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Nahm, Francis Sahn-Gun,Lee, Pyung-Bok,Kim, Tae-Hun,Kim, Yong-Chul,Lee, Chul-Joong The Korean Pain Society 2010 The Korean Journal of Pain Vol.23 No.1
Background: An independent medical examination (IME) is a critical process for awarding reparation for injury. However, conducting an IME in pain medicine is very difficult, not only because pain is a subjective symptom, but also because there are no proper objective methods to demonstrate it. This study was conducted to compare IME reports and the court decisions on the disability status of the patients. Methods: We analyzed 79 IME reports and 25 corresponding court decisions on the disability status of patients. The diagnoses, causal relationships between the patients' status and the trauma, McBride's degree of disability, the American Medical Association's impairment ratings, the estimated annual cost for future treatment, and the necessity of care-giving were compared and analyzed. Results: The diagnoses in the 79 cases were complex regional pain syndrome (CRPS) type I (58 cases), CRPS type II (7 cases), peripheral neuropathy (5 cases), myofascial pain syndrome (4 cases), herniated intervertebral disc (2 cases), and fibromyalgia (1 case). The types of accidents were road traffic accidents (50 cases), military injuries (14 cases), industrial accidents (11 cases), and others (4 cases). The IME reports and the court decisions stated considerably different McBride's degrees of disability (P = 0.014). However, there was no significant difference in the estimated cost for future treatment between the IME reports and the court decisions (P = 0.912). Conclusions: IME reports should be accurate, fair, and based on objective findings. Feedback on IMEs from the court decisions is helpful for reference use.
Analysis of Statistical Methods and Errors in the Articles Published in the Korean Journal of Pain
Yim, Kyoung-Hoon,Nahm, Francis Sahn-Gun,Han, Kyoung-Ah,Park, Soo-Young The Korean Pain Society 2010 The Korean Journal of Pain Vol.23 No.1
Background: Statistical analysis is essential in regard to obtaining objective reliability for medical research. However, medical researchers do not have enough statistical knowledge to properly analyze their study data. To help understand and potentially alleviate this problem, we have analyzed the statistical methods and errors of articles published in the Korean Journal of Pain (KJP), with the intention to improve the statistical quality of the journal. Methods: All the articles, except case reports and editorials, published from 2004 to 2008 in the KJP were reviewed. The types of applied statistical methods and errors in the articles were evaluated. Results: One hundred and thirty-nine original articles were reviewed. Inferential statistics and descriptive statistics were used in 119 papers and 20 papers, respectively. Only 20.9% of the papers were free from statistical errors. The most commonly adopted statistical method was the t-test (21.0%) followed by the chi-square test (15.9%). Errors of omission were encountered 101 times in 70 papers. Among the errors of omission, "no statistics used even though statistical methods were required" was the most common (40.6%). The errors of commission were encountered 165 times in 86 papers, among which "parametric inference for nonparametric data" was the most common (33.9%). Conclusions: We found various types of statistical errors in the articles published in the KJP. This suggests that meticulous attention should be given not only in the applying statistical procedures but also in the reviewing process to improve the value of the article.
Pulsed Radiofrequency Lesioning of the Axillary and Suprascapular Nerve in Calcific Tendinitis
Kim, Jun-Sik,Nahm, Francis Sahn-Gun,Choi, Eun-Joo,Lee, Pyung-Bok,Lee, Guen-Young The Korean Pain Society 2012 The Korean Journal of Pain Vol.25 No.1
The patient was a 45-year-female who presented with pain at right shoulder and right upper arm. The patient suffered from right shoulder and arm pain for 3 years and had pain management which was performed using medication and conservative management after she had been diagnosed with calcific tendinitis. However, substantial pain relief was not consistently achieved, and recurrence of pain was reported. Therefore, we performed right axillary nerve and suprascapular nerve block through pulsed radiofrequency. Two months after the procedure, the shoulder pain gradually subsided with the size reduction of the calcified nodule and she needed no more pain management.
