Publications by authors named "Dong-Eon Moon"

33 Publications

Contrast Runoff Correlates with the Clinical Outcome of Cervical Epidural Neuroplasty Using a Racz Catheter.

Pain Physician 2016 Sep-Oct;19(7):E1035-40

Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea.

Background: Epidural neuroplasty using a Racz catheter has a therapeutic effect. Studies have found no correlation between foraminal stenosis and the outcome of epidural neuroplasty, which is thought to depend on contrast runoff.

Objective: To examine the correlation between the contrast spread pattern and pain reduction in cervical epidural neuroplasty using a Racz catheter.

Study Design: Retrospective study.

Setting: An interventional pain-management practice in a university hospital.

Methods: Fluoroscopic images were reviewed retrospectively. The spread of contrast from the neural foramen to a nerve root was called contrast runoff. If the contrast did not spread in this manner, then there was no contrast runoff. We defined successful epidural neuroplasty as a 50% or greater reduction from the pre-procedure numeric rating scale (NRS) score for total pain, and an at least 40% reduction in the neck pain and disability scale (NPDS) score.

Results: This study reviewed 169 patients. Among the patients who had a contrast runoff pattern, the epidural neuroplasty was rated as successful in 96 (74.4%), 97 (75.2%), 86 (66.7%), and 79 (61.2%) cases one, 3, 6, and 12 months after the procedure, respectively. When there was no contrast runoff, the epidural neuroplasty was successful in 12 (30%), 12 (30%), 10 (25%), and 10 (25%) cases at one, 3, 6, and 12 months after the procedure (P < 0.001). Logistic regression of the contrast spread pattern and predicting successful epidural neuroplasty gave similar results. Patients with a contrast runoff pattern had odds ratios of 6.788, 7.073, 6.000, and 4.740 at one, 3, 6, and 12 months, respectively (P < 0.001).

Limitations: This study lacked a control group, and the patients were not classified by their diagnosed disease, such as spinal stenosis, herniated nucleus pulposus, and post-spinal surgery syndrome.

Conclusions: Cervical epidural neuroplasty with a contrast runoff pattern had a higher success rate. Contrast runoff should be observed during neuroplasty, even in the presence of foraminal stenosis.

Key Words: Cervical spinal pain, contrast, contrast runoff, epidural neuroplasty, percutaneous adhesiolysis, Racz catheter.
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July 2017

Radiologic Analysis and Clinical Study of the Upper One-third Joint Technique for Fluoroscopically Guided Sacroiliac Joint Injection.

Pain Physician 2015 Sep-Oct;18(5):495-503

Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea.

Background: Sacroiliac intraarticular injection by the traditional technique can be challenging to perform when the joint is covered with osteophytes or is extremely narrow.

Objective: To examine whether there is enough space for the needle to be advanced from the L5-S1 interspinous space to the upper one-third sacroiliac joint (SIJ) by magnetic resonance image (MRI) analysis as an alternative to fluoroscopically guided SIJ injection with the lower one-third joint technique, and to determine the feasibility of this novel technique in clinical practice.

Study Design: MRI analysis and observational study.

Setting: An interventional pain management practice at a university hospital.

Methods: We analyzed 200 axial T2-weighted MRIs between the L5 and S1 vertebrae of 100 consecutive patients. The following measurements were obtained on both sides: 1) the thickness of fat in the midline; 2) the distance between the midline (Point C) and the junction (Point A) of the skin and the imaginary line that connects the SIJ and the most medial cortex of the ilium; 3) the distance between the midline (Point C) and the junction (Point B) of the skin and the imaginary line that connects the SIJ and the L5 spinous process; 4) the distance between the SIJ and midline (Point C) on the skin, or between the SIJ and the midpoint (Point C') of the line from Point A to Point B; and 5) the angle between the sagittal line and the imaginary line that connects the SIJ and the midline on the skin. The upper one-third joint technique was performed to establish the feasibility of the alternative technique in 20 patients who had unsuccessful sacroiliac intraarticular injections using the lower one-third joint technique.

Results: The mean distances from the midline to Point A and to Point B were 21.9 ± 13.7 mm and 27.8 ± 13.6 mm, respectively. The mean distance between the SIJ and Point C (or Point C') was 81.0 ± 13.3 mm. The angle between the sagittal line and the imaginary line that connects the SIJ and the midline on the skin was 42.8 ± 5.1°. The success rate of sacroiliac intraarticular injections with the upper one-third joint technique was 90% (18/20).

Limitations: This was an observational study and lacked a control group.

Conclusions: Sacroiliac intraarticular injections with the upper one-third joint technique are advisable when it is hard to perform them with the lower one-third joint technique.
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June 2016

Assessment of clinical outcomes of cervical epidural neuroplasty using a Racz-catheter and predictive factors of efficacy in patients with cervical spinal pain.

Pain Physician 2015 Mar-Apr;18(2):E163-70

Background: Epidural neuroplasty using the Racz catheter has a therapeutic effect in patients with cervical disc herniation and central stenosis who do not respond to fluoroscopically guided epidural injections.

Objective: To evaluate the clinical outcomes of cervical epidural neuroplasty in patients with posterior neck and upper extremity pain and to demonstrate correlations between predictive factors and unsuccessful results of cervical epidural neuroplasty.

Study Design: Observational study.

Setting: An interventional pain management practice in a university hospital.

Methods: Outcome measures were obtained using the numeric rating scale (NRS) for total pain, neck pain, arm pain, and sleep disturbance; and the neck pain and disability scale (NPDS); as well as opioid consumption at preprocedure, one month, 3, 6, and 12 months after procedure. Successful epidural neuroplasty was defined as 50% or greater reduction from the preprocedure NRS for total pain, and at least a 40% reduction in the NPDS. We obtained clinical data and radiologic findings to evaluate correlations between predictive factors and efficacy of epidural neuroplasty.

Results: Of the 169 patients, successful outcomes were observed in 108 patients (63.9%) at one month following the procedure, in 109 patients (64.5%) at 3 months, in 96 patients (56.8%) at 6 months, and in 89 patients (52.7%) at 12 months. Previous surgery, spondylolisthesis, and ossification of the posterior longitudinal ligament were significantly associated with unsuccessful outcomes as measured by NRS and NPDS (P < 0.05).

Limitations: Limitations of this evaluation include the lack of a placebo group.

