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윤승현,최종훈,김성택,안형준,권정승,Yoon, Seung-Hyun,Choi, Jong-Hoon,Kim, Seong-Taek,Ahn, Hyung-Joon,Kwon, Jeong-Seung 대한안면통증구강내과학회 2008 Journal of Oral Medicine and Pain Vol.33 No.4
치아의 통증은 구강안면부에서 가장 흔하게 발생하는 통증이다. 대부분의 치아 통증은 치수 및 치주조직의 병적인 변화로 인한 치성 통증이지만, 구강안면부의 다른 구조물의 병적 변화 또는 다른 질병 등에 의한 통증이 치아의 통증으로 나타나는 경우도 흔히 존재하며, 이러한 통증을 '비치성치통'이라고 한다. 비치성치통은 통증의 발현 부위와 통증의 원인 부위가 일치하는 원발성 통증이 아니라, 통증의 발현 부위와 통증의 원인 부위가 동일하지 않은 이소성 통증에 속하므로 통증의 원인을 찾아 치료해야만 개선될 수 있다. 비치성 치통을 유발하는 요인에는 신경병증성 통증, 부비동질환 기원의 통증, 근막통증, 신경혈관성 통증, 심장질환, 두개 및 구강안면부 종양, 중이염 등에 의한 전이통, 심인성 원인 등이 있다. 이러한 다양한 원인에 의한 통증이 치아부위에 나타나는 경우 치아 및 치주조직에 대한 임상 및 방사선 사진 검사 상 병적인 소견이 관찰되지 않음에도 불구하고, 치아통증과 유사한 임상적 증상을 나타낼 수 있다. 그러므로, 임상가들은 비치성 치통을 유발할 수 있는 원인 및 관련 증상들에 대하여 잘 알고 있어야 하며, 세심한 병력 청취, 치아 관련 구조물 및 그 외의 구조물에 대한 정확한 임상 검사를 통해 치성 통증과 감별할 수 있어야 한다. 본 증례 보고에서는, 치아 통증과 유사한 양상을 보이는 비치성 치통으로 내원한 환자의 진단 및 치료에 관한 증례를 통해, 비치성 치통에 대한 고찰 및 진단과 치료시의 고려 사항에 대하여 살펴보고자 한다.
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배성제,김완수,강수경,어규식,홍정표,전양현,Bae, Sung-Jae,Kim, Wan-Su,Kang, Soo-Kyung,Auh, Q-Schick,Hong, Jung-Pyo,Chun, Yang-Hyun 대한안면통증구강내과학회 2013 Journal of Oral Medicine and Pain Vol.38 No.4
이 연구에서는 말초 opioid 수용체를 이용한 저작근 통증 조절 시 성별 효과의 차이를 확인하고자 RDC/TMD로 진단된 지원자 남성 20명, 여성 20명을 saline 주사군, lidocaine 주사군, morphine 1.5 mg 주사군, morphine 3 mg 주사군 각각 5명씩 배정하였다. 통증부위에 주사 전, 주사 후 1시간, 24시간, 48시간에 각각 주관적인 통증 평가인 시각유추척도평가, 맥길통증설문지 평가, 통증부위표시평가 그리고 객관적인 통증 평가인 압력통증역치평가와 압력통증한계평가를 실시하였다. 검사 후 평가된 자료를 통계 처리하여 다음과 같은 결과를 얻었다. 1. 시각유추척도평가에서는 남녀 모두가 morphine 3 mg군에서 통계학적으로 유의성 있는 효과가 있었다. (male: p<0.05, female: p<0.05) 2. 맥길통증설문지 평가에서는 남녀 모두가 morphine 1.5 mg군 보다 morphine 3 mg군에서 더 통계학적으로 유의성 있는 효과가 있었다. (male: p<0.001, female: p<0.01) 3. 통증부위표시평가와 압력통증역치평가에서는 남성이 morphine 3 mg군에서 통계학적으로 유의성 있는 효과가 있었다. (PD: p<0.001, PPT: p<0.05) 이상의 연구 결과로 저작근 통증을 조절하기 위해서 morphine 3 mg을 통증부위에 주사한 경우 객관적인 통증 평가에서 여성 환자보다 남성 환자에게 더 효과가 있다는 것을 알 수 있었으며, 앞으로 시간에 따른 그리고 용량에 따른 남녀 치료효과의 차이에 관한 연구가 더 필요 할 것으로 생각된다.
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Morphine 과 병용한 경막외 Low-dose Ketamine 의 술후 통증에 대한 효과
김명옥(Myoung Oak Kim),주경화(Koung Hwa Joo),김운 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.2
Background: Epidural morphine for postoperative pain control has a serious risk of respiratory depression and other side effects such as pruritus, nausea and urinary retention, In recent years, it is known that epidural administration of ketamine potentiates the effect of epidural morphine, and so decrease the side effects of epidural morphine. This study was performed to evaluate the analgesic efficacy of epidurally administered ketamine and whether this epidural administration can decrease the amount of epidural morphine. Methods: Sixty patients scheduled for the elective cesarean section were randomly selected. All patients were given subarachnoid injection of tetracaine 9 mg. Group I received epidural bolus injection of 0.15% bupivacaine 10 ml with morphine 2 mg followed by a continuous infusion of 0.125% bupivacaine 100 ml containing morphine 4 mg after peritoneum closure, and group II received the same method as group I except for the addition of epidural ketamine 30 mg. Analgesic effects were assessed using Numeric Rating Score (NRS) and Prince Henry Score (PHS). Also, the degree of satisfaction and the incidence of the side effects were observed. Results: Analgesic effects were significant in both groups after drug administration. But NRS and PHS were not significantly different between two groups at all times. The incidence of nausea and vomiting was 11 out of 30 in group I and 9 out of 30 in group II and the incidence of itching was ll out of 30 in group I and 8 out of 30 in group II, Number of patients using additional analgesics were 2 and 1 in group I and II, respectively. Conclusions: Epidural ketamine did not potentiate the analgesic effect of epidural motphine and could not decrease the side effect of epidural morphine.
