PURPOSE: Pudendal neuralgia (PN) is a painful and disabling condition, which reduces the quality of life as well. Pudendal nerve infiltrations are essential for the diagnosis and the management of PN. The purpose of this study was to compare the effectiveness of finger-guided transvaginal pudendal nerve infiltration (TV-PNI) technique and the ultrasound-guided transgluteal pudendal nerve infiltration (TG-PNI) technique.METHODS: Forty patients who underwent PNI for the diagnosis of PN were evaluated. Thirty-five of these 40 patients, who were diagnosed as PN, underwent a total of 70 further unilateral PNI. All the patients underwent PNI for twice after the first diagnostic PNI, 1 week apart.RESULTS: In the ultrasound (US)-guided TG-PNI group, the success rate was 68.8% (11 of 16) in both “pain in the sitting position” and “pain in the region from the anus to the clitoris.” The success rate of blocks in the US-guided TG-PNI group was 75% (12 of 16) in terms of pain during/after intercourse. In the finger-guided TV-PNI group, the success rate was 84.2% in both “pain in the sitting position” and “pain in the region from the anus to the clitoris.” The success rate of blocks in the fingerguided TV-PNI group was 89.5% (17 of 19) in terms of pain during/after intercourse. There was no statistically significant difference in the success rate of the 3 assessed conditions between the 2 groups (P>0.05).CONCLUSIONS: The TV-PNI may be an alternative to US-guidance technique as a safe, simple, effective approach in pudendal nerve blocks.
Anal Canal ; Anesthesia, Obstetrical ; Diagnosis ; Humans ; Nerve Block ; Neuralgia ; Pelvic Pain ; Pudendal Nerve ; Pudendal Neuralgia ; Quality of Life ; Ultrasonography ; Ultrasonography, Interventional

OBJECTIVE: To evaluate which Korean pain descriptors are frequently used in the patients with neuromusculoskeletal diseases and compare the frequency of Korean pain descriptor according to age, gender, pain pattern and intensity, and clinical diagnosis.METHOD: Two hundreds sixty nine patients with neuromusculoskeletal diseases were enrolled in this study. The patients were asked to fill out a pain questionnaire using Korean. The Korean pain descriptors were collected and classified according to neurophysiological mechanism. The frequency of Korean pain descriptor was analyzed by age, gender, pain pattern and intensity, and clinical diagnosis. They were divided into axial spine and peripheral joint pain group depending on the location of causal disease and shoulder pain descriptors were divided into intra-articular and bursa group.RESULTS: Among 24 Korean pain descriptors, ‘arida’ was the most common pain descriptor, followed by ‘ssusida’ and ‘jjireunda’. When the pain descriptors were classified according to neurophysiological mechanism, superficial somatic pain was the most common, followed by deep somatic pain. There was a significant difference in the frequency of the pain descriptor between axial spine and peripheral joint pain group (p=0.007). The pain descriptor ‘danggida’ was used significantly more in the patients with axial spine pain than peripheral joint pain (p=0.024). However, there was no significant difference in other factors.CONCLUSION: The patients with neuromusculoskeletal diseases expressed their pain using various Korean pain descriptors with stabbing nature and superficial somatic pain. Our results may be helpful to assess and develop a new Korean pain quality measure in the patients with neuromusculoskeletal diseases.
Arthralgia ; Diagnosis ; Humans ; Methods ; Musculoskeletal Pain ; Neuralgia ; Nociceptive Pain ; Sensation ; Shoulder Pain ; Spine ; Subject Headings

Meralgia paresthetica (MP) is a neuropathic pain caused by the entrapment of the lateral femoral cutaneous nerve (LFCN). There have been reports of MP following various surgeries; however, it has not yet been reported after hemorrhoid surgery. We report a case of bilateral MP after hemorrhoid surgery in a jack-knife position. The patient presented with pain, tightness, and a tingling sensation in the anterolateral aspect of both thighs. Ultrasonography-guided LFCN block was used for diagnosis and treatment, along with conservative management for 20 days with oral medication. One month later, the patient's symptoms had resolved completely. MP due to the jack-knife position may occur postoperatively in patients with predisposing risk factors such as obesity and diabetes mellitus, despite adequate padding and a shorter operating time.
Diabetes Mellitus ; Diagnosis ; Femoral Neuropathy ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Nerve Compression Syndromes ; Neuralgia ; Obesity ; Prone Position ; Risk Factors ; Sensation ; Thigh

