통증과 우울증의 병합 동물모델에 대한 최신 연구 동향 분석

송지혜 ( Ji-hye Song ),국혜정 ( Hye-jung Kook ),박병진 ( Byung-jin Park ),김송이 ( Song-yi Kim ),박지연 ( Ji-yeun Park ) 경락경혈학회 2021 Korean Journal of Acupuncture Vol.38 No.2

Objectives : The purpose of this study is to analyze animal behavioral changes and related neurobiological mechanisms in recent studies using animal models with pain and depression. Methods : We conducted database search in Pubmed, NDSL, and EMBASE up to January 2021. Included studies were classified as depression-like behavior observed in pain model, pain-like behavior observed in depression model, and pain and depression comorbidity model. The results of pain- and depression-like behaviors, the changes of neurobiological mechanisms, and the treatment methods such as drugs, natural substance-derived chemicals, or acupuncture were analyzed. Results : We included 124 studies (81 studies in depression-like behavior observed in pain model, 19 studies in pain-like behavior observed in depression model, and 24 studies in pain and depression comorbidity model). Pain and depression comorbidity animal models were induced using various methods by drugs or surgery. Von frey test, a method for evaluating mechanical allodynia was the most commonly used for measuring pain-like behavior and the forced swimming test was the most commonly used for measuring depression-likes behavior. The changes of neurobiological factors, such as decrease of 5-hydroxytryptamine and increase of oxidative stress and pro-inflammation cytokines were generally changed in the frontal cortex, hippocampus, thalamus, and spinal cord in all types of models. For treating pain and depression-like behaviors, various types of drugs such as antidepressant, tranquilizer, analgesic, and natural substance-derived chemicals were used. Acupuncture treatment was used in 4 studies. Conclusions : In the future, more diverse studies on the combined model of pain and depression need to be conducted. In addition, it is necessary to establish a mechanistic basis for the development of various treatments by identifying the common mechanisms of pain and depression.

Relationship between pain and effusion on magnetic resonance imaging in temporomandibular disorder patients

박하나,김경아,고광준 대한영상치의학회 2014 Imaging Science in Dentistry Vol.44 No.4

Purpose: This study was performed to find the relationship between pain and joint effusion using magnetic resonance imaging (MRI) in temporomandibular disorder (TMD) patients. Materials and Methods: The study subjects included 232 TMD patients. The inclusion criteria in this study were the presence of spontaneous pain or provoked pain on one or both temporomandibular joints (TMJs). The provoked pain was divided into three groups: pain on palpation (G1), pain on mouth opening (G2), and pain on mastication (G3). MRI examinations were performed using a 1.5-T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the T2-weighted image findings, the cases of effusions were divided into four groups: normal, mild (E1), moderate (E2), and marked effusion (E3). A statistical analysis was carried out using the χ2 test with SPSS (version 12.0, SPSS Inc., Chicago, IL, USA). Results: Spontaneous pain, provoked pain, and both spontaneous and provoked pain were significantly related to joint effusion in TMD patients (p<0.05). However, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ (G1) was not related to joint effusion in TMD patients (p>0.05). Conclusion: Spontaneous pain was related to the MRI findings of joint effusion; however, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ was not related to the MRI findings of joint effusion. These results suggest that joint effusion has a significant influence on the prediction of TMJ pain.

통증 치료에 있어서 신경과 의사의 역할 – 2020년 시행한 대한신경과학회의 설문조사를 기반으로

최교민,권오현,김상범,민양기,박기덕,서범천,서종근,손은희,오건세,오지영,이광수,이동국,정종필,조수진,조수현,한영수,주인수 대한신경과학회 2021 대한신경과학회지 Vol.39 No.3

Background: Pain is one of the most common chief complaints in neurological field. Authors try to inform the current situation of pain medicine in neurological practice and present an effective method for pain-related education during neurology residency and for practicing neurologists. Methods: A survey was conducted from November 16 to November 27, 2020 for members of the Korean Neurological Association, and the results were analyzed. Results: About two-thirds of neurologists replied that more than 25% of their patients were suffered from diverse pain including headache, spine pain or neuropathic pain. Despite many patients are visiting to neurologist for pain treatment, most neurologists are aware that they have not received sufficient practical pain education in the past and present. Therefore, they want more educational opportunities in pain medicine including interventional pain management and physical and pharmacologic therapies for more effective treatment. Conclusions: More follow-up studies on pain treatment and education should be conducted. It is also essential that the members of the society continue to interest and participate in the change of the pain education program.