Kwon, Hyun-Woo,Paeng, Jin-Chul,Nahm, Francis Sahn-Gun,Kim, Seog-Gyun,Zehra, Tanzeel,Oh, So-Won,Lee, Hyo-Sang,Kang, Keon-Wook,Chung, June-Key,Lee, Myung-Chul,Lee, Dong-Soo The Korea Society of Nuclear Medicine 2011 핵의학 분자영상 Vol.45 No.4
Purpose Although the three-phase bone scan (TBPS) is one of the widely used imaging studies for diagnosing complex regional pain syndrome type I (CRPS-1), there is some controversy regarding the TPBS image criteria for CRPS-1. In this study, we modified the image criteria using image pattern and quantitative analysis in the patients diagnosed using the most recent consensus clinical diagnostic criteria. Materials and Methods The study included 140 patients with suspected CRPS-1 (CRPS-1, n=79; non-CRPS, n=61; mean age $39{\pm}15$ years) who underwent TPBS. The clinical diagnostic criteria for CRPS-1 revised by the Budapest consensus group were used for confirmative diagnosis. Patients were classified according to flow/pool and delayed uptake (DU) image patterns, and the time interval between the initiating event and TPBS ($TI_{event-scan}$). Quantitative analysis for lesion-to-contralateral ratio (LCR) was performed. Modified TPBS image criteria were created and evaluated for optimal diagnostic performance. Results Both increased and decreased periarticular DU were significant image findings for CRPS-1 (CRPS-1 positive-rate=73% in the increased DU group, 75% in the decreased DU group). The $TI_{event-scan}$ did not differ significantly between the different image pattern groups. Quantitative analysis revealed an LCR of 1.43 was the optimal cutoff value for CRPS-1 and diagnostic performance was significantly improved in the increased DU group (area under the curve=0.732). Given the modified image criteria, the sensitivity and specificity of TPBS for diagnosing CRPS-1 were 80% and 72%, respectively. Conclusions Optimally modified TPBS image criteria for CRPS-1 were suggested using image pattern and quantitative analysis. With the criteria, TPBS is an effective imaging study for CRPS-1 even with the most recent consensus clinical diagnostic criteria.
Catheter Obstruction of Intrathecal Drug Administration System -A Case Report-
Rhee, Seok-Myeon,Choi, Eun-Joo,Lee, Pyung-Bok,Nahm, Francis Sahn-Gun The Korean Pain Society 2012 The Korean Journal of Pain Vol.25 No.1
Intrathecal drug administration system (ITDAS) can reduce the side effects while increasing the effectiveness of opioids compared to systemic opioid administration. Therefore, the use of ITDAS has increased in the management of cancer pain and chronic intractable pain. Catheter obstruction is a serious complication of ITDAS. Here, we present a case of catheter obstruction by a mass formed at the side hole and in the lumen. A 37-year-old man suffering from failed back surgery syndrome received an ITDAS implantation, and the ITDAS was refilled with morphine every 3 months. When the patient visited the hospital 18 months after ITDAS implantation for a refill, the amount of delivered morphine sulfate was much less than expected. Movement of the pump rotor was examined with fluoroscopy; however, it was normal. CSF aspiration through the catheter access port was impossible. When the intrathecal catheter was removed, we observed that the side hole and lumen of the catheter was plugged.
Baik, Ji-Seok,Choi, Eun-Joo,Lee, Pyung-Bok,Nahm, Francis Sahn-Gun The Korean Pain Society 2012 The Korean Journal of Pain Vol.25 No.1
The superior hypogastric plexus block (SHPB) is used for treating pelvic pain, especially in patients with gynecological malignancies. Various approaches to this procedure have been reported due to the anatomic obstacles of a high iliac crest or large transverse process of the $5^{th}$ lumbar vertebra. Here, we report a new technique of superior hypogastric plexus block using a unilateral single-needle approach to block the bilateral superior hypogastric plexus with a Tuohy needle and epidural catheter. We have confidence that this new technique can be another option in performing the SHPB when the conventional bilateral approach is difficult to perform.
Unrecognized C1 Lateral Mass Fracture Without Instability: The Origin of Posterior Neck Pain
Seo, So-Jin,Kim, Hye-Rim,Choi, Eun-Joo,Nahm, Francis Sahn-Gun The Korean Pain Society 2012 The Korean Journal of Pain Vol.25 No.4
Posterior neck pain is a common complaint of patients in the pain clinic. The atlas (C1) burst fracture is known to be a cause of posterior neck pain and instability. Although the atlas burst fracture and instability can be discovered by plain X-rays which show lateral mass displacement or widening of the atlantodental interval, assessment of an atlas burst fracture can be difficult if there is no instability in the imaging study. Here we report a case of a 46-year-old female patient who had complained of sustained posterior neck pain for 6 months. Plain X-rays showed only disc space narrowing at C4/5 and C5/6, without any cervical instability. However, an unrecognized C1 lateral mass fracture was detected by CT and MRI. The patient's pain was then successfully treated after atlantoaxial joint injection with a C2 DRG block.