BACKGROUND: The aim of this study was to investigate the clinical characteristics of complex regional pain syndrome (CRPS) in young male patients in South Korea, especially focusing on the association with military service. METHODS: From January 2007 to May 2017, we investigated the electronic medical records of 430 consecutive patients, aged 18 to 30 years, who visited Seoul National University Hospital Pain Center, with a suspected diagnosis of CRPS at the initial visit. The following patient details were available for analysis: demographic and disease-related variables, relevance to military service, medications, and the treatment modalities received. RESULTS: Out of 430 patients, 245 (57.0%) were diagnosed with CRPS, of which, 200 were male patients and 45 were female patients. Of the male patients, 95 (47.5%) developed CRPS during military service. CRPS during military service was more likely to result from sprain/strain, and the incidence of CRPS was significantly higher in the lower extremities in patients from the military service group than in those from the non-military service group. During the follow-up period, 37.9% of male CRPS patients (n = 61/161) were treated successfully. Patients with moderate to severe initial pain intensity, and diagnosed during their military service, showed better outcomes. CONCLUSIONS: Our results demonstrated that manifestation of CRPS in the young Korean population was more common in male and among those male CRPS patients, about half the cases developed during the military service period.
Chronic Pain ; Diagnosis ; Electronic Health Records ; Epidemiology ; Female ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Lower Extremity ; Male ; Military Medicine ; Military Personnel ; Neuralgia ; Pain Clinics ; Retrospective Studies ; Seoul ; Stress, Psychological

Ossification of parts of the intracranial dura mater is common and is generally accepted as an age-related finding. Additionally, duplication of the abducens nerve along its course to the lateral rectus muscle is a known, although uncommon anatomical variant. During routine cadaveric dissection, an ossified portion of dura mater traveling over the trigeminal nerve's entrance (porus trigeminus) into the middle cranial fossa was observed unilaterally. Ipsilaterally, a duplicated abducens nerve was also observed, with a unique foramen superolateral to the entrance of Dorello's canal. To our knowledge, there has been no existing report of a simultaneous ossified roof of the porus trigeminus with an ipsilateral duplicated abducens nerve. Herein, we discuss this case and the potential clinical and surgical applications. We believe this case report will be informative for the skull base surgeon in the diagnosis of neuralgic pain in the frontomaxillary, andibular, orbital, and external and middle ear regions.
Abducens Nerve ; Cadaver ; Cranial Fossa, Middle ; Diagnosis ; Dura Mater ; Ear, Middle ; Orbit ; Skull Base ; Trigeminal Neuralgia

Central pain, a neuropathic pain caused by an injury or dysfunction of the central nervous system, is a common, annoying sequela of mild traumatic brain injury (mTBI). Clarification of the pathogenetic mechanism of central pain is mandatory for precise diagnosis, proper management, and prognosis prediction. The introduction of diffusion tensor imaging allowed assessment of the association of the central pain and injury of the spinothalamic tract (STT), and traumatic axonal injury (TAI) in mTBI. In this review, 6 diffusion tensor tractography studies on central pain due to TAI of the STT in patients with mTBI are reviewed. The diagnostic approach for TAI of the STT in individual patients with mTBI is discussed, centering around the methods that these studies employed to demonstrate TAI of the STT.
Axons* ; Brain Concussion ; Brain Injuries* ; Central Nervous System ; Diagnosis ; Diffusion ; Diffusion Tensor Imaging ; Humans ; Neuralgia ; Prognosis ; Spinothalamic Tracts*

BACKGROUND: Increasing evidence suggests a pivotal role for neuronal inflammation in response to replicating varicella zoster virus in the development of postherpetic neuralgia (PHN). OBJECTIVE: In this study, we investigated the value of serum levels of various inflammatory markers in acute herpes zoster (HZ) as predictors for the development of PHN. METHODS: A total of 116 patients with acute HZ were enrolled in this study. We measured scores on the pain visual analogue scale (VAS) at baseline and at 1, 3, and 6 months after diagnosis of HZ. We defined PHN as pain greater than 1 on the VAS lasting for more than 6 months. Serum samples for laboratory assay, including complete blood count were obtained at the initial visit. Correlations between the levels of each inflammatory marker and the development of PHN were evaluated. RESULTS: Levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lymphocyte count, and albumin showed significant correlations with development of PHN in univariate analysis. Levels of ESR, CRP, and lymphocyte count also showed significant correlations in multivariate analysis. ESR level showed stronger correlations with development of PHN than levels of CRP and lymphocyte count. CONCLUSION: In this study, we confirmed that elevated ESR was an independent and significant predictor of PHN in patients with acute HZ. To validate these results, further well-designed, randomized clinical trials are needed.
Blood Cell Count ; Blood Sedimentation ; C-Reactive Protein ; Diagnosis ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Inflammation ; Lymphocyte Count ; Multivariate Analysis ; Neuralgia, Postherpetic* ; Neurons

