10.3344/kjp.2011.24.1.48

Occipital neuralgia is usually defined as paroxysmal stabbing pain in the greater or lesser occipital nerve (GON or LON) distribution. In occipital neuralgia patients, surgical considerations are carefully taken into account if medical management is ineffective. However, identification of the occipital artery by palpation in patients with thick necks or small occipital arteries can be technically difficult. Therefore, we established a new technique using transcranial Doppler (TCD) sonography for more accurate and rapid identification. The patient was a 64-year-old man who had undergone C1-C3 screw fixation and presented with intractable stabbing pain in the bilateral GON and LON distributions. In cases in which pain management was performed using medication, physical therapy, nerve block, or radiofrequency thermocoagulation, substantial pain relief was not consistently achieved, and recurrence of pain was reported. Therefore, we performed occipital neurectomy of the bilateral GON and LON by using TCD sonography, which helped detect the greater occipital artery easily. After the operation, the patient's headache disappeared gradually, although he had discontinued all medication except antidepressants. We believe that this new technique of occipital neurectomy via a small skin incision performed using TCD sonography is easy and reliable, has a short operative time, and provides rapid pain relief.
Antidepressive Agents ; Arteries ; Electrocoagulation ; Headache ; Humans ; Middle Aged ; Neck ; Nerve Block ; Neuralgia ; Operative Time ; Pain Management ; Palpation ; Recurrence ; Skin ; Ultrasonography, Doppler, Transcranial

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Epidural Catheter Malposition in a Failed Epidural Anesthesia Confirmed by Computed Tomography.

Se Jin LEE ; Sang Ho KIM ; Sun Young PARK ; Mun Gyu KIM ; Bo Il JUNG ; Si Young OK

The Korean Journal of Pain.2011;24(1):44-47. doi:10.3344/kjp.2011.24.1.44

We report a case of failed epidural anesthesia despite successful identification of the epidural space, loss of resistance technique, hanging drop method and drip infusion. This case evaluated the use of computed tomography to confirm epidural catheter position, which showed the catheter accidentally positioned at the T2 lamina. Because epidural anesthesia can even after successful procedure using standardized techniques such as loss of resistance, we recommend performing the procedure under fluoroscopic guidance to improve success rate and patient safety.
Anesthesia, Epidural ; Catheters ; Epidural Space ; Infusions, Intravenous ; Patient Safety

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The Results of Cervical Nucleoplasty in Patients with Cervical Disc Disorder: A Retrospective Clinical Study of 22 Patients.

Sung Eun SIM ; Eun Sung KO ; Duk Kyung KIM ; Hae Kyoung KIM ; Yong Chul KIM ; Hwa Yong SHIN

The Korean Journal of Pain.2011;24(1):36-43. doi:10.3344/kjp.2011.24.1.36

BACKGROUND: Nucleoplasty is a minimally invasive spinal surgery using a Coblation(R) technique that creates small voids within the disc. The purpose of this study was to evaluate the efficacy of cervical nucleoplasty in patients with cervical disc disorder. METHODS: Between March 2008 and December 2009, 22 patients with cervical disc disorders were treated with cervical nucleoplasty after failed conservative treatment. All procedures were performed under local anesthesia, and fluoroscopic guidance and voids were created in the disc with the Perc(TM) DC Spine Wand(TM). Clinical outcomes were evaluated by the Modified Macnab criteria and VAS score at preprocedure, postprocedure 1 month, and 6 months. RESULTS: Six patients had one, eight patients had two and eight patients had three discs treated; a total of 46 procedures was performed. Mean VAS reduced from 9.3 at preprocedure to 3.7 at postprocedure 1 month and to 3.4 at postprocedure 6 months. There was no significant complication related to the procedure within the first month. Outcomes were good or excellent in 17/22 (77.3%) cases. Postprocedure magnetic resonance imaging was acquired in two patients after two months showing morphologic evidence of volume reduction of protruded disc material in one patient but not in the other. CONCLUSIONS: Percutaneous decompression with a nucleoplasty using a Coblation(R) technique in the treatment of cervical disc disorder is a safe, minimally-invasive and less uncomfortable procedure, with an excellent short-term clinical outcome.
Anesthesia, Local ; Decompression ; Diskectomy ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Spine

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Comparison of Postoperative Analgesic Efficacy of Caudal Block versus Dorsal Penile Nerve Block with Levobupivacaine for Circumcision in Children.