Comparison of postoperative pain according to the harvesting method used in hair restorative surgery

Yang Seok Kim,Young Cheon Na,Jae Hyun Park 대한성형외과학회 2019 Archives of Plastic Surgery Vol.46 No.3

Background Postoperative pain is one of the most common concerns of patients undergoing hair transplantation surgery. Because most patients are satisfied with the cosmetic improvement after transplantation, amelioration of postoperative pain would help to increase patient accessibility to hair restorative surgery and greatly impact patient satisfaction with the final cosmetic results. This study was performed to investigate postoperative pain after hair transplantation. Methods In total, 241 patients (202 who underwent follicular unit transplantation [FUT] and 39 who underwent follicular unit extraction [FUE]) were eligible for the study. Postoperative pain was evaluated on postoperative days 1, 2, 3, 4, 5, and 7 using the Wong-Baker Faces Pain Scale. The patients’ medical records were retrospectively reviewed for information on the harvesting method, number of transplanted grafts, size of donor design, and laxity, elasticity, and glidability of the scalp in relation to postoperative pain. Results Postoperative pain after hair transplantation, assessed with the Wong-Baker Faces Pain Scale, seemed to provide very subjective results. None of the variables were correlated with postoperative pain in the FUT group. Such pain, however, tended to disappear by postoperative day 3. Patients in the FUE group experienced significantly less severe pain than those in the FUT group. Conclusions Postoperative pain was significantly less severe in patients whose donor hair was harvested by the FUE than FUT method. Postoperative pain had almost disappeared by postoperative day 3 in the FUT group, whereas only minimal pain was present even on postoperative day 1 in the FUE group.

말기 암환자의 통증 및 통증관리에 영향을 미치는 요인

윤영호,허대석,김홍수,오상우,유태우,김유영,허봉렬,Yun, Young-Ho,Heo, Dae-Seog,Kim, Hong-Soo,Ou, Sang-Woo,Yoo, Tai-Woo,Kim, You-Young,Huh, Bong-Yul 한국호스피스완화의료학회 1998 한국호스피스.완화의료학회지 Vol.1 No.1

목적: WHO의 통증관리원칙에 따른 통증관리의 효과가 입증되었으며 불충분한 통증관리의 문제점을 해결하려는 많은 노력이 있어 왔다. 본 연구는 말기암환자들의 통증정도와 불충분한 통증관리에 영향을 미치는 환자의 특성을 밝히고자 하였다. 방법: 1997년 6월부터 1997년 11월까지 서울대학교병원에서 말기암으로 판정받은 성인 암환자 100명을 대상으로 활동도, 전이여부 등을 포함한 인구 의학적 특성과, 사용되고 있는 진통제를 보정한 통증정도를 조사하였다. WHO의 통증관리지침에 따라 통증관리의 적절성을 평가하였으며 이에 영향을 미치는 환자의 특성을 조사하였다. 결과: 말기암판정당시 85%의 환자들이 통증이 있었으며 65%의 환자들이 중등도이상의 통증을 갖고 있었다. 말기암환자 38%가 불충분한 통증관리를 받고 있었으며 통증의 정도가 심할수록 불충분한 통증관리를 받고 있었다(P<0.001). 성별 연령, 암의 원발부위, 전이여부, 우울 및 불안 증상, 활동도는 통계적 유의성이 없었다. 결론: 통증관리지침이 제시되었음에도 불구하고 많은 말기암환자들이 충분한 통증관리를 받지 못하고 있다. 이를 해결하기 위해서 통증 평가방법과 통증관리지침에 관한 적극적인 교육 및 훈련이 필요하다. Purpose : Validity of WHO guideline of cancer pain management has been proven and many trials were done for resolution of inadequate management of cancer pain. We assessed the severity of pain in terminal cancer patients and patient's characteristics influencing inadequate pain management. Methods : This study was done on 100 patients who was confirmed as terminal in Seoul National University Hospital from lune 1997 to November. For getting the informations about dermographic and medical characteristics such as performance and metastasis, and drug-adjusted pain severity the patients, we reviewed the medical records and interview the patients. we assessed the adequacy of prescribed analgesics with WHO guidelines of pain management, and patient's characteristics influencing on adequacy of pain management. Results : 85.0 percent of cancer patient had pain when diagnosed as terminal cancer and 68% of patient had pain above moderate severity. 38.0 percent of those were given inadequate pain management and the greater pain severity, the less adequate(P<0.001). Sex, age, primary site of cancer, metastasis, symptoms such as depression and anxiety, and performance were not significant. Conclusion : Despite guidelines for pain management, many patients with terminal cancer received inadequate pan management. Their is a need for education about evaluation of pain and guidelines of pain management.

