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Atypical May-Thurner Syndrome Caused by Bone Spur of the L4∼5 Lumbar Vertebrae

Clinical Pain.2023;22(1):57-60. doi:10.35827/cp.2023.22.1.57

May–Thurner syndrome (MTS) is a condition in which the left common iliac vein is irritated by chronic pulsatile compression between the right common iliac artery and the upper iliac or lumbar spine. It mainly causes swelling and pain in the left lower extremity, venous thrombosis, and repeated deep venous thrombosis. In patients with sudden swelling and pain in the left lower extremity and suspected lower extremity thrombosis, when no other obvious cause can be found, the possibility of MTS should be considered. We experienced a rare case of an older patient with atypical MTS caused by bone spur of the 4th and 5th lumbar vertebrae, which has been reported here along with a review of the literature.

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Clinical Effect of Selective Neuroablative Technique Using Radiofrequency on Spasticity in a Patient with Stroke

Hyo Jeong LEE ; Yeon-Jae SEONG ; Yoon Ghil PARK

Clinical Pain.2023;22(1):52-56. doi:10.35827/cp.2023.22.1.52

Radiofrequency energy, such as that used in neuroablation, has been applied in various medical and surgical fields. However, no consensus exists regarding neuroablation protocols using radiofrequency. This study aimed to report the effect of a radiofrequency neuroablative technique on spastic foot management in a patient with stroke and present its safety and persistence. A 59-year-old man with hemiplegic gait by the intracerebral hemorrhage had radiofrequency ablation of the motor nerve branch supplying the medial gastrocnemius. The patient’s subjective and objective measurements of the spastic limb improved after the intervention. The effect lasted for 3 months. Radiofrequency neuroablative technique may be beneficial for treating spastic gait in patients with stroke. The above technique must be used to verify patients with spasticity, and research should be investigated to determine appropriated parameters.

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Painful Chronic Expanding Hematoma of the Transtibial Amputation Stump

Son Mi LEE ; Donghyun SHIN ; Jongkyu KIM

Clinical Pain.2023;22(1):48-51. doi:10.35827/cp.2023.22.1.48

Chronic expanding hematoma (CEH) is a hematoma that increases in size, usually occurring after trauma or surgery, more than a month after initial bleeding. Thighs and upper limbs are the most common sites of CEH. Only a few cases of CEH have been reported in the amputation stump site since CEH itself is a rare disease.We experienced a case of a 59-year-old man who underwent transtibial amputation and suffered from recurrent non-infectious hematoma. For the treatment of CEH, the patient underwent an open bursectomy, followed by bony spur removal surgery. However, CEH recurred, and the pain was only managed by intermittent aspiration and compression. We report a long journey of managing painful CEH of the transtibial amputation stump.

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The Effects of Online-Based Interventions for Chronic Low Back Pain Patients: A Clinical Trial

Dong Jin HEO ; Jaewon KIM ; Jae Min KIM

Clinical Pain.2023;22(1):38-47. doi:10.35827/cp.2023.22.1.38

Objective: Chronic low back pain (LBP) is a huge social burden, and optimal exercise therapies for chronic LBP patients are continuously being studied. To evaluate the effects of digital intervention on pain and disability in patients with chronic LBP, we performed a prospective cohort study. Method: From February 2020 to January 2021, 25 patients with chronic LBP were recruited. Digital intervention contains education contents and video demonstration for individually prescribed exercise. The exercise prescription was renewed every 4 weeks according to subjects’ condition and accomplishment of exercise. This intervention was performed for more than 30 weeks. The pain intensity was assessed using a numeric rating scale (NRS) while their degree of disability was assessed using the Roland-Morris Disability Questionnaire (RMDQ). The pain intensity and disability was evaluated at short term (8∼20 weeks) and long term (30 weeks). Results: As a result, pain intensity (NRS) decreased significantly over the short term and long term (p<0.05). However, pain related disability (RMDQ score) did not change significantly over the follow-up period (p=0.554). Conclusion Our findings indicate that online-based digital intervention reduced the intensity of chronic LBP. Further research is needed to identify methods to cost-effectively and consistently manage chronic LBP.

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Ultrasound Guided Therapeutic Medial Branch Block for the Facet Joint Pain

Yongbum PARK ; Jun Hyeong SONG

Clinical Pain.2023;22(1):33-37. doi:10.35827/cp.2023.22.1.33

The facet joints are a common source of chronic spinal pain. Blocks of the nerves supplying the facet joints are validated tools in the diagnosis and treatment for facet joint pain. These interventions are typically performed with fluoroscopic guidance. However, the target, which is the nerve, is radiolucent and cannot be identified with fluoroscopy. Recently, several ultrasound guided techniques in the domain of spinal pain have been emerging because ultrasound is useful in visualization of the inner structures, is portable, and is not associated with the radiation exposure. This paper reviews a variety of techniques for ultrasound guided interventions for the medial branch block which has been reported in treating axial pain originating from the facet joint.

