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Cervical epidural steroid injection (CESI) is conducted to treat the patient with neck or upper limb pain from various cervical pathologies. Despite its clinical usefulness that have been supported by numerous literatures, concerns for serious complication associated with its technical and relevant anatomical properties give up its application at clinical setting to target non-specific treatment, medication, as compared with lumbosacral correspondence. But it is desirable as pain physician to conduct disease specific treatment by overcoming the barriers. This review is to explore the technical consideration of CESI to stress the clinical importance of CESI as target-specific conservative treatment for pain from cervical diseases. This describes technical consideration of transforaminal and interlaminar approach and the topic of ultrasound guided injection as replacement with non-radiation exposure to C arm guided injection. In conclusion, appropriate procedural application based on exact knowledge of relevant technical considerations promotes clinical usefulness of CESI, which leads CESI to valuable treatment option of the patients with cervical diseases.

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Background: We conducted this study to assess the efficacy and safety of PF-72 (TGel Bio Co. Ltd., Seoul, Korea) combined with 0.75% ropivacaine hydrochloride in relieving the postoperative pain in patients undergoing single-level lumbar discectomy.
Methods: A total of 95 eligible patients were randomized to either the trial group (n = 47; PF-72 combined with 0.75% ropivacaine hydrochloride) or the control group (n = 48; ramosetron hydrochloride 0.3 mg). The patients were monitored at 3, 6, 24, 48 and 72 hours postoperatively, for which the cumulative area under the curve (AUC_0-72) of NRS pain scores was plotted and the amount of rescue analgesics used at 6, 24, 48 and 72 hours or 24, 48 and 72 hours postoperatively. Moreover, incidences of treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs) were analyzed.
Results: The amount of analgesics used and the AUC_0-72 of the NRS pain scores was significantly smaller and the NRS pain scores were significantly lower in the trial group as compared with the control group (P < 0.05). In addition, there was no significant difference in the number of the patients presenting with no pain (NRS pain scores ≤ 3) between the two groups at 48 and 72 hours postoperatively (P > 0.05). There were no significant differences in the incidences of TEAEs and SAEs between the two groups (P > 0.05).
Conclusions: PF-72 combined with 0.75% ropivacaine hydrochloride is an effective, safe drug delivery system.

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Background: PF-72 (TGel Bio Co. Ltd., Seoul, Republic of Korea) is a type of temperature-responsive hydrogel.
Methods: The eligible patients (n = 72) were randomized to either the trial group (n = 35; PF-72 mixed with 0.75% ropivacaine hydrochloride) or the control group (n = 37; patient-controlled anesthesia). We compared the amount of used rescue analgesics, numeric rating scale (NRS) pain scores, the cumulative area under the curve (AUC_0-72) of NRS pain scores and incidences of treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs). We estimated time-to-events (TTEs).
Results: There were significant differences in the amount of used analgesics and NRS pain scores between the two groups at 3, 6, 24, 48 and 72 hours postoperatively (P = 0.000). There were also significant differences in AUC_0-6, AUC_0-24, AUC_0-48 and AUC_0-72 of NRS pain scores between the two groups (P = 0.000). There was a significant difference in the proportion of the patients presenting with no pain between the two groups at 3, 6 and 24 hours postoperatively (P = 0.000). There were no significant differences in the incidences of TEAEs and SAEs between the two groups (P > 0.05). TTEs are estimated at 7.486 ± 2.758 (95% confidence interval [CI] 2.081 ± 12.890) hr in the trial group and 9.324 ± 2.488 (95% CI 4.448 ± 14.200) hr in the control group.
Conclusions: PF-72 mixed with 0.75% ropivacaine hydrochloride is an effective, safe modality in alleviating pain in the patients undergoing elective arthroscopic shoulder surgery.

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Background: Mesenchymal stem cells (MSCs) are undifferentiated cells that give rise to the mesodermal lineage. Adipose-derived MSCs are an easy and widely used source for MSCs isolation. In this study, adipose tissue was isolated and processed for MSCs isolation. MSCs’ proliferation, surface marker expression, in vitro differentiation potential, and polymerase chain reaction (PCR) results were evaluated by subculturing.
Methods: Adipose tissue collected from a patient during spinal cord injury surgery was stored in PBS without shaking. First, the connective tissue was removed and the fat tissue was secured. Thereafter, the fat tissue was digested with collagenase type 1 at 37°C and 140 rpm for 1 h. After centrifugation, the remaining cell pellet was resuspended and filtered. Cells were cultured in Dulbecco’s modified Eagle’s medium supplemented with 10% FBS, fibroblast growth factor, and platelet-derived growth factor. Characterization analyses were performed to assess trilineage differentiation and marker expression using PCR and fluorescence-activated cell sorting.
Results: Our results confirm that adipose-derived MSCs have a high proliferation rate. Additionally, marker gene expressions were confirmed by PCR. Evaluation of the surface marker expression of MSCs revealed positive expressions of CD73, CD90, and CD105, and negative expressions of CD14, CD34, and CD45. The MSCs showed differentiation potential into adipocytes, chondrocytes, and osteocytes in differentiation medium.
Conclusions: MSCs can be isolated from the adipose tissue. Adipose-derived MSCs have adipose, chondrogenic, and osteogenic differentiation potential. The characterization and differentiation potential of MSCs are useful for evaluating their potential applications in various field of basic research, including pain research.