Pain Asymbolia

Song-Yi Kim,Younbyoung Chae 대한스트레스학회 2011 스트레스硏究 Vol.19 No.4

통증은 일반적으로 감각-구별, 정서차원, 인지평가의 요인들에 의해 영향을 받는 유해 자극의 의식적 경험 및 해석으로 여겨진다. “통각마비”는 통증 자극이 있다는 것은 인지하지만 고통스럽지 않은 것으로 통증해리라고도 한다. 본 연구는 “통각마비”라는 현상을 신경심리학 측면에서 설명하고자 한다. 뇌 손상 환자를 통한 통증마비와 관련된 증례에 관해 살펴보았다. 일차 및 이차 감각영역은 촉각 감각의 특성을 인지하는 것에 관여하고, 전두대피질 및 섬 등 변연계 및 부변연계은 통증의 정서적 측면에 관여한다. 통증신호 처리에 대한 뇌 영상 연구와 통증마비에 대한 신경학적 특징에 대한 이해를 통해, 통각마비에 대한 신경심리학적 작용기전을 이해할 수 있을 것으로 기대된다. Pain has been defined as a conscious experience, an interpretation of the nociceptive input influenced by multiple components, including sensory-discriminative, affective-dimensional, and cognitive-evaluative. Pain asymbolia, one of neuropsychological disorders, is a condition in which pain is perceived, but does not cause suffering. We would like to explain the pain asymbolia from the perspective of neuropsychology. The current review summarized the existing brain lesion evidence for the anatomical basis of pain asymbolia. The somatosensory cortices are more involved in the perception of sensory features, whereas limbic and paralimbic regions, such as anterior cingulate cortex and insula, are associated with the emotional and motivational aspects of pain. The understanding of the neural substrates of pain processing and the neurological characteristics of pain asymbolia would help us to identify the putative anatomical basis of the neuropsychological disorder. (Korean J Str Res 2011;19:267∼271)

The mechanism of action of pulsed radiofrequency in reducing pain: a narrative review

Donghwi Park,장민철 영남대학교 의과대학 2022 Yeungnam University Journal of Medicine Vol.39 No.3

Pain from nervous or musculoskeletal disorders is one of the most common complaints in clinical practice. Corticosteroids have a high pain-reducing effect, and their injection is generally used to control various types of pain. However, they have various adverse effects including flushing, hyperglycemia, allergic reactions, menstrual changes, immunosuppression, and adrenal suppression. Pulsed radiofrequency (PRF) is known to have a pain-reducing effect similar to that of corticosteroid injection, with nearly no major side effects. Therefore, it has been widely used to treat various types of pain, such as neuropathic, joint, discogenic, and muscle pain. In the current review, we outlined the pain-reducing mechanisms of PRF by reviewing previous studies. When PRF was first introduced, it was supposed to reduce pain by long-term depression of pain signaling from the peripheral nerve to the central nervous system. In addition, deactivation of microglia at the level of the spinal dorsal horn, reduction of proinflammatory cytokines, increased endogenous opioid precursor messenger ribonucleic acid, enhancement of noradrenergic and serotonergic descending pain inhibitory pathways, suppression of excitation of C-afferent fibers, and microscopic damage of nociceptive C- and A-delta fibers have been found to contribute to pain reduction after PRF application. However, the pain-reducing mechanism of PRF has not been clearly and definitely elucidated. Further studies are warranted to clarify the pain-reducing mechanism of PRF.

