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  • Original Article 2018-12-31 2018-12-31 \ 0 \ 84 \ 14

    Radiating Pain and Postural Balance with Pulsed Radiofrequency Treatment in Patients with Lumbosacral Radiculopathy

    Jung Ho Kwon, M.D., Jinnman Chon, M.D., Ph.D., Hee-Sang Kim, M.D., Ph.D., Jong Ha Lee, M.D., Ph.D., Dong Hwan Kim, M.D., Ph.D., Seung Ah Lee, M.D., Ph.D., Yun Soo Soh, M.D., Ph.D., Yong Kim, M.D., Ph.D., Myung Chul Yoo, M.D. and Haneul Jang, M.D.

    Abstract
    Objective: To investigate the effect of pulsed radiofrequency (PRF) treatment on pain and balance in patients with lumbosacral radiculopathy. Method: This study included twenty-five patients who were diagnosed with chronic lumbosacral radiculopathy. They underwent PRF treatment in prone position under the fluoroscopic guidance. The effect of PRF was measured by the visual analog score (VAS). Patient ability to balance was evaluated by using the Tetra-ataxiometric posturography (Tetrax). Results: After PRF all patients showed improvement in pain as measured by VAS (p<0.001) and none of the patients reported any side effects. The posturographic balance, which was evaluated by Tetrax showed no significant decline after PRF treatment. The weight distribution index (WDI) with eyes open before treatment was 5.43 ± 2.88 and after treatment was 5.37 ± 2.65 (p=0.917). The mean stability index (SI) with eyes open before treatment was 16.52 ± 6.05 and after treatment was 16.61 ± 4.85 (p=0.906). The mean WDI with eyes closed before treatment was 5.66 ± 2.81 and after treatment was 5.16 ± 2.70 (p=0.470). Finally, the mean SI with eyes closed before was 25.88 ± 9.88 and after treatment was 25.99 ± 12.30 (p=0.962). Conclusion: The results suggest that PRF has an effect on pain in patients with chronic lumbosacral radiculopathy. The patients did not experience adverse effects, such as hypoesthesia, dysesthesia and decreased proprioception after PRF, and there were no significant declines in balance.
  • Original Article 2018-12-31 2018-12-31 \ 0 \ 76 \ 24

    Epidural Neuroplasty with Single Bolus Injection versus Continuous Infusion of Steroid in Patients with Spinal Stenosis

    Byung Chan Lee, M.D., Jong Dae Eun, M.D., Hyun Woo Rho, M.D., Eun Sang Kim, M.D., Ph.D., Jeong-Yi Kwon, M.D., Ph.D. and Sang Jun Kim, M.D., Ph.D.

    Abstract
    Objective: To compare the efficacy of epidural adhesiolysis with a single bolus steroid injection (EAS) and continuous steroid infusion (EAC). Method: Thirty-one patients were allocated to the EAS group (10 patients) and EAC group (21 patients). EAS received single bolus of 10 mg of dexamethasone. EAC received a total of 96 mL dexamethasone solution (20.0 mg of dexamethasone) for 48 hrs. Oswestry Disability Index (ODI) was evaluated before, one month after the procedure. Three months after the procedure, the Patient’s Global Impression of Change (PGIC) was evaluated. Results: Pre-treatment ODI was 38.3 ± 3.1 in EAS and 46.40 ± 4.0 in EAC. One month later, ODI was decreased to 35.60 ± 3.33, 43.08 ± 6.96 in each group (p=0.174). Three months later, 2 patients in the EAS (20.0%) and 8 patients in EAC (38.1%) showed ‘much improvement’ in PGIC, 5 patients in EAS (50.0%) and 6 patients in EAC (38.1%) showed ‘slight improvement’, 3 patients in EAS (30.0%) and 7 patients in EAC (33.3%) showed ‘no improvement’ (χ2=1.588, p=0.510). Conclusion: Epidural adhesiolysis with continuous infusion did not show any superiority than single bolus injection.
  • Original Article 2018-12-31 2018-12-31 \ 0 \ 65 \ 30

    Long Term Effect of Custom-Molded Foot Orthoses on Foot Pain and Balance in Children with Symptomatic Flexible Flat Feet

    Hong-Jae Lee, M.D., Kil-Byung Lim, M.D., Ph.D., Jeehyun Yoo, M.D., Jiyong Kim, M.D., Joongmo Kang, M.D., Hojin Lee, M.D. and Tae-Ho Jeong, M.S.

