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We have applied a new method called "the pumping technique" to the capsule-preserving hydraulic distension for frozen shoulder. With this technique, the stretching effect can be directly applied to the joint capsule of the affected shoulder.We attempted to evaluate the effect of capsule-preserving hydraulic distension using the pumping technique by comparing capsule-preserving hydraulic distension without it.A case-controlled, retrospective, comparative study.Outpatient clinic of department of rehabilitation medicine in a single university hospital.Patients (n = 47) with frozen shoulder who were treated with hydraulic distension were assigned into the pumping group (n = 24) and the nonpumping group (n = 23). Range of motion (ROM), Shoulder Pain and Disability Index (SPADI), and Visual Analog Scale (VAS) scores were assessed.Significant improvement of VAS, ROM, and SPADI scores was observed after the second injection in each group (P0.05). There were significant differences in total passive ROM, abduction, and flexion after the fifth injection between the 2 groups (P0.05). There was a significant difference in the disability domain of SPADI after the second injection between the 2 groups (P0.05). However, there was no significant interaction between time and group with respect to VAS scores. There were no serious complications after procedures.This was a retrospective study. There might be some limitations in gathering comprehensive records of outcome measurements. In addition, because the objective of this study was to determine the effect of the new pumping technique, included patients range was very narrow. This study only included patients who were treated 5 times with capsule-preserving hydraulic distensions with or without the pumping technique.Although the effect on pain was excellent in both groups, the superiority of the new pumping technique was demonstrated by reduction of SPADI disability subscale score and improvement of ROM of the shoulder compared with the nonpumping technique.Shoulder pain, injections, stretch, exercise, ultrasonography, joint capsule, steroids, range of motion.

Background: Radiofrequency thermocoagulation (RFT) has been widely used to manage trigeminal neuralgia (TN) refractory to oral medication. Careful selection of patients for managing TN with RFT can decrease morbidity and improve treatment efficacy. Objectives: The goal of this study was to determine clinical variables related to the treatment outcome in patients with TN undergoing RFT. Study Design: Retrospective analysis. Setting: University hospital in Korea. Methods: Demographic and clinical data were garnered by billing records for patients with TN who received RFT by one pain physician between January 2005 and August 2014. A successful outcome was pre-defined as at least 50% pain relief on a 0 – 10 NRS pain score for longer than 6 months after RFT. Variables evaluated for their association with outcome included age, gender, baseline pain score, etiology, type of pain, co-existing psychopathology, and history of previous intervention. Results: Among 90 patients who underwent RFT for managing TN, 75 patients (83.3%) reported a successful outcome (> 50% pain relief at 6 months after RFT procedure). Pain characteristics was the most significant predictor associated with successful outcomes of RFT in both univariate and multivariate logistic analysis; odds ratio of provoked paroxysmal pain was 131.516 and mixed type of pain was 20.602 in multivariate analysis. Limitations: Prospective studies are recommended to confirm our findings and ascertain which additional variables can be taken into account to improve the likelihood of a successful outcome for RFT in patients with TN. Conclusion: A provoked paroxysmal pain or mixed pain condition was associated with a positive outcome for RFT in patients with TN. In addition, bilateral TN, high baseline NRS pain score, or co-morbid psychiatric condition was related with negative outcomes in univariate analysis. Pain clinicians should consider these findings when selecting patients for managing TN to increase the efficacy of RFT. Key words: Facial pain, outcome assessment, predictive value, radiofrequency thermocoagulation, trigeminal neuralgia

Background: The close anatomic and functional relationship between the proximal parts of the adductor longus and pectineus muscles produce considerable overlap in symptoms and signs in the inguinal region. To our knowledge, there have been no publications of ultrasound (US)-guided injection techniques into the 2 muscles. Objective: This study sought to describe US-guided injection techniques in the proximal part of the adductor longus and pectineus muscles and to validate whether these techniques deliver injections appropriately to their target muscles in unembalmed cadavers. Study Design: Cadaveric study. Methods: A preliminary trial with 2 unembalmed cadavers provided information on the target sonographic structures of proximal adductor longus and pectineus muscles. Bilateral US-guided intramuscular injections in the proximal adductor longus and pectineus were performed using the remaining 5 unembalmed male cadavers. To avoid confusion of dye location, we did not inject into both the adductor longus and pectineus muscle in the same side. After injections, each specimen was dissected to evaluate the accuracy of injection. Results: Ten injections (5 for the adductor longus muscle and 5 for the pectineus muscle) were performed targeting the proximal parts of muscles in 5 cadaveric specimens. All injections were successful and blue dye was injected accurately at the target area within the adductor longus and the pectineus muscles. No other muscles were injected unintentionally. There were no accidental penetrations and/or injuries at adjacent neurovascular structures as well. Limitation: Despite successful injection of the proximal parts of adductor longus and pectineus, this study did not verify the usefulness of this technique in clinical practice. Conclusions: The results of this study may play a role in the diagnosis and management of patients presenting with chronic pelvic pain syndrome and sports hernia. Key words: Inguinal, injections, ultrasonography, pain, cadaver, pectineus, adductor, pelvis