Serbulent Gokhan BEYAZ

The Korean Journal of Pain.2011;24(1):31-35. doi:10.3344/kjp.2011.24.1.31

BACKGROUND: Circumcision is a painful intervention frequently performed in pediatric surgery. We aim to compare the efficacy of caudal block versus dorsal penile block (DPNB) under general anesthesia for children undergoing circumcision. METHODS: This study was performed between July 1, 2009 and October 16, 2009. Fifty male children American Society of Anesthesiolgists physical status classification I, aged between 3 and 12 were included in this randomized, prospective, comparative study. Anesthetic techniques were standardized for all children. Patients were randomized into 2 groups. Using 0.25% 0.5 ml/kg levobupivacain, we performed DPNB for Group 1 and caudal block for Group 2. Postoperative analgesia was evaluated for six hours with the Flacc Pain Scale for five categories; (F) Face, (L) Legs, (A) Activity, (C) Cry, and (C) Consolability. For every child, supplemental analgesic amounts, times, and probable local or systemic complications were recorded. RESULTS: No significant difference between the groups (P > 0.05) was found in mean age, body weight, anesthesia duration, FLACC pain, and sedation scores (P > 0.05). However, on subsequent measurements, a significant decrease of pain and sedation scores was noted in both the DPNB group and the caudal block group (P < 0.001). No major complication was found when using either technique. CONCLUSIONS: DPNB and caudal block provided similar postoperative analgesic effects without major complications for children under general anesthesia.
Aged ; Analgesia ; Anesthesia ; Anesthesia, General ; Body Weight ; Bupivacaine ; Child ; Circumcision, Male ; Female ; Humans ; Leg ; Male ; Prospective Studies ; Pudendal Nerve

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A Randomised, Placebo-controlled Trial of the Effects of Preoperative Pregabalin on Pain Intensity and Opioid Consumption following Lumbar Discectomy.

Dominic A HEGARTY ; George D SHORTEN

The Korean Journal of Pain.2011;24(1):22-30. doi:10.3344/kjp.2011.24.1.22

BACKGROUND: Pregabalin has been shown to have analgesic effect in acute pain models. The primary objective was to examine the efficacy a single dose of pregabalin, would have on morphine consumption following lumbar discectomy. METHODS: With ethical approval a randomized, placebo-controlled prospective trial was undertaken in 32 patients (ASA I-II, 18-65 years) with radicular low back pain for > 3 months undergoing elective lumbar discectomy. Patients received either oral pregabalin 300 mg (PG Group) or placebo (C Group) one hour before surgery. Pain intensity, the accumulative morphine consumption and adverse effects were recorded for 24 hours following surgery. Functional, psychological and quantitative sensory testing were also assessed. RESULTS: Fourteen patients out of the 32 recruited were randomized to receive pregabalin. Morphine consumption was reduced (absolute difference of 42.3%) between groups with medium effect size. (Mann-Whitney; U = 52.5, z-score= 2.84, P = 0.004, r = 0.14). This was not associated with a significant difference in the incidence of adverse effects between the two groups. The median pain intensity (VAS) on movement was not significantly different between groups. CONCLUSIONS: A single pre-operative dose of pregabalin (300 mg) did not result in a reduction in pain intensity compared to placebo in this patient cohort but the significant reduction in morphine consumption suggests that a fixed peri-operative dosing regime warrants investigation.
Acute Pain ; Cohort Studies ; Diskectomy ; gamma-Aminobutyric Acid ; Humans ; Incidence ; Low Back Pain ; Morphine ; Prospective Studies ; Pregabalin

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Daily Functioning in Chronic Pain: Study of Structural Relations with Posttraumatic Stress Disorder Symptoms, Pain Intensity, and Pain Avoidance.

Sung Kun CHO ; Elaine M HEIBY ; Lance M MCCRACKEN ; Dong Eon MOON ; Jang Han LEE

The Korean Journal of Pain.2011;24(1):13-21. doi:10.3344/kjp.2011.24.1.13

BACKGROUND: This study aimed to evaluate processes from the mutual maintenance model in relation to daily functioning in patients with both chronic pain and a history of a traumatic experience. The mechanism illustrated the structural relations for daily functioning among pain intensity, hyperarousal, re-experiencing, trauma avoidance, and pain avoidance. METHODS: Archival data (N = 214) was used for this study and data were analyzed for 142 chronic pain patients reporting a traumatic experience and seeking treatment at a tertiary pain clinic in Korea. RESULTS: The results indicated that pain intensity, hyperarousal, and pain avoidance had significant direct effects on daily functioning. Also, pain intensity showed significant indirect effects on daily functioning through hyperarousal and pain avoidance; and hyperarousal through pain avoidance. CONCLUSIONS: Results suggest a direct contribution of high levels of pain, hyperarousal symptoms of PTSD, and pain avoidance behaviors to reduced daily functioning. Also, elevated pain as reminders of the trauma may trigger high levels of hyperarousal symptoms of PTSD. Subsequently, avoidant coping strategies may be used to minimize pain so that the trauma would not be re-experienced, thus inhibiting the activation of hyperarousal symptoms of PTSD. However, prolonged use of such strategies may contribute to decline in daily functioning.
Chronic Pain ; Humans ; Pain Clinics ; Stress Disorders, Post-Traumatic

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The Effects of Intraoperative Adenosine Infusion on Acute Opioid Tolerance and Opioid Induced Hyperalgesia Induced by Remifentanil in Adult Patients Undergoing Tonsillectomy.

