이 연구는 Morphine을 이용한 저작근통증의 조절 효과를 확인하기 위해서 시행되었으며, 경희대학교 치과대학병원 구강내과에 내원한 환자 중 RDC/TMD로 진단된 지원자를 saline 주사군, lidocaine 주사군, morphine 주사군 각각 10명씩 배정하였다. 통증부위에 주사 전, 주사 후 10분, 30분, 60분에 각각 주관적인 통증 평가인 시각유추척도검사, 맥길통증설문지검사 그리고 통증부위표시검사와 객관적인 통증 평가인 압력통증역치검사와 압력통증한계검사를 실시하였다. 검사 후 평가된 자료를 통계 처리하여 다음과 같은 결과를 얻었다. 1. 주관적인 통증 평가와 객관적인 통증 평가 모두 집단 내 효과가 있었다. (p<0.001) 2. 주관적인 통증 평가인 통증부위표시검사(p<0.001)에서 집단 간 효과가 있었다. 3. 객관적인 통증 평가인 압력통증역치검사(p=0.025)에서 집단 간 효과가 있었다. 4. 주관적인 통증 평가인 통증부위표시검사는 morphine 주사군(p=0.001)이 saline 주사군에 비해서 효과가 있었다. 이상의 연구결과로 저작근에 통증이 있는 환자에게 morphine 주사 시 60분 이내에는 주관적인 평가에서 통증 조절 효과가 있었으며, 향후 시간 연장에 따른 지속적인 추가 연구가 필요 할 것으로 생각된다.
이 연구는 Morphine을 이용한 저작근통증의 조절 효과를 확인하기 위해서 시행되었으며, 경희대학교 치과대학병원 구강내과에 내원한 환자 중 RDC/TMD로 진단된 지원자를 saline 주사군, lidocaine 주사군, morphine 주사군 각각 10명씩 배정하였다. 통증부위에 주사 전, 주사 후 10분, 30분, 60분에 각각 주관적인 통증 평가인 시각유추척도검사, 맥길통증설문지검사 그리고 통증부위표시검사와 객관적인 통증 평가인 압력통증역치검사와 압력통증한계검사를 실시하였다. 검사 후 평가된 자료를 통계 처리하여 다음과 같은 결과를 얻었다. 1. 주관적인 통증 평가와 객관적인 통증 평가 모두 집단 내 효과가 있었다. (p<0.001) 2. 주관적인 통증 평가인 통증부위표시검사(p<0.001)에서 집단 간 효과가 있었다. 3. 객관적인 통증 평가인 압력통증역치검사(p=0.025)에서 집단 간 효과가 있었다. 4. 주관적인 통증 평가인 통증부위표시검사는 morphine 주사군(p=0.001)이 saline 주사군에 비해서 효과가 있었다. 이상의 연구결과로 저작근에 통증이 있는 환자에게 morphine 주사 시 60분 이내에는 주관적인 평가에서 통증 조절 효과가 있었으며, 향후 시간 연장에 따른 지속적인 추가 연구가 필요 할 것으로 생각된다.
This study was designed to evaluate the pain control effect by morphine injection to masticatory muscle pain patients. Patients with masticatory muscle pain visited the Department of Oral Medicine, Kyung Hee University Dental Hospital were recruited to this study and diagnosed by RDC/TMD. Experiment...
This study was designed to evaluate the pain control effect by morphine injection to masticatory muscle pain patients. Patients with masticatory muscle pain visited the Department of Oral Medicine, Kyung Hee University Dental Hospital were recruited to this study and diagnosed by RDC/TMD. Experimental group were divided into three group; saline injection group(n=10), lidocaine injection group(n=10) and morphine injection group(n=10). Evaluation list was the subjective pain evaluation(visual analogue scale, Mc Gill pain questionnaire, pain drawing) and the objective pain evaluation(pressure pain threshold, pressure pain tolerance) and evaluation time was injection before, after 10min, 30min, 60min and then it was analyzed statistically. The results were as follows : 1. The subjective pain evaluation and the objective pain evaluation were significantly different statistically in within subject effects(p<0.001). 2. The subjective pain drawing evaluation(p<0.001) were significantly different statistically in between subject effects. 3. The objective pressure pain threshold evaluation(p=0.025) were significantly different statistically in between subject effects. 4. The morphine injection group(p=0.001) were more significantly different than the saline injection group statistically in the subject pain drawing evaluation. Therefore, it was considered that the morphine injection was effective to pain control for masticatory muscle pain patients within 60 minute.
This study was designed to evaluate the pain control effect by morphine injection to masticatory muscle pain patients. Patients with masticatory muscle pain visited the Department of Oral Medicine, Kyung Hee University Dental Hospital were recruited to this study and diagnosed by RDC/TMD. Experimental group were divided into three group; saline injection group(n=10), lidocaine injection group(n=10) and morphine injection group(n=10). Evaluation list was the subjective pain evaluation(visual analogue scale, Mc Gill pain questionnaire, pain drawing) and the objective pain evaluation(pressure pain threshold, pressure pain tolerance) and evaluation time was injection before, after 10min, 30min, 60min and then it was analyzed statistically. The results were as follows : 1. The subjective pain evaluation and the objective pain evaluation were significantly different statistically in within subject effects(p<0.001). 2. The subjective pain drawing evaluation(p<0.001) were significantly different statistically in between subject effects. 3. The objective pressure pain threshold evaluation(p=0.025) were significantly different statistically in between subject effects. 4. The morphine injection group(p=0.001) were more significantly different than the saline injection group statistically in the subject pain drawing evaluation. Therefore, it was considered that the morphine injection was effective to pain control for masticatory muscle pain patients within 60 minute.
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가설 설정
1. The subjective pain evaluation and the objective pain evaluation were significantly different statistically in within subject effects(p<0.001).
