The Pharmacologic Management of Chronic Non-Cancer Pain

Chronic pain is defined as pain that persists for more than 3 months. While it is a common condition that affects an estimated 20% of the population worldwide, its management is generally unsatisfactory. Owing to its multidimensional and complex pathophysiology, a multi-modal approach is required to manage chronic pain. Pharmacologic therapy is an important treatment modality for this condition; however, in South Korea, pragmatic guidelines for chronic pain management are rarely published. Due to differences in the ethnicity and health-care settings, Western guidelines cannot be fully applied to South Korea. In the present study, new clinical evidences for chronic pain medications (acetaminophen, nonsteroidal antiinflammatory drugs, opioids, anticonvulsants, antidepressants, herbal agents, and so on) were reviewed and the pragmatic stepwise medication strategies for the following three common chronic pain conditions were developed: chronic musculoskeletal pain (caused by osteoarthritis), chronic musculoskeletal pain (caused by reasons other than osteoarthritis), and chronic neuropathic pain.

The Efficacy of Postoperative Ultrasound-Guided Sciatic Nerve Block to Relieve Pain after Hallux Valgus Surgery / 대한족부족관절학회지

PURPOSE: Modified Mau and Akin osteotomy for hallux valgus is followed by moderate to severe postoperative pain. Ultrasound-guided sciatic nerve block can be an effective option for pain control. We attempted to evaluate the efficacy of the ultrasound-guided sciatic nerve block in controlling postoperative pain. MATERIALS AND METHODS: The charts of 59 consecutive patients were retrospectively reviewed between December 2014 and August 2015. Twenty-eight patients (the patient group) has received the ultrasound-guided sciatic nerve block after surgery, and 31 patients (the control group) has not received such procedure. The primary outcome was the satisfaction scale for postoperative pain control and postoperative visual analogue scale (VAS) score. RESULTS: The VAS score at postoperative day one was significantly lower in the patient group than in the control group. The satisfaction scale for pain control for postoperative 1 day was significantly different between the two groups. In patient group, most patients have rated positively ('strongly agree' 42.9%, 'agree' 42.9%); however, in the control group, the rating scales were distributed relatively negatively ('strongly agree' 9.7%, 'agree' 22.6%, 'neutral' 29.0%, 'disagree' 25.8%, 'strongly disagree' 12.9%). The number of postoperative rescue analgesics injection was significantly lower in the patient group than in the control group. CONCLUSION: Postoperative ultrasound-guided sciatic nerve block was effective for pain relief after hallux valgus surgery.

A study on the menstruation of Korean adolescent girls in Seoul / 소아과

PURPOSE: Westernized eating habits have been associated with early-age menstruation, which increases the incidence of dysmenorrhea and premenstrual syndrome among adolescent girls. We therefore surveyed changes in menarche timing and the general menstrual characteristics of adolescent girls in Seoul, Korea. METHODS: We surveyed 538 teenage girls who visited our hospital between July and November 2007. Items explored included age at menarche, general menstrual characteristics, occurrence of premenstrual syndrome and treatment thereof, and an association between present dysmenorrhea and a family history of the condition. RESULTS: Average age at menarche was 12.6 years, with 29% (n=156) subjects beginning menstruation at age 12 years. The prevalence of dysmenorrhea was 82% (n=435). The main symptoms were abdominal (53.2%) and lower back pain (34.2%), and 15.2% of girls who experienced such symptoms required medication. Present dysmenorrhea, and a family history thereof, were statistically correlated (P<0.05). In addition, 58.8% (n=316) of teenage girls had symptoms of premenstrual syndrome. The most frequent psychological symptoms were fatigue (36.4%) and nervousness (38.7%), whereas the most common physical symptom was menstrual cramps (46.5%). Most subjects (87.6%) tolerated the symptoms of premenstrual syndrome without medication; 11.4% took medicines including painkillers; but only 0.1% of subjects visited a doctor. CONCLUSION: The average age at menarche in Korean girls was 12.6 years, thus younger than in the past. Most teenage girls experienced dysmenorrhea and premenstrual syndrome, but few consulted a doctor. Organized treatment plans are required to manage menstrual problems in teenage girls.

A study of adolescent smoking and drinking in Korea / 소아과

PURPOSE: Adolescence is a period of growth and development in body structure and physiologic, psychologic, and social functioning. Smoking and drinking in this period are very harmful and may lead to other forms of substance abuse. We surveyed the actual aspects of smoking and drinking among Korean adolescents and analyzed associated factors. METHODS: A survey was performed among adolescents using a questionnaire about smoking and drinking. Data were collected from students who visited pediatric clinics for routine school examinations from July to November 2007. RESULTS: A total of 2,546 adolescents (smoking 1,512; drinking 1,034) participated in the study. The overall smoking and drinking rates were 29.2% and 48.2%, respectively, and the mean age at the first instance of smoking and drinking was 13.8 and 14.1 years, respectively. Among drinking adolescents, 30.1% were offered a drink by their parents, although most adolescents were encouraged to smoke or drink by their friends. Dissatisfaction with family and school life, economic status, and school performance was associated with a higher smoking and drinking rate (P<0.001). Broken families were associated with a high rate of smoking, but peer satisfaction was not related to smoking or drinking. The frequency and amount of smoking and drinking in adolescents were as high as those in adults. Social sanctions seemed insufficient to keep adolescents from smoking and drinking. CONCLUSION: Adolescent smoking and drinking are highly influenced by family and school environments, so more active social sanctions are required, including parental involvement and legislation preventing adolescents from smoking and drinking.

An Autopsy Case of New Bronchopulmonary Dysplasia / 소아알레르기및호흡기학회지

Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects premature babies and contributes to their increased morbidity and mortality. The classic progressive stage with prominent fibroproliferation that first characterized BPD is generally less striking and the disease is currently predominantly defined by a disruption of distal lung growth, thus it has been termed "new BPD." We present here in a case of 5-month-old girl dying from BPD and pulmonary hypertension. Autopsy findings of the lung showed fewer and larger alveoli with less fibrosis, which is consistent with those of "new BPD."

Three cases of pulmonary and/or intestinal tuberculosis in adolescents / 소아과

Since the tuberculosis (TB) in adolescents has unique clinical characteristics, special attention should be paid to this age group. Adolescents are more susceptible to developing TB disease and more likely to have cavitary pulmonary disease. Also, adolescent patients with TB more frequently present with extrapulmonary disease. We report three adolescents with active pulmonary and/or intestinal TB: one had pulmonary and intestinal TB, another had a pulmonary TB, and the third exclusively had an intestinal TB. Diagnosis was confirmed by pathologic examination of the lung and/or intestines. All three patients were treated successfully without complication. A brief review of the literature has been included.