Journal of Yeungnam Medical Science

Communications

Algorithm for multimodal medication therapy in patients with complex regional pain syndrome: Min Cheol Chang, Donghwi Park; Received April 3, 2023 Accepted May 15, 2023 Published online July 12, 2023; DOI: https://doi.org/10.12701/jyms.2023.00360 [Epub ahead of print]

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Abstract PDF: Complex regional pain syndrome (CRPS), previously known as reflex sympathetic dystrophy and causalgia, is a clinical entity characterized by classic neuropathic pain, autonomic involvement, motor symptoms, and trophic changes in the skin, nails, and hair. Although various therapeutic modalities are used to control CRPS-related pain, severe pain due to CRPS often persists and progresses to the chronic phase. In this study, we constructed an algorithm for multimodal medication therapy for CRPS based on the established pathology of CRPS. Oral steroid pulse therapy is recommended for initial pain management in patients with CRPS. Oral steroid therapy can reduce peripheral and central neuroinflammation, contributing to the development of neuropathic pain during the acute and chronic phases. If steroid pulse therapy offers poor relief or is ineffective, treatment to control central sensitization in the chronic phase should be initiated. If pain persists despite all drug adjustments, ketamine with midazolam 2 mg before and after ketamine injection can be administered intravenously to inhibit the N-methyl D-aspartate receptor. If this treatment fails to achieve sufficient efficacy, intravenous lidocaine can be administered for 2 weeks. We hope that our proposed drug treatment algorithm to control CRPS pain will help clinicians appropriately treat patients with CRPS. Further clinical studies assessing patients with CRPS are warranted to establish this treatment algorithm in clinical practice.

Some suggestions for pain physicians working in real-world clinical settings: Jung Hwan Lee, Min Cheol Chang; Received March 14, 2023 Accepted April 5, 2023 Published online May 23, 2023; DOI: https://doi.org/10.12701/jyms.2023.00255 [Epub ahead of print]

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Abstract PDF: Musculoskeletal pain is a common reason for patients visiting hospitals or clinics. Various therapeutic tools including oral medications, physical modalities, and procedures have been used to alleviate musculoskeletal pain. Numerous clinical trials have been conducted to demonstrate the therapeutic effect of each treatment and compare the efficacy of different protocols. These trials were conducted under controlled conditions with specific endpoints and timeframes, and the individual constraints of each patient were not considered. We believe that the findings of such studies may not accurately reflect clinical reality in real-world settings. In this article, we propose treatment principles for patients in pain clinics. We propose two principles for pain treatment: first, “Healing, in the end, is not healing.” and second, “The patient’s job is not a patient.” The main role of pain physicians is to quickly and actively reduce pain and help patients focus on their work and lives.

Resident fellow section: Clinical vignette

Differential diagnosis of suddenly developed motor weakness in bilateral lower extremities of a 79-year-old male patient: Seong Yeob Kwak, Mathieu Boudier-Revéret, Min Cheol Chang; Received October 21, 2022 Accepted November 5, 2022 Published online January 9, 2023; DOI: https://doi.org/10.12701/jyms.2022.00787 [Epub ahead of print]

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Resident fellow section: Teaching images

A 40-year-old man with neuropathic pain in the entire left foot: Jae Hwa Bae, Mathieu Boudier-Revéret, Min Cheol Chang; J Yeungnam Med Sci. 2023;40(2):223-224. Published online August 30, 2022; DOI: https://doi.org/10.12701/jyms.2022.00486

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Original articles

Effects of early clinical and basic laboratory exposure program on premedical students: a questionnaire survey: Kyu Hyang Cho, Hyun Sook Ko, Kyung Hee Lee, Tae-Yoon Hwang, Keun-Mi Lee, Sae Yoon Kim, Min Cheol Chang; J Yeungnam Med Sci. 2022;39(4):309-313. Published online July 20, 2022; DOI: https://doi.org/10.12701/jyms.2022.00318

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Abstract PDF: Background
Because premed students do not take courses related to medicine during their first 2 years, they cannot establish their identity as students at medical schools, making it difficult for them to set goals as future doctors. We conducted an early clinical and basic laboratory exposure program for premed students and studied the effects of the program and student satisfaction levels.
Methods
We performed an early clinical and basic laboratory exposure program for premed students for 2 days and evaluated the effects of the program and student satisfaction with it. The program consisted of two types: type 1, where two to four students formed a group, which was assigned to a particular department to participate and make observations during ward rounds, outpatient clinics, examinations, procedures, and surgeries (in the case of basic laboratory work, the students partook in experimental observations); and type 2, where one student followed a medical school professor to observe the professor’s day. After the program ended, an online survey was conducted to investigate the effects on students, their thoughts, and satisfaction levels.
Results
In total, 114 students (91.2%) responded to the survey. Approximately 94% of them were satisfied with the program. They found that the program would be useful for deciding on future career paths, gaining knowledge about a department of interest, studying for a medical program after premedical studies, and befriending residents and professors in certain departments.
Conclusion
Early clinical and basic laboratory exposure programs are recommended for premedical students.

