Korean Pain Society Research Articles

Current practices of cervical epidural block for cervical radicular pain: a multicenter survey conducted by the Korean Pain Society.

Cervical epidural block (CEB) is an effective intervention for managing cervical radicular pain. This study aimed to investigate the current status of performing CEB in South Korea. Pain physicians affiliated with the Korean Pain Society were asked to complete anonymous questionnaires regarding CEB between September and October 2022. The questionnaire consisted of 24 questions assessing the current status and methods of CEB in detail. Of the 198 surveys collected, 171 physicians (86.4%) reported performing CEB. Among those, the majority (94.7%) used fluoroscopy during the procedure. The paramedian interlaminar (IL) approach was the most preferred method (50.3%). Respondents performing fluoroscopic-guided IL CEB were categorized into two groups based on clinical experience: those with ≤10 years of experience (≤10-year group, n = 91) and those with >10 years of experience (>10-year group, n = 71). The proportion of physicians obtaining informed consent in the ≤10-year group and >10-year group was 50.5% and 56.3%, respectively. When entering the epidural space during IL CEB, the contralateral oblique view was the second most frequently used in both groups (≤10-year group, 42.9%; >10-year group, 29.6%). In targeting the upper cervical lesions (C3-4), the proportion of respondents who used an IL space higher than C6-7 was 17.6% in the ≤10-year group and 29.5% in the >10-year experience group. This study demonstrated variability in the CEB technique used by pain physicians in South Korea. The findings highlight the need for education on informed consent and techniques to enhance safety.

Updated guidelines for prescribing opioids to treat patients with chronic non-cancer pain in Korea: developed by committee on hospice and palliative care of the Korean Pain Society.

There are growing concerns regarding the safety of long-term treatment with opioids of patients with chronic non-cancer pain. In 2017, the Korean Pain Society (KPS) developed guidelines for opioid prescriptions for chronic non-cancer pain to guide physicians to prescribe opioids effectively and safely. Since then, investigations have provided updated data regarding opioid therapy for chronic non-cancer pain and have focused on initial dosing schedules, reassessment follow-ups, recommended dosage thresholds considering the risk-benefit ratio, dose-reducing schedules for tapering and discontinuation, adverse effects, and inadvertent problems resulting from inappropriate application of the previous guidelines. Herein, we have updated the previous KPS guidelines based on a comprehensive literature review and consensus development following discussions among experts affiliated with the Committee on Hospice and Palliative Care in the KPS. These guidelines may assist physicians in prescribing opioids for chronic non-cancer pain in adult outpatient settings, but should not to be regarded as an inflexible standard. Clinical judgements by the attending physician and patient-centered decisions should always be prioritized.

State of education regarding ultrasound-guided interventions during pain fellowships in Korea: a survey of recent fellows.

BackgroundRecently, the use of ultrasound (US) techniques in regional anesthesia and pain medicine has increased significantly. However, the current extent of training in the use of US-guided pain management procedures in Korea remains unknown. The purpose of the present study was to assess the current state of US training provided during Korean Pain Society (KPS) pain fellowship programs through the comparative analysis between training hospitals.MethodsWe conducted an anonymous survey of 51 pain physicians who had completed KPS fellowships in 2017. Items pertained to current US practices and education, as well as the types of techniques and amount of experience with US-guided pain management procedures. Responses were compared based on the tier of the training hospital.ResultsAmong the 51 respondents, 14 received training at first- and second-tier hospitals (Group A), while 37 received training at third-tier hospitals (Group B). The mean total duration of pain training during the 1-year fellowship was 7.4 months in Group A and 8.4 months in Group B. Our analysis revealed that 36% and 40% of respondents in Groups A and B received dedicated US training, respectively. Most respondents underwent US training in patient-care settings under the supervision of attending physicians. Cervical root, stellate ganglion, piriformis, and lumbar plexus blocks were more commonly performed by Group B than by Group A (P < 0.05).ConclusionsInstruction regarding US-guided pain management interventions varied among fellowship training hospitals, highlighting the need for the development of educational standards that mandate a minimum number of US-guided nerve blocks or injections during fellowships in interventional pain management.

Guidelines for prescribing opioids for chronic non-cancer pain in Korea.

As the treatment of chronic non-cancer pain gradually increases, clinicians have more opportunities to encounter opioid prescription. However, guidelines for prescribing opioids for chronic non-cancer pain have never been published in Korea. The present guidelines were prepared by reviewing various research data. In cases in which the data were insufficient, recommendations were presented following discussion among experts affiliated with the Opioids Research Group in the Korean Pain Society. The present guidelines may need to be continuously revised and amended as more clinical evidence is acquired.

