The 2024 fall conference of the Korean Pain Research Society (KPRS) was held on October 13 at Samsung Medical Center’s Cancer Hospital in Seoul, South Korea. Founded on September 2, 1983, as the Korean chapter of the International Association for the Study of Pain (IASP), KPRS serves as a multidisciplinary hub for pain research and treatment strategies across basic and clinical sciences [1]. The conference brought together experts from various fields, including neurosurgery, neurology, anesthesiology, rehabilitation medicine, and basic sciences. Effective pain management often requires collaboration across neurosurgery, neurology, anesthesiology, rehabilitation medicine, and basic sciences, as these disciplines collectively address the complex nature of pain. Neurosurgeons can provide surgical interventions for structural issues causing pain, while anesthesiologists contribute expertise in nerve block techniques or spinal injections. Neurologists paly a vital role in pain management by diagnosing and treating pain related to the nervous system. Physiatrists help patients regain function and mobility, which is crucial for long-term pain relief and quality of life improvement. Meanwhile, basic research offers insights into the mechanisms of pain at molecular and cellular levers, which guides evidence-based approaches and the development of innovative treatments. This multidisciplinary approach enables comprehensive, personalized care, optimizing outcomes for patients suffering from chronic pain. The conference of KPRS provided a platform for research presentations that shared cutting-edge findings and facilitated discussions aimed at generating new insights. The key topics presented at the conference are summarized below.

1. Diagnostic approaches and pain mechanisms in lumbar spinal pain

Prof. Sungjoon Lee (Samsung Medical Center, Seoul, South Korea) highlighted that lumbar spinal pain may be nociceptive, neuropathic, or psychological in origin, and distinguishing between these types in clinical practice can be challenging [2]. Focusing on lower back pain (LBP), he noted that common contributors include disc, facet, and sacroiliac joint pathologies, although the origin of pain often remains unidentified. Additionally, he emphasized that nociceptive nerves are more concentrated in the vertebral endplate rather than the disc, suggesting that endplate alterations could potentially cause pain in patients with Modic changes [3]. A discussion followed on the role of injection therapies for acute LBP, which often resolves naturally within 4-6 weeks. Prof. Lee suggested that while injections are widely available in Korea, patients should be given autonomy in deciding whether to pursue these treatments.

2. Latest surgical insights for diseases causing lumbar spinal pain

Prof. Woon Tak Yuh (Department of Neurosurgery, Hallym University Medical Center, Hwaseong-si, Gyeonggi-do, South Korea) provided a comprehensive review of the latest advancements in endoscopic spine decompression surgery [4]. He introduced several techniques, including percutaneous endoscopic lumbar discectomy, unilateral biportal endoscopy, and endofusion, using surgical images and videos to illustrate their differences, advantages, and disadvantages.

3. Insights into diseases causing lumbar spinal pain: open surgery (minimally invasive spinal surgery technique)

Prof. Jung Hwan Lee (Department of Neurosurgery, Yeouido St. Mary's Hospital, Seoul, South Korea) presented on minimally invasive spinal surgery. He reviewed the key aspects of open surgery for treating lumbar spine pathologies and described the most commonly used minimally invasive techniques, such as tubular retractors, percutaneous pedicle screw insertion, and minimally invasive lumbar interbody fusion. He also reported that minimally invasive surgery has become mainstream in up to 72.8% of clinical practices in Asia.

4. Evidence for postoperative rehabilitation therapy after lumbar spine surgery and effective rehabilitation techniques

Prof. Seoyon Yang (Department of Rehabilitation Medicine, Ewha Woman's University Seoul Hospital, Seoul, South Korea) lectured on postoperative rehabilitation following lumbar spine surgery. She emphasized the importance of promoting functional recovery to address issues such as muscle weakness, atrophy, reduced endurance, and spinal imbalance. Moreover, she highlighted the role of rehabilitation in preventing recurrence. She presented meta-analytic data demonstrating that early rehabilitation (within 4-6 weeks post-surgery) significantly reduces pain and disability [5]. Prof. Yang also underscored the benefits of early ambulation, which improves cardiovascular function, enhances blood circulation, supplies nutrients to intervertebral discs, and provides rhythmic spinal loading. Strengthening exercises targeting the transverse abdominis and multifidus muscles were identified as key components of postoperative rehabilitation. Prof. Yang concluded her lecture by summarizing recommended rehabilitation exercises at various postoperative stages.

1. Astrocytic GABA-mediated cascade: key to the mechanism of neuropathic pain

Min-Ho Nam (Korea Institute of Science and Technology, Seoul, South Korea) delivered a lecture on γ-aminobutyric acid (GABA) produced in astrocytes. He explained that, contrary to GABA’s typical inhibitory function, these neurotransmitters excite surrounding neurons and postsynaptic neurons. Using electrophysiological methods, Nam et al. demonstrated that reactive astrocytes, through excessive GABA release in the spinal dorsal horn, paradoxically led to tonic excitation of neighboring neurons in a rat model of neuropathic pain [6].

2. Thiolate poly (lactic-co-glycolic acid) nanofibers for sustained drug release in neuropathic pain treatment

Seil Sohn (Bundang CHA Medical Center, Seongnam-si, Gyeonggi-do, South Korea) presented his research on the sustained release of dexamethasone and ropivacaine through thiolate poly (lactic-co-glycolic acid) nanofibers for local neuropathic pain treatment. He reported that injections of these nanofibers significantly reduced macrophage infiltration, providing more effective and sustained pain control compared to standard drug injections in rat models of neuropathic pain.

