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Summary of Our Symposium

Int J Pain 2023; 14(1): 28-32

Published online June 30, 2023 https://doi.org/10.56718/ijp.23-006

Copyright © The Korean Association for the Study of Pain.

The 47th Korean Pain Interventional Society Symposium: April 16, 2023

Min Cheol Chang1, Dong Ah Shin2, Gi-Wook Kim3, Sang-Hyuk Park4, Jung Hwan Lee5, Yun Woo Cho6, Pyung Goo Cho7, Gyu Yeul Ji8, Nack Hwan Kim9, Donghwi Park10, The Korean Pain Interventional Society (KORSIS)

1Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, 2Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 3Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, 4Yonsei Goodwalk Clinic, Anyang, 5Namdarun Rehabilitation Clinic, Yongin, 6Dr Ahn`s Rehabilitation Clinic, Daegu, 7Department of Neurosurgery, Ajou University College of Medicine, Suwon, 8Department of Neurosurgery, Yonsei Hana Research Institute, Yonsei Hana Hospital, Gimpo, 9Department of Physical Medicine and Rehabilitation, College of Medicine, Korea University, Ansan, 10Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Korea

Correspondence to:Donghwi Park, Department of Rehabilitation Medicine, Daegu Fatima Hospital, 99 Ayang-ro, Dong-gu, Daegu 41199, Korea. Tel: +82-53-940-7820, Fax: +82-53-954-7417, E-mail: bdome@hanmail.net

Received: May 1, 2023; Revised: May 9, 2023; Accepted: May 16, 2023

The Korean Pain Interventional Society (KORSIS) was established in 2004 to foster pain interventionalists through research, education, and imaging guidance on interventions in relation to pain originating from the spine and peripheral neuromuscular structures. The 47th symposium was held at Samjung Hotel, Seoul, Korea, from 09:00 to 16:00 on Sunday, April 16, 2023. The symposium addressed headaches and facial pain treatment that patients frequently complain of in clinical practice but which are challenging to treat. It also addressed the diagnosis of peripheral neuropathy, including cubital tunnel syndrome, injection procedure methods for treatment of peripheral neuropathy, imaging study findings of the ankle joint, and the experiences and pain treatment techniques of clinicians experienced in pain management. It is hoped that the attendees at this symposium will apply what they have learned in clinical practice to enhance patient treatment.

Keywordsintervention, korean pain research society, neuropathic pain, pain.

The Korean Pain Interventional Society (KORSIS) was established in 2004 to foster pain interventionalists through research, education, and imaging guidance on interventions in relation to pain originating from the spine and peripheral neuromuscular structures. The 47th symposium was held at Samjung Hotel, Seoul, Korea, from 09:00 to 16:00 on Sunday, April 16, 2023 (Table 1, Fig. 1). The symposium was also broadcast online. There were 75 offline attendees and 420 online attendees. The following is a summary of the symposium.

Table 1 Symposium order of events

09:00Opening addressPresident Dong Ah Shin, The Korean Pain Interventional Society
Session 1. The treatment of headache and facial pain (e.g., medication, fluids, and interventional procedures for headache and facial pain)
09:10–09:40Types and mechanisms of headache medications (including anti-CGRP) commonly seen in neurology clinicsJi-Yun Park, Ulsan University Hospital Department of Neurology
09:40–10:10Interventional procedures for controlling headache and facial pain (including trigeminal nerve block)Kim Chan, Kim Chan Hospital Department of Anesthesiology
10:10–10:40Interventional procedures for controlling facial and jaw pain in dentistry (including temporomandibular joint injection)Ji Rak Kim, Kyungpook National University Dental Hospital Department of Oral Medicine
Session 2: Peripheral nerve surgery: advanced edition
10:50–11:20Conservative and surgical treatment of cubital tunnel syndromeSang Hyun Woo, W Hospital Department of Plastic Surgery
11:20–11:50Structures that may be damaged during an ultrasound-guided injection (e.g., damage to the superficial radial nerve, the palmar cutaneous branch of medical nerve, and the dorsal ulnar branch) and methods for safe proceduresSang Hoon Lee, Madi Pain Clinic
11:50–12:20Ultrasound-guided diagnosis and treatment of pain from cutaneous nerve entrapmentKe-Vin Chang, National Taiwan University Hospital Department of Rehabilitation Medicine
12:20-13:20Lunch
Session 3. Ankle joint imaging
13:20–13:50Common pathologies and methods for ankle MRI readingByeong Seong Kang, Ulsan University Hospital Department of Radiology
13:50–14:20Types of plain ankle radiographs for patients with ankle pain, radiograph reading methods, and common pathologiesHyun Kook Youn, Bal-A Orthopedic Clinic
14:20–15:00Ultrasound ankle evaluation, diagnosis, common pathologies, and interventional treatmentsLevent Özçakar, Department of Physical and Rehabilitation Medicine, Hacettepe University Hospital
Session 4. Clinical experience from specialists in pain management (complex cases, missed cases, and cases speakers wanted to introduce)
15:00–15:30Case report 1Sang Ho Ahn, Ahn's Rehabilitation Clinic
15:30-16:00Case report 2Jung Hwan Lee, Namdarun Rehabilitation Clinic
16:00Closing addressPresident Dong Ah Shin, The Korean Pain Interventional Society