The Impact of Manual Therapy on Pain Catastrophizing in Chronic Pain Conditions: A Systematic Review and Meta-analysis

Hyun-Joong Kim,Seungwon Lee 물리치료재활과학회 2023 Physical therapy rehabilitation science Vol.12 No.2

Objective: Manual therapy is a commonly utilized approach in managing chronic pain, but its specific impact on pain catastrophizing remains uncertain. The objective of this systematic review and meta-analysis was to examine the effects of manual therapy on pain catastrophizing in individuals with chronic pain. Design: A systematic review and meta-analysisMethods: A comprehensive search was conducted in electronic databases to identify relevant studies published from 2014 onwards. Studies that evaluated the impact of manual therapy on pain catastrophizing in individuals with chronic pain were incorporated. The risk of bias in the selected studies was evaluated using the Cochrane tool for risk of bias in qualitative analysis. For the quantitative analysis, RevMan 5.4 software was utilized, employing a random-effects model as the analysis model. The effect measure used in the analysis was the standardized mean difference (SMD). Results: In total, 26 studies were collected, and following the screening process, three of them were incorporated into the final analysis. The included studies involved a total of 153 patients with chronic pain. The interventions comprised various manual therapy techniques targeting different areas of the body. Pain catastrophizing and pain intensity were the primary outcomes of interest. The meta-analysis revealed a significant reduction in pain catastrophizing scores following manual therapy intervention compared to control conditions (SMD = -0.91, 95% CI: -1.25 to -0.58). However, heterogeneity between the studies was observed. Conclusions: Despite the limited quantity and heterogeneity of studies, it has been demonstrated that manual therapy intervention is effective in reducing pain catastrophizing in individuals with chronic pain.

통증 어휘에 따른 통증 종류와 강도 간의 관련성

황주성,전지훈,이영규,이충민,박민지,김현희,Hwang, Ju-Seong,Jeon, Ji-Hoon,Lee, Young-Kyu,Lee, Chung-Min,Park, Min-Ji,Kim, Hyun-Hee 대한물리치료과학회 2015 대한물리치료과학회지 Vol.22 No.1

Purpose : The purpose of present study was to improve communication of pain expressing terms and pain intensity between patient and physical therapist, and initiated to objectify a measurement of subjective pain. Methods : Data were delivered to 249 people by a self-completion questionnaire, and analyzed 160 copies except for 87 mark error of the collected 247 questionnaires. The questionnaire included a question on 55 terms used to describe pain, the type of the pain, and pain intensity using VAS (visual analogue scale). Results : The results were as follows; 'Tight' was the most frequently being expressed term of muscular pain, subsequently to 'knot' and 'dull'. 'Tear' was the term representing the most strong pain of muscular pain, subsequently to 'rupture' and 'squeeze'. 'Stinging' was the most frequently being expressed term of neurologic pain, subsequently to 'get shocked' and 'wriggle'. 'Burn' was the term representing the most strong pain of neurologic pain, subsequently to 'sear' and 'get shocked'. 'Creak' was the most frequently being expressed term of joint pain, subsequently to 'peel' and 'out of joint'. 'Break' was the term representing the most strong pain of joint pain, subsequently to 'peel' and 'crack'. Conclusion : The objectification of pain terms will be used to help physical therapist to check the patient's pain.

비급성기 요통환자에 있어 장애를 예측하는 요인으로서의 통증관련 두려움과 우울

원종임(Jong-im Won) 한국전문물리치료학회 2009 한국전문물리치료학회지 Vol.16 No.3

Psychsocial factors appear to play an important role in the maintenance and development of chronic disability from low back pain. Fear of pain may be more disabling than the pain itself in patients with nonacute low back pain. The purpose of this study was to identify the contribution of gender, age, depression and pain-related fear to pain intensity and disability in nonacute low back pain patients. This was a cross-sectional survey study of eighty four patients who had low back pain for at least 4 weeks. More than moderate correlations were found between pain intensity, disability, fear-avoidance beliefs and depression. Regression analyses revealed that disability ratings and fear-avoidance beliefs for work activities significantly contributed to the prediction of pain intensity, even when controlling for age, gender and pain duration. Also, fear-avoidance beliefs for physical activity, pain intensity, age and depression, significantly contributed to the prediction of disability, even when controlling for gender and pain duration. These findings suggest that disability scores and fear-avoidance beliefs for work activities are important determinants of pain intensity. They also suggest that fear-avoidance beliefs for physical activity, pain intensity, age and depression are important determinants of disability.