Conclusions: Cervical epidural neuroplasty may be an effective treatment for pain reduction and functional improvement in patients with cervical spinal pain who did not respond to conservative treatment, and may decrease surgical demand. Previous surgery, spondylolisthesis, and ossification of the posterior longitudinal ligament are associated with unsuccessful outcomes of epidural neuroplasty.
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October 2015

Ultrasound-guided Pararadicular Injection in the Lumbar Spine: A Comparative Study of the Paramedian Sagittal and Paramedian Sagittal Oblique Approaches.

Pain Pract 2015 Nov 14;15(8):693-700. Epub 2014 Oct 14.

Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Background: Ultrasound-guided nerve root blocks and transforaminal injections are well established, and several procedural feasibility studies have been reported. However, the contrast dispersion pattern during ultrasound-guided pararadicular injection has not been reported. We hypothesized that the paramedian sagittal oblique approach provides a superior intraforaminal contrast-spread pattern compared to the paramedian sagittal approach during ultrasound-guided pararadicular injections in the lumbar spine.

Methods: Ninety injections were performed in 42 adult patients using pararadicular injections. Each injection was allocated to 1 of 2 groups. In the paramedian sagittal approach group, the transducer was positioned perpendicularly over the skin, and a bent needle was inserted using an in-plane technique. In the paramedian sagittal oblique approach group, the needle was advanced with the transducer tilted ~20 to 25° toward the pararadicular aditus plane. In both groups, the needle was advanced until the intertransverse ligament was punctured. Nonionic contrast media was injected under fluoroscopic guidance.

Results: The contrast was injected in the targeted pararadicular compartment in 83 of 90 injections (92.2%). Among the successful pararadicular injections, the intraforaminal contrast pattern was detected in 17 cases (39.5%) in the paramedian sagittal approach group and in 35 cases (87.5%) in the paramedian sagittal oblique approach group (P < 0.001). Both groups showed significant pain reduction compared to the baseline (P < 0.001); however, the visual analog scale for pain showed significantly lower pain in the paramedian sagittal oblique approach group compared to the paramedian sagittal approach group (P = 0.036). Rates of ventral epidural flow, intra- and extraepineural pattern of contrast, and intravascular injections were similar between the two approaches.

Conclusion: The paramedian sagittal oblique approach delivered a superior intraforaminal contrast-spread pattern and significantly greater pain relief than the paramedian sagittal approach during ultrasound-guided pararadicular injections in the lumbar spine.
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http://dx.doi.org/10.1111/papr.12249DOI Listing
November 2015

Assessment of factors affecting the difficulty of caudal epidural injections in adults using ultrasound.

Pain Res Manag 2014 Sep-Oct;19(5):275-9. Epub 2014 Aug 11.

Background: In unaided caudal epidural block (CEB), incorrect needle insertion has been reported to occur in 15% to 38% of attempts.

Objective: To statistically analyze the anatomical variables affecting difficult CEB using ultrasonographic measurement.

Methods: Preprocedural ultrasonography was performed and the following measurements were obtained in 146 patients: the distance from the skin to the apex of the sacral hiatus; the depth of the sacral canal at the apex of the sacral hiatus; the length of the sacrococcygeal ligament between the apex of the sacral hiatus and sacral base; the distance from the skin to the apex of the sacral cornu; and the distance between the apexes of bilateral cornua. One clinician, unaware of the ultrasonographic findings, performed the injections using the landmark technique. The procedures were videotaped and were subsequently reviewed by an independent investigator.

Results: The means (± SDs) of the abovementioned measurements were 12.1±3.7 mm, 6.1±2.1 mm, 25.9±7.4 mm, 10.0±4.0 mm and 16.4±3.2 mm, respectively. Injections failed in 16 (11%) patients and were defined as difficult in 21 (14.4%) patients. The depth of the sacral canal at the apex of sacral hiatus (P<0.001) and the length of the sacrococcygeal ligament between the apex of the sacral hiatus and sacral base (P=0.001) were significant predictors of difficult CEB. Of all patients, 85.7% and 75.2% were correctly classified as difficult or not difficult, respectively. The cutoff values of the depth of the sacral canal at the apex of the sacral hiatus and the length of the sacrococcygeal ligament between the apex of the sacral hiatus and the sacral base to predict a difficult CEB were 3.7 mm and 17.6 mm, respectively.

Conclusions: Both the depth of the sacral canal at the apex of the sacral hiatus and the length of the sacrococcygeal ligament between the apex of the sacral hiatus and sacral base are significant variables affecting the difficulty of the CEB.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197755PMC
http://dx.doi.org/10.1155/2014/679128DOI Listing
June 2015

Genome-wide expression profiling of complex regional pain syndrome.

PLoS One 2013 14;8(11):e79435. Epub 2013 Nov 14.

Research Institute for Medical Sciences, College of Medicine, Chungnam National University, Daejeon, Korea ; Clinical Trials Center, Chungnam National University Hospital, Daejeon, Korea.

Complex regional pain syndrome (CRPS) is a chronic, progressive, and devastating pain syndrome characterized by spontaneous pain, hyperalgesia, allodynia, altered skin temperature, and motor dysfunction. Although previous gene expression profiling studies have been conducted in animal pain models, there genome-wide expression profiling in the whole blood of CRPS patients has not been reported yet. Here, we successfully identified certain pain-related genes through genome-wide expression profiling in the blood from CRPS patients. We found that 80 genes were differentially expressed between 4 CRPS patients (2 CRPS I and 2 CRPS II) and 5 controls (cut-off value: 1.5-fold change and p<0.05). Most of those genes were associated with signal transduction, developmental processes, cell structure and motility, and immunity and defense. The expression levels of major histocompatibility complex class I A subtype (HLA-A29.1), matrix metalloproteinase 9 (MMP9), alanine aminopeptidase N (ANPEP), l-histidine decarboxylase (HDC), granulocyte colony-stimulating factor 3 receptor (G-CSF3R), and signal transducer and activator of transcription 3 (STAT3) genes selected from the microarray were confirmed in 24 CRPS patients and 18 controls by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). We focused on the MMP9 gene that, by qRT-PCR, showed a statistically significant difference in expression in CRPS patients compared to controls with the highest relative fold change (4.0±1.23 times and p = 1.4×10(-4)). The up-regulation of MMP9 gene in the blood may be related to the pain progression in CRPS patients. Our findings, which offer a valuable contribution to the understanding of the differential gene expression in CRPS may help in the understanding of the pathophysiology of CRPS pain progression.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0079435PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3828360PMC
November 2014

Occurrence of a spinal intradural arachnoid cyst after epiduroscopic neural decompression.

