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.

Pain on injection with microemulsion propofol

Sim, Ji-Yeon,Lee, Soo-Han,Park, Do-Yang,Jung, Jin-Ah,Ki, Kyoung-Ho,Lee, Dong-Ho,Noh, Gyu-Jeong Blackwell Publishing Ltd 2009 British Journal of Clinical Pharmacology Vol.67 No.3

<P><B>WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT</B></P><P>• Aqueous free propofol in lipid emulsion elicits pain.</P><P>• No data on the incidence and severity of injection pain for Aquafol™ (Daewon Pharmaceutical Co., Ltd, Seoul, Korea), a lipid-free microemulsion propofol, are available.</P><P>• Two hypotheses involving plasma bradykinin generation have been proposed to explain propofol-induced pain; one implicates aqueous free propofol, the other implicates the lipid solvent.</P><P><B>WHAT THIS STUDY ADDS</B></P><P>• Microemulsion propofol produces more frequent and severe pain on injection, an effect that may be attributable to the high concentration of aqueous free propofol.</P><P>• There was no evidence that plasma bradykinin generation caused propofol-induced pain.</P><P>• In addition, agents known to prevent propofol-induced pain did not decrease aqueous free propofol concentrations.</P><P>AIMS</P><P>To evaluate the incidence and severity of injection pain caused by microemulsion propofol and lipid emulsion propofol in relation to plasma bradykinin generation and aqueous free propofol concentrations.</P><P>METHODS</P><P>Injection pain was evaluated in 147 patients. Aqueous free propofol concentrations in each formulation, and in formulation mixtures containing agents that reduce propofol-induced pain, were measured by high-performance liquid chromatography. Plasma bradykinin concentrations in both formulations and in their components mixed with blood sampled from six volunteers were measured by radioimmunoassays. Injection pain caused by 8% polyethylene glycol 660 hydroxystearate (PEG660 HS) was evaluated in another 10 volunteers.</P><P>RESULTS</P><P>The incidence of injection pain [visual analogue scale (VAS) >30 mm] caused by microemulsion and lipid emulsion propofol was 69.7 and 42.3% (<I>P</I> < 0.001), respectively. The median VAS scores for microemulsion and lipid emulsion propofol were 59 and 24 mm, respectively (95% confidence interval for the difference 12.5, 40.0). The aqueous free propofol concentration of microemulsion propofol was seven times higher than that of lipid emulsion propofol. Agents that reduce injection pain did not affect aqueous free propofol concentrations. Microemulsion propofol and 8% PEG660 HS enhanced plasma bradykinin generation, whereas lipid emulsion propofol and lipid solvent did not. PEG660 HS did not cause injection pain.</P><P>CONCLUSIONS</P><P>Higher aqueous free propofol concentrations of microemulsion propofol produce more frequent and severe pain. The plasma kallikrein–kinin system may not be involved, and the agents that reduce injection pain may not act by decreasing aqueous free propofol concentrations.</P>

Quality of Life and Anxiety in Patients with Acute and Chronic Pain

임길병,Hai-Jin Park,Dug-Young Kim,Seong-Soo Kim 대한재활의학회 2010 Annals of Rehabilitation Medicine Vol.34 No.6

ObjectiveTo compare the factors such as quality of life (QOL), anxiety and pain intensity in patients with acute and chronic pain. MethodTwenty patients with acute (pain duration <2 months) and chronic (pain duration >3 months) musculoskeletal pain were recruited. Pain intensity was assessed using 3 measures: ratings of average pain on a visual analogue scale (VAS), ratings of average pain on the short form McGill pain questionnaire (SF-MPQ), and ratings of pain on the present pain intensity (PPI) verbal rating scale. Quality of life and anxiety were assessed using 2 measures: the SF-36 (medical outcomes study 36-item short-form health survey) and the STAI (state-trait anxiety inventory). ResultsThe SF-36 scale was lower and state anxiety scale was higher in chronic pain group. The SF-36 and the state anxiety scale revealed significant difference between the acute and chronic groups (p<0.05), but there was no significant difference between the the groups regarding pain intensity and the trait anxiety scale. ConclusionPatients with chronic pain showed low well-being status and increased anxiety level compared to acute pain patients. According to the above results, proper management of chronic pain might be helpful for enhancing their psychosocial function.

PAIN-T A Tool for Patient Self-Assessment of Pain

Onishi, Eriko,Plumbo, Marty,Park, Soojin 인제대학교 디자인연구소 2013 Journal of Integrated Design Research (JIDR) Vol.12 No.3

Pain can provide important information to be used in treating illness. But since there is no medical device that can directly measure a patient’s pain, physicians and medical staff must rely on patients themselves to indicate the location and intensity of their pain. This task is typically accomplished using instruments that facilitate patients expressing their pain in terms of abstract schema that correlate to medical formalisms for quantifying pain. This paper examines the preliminary development and testing of PAIN-T, a novel system utilizing successful elements from existing pain assessment approaches along with the unique capabilities of multitouch tablet computers to allow patients to easily and accurately asses their own pain with a minimum of instruction and assistance.

