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Comparison of intrathecal versus intra-articular dexmedetomidine as an adjuvant to bupivacaine on postoperative pain following knee arthroscopy: a randomized clinical trial.

Eman A ISMAIL ; Jehan A SAYED ; Mohamed H BAKRI ; Reda Z MAHFOUZ

The Korean Journal of Pain.2017;30(2):134-141. doi:10.3344/kjp.2017.30.2.134

BACKGROUND: Postoperative pain is a common, distressing symptom following arthroscopic knee surgery. The aim of this study was to compare the potential analgesic effect of dexmedetomidine after intrathecal versus intra-articular administration following arthroscopic knee surgery. METHODS: Ninety patients undergoing unilateral elective arthroscopic knee surgery were randomly assigned into three groups in a double-blind placebo controlled study. The intrathecal dexmedetomidine group (IT) received an intrathecal block with intrathecal dexmedetomidine, the intra-articular group (IA) received an intrathecal block and intra-articular dexmedetomidine, and the control group received an intrathecal block and intra-articular saline. The primary outcome of our study was postoperative pain as assessed by the visual analogue scale of pain (VAS). Secondary outcomes included the effect of dexmedetomidine on total postoperative analgesic use and time to the first analgesic request, hemodynamics, sedation, postoperative nausea and vomiting, patient satisfaction, and postoperative C-reactive protein (CRP) levels. RESULTS: Dexmedetomidine administration decreased pain scores for 4 h in both the intrathecal and intra-articular groups, compared to only 2 h in the control patient group. Furthermore, there was a significant reduction in pain scores for 6 h in the intra-articular group. The time to the first postoperative analgesia request was longer in the intra-articular group compared to the intrathecal and control groups. The total meperidine requirement was significantly lower in the intra-articular and intrathecal groups than in the control group. CONCLUSIONS: Both intrathecal and intra-articular dexmedetomidine enhanced postoperative analgesia after arthroscopic knee surgery. Less total meperidine was required with intra-articular administration to extend postoperative analgesia to 6 h with hemodynamic stability.
Analgesia ; Arthroscopy* ; Bupivacaine* ; C-Reactive Protein ; Dexmedetomidine* ; Hemodynamics ; Humans ; Knee* ; Meperidine ; Pain, Postoperative* ; Patient Satisfaction ; Postoperative Nausea and Vomiting

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The relationship between the development of musculoskeletal disorders, body mass index, and academic stress in Bahraini University students.

Sayed A TANTAWY ; Asma ABDUL RAHMAN ; Maryam ABDUL AMEER

The Korean Journal of Pain.2017;30(2):126-133. doi:10.3344/kjp.2017.30.2.126

BACKGROUND: There are many mechanisms in which stress can lead to weight gain thus high a BMI. The endocrine and inflammatory pathway can directly increase abdominal adiposity. Another way in which stress leads to weight gain is through changes in health behaviors. The study aimed to investigate the prevalence of musculoskeletal disorders (MSDs) among healthy students of Ahlia University, and to determine the relationship between the development of MSDs and academic stressors and body mass index. METHODS: Self-administered questionnaires were distributed to 94 students aged 18-26 years who were enrolled at various Ahlia University colleges and met other inclusion criteria. The students responded to the standardized Nordic musculoskeletal questionnaire and the modified College Student Stress Inventory regarding musculoskeletal symptoms and academic stressors. Height and weight measurements were also obtained to determine body mass index. RESULTS: A total of 77.66% reported MSDs in one or more body part, with the prevalence being higher among women than among men. The 7-day prevalence of MSDs severe enough to interfere with activities of daily living was 60.64%, and 44.68% by female and male students, respectively. There was a significant relationship between academic stress and MSDs in the neck, shoulders, lower back, and hips, while the relationship between MSDs, and body mass index, academic stress, and grade point average was not significant. CONCLUSIONS: The prevalence of MSDs among Ahlia University students was found to be high. Apart from the positive correlation between academic stress and MSDs in certain body parts, other correlations were not significant.
Activities of Daily Living ; Adiposity ; Body Mass Index* ; Female ; Health Behavior ; Hip ; Human Body ; Humans ; Male ; Musculoskeletal Diseases ; Neck ; Pain Measurement ; Prevalence ; Shoulder ; Stress, Psychological ; Weight Gain

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Sufficient explanation of management affects patient satisfaction and the practice of post-treatment management in spinal pain, a multicenter study of 1007 patients.