3. Spinal cord tissue repair to rebuild neural circuits following injury

Prof. Byung Gon Kim (Department of Brain Science and Neurology, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, South Korea) presented on spinal cord tissue repair. His research highlighted the challenges of tissue defects and cystic cavities following traumatic spinal cord injury, which hinder regenerative recovery. His team introduced an injectable hydrogel scaffold as a promising strategy for bridging cavitary lesions in spinal cord trauma. The polymer hydrogel successfully promoted extracellular matrix remodeling and repaired tissue defects in a clinically relevant spinal cord injury rat model [7].

4. Microglia in neuropathic pain: molecular signaling and therapeutic potential

Prof. Temugin Berta (University of Cincinnati, Cincinnati, Ohio, United States) presented findings on the role of microglia in neuropathic pain. His team showed that the stimulator of interferon genes (STING) protein is highly expressed in microglia and involved in the immune response. They observed increased STING expression in spinal microglia after nerve injury in a mouse model of neuropathic pain. Although microglial STING was not required for mechanical allodynia development, its activation alleviated mechanical allodynia while increasing pro-inflammatory cytokine levels, counteracting the analgesic effect [8].

1. Latest insights on lumbar interlaminar and transforaminal epidural block, medial branch block, and facet block

Prof. Hyun Gon Lee (Department of Anesthesiology and Pain Medicine, Chonnam National University Hospital, Gwangju, South Korea) provided an overview of each block procedure, its adverse effects, and the level of evidence. His lecture emphasized that improper injections, such as subdural or intrathecal placement, could be detected using contrast imaging.

2. Types, effects, and tips for lumbar radiofrequency ablation

Prof. Kyeong Hwan Seo (Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Deagu, South Korea) explained the basics of radiofrequency ablation and its applications in targeting the medial branches, nerve roots, and intervertebral discs. He also introduced the different radiofrequency modes used in each procedure.

3. Lumbar neuroplasty: optimizing therapeutic efficacy

Prof. Seong-Soo Choi (Department of Anesthesiology and Pain Medicine, Asan Medical Center, Seoul, South Korea) emphasized the importance of selecting appropriate patients, identifying precise target areas, and following proper procedures to optimize the outcomes of lumbar neuroplasty. Factors associated with successful neuroplasty included chronic radicular pain with minimal LBP, neurogenic intermittent claudication, minimal neuropathic components (e.g., diabetic neuropathy), pain duration of less than 14 months in post-lumbar surgery syndrome, lumbar foraminal stenosis caused by degenerative disc disease, and perineural adhesion due to a chronic degenerative disc, such as a herniated disc.

1. Lumbar plane block, lumbar plexus block, and quadratus lumborum block

Prof. Jung Hyun Park (Department of Anesthesiology and Pain Medicine, Incheon St. Mary's Hospital, Incheon, South Korea) introduced techniques for performing lumbar plexus and quadratus lumborum blocks under ultrasound guidance.

2. Steroids: safe and effective use

Dr. Jung Hwan Lee (Namdarun Rehabilitation Clinic, Seongnam-si, Gyeonggi-do, South Korea) explained the molecular differences between particulate and nonparticulate steroids. He warned that particulate steroids pose a risk of spinal cord or cerebral embolic infarction when used in transforaminal injections but are safe in interlaminar epidural injections. He highlighted that improperly administered intrathecal particulate steroids increase the risk of arachnoiditis. Additionally, he noted that both steroid types suppress the hypothalamic-pituitary-adrenal (HPA) axis, with recovery taking about three weeks [9]. The degree of HPA axis suppression is dose-dependent, and the North American Spine Society recommends no more than three injections within six months and no more than six per year. However, these guidelines do not account for dosage variations.

3. Drugs in regenerative medicine: polydeoxyribonucleotide, collagen, and platelet-rich plasma

Prof. Jong Bum Choi (Department of Anesthesiology and Pain Medicine, Ajou University Hospital) discussed the molecular structure and regenerative effects of collagen products. He focused on Polydeoxyribonucleotide injections as pain control agents and shared his clinical experience in managing LBP and radicular pain using Polydeoxyribonucleotide injections.

1. Clinical symptoms and diagnosis of abdominal pain related to the spine

Dr. Donghwi Park (Seoul Spine Rehabilitation Clinic, Ulsan, South Korea) explained that abdominal pain is often linked to musculoskeletal disorders, particularly thoracic spinal conditions such as herniated thoracic discs or spinal cord injuries. He illustrated these concepts using case reports from the literature [10,11].

2. Mechanisms, symptoms, and differential diagnosis of pelvic pain

Prof. Sang Beom Kim (Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea) discussed the mechanisms underlying pelvic pain, emphasizing the need for interdisciplinary collaboration, as many cases originate from urological or gynecological conditions.

3. Interventions for abdominal and pelvic pain (abdominal wall, pudendal, and sacroiliac joint blocks)

Prof. Sang Hun Kim (Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, South Korea) detailed the techniques of quadratus lumborum plane block, anterior cutaneous nerve block, lateral cutaneous nerve block, transversalis fascia plane block, pudendal block, and sacroiliac joint block, all performed under ultrasound guidance.

The 2024 fall conference of the KPRS provided a critical platform for sharing the latest advancements and techniques in pain management and research. Experts from various specialties, including neurosurgery, anesthesiology, pain medicine, rehabilitation medicine, and basic research, collaborated to expand knowledge on pain mechanisms, surgical innovations, and non-surgical approaches. Discussions highlighted the significance of rehabilitation in postoperative recovery, along with a novel rehabilitation technique. Key topics included cellular mechanisms of neuropathic pain, therapeutic strategies, neuroregeneration following spinal injury, and treatments for abdominal and pelvic pain. The conference reinforced the importance of a multidisciplinary approach to pain management, setting the stage for future clinical and research developments. The KPRS remains committed to advancing pain treatment and research through continued collaboration and academic exchange.

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No potential conflict of interest relevant to this article was reported.