• Journal of Oral Medicine and Pain
• /
• v.42 no.2
• /
• pp.44-48
• /
• 2017

Chronic temporomandibular joint dislocation is defined as an acute dislocation that cannot be reduced or that recurs for more than one month. The management of dislocation depends on patient status and the duration of dislocation and ranges from conservative reduction to a surgical approach. In the present cases, a 64-year-old male was referred to our department for treatment of chronic dislocation for 6 weeks. The dislocation might be occurred by endotracheal intubation. A 70-year-old female was referred to our department with repeat right condyle dislocation after reduction of dislocation at a local clinic. When she visited for later treatment of new dentures, her condyle had been dislocated again for several weeks. In both cases, we tried to treat the dislocation with several manipulations, which were unsuccessful. Finally, chronic dislocation was successfully treated by surgical traction under general anesthesia without relapse. Surgical traction is a simple, effective option with the lowest morbidity of surgical procedures for chronic dislocation when conservative reduction is unsuccessful.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.37
• /
• pp.23.1-23.8
• /
• 2015

Background: The purpose of this study was to investigate the functional effects of temporalis myofascial flap after condylectomy, with or without disc removal, in elderly patients with anterior disc displacement (ADD) without reduction and an erosive condylar surface of the temporomandibular joint (TMJ). Methods: A total of 15 joints from 11 elderly patients (71-78 years old) were included. The patients had pain, mandibular dysfunction symptoms, and unilateral or bilateral ADD as well as an erosive condylar surface of the TMJ. All patients underwent temporalis myofascial flap reconstruction after condylectomy, with or without disc removal. If the maximal mouth opening (MMO) remained <35 mm after condylectomy, coronoidotomy was also performed. Self-assessed pain and mandibular function, including MMO and protrusive and lateral movements, were evaluated. Results: No patient experienced serious complications. Most measurements improved significantly after surgery compared to preoperatively. Most patients achieved nearly-normal mouth opening at 4 weeks after surgery. Although most patients felt discomfort during active postoperative physiotherapy, no patient reported serious pain during the follow-up period. Conclusion: Although nonsurgical therapy is often the first treatment choice for ADD without reduction of the TMJ, surgical intervention involving condylectomy and temporalis myofascial flap reconstruction may be a reasonable first option for elderly patients with an erosive condylar surface of the TMJ.

• Archives of Plastic Surgery
• /
• v.40 no.5
• /
• pp.559-563
• /
• 2013

Background One of the reasons women with macromastia chose to undergo a breast reduction is to relieve their complaints of back, neck, and shoulder pain. We hypothesized that changes in posture after surgery may be the reason for the pain relief and that patient posture may correlate with symptomatic macromastia and may serve as an objective measure for complaints. The purpose of our study was to evaluate the effect of reduction mammaplasty on the posture of women with macromastia. Methods A prospective controlled study at a university medical center. Forty-two patients that underwent breast reduction were studied before surgery and an average of 4.3 years following surgery. Thirty-seven healthy women served as controls. Standardized lateral photos were taken. The inclination angle of the back was measured. Regression analysis was performed for the inclination angle. Results Preoperatively, the mean inclination angle was 1.61 degrees ventrally; this diminished postoperatively to 0.72 degrees ventrally. This change was not significant (P-value=0.104). In the control group that angle was 0.28 degrees dorsally. Univariate regression analysis revealed that the inclination was dependent on body mass index (BMI) and having symptomatic macromastia; on multiple regression it was only dependent on BMI. Conclusions The inclination angle of the back in breast reduction candidates is significantly different from that of controls; however, this difference is small and probably does not account for the symptoms associated with macromastia. Back inclination should not be used as a surrogate "objective" measure for symptomatic macromastia.

• Journal of Korean society of Dental Hygiene
• /
• v.1 no.1
• /
• pp.63-76
• /
• 2001

This study was designed to evaluate the effects of music on dental pain and anxiety during ultrasonic scaling. One hundred and twenty five patients visited dental unit of Soonchunhyang University Chunan hospital for scaling were enrolled during August 1999 and February 2000. The patients were allocated randomly into two groups. music (n = 61) and control groups (n = 65). The music group patients listened to self-selected music using an earphone during scaling. Standardized questionnaire were used to assess the subjective denial pain and anxiety before and after scaling in both groups. In music group, more information on music effect was collected. To evaluate changes of physical signs by scaling, blood pressure and pulse were checked by a wrist check oscillometric. The results were as follows: 1. No significant difference in dental pain and anxiety between before and after scaling was observed in music group. However, the music group patients were satisfied with music because of reduction of pain(93.5%) and anxiety(93.4%), 96.7% of music subjects wanted to listen to music in next scaling. 2. While no significant difference in systolic blood pressure before scaling between music and control groups, systolic blood pressure of control group during scaling was significantly higher than that of music group(P<0.05). 3. In multiple logistic regression. the odds ratio(OR) of pain was decreased with age and female patients had higher OR (1.7, p>0.05). Patients with previous scaling experience complained of more dental pain during scaling than patients without experience. Music was not a significant predictor of denial pain during scaling, controlling for possible confounders. 4. While age. music. and scaling experience were not related to dental anxiety during scaling, sex and dental hygiene index were significant predictors of dental anxiety in multiple logistic regression. 5. Both during and after scaling. mean blood pressure of music patients were significantly lower than control patients after controlling for age, sex, and BMI. In conclusion, our data demonstrated that although listening to music did not disappear the dental pain and anxiety. but reduced the intensity of pain and anxiety during scaling. Furthermore, our data imply thai music has a effect of reduction of increasing blood pressure by scaling.