Pediatricians’ perception of factors concerning the clinical application of blockchain technology to pediatric health care: a questionnaire survey: Yong Sauk Hau, Min Cheol Chang, Jae Chan Park, Young Joo Lee, Seong Su Kim, Jae Min Lee; J Yeungnam Med Sci. 2023;40(2):156-163. Published online July 18, 2022; DOI: https://doi.org/10.12701/jyms.2022.00241

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Abstract PDF Supplementary Material: Background
Interest in digital medical information has increased because it allows doctors to easily access a patient’s medical records and provide appropriate medical care. Blockchain technology ensures data safety, reliability, integrity, and transparency by distributing medical data to all users over a peer-to-peer network. This study attempted to assess pediatricians’ thoughts and attitudes toward introducing blockchain technology into the medical field.
Methods
This study used a questionnaire survey to examine the thoughts and attitudes of 30- to 60-year-old pediatricians regarding the introduction of blockchain technology into the medical field. Responses to each item were recorded on a scale ranging from 1 (never agree) to 7 (completely agree).
Results
The scores for the intentions and expectations of using blockchain technology were 4.0 to 4.6. Pediatricians from tertiary hospitals responded more positively (4.5–4.9) to the idea of using blockchain technology for hospital work relative to the general population (4.3–4.7). However, pediatricians working in primary and secondary hospitals had a slightly negative view of the application of blockchain technology to hospital work (p=0.018).
Conclusion
When introducing the medical records of related pediatric and adolescent patients using blockchain technology in the future, it would be better to conduct a pilot project that prioritizes pediatricians in tertiary hospitals. The cost, policy, and market participants’ perceptions are essential factors to consider when introducing technology in the medical field.

Editorial

The blind spot and challenges in pain management: Min Cheol Chang; J Yeungnam Med Sci. 2022;39(3):179-180. Published online June 9, 2022; DOI: https://doi.org/10.12701/jyms.2022.00339

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Citations

Citations to this article as recorded by

Deep-Learning Algorithms for Prescribing Insoles to Patients with Foot Pain
Jeoung Kun Kim, Yoo Jin Choo, In Sik Park, Jin-Woo Choi, Donghwi Park, Min Cheol Chang
Applied Sciences.2023; 13(4): 2208. CrossRef
Use of QR Codes for Promoting a Home-Based Therapeutic Exercise in Patients with Lumbar Disc Herniation and Lumbar Spinal Stenosis: A Prospective Randomized Study
Min Cheol Chang, Donghwi Park, Yoo Jin Choo
Journal of Pain Research.2022; Volume 15: 4065. CrossRef

Review articles

Ultrasound-guided interventions for controlling the thoracic spine and chest wall pain: a narrative review: Donghwi Park, Min Cheol Chang; J Yeungnam Med Sci. 2022;39(3):190-199. Published online April 26, 2022; DOI: https://doi.org/10.12701/jyms.2022.00192

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Abstract PDF

Ultrasound-guided injection is useful for managing thoracic spine and chest wall pain. With ultrasound, pain physicians perform the injection with real-time viewing of major structures, such as the pleura, vasculature, and nerves. Therefore, the ultrasound-guided injection procedure not only prevents procedure-related adverse events but also increases the accuracy of the procedure. Here, ultrasound-guided interventions that could be applied for thoracic spine and chest wall pain were described. We presented ultrasound-guided thoracic facet joint and costotransverse joint injections and thoracic paravertebral, intercostal nerve, erector spinae plane, and pectoralis and serratus plane blocks. The indication, anatomy, Sonoanatomy, and technique for each procedure were also described. We believe that our article is helpful for clinicians to conduct ultrasound-guided injections for controlling thoracic spine and chest wall pain precisely and safely.