Figure 1.The photo of symposium.

The first session concerned the diagnosis and treatment of headaches and facial pain. Dr. Ji-Yun Park of Ulsan University Hospital Department of Neurology delivered the first lecture on the types and mechanisms of headache medication commonly seen in neurology clinics. This lecture covered tension headaches, migraines, the clinical presentation of cluster headaches, diagnostic criteria, pathophysiology, and treatment. In particular, Dr. Park presented the therapeutic mechanisms, application indications, and application methods of recently emerging drugs such as calcitonin gene-related peptide antibodies (CGRP) and monoclonal antibodies. The final section of the lecture comprised a presentation of cases involving headaches due to chronic migraine and cerebral venous sinus thrombosis, headaches resulting from intracranial hypotension, and tension-type headaches, to enhance the clinical application of the lecture contents in the clinical field. Furthermore, Dr. Park highlighted the red flags for secondary headaches, and emphasized that patients with headache should always be treated with consideration for the possibility of secondary headaches.

The second lecture was delivered by Dr. Chan Kim of Kim Chan Hospital, an anesthesiologist, concerning supraorbital, supratrochlear, infraorbital, mental, maxillary, and mandibular nerve block methods, as well as the use of Gasserian ganglion blocks, for the treatment of trigeminal neuralgia. In particular, he shared his expertise when performing a nerve block procedure in relation to the needle insertion point and the needle tilting angle during injection needle insertion.

The third lecture was delivered by Dr. Ji Rak Kim of Kyungpook National University Dental Hospital Department of Oral Medicine on temporomandibular joint injection and auriculotemporal nerve block. Dr. Kim explained the need to always consider the possibility of the facial nerve being blocked at the time of the auriculotemporal nerve block, and that this possibility should be clearly explained to the patient prior to this procedure. He also presented images concerning single- and double-needle techniques and compared the advantages, disadvantages, and the effects of adopting these techniques.

The second session focused on the diagnosis and treatment of peripheral neuropathy. Dr. Sang Hyun Woo, a plastic surgeon at W Hospital, delivered the first lecture in this session on cubital tunnel syndrome. He noted that as cubital tunnel syndrome can resolve without specialized treatment, actual prevalence rates are likely to be higher than those reported in the scientific literature. Dr. Woo explained the anatomical structures and mechanisms through which cubital tunnel syndrome can develop and the diagnosis of cubital tunnel syndrome using physical examination, patient history, ultrasonography, electrophysiological tests, and MRI. Furthermore, he emphasized the importance of correcting patients' arm postures as part of conservative therapy (for example, preventing the patient from bending the elbow for long periods of time, and protecting the main elbow body from undue pressure) and detailed treatment using night splints. He discussed a prior study that had reported no difference in treatment effect between splints and steroid injections, and shared various surgical procedures for the treatment of cubital tunnel syndrome.

The second lecture, delivered by Dr. Sang Hoon Lee of Madi Pain Clinic, focused on how to avoid peripheral nerve damage when using injections for pain treatment. Dr. Lee emphasized that the needle tip and the injection target structure must both be observed when performing an ultrasound procedure. He also pointed out that ergonomic ultrasound procedures are essential to avoid needle injuries and that the probe and the needle direction should be aligned in parallel. Using several YouTube videos as examples, he identified specific aspects of the procedure that practitioners in the video were performing incorrectly and explained the correct ultrasound-guided injection procedures. He also described how to avoid damage to the recurrent palmar cutaneous nerve, the superficial radial nerve, and the dorsal cutaneous nerve during injection treatment using a video presentation.