Korean J Anesthesiol 2013 Sep;65(3):270-2

Department of Anesthesiology and Pain Medicine, School of Medicine, The Catholic University of Korea, Seoul, Korea.

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http://dx.doi.org/10.4097/kjae.2013.65.3.270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3790042PMC
September 2013

Ultrasound-guided Pulsed Radiofrequency of the Third Occipital Nerve.

Korean J Pain 2013 Apr 3;26(2):186-90. Epub 2013 Apr 3.

Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.

A C2-3 zygapophygeal joint is a major source of cervicogenic headache. Radiofrequency (RF) neurotomy is preformed widely for zygapophygeal joint pain. Conventional RF denervation technique is generally performed under fluoroscopic control. Recently, ultrasound-guided radiofrequency on zygapophygeal joint has emerged as an alternative method. We report our experiences of two successful ultrasound-guided pulsed radiofrequencies on 39-year-old and 42-year-old males, who complained occipital headache and posterior neck pain.
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http://dx.doi.org/10.3344/kjp.2013.26.2.186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3629349PMC
April 2013

Anti-allodynic effects of levodopa in neuropathic rats.

Yonsei Med J 2013 Mar;54(2):330-5

Department of Anaesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea.

Purpose: Levodopa is the most effective anti-Parkinsonian agent. It has also been known to exhibit analgesic properties in laboratory and clinical settings. However, studies evaluating its effects on neuropathic pain are limited. The aim of the present study was to examine the anti-allodynic effects of levodopa in neuropathic rats.

Materials And Methods: Sprague-Dawley male rats underwent the surgical procedure for L5 and L6 spinal nerves ligation. Sixty neuropathic rats were randomly divided into 6 groups for the oral administration of distilled water and levodopa at 10, 30, 50, 70, and 100 mg/kg, respectively. We co-administered carbidopa with levodopa to prevent peripheral synthesis of dopamine from levodopa, and observed tactile, cold, and heat allodynia pre-administration, and at 15, 30, 60, 90, 120, 150, 180, and 240 min after drug administration. We also measured locomotor function of neuropathic rats using rotarod test to examine whether levodopa caused side effects or not.

Results: Distilled water group didn't show any difference in all allodynia. For the levodopa groups (10-100 mg/kg), tactile and heat withdrawal thresholds were increased, and cold withdrawal frequency was decreased dose-dependently (p<0.01). In addition, levodopa induced biphasic analgesia. Different dosage of levodopa did not impact on the rotarod time (p>0.05).

Conclusion: Levodopa reversed tactile, cold and heat allodynia in neuropathic rat without any side effects.
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http://dx.doi.org/10.3349/ymj.2013.54.2.330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3575974PMC
March 2013

Stevens-johnson syndrome induced by carbamazepine treatment in a patient who previously had carbamazepine induced pruritus - a case report -.

Korean J Pain 2013 Jan 4;26(1):80-3. Epub 2013 Jan 4.

Department of Anesthesiology and Pain Medicine, Catholic Medical Center, School of Medicine, The Catholic University of Korea, Seoul, Korea.

Stevens-Johnson syndrome (SJS) is a rare but life-threatening skin reaction disease and carbamazepine is one of its most common causes. We report a case of SJS secondary to carbamazepine in a patient with previous pruritus due to carbamazepine which was given for treatment of trigeminal neuralgia. We would like to caution all providers that carbamazepine readministration should be avoided in the patient with a previous history of SJS or adverse skin reaction. In addition, we strongly recommend gradual titration when initiating treatment with carbamazepine.
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http://dx.doi.org/10.3344/kjp.2013.26.1.80DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546217PMC
January 2013

Analgesic effects of dexmedetomidine in vincristine-evoked painful neuropathic rats.

J Korean Med Sci 2012 Nov 30;27(11):1411-7. Epub 2012 Oct 30.

Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.

Dexmedetomidine, which is a selective α2-adrenoceptor agonist, was recently introduced into clinical practice for its analgesic properties. The purpose of this study was to evaluate the effects of dexmedetomidine in a vincristine-evoked neuropathic rat models. Sprague-Dawley rats were injected intraperitoneally with vincristine or saline (0.1 mg/kg/day) using a 5-day-on, 2-day-off schedule for 2 weeks. Saline and dexmedetomidine (12.5, 25, 50, and 100 µg/kg) were injected to rats developed allodynia 14 days after vincristine injection, respectively. We evaluated allodynia at before, 15, 30, 60, 90, 120, 180, and 240 min, and 24 hr after intraperitoneal drug (normal saline or dexmedetomidine) injection. Saline treatment did not show any differences for all the allodynia. Maximal paw withdrawal thresholds to mechanical stimuli were 3.0 ± 0.4, 9.1 ± 1.9, 13.0 ± 3.6, 16.6 ± 2.4, and 24.4 ± 1.6 g at saline, 12.5, 25, 50, and 100 µg/kg dexmedetomidine injection, respectively. Minimal withdrawal frequency to cold stimuli were 73.3 ± 4.2, 57.1 ± 6.8, 34.3 ± 5.7, 20.0 ± 6.2, and 14.3 ± 9.5 g at saline, 12.5, 25, 50, and 100 µg/kg dexmedetomidine injection, respectively. Dexmedetomidine shows a dose-dependent antiallodynic effect on mechanical and cold stimuli in vincristine-evoked neuropathic rat models (P < 0.05).
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http://dx.doi.org/10.3346/jkms.2012.27.11.1411DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492679PMC
November 2012

Ginkgo biloba extract attenuates hyperalgesia in a rat model of vincristine-induced peripheral neuropathy.

Anesth Analg 2012 Nov 25;115(5):1228-33. Epub 2012 Sep 25.

Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul.

Background: Chemotherapy-induced peripheral neuropathy is a common, dose-limiting side effect of cancer chemotherapeutic drugs. Hyperalgesia is a common component of neuropathic pain. Ginkgo biloba extract (GBE) is an oriental herbal medicine that has various pharmacological actions. In this study, we evaluated the effects of oral GBE on hyperalgesia in a rat model of vincristine-induced neuropathy.

