Spinal Cauda Equina Stimulation for Alternative Location of Spinal Cord Stimulation in Intractable Phantom Limb Pain Syndrome -A Case Report-

Lee, Pil Moo,So, Yun,Park, Jung Min,Park, Chul Min,Kim, Hae Kyoung,Kim, Jae Hun The Korean Pain Society 2016 The Korean Journal of Pain Vol.29 No.2

Phantom limb pain is a phenomenon in which patients experience pain in a part of the body that no longer exists. In several treatment modalities, spinal cord stimulation (SCS) has been introduced for the management of intractable post-amputation pain. A 46-year-old male patient complained of severe ankle and foot pain, following above-the-knee amputation surgery on the right side amputation surgery three years earlier. Despite undergoing treatment with multiple modalities for pain management involving numerous oral and intravenous medications, nerve blocks, and pulsed radiofrequency (RF) treatment, the effect duration was temporary and the decreases in the patient's pain score were not acceptable. Even the use of SCS did not provide completely satisfactory pain management. However, the trial lead positioning in the cauda equina was able to stimulate the site of the severe pain, and the patient's pain score was dramatically decreased. We report a case of successful pain management with spinal cauda equina stimulation following the failure of SCS in the treatment of intractable phantom limb pain.

Case Report : Spinal Cauda Equina Stimulation for Alternative Location of Spinal Cord Stimulation in Intractable Phantom Limb Pain Syndrome -A Case Report-

( Pil Moo Lee ),( Yun So ),( Jung Min Park ),( Chul Min Park ),( Hae Kyoung Kim ),( Jae Hun Kim ) 대한통증학회 2016 The Korean Journal of Pain Vol.29 No.2

Phantom limb pain is a phenomenon in which patients experience pain in a part of the body that no longer exists. In several treatment modalities, spinal cord stimulation (SCS) has been introduced for the management of intractable post-amputation pain. A 46-year-old male patient complained of severe ankle and foot pain, following above-the-knee amputation surgery on the right side amputation surgery three years earlier. Despite undergoing treatment with multiple modalities for pain management involving numerous oral and intravenous medications, nerve blocks, and pulsed radiofrequency (RF) treatment, the effect duration was temporary and the decreases in the patient’s pain score were not acceptable. Even the use of SCS did not provide completely satisfactory pain management. However, the trial lead positioning in the cauda equina was able to stimulate the site of the severe pain, and the patient’s pain score was dramatically decreased. We report a case of successful pain management with spinal cauda equina stimulation following the failure of SCS in the treatment of intractable phantom limb pain. (Korean J Pain 2016; 29: 123-8)

Relationship between Lower Limb Pain Intensity and Dynamic Lumbopelvic-Hip Alignment in Patients with Degenerative Lumbar Spinal Canal Stenosis: A Cross-Sectional Study

Miura Takuya,Tominaga Ryoji,Sato Keita,Endo Tatsuya,Iwabuchi Masumi,Ito Toshikazu,Shirado Osamu 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.6

Study Design: This cross-sectional study was conducted in a single hospital.Purpose: To clarify the relationship between lower limb pain intensity and dynamic lumbopelvic-hip alignment in patients with lumbar spinal canal stenosis (LSS), using a three-dimensional (3D) motion analysis system.Overview of Literature: Although it is well known that leg symptoms have a close relationship with posture in patients with LSS, the relationship under dynamic conditions, such as gait, remain unclear.Methods: Thirty patients with LSS scheduled for spine surgery participated in this study. Lower limb pain was assessed using the Visual Analog Scale (VAS), and the patients were divided into two groups based on the mean scores (patients with scores above and below the mean were classified as the high-VAS and low-VAS groups, respectively). The kinematics of the spine, pelvis, and hip joints during gait were then measured using a 3D motion analysis system. Student paired t -tests were used to compare the angles of the spine, pelvis, and hip during gait between the two groups.Results: Compared to those in the low-VAS group, the spine was significantly extended and bent toward the more painful lower limb side, and the pelvis was significantly anteriorly tilted among individuals in the high-VAS group.Conclusions: Patients with LSS experiencing severe pain in their lower limb tend to keep the spine in a more extended position, bend laterally toward the painful side, and have an anteriorly tilted pelvic posture. The dynamic spinal and pelvic alignment was closely related to the intensity of the lower limb pain.

