Application of Pulsed Radiofrequency to Intractable Neuropathic Pain / 대한마취과학회지

For several decades, Radiofrequency lesioning has been used for intractable pain that originates from the spinal area. Heating of the tissue has been assumed to be the only mechanism that can cause this effect. There has never been the suggestion that the RF fields themselves can modify the neuro-cellular function independently of the thermal effect. Additionally, Radiofrequency machines can not be used in neuropathic pain because of their thermal effect. Recently, a modified type of Radiofrequency machine was developed, using a non-thermal pulse, and applying a relatively high voltage. Some authors have reported remarkable results using this technique recently. There are several possible mechanisms and several attempts have been tried to explain this therapeutic effect respectively, but none of them explain it fully. One possible mechanism is through an Electro-Magnetic Field (EMF) that doesn't produce high temperature in the tip area. This is done in a pulsed fashion to avoid the high temperature made during the active cycle. However there is no apparent mechanism that explains this therapeutic effect clearly. The patient whom we report now was a 23 year-old male who suffered from repetitive low back pain and radiculopathy. He failed to respond to other oral and invasive conventional therapies. We experienced a successful result in the treatment of his intractable neuropathic pain using this pulsed RF machine.

The Effects of Selective Spinal Nerve Root Steroid Injedtion for Low Back Pain and Radicular Pain in Patients with Interbetebral Disc Herniation or Spinal stenosis / 대한마취과학회지

BACKGROUND: At present, epidural steroid injection is one of the most frequently used methods in the treatment for low back pain.. But this method is nonspecific and results in a widespread of injected agent around the target point. Therefore we thought direct injection to the nerve root is more specific and effective. METHODS: The authors evaluated the effects of lumbar paravertebral steroid injection in 39 patients with low back pain and radicular pain, retrospectively. We used triamcinolone 40mg(1ml) and 0.25% bupivacaine 3ml as injection agents and used pain relief scale(PRS) score for assessment of the effect. RESULTS: One week after injection, the patients of PRS score less than 5 were 65% in spinal stenosis and 85% in herniated intervertebral disc(HIVD). The patients of effective response more than 4 weeks after injection were 48% in spinal stenosis and 68% in HIVD, more than 12 weeks were 22% and 38%, respectively. The patients of PRS score less than 5 were 45% at the time of follow-up study. CONCLUSIONS: We think paravertebral steroid injection is effective in patients with low back pain and radicular pain. Therefore, this technique could be alternative method to epidural steroid injection.

The Effects of Single Epidural Triamcinolone Injection on the Blood ACTH and Cortisol Level / 대한마취과학회지

BACKGROUND: Epidural steroids injections are often used for the treatment of low back pain but their effects on the endocrine system have not been determined. Few studies have quantified the degree or duration of the suppression of the hypothalamic-pituitary-adrenal (HPA) axis in humans given epidural triamcinolone injection (ETI) for low back pain. The evaluation of the blood adrenocorticotropic hormone (ACTH) and cortisol was undertaken to determine the extent of suppression of the HPA axis in patients given ETI. METHODS: Lumbar epidural triamcinolone injections were performed on the painful lumbar intervertebral space with patients in the lateral decubitus position. The injection consisted of 40 mg of triamcinolone acetonide diluted in 10 mL of 1% lidocaine. Patients remained in the lateral position for 10 min after the procedure. Basal blood sampling was performed at 30 min before ETI and tested blood sampling was obtained at 7 days, 10 days, and 14 days after ETI. RESULTS: The blood cortisol level was significantly decreased at 7 days and 10 days but at 14 days was not significantly decreased and the blood ACTH level was not significantly decreased at 7 days, 10 days, and 14 days. CONCLUSIONS: Above results demonstrate that blood ACTH and cortisol level normalize 7 days and 14 days, respectively, after epidural triamcinolone 40 mg injection.