한방의료의 통증치료 실태

박지은(Ji-Eun Park),정희정(Hee-Jung Jung),김애란(Aeran Kim),정소영(Soyoung Jung),황혜숙(Hye Suk Hwang),최선미(Sun-Mi Choi) 대한한의학회 2011 대한한의학회지 Vol.32 No.2

통증의 외과적 치료

김영수 한양대학교 의과대학 2003 한양의대 학술지 Vol.23 No.1

봉약침 시술 후에 발생한 Pain Shock 환자에 대한 임상보고

안창석,권기록,이진선,An, Chang-Suk,Kwon, Gi-Rok,Lee, Jin-Seon 대한약침학회 2001 Journal of pharmacopuncture Vol.4 No.3

Objective : There has been no known report on the pain shock after administering Korean bee-venom therapy. Three accounts of pain shock were observed at the Sangji university affiliated Oriental medicine clinic from July 2001 through September 2001. This thesis will inform clinical progression and cautions on administering Korean bee-venom therapy. Methods: We were able to witness different patterns of pain shock during the treatment of degenerative knee joint, progressive oral paralysis, and A.L.S. In order to reduce heat toxicity of the bee venom, needling points were first massaged with the ice for 10 minutes before injecting $0.1{\sim}0.2cc$ of the bee venom. Points of injection were ST36, LI11, LI4 and others. Pain shock occurred after injecting on inner xi-an, outer xi-an and LI4. The phenomena associated with pain shock was recorded in chronological order and local changes were examined. Results: Through examining 3 patients with the pain shock, we managed to observe clinical progression, duration, and time linked changes on specific regions. We also managed to determine sensitive needling points for the pain shock. Conclution: Following results were obtained from 3 patients with the pain shock caused by Korean bee-venom therapy from July 2001 to September 2001. 1. Either positive or negative responses were shown after the pain shock. For case 1, extreme pain was accompanied with muscular convulsion and tremble, ocular hyperemia, delirium, stiffening of extremities, and hyper ventilation which all suggest positive responses. For case 2 and 3, extreme pain was accompanied with facial sweating, asthenia of extremities, pallor face, dizziness, weak voice, and sleepiness which are the signs of negative responses. 2. The time required to recover to stable state took nearly an hour (including sleeping time) and there was no side effect. 3. Precautions required to prevent the pain shock includes full concentration from the practitioner, accurate point location, precise amount of injection, physiological condition and psychological stability of the patient 4. Coping with the pain shock should be similar with a needle shock, and since extreme pain is accompanied, sufficient psychological rest must be provided. 5. Pain shock occurs because the patient cannot tolerate stimulation on the needling point. Thus, symptoms were similar to the needle shock in addition to excruciating pain. Further investigation and research must be done to have better understanding of an immune response and the pain shock associated with Korean bee-venom therapy.

Pain measurement in oral and maxillofacial surgery

Sirintawat, Nattapong,Sawang, Kamonpun,Chaiyasamut, Teeranut,Wongsirichat, Natthamet The Korean Dental Society of Anesthsiology 2017 Journal of Dental Anesthesia and Pain Medicine Vol.17 No.4

Regardless of whether it is acute or chronic, the assessment of pain should be simple and practical. Since the intensity of pain is thought to be one of the primary factors that determine its effect on a human's overall function and sense, there are many scales to assess pain. The aim of the current article was to review pain intensity scales that are commonly used in dental and oral and maxillofacial surgery (OMFS). Previous studies demonstrated that multidimensional scales, such as the McGill Pain Questionnaire, Short form of the McGill Pain Questionnaire, and Wisconsin Brief Pain Questionnaire were suitable for assessing chronic pain, while unidimensional scales, like the Visual Analogue Scales (VAS), Verbal descriptor scale, Verbal rating scale, Numerical rating Scale, Faces Pain Scale, Wong-Baker Faces Pain Rating Scale (WBS), and Full Cup Test, were used to evaluate acute pain. The WBS is widely used to assess pain in children and elderly because other scales are often difficult to understand, which could consequently lead to an overestimation of the pain intensity. In dental or OMFS research, the use of the VAS is more common because it is more reliable, valid, sensitive, and appropriate. However, some researchers use NRS to evaluate OMFS pain in adults because this scale is easier to use than VAS and yields relatively similar pain scores. This review only assessed pain scales used for post-operative OMFS or dental 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.

Evaluation of pain experienced by orthodontic patients following elastomeric separator insertion: A cross-sectional study

Hareem Sultan,Hana Pervez,Sidra Maqsood,Wajeeh Syed Zeeshan 대한치과교정학회 2023 대한치과교정학회지 Vol.53 No.5

Objective: Pain following the insertion of separators and archwires varies with age, sex, race, ethnicity, threshold, and health status. This study aimed to evaluate the characteristics of pain in orthodontic patients after the insertion of elastomeric separators, its effects on daily life, and its association with age and sex in a population not previously studied in this regard. Methods: A cross-sectional study of 130 patients undergoing orthodontic treatment included collecting data on demographics, pain experienced following the placement of separators, time of onset, duration, characteristics, change in dietary pattern or chewing side, intake of analgesics, and severity of pain on the Wong Baker’s scale. The results are reported as counts and percentages. Associations between sex and age were evaluated using Pearson’s chi-square test. Results: Among the 130 patients, 56.2% were 9–20 years old, 63.8% experienced pain following the insertion of separators, 22.9% had their first episode of pain at 4 hours, 56.6% experienced intermittent pain, and 37.3% experienced discomfort; 18.1% malesand 81.9% females experienced pain following the insertion of separators. Pearson’s chi-square test showed a significant association between pain and sex (P = 0.04). Most patients (37.3%) reported “hurts little more” for pain intensity on Wong Baker’s scale and 21.7% reported all four quadrants as sites of pain. Conclusions: The pain experienced after separator insertion was associated with sex and age. Females experienced more pain than males and patients between the age range of 21 and 36 years suffered more pain during mastication than between 9 and 20 years old.