Methods: Male Sprague-Dawley rats (200-250 g) were injected intraperitoneally with vincristine or saline (0.1 mg/kg/d) using a 5-day-on, 2-day-off schedule over 12 days. All the behavioral tests for mechanical, cold, and heat hyperalgesia were conducted before the daily injection during the course of vincristine treatment. Rats that developed hyperalgesia 14 days after vincristine injection were randomly assigned into 4 groups. Distilled water and GBE (50, 100, and 150 mg/kg) were administered, respectively, to the individual groups. We examined the hyperalgesia at preadministration and at 15, 30, 60, 90, 120, 150, and 180 minutes after oral drug administration.

Results: Saline injection did not have any significant effect on mechanical, cold, and heat hyperalgesia. Vincristine injection produced mechanical and cold hyperalgesia. For the GBE groups, the paw withdrawal threshold to mechanical stimuli was significantly increased and withdrawal frequency to cold stimuli was significantly reduced versus the control group dose-dependently (P < 0.05).

Conclusions: This study demonstrates that oral administration of GBE is associated with a dose-dependent antihyperalgesic effect on mechanical and cold stimuli in a rat model of vincristine-induced neuropathy.
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http://dx.doi.org/10.1213/ANE.0b013e318262e170DOI Listing
November 2012

Pain acceptance-based coping in complex regional pain syndrome Type I: daily relations with pain intensity, activity, and mood.

J Behav Med 2013 Oct 2;36(5):531-8. Epub 2012 Aug 2.

Department of Psychology, Chung-Ang University, 221 Heukseok-dong, Dongjak-gu, Seoul, 156-756, Korea.

This study aimed to examine the temporal patterning of pain acceptance-based coping, activity, and mood in patients with complex regional pain syndrome Type I (CRPS-I), by using a daily diary method. A total of 30 patients with CRPS-I seeking treatment in a tertiary pain management center located in Seoul, Korea participated in the study. Multilevel random effects analyses indicated that (a) engagement in pain acceptance-based coping was significantly associated with lower same-day pain and negative mood and greater same-day activity and positive mood; (b) pain acceptance-based coping predicted increases in activity on the following day; (c) greater pain intensity was significantly associated with lower same-day pain acceptance-based coping and activity and greater same-day negative mood; and (d) pain intensity did not predict pain acceptance-based coping, activity, or mood on the following day. These findings suggest that patients with CRPS-I may benefit from responding to pain with acceptance. Further study and eventual application of this process in CRPS-I may improve upon the success of current approaches to this problem.
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http://dx.doi.org/10.1007/s10865-012-9448-7DOI Listing
October 2013

The antinociceptive effect of acetaminophen in a rat model of neuropathic pain.

Kaohsiung J Med Sci 2012 May 22;28(5):251-8. Epub 2012 Feb 22.

Department of Anesthesiology and Pain Medicine, School of Medicine, The Catholic University of Korea, Seoul, South Korea.

Acetaminophen is one of the most popular and widely used analgesics for the treatment of pain and fever but few studies have evaluated its effects on neuropathic pain. This study examined the effect of acetaminophen on thermal hyperalgesia, mechanical and cold allodynia in a rat model of neuropathic pain. Male Sprague-Dawley rats were prepared by tightly ligating the left L5 and L6 spinal nerves to produce a model of neuropathic pain. Sixty neuropathic rats were assigned randomly into six groups. Normal saline and acetaminophen (25, 50, 100, 200 and 300 mg/kg) were administered intraperitoneally to these individual groups. Thermal hyperalgesia, mechanical and cold allodynia were examined at preadministration and at 15, 30, 60, 90, 120, 180, 240 and 360 min after administering the drug. Mechanical allodynia was quantified by measuring the paw withdrawal threshold to stimuli with von Frey filaments. Cold allodynia was quantified by measuring the frequency of foot lift after applying 100% acetone. Thermal hyperalgesia was quantified by measuring the thermal withdrawal threshold. The rotarod performance was measured to detect any drug-induced adverse effects, such as drowsiness. The hepatic and renal adverse effect was also assessed by measuring the serum levels of aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen and creatinine. The paw withdrawal thresholds to mechanical stimuli and the thermal withdrawal threshold were increased significantly and withdrawal frequencies to cold stimuli were reduced by acetaminophen administration in a dose-dependent manner. Acetaminophen reduces thermal hyperalgesia, mechanical and cold allodynia in a rat model of neuropathic pain, and might be useful for managing neuropathic pain.
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http://dx.doi.org/10.1016/j.kjms.2011.11.003DOI Listing
May 2012

A new technique for inferior hypogastric plexus block: a coccygeal transverse approach -a case report-.

Korean J Pain 2012 Jan 2;25(1):38-42. Epub 2012 Jan 2.

Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.

Chronic pelvic pain is a common problem with variable etiology. The sympathetic nervous system plays an important role in the transmission of visceral pain regardless of its etiology. Sympathetic nerve block is effective and safe for treatment of pelvic visceral pain. One of them, the inferior hypogastric plexus, is not easily assessable to blockade by local anesthetics and neurolytic agents. Inferior hypogastric plexus block is not commonly used in chronic pelvic pain patients due to pre-sacral location. Therefore, inferior hypogastric plexus is not readily blocked using paravertebral or transdiscal approaches. There is only one report of inferior hypogastric plexus block via transsacral approach. This approach has several disadvantages. In this case a favorable outcome was obtained by using coccygeal transverse approach of inferior hypogastric plexus. Thus, we report a patient who was successfully given inferior hypogastric plexus block via coccygeal transverse approach to treat chronic pelvic pain conditions involving the lower pelvic viscera.
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http://dx.doi.org/10.3344/kjp.2012.25.1.38DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259136PMC
January 2012

Ultrasound-guided Aspiration of the Iatrogenic Pneumothorax Caused by Paravertebral Block -A Case Report-.

Korean J Pain 2012 Jan 2;25(1):33-7. Epub 2012 Jan 2.

Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Thoracic paravertebral block is performed for the treatment of patients with chronic pain, such as complex regional pain syndrome (CRPS) and post-herpetic neuralgia. Thoracic paravertebral block can result in iatrogenic pneumothorax. Because pneumothorax can develop into medical emergencies and needle aspiration or chest tube placement may be needed, early diagnosis is very important. Recently, thoracic ultrasonography has begun to be used to diagnose pneumothorax. In addition, ultrasound-guided aspiration can be an accurate and safe technique for treatment of pneumothorax, as the needle position can be followed in real time. We report a case of iatrogenic pneumothorax following thoracic paravertebral block for the treatment of chronic pain due to CRPS, treated successfully by ultrasound-guided aspiration.
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http://dx.doi.org/10.3344/kjp.2012.25.1.33DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259135PMC
January 2012

Sacral nerve stimulation for the treatment of sacroiliac joint dysfunction: A case report.

Neuromodulation 2010 Oct;13(4):306-10

Department of Anesthesiology and Pain Medicine, School of Medicine, The Catholic University of Korea, Seoul, Korea.

Introduction: Sacroiliac joint (SIJ) dysfunction is a significant contributing factor in 10-30% of individuals with lower back pain. However, definitive diagnostic methods and treatments are still controversial.

Methods: We present a case of a 41-year-old woman with left buttock pain, referred pain to the left leg, and dyspareunia. Her visual analogue scale (VAS) pain score was 9/10. Although we performed intramuscular injection into piriformis muscle, intra-articular injection into SIJ, and radiofrequency denervation for the treatment of SIJ pain, her pain repeatedly improved and was reaggravated. Sacral nerve stimulation to the left first sacral foramen via the retrograde cephalocaudal approach was performed.

Results: Her VAS pain score decreased to 2-3/10 following sacral nerve stimulation to the left first sacral foramen via the retrograde cephalocaudal approach. Before undergoing sacral nerve stimulation, she had taken anti-depressants, anti-anxietics, analgesics, and anti-convulsants. After the procedure, she required intermittent analgesics only.

Conclusions: Sacral nerve stimulation with a percutaneous retrograde cephalocaudal approach is considered to be a useful therapeutic option in the treatment of intractable SIJ dysfunction.
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http://dx.doi.org/10.1111/j.1525-1403.2009.00270.xDOI Listing
October 2010

Psychometric properties of a Korean version of the Chronic Pain Acceptance Questionnaire in chronic pain patients.

Qual Life Res 2012 Aug 17;21(6):1059-64. Epub 2011 Sep 17.

Department of Psychology, Chung-Ang University, 221 Heukseok-dong, Dongjak-gu, Seoul, 156-756, Korea.

Purpose: Accepting pain rather than trying to control it has been the focus of recent pain management research. Pain acceptance often has been assessed using the chronic pain acceptance questionnaire (CPAQ). This study aimed to evaluate the factor structure and other psychometric properties of a Korean language version of the CPAQ (KCPAQ).

Methods: This study used two archival data sets collected over two different time periods at the same site in Korea, generating two samples (Total N = 361).

Results: Exploratory factor analysis using sample 1 (N = 182) provided support for the same two-factor structure as the original English CPAQ. Confirmatory factor analysis using sample 2 (N = 179) demonstrated the adequacy of the two-factor model obtained from sample 1. Samples 1 and 2 were combined for the reliability and validity analyses. The results indicated that the KCPAQ has good internal consistency and test-retest stability. The KCPAQ was significantly correlated with pain intensity, pain-related anxiety, depressive symptoms, physical adjustment, and psychosocial adjustment.

Conclusion: The KCPAQ has reliability and construct validity support for the measurement of pain acceptance in a Korean patient sample with chronic pain.
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http://dx.doi.org/10.1007/s11136-011-0010-9DOI Listing
August 2012

Daily functioning in chronic pain: study of structural relations with posttraumatic stress disorder symptoms, pain intensity, and pain avoidance.

Korean J Pain 2011 Mar 25;24(1):13-21. Epub 2011 Feb 25.

Department of Psychology, College of Medicine, Chung-Ang University, Seoul, Korea.

Background: This study aimed to evaluate processes from the mutual maintenance model in relation to daily functioning in patients with both chronic pain and a history of a traumatic experience. The mechanism illustrated the structural relations for daily functioning among pain intensity, hyperarousal, re-experiencing, trauma avoidance, and pain avoidance.

Methods: Archival data (N = 214) was used for this study and data were analyzed for 142 chronic pain patients reporting a traumatic experience and seeking treatment at a tertiary pain clinic in Korea.

Results: The results indicated that pain intensity, hyperarousal, and pain avoidance had significant direct effects on daily functioning. Also, pain intensity showed significant indirect effects on daily functioning through hyperarousal and pain avoidance; and hyperarousal through pain avoidance.

Conclusions: Results suggest a direct contribution of high levels of pain, hyperarousal symptoms of PTSD, and pain avoidance behaviors to reduced daily functioning. Also, elevated pain as reminders of the trauma may trigger high levels of hyperarousal symptoms of PTSD. Subsequently, avoidant coping strategies may be used to minimize pain so that the trauma would not be re-experienced, thus inhibiting the activation of hyperarousal symptoms of PTSD. However, prolonged use of such strategies may contribute to decline in daily functioning.
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http://dx.doi.org/10.3344/kjp.2011.24.1.13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3049972PMC
March 2011

Reversible posterior leukoencephalopathy syndrome after cervical transforaminal epidural steroid injection presenting as transient blindness.

Anesth Analg 2011 Apr 8;112(4):967-70. Epub 2011 Mar 8.

Department of Neurology, National Cancer Center, Goyang, Korea.

Transforaminal epidural steroid injections have been introduced as a nonsurgical treatment for cervical pain syndromes; however, they have also raised safety concerns. We present a patient who developed a headache and bilateral visual disturbance after cervical transforaminal epidural steroid injections. Brain magnetic resonance imaging showed a high signal intensity in the posterior region on T2-weighted and fluid-attenuated inversion recovery images, and the findings of diffusion-weighted imaging and the apparent diffusion coefficient map suggested vasogenic edema. The symptoms and abnormal imaging findings disappeared during follow-up. The clinical and imaging characteristics and their complete reversibility corresponded to reversible posterior leukoencephalopathy syndrome.
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http://dx.doi.org/10.1213/ANE.0b013e31820bff7eDOI Listing
April 2011

Efficacy and tolerability of pregabalin using a flexible, optimized dose schedule in Korean patients with peripheral neuropathic pain: a 10-week, randomized, double-blind, placebo-controlled, multicenter study.

Clin Ther 2010 Dec;32(14):2370-85

Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Korea, Seoul, Korea.

