Lead Breakage in Implanted Spinal Cord Stimulation Systems: A case report / 대한마취과학회지

Spinal cord stimulation (SCS) has become an established clinical option for treatment of refractory chronic pain. Current hardware and implantation techniques for SCS are already highly developed and continuously improving, however equipment failures over the course of the long-term treatment are still encountered in a relatively high proportion of treated cases. Percutaneous SCS leads seem to be particularly prone to dislocation and insulation failures. We describe our experience of lead breakage in implanted SCS which was inserted to a complex regional pain syndrome patient who obtained satisfactory pain relief after the revision of SCS.

Infrared Thermography in the Assessment of Temporomandibular Joint Dysorder / 대한통증학회지

BACKGROUND: Temporomandibular joint disorder (TMD) is a group of musculoskeletal conditions characterized by pain in the pre-auricular area, limitation of jaw movement and palpable muscle tenderness. Thermography is a nonionizing, noninvasive diagnostic alternative for the evaluation of TMD. This study was conducted to evaluate the usefulness of thermography in the assessment of TMD. METHODS: Thermography was conducted on the 61 patients who had been diagnosed with TMD, and on the 34 normal symptom-free volunteers. The temperature differences between opposite sides of the temporomandibular joint (DeltaTTMJ) and the masseter muscle (DeltaTMST) were calculated. The sensitivity and specificity of thermography was calculated at the cut off values of 0.2, 0.3, and 0.4 degrees C. RESULTS: In the patient group, the DeltaTTMJ was 0.42 +/- 0.38 degrees C and the DeltaTMST was 0.38 +/- 0.33 degrees C, whereas in the control group the DeltaTTMJ was 0.10 +/- 0.07 degrees C and the DeltaTMST 0.15 +/- 0.10 degrees C. In addition, the patient group demonstrated a significantly lower level of thermal symmetry than the control group (P < 0.001) in both the temporomandibular joints and the masseter muscles. The sensitivity of thermography at the cut off values of 0.2, 0.3 and 0.4 degrees C was 67.2, 49.2, and 42.6% in the temporomandibular joint (TMJ) and 60.7, 49.2 and 37.7% in the masseter muscle, respectively. The specificity of thermography at the cut off values of 0.2, 0.3 and 0.4 degrees C was 88.2, 100, and 100% in the TMJ and 61.8, 91.2 and 100% in the masseter muscles, respectively. The accuracy of thermography at the cut off values of 0.2, 0.3 and 0.4 degrees C was 74.7, 67.4, and 63.2% in TMJ and 61.1, 64.2 and 60.0% in the masseter muscles, respectively. CONCLUSIONS: Temperature differences exist between the opposite sides of the TMD and masseter muscles in patients with TMD. Although the sensitivity of thermography in the diagnosis of TMD is low, it has high specificity in the evaluation of TMD, and is therefore applicable to patients with TMD.

Pain Management via a Subcutaneous Infusion of Ketamine in a Patient with Complex Regional Pain Syndrome: A case report / 대한통증학회지

Complex regional pain syndrome (CRPS), which is a syndrome that is defined by pain and sudomotor and/or vasomotor instability, is usually resistant to conventional treatment. Here, a case involving a 30-year-old male patient with CRPS type I who showed severe intractable right shoulder pain with allodynia and hyperalgesia despite being treated with oral medications, nerve blocks including thoracic sympathetic neurolysis, and spinal cord stimulation is described. The patient frequently visited the emergency room due to severe uncontrollable breakthrough pain. Although a favorable effect was observed in response to intermittent ketamine infusion therapies that were performed on an outpatient basis, acute exacerbation of pain occurred frequently during the night and could not be controlled. Therefore, subcutaneous ketamine infusion therapy using a patient-controlled analgesic system was attempted and found to effectively control acute exacerbation of pain during 6 weeks of infusion without serious complications.

Compression Fractures Diagnosed during the Treatment of Postherpetic Neuralgia : A case report / 대한통증학회지

Vertebral compression fractures can occur due to trauma, a malignancy, or most commonly, osteoporosis. These fractures are frequently seen in elderly women; 30% of postmenopausal women are affected by vertebral compression fractures. These fragile fractures frequently result in both acute and chronic pain, but more importantly, are a source of increased morbidity and possibly, mortality. These injuries can be treated both conservatively and with surgery. The use of percutaneous vertebral augmentation offers a minimally invasive approach for the treatment of vertebral compression fractures. We experienced two cases of compression fractures diagnosed during the treatment of thoracic postherpetic neuralgia. Two patients suffering from postherpetic neuralgia with a sharp and stabbing pain in the thoracic dermatomes that was unresponsive to conservative treatment were transferred to our clinic. During the management of postherpetic neuralgia, we incidentally found thoracic compression fractures after obtaining fluoroscopic guided images. After a balloon kyphoplasty, the preoperative pain related to the postherpetic neuralgia was successfully relieved soon after the procedure, and there were no complications.

Comparison of the Two Impairment Classes Publicized by the American Medical Association in Complex Regional Pain Syndrome Patients / 대한통증학회지

BACKGROUND: Complex regional pain syndrome (CRPS) is not regarded as an impairment in Korea. Guidelines for rating this impairment are under development by the Korean Academy of Medical Science based on that of the American Medical Association (AMA). However, no studies have been done on the validity of these guidelines in Korea. We therefore evaluated the validity of these guidelines using the criteria from the chapter on the central and peripheral nervous system (CNS-PNS class) and the worksheet for calculating total pain-related impairment score (TPRIS class). METHODS: TPRIS and CNS-PNS classes were calculated through interviews of 28 CRPS patients. The correlation between the two classes was calculated. RESULTS: TPRIS class and CNS-PNS class were well correlated (r = 0.593, P < 0.05). CONCLUSIONS: Both TPRIS or CNS-PNS classes were well correlated and could be used for evaluation of impairment. However, the CNS-PNS class is simpler and quicker to complete.

Anesthetic Management in a Patient with Cross-Sensitivity to Muscle Relaxants: A case report / 대한마취과학회지

Anaphylactic reactions to muscle relaxants have been increasingly reported during recent 30 years. An adequate investigation of patient's history and avoidance of the muscle relaxant responsible for the previous reaction would reduce the risk of second reaction. A 56-year-old woman was admitted for laparoscopic cholecystectomy. She had a history of serious anaphylactic reaction to vecuronium. Preoperative intradermal skin test against muscle relaxants showed positive reactions to succinylcholine, atracurium and rocuronium. General anesthesia was induced with midazolam, fentanyl, 8 vol% sevoflurane mixed with 50% oxygen. Laryngeal mask airway was inserted without muscle relaxant and anesthesia was maintained with 4-6 vol% sevoflurane, air and oxygen without muscle relaxant. The anesthesia and postoperative course of this patient were uneventful.