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

Effectiveness and safety of Korean medicine for pain management after musculoskeletal surgery: a retrospective study

Hansol Lee,Hyungsuk Kim,Koh-Woon Kim,Jae-Heung Cho,Mi-Yeon Song,Won-Seok Chung 경희대학교 융합한의과학연구소 2022 Oriental Pharmacy and Experimental Medicine Vol.22 No.4

To assess the effectiveness and safety of Korean medicine in managing postoperative pain. Retrospective, observational study. Medical records of 233 inpatients at a Korean medicine hospital who underwent Korean medicine treatments such as acupuncture, moxibustion, cuppping, bee-venom and herbal acupuncture, electrical therapy, herbal medicine, and carbon-beam therapy after musculoskeletal surgery were reviewed, and numeric ratings for pain were compared between baseline and follow-up. A correlation analysis between pain improvement and therapeutic factors was performed, and a regression analysis was conducted to determine the predictors of pain reduction. Serum laboratory test results at baseline and follow-up were subsequently compared to identify safety. Numeric rating scale scores for pain; presence of infection, drug-induced liver injury (DILI), and drug-induced kidney injury (DIKI) for safety. After Korean medicine treatment, the pain scores decreased from an average of 4.09 to 1.79 in the numeric rating scale (p < 0.001). Frequency of acupuncture therapy during hospitalization showed the strongest positive correlation with pain improvement (r = 0.341, p = 0.000) and was a predictor of pain reduction (adjusted R2 = 0.145). Improvements in serum laboratory data to reference limits were observed. All kappa coefficient values, except for white blood cell (WBC) count, were between 0.3 and 0.7, indicating that the follow-up data matched the baseline data. The low kappa coefficient value of WBC count was due to the high ratio of outliers. One (0.43%) and no cases of DILI and DIKI were identified, respectively. Korean medicine could be used for managing pain after musculoskeletal surgery.

파킨슨병 환자의 통증에 대한 한의치료의 효과 : 후향적 연구

정혜선,김하리,김서영,임태빈,진철,권승원,조승연,정우상,문상관,박정미,고창남,박성욱 대한한방내과학회 2020 大韓韓方內科學會誌 Vol.41 No.6

Objectives: To investigate efficacy of Korean medicine for patients with Parkinson’s Disease (PD) with pain. Methods: We performed a retrospective review of the medical records for patients diagnosed with PD between 2012 and 2019 at Gangdong Kyung Hee University Korean Medicine Hospital in South Korea. Results: Twenty-two patients with King's Parkinson's Disease Pain Scale(KPPS) scores at least twice were analyzed for evaluating the efficacy of Korean medicine for pain treatment in PD. The mean total scores before and after Korean medicine treatment were 15.23±11.01 and 9.2±8.7, respectively, and the mean difference between the before/after total scores was 6.0±5.8 (P<0.001). Specifically, the score of radicular pain was significantly decreased (P=0.048). Conclusions: These findings suggest that Korean medicine could be beneficial for reducing pain associated with PD. Clinical efficacy should be confirmed by further studies, such as large-sample cohort studies and randomized controlled trials to clarify the pathological pain relief mechanism and the analgesic effect of Korean medicine.