Jae Yun KIM ; Jae Hang SHIM ; Sung Jun HONG ; Jong Yeun YANG ; Hey Ran CHOI ; Yun Hee LIM ; Ho Sik MOON ; Jaemoon LEE ; Jae Hun KIM

The Korean Journal of Pain.2017;30(2):116-125. doi:10.3344/kjp.2017.30.2.116

BACKGROUND: Spinal pain is most common symptom in pain clinic. In most cases, before the treatment of spinal pain, physician explains the patient's disease and treatment. We investigated patient's satisfaction and physician's explanation related to treatments in spinal pain patients by questionnaires. METHODS: Anonymous questionnaires about physician's explanation and patient's satisfaction in each treatment and post-treatment management were asked to individuals suffering from spinal pain. Patients who have spinal pain were participated in our survey of nationwide university hospitals in Korea. The relationships between patient's satisfaction and other factors were analyzed. RESULTS: Between June 2016 and August 2016, 1007 patients in 37 university hospitals completed the questionnaire. In the statistical analysis, patient's satisfaction of treatment increased when pain severity was low or received sufficient preceding explanation about nerve block and medication (P < 0.01). Sufficient explanation increased patient's necessity of a post-treatment management and patients' performance rate of post-treatment management (P < 0.01). CONCLUSIONS: These results show that sufficient explanation increased patients' satisfaction after nerve block and medication. Sufficient explanation also increased the practice of patients' post-treatment management.
Anonyms and Pseudonyms ; Hospitals, University ; Humans ; Korea ; Nerve Block ; Pain Clinics ; Patient Satisfaction*

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The radiation safety education and the pain physicians' efforts to reduce radiation exposure.

Tae Hee KIM ; Seung Wan HONG ; Nam Sik WOO ; Hae Kyoung KIM ; Jae Hun KIM

The Korean Journal of Pain.2017;30(2):104-115. doi:10.3344/kjp.2017.30.2.104

BACKGROUND: C-arm fluoroscopy equipment is important for interventional pain management and can cause radiation injury to physicians and patients. We compared radiation safety education and efforts to reduce the radiation exposure of pain specialists. METHODS: A survey of 49 pain specialists was conducted anonymously in 2016. The questionnaire had 16 questions. That questionnaire was about radiation safety knowledge and efforts to reduce exposure. We investigated the correlation between radiation safety education and efforts of radiation protection. We compared the results from 2016 and a published survey from 2011. RESULTS: According to the 2016 survey, all respondents used C-arm fluoroscopy in pain interventions. Nineteen respondents (39%) had received radiation safety education. Physicians had insufficient knowledge about radiation safety. When the radiation safety education group and the non-education group are compared, there was no significant difference in efforts to reduce radiation exposure and radiation safety knowledge. When the 2011 and 2016 surveys were compared, the use of low dose mode (P = 0.000) and pulsed mode had increased significantly (P = 0.001). The number checking for damage to radiation protective garments (P = 0.000) and use of the dosimeter had also increased significantly (P = 0.009). But there was no significant difference in other efforts to reduce radiation exposure. CONCLUSIONS: Pain physicians seem to lack knowledge of radiation safety and the number of physicians receiving radiation safety education is low. According to this study, education does not lead to practice. Therefore, pain physicians should receive regular radiation safety education and the education should be mandatory.
Anonyms and Pseudonyms ; Clothing ; Education* ; Fluoroscopy ; Humans ; Pain Management ; Radiation Exposure* ; Radiation Injuries ; Radiation Protection ; Specialization ; Surveys and Questionnaires

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Antinociceptive effect of intrathecal sec-O-glucosylhamaudol on the formalin-induced pain in rats.

Sang Hun KIM ; Hwa Song JONG ; Myung Ha YOON ; Seon Hee OH ; Ki Tae JUNG

The Korean Journal of Pain.2017;30(2):98-103. doi:10.3344/kjp.2017.30.2.98

BACKGROUND: The root of Peucedanum japonicum Thunb., a perennial herb found in Japan, the Philippines, China, and Korea, is used as an analgesic. In a previous study, sec-O-glucosylhamaudol (SOG) showed an analgesic effect. This study was performed to examine the antinociceptive effect of intrathecal SOG in the formalin test. METHODS: Male Sprague-Dawley rats were implanted with an intrathecal catheter. Rats were randomly treated with a vehicle and SOG (10 µg, 30 µg, 60 µg, and 100 µg) before formalin injection. Five percent formalin was injected into the hind-paw, and a biphasic reaction followed, consisting of flinching and licking behaviors (phase 1, 0–10 min; phase 2, 10–60 min). Naloxone was injected 10 min before administration of SOG 100 µg to evaluate the involvement of SOG with an opioid receptor. Dose-responsiveness and ED50 values were calculated. RESULTS: Intrathecal SOG showed a significant reduction of the flinching responses at both phases in a dose-dependent manner. Significant effects were showed from the dose of 30 µg and maximum effects were achieved at a dose of 100 µg in both phases. The ED50 value (95% confidence intervals) of intrathecal SOG was 30.3 (25.8–35.5) µg during phase 1, and 48.0 (41.4–55.7) during phase 2. The antinociceptive effects of SOG (100 µg) were significantly reverted at both phases of the formalin test by naloxone. CONCLUSIONS: These results demonstrate that intrathecal SOG has a very strong antinociceptive effect in the formalin test and it seems the effect is related to an opioid receptor.
Analgesia ; Animals ; Catheters ; China ; Formaldehyde ; Humans ; Japan ; Korea ; Male ; Naloxone ; Nociception ; Pain Measurement ; Philippines ; Rats* ; Rats, Sprague-Dawley ; Receptors, Opioid

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Sphenopalatine ganglion block for relieving postdural puncture headache: technique and mechanism of action of block with a narrative review of efficacy.