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단독 경막외 통증자가조절법과 지속주입을 병용한 경막외 통증자가조절법의 비교
김동희(Dong Hee Kim),이태수(Tae Soo Lee) 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2
Background: The purpose of this study was to determine whether there is any advantage for a continuous background infusion during patient controlled epidural analge- sia(PCEA) for postoperative pain control. Methods: 60 patients scheduled for elective cesarean section under epidural anesthesia were assigned randomly in a double-blind fashion to receive fentanyl and bupivacaine by PCEA with or without background infusion for 48 hours postoperatively. Results: Total amount of fentanyl and bupivacaine consumption and degree of sedation were not significantly different between the two groups. Visual analogue scale(VAS) pain scores at 24, 36, and 48h and sleep disturbance were significantly lower in background in- fusion group. Conclusions: Administration of fentanyl with bupivacaine by continuous background infu- sion is appropriate for PCEA for postcesarean section pain control.
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백서에서 제 5 , 6 번 요추신경의 결찰에 의하여 유발된 작열통성 통증에 대한 Ketamine의 치료효과
이원형(Won Hyung Lee),한능희(Neung Hee Han),김태헌 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.1
We produced the causalgiform pain by the tight ligation of L5 and L6 spinal nerves in the adult rats. To evalute the effect of ketamine noncompetitive NMDA(N-methyl-D aspartate) antagoinst on the causalgiform pain, we tested the changes of; withdrawal sensitivity to the innocuous mechanical stimulation of Von Frey hair 2.35 g(mechanical allodyniag withdrawal frequency to the cold stimulation of acetone(cold allodynia); and total withdrawal time(second) to the cold(4 ℃) plate stimulation(cold hyperalgesia) after the administration of I mg, 3 mg, 10 mg/kg ketamine. The results were as follows.' 1) Cold hyperalgesia was significantly reduced(p<0.05) by 1 mg, 3 mg, 10 mg/kg ketamine. 2) Cold allodynia and mechanical allodynia was significantly reduced(p<0.05) by l0mg/kg keiamine. Above results suggest a therapeutic utility of ketamine in treatment of causalgia especial- ly, cold hyperalgesia.
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말기암 환자의 통증 양상과 통증관리에 영향을 미치는 요소들
이수련(Soo Ryun Lee),길호영(Ho Yeong Kil),한태형(T 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.2
Background: Validity of WHO guideline of cancer pain management has been proven and many trials have been done to derive solutions for inadequate cancer pain management. We assessed the severity of pain of terminal cancer patients in a few different ways and patients'characteristics influencing inadequate pain management. Methods: This study was based on 100 adult oncological patients who were confirmed as terminal stage in our institution from 3/1998 to 11/1998. Medical records were reviewed and individual patients were interviewed to obtain demographic information and medical characteristics such as; daily activity performance, metastasis, and drug-adjusted pain severity. Adequacy of prescribed analgesics in accordance with WHO guidelines of pain management and patients characteristics influencing adequacy of pain management were assessed. Results: Among those cancer patients diagnosed as terminal stage, 85% complained of pain, and 68% of those patients reported pain above moderate severity. 38% of those patients received inadequate pain management resulting in greater severity of pain; the less adequate pain relief was(p<0.01). Sex, age, primary cancer site metastasis, symptoms such as depression and anxiety, and daily activity performance were not significantly related. Conclusions: Despite WHO guidelines for pain management, majority of the terminal cancer patients received inadequate pain management. There is a necessity for education on proper pain evaluation and strict implimentation for WHO guidelines of pain management.
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정맥내 통증 자가조절법에 의한 술후 통증관리 1,590예에 대한 분석
송선옥(Sun Ok Song),지대림(Dae Lim Jee),구본업(Bon 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2
Background: We started postoperative pain management service using an intravenous patient-controlled analgesia(IV-PCA, PCA), which is known as convenient and effective an- algesic method. In this report, we describe the efficacy and safety of PCA and the experi- ence of developing an acute pain service to treat postoperative pain using a PCA. Methods: Practices of an acute pain service were started at a ward for general surgery after preparation of the standardized protocols for PCA. In each patient, PCA was con- nected following administration o;. initial loading doses of analgesics at recovery room after operation. All patients were checked by acute pain service team once or twice daily. The scope of acute pain service was gradually spread to other departments such as ortho- pedic, thoracic, obstetric and gynecologic departments by requests of patients or surgeons. We managed 1,590 patients during first 22 months. Among them, nine hundred seventy two cases were prospectively evaluated for their analgesic efficacy and side effects of PCA. Results: The number of patients was increased day by day. The most common type of operation was gastrectomy(21.6%). Cominonly used analgesics were nalbuphine(59%) and morphine(37%,). The mean duration of PCA attachment was 3.3 days. The degree of anal- gesia on operation day was good in 44.8#k and tolerable in 52.6% of patients. Only 3.9% of patients complained severe pain during their postoperative periods. One elderly patient ex- perienced respiratory depression(0.06%) owing to accidental misuse of PCA by his relatives. Overall patient's satisfaction was over 93%. Conclusions: According to our experiences, we conclude that PCA is an effective, relative- ly safe and highly satisfactory method for postoperative pain management. Because of these advantages of PCA, the creation of our acute pain service using a PCA was success- ful and expanded rapidly.
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