통증의 스트레스 정도와 심리변화 관계 연구

신상수 한국인간복지실천학회 2008 한국인간복지실천연구 Vol.1 No.-

통증(pain)은 오늘날 기능장애(impairment)나 능력장애(disability)를 치료하는데 중요한 고려 대상이 되고 있을 뿐만 아니라 치료비용 또한 사회에 엄청난 재정적 부담을 주고 있는데, 실제로 노인성질환(Geriatric disease)으로 인해 노인의료비가 급증하여 국민건강보험 재정에 막대한 영향을 미치고 있다. 이와 같은 노인의료비의 해결과 노인 가족의 부양부담 및 노인의 삶의 질 향상을 위해 2008년 7월부터 노인장기요양보험제도를 실행하게 되었다. 따라서 본 연구의 목적은 통증의 스트레스 정도 및 심리적 변화를 알아보고 통증과 심신관계를 분석하는데 있다. 심리적 변인의 중요성을 강조하고 있는 Melzack과 Wall의 통증이론을 토대로 임상에서 실제로 통증을 호소하는 환자를 대상으로 연구한 결과 다음과 같은 결론을 얻었다. 첫째, 통증에 있어 연령은 40~50대(52.3%)가 가장 많았으며, 연령에 의한 스트레스 정도는 통계적으로 유의하였으며(p<0.05), 연령에 따른 심리적 변화에 영향은 통계적으로 무의미함을 알 수 있었다. 둘째, 통증의 원인은 교통사고(35.4%)가 가장 많았고, 통증의 기간은 3개월 이상 만성 통증(69.2%)이 많았으며, 통증의 형태는 둔한 통증(dull, 41.5%)이 높아 근육이상으로 인한 통증이 많음을 알 수 있었다. 셋째, 통증으로 인한 스트레스와 심리적 변화의 상관관계는 현재의 통증으로 인하여 스트레스를 받고 있음을 알 수 있으며, 통증으로 인해 심리적 변화에 영향을 주었음을 알 수 있었다(r=0.493).Melzack과 Wall의 Gate-control theory는 지금도 가장 포괄적이고, 통증의 인지적 측면을 이해하는데 모든 이론과 관련되어 있다. 여러 형태의 통증들은 다양한 정도와 특징을 가진 감정적 고통, 일차적으로 공포, 불안, 분노 및 우울을 동반한다. 그러나 아직은 통증 정동(pain affect)보다는 통증 지각(pain sensation)에 더 관심을 갖는다. 본 연구를 통하여 통증은 심신상관의학(psychosomatic medicine) 차원에서 동통지각과 조절에 중요한 인지적 개입(cognitive interventions)인 통증을 효과적으로 조절할 수 있다는 환자의 지각이 요구된다. 본 논문의 연구 결과를 토대로 후속 논문으로 65세 이상의 노인을 대상으로 통증과 심신상관관계 연구가 필요하다고 사료된다. Not only the pain is being the important consideration today in curing impairment or disability, but also the treatment cost is also giving hugh financial burden to society. Actually due to geriatric disease, the medical cost for the elderly rapidly increased, thereby having tremendous influence upon finances of National Health Insurance. In order to solve this medical cost for the elderly, and to enhance the care-giving burden for the elderly family, and the quality of life in old people, the elderly long-term care insurance system came to be implemented from July in 2008. Accordingly, the purpose of this study is to examine the stress affect in pain and the psychological change, and to analyze the relationship between pain and mind & body. As a result of researching targeting patients who actually appeal for pain in clinic based on the pain theory in Melzack and Wall who emphasize importance of psychological variables, the following conclusions were obtained. First, the pain was the largest in their 40~50s(52.3%). The stress affect depending on age was statistically significant(p<0.05). And, the effect on psychological change depending on age could be known to be statistically insignificant. Second, a cause for pain was the largest in traffic accident(35.4%). The period of pain was the largest in chronic pain(69.2%) for more than 3 months. And, the form in pain was high in dull pain(41.5%), thereby having been able to be known that the pain due to muscular disorder was large. Third, as for the relationship between the stress due to pain and the psychological change, it could be known to be stressed by the current pain, and could be known to have an effect on the psychological change due to pain(r=0.493).The gate-control theory in Melzack and Wall is the most comprehensive even now, and is related to all theories in understanding cognitive aspect in pain. Pains in several forms are accompanied by emotional pain, primary horror, anxiety, anger, and depression, which have diverse affects and characteristics. However, the pain sensation is paid more attention yet than to the pain affect. Through this study, the pain is required the patients’ perception of being able to control pain effectively, which is the important cognitive interventions to pain sensation and control in the dimension of psychosomatic medicine. It is considered that a study on correlation between pain and mind & body is needed targeting the elderly more than 65 years old, as a follow-up thesis.

급성 요통 증후군 환자에 대해 봉독약침요법을 병행한 한의학적 치료 효과: 증례보고

봉성민 ( Sung Min Bong ),장우석 ( Woo Seok Jang ),김경호 ( Kyung Ho Kim ) 경락경혈학회 2020 Korean Journal of Acupuncture Vol.37 No.1