Topical capsaicin therapy may be of benefit in providing pain relief in patients with peripheral neuropathy.To investigate the efficacy and safety of 0.625% (50 µg/cm2) and 1.25% (100 µg/cm2) capsaicin patches (CPs) compared to conventional 0.075% capsaicin cream or placebo patches in patients suffering from peripheral neuropathy.Early Phase II, multi-center, randomized, semi-double-blind, and placebo-controlled clinical trial.Two medical college teaching hospitals.Sixty patients were randomized to the 0.625% CP, 1.25% CP, placebo-controlled patch, or 0.075% capsaicin cream. The primary efficacy endpoint was the mean difference in the change of daily numerical rating scale (NRS) pain score. Secondary endpoints included values for the Daily Sleep Interference Scale, the percentage of patients achieving a/= 30% or/= 50% reduction in pain, and data for Global Impression Change (GIC) and EQ-5D.Patients treated with the 0.625% CP and 0.075% capsaicin cream showed statistically significant improvements in pain after 6-weeks of test drug application. Daily sleep disorder scores were improved only for those patients applying the 0.075% capsaicin cream. For patient-derived GIC scores, the majority (11 of 12) of patients in the 0.625% CP group reported that their pain was improved. For the safety evaluation, 2 severe adverse events were reported for the 0.075% capsaicin cream group only. Repetitive patch application was related to minor skin problems such as a burning sensation, erythema, pruritus, and vesicles in 28 patients (46.67%).The small sample size and relatively high dropout rates.Our data indicate that the 0.625% CP may prove to be an effective and safe alternative with which to treat patients with peripheral neuropathy and could replace the high concentration (8%) CP. Further studies are now needed to definitively establish efficacy.Key words: Capsaicin, patch, CP, topical capsaicin, neuropathic pain, peripheral neuropathic pain, PNP, high concentration CPTrial Registration: ClinicalTrials.gov, NCT02228928.

In the cervical spine, the ligamentum flavum (LF) is often incompletely fused at the midline. Therefore, accessing the epidural space (ES) using the loss of resistance (LOR) technique via the midline approach could be less reliable than the paramedian approach. Since the tactile sensation of LOR is due to abrupt loss of pressure upon entering the ES, we have compared pressure changes between the 2 different cervical epidural techniques.The aim of this study was to compare pressure changes during the pathway to the cervical ES between the 2 approaches.A prospective, open-labeled, randomized, comparative study.An interventional pain management practice in a hospital, Republic of Korea.The 74 patients were randomly assigned to either a midline or paramedian group. The pressure changes were monitored and classified into 4 grades according to the following criteria: Grade I. The pressure waveform sequence consisted of 3 components in chronological order: 1) a high positive pressure just prior to entering the ES; 2) an abrupt pressure decrease at the moment of entering the ES; and 3) a negative peak pressure before cervical epidural pressure equilibration. Grade II. A high positive pressure followed by a precipitous pressure drop, without negative peak pressure upon entering the ES. Grade III. High positive pressure before entering the ES, followed by continuous pressure decrease without negative pressure. Grade IV. No pressure changes before or after entering the cervical ES.An abrupt pressure decrease at the moment of exiting the LF or entering the ES was more frequently observed when using the paramedian approach (P0.05) with the odds ratio of 4.96 (95% CI, 1.63 - 15.12) as compared with the midline approach.A correlation between the abrupt pressure decrease and LOR tactile sensation has been assumed.Under the assumption that the LOR sensation is due to an abrupt decrease in pressure the moment the needle enters the ES or exits the LF, this study claims that the accuracy of accessing the cervical ES can be improved significantly using the paramedian approach.NCT01009385. Institutional Review Board (IRB): H-1208-107-422.

Cervical central stenosis (CCS) is a narrowing of the spinal canal that can cause mechanical compression of the spinal nerve and roots, leading to neck pain and/or radicular pain. Cervical epidural steroid injections are commonly used in the treatment of CCS. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis with a targeted drug delivery.The aim of our study is to evaluate the effectiveness of percutaneous cervical epidural adhesiolysis in patients with chronic posterior neck pain and upper extremity pain due to CCS.This was a preliminary, prospective study.Thirty-nine patients with CCS were enrolled and all subjects underwent cervical spine magnetic resonance imaging. All patients received percutaneous adhesiolysis and appropriate placement of a Racz catheter, followed by an injection of 5 mL of 0.2 % preservative-free ropivacaine containing 1,500 units of hyaluronidase and 4 mg of dexamethasone. In the recovery room, each patient also received 6 mL of 10% hypertonic sodium chloride solution, after which the catheter was removed. Outcome measures were obtained using a 5-point patient's satisfaction scale at 2 weeks and at 6 months post-treatment. To evaluate treatment effectiveness, we divided the patients into 2 groups according to their treatment response.Secondary outcomes were not measured. The study did not include a long-term follow-up period or control group.Improvement designated as reports of moderate pain, little pain, and no pain was observed in 30 patients (77.0 %) at 2 weeks and 28 patients (71.8 %) at 6 months after the procedure. There was no statistically significant correlation between pain relief and the severity of CCS.Percutaneous adhesiolysis utilizing local anesthetic steroids and hypertonic sodium chloride solution may be an effective management strategy in patients with chronic posterior neck and upper extremity pain due to cervical central spinal stenosis, although there is no correlation between therapeutic response and the grade of CCS.