Dr. Ke-Vin Chang of the National Taiwan University Hospital Department of Rehabilitation Medicine delivered the third lecture on how to observe cutaneous nerves (i.e., medial antebrachial cutaneous, medial brachial cutaneous, lateral antebrachial cutaneous, posterior antebrachial cutaneous, intercostobrachial cutaneous, superficial radial, anterior femoral cutaneous, posterior femoral cutaneous, lateral femoral cutaneous, lateral and medial sural cutaneous, and saphenous nerves, and the infrapatellar branch) of the upper and lower extremities on ultrasound. He presented examples of several cutaneous nerve entrapments identified using ultrasound imaging. Dr. Chang also presented cases of compressed cutaneous nerves due to lipoma and enlarged lymph nodes, along with cases of cutaneous nerve adhesion due to scar tissues, which had subsequently caused pain.

The third session consisted of lectures on MRI, plain radiographs, and ultrasound images of the ankle joint. In the first lecture, Dr. Byeong Seong Kang of the Ulsan University Hospital Department of Radiology introduced and described common lesions among representative ligaments, tendons, and joints observed in ankle MRI.

In the second lecture, Dr. Hyun Kook Youn of Bal-A Orthopedics Clinic, discussed the use of plain ankle radiographs for patients with ankle pain, and emphasized that lesions can be underestimated when non-weight-bearing plain radiographs are taken, and that weight-bearing plain radiographs are preferable. He also stated that an ankle mortise view showed the configuration of the ankle joint more clearly than an ankle AP view, especially the condition of the lateral area of the ankle joint; therefore, the ankle mortise view should be used more extensively in clinical practice. Finally, he described optimal methods of foot alignment and foot position when taking these views.

The last lecture by Dr. Levent Özçakar of Hacettepe University Hospital, Turkey, described ultrasound findings in relation to the following pathologies: tarsal tunnel syndrome, tibial neuropathy, achilles tendinopathy, plantar fibromatosis, nerve entrapment, peroneal tendon subluxation, plantar fasciitis, and Morton's neuroma) that involve the ankle joint and foot.

The fourth session was intended to allow the audience to gain indirect clinical experience through listening to the treatment experiences of specialists working in pain clinics. In the first lecture, Dr. Sang Ho Ahn of Ahn's Rehabilitation Clinic shared his clinical experience in relation to neuralgic amyotrophy. He stated that because amyotrophy has various clinical symptoms ranging from mild to severe pain and paralysis, it is necessary to consider neuralgic amyotrophy when there is upper extremity pain and decreased muscle strength inconsistent with MRI findings. Furthermore, he shared that MR neurography can help diagnose neuralgic amyotrophy, presenting the findings of neuralgic amyotrophy found in several MR neurography studies [1,2]. He also noted that it is worth applying the conventional treatment method of injecting a steroid directly into the lesioned nerve, rather than oral steroid treatment, to reduce systemic side-effects and achieve a satisfactory therapeutic result.

The second lecture was delivered by Dr. Jung Hwan Lee of Namdarun Rehabilitation Clinic. He stated that patients' pain often appears broadly and vaguely rather than being confined to a specific dermatome or following a dermatome. He discussed whether it would be better to administer a spinal injection directly to allow the steroid medication to spread more widely, given a herniated disc irritates not only the nerve root but also the sinuvertebral nerve distributed in the disc or meninges. He also noted that when injection treatment was performed without confirming a spinal lesion on MRI, an effect similar to that of an injection treatment with MRI confirmation of the lesion was obtained [3]. His research findings are pending publication, subsequent to final acceptance after a minor revision.

The symposium addressed headaches and facial pain treatment that patients frequently complain of in clinical practice but which are challenging to treat. It also addressed the diagnosis of peripheral neuropathy, including cubital tunnel syndrome, injection procedure methods for treatment of peripheral neuropathy, imaging study findings of the ankle joint, and the experiences and pain treatment techniques of clinicians experienced in pain management. It is hoped that the attendees at this symposium will apply what they have learned in clinical practice to enhance patient treatment.