Background: Clinical trials from various countries have reported the efficacy of pregabalin for reducing peripheral neuropathic pain.

Objective: This study assessed the efficacy and tolerability of pregabalin in Korean patients with neuropathic pain.

Methods: This was a Phase III, 10-week, randomized, double-blind, placebo-controlled, multicenter study. Patients aged ≥ 18 years with neuropathic pain (diabetic peripheral neuropathy, postherpetic neuralgia, or posttraumatic neuropathic pain) were enrolled and randomly assigned (2:1 ratio) to pregabalin (150-600 mg/d) or matching placebo. Randomization was performed using a proprietary telerandomization system. The primary end point was the difference in week 8 least squares (LS) mean Daily Pain Rating Scale (DPRS) score (rated once daily from 0 ["no pain"] to 10 ["worst possible pain"]) between pregabalin and placebo, calculated using the average of the last 7 available DPRS scores. Secondary efficacy measures included the following: the proportion of responders whose DPRS scores were reduced by ≥ 30% or ≥ 50% versus baseline, the Daily Sleep Interference Scale (DSIS; 11-point scale, scored daily), the Euro Quality of Life assessment (EQ-5D; 2 items scored separately), the Medical Outcomes Study (MOS) Sleep Scale (12 items each scored separately), the Hospital Anxiety and Depression Scale (HADS; 2 items scored from 0 to 21), the Patient Global Impression of Change (PGIC) and the Clinical Global Impression of Change (CGIC; each scored on a 7-point scale), and tolerability assessments. Adverse events and vital signs were monitored throughout the study with laboratory measurements, physical examinations, neurologic examinations, and 12-lead ECG tests. Data were analyzed using ANCOVA or Cochran-Mantel-Haenszel test, and P < 0.05 was considered statistically significant.

Results: The treatment groups (n = 162 pregabalin; n = 78 placebo) were well matched at baseline (pregabalin: 51.2% [83/162] female; mean [SD] age, 59.7 [10.8] years; weight, 63.6 [9.3] kg; placebo: 59.0% [46/78] female; mean age, 61.3 [12.9] years; weight, 62.0 [9.5] kg). All patients were Korean. The mean doses at end point were 480 mg/d for pregabalin and 513 mg/d for the placebo equivalent. Most patients received concomitant drug treatments during the study: 79.6% (129/162) in the pregabalin group and 92.3% (72/78) in the placebo group. The mean DPRS score at end point was significantly lower in the pregabalin group than in the placebo group (LS mean difference, -0.50; 95% CI, -1.00 to 0.00; P = 0.049). In total, 26.1% (42/161) of pregabalin-treated patients reported ≥ 50% improvement in mean DPRS scores from baseline, compared with 14.3% (11/77) for placebo (P = 0.041 between groups). The LS mean change in the DSIS from baseline to end point favored pregabalin (-0.51; 95% CI, -0.96 to -0.07; P = 0.024). Significant improvements were also recorded for overall MOS sleep interference score (difference in LS means, -0.65; P = 0.018) and HADS anxiety subscale score (-0.85; P = 0.038). Other secondary assessments (eg, EQ-5D, HADS depression subscale, PGIC, and CGIC) did not reach significance. A higher proportion of patients reported treatment-related adverse events with pregabalin (43.8% [71/162]) than with placebo (29.5% [23/78]). Dizziness (21.0% [34/162]), somnolence (13.6% [22/162]), face edema (6.2% [10/162]), peripheral edema (6.2% [10/162]), and weight gain (5.6% [9/162]) were the most commonly reported adverse events in the pregabalin group.

Conclusion: Flexible-dose pregabalin (150-600 mg/d for 8 weeks) was associated with a significant, although modest, reduction in mean DPRS score; an improvement in anxiety and subjective sleep; and generally good tolerability compared with placebo in these Korean patients with neuropathic pain due to diabetic peripheral neuropathy, postherpetic neuralgia, or posttraumatic neuropathic pain.
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http://dx.doi.org/10.1016/j.clinthera.2011.01.014DOI Listing
December 2010

The effects of preoperative intravenous acetaminophen in patients undergoing abdominal hysterectomy.

Arch Gynecol Obstet 2011 Dec 23;284(6):1455-60. Epub 2011 Feb 23.

Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, Catholic Medical College, Banpo-dong, Seoul, South Korea.

Purpose: Although intravenous acetaminophen is commonly used for the management of postoperative pain, very limited evidence supports the usefulness of preoperative administration. The aim of this study was to determine the analgesic effect of preoperative acetaminophen on opioid consumption, pain scores, and side effects in patients receiving an elective abdominal hysterectomy.

Methods: A randomized, double-blinded, placebo-controlled clinical trial was performed in 76 women undergoing abdominal hysterectomy. Patients received either acetaminophen 2 g (group A) or placebo (group C) intravenously 30 min before surgery under general anesthesia. Postoperative pain was treated with patient-controlled intravenous hydromorphone 0.2 mg bolus. Hydromorphone consumption, pain scores during rest and movement, and any adverse effects were recorded at 1, 2, 6, 12, and 24 h after the operation.

Results: Overall hydromorphone consumption was significantly lower in group A compared with group C at all the time points (P = 0.013). The total 24-h hydromorphone consumption was reduced by 30% in group A. There was no significant difference in pain scores. The incidence of postoperative nausea and vomiting after the operation were significantly lower in group A than in group C (P < 0.05).

Conclusions: Premedication with acetaminophen reduced hydromorphone consumption and opioid-related side effect in patients undergoing abdominal hysterectomy, but did not significantly reduce pain intensity.
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http://dx.doi.org/10.1007/s00404-011-1860-7DOI Listing
December 2011

Pharmacologic management of chronic pain.

Korean J Pain 2010 Jun 31;23(2):99-108. Epub 2010 May 31.

Department of Anesthesiology and Pain Medicine, School of Medicine, The Catholic University of Korea, Seoul, Korea.