Abhijit S NAIR ; Basanth Kumar RAYANI

The Korean Journal of Pain.2017;30(2):93-97. doi:10.3344/kjp.2017.30.2.93

The sphenopalatine ganglion (SPG) is a parasympathetic ganglion, located in the pterygopalatine fossa. The SPG block has been used for a long time for treating headaches of varying etiologies. For anesthesiologists, treating postdural puncture headaches (PDPH) has always been challenging. The epidural block patch (EBP) was the only option until researchers explored the role of the SPG block as a relatively simple and effective way to treat PDPH. Also, since the existing evidence proving the efficacy of the SPG block in PDPH is scarce, the block cannot be offered to all patients. EBP can be still considered if an SPG block is not able to alleviate pain due to PDPH.
Blood Patch, Epidural ; Ganglia, Parasympathetic ; Ganglion Cysts ; Headache ; Humans ; Pain Management ; Post-Dural Puncture Headache* ; Pterygopalatine Fossa ; Sphenopalatine Ganglion Block*

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Can denosumab be a substitute, competitor, or complement to bisphosphonates?.

Su Young KIM ; Hwoe Gyeong OK ; Christof BIRKENMAIER ; Kyung Hoon KIM

The Korean Journal of Pain.2017;30(2):86-92. doi:10.3344/kjp.2017.30.2.86

Osteoblasts, originating from mesenchymal cells, make the receptor activator of the nuclear factor kappa B ligand (RANKL) and osteoprotegerin (OPG) in order to control differentiation of activated osteoclasts, originating from hematopoietic stem cells. When the RANKL binds to the RANK of the pre-osteoclasts or mature osteoclasts, bone resorption increases. On the contrary, when OPG binds to the RANK, bone resorption decreases. Denosumab (AMG 162), like OPG (a decoy receptor), binds to the RANKL, and reduces binding between the RANK and the RANKL resulting in inhibition of osteoclastogenesis and reduction of bone resorption. Bisphosphonates (BPs), which bind to the bone mineral and occupy the site of resorption performed by activated osteoclasts, are still the drugs of choice to prevent and treat osteoporosis. The merits of denosumab are reversibility targeting the RANKL, lack of adverse gastrointestinal events, improved adherence due to convenient biannual subcutaneous administration, and potential use with impaired renal function. The known adverse reactions are musculoskeletal pain, increased infections with adverse dermatologic reactions, osteonecrosis of the jaw, hypersensitivity reaction, and hypocalcemia. Treatment with 60 mg of denosumab reduces the bone resorption marker, serum type 1 C-telopeptide, by 3 days, with maximum reduction occurring by 1 month. The mean time to maximum denosumab concentration is 10 days with a mean half-life of 25.4 days. In conclusion, the convenient biannual subcutaneous administration of 60 mg of denosumab can be considered as a first-line treatment for osteoporosis in cases of low compliance with BPs due to gastrointestinal trouble and impaired renal function.
Antibodies, Monoclonal ; Biomarkers ; Bone Density ; Bone Resorption ; Compliance ; Denosumab* ; Diphosphonates* ; Half-Life ; Hematopoietic Stem Cells ; Hypersensitivity ; Hypocalcemia ; Jaw ; Miners ; Musculoskeletal Pain ; NF-kappa B ; Osteoblasts ; Osteoclasts ; Osteonecrosis ; Osteoporosis ; Osteoprotegerin ; RANK Ligand

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Medications for osteoporotic pain.

Sang Wook SHIN

The Korean Journal of Pain.2017;30(2):85-85. doi:10.3344/kjp.2017.30.2.85

No abstract available.
Fractures ; Compression Pain

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Erratum: correction of author name, rearrangement of author list, and adding foot note.

Woo Seog SIM

The Korean Journal of Pain.2017;30(1):73-73. doi:10.3344/kjp.2017.30.1.73

I apologize readers for any inconveniences originated from this. All co-authors agreed to correct those errors.

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Repetitive transcranial magnetic stimulation: a potential therapeutic modality for chronic low back pain.

Sajad SHAFIEE ; Farshad HASANZADEH KIABI ; Misagh SHAFIZAD ; Amir EMAMI ZEYDI

The Korean Journal of Pain.2017;30(1):71-72. doi:10.3344/kjp.2017.30.1.71

No abstract available.
Low Back Pain* ; Transcranial Magnetic Stimulation*

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