(Fig. 4) But the saline injection group showed low threshold range compared to morphine injection group and lidocaine injection group. The PPTol test shows relatively variable tendencies with time.
제안 방법
Another researcher injected 0.2 ml drug with 27G subcutaneous needle and 1.0 ml disposable syringe(SOFJEC® ; HWAJINMEDICAL, KOREA) into each subjects in 10 seconds, and injection point was the most painful area on unilateral masticatory muscle in palpation.
Evaluation list was the subjective pain evaluation(visual analogue scale, Mc Gill pain questionnaire, pain drawing) and the objective pain evaluation(pressure pain threshold, pressure pain tolerance) and evaluation time was injection before, after 10min, 30min, 60min and then it was analyzed statistically.
In the VAS test, subjects were asked to mark their pain with marking pen(namepenF®, Monami, KOREA) on 100 mm straight line according to pain extent; start point of 100 mm straight line with no pain, end point with the strongest pain that could imagine.
One researcher divided randomly the subjects into three groups 10 persons each who had diagnosed according to RDC/TMD.
Analgesic effect of peripheral opioid receptor has been studied steadily, but clinical study on human masticatory muscle has not been performed actively. So in this study we injected low dose of morphine to masseter muscle of myofascial pain patients who were diagnosed from RDC/TMD and we confirmed the analgesic effects in 60 minutes, compared the results with lidocaine and saline injection.
The PPT test used in this study was to estimate the pressure pain threshold around the most painful masticatory area before and after the injection with pressure pain measuring instrument(Wagner Instruments, Greenwich CT, USA), then converted into numbers.
The other researcher ordered randomly the sequence of injected drugs , as a result, double blind procedure about the injected drug was done to both researcher and subjects.
The pressure was applied to muscle vertically with 11mm diameter probe by 30kPa/s velocity, the measured kgf value was divided by area of the probe and converted to kPa value. The subjects were asked to rise their left hand at the moment they felt the first pain and intolerable pain, then the values were recorded and calculated for the PPT and PPTol.
대상 데이터
The subjects consisted of 16 males and 14 females, total 30 people and age range was 20 to 52years, average age was 29.4±4.5years.
The subjects participated in this study were volunteers among outpatients of Department of Oral medicine, Kyung Hee University Dental Hospital during the period from August to November 2010. This study was conducted in Department of Oral medicine, Kyung Hee University Dental Hospital after receiving approval from Institutional review board of Kyung Hee University Dental Hospital.
And all the participants are limited that Visual Analog Scale(VAS) is over 50 and age between 20 to 55 who are diagnosed to Axis I:Group Ia Myofascial Pain by Research Diagnostic Criteria for Temporomandibular Disorders(RDC/ TMD). The subjects were excluded who had systemic musculoskeletal pain, systemic arthritis, malignant tumor, hypertension, diabetes mellitus, cardiovascular disease and pregnant women or chronic analgesic or psychiatric drug user.
The subjects participated in this study were volunteers among outpatients of Department of Oral medicine, Kyung Hee University Dental Hospital during the period from August to November 2010. This study was conducted in Department of Oral medicine, Kyung Hee University Dental Hospital after receiving approval from Institutional review board of Kyung Hee University Dental Hospital. The participants were informed about the details of this experiment and signed the consent paper after reading it.
데이터처리
The results from three subjective pain evaluation tests and two objective pain evaluation tests were done the repeated measures ANOVA test using descriptive statistics and Greenhouse-Geisser method. At first, we verified the effects through within subject effects, between subject effects and interaction effects.
이론/모형
The methods used to evaluate subjective pain in this study were visual analogue scale(VAS test), McGill Pain Questionnaire(MGQ test) and Pain drawing(PD test).
At first, we verified the effects through within subject effects, between subject effects and interaction effects. When there were effects, we tried Post Hoc through multiple comparisons using Tukey HSD method. Every statistics significance level was p<0.
성능/효과
(Fig. 1) The results of MGQ test show that morphine injection group decreased steeply the most with time, lidocaine injection group decreased obviously after 10 minutes, but saline injection group had little changed.(Fig.
(Fig. 2) The results of PD test show similar pattern in morphine injection group and lidocaine injection group with time, but a quite different pattern in saline injection group. Especially, difference between saline injection group and morphine injection group, and difference between saline injection group and lidocaine injection group were remarkable.
2. The subjective pain drawing evaluation(p<0.001) were significantly different statistically in between subject effects.
3. The objective pressure pain threshold evaluation(p=0.025) were significantly different statistically in between subject effects.
001). As a result, VAS, MGQ and PD test, all were significantly different statistically in within subject effects, but only PD test was significantly different statistically in between subject effects.
025), too. As a result, both PPT and PPTol test were significantly different statistically in within subject effects, but only PPT test was significantly different statistically in between subject effects.
The results of MGQ test which is questionnaire -styled subjective pain evaluation method show that morphine injection group decreased steeply the most with time, lidocaine injection group decreased obviously after 10 minutes, but saline injection group had little changed.(Fig.
The results of PPT test as a objective pain evaluation method show that morphine injection group, lidocaine injection group and saline injection group had similarly increasing tendencies with time by 30 minutes. But the saline injection group showed low threshold range compared to morphine injection group and lidocaine injection group.
The results of VAS test as a subjective pain evaluation method show that morphine injection group decreased the most with time, followed by lidocaine injection group, but the saline injection group had little changed. Especially, these tendencies was prominent from 10 minutes after the injection to 30 minutes, and in 60 minutes after the injection, the differences between groups were lasted.
후속연구
Therefore, it was considered that the morphine injection was effective to pain control for masticatory muscle pain patients within 60 minutes. It could be further investigation on time extension.
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