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Exercise-Induced Pain Reduction and Its Central Mechanism in Patients with Chronic Pain

Suk Hoon OHN

Clinical Pain.2023;22(1):29-32. doi:10.35827/cp.2023.22.1.29

For the effective rehabilitation of chronic pain, it is necessary to know the changes in the pain networks of patients with chronic pain. There is a need for attention to changes in emotional pain networks and cognitive pain networks. In patients with chronic pain, post-exercise pain reduction is less pronounced than in those without chronic pain. In order to achieve the exercise effect, emotional problems must be considered in addition to the patient's physical changes. In addition, a detailed prior explanation is needed to raise the expectations for exercise effect, moreover, in order to continue exercising for a safe and long period, exercise suitable for patients should be selected and low-intensity exercise protocols should be provided.

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Muscle and Tendon Injury in Thigh

Ho Jun LEE

Clinical Pain.2023;22(1):22-28. doi:10.35827/cp.2023.22.1.22

Most muscle and tendon injuries in thigh occur in sports activities with high energy, for example kicking and running, related with deceleration phase, which require eccentric contraction of quadriceps and hamstring. Most common injury is hamstring strain injury (HSI) and also common injuries of anterior thigh is quadriceps strain injury. Strain injuries occur at myo-tendinous junction and surrounding muscle fibers and in most strains except complete rupture first choice of treatment is conservative treatment including RICE in acute phase and subsequent rehabilitation programs. In competitive sports activities such as football quadriceps contusion injury is common after heavy collision. Prognosis is dependent on the extension of muscle fiber damage and hematoma formation. Hematoma formation can develop to myositis ossificans or Morel-Lavellee lesion, which can induce pain and disability. Hamstring and quadriceps strain and tendon tear can occur in middle-aged or elderly people in community circumstances after slip down or falling, which lead to sudden lengthening and eccentric contraction of hamstring or quadriceps.Tendon tear including avulsion tear in greater tuberosity has higher proportion than strain, that is opposite in sports injuries, because middle aged or elderly people have higher possibility of tendon degeneration and tendinosis with higher risk of tendon tear. Therefore rapid and accurate diagnosis and proper treatment including rehabilitation program for hamstring and quadriceps injury is necessary in middle aged or elderly people.

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Ultrasound Findings and Procedures for Knee and Distal Femur Pathologies

Seok KANG

Clinical Pain.2023;22(1):14-21. doi:10.35827/cp.2023.22.1.14

Ultrasound imaging of the musculoskeletal system is widely used for diagnosis and treatment. Pathologies occurring in the knee joint and the distal femur are among the challenging areas for ultrasound diagnosis due to their complex structural nature. However, advancements in ultrasound technology have made it possible to assess and diagnose superficial structures using ultrasound. Moreover, ultrasound-guided procedures have gained significant popularity due to their advantages in terms of efficacy and safety. This paper aims to explore the ultrasound findings of commonly occurring conditions in the knee joint and proximal femur and discuss ultrasound-guided interventions that can be performed in these areas for treatment.

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Usefulness of Ultrasound for Carpal Tunnel Syndrome Proven in Meta-Analysis Studies

Sang Chul LEE

Clinical Pain.2023;22(1):9-13. doi:10.35827/cp.2023.22.1.9

Carpal tunnel syndrome is a very common and important disease caused by entrapment of the median nerve in the carpal tunnel. With the widespread use of high-resolution ultrasound, ultrasound is being used usefully in the diagnosis of carpal tunnel syndrome. Compared to electrodiagnostic study, ultrasound examinations are easier and, above all, non-invasive. In addition, ultrasound-guided injection can be performed alone or in combination with ultrasound examination. In the case of nerve hydrodissection, which has recently been spotlighted as a treatment for carpal tunnel syndrome, it is the procedure that could not be attempted before without ultrasound equipment. In this paper, through a comprehensive review of meta-analysis literatures, we look back at the value of ultrasound as a diagnostic tool for carpal tunnel syndrome and the effect of ultrasound-guided injection to get an objective perspective and gain new insights. The usefulness of ultrasound will be largely divided into applications of ultrasound-guided injection, diagnosis, and sonoelastography.

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Intramuscular Stimulation Therapy

Jinyoung PARK

Clinical Pain.2023;22(1):1-8. doi:10.35827/cp.2023.22.1.1

Muscle pain can be caused by various causes and it deteriorates the patient’s function and quality of life. Intramuscular stimulation therapy, performed under the concept of myofascial pain syndrome, is an effective treatment for relieving somatic pain in skeletal muscles through muscle relaxation, improving the limited range of motion of joints, enhancing muscle strength, and improving accompanying autonomic nervous system symptoms. Dry needling, trigger point injection, and intramuscular electrical stimulation are typical methods of intramuscular stimulation, and they must be safely performed by experienced practitioners. The mechanism, clinical use, efficacy, and precautions of intramuscular stimulation therapy will be reviewed in this article. Although additional supplementation of the academic evidence of intramuscular stimulation is still needed through experimental research, it is expected that the clinical application area can be expanded.

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