• The Korean Journal of Pain
• /
• v.12 no.2
• /
• pp.238-241
• /
• 1999

Intractable pain arising from disorders of the viscera and somatic structures within the pelvis and perineum often poses difficult problems for the pain pratitioner. The reason for this difficulty is that the region contains diverse anatomic structures with mixed somatic, visceral, and autonomic innervation affecting bladder and bowel control and sexual function. Clinically, sympathetic pain in the perineum has a distinctly vague, burning, and poorly localized quality and is frequently associated with the sensation of urgency. Although various approaches have been proposed for the management of intractable perineal pain, their efficacy and applications are limited. Historically, neurolytic blockade in this region has been focused mainly on somatic rather than sympathetic components. The efficacy of neurolytic ganglion impar block has been demonstrated in treating perineal pain without significant somatovisceral dysfunctions for patient with advanced cancer in 1990. The introduction of superior hypogastric plexus block in 1990 demonstrated its effectiveness in patients with cancer related pelvic pain. In our report, five patients had advanced cancer (rectal caner 3; cervix cancer 1; metastases to sacral portion of renal cell cancer 1). Localized perineal pain was present in all cases and was characterized as burning and urgent with 9~10/10 pain intensity. After neurolytic block of ganglion impar, patients experiened incomplete pain reduction (7~8/10), as determined by the VAS (visual analogue scale), and change in pain site. We then treated with superior hypogastric plexus block, which produced satisfactory pain relief (to less than 4/10), without complication.

• The Korean Journal of Pain
• /
• v.20 no.1
• /
• pp.54-59
• /
• 2007

Background: Selective transforaminal epidural block (STEB) has showen effectiveness as a diagnostic and therapeutic option for the management of patients with low back pain or sciatica. This study was carried out in order to determine the short-term effects and prognostic factors associated with STEB in patients with low back pain or sciatica. Methods: Ninety-seven patients were selectedfor participation in this study. Their diagnosis were based werewason the clinical symptoms and MRI findings. We performed STEB under fluoroscopic guidance and injected 3 ml of radio opaque dye in order to confirm the technical success of the procedure. We then injected 20 mg of triamcinolone mixed into 3 ml of 0.5% mepivacaine. One month later, we classified the patient outcomes as excellent, good, moderate or poor, according to the degree of reduction in VAS score from baseline. The independent variables assessed included symptom duration, block level, number of blocks, primary diagnosis, prior caudal block, anterior epidural space filling of dye, medication history, demographic data, radiating pain, back surgery and spondylolisthesis. Results: At a mean follow-up period of 1 month after STEB, excellent results were noted in the patients diagnosed with herniated lumbar disc (70%), non-specific spondylosis (54%), spinal stenosis (44%), and failed back syndrome (28%). The patients with epidural adhesion and combined spondylolisthesis were associated with poorer outcomes. Combined caudal block, symptom duration and the extent of epidural spread of the drug were not related to the effectiveness of the treatment. Conclusions: Selective transforaminal epidural block is effective in treating patients with radiculopathy, such as herniated lumbar disc, but it isrelatively ineffective in treating patients with structural deformities, such as failed back syndrome and spondylolisthesis.

• PNF and Movement
• /
• v.13 no.2
• /
• pp.103-109
• /
• 2015

Purpose: Abdominal breathing exercises are recommended to activate the breathing muscles and the pelvic floor muscles, as well as to increase postural alignment during exhalation. The purpose of this study was to clarify the effect of improving abdominal muscle strength on menstrual pain in women in their twenties using abdominal breathing exercises. Method: In this study, 32 female university students were included as the subjects. The subjects were divided into two groups based on the area of menstrual pain: lumbar pain (n=16) and lower abdomen pain (n=16). The abdominal breathing positions were divided into two positions, which included a hook lying position and hip and knee flexions at $90^{\circ}$ in the supine position. Exercises were used to strengthen the abdominal muscles during exhalation. Four sets of the exercises were completed three times a week over the course of eight weeks. The degree of pain was measured using the Numeric Rating Scale (NRS). Muscle thickness was measured using an ultrasound. Result: The thickness of the transverse abdominis (TrA) and internal oblique (IO) increased in the lower abdomen pain group. However, thickness of the external oblique (EO) did not increased following abdominal breathing. No significant difference in posture was identified in the lower abdomen group. TrA thickness increased significantly in the lumbar pain group. However, thickness did not increase significantly in the lumbar pain group. In addition, the lumbar pain group experienced no significant effects on posture. IO thickness increased following hip and knee flexions at $90^{\circ}$ in the lumbar pain group. Menstrual pain decreased following intervention in both groups. There was no significant difference in the degree of pain reduction between both groups. Conclusion: As examples of alternative medicine, abdominal breathing exercises may be effective in decreasing menstrual pain.