Citations

Citations to this article as recorded by

The blind spot and challenges in pain management
Min Cheol Chang
Journal of Yeungnam Medical Science.2022; 39(3): 179. CrossRef

The mechanism of action of pulsed radiofrequency in reducing pain: a narrative review: Donghwi Park, Min Cheol Chang; J Yeungnam Med Sci. 2022;39(3):200-205. Published online April 7, 2022; DOI: https://doi.org/10.12701/jyms.2022.00101

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5 Citations

Abstract PDF

Pain from nervous or musculoskeletal disorders is one of the most common complaints in clinical practice. Corticosteroids have a high pain-reducing effect, and their injection is generally used to control various types of pain. However, they have various adverse effects including flushing, hyperglycemia, allergic reactions, menstrual changes, immunosuppression, and adrenal suppression. Pulsed radiofrequency (PRF) is known to have a pain-reducing effect similar to that of corticosteroid injection, with nearly no major side effects. Therefore, it has been widely used to treat various types of pain, such as neuropathic, joint, discogenic, and muscle pain. In the current review, we outlined the pain-reducing mechanisms of PRF by reviewing previous studies. When PRF was first introduced, it was supposed to reduce pain by long-term depression of pain signaling from the peripheral nerve to the central nervous system. In addition, deactivation of microglia at the level of the spinal dorsal horn, reduction of proinflammatory cytokines, increased endogenous opioid precursor messenger ribonucleic acid, enhancement of noradrenergic and serotonergic descending pain inhibitory pathways, suppression of excitation of C-afferent fibers, and microscopic damage of nociceptive C- and A-delta fibers have been found to contribute to pain reduction after PRF application. However, the pain-reducing mechanism of PRF has not been clearly and definitely elucidated. Further studies are warranted to clarify the pain-reducing mechanism of PRF.

Citations

Citations to this article as recorded by

Comparison of two distinct needle tip positions in pulsed radiofrequency for herpes zoster‐related pain
Shao‐jun Li, Dan Feng
CNS Neuroscience & Therapeutics.2023; 29(7): 1881. CrossRef
Previous Lumbar Spine Surgery Decreases the Therapeutic Efficacy of Dorsal Root Ganglion Pulsed Radiofrequency in Patients with Chronic Lumbosacral Radicular Pain
Jiri Jandura, Milan Vajda, Roman Kostysyn, Jiri Vanasek, Eva Cermakova, Jan Zizka, Pavel Ryska
Journal of Personalized Medicine.2023; 13(7): 1054. CrossRef
Spinal Injections: A Narrative Review from a Surgeon’s Perspective
Dong Ah Shin, Yoo Jin Choo, Min Cheol Chang
Healthcare.2023; 11(16): 2355. CrossRef
The blind spot and challenges in pain management
Min Cheol Chang
Journal of Yeungnam Medical Science.2022; 39(3): 179. CrossRef
Use of QR Codes for Promoting a Home-Based Therapeutic Exercise in Patients with Lumbar Disc Herniation and Lumbar Spinal Stenosis: A Prospective Randomized Study
Min Cheol Chang, Donghwi Park, Yoo Jin Choo
Journal of Pain Research.2022; Volume 15: 4065. CrossRef

Communication

The pros and cons of entry restrictions: are entry restrictions really effective in preventing the spread of SARS-CoV-2?: Donghwi Park, Mathieu Boudier-Revéret, Min Cheol Chang; J Yeungnam Med Sci. 2022;39(4):344-346. Published online January 14, 2022; DOI: https://doi.org/10.12701/yujm.2021.01599

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Abstract PDF: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread worldwide, leading the World Health Organization to declare coronavirus disease 2019 (COVID-19) a pandemic. To curb the unchecked spread of SARS-CoV-2 infection, most countries have enforced travel restrictions. However, it is debatable whether such restrictions are effective in containing infections and preventing pandemics. Rather, they may negatively impact economies and diplomatic relationships. Each government should conduct an extensive and appropriate analysis of its national economy, diplomatic status, and COVID-19 preparedness to decide whether it is best to restrict entering travelers. Even if travelers from other countries are allowed entry, extensive contact tracing is required to prevent the spread of COVID-19. In addition, governments can implement “travel bubbles,” which allow the quarantine-free flow of people among countries with relatively low levels of community transmission. An accurate evaluation of the benefits and losses due to entry restrictions during the COVID-19 pandemic would be helpful in determining whether entry restrictions are an effective measure to reduce the spread of infection in future pandemics.