    Abstract
    Objective: To evaluate the long termeffect of custom-molded foot orthoses on foot pain and balance ability in children with symptomatic flexible flat feet after 1 year. Method: A total of 35 children over 6 year-old with flexible flat feet and foot pain for at least 6 months were recruited. Individual custom-molded rigid foot orthoses fabricated with the inverted orthotic technique was prescribed. Pain related parameters (pain sites, degree, and frequency) were obtained through questionnaires. Pain assessment was performed prior to application of the foot orthoses, and 1, 3, 6, 12 months after applying the orthoses. Balance ability was tested by computerized posturography. Such measures were evaluated prior to, 3 months, and 12 months after applying the foot orthoses. Additionally, the difference inbalance ability between barefoot and withfoot orthosesat 12 months was assessed to estimate carryover effect. Results: 17 out of 35 children completed the study. Significant improvements were noted upto 12 months in pain parameters and balance ability. The carry over effect of the orthoses was confirmed. Conclusion: There were significant improvements offoot pain and balance ability in children with symptomatic flexible flat foot after wearing foot orthoses fabricated with the inverted orthotic technique over 1year period.
  • Original Article 2018-12-31 2018-12-31 \ 0 \ 73 \ 22

    Measurements of Multifidus Signal Intensity in Magnetic Resonance Imaging of the Patients with Unilateral Lumbar Radiculopathy

    Eun Sol Cho, M.D., Yun Hee Park, M.D., Young Sook Park, M.D. and Hyun Jung Chang, M.D.

    Abstract
    Objective: To quantitatively evaluate the side- and level-specific change of the multifidus muscle in unilateral radicular pain caused by lumbar disc herniation using magnetic resonance imaging (MRI). Method: Sixty-nine patients with L4-5 disc herniation who underwent electrodiagnostic study and spine MRI were enrolled and divided into the radiculopathy group (n=30) and the control group (n=39) according to the presence of L5 radiculopathy. The radiculopathy group was subdivided into the paraspinalis group (n=12) and the limb group (n=18) according to whether or not paraspinalis muscle was denervated. The cross-sectional area (CSA) and signal intensity (SI) of the multifidus muscle were measured bilaterally at L4-5 and L5-S1 middle intervertebral levels on axial T2-weighted MRI. Results: There was no significant difference in the CSA of the multifidus muscle between the radiculopathy group and the control group. In the radiculopathy group, multifidus SI was greater than the control group on the affected side and below the level of herniation (p=0.015). In the subgroup comparison, affected side L5-S1 multifidus SI was significantly different between the paraspinalis group and the control group (p=0.001), but not between the limb group and the control group (p>0.05). Conclusion: Our findings suggest that quantitative measurement of multifidus SI may be indicative of the location of nerve root compromise through side- and level- specific changes.
  • Case Report 2018-12-31 2018-12-31 \ 0 \ 104 \ 21

    Segmental Motor Paresis Presenting with Abdominal Wall Pseudohernia due to Herpes Zoster

    Sang Yoon Lee, M.D., Seong Woo Kim, M.D., Hyoung Seop Kim, M.D., Hyeon Su Kim, M.D. and Ha Ra Jeon, M.D.

    Abstract
    Herpes zoster is characterized by vesicular eruption and rash of the skin in the affected dermatomes. Sensory symptoms such as pain and hypesthesia are often accompanied in patients with herpes zoster. While motor paralysis is uncommon, abdominal paralysis can result in rare complications such as abdominal wall pseudohernia. In the present report, we discuss the case of a 62 year-old man who presented with abdominal wall protrusion after herpes zoster infection involving the right T10-T12 dermatomes. Magnetic resonance imaging findings were not specifically correlated with abdominal wall protrusion. Needle electromyography revealed abnormal spontaneous activity in the right paraspinal muscles at the T10-T12 levels, rectus abdominis, and external oblique muscles. Dermatomal somatosensory evoked potentials (SEPs) exhibited prolonged latency in the right T10 and T12 dermatomes. These findings suggest that herpes zoster infection can affect both motor and sensory nerves.
  • Case Report 2018-12-31 2018-12-31 \ 0 \ 85 \ 59

    The Therapeutic Effect of Hydraulic Distension with Pumping Technique on the Patient with Frozen Shoulder

    Sang Hoon Shin, M.D., Ho Sang Yoo, M.D., Young Seok Kim, M.D., Hyeon Su Kim, M.D. and Sang Chul Lee, M.D., Ph.D.

    Abstract
    Frozen shoulder is a disease characterized by shoulder pain and limited range of motion. Conservative treatment is preceded by surgical treatment to reduce pain and recover range of motion. Hydraulic distention is a procedure in which a sufficient amount of solution is injected into the shoulder joint to rupture the rigid joint capsule. Recently, the method of continuously maintaining the expanded capsular state after injection without the process of rupturing the rigid joint has also been used. However, in order to obtain the maximal stretching effect, we proposed a ‘pumping technique’ that inflates and shrinks the rigid joint capsule by repeating the process of infusion and regurgitation of the injection fluid into the capsule. Our proposed ‘pumping technique’ was shown to be more effective in increasing range of motion than the conventional hydraulic distension. This 'pumping technique' can be suggested as an effective therapeutic option for frozen shoulder.
  • Case Report 2018-12-31 2018-12-31 \ 0 \ 105 \ 11

    The Effect of Cervical Stellate Ganglion Block Using Botulinum Toxin Type A in Intractable Cancer-related Pain

    Donggyun Sohn, M.D., Geun-Young Park, M.D., Ph.D., Sun Im, M.D., Ph.D., Sang Hoon Jeon, M.D. and Yongmin Choi, M.D.