Risks and Pitfalls of Epidural Injections during Management of Lumbar Disc Herniation: Few Comments.

Received March 13, 2015. Accepted April 3, 2015. Correspondence to: Mohamed Amin Ghobadifar Research Center for Social Determinants of Health, Medicine School, Jahrom University of Medical Sciences, Motahari Avenue, Jahrom 12345, Iran Tel: +98-936-620-8078, Fax: +98-713-635-4094, E-mail: amin_m505@yahoo.com This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright c The Korean Pain Society, 2015 LETTERS TO EDITORS

In Response to Risks and Pitfalls of Epidural Injections during Management of Lumbar Disc Herniation: Few Comments.

Received April 1, 2015. Accepted April 3, 2015. Correspondence to: Laxmaiah Manchikanti Pain Management Center of Paducah, Paducah, and University of Louisville, Louisville, KY, 2831, Lone Oak Road, Paducah, Kentucky 42003, USA Tel: +1-270-554-9412, Fax: +1-270-554-8987, E-mail: drlm@thepainmd.com This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright c The Korean Pain Society, 2015 LETTERS TO EDITORS

An Update on the Management of Diabetic Neuropathic Pain: A Few Comments

Received December 15, 2014. Revised March 6, 2015. Accepted March 11, 2015.Correspondence to: Mohamed Amin GhobadifarZoonoses Research Center, Medicine School, Jahrom University of Medical Sciences, Motahari Avenue, Jahrom 12345, IranTel: ＋98-936-620-8078, Fax: ＋98-713-635-4094, E-mail: amin_m505@yahoo.com This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Copyright ⓒThe Korean Pain Society, 2015

Which Methods of Epidural Steroid Injections Is More Effective in Reducing the Radicular Pain; Transforaminal or Interlaminar?

Received November 14, 2014. Accepted November 16, 2014.Correspondence to: Mohamed Amin GhobadifarZoonoses Research Center, Medicine School, Jahrom University of Medical Sciences, Motahari Avenue, Jahrom 12345, IranTel: ＋98-936-620-8078, Fax: ＋98-711-636-13-86, E-mail: amin_m505@yahoo.com This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Copyright ⓒThe Korean Pain Society, 2015

The potential role of intrathecal nefopam in the management of neuropathic pain.

Received April 22, 2014. Accepted May 10, 2014. Correspondence to: Mohamed Amin Ghobadifar Department of Student Research Committee, Medicine School, Jahrom University of Medical Sciences, Motahari Avenue, Jahrom, Iran Tel: +98-936-620-8078, Fax: +98-711-636-13-86, E-mail: amin_m505@yahoo.com This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright c The Korean Pain Society, 2014 LETTERS TO EDITORS

Herpes Zoster and Diabetes Mellitus

Received November 20, 2013. Revised November 25, 2013. Accepted November 25, 2013. Correspondence to: Ivan Chernev ARH Southern WV Clinic, 250 Stanaford Road, Beckley, West Virginia, 25801, USA Tel: +1-304-254-2646, Fax: +1-304-254-2794, E-mail: ivantchernev@yahoo.com This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright c The Korean Pain Society, 2014 LETTERS TO EDITORS

Comments on "The Effect of Low-dose Ketamine on Post-caesarean Delivery Analgesia after Spinal Anesthesia"

Received September 24, 2013. Accepted October 8, 2013. Correspondence to: Mohamed Amin Ghobadifar Department of Student Research Committee, Medicine School, Jahrom University of Medical Sciences, Motahari Avenue, Jahrom, Iran Tel: +98-917-1020-790, Fax: +98-711-635-40-94, E-mail: amin_m505@yahoo.com This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright c The Korean Pain Society, 2014 LETTERS TO EDITORS

Epidural Steroid Injection in Korean Pain Physicians: A National Survey

BackgroundEpidural steroid injection (ESI) is one of the most common procedures for patients presenting low back pain and radiculopathy. However, there is no clear consensus on what constitutes appropriate steroid use for ESIs. To investigate optimal steroid injection methods for ESIs, surveys were sent to all academic pain centers and selected private practices in Korea via e-mail.MethodsAmong 173 pain centers which requested the public health insurance reimbursements for their ESIs and were enrolled in the Korean Pain Society, 122 completed questionnaires were returned, for a rate of 70.5%; also returned were surveys from 39 academic programs and 85 private practices with response rates of 83.0% and 65.9%, respectively.ResultsMore than half (55%) of Korean pain physicians used dexamethasone for ESIs. The minimum interval of subsequent ESIs at the academic institutions (3.1 weeks) and the private practices (2.1 weeks) were statistically different (P = 0.01).ConclusionsAlthough there was a wide range of variation, there were no significant differences between the academic institutions and the private practices in terms of the types and single doses of steroids for ESIs, the annual dose of steroids, or the limitations of doses in the event of diabetes, with the exception of the minimum interval before the subsequent ESI.