하지직거상검사(下肢直擧上檢査)상 제한을 보이는 요추추간판태출증(腰椎椎間板脫出症) 환자 30례에 대한 방광정격(膀胱正格)과 체침(體鍼)의 비교연구

윤광식,이현,강재희,최주영,Yoon, Kwang-Shik,Lee, Hyun,Kang, Jae-Hui,Choi, Joo-Young 대한침구의학회 2010 대한침구의학회지 Vol.27 No.5

Objectives : This study was designed to evaluate the effects of treatment of HIVD patients with lower back pain, lower limb radiating pain and restricted on SLRT by the Sa-Am acupuncture. Methods : From March 2010 to July 2010, thirty HIVD patients who admitted to Cheonan oriental medical hospital in Daejeon university were divided into two groups. Group I was treated by Sa-Am acupuncture Banggwangjeonggyeok and general acupuncture, Group II by general acupuncture. We evaluated the treatment effect of each group with the Visual Analog Scale(VAS), Oswestry Disability Index(ODI), SLR test, dividing two period(from admission day to third day after admission and from third day to sixth day after admission). Results : 1. Group I is more effective than Group II in early pain and reducing rate of pain. 2. Group I is more effective than Group II in ODI score reducing rate from admission day to third day after admission, but there was no significant difference between the two groups from third day to sixth day after admission. 3. Group I is more effective than Group II in early SLR test improvement rate. Conclusions : Sa-Am acupuncture Banggwangjeonggyeok on HIVD patients with lower back pain, lower limb radiating pain and restricted on SLR test was effective in reducing pain and improving SLR test.

Classification Model to Discriminate People with and without Pain in the Lower Back and Lower Limb using Symmetry Data

김시현,정시우,박규남 KEMA학회 2021 근골격계과학기술학회 Vol.5 No.2

Background Multiple factors are associated with lower back and lower limb (LB & LL) pain, such as impaired muscle strength, balance, endurance, and motor control, and altered movement patterns. Symmetry of motion, strength and balance are goals for rehabilitation in patients with LB & LL pain. When classifying patients before or during on- and offline assessment, it is necessary that an easy to use functional test be available for clinicians. Purpose To establish a classification tree model for discriminating people with and without LB & LL pain during walking using symmetry values from side plank endurance test, hip abductor strength test, one-leg standing time tests and walking tests. Study design Cross-sectional study Methods A total of 100 subjects with and without LB & LL pain during walking participated. We measured the side plank endurance time, hip abductor strength and one-leg standing time with eyes open and closed, and the sagittal and frontal head angles at comfortable and fast walking speeds using a wearable wireless earbud sensor and calculated the symmetry index (SI) for each test. Classification and regression tree analysis with 10-fold cross validation was used to develop the classification model. Results The classification tree had 83% accuracy for discriminating people with and without LB & LL pain during walking. The most important factor for classification was the SI of the one-leg standing time with eyes closed; the second-most important factor was the SI of the frontal head angle during fast walking. Conclusions The present classification model can differentiate people with and without LB & LL pain during walking based on symmetry data acquired during functional tests, such as one-leg standing time with the eyes closed and fast walking test using the wearable device. Based on the present results, clinicians can classify patients before and during on- and offline assessments using cutoff values of the SI of the one-leg standing test with eyes closed of 63.88%, and of frontal head motion during a fast-walking test of 63.31%.

등받이 유무에 따른 하지 운동프로그램이 허리통증이 있는 대학생들에게 미치는 영향

김윤환(Yoon-Hwan Kim),서태화(Tae-Hwa Seo) 한국엔터테인먼트산업학회 2020 한국엔터테인먼트산업학회논문지 Vol.14 No.7

본 연구는 등받이 유무에 따른 하지 운동프로그램이 허리통증이 있는 대학생에게 미치는 영향을 알아보기 위해 균형능력, KODI, VAS 검사를 이용하였다. 광주광역시 소재 K대학교 학생 32명을 대상으로 4주간 탄력밴드를 이용한 하지 운동프로그램을 진행하였으며 등받이의 유무에 따른 집단 별 16명씩 무작위로 선정하여 진행하였다. 균형능력과 KODI 점수에서는 집단과 시간에 의한 상호작용이 없는 것으로 나타난 반면 VAS 점수에서는 집단과 시간에 의한 상호작용이 나타났다. 또한 두 집단 모두 중재 후에 균형능력, KODI, VAS 점수에서 유의하게 증가하였다. 따라서 등받이 유무와 상관없이 의자에 앉아서 시행하는 하지운동 프로그램이 오랜시간 앉아서 생활하며 허리통증이 있는 학생과 직장인에게 일상에서 쉽게 할 수 있는 운동 프로그램으로 적용하는 것이 필요할 것으로 생각된다. This study was conducted on college students with low back pain to find out how a backrest exercise program affects the pain and balance of students. Thirty-two students at K University in Gwangju City were randomly classified with backrests and without backrests group respectively. Each group conducted the program for lasted three times a week for a total of 30 minutes for four weeks. Visual Analog Scale (VAS) was measured for pain assessment before and after arbitration, and the Korean Oswestry Disability Index (KODI) was measured for functional disability assessment. TETRAX is used to measure the weight distribution index and posture stability. According to the results of the experiment, the Visual Analog Scale (VAS) and the Korean Oswestry Disability Index (KODI) and weight distribution index showed significant differences over time, but the posture stability was no significant difference. The results of this study show that the lower limb exercise program is effective in back pain, dysfunction and weight distribution index, and it is believed that the pain reduction is significant when performed by distal movement in the area of back pain, It can be applied effectively to reduce low back pain in college students who spend a lot of time sitting down.