  1. Cejas C, Pastor Rueda JM, Hernández Pinzón J, Stefanoff N, Barroso F: Neuralgic amyotrophy detected by magnetic resonance neurography: subclinical, bilateral, and multifocal brachial plexus involvement. Neurol Res 2023; 45: 283-9.
    Pubmed CrossRef
  2. Queler SC, Towbin AJ, Milani C, Whang J, Sneag DB: Parsonage-turner syndrome following COVID-19 vaccination: MR neurography. Radiology 2022; 302: 84-7.
    Pubmed KoreaMed CrossRef
  3. Lee JH, Lee JH, Chang MC: Transforaminal epidural steroid injection for patients with lumbosacral disc herniation in the absence of spine magnetic resonance imaging - is better really the enemy of the best? J Pain Res 2023; 16: 1477-85.
    Pubmed KoreaMed CrossRef

Article

Summary of Our Symposium

Int J Pain 2023; 14(1): 28-32

Published online June 30, 2023 https://doi.org/10.56718/ijp.23-006

Copyright © The Korean Association for the Study of Pain.

The 47th Korean Pain Interventional Society Symposium: April 16, 2023

Min Cheol Chang1, Dong Ah Shin2, Gi-Wook Kim3, Sang-Hyuk Park4, Jung Hwan Lee5, Yun Woo Cho6, Pyung Goo Cho7, Gyu Yeul Ji8, Nack Hwan Kim9, Donghwi Park10, The Korean Pain Interventional Society (KORSIS)

1Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, 2Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, 3Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, 4Yonsei Goodwalk Clinic, Anyang, 5Namdarun Rehabilitation Clinic, Yongin, 6Dr Ahn`s Rehabilitation Clinic, Daegu, 7Department of Neurosurgery, Ajou University College of Medicine, Suwon, 8Department of Neurosurgery, Yonsei Hana Research Institute, Yonsei Hana Hospital, Gimpo, 9Department of Physical Medicine and Rehabilitation, College of Medicine, Korea University, Ansan, 10Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Korea

Correspondence to:Donghwi Park, Department of Rehabilitation Medicine, Daegu Fatima Hospital, 99 Ayang-ro, Dong-gu, Daegu 41199, Korea. Tel: +82-53-940-7820, Fax: +82-53-954-7417, E-mail: bdome@hanmail.net

Received: May 1, 2023; Revised: May 9, 2023; Accepted: May 16, 2023

Abstract

The Korean Pain Interventional Society (KORSIS) was established in 2004 to foster pain interventionalists through research, education, and imaging guidance on interventions in relation to pain originating from the spine and peripheral neuromuscular structures. The 47th symposium was held at Samjung Hotel, Seoul, Korea, from 09:00 to 16:00 on Sunday, April 16, 2023. The symposium addressed headaches and facial pain treatment that patients frequently complain of in clinical practice but which are challenging to treat. It also addressed the diagnosis of peripheral neuropathy, including cubital tunnel syndrome, injection procedure methods for treatment of peripheral neuropathy, imaging study findings of the ankle joint, and the experiences and pain treatment techniques of clinicians experienced in pain management. It is hoped that the attendees at this symposium will apply what they have learned in clinical practice to enhance patient treatment.

Keywords: intervention, korean pain research society, neuropathic pain, pain.

INTRODUCTION

The Korean Pain Interventional Society (KORSIS) was established in 2004 to foster pain interventionalists through research, education, and imaging guidance on interventions in relation to pain originating from the spine and peripheral neuromuscular structures. The 47th symposium was held at Samjung Hotel, Seoul, Korea, from 09:00 to 16:00 on Sunday, April 16, 2023 (Table 1, Fig. 1). The symposium was also broadcast online. There were 75 offline attendees and 420 online attendees. The following is a summary of the symposium.

Table 1 . Symposium order of events.