Image vignette

Tarsal tunnel syndrome due to talocalcaneal coalition: Chul Hyun Park, Mathieu Boudier-Revéret, Min Cheol Chang; J Yeungnam Med Sci. 2023;40(1):106-108. Published online October 5, 2021; DOI: https://doi.org/10.12701/yujm.2021.01473

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1 Citations

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Citations

Citations to this article as recorded by

Deep-Learning Algorithms for Prescribing Insoles to Patients with Foot Pain
Jeoung Kun Kim, Yoo Jin Choo, In Sik Park, Jin-Woo Choi, Donghwi Park, Min Cheol Chang
Applied Sciences.2023; 13(4): 2208. CrossRef

Original article

Storing information of stroke rehabilitation patients using blockchain technology: a software study: Min Cheol Chang; J Yeungnam Med Sci. 2022;39(2):98-107. Published online September 7, 2021; DOI: https://doi.org/10.12701/yujm.2021.01368

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1 Citations

Abstract PDF

Background
Stroke patients usually experience damage to multiple functions and a long rehabilitation period. Hence, there is a large volume of patient clinical information. It thus takes a long time for clinicians to identify the patient’s information and essential pieces of information may be overlooked. To solve this, we stored the essential clinical information of stroke patients in a blockchain and implemented the blockchain technology using the Java programming language.
Methods
We created a mini blockchain to store the medical information of patients using the Java programming language.
Results
After generating a unique pair of public/private keys for identity verification, a patient’s identity is verified by applying the Elliptic Curve Digital Signature Algorithm based on the generated keys. When the identity verification is complete, new medical data are stored in the transaction list and the generated transaction is verified. When verification is completed normally, the block hash value is derived using the transaction value and the hash value of the previous block. The hash value of the previous block is then stored in the generated block to interconnect the blocks.
Conclusion
We demonstrated that blockchain can be used to store and deliver the patient information of stroke patients. It may be difficult to directly implement the code that we developed in the medical field, but it can serve as a starting point for the creation of a blockchain system to be used in the field.

Citations

Citations to this article as recorded by

Use of QR Codes for Promoting a Home-Based Therapeutic Exercise in Patients with Lumbar Disc Herniation and Lumbar Spinal Stenosis: A Prospective Randomized Study
Min Cheol Chang, Donghwi Park, Yoo Jin Choo
Journal of Pain Research.2022; Volume 15: 4065. CrossRef

Case reports

Serotonin syndrome in a patient with chronic pain taking analgesic drugs mistaken for psychogenic nonepileptic seizure: a case report: Mathieu Boudier-Revéret, Min Cheol Chang; Yeungnam Univ J Med. 2021;38(4):371-373. Published online April 5, 2021; DOI: https://doi.org/10.12701/yujm.2021.00948

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Abstract PDF Supplementary Material: Serotonin syndrome (SS) is a potentially life-threatening condition that is caused by the administration of drugs that increase serotonergic activity in the central nervous system. We report a case of serotonin syndrome in a patient with chronic pain who was taking analgesic drugs. A 36-year-old female with chronic pain in the lower back and right buttock area had been taking tramadol hydrochloride 187.5 mg, acetaminophen 325 mg, pregabalin 150 mg, duloxetine 60 mg, and triazolam 0.25 mg daily for several months. After amitriptyline 10 mg was added to achieve better pain control, the patient developed SS, which was mistaken for psychogenic nonepileptic seizure. However, her symptoms completely disappeared after discontinuation of the drugs that were thought to trigger SS and subsequent hydration with normal saline. Various drugs that can increase serotonergic activity are being widely prescribed for patients with chronic pain. Clinicians should be aware of the potential for the occurrence of SS when prescribing pain medications to patients with chronic pain.

Ultrasonographic and magnetic resonance images of a gluteus maximus tear: Jong Bum Kim, Wonho Lee, Min Cheol Chang; Yeungnam Univ J Med. 2021;38(2):157-159. Published online July 31, 2020; DOI: https://doi.org/10.12701/yujm.2020.00500

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2 Citations

Abstract PDF

The diagnosis of a gluteal muscle tear or strain is based on clinical findings. However, for an accurate diagnosis, imaging examinations are also needed. Herein, we describe the case of a patient with a gluteus maximus muscle tear confirmed by ultrasonography (US) and magnetic resonance imaging (MRI). A 58-year-old woman complained of dull pain in the left lateral gluteal region that she had been experiencing for 8 days. In the axial US image, retraction of the left gluteus maximus muscle was noted around its insertion site in the iliotibial band. On an MRI, a partial tear in the left gluteus maximus was observed at its insertion site in the left iliotibial band. In addition, fluid infiltration due to edema and hemorrhage was observed. A partial left gluteal muscle tear was diagnosed. The patient was treated with physical therapy at the involved region and oral analgesics. She reported relief from the pain after 1 month of treatment. Based on this experience, we recommend US or MRI for accurate diagnosis of muscle tear or strain.