Lower limb load symmetry of non-specific chronic low back pain patients during natural standing and walking

( Xiaolan Chen ),( Lin Wang ),( Xiaotian Liang ) 대한운동사협회 2017 대한운동사협회 운동사대회자료집 Vol.2017 No.-

하지통증을 호소하는 샤르코마리투스 질환 환자에 대한 복합적 한방처치 1례

문희영,류광현,추원정,최요섭,박지원,김두리,류원형,전용현 대한한방내과학회 2018 大韓韓方內科學會誌 Vol.39 No.6

Objective: This study was performed to report on the effects of traditional Korean Medicine as a treatment for a patient with Charcot-Marie-Tooth disease, with lower limb pain as the chief complaint. Methods: We treated this patient with traditional Korean medicine and measured symptom severity using the Visual Analogue Scale (VAS), and the Oswestry Disability Index (ODI) as well as measuring the length of the patient’s self-exercising time. Results: After about 7 weeks of treatment, most pathological symptoms had decreased. There was a gradual decline in the VAS and a gradual increase in the length of the self-exercising time. Although there was an increase in the ODI scale during the first 2 weeks, it eventually showed a decline in the rest of the period. Conclusions: Traditional Korean medicine can be a solution for the patients with Charcot-Marie-Tooth disease suffering from peripheral neurological symptoms.

무릎넙다리통증증후군 태권도 선수들의 복합 운동재활이 하지 근기능 및 사이토카인의 효과에 관한 융합적 연구

안환필 한국융합학회 2017 한국융합학회논문지 Vol.8 No.1

본 연구의 목적은 복합 운동재활이 무릎넙다리통증증후군 태권도 선수들의 하지 근기능 및 사이토카인에 미치는 융합적 효과를 규명하는 것이다. 본 연구에서는 무릎넙다리통증증후군 대학 태권도 선수 20명(복합 운동재 활 집단 n=10, 통제집단 n=10)을 대상으로 복합 운동재활(수중운동 주 3회, 저항운동 주2회)을 8주 간 실시하였고, 통계적 유의성 검증은 SPSS 18.0 프로그램을 이용하여 혼합 설계로써 반복측정에 의한 이원변량 분석을 실시 하였 으며, 모든 유의성 검증은 α=.05 수준으로 설정하였다. 그 결과는 다음과 같다. 복합 운동재활 집단이 각속도 60°/sec의 피크토크(peak torque)는 처치기간이 증가함에 따라 신근(p<.001)과 굴근(p<.01) 모두 유의하게 증가하 였다. 복합 운동재활 집단이 각속도 180°/sec의 평균파워(average power)는 처치기간이 증가함에 따라 신근이 유 의하게 증가하였다(p<.001). 복합 운동재활 집단의 TNF-α 변화는 처치기간이 증가함에 따라 유의하게 감소하였다. 따라서, 복합 운동재활 프로그램이 무릎넙다리통증증후군 환자의 하지 근기능과 TNF-a의 개선에 효과가 있는 것으로 사료된다. The purpose of this study was to determined the converge effects of combined exercise rehabilitation on lower limb muscular function and cytokines in taekwondo player with patellofemoral pain syndrome. In this study, combined exercise rehabilitation(aquatic exercise 3 times a week, resistance exercise 2 times a week) was performed and 20 collegiate taekwondo player with patellofemoral pain syndrome(control group: n=10, combined exercise rehabilitation group: n=10) were participated for 8 weeks. Statistical significance verification was carried out by a two - way ANOVA repeated measures design as a mixture using the SPSS 18.0 program. The statistically significant level was set at 0.05. The results of this study were as following. Peak torque was higher significantly in extensor(p<.001) and flexor(p<.01) at 60°/sec in the combined exercise rehabilitation group than the control group over combined exercise treatment period. Average power was higher significantly in extensor muscles at 180°/sec in the combined exercise rehabilitation group than the control group over combined exercise treatment period.(p <.01). The variable of TNF-a was higher significantly in the combined exercise rehabilitation group than the control group as over combined exercise treatment period. Therefore, it can be concluded that a combined exercise rehabilitation program is effective in improving the lower limb muscular function and TNF-a in Patellofemoral Pain Syndrome patient.