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The goal of rehabilitating individuals with chronic pain is to assist them in reclaiming control over their pain management and channeling their focus towards well-being and improving function. By providing rational information that helps patients understand their pain, their distress can be alleviated, resulting in positive changes in both their emotional and behavioral responses. Practitioners can assist patients in comprehending their pain and developing an effective management plan by employing a case formulation model. Within the cognitive behavioral model of chronic pain, event-meaning coupling can be emphasized in case formulation, allowing for a greater focus on the patient’s internal cognitive processes, helping them gaining insight into their pain. This model also considers potential biopsychosocial factors that could afford the patient’s ability to make new meaning from events. By assessing and promoting positive event-meaning couplings, patients can be empowered to interact more effectively with their biopsychosocial arena, which in turn can foster a virtuous cycle for self-expansion for successful rehabilitation.

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Osteoarthritis (OA) is a leading cause of chronic pain and disability worldwide. Animal models are required to improve our understanding of the underlying pain mechanisms associated with OA and to evaluate potential therapeutics. In this review, discuss the variety of animal models used in OA research, with a focus on their relevance to human OA and the pain behavioral methods. We discuss commonly used pain behavioral assays, the technical nuances, advantages, and limitations. Moreover, we discuss how these models and methods translate into the clinic by emphasizing any interventions or findings that have guided clinical trials or drug development. Although animal models provide invaluable insight, they still have challenges and controversies, particularly with respect to their true representation of human OA pain as well as ethical considerations. We highlight the need for refining and standardizing pain assessment techniques in animal models and address emerging technologies that promise greater translational significance. This review provides insight into the role of animal models in advancing our understanding of OA pain and paves the way for future research in this field.

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Background: The purpose of this experimental study was to confirm whether the overall disease severity of Parkinson’s disease (PD), gait function, balance, and pain could be improved through the application of the lumbar muscle myofascial release technique (LMTT).
Methods: LMTT treatments were administered to 12 patients with PD and chronic pain and evaluated pre-and post-intervention. The LMTT device was designed to provide acupressure to the operational portion, to which the bogie method was applied. To increase the therapeutic effect, aluminum, with high thermal conductivity, was used to apply heat up to 70°C and acupressure simultaneously. A heating wire was also attached. The Timed Up and Go (TUG), 10 m gait speed, 6-min walk test, Berg Balance Scale (BBS), Functional Ambulatory Category (FAC), Visual Analog Scale (VAS), fear of falling, Oswestry Disability Index, and Geriatric Depression Scale Short-Form (GDSSS) were evaluated.
Results: The VAS score showed a significant decrease immediately after five treatments (4.46 points) and 10 treatments (3.00 points) compared to the pre-intervention evaluation (6.54 points). We found that this decrease was maintained after a 2 week follow-up (P < .001). Significant improvements were also confirmed in the TUG (P < .001), 10 m gait speed (P = .001), 6 min walk test (P = .001), and BBS (P = .001).
Conclusions: By applying LMTT, a significant reduction in pain was confirmed in patients with PD who experience chronic back pain.

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Background: The currently available topical diclofenac products do not provide effective penetration of diclofenac across the layers of skin. Troikaa Pharmaceuticals Ltd, has developed Dynapar QPS Plus^Ⓡ, a novel, topical formulation of diclofenac and compared its skin penetration with Diclofenac Aerosol Spray.
Methods: In this randomized, two way crossover study, healthy human subjects (n = 8) received single dose of either 2 ml of Dynapar QPS Plus or approximately 4 gm of marketed Diclofenac Aerosol Spray. The blood samples were drawn at pre dose and up to 24 hours post dose. The plasma concentrations of Diclofenac was measured using validated LC-MS/MS bioanalytical method.
Results: The mean Cmax after administration of Dynapar QPS Plus and Diclofenac Aerosol Spray were 102.945 ± 66.0109 and 15.885 ± 14.7750 ng/ml, respectively. Median Tmax for Dynapar QPS Plus was earlier compared to Diclofenac Aerosol Spray (7 hrs vs. 19 hrs). The mean AUC_0-t after administration of Dynapar QPS Plus was significantly higher as compared to Diclofenac Aerosol Spray (AUC_0-t: 855.289 ± 494.0262 vs. 149.707 ± 116.6317). Both the products were well tolerated and no adverse event occurred during the study.
Conclusions: The results of this study showed that Dynapar QPS Plus is safe and provides faster and more than six times higher skin penetration of diclofenac in comparison to marketed Diclofenac Aerosol Spray. Due to faster and higher penetration of diclofenac, from Dynapar QPS Plus it is best suitable option to treat pain and inflammation related to acute as well chronic musculoskeletal disorders.