Citations

Citations to this article as recorded by

Essentials of thoracic outlet syndrome: A narrative review
Min Cheol Chang, Du Hwan Kim
World Journal of Clinical Cases.2021; 9(21): 5804. CrossRef
Obturator hernia - a rare etiology of lateral thigh pain: A case report
Jun Young Kim, Min Cheol Chang
World Journal of Clinical Cases.2021; 9(34): 10728. CrossRef

Review article

Effectiveness of orthoses for treatment in patients with spinal pain: Yoo Jin Choo, Min Cheol Chang; Yeungnam Univ J Med. 2020;37(2):84-89. Published online March 24, 2020; DOI: https://doi.org/10.12701/yujm.2020.00150

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11 Citations

Abstract PDF

Spinal pain is a common patient complaint in clinical practice. Conservative treatment methods include oral medication, physical therapy, injections, and spinal orthoses. The clinical application of orthoses is debated because of potential complications associated with long-term use, such as muscle weakness and joint contracture. We reviewed the orthoses most frequently used to manage spinal pain. We review the use of soft cervical and Philadelphia collars, lumbosacral corsets, and thoracolumbosacral orthosis to manage spinal pain. Spinal orthoses can help reduce pain by protecting the muscles and joints of the injured spinal region, preventing or correcting malformations, and limiting trunk flexion, extension, lateral flexion, and rotation. The short-term use of spinal orthoses is known to improve pain and disability during the treatment period without significant adverse effects. Spinal orthoses are expected to alleviate pain and improve patients’ lifestyle.

Citations

Citations to this article as recorded by

Spinal Injections: A Narrative Review from a Surgeon’s Perspective
Dong Ah Shin, Yoo Jin Choo, Min Cheol Chang
Healthcare.2023; 11(16): 2355. CrossRef
Effectiveness and Safety of Inelastic Versus Elastic Lumbosacral Orthoses on Low Back Pain Prevention in Healthy Nurses
Jianzhong Hu, Liyuan Jiang, Yong Cao, Jin Qu, Hongbin Lu
Spine.2022; 47(9): 656. CrossRef
The mechanism of action of pulsed radiofrequency in reducing pain: a narrative review
Donghwi Park, Min Cheol Chang
Journal of Yeungnam Medical Science.2022; 39(3): 200. CrossRef
Effectiveness of pulsed radiofrequency on the medial cervical branches for cervical facet joint pain
Min Cheol Chang, Seoyon Yang
World Journal of Clinical Cases.2022; 10(22): 7720. CrossRef
The Effectiveness of Facet Joint Injection with Steroid and Botulinum Toxin in Severe Lumbar Central Spinal Stenosis: A Randomized Controlled Trial
Sang Lee, Hyun Choi, Min Chang
Toxins.2022; 15(1): 11. CrossRef
Use of Pulsed Radiofrequency for the Treatment of Discogenic Back Pain: A Narrative Review
Seoyon Yang, Mathieu Boudier‐Revéret, Min Cheol Chang
Pain Practice.2021; 21(5): 594. CrossRef
YouTube as a Source of Information on Epidural Steroid Injection
Min Cheol Chang, Donghwi Park
Journal of Pain Research.2021; Volume 14: 1353. CrossRef
Comparison of Physical Activity Levels of Individuals Using Orthosis Without Pain and Kinesiophobia with Healthy Controls and within Themselves
Melek VOLKAN-YAZICI, Fatmagül VAROL
Ergoterapi ve Rehabilitasyon Dergisi.2021; 9(3): 79. CrossRef
The role of assistive devices in frail elderly people with fragility fractures: a narrative review
Giovanni Iolascon, Carla Michini, Robin Kuruvila Sentinella, Milena Aulicino, Antimo Moretti
International Journal of Bone Fragility.2021; 1(2): 53. CrossRef
Conservative Treatments Frequently Used for Chronic Pain Patients in Clinical Practice: A Literature Review
Min Cheol Chang
Cureus.2020;[Epub] CrossRef
Association between Chronic Pain and Alterations in the Mesolimbic Dopaminergic System
Seoyon Yang, Mathieu Boudier-Revéret, Yoo Jin Choo, Min Cheol Chang
Brain Sciences.2020; 10(10): 701. CrossRef

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