2019년 10월 16일부터 2019년 12월 16일까지 동국대학교 일산한방병원에서 요통을 호소하시며 X-ray 상 급성기 이상 소견이 없는 환자 3명을 대상으로 하였다. 한방응급실을 통해 입원한 급성 요통 증후군 환자에 대한 봉독약침요법을 포함한 한의학적 치료를 시행한 증례에 있어서 다양한 치료 효과를 확인하였다. NRS, ODI, EQ-5D, EQ-VAS의 모든 지표에서 임상적 호전의 결과를 관찰할 수 있었으며 환자의 주관적인 호전도에 있어서도 큰 변화를 얻을 수 있었고, 봉독약침에 대한 이상반응은 없었다. 봉독약침요법을 포함한 한의학적 치료를 통해 급성 요통이 완화되었으며 요추 ROM 증진 및 운동기능이 개선되고, 치료 기간을 단축시켜 환자의 삶의 질적인 측면에서 큰 호전을 보였다. 향후 급성 요통 증후군에 대한 봉독약침요법의 치료효과를 확인하기 위해 대규모 전향적 연구뿐만 아니라 대조군 연구가 필요할 것으로 사료된다. Objectives : Acute low back pain syndrome causes pain and poor quality of life. There are various studies of SBV (Sweet bee venom) pharmacopuncture, but few have identified the therapeutic effects for patients unable to walk due to acute back pain. This case series report three cases of acute low back pain syndrome treated with SBV pharmacopuncture combined with Korean Medicine (KM) treatments. Methods : Three acute low back pain syndrome patients with no other acute abnormalities in the imaging were treated by KM treatments including SBV pharmacopuncture, acupuncture, cupping, herbal medicine and physical therapy. The improvement of symptoms was evaluated using Numerical rating scale (NRS), Oswestry disability Index (ODI), EuroQol-5 dimension index (EQ-5D) and EuroQol-visual analogue scale (EQ-VAS). Results : Patients who were unable to walk due to acute back pain were able to walk. There were significant improvements of NRS, ODI, EQ-5D and EQ-VAS after treatment. The patients experienced an average 90% decrease in low back pain after inpatient KM treatment for about 8 days. NRS decreased by an average of 78.9%, ODI decreased by an average of 49.4%, and EQ-VAS increased by an average of 92.6%. In the case 1, EQ-5D decreased in all categories, but in the case 2, it decreased in all categories except for pain/discomfort and anxiety/depression, but in the case 3, it decreased in all categories except anxiety/depression. There was no serious side effect after treatment of SBV pharmacopuncture. Conclusions : KM treatments including SBV pharmacopuncture may be effective for acute low back pain syndrome patients. However, randomized controlled trials are needed in the future to confirm the clinical effects of these interventions.

요통에 대한 협진 레지스트리 임상연구: 예비 임상연구 프로토콜

김병준 ( Byung-jun Kim ),신병철 ( Byung-cheul Shin ),허인 ( In Heo ),임경태 ( Kyeong-tae Lim ),박인화 ( In Hwa Park ),황의형 ( Eui-hyoung Hwang ) 대한한의학회 한방재활의학과학회 2017 한방재활의학과학회지 Vol.27 No.3

Objectives Collaboration medicine means cooperate with western medicine and traditional korean medicine to treat the one disease. In Korea, Interest in collaboration medicine is increasing, But the number of studies is scare. Therefore we will conduct collaboration medicine study for the low back pain. Methods This study composes prospective cohort registry study. If the patients who need collaboration medicine by doctor come, we will ask regist this study. And patient select collaboration treatment group and single treatment group. Total 120 patients will recruit from collaboration pilot project hospitals. Each group patient will observed 4 weeks. Telephone research will conducted after 1 month from the last follow up. During the treatment, patients are treated usual treatment type of each medicine. Primary outcome is NRS and secondary outcomes are EQ-5D and ODI. We will analyze difference of 1 week and 4 week outcome result. Conclusions This study is the first large sample size study effect of collaboration medicine in Korea for low back pain. We check present collaboration system and improve collaboration system. Aim of this study is to find the effectiveness collaboration medicine for low back pain in the real condition. And we expect this pilot study will provide the clinical collaboration information and basis. (J Korean Med Rehabil 2017;27(3):117-124)

어깨통증의 한의학적 치료에 대한 국내 임상 연구 고찰

김찬영(Chan-young Kim),양지혜(Ji-hye Yang),채인철(In-cheol Chae),최인우(In-woo Choi),유주영(Ju-young Ryu),정은선(Eun-sun Jung),김윤식(Yoon-sik Kim),설인찬(In-chan Seol),유호룡(Ho-ryong Yoo) 대한한의학회 2020 대한한의학회지 Vol.41 No.3

Bone scintigraphy in patients with pain

( Seung Hyeon Shin ),( Seong Jang Kim ) 대한통증학회 2017 The Korean Journal of Pain Vol.30 No.3