Postoperative Orthostatic Intolerance and Gender Differences

Received September 13, 2013. Accepted September 13, 2013. Correspondence to: Sang Wook Shin, MD Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Beomeo-ri, Mulgeum-eup, Yangsan 626-770, Korea Tel: +82-55-360-2752, Fax: +82-55-360-2149, E-mail: shinsw@pusan.ac.kr This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright c The Korean Pain Society, 2013 LETTER TO EDITORS

A Simple Working Classification Proposed for Orofacial Pain (OFP) Commonly Encountered in Dental Practice

Received June 11, 2013. Accepted August 28, 2013.Correspondence to: Thorakkal Shamim, MDSDepartment of Dentistry, Government Taluk Head Quarters Hospital, Nilambur 679329, India Tel: ＋91-989-5447351, E-mail: shamu3duad@gmail.com This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Copyright ⓒThe Korean Pain Society, 2013

Mirror Therapy as an Alternative Treatment for Phantom Limb Pain: A Short Literature Review

Received May 10, 2013. Accepted May 21, 2013. Correspondence to: Aria Soleimani, MD Department of Anesthesiology, Mazandaran Heart Center, Hazrat Fatima Hospital, Artesh Boulevard, Mazandaran Province, Sari, Iran Tel: +98-1512226262, Fax: +98-1512268915, E-mail: contactroute@yahoo.com This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright c The Korean Pain Society, 2013 LETTER TO EDITORS

Relieving Pain with Acupuncture after Inguinal Surgeries

Received March 28, 2013. Accepted April 18, 2013. Correspondence to: Mohamed Amin Ghobadifar, MD Department of Student Research Committee, Medicine School, Jahrom University of Medical Sciences, Motahari Avenue, Jahrom, Iran Tel: +98-936-620-8078, Fax: +98-711-636-13-86, E-mail: amin_m505@yahoo.com This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright c The Korean Pain Society, 2013 LETTER TO EDITORS

Effect of Collimation on Radiation Exposure and Image Quality

Received May 15, 2013. Accepted May 31, 2013.Correspondence to: Mohamed Amin Ghobadifar, MDDepartment of Student Research Committee, Medicine School, Jahrom University of Medical Sciences, Motahari Avenue, Jahrom, IranTel: ＋98-936-620-8078, Fax: ＋98-711-636-13-86, E-mail: amin_m505@yahoo.com This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Copyright ⓒThe Korean Pain Society, 2013

Can Vitamin C Be Used as an Adjuvant for Managing Postoperative Pain? A Short Literature Review

Received January 14, 2013. Accepted January 29, 2013. Correspondence to: Mohammad Reza Habibi, MD Mazandaran Heart Center, Hazrat Fatima Hospital, Artesh Boulevard, Mazandaran Province, Sari, Iran Tel: +98-1512226262, Fax: +98-1512268915, E-mail: contactroute@yahoo.com This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright c The Korean Pain Society, 2013 LETTER TO EDITORS

Replay to the Letter: Are Doctors Exposed to Radiation Even When Wearing Protectors during Fluoroscopic Procedures?

Received March 15, 2013. Accepted March 20, 2013. Correspondence to: Jae Hun Kim, MD Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, Korea Tel: +82-2-2030-5470, Fax: +82-2-2030-5449, E-mail: painfree@kuh.ac.kr This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright c The Korean Pain Society, 2013 REPLY TO THE LETTER

Is Fluoroscopy-guided Suprascapular Nerve Block Better Than Other Techniques?

Received November 15, 2012. Accepted November 16, 2012. Correspondence to: Jae Hang Shim, MD Department of Anesthesiology and Pain Medicine, School of Medicine, Hanyang University, 249-1 Kyomun-dong, Guri 471-701, Korea Tel: +82-31-560-2390, Fax: +82-31-563-1731, E-mail: jhshim@hanyang.ac.kr This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright c The Korean Pain Society, 2013 LETTER TO EDITORS