Chronic pain is a multifactorial condition with both physical and psychological symptoms, and it affects around 20% of the population in the developed world. In spite of outstanding advances in pain management over the past decades, chronic pain remains a significant problem. This article provides a mechanism- and evidence-based approach to improve the outcome for pharmacologic management of chronic pain. The usual approach to treat mild to moderate pain is to start with a nonopioid analgesic. If this is inadequate, and if there is an element of sleep deprivation, then it is reasonable to add an antidepressant with analgesic qualities. If there is a component of neuropathic pain or fibromyalgia, then a trial with one of the gabapentinoids is appropriate. If these steps are inadequate, then an opioid analgesic may be added. For moderate to severe pain, one would initiate an earlier trial of a long term opioid. Skeletal muscle relaxants and topicals may also be appropriate as single agents or in combination. Meanwhile, the steps of pharmacologic treatments for neuropathic pain include (1) certain antidepressants (tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors), calcium channel alpha(2)-delta ligands (gabapentin and pregabalin) and topical lidocaine, (2) opioid analgesics and tramadol (for first-line use in selected clinical circumstances) and (3) certain other antidepressant and antiepileptic medications (topical capsaicin, mexiletine, and N-methyl-d-aspartate receptor antagonists). It is essential to have a thorough understanding about the different pain mechanisms of chronic pain and evidence-based multi-mechanistic treatment. It is also essential to increase the individualization of treatment.
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http://dx.doi.org/10.3344/kjp.2010.23.2.99DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886242PMC
June 2010

Ganglion impar block with botulinum toxin type a for chronic perineal pain -a case report-.

Korean J Pain 2010 Mar 10;23(1):65-9. Epub 2010 Mar 10.

Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.

Chronic perineal pain is an often encountered problem, which produces a great degree of functional impairment and frustration to the patient and a challenge to the treating physician. The reason for this problem is that the region contains diverse anatomic structures with mixed somatic, visceral and autonomic innervations affecting bladder and bowel control and sexual function. A blockade of nociceptive and sympathetic supply to the perineal region, supplied through the ganglion impar has been shown to benefit patients with chronic perineal pain. Several options to this block have been described that chemical neurolysis, radiofrequency ablation etc. Although the analgesic effect of Botulinum toxin type A (BoNT-A) has long been considered secondary to its action for muscle relaxation, BoNT-A also affects the release of the neurotransmitters that are involved in pain perception. We describe a patient who was successfully given ganglion impar block with BoNT-A.
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http://dx.doi.org/10.3344/kjp.2010.23.1.65DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884216PMC
March 2010

Sacral nerve stimulation for treatment of chronic intractable anorectal pain -a case report-.

Korean J Pain 2010 Mar 10;23(1):60-4. Epub 2010 Mar 10.

Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.

Despite recent methodological advancement of the practical pain medicine, many cases of the chronic anorectal pain have been intractable. A 54-year-old female patient who had a month history of a constant severe anorectal pain was referred to our clinic for further management. No organic or functional pathology was found. In spite of several modalities of management, such as medications and nerve blocks had been applied, the efficacy of such treatments was not long-lasting. Eventually, she underwent temporary then subsequent permanent sacral nerve stimulation. Her sequential numerical rating scale for pain and pain disability index were markedly improved. We report a successful management of the chronic intractable anorectal pain via permanent sacral nerve stimulation. But further controlled studies may be needed.
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http://dx.doi.org/10.3344/kjp.2010.23.1.60DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884202PMC
March 2010

Accuracy of live fluoroscopy to detect intravascular injection during lumbar transforaminal epidural injections.

Korean J Pain 2010 Mar 10;23(1):18-23. Epub 2010 Mar 10.

Department of Anesthesiology and Pain Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.

Background: Complications following lumbar transforaminal epidural injection are frequently related to inadvertent vascular injection of corticosteroids. Several methods have been proposed to reduce the risk of vascular injection. The generally accepted technique during epidural steroid injection is intermittent fluoroscopy. In fact, this technique may miss vascular uptake due to rapid washout. Because of the fleeting appearance of vascular contrast patterns, live fluoroscopy is recommended during contrast injection. However, when vascular contrast patterns are overlapped by expected epidural patterns, it is hard to distinguish them even on live fluoroscopy.

Methods: During 87 lumbar transforaminal epidural injections, dynamic contrast flows were observed under live fluoroscopy with using digital subtraction enhancement. Two dynamic fluoroscopy fluoroscopic images were saved from each injection. These injections were performed by five physicians with experience independently. Accuracy of live fluoroscopy was determined by comparing the interpretation of the digital subtraction fluoroscopic images.

Results: Using digital subtraction guidance with contrast confirmation, the twenty cases of intravascular injection were found (the rate of incidence was 23%). There was no significant difference in incidence of intravascular injections based either on gender or diagnosis. Only five cases of intravascular injections were predicted with either flash or aspiration of blood (sensitivity = 25%). Under live fluoroscopic guidance with contrast confirmation to predict intravascular injection, twelve cases were predicted (sensitivity = 60%).

Conclusions: This finding demonstrate that digital subtraction fluoroscopic imaging is superior to blood aspiration or live fluoroscopy in detecting intravascular injections with lumbar transforaminal epidural injection.
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http://dx.doi.org/10.3344/kjp.2010.23.1.18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884208PMC
March 2010

Attenuation of neuropathy-induced allodynia following intraplantar injection of pregabalin.

Can J Anaesth 2010 Jul 4;57(7):664-71. Epub 2010 May 4.

Department of Anesthesiology and Pain Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Korea.

Purpose: Pregabalin exhibits potent anticonvulsant, analgesic, and anxiolytic activity in animal models. However, few studies have evaluated pregabalin's potential peripheral effects on neuropathic pain. The aim of this study was to evaluate the peripheral analgesic effects of pregabalin in a rat model of neuropathic pain.

Methods: Male Sprague-Dawley rats were prepared by ligating the left L5 and L6 spinal nerves to produce neuropathic pain. Sixty rats with neuropathic pain were randomly assigned to six groups. Normal saline (control) and pregabalin (10, 20, 30, and 50 mg.kg(-1)) were administered to the plantar surface of the affected left hind paw. Pregabalin (50 mg.kg(-1)) was administered into the unaffected contralateral paw in order to determine its systemic effect. Responses to mechanical, cold, and heat stimulation were recorded at 15, 30, 60, 90, 120, 150, and 180 min after drug administration. Rotarod performance was measured to detect drug-induced side effects, including sedation and reduced motor coordination.

Results: Saline injected into the affected paw and a pregabalin dose of 50 mg.kg(-1) injected into the contralateral paw showed no differences for mechanical, cold, and heat allodynia. Administration of pregabalin to the affected left hind paw in the dose range of 10-50 mg.kg(-1) resulted in a dose-dependent increase in thresholds to mechanical, cold, and heat stimulation.