Nuclear medicine imaging is widely used in pain medicine. Low back pain is commonly encountered by physicians, with its prevalence from 49% to 70%. Computed tomography (CT) or magnetic resonance imaging (MRI) are usually used to evaluate the cause of low back pain, however, these findings from these scans could also be observed in asymptomatic patients. Bone scintigraphy has an additional value in patients with low back pain. Complex regional pain syndrome (CRPS) is defined as a painful disorder of the extremities, which is characterized by sensory, autonomic, vasomotor, and trophic disturbances. To assist the diagnosis of CRPS, three-phase bone scintigraphy is thought to be superior compared to other modalities, and could be used to rule out CRPS due to its high specificity. Studies regarding the effect of bone scintigraphy in patients with extremity pain have not been widely conducted. Ultrasound, CT and MRI are widely used imaging modalities for evaluating extremity pain. However, SPECT/CT has an additional role in assessing pain in the extremities. (Korean J Pain 2017; 30: 165-75)

한국과 중국 논문에서 사용된 요통 변증에 관한 고찰

김민우 ( Min Woo Kim ),고연석 ( Youn Seok Ko ),이정한 ( Jung Han Lee ),정원석 ( Won Suk Chung ),신병철 ( Byung Cheul Shin ),차윤엽 ( Yun Yeop Cha ),고호연 ( Ho Yeon Go ),선승호 ( Seong Ho Sun ),전찬용 ( Chan Yong Jeon ),장보형 ( B 한방재활의학과학회 2013 한방재활의학과학회지 Vol.23 No.2

Objectives :This study aims to contribute to developing new pattern identification based on searches regarding pattern identification of low back pain, which is used in thesis both in Korea and China.Methods :First of all, we searched thesis concerning pattern identification of low back pain from RISS, OASIS, Korean traditional knowledge portal, CNKI.Results : 1. There were overall 34 thesis, consist of 18 Korean thesis(13 clinical papers and 5 analytical papers) and 9 Chinese thesis(7 clinical papers and 9 analytical papers).2. 10 of 11 Korean thesis used more than 9 patterns for pattern identification, 9 of 14 Chinese thesis used less than 4 patterns for pattern identification of low back pain.3. Patterns, which were repeatedly used in Korea, were 腎虛腰痛(Kidney deficiency low back pain), 濕熱腰痛(Dampness-heat low back pain), 寒濕腰痛(Cold-dampness low back pain), 痰飮腰痛(Phlegm-fluid retention low back pain), 風腰痛(Wind low back pain), 食積腰痛(Food accumulation low back pain), 濕腰痛(Dampness low back pain), 挫閃腰痛(Sprain low back pain), 瘀血腰痛(Static blood low back pain), 氣腰痛(Qi low back pain).4. Patterns, which were repeatedly used in China, were 腎虛腰痛(Kidney deficiency low back pain), 濕熱腰痛(Dampness-heat low back pain), 寒濕腰痛(Cold-dampness low back pain), 氣滯血瘀腰痛(Blood stasis due to qi stagnation low back pain).Conclusions :Based on these results, it is considered that an advanced type of pattern identification of low back pain should be made or existing type needs to be practically and objectively improved.

산후 요통의 한의학적 치료 효과에 대한 고찰

이시원,황덕상,이진무,장준복,이창훈 대한한방부인과학회 2023 大韓韓方婦人科學會誌 Vol.36 No.1

Objectives: The purpose of this review is to analyze domestic and foreign studies related to the effect of Korean Medicine Treatment for Postpartum Back Pain. Methods: Clinical studies applying Korean Medicine Treatment on Postpartum Back Pain were searched using domestic and foreign search engines up to December 2022. After searching studies, we analyzed selected studies and 11 studies were selected as a result. Results: All of the patients studied in the case study showed a decrease in Postpartum Back Pain after treatment compared to before treatment and in the control study, it was found that indices evaluating Postpartum Back Pain after treatment were significantly improved in the experimental group compared to before treatment in the experimental group. It was found that the scores of the relevant indicators were more significantly improved in the experimental group than control group. Conclusions: Korean Medicine Treatment is effective for Postpartum Back Pain. In the future, studies to analyze the specific effects and safety of each Korean Medicine Treatment for postpartum back pain and well-designed studies will be needed to establish the foundation of Korean Medicine Treatment for Postpartum Back Pain.