Polyacrylamide hydrogel is a widely used filler material in cosmetic procedures performed on the face and breasts. Recently, however, complications including inflammation, deformity, and pain have been reported. The present article addresses unregulated materials/products injected as dermal fillers. The authors report a case involving a 29-year-old woman who developed severe facial pain after undergoing a cosmetic procedure with injectable triamcinolone and hyaluronidase. Two months later, the pain spread to her upper and lower limbs, and abdomen, which eventually led to the the development and diagnosis of complex regional pain syndrome (CRPS) in the upper limbs. The authors hypothesize that CRPS in the upper limbs was responsible for the facial pain through sensitization of third-order neurons and the trigeminal nucleus caudalis extending to the upper cervical segments.
Abdomen ; Adult ; Breast ; Congenital Abnormalities ; Dermal Fillers ; Diagnosis ; Facial Neuralgia ; Facial Pain* ; Female ; Humans ; Hyaluronic Acid ; Hyaluronoglucosaminidase ; Hydrogel ; Inflammation ; Lower Extremity ; Neurons ; Triamcinolone ; Trigeminal Nuclei ; Upper Extremity*

Postherpetic neuralgia (PHN) is the most troublesome side effect of Herpes Zoster (HZ), which mainly affects the elderly and immunocompromised populations. Despite the current advancement of treatments, PHN persists in many individuals influencing their daily activities and reducing their quality of life. Anticonvulsants, antidepressants, topical therapies including lidocaine and capsaicin, and opioids, are the most widely used therapies for the treatment of PHN. These medications come with their adverse effects, so they should be used carefully with the elderly or with patients with significant comorbidities. Other measures like botulinum toxin, nerve blocks, spinal cord stimulation, and radiofrequency have also contributed significantly to the management of PHN. However, the efficacy, safety, and tolerability of these invasive methods need to be carefully monitored when administering them. Early diagnosis and early initiation of treatment can reduce the burden associated with PHN. The zoster vaccine has effectively reduced the incidence of HZ and PHN. In this article, we discuss the treatment options available for the management of PHN, mainly focusing on the efficacy and safety of different therapeutic modalities.
Aged ; Analgesics, Opioid ; Anticonvulsants ; Antidepressive Agents ; Botulinum Toxins ; Capsaicin ; Comorbidity ; Early Diagnosis ; Herpes Zoster ; Herpes Zoster Vaccine ; Humans ; Incidence ; Lidocaine ; Nerve Block ; Neuralgia, Postherpetic ; Quality of Life ; Spinal Cord Stimulation

Kaposiform hemangioendothelioma (KHE) is a very rare, locally aggressive vascular neoplasm. It occurs mostly in children and is rarely observed in adults. It typically originates on the skin, later affecting the deep soft tissue of the extremities, head or neck, and retroperitoneum by infiltrative growth. It is locally aggressive, does not regress spontaneously, and tends to metastasize locally as well as to the regional lymph nodes. In this article, we report a case of adult-onset KHE with neurofibromatosis type 1. The patient presented to our department with a 2-month history of a painful ulceration in her left popliteal area. Since KHE had not previously been reported in patients with neurofibromatosis, the diagnosis was difficult due to the similarity of the skin manifestation to neurofibromatosis-associated lesions. We share our experience of diagnosing and treating this rare case of adult-onset KHE.
Adult ; Child ; Diagnosis ; Extremities ; Head ; Hemangioendothelioma* ; Humans ; Lymph Nodes ; Neck ; Neoplasms, Vascular Tissue ; Neuralgia ; Neurofibromatoses* ; Neurofibromatosis 1* ; Skin ; Skin Manifestations ; Ulcer ; Vascular Neoplasms