Conclusion: Peripherally administered pregabalin attenuates mechanical, cold, and heat allodynia in a rat model of neuropathic pain.
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http://dx.doi.org/10.1007/s12630-010-9318-0DOI Listing
July 2010

Pain-related anxiety as a mediator of the effects of mindfulness on physical and psychosocial functioning in chronic pain patients in Korea.

J Pain 2010 Aug 24;11(8):789-97. Epub 2010 Mar 24.

Department of Psychology, University of Hawaii at Manoa, Honolulu, HI 96822, USA.

Unlabelled: Mindfulness involves reducing potential influences from aversive cognitions, sensations, and emotions on behavior. Mindfulness may influence the experience of pain-related anxiety, and thereby enhance other aspects of physical and psychosocial functioning. Thus, the purpose of this study was to investigate a potential mediating role of pain-related anxiety between mindfulness and physical and psychosocial functioning in chronic pain patients. This cross-sectional/correlational study used archival data (N = 226) obtained from the larger Korean Pain Study at a university-based pain-management center in Korea. Based on the inclusion criterion for the present study, archival data were analyzed for a final sample of 179 patients with chronic pain. Structural equation analyses showed that both the partial- and full-mediation models had adequate goodness-of-fit indices for physical and psychosocial functioning. Subsequent chi-square tests, however, indicated that the more parsimonious full-mediation model was preferred to the partial-mediation model for physical and psychosocial functioning. Bootstrapping procedures yielded significant mediation effects of pain-related anxiety in the full-mediation models on physical and psychosocial functioning. These findings suggest that being mindful may lead indirectly to a decrease in the disabling influences of pain-related anxiety, thereby contributing to better physical and psychosocial functioning, rather than playing a direct contributing role for better functioning among chronic pain patients in Korea.

Perspective: This article examines the mediating role of pain-related anxiety between mindfulness and physical/psychosocial functioning. Results suggest that mindfulness methods may benefit patients having pain-related anxiety and consequent disability. These benefits may derive from the way processes of mindfulness interact with processes of avoidance and with cognitive influences on emotional suffering.
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http://dx.doi.org/10.1016/j.jpain.2009.12.006DOI Listing
August 2010

Psychometric properties of a Korean version of the Pain Anxiety Symptoms Scale-20 in chronic pain patients.

Int J Behav Med 2010 Jun;17(2):108-17

Department of Psychology, University of Hawaii at Manoa, Manoa, HI, USA.

Background: The Pain Anxiety Symptoms Scale (PASS-20) consists of 20 items designed to assess four aspects of pain-related anxiety: cognitive anxiety, escape-avoidance behaviors, fear of pain, and physiological symptoms of anxiety. Although the PASS-20 is a well-established measure of pain-related anxiety in Western samples, different cultures may yield a different factor structure or different associations with pain-related outcome variables.

Purpose: The purposes of this study were (1) to examine the factor structure of a Korean language version of the PASS-20 (KPASS-20); (2) to examine reliability and construct validity of the KPASS-20; and (3) to compare the findings of this study with those of the original psychometric study using a Western sample.

Method: A total of 166 patients seeking treatment in a university pain management center located in Seoul, Korea participated.

Results: Results indicated that the KPASS-20 consists of three factors, "fearful thinking," "physiological response," and "avoidance," and has adequate reliability and construct validity estimates. On the mean total score of the KPASS-20, the Korean sample had a significantly higher score than the original Western sample. In addition, in correlation analyses between the total score of the KPASS-20, physical functioning, and pain severity, the Korean sample had significantly higher coefficients, whereas similar differences were not found in the analyses of psychological functioning and depression.

Conclusion: The findings provide preliminary support for the reliability and validity of the KPASS-20.
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http://dx.doi.org/10.1007/s12529-010-9080-2DOI Listing
June 2010

The effects of Ginkgo biloba extract EGb 761 on mechanical and cold allodynia in a rat model of neuropathic pain.

Anesth Analg 2009 Jun;108(6):1958-63

Department of Anesthesiology and Pain Medicine, School of Medicine, The Catholic University of Korea, Seoul, Korea.

Background: Neuropathic pain is chronic pain that is caused by an injury to the peripheral or central nervous system. The symptoms of neuropathic pain are continuing pain, hyperalgesia, and allodynia. Ginkgo biloba extract is an oriental herbal medicine that has various pharmacological actions. We examined the effect of Ginkgo biloba extract, EGb 761, on the mechanical and cold allodynia in a rat model of neuropathic pain.

Methods: Male Sprague-Dawley rats were prepared by tightly ligating the left L5 and L6 spinal nerves. All the rats developed mechanical and cold allodynia 7 days after surgery. Fifty neuropathic rats were assigned into five groups for the intraperitoneal administration of drugs. The study was double-blind and the order of the treatments was randomized. Normal saline and EGb 761 (50, 100, 150, and 200 mg/kg) were administered, respectively, to the individual groups. We examined mechanical and cold allodynia at preadministration and at 15, 30, 60, 90, 120, 150, and 180 min after intraperitoneal drug administration. Mechanical allodynia was quantified by measuring the paw withdrawal threshold to stimuli with von Frey filaments of 1.0, 1.4, 2.0, 4.0, 6.0, 8.0, 10.0, 12.0, 15.0, and 26.0 g. Cold allodynia was quantified by measuring the frequency of foot lift with applying 100% acetone. We measured the locomotor function of the neuropathic rats by using the rotarod test to reveal if EGb 761 has side effects, such as sedation or reduced motor coordination.

Results: The control group showed no differences for mechanical and cold allodynia. For the EGb 761 groups, the paw withdrawal thresholds to mechanical stimuli and withdrawal frequencies to cold stimuli were significantly reduced versus the preadministration values and versus the control group. The duration of antiallodynic effects increased in a dose-dependent fashion, and these were maintained for 120 min at the highest dose (P < 0.05). Only at the highest dose (200 mg/kg) did EGb 761 reduce the rotarod performance time.

Conclusion: We conclude that Ginkgo biloba extract, EGb 761, attenuates mechanical and cold allodynia in a rat model of neuropathic pain, and it may be useful for the management of neuropathic pain.
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http://dx.doi.org/10.1213/ane.0b013e31819f1972DOI Listing
June 2009
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