09:00Opening addressPresident Dong Ah Shin, The Korean Pain Interventional Society
Session 1. The treatment of headache and facial pain (e.g., medication, fluids, and interventional procedures for headache and facial pain)
09:10–09:40Types and mechanisms of headache medications (including anti-CGRP) commonly seen in neurology clinicsJi-Yun Park, Ulsan University Hospital Department of Neurology
09:40–10:10Interventional procedures for controlling headache and facial pain (including trigeminal nerve block)Kim Chan, Kim Chan Hospital Department of Anesthesiology
10:10–10:40Interventional procedures for controlling facial and jaw pain in dentistry (including temporomandibular joint injection)Ji Rak Kim, Kyungpook National University Dental Hospital Department of Oral Medicine
Session 2: Peripheral nerve surgery: advanced edition
10:50–11:20Conservative and surgical treatment of cubital tunnel syndromeSang Hyun Woo, W Hospital Department of Plastic Surgery
11:20–11:50Structures that may be damaged during an ultrasound-guided injection (e.g., damage to the superficial radial nerve, the palmar cutaneous branch of medical nerve, and the dorsal ulnar branch) and methods for safe proceduresSang Hoon Lee, Madi Pain Clinic
11:50–12:20Ultrasound-guided diagnosis and treatment of pain from cutaneous nerve entrapmentKe-Vin Chang, National Taiwan University Hospital Department of Rehabilitation Medicine
12:20-13:20Lunch
Session 3. Ankle joint imaging
13:20–13:50Common pathologies and methods for ankle MRI readingByeong Seong Kang, Ulsan University Hospital Department of Radiology
13:50–14:20Types of plain ankle radiographs for patients with ankle pain, radiograph reading methods, and common pathologiesHyun Kook Youn, Bal-A Orthopedic Clinic
14:20–15:00Ultrasound ankle evaluation, diagnosis, common pathologies, and interventional treatmentsLevent Özçakar, Department of Physical and Rehabilitation Medicine, Hacettepe University Hospital
Session 4. Clinical experience from specialists in pain management (complex cases, missed cases, and cases speakers wanted to introduce)
15:00–15:30Case report 1Sang Ho Ahn, Ahn's Rehabilitation Clinic
15:30-16:00Case report 2Jung Hwan Lee, Namdarun Rehabilitation Clinic
16:00Closing addressPresident Dong Ah Shin, The Korean Pain Interventional Society


Figure 1. The photo of symposium.

SESSION 1: THE TREATMENT OF HEADACHE AND FACIAL PAIN

The first session concerned the diagnosis and treatment of headaches and facial pain. Dr. Ji-Yun Park of Ulsan University Hospital Department of Neurology delivered the first lecture on the types and mechanisms of headache medication commonly seen in neurology clinics. This lecture covered tension headaches, migraines, the clinical presentation of cluster headaches, diagnostic criteria, pathophysiology, and treatment. In particular, Dr. Park presented the therapeutic mechanisms, application indications, and application methods of recently emerging drugs such as calcitonin gene-related peptide antibodies (CGRP) and monoclonal antibodies. The final section of the lecture comprised a presentation of cases involving headaches due to chronic migraine and cerebral venous sinus thrombosis, headaches resulting from intracranial hypotension, and tension-type headaches, to enhance the clinical application of the lecture contents in the clinical field. Furthermore, Dr. Park highlighted the red flags for secondary headaches, and emphasized that patients with headache should always be treated with consideration for the possibility of secondary headaches.

The second lecture was delivered by Dr. Chan Kim of Kim Chan Hospital, an anesthesiologist, concerning supraorbital, supratrochlear, infraorbital, mental, maxillary, and mandibular nerve block methods, as well as the use of Gasserian ganglion blocks, for the treatment of trigeminal neuralgia. In particular, he shared his expertise when performing a nerve block procedure in relation to the needle insertion point and the needle tilting angle during injection needle insertion.

The third lecture was delivered by Dr. Ji Rak Kim of Kyungpook National University Dental Hospital Department of Oral Medicine on temporomandibular joint injection and auriculotemporal nerve block. Dr. Kim explained the need to always consider the possibility of the facial nerve being blocked at the time of the auriculotemporal nerve block, and that this possibility should be clearly explained to the patient prior to this procedure. He also presented images concerning single- and double-needle techniques and compared the advantages, disadvantages, and the effects of adopting these techniques.

SESSION 2: PERIPHERAL NERVE SURGERY

The second session focused on the diagnosis and treatment of peripheral neuropathy. Dr. Sang Hyun Woo, a plastic surgeon at W Hospital, delivered the first lecture in this session on cubital tunnel syndrome. He noted that as cubital tunnel syndrome can resolve without specialized treatment, actual prevalence rates are likely to be higher than those reported in the scientific literature. Dr. Woo explained the anatomical structures and mechanisms through which cubital tunnel syndrome can develop and the diagnosis of cubital tunnel syndrome using physical examination, patient history, ultrasonography, electrophysiological tests, and MRI. Furthermore, he emphasized the importance of correcting patients' arm postures as part of conservative therapy (for example, preventing the patient from bending the elbow for long periods of time, and protecting the main elbow body from undue pressure) and detailed treatment using night splints. He discussed a prior study that had reported no difference in treatment effect between splints and steroid injections, and shared various surgical procedures for the treatment of cubital tunnel syndrome.

