We report a case of paraplegia without neurologic deficit of upper extremities following cervical epidural catheterization using air during the loss of resistance technique. A 41-year-old woman diagnosed with complex regional pain syndrome had upper and lower extremity pain. A thoracic epidural lead was inserted for a trial spinal cord stimulation for treating lower extremity pain and cervical epidural catheterization was performed for treating upper extremity pain. Rapidly progressive paraplegia developed six hours after cervical epidural catheterization. Spine CT revealed air entrapment in multiple thoracic intervertebral foraminal spaces and surrounding epidural space without obvious spinal cord compression before the decompressive operation, which disappeared one day after the decompressive operation. Her paraplegia symptoms were normalized immediately after the operation. The presumed cause of paraplegia was transient interruption of blood supply to the spinal cord through the segmental radiculomedullary arteries feeding the spinal cord at the thoracic level of the intervertebral foramen caused by the air.
Adult ; Arteries ; Catheterization* ; Catheters* ; Epidural Space ; Female ; Humans ; Lower Extremity ; Neurologic Manifestations ; Paraplegia* ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Ischemia ; Spinal Cord Stimulation ; Spine ; Upper Extremity

Postherpetic neuralgia (PHN) and vertebral compression fracture (VCF) are common causes of chronic pain in the elderly population. Careful history taking and imaging studies are needed for diagnosis when both diseases coexist. Vertebroplasty is a clinically efficient surgical treatment of VCF, while nerve block and/or medications are the mainstay of PHN pain control. The most serious complications of vertebroplasty are pulmonary embolism or neurologic deficit due to cement leakage. An 80-year-old female patient was diagnosed with PHN of the right L1 dermatome; however, her pain expanded to the midback and subcostal area. Thoracic magnetic resonance imaging and abdominal computed tomography revealed recent L2 compression fracture with prevertebral hematoma caused by cortical bone defect of the L2 body. Even though the risk of cement leakage was high, L2 vertebral body augmentation was performed using a bone filler device and high-viscosity cement; this treatment was successful, without cement leakage or any other complications.
Aged ; Aged, 80 and over ; Bone Cements ; Chronic Pain ; Diagnosis ; Female ; Fractures, Compression* ; Hematoma* ; Humans ; Magnetic Resonance Imaging ; Nerve Block ; Neuralgia ; Neuralgia, Postherpetic* ; Neurologic Manifestations ; Pulmonary Embolism ; Spine ; Vertebroplasty*

Since the early 1980s, the implantable intrathecal drug pump (ITDP) has been used increasingly to manage chronic pain. Prior to making a decision to implant an ITDP, trial administration of the intrathecal (IT) drug should be performed to estimate the effective dose for a starting set of implantable ITDPs. There is no standard method of trial IT drug administration, though. Therefore, this paper reports 20 cases of IT morphine trial with single and repetitive injections until the appropriate dose was attained with respect to analgesia and its side effects. The trial procedure was performed with daily sequential IT injections using morphine and 0.3% mepivacaine. Twelve out of the total of 20 patients had positive responses. Thus, it is inferred that daily sequential IT morphine injections combined with a placebo injection as a trial ITDP would be useful in evaluating the effectiveness and adverse effects of IT morphine infusion with clinically insignificant side effects.
Analgesia ; Chronic Pain ; Humans ; Mepivacaine ; Morphine ; Pain, Intractable

Glossopharyneal neuralgia (GPN) is generally considered to be a pain disease. However, it can be also be a life-threatening cardiac cause of syncope. Neuralgia in the throat and neck can trigger severe bradycardia up to the point of asystole, which can progress to cardiac syncope with or without seizures. A 65 year-old male patient diagnosed with glossopharyngeal neuralgia complained of severe paroxysmal pain in his right chin and ear followed by bradycardia, aystole and syncope. We report a case successfully treated with a permanent pacemaker and carbamazepine in a patient with GPN who had syncopal attacks preceded by paroxysms of pain.
Bradycardia ; Carbamazepine ; Chin ; Ear ; Glossopharyngeal Nerve Diseases ; Heart Arrest ; Humans ; Male ; Neck ; Neuralgia ; Pharynx ; Seizures ; Syncope ; Syncope, Vasovagal

Fabry disease is an X-linked lysosomal disease caused by deficiency of alpha-galactosidase, in which early diagnosis may be missed due to the wide variety of clinical symptoms presenting during disease progression. A 13 year-old boy visited our pain clinic complaining of pricking and burning pain in the toe tips of both feet. Continuous epidural infusion for pain management was performed because of oral analgesics ineffectiveness. The patient underwent alpha-galactosidase A (GLA) enzyme analysis based on the clinical impression of Fabry disease from pain with a peripheral neuropathic component and history of anhidrosis. He was diagnosed with Fabry disease after confirming mutation of the GLA gene through a screening test of GLA activity. Enzyme replacement therapy was initiated and pain was tolerated with oral analgesics.
alpha-Galactosidase ; Analgesics ; Burns ; Disease Progression ; Early Diagnosis ; Enzyme Replacement Therapy ; Fabry Disease ; Foot ; Humans ; Hypohidrosis ; Isoenzymes ; Mass Screening ; Pain Clinics ; Pain Management ; Toes

Hyperhidrosis is a disorder of perspiration in excess of the body's physiologic need and significantly impacts one's occupational, physical, emotional, and social life. The purpose of our study was to investigate the characteristics of primary hyperhidrosis in 255 patients at Ajou University Hospital Hyperhidrosis Center from March 2006, to February 2008. Information collected from the medical records was: sex, sites of hyperhidrosis, age at visit, age of onset, aggravating factors, hyperhidrosis disease severity scale (HDSS) rank, family history, occupation, and past treatment. A total of 255 patient records were reviewed; 57.6% were male. Patients with a family history (34.1%) showed a lower age of onset (13.21+/-5.80 yr vs. 16.04+/-9.83 yr in those without family history); 16.5% had previous treatment, most commonly oriental medicine. Palmar and plantar sites were the most commonly affected, and 87.9% of patients felt their sweating was intolerable and always interfered with their daily activities. Our study provides some original information on the Korean primary hyperhidrosis population. Patients who have a family history show signs of disease in early age than those without family history.
Academic Medical Centers/statistics & numerical data ; Adult ; Female ; Genetic Predisposition to Disease/*epidemiology/*genetics ; Hospitalization/*statistics & numerical data ; Humans ; Hyperhidrosis/*epidemiology/*genetics ; Incidence ; Male ; Risk Assessment ; Risk Factors

Neuroablation should be performed cautiously because neuropathic pain can occur following denervation of a somatic nerve. A 34-year-old man presented with severe penile pain and allodynia following a selective neurectomy of the sensory nerve that innervated the glans penis for treatment of his premature ejaculation. He was treated with various nerve blocks, including continuous epidural infusion, lumbar sympathetic block and sacral selective transforaminal epidural blocks, as well as intravenous ketamine therapy. However, all of the treatments had little effect on the relief of his pain. We performed spinal cord stimulation as the next therapy. After this therapy, the patient has currently been satisfied for 3 months.
Adult ; Denervation ; Humans ; Hyperalgesia ; Ketamine ; Male ; Nerve Block ; Neuralgia ; Penis ; Premature Ejaculation ; Pudendal Nerve ; Spinal Cord ; Spinal Cord Stimulation

Implantable intrathecal pump is one of the therapeutic options for intractable pain. A 24-year-old male with complex regional pain syndrome was suffering from right lower extremity pain. He had all modalities of treatment including spinal cord stimulator. However, his pain had been worse in the past 6 months. His visual analogue pain scale (VAS) was 8-10 and he could not sit or walk. Only opioid was thought to be effective. Then, intrathecal pump was considered. We estimated the minimal effective dose of spinal morphine before implantation. 0.3 mg of morphine was injected intrathecally as a starting dose. Dosage had been increased up to 0.8 mg in 10 days. His VAS score decreased from 8 to 5. He could sleep without pain and walk with crutch. Therefore, intrathecal pump was inserted. He could tolerate to pain. This case suggests that intrathecal morphine delivery can provide effective treatment for intractable non-malignant pain.
Humans ; Lower Extremity ; Male ; Morphine ; Pain Measurement ; Pain, Intractable ; Spinal Cord ; Stress, Psychological ; Young Adult

BACKGROUND: Transforaminal epidural injection (TEI) may be useful to treat unilateral pain that has a dermatomal distribution. In this approach, the needle tip can be placed closer to the dorsal root ganglion and ventral aspect of the nerve root. However many studies have reported that serious complications following TEI occurred more frequently when it was conducted at the cervical level. One of the presumptive mechanisms of the complication is intravascular injection. Therefore this study was conducted to identify the incidence of complications in response to intravascular injections at cervical segments. METHODS: This study included all patients, who visited our pain clinic and had radicular symptoms or herpes zoster associated pain. All procedures were conducted under fluoroscopic guidance with contrast enhancement by one of the authors. After the ideal needle position was confirmed by biplanar fluoroscopy, the blood aspiration through the needle hub was evaluated, and a 3 ml mixture of nonionic contrast (2 ml) with normal saline (1 ml) was injected at a rate of 0.3-0.5 ml/sec continuously under real time fluoroscopic visualization. We then classified the contrast spreading pattern as neural, simultaneous neural and vascular, or vascular. RESULTS: A total 71 cervical TEIs were performed. In 26 cases (36.6%), the contrast only spread to the nerve sheath. However, 45 cases (63.4%) showed an intravascular spreading pattern, 37 (52.1%) of which showed a neural and vascular pattern and 8 (11.3%) of which showed only a vascular pattern. CONCLUSIONS: Approximately two thirds of the cases of cervical TEI were found to lead to intravascular spreading, which is much higher than the incidence reported in previous studies.
Fluoroscopy ; Ganglia, Spinal ; Herpes Zoster ; Humans ; Incidence ; Injections, Epidural ; Needles ; Pain Clinics

BACKGROUND: Complex regional pain syndrome (CRPS) is still difficult to diagnose in the field of chronic pain management. CRPS is diagnosed by purely clinical criteria based on the characteristic signs and symptoms, which have to be differentiated from similar pain conditions like posttraumatic neuropathic pain. Until now, there has been a lack of objective diagnostic tools to confirm the diagnosis of CRPS. The aim of this study was to evaluate the usefulness of a three phase bone scan (TBS) for making the diagnosis of CRPS. METHODS: A total of 121 patients who had been diagnosed with CRPS were evaluated. All the patients were examined by performing a TBS as a part of the diagnostic work-up. A diffuse increased tracer uptake on the delayed image (phase III) was defined as a positive finding for CRPS. RESULTS: Forty-one patients (33.9%) out of 121 showed the positive results on the TBS. The patients with a duration of pain of less than 24 months had a significantly higher positive result (43.4%) on the TBS than did the patients with duration of pain longer than 24 months (12.1%). CONCLUSIONS: A TBS could give a better objective result for diagnosing CRPS for patients with a shorter duration of pain and a TBS gives little information for the diagnosis of CRPS in patients with a duration of pain longer than 24 months.
Chronic Pain ; Humans ; Neuralgia