    Abstract
    Objective: For patients who do not relieve with pharmacological intervention, interventional treatment including neurolytic blocks may have a specific role in palliative cancer management. Method: We performed cervical stellate ganglion block for the second time with Botulinum toxin type A mixed with 4 ml of normal saline, total 75 IU of Botulinum toxin type A, minimal effective dosage was measured to minimize the possible side effects. Results: About 3 days later, the patient reported that her continuous pain intensity had decreased from 8/10 to 4/10 on the visual analogue scale score. The frequency of the pain attack that required additional morphine injections was also decreased. As a result, her maximum morphine requirement dose per day was significantly reduced. Conclusion: In this case, cervical stellate ganglion block with Botulinum toxin had longer lasting effect in the continuous pain intensity and resulted in less frequent pain attack. Botulinum toxin can be a possible intervention material in intractable neuropathic pain related to cancer.
  • Case Report 2018-12-31 2018-12-31 \ 0 \ 60 \ 41

    Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome

    Jong Won Lee, M.D., Kyeong Eun Uhm, M.D. and Jongmin Lee, M.D., Ph.D.

    Abstract
    Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is a rare condition that occurs in elderly individuals. It is characterized by sudden onset of bilateral symmetrical distal tenosynovitis that accompanied by obvious swelling
    of the hand with pitting edema and absence of rheumatoid factor (RF). This disease entity sometimes presented as overlap syndrome with other rheumatic diseases and needed to be differentiated from those. However, if the diagnosis is confirmed, the response to steroid is good. The purpose of this report is to describe the case of RS3PE syndrome presented with bilateral hand dorsum edema in a middle-aged woman.
  • Case Report 2018-12-31 2018-12-31 \ 0 \ 46 \ 20

    Successful Treatment of Burn-Induced Digital Ischemic Ulcer with Stellate Ganglion Block

    Shin Who Park, M.D., Jin Seok Bae, M.D., Kang Jae Jung, M.D. and Jae-Hyung Kim, M.D., Ph.D.

    Abstract
    The Stellate ganglion block (SGB) could be used to treat sympathetic dependent circulatory insufficiency. We report a 36-year-old female patient with burn-induced refractory ischemic ulcer in distal phalanges. The patient admitted in department of plastic surgery for second degree burn wound in the right second through fifth fingertips. Continuous dressing treatment was conducted. However digital burn wounds were not healed but seems to be refractory. The upper extremity angiography revealed decreased perfusion and the fingertip wounds were diagnosed as ischemic ulcer. Despite of botulinum toxin injection into the perineural tissue and aspirin prescription, burn wounds showed ulcerative necrotic change. The SGBs were performed twice a week for 3 weeks to restore vasoconstriction of the upper extremity arteries. The follow-up angiography showed significant improvement of fingertip perfusion. Consequently, wounds were completely healed. In conclusion, SGB could be a rational option to overcome burn-induced digital ischemia refractory to other medical therapy.
  • Case Report 2018-12-31 2018-12-31 \ 0 \ 103 \ 25

    The Effectiveness of Complex Decongestive Physical Therapy for Pain in Patients with Rheumatoid Lymphedema

    Baek Hee Jang, M.D., Seong Wook Son, M.D. and Chung Reen Kim, M.D., M.S.

    Abstract
    Rheumatoid lymphedema (RL) is a rare complication of rheumatoid arthritis (RA). The pathophysiology of RL is not yet fully understood, and the management is also not standardized. As yet, there is low awareness regarding RL and complex decongestive physical therapy (CDPT) among physicians; hence, diagnosis and treatment are delayed. A few studies have reported the positive effects of tumor necrosis factor-α inhibitory drugs on RL. CDPT is still considered the gold standard for the treatment of cancer related lymphedema, but there are few reports on the effects of CDPT on RL. Therefore, we report two cases of chronic International Society of Lymphology lymphedema stage II RL that exhibited good therapeutic outcomes after CDPT. One of the two patient had taken a tumor necrosis factor-α inhibitory drug, but RL still has progressed. However, CDPT with multilayer bandage showed significant reduction in the pain and edema of the lower extremities.
Korean Association of Pain Medicine

Vol.23 No.2
2018-12-31

eISSN: 2765-5156

Frequency: Semi Annual

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