The second lecture, delivered by Dr. Sang Hoon Lee of Madi Pain Clinic, focused on how to avoid peripheral nerve damage when using injections for pain treatment. Dr. Lee emphasized that the needle tip and the injection target structure must both be observed when performing an ultrasound procedure. He also pointed out that ergonomic ultrasound procedures are essential to avoid needle injuries and that the probe and the needle direction should be aligned in parallel. Using several YouTube videos as examples, he identified specific aspects of the procedure that practitioners in the video were performing incorrectly and explained the correct ultrasound-guided injection procedures. He also described how to avoid damage to the recurrent palmar cutaneous nerve, the superficial radial nerve, and the dorsal cutaneous nerve during injection treatment using a video presentation.

Dr. Ke-Vin Chang of the National Taiwan University Hospital Department of Rehabilitation Medicine delivered the third lecture on how to observe cutaneous nerves (i.e., medial antebrachial cutaneous, medial brachial cutaneous, lateral antebrachial cutaneous, posterior antebrachial cutaneous, intercostobrachial cutaneous, superficial radial, anterior femoral cutaneous, posterior femoral cutaneous, lateral femoral cutaneous, lateral and medial sural cutaneous, and saphenous nerves, and the infrapatellar branch) of the upper and lower extremities on ultrasound. He presented examples of several cutaneous nerve entrapments identified using ultrasound imaging. Dr. Chang also presented cases of compressed cutaneous nerves due to lipoma and enlarged lymph nodes, along with cases of cutaneous nerve adhesion due to scar tissues, which had subsequently caused pain.

SESSION 3: ANKLE JOINT IMAGES

The third session consisted of lectures on MRI, plain radiographs, and ultrasound images of the ankle joint. In the first lecture, Dr. Byeong Seong Kang of the Ulsan University Hospital Department of Radiology introduced and described common lesions among representative ligaments, tendons, and joints observed in ankle MRI.

In the second lecture, Dr. Hyun Kook Youn of Bal-A Orthopedics Clinic, discussed the use of plain ankle radiographs for patients with ankle pain, and emphasized that lesions can be underestimated when non-weight-bearing plain radiographs are taken, and that weight-bearing plain radiographs are preferable. He also stated that an ankle mortise view showed the configuration of the ankle joint more clearly than an ankle AP view, especially the condition of the lateral area of the ankle joint; therefore, the ankle mortise view should be used more extensively in clinical practice. Finally, he described optimal methods of foot alignment and foot position when taking these views.

The last lecture by Dr. Levent Özçakar of Hacettepe University Hospital, Turkey, described ultrasound findings in relation to the following pathologies: tarsal tunnel syndrome, tibial neuropathy, achilles tendinopathy, plantar fibromatosis, nerve entrapment, peroneal tendon subluxation, plantar fasciitis, and Morton's neuroma) that involve the ankle joint and foot.

SESSION 4: CLINICAL EXPERIENCE FROM SPECIALISTS IN PAIN MANAGEMENT(COMPLEX CASES, MISSED CASES, AND CASES SPEAKERS WANTED TO INTRODUCE)

The fourth session was intended to allow the audience to gain indirect clinical experience through listening to the treatment experiences of specialists working in pain clinics. In the first lecture, Dr. Sang Ho Ahn of Ahn's Rehabilitation Clinic shared his clinical experience in relation to neuralgic amyotrophy. He stated that because amyotrophy has various clinical symptoms ranging from mild to severe pain and paralysis, it is necessary to consider neuralgic amyotrophy when there is upper extremity pain and decreased muscle strength inconsistent with MRI findings. Furthermore, he shared that MR neurography can help diagnose neuralgic amyotrophy, presenting the findings of neuralgic amyotrophy found in several MR neurography studies [1,2]. He also noted that it is worth applying the conventional treatment method of injecting a steroid directly into the lesioned nerve, rather than oral steroid treatment, to reduce systemic side-effects and achieve a satisfactory therapeutic result.

The second lecture was delivered by Dr. Jung Hwan Lee of Namdarun Rehabilitation Clinic. He stated that patients' pain often appears broadly and vaguely rather than being confined to a specific dermatome or following a dermatome. He discussed whether it would be better to administer a spinal injection directly to allow the steroid medication to spread more widely, given a herniated disc irritates not only the nerve root but also the sinuvertebral nerve distributed in the disc or meninges. He also noted that when injection treatment was performed without confirming a spinal lesion on MRI, an effect similar to that of an injection treatment with MRI confirmation of the lesion was obtained [3]. His research findings are pending publication, subsequent to final acceptance after a minor revision.