• The Korean Journal of Pain
• /
• v.32 no.2
• /
• pp.113-119
• /
• 2019

Background: Discogenic pain is a common cause of disability and is assumed to be a major cause of non-specific low back pain. Various treatment methods have been used for the treatment of discogenic pain. This study was conducted to compare the therapeutic success of radiofrequency (an intradiscal procedure) and laser annuloplasty (both an intradiscal and extradiscal procedure). Methods: This single-center study included 80 patients and followed them for 6 months. Transforaminal laser annuloplasty (TFLA, 37 patients) or intradiscal radiofrequency annuloplasty (IDRA, 43 patients) was performed. The main outcomes included pain scores, determined by the numeric rating scale (NRS), and Oswestry disability index (ODI), at pre-treatment and at post-treatment months 1 and 6. Results: The patients were grouped according to procedure. In all procedures, NRS and ODI scores were significantly decreased over time. Mean post-treatment pain scores at months 1 and 6 were significantly lower (P < 0.01) in both groups, and between-group differences were not significant. The ODI score was also significantly decreased compared with baseline. Among patients undergoing TFLA, 70.3% (n = 26) reported pain relief (NRS scores < 50% of baseline) at post-treatment 6 months, vs. 58.1% (n = 25) of those undergoing IDRA. There were no statistically significant differences between the groups in ODI reduction of > 40%. Conclusions: Our results indicate that annuloplasty is a reasonable treatment option for carefully selected patients with lower back and radicular pain of discogenic origin, and TFLA might be superior to IDRA in patients with discogenic low back pain.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.18 no.3
• /
• pp.151-159
• /
• 2018

Background: The pain involved in orthodontic treatments may involve inflammatory processes. This study evaluated the effect of using a naproxen patch for pain reduction in the separating stage of fixed orthodontic treatment. Methods: In this double-blind, randomized, controlled clinical trial of 35 orthodontic patients (age: 14-19 years) who had pain during separator placement, each patient randomly placed naproxen and placebo patches in the first permanent molar region, in opposite quadrants of the same jaw. Patches were replaced every 8 hours until 3 days after separator placement. Patients recorded their pain perception at 2, 6, and 24 hours, and on days 2 (6 PM), 3 (10 AM and 6 PM), and 7 (10 AM and 6 PM), using a visual analog scale. Mean pain scores were compared for the two patches, and effects of sex and age thereon determined. Results: Data from 29 patients (21 girls, eight boys) were analyzed. Mean pain values decreased over time for both patches (P < 0.001). Recorded pain did not differ significantly between the sexes (P = 0.059) or between those aged <16 and those ${\geq}16years$ (P = 0.106). Mean pain recorded with naproxen patches was statistically significantly less than that with placebo patches at all time points (P = 0.004). Conclusion: The naproxen patch was more efficient than the placebo patch for reducing pain at all time points. The highest pain score was recorded at 6 hours, and the least pain was recorded at the $7^{th}$ day after separator placement.

• The Korean Nurse
• /
• v.33 no.1
• /
• pp.37-51
• /
• 1994

The cutaneous stimulation is an independent nursing intervention used in various painful conditions, and is explained by gate control theory. This study was aimed at identifying the effect of cutaneous stimulation on reduction of arteriovenous fistula puncture pain of hemodialysis patients. One group repeated measurement post test research was designed. Forty-five hemodialysis patients who received arteriovenous fistula puncture regulary in hemodialysis units of an attacted D hospital to K university have been studied from August 16 to 21, 1993. First the arteriovenous fistula puncture pain of control period was measured, and then the arteriovenous fistula puncture pain of experimental period(with cutaneous stimulation) was measured. The instrument used for this study were visual analogue pain scale as subjective pain measurement, objective pain behavior checklist and Spielberger's Trait Anxiety Inventory as intervening variables. Analysis of data was done by use of paired t-test, t-test, ANOVA and Perarson correlation coefficient. The results of this study were summarized as follows; 1) The first hypothesis that the subjective pain score of arteriovenous fistula puncture pain in experimental period(with cutaneous stimulation) will be lower than in control period was partly supported. The subjective pain score of arterial line was rejected(paired t=-0.28, p=0.77) and the subjective pain score of venous line was supported(paired t=2.61, p=0.01). 2) The second hypothesis that the objective pain behavior score of arteriovenous fistula pain in experimental period(with cutaneous stimulation) will be lower than in control period was rejected(arterial line paired t=-0.45, p=0.65; venous line paired t=-0.36, p=0.72). 3) The third hypothesis that the cardiopulmonary signs of arteriovenous fistula puncture pain in experimental period(with cutaneous stimulation) will be lower than in control period was rejected(pulse paired t=-0.8, p=0.42; systolic BP paired t=0.98, p=0.33; diastolic BP paired t=0.43, p=0.66). Further experimental studies with simple intravenous injection patients will be recommended in order to identify the effect of cutaneous stimulation.