Cheol LEE ; Yoon Kwang SONG ; Ju Hwan LEE ; Soo Mi HA

The Korean Journal of Pain.2011;24(1):7-12. doi:10.3344/kjp.2011.24.1.7

BACKGROUND: Adenosine has been shown to have a wide spectrum of unique pain-relieving effects in various clinical situations. The aim of this study was to investigate the effects of intraoperative adenosine infusion on acute opioid tolerance and opioid induced hyperalgesia induced by remifentanil in adult patients undergoing tonsillectomy. METHODS: For this study, ninety patients were randomly allocated into groups that receive either adenosine (adenosine group) or saline (remifentnail group) intravenously under remifentanil based anesthesia and saline (sevoflurane group) under sevoflurane anesthesia. The patients in adenosine group received adenosine at dose of 80 microg/kg/min, and those in remifentnail group and sevoflurane group received an equal volume of saline 10 minutes after the induction of anesthesia until the end of surgery. Intraoperative evaluation included time weighted mean remifentanil dose, and postoperative evaluations included degree of pain severity at 1, 6, 12, and 24 hours, time to first postoperative requirement, and analgesic dose required during 24 hours after operation. RESULTS: Time weighted mean remifentanil dose during intraoperative period in adenosine group was significantly lower than that of remifentnail group (P = 0.00). The first postoperative analgesic were required earlier in remifentanil group than sevoflurane group or adenosine group (P = 0.00). Pethidine requirement during 24 hours in sevoflurane group and adenosine group was significantly lower than that of remifentnail group (P = 0.00). The visual analog scale scores for pain in sevoflurane group and adenosine group were significantly lower than those of remifentnail group for 12 hours after operation (P = 0.00). Incidence of hypotension (P = 0.024) and number of ephedrine administered (P = 0.011) in adenosine group were significantly higher than those of sevoflurane group. CONCLUSIONS: The above results suggest that intraoperative adenosine infusion prevent acute opioid tolerance and opioid induced hyperalgesia induced by remifentanil.
Adenosine ; Adult ; Anesthesia ; Ephedrine ; Humans ; Hyperalgesia ; Hypotension ; Incidence ; Intraoperative Period ; Meperidine ; Methyl Ethers ; Piperidines ; Tonsillectomy

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Application of Botulinum Toxin in Pain Management.

Woo Seog SIM

The Korean Journal of Pain.2011;24(1):1-6. doi:10.3344/kjp.2011.24.1.1

Botulinum toxin has been used for the treatment of many clinical disorders by producing temporary skeletal muscle relaxation. In pain management, botulinum toxin has demonstrated an analgesic effect by reducing muscular hyperactivity, but recent studies suggest this neurotoxin could have direct analgesic mechanisms different from its neuromuscular actions. At the moment, botulinum toxin is widely investigated and used in many painful diseases such as myofascial syndrome, headaches, arthritis, and neuropathic pain. Further studies are needed to understand the exact analgesic mechanisms, efficacy and complications of botulinum toxin in chronic pain disorders.
Arthritis ; Botulinum Toxins ; Chronic Pain ; Headache ; Muscle, Skeletal ; Neuralgia ; Pain Management ; Relaxation

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Pulsed Radiofrequency Treatment of Pain Relieving Point in a Soft Tissue.

Jeong Soo LEE ; Kyung Bong YOON ; In Ki KIM ; Duck Mi YOON

The Korean Journal of Pain.2011;24(1):57-60. doi:10.3344/kjp.2011.24.1.57

Pulsed radiofrequency (PRF) treatment of nervous tissue has been proposed as a less neurodestructive technique alternative to continuous RF heat lesioning. Recently, clinical reports using PRF have shown favorable effects in the treatment of a variety of focal pain areas, even in non-nervous tissues; however, the mechanism of effect underlying this treatment to non-nervous tissue remains unclear. We report the case of a 67-year-old male who presented with pain reliving point in the posterior neck. The patient had pain in the posterior neck for 3 years. The pain subsided with pressure applied to a point in the posterior neck. There were no specific abnormal findings on laboratory testing and radiologic examinations. After PRF treatment to the pain-relieving point, he had pain relief which lasted more than 5 months.
Aged ; Hot Temperature ; Humans ; Male ; Neck ; Pulsed Radiofrequency Treatment

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Relief of Postherpetic Neuralgia with Transforaminal Epidural Injection of Magnesium: A Case Report.

Ho Kyoung YU ; Joon Ho LEE ; Sung Hwan CHO ; Yong Ik KIM

The Korean Journal of Pain.2011;24(1):53-56. doi:10.3344/kjp.2011.24.1.53

Although postherpetic neuralgia (PHN) is a common chronic pain syndrome, the pathophysiology of this disorder is not well known and management is often very difficult. N-Methyl-D-Aspartate (NMDA) receptor antagonists are known to be effective in PHN, and magnesium, a physiological blocker of NMDA receptors, is widely used to treat various chronic pain disorders. Here, we present a case of the PHN refractory to conventional treatment, which was treated successfully with transforaminal epidural injection of magnesium sulphate at the affected dermatome.
Chronic Pain ; Injections, Epidural ; Magnesium ; N-Methylaspartate ; Neuralgia, Postherpetic ; Receptors, N-Methyl-D-Aspartate

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