The symposium addressed headaches and facial pain treatment that patients frequently complain of in clinical practice but which are challenging to treat. It also addressed the diagnosis of peripheral neuropathy, including cubital tunnel syndrome, injection procedure methods for treatment of peripheral neuropathy, imaging study findings of the ankle joint, and the experiences and pain treatment techniques of clinicians experienced in pain management. It is hoped that the attendees at this symposium will apply what they have learned in clinical practice to enhance patient treatment.

CONFLICT OF INTEREST

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

Fig 1.

Figure 1.The photo of symposium.
International Journal of Pain 2023; 14: 28-32https://doi.org/10.56718/ijp.23-006

Table 1 Symposium order of events

09:00Opening addressPresident Dong Ah Shin, The Korean Pain Interventional Society
Session 1. The treatment of headache and facial pain (e.g., medication, fluids, and interventional procedures for headache and facial pain)
09:10–09:40Types and mechanisms of headache medications (including anti-CGRP) commonly seen in neurology clinicsJi-Yun Park, Ulsan University Hospital Department of Neurology
09:40–10:10Interventional procedures for controlling headache and facial pain (including trigeminal nerve block)Kim Chan, Kim Chan Hospital Department of Anesthesiology
10:10–10:40Interventional procedures for controlling facial and jaw pain in dentistry (including temporomandibular joint injection)Ji Rak Kim, Kyungpook National University Dental Hospital Department of Oral Medicine
Session 2: Peripheral nerve surgery: advanced edition
10:50–11:20Conservative and surgical treatment of cubital tunnel syndromeSang Hyun Woo, W Hospital Department of Plastic Surgery
11:20–11:50Structures that may be damaged during an ultrasound-guided injection (e.g., damage to the superficial radial nerve, the palmar cutaneous branch of medical nerve, and the dorsal ulnar branch) and methods for safe proceduresSang Hoon Lee, Madi Pain Clinic
11:50–12:20Ultrasound-guided diagnosis and treatment of pain from cutaneous nerve entrapmentKe-Vin Chang, National Taiwan University Hospital Department of Rehabilitation Medicine
12:20-13:20Lunch
Session 3. Ankle joint imaging
13:20–13:50Common pathologies and methods for ankle MRI readingByeong Seong Kang, Ulsan University Hospital Department of Radiology
13:50–14:20Types of plain ankle radiographs for patients with ankle pain, radiograph reading methods, and common pathologiesHyun Kook Youn, Bal-A Orthopedic Clinic
14:20–15:00Ultrasound ankle evaluation, diagnosis, common pathologies, and interventional treatmentsLevent Özçakar, Department of Physical and Rehabilitation Medicine, Hacettepe University Hospital
Session 4. Clinical experience from specialists in pain management (complex cases, missed cases, and cases speakers wanted to introduce)
15:00–15:30Case report 1Sang Ho Ahn, Ahn's Rehabilitation Clinic
15:30-16:00Case report 2Jung Hwan Lee, Namdarun Rehabilitation Clinic
16:00Closing addressPresident Dong Ah Shin, The Korean Pain Interventional Society

References

  1. Cejas C, Pastor Rueda JM, Hernández Pinzón J, Stefanoff N, Barroso F: Neuralgic amyotrophy detected by magnetic resonance neurography: subclinical, bilateral, and multifocal brachial plexus involvement. Neurol Res 2023; 45: 283-9.
    Pubmed CrossRef
  2. Queler SC, Towbin AJ, Milani C, Whang J, Sneag DB: Parsonage-turner syndrome following COVID-19 vaccination: MR neurography. Radiology 2022; 302: 84-7.
    Pubmed KoreaMed CrossRef
  3. Lee JH, Lee JH, Chang MC: Transforaminal epidural steroid injection for patients with lumbosacral disc herniation in the absence of spine magnetic resonance imaging - is better really the enemy of the best? J Pain Res 2023; 16: 1477-85.
    Pubmed KoreaMed CrossRef
The Korean Association for the Study of Pain

Vol.14 No.2
December 2023

pISSN 2233-4793
eISSN 2233-4807

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