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Background: This study aims to find out which clinical and radiologic factors affect how well intradiscal steroid injections (ISI) work for patients with discogenic lower back pain (DLBP).
Methods: We looked back at the clinical records and radiologic images of 60 patients with DLBP, confirmed using a provocation discography. They all received ISI between May 2011 and December 2014 at a single clinic. We evaluated the degeneration grade of the discs, whether they showed a high intensity zone (HIZ), and Modic changes in the adjacent vertebral bodies. Clinical outcome was assessed by visual analogue scale (VAS).
Results: Six months post ISI, patients with pain duration < 6 months (P = 0.02), type I Modic change (P = 0.048), and the presence of HIZ (P = 0.046) exhibited significantly greater reductions in the VAS. Multivariate logistic regression analysis highlighted three factors linked to successful outcomes after ISI: pain duration < 6 months (OR = 8.695, P = 0.007), type 1 Modic change (OR = 3.382, P = 0.021), and the presence of HIZ (OR = 4.902, P = 0.015).
Conclusions: We found three important factors through statistics: pain for < 6 months, Type I Modic changes, and the presence of a HIZ. By carefully choosing patients with these characteristics, considering the risks of treatment, and factors predicting outcomes, we can anticipate better results in treating DLBP.

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Spontaneous intracranial hypotension (SIH) is caused by cerebrospinal fluid leakage and subsequent hypovolemia in the spinal subarachnoid membrane or, rarely, the intracranial space. Subdural fluid collection is a rare complication of SIH caused by the persistence of negative pressure. This report describes a case of SIH with subdural fluid collection in a patient who underwent surgical hematoma evacuation before an epidural blood patch (EBP). A 60-year-old man and 43-year-old man were initially diagnosed with SIH secondary to an orthostatic headache that became exacerbated. Brain computed tomography revealed subdural hemorrhage (SDH). Because their condition deteriorated gradually, they underwent burrhole trephination to evacuate the SDH. An epidural blood patch was applied to treat the remaining symptoms of SIH after evacuation. During the next 3 days, headache completely resolved with satisfactory results. We report this case of SIH with SDH resulting in surgical hematoma evacuation before EBP that successfully resolved.

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Bertolotti's syndrome (BS) is a condition that causes lower back pain due to the presence of a lumbosacral transitional vertebra (LSTV). A spectrum of therapeutic modalities, ranging from conservative management to surgical intervention, has been endeavored in its management. It has been reported that LSTV may subsequently lead to conditions such as scoliosis, facet joint arthritis, strains of the quadratus lumborum and iliopsoas muscles, and herniated discs. Moreover, BS commonly manifests with lower back pain; however, it is rarely associated with radiation-induced leg pain. In this case report, we aimed to investigate the effectiveness of pulsed radiofrequency treatment in patients who underwent diagnostic nerve blocks for radicular pain suspected to be induced by BS and demonstrated temporary pain relief.

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Granular cell tumors (GCTs) are uncommon soft tissue tumors usually originating from the nerve sheath, affecting any body part but rarely the spinal region. Only 2% of GCTs are malignant, which is associated with a very poor prognosis. They occur most frequently in middle-aged females. Clinical symptoms of GCTs from the spine origin depend on their location. Radical resection is the treatment of choice for GCTs, followed by radiotherapy and chemotherapy if it turns out malignancy or complete resection is impossible. Herewith, we report a case of malignant GCTs of the upper thoracic spine with pleural metastasis. Although the initial upper extremity MRI showed a small thoracic paravertebral mass, it was missed, resulting in a delayed diagnosis of malignancy. From the case, we can learn that vigilant suspicion to rule out any malignancy is essential if aggravation of symptoms is observed even under active pain management.

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The 48th Korean Pain Intervention Society (KORSIS) Symposium was held on October 29, 2023, between 9 a.m. and 4 p.m., at Samjung Hotel in Seoul, South Korea. The symposium focused on potential management strategies for patients of the pain clinic, who have pain control challenges. In particular, the therapeutic evidence for extracorporeal shockwave therapy (ESWT), which has been popular among pain clinics in recent times, was examined. The symposium presented the following sessions. 1) Functional medicine applicable to the pain clinic. 2) Available procedures when the epidural steroid injection is ineffective. 3) The evidence for using ESWT in regeneration in the pain clinic. 4) The prescription know-how: A case series.