Jee Youn Moon

An exploratory study on the effectiveness of “Calmare therapy” in patients with cancer-related neuropathic pain: A pilot study

PURPOSEnCalmare therapy (CT) has been suggested as a novel treatment for managing chronic pain. Recently, it was reported to show a positive therapeutic outcome for managing neuropathic pain condition. We performed an exploratory prospective study on the effectiveness of CT in patients with various types of cancer-related neuropathic pain (CNP).nnnMETHODnWe performed an open-labeled, single-arm, exploratory study on the effectiveness of CT in patients with various types of cancer-related neuropathic pain (CNP). The primary endpoint was a comparison of the 11-point Numerical Rating Scale (NRS) pain score at one month with the baseline score in each patient. Brief Pain Inventory (BPI) and consumption of opioid were also evaluated during follow-up period.nnnRESULTSnCT significantly decreased NRS pain score at one month from baseline (pxa0<xa00.001) in 20 patients with chemotherapy-induced peripheral neuropathy (nxa0=xa06), metastatic bone pain (nxa0=xa07), and post-surgical neuropathic pain (nxa0=xa07). It also improved overall BPI scores, decreased consumption of rescue opioid (pxa0=xa00.050), and was found satisfactory by a half of patients (nxa0=xa010, 50.0%).nnnCONCLUSIONSnOur preliminary results suggest that CT may be considered for cancer patients with various types of CNP. Large studies are necessary to confirm our findings and ascertain which additional CNP show positive response to CT.

The Value of SPECT/CT in Localizing Pain Site and Prediction of Treatment Response in Patients with Chronic Low Back Pain

In many circumstances, causing sites of low back pain (LBP) cannot be determined only by anatomical imaging. Combined functional and morphological imaging such as bone scan with single-photon emission computed tomography/computed tomography (SPECT/CT) may be helpful in identifying active lesions. The purpose of this study was to evaluate the usefulness of bone SPECT/CT in localizing the pain site and the treatment of chronic LBP. One hundred seventy-five patients suffering from chronic LBP who underwent SPECT/CT were included, retrospectively. All of the patients received multiple general treatments according to the symptoms, and some of them underwent additional target-specific treatment based on SPECT/CT. Numerical rating scale (NRS) pain score was used to assess the pain intensity. Of 175 patients, 127 showed good response to the given therapies, while the rest did not. Overall, 79.4% of patients with definite active lesions showed good response. Patients with mild active or no lesions on SPECT/CT had relatively lower response rate of 63.0%. Good response was observed by the treatment with the guidance of active lesions identified on SPECT/CT. SPECT/CT could be useful in identifying active lesions in patients with chronic LBP and guiding the clinicians to use adequate treatment. Graphical Abstract

Korean Version of the painDETECT Questionnaire: A Study for Cultural Adaptation and Validation.

The purpose of this study was to adapt the painDETECT Questionnaire (PD‐Q) into a Korean version (KPD‐Q) and validate it.

Review of Sympathetic Blocks: Anatomy, Sonoanatomy, Evidence, and Techniques

Abstract The autonomic nervous system is composed of the sympathetic and parasympathetic nervous systems. The sympathetic nervous system is implicated in situations involving emergent action by the body and additionally plays a role in mediating pain states and pathologies in the body. Painful conditions thought to have a sympathetically mediated component may respond to blockade of the corresponding sympathetic fibers. The paravertebral sympathetic chain has been targeted for various painful conditions. Although initially injected using landmark-based techniques, fluoroscopy and more recently ultrasound imaging have allowed greater visualization and facilitated injections of these structures. In addition to treating painful conditions, sympathetic blockade has been used to improve perfusion, treat angina, and even suppress posttraumatic stress disorder symptoms. This review explores the anatomy, sonoanatomy, and evidence supporting these injections and focuses on ultrasound-guided/assisted technique for the performance of these blocks.

The minimal effective dose of cis-9-cetylmyristoleate (CMO) in persons presenting with knee joint pain: A double-blind, randomized, placebo-controlled trial

Background: Nutraceuticals containing cis-9-cetylmyristoleate (CMO) are used to improve knee pain despite the lack of placebo-controlled studies in humans. The aim of the study was to explore the minimal effective dose of CMO for relieving knee joint pain. Methods: Twenty-eight subjects with mild degree arthritic knee joint pain were randomized into 4 groups; groups A, B, and C that contained 100%, 80%, and 62.4% of fatty acid component with 12.5% of CMO, and control group D (starch 100%). The pain intensity, functional disability, and the Patient Global Impression of Change (PGIC) were assessed for a 12-week ingestion period. Results: Compared to group D (nu200a=u200a6), there were significant differences in pain score in group A (nu200a=u200a7, Pu200a=u200a0.005) and group C (nu200a=u200a7, Pu200a=u200a0.012), but not significant in group B (nu200a=u200a6, Pu200a=u200a0.180). Western Ontario and McMaster Universities Arthritis (WOMAC) score decreased significantly in groups A and C. The PGIC was positive in the majority (>50%) in groups A, B, and C, whereas negative in 83.3% in group D (control). Conclusion: CMO is effective in alleviating knee pain in persons with mild degree arthritis of the knee joint, at an effective dose of 62.4%.

Impact of Type of Needle on Incidence of Intravascular Injection During Diagnostic Lumbar Medial Branch Block.

Background and Objectives Intravascular (IV) injection of local anesthetics is a potential cause of false-negative results after lumbar medial branch nerve blockade (L-MBB) performed to diagnose facetogenic back pain. The aim of the present study was to identify the relationship between the needle type and the incidence of IV injection in patients undergoing L-MBB using fluoroscopy with digital subtraction imaging (DSI). Methods In this prospective randomized study, we compared the incidence of IV uptake of contrast medium using the Quincke needle and Whitacre needle under real-time DSI during L-MBB. Clinical and demographic factors associated with the occurrence of IV uptake were also investigated. Results In total, 126 patients were randomized into the Quincke needle group (n = 62) and Whitacre needle group (n = 64). Intravascular uptake of contrast medium was observed in 66 (9.8%) of 671 L-MBB procedures under DSI. The incidence of IV uptake was 13.9% (47/338) using the Quincke needle and 5.7% (19/333) using the Whitacre needle. In the multivariate generalized estimating equations analysis, use of a Quincke needle was related to positive IV injection at a 1.898-fold higher rate than was use of a Whitacre needle (95% confidence interval, 1.025–3.516) and a positive aspiration test predicted IV injection at a 21.735-fold higher rate (95% confidence interval, 11.996–52.258). Conclusions Lumbar medial branch nerve blockade using the Quincke needle was associated with a 1.9-fold higher rate of IV injection than was L-MBB using the Whitacre needle under DSI. Although further study is needed to confirm the clinical efficacy, Whitacre needles can be considered to reduce the risk of IV injection during L-MBB.

Clinical Association Between Brain MRI Findings With Epidural Blood Patch in Spontaneous Intracranial Hypotension.

Background: Spontaneous intracranial hypotension (SIH) is characterized by spontaneous postural headache with neck stiffness, nausea, vomiting, tinnitus, and vertigo in patients with low cerebrospinal fluid pressure. Epidural blood patch (EBP) can be a treatment of choice in patients nonresponsive to the initial noninvasive treatments. We compared brain magnetic resonance imaging (MRI) findings and clinical variables between patients with conservative management only and patients with added EBP, to help physicians plan the management modalities for SIH patients. In addition, clinical factors associated with MRI abnormalities in SIH, and the response to EBP between elderly and young patients were assessed. Materials and Methods: We retrospectively reviewed the medical records of patients fulfilling the symptomatic diagnostic criteria for SIH between 2001 and 2014. The following data were collected and analyzed by reviewing electronic medical records: demographic variables, initial clinical symptoms (nausea and vomiting, neck stiffness, vertigo, and tinnitus), initial pain score, reports of brain MRI, identified leakage site by cisternography or myelography, finding(s) of spine MRI, and duration of hospital stay. The response to EBP between elderly and young patients based on the age of 45 years, that is, the mean age of EBP in the study, were also compared. Results: The incidence of abnormalities of brain MRI findings did not show significant differences between conservative treatment and EBP. However, the proportion of patients with severe pain was higher in patients who underwent EBP. In multivariate regression analysis, the incidence of positive brain MRI finding(s) for SIH increased in patients with older age, higher weight, and an absence in nausea/vomiting. EBP procedure was effective in both younger and elderly patients. Conclusions: The results of our study indicated no difference between MRI findings in both conservative treatment and EBP modalities; however, there were differences in initial pain score. Therefore, clinical presentation of SIH patients may be critical and help physicians make a decision of EBP procedure.