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1.  Comparison of Morphine and Tramadol in Transforaminal Epidural Injections for Lumbar Radicular Pain 
The Korean Journal of Pain  2013;26(3):265-269.
Background
Transforaminal epidural steroid injections are known to reduce inflammation by inhibiting synthesis of various proinflammatory mediators and have been used increasingly. The anti-inflammatory properties of opioids are not as fully understood but apparently involve antagonism sensory neuron excitability and pro-inflammatory neuropeptide release. To date, no studies have addressed the efficacy of transforaminal epidural morphine in patients with radicular pain, and none have directly compared morphine with a tramadol for this indication. The aim of this study was to compare morphine and tramadol analgesia when administered via epidural injection to patients with lumbar radicular pain.
Methods
A total of 59 patients were randomly allocated to 1 of 2 treatment groups and followed for 3 months after procedure. Each patient was subjected to C-arm guided transforaminal epidural injection (TFEI) of an affected nerve root. As assigned, patients received either morphine sulfate (2.5 mg/2.5 ml) or tramadol (25 mg/0.5 ml) in combination with 0.2% ropivacaine (1 ml). Using numeric rating scale was subsequently rates at 2 weeks and 3 months following injection for comparison with baseline.
Results
Both groups had significantly lower mean pain scores at 2 weeks and at 3 months after treatment, but outcomes did not differ significantly between groups.
Conclusions
TFEI of an opioid plus local anesthetic proved effective in treating radicular pain. Although morphine surpassed tramadol in pain relief scores, the difference was not statistically significant.
doi:10.3344/kjp.2013.26.3.265
PMCID: PMC3710940  PMID: 23862000
chronic pain; epidural analgesia; injection; morphine; radicular pain; spinal
2.  Sacral Nerve Stimulation Through the Sacral Hiatus 
The Korean Journal of Pain  2012;25(3):195-197.
Sacral nerve stimulation through the retrograde approach has been used for peroneal or irritable bowel syndrome through the retrograde approach. However, several reasons, lead could not be advanced down ward. In this case, anterograde sacral nerve stimulation through the sacral hiatus could be used. The aim of this report is to present of technique of sacral nerve root stimulation through the sacral hiatus approach.
doi:10.3344/kjp.2012.25.3.195
PMCID: PMC3389326  PMID: 22787552
anterograde; sacral nerve stimulation; spinal cord stimulation
3.  Effect of Intravenous Lidocaine on the Neuropathic Pain of Failed Back Surgery Syndrome 
The Korean Journal of Pain  2012;25(2):94-98.
Background
An intravenous infusion of lidocaine has been used on numerous occasions to produce analgesia in neuropathic pain. In the cases of failed back surgery syndrom, the pain generated as result of abnormal impulse from the dorsal root ganglion and spinal cord, for instance as a result of nerve injury may be particularly sensitive to lidocaine. The aim of the present study was to identify the effects of IV lidocaine on neuropathic pain items of FBSS.
Methods
The study was a randomized, prospective, double-blinded, crossover study involving eighteen patients with failed back surgery syndrome. The treatments were: 0.9% normal saline, lidocaine 1 mg/kg in 500 ml normal saline, and lidocaine 5 mg/kg in 500 ml normal saline over 60 minutes. The patients underwent infusions on three different appointments, at least two weeks apart. Thus all patients received all 3 treatments. Pain measurement was taken by visual analogue scale (VAS), and neuropathic pain questionnaire.
Results
Both lidocaine (1 mg/kg, 5 mg/kg) and placebo significantly reduced the intense, sharp, hot, dull, cold, sensitivity, itchy, unpleasant, deep and superficial of pain. The amount of change was not significantly different among either of the lidocaine and placebo, or among the lidocaine treatments themselves, for any of the pain responses, except sharp, dull, cold, unpleasant, and deep pain. And VAS was decreased during infusion in all 3 group and there were no difference among groups.
Conclusions
This study shows that 1 mg/kg, or 5 mg/kg of IV lidocaine, and palcebo was effective in patients with neuropathic pain attributable to FBSS, but effect of licoaine did not differ from placebo saline.
doi:10.3344/kjp.2012.25.2.94
PMCID: PMC3324747  PMID: 22514776
failed back surgery syndrome; neuropathic pain; pain quality; systemic lidociane
4.  Comprasion of Effectiveness of CT vs C-arm Guided Percutaneous Radiofrequency Lumbar Facet Rhizotomy 
The Korean Journal of Pain  2010;23(2):137-141.
Background
Facet joint have been implicated as a source of chronic low back pain. Radiofrequency denervation has demonstrated the most solid evidence. To increase safety and efficacy of treatment, computed tomography (CT) guidance injection has been used in several disease. The purpose of this study was to evaluate the efficacy of CT-guided radiofrequency rhizotomy in the treatment of facet joint pain.
Methods
A total of 40 patients were randomized to undergo radiofrequency facet joint denervation under CT guidance or C-arm guidance. All patients were examined visual analogue scale (VAS) score before treatment, 1 month, and 3 months after treatment.
Results
The VAS in both groups showed significant improvement over the 1-month interval. No significant difference in the VAS score among the group was observed.
Conclusions
In this study there was no significant difference between CT guidance lumbar rhizotomy and C-arm guidance lumbar rhizotomy. Therefore CT-guided radiofrequency denervation of the lumbar facet joint was a minimally invasive technique that appears effective.
doi:10.3344/kjp.2010.23.2.137
PMCID: PMC2886243  PMID: 20556216
computed tomography; low back pain; lumbar facet joint; radiofrequency rhizotomy
5.  Investigation of High-Sensitivity C-reactive Protein and Erythrocyte Sedimentation Rate in Low Back Pain Patients 
The Korean Journal of Pain  2010;23(2):147-150.
Background
Chronic low back pain can be a manifestation of lumbar degenerative disease, herniation of intervertebral discs, arthritis, or lumbar stenosis. When nerve roots are compromised, low back pain, with or without lower extremity involvement, may occur. Local inflammatory processes play an important role in patients with acute lumbosciatic pain. The purpose of this study was to assess the value of erythrocyte sedimentation rate (ESR) and high sensitivity C-reactive protein (hsCRP) measurements in patients with chronic low back pain or radiculopathy.
Methods
ESR and hsCRP were measured in 273 blood samples from male and female subjects with low back pain and/or radiculopathy due to herniated lumbar disc, spinal stenosis, facet syndrome, and other diseases. The hsCRP and ESR were measured prior to lumbar epidural steroid injection.
Results
The mean ESR was 18.8 mm/h and mean hsCRP was 1.1 mg/L. ESR had a correlation with age.
Conclusions
A significant systemic inflammatory reaction did not appear to arise in patients with chronic low back pain.
doi:10.3344/kjp.2010.23.2.147
PMCID: PMC2886244  PMID: 20556218
ESR; hsCRP; low back pain
6.  Involvement of Selective Alpha-2 Adrenoreceptor in Sympathetically Maintained Pain 
Objective
Peripheral nerve injury often leads to neuropathic pain, which is characterized by burning pain, allodynia, and hyperalgesia. The role of the sympathetic nervous system in neuropathic pain is a complex and controversial issue. It is generally accepted that the alpha adrenoreceptor (AR) in sympathetic nerve system plays a significant role in the maintenance of pain. Among alpha adrenoreceptor, alpha-1 receptors play a major role in the sympathetic mediated pain. The primary goal of this study is to test the hypothesis that sympathetically maintained pain involves peripheral alpha-2 receptors in human.
Methods
The study was a randomized, prospective, double-blinded, crossover study involving twenty patients. The treatments were : Yohimbine (30 mg mixed in 500 mL normal saline), and Phentolamine (1 mg/kg in 500 mL normal saline) in 500 mL normal saline at 70 mL/hr initially then titrated. The patients underwent infusions on three different appointments, at least one month apart. Thus, all patients received all 2 treatments. Pain measurement was by visual analogue scale, neuropathic pain questionnaire, and McGill pain questionnaire.
Results
There were significant decreases in the visual analogue scale, neuropathic score, McGill pain score of yohimnine, and phentolamine.
Conclusion
We conclude that alpha-2 adrenoreceptor, along with alpha-2 adrenoreceptor, may be play role in sympathetically maintained pain in human.
doi:10.3340/jkns.2010.47.6.420
PMCID: PMC2899027  PMID: 20617085
Reflex sympathetic dystrophy; Yohimbine; Alpha-2 antagonist
7.  Retrospective analysis of low-dose methadone and QTc prolongation in chronic pain patients 
Korean Journal of Anesthesiology  2010;58(4):338-343.
Background
Methadone is a synthetic opioid that is widely used for the treatment of chronic pain. The association between methadone treatment and QT interval prolongation or which can lead to torsades de pointes has been confirmed with larger studies on high dose methadone. The aim of this study was to determine the effect of methadone on the QTc interval in patients, whether the daily dose of methadone should be lower than what has been previously investigated.
Methods
A total of 130 patients were included, with 90 patients in the methadone group and 40 patients in the control group. For each ECG, heart rate, QT interval and corrected QT (QTc) interval were recorded. The patient demographics, methadone dose and serum level, duration of methadone use and past medical history were collected.
Results
The QTc interval was significantly longer in the treatment group than in the control group (443 ± 30.0 ms versus 408 ± 28.0 ms, respectively, P < 0.0001) and more patients in the treatment group had a QTc interval greater than 450 ms (36.7% versus 7.5%, respectively, P = 0.0005). The QTc interval was not associated with methadone dose P = 0.9278), serum level (P = 0.2256) or duration of treatment (P = 0.1822).
Conclusions
This study has shown that methadone use is associated with longer QTc intervals, even among patients with daily doses of less than 80 mg. In this study, no correlation was found between QTc duration and methadone dose, serum levels or duration of use. However, the magnitude of the QTc interval was associated with female gender and the use of antidepressants.
doi:10.4097/kjae.2010.58.4.338
PMCID: PMC2876853  PMID: 20508789
Methadone; Opioid; QT interval
8.  Piriformis Muscle: Clinical Anatomy with Computed Tomography in Korean Population 
The Korean Journal of Pain  2011;24(2):87-92.
Background
The objective was to evaluate the distance from the skin and the diameter of the piriformis muscle and their relationship to the body mass index (BMI).
Methods
The study was a prospective study involving 60 patients. Patients were prepared on a radiological table in the prone position. Several images were obtained of each. In this view, the distance between the subcutaneous tissue and the piriformis muscle, and the diameter of the piriformis, were measured at three points (medially to laterally).
Results
The distance to the piriformis from the skin was 6.6 ± 0.9 cm, 6.3 ± 0.8 cm, and 5.2 ± 0.9 cm in terms of the lateral, center, and medial measurement, respectively. The center of the piriformis had a greater diameter with 1.7 ± 0.4 (0.9-2.5) cm. The distance to the piriformis increased with BMI.
Conclusions
This study shows that the lateral of the piriformis muscle has a relatively greater distance from the skin. The center of the piriformis showed a greater diameter than other two portions. We found that the distance of the piriformis from subcutaneous tissues was correlated with BMI, but the diameter of the piriformis was not affected by BMI. These measurements can be used as a reference for determining the piriformis injection site in patients with piriformis syndrome.
doi:10.3344/kjp.2011.24.2.87
PMCID: PMC3111565  PMID: 21716616
anatomy; CT